bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel bacterial β-N-acetyl glucosaminidase from Chitinolyticbacter meiyuanensis possessing transglycosylation and reverse hydrolysis activities
Authors: Zhang Alei , Mo Xiaofang , Zhou Ning , Wang Yingying , Wei Guoguang , Chen Jie , Chen Kequan , Ouyang Pingkai
Published: June 2020

Background: N-acetyl glucosamine (GlcNAc) and N-acetyl chitooligosaccharides (N-acetyl COSs) exhibit many biological activities, and have been widely used in the pharmaceutical, agriculture, food, and chemical industries. Particularly, higher N-acetyl COSs with degree of polymerization from 4 to 7 ((GlcNAc)4−(GlcNAc)7) show good antitumor and antimicrobial activity, as well as possessing strong stimulating activity towards natural killer cells. Thus, it is of great significance to discover a β-N-acetyl glucosaminidase (NAGase) that can not only produce GlcNAc, but also synthesize N-acetyl COSs. Results: The gene encoding the novel β-N-acetyl glucosaminidase, designated CmNAGase, was cloned from Chitinolyticbacter meiyuanensis SYBC-H1. The deduced amino acid sequence of CmNAGase contains a glycoside hydrolase family 20 catalytic module that shows low identity (12−35%) with the corresponding domain of most well-characterized NAGases. The CmNAGase gene was highly expressed with an active form in Escherichia coli BL21 (DE3) cells. The specific activity of purified CmNAGase toward p-nitrophenyl-N-acetyl glucosaminide (pNP-GlcNAc) was 4,878.6 U/mg of protein. CmNAGase had a molecular mass of 92 kDa, and its optimum activity was at pH 5.4 and 40ºC. The Vmax, Km, Kcat, and Kcat/Km of CmNAGase for pNP-GlcNAc were 16,666.67 μmol min-1 mg-1, 0.50 μmol mL-1, 25,555.56 s-1, and 51,111.12 mL μmol-1 s-1, respectively. Analysis of the hydrolysis products of N-acetyl COSs and colloidal chitin revealed that CmNAGase is a typical exo-acting NAGase. Particularly, CmNAGase can synthesize higher N-acetyl COSs ((GlcNAc)3−(GlcNAc)7) from (GlcNAc)2−(GlcNAc)6, respectively, showed that it possesses transglycosylation activity. In addition, CmNAGase also has reverse hydrolysis activity toward GlcNAc, synthesizing various linked GlcNAc dimers. Conclusions: The observations recorded in this study that CmNAGase is a novel NAGase with exo-acting, transglycosylation, and reverse hydrolysis activities, suggests a possible application in the production of GlcNAc or higher N-acetyl COSs.
Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.
Authors: Ke Wujian , Li Dongling , Tso Lai Sze , Wei Ran , Lan Yinyuan , Chen Zhengyu , Zhang Xiaohui , Wang Liuyuan , Liang Chunmei , Liao Yuying , Chen Huiru , Liu Yahui , Zheng Heping , Yang Ligang
Published: June 2020

Background: Antimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated to macrolide and fluoroquinolones, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China.Methods: A total of 154 stored M. genitalium positive specimens from men and women attending an STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR with a sensitivity of five genome equivalents (geq)/reaction. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA).Results: 98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2059G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2059G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2059G + A96T + S83I).Conclusions: The high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.
Evaluation of standard and semantically-augmented distance metrics for neurology patients
Authors: Hier Daniel B , Kopel Jonathan , Brint Steven U , II Donald C Wunsch , Olbricht Gayla R , Azizi Sima , Allen Blaine
Published: June 2020

Background: When patient distances are calculated based on phenotype, signs and symptoms are often converted to concepts from an ontological hierarchy. There is controversy as to whether patient distance metrics that consider the semantic similarity between concepts can outperform standard patient distance metrics that are agnostic to concept similarity. The choice of distance metric often dominates the performance of classification or clustering algorithms. Our objective was to determine if semantically augmented distance metrics would outperform standard metrics on machine learning tasks. Methods: We converted the neurological signs and symptoms from 382 published neurology cases into sets of concepts with corresponding machine-readable codes. We calculated inter-patient distances by four different metrics (cosine distance, a semantically augmented cosine distance, Jaccard distance, and a semantically augmented bipartite distance). Semantic augmentation for two of the metrics depended on concept similarities from a hierarchical neuro-ontology. For machine learning algorithms, we used the patient diagnosis as the ground truth label and patient signs and symptoms as the machine learning features . We assessed classification accuracy for four classifiers and cluster quality for two clustering algorithms for each of the distance metrics. Results: Inter-patient distances were smaller when the distance metric was semantically augmented. Classification accuracy and cluster quality were not significantly different by distance metric. Conclusion: Using patient diagnoses as labels and patient signs and symptoms as features, we did not find improved classification accuracy or improved cluster quality with semantically augmented distance metrics. Semantic augmentation reduced inter-patient distances but did not improve machine learning performance.
Efficacy of combined education to promote self efficacy and self-care oral health behaviors of students: a randomized controlled trial
Authors: Hashemi Zahra Sadat , khorsandi Mahboobeh , Shamsi Mohsen , Moradzadeh Rahmatollah
Published: June 2020

Background: In order to prevent oral diseases, the use of appropriate educational methods at childhood is one of the most important strategies for the public health. Therefore, the present study aimed to evaluate the effect of training through animations and games on oral health self-efficacy and self-care behaviors among 6-12-aged students. Methods: In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for control group). The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.Results: Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p >0.05)Conclusion: The use of combined methods for oral health self-care education can positively influence the students' performance and self-efficacy
Use of Resuscitation promoting factors to screen for tuberculosis infection in household-exposed children in The Gambia
Authors: Loon Welmoed Van , Gomez Marie P , Jobe Dawda , Franken Kees CLMC , Ottenhoff Tom HM , Corninx Michael , Kestens Luc , Sutherland Jayne , Kampmann Beate , Djomkam Leopold Tientcheu
Published: June 2020

Background Interferon-γ release assays (IGRA) with Resuscitation promoting factor (Rpf) proteins enhanced tuberculosis (TB) screening and diagnosis in adults but have not been evaluated in children. Children often develop paucibacillary TB and their immune response differs from that of adults, which together affect TB disease diagnostics and immunodiagnostics. We assessed the ability of Rpf to identify infection among household TB-exposed children in The Gambia and investigated their ability to discriminate Mycobacterium tuberculosis complex (MTBC) infection from active TB disease in children. Methods Detailed clinical investigations were done on 93 household TB-exposed Gambian children and a tuberculin skin test (TST) was administered to asymptomatic children. Venous blood was collected for overnight stimulation with ESAT-6/CFP-10-fusion protein (EC), purified protein derivative and RpfA, B, C, D and E. Interferon gamma (IFN-γ) production was measured by ELISA in supernatants and corrected for the background level. Infection status was defined by IGRA with EC and TB disease by mycobacterial confirmation and/or clinical diagnosis. We compared IFN-γ levels between infected and uninfected children and between infected and TB diseased children using a binomial logistic regression model while correcting for age and sex. A Receiver Operating Characteristics analysis was done to find the best cut-off for IFN-γ level and calculate sensitivity and specificity. Results Interferon gamma production was significantly higher in infected (IGRA+, n=45) than in uninfected (IGRA-, n=20) children after stimulation with RpfA, B, C, and D (P = 0.03; 0.007; 0.03 and 0.003, respectively). Using RpfB and D-specific IFN-γ cut-offs (33.9 pg/mL and 67.0 pg/mL), infection was classified with a sensitivity-specificity combination of 73%-92% and 77%-72% respectively, which was similar to and better than 65%-75% for TST. Moreover, IFN-γ production was higher in infected than in TB diseased children (n=28, 5 bacteriologically confirmed, 23 clinically diagnosed), following RpfB and D stimulation (P = 0.02 and 0.03, respectively). Conclusion RpfB and RpfD show promising results for childhood MTBC infection screening, and both performed similar to and better than the TST in our study population. Additionally, both antigens appear to discriminate between infection and disease in children and thus warrant further investigation as screening and diagnostic antigens for childhood TB.
Association of interleukin 2, interleukin 12, and interferon-γ with intervertebral disc degeneration in Iranian population
Authors: Hanaei Sara , Abdollahzade Sina , Sadr Maryam , Mirbolouk Mohammad Hossein , Fattahi Ehsan , Khoshnevisan Alireza , Rezaei Nima
Published: June 2020

Background: Intervertebral disc degeneration (IVDD) is an age-related degenerative disease, presenting with low back pain or radicular pain. The inflammatory changes would occur in discs in the process of IVDD. Therefore, the inflammatory and anti-inflammatory cytokines, as well as their respective genes, have been proposed to play roles in pathophysiology of disease. This study has been conducted to elucidate the role of IL-2, IL-12, and IFN-γ single nucleotide polymorphisms (SNP) in this disease.Method: 76 patients who were diagnosed with IVDD and 140 healthy controls who complied with eligibility criteria were included. A total volume of 5cc peripheral blood was obtained from each participant to investigate the IL-2 +166G/T, IL-2 -330G/T, IL-12 -1188A/C, and IFN-γ +847A/T SNPs through PCR-SSP method.Results: The ‘TG’ and ‘TT’ genotypes of IL-2 -330G/T polymorphism were significantly more common among patients and healthy controls respectively. The ‘GT’ and ‘TT’ haplotypes of IL-2 (comprised of -330G/T, and +166G/T SNPs) were also more common among patients and controls respectively.Conclusion: This study indicated the significant role of IL-2 genotypes and haplotypes in IVDD. These SNPs were differently distributed in patients and controls. Therefore, alteration in the structure of IL-2 gene could play an important role in pathophysiology of IVDD.
Effectiveness of SMS messaging for diarrhoea measurement: a factorial cross-over randomised controlled trial
Authors: Rego Ryan Trevor Titus , Watson Samuel , Ishengoma Philbert , Langat Philemon , Otieno Hezekiah Pireh , Lilford Richard
Published: June 2020

Background Text messaging systems are used to collect data on symptom prevalence. Using a text messaging system, we evaluated the effects of question load, question frequency, and financial incentive on response rates and reported infant diarrhoea rates in an infant diarrhoea survey. Methods We performed a factorial cross-over randomised controlled trial of an SMS surveying system for infant diarrhoea surveillance with treatments: financial incentive (yes/no), question load (1-question/3-question), and questioning frequency (daily/fortnightly). Participants progressed through all treatment combinations over eight two-week rounds. Data were analysed using multivariable logistic regressions to determine the impacts of the treatments on the response rates and reported diarrhoea rates. Attitudes were explored through qualitative interviews.Results For the 141 participants, the mean response rate was 47%. In terms of percentage point differences (ppd), daily questioning was associated with a lower response rate than fortnightly (-1·2[95%CI:-4·9,2·5]); high (3-question) question loads were associated with a lower response rate than low (1-question) question loads (-7·0[95%CI:-10·8,-3·1]); and financial incentivisation was associated with a higher response rate than no financial incentivisation (6·4[95%CI:2·6,10·2]). The mean two-week diarrhoea rate was 36·4%. Daily questioning was associated with a higher reported diarrhoea rate than fortnightly (29·9[95%CI:22·8,36·9]); with little evidence for impact by incentivisation or question load. Conclusions Close to half of all participants responded to the SMS survey. Daily questioning evoked a statistically higher rate of reported diarrhoea, while financial incentivisation and low (1-question) question loads evoked higher response rates than no incentive and high (3-question) question loads respectively.Trial RegistrationThe protocol was registered on ISRCTN on the 20th of March 2019 under number ISRCTN11410773.
Expanding Medical Student Interaction In Neurology With A Redesigned Student Interest Group In Neurology (SIGN) Chapter
Authors: Gummi Rohit , Smith Ross , Govindarajan Raghav
Published: June 2020

Background: SIGN chapters across the country provide opportunities for medical students to participate in clinical, research, and service activities in neurology. Despite these, enrollment in SIGN chapters has been traditionally low.Methods: Following changes were introduced: an open board style SIGN chapter executive committee with greater active engagement of first and second year students, new types SIGN chapter activities including journal club articles, hands on workshop (example EMG), celebration/cause events (example ALS walk). In addition, a free neurology clinic was introduced. Activities were planned in consultation with office of medical education, and were organized during ‘down times’. Data on student enrollment, activities successfully carried out, students interested in neurology residency, number of neurology-related research projects with student involvement were collected prior to changes and compared to values after changes were introduced.Results: Post intervention, student engagement in neurology activities and projects increased significantly. There were also significantly more students engaged in neurology related research projects and significantly more students reported interest in neurology. However, a similar increase in applications to neurology residency was not yet observed.Conclusions: An open chapter with early engagement and involvement of first and second year medical students, creating a variety of chapter activities with greater hands on involvement, planned in conjunction with office of medical education has reinvigorated our SIGN chapter.
Application of magnesium sulphate as a " multimodal general anesthesia" protocol in patients undergoing hysteroscopy: a randomized controlled study
Authors: Gao Peng-fei , Lin Jing-yan , Wang Shun , Zhang Yun-feng , Wang Guo-qiang , Xu Qi , Guo Xiao
Published: June 2020

Background: The purpose of the study was to applicate magnesium sulphate as a " multimodal general anesthesia" protocol to reduce perioperative opioids requirements in patients undergoing hysteroscopy.Methods: 70 patients scheduled for hysteroscopy were randomly divided into 2 groups. Patients in Group M received intravenous magnesium sulfate 50 mg/kg in 100 ml of isotonic saline over 15 min before fentanyl injection and then 15 mg/kg per hour by continuous intravenous infusion. Patients in the control group received an equal volume of normal saline as placebo. All patients were anesthetized under a BIS guided monitored anesthesia care with propofol and fentanyl. Intraoperative hemodynamic variables were recorded and postoperative pain scores were assessed with verbal numerical rating scale (VNRS) 1 min, 15 min, 30 min, 1 hour, and 4 hours after recovery of consciousness. The primary outcome of our study was total amount of intraoperative and postoperative analgesics administered.Results: Postoperative serum magnesium concentrations in Group C were significantly decreased than preoperative levels (0.86 ± 0.06 to 0.80 ± 0.08 mmol/L, P=0.001) while there was no statistical change in Group M (0.86 ± 0.07 to 0.89 ± 0.07 mmol/L, P=0.129). Bradycardia did not occur in either group and the incidence of hypotension was comparable between the two groups. Total dose of fentanyl given to patients in Group M was less than the one administered to Group C [100 (75-150) vs 145 (75-175) μg, median (range); P < 0.001]. Fewer patients in Group M required additional analgesics postoperatively. In addition, patients receiving magnesium displayed lower VNRS scores at 15 min, 30 min, 1 hour, and 4 hours postoperatively. Conclusions: Intravenous infusion of magnesium sulphate significantly reduces postoperative pain and perioperative opioid requirements without increasing the risk of cardiovascular side effects. Meanwhile, it was beneficial to maintain a stable serum magnesium concentration after the procedure.Trial registration: www.chictr.org.cn ChiCTR1900024596 date of registration: July 18th 2019.
A Study of Pre-hospital Emergency Care Personnel's Perception of Ethical Dilemmas in the Field: a qualitative study
Authors: Bijani Mostafa , Mohammadi Fateme , Hatami Mahmood
Published: June 2020

Background Due to their unpredictable and critical working conditions, pre-hospital emergency care personnel experience difficult and complicated situations in the field presenting them with various ethical dilemmas which affect their clinical decisions. Lack of studies on the ethical dilemmas which pre-hospital emergency care personnel face necessitates more research into these ethical challenges and dilemmas. The present study aims to determine pre-hospital emergency care personnel's perception of the ethical dilemmas they face in the field. Methods The present study is a work of qualitative research with a content analysis approach. Data were collected through semi-structured, in-depth interviews and field notes. The collected data were analyzed using conventional content analysis. The participants were 25 pre-hospital emergency care personnel members in Iran who met the inclusion criteria. They were selected via purposeful sampling which was continued to saturation point. The study lasted from February to May 2020. Results Two main themes—paradox in decision-making and patients' ethics and values—with 8 categories were extracted from the collected data. Conclusion The results of the present study show that, in the field, pre-hospital emergency care personnel confront various ethical dilemmas which create paradoxes in their professional performance and ethical decisions. Yet, they should make the best ethical decision and provide care combined with respect for patients' ethical identities and beliefs to achieve satisfactory medical care results. To provide high-quality care, pre-hospital emergency care personnel must be provided with a proper cultural, professional, and organizational environment which is free of ethical distress.
Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia
Authors: Li Qiu-Mei , Wang Feng , Wu Zhe-Ming , Liu Zhen , Zhan Chuan , Chen Bing-Heng , Sima Jing , Stieger Knut , Li Shao-Wei
Published: June 2020

Background: With the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.Methods: This retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.Results: 21 Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was −0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ± 0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ± 1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.Conclusions: Trifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.
Identifying maternal needs following childbirth: comparison between pregnant women and recent mothers
Authors: Slomian Justine , Reginster Jean-Yves , Emonts Patrick , Bruyère Olivier
Published: June 2020

Background

The postnatal period is associated with new needs for mothers. Four categories of needs were highlighted in our previous study: for information, for psychological support, for the sharing of experiences and for practical and material support. The aims of this study were as follows: (1) to validate these 4 needs by comparing recent mothers’ needs with the needs of pregnant women and (2) to compare these needs between primiparous and multiparous women.
Methods

The 4 needs previously identified were investigated by online self-report questionnaires completed by women in their last trimester of pregnancy and by mothers who had a child between 0 and 6 months of age.
Results

The 4 needs were largely present during the postpartum period. The need for information seemed to be more present during pregnancy (92.4%) than during the postpartum period (84.6%, p = 0.03), but women used the Internet significantly more often to search for information after childbirth (54.8%) than during pregnancy (41.2%, p < 0.0001). The needs for psychological support and to share experiences seemed to be closely linked. Even if the global satisfaction with psychological support was fairly high, it weakened after childbirth (p < 0.05). Feelings of loneliness (p < 0.0001) and depression scores (p = 0.01) were also higher during the postpartum period than during pregnancy. Not surprisingly, primiparous women felt less reassured in their roles as mothers and more stressed during the postpartum period than multiparous women (p < 0.0001). Finally, the need for practical support was also more pronounced during the postpartum period than during pregnancy (p = 0.01).
Conclusion

All mothers seem to meet the 4 identified needs during the postpartum period but at different levels of intensity. Trying to meet these needs could offer an opportunity to improve mothers’ quality of life.
A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-VII (2014–2017)
Authors: Lee Mee-Ri , Jung Sung Min
Published: June 2020

Background
To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.
Methods
In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having two or more chronic diseases. A total of 19,779 participants were eligible for the study (8,730 male and 11,409 female). We grouped and analysed participants based on age and sex (men and women aged 19–49 years, men and women aged 50–80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).
Results
Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19–49 years: 3.76 and aged 50–80 years: 2.11; women aged 19–49 years: 1.52 and aged 50–80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19–49 years with a BMI ≥ 25 kg/m2.
Conclusion
In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with two or more chronic diseases. Male participants with a low handgrip strength aged between 19–49 years with a BMI ≥ 25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity
Bone Impaction Grafting with Trabecular Metal Augments in Large Defects in Young Patients: Unravelling A New Perspective in Surgical Technique
Authors: Torre-Escurero Basilio De la , Gómez-González Eva , Álvarez-Villar Slavador , Bujan Julia , Ortega Miguel A
Published: June 2020

Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.
A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event
Authors: Tahlil Kadija M , Obiezu-Umeh Chisom , Gbajabiamila Titi , Nwaozuru Ucheoma , Oladele David , Musa Adesola Z , Idigbe Ifeoma , Okwuzu Jane , David Agatha N , Bamidele Tajudeen A , Airhihenbuwa Collins O , Rosenberg Nora E , Tang Weiming , Ong Jason J , Conserve Donaldson F , Iwelunmor Juliet , Ezechi Oliver , Tucker Joseph D
Published: June 2020

Background
Youth are at high risk for HIV, but are often left out of designing interventions, including those focused on adolescents. We organized a designathon for Nigerian youth to develop HIV self-testing (HIVST) strategies for potential implementation in their local communities. A designathon is a problem-focused event where participants work together over a short period to create and present solutions to a judging panel.
Methods
We organized a 72-hour designathon for youth (14–24 years old) in Nigeria to design strategies to increase youth HIVST uptake. Proposals included details about HIVST kit service delivery, method of distribution, promotional strategy, and youth audience. Teams pitched their proposals to a diverse seven-member judging panel who scored proposals based on desirability, feasibility, potential impact and teamwork. We examined participants’ socio-demographic characteristics and summarized themes from their HIVST proposals.
Results
Forty-two youth on 13 teams participated in the designathon. The median team size was 3 participants (IQR: 2–4). The median age was 22.5 years (IQR: 21–24), 66.7% were male, 47.4% completed tertiary education, and 50% lived in Lagos State. Themes from proposals included HIVST integration with other health services, digital marketing and distribution approaches, and engaging students. Judges identified seven teams with exceptional HIVST proposals and five teams were supported for further training.
Conclusions
The designathon provided a structured method for incorporating youth ideas into HIV service delivery. This approach could differentiate HIV services to be more youth-friendly in Nigeria and other settings.
Ethical challenges of the healthcare transition to adult Antiretroviral therapy (ART) clinics for HIV infected adolescents and young people in Uganda
Authors: Mbalinda Scovia Nalugo , Bakeera-Kitaka Sabrina , Amooti Derrick Lusota , Magongo Eleanor Namusoke , Musoke Philippa , Dan Kaye K
Published: June 2020

Introduction Many HIV infected adolescents require transfer of care from paediatric/ adolescent clinics to adult ART clinics. Transition is beset with factors that hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a successful transition. The purpose of this study was to analyse the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Method We conducted 18 focus group discussions among 191 adolescents attending 9 different health facilities in Uganda. We explored facilitators and barriers regarding adolescent transitioning to adult HIV clinics. Thematic data analysis was used to analyze the data. The Silences Framework guided the data analysis and interpretation. The principles of Bioethics and the four-boxes ethics framework for clinical care (Patient autonomy, Medical indications, Context of care and Quality of life) were used to analyze the ethical issues surrounding the transition to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of both privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort; and contextual factors are critical to successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition to ensure retention in HIV care, facilitate long-term self-care, provide ongoing holistic healthcare and support in order to promote health and wellbeing, and build trust in the healthcare system. Identifying what facilitates successful transitions, and the gaps that interventions can target, may ensure HIV-infected youth remain healthy across the healthcare transition.
Value of CT and three-dimensional reconstruction revealing specific radiological signs for screening causative high jugular bulb in patients with Menière's disease
Authors: Hu Junjiao , Peng Anquan , Deng Kai , Huang Chao , Wang Qin , Pang Xueying , Liu Wei , Zhang Zhiwen , Jiang Wenqi , Chen Yichao
Published: June 2020

Background The aim of the present study was to investigate the pathological features of vestibular aqueduct (VA) related high jugular bulb (HJB) and explore the possible cause-consequence relation between HJB and endolymphatic hydrops (EH), and the potential specific radiological signs for screening causative HJB in MD. Methods High-resolution computed tomography (HRCT) and three-dimensional reconstruction (3DRC) were used to detect the anatomical variables associated with VA and jugular bulb (JB) in hydropic and non-hydropic ears. The presence or absence of EH in the inner ear was determined by gadopentetate dimeglumine-enhanced magnetic resonance imaging. Results JB was classified as: Type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (PSCC); type 3, between the inferior margin of the PSCC and the inferior margin of the internal auditory canal (IAC); type 4, above the inferior margin of the IAC. There were no significant differences in the presence of types 1, 2 and 3 JB between two groups. The presence of type 4 JB, average height of the JB and prevalence of the non-visualization of the VA in CT scans showed significant differences between two groups. The morphological pattern between the JB and VA revealing by 3DRC was classified as: Type I, the JB was not in contact with the VA; type II, the JB was in contact with the VA, but the latter was intact without obstruction; type III, the VA was obliterated by HJB encroachment. There were no significant differences in the presence of type I and II between two groups. Type III was identified in 5 hydropic ears but no non-hydropic ears, with a significant difference observed between the two groups.Conclusion The present results showed that JB height and non-visualization of the VA on Pöschl's plane could render patients susceptible to the development of EH. A jugular bulb reaching above the inferior margin of the IAC (type 4 JB) could obstruct VA, resulting in EH in a few isolated patients with MD. VA obliteration revealed by 3DRC, as a specific radiological sign, may have the potential for screening causative HJB in MD.
Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China
Authors: Zhao Huiying , Wang Guangjie , Lyu Jie , Zhang Xiaohong , An Youzhong
Published: June 2020

BackgroundMaternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.MethodsThe clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.ResultsOut of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 hours. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) = 1.296, P = 0.029), acute kidney injury (AKI) (OR = 4.305, P = 0.013), myocardial injury (OR = 4.586, P = 0.012), and PaO2/FiO2 (OR = 0.989, P < 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.ConclusionsEstimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.
A physical activity program versus usual care in the management of quality of life for pre-frail older adults with chronic pain in primary care: randomized controlled trial.
Authors: Otones Pedro , García Eva , Sanz Teresa , Pedraz Azucena
Published: June 2020

Background
Exercise have shown being effective for managing chronic pain and preventing frailty status in older adults but the effect of an exercise program in the quality of life of pre-frail older adults with chronic pain remains unclear. Our objective was to evaluate the effectiveness of multicomponent structured physical exercise program for pre-frail adults aged 65 years or more with chronic pain to improve their perceived health related quality of life, compared with usual care.
Methods
Open label randomized controlled trial. Participants were community-dwelling pre-frail older adults aged 65 years or older with chronic pain and non-dependent for basic activities of daily living attending a Primary Healthcare Centre. Forty-four participants were randomly allocated to a control group (n = 20) that received usual care or an intervention group (n = 24) that received an 8-week physical activity and education program. Frailty status (SHARE Frailty Index), quality of life (EuroQol-5D-5L), pain intensity (Visual Analogue Scale), physical performance (Short Physical Performance Battery) and depression (Yessavage) were assessed at baseline, after the intervention and after 3 months follow-up. The effect of the intervention was analysed by mean differences between the intervention and control groups.
Results
The follow-up period (3 months) was completed by 32 patients (73%), 17 in the control group and 15 in the intervention group. Most participants were women (78.1%) with a mean age (standard deviation) of 77.2 (5.9) years and a mean pain intensity of 48.1 (24.4) mm. No relevant differences were found between groups at baseline. After the intervention, mean differences in the EuroQol Index Value between control and intervention groups were significant (-0.19 95%CI(-0.33- -0.04)) and remained after three months follow-up (-0.21 95%CI(-0.37- -0.05)). Participants in the exercise group showed better results in pain intensity and frailty after the intervention, and an improvement in physical performance after the intervention and after three months.
Conclusions
An eight-week physical activity and education program for pre-frail older adults with chronic pain, compared with usual care, could be effective to improve quality of life after the intervention and after three-months follow-up.
Study registration details:
This study was retrospectively registered in ClinicalTrials.gov with the identifier NCT04045535.
Probability Bankruptcy Using Support Vector Regression
Authors: Manurung Adler Haymans , Suhartono Derwin , Hutahayan Benny , Halimawan Noptovius
Published: June 2020

This paper aims to investigate probability bankruptcy using Support Vector Regression. There is 7 Variable for period 2016 to 2018 and 17 companies. The result of Support Vector Regression has good model because it has highest of coefficient of determination.
Low Annexin A1 Level in HTLV-1 Infected Patients is a Potential Biomarker for the Clinical Progression and Diagnosis of HAM/TSP
Authors: Santana Bárbara Brasil , Queiroz Maria Alice Freitas , Cerveira Rodrigo Arcoverde , Rodrigues Claudia Mendonça , Amoras Ednelza da Silva Graça , Costa Carlos Araújo da , Sousa Maisa Silva de , Ishak Ricardo , Goulart Luiz Ricardo , Vallinoto Antonio Carlos Rosário
Published: June 2020

Background: Human T-lymphotropic virus 1 (HTLV-1) is etiologically associated with the chronic inflammatory neurodegenerative disease HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) Annexin A1 (AnxA1) is an anti-inflammatory protein with proposed neuroprotective and anti-neuroinflammatory functions. We hypothesized that ANXA1 gene expression may be dysregulated in HTLV-1-infected HAM/TSP patients. Methods: This study involved 37 individuals infected with HTLV-1, including 21 asymptomatic (AS) carriers and 16 with HAM/TSP, and a control group of 30 individuals negative for HTLV-1 and HTLV-2. For AS HTLV-1-positive and HAM/TSP patients, ANXA1 and formyl peptide receptor (FPR1, FPR2 and FPR3) expression and HTLV-1 proviral load (PVL) in peripheral blood cells were evaluated by real-time quantitative PCR (qPCR), and plasma AnxA1 levels were determined by enzyme-linked immunosorbent assay (ELISA).Results: ANXA1 gene expression was increased in the AS group compared with the HAM/TSP and control groups, but the differences were not statistically significant. FPR1 gene expression was higher in patients with HTLV-1 than in controls (AS, p= 0.0032; HAM/TSP, p< 0.0001). Plasma AnxA1 levels were higher in the AS group than in the HAM/TSP group (p= 0.0045), and PVL was higher in patients with HAM/TSP than in AS individuals (p= 0.0162). The use of a combined ROC curve using Annexin 1 levels and proviral load significantly increased the sensitivity and specificity to predict progression to HAM/TSP (AUC = 0.851 and AUC = 0.937, respectively, to AUC=1,000). Conclusions: Our results suggest that AnxA1 may be dysregulated in HAM/TSP patients. Serological detection of AnxA1 in association with proviral load may provide a prognostic biomarker for HTLV-1-associated neurodegenerative disease.
Double Plating With Autogenous Bone Grafting as a Salvage Procedure for Recalcitrant Humeral Shaft Nonunion
Authors: Feng Dongxu , Wang Xiaolong , Sun Liang , Cai Xiao , Zhang Kun , Wang Zhan , Zhu Yangjun
Published: June 2020

Background: Despite the majority humeral shaft nonunions respond well to surgical intervention, a surgeon still encounters a patient with humeral shaft nonunion who had already undergone repeated surgeries for nonunion. This study is a retrospective analysis of the efficacy of the treatment of recalcitrant humeral shaft nonunions using double locking compression plate (LCP) fixation in combination with autogenous iliac crest bone grafting.Methods: A consecutive series of aseptic recalcitrant humeral shaft nonunion underwent surgical treatment between May 2010 and August 2017 in the authors’ institute. Standardized treatment included a thorough debridement, double LCP and screw fixation, and autogenous iliac bone graft. The injury type, the bone affected by nonunion, and the duration of nonunion were recorded for all patients. The main outcome measurements were Constant and Murley scale for shoulder function, Mayo elbow performance index (MEPI) for elbow function and the visual analog scale (VAS) for pain. In addition, all complications were documented.Results: The study consisted of six females and nine males with a mean age of 45.3±13.1 years. Each patient had already undergone at least once failed surgical management for nonunion. The average duration that the bone remained ununited before the index intervention was 126.8±124.2 months. All patients achieved bone union without implant failure. At the final follow-up, both the mean Constant and Murley joint function score and the mean MEPI were significantly improved, and the mean VAS score significantly decreased. Each patient was highly satisfied with the treatment. Complications were only seen in four patents, including one super wound infection, one radial nerve palsy, one ulnar never palsy, and one discomfort at the iliac crest.Conclusion: Double plate fixation combined with autogenous iliac crest bone grafting can result in successful salvage of humerus nonunions in patients who have failed prior surgical interventions.
How Do They Learn: Types and Characteristics of Medical Student Engagement in the Simulation-Based Learning Environment
Authors: Wang Yashuang , JI YAN
Published: June 2020

Background Student engagement can predict successful learning outcomes and academic development. Expansion of simulation-based medical education will bring about challenges to educators and require them to help medical students to engage themselves in a simulation-based learning environment. Methods We conducted semi-structured interviews with ten medical students to explore their learning types and characteristics in the simulation-based learning environment. The interpretative phenomenological methods were used to analyze the data. Results The interviews were thematically analyzed to form three types of student engagement in the simulation-based learning environment: reflective engagement, performance engagement, and interactive engagement. The analysis also identified eight sub-themes: active, persistent, and focused thinking engagement; problem-oriented thinking engagement; active “voice” in class; strong emotional experience and disclosure; demonstration of professional leadership; interaction with realistic learning situations; support from teammates; and friendship-like lecturer-student interaction.Conclusions The findings explain the mechanisms behind student engagement in the simulation-based learning environment from two perspectives: the two-way construction of individuality and space in learning along with the interdependence of the learner and the learning community. That is, expanding the learning space centering around “inquiry” helps strengthen reflective communication and dialogue. It also facilitates imagination, stimulates empathy, and builds an inter-professional learning community. In this way, medical students are expected to learn from the two-way transmission of information, cultivate and reshape the interpersonal relationship, so as to improve engagement in the simulation-based learning environment.