bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle Strains in the Lower Extremity of Japanese Professional Baseball Players
Authors: Kokubu Takeshi , Mifune Yutaka , Kanzaki Noriyuki , Hoshino Yuichi , Kakutani Kenichiro , Inui Atsuyuki , Hashimoto Shingo , Kuroda Ryosuke
Published: October 2020

Background:

Predicting when athletes can return to play after muscle strains is not always simple because of difficulties in evaluating the severity of such injuries.

Purpose/Hypothesis:

The purpose of this study was to evaluate the use of magnetic resonance imaging (MRI) to classify lower extremity muscle strains in Japanese professional baseball players. The hypothesis was that MRI grading can be used to diagnose the severity of muscle strains in the lower extremity and predict return to play in athletes.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 55 muscle strains occurred in the lower extremity of players on a professional baseball team between the 2006 and 2015 seasons; all players had undergone MRI examination. Age, player position, location of injury, cause of injury, and duration until return to play (in days) were extracted from the medical records. MRI scans were classified using the following system: grade 0, no abnormal findings; grade 1a, T2-weighted high intensity only between muscles; grade 1b, T2-weighted high intensity between muscles and in muscle belly; grade 2, injury of musculotendinous junction; and grade 3, rupture of tendon insertion.

Results:

The sites of injuries were distributed as follows: hamstrings (n = 33), quadriceps (n = 6), hip adductors (n = 6), and calves (n = 10). MRI findings revealed 9 muscle strains (16%), 19 grade 1a (34%), 19 grade 1b (34%), and 8 grade 2 muscle strains (16%). The length of time until return to training and competition, respectively, was 15 and 26 days for grade 1a injuries, 19 and 36 days for grade 1b injuries, and 55 and 69 days for grade 2 injuries.

Conclusion:

Players with grade 1 injuries took 4 to 5 weeks to return to play, whereas players with grade 2 injuries took 10 weeks to return. MRI can be useful for diagnosing lower extremity muscle strains and predicting the time to return to play.
Arthroscopic Rotator Cuff Repair With Muscle Advancement and Artificial Biodegradable Sheet Reinforcement for Massive Rotator Cuff Tears
Authors: Yokoya Shin , Harada Yohei , Negi Hiroshi , Matsushita Ryosuke , Matsubara Norimasa , Adachi Nobuo
Published: October 2020

Background:

Because high failure rates have frequently been reported after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (mRCTs), we introduced the technique of ARCR with supraspinatus and infraspinatus muscle advancement (MA). However, for cases where the original footprint cannot be completely covered, additional surgery using an approved artificial biomaterial is performed.

Purpose:

To investigate the postoperative clinical outcomes and failure rate after MA-ARCR, with and without our reinforcement technique.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 74 patients (mean ± SD age, 68.7 ± 7.7 years) diagnosed with mRCT with a minimum postoperative follow-up of 2 years were included in the current study. Of these patients, 47 underwent MA-ARCR with polyglycolic acid (PGA) sheet reinforcement (study group), and 27 patients underwent MA-ARCR alone (control group). PGA reinforcement was performed when full coverage of the footprint could not be achieved by MA alone, but where the latter was possible, reinforcement was not required. Thus, the study group had significantly worse muscle quality than the control group ( P < .05). The pre- and postoperative range of motion (ROM), isometric muscle strength, acromiohumeral interval, and clinical outcomes were evaluated and compared between these 2 groups. Cuff integrity during the last follow-up period was assessed with magnetic resonance imaging, and the failure rate was calculated. In addition, the postoperative foreign body reaction was investigated in the study group.

Results:

In both groups, significant postoperative improvements were seen in acromiohumeral interval, clinical scores, ROM in anterior flexion, and isometric muscle strength in abduction, external rotation, and internal rotation ( P < .001 for all). The failure rate of the study group was 12.8% (6 patients) and that of the control group was 25.9% (7 patients). No significant differences were noted between the 2 groups on any of the data findings, even regarding the failure rate. Foreign body reactions in the early period were found in 3 patients, although these spontaneously disappeared within 3 months.

Conclusion:

Patients who underwent PGA patch reinforcement for MA-ARCR when the footprint could not be completely covered had clinical results similar to isolated MA-ARCR when the footprint could be covered. Both procedures resulted in significant improvement in symptoms and function compared with preoperatively.
Pupil Dilation Is Sensitive to Semantic Ambiguity and Acoustic Degradation
Authors: Kadem Mason , Herrmann Björn , Rodd Jennifer M. , Johnsrude Ingrid S.
Published: October 2020

Speech comprehension is challenged by background noise, acoustic interference, and linguistic factors, such as the presence of words with more than one meaning (homonyms and homophones). Previous work suggests that homophony in spoken language increases cognitive demand. Here, we measured pupil dilation—a physiological index of cognitive demand—while listeners heard high-ambiguity sentences, containing words with more than one meaning, or well-matched low-ambiguity sentences without ambiguous words. This semantic-ambiguity manipulation was crossed with an acoustic manipulation in two experiments. In Experiment 1, sentences were masked with 30-talker babble at 0 and +6 dB signal-to-noise ratio (SNR), and in Experiment 2, sentences were heard with or without a pink noise masker at –2 dB SNR. Speech comprehension was measured by asking listeners to judge the semantic relatedness of a visual probe word to the previous sentence. In both experiments, comprehension was lower for high- than for low-ambiguity sentences when SNRs were low. Pupils dilated more when sentences included ambiguous words, even when no noise was added (Experiment 2). Pupil also dilated more when SNRs were low. The effect of masking was larger than the effect of ambiguity for performance and pupil responses. This work demonstrates that the presence of homophones, a condition that is ubiquitous in natural language, increases cognitive demand and reduces intelligibility of speech heard with a noisy background.
Cystic Fibrosis Diagnosed Using Indigenously Wrapped Sweating Technique: First Large-Scale Study Reporting Socio-Demographic, Clinical, and Laboratory Features among the Children in Bangladesh A Lower Middle Income Country
Authors: Kabir ARM Luthful , Roy Sudipta , Habib Rahat Bin , Anwar Kazi Selim , Mollah Md. Abid Hossain , Amin Ruhul , Mridha Al Amin , Majumder Jasim Uddin , Hossain Md. Delwar , Haque Nazmul , Ahmed Shakil , Chisti Mohammod Jobayer
Published: October 2020

Due to lack of robust data on childhood cystic fibrosis (CF) in Bangladesh we sought to evaluate their clinico-epidemiology. A cross-sectional observation was conducted adopting CF-foundation consensus-panel-diagnostic criteria in 3 tertiary-care-hospitals in Bangladesh from 2000 to 2017. Clinically suspected 95 CF-cases were subjected to sweat-chloride testing using locally-developed a fast, cheap and effective indigenously body-wrapped sweating technique measured by US-Easy Lyte-automated microprocessor-controlled analyzer marking ≥60 mmol/L as positive. Mean-age of CF-cases at disease-onset was 16.9 ± 26.6 months that significantly differed with age-at-diagnosis ( P < .02). Pulmonary syndromes included chronic wet cough in 100%, respiratory distress in 90.5%, digital-clubbing in 78%, mucopurulent-sputum in 74%-cases, and crepitation in 82%. Radio-imaging revealed bronchiectasis in 60%, hyperinflation/peribronchial-thickening in 22% and, pan-sinusitis in 89%-cases. While 37% had history-of malabsorption, high-fecal-fat revealed in 53%-cases. Malnutrition prevailed as severe-underweight in 87%-cases and all CF-cases (100%) had high sweat-chloride (mean = 118 ± 53.34 mmol/L). Thus, children with pulmonary features coupled with severe malnutrition and associated radio-imaging bronchiectasis should be screened for CF with a fast, cheap and effective sweat test in resource poor settings.
Incomplete Vaccination and Its Predictors among Children in Ethiopia: A Systematic Review and Meta-Analysis
Authors: Desalew Assefa , Semahegn Agumasie , Birhanu Simon , Tesfaye Gezahegn
Published: October 2020

Background. Vaccination is an effective public health intervention that has contributed to a substantial reduction in the burden of vaccine-preventable diseases. Abridged evidence on incomplete vaccination is not well established in Ethiopia. Therefore, this meta-analysis aimed to estimate the pooled prevalence of incomplete vaccination and its predictors among children aged 12 to 23 months. Methods. Primary studies conducted in Ethiopia were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The analysis was conducted using STATA 14 and RevMan. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using I2 statistics. Pooled prevalence and odds ratio (OR) were computed at a 95% confidence interval (CI). Results. The pooled prevalence of incomplete vaccination was 30% (95% CI: 25-35). Maternal illiteracy (OR = 1.96; 95% CI: 1.40, 2.74) and home delivery (OR = 2.78; 95% CI: 2.28, 3.38) were associated factors that increased incomplete vaccination. However, maternal autonomy (OR = 0.54; 95% CI: 0.33, 0.89), maternal knowledge (OR = 0.31; 95% CI: 0.20, 0.47), husband employment (OR = 0.49; 95% CI: 0.35, 0.67), urban residence (OR = 0.61; 95% CI: 0.43, 0.86), ANC visits (OR = 0.30; 95% CI: 0.23, 0.39), postnatal care (OR = 0.39; 95% CI: 0.30, 0.52), and tetanus toxoid vaccine (3+) (OR = 0.42; 95% CI: 0.26, 0.69) were factors that reduced incomplete vaccination. Conclusion. In Ethiopia, 3 out of 10 children have incomplete vaccination. Policies should focus on strengthening and improving women’s education, maternal health knowledge, empowering women, and the utilization of prenatal care can overcome some of the barriers.
Update on Coccidioidomycosis in the United States and Beyond
Authors: Bajwa Alisha K. , Rongkavilit Chokechai
Published: October 2020

Coccidioidomycosis is a fungal infection that is prevalent in western United States, Central America, and South America. The infection is acquired by inhalation. It can affect persons of all ages including infants and children. The majority of cases are asymptomatic and the incidence of infection is greater during a dry summer season after heavy rainfall in prior winter. For those with symptoms, they may experience a self-limiting influenza-like illness. However, some may progress toward pneumonia or disseminated diseases involving skeletal system and central nervous system. The diagnosis is based mainly on various serology testing. Antifungal treatment is generally not required for those with mild symptoms. For those with moderate to severe infections, the mainstay of treatment is azole, with fluconazole being often considered as the first line therapy. Currently there is no effective solution to prevent coccidioidomycosis. Those who work in high-risk conditions should be given appropriate protective equipment as well as education on proper precaution.
Improving the Performance of Residents in Pediatric Resuscitation with Frequent Simulated Codes
Authors: Doymaz Sule , Rizvi Munaza , Giambruno Clara
Published: October 2020

Aim. Exposure to real codes during pediatric residency training is scarce. Consequently, experiencing mock codes scenarios can provide an opportunity to increase residents’ confidence and knowledge in managing pediatric emergencies. Hypothesis. Pediatric senior residents perform better as code team leaders if they are exposed to frequent mock codes. Material and Methods. Forty-three pediatric senior residents (postgraduate year [PGY] two and three) participated in the study. Team leader performance was assessed utilizing the Team Emergency Assessment Measure (TEAM) scoring. Residents’ team leadership performance was assessed before and 6 months after the implementation of weekly mock codes. Results. Pediatric residents’ team leadership performance in mock codes improved after exposure to weekly practice mock code sessions (71.93 ± 18.50 vs 81.44 ± 11.84, P = 0.01). Conclusion. Increasing the frequency of mock code sessions during residency training led to an improvement in code team leadership performance in pediatric senior residents.
Public and private human T-cell clones respond differentially to HCMV antigen when boosted by CD3 copotentiation
Authors: Becher Laura R. E. , Nevala Wendy K. , Sutor Shari Lee , Abergel Megan , Hoffmann Michele M. , Parks Christopher A. , Pease Larry R. , Schrum Adam G. , Markovic Svetomir N. , Gil Diana
Published: October 2020

Human cytomegalovirus (HCMV) induces long-lasting T-cell immune responses that control but do not clear infection. Typical responses involve private T-cell clones, expressing T-cell antigen receptors (TCRs) unique to a person, and public T-cell clones with identical TCRs active in different people. Here, we report the development of a pretherapeutic immunostimulation modality against HCMV for human T cells, CD3 copotentiation, and the clonal analysis of its effects in recall assays at single-cell resolution. CD3 copotentiation of human T cells required identification of an intrinsically inert anti-CD3 Fab fragment that conditionally augmented signaling only when TCR was coengaged with antigen. When applied in recall assays, CD3 copotentiation enhanced the expansion of both public and private T-cell clones responding to autologous HLA-A2(+) antigen-presenting cells and immunodominant NLVPMVATV (NLV) peptide from HCMV pp65 protein. Interestingly, public vs private TCR expression was associated with distinct clonal expansion signatures in response to recall stimulus. This implied that besides possible differences in their generation and selection in an immune response, public and private T cells may respond differently to pharmacoimmunomodulation. Furthermore, a third clonal expansion profile was observed upon CD3 copotentiation of T-cell clones from HLA-A2(−) donors and 1 HLA-A2(+) presumed-uninfected donor, where NLV was of low intrinsic potency. We conclude that human T-cell copotentiation can increase the expansion of different classes of T-cell clones responding to recall antigens of different strengths, and this may be exploitable for therapeutic development against chronic, persistent infections such as HCMV.
Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis
Authors: Zhao Jie , Li Lei-qing , Chen Cheng-yang , Zhang Gen-sheng , Cui Wei , Tian Bao-ping
Published: October 2020

Background

Probiotic treatments might contribute to the prevention of ventilator-associated pneumonia (VAP). Due to its unclear clinical effects, here we intend to assess the preventive effect and safety of probiotics on intensive care unit (ICU) patients.

Methods

Eligible randomised controlled trials were selected in databases until 30 September 2019. The characteristics of the studies were extracted, including study design, definition of VAP, probiotics intervention, category of included patients, incidence of VAP, mortality, duration of mechanical ventilation (MV) and ICU stay. Heterogeneity was evaluated by Chi-squared and I2tests.

Results

15 studies involving 2039 patients were identified for analysis. The pooled analysis suggests significant reduction on VAP (risk ratio, 0.68; 95% Cl, 0.60 to 0.77; p<0.00001) in a fixed-effects model. Subgroup analyses performed on the category of clinical and microbiological criteria both support the above conclusion; however, there were no significant differences in duration of MV or length of ICU stay in a random-effects model. Also, no significant differences in total mortality, overall mortality, 28-day mortality or 90-day mortality were found in the fixed-effects model.

Conclusions

The probiotics helped to prevent VAP without impacting the duration of MV, length of ICU stay or mortality.
Severe asthma: adding new evidence – Latin American Thoracic Society
Authors: García Gabriel , Bergna Miguel , Vásquez Juan C. , Cano Salas Maria C. , Miguel José L. , Celis Preciado Carlos , Acuña Izcaray Agustin , Barros Monge Manuel , García Batista Natalia , Zabert Ignacio , Mayorga José L. , Casanova Mendoza Renato , Gutierrez Martha , Montero Arias Maria F. , Urtecho Perez Luzcenelia , Antúnez Miguel , Williams Derby Victoria , Villatoro Azméquita Alejandra , Motiño Luis , De Oliveira M. Alenita , Rey Sanchez Diana , Arroyo Marisol , Rodriguez Mario
Published: October 2020

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL−1for mepolizumab and above 400 cells·µL−1for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL−1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.
Response to exercise in patients with pulmonary arterial hypertension treated with combination therapy
Authors: Nishizaki Mari , Ogawa Aiko , Matsubara Hiromi
Published: October 2020

Pulmonary arterial hypertension (PAH)-specific combination therapy improves pulmonary haemodynamics at rest in patients with PAH; nevertheless, exertional dyspnoea remains. We investigated pulmonary haemodynamic response to exercise, and the relationship to ventilatory efficiency and hypoxaemia in patients with PAH treated with combination therapy. 32 clinically stable patients with PAH undergoing combination therapy underwent cardiopulmonary exercise testing with right heart catheterisation. Haemodynamic impairment was moderate to severe before treatment. However, after treatment it was significantly improved, and the mean pulmonary arterial pressure (mPAP) at rest was <25 mmHg in 13 patients. The mPAP increased significantly from 27.9±10.7 to 45.9±16.7 mmHg (p<0.01) during exercise. The cardiac index increased inadequately, and the total pulmonary resistance (TPR) increased significantly from 5.74±3.42 to 6.58±3.82 Wood units (p<0.01). The mPAP/cardiac output (CO) slope was steep (10.0±6.7 mmHg·min·L−1). It significantly correlated with both the minute ventilation/carbon dioxide output slope (r=0.51, p<0.01) and peripheral arterial oxygen saturation/workload slope (r=−0.41, p=0.02). In addition, the mPAP/CO slope correlated significantly with mPAP at rest (r=0.73, p<0.01) and TPR at rest (r=0.64, p<0.01). Even after pulmonary haemodynamics at rest was significantly improved in PAH patients with PAH-specific combination therapy, the mPAP/CO slope was steep and the steep mPAP/CO slope related to decreased ventilatory efficiency and the severity of hypoxaemia. The mPAP/CO slope was steeper in patients with higher mPAP and TPR at rest.
m5CPred-SVM: a novel method for predicting m5C sites of RNA
Authors: Chen Xiao , Xiong Yi , Liu Yinbo , Chen Yuqing , Bi Shoudong , Zhu Xiaolei
Published: October 2020

Background

As one of the most common post-transcriptional modifications (PTCM) in RNA, 5-cytosine-methylation plays important roles in many biological functions such as RNA metabolism and cell fate decision. Through accurate identification of 5-methylcytosine (m5C) sites on RNA, researchers can better understand the exact role of 5-cytosine-methylation in these biological functions. In recent years, computational methods of predicting m5C sites have attracted lots of interests because of its efficiency and low-cost. However, both the accuracy and efficiency of these methods are not satisfactory yet and need further improvement.

Results

In this work, we have developed a new computational method, m5CPred-SVM, to identify m5C sites in three species, H. sapiens, M. musculus and A. thaliana. To build this model, we first collected benchmark datasets following three recently published methods. Then, six types of sequence-based features were generated based on RNA segments and the sequential forward feature selection strategy was used to obtain the optimal feature subset. After that, the performance of models based on different learning algorithms were compared, and the model based on the support vector machine provided the highest prediction accuracy. Finally, our proposed method, m5CPred-SVM was compared with several existing methods, and the result showed that m5CPred-SVM offered substantially higher prediction accuracy than previously published methods. It is expected that our method, m5CPred-SVM, can become a useful tool for accurate identification of m5C sites.

Conclusion

In this study, by introducing position-specific propensity related features, we built a new model, m5CPred-SVM, to predict RNA m5C sites of three different species. The result shows that our model outperformed the existing state-of-art models. Our model is available for users through a web server at https://zhulab.ahu.edu.cn/m5CPred-SVM.
IL6/sIL6R regulates TNFα-inflammatory response in synovial fibroblasts through modulation of transcriptional and post-transcriptional mechanisms
Authors: Valin Alvaro , Del Rey Manuel J. , Municio Cristina , Usategui Alicia , Romero Marina , Fernández-Felipe Jesús , Cañete Juan D. , Blanco Francisco J. , Ruano Yolanda , Criado Gabriel , Pablos José L.
Published: October 2020

Introduction

The clinical efficacy of specific interleukin-6 inhibitors has confirmed the central role of IL6 in rheumatoid arthritis (RA). However the local role of IL6, in particular in synovial fibroblasts (SF) as a direct cellular target to IL6/sIL6R signal is not well characterized. The purpose of the study was to characterize the crosstalk between TNFα and IL6/sIL6R signaling to the effector pro-inflammatory response of SF.

Methods

SF lines were stimulated with either TNFα, IL6/sIL6R, or both together, for the time and dose indicated for each experiment, and where indicated, cells were treated with inhibitors actinomycin D, adalimumab, ruxolitinib and cycloheximide. mRNA expression of cytokines, chemokines and matrix metalloproteases (MMPs) were analyzed by quantitative RT-PCR. Level of IL8/CXCL8 and CCL8 in culture supernatants was measured by ELISA. Mononuclear and polymorphonuclear cells migration assays were assessed by transwell using conditioned medium from SF cultures. Statistical analyses were performed as indicated in the corresponding figure legends and ap-value < 0.05 was considered statistically significant.

Results

The stimulation of SF with IL6/sIL6R and TNFα, cooperatively promotes the expression of mono- and lymphocytic chemokines such as IL6, CCL8 and CCL2, as well as matrix degrading enzymes such as MMP1, while inhibiting the induction of central neutrophil chemokines such as IL8/CXCL8. These changes in the pattern of chemokines expression resulted in reduced polymorphonuclear (PMN) and increased mononuclear cells (MNC) chemoattraction by SF. Mechanistic analyses of the temporal expression of genes demonstrated that the cooperative regulation mediated by these two factors is mostly induced through de novo transcriptional mechanisms activated by IL6/sIL6R. Furthermore, we also demonstrate that TNFα and IL6/sIL6R cooperation is partially mediated by the expression of secondary factors signaling through JAK/STAT pathways.

Conclusions

These results point out to a highly orchestrated response to IL6 in TNFα-induced SF and provide additional insights into the role of IL6/sIL6R in the context of RA, highlighting the contribution of IL6/sIL6R to the interplay of SF with other inflammatory cells.
The effects of human pregnancy-specific β1-glycoprotein preparation on Th17 polarization of CD4+ cells and their cytokine profile
Authors: Timganova Valeria P. , Zamorina Svetlana A. , Litvinova Larisa S. , Todosenko Natalia M. , Bochkova Maria S. , Khramtsov Pavel V. , Rayev Mikhail B.
Published: October 2020

Background

Pregnancy-specific β1-glycoproteins are capable of regulating innate and adaptive immunity, exerting predominantly suppressive effects. In this regard, they are of interest in terms of their pharmacological potential for the treatment of autoimmune diseases and post-transplant complications. The effect of these proteins on the main pro-inflammatory subpopulation of T lymphocytes, IL-17-producing helper T cells (Th17), has not been comprehensively studied. Therefore, the effects of the native pregnancy-specific β1-glycoprotein on the proliferation, Th17 polarization and cytokine profile of human CD4+ cells were assessed.

Results

Native human pregnancy-specific β1-glycoprotein (PSG) at а concentration of 100 μg/mL was shown to decrease the frequency of Th17 (RORγτ+) in CD4+ cell culture and to suppress the proliferation of these cells (RORγτ+Ki-67+), along with the proliferation of other cells (Ki-67+) (n = 11). A PSG concentration of 10 μg/mL showed similar effect, decreasing the frequency of Ki-67+ and RORγτ+Ki67+ cells. Using Luminex xMAP technology, it was shown that PSG decreased IL-4, IL-5, IL-8, IL-12, IL-13, IL-17, MIP-1β, IL-10, IFN-γ, TNF-α, G-CSF, and GM-CSF concentrations in Th17-polarized CD4+ cell cultures but did not affect IL-2, IL-7, and MCP-1 output.

Conclusions

In the experimental model used, PSG had а mainly suppressive effect on the Th17 polarization and cytokine profile of Th17-polarized CD4+ cell cultures. As Th17 activity and a pro-inflammatory cytokine background are unfavorable during pregnancy, the observed PSG effects may play a fetoprotective role in vivo.
Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers
Authors: Varg Sofi , Vicente Veronica , Castren Maaret , Lindgren Peter , Rehnberg Clas
Published: October 2020

Background

A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers.

Methods

The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases.

Results

Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department.

Conclusions

The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.
Hepatitis C virus infection and its associated factors among prisoners in a Nigerian prison
Authors: Okafor Ifeyinwa M. , Ugwu Solomon O. , Okoroiwu Henshaw U.
Published: October 2020

Background

The prison population is considered at high risk of acquiring infectious diseases due to confined conditions, behavioral factors, injection drug use, unprotected sexual activity, non-professional tattooing and scarification, and needle sharing. Hepatitis C virus (HCV) is a blood borne pathogen mostly transmitted via percutaneous exposure that results in inflammation of the liver. It is one of the public health problem worldwide and is the principal cause of parenterally transmitted non-A, non-B hepatitis. The study was aimed at evaluating the prevalence of HCV among prison inmates in Calabar, Cross River State, Nigeria and the associated factors.

Methods

The study took a descriptive cross sectional approach using multi-stage sampling technique. One hundred and forty-two (142) prison inmates within the age range of 18–50 years and above were recruited for this study.

Result

Forty two (42); [29.6%] of the participating prison inmates were seropositive for HCV. Gender stratification showed that 31.0% of the males were seropositive for HCV while 15.4% of the females were seropositive for HCV. Fisher exact test showed that gender, age, marital status, occupation and level of education had no association in distribution of seroprevalence of HCV (p > 0.05) but the duration in prison was significantly associated with distribution of seropositivity of HCV in the studied population (p < 0.05). Bivariate logistic regression showed that tattoo/scarification, injection drug use, history of blood transfusion, sexual experience, shaving equipment sharing and multiple sexual partners were not risk factor for distribution of HCV prevalence in the studied population (p > 0.05). However, 23.5% who had tattoo/scarification, 29.6% who used injection drug, 33.3% who had history of blood transfusion, 29.8% who had sexual experience, 21.2% who shared shaving equipment, and 28.3% who had multiple sex partners were seropositive for HCV.

Conclusion

Approximately 29.6% prevalence of Hepatitis C virus infection observed among inmates studied is high and calls for concern. Attitude and behaviors by inmates such as tattooing/scarification, injection drugs use, sharing of shaving equipment, multiple sexual partners should be discouraged.
Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review
Authors: Backhaus Ramona , Hoek Linda J. M. , de Vries Erica , van Haastregt Jolanda C. M. , Hamers Jan P. H. , Verbeek Hilde
Published: October 2020

Background

Family inclusion in nursing homes is central to the provision of individualized care for people with dementia. Although positive effects can be recognized, barriers have been identified that hamper family inclusion in nursing homes. Specifically for people with dementia, insight into the content of interventions to foster family inclusion is lacking.

Methods

A systematic review was performed by systematically searching the databases PubMed, Cinahl, PsycInfo and Embase. Studies were eligible if they examined (1) nursing home settings, (2) interventions to foster the inclusion of family members from people with dementia, (3) were original research articles in which effects/experiences of/with these interventions were evaluated, and (4) were written in English, Dutch or German. Findings were summarized systematically.

Results

Twenty-nine studies were included. Two interventions were targeted at creating family-staff partnerships from a two-way perspective. Other interventions focused on single components, such as including family members in formal decisions (n = 9), enabling them to make better informed decisions and/or participate more actively (n = 7), or providing psychoeducation for family members (n = 3). Within the interventions, family and staff members are often treated differently. Effects on actual increase in family inclusion remain unclear.

Conclusions

Very few interventions exist that try to enhance equal family-staff partnerships in nursing homes. Future interventions should pay specific attention to mutual exchange and reciprocity between family and staff. As little is known about promising (components of) interventions to foster family inclusion in nursing homes for people with dementia, more effectiveness research is needed.
Association between HLA-A gene polymorphism and early-onset preeclampsia in Chinese pregnant women early-onset
Authors: Zheng Yuanyuan , Ma Cui , Liu Xiaowei , Wu Shaowen , Zhang Weiyuan , Zhao Shenglong
Published: October 2020

Background

Preeclampsia is an idiopathic disease during pregnancy. This study explores the correlation between HLA-A polymorphism and the onset of preeclampsia.

Methods

The Illumina HiSeq2500 sequencing platform was used to genotyping HLA-A allele in venous blood DNA of 50 preeclampsia pregnant women and 48 normal pregnant women and umbilical cord blood DNA of their children of Han nationality in China. The frequencies and distributions of alleles and genotypes among the mothers and their children were compared between the two groups. The differences of frequencies and distributions of genotypes were compared between the two groups according to the mothers’ genotype compatibility.

Results

Twenty HLA-A alleles were detected in preeclampsia pregnant women and normal pregnant women; 21 HLA-A alleles were found in preeclampsia group fetuses and 22 HLA-A alleles in control group fetuses. There was no statistical difference in the HLA-A genes’ frequency between the two groups of pregnant women and their fetuses. When the sharing antigen was 1, the number of maternal-fetal pairs in the preeclampsia group was more than that in the control group; the difference was statistically significant (P < 0.05). The frequency of neither mother nor fetus carrying the HLA-A * 24: 02 gene in the preeclampsia group was significantly lower than that in the control group (P < 0.05). HLA-A gene homozygosity in fetuses of early-onset preeclampsia group was substantially higher than that of the control group (P = 0.0148); there is no significant difference in pregnant women’s genes homozygosity between early-onset preeclampsia group and the control group.

Conclusions

HLA-A * 24: 02 may be a susceptibility gene for early preeclampsia.
Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis
Authors: Liu Qiang , Ling Guan-jun , Zhang Shao-quan , Zhai Wen-qing , Chen Yi-juan
Published: October 2020

Background

HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes.

Methods

We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models.

Results

This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P<0.001), fetal mortality (OR1.56 95% CI 1.45 ~ 2.11, P<0.001) and Maternal death (OR3.70 95% CI 1.72 ~ 7.99, P<0.001).

Conclusions

HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.
Randomised prospective phase II trial in multiple brain metastases comparing outcomes between hippocampal avoidance whole brain radiotherapy with or without simultaneous integrated boost: HA-SIB-WBRT study protocol
Authors: Chia Brendan Seng Hup , Leong Jing Yun , Ong Ashley Li Kuan , Lim Cindy , Poon Shi Hui , Chua Melvin Lee Kiang , Chua Kevin Lee Min , Kusumawidjaja Grace , Chua Eu Tiong , Wong Fuh Yong , Lee Tih Shih
Published: October 2020

Background

Recent evidence supports hippocampal avoidance with whole brain radiotherapy (HA-WBRT) as the recommended treatment option in patients with good prognosis and multiple brain metastases as this results in better neurocognitive preservation compared to whole brain radiotherapy. However, there is often poor tumour control with this technique due to the low doses given. Stereotactic Radiosurgery (SRS), a form of focused radiotherapy which is given to patients who have a limited number of brain metastases, delivers a higher radiation dose to the metastases resulting in better target lesion control. With improvements in radiation technology, advanced dose-painting techniques now allow a simultaneous integrated boost (SIB) dose to lesions whilst minimising doses to the hippocampus to potentially improve brain tumour control and preserve cognitive outcomes. This technique is abbreviated to HA-SIB-WBRT or HA-WBRT+SIB.

Methods

We hypothesise that the SIB in HA-SIB-WBRT (experimental arm) will result in better tumour control compared to HA-WBRT (control arm). This may also lead to better intracranial disease control as well as functional and survival outcomes. We aim to conduct a prospective randomised phase II trial in patients who have good performance status, multiple brain metastases (4–25 lesions) and a reasonable life expectancy (> 6 months). These patients will be stratified according to the number of brain metastases and randomised between the 2 arms. We aim for a recruitment of 100 patients from a single centre over a period of 2 years. Our primary endpoint is target lesion control. These patients will be followed up over the following year and data on imaging, toxicity, quality of life, activities of daily living and cognitive measurements will be collected at set time points. The results will then be compared across the 2 arms and analysed.

Discussion

Patients with brain metastases are living longer. Maintaining functional independence and intracranial disease control is thus increasingly important. Improving radiotherapy treatment techniques could provide better control and survival outcomes whilst maintaining quality of life, cognition and functional capacity. This trial will assess the benefits and possible toxicities of giving a SIB to HA-WBRT.

Trial registration

Clinicaltrials.gov identifier: NCT04452084. Date of registration 30th June 2020.
Machine learning model demonstrates stunting at birth and systemic inflammatory biomarkers as predictors of subsequent infant growth – a four-year prospective study
Authors: Harrison Elizabeth , Syed Sana , Ehsan Lubaina , Iqbal Najeeha T. , Sadiq Kamran , Umrani Fayyaz , Ahmed Sheraz , Rahman Najeeb , Jakhro Sadaf , Ma Jennie Z. , Hughes Molly , Ali S. Asad
Published: October 2020

Background

Stunting affects up to one-third of the children in low-to-middle income countries (LMICs) and has been correlated with decline in cognitive capacity and vaccine immunogenicity. Early identification of infants at risk is critical for early intervention and prevention of morbidity. The aim of this study was to investigate patterns of growth in infants up through 48 months of age to assess whether the growth of infants with stunting eventually improved as well as the potential predictors of growth.

Methods

Height-for-age z-scores (HAZ) of children from Matiari (rural site, Pakistan) at birth, 18 months, and 48 months were obtained. Results of serum-based biomarkers collected at 6 and 9 months were recorded. A descriptive analysis of the population was followed by assessment of growth predictors via traditional machine learning random forest models.

Results

Of the 107 children who were followed up till 48 months of age, 51% were stunted (HAZ < − 2) at birth which increased to 54% by 48 months of age. Stunting status for the majority of children at 48 months was found to be the same as at 18 months. Most children with large gains started off stunted or severely stunted, while all of those with notably large losses were not stunted at birth. Random forest models identified HAZ at birth as the most important feature in predicting HAZ at 18 months. Of the biomarkers, AGP (Alpha- 1-acid Glycoprotein), CRP (C-Reactive Protein), and IL1 (interleukin-1) were identified as strong subsequent growth predictors across both the classification and regressor models.

Conclusion

We demonstrated that children most children with stunting at birth remained stunted at 48 months of age. Value was added for predicting growth outcomes with the use of traditional machine learning random forest models. HAZ at birth was found to be a strong predictor of subsequent growth in infants up through 48 months of age. Biomarkers of systemic inflammation, AGP, CRP, IL1, were also strong predictors of growth outcomes. These findings provide support for continued focus on interventions prenatally, at birth, and early infancy in children at risk for stunting who live in resource-constrained regions of the world.
Exploring mediators of the recovery process over time among mental health service users, using a mixed model regression analysis based on cluster RCT data
Authors: Argentzell Elisabeth , Bäckström Martin , Lund Kristine , Eklund Mona
Published: October 2020

Background

Personal recovery is associated with many significant health-related factors, but studies exploring associations between activity factors and personal recovery among service users are scarce. The aims of this study were hence to; 1) investigate if various aspects of activity may mediate change in recovery while also acknowledging clinical, sociodemographic and well-being factors; 2) explore the effects of two activity-based interventions, Balancing Everyday Life (BEL) or standard occupational therapy (SOT), on personal recovery among service users.

Methods

Two-hundred-and-twenty-six service users were included in a cluster RCT, 133 from BEL units and 93 from SOT units. Participants commonly had a diagnosis of mood disorder and the mean age was 40. Instruments used targeted activity, mastery and functioning. A mixed-model regression analysis was employed.

Results

The model tested was whether selected variables could be used to mediate the change in recovery from the start to a six-month follow-up after intervention. Participants’ personal recovery increased after treatment and increased further at the follow-up. The general level of recovery was negatively related to a diagnosis of depression/anxiety, both before and after treatment, but depressed/anxious service users still increased their recovery. There were no significant relations between recovery and sex or age. The interactions between change in recovery and changes in depression/anxiety, satisfaction with activities, sex, and age were all non-significant. All possible treatment mediators included were related to change in recovery, the strongest being occupational engagement and mastery, followed by activity satisfaction and symptoms. Mediation was shown by the decrease in the effect of the time factor (from intervention start to completion) when the covariates were introduced. In all cases the time variable was still significant. When testing a model with all variables simultaneously as covariates, occupational engagement and mastery were strongly significant. There was no difference between interventions regarding recovery improvement.

Conclusion

The treatments were equally beneficial and were effective regardless of gender, age and diagnosis. Those who gained most from the treatment also gained in feelings of mastery and activity engagement. Activity engagement also moderated the level of recovery. To enhance recovery, interventions should facilitate meaningful activities and gaining control in life.

Trial registration

The study was registered with ClinicalTrials.gov. Reg. No. NCT02619318. Retrospectively registered: December 2, 2015.
Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation
Authors: Pelloni Lorenzo Stefano , Pelloni Raffaele , Borradori Luca
Published: October 2020

Background

Herpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects.

Case presentation

A 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery.

Conclusions

Among immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk.