bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Biodegradation of Harmful Cylindrospermopsis Raciborskii and Cylindrospermopsin Toxin in Batch Culture by Single Bacillus Strain
Authors: Mohamed Zakaria , Alamri Saad , Hashem Mohamed
Published: December 2020

This study investigates the capability of a Bacillus flexus strain isolated from decayed cyanobacterial blooms for the bioremediation of Cylindrospermopsis raciborskii and cylindrospermopsin (CYN) toxin. The algicidal activity of this strain was tested by co-cultivation with C. raciborskii cultures. CYN biodegradation was investigated in the presence of living and heat-inactivated bacterial cells or bacterial filtrate. Living bacterial cells inhibited C. raciborskii growth after 2 days of incubation with complete cell death at day 5. Bacterial filtrate caused a rapid reduction in C. raciborskii growth at the first day, with complete cell lysis at day3. Only living cells of SSZ01 caused reduction in CYN released into the medium during the bacterial decay of C. raciborskii cells. The biodegradation rate of CYN by SSZ01 relied on initial toxin concentrations. The highest rate (42 µg CYN L-1 day-1) was obtained at the higher initial concentration (300 µg L-1), and the lowest (4µg CYN L-1 day-1) was at lower concentration (50 µg L-1). These results suggest that this bacterial strain could be employed to bioremediate cyanobacterial blooms in freshwaters. Also, the application of this bacterium in slow sand filters would give possibilities for degradation and bioremediation of cyanotoxins in drinking water treatment plants.
Objective Assessment of Impulse Control Disorder in Patients with Parkinson’s Disease Using a Low-Cost LEGO-Like EEG Headset
Authors: Lin Yuan-Pin , Liang Hsing-Yi , Chen Yueh-Sheng , Lu Cheng-Hsien , Wu Yih-Ru , Chang Yung-Yee , Lin Wei-Che
Published: December 2020

BackgroundPatients with Parkinson’s disease (PD) can develop the cognitive adverse effect of impulse control disorders (ICDs) while undergoing a pharmacological treatment for motor control dysfunctions with a dopamine agonist (DA). Conventional clinical interviews or questionnaires can be biased and may not provide an accurate diagnosis in the early stage. A wearable electroencephalogram (EEG)-sensing headset paired with an examination procedure can be a potential user-friendly method to explore ICD-related biomarkers that can reflect brain activity abnormalities and detect its early signs and progression.MethodsA stereotypical Go/NoGo test that targets impulse inhibition was performed with 59 individuals, including heathy controls, patients with PD, and patients with PD diagnosed with ICD. A low-cost LEGO-like EEG headset was used to record concurrent EEG signals. The event-related potential (ERP) analytical framework was then used to explore ICD-related EEG abnormalities after DA treatment.ResultsOnly PD patients with ICD exhibited a tendency for N2 and P3 amplitude deterioration at the fronto-central regions (i.e., Fz, FCz, and Cz); in particular, the P3 counterpart reached statistical significance (p<0.05). Neither PD patients nor healthy controls (without DA) replicated such findings. Furthermore, N2 amplitude deterioration was found to be related to ICD severity at Fz (r=-0.28, p=0.04).ConclusionsA low-cost LEGO-like EEG headset successfully captured ERP neuromarkers for the objective assessment of ICD in PD patients undergoing DA treatment. The present objective neuro-evidence could provide complementary information to conventional clinical scales used to diagnose the ICD adverse effect.
Lahar Risk Assessment: the Case Study of Vulcano Island, Italy
Authors: Gattuso Alessandro , Bonadonna Costanza , Frischknecht Corine , Cuomo Sabatino , Baumann Valerie , Pistolesi Marco , Biass Sebastian , Arrowsmith Ramon , Moscariello Mariagiovanna , Rosi Mauro
Published: December 2020

Lahars are rapid flows composed of water and volcaniclastic sediments, which have the potential to impact residential buildings and critical infrastructure as well as to disrupt critical services, especially in absence of a hazard-based land-use planning. Their destructive power is mostly associated with their velocity (related to flow rheology and surrounding topography) and to their ability to bury buildings and structures (related to the deposit thickness). The distance reached by lahars depends on their volume, on sediments/water ratio, as well as on the overall characteristics of the path where they propagate. Here we present a novel strategy for the assessment of risk associated with lahar inundation related both to flow velocity and deposit thickness using Vulcano island (Italy) as a case study. First, a range of hazard scenarios has been identified that are related to the mobilization by intense rain events of tephra fallout deposited on the slopes of the La Fossa cone by a future Vulcanian eruption. Second, a numerical model has been used to identify the potential lahar impact areas on the northern sector of Vulcano, where both residential and touristic facilities are present. In this specific case we have used the Smoothed Particle Hydrodynamic (SPH) model that provides information on both flow velocity and deposit thickness. Finally, exposure and vulnerability surveys were carried out in order to compile risk maps for both lahar-flow velocity and final lahar-deposit thickness. Our analyses show the importance of carrying out accurate and detailed risk assessments exploring a variety of initial conditions in order to best quantify the potential damage and identify suitable mitigation strategies.
Association Between Dietary Theobromine and Cognitive Function in a Representative Elderly American Population: A Cross-Sectional Study
Authors: Gao Lijie , Cui Chaohua , Yuan Zhengzhou , Ge Wenjing , Liu Qian , Li Jie , Liu Na , Lei Chunyan , Liu Jie
Published: December 2020

Background: Despite reports on neuroprotective effects of dietary theobromine intake, whether dietary theobromine can exert beneficial effects on cognitive function is unclear. We aimed to investigate the association between dietary theobromine and cognitive function in old American population.Methods: We collected data from the 2011-2012 and 2013-2014 cycles of the National Health and Nutrition Examination Survey, a cross-sectional survey. Daily dietary theobromine was treated as a continuous variable and a log transform. Cognitive function was measured by four tests: Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning tests, CERAD delayed recall test, animal fluency test, and digit symbol substitution test (DSST). We conducted linear regression analyses and subgroup analyses to study the association between theobromine intake and cognitive performance. Basic characteristics, lifestyle factors, disease history, and nutritional intake were adjusted in these models.Results: A total of 2,845 participants were included in this study. Daily theobromine intake was not significantly different between the 2011-2012 and 2013-2014 cycles. The CERAD-immediate and delayed recall scores were significantly different between these two cycles, but not the animal fluency score or digital symbol score. The daily dietary theobromine intake in log form was positively associated with immediate recall score (β, 95% CI, P: 0.661, 0.222-1.101, <0.01), delayed recall score (β, 95% CI, P: 0.232, 0.016-0.449, 0.04), and DSST score (β, 95% CI, P: 1.395, 0.140-2.649, 0.03) in the fully adjusted model, but not with the animal fluency score (β, 95% CI: 0.001, -0.122-0.907, 0.13). Sensitive analyses showed that L-theobromine intake was linearly associated with cognitive performance.Conclusions: Daily theobromine intake was associated with cognitive performance in a large national representative population. However, further research is needed in order to corroborate our findings.
Urine Output Calculated Using Actual Body Weight may Result in Overestimation of Acute Kidney Injury for Obese Patients
Authors: Jiang Jun , Zhang Jing , Liu Ye , Xu Dongxue , Peng Zhi-Yong
Published: December 2020

Background: The derived hourly urine output (UO) indexed by body weight is one of the major criteria for diagnosis of acute kidney injury (AKI). However, it is unknown whether actual body weight (ABW) or ideal body weight (IBW) should be used. This study aims to explore whether UO calculation based on ABW might lead to overestimation of AKI.Methods: AKI patients identified in the MIMIC database by different components of the KDIGO guidelines and different definitions of body weight were retrospectively studied. We compared hospital and 90-day mortality to decide whether AKI patients diagnosed by ABW- or IBW-normalized UO had the same outcome.Results: In the cohort of 14,725 patients, AKI was identified in 4,298 (29.19%) and 3,060 (20.78%) patients respectively when ABW or IBW was used to calculate hourly UO (p < 0.001). AKI stages differed between these patients (p < 0.001) with a kappa of 0.87 (95% CI, 0.86 ~ 0.88) and an agreement percentage of 90.40%. Multivariate logistic regression revealed AKI patients identified by UO calculated from ABW had similar hospital and 90-day mortality to that of patients with no evidence of AKI. Whereas AKI patients identified by SCr or by both ABW and IBW had over twice higher the risks of hospital death, 1.7 and 1.4 times higher the risks of 90-day death respectively compared with patients with no evidence of AKI. Results were confirmed in sensitivity analysis where patients whose admission creatinine levels were within the normal reference ranges and sepsis patients were studied.Conclusions: Calculating hourly body weight normalized UO using ABW may lead to underestimation of UO and overestimation of AKI.
Comparison of Cinical Outcomes Between Nurse Practitioner and Registrar led Medical Emergency Teams – A Propensity Matched Analysis.
Authors: Gupta Sachin , Balachandran Mayurathan , Bolton Gaby , Pratt Naomi , Molloy Jo , Paul Eldho , Tiruvoipati Ravindranath
Published: December 2020

Objective: Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine if NP led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR) led MET calls.Methods: The composite primary outcome included recurrence of MET call, occurrence of Code blue or ICU admission within 24 hours. Secondary outcomes were mortality within 24 hours of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group.Results: A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR led MET calls (26.7% vs 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 hours (3.4% vs 7.7%, p = 0.002) and hospital mortality (12.7% vs 20.5%, p = 0.001) was higher in ICUR led MET calls. Propensity score matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups but NP led group was associated with reduced risk of hospital mortality (OR 0.57, 95%CI 0.35-0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09-2.2, p=0.015). Conclusion: Acute patient deterioration was comparable between ICUR and NP led MET Calls. NP led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.
Dexmedetomidine use and Mortality in Mechanically-Ventilated Patients with Severe Burns: A Cohort Study Using a National Inpatient Database in Japan
Authors: Enomoto Yuki , Iwagami Masao , Tsuchiya Asuka , Morita Kojiro , Abe Toshikazu , Kido Takahiro , Uda Kazuaki , Inokuchi Ryota , Yasunaga Hideo , Inoue Yoshiaki , Tamiya Nanako
Published: December 2020

Background: Dexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine has the potential to reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine and mortality in mechanically-ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.Methods: We included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in all patients and survivors.Results: Eligible patients (n = 1,888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1,517). After one-to-one propensity score matching, we compared 329 patients from each of the two groups. No significant difference was observed in 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71-1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.Conclusions: We found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically-ventilated patients with severe burns. Dexmedetomidine use may not improve the above-mentioned outcomes; therefore, its selection should be based on the patient’s general condition and the target level of sedation.
The Effectiveness of a Men-only Supportive Expressive Therapy Group Intervention for Psychosocial Health Outcomes in Gastrointestinal Cancer Patients: A 6-month longitudinal study 
Authors: Oberoi Devesh , Martopullo Celestina , Bultz Barry D. , Carlson Linda Ellen
Published: December 2020

Background: An increasing number of gastrointestinal cancer (GI) patients suffer from the side effects of cancer treatment that can affect their psychosocial health outcomes such as mood states and quality of life. Despite its demonstrated usefulness in female cancer patients, the Supportive Expressive Group Therapy (SEGT) has not been tested in male cancer patients. The current study sought to examine the longitudinal effects of a professionally-led, men-only supportive-expressive group therapy (SEGT) on mood states, coping, and quality of life (QoL) in male GI cancer patients. Methods: Male GI cancer patients (n=31), at different stages of cancer treatment, were recruited from an ongoing men-only biweekly GI cancer SEGT. Data were collected at baseline (before or near the beginning of group attendance) and at three months and six months follow-up. All outcomes were patient-reported and included demographic data as well as the validated questionnaires: Profile of Mood States (POMS) for mood states, Functional Assessment of Cancer Therapy-General (FACT-G) for QoL, and Ways of Coping-cancer version (WOC) for coping. Linear mixed models were used to examine the change in the outcomes over time. Effect sizes were estimated using Cohen’s d. Results: The Anxiety (p=.04; d=0.70), Depression (p=.03; d=0.93) and Anger (p=.04; d=1.28) subscales of the POMS decreased between baseline and six months. Participants also reported improvements in coping through Distancing (distancing oneself from negative thoughts, being more accepting of the situation, and looking for positives) of the WOC (p=.04; d=0.4) between baseline and six months. There was no change in any of the FACT subscales (QoL) over time. Conclusions: This is the first study to investigate the effects of a SEGT intervention in male cancer patients. SEGT resulted in improved mood states and coping in male GI cancer patients; however, there was no change in measures of QoL. Given the direct effects of SEGT on anxiety, depression and anger, as well as a strong association between anger and depression in men as reported in past studies, SEGT could be impactful in improving psychosocial health outcomes in male GI cancer patients.
Psychometric properties of the Chinese version of the aging transformation scale for elderly dementia patients
Authors: Li You Lai , Sun Ning , Yu Bo Li , Dong Xin Xiao , Ying Chen Yu , Lang Jun Han , Zhou Heng Li
Published: December 2020

Background: The key part of home care services is the assessment of the needs of the home environment for elderly patients with dementia. The present study was conducted to evaluate the psychometric properties of a newly adapted Chinese version of an instrument designed to measure aging transformation needs among elderly patients with dementia.Methods: A sample of 175 patients with elderly dementia was selected from ten communities in China. The 55-item aging transformation needs scale was answered by the participants. Content validity, Cronbach’s alpha, item-to-total correlation, and exploratory factor analysis were used to assess the reliability and validity of the instrument.Results: The aging transformation needs scale has a good surface validity, content validity, and structural validity. The content validity was 0.965; 55 items had large factor loads on their corresponding principal components (≥0.5). There was a significant correlation between the aging transformation needs scale and each component (r = 0.897-0.973, all P<0.01), and 9 components also had a high correlation (r = 765～0.977, all P<0.01); the total table Cronbach's α was 0.993, the Cronbach's α of each constituent factor was 0.944～0.990, and the correlation coefficient between factor and content was >0.40 (all P<0.01). Conclusions: Evidence was found to support the reliability and validity of the aging transformation needs scale that measures the quality of the aging transformation needs for patients with elderly dementia from an aging transformation needs perspective.
"The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes - case-control study".
Authors: Wojtkowska Agnieszka , Zapolski Tomasz , Wysokinska-Miszczuk Joanna , Wysokinski Andrzej P.
Published: December 2020

Background: Coronary atherosclerosis and periodontal disease, due to their prevalence, are a serious epidemiological problem. Pathophysiological evidence points to their possible common inflammatory etiopathological background. The aim of the study was to analyze the relationship between the presence and severity of periodontitis, systemic inflammation and selected parameters of myocardial injury and heart function in patients with acute myocardial infarction. Methods: The study group consisted of 71 patients 54.22(7.05) - year - old hospitalized due to acute myocardial infarction. The patients underwent a coronary angiographic examination and echocardiography. The following laboratory parameters were determined: blood morphology, hsCRP, ESR, fibrinogen, troponin I, CK-MB, BNP, lipidogram, glucose, creatinine, GFR, TSH, HbA1c. Dental assessment of the patients was performed and the following indicators were included: the number of teeth preserved, approximal plaque index (API), bleeding on probing (BoP), pocket depth (PD), the number of bleeding periodontal pockets ≥ 4 mm in depth (NoPD≥4 mm), the percentage of bleeding periodontal pockets ≥ 4 mm in depth (%PD≥4 mm), clinical attachment loss (CAL). The control consisted of 40 patients 52 (± 8.43)- year-old without a history of coronary heart disease. These patients were subjected to a periodontal examination using the above parameters and classification methods. Results: The BI (bleeding index) significantly correlated with fibrynogen. All indices regarding the pocket depth (PD, NoPD≥4mm,% PD4≥mm) correlated significantly with the number of leukocytes. PD and NoPD≥4mm were also associated significantly with the level of hsCRP. The BI is correlated closely with the levels of BNP. The multifactorial analysis showed that significant predictors of myocardial infarction are API and BI. The analysis showed that API and BI are important predictors of troponin levels. Linear regression analysis showed that only CAL is a significant predictor of BNP.Conclusions: Patients with acute myocardial infarction have worse periodontal status compared to people without coronary heart disease. Greater severity of periodontitis, plaque accumulation and bleeding on probing are associated with acute myocardial infarction. Periodontitis is a risk factor for myocardial infarction and also affects the degree of post-infarction left ventricular damage, which means that there is an inflammatory link between these two diseases.
Degradation of terrestrial organic matter by aquatic microbial genomes in the Amazon River
Authors: Santos-Junior Celio Dias , Logares Ramiro , Henrique-Silva Flavio
Published: December 2020

Rivers connect the carbon cycle in land with that in aquatic ecosystems by transporting and transforming terrestrial organic matter (TeOM). The Amazon River receives huge loads of TeOM from the surrounding rainforest, promoting a substantial microbial heterotrophic activity and consequently, CO2 outgassing. In the Amazon River, microbes degrade up to 55% of the lignin present in the TeOM. Yet, the main microbial genomes involved in TeOM degradation were unknown. Here, we characterize 51 Population Genomes (PGs) representing some of the most abundant microbes in the Amazon River deriving from 106 metagenomes. The 51 reconstructed PGs are among the most abundant microbes in the Amazon River, and 53% of them are not able to degrade TeOM. Among the PGs capable of degrading TeOM, 20% were exclusively cellulolytic, while the others could also oxidize lignin. The transport and consumption of lignin oxidation by-products seemed to be decoupled from the oxidation process, being apparently performed by different groups of microorganisms. By connecting the genomic features of abundant microbes in the Amazon River with the degradation machinery of TeOM, we suggest that a microbial consortium following a priming effect model could explain the quick turnover of TeOM previously observed in this ecosystem.
Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey
Authors: Hayashi Fumikazu , Ohira Tetsuya , Nakano Hironori , Nagao Masanori , Okazaki Kanako , Harigane Mayumi , Yasumura Seiji , Maeda Masaharu , Takahashi Atsushi , Yabe Hirooki , Suzuki Yuriko , Kamiya Kenji
Published: December 2020

Background It has been reported that psychological stress affects bone metabolism and increases the risk of fracture. However, the relationship between bone fractures and post-traumatic stress disorder (PTSD) is unclear. This study aimed to evaluate the effects of disaster-induced PTSD symptoms on fracture risk in older adults.Methods This study evaluated responses from 17,474 individuals aged ≥65 years without a history of fractures during the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. The obtained data could determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between the fractures and each factor. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors.Results In total, 2,097 (12.0%) fractures were observed throughout the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex.Conclusions The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within the Fukushima Prefecture.
Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care
Authors: VINCENT Yves-Marie , FRACHON Adèle , BUFFETEAU Clotilde , CONORT Guillaume
Published: December 2020

Background: Uncomplicated urinary tract infection (uUTI) is very common among women in primary care. The risk of developing pyelonephritis remains low after uUTI, nonetheless, empiric antibiotic therapy is frequently prescribed for symptomatic purposes. This may lead to adverse effects and antibiotic resistance. Furthermore, patients may express the will to limit the use of antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of this study is to create a patient decision aid (PtDA) used in primary care settings to make a shared decision between practitioners and women about whether or not to treat uUTI with antibiotics.Methods: We followed the steps recommended by the International Patient Decision Aids Standards, with a scoping phase, a design phase (including focus groups and literature review), and an alpha-testing phase. A steering group, made of patients and physicians, met throughout the study to develop a prototype PtDA.Results: The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks, and consequences, based on a review of the literature. The results of the focus group made possible to determine the patient's values and preferences to consider in decision-making, including: the discomfort felt, the impact on daily life, patients’ perceptions of antibiotics, and the position relative to the risk of adverse effect. The choices in presentation, organisation and design are the result of the work of the steering group, improved by feedback from alpha testing. We confirmed the need for shared decision-making and the equipoise in this situation.Conclusions: We developed a PtDA to be used in primary care for sharing decision on the use of antibiotic in uUTI. It needs to be validated in a beta-testing phase, with complementary advice from peers, and then tested in a clinical study comparing its use with the systematic prescription approach.
Physical Exercise for Individuals with Dementia: potential benefits perceived by Formal Caregivers
Authors: Sampaio Arnaldina , Marques-Aleixo I , Seabra A , Mota J , Carvalho J
Published: December 2020

Background: The social and economic impact of dementia for the development of accessible and sustainable care for individuals with dementia (IwD). Physical exercise has been seen as a beneficial non-pharmacological therapy in the prevention and management of dementia, and possible benefits may not only impact on participants, but also indirectly on their caregivers. Thus, this quasi-experimental non-randomized study aimed to analyze the effects of an exercise intervention on functional capacity, behavioural and psychological symptoms in dementia (BPSD) and quality of life of institutionalized older adults with dementia, perceived by their formal caregivers. Methods: Sixty-four institutionalized older adults (from both genders, aged 65–93 yrs. old), clinically diagnosed with dementia, were divided into two groups: control group (CG, continued with usual care, n= 26) and exercise group (EG, 6-month supervised multicomponent exercise intervention, n= 38). Nine caregivers (female, aged 28-47 yrs old) from nine different nursing homes, reported about their distress related to BPSD and proxy-reported about participants’ functional capacity (Katz index), quality of life (QoL-AD), BPSD (NPI) before and after 6 months of an exercise intervention (aerobic, muscular resistance, flexibility and postural exercises). Results: A two-way ANOVA, with repeated measures, revealed significant group and time interactions on Total Katz index and QoL-AD. The CG's performance functional capacity and quality of life score worsen over time while in EG maintains these values after the exercise intervention. Moreover, formal caregiver´s distress triggered by apathy and disinhibition increased in CG while after 6 months of an exercise intervention no alterations were seen regarding these distress causes in EG. No significant main effects were observed for total NPI score or NPI distress.Conclusions: Overall results show that after the exercise intervention, IwD from the EG, was capable of preserving the functional capacity, quality of life and neuropsychiatric symptoms were attenuate, contributing to a lower load of distress for the caregivers.Trial registration: clinicaltrials.gov, NCT04095962. Retrospectively registered on 19 September 2019, https://clinicaltrials.gov/ct2/show/NCT04095962
The emotional and social burden of heart failure: integrating physicians’, patients’, and caregivers’ perspectives through Narrative Medicine
Authors: Testa Marco , Cappuccio Antonietta , Latella Maura , Napolitano Silvia , Milli Massimo , Volpe Massimo , Marini Maria Giulia
Published: December 2020

Background: The TRUST (The Roadmap Using Story Telling) project used a Narrative Medicine (NM) framework to assess the perspectives of people with heart failure (HF), their informal caregivers and HF specialists of the impact of heart failure (HF) on the daily life of patients and their carers. Methods: Italian HF specialists participated on a voluntary basis, completing their own narratives, and inviting patients and their caregivers to write anonymously about their experiences, all on a dedicated online platform. The narratives were analyzed according to standard NM methodology. Results: 82 narratives were collected from patients, 61 from caregivers, and 104 from HF specialists. Analysis of the three points of view revealed the extent of the burden of illness on the entire family, particularly that of the caregiver. The impact was mainly experienced as emotional and social limitations in patients’ and their caregivers’ daily lives. The analysis of all three points of view highlighted a strong difference between how HF is perceived by patients, caregivers, and HF specialists. Conclusions: This NM project illustrates the complex issues of living with HF and gave insights to integrate three different perspectives into the HF pathway of care.
MHC class I evolution; from Northern pike to salmonids
Authors: Grimholt Unni , Lukacs Morten
Published: December 2020

Background: Salmonids are of major importance both as farmed and wild animals. With the changing environment comes changes in pathogenic pressures so understanding the immune system of all salmonid species is of essence. Major histocompatibility complex (MHC) genes are key players in the adaptive immune system signalling infection to responding T-cells populations. Classical MHC class I (MHCI) genes, defined by high polymorphism, broad expression patterns and peptide binding ability, have a key role in inducing immunity. In salmonids, the fourth whole genome duplication that occurred 94 million years ago has provided salmonids with duplicate MHCI regions, while Northern Pike, a basal sister clade to salmonids, represent a species which has not experienced this whole genome duplication. Results: Comparing the gene organization and evolution of MHC class I gene sequences in Northern pike versus salmonids displays a complex picture of how many of these genes evolved. Regional salmonid Ia and Ib Z lineage gene duplicates are not orthologs to the Northern pike Z lineage sequences. Instead, salmonids have experienced unique gene duplications in both duplicate regions as well as in the Salmo and Oncorhynchus branch. Species-specific gene duplications are even more pronounced for some L lineage genes. Conclusions: Although both Northern pike as well as salmonids have expanded their U and Z lineage genes, these gene duplications occurred separately in pike and in salmonids. However, the similarity between these duplications suggest the transposable machinery was present in a common ancestor. The salmonid MHCIa and MHCIb regions were formed during the 94 MYA since the split from pike and before the Oncorhynchus and Salmo branch separated. As seen in tetrapods, the non-classical U lineage genes are diversified duplicates of their classical counterpart. One MHCI lineage, the L lineage, experienced massive species-specific gene duplications after Oncorhynchus and Salmo split approximately 25 MYA. Based on what we currently know about L lineage genes, this large variation in number of L lineage genes also signals a large functional diversity in salmonids.
Radiofrequency ablation combined with conductive fluid-based dopants (saline normal and colloidal gold): Computer modeling and ex vivo experiments.
Authors: Castro-Lopez Dora Luz , Berjano Enrique , Romero-mendez Ricardo
Published: December 2020

Background: The volume of the coagulation zones created during radiofrequency ablation (RFA) is limited by the appearance of roll-off. Doping the tissue with conductive fluids, e.g. gold nanoparticles (AuNPs) could enlarge these zones by delaying roll-off. Our goal was to characterize the electrical conductivity of a substrate doped with AuNPs in a computer modeling study and ex vivo experiments to investigate their effect on coagulation zone volumes. Methods: The electrical conductivity of substrates doped with normal saline or AuNPs was assessed experimentally on agar phantoms. The computer models, built and solved on COMSOL Multiphysics, consisted of a cylindrical domain mimicking liver tissue and a spherical domain mimicking a doped zone with 2, 3 and 4 cm diameters. Ex vivo experiments were conducted on bovine liver fragments under three different conditions: 1) non-doped tissue (ND Group), 2 mL of 0.9% NaCl (NaCl Group), and 2 mL of AuNPs 0.1 wt% (AuNPs Group). Results: The theoretical analysis showed that adding normal saline or colloidal gold in concentrations lower than 10% only modifies the electrical conductivity of the doped substrate with practically no change in the thermal characteristics. The computer results showed a relationship between doped zone size and electrode length regarding the created coagulation zone. There was good agreement between the ex vivo and computational results in terms of transverse diameter of the coagulation zone.Conclusions: Both the computer and ex vivo experiments showed that doping with AuNPs can enlarge the coagulation zone, especially the transverse diameter and hence enhance sphericity.
Improvement in BMI z-score following adenotonsillectomy in adolescents aged 12-18 years: a retrospective cohort study
Authors: Nathan Keren , Livnat Galit , Feraru Liat , Pillar Giora
Published: December 2020

Background: obstructive sleep apnea (OSA) is associated with different patient characteristics according to age groups. OSA in babies and in prepubertal children is usually accompanied by a failure to thrive (FTT) and underweight. Adenotonsillectomy (T&A) is the first line of treatment for obstructive sleep apnea (OSA) in childhood. In the adult population and partly in adolescents OSA is commonly associated with obesity and the metabolic syndrome. In adolescents with OSA managed with a T&A the change in BMI was only occasionally studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. Methods: in Israel, Clalit Health Services is the largest health care organization with the largest patient registry (more than 50% of the population). From the Clalit registry, 242 adolescents aged 12-18 who underwent T&A between 2006-2015 were retrospectively studied. BMI z-score changes from up to 3 months prior to T&A were compared to BMI measures in the following 3 years post T&A.Results: there were changes to all directions with overall small increase, not statistically significant (P=0.26) in BMI Z-score with a median of 0.79 prior to and 0.835 following T&A. Overweight children (n=74) tended to reduce their BMI z-score from 1.508 to 1.48 following T&A (p=NS), and in obese children (n=33) BMI z-score decreased from 2.288 to 2.000 accordingly (P=0.06, 2 tailed). Interestingly thin individuals (n=6) increased their BMI z-score following T&A from -2.4 to -0.59 (p=0.046).Conclusions: adolescents managed with T&A show variable changes in their BMI z-score following the procedure. In this regard their BMI z-score change is closer to the change seen in adults treated for OSA and not young children. The changes observed show trend to normalize the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.
MRI Study on Tibial Nerve of the Ankle Canal and Its Branches:A method of multiplanar reconstruction with 3D-FIESTA-C sequences
Authors: Zhang Yan , He Xucheng , Li Juan , Ye Ju , Han Wenjuan , Zhou Shanshan , Zhu Jianzhong , Wang Guisheng , Chen Xiaoxia
Published: December 2020

Background: The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of tibial nerve and its branches of the ankle canal.Methods: The subjects were 20 healthy volunteers (40 ankles), aged 22-50, with no history of ankle joint disease. 3D-FIESTA-C sequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reformation.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcal caneal nerve were 100%, and the starting point of the subcal caneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches and the bifurcation point’s projection position on the body surface can be marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.
The effect of inhaling mother’s breast milk odor on the behavioral responses to pain caused by hepatitis B vaccine in preterm infants: a randomized clinical trial
Authors: Rad Zahra Akbarian , Aziznejadroshan Parvin , Amiri Adeleh Saebi , Ahangar Hemmat Gholinia , Valizadehchari Zahra
Published: December 2020

Background: Non-pharmacologic pain relief in preterm infant is an important measure. Familiar odors for neonates have soothing effects in some researches. The aim of this study was to compare the effect of maternal breast milk odor (MBMO) with that of another mother’s breast milk odor (BMO) on the behavioral responses to pain caused by hepatitis B (HB) vaccine injection in preterm infants.Methods: This single-blind randomized clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran from February 2019 to March 2020. Ninety preterm infants who must to be receive the HB vaccine, were randomly assigned into three groups of MBMO (A), another mother’s BMO (B) and control with distilled water(C). Oxygen saturation(SaO2), blood pressure(BP) and heart rate(HR) were recorded by electronic monitoring and premature infant pain profile (PIPP) were determined through video recording in tree groups during intervention. The chi-square, ANOVA and ANCOVA were used for analyzing data, and P<0.05 was considered significant.Results: No significant differences were seen between tree groups in mean± SD of HR, BP, Sao2 before intervention, (P>0.05). After intervention, the mean heart rate in group A, B and C was 146. 6±14.3, 153.70±17.5 and 155.70±17.7 respectively, (P=0.01). There was no significant difference between groups in the mean of SaO2, systolic and diastolic blood pressure after intervention (P>0.05). The mean PIPP score in groups A, B and C was 6.6±1.3, 10 ±2 and 11.4±1.9 respectively, (P<0.001).Conclusions: Stimulation with MBMO is effective in reducing the pain of preterm infants, so it can be used in less invasive procedures such as needling.Trial registration: IRCT, IRCT20190220042771N1. Registered 18 May 2019- Retrospectively registered, https://en.irct.ir/trial/37646
Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination. A prospective observational study​
Authors: Ciscar Ana , Badia Josep Maria , Novell Francesc , Bolivar Santiago , Mans Esther
Published: December 2020

BACKGROUND: Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. METHODS: A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a four months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. RESULTS: 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14 - 10.515, p = 0.028) and body mass index (BMI) ≥30 Kg / m2 (OR 3.313 CI 1.037-10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p <0.001). Mean follow-up time was 34 months.CONCLUSIONS: TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years.
Effects of Quran Recitation on the Reduction of Preoperative Anxiety in Elective Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Gavgani Vahideh Zarea , Ghojazadeh Mortaza , Sadeghi-Ghyassi Fatemeh , Khodapanah Tahmineh
Published: December 2020

Background: Anxiety is a common reaction among patients undergoing surgery. This study aim to assess effectiveness of Quran recitation on reducing the preoperative anxiety.Methods: A systematic review of the citations in the Medline, EMBASE, Cochrane Library, PsycInfo, Arab World Research Source and other relevant databases was performed to collect the data. Randomized clinical trials about the effect of Quran recitation on the reduction of preoperative anxiety in elective surgery were included without any Language and date restriction. Interventions with self-reading/self-recitation were excluded. The Cochran’s Q statistic and the (I2) with 50 percent threshold was used for calculation of the heterogeneity and inconsistency index. Subgroup analysis was conducted based on the type of surgery. The funnel plot has been used to evaluate the possibility of the publication bias.Results:Twelve studies were included in the qualitative synthesis and nine studies included in the quantitative synthesis. Our meta-analysis showed a significant reduction in the anxiety level with Quran recitation. The heterogeneity of the included studies was statistically significant (Q=23.05, I2=65.29, P=0.003). The pooled effect size of the anxiety was d=−8.893; 95% CI=[−10.763 to −7.022] (P < 0.001). The subgroup analysis showed that Quran recitation has a beneficial effect on reducing anxiety in both major and minor surgeries.There was no publication bias (t=0.907, P=0.39) in the studies.Conclusion: Quran recitation can be considered as a non-invasive and peaceful intervention to reduce preoperative anxiety in elective surgery.
Usability evaluation of an integrated Electronic Medication Management System implemented in an Oncology setting using the Unified Theory of the Acceptance and Use of Technology.
Authors: dabliz racha , Poon Simon K. , Ritchie Angus , Burke Rosemary , Penm Jonathan
Published: December 2020

Background: Medication management processes in an Oncology setting are complex and difficult to examine in isolation from interrelated processes and contextual factors. This qualitative study aims to evaluate the usability of an Electronic Medication Management System (EMMS) implemented in a specialised oncology unit using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. Methods: The study was conducted in a 12-bed outpatient Oncology unit of a major teaching hospital six months following implementation of a commercial EMMS. In-depth semi-structured interviews were conducted with doctors, nurses and pharmacists using the system to assess usability. The UTAUT framework was used to analyse the results, which facilitated evaluation of interrelated aspects and provided a structured summary of user experience and usability factors. Results: Direct cross-comparison between user groups illustrated that doctors and pharmacists were generally satisfied with the facilitating conditions (hardware and training), but had divergent perceptions of performance (automation, standardised protocols and communication and documented) and effort (mental and temporal demand). In counterpoint, nurses were generally satisfied across all constructs. Prior experience using an alternative EMMS influenced performance and effort expectancy and was related to early dissatisfaction with the implemented system. Furthermore, whilst not originally designed for the healthcare setting, the flexibility of the UTAUT allowed for translation to the hospital environment. Conclusion: Nurses demonstrated overall satisfaction with the EMMS, whilst doctors and pharmacists perceived some usability problems, particularly related to restricted automaticity and system complexity, which hindered user uptake and EMMS success. The study demonstrates the feasibility and utility of the UTAUT framework to evaluate usability of an EMMS for multiple user groups in the Oncology setting.