bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing the use of physical restraints in home care - Development and evaluation of a multicomponent program to support the implementation of a guideline
Authors: Vandervelde Sara , Scheepmans Kristien , Milisen Koen , Achterberg Theo van , Vlaeyen Ellen , Flamaing Johan , de Casterlé Bernadette Dierckx
Published: August 2020

Background: A validated evidence-based guideline was developed to reduce physical restraint use in home care. However, the implementation of guidelines in home care is challenging. Therefore, this study aims to systematically develop and evaluate a multicomponent program for the implementation of the guideline for reducing the use of physical restraints in home care.Methods: Intervention Mapping was used to develop a multicomponent program. This method contains six steps. Each step comprises several tasks towards the design, implementation and evaluation of an intervention; which is theory and evidence informed, as well as practical. To ensure that the multicomponent program would support the implementation of the guideline in home care, a feasibility study of eight months was organized in one primary care district in Flanders, Belgium. A concurrent mixed methods design was used to evaluate the multicomponent program consisting of a knowledge test, focus groups and an online survey.Results: The Social Cognitive Theory and the Theory of Planned Behavior are the foundations of the multicomponent program. Based on modeling, active learning, guided practice, belief selection and resistance to social pressure, eight practical applications were developed to operationalize these methods. The key components of the program are: the ambassadors for restraint-free home care (n =15), the tutorials, the physical restraint checklist and the flyer. The results of the feasibility study show the necessity to select uniform terminology and definition for physical restraints, to involve all stakeholders from the beginning of the process, to take time for the implementation process, to select competent ambassadors and to collaborate with other home care providers.Conclusions: The multicomponent program shows promising results. Prior to future use, further research needs to focus on the last two steps of Intervention Mapping (program implementation plan and developing an evaluation plan), to guide implementation on a larger scale and to formally evaluate the effectiveness of the multicomponent program.
A review of clinical profile, complications and antibiotic susceptibility pattern of extensively drug resistant (XDR) Salmonella Typhi isolates in children in Karachi.
Authors: Shahid Saba , Mahesar Marvi , Ghouri Nida , Noreen Saba
Published: August 2020

Background: Enteric fever is a systemic infection, which can be caused by Salmonella enterica; Typhi and Paratyphi A. Over a period of time Salmonella Typhi has developed resistance to many antibiotics which has resulted in emergence of extensively drug resistant (XDR) enteric fever. WHO estimated 5274 cases of XDR Enteric fever in Karachi from November 2016 to December 2019.This study aims to determine clinical course, complications and outcomes of XDR enteric fever among the pediatric population coming to Indus HospitalMethods: A retrospective chart review of pediatric patients (aged 1 month–15 years) seen in Indus Hospital between July 2017 to December 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about seasonality and distribution of cases, demographic details, signs and symptoms, clinical course, treatment, complications and final outcomes of the cases treated for XDR Enteric feverResults: Six hundred and eighty children were included in the study. The median (IQR) age of the patients was 5 (2-8) years. More than half (n=391, 57.5%) of the patients were males. Most common clinical manifestations included fever vomiting and diarrhea which were noted in 680 (100%), 242 (35%) and 174 patients (25%) Final outcomes of 270 (39.7%) patients have been recorded; 351 (51.6%) were lost to follow up, 52 (7.6%) were referred out and 7 (1%) left without medical advice. 266 (39.1%) patients were cured and 4 children (0.6%) expired. Seventy eight patients (82%) and 15 patients (16.3%) got cured on Azithromycin and Meropenum alone while 157 patients got cured on combination of drugs.Conclusion: Our review indicated that children under 5 years of age were affected more with XDR Enteric fever. Meropenum and Azithromycin, either alone or in combination were the most effective antibiotics for treating XDR Enteric fever in children coming to Indus hospital
Quad test for fetal aneuploidy screening as a predictor of fetal growth restriction: A population-based study
Authors: Boonpiam Rakchanok , Wanapirak Chanane , Sirichotiyakul Supatra , Sekararithi Ratanaporn , Traisrisilp Kuntharee , Tongsong Theera
Published: August 2020

Background: To identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for fetal growth restriction (FGR).Methods: Women who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiple of median (MoMs) of the four biochemical markers for the FGR group and those of normal fetuses were compared. The models for predicting FGR by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting FGR were determined.Results: Of 10,155 eligible pregnant women, 578 (5.7%) and 9577 (94.3%) had FGR and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of FGR. The constructed predictive equations had predictive performance for FGR, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively.Conclusion: The quad test for aneuploidy screening could also be used as a predictor of FGR, without extra-effort and extra-cost.
A prospective study of the muscle strength and reaction time of the quadriceps, hamstring, and gastrocnemius muscles in patients with plantar fasciitis
Authors: Lee Jin Hyuck , Jang Woo Young
Published: August 2020

Background: Muscle weakness has been reported to be an important etiological factor in plantar fasciitis (PF), but the data available in the quadriceps, hamstring, gastrocnemius (GCM) muscles is limited . The aim of the study was to compare the strength and reaction time of the quadriceps, hamstring, and gastrocnemius (GCM) muscles and foot pressure between patients with PF and normal controls. Methods: 21 PF patients and 21 normal controls were registered. Muscle strength was measured by the peak torque per body weight (Nm kg−1 × 100). Muscle reaction time was evaluated by the acceleration time (AT, milliseconds). Foot pressure and posture were assessed by pedobarography [valgus/varus index (VV index), %].Results: The strength of the quadriceps was significantly decreased in the affected ankles of the PF group than in the control group (p=0.005). The AT of the quadriceps and hamstring muscles was significantly increased in the affected ankles of the PF group than in the control group (quadriceps: p=0.012, hamstring: p=0.001), while the AT of the GCM muscle was significantly decreased (p=0.009) and was significantly negatively correlated with quadriceps muscle strength (r=-.598, p = .004) and AT (r=-.472, p=.031). Forefoot (p=0.001) and hindfoot (p=0.000) pressure were significantly greater, with the VV index showing hindfoot valgus, in the affected ankles of the PF group when compared to those of the control group (p=0.039).Conclusion: This study demonstrated weakness and delayed reaction time of the quadriceps and hamstring muscles, with a rapid reaction time of the GCM muscle, in PF patients. Clinical Relevance: Clinicians and therapists should assess the function of the quadriceps and hamstring muscles when planning the management of PF patients without muscle tightness.
Hypoxia-sensitive Long Noncoding RNA CASC15 Promotes Lung Tumorigenesis by Regulating the SOX4/β-catenin Axis
Authors: Sun Jianyong , Xiong Yanlu , Jiang Kuo , Xin Bo , Jiang Tongtong , Wei Renji , Zou Yuankang , Tan Hong , Jiang Tao , Yang Angang , Jia Lintao , Wang Lei
Published: August 2020

Background: Accumulating evidence has demonstrated that long non-coding RNAs (lncRNAs) are involved in the hypoxia-related cancer process and play pivotal roles in enabling malignant cells to survive under hypoxic stress. However, the molecular crosstalk between lncRNAs and hypoxia signaling cascades in non-small cell lung cancer (NSCLC) remains largely elusive. Methods: Firstly, we identified differentially expressed lncRNA cancer susceptibility candidate 15 (CASC15) as associated with NSCLC based on bioinformatic data. The clinical significance of CASC15 in lung cancer was investigated by Kaplan-Meier survival analysis. Then, we modulated CASC15 expression in NSCLC cell lines by RNAi. CCK-8 and transwell assays were carried out to examine the effects of CASC15 on proliferation and migration of NSCLC cells. Upstream activator and downstream targets of CASC15 were validated by luciferase reporter assay, qRT-PCR, Western blotting, and chromatin immunoprecipitation (ChIP). Lastly, RNA in situ hybridization (RNA-ISH) and immunohistochemistry (IHC) were performed to confirm the genetic relationships between CASC15 and related genes in clinical samples. Results: CASC15 was highly expressed in NSCLC tissues and closely associated with poor prognosis. Loss-of-function analysis demonstrated that CASC15 was essential for NSCLC cell migration and growth. Mechanistic study revealed that CASC15 was transcriptionally activated by hypoxia signaling in NSCLC cells. Further analysis showed that hypoxia-induced CASC15 transactivation was mainly dependent on hypoxia-inducible factor 1α (HIF-1α) and hypoxia response elements (HREs) located in CASC15 promoter. CASC15 promotes the expression of its chromosomally nearby gene, SOX4. Then SOX4 functions to stabilize β-catenin protein, thereby enhancing the proliferation and migration of NSCLC cells. HIF-1α/CASC15/SOX4/β-catenin pathway was activated in a substantial subset of NSCLC patients. Conclusions: HIF-1α/CASC15/SOX4/β-catenin axis plays an essential role in the development and progression of NSCLC. The present work provides new evidence that lncRNA CASC15 holds great promise to be used as novel biomarkers for NSCLC. Blocking the HIF-1α/CASC15/SOX4/β-catenin axis can serve as a potential therapeutic strategy for treating NSCLC.
Long Non-Coding RNA SNHG12 Promotes Prostate Tumor Occurrence and Progression via AKT Regulation
Authors: Chen Zheng , Qi Tao , Qin Xiaoping , Wang Jue , Huang Zhangsen , Hu Xiaoyong , Chen Guo , Ju Lijun , Zhuo Yu-min
Published: August 2020

The authors have withdrawn this preprint due to author disagreement.
Non-synonymous to Synonymous Substitutions Suggest That Orthologs Tend to Keep Their Functions, While Paralogs Are a Source of Functional Novelty
Authors: Escorcia-Rodriguez Juan Miguel , Esposito Mario , Freyre-Gonzalez Julio Augusto , Moreno-Hagelsieb Gabriel
Published: August 2020

Background: Orthologs diverge after speciation events and paralogs after gene duplication. It is thus expected that orthologs would tend to keep their functions, while paralogs could be a source of new functions. Because protein functional divergence follows from non-synonymous substitutions, we performed an analysis based on the ratio of non-synonymous to synonymous substitutions (dN/dS) as proxy for functional divergence. We used four working definitions of orthology, including reciprocal best hits (RBH), among other definitions based on network analyses and clustering.Results: The results showed that orthologs, by all definitions tested, had values of dN/dS noticeably lower than those of paralogs, not only suggesting that orthologs keep their functions better, but also that paralogs are a readily source of functional novelty. The differences in dN/dS ratios remained favouring the functional stability of orthologs after eliminating gene comparisons with potential problems, such as genes having a high codon usage bias, low coverage of either of the aligned sequences, or sequences with very high similarities. The dN/dS ratios kept suggesting better functional stability of orthologs regardless of overall sequence divergence.Availability: A couple of programs for obtaining orthologs and dN/dS values as tested in this manuscript are available at github: https://github.com/Computational-conSequences/SequenceTools.
Air Pollutants and Hospital Visits for Pneumonia: A Case-crossover Study in Qingdao, China.
Authors: Zhang Jianzhong , Ren Dunqiang , Cao Xue , Wang Tao , Geng Xue , Li Xin , Tang Jinglong , Leng Shuguang , Wang Hongmei , Zheng Yuxin
Published: August 2020

Background: Pneumonia is one of the principal reasons for incidence and death in the world. The former research mainly concentrated on specific sources of patients. Besides, due to the heterogeneity among regions, there are inconsistencies in the outcome of these surveys. To explore the significance of the relationship between atmospheric pollution and hospital visits for pneumonia under the climate and pollution conditions in Qingdao, we carried out this study.Methods: The medical records of pneumonia patients were gathered from the affiliated hospital of Qingdao University during Jan 1st, 2014, and Dec 31st,2018. Daily concentrations of PM2.5, PM10, SO2, NO2, as well as CO, were collected from the national air quality monitoring stations in Qingdao. Case-crossover design and conditional logistic regression were used to calculate these materials. A principal component analysis was used to solve the multicollinearity between atmospheric pollutants and investigate the relationship between various air pollutants and pneumonia occurs.Results: In the single pollutant model, with interquartile range increment of the density of PM2.5, PM10, SO2 and NO2 at the lag2 days, the odds ratio of hospital visits for pneumonia patients increased by 6.4% (95%CI, 2.3-10.7%), 7.7% (95%CI, 3.2-12.4%), 6.7% (95%CI, 1.0-12.7%), and 7.2% (95%CI, 1.1-13.5%). Stratified analysis showed that pollutants were more significant in the cold period. Besides, the impact of atmospheric particulates on different ages mainly occurs in the younger child. The odds ratio was 1.042 (95%CI, 1.2-7.2%) when the principal components of atmospheric pollutants were included in the conditional logistic model.Conclusion: Our study found a significant relationship between short-term uncovering to PM2.5, PM10, NO2, SO2, and hospital visits for pneumonia in Qingdao. The effect of atmospheric pollutants mainly arose in a cold period. Particulate matter might the principal reason in inducing hospital visits for pneumonia.
Reflecting on the first two COVID-19 deaths in Uganda: a public health case study
Authors: Kawuki Joseph , Sserwanja Quraish , Obore Nathan , Wang Johnson , Lau Joseph
Published: August 2020

Objective: COVID-19 being a rapidly evolving pandemic, early lessons from the first deaths must be learnt to help feed into the public health guidelines. This study, therefore, aims to present the first two deaths due to COVID-19 in Uganda and their public health relevance.Cases: The first case was a 34-year female and support staff at a health center II. She first presented with COVID-19 like symptoms before dying on 21st July 2020. The second case was an 80 years old female, who also presented with COVID-19 like symptoms before dying on 24th July 2020. The postmortem samples of both cases were confirmed positive for COVID-19. Conclusion: This study identifies a need for timely identification and testing of COVID-19 suspects, strengthening of health center capacity, as well as more awareness for effective prevention and control of COVID-19.
Mid-long term results of total knee arthroplasty followed by ipsilateral total hip arthroplasty versus total hip arthroplasty subsequent to ipsilateral total knee arthroplasty: A retrospective cohort study
Authors: Liu Zunhan , Zeng Wei-Nan , Luo Zhenyu , Zhao Enze , Li Hao , Zhou Zongke
Published: August 2020

Background

Total hip arthroplasty (THA) altered the mechanical axis and loading distribution of the lower extremity. The effect of a prior THA on clinical outcomes of a subsequent ipsilateral total knee arthroplasty (TKA) remains unknown.
Methods

We reviewed 83 patients who underwent ipsilateral THA and TKA for rheumatoid arthritis or osteoarthritis between January 2008 and April 2014. Forty-seven patients were classified as TKA followed by ipsilateral THA (THA-TKA group) and 36 as THA subsequent to ipsilateral TKA (TKA-THA group). Twenty-eight patients (30 hips and knees) were selected for each group after the propensity score was matched with preoperative demographics and hip-knee-ankle angle (HKA). Clinical measurements, radiographic evaluations, and complication data were compared between 2 groups.
Results

Both groups had a significant improvement in modified Harris Hip Scores (HHS), Knee Society Score (KSS), and Short Form-12 at final follow-up compared to baseline (p < .001). The clinical parameters were actually lower in THA-TKA group. However, those differences were not significant (p > .05). Meanwhile, there was no significant difference in postoperative radiographic axial alignment and implant survivorship (90.0% vs 96.7%, p = .305). The rate of complication was also similar in both groups.
Conclusions

A prior THA does not appear to influence clinical outcome of a subsequent ipsilateral TKA. Patients with different sequence of ipsilateral THA and TKA have similar mid-long term clinical outcomes and implant survivorship.
Trial registration:

The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000035147) dated 2rd August 2020.
Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography
Authors: Sumiya Satoshi , Fukushima Kazuyuki , Kurosa Yoshiro , Hirai Takashi , Inose Hiroyuki , Yoshii Toshitaka , Okawa Atsushi
Published: August 2020

Background
No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.
Methods
This was a retrospective analysis of prospectively collected data for 636 pedicle screws placed in 66 consecutive patients who underwent at least triple-level posterior fixation of the thoracic or lumbar spine between April 2014 and March 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. The risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.
Results
Pedicle screw pull-out was seen with 17 pedicle screws (2.7%) in 13 (19.7%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), presence of osteoporosis, and advanced elderly medical service system insurance for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.15, 95% confidence interval 1.04–1.272) and a diagnosis of DISH (odds ratio 6.10, 95% confidence interval, 1.23–30.20).
Conclusions
Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.
Tige Cycline Successfully Treats One Case of Relapsed Leukemia-drug-resistant Double Sepsis
Authors: Jie Huang , Han Li Xiao , Fan Fei Xiao
Published: August 2020

Background

Nowadays, tigecycline is often used in combination with other antibiotics. To the best of our knowledge, this was the first documented use tigecycline alone for drug-resistant double sepsis in a patient suffering from leukemia.. The aim of this study is to reduce unnecessary drug combinations associated with tigecycline and use antibiotics reasonably.
Methods

The patient was a relapsed patient with advanced acute leukemia, with severe perianal infection and neutrophil deficiency. At the same time, blood culture suggested Acinetobacter luffi (Imipenem resistance) and Enterococcus faecium (vancomycin resistance). The doctor has no other choice according to drug susceptibility results. Tigecycline is used alone, and conventional doses are used .
Results

the patient's temperature gradually became normal, blood pressure was stable, blood in the stool stopped, perianal swelling subsided, pain was reduced, and infection improved.
Conclusion

generally speaking, tigecycline is a bacteriostatic agent; doctors are used to a combination of Tigecycline and other antibiotics in fighting infections.In this case, the patient's immunity is low.Tigecycline is used alone, and conventional doses are used to achieve the effect of curing double sepsis experience.This helps in the rational use of antibiotics.
Extracellular GAPDH promotes Alzheimer disease progression by enhancing amyloid-β aggregation and cytotoxicity
Authors: Lazarev Vladimir F. , Tsolaki Magda , Mikhaylova Elena R. , Benken Konstantin A. , Shevtsov Maxim A. , Nikotina Alina D. , Lechpammer Mirna , Mitkevich Vladimir A. , Makarov Alexander A. , Kozin Sergey A. , Margulis Boris A. , Guzhova Irina V , Nudler Evgeny
Published: August 2020

Background

Neuronal cell death during Alzheimer disease (AD) causes the release of cytosolic proteins, particularly glyceraldehyde-3-phosphate dehydrogenase (GAPDH), which forms highly cytotoxic detergent-insoluble complexes with amyloid-β (Aβ) and promotes neurodegeneration.

Methods

We detected and quantified the complex formation between Aβ and GAPDH released from brain tissue of patients with AD using ultrafiltration, and fluorescence resonance energy transfer (FRET). To explore the biochemical and structural features of Aβ-GAPDH complexes we employed novel immunoenzyme assays and atomic force microscopy. Lentiviral infection in situ was used to elevate GAPDH in brain tissue of rat and mouse models of AD. The Morris maize water test, MRI, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and lactate dehydrogenase (LDH)-activity assays were used to characterize the effects of Aβ-GAPDH complexes in animal and cellular models of AD.

Results

Here we report that GAPDH forms stable aggregates with extracellular Aβ. We detected these aggregates in cerebrospinal fluid (CSF) from AD patients at levels directly proportional to the progressive stages of AD. We found that GAPDH forms a covalent bond with Q15 of Aβ that is mediated by transglutaminase (tTG). The Q15A substitution weakens the interaction between Aβ and GAPDH and reduces Aβ-GAPDH cytotoxicity. Lentivirus-driven GAPDH overexpression in two AD animal models increased the level of apoptosis of hippocampal neurons, neuronal degeneration, and cognitive dysfunction. In contrast, in vivo knockdown of GAPDH reversed these pathogenic abnormalities suggesting a pivotal role of GAPDH in Aβ-stimulated neurodegeneration. CSF obtained from animals with enhanced GAPDH expression demonstrated increased cytotoxicity in vitro . Furthermore, RX-624, a specific GAPDH small molecular ligand reduced accumulation of Aβ aggregates and reversed memory deficit in AD transgenic mice.

Conclusions

Extracellular GAPDH compromises Aβ clearance and accelerates neurodegeneration, thus representing a promising pharmacological target for AD.
Rationale and Study Design of an Early Care, Therapeutic Education, and Psychological Intervention for the Management of Post-intensive Care Syndrome and Chronic Pain After Coronavirus Disease 2019 (PAIN-COVID): Study protocol for a randomized controlled trial
Authors: Ojeda Antonio , Calvo Andrea , Cuñat Tomas , Artigas Ricard Mellado , Comino-Trinidad Oscar , Aliaga Jorge , Arias Marilyn , Ahuir Maribel , Ferrando Carlos , Dürsteler Christian
Published: August 2020

Background: Critically ill patients with COVID-19 disease are an especially susceptible population to develop Post-intensive Care Syndrome (PICS) due to acute respiratory distress syndrome (ARDS). Patients can suffer acute severe pain and may have long-term deterioration in mental, cognitive, and functional health after discharge. However, few controlled trials are evaluating interventions for the prevention and treatment of PICS. The study hypothesis is that a specific care program based on early therapeutic education and a psychological intervention improves the quality of life of patients at risk of developing PICS and chronic pain after COVID-19 disease. The primary objective is to determine if the program is superior to standard-of-care on health-related life quality at six months after hospital discharge. The secondary objectives are to determine if the intervention is superior to standard care, evaluating the health-related life quality, the incidence of chronic pain and the degree of functional limitation, the incidence of anxiety, depression, and post-traumatic stress syndrome at 3 and 6 months after hospital discharge.Methods: The PAINCOVID trial is a unicentric randomized, controlled, patient blinded superiority trial with two parallel groups. The primary endpoint is the health-related quality of life at six months after hospital discharge, and randomization will be performed with a 1:1 allocation. This paper details the methodology and statistical analysis plan of the trial and was submitted before outcome data were available.Discussion: This the first randomized clinical trial assessing the effectiveness of an early care therapeutic education, and psychological intervention for the management of PICS and Chronic Pain after COVID-19. The intervention will serve as a sample of the need to implement early care programs on early stages, having an incalculable impact given the current scenario of the pandemic.Trial registration: This study is being in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board Comité Ético de Investigación Clínica del Hospital Clinic de Barcelona (approval number: HCB/2020/0549) and was registered on May 9, 2020 at clinicaltrials.gov (NCT04394169).
The Regional Diversity of Gut Microbiome Along the GI Tract
Authors: Lkhagv Enkhchimeg , Chung Hea-Jong , Hong Jinny , Tang Wai Hong Wilson , Lee Sang-Il , Hong Seong-Tshool , Lee Seungkoo
Published: August 2020

Background: The proliferation and survival of microbial organisms including intestinal microbes are determined by their surrounding environments. Contrary to popular myth, the nutritional and chemical compositions, water contents, O2 contents, temperatures, and pH in the gastrointestinal (GI) tract of human are very different in a location-specific manner, implying heterogeneity of the microbial composition in a location specific manner.Results: We first investigated the environmental conditions at 6 different locations along the along the GI tract and feces of ten weeks’ old male SPF C57BL/6 mice. As previously known, the pH and water contents of the GI contents at the different location of the GI tract were very different from each other in a location-specific manner, and none of which were not even similar to those of feces. After confirming the heterogeneous nature of the GI contents in specific location and feces, we thoroughly analyzed the composition of microbiome of the GI contents and feces. Metagenome sequencing on the GI contents and feces showed presence of 13 different phyla. The abundance of Firmicutes gradually decreased from the stomach to feces while the abundance of Bacteroidetes gradually increased. The taxonomic α-diversities measured by ACE richness, Shannon diversity and Fisher’s alpha all indicated that the diversities of gut microbiota at colon and cecum were much higher than that of feces. The diversities of microbiome compositions were lowest in jejunum and ilium while highest in cecum and colon. Interestingly, the diversities of fecal microbiome were lower than those of cecum and colon. Beta diversity analyses by NMDS plots, PCA, and un-supervised hierarchical clustering all showed that the microbiome compositions were very diverse in location-specific manner. Direct comparison of the fecal microbiome with the microbiome of the whole GI tracts by α-and β-diversities showed that fecal microbiome did not represent the microbiome of the whole GI tractConclusion: The fecal microbiome is different from the whole microbiome of the GI tract, contrary to the baseline assumption in the large majority of contemporary microbiome research work.
Study on the Status of Health Literacy and its Relationship with Chronic Diseases in Poor Areas
Authors: Chen Xuejiao , Shi Songhe , Yang Liyong , Dong Qian , He Jingyang , Zhang Yulin , Tian Qing-Feng
Published: August 2020

Aims

We conducted an epidemiological survey of health literacy and chronic diseases among people in poverty-stricken areas in China to understand the current status of health literacy among poor individuals and the epidemic characteristics of chronic diseases.
Methods

In June 2018, multistage stratified random sampling was used to conduct a face-to-face questionnaire survey of 1,700 residents (response rate: 97.71%) in 7 national-level poverty-stricken counties in Henan Province, China. The questionnaire assessed social demographics, health literacy, health-related behaviours, and the status of chronic diseases (such as diabetes, hypertension, and heart disease). Structural equation models were used to examine the relationships among health literacy, health-related behaviours, and chronic diseases. Statistical analysis was performed using IBM SPSS Statistics 21.0 and Mplus 7.0.
Results

There were 69 people with sufficient health literacy in poverty-stricken areas, accounting for 4.15% of the total sample, with an average score of 31.95 ± 11.81 points. Individuals who were male, older, poorer, less educated and suffering from chronic diseases were less likely to have sufficient health literacy. A total of 574 patients had chronic diseases, accounting for 34.56% of the total sample. The health literacy score was related to the number of chronic diseases (β = 0.041, 95% confidence interval [CI]: 0.033 ~ 0.049), while health literacy and health-related behaviour were indirectly related (β = -0.002, 95% CI: -0.003~ -0.001). Health-related behaviours mediated the relationship between health literacy and the number of chronic diseases.
Conclusions

It is possible to further increase the health literacy level of residents in poverty-stricken areas by increasing the promotion of health literacy knowledge and avoiding unhealthy behaviours, thereby reducing the incidence of chronic diseases and improving their health status.
Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study
Authors: Bali Ayele Geleto , Chojenta Catherine , Taddele Tefera , Loxton Deborah
Published: August 2020

Background

Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia.
Methods

Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05.
Results

The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 live births. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 live births in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant.
Conclusions

At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.
Knowledge, Attitudes and Understanding of Probiotics Among Pediatricians in Different Regions of Saudi Arabia
Authors: Hasosah Mohammed , Qurashi Mansour , Balkhair Abdullah , Alzahrani Ziyad , Alabbasi Abdullah , Alzahrani Muhanad , Alnahdi Wejdan , Shafei Sohaib , Bafaqih Malak , Khan Muhammad A
Published: August 2020

BACKGROUND: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Many studies reported that knowledge and attitudes of health professionals have a medium level of knowledge of probiotics. OBJECTIVE: Evaluate knowledge and practice styles among pediatricians working in different regions of Saudi Arabia regarding probiotics.DESIGN: Cross-sectional study.SETTING: Pediatric hospitals; central, western, eastern, northern, and southern regions, Saudi Arabia.PATIENTS AND METHODS: A survey of 550 pediatric providers (PPs) conducted and completed by pediatricians which included pediatric residents (PRs), pediatric specialist (PSs) and pediatric consultants (PCs) and pediatric gastroenterologists (PGs). They were asked anonymously about knowledge and practice of probiotics.MAIN OUTCOME MEASURES: Evaluate knowledge and practice styles among pediatricians working in Saudi Arabia regarding probiotics.SAMPLE SIZE: 550 pediatric providers (PPs) in the cross-sectional analysis.RESULTS: A response rate of 82% yielded 452 questionnaires. Among respondents, 261 of 452 (57.7%) were aware of the definition of probiotics. There were significant differences in the percentage of participants who have little knowledge of probiotics (P<0.05), with a maximum in PRs and a minimum in PGs. The most common probiotic used by all participants was lactobacillus acidophilus (63.3%), and mycobacterium avium was the probiotic least often prescribed (8.6%). The majority of participants reported that probiotics were used to improve digestion and improve GI immunity, but there were no significant differences found between groups (P=0.298). The majority of PRs and PSs correctly reported that probiotics reduce the risk of antibiotic-induced diarrhea (74.9% and 80.2%) respectively, but there were no significant differences among them. Internet (50.0%) was the source of probiotics-related information to all pediatricians.LIMITATION: There may be some response bias—PPs who have a special interest in probiotics may have been more likely to respond to the survey.CONCLUSION: Significant differences in knowledge and practice patterns exist regarding probiotics. Identification of knowledge gaps may be useful to develop educational materials to improve proper definition, knowledge, and the use of probiotics.
The association between dietary acid load and the migraine odds
Authors: Mousavi Maryam , Jahromi Soodeh Razeghi , Togha Mansoureh , Ghorbani Zeinab , Hekmatdoost Azita , Rafiee Pegah , Torkan Boshra , Shirani Pedram , Ansari Hossein , Karami Ahmadreza , Nourmohammadi Morvarid , Khorsha Faezeh
Published: August 2020

Background: According to previous evidence, it has been shown that high acidic load in human body could affect inflammatory factors and the nitric oxide pathway. On the other hand, these factors are thought to play a role in initiation of migraine attacks. Therefore, we aimed to explore the association between dietary acid load and the odds of migraine in a case-control study.Methods: The migraine group (n=514, diagnosed according to the ICHDIII criteria) was recruited from a tertiary headache clinic. The controls consisted of 582 sex-matched healthy volunteers who were randomly selected from the general population. For dietary intake assessments, we used a validated 168-item semiquantitative food frequency questionnaire (FFQ). Using three different measures, such as potential renal acid load (PRAL), net endogenous acid production (NEAP), and protein /potassium ratio for estimation of the dietary acid load.Results: According to multivariable logistic regression analysis, in comparison with the lowest tertile, highest tertile of dietary acid load measures including PRAL (OR=7.208, 95% CI 3.33– 15.55), NEAP (OR=4.108, 95% CI 1.924– 8.774), protein/potassium ratio (OR=4.127, 95% CI 1.933– 8.814) were shown to significantly increase odds of migraine (P for trend= <0.001).Conclusions: In this study, it was found that high dietary acid load may be associated with higher odds of migraine. Consequently, restricting dietary acid load could be beneficial in reducing the odds of developing migraine in susceptible subjects.
Global Metabolomic and Lipidomic Analysis Reveals the Potential Mechanisms of Hemolysis Effect of Ophiopogonin D and Ophiopogonin D’ in vivo
Authors: Huan-Hua Xu , Jiang Zhen-Hong , Huang Cong-Shu , Sun Yu-Ting , Xu Long-Long , Tang Xiang-Ling , Tan Hong-Ling , Ma Zeng-Chun , Gao Yue
Published: August 2020

Background

OPD and OPD’ are the two main active monomers of Ophiopogon japonicus in Shenmai injection, being isomers of each other with the same chemical formula and similar chemical structure. According to common sense, they are supposed to have similar pharmacological activities, but the actual situation is exactly the opposite. The difference of distinct hemolytic behavior between OPD and OPD’ in vivo and in vitro was discovered and reported by our group for the first time. In the hemolysis experiment in vitro, only OPD’ showed hemolysis reaction, while in vivo, both OPD and OPD’ revealed hemolysis reaction. The primary cause of hemolysis in vitro has been confirmed to be related to the difference between physical and chemical properties of OPD and OPD’, but the mechanism of hemolysis in vivo is still unclear, especially the existing research are still difficult to explain why OPD shows the inconsistent hemolysis behavior in vivo and in vitro. However, the detection of hemolysis of OPD and OPD’ in vivo is of great practical significance in response to the increase of adverse events of Shenmai injection.

Methods

Aiming at the phenomenon of hemolysis in vivo, this paper adopted untargeted metabolomics and lipidomics technology to preliminarily explore the changes of plasma metabolites and lipids of OPD and OPD’ in vivo during the occurrence of hemolysis. Metabolomics and lipidomics analysis was performed on ultra-high performance liquid chromatography (UPLC) system tandem with different mass spectrometer and different columns respectively. Multivariate statistical approaches such as principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA) were applied to screen the differential metabolites and lipids.

Results

Both OPD and OPD’ groups experienced hemolysis, Changes in endogenous differential metabolites and differential lipids, enrichment of differential metabolic pathways, and correlation analysis of differential metabolites and lipids all indicated that the causes of hemolysis by OPD and OPD’ were closely related to the interference of phospholipid metabolism.

Conclusions

This study provided a comprehensive description of metabolomics and lipidomic changes between OPD and OPD’ treated rats, which also provided scientific guidance for the subsequent mechanism research, and the underlying mechanism require further research.
A comparison of the chemical compounds in single- and co-boiled Zhi-Zi-Da-Huang decoctions with UPLC-qTOF-MS/MS and UPLC-DAD
Authors: Xia Mengyu , Zhang Xue , Wu Hongwei , Wang Yun , Zhang Cun
Published: August 2020

Background

Zhi-Zi-Da-Huang decoction (ZZDHD) is a famous Traditional Chinese Medicine decoction due to its therapeutic effects on clinical hepatobiliary disorders. ZZDHD is composed of Gardeniae Fructus, Rhei Radix et Rhizoma, Fructus Aurantii Immaturus, and Sojae Semen Praeparatum. With the development of current technology, dispensing granules have been widely used for convenience. However, limited research has been conducted to determine differences in the chemical compounds between dispensing granules and traditional decoction.
Methods

A strategy based on UPLC-qTOF-MS/MS and UPLC-DAD was established to quantitatively and qualitatively analyze the chemical compounds present in single- and co-boiled ZZDHD. First, we utilized UPLC-qTOF-MS/MS to identify the compounds in single- and co-boiled ZZDHD. Then, 15 compounds were quantitatively analyzed in ZZDHD by UPLC-DAD. Finally, fingerprint and chemometric analyses were adopted to evaluate the difference between single- and co-boiled ZZDHD.
Results

One hundred and forty-seven compounds were authenticated or determined according to their retention behaviors, mass mensuration, and characteristic fragment ions. In addition, 15 analytes of single- and co-boiled ZZDHD indicated a significant difference in the content of many compounds, including geniposide (G2), emodin, chrysophanol, daidzin, and crocin-I. The similarities of single and co-boiled ZZDHD were higher than 0.99, as evaluated by fingerprinting; 30 common peaks were evaluated by the chemometric analysis, which found 13 important variable values (VIP > 1) including C3, A3, crocetin, daidzin, C5, physcion, G2, genipin-1-O-β-D-gentiobioside (G1), chrysophanol, emodin, A2, A5, and C6.
Conclusions

This study provided an experimental basis for explaining the rationality of single-and co-boiled ZZDHD, and a study model for comparing the chemical substances between traditional decoctions and dispensing granules.
Healthcare providers’ practice and attitude towards abortion service provision in Gulu city, Northern Uganda
Authors: Pebalo Francis Pebolo , Grace Auma Anna , Henry Obol James
Published: August 2020

Background: Unsafe abortion is a growing public health problem concern globally despite being preventable. The World Health Organization estimates that about 20 million pregnancies results into unsafe abortion globally. The proportion of unsafe abortion has been increasing with developing countries contributing about 97% of unsafe abortions cases including Uganda. Unsafe abortion is among the four leading causes of pregnancy related mortality, injuries, and disability globally. The restrictive abortion laws and religious situation make abortion a highly controversial social issue in Uganda leading to high stigma in the society, and a majority of the healthcare providers are reluctant to perform an abortion even if indicated for fear of possible legal consequences.Methods: We conducted survey among health worker about knowledge of complications, practice, and attitudes of induced abortion between September and November 2019 among 252 healthcare providers in Gulu Municipality, Northern Uganda. Multivariate analysis showed associations between healthcare providers' characteristics and adequate knowledge about abortion complications. Ordinary least square regression analysis found associations between providers' characteristics and their intention for general support, generally not in support, conditional support for abortion provision, as well as their personal attitudes and beliefs against or towards abortion provision.Results: The mean attitudinal score for generally in support, generally not in support, conditional in support, personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Participants who were married and practice Anglican religion were more likely to have good knowledge of abortion complications, p-values 0.035, and 0.042 respectively, meanwhile participants who were employed in faith-based facilities were more likely to have poor knowledge of abortion complications p-value 0.002.Conclusion: Ministry of Health and stakeholders need to provide training of health workers to improve quality of abortion services. Medical training institutions should ensure that students understand the laws and responsibilities that govern their professional actions with respect to abortion care regardless of their personal views, beliefs, and attitudes.
Overlapping syndrome mimicking infectious meningoencephalitis in a patient with MOG and GFAP IgG
Authors: Ji Su-qiong , Liu Chen-chen , Bu Bi-tao
Published: August 2020

Background
The presence of CNS overlapping autoimmune syndrome is not uncommon, but only one case of overlapping syndrome with coexistence of MOG-IgG and GFAP-IgG had been reported. This is the first reported case of these double antibodies positive presenting as clinical meningoencephalitis.
Case presentation:
A 23-year-old woman presented with transient convulsions,loss of consciousness, persistent fever, headache and vomiting. The cerebrospinal fluid (CSF) analysis revealed elevated cellularity, Magnetic resonance imaging (MRI) showed diffuse leptomeningeal enhancement. She remained fever and headache with antiviral and antibiotic treatment for two weeks, then was treated with empirical anti-tuberculosis treatment and oral prednisolone therapy. She followed up at 3 months from presentation with symptoms improved and normal CSF analysis. 3-month follow-up MRI performed asymmetric lesions in the cerebellum, corona radiata, and white matter with enhancement. Anti-tuberculosis treatment was continued and steroid was discontinued. After She stopped taking the prednisolone, interrupted headache gradually appeared. MRI at 4 months after presentation revealed partial reduced extent of lesions, but enlarged areas in left cerebellum and right parietal white matter, as well as a new lesion in the region of the right ependyma with linearly enhancement. Screening for anti-myelin oligodendrocyte glycoprotein (MOG) antibody and anti-glial fibrillary acidic protein (GFAP) antibody were positive in CSF by transfected cell-based assay. She was diagnosed with overlapping syndrome of MOG‑IgG‑associated disease and GFAP astrocytopathy and received steroid pulse therapy (methylprednisolone 1 g for 5 days) followed by a gradual tapering of oral prednisolone, as well as addition of immunosuppressant (tacrolimus, 3 mg per day). 6 months after the patient’s initial presentation, no symptom was found, MRI showed the lesions had obviously diminished and no enhancement was found.
Conclusions
To our knowledge, this is the first reported case of overlapping syndrome with coexistence of MOG-IgG and GFAP-IgG presenting as clinical meningoencephalitis. The early screening of autoantibodies against CNS antigens was of great importance for the patient suspected of intracranial infection to make the definite diagnosis.