bluuebunny/crossref_metadata_2025 huggingface dataset:
Undetectable high-sensitivity troponin in combination with clinical assessment for risk stratification of patients with chest pain and normal troponin at hospital arrival
Authors: Sanchis Juan , Valero Ernesto , García Blas Sergio , Barba Esther , Pernias Vicente , Miñana Gema , Brasó José , Fernandez-Cisnal Agustín , Gonzalez Jessika , Noceda José , Carratalá Arturo , Chorro Francisco J , Núñez Julio , Pickering John W
Published: February 2020

Background

Undetectable high-sensitivity cardiac troponin (hs-cTn) in a single determination upon admission may rule out acute coronary syndrome. We investigated undetectable hs-cTnT (<detection limit; <5 ng/l) together with clinical risk scores (GRACE, TIMI, HEART and a previously published simple score), for one-year outcomes in patients with chest pain and normal hs-cTnT (<99th percentile; <14 ng/l) upon admission.

Methods

This study was a retrospective design involving 2254 consecutive patients (July 2016–November 2017). The primary endpoint was one-year death or acute myocardial infarction; the secondary endpoint added unstable angina requiring revascularization. Early (<90 minutes since pain onset, n = 661) and late (n = 1593) presenters were separately considered.

Results

A total of 56 (2.5%) patients reached the primary endpoint and 91 (4%) the secondary endpoint. Undetectable hs-cTnT had a poor C-statistic in early and late presenters (0.648 and 0.703, respectively). Adding hs-cTnT measurable concentrations above the detection limit (as continuous variable) significantly enhanced the C-statistics (0.754 and 0.847, respectively). Addition of the HEART (0.809, p = 0.005) or simple clinical scores (0.804, p = 0.02) further improved the model and significantly reclassified patient risk, in early presenters. The results were similar for the secondary endpoint. The TIMI risk score performed worse and the GRACE score did not give additional information. In late presenters, no clinical score provided significant additional information over hs-cTnT.

Conclusions

Diagnostic algorithms should consider not only whether hs-cTnT is above or below the detection limit but also its concentration if above, for risk stratification over one year in patients with initial normal hs-cTnT. The clinical scores provide valuable additional information in early presenters.
York University and Cupe 3903— Future of Collective Bargaining Rights
Authors: Mehrotra Sonia , Risavy Stephen D.
Published: February 2020

The Canadian Union of Public Employees (CUPE) 3903 view the introduction of the new Ontario government’s ‘back to work’ legislation (Bill 2) as detrimental and a threat to their fundamental bargaining rights. Why is the government legislating the CUPE members back to work instead of allowing them to further negotiate with the administration of York University? If resolving issues through the collective bargaining process is not allowed, then what will happen to the relationship between the union and the university authorities?

Dilemma

Why did the government bring in the bill with ‘back to work’ clause? The concerned parties could have settled the issue through negotiation. Theory: Labour relations, integrative vs. distributive negotiation and third-party interventions Type of the case: Decisional and applied Protagonist: Not needed

Options

Negotiation, appointing mediator, adopting competitive distributive strategy or collaborative integrative strategy

Discussions and Case Questions

Suggest a more effective way to resolve the crisis. What are the main contentions of CUPE 3903 and the York University Administration in this negotiation? Discuss the strategies and tactics as used by CUPE 3903 and the York University Administration. Could these be optimized further? Evaluate the gap between the current strategy and the optimal one Is there any way in which a third-party mediator could craft a mutually beneficial agreement?
Effect of leg dominance on early functional outcomes and return to sports after anterior cruciate ligament reconstruction
Authors: Boo HC , Howe TS , Koh Joyce SB
Published: February 2020

Introduction:

The effect of leg dominance on anterior cruciate ligament (ACL) injuries has been studied with some studies noting a propensity for injuries in the non-dominant leg. Its effect on post-ACL reconstruction recovery, however, is not well known. The authors hypothesize that dominant limb injuries undergo rehabilitation faster and positively affect early functional outcome scores and return to sports and set about studying these effects.

Methods:

This is a retrospective study of 254 patients from a single institution who underwent ACL reconstruction for acute ACL ruptures and the results were compared between patients with dominant and non-dominant limb injuries. Objective measurements including the KT-1000, single-leg hop distance and Biodex knee extension peak torque were used to evaluate recovery. Pre- and post-operative functional outcome scores such as the International Knee Documentation Committee (IKDC), Tegner activity score and Lysholm knee scale were documented.

Results:

Early functional outcomes were similar. Minimal clinically important difference (MCID) improvement in IKDC scores was achieved in 69.7% of the dominant versus 66.0% of the non-dominant injury group ( p = 0.99), 75.2% versus 79.6% ( p = 0.45) for the Lysholm knee scale, and 81.6% versus 84.9% ( p = 0.50) for the Tegner activity score. The majority of patients in both subgroups had a return of at least 80% of peak knee flexion and extension peak torque at 5.4 months post-operatively; 92.9% of subjects with a non-dominant leg injury and 87.2% with a dominant leg injury had returned to their pre-injury sports 1 year from surgery.

Conclusions:

Results from this study suggest that despite theoretical differences, leg dominance does not have a significant impact on short-term functional outcomes and return to sports. Objective measurements suggest that limb strength recovers at a comparable rate. Injuries to either leg demonstrate equally positive improvement post-ACL reconstruction given the same post-operative rehabilitation.

Level of Evidence:

III, retrospective comparative study.

Level of Evidence:

III, retrospective cohort study.
International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS))
Authors:   International Olympic Committee Injury and Illness Epidemiology Consensus Group, Bahr Roald , Clarsen Ben , Derman Wayne , Dvorak Jiri , Emery Carolyn A. , Finch Caroline F. , Hägglund Martin , Junge Astrid , Kemp Simon , Khan Karim M. , Marshall Stephen W. , Meeuwisse Willem , Mountjoy Margo , Orchard John W. , Pluim Babette , Quarrie Kenneth L. , Reider Bruce , Schwellnus Martin , Soligard Torbjørn , Stokes Keith A. , Timpka Toomas , Verhagen Evert , Bindra Abhinav , Budgett Richard , Engebretsen Lars , Erdener Uğur , Chamari Karim
Published: February 2020

Background:

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date.

Objective:

To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension.

Study Design:

Consensus statement of the International Olympic Committee (IOC).

Methods:

The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019.

Results:

This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS).

Conclusion:

The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
Developing a High-Impact Learning Program for Global Health Professionals: The STAR Project
Authors: Hansoti Bhakti , Schleiff Meike , Akridge Anike , Dolive Caroline , Gordon Angelina , Rodríguez Daniela C. , Hausner David , Pariyo George , Quinn Thomas , Rudy Sharon , Tackett Sean , Bennett Sara
Published: February 2020

Background. The Sustaining Technical and Analytical Resources (STAR) project seeks to invest in and expand the capacity of diverse senior global public health professionals. STAR builds on traditional work-based fellowships by partnering with universities in order to curate (or develop) and deliver high-quality, tailored learning across a set of required “core competency domains” as well as elective skills- or content-based competency domains. Pedagogy. In a rapidly changing global health context, ongoing learning is essential but often gets sidelined by other pressures; STAR’s approach aims to respond to these challenges by developing a learning curriculum tailored to the needs of our participants and their roles in global health. STAR’s pedagogy utilizes individualized learning plans, a deliberate practice approach, and a hybrid mentorship model to support project participants to achieve their learning objectives as well as broader project goals. Next Steps. The STAR project is in its first year of implementation. Furthermore, our future work will focus on developing a monitoring and evaluation plan that seeks to track the progress of our participants, guide project improvements, measure the impact of learning activities, and inform the pedagogy of future global health training initiatives.
The effects of ‘publicness’ and quality of publicly accessible open space upon user satisfaction
Authors: Ho Daniel CW , Lai Lawrence WC , Wang Anqi
Published: February 2020

There is a worldwide trend for planning bodies to allow, require, or encourage developers to provide open spaces in their properties for public enjoyment to complement the open spaces on government lands. The two types of privately owned open space and government-owned open space, both accessible to public, can influence on people’s quality of life. Whether and how the land ownership of open spaces would influence their performance and, in turn, affect user satisfaction has not yet been studied and is worthy of exploration. This paper aims to examine the interactive relationships among three variables: ‘publicness’, quality/performance, and user satisfaction in both types of open space in Hong Kong. A questionnaire survey was administered to users of privately owned open space and government-owned open space and found that satisfaction with government-owned open space was marginally higher than with privately owned open space, with respect to activity facilities, amenities, and the overall utilization. Nevertheless, the differences in satisfaction were mainly the result of open space quality rather than land ownership per se. This study also examines the determinants of satisfaction, open space provision, and management and trends in spatial use. Findings from this study can deepen the understanding of utilizing both government-owned open space and privately owned open space from the user’s perspective, which will help improve the planning, design, and management of open spaces in cities.
An Inflammatory Myofibroblastic Tumor of the Appendix Mimicking an Appendicular Malignant Lesion
Authors: Gonzalez-Urquijo Mauricio , Romero-Davila Andrea , Kettenhofen Samuel Eugene , Gonzalez-Ramirez Rogelio , Gil-Galindo Gerardo
Published: February 2020

Inflammatory myofibroblastic tumor (IMT) is a very rare lesion of unknown etiology. Cases of IMT involving the appendix are exceptional, and they can mimic malignant appendicular tumors. We present a case of a 65-year-old man who presented to our emergency room on septic shock and acute abdomen secondary to visceral perforation. The patient underwent exploratory laparotomy; massive bowel dilatation was encountered, along with 3 L of purulent intraperitoneal fluid and a perforated appendicular mass of 6 cm. An appendicectomy was performed. Histopathologic examination established the diagnosis of inflammatory pseudotumor with appendiceal perforation. This study constitutes the 14th confirmed case report of an appendicular IMT. It is important to include IMT in differential diagnoses of appendicular masses to avoid excessive resections.
Association of wood use in bedrooms with comfort and sleep among workers in Japan: a cross-sectional analysis of the SLeep Epidemiology Project at the University of Tsukuba (SLEPT) study
Authors: Morita Emi , Yanagisawa Masashi , Ishihara Asuka , Matsumoto Sumire , Suzuki Chihiro , Ikeda Yu , Ishitsuka Mami , Hori Daisuke , Doki Shotaro , Oi Yuichi , Sasahara Shinichiro , Matsuzaki Ichiyo , Satoh Makoto
Published: February 2020

Several priority characteristics of wood that have beneficial effects on human beings have been reported. However, the advantages of wood use in bedroom interiors for sleep have not been fully evaluated. The aim of this cross-sectional epidemiological study was to evaluate the association of wood use in housing and bedrooms with comfort in the bedroom and sleep among workers in Japan. The study methods included sleep measurements using actigraphy and a self-administered questionnaire survey. In total, 671 workers (298 men and 373 women; mean age ± standard deviation: 43.3 ± 11.2 years) were included in the analysis. The amount of wood used in bedrooms was significantly associated with comfort in bedrooms, inversely associated with suspicion of insomnia, partly inversely associated with self-rated poor sleep quality, but not associated with low sleep efficiency. On logistic regression analysis, the adjusted odds ratio (aOR) of the “large amount of wood” group relative to the “no wood” group was 3.25 [95% confidence interval (CI) 1.63–6.47] for comfort. The aOR of the “no wood” group relative to the “large amount of wood” group was 2.15 (95% CI 1.11–4.16) for suspicion of insomnia. Wood structure of housing, as well as wood use on either the floor, wall, or ceiling, were not significantly associated with comfort and sleep conditions. Our study suggested that the use of a large amount of wood used in the bedroom interior could be beneficial for comfort, sleep, and therefore, health of workers. Further studies are required to obtain generalizable results.
Three-Dimensional CuO/TiO2 Hybrid Nanorod Arrays Prepared by Electrodeposition in AAO Membranes as an Excellent Fenton-Like Photocatalyst for Dye Degradation
Authors: Date Manisha Kondiba , Yang Li-Heng , Yang Tzu-Yi , Wang Kuang-ye , Su Teng-Yu , Wu Ding-Chou , Cheuh Yu-Lun
Published: February 2020

Three-dimensional (3D) CuO/TiO2 hybrid heterostructure nanorod arrays (NRs) with noble-metal-free composition, fabricated by template-assisted low-cost processes, were used as the photo-Fenton-like catalyst for dye degradation. Here, CuO NRs were deposited into anodic aluminum oxide templates by electrodeposition method annealed at various temperatures, followed by deposition of TiO2 thin films through E-gun evaporation, resulting in the formation of CuO/TiO2 p-n heterojunction. The distribution of elements and compositions of the CuO/TiO2 p-n heterojunction were analyzed by EDS mapping and EELS profiles, respectively. In the presence of H2O2, CuO/TiO2 hybrid structure performed more efficiently than CuO NRs for Rhodamine B degradation under the irradiation of 500-W mercury-xenon arc lamp. This study demonstrated the effect of length of CuO NRs, on the photo-degradation performance of CuO NRs as well as CuO/TiO2 heterostructure. The optimized CuO/TiO2 hybrid NR array structure exhibited the highest photo-degradation activity, and the mechanism and role of photo-Fenton acting as the catalyst in photo-degradation of dye was also investigated.
Mechano-calcium and mechano-electric feedbacks in the human cardiomyocyte analyzed in a mathematical model
Authors: Balakina-Vikulova Nathalie A. , Panfilov Alexander , Solovyova Olga , Katsnelson Leonid B.
Published: February 2020

Experiments on animal hearts (rat, rabbit, guinea pig, etc.) have demonstrated that mechano-calcium feedback (MCF) and mechano-electric feedback (MEF) are very important for myocardial self-regulation because they adjust the cardiomyocyte contractile function to various mechanical loads and to mechanical interactions between heterogeneous myocardial segments in the ventricle walls. In in vitro experiments on these animals, MCF and MEF manifested themselves in several basic classical phenomena (e.g., load dependence, length dependence of isometric twitches, etc.), and in the respective responses of calcium transients and action potentials. However, it is extremely difficult to study simultaneously the electrical, calcium, and mechanical activities of the human heart muscle in vitro. Mathematical modeling is a useful tool for exploring these phenomena. We have developed a novel model to describe electromechanical coupling and mechano-electric feedbacks in the human cardiomyocyte. It combines the ‘ten Tusscher–Panfilov’ electrophysiological model of the human cardiomyocyte with our module of myocardium mechanical activity taken from the ‘Ekaterinburg–Oxford’ model and adjusted to human data. Using it, we simulated isometric and afterloaded twitches and effects of MCF and MEF on excitation–contraction coupling. MCF and MEF were found to affect significantly the duration of the calcium transient and action potential in the human cardiomyocyte model in response to both smaller afterloads as compared to bigger ones and various mechanical interventions applied during isometric and afterloaded twitches.
Tracking intratumoral heterogeneity in glioblastoma via regularized classification of single-cell RNA-Seq data
Authors: Lopes Marta B. , Vinga Susana
Published: February 2020

Background

Understanding cellular and molecular heterogeneity in glioblastoma (GBM), the most common and aggressive primary brain malignancy, is a crucial step towards the development of effective therapies. Besides the inter-patient variability, the presence of multiple cell populations within tumors calls for the need to develop modeling strategies able to extract the molecular signatures driving tumor evolution and treatment failure. With the advances in single-cell RNA Sequencing (scRNA-Seq), tumors can now be dissected at the cell level, unveiling information from their life history to their clinical implications.

Results

We propose a classification setting based on GBM scRNA-Seq data, through sparse logistic regression, where different cell populations (neoplastic and normal cells) are taken as classes. The goal is to identify gene features discriminating between the classes, but also those shared by different neoplastic clones. The latter will be approached via the network-based regularizer to identify gene signatures shared by neoplastic cells from the tumor core and infiltrating neoplastic cells originated from the tumor periphery, as putative disease biomarkers to target multiple neoplastic clones. Our analysis is supported by the literature through the identification of several known molecular players in GBM. Moreover, the relevance of the selected genes was confirmed by their significance in the survival outcomes in bulk GBM RNA-Seq data, as well as their association with several Gene Ontology (GO) biological process terms.

Conclusions

We presented a methodology intended to identify genes discriminating between GBM clones, but also those playing a similar role in different GBM neoplastic clones (including migrating cells), therefore potential targets for therapy research. Our results contribute to a deeper understanding on the genetic features behind GBM, by disclosing novel therapeutic directions accounting for GBM heterogeneity.
IPCO: Inference of Pathways from Co-variance analysis
Authors: Das Mrinmoy , Ghosh Tarini Shankar , Jeffery Ian B.
Published: February 2020

Background

Key aspects of microbiome research are the accurate identification of taxa and the profiling of their functionality. Amplicon profiling based on the 16S ribosomal DNA sequence is a ubiquitous technique to identify and profile the abundance of the various taxa. However, it does not provide information on their encoded functionality. Predictive tools that can accurately extrapolate the functional information of a microbiome based on taxonomic profile composition are essential. At present, the applicability of these tools is limited due to requirement of reference genomes from known species. We present IPCO (Inference of Pathways from Co-variance analysis), a new method of inferring functionality for 16S-based microbiome profiles independent of reference genomes. IPCO utilises the biological co-variance observed between paired taxonomic and functional profiles and co-varies it with the queried dataset.

Results

IPCO outperforms other established methods both in terms of sample and feature profile prediction. Validation results confirmed that IPCO can replicate observed biological associations between shotgun and metabolite profiles. Comparative analysis of predicted functionality profiles with other popular 16S-based functional prediction tools showed significantly lower performances with predicted functionality showing little to no correlation with paired shotgun features across samples.

Conclusions

IPCO can infer functionality from 16S datasets and significantly outperforms existing tools. IPCO is implemented in R and available fromhttps://github.com/IPCO-Rlibrary/IPCO.
A multiplex PCR assay for rapid identification of major tospovirus vectors reported in India
Authors: Jangra Sumit , Mittal Anubha , Dhall Heena , Jain Rakesh Kumar , Ghosh Amalendu
Published: February 2020

Background

To date, four thrips vectors have been reported to transmit five different tospoviruses in India. Their identification at an early stage is crucial in formulating appropriate pest management strategies. Since morphometric key-based thrips identification based on the adult stage is time-consuming, there is a need to develop diagnostic tools which are rapid, accurate, and independent of developmental stages. Here, we report a multiplex PCR assay to identify four major thrips vectors viz. Thrips palmi, T. tabaci, Scirtothrips dorsalis, and Frankliniella schultzei present in India.

Results

Cytochrome oxidase subunit III and internal transcribed spacer region 2 were utilized to design species-specific primers. Of 38 pairs of primers tested, primer pairs AG35F-AG36R, AG47F-AG48R, AG87F-AG88R, and AG79F-AG80R amplified 568 bp, 713 bp, 388 bp, and 200 bp products from the DNA templates of T. palmi, S. dorsalis, T. tabaci, and F. schultzei, respectively at same PCR conditions. The specificity of the primer pairs was validated with a large number of known specimens and no cross-reactivity was observed with other thrips species. The multiplex PCR assay with a cocktail of all the four primer pairs detected four thrips vectors efficiently and could discriminate all of them concurrently in a single reaction.

Conclusion

The multiplex PCR reported in this study could identify the major thrips vectors reported in India. The assay will be useful in ascertaining distribution profile of major thrips vectors, disease epidemiology, screening large samples, and quarantine.
Transcriptional reprogramming strategies and miRNA-mediated regulation networks of Taxus media induced into callus cells from tissues
Authors: Chen Ying , Zhang Meng , Jin Xiaofei , Tao Haoran , Wang Yamin , Peng Bo , Fu Chunhua , Yu Longjiang
Published: February 2020

Background

Taxus cells are a potential sustainable and environment-friendly source of taxol, but they have low survival ratios and slow grow rates. Despite these limitations, Taxus callus cells induced through 6 months of culture contain more taxol than their parent tissues. In this work, we utilized 6-month-old Taxus media calli to investigate their regulatory mechanisms of taxol biosynthesis by applying multiomics technologies. Our results provide insights into the adaptation strategies of T. media by transcriptional reprogramming when induced into calli from parent tissues.

Results

Seven out of 12 known taxol, most of flavonoid and phenylpropanoid biosynthesis genes were significantly upregulated in callus cells relative to that in the parent tissue, thus indicating that secondary metabolism is significantly strengthened. The expression of genes involved in pathways metabolizing biological materials, such as amino acids and sugars, also dramatically increased because all nutrients are supplied from the medium. The expression level of 94.1% genes involved in photosynthesis significantly decreased. These results reveal that callus cells undergo transcriptional reprogramming and transition into heterotrophs. Interestingly, common defense and immune activities, such as “plant–pathogen interaction” and salicylic acid- and jasmonic acid-signaling transduction, were repressed in calli. Thus, it’s an intelligent adaption strategy to use secondary metabolites as a cost-effective defense system. MiRNA- and degradome-sequencing results showed the involvement of a precise regulatory network in the miRNA-mediated transcriptional reprogramming of calli. MiRNAs act as direct regulators to enhance the metabolism of biological substances and repress defense activities. Given that only 17 genes of secondary metabolite biosynthesis were effectively regulated, miRNAs are likely to play intermediate roles in the biosynthesis of secondary metabolites by regulating transcriptional factors (TFs), such as ERF, WRKY, and SPL.

Conclusion

Our results suggest that increasing the biosynthesis of taxol and other secondary metabolites is an active regulatory measure of calli to adapt to heterotrophic culture, and this alteration mainly involved direct and indirect miRNA-induced transcriptional reprogramming. These results expand our understanding of the relationships among the metabolism of biological substances, the biosynthesis of secondary metabolites, and defense systems. They also provide a series of candidate miRNAs and transcription factors for taxol biosynthesis.
Effect of availability of HIV self-testing on HIV testing frequency among men who have sex with men attending university in China (UniTest): protocol of a stepped-wedge randomized controlled trial
Authors: Fan Song , Liu Zhongquan , Luo Zhenzhou , Yu Maohe , Ouyang Lin , Gong Hui , Ding Yi , Li Peiyang , Yuan Tanwei , Zhou Yepeng , Wu Guohui , Zou Huachun
Published: February 2020

Background

HIV testing plays a central role in the combat against HIV. We aimed to determine if the availability of HIV self-testing (HIVST) would increase the frequency of testing among men who have sex with men (MSM) attending university in China.

Methods

A stepped wedge randomized controlled trial will be conducted in 4 provinces in China: Chongqing, Guangdong, Shandong, and Tianjin. Eligibility assessment will include (1) male, aged 16 years or older, (2) university student (technical diploma and undergraduate students), (3) MSM (sexual behaviors including mutual masturbation, oral sex, and anal sex), (4) HIV negative, and (5) willing to provide informed consent.

Participants will be randomly allocated to HIV self-testing intervention with free HIVST kits in every 30 days according to the intervention waiting lists with a computer-generated randomized sequence. All participants will complete a self-administrated online questionnaire onsite at baseline and 12-month follow-up and complete an online questionnaire at 4- and 8-month.

The primary outcome is the effect of HIVST on HIV testing frequency. Secondary outcomes include the change in sexual behaviors and HIV incidence.

Discussion

No previous study had measured the effect of social media based HIVST intervention on the change in HIV testing behaviors, sexual behaviors and incident HIV infection among MSM attending university in China. Findings from this study will provide evidence for further interventional practice promotions and prevention strategies scale-up, including HIV testing, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and sexual partner serosorting.

Trial registration

Chinese Clinical Trial Registry: ChiCTR1900020645. Registered 11 January 2019.
Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand
Authors: Husada Dominicus , Chanthavanich Pornthep , Chotigeat Uraiwan , Sunttarattiwong Piyarat , Sirivichayakul Chukiat , Pengsaa Krisana , Chokejindachai Watcharee , Kaewkungwal Jaranit
Published: February 2020

Background

Early diagnosis of neonatal sepsis is essential to prevent severe complications and avoid unnecessary use of antibiotics. The mortality of neonatal sepsis is over 18%in many countries. This study aimed to develop a predictive model for the diagnosis of bacterial late-onset neonatal sepsis.

Methods

A case-control study was conducted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data were derived from the medical records of 52 sepsis cases and 156 non-sepsis controls. Only proven bacterial neonatal sepsis cases were included in the sepsis group. The non-sepsis group consisted of neonates without any infection. Potential predictors consisted of risk factors, clinical conditions, laboratory data, and treatment modalities. The model was developed based on multiple logistic regression analysis.

Results

The incidence of late proven neonatal sepsis was 1.46%. The model had 6 significant variables: poor feeding, abnormal heart rate (outside the range 100–180 x/min), abnormal temperature (outside the range 36o-37.9 °C), abnormal oxygen saturation, abnormal leucocytes (according to Manroe’s criteria by age), and abnormal pH (outside the range 7.27–7.45). The area below the Receiver Operating Characteristics (ROC) curve was 95.5%. The score had a sensitivity of 88.5% and specificity of 90.4%.

Conclusion

A predictive model and a scoring system were developed for proven bacterial late-onset neonatal sepsis. This simpler tool is expected to somewhat replace microbiological culture, especially in resource-limited settings.
BSCN: bidirectional symmetric cascade network for retinal vessel segmentation
Authors: Guo Yanfei , Peng Yanjun
Published: February 2020

Background

Retinal blood vessel segmentation has an important guiding significance for the analysis and diagnosis of cardiovascular diseases such as hypertension and diabetes. But the traditional manual method of retinal blood vessel segmentation is not only time-consuming and laborious but also cannot guarantee the accuracy and efficiency of diagnosis. Therefore, it is especially significant to create a computer-aided method of automatic and accurate retinal vessel segmentation.

Methods

In order to extract the blood vessels’ contours of different diameters to realize fine segmentation of retinal vessels, we propose a Bidirectional Symmetric Cascade Network (BSCN) where each layer is supervised by vessel contour labels of specific diameter scale instead of using one general ground truth to train different network layers. In addition, to increase the multi-scale feature representation of retinal blood vessels, we propose the Dense Dilated Convolution Module (DDCM), which extracts retinal vessel features of different diameters by adjusting the dilation rate in the dilated convolution branches and generates two blood vessel contour prediction results by two directions respectively. All dense dilated convolution module outputs are fused to obtain the final vessel segmentation results.

Results

We experimented the three datasets of DRIVE, STARE, HRF and CHASE_DB1, and the proposed method reaches accuracy of 0.9846/0.9872/0.9856/0.9889 and AUC of 0.9874/0.9941/0.9882/0.9874 on DRIVE, STARE, HRF and CHASE_DB1.

Conclusions

The experimental results show that compared with the state-of-art methods, the proposed method has strong robustness, it not only avoids the adverse interference of the lesion background but also detects the tiny blood vessels at the intersection accurately.
A phase-II/III randomized controlled trial of adjuvant radiotherapy or concurrent chemoradiotherapy after surgery versus surgery alone in patients with stage-IIB/III esophageal squamous cell carcinoma
Authors: Ni Wenjie , Yu Shufei , Zhang Wencheng , Xiao Zefen , Zhou Zongmei , Chen Dongfu , Feng Qinfu , Liang Jun , Lv Jima , Gao Shugeng , Mao Yousheng , Xue Qi , Sun Kelin , Liu Xiangyang , Fang Dekang , Li Jian , Wang Dali
Published: February 2020

Background

Preoperative chemoradiotherapy (CRT) followed by surgery is the most common approach for patients with resectable esophageal cancer. Nevertheless, considerable numbers of esophageal-cancer patients undergo surgery as the first treatment. The benefit of neoadjuvant therapy might only be for patients with a pathologic complete response, so stratified research is necessary. Postoperative treatments have important roles because of the poor survival rates of patients with stage-IIB/III disease treated with resection alone. Five-year survival of patients with stage-IIB/III thoracic esophageal squamous cell carcinoma (TESCC) after surgery is 20.0–28.4%, and locoregional lymph-node metastases are the main cause of failure. Several retrospective studies have shown that postoperative radiotherapy (PORT) and postoperative chemoradiotherapy (POCRT) after radical esophagectomy for esophageal carcinoma with positive lymph-node metastases and stage-III disease can decrease locoregional recurrence and increase overall survival (OS). Using intensity-modulated RT, PORT reduces locoregional recurrence further. However, the rate of distant metastases increases to 30.7%. Hence, chemotherapy may be vital for these patients. Therefore, a prospective randomized controlled trial (RCT) is needed to evaluate the value of PORT and concurrent POCRT in comparison with surgery alone (SA) for esophageal cancer.

Method

This will be a phase-II/III RCT. The patients with pathologic stage-IIB/III esophageal squamous cell carcinoma will receive concurrent POCRT or PORT after radical esophagectomy compared with those who have SA. A total of 120 patients in each group will be recruited. POCRT patients will be 50.4 Gy concurrent with paclitaxel (135–150 mg/m2) plus cisplatin or nedaplatin (50–75 mg/m2) treatment every 28 days. Two cycles will be required for concurrent chemotherapy. The prescription dose will be 54 Gy for PORT. The primary endpoint will be disease-free survival (DFS). The secondary endpoint will be OS. Other pre-specified outcome measures will be the proportion of patients who complete treatment, toxicity, and out-of-field regional recurrence rate between PORT and POCRT.

Discussion

This prospective RCT will provide high-level evidence for postoperative adjuvant treatment of pathologic stage-IIB/III esophageal squamous cell carcinoma.

Trial registration

clinicaltrials.gov (NCT02279134). Registered on October 26, 2014.
Diacron reactive oxygen metabolites and biological antioxidant potential tests for patients with age-related macular degeneration
Authors: Matsuura Toshiyuki , Kaneko Hiroki , Takayama Kei , Shibata Rei , Kataoka Keiko , Ito Seina , Tsunekawa Taichi , Shimizu Hideyuki , Suzumura Ayana , Namba Rina , Ito Yasuki , Murohara Toyoaki , Terasaki Hiroko
Published: February 2020

Background

Previously, we showed that serum malondialdehyde (MDA) was significantly higher in patients with neovascular age-related macular degeneration (nAMD) than in those without AMD. The Diacron reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) tests are known markers of oxidative stress. The aim of this study was to use d-ROMs and BAP tests to evaluate changes in systemic oxidative stress in patients with nAMD.

Methods

Blood serum samples were collected from 34 patients with nAMD (mean age: 76.5 ± 7.7 years; 22 men) and 20 control subjects (mean age: 62.9 ± 14.0 years; 10 men), and d-ROMs and BAP tests were examined.

Results

In men, the mean level of d-ROMs for the nAMD patients was significantly higher than that for the controls (312.0 ± 52.4 vs. 275.1 ± 45.5 U.CARR, respectively; P < .05). There was a significant correlation between d-ROM level and CNV lesion area in the male nAMD group (r = .42, P = .05). There were no significant differences in mean BAP test results between the nAMD patients and controls for either sex (men: 2241 ± 549 vs. 2136 ± 246 μmol/L; women: 2263 ± 292 vs. 2335 ± 161 μmol/L).

Conclusion

The d-ROMs test may provide a useful indicator of nAMD in men but not in women.
Dynamics of toxigenic Clostridium perfringens colonisation in a cohort of prematurely born neonatal infants
Authors: Shaw Alexander G. , Cornwell Emma , Sim Kathleen , Thrower Hannah , Scott Hannah , Brown Joseph C. S. , Dixon Ronald A. , Kroll J. Simon
Published: February 2020

Background

Clostridium perfringens forms part of the human gut microbiota and has been associated with life-threatening necrotising enterocolitis (NEC) in premature infants. Whether specific toxigenic strains are responsible is unknown, as is the extent of diversity of strains in healthy premature babies. We investigated the C. perfringens carrier status of premature infants in the neonatal intensive care unit, factors influence this status, and the toxic potential of the strains.

Methods

C. perfringens was isolated by culture from faecal samples from 333 infants and their toxin gene profiles analysed by PCR. A survival analysis was used to identify factors affecting probability of carriage. Competitive growth experiments were used to explore the results of the survival analysis.

Results

29.4% of infants were colonized with C. perfringens before they left hospital. Three factors were inversely associated with probability of carriage: increased duration of maternal milk feeds, CPAP oxygen treatment and antibiotic treatment. C. perfringens grew poorly in breast milk and was significantly outperformed by Bifidobacterium infantis, whether grown together or separately. Toxin gene screening revealed that infants carried isolates positive for collagenase, perfringolysin O, beta 2, beta, becA/B, netB and enterotoxin toxin genes, yet none were observed to be associated with the development of NEC.

Conclusions

Approximately a third of preterm infants are colonised 3 weeks after birth with toxin gene-carrying C. perfringens. We speculate that increased maternal breast milk, oxygen and antibiotic treatment creates an environment in the gut hostile to growth of C. perfringens. Whilst potentially toxigenic C. perfringens isolates were frequent, no toxin type was associated with NEC.

Trial registration

clinicaltrials.govNCT01102738, registered 13th April 2010.
Treatment utilization and treatment barriers in individuals with body dysmorphic disorder
Authors: Schulte Johanna , Schulz Claudia , Wilhelm Sabine , Buhlmann Ulrike
Published: February 2020

Background

Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics.

Methods

German individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively.

Results

Only 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight.

Conclusions

The results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.
The association of genetic polymorphisms in CYP1A2, UGT1A4, and ABCB1 with autonomic nervous system dysfunction in schizophrenia patients treated with olanzapine
Authors: Hattori Saki , Suda Akira , Miyauchi Masatoshi , Shiraishi Yohko , Saeki Takashi , Fukushima Tadashi , Fujibayashi Mami , Tsujita Natsuki , Ishii Chie , Ishii Norio , Moritani Tosiho , Saigusa Yusuke , Kishida Ikuko
Published: February 2020

Background

Use of the antipsychotic drug olanzapine by patients with schizophrenia is associated with autonomic nervous system (ANS) dysfunction. It is presumed that there are interindividual differences in ANS dysfunction that correspond to pharmacogenetics. In this study, we investigated whether genetic polymorphisms in ABCB1, CYP1A2, and UGT1A4 are associated with this observed ANS dysfunction.

Methods

A total of 91 schizophrenia patients treated with olanzapine monotherapy participated in this study. A power spectral analysis of heart rate variability was used to assess ANS activity. The TaqMan system was used to genotype seven single nucleotide polymorphisms (SNPs) in CYP1A2 (rs2069514 and rs762551), UGT1A4 (rs2011425), and ABCB1 (rs1045642, rs1128503, rs2032582, rs2235048).

Results

Sympathetic nervous activity was significantly higher in individuals with the UGT1A4 rs2011425 G allele than in those with the UGT1A4 rs2011425 non-G allele (sympathetic activity, p = .001). Furthermore, sympathetic nervous activity was also significantly associated with UGT1A4 rs2011425 genotype as revealed by multiple regression analysis (sympathetic activity, p = .008).

Conclusions

We suggest that the UGT1A4 rs2011425 polymorphism affects olanzapine tolerability because it is associated with the observed side effects of olanzapine in schizophrenia patients, namely sympathetic dysfunction.
The prevalence of selected non-communicable disease risk factors among HIV patients on anti-retroviral therapy in Bushbuckridge sub-district, Mpumalanga province
Authors: Mathebula Rudy Londile , Maimela Eric , Ntuli Nthembelihle Samuel
Published: February 2020

Background

The rates of non-communicable diseases (NCD’s) appear to be increasing in human immunodeficiency virus (HIV) infected people as compared to non-HIV infected people and this will have major implications for clinical care. The aim of the current study was to profile selected cardiovascular disease risk factors among HIV patients on anti-retroviral therapy (ART) in Bushbuckridge sub-district.

Methods

The current study followed a quantitative cross-sectional study design using a questionnaire which was adapted from World Health Organization STEPwise approach to Surveillance (WHO STEPS). Participants were HIV infected people on ART and data was entered into a computer software Microsoft excel, then imported to Stata 12 for analysis.

Discussion

The overall prevalence of overweight at the initiation of ART amongst the participants was 18.1% and obesity was 11.5% as compared to the time of the study which was 21.4% overweight and 19.6% obese. The average time of ART initiation to study period was 3.6 years. The study findings revealed a significant difference (p-value 0.006) between the baseline and current body mass index at time of study for females. Hypertension was found to be having a significant difference (p-value 0.026 and 0.038) between the baseline and current body mass index at time of study for males and females respectively. The overall prevalence of hypertension was found to be 34.6%, overweight was 21.4% obesity was 19.6%.

The overall prevalence of abnormal waist circumference was 31.9% and females had a higher prevalence of 42.5% as compared to 4.4% of males. The overall prevalence of smoking 10.8% and alcohol consumption was 21.7%. Males were 22.5 times more likely to be smokers than females (p < 0.001) and older people were found to be 0.3 times less likely to consume alcohol as compared to young people.

Conclusions

The high levels of selected risk factors for NCDs among adults on ART in the current study area suggest an urgent need for health interventions to control risk factors in an era of HIV with an aim of reducing multiple morbidity of chronic diseases. Occurrence of NCDs and their risk factors with an aim to achieve positive effects of the long-term ART.
The association between parental migration and early childhood nutrition of left-behind children in rural China
Authors: Shi Huifeng , Zhang Jingxu , Du Yufeng , Zhao Chunxia , Huang Xiaona , Wang Xiaoli
Published: February 2020

Background

More than one-third of children under 3 years old are left behind at home due to parental migration in rural China, and we know very little about early childhood nutrition of left-behind children (LBC) because of the dearth of research. This study examined the association between parental migration and early childhood nutrition of LBC in rural China.

Methods

We used repeated cross-sectional data of rural children aged 6–35 months who participated in two surveys in six counties of northern and southern China in 2013 and 2016 respectively. The length, weight, and hemoglobin concentration were measured by trained health-care workers blinded to parental migration status. Stunting, underweight, wasting, and anemia were identified with the standards recommended by WHO. Generalized linear regressions and multivariate logistic regressions were employed to explore the association between parental migration and these nutritional outcomes at each time point.

Results

Two thousand three hundred thirty-six and 2210 children aged 6–35 months were enrolled in 2013 and 2016, respectively. The results show a reduction of the risks of stunting, underweight, and wasting from 2013 (16.4, 8.5, and 3.5%, respectively) to 2016 (12.1, 4.0, and 1.5%, respectively) but highlight a constantly and alarmingly high risk of anemia among these children (44.8% in 2013 and 43.8% in 2016). Children with migrant fathers performed as well as or better than those with non-migrants on these indicators. Children with migrant parents performed slightly worse in 2013, but equal or slightly superior in 2016 on these indicators compared with children with non-migrants and migrant fathers. Children aged 6–17 months with migrant parents had a significantly lower risk of anemia than those living with their mothers or with both parents (43.1% vs. 63.6% and 61.5 in 2013, and 42.5 vs. 60.1 and 66.2% in 2016), even after controlling for children’s sociodemographic characteristics.

Conclusions

Parental migration may be not detrimental and even beneficial to early childhood nutrition of LBC in rural China. Continued nutritional support is needed for all rural children, especially interventions for preventing micronutrient deficiency. Programs for LBC are recommended to continue to focus on nutrition but pay more attention to other important health issues.