bluuebunny/crossref_metadata_2025 huggingface dataset:
Methodological framework for radiomics applications in Hodgkin Lymphoma
Authors: Sollini Martina , Kirienko Margarita , Cavinato Lara , Ricci Francesca , Biroli Matteo , Ieva Francesca , Calderoni Letizia , Tabacchi Elena , Nanni Cristina , Zinzani Pier Luigi , Fanti Stefano , Guidetti Anna , Alessi Alessandra , Corradini Paolo , Seregni Ettore , Stella Carmelo Carlo , Chiti Arturo
Published: March 2020

Background According to published data radiomics features differ between lesions of refractory/relapsing HL patients from those of long-term responders. However, several methodological aspects have not been elucidated yet.Purpose The study aimed at setting up a methodological framework in radiomics applications in Hodgkin Lymphoma (HL), especially at: a) developing a novel feature selection approach; b) evaluating radiomic intra-patient lesions’ similarity; c) classifying relapsing refractory (R/R) vs non-(R/R) patients.Methods We retrospectively included 85 patients (male:female=52:33; median age 35 years, range 19-74). LIFEx (www.lifexsoft.org) was used for [18F]FDG-PET/CT segmentation and feature extraction. Features were a-priori selected if they were highly correlated or uncorrelated to the volume. Principal component analysis-transformed features were used to build the fingerprints, that were tested to assess lesions’ similarity, using the silhouette. For intra-patient similarity analysis, we used patients having multiple lesions only. To classify patients as non-R/R and R/R, the fingerprint considering one single lesion (fingerprint_One) and all lesions (fingerprint_All) was tested using Random Undersamplig Boosting of Tree Ensemble (RUBTE). Results HL fingerprints included up to 15 features. Intra-patient lesion similarity analysis resulted in mean/median silhouette values below 0.5 (low similarity especially in the non-R/R group). In the test set, the fingerprint_One classification accuracy was 62% (78% sensitivity and 53% specificity); the classification by RUBTE using fingerprint_All resulted in 82% accuracy (70% sensitivity and 88% specificity). Conclusions Lesion similarity analysis was developed, and it allowed to demonstrate that HL lesions were not homogeneous within patients in terms of radiomics signature. Therefore, a random target lesion selection should not be adopted for radiomics applications. Moreover, the classifier to predict R/R vs non-R/R, performed the best when all the lesions were used.
The role of ICOSL in children with neutrophilic asthma
Authors: Dong Heting , JIANG Wujun , HUANG Li , WANG Meijuan , YAN Yongdong , HAO Chuangli , ZHANG Xinxing , GU Wenjing , SHAO Xuejun , Chen Zhengrong , Ji Wei
Published: March 2020

Background: It has been shown that certain severe and refractory asthma cases are due to neutrophil and not eosinophil infiltration. ICOSL (Inducible costimulatory molecular ligand) expression is closely associated with tumor and autoimmune diseases, while a limited amount of data has been published regarding the significance of ICOSL in children with neutrophilic asthma. The present study aimed to explore the abnormal expression of ICOSL in peripheral blood and bronchoalveolar lavage fluid (BALF) samples of children with neutrophilic asthma and their clinical significance. Methods: The present clinical study selected children who met the diagnostic criteria of asthma from the children's Hospital of Suchow University and excluded the patients with positive etiology. The children who were admitted to the hospital for foreign body inhalation in the same period were collected as the control group. The children with more than 50% (the percentage of neutrophils in BALF was 95% of the percentile in the control group) of neutrophils in BALF samples were assigned to the neutrophilic asthma group (NA group), whereas the remaining subjects comprised the asthma group (A group). The expression levels of ICOSL, IL-4, IL-17, IFN-, neutrophil elastase (NE) and matrix metalloproteinase (MMP)-9 were detected in plasma and BALF samples by enzyme-linked immunosorbent assays in order to analyze the differences in the levels of cytokines and clinical characteristics between children with neutrophilic asthma and non-neutrophilic asthma. Moreover, the potential mechanism of ICOSL in neutrophilic asthma was explored. Results: In strict accordance with the diagnostic criteria of asthma and following exclusion of pathogenic positive children, 32 children were finally enrolled, including 12 children in the NA group and 20 children in the A group. The mean hospitalization time of the NA group was longer than that of the A group (P<0.05). The concentration levels of ICOSL, IL-17, NE and MMP9 of the NA group in plasma and BALF samples were higher than those in the A group, while the levels of IFN-γ exhibited the opposite trend. A significant correlation was evident between ICOSL and IL-17 levels in plasma（r=0.753，P=0.012） and BALF（r=0.774，P=0.009）samples of the NA group. Conclusion: Children with asthma exhibited an immunity imbalance of Th1/Th2/Th17, whereas neutrophilic asthma children were more severely affected. The clinical treatment was considerably difficult and the hospitalization time was longer. ICOSL may regulate the secretion of IL-17 by Th17 and increase the levels of NE and MMP9, which are involved in the development of immune inflammation in neutrophils.
Whole-exome sequencing identifies GPSM1 as a susceptibility gene for premature ovarian insufficiency
Authors: Cai Xuzi , Fu Huijiao , Wang Yan , Liu Qiwen , Wang Xuefeng
Published: March 2020

Background Genetic causes of premature ovarian insufficiency (POI) account for approximately 20~25% of patients. So far, only a few genes have been identified. Results Here, we first identified the c.1840C>A on G-protein signaling modulator 1 (GPSM1) as a susceptibility locus for POI in 10 sporadic POI patients by whole-exome sequencing. The frequency of GPSM1 c.1840C>A was then verified as 3/20 in a POI sample of 20 patients (including the above 10 patients) by Sanger sequencing. RT-PCR and western blot analysis showed the expression of GPSM1 in rat ovaries was increased in the large antral follicle stage compared to the primordial follicle stage (P<0.01). The cell proliferation assay (CCK8) and flow cytometry suggested that the small-interfering RNA-induced silencing of Gpsm1 significantly increased apoptosis and decreased proliferation of rat ovarian granulosa cells (GCs) (P<0.01). Furthermore, suppression of Gpsm1 in GCs reduced levels of cAMP, PKAc, p-CREB as well as the ratio of Bcl-2/Bax, and increased the expression of Caspase-3 and Cleaved Caspase-3 (P<0.01). Conclusions In summary, this study identified a susceptibility variant GPSM1 c.1840C>A of POI for the first time. Gpsm1 was related to rat follicle development, and silencing increased apoptosis and decreased proliferation in rat GCs, possibly through inhibition of the cAMP-PKA-CREB pathway. These findings facilitate the development of the early molecular diagnosis of POI.
The Connection Between Triglycerides and Ectopic Fat Obesity: An Inverted U-Shaped Curve
Authors: Zou Yang , Yu Meng , Sheng Guotai , Xie Guobo
Published: March 2020

Background: Ectopic fat obesity and Triglycerides are risk factors for diabetes and multiple cardiovascular diseases, but the data on the relationship between Triglycerides and the risk of ectopic fat obesity are limited. The purpose of this study is to explore the connection between Triglycerides and ectopic fat obesity.Methods: This is a cross-sectional study, we retrospectively analyzed 15464 adult participants recruited by Murakami Memorial Hospital from 2004-2015(8430 men and 7034 women, average age 43.71±8.9), to performed the relationship between Triglycerides and ectopic fat obesity, we divided all patients into 4 groups according to the quartile of Triglycerides. Logistic regression model was used to analyze the relationship between Triglycerides and the risk of ectopic fat obesity, and the generalized additive model was used to identify the nonlinear relationship.Results: In the study population, the prevalence of ectopic fat obesity was 17.73%, and gradually increased in the quartile of Triglycerides (2.86,7.89,18.25 and 41.22% respectively, P < 0.001).After adjusting other covariables, Triglycerides was positively correlated with the risk of ectopic fat obesity (OR:1.55,95%CI:1.41-1.69, p<0.00001). Then we carried out smooth curve fitting and found that there was an inverted U-shaped curve relationship between Triglycerides and ectopic fat obesity, even if those adjusted covariables were removed from the model, the result remained unchanged, and the inflection point of the curve was 3.98. On the left side of the inflection point, Triglycerides was positively correlated with the risk of ectopic fat obesity(OR:1.784,95%CI:1.611-1.975,p<0.0001), while on the right side of the inflection point, there was a negative correlation (OR:0.519,95%CI:0.333-0.810,p=0.0039).Conclusions: Our research shows that there is a significant correlation between Triglycerides and ectopic fat obesity, this relation is not a simple linear relationship, but it was an inverted U-shaped curve relationship.
Genomic and transcriptome analyses of a thermophilic bacterium Geobacillus stearothermophilus B5 isolated from compost reveal its enzymatic basis for lignocellulose degradation
Authors: Wang Mengmeng , Miao Jiaxi , Wang Xuanqing , Li Tuo , Zhu Han , Liu Dongyang , Shen Qirong
Published: March 2020

Background Composting is a special global carbon cycle which sustains various microbes engendering the cellulose degradation. Studies have obtained substantial compost microbiomes, yet the expressions and functions of these lignocellulolytic enzymes remains obscure. Thus, the discovery of thermophilic microorganisms as considerable biochemical catalysts for biofuels is becoming more and more attractive.Results A lignocellulose degrading strain isolated from thermophilic compost was identified as Geobacillus stearothermophilus B5, which could secrete considerable enzymes at the optimal temperature (60°C) and pH (7.5). One single contig of 3.37 Mbp was obtained from raw data and 3371 protein-coding genes were predicted, and the clusters of orthologous groups (COG) analysis revealed various genes with function of polymeric substrates degradation, especially for abundant CAZymes including glycoside hydrolases (GH, 29%) and glycosyl transferases (GT, 36%). Furthermore, the transcriptional responses of B5 at different temperature by using rice straw as sole carbon sources were also analyzed, based on which the mechanism of lignocellulose degradation at high temperature was revealed that B5 could resist the heat by up-regulating the heat shock proteins (HSP) and then secrete various Carbohydrate-Active enzymes (CAZymes) to realize energy balance.Conclusions The comparative whole-genome along with transcriptome analysis indicated that G. stearothermophilus B5 owned the ability of lignocellulose degradation and could be considered as a potential inoculant in composting efficiency, thus are also valuable for the lignocellulosic bioenergy industry.
Chronic vagus nerve stimulation for drug-resistant epilepsy influences fasting blood glucose concentration
Authors: Liu Hongyun , Zhan Ping , Meng Fangang , Wang Weidong
Published: March 2020

Background Cervical vagus nerve stimulation (VNS) has been widely accepted as adjunctive therapy for drug-resistant epilepsy and major depression. Its effects on glycemic control in humans were however poorly understood. The aim of our study was to investigate the potential effects of VNS on fasting blood glucose in patients with drug-resistant epilepsy.Methods Patients with drug-resistant epilepsy who had received VNS implants at the same hospital in a randomized, controlled trial were retrospectively studied. Effects on fasting blood glucose, weight, body mass index and blood pressure were evaluated at 4, 8 and 12 months of follow-up.Results 32 subjects (11 females/21males, 19±9 years, body mass index 22.2±4.0 kg/m 2 ) completed 12-month follow-up. At the 4 months, there were no significant changes in fasting blood glucose concentrations from baseline to follow-up in both Sham-VNS (4.89±0.54 vs. 4.56±0.54 mmol/L, p=0.101) and VNS (4.80±0.54 vs. 4.50±0.56 mmol/L, p=0.117) groups. However, after 8 (4.90±0.42 mmol/L, p=0.001) and 12 (4.86±0.40 mmol/L, p=0.002) months of VNS, fasting blood glucose levels significantly increased compared to baseline values (4.52±0.54 mmol/L). Changes in fasting blood glucose concentrations at both 8 (R 2 =0.502, p<0.001) and 12 (R 2 =0.572, p<0.001) months were negatively correlated with baseline fasting blood glucose levels.Conclusions Our study suggests that chronic cervical VNS elevates fasting blood glucose levels with commonly used stimulation parameters in patients with epilepsy.Trial registration: VNSRE, NCT02378792. Registered 4 March 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02378792
DEHP chronic exposure disturbs the gut microbial community and metabolic homeostasis: Gender-based differences in zebrafish
Authors: Pei Desheng , Jia Pan-Pan Chongqing Institute of Green and Intelligent Techn , Xin Guang-Yuan , Junaid Muhammad , Wang Yan , Ma Yan-Bo
Published: March 2020

Background: Di-(2-ethylhexyl) phthalate (DEHP), a predominant phthalate ester (PAE), exhibits various toxic potentials with environmental and human health risks. However, the chronic effects of DEHP exposure on gut microbiota and associated host’s health are still largely unexplored. Here, zebrafish were exposed to relative environmental levels (0-100 μg/L) of DEHP from embryos to adult (3.5 months), then the developmental indexes and microbiota as well as the related energy metabolites in gut tissues were checked to unveil the effects during the growth progress. Results: The results indicated that the composition of gut microbiota was different among male and female adult zebrafish, and DEHP disrupted the diversity and richness of the bacterial community. The histopathological analysis of intestinal tissues revealed the decrease of villus length and tunica muscularis thickness, especially the goblet cells per villi in male fish. Moreover, energy metabolites in gut tissues were actively increased at lower levels groups, which probably contribute to the condition factor of host. For immune-related genes, the expression levels of il-8 was increased both in female and male fish in the lowest concentration (10 μg/L), but the tlr-5 and il-1β genes were in the different response with significantly decreased in female fish. Conclusion: Taken all together, those results indicated that chronic exposure to DEHP led to zebrafish obesity with the disturbed bacterial community in the gut and related metabolism pathways. Those findings provided deep insights on the perturbation of gut microbiota, metabolic homeostasis, and gender-based differences by DEHP exposure.
Fungal Composition and Diversity of the Tobacco Leaf Phyllosphere during Curing of Leaves
Authors: Chen Qian-Li , Cai Lin , Wang Hancheng , Cai Liu-Ti , Goodwin Paul , Ma Jun , Wang Feng , Li Zhong
Published: March 2020

Background: Rhizopus oryzae causes tobacco pole rot in China during tobacco flue-curing. Flue-curing is a post-harvest process done to prepare tobacco leaves and involves three different stages: the yellowing stage has the lowest temperatures and highest humidity, then the color-fixing stage has higher temperatures and medium humidity, and finally the stem-drying stage has the highest temperatures and lowest humidity.Results: In this study, fungal culturing and IonS5TMXL high-throughput sequencing techniques were used to reveal the fungal community of the petioles and lamina of tobacco leaves infected with pole rot during flue-curing. A total of 108 fungal isolates belonging to 5 genera and 10 species were isolated on media. The most common fungi isolated was R. oryzae, most often found equally on petioles and laminas in the color-fixing stage, followed by saprotrophs, mostly Aspergillus fumigatus and Aspergillus flavus. High-throughput sequencing revealed saprotrophs, Alternaria being the most abundant genus, followed by Phoma, Cercospora and Aspergillus, whereas Rhizopus was the tenth most abundant genus, which was mostly found on petioles at the yellowing stage. Both culturable fungal diversity and fungal sequence diversity was higher at stem-drying stage than the yellowing and color-fixing stages, and diversity was higher with leaf lamina than petioles revealing that the changes in fungal composition and diversity during the curing process were similar with both methods.Conclusions: A better understanding of the saprotrophic fungi during curing of leaves with pole rot could result in the identification of highly competitive saproptrophs that may act as potential biocontrol agents of tobacco pole rot.
Meta-analysis in periprosthetic joint infection: a global bibliometric analysis
Authors: Li Cheng , Thies Cristina Ojeda , Xu Chi , Trampuz Andrej
Published: March 2020

Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.
Clinical features of a Chinese female Non-gestational Choriocarcinoma cohort: a retrospective study of 37 patients
Authors: Shao Yuming , Xiang Yang , Jiang Fang , Pan Boju , Wan Xirun , Yang Junjun , Feng Fengzhi , Ren Tong , Zhao Jun
Published: March 2020

Background Choriocarcinoma is a rare malignant neoplasm, classified as gestational choriocarcinoma and non-gestational choriocarcinoma. The purpose of this study is to demonstrate the clinical characteristics of Chinese female non-gestational choriocarcinoma patients and introduce our experience of treating this rare disease.Results We conducted a single-centered retrospective study on a sample of 37 non-gestational choriocarcinoma patients who were diagnosed and treated at Peking Union Medical College Hospital from March 1982 to March 2020. Their demographic, clinical, laboratory, and therapeutic data were collected. Detailed information were available for all individuals in our sample of 37 patients. The primary lesions included 34 in ovary, 2 in pituitary and 1 in stomach. The mean of onset age was 22.8 years. The mean follow-up period spanned 87.5 months. Lung (40.5%) were the most commonly observed metastatic sites. All subjects were treated by surgeries and multi-drug chemotherapies with a mean of 5.8 courses to achieve complete remission. The overall complete remission rate, relapse rate, 3-year and 5-year survival rates are 81.1%, 16.7%, 80.0%, and 75.5%.Conclusions Non-gestational choriocarcinoma could be managed well with surgeries and multi-drug chemotherapies, but the overall outcome was still worse than gestational ones. Both ovary cancer and gestational choriocarcinoma classification could be applied for ovary non-gestational choriocarcinoma. Mixed non-gestational choriocarcinoma seems to have similar therapeutic effects compared with pure ones.
Comparison of diagnostic accuracy of 18F-fluoroestradiol and 18F-fluorodeoxyglucose positron emission tomography/computed tomography for breast cancer recurrence in patients with a history of estrogen receptor-positive primary breast cancer
Authors: Chae Sun Young , Son Hye Joo , Lee Dong Yun , Shin Eonwoo , Oh Jungsu S. , Seo Seung Yeon , Baek Sora , Kim Ji Young , Na Sae Jung , Moon Dae Hyuk
Published: March 2020

Background To compare the diagnostic accuracy of 18F-fluoroestradiol (18F-FES) and 18F-fluorodoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for breast cancer recurrence in patients with estrogen receptor (ER)-positive primary breast cancer.Methods Our database of consecutive patients enrolled in a previous prospective cohort study to assess 18F-FES PET/CT was reviewed to identify eligible patients who had ER-positive primary breast cancer with suspected first recurrence at presentation and who underwent 18F-FDG PET/CT. The diagnostic accuracy of qualitative 18F-FES and 18F-FDG PET/CT interpretations was assessed, comparing them with histological diagnoses.Results Of the 46 enrolled patients, 45 were confirmed as having recurrent breast cancer, while one was diagnosed with chronic granulomatous inflammation. Forty (89%) patients were ER-positive, four (9%) were ER-negative, and one (2%) patient did not undergo an ER assay. The sensitivity of 18F-FES PET/CT was 71.1% (32/45, 95% CI: 55.7–83.6), while that of 18F-FDG PET/CT was 80.0% (36/45, 95% CI: 65.4–90.4) when malignant interpretation was defined as positive, and 93.3% (42/45, 95% CI: 81.7–98.6) when an equivocal or malignant interpretation was considered positive. There was no significant difference in sensitivity between 18F-FES and 18F-FDG PET/CT (P=0.48) when malignant 18F-FDG interpretation was considered positive, but the sensitivity of 18F-FDG was significantly higher than 18F-FES (P=0.013) when equivocal or malignant interpretation was considered positive. One patient with a benign lesion showed negative 18F-FES but malignant 18F-FDG uptake.Conclusions The restaging of patients who had ER-positive primary breast cancer and present with recurrent disease may include 18F-FES PET/CT.
Adaptation of IncX3 plasmid encoding blaNDM-4 within broad host range: A study from India
Authors: Choudhury Nargis Alom , Paul Deepjyoti , Das Bhaskar Jyoti , Dhar Debadatta , Bhattacharjee Amitabha
Published: March 2020

Background: Different variants of blaNDM have been reported across Indian subcontinent within diverse host range of gram negative bacilli. Most of their transferability depends on types of plasmid that encodes resistance determinant. These plasmids with external sub-inhibitory stress of antibiotics facilitate their propagation and maintenance within broad host range. IncX type plasmid is more recently known for carrying carbapenem resistance and NDM-4 variant is considered to have better hydrolytic property than other variants. Both of these factors interferes with therapeutic outcome in clinical setting. The current study was aimed to investigate the maintenance and stability of blaNDM-4 within broad host range and transcriptional response.Results: IncX3 plasmid encoding blaNDM-4 was successfully transferred in six different host when imipenem (0.5µg/ml) screen agar was used for selection of transformants. It was also found to coharbour resistance for aminoglycosides and quinolone. When checked for stability, it was observed that the plasmid was successfully expanded within all the six recipients for 55th serial passages. Transcriptional expression with IncX3 was random but at consistent level for wild type and without concentration gradient stress of imipenem. Transcriptional expression with NDM gene was variable for parent isolates though for new hosts it was showing randomly increased pattern in proteus, E.coli, and DH5α Conclusion: the present study could highlight that external carbapenem pressure helps in maintenance and expression of blaNDM-4 within different host range. This study is of epidemiological significance and will help in tracking the genetic vehicle responsible for their transmission theirby restricting their spread.
Analysis of the metabolic pathways affected by hot-Humid or dry climate based on fecal metabolomics coupled with serum metabolic changes in broiler chickens
Authors: Zhou Ying , Liu Huchuan , Zhang Minhong
Published: March 2020

Background: Air temperature and humidity are two important climatic elements that affect animal welfare and health. The prevailing hot and humid or dry climate is one of the major constraints for optimum poultry production especially in the tropics and subtropical regions. Many studies have suggested that exposure hot-humid or dry climate is associated with a high risk of metabolic imbalance; however, the underlying metabolic route caused by low or high RH climate is not yet well understood. Therefore, we used a comprehensive UHPLC-Q-TOF/MS-based metabolic profiling of fecal samples to explore the effects of hot-humid and dry on metabolic pathway in broilers.Results: Significant changes in the levels of 36 metabolites were detected. Evidence of changes in gluconeogenesis associated to pyruvate metabolism, galactose metabolism and ABC transporter were observed. In addition, hot-humid and dry stress also affected protein translation process caused by aminoacyl-tRNA biosynthesis, which may be associated with protein synthesis and hormone secretion disorders. Furthermore, we observed significant changes in primary bile acid biosynthesis and taurine and hypotaurine metabolism, which indicated that fat synthesis was affected. We also observed significant changes in arginine and proline metabolism and histidine metabolism, which were associated with skin vasodilation and blood flow.Conclusions: These results provide biochemical insights into metabolism route of hot-humid or dry climate.
Socioeconomic Determinants of Unmet Healthcare Needs in Iran
Authors: Vahedi Sajad , Torabipour Amin , Takian Amirhossein , Mohammadpur Saeed , Oliaeemanesh Alireza , Kiani Mohammad Mehdi
Published: March 2020

Background: Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods: We used the data of 13005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariate logistic regression was used to determine significant predictors of unmet need and associated major reasons. Results: About 17% of the respondents (N=2,217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Low education was associated with higher responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles and people with higher outpatient needs, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The elderly and those with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Conclusion: It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status. Keyword: Iran, Healthcare services, Access, Unmet need
Prevalence and Genotype Distribution of Genital Human Papillomavirus Infection in Female Sex Workers in the World: A Systematic Review and Meta-Analysis
Authors: Farahmand Mohammad , Moghoofei Mohsen , Monavari Seyed Hamidreza , Kiani Seyed Jalal , Tavakoli Ahmad
Published: March 2020

Background: Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and distribution of HPV types among FSWs across the world. Methods: Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the “Metaprop” function in the R package Meta. Results: Sixty-six studies involving 22938 FSWs from 34 countries were included in this meta-analysis, and the pooled HPV prevalence was 41.97% (95% confidence interval (CI): 37.99%-46.05%). HPV-16 (10.42%, 95% CI: 8.61%–12.55%), HPV-52 (7.76%, 95% CI: 5.75%–10.39%), and HPV-53 (6.09%, 95% CI: 4.55%–8.12%) were the most common high-risk HPV types identified among FSWs. The polled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.64% (95% CI: 36.12%-51.46%) and 41.01% (95% CI: 36.35%-45.83%), respectively. Conclusion: Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and incidence of HPV-associated malignancies among the general population.
Energy drink - the prevalence of consumption and awareness regarding its associated potential health problems among commercial bus drivers in Ho, Ghana
Authors: Saku Emmanuella Yayra , Nuro-Ameyaw Peter , Amenya Priscilla Cecilia , Kpodo Fidelis Mawunyo , Amoafo Paul Esua , Kortei Nii Korley
Published: March 2020

Background Consumption of energy drinks has become an escalating global public health problem. The work schedule and irregular sleeping habits of commercial bus drivers make them highly susceptible to getting fatigued, hence most of them consume energy drinks as a fatigue management strategy. However, consumption of energy drinks produces numerous psychomotor side effects that if consumed among drivers puts the traveling public in danger of road accidents. This study sought to assess the prevalence of energy drink consumption and awareness of associated potential health problems among commercial long-distance bus drivers operating from the Ho municipality. Methods This was a cross-sectional study involving 132 participants who completed a structured questionnaire on the participants' socio-demographic characteristics, frequency of consumption and reasons for consumption. It also included questions to assess the knowledge of the ingredients and side effects of energy drinks. Results A majority (62.1%) of the drivers had more than 10 years of commercial driving experience. A 75% energy drink consumption prevalence was recorded with driving performance enhancement (78.8%) as the predominant reason for consumption. 7 - 10 bottles per week were consumed by most (32.2%) of the drivers with the most consumed brand being Rush energy drink (54.5%). Also, 72.0% had poor knowledge of the side effects linked with energy drink intake likewise the ingredients in them. Conclusion Energy drinks were consumed by the majority of the drivers at the Ho main bus terminal of which most of the drivers had poor knowledge of the potential health problems linked with the consumption of these drinks. The consumption of energy drinks was observed to be higher among the drivers with lower education levels, higher monthly income and those who worked long hours in a day. The Ghana National Road Safety Commission (GNRC) in collaboration with other private road transport unions in Ghana should organize regular seminars for commercial bus drivers on the potential dangers and effects associated with energy drink consumption.
How people with type two diabetes in England learn about digital health technologies, and what are the barriers to access and motivators for use? A qualitative study
Authors: Turnbull Sophie , Lucas Patricia , Hay Alastair D , Cabral Christie
Published: March 2020

BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, digital health interventions might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use web-based self-care technology and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a web-based intervention to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about Digital Health Technology (DHT) that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHT are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHT from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHT because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to technology and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHT to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when interventions are developed and implemented.
Optimization on reagent-loading manner for modular clinical chemistry analyzer series: simulations and verifications
Authors: Wang Mingyang , Ming Liang
Published: March 2020

Background: The analytical process, especially reagent-related factors, demonstrates a significant effect on clinical chemistry analyzer. Therefore, it should have our attention both in total laboratory system (TLA) and modular automation (MA). The reagent-loading mode of modular analyzer influences testing turnaround time (tTAT) and the cost.Methods: Parameters were simulated by cobas 8000 workflow simulator for reagent-loading manner with at least three positions (Pattern 1), the module-parallel reagent-loading manner (Pattern 2) and the single-position loading mode (Pattern 3). Then, we chose Pattern 2 for Tuesday effect-based optimization verification.Results: tTAT, reagent on-line time, quality control cost and performance verification times all declined by 43%. Tuesday effect solved the repetitive problem for verification. With comprehensive comparison between Pattern 1, Pattern 2 and Pattern 3, Pattern 2 shows optimal performance in subsequent verification.Conclusions: The optimization of reagent-loading manner saved much workforce, and reduced the quality control cost and internal quality assessment consumption.Trial registration: This article did not report the results of a health care intervention on human participants. Trial registration was not needed here.
The effects of clinical decision support system for prescribing on patient outcomes and physician practice performance: A systematic review
Authors: Moghadam Sharare Taheri , Velayati Farnia , Sadoughi Farahnaz , Ehsanzadeh S.J. , Poursharif Shayan
Published: March 2020

Background The clinical decision support systems(CDSSs) for prescription medications is one of the technologies aimed at improving physician practice behavior and patient outcomes by reducing drug prescription errors. This study was conducted to investigate the effect of various CDSSs on physician practice behavior and patient outcomes.Methods This systematic review was conducted by searching in PubMed, EMBASE, Web of Science, Scopus and Cochrane Library from January 2005 to November 2019. Two researchers independently evaluated the studies. Any discrepancies over the eligibility of the studies between the two researchers were then resolved by consulting a third researcher. Finally, data were extracted from the articles; however, we could not able to conduct meta-analysis due to the heterogeneity of the studies and the narrative form of the findings.Results Based on the inclusion criteria, 46 studies were considered eligible for the analysis in this review. The CDSS for prescription medications had been used for various diseases, namely cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, mental disease. Meanwhile, other cases such as the concurrent prescription of multiple drugs for the patient and its effects on the above-mentioned outcomes were evaluated. The analysis shows that in some cases the application of CDSS provides positive effects on patient outcomes and physician practice behaviors. No significant difference was observed in comparison between some other cases and conventional methods. We think that this could be due to the disease type, the quantity and type of CDSS requirements that influence the comparison.Conclusions Our findings suggest that the positive effects of the CDSS are due to factors such as user-friendliness, compliance with clinical guidelines, patient and doctor cooperation, integration of electronic health records, CDSS and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts and their real-time alerts in the prescription.Registration number on PROSPERO CRD42018079936.
The relationship between non-HDL cholesterol and coronary collateral circulation
Authors: Yildirim Tarik , Yildirim Seda Elcim , Argan Onur , Kisacik Halil Lutfi , Safak Ozgen , Toklu Oguzhan , Avci Eyup , Kadi Hasan
Published: March 2020

Objective Non high density lipoprotein cholesterol (non HDL-C) covers all aterojenic lipoproteins and correlates with C reactive protein (CRP) which is reliable marker of inflammation. CRP is related to poor angiographic coronary collateral circulation (CCC). We aimed to show whether non HDL-C is associated with CCC.Methods Patients who underwent coronary angiography for stable coronary artery disease and at least one epicardial coronary artery occluded in the proximal or middle region were included in the study. Accrording to the Rentrop scoring system Rentrop 0 and 1 were considered to be poor CCC, and Rentrop 2 and 3 were considered to be good CCC. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC).Results 84 patients were included in the study. While 44 patients (52%) had good CCC, 40 patients (48%) had poor CCC. TC was found to be higher in the poor CCC group than in the good CCC group (224.3 ± 35.6 vs 179.2 ± 25.5 p = 0.000). HDL-C levels were found to be lower in the poor CCC group than in the good CCC group (37.3 ± 9.8 vs 44.1 ± 8.6 p = 0.001). Non-HDL-C cholesterol levels were higher in the group with poor CCC (185.7 ± 39.2 vs 132.8 ± 28.1 p = 0.000). CRP levels were found to be higher in the poor CCC group (3.73 ± 2.5 vs 1.67 ± 1.4 p = 0,000).Conclusion Non-HDL-C is independent predictors of poor CCC.
Inducing Multiple Antibodies to Treat Squamous Cell Esophageal Carcinoma
Authors: Hoshino Isamu , Nabeya Yoshihiro , Takiguchi Nobuhiro , Gunji Hisashi , Ishige Fumitaka , Iwatate Yosuke , Kuwajima Akiko , Shiratori Fumiaki , Okada Rei , Shimada Hideaki
Published: March 2020

BackgroundWe examined the positive response and clinical usefulness of 14 serum antibodies in patients with squamous cell esophageal carcinoma (ESCC). The Cancer Genome Atlas (TCGA) was used to study the frequency of gene expressions, mutations, and amplification of these 14 antigens, and this database helped investigate the possible effects of antibody induction.MethodsBlood serum from 85 ESCC patients was collected and tested for 14 antibodies using an ELISA assay. The prognosis between positive and negative antibodies were then compared. The antibody panel included Galectin1, HCA25a, HCC-22-5, and HSP70.ResultsPatient serum was positive for all antibodies except VEGF, ranging from 1.18 to 10.59%. Positive rates of Galectin1, HCA25a, HCC-22-5, and HSP70 were more than 10%. TCGA data showed all antigen-related genes had little or no mutation or amplification, so an increase in gene expression effected antibody induction. The positive results from the panel accounted for the positive rate comparable to the combination of CEA and SCC. There was no significant association between the presence of antibodies and disease prognosis.ConclusionsThe presence of Galectin1, HCA25a, HCC-22-5, and HSP70 were 10% higher in ESCC patients. Gene overexpression may be involved in such antibody production. The utility of using these four antibodies compared to conventional tumor markers was shown as a panel. Furthermore, it was confirmed that the combination of this panel and conventional tumor markers significantly improved the positive rate
Impact of early versus delayed androgen-deprivation therapy on survival outcomes of patients with localized prostate cancer who underwent radical prostatectomy and later developed metastasis: Can we define a PSA threshold?
Authors: Ahn Hyun Kyu , Lee Kwang Suk , Kim Daeho , Rha Koon Ho , Hong Sung Joon , Chung Byung Ha , Koo Kyo Chul
Published: March 2020

Background: The benefits of early administration of androgen-deprivation therapy (ADT) in patients with prostate-specific antigen (PSA)-only recurrent prostate cancer (PCa) following radical prostatectomy (RP) are controversial. We investigated the impact of early versus delayed ADT on survival outcomes in patients with non-metastatic, localized or locally advanced PCa who received radiation therapy following RP and later developed distant metastasis.Methods: A retrospective analysis was performed on 69 patients with non-metastatic, localized or locally advanced PCa who received radiation therapy following RP and later developed distant metastasis between January 2006 and December 2012. Patients were stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL). Study endpoints were progression to castration-resistant prostate cancer (CRPC)-free survival and cancer-specific survival (CSS) assessed by Kaplan-Meier analysis and Cox-regression models.Results: Patients were stratified according to the level of PSA at which ADT was administered (<2 ng/mL vs. ≥2 ng/mL) based on the Youden sensitivity analysis. Delayed ADT at PSA ≥2 ng/mL was an independent prognosticator of cancer-specific mortality (p=0.047), and a marginally significant prognosticator of progression to CRPC (p=0.051). During the median follow-up of 81.0 (IQR 54.2-115.7) months, patients who received early ADT at PSA <2 ng/mL had significantly higher CSS rates than patients who received delayed ADT at PSA ≥2 ng/mL (p=0.002). Progression to CRPC-free survival was comparable between the two groups (p=0.331).Conclusions: Early ADT at the PSA level of less than 2 ng/mL confers CSS benefits in patients with localized or locally advanced PCa previously treated with RP.
Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres from Poland
Authors: Brzozowski Marcin , Krukowska Żaneta , Galant Katarzyna , Jursa-Kulesza Joanna , Kosik-Bogacka Danuta Izabela
Published: March 2020

Background: Pseudomonas aeruginosa is a Gram-negative bacillus responsible for infections in immunocompromised patients and is one of the most common causes of nosocomial infections particularly in intensive care and burn units. We aimed to investigate the population structure of P. aeruginosa strains isolated from patients at different hospital wards. Methods: We analysed a possible presence of P. aeruginosa epidemic or endemic strains in hospitals of the selected region. A genotyping analysis was performed for 202 P. aeruginosa isolates collected from patients of eleven hospitals in north-western Poland. Collections of P. aeruginosa were genotyped using pulsed-field gel electrophoresis (PFGE). Phenotypic screening for antibiotic susceptibility was performed for the common antimicrobial agents.Results: All P. aeruginosa isolates were distributed among 116 different pulsotype groups. We identified 30 groups of clonally related strains, each containing from 2 to 17 isolates. Typed the obtained 13 unique patterns, designated as A, D, J, K, M, N, Ó, P, T, X, AC, AD, and AH. The two largest clusters, D and E, contained 17 and 13 isolates, respectively. Strains of those groups were continuously isolated from patients at intensive care units and burn units, indicating transmission of those strains. Conclusions: In this study, we demonstrate the clonal relatedness of P. aeruginosa strains and their constant exchange in hospitals over a period of 15 months. The obtained results indicate a predominantly non-clonal structure of P. aeruginosa.