bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of RGOs on the Efficacy of Nkx2.5 Transfected Bone Marrow Mesenchymal Stem Cells Transplantation in Treatment Heart Failure in Rats
Authors: Wang Lin , Deng Bo , Zhang Ran , Hu Xingxing , Li Yang , Zhu Qinglei
Published: December 2020

Background: Heart failure (HF) is one of the major serious diseases to do harm to human health. Drugs, interventional treatment and heart transplantation are currently the main methods to treat HF. However, they fail to improve the patient's condition. Mesenchymal stem cells (MSCs) can regenerate functional cardiomyocytes and are promising to become a new therapeutic measure to treat heart failure. We assumed that Rehmannia glutinosa oligosaccharide (RGOs) has the synergistic effect with Nkx2.5 transfected MSCs (Nkx2.5) transplantation in treatment heart failure. Methods: MSCs and Nkx2.5 were preconditioned by RGOs. The apoptosis rate was detected by flow cytometry and the expressions of cardiac specific genes were analyzed with quantitative real-time PCR and Western blot in vitro. Heart failure models were duplicated by injecting doxorubicin (total dose of 15mg/kg) intraperitoneally in male SD rats. When the models were prepared, rats were randomly divided into 6 groups: Control (CON), HF, MSCs, Nkx2.5, RGOs and RGOs combined with Nkx2.5 (RGOs+Nkx2.5) group. Echocardiography was used to detect cardiac function in rats. HE staining was used to observe the pathological changes of myocardium, and Masson staining was used to calculate the collagen volume fraction to detect the degree of myocardial fibrosis. The total mRNA was extracted to detect the following genes including cTnI, CX43, TGF-β1, Collagen I, MEF2 and GATA4 by Q-PCR. Protein of myocardial tissue was extracted to detect the expression of cTnI, CX43, MEF2 and GATA4, by western blot. Results: RGOs could not enhance cardiac specific gene expressions including CK, α-MHC, however it improved the survival of Nkx2.5 induced by H2O2 in vitro. In rat heart failure models, RGOs alone improved the heart pumping function and decreased collagen volume fraction (CVF), TGF-β1 and collagen I expression, and increased MEF2 and GATA4 mRNA expression. Moreover, RGOs cooperated with Nkx2.5 in improving left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). Furthermore, RGOs and Nkx2.5 combination also increased CX43 expression, whereas decreased CVF and collagen I expression. Conclusion: RGOs has the synergistic effect with Nkx2.5 gene transfected MSCs transplantation in treatment with heart failure through decreasing myocardial fibrosis, inhibiting ventricular remodeling, and increasing the expressions of GATA4, MEF2.
Genetic Diversity and Antifungal Susceptibility of Candida Albicans Strains Isolated from Lranian HIV+ Patients With Oral Candidiasis
Authors: Tamai Iradj Ashrafi , Pakbin Babak , Fasaei Bahar Nayeri
Published: December 2020

Objective: The objectives of this study were to investigate the antifungal susceptibility and genetic diversity of oral Candida albicans strains isolated from HIV+ patients with oropharyngeal candidiasis. A total of 50 C. albicans isolates were cultured on Sabouraud glucose agar containing chloramohenicol. The antifungal susceptibility of C. albicans against fluconazole, clotrimazole, nystatin, amphotericin B, ketoconazole and flucytosine was assessed using disc diffusion method. The genetic diversity of different C. albicans strains was determined using random amplified polymorphic DNA technique. Results: The inhibition zones ranged from 4±1.8 to 40±3.8 mm for fluconazole, 7±1.0 to 37±1.8 mm for ketoconazole, 14±0.8 to24±0.8 mm for amphotericin B, 25±0.0 to 33±0.0 mm for nystatin and 7±4.2 to 40±0.0 mm for clotrimazole. At 90% similarity, three distinct groups were observed. The smallest cluster composed of 3 of 50 C. albicans isolates, whereas the largest cluster composed of 17 of 50 isolates. Of 50 C. albicans isolates, 32%, 28% and 14% were resistant to fluconazole, ketoconazole and clotrimazole, respectively. There were no significant differences among antifungal susceptibility of different C. albicans strains from three genotype clusters.
Impact of Age for Overall Survival in Head and Neck Sarcoma
Authors: Suzuki Hidenori , Takano Gaku , Tsukushi Satoshi , Ando Masashi , Yasushi Yatabe , Kodaira Takeshi , Nishikawa Daisuke , Beppu Shintaro , Hasegawa Yasuhisa , Hanai Nobuhiro
Published: December 2020

Background：The association between age and survival outcomes in head and neck sarcoma (HNS) has yet to be fully investigated due to rare tumor. To research the association between age at surgery and survival outcomes of patients with HNS. Methods: Twenty-six patients with HNS who underwent by surgery from 2003 to 2017 were retrospectively enrolled. The association between clinicopathological parameters and age was assessed by Mann-Whitney U test, and the optimal cut-off age at surgery for predicting death was determined by receiver operating curve analysis. Log-rank test and Cox proportional hazards model were used for survival analyses.Results: Patients who did not undergo chemotherapy were significantly older age at surgery. Fifty-five was the cut-off age that predicted death. Shorter survival rates of overall, disease-specific, local recurrence-free and disease-free were associated with older age. Age (≥ 55 years/< 55 years) was correlated with shorter overall survival by multivariate analysis adjusting with chemotherapy (absence/presence). Conclusion: Older age predicts worse overall survival in HNS.
Pathological Complete Response After Immune-Checkpoint Inhibitor Followed by Salvage Surgery for Clinical Stage IV Pulmonary Adenocarcinoma with Continuous Low Neutrophil-to-Lymphocyte Ratio: A Case Report
Authors: Higuchi Mitsunori , Kawamata Takahiro , Oshibe Ikuro , Soeta Nobutoshi , Saito Takuro , Hojo Hiroshi , Matsumura Yuki , Suzuki Hiroyuki
Published: December 2020

Background: Immune-checkpoint inhibitors (ICIs) play a crucial role in the treatment of advanced non-small cell lung cancer (NSCLC), however, most patients fail this treatment after a limited period. We here report a patient with a pathological complete response (CR) after treatment with ICI for stage IV pulmonary adenocarcinoma.Case presentation: A 73-year-old man was referred to our hospital because of hoarseness. A roentgenogram and chest CT scan revealed a huge (78-mm diameter) pulmonary tumor in the right upper lobe and a tumor with cavitation in the left lower lobe. A CT scan also showed enlarged upper mediastinal lymph nodes. Transbronchial lung biopsy (TBLB) of the tumors showed adenocarcinomas in both. The tumor in the right upper lobe was considered to be the primary with mediastinal lymph nodes metastasis and that in the left lower lobe a pulmonary metastasis. The disease was determined to be cT4N2M1a stage IVA after whole body evaluation . He was treated with first line chemotherapy comprising cisplatin, pemetrexed, and bevacizumab for six cycles, achieving a partial response. However, 6 months after initial treatment, the primary and metastatic tumors enlarged and he was treated with second line anti-PD-1 therapy for 7 months with a partial response. 18-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed weak accumulation of FDG in the primary tumor only with no accumulation in the left pulmonary metastasis or mediastinal lymph nodes, despite the lymph nodes still being enlarged. He was diagnosed as having ycT1bN0M0 stage IA2 disease and underwent right upper lobectomy. Postoperative pathological findings revealed that cancer tissues had been replaced by scar tissue and that CD4 positive T cells, rather than CD8 positive T cells, were predominant. It was also noted that he had a lower neutrophil-to-lymphocyte ratio (NLR) during immunotherapy than before immunotherapy and after surgery. He was diagnosed to be ypT0N0M0 stage 0 (Ef.3). His postoperative course was uneventful and he remained well for twelve months after surgery with no further treatment.Conclusions: Neoadjuvant chemotherapy with ICIs for advanced NSCLC may be a promising modality, even for clinical stage IV disease, in the near future. Furthermore, NLR during immunotherapy may be a promising biomarker of ICIs treatment.
Comprehensive Case Study Program of Ethics Course Based on the Blended Learning Model and its Impact on Active Learning Indicators
Authors: mosalanejad leili , karamzadeh Atefeh , Bazrafkan Leila
Published: December 2020

Background Now in training physicians, should be pay attention to medical education and clinical skills with respect to justice, dignity and human rights. This is the ultimate goal of medical ethics. The purpose of this study is a comprehensive case study educational program of ethics course based on blended learning model and its effect on indicators of active learning. MethodsThis quasi-experimental intervention study was performed on 70 physiopathology medical students who had taken medical ethics course. The students' educational program included teaching theoretical topics of medical ethics, discussing ethical issues and clinical reasoning on cases, discussing in forum environment and individual assignments in LMS system and completing portfolio. Student evaluation was associated with evaluating the effect of method on students' knowledge, attitude and ethical reasoning skills. The impact of intervention on self-directed learning and self-regulation was also investigated. Data collection tools were Gaglimino (1978) and Beauford (1995) self-directed readiness questionnaires that students answered before and after their intervention. . Data analysis was performed using SPSS software at two levels of descriptive and analytic statistics. Results The results showed that there was a significant difference between students 'self-direction after the intervention compared to before the intervention (p = 0.005). but, students' self-regulation was not significant despite the increase after the intervention (p = 0.149). Also, the total score of students in intervention group were significant compared to traditional group (p<.05).Conclusion According to research findings, it is suggested that while considering student-centered educational approaches based on case study, the use of blended learning in medical ethics course, can have a positive effects on improving students' learning and individual learning indicators (self-regulation and self-directed learning). Using those method suggest in other medical courses.
Acquiring University Teaching Competences with Clinical Simulation in Health Sciences Education
Authors: Castillo Rafael Fernandez , Gómez Francisco Jose Gómez , Perez Raquel Garcia , Gonzalez Antonio Liñan
Published: December 2020

Backgorund:Clinical simulation exercises provide students with the opportunity to engage in role-playing and to reenact a professional situation. They can thus practice treating patients in simulation labs that replicate real-life scenarios that can be complicated, stressful, or even conflictive. The aim of this study was to determine the degree of satisfaction of a group of postgraduate students enrolled in the Masters in Teaching at the University of Granada (Spain) with this teaching technique. Methods: We conducted a longitudinal study over the 4-year perio. To ascertain the students’ satisfaction with quality of the clinical simulation lab, they were asked to fill out a survey. The sample population of this study consisted of 108 students in the four groups of the Master’s program. During the 4-year study period, students were required to design and prepare a clinical case study, with a set of objectives and a topic related to their degree or specialization. The presentation, which had a duration of fifteen minutes, was given in a simulation lab. Results:The 100% of the Master’s students either agreed or strongly agreed that simulation was a useful teaching method and that the simulation scenarios envisaged were realistic. Of the sample, 77.8% affirmed that the simulation experience had improved their use of new technologies. All of the students agreed or strongly agreed that the simulation helped to develop their capacity for critical reasoning and decision-making.Conclusions. The results obtained confirmed that the students valued this technique and regarded it as an innovative strategy that fosters immersive learning, and which has great potential for the development of clinical competence. Not only did it boost their self-confidence, but they claimed that it also opened new professional doors for them and trained them for a possible future as a university lecturer.
Stakeholder Perspectives to Inform Adaptation of a Hypertension Treatment Program in Primary Healthcare Centers in the Federal Capital Territory, Nigeria: A Qualitative Study
Authors: Okoli Rosemary CB , Shedul Gabriel , Hirschhorn Lisa R , Orji Ikechukwu A , Ojo Tunde M , Egenti Nonye , Omitiran Kasarachi , Akor Blessing , Baldridge Abigail S. , Huffman Mark D , Ojji Dike , Kandula Namratha R
Published: December 2020

Background: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods: Purposive sampling in 8 PHCs identified patients (n=8), non-physician health workers (n= 12), administrators (n=3), and primary care physicians (n=6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment; (2) expansion of team-based care with additional training; (3) information systems to track patients and medication supply chain; and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: first contact accessibility, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could limit effectiveness of the HTN Program. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to raise awareness about the HTN Program and to train community members in blood pressure measurement. Conclusions: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria with the ultimate aim of scaling it to other parts of the country.
Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)
Authors: Joueidi Samia El , Bardosh Kevin , Musoke Richard , Tilahun Binyam , Moslim Maryam Abo , Gourlay Katie , MacMullin Alissa , Cook Victoria J. , Murray Melanie , Mbaraga Gilbert , Nsanzimana Sabin , Lester Richard
Published: December 2020

Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012
Importance of the number emission factor of combustion-generated aerosols from nano-enabled products
Authors: Hammer Tobias , Bossa Nathan , Persson Michael , Wichser Adrian , Lehner Ken , Ruggiero Emmanuel , Fonseca Ana Sofia , Jovic Milijana , Gaan Sabyasachi , Wohlleben Wendel , Wang Jing
Published: December 2020

Accidental or open waste burning and incineration of nano-enabled products (NEPs) might lead to the release of incidental nanomaterials (NMs) into the environment resulting in harmful effects on humans. We have investigated combustion-generated NM release during accidental burning for several real-life NEPs such as paints with silica (SiO2) and spruce wood panels containing SiO2 and Fe2O3 NMs, paper with SiO2 and Fe2O3 NMs and polymeric composites with CuPhthtalocyanine NMs in poly lactic acid (PLA), polyamide 6 (PA6) and thermoplastic pol-urethane (TPU) matrices.Chemical compositions, aerosols number emission factors (nefs) and concentrations of the signature elements of the NMs of the combustion-generated aerosols were investigated. In addition, the residual ash was analyzed. The outcomes of this study shed light on how NM and matrix types influenced the properties of the released aerosols. Based on our results it was established that the combustion-generated aerosols were composed of transformed NMs with modified physical-chemical characteristics compared to the pristine NMs. In addition to the transformed NMs, there were also particles due to incomplete combustion of the matrix. Types of the pristine NMs and matrices affected the characteristics of the released aerosols. Since the hazard of the aerosols is related to the inhaled aerosol number concentration, the nef is an important parameter. Our results showed that the nefs in the size range of 5.6 to 560 nm depended strongly on the type of combusted NEP, which indicated that the NEPs could be categorized according to their potential to release aerosols in this size range when they were burnt. The generated release data facilitate the assessment of human and environmental exposure and the associated risk assessment of combustion-generated aerosols from NEPs.
Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn
Authors: Huang Ruo-Yi , Chen Szu-Jen , Hsiao Yen-Chang , Kuo Ling-Wei , Liao Chien-Hung , Hsieh Chi-Hsun , Bajani Francesco , Fu Chih-Yuan
Published: December 2020

BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.
Accelerating Gut Microbiome Research with Robust Sample Collection
Authors: Zreloff Zoe J. , Lange Danielle , Vernon Suzanne D. , Carlin Martha R. , Cano Raul de Jesus
Published: December 2020

Background. Inferior quality of biological material compromises data, slows discovery, and wastes research funds. The gut microbiome plays a critical role in human health and disease, yet little attention has been given to optimizing collection and processing methods of human stool. Methods. We collected the entire bowel movement from 2 healthy volunteers: one to examine stool sample heterogeneity and one to test stool sample handling parameters. Sequencing and bioinformatic analyses were used to examine the microbiome composition. Results. The microbiome profile varied depending on where the subsample was obtained from the stool. The exterior cortex of the stool was rich in specific phyla and deficient in others while the interior core of the stool revealed opposite microbiome profiles. Sample processing also resulted in varying microbiome profiles. Homogenization and stabilization at 4°C gave superior microbial diversity profiles compared to the fresh or frozen subsamples of the same stool sample. Bacterial proliferation continued in the fresh subsample when processed at ambient temperature. Bacteroidetes proliferated and Firmicutes diminished during the 30-minute processing of fresh sample. The frozen sample had good overall diversity but Proteobacteria diminished likely because of the freeze/thaw. Conclusions. The microbiome profile is specific to the section of the stool being sampled. Stool sample collection, homogenization, and stabilization at 4°C for 24 hours provides a “neat”, high-quality sample of sufficient quantity that can be banked into aliquots with nearly identical microbial diversity profiles. This collection pipeline is essential to accelerate our understanding of the gut microbiome in health and disease
Succession of the Gut Microbiome in the Tibetan Population of Minjiang River Basin
Authors: Li Jun , Sun Lin , Mo Chunfeng , Fu Xiangsheng , Chen Baijun , Liu Jing , Li Xuemei , Song Lingmeng , Yang Wen , Zuo Luo , Zhou Yan , Sun Jingping , Qin Ling , He Feng , Deng Li , Tang Yuanqin , Yang Lin , Kang Lesiji , He Yonghua , Wang Songbo , Chen Junru , Wang Xianyue , Qin Xiaofeng , Li Xiaoan
Published: December 2020

Background: Tibetans are one of the oldest ethnic groups in China and South Asia. Tibetan has a unique lifestyle and a long history, which leads to the particularity of their gut microflora in composition and function. Different from the Tibetan population on the Qinghai-Tibet Plateau, Tibetans in Minjiang River Basin have gradually increased their migration to Chengdu Plain in recent years. Based on the analysis of 1059 Tibetans in the Minjiang River Basin at an altitude of 500-4001m, we found that the dominant phylum of Tibetan population is Bacteroidea and Firmicum, and the main genera are Prevotella and Bacteroides. These findings reflect the characteristics of Tibetan population. Results: In order to further study the factors affecting gut microbial composition of Tibetan population, 115 total parameters of 7 categories were evaluated. The results showed that altitude was the most important factor affecting the variation of microbial community in Tibetan population, and the change of altitude promoted the succession of gut microbial community. In the process of migration from high altitude to plain, the intestinal microbial composition of late immigrants was similar to that of plateau aborigines, while that of early immigrants was similar to that of plain aborigines. Migration to Tibet is related to the loss of indigenous gut microbial community species. In addition, from low altitude to high altitude, the similarity of microbial community with high altitude population increased with the reproduction of offspring after marriage. And the change of these flora will affect the metabolism, disease and cell function of Tibetan population. The other two sets (AGP and Z208) of altitude data also show the impact of altitude on the microbial community. Conclusions: This is the first large-scale study on the influencing factors of gut microflora in Tibetan population. Our study confirmed that altitude change is the most important factor affecting the distribution of Tibetan population flora, and provided abundant and unique data to explore the interaction of impact parameter-gut microbiome-host function and disease.
Nutrient Utilization in Yankasa Rams Fed Crop Residue Supplemented With Xylanase and Glucanase Combinations
Authors: Millam Jacob Jafiya , Waja Augustine , Papas Hyellafiya
Published: December 2020

Background: There is less information in Nigeria with regard the understanding of the use of exogenous enzymes widely used in monogastric diets in ruminant’s rations. The study evaluated the effects of supplementing xylanase and glucanase in combination in rations of Yankasa rams. Sixteen yearling Yankasa rams (average 21 kg) were used. Four treatments were evaluated: control (without enzyme combination), 50:50, 75:25 and 25:75 xylanase-glucanase combinations denoted as T1, T2, T3, and T4 respectively. The basal roughage was cowpea husk and sorghum husk. The feeding trial was conducted using complete randomize design.Results: There were differences (p<0.05) with regard to nutrient intake and total digestibility coefficient except crude protein and nitrogen free extract digestibility (p>0.05). The intake and digestibility increased with supplementation of xylanase and glucanase combination at 25:75 ratio respectively. It increased DM intake by 211.90 g/d, DM digestibility by 17.73%, ADF digestibility by 1.17% and NDF digestibility by 1.02%. The nitrogen balance in the body did not increase (p>0.05) with supplementation of 50:50 xylanase-glucanase combination. The efficiency of nitrogen utilization did not differ between the control and 50:50 xylanase-glucanase combination. Conclusion: The combination of xylanase and glucanase at ratio 25:75 respectively improved nutrient intake and digestibility but did not influence nitrogen utilization.
Incidence and Risk Factors of Relapse After Elective Electrical Cardioversion for Atrial Fibrillation: a Protocol for Systematic Review and Meta-analysis
Authors: Temgoua Mazou , Boombhi Jerome , Tochie Joel Noutakdie , Nkoke Clovis , Tsinda Cedric , Menanga Alain , Kingue Samuel
Published: December 2020

BackgroundAtrial Fibrillation (AF) is the most frequent cardiac arrhythmia and it is associated with life-threatening complications such as hemodynamic instability and thromboembolic events. Electrical cardioversion remains its mainstay of treatment and can be performed either urgently or electively. Relapse after electrical cardioversion has been reported by several primary studies with divergent results, but no detailed summary exists for a critical appraisal of its global incidence and risk factors.Therefore, we propose the first systematic review and meta-analysis to synthesize the existing data on the global incidence and risk factors of relapse after electrical cardioversion for AF.MethodsWe will include case-control and cohort studies reporting on the incidence and risk factors of relapse after electrical cardioversion for atrial fibrillation. Electronic databases including PubMed, Embase, WHO Global Health Library and Web of Science will be searched for relevant records published between January 01, 2000, and December 15, 2020. Pairs of independents reviewers will perform study selection and data extraction, as well as an assessment of the methodological quality of included studies. Appropriate meta-analysis will then be used to pool studies judged to be clinically homogenous. Egger’s test and funnel plots will be used to detect publication bias. Findings will be reported and compared by the human development level of countries. ResultsThis systematic review and meta-analysis to synthesize the existing data on the global incidence and risk factors of relapse after electrical cardioversion for AFConclusionThis review is expected to provide relevant data to help in evaluating the burden and risk factors of relapse after electrical cardioversion for atrial fibrillation. The overall findings of this research will be published in a peer-reviewed journal. Systematic Review RegistrationThe protocol has been registered in Prospero with this registration number: CRD42020209301
Elastic Modulus Is an Ideal Indicator to Evaluate Maize Stem Strength
Authors: Lei En , Li Wen Xue , Wang Chao Bo , Wang Yue Dong , Yang Yong Bing , Tang Qi Yuan
Published: December 2020

Background: Stem lodging seriously restricts the development of mechanized maize harvesting. However, currently there is no comprehensive stem strength evaluation standard for cultivating new maize varieties with excellent stem performance that are suitable for mechanical harvesting. In this study, we constructed a panel of maize germplasm accessions with various stem strengths by setting up different levels of stalk-rot resistance. We investigated the factors influencing maize stem strength, as well as the relationships among them to clarify the key indices for evaluating stem strength. Results: Our results indicated that the stem density, moisture content, bending strength and rind puncture strength were responsive to stalk-rot resistance. However, these indices were in agreement with stem resistance only after the physiological maturity of maize. In particular, the stem rind puncture strength exhibited a closer correlation with the stem resistance in the late stage of physiological maturity. It was also demonstrated that stem density directly affected bending strength and rind puncture strength, whereas indirectly affected the elastic modulus. The elastic modulus includes both load and displacement; therefore, it can prompt the reliability of stem strength evaluation, and is the best description of stalk toughness. The attenuation amplitude of the elastic modulus is always the largest whether it is caused by the aggravation of the disease, the growth stage delay, or the internode position rise, which significantly improves the sensitivity of stalk strength evaluation. Our results showed that the elastic modulus was correspondent with stem resistance from the silking stage of maize, which not only effectively improved the accuracy of the stalk strength evaluation, but also was extremely beneficial to improve the efficiency of maize variety selection. Conclusions: The elastic modulus can be used to evaluate the maize stem strength truly and accurately, and especially in the high stalk rot incidence region, it is very beneficial to improve the breeding efficiency of the maize varieties suitable for mechanical harvesting.
Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study
Authors: Kim Jae Heon , Jeon Hankyu , Lee Sang Soo , Kim Hee Jin , Cha Ra Ri , Lee Jae Min , Kim Hyun Jin
Published: December 2020

Background: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality in intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia in intensive care unit patients and evaluate the factors related to 90-day mortality. Methods: Between February 2016 and February 2020, 972 cases in 948 intensive care unit patients without hepatic disease were retrospectively enrolled and classified as hyperammonemia grades 0 (≤80 µg/dL; n=585 (60.2%)), 1 (≤160 µg/dL; n=291 (29.9%)), 2 (≤240 µg/dL; n=55 (5.7%)), and 3 (>240 µg/dL; n=41 (4.2%)). Factors associated with hyperammonemia and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for 90-day mortality were constructed.Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984 per year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272 per unit), and albumin (0.694 per g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of 90-day mortality in intensive care unit patients. Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with 90-day mortality in intensive care unit patients. Therefore, clinicians must examine serum ammonia levels in patients before admission to intensive care unit.
Unraveling Patient Heterogeneity in ICU With Deep Embedded Clustering Using Co-morbidity, Clinical Examination, and Laboratory Data
Authors: Forte José Castela , Yeshmagambetova Galiya , Grinten Maureen van der , Hiemstra Bart , Kaufmann Thomas , Eck Ruben , Keus Frederik , Epema Anne , Wiering Marco , Horst Iwan van der
Published: December 2020

Introduction Despite extensive research, the goal of unravelling patient heterogeneity in critical care remains largely unattained. Combining clustering analysis of routinely collected high-frequency data with the identification of features driving cluster separation may constitute a step towards improving patient characterization. Methods In this study, we analysed prospectively collected data from 743 patients including co-morbidities, clinical examination, and laboratory parameters. We compared four clustering methodologies – deep embedded clustering (DEC), hierarchical clustering with and without dynamic time warping, and k-means – and trained a classifier to predict and validate cluster membership. The contribution of different variables to the predicted cluster membership was assessed using SHapley Additive exPlanations values.Results DEC yielded better results compared to the traditional clustering algorithms, with the best Jaccard and entropy scores being achieved for 6 clusters. These clusters were characterized as medium to high co-morbidity patients with respiratory pathology and sepsis (cluster 1), patients with primarily acute and chronic cardiac conditions and surgical admission (cluster 2), patients with diverse disease etiology and poor outcomes (cluster 3), low co-morbidity neurological, neurosurgical, and trauma patients (cluster 4), medium co-morbidity patients with cardio-respiratory problems, and neuro-trauma patients with longer length of stay (cluster 5), and patients with sepsis and respiratory infections (cluster 6). All clusters differed in in-ICU, 30-day, and 90-day mortality, as well as incidence of acute kidney injury, and two clusters were categorized as having higher mortality risk, and one cluster as lower mortality risk. Conclusions This machine learning methodology, which we made publicly available, is a possible solution to challenges previously encountered by clustering analyses, and may help unravel patient heterogeneity in critical care.
Comparison of the drug retention and reasons for discontinuation of Tumor Necrosis Factor Inhibitors and Interleukin-6 Inhibitors in patients with Elderly-onset Rheumatoid Arthritis-the ANSWER cohort study
Authors: Jinno Sadao , Onishi Akira , Dubreuil Maureen , Hashimoto Motomu , Yamamoto Wataru , Murata Koichi , Takeuchi Tohru , Kotani Takuya , Maeda Yuichi , Ebina Kosuke , Son Yonsu , Amuro Hideki , Hara Ryota , Katayama Masaki , Saegusa Jun
Published: December 2020

Background: This multi-center, retrospective study aimed to clarify retention rates and reasons for discontinuation of either Tumor Necrosis Factor inhibitors (TNFi) or Interleukin-6 Inhibitors (IL-6i) in patients with elderly-onset rheumatoid arthritis (EORA).Methods: Patients with rheumatoid arthritis (RA) enrolled in a Japanese multicenter observational registry between 2011 and 2020 were included. EORA was defined as RA with onset at 60 or over. To adjust confounding by indication for treatment with TNFi or IL-6i, a propensity score based on multiple baseline characteristics variables was used to compare the drug retention and causes for discontinuation between TNFi and IL-6i. Adjusted cumulative incidence of drug discontinuation for each reason was compared between the two groups using the Fine-Gray model. Results: Among a total of 9550 patients in the registry, 674 TNFi and 297 IL-6i initiators with EORA were identified. Age, the proportion of females, disease duration, and baseline disease activity at the time of TNFi or IL-6i initiation were similar between the two groups. After adjusting for differences in baseline characteristics between the two groups, overall drug discontinuation was significantly lower in the IL-6i as compared to the TNFi (HR=0.71, 95%CI=0.59-0.86, p<0.001). The adjusted cumulative incidence of discontinuation due to lack of effectiveness was lower with the IL-6i (HR=0.46, 95%CI=0.33-0.63, p<0.001) while those due to adverse events (HR=0.82, 95%CI=0.56-1.18, p=0.28) or achievement of clinical remission (HR=1.09, 95%CI=0.62-1.91, p=0.76) were similar between the two groups.Conclusions: In EORA patients initiating a TNFi or IL-6i, significantly higher drug retention was observed with IL-6i. Discontinuation due to lack of effectiveness was significantly less frequent in IL-6i while discontinuations due to adverse event or achievement of clinical remission were similar between the two groups.
A novel variant in PAX6 as the cause of aniridia in a Chinese family
Authors: Jin Xin , Liu Wei , Huang HouBin , Qv Linghui , Xv Wenqin
Published: December 2020

Background: Aniridia is a kind of congenital human pan-ocular anomaly, which is related to PAX6 commonly.Methods: The ophthalmic examinations including visual acuity, slit lamp and fundoscopy examination were performed in a Chinese aniridia pedigree. The targeted next-generation sequencing of aniridia genes was used to identify the causative mutation.Results: A novel heterozygous PAX6 nonsense mutation c.619A>T (p.K207*) was identified in the Chinese autosomal dominant family with aniridia. Phenotype related to the novel mutation included nystagmus, keratopathy, absence of iris, cataract and foveal hypoplasia.Conclusion: The novel nonsense variation in PAX6 was the cause of aniridia in this family, which expanded the spectrum of the PAX6 mutation.
Partner’s emotional reaction to pregnancy mediates the relationship between pregnancy planning and prenatal mental health
Authors: Kazemi Ashraf , Ghaedrahmati Maryam , Kheirabadi Gholamreza
Published: December 2020

Background: An unplanned pregnancy may be followed by increased depression and anxiety. The aim of the present study was to evaluate the mediating role of partner’s emotional reaction to pregnancy (PERP) on the relationship between pregnancy planning and prenatal mental health.Methods: This cross-sectional study was conducted on 303 healthy Iranian pregnant women during their third trimester. The levels of depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The PERP score was also measured using a researcher-made questionnaire. The data were analyzed using the plug-in application PROCESS macro.Results: The results showed that PERP score was reversely related to pregnancy planning and prenatal depression and anxiety. The direct effect of the pregnancy planning on depression (c=-.05) and anxiety levels (c= -.02) were not significant; but the indirect effect of pregnancy planning on depression (Point Estimate= -.379, CI: -.523 to -.250) and anxiety levels (Point Estimate=-.560, CI: -.741 to -.385) with the mediating role of PERP were significant. Conclusions: The results indicated that the effect of pregnancy planning on prenatal mental health is mediated by PERP, and in unplanned pregnancy women need to receive positive reaction of their partners toward pregnancy so that they can preserve their mental health.
Malaria Intermittent Preventive Treatment in Nigeria: A Qualitative study to explore barriers
Authors: Mahmud Fatima Muhammad , Nedjat Saharnaz , Sajadi Haniye Sadat , Parseian Mahboubeh , Majdzadeh Reza , Assan Abraham
Published: December 2020

Background: While the use of sulphadoxine pyrimethamine (SP) is effective in preventing malaria infection during pregnancy, challenges exist which limits its uptake in Nigeria. This study aimed to explore the barriers of IPTp use among pregnant women in Kano state, Nigeria.Methods: This is a qualitative study. We employed the purposive sampling strategy to select 14 key informants for interview. We also conducted three focus group discussions (FGD) with pregnant women, and married men. The conventional content analysis method was used. MAXQDA 10 software was used for data management and analysis, i.e., to develop categories, subcategories and codes.Results: Poor policy implementation, poor antenatal care attendance, inadequate access to intermittent preventive treatment at the community levels, lack of sustainable funding and poor community engagement emerged as major barriers to IPTp use.Conclusion:While the political will to allocate sufficient financial resources could help improve service delivery and IPTp use among pregnant women, community participation is also critical to sustain gains.
Data quality of the routine health management information system at the primary healthcare facility and district levels in Tanzania
Authors: RUMISHA SUSAN F. , LYIMO EMANUEL P. , MREMI IRENE R. , TUNGU PATRICK K. , MWINGIRA VICTOR S. , MBATA DORIS , MALEKIA SIA E. , JOACHIM CATHERINE , Mboera Leonard
Published: December 2020

Background: Effective planning for disease prevention and control requires accurate, adequately-analysed, interpreted and communicated data. In recent years, efforts have been put in strengthening health management information systems (HMIS) in Sub-Saharan Africa to improve data accessibility to decision-makers. This study assessed the quality of routine HMIS data at primary healthcare facility (HF) and district levels in Tanzania.Methods: This cross-sectional study involved reviews of documents, information systems and databases, and collection of primary data from facility-level registers, tally sheets and monthly summary reports. Thirty-four indicators from Outpatient, Inpatient, Antenatal care, Family Planning, Post-natal care, Labour and Delivery, and Provider-Initiated Testing and Counselling service areas were assessed. Indicator records were tracked and compared across the process of data collection, compilation and submission to the district office. Copies of monthly report forms submitted by facilities to the district were also reviewed. The availability and utilization of HMIS tools were assessed, while completeness and data accuracy levels were quantified for each phase of the reporting system.Results: A total of 115 HFs (including hospitals, health centres, dispensaries) in 11 districts were involved. Registers (availability rate=91.1%; interquartile range (IQR):66.7%-100%) and report forms (86.9%; IQR:62.2%-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%; IQR:35.6%-100%). Tools availability at the dispensary was 91.1%, health centre 82.2% and hospital 77.8%, and was low in urban districts. The availability rate at the district level was 65% (IQR:48%-75%). Wrongly filled or empty cells in registers and poor adherence to the coding procedures were observed. Reports were highly over-represented in comparison to registers’ records, with large differences observed at the HF phase of the reporting system. The OPD and IPD areas indicated the highest levels of mismatch between data source and district office. Indicators with large number of clients, multiple variables, disease categorization, or those linked with dispensing medicine performed poorly. Conclusion: There are high variations in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the source. These results highlight the need to design tailored and inter-service strategies for improving data quality.