bluuebunny/crossref_metadata_2025 huggingface dataset:
PGRMC1 phosphorylation affects cell shape, motility, glycolysis, mitochondrial form and function, and tumor growth
Authors: Thejer Bashar M. , Adhikary Partho P. , Kaur Amandeep , Teakel Sarah L. , Oosterum Ashleigh Van , Seth Ishith , Pajic Marina , Hannan Katherine M. , Pavy Megan , Poh Perlita , Jazayeri Jalal A , Zaw Thiri , Pascovici Dana , Ludescher Marina , Pawlak Michael , Cassano Juan C. , Turnbull Lynne , Jazayeri Mitra , James Alexander C. , Coorey Craig P. , Roberts Tara L. , Kinder Simon J. , Hannan Ross D. , Patrick Ellis , Molloy Mark P. , J. Elizabeth , Fehm Tanja N. , Neubauer Hans , Goldys Ewa M. , Weston Leslie A. , CAHILL Michael
Published: March 2020

Background: Progesterone Receptor Membrane Component 1 (PGRMC1) is expressed in many cancer cells, where it is associated with detrimental patient outcomes. It contains phosphorylated tyrosines which evolutionarily preceded deuterostome gastrulation and tissue differentiation mechanisms. Results: We demonstrate that manipulating PGRMC1 phosphorylation status in MIA PaCa-2 (MP) cells imposes broad pleiotropic effects. Relative to parental cells over-expressing hemagglutinin-tagged wild-type (WT) PGRMC1-HA, cells expressing a PGRMC1-HA-S57A/S181A double mutant (DM) exhibited reduced levels of proteins involved in energy metabolism and mitochondrial function, and altered glucose metabolism suggesting modulation of the Warburg effect. This was associated with increased PI3K/Akt activity, altered cell shape, actin cytoskeleton, motility, and mitochondrial properties. An S57A/Y180F/S181A triple mutant (TM) indicated the involvement of Y180 in PI3K/Akt activation. Mutation of Y180F strongly attenuated subcutaneous xenograft tumor growth in NOD-SCID gamma mice. Elsewhere we demonstrate altered metabolism, mutation incidence, and epigenetic status in these cells. Conclusions: Altogether, these results indicate that mutational manipulation of PGRMC1 phosphorylation status exerts broad pleiotropic effects relevant to cancer and other cell biology.
Therapeutic effect of acetabular fractures using the Pararectus approach combined with 3D printing technique
Authors: Zou Ruyi , Wu Min , Guan Jianzhong , Xiao Yuzhou , Chen Xiaotian
Published: March 2020

Objective: To explore the clinical efficacy of pararectus approach combined with 3D printing technique for the surgical treatment of partial acetabular fractures.Methods: We retrospectively evaluated 33 (20 males and 13 females) patients with acetabular fractures in the period of June 2017 to December 2018; According to judet-letenneal classification: 11 cases were of anterior column fracture, 10 cases were of double column fracture, 7 fractures were of the anterior column with posterior half transverse,3 fractures were of transverse fracture, and 2 case was of "T" fracture. For all cases, 3D printing is used to print the acetabular model. Pre-bent reconstruction plates from the model were placed to fixate fractures via the pararectus approach. Results : Thirty-three patients were followed up for 12-18 months (average,14 months); two patients (6.0%) developed postoperative ossifying myositis, and there are no obvious symptoms at present; One patient (3.0%) developed postoperative wound infection, and the wound completely improved by secretion culture, enhanced dressing and effective antibiotics; All the acetabular fractures united after 12 to 16 weeks(average,13 weeks);According to the modified Merle d’Aubigne and Postel scoring system to assess the hip function: excellent in 22 cases (66.7%), good in 7 cases(21.2%) and fair in 4 cases(12.1%).Conclusions: In the treatment of partial acetabular fractures, the pararectus approach combined with 3D printing technique can achieve effective reduction and fixation, decrease intraoperative hemorrhage, shorten operation time and the internal fixation position can be properly adjusted during the operation by looking directly at the model.
The association of dry eye syndrome and psychiatric disorders: a nationwide population-based cohort study
Authors: Liang Chiao-Ying , Cheang Wai-Man , Wang Chun-Yuan , Lin Keng-Hung , Wei Li-Chen , Chen Yu-Yen , Shen Ying-Cheng
Published: March 2020

Background Several previous studies reported a greater prevalence of dry eye syndrome (DES) among patients with psychiatric diseases. The aim of this study is to investigate the prevalence and risk factors of DES in patients with psychiatric disorders (PD) using nationwide population-based data in Taiwan. Methods This population-based cohort study retrospectively identified patients with PD from 1997 to 2011. Patients with both PD and DES served as the DES cohort, and PD patients without DES comprised the non-DES cohort. PD was defined as a diagnosis of PD (ICD-9-CM 290-319) made by psychiatrists only, with at least three consecutive outpatient visits or at least one inpatient visit. DES was defined as a diagnosis of DES (ICD-9-CM 375.15) and a prescription for an eye lubricant (anatomical therapeutic chemical code, ATC code: S01XA). The main outcome measures were the prevalence of DES in these patients and associated risk factors. Results A total of 75,650 patients with PD (3,665 in the DES cohort and 71,985 in the non-DES cohort) were included in the final analysis. The majority of patients in the DES group were women (72.6%), compared the non-DES group (57.8%). The mean age of patients in the DES cohort was 62.2 ± 14.9, which was significantly older than those in the non-DES group (50.9 ± 17.5). The patients with DES had a significantly greater likelihood of having dementia, bipolar disorder, depression, and neurotic disorders. Conditional regression analyses revealed that patients with dry eye disease were more likely to have schizophrenia (OR = 1.34), bipolar disorder (OR = 1.9), depression (OR = 1.54), and neurotic disorders (OR = 1.62). In addition, patients with DES were more likely to use 1st generation anti-psychotics (OR=1.28) and had a lower risk of using 2 nd generation anti-psychotics (OR=0.64) Conclusion The study demonstrated that among PD patients, DES is highly prevalence in certain subtypes of PD, such as depression, bipolar disorder, and neurotic disorders, after adjusting for the comorbidities.
A Bespoke Sexual Health Promotion Intervention for People with Serious Mental Illness in Community Mental Health Services in the UK Compared with Treatment as Usual: the RESPECT Feasibility Randomised Controlled trial
Authors: Hughes Elizabeth , Mitchell Natasha , Gascoyne Samantha , Byrne Thirimon , Edmondson Amanda , Coleman Elizabeth , Millett Lottie , Ali Shehzad , Cournos Francine , Dare Ceri , Hewitt Catherine , Johnson Sonia , Kaur Harminder Dosanjh , McKinnon Karen , Mercer Catherine , Nolan Fiona , Walker Charlotte , Wainberg Milton , Watson Jude
Published: March 2020

BackgroundPeople with serious mental illness (SMI) have sexual health needs but there is little evidence to inform effective interventions to address them. In fact, there are few studies that have addressed this topic for people with SMI outside USA and Brazil. Therefore, the aim of the study was to establish the acceptability and feasibility of a trial of a sexual health promotion intervention for people with SMI in the UK.MethodThe RESPECT study was a two-armed randomised controlled, open feasibility study comparing Sexual health promotion intervention (3 individual sessions of 1 hour) (I) or usual care (UC) for adults aged 18 or over, with SMI, within community mental health services in four UK cities. The main outcome of interest was the percentage who consented to participate, and retained in each arm of the trial, retention for the intervention, and completeness of data collection. A nested qualitative study obtained the views of participants regarding the acceptability of the study using individual telephone interviews conducted by lived experience researchers. ResultsOf a target sample of 100, a total of 72 people were enrolled in the trial over 12 months. Recruitment in the initial months was low and so an extension was granted. However this extension meant that the later recruited participants would only be followed up to the 3 month point. There was good retention in the intervention and the study as a whole; 77.8% of those allocated to intervention (n=28) received it. At three months, 81.9% (30 I; 29 UC) and at 6 months, 76.3% (13 I and 16 UC) completed the follow-up interviews. No adverse events were reported. There was good completeness of the data. The sexual health outcomes for the intervention group changed in favour of the intervention. Based on analysis of the qualitative interviews, the methods of recruitment, the quality of the participant information, the data collection, and the intervention were deemed to be acceptable to the participants (n=22). ConclusionsThe target of 100 participants was not achieved within the study’s timescale. However, effective strategies were identified that improved recruitment in the final few months. Retention rates and completeness of data in both groups indicate that it is acceptable and feasible to undertake a study promoting sexual health for people with SMI. A fully powered RCT is required to establish effectiveness of the intervention in adoption of safer sex.
Cessation of nucleos(t)ide analogues therapy in chronic hepatitis B: a systematic review and meta-analysis
Authors: Xie Yandi , Jin Rui , Song Guangjun , Ma Hui , Feng Bo
Published: March 2020

Background To address the possibility of safe cessation of nucleos(t)ide analogues (NAs) therapy in chronic hepatitis B (CHB) and to identify factors associated with off-NAs virological relapse (VR). Methods A published work search was performed to identify all published studies including patients who ceased NAs and were followed for ≥12 months. A meta-analysis was performed. Results Twenty-six studies involving 2573 patients who discontinued NAs were included. The pooled rate of off-NAs VR was 0.63, being lower in initially hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients (0.57 versus 0.62, P = 0.732). The pooled rates of VR were 0.47, 0.55, 0.61, 0.51, 0.73 and 0.64 at 6, 12, 24, 36, 48 and 60 months after NAs cessation, respectively, being relatively lower in initially HBeAg–positive (0.31, 0.45, 0.55, 0.44, 0.48, 0.52) than HBeAg-negative patients (0.50, 0.55, 0.69, 0.57, 0.53, 0.68) (P = 0.405). The pooled rate of biochemical relapse was 0.44, being lower in initially HBeAg-positive than HBeAg-negative patients (0.43 versus 0.48, P = 0.554). The pooled rates of hepatitis B surface antigen loss and seroconversion was 0.09 and 0.06, respectively. The pooled rates of VR at 12 months after NAs cessation were significant different between duration of on-NAs virological response ≤24 months and >24 months in all patients (0.55 versus 0.41, P = 0.011), initially HBeAg-positive patients (0.59 versus 0.41, P = 0.031), and initially HBeAg-negative patients (0.53 versus 0.37, P = 0.025). Conclusions Safe cessation of NAs therapy seems to be feasible in a substantial proportion of CHB patients. On-NAs virological response >24 months reduces the risk of off-NAs VR. Stopping NAs treatment may have an impact on long-term HBsAg decline and also HBsAg clearance.
Measurement of drug concentration and bacterial contamination after diluting morphine for intrathecal administration: an experimental study
Authors: Teunissen Aart Jan W. , Koning Mark V , Ruijgrok Elisabeth J , Liefers Willem J , Bruijn Bart J , Koopman Seppe A
Published: March 2020

Background: We did this study to analyse the risks posed by manual diluted morphine solutions intended for intrathecal use. Dilution of morphine is needed to achieve low concentrations for intrathecal injection. Dilution poses the risk of dilution errors and bacterial contamination. The primary goal was to compare the concentrations of morphine and bupivacaine between four groups of syringes. The secondary goal was to investigate the difference in contamination rate between these groups. Methods: 25 experienced anaesthesia providers were asked to prepare a mixture of bupivacaine 2.0 mg/ml and morphine 60 µg/ml using 3 different methods as clean and precise as possible. The fourth method used was the aspiration of ampoules prepared by the pharmacy. The concentrations of morphine and bupivacaine were measured by High-Pressure Liquid Chromatography (HPLC). The medication was cultured for bacterial contamination. Results: Group 1 (60 µg/ml; 95% CI: 59-110 µg/ml) yielded 3 outliers above 180 µg/ml morphine concentration. Group 2 (76 µg/ml; 95% CI: 72-80 µg/ml) and 3 (69 µg/ml; 95% CI: 66-71 µg/ml) were consistently higher than the target concentration of 60 µg. The group “pharmacy” was precise and accurate (59 µg/ml; 95% CI: 59-59 µg/ml). Two groups had one contaminated sample with a spore-forming aerobic gram-positive rod. Conclusion: Manually diluted morphine is at risk for deviating concentrations, which could lead to increased side-effects. Medication produced by the hospital pharmacy was highly accurate. Furthermore, even when precautions are undertaken, contamination of the medication is a serious risk and appeared to be unrelated to the dilution process. Trial registration: Not applicable
Occupational pesticide exposure and the risk of death in patients with Parkinson’s disease: an observational study in Southern Brazil.
Authors: Medeiros Márcio Schneider , Reddy Sumanth P. , Socal Mariana P. , Schumacher-Schuh Artur Francisco , Rieder Carlos Roberto de Mello
Published: March 2020

Background Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil, when accounting for socioeconomic status, nicotine exposure, and caffeine exposure. Methods 150 patients with idiopathic PD were enrolled from 2008-2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures. Results Twenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.22). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history and another which included several measures of socioeconomic status. Conclusion In this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality.
The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China
Authors: Tan Lishan , Chen Li , Li Lingyan , Wang Jinwei , Huang Xiaoyan , Luo Qiong , Yang Li , Xiong Zuying
Published: March 2020

Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.
The effect of natural materials using as sediment remediation on phosphorus and nitrogen control in a mesocosm
Authors: Tang Mengjuan , Deng Qinghui , Li Xiaowen , Cao Xiuyun , Zhang Zhimin , Zhou Yiyong , Sun Qingye , Song Chunlei
Published: March 2020

Background Nitrogen (N) and phosphorus (P) control in sediment remediation through adding natural material has been paid more and more attention. In this study, different natural material including iron-rich clay mineral, calcite, kaoline, sugarcane bagasse and Phragmites detritus was applied to test the effect on N and P control in a mesocosm experiment. Results Iron-rich clay mineral and Phragmites detritus had an obvious advantage on P control in terms of almost undetectable soluble reactive phosphorus (SRP) in water column throughout the experiment, which could be explained by strong P adsorption ability. The high available organic carbon in sediment and water column after sugarcane bagasse addition provided enough electron donors for denitrification and dissimilatory nitrate reduction to ammonium (DNRA), which was responsible for nitrate (NO 3 - -N) deficiency and ammonium (NH 4 + -N) accumulation in water column. Also this resulted in anaerobic status, further fuelling P release from iron-bound P induced by anoxia. Thus, sugarcane bagasse application should be considered its dosage in order to balance the denitrification and DNRA as well as P release. Calcite and Phragmites detritus should be recommended as remediation material for N removal according to the significant promotion of denitrification and limitation of DNRA, finally resulting in low NO 3 - -N and NH 4 + -N. These results could be explained by the shift of functional microbial community composition and abundance after natural material addition. Conclusions Iron-rich clay mineral and Phragmites detritus should be regarded as the promising sediment remediation material for P immobilization due to the increase of P adsorption ability. Taken together, the selection of sediment remediation material should combine the N and P coupling relationship, avoiding that NO 3 - -N removal caused the P leaching or NH 4 + -N accumulation.
Association between post-operative complications and investigations costs during the acute hospital stay following total hip or knee arthroplasty
Authors: Cheng Emma Tsz Lou , Lewin Adriane , Churches Tim , Harris Ian , Naylor Justine
Published: March 2020

Background Total hip and total knee arthroplasties are among the most common types of surgery performed in Australia today and are effective treatments for severe osteoarthritis. However, the increasing financial burden on the health system owing to the increasing rates of surgery has led to a growing interest in improving the cost-effectiveness and safety of arthroplasty care. This study was designed to examine the association between post-operative complications, a major cost driver, and the cost of investigations following total hip or knee arthroplasty. Methods This is a prospective cohort study of consecutive patients undergoing primary total hip or knee arthroplasty at an Australian public hospital. We measured the number and cost of imaging and pathology tests performed during the acute hospital stay and used linear regression to examine the association between complication status and investigations costs. Results 500 patients were included in the analysis. On average, those with complications received more tests, and more expensive tests. The mean combined cost of imaging and pathology tests in patients with no complications was AU$ 187 (SD: 12.0). In comparison, patients with minor complications had a mean additional cost of AU$ 270 (SD: 31.0), and those with major complications had a mean additional cost of AU$ 493 (SD: 54.2) (p<0.001). Conclusions In patients undergoing hip or knee arthroplasty, investigation costs are substantially greater in the presence of either minor or major complications. With growing volumes of total hip and total hip arthroplasties, a potential focus of future research could include optimising investigation practices for patients with and without complications.
Barriers to accessing health-care services: A qualitative study of migrant construction workers in a Southwestern Indian city
Authors: Santalahti Maija , Sumit Kumar , Perkiö Mikko
Published: March 2020

Background: This study examined access to health care in an occupational context in an urban city of India. Many people migrate from rural areas to cities, often across Indian states, for employment prospects. The purpose of the study is to explore the barriers to accessing health care among a vulnerable group – internal migrants working in the construction sector in Manipal, Karnataka. Understanding the lay workers’ accounts of access to health service can help to comprehend the diversity of factors that hinder access to health care. Methods: Individual semi-structured interviews involving 15 migrant construction workers were conducted. The study applied theory-guided content analysis to investigate access to health services among the construction workers. The adductive analysis combined deductive and inductive approaches with the aim of verifying the existing barrier theory in a vulnerable context and further developing the health-care access barrier theory. Results: This study’s result is a revised version of the health-care access barriers model, including the dimension of trust. Three known health-care access barriers – financial, cognitive and structural, as well as the new barrier (distrust in public health-care services), were identified among migrant construction workers in a city context in Karnataka, India.Conclusions: Further qualitative research on vulnerable groups would produce a more comprehensive account of access to health care. The socioeconomic status behind access to health care, as well as distrust in public health services, forms focal challenges for any policymaker hoping to improve health services to match people’s needs.
Predictors of risk of financial hardship and coping with computed tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study.
Authors: Tambe Joshua , Mbuagbaw Lawrence , Ongolo-Zogo Pierre , Nguefack-Tsague Georges , Edjua Andrew , Mbome-Njie Victor , Minkande Jacqueline Ze
Published: March 2020

Background Computed tomography (CT) is still fairly expensive in Cameroon and is mainly accessed through out-of-pocket (OOP) payments. Its introduction to peripheral health facilities in communities where many live below the poverty line and do not have financial risk protection is a laudable effort though current price listings suggest a mismatch with the purchasing power of potential users. Risk of financial hardship after CT use is an expected reality and we sought to determine predisposing factors and elaborate on how users adapt and cope. Methods We carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by an in-depth interview of some purposively selected participants who reported risk of financial hardship after CT use. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Themes emerging from the in-depth interviews were categorized. Quantitative and qualitative data were integrated. Results A total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59%-68%) and the top three indications were suspected stroke (27% [95%CI: 22%-32%]), trauma (14% [95%CI: 10%-18%]) and persistent headaches with blurred vision (14% [95%CI: 10%-18%]). Seventy-two percent (95%CI: 67%-76%) of respondents declared being at risk of financial hardship after CT use and predictors in the multivariable analysis were low socioeconomic status (aOR: 0.19 [95%CI: 0.10-0.38]; p<0.001) and not having any form of financial risk protection (aOR: 3.59 [95%CI: 1.31-9.85]; p=0.013). Coping strategies included relying on family members and friends for financial assistance, lobbying hospital administration, social services and healthcare staff for a reduction of the direct cost, and borrowing of money. Conclusion The risk of financial hardship is a real threat to CT utilization and some users resort to different practices to minimize the burden of OOP payments. Opportunities to improve CT affordability should be enhanced to reduce this burden and the negative consequences of the coping strategies.
Validation of an e-health readiness assessment framework for developing countries
Authors: Mauco Kabelo Leonard , Scott Richard E , Mars Maurice
Published: March 2020

Background Studies document e-health as having potential to improve quality of healthcare services, resulting in both developed and developing countries demonstrating continued interest in e-health uptake and use. e-Health implementations are not always successful as high failure rates have been reported in both developed and developing countries. These failures are often a result of lack of e-health readiness. e-Health readiness has been defined as the preparedness of healthcare institutions or communities for the anticipated change brought by programs related to information and communication technologies. As such it is critical to conduct an e-health readiness assessment prior to implementation of e-health innovations so as to reduce chances of project failure. Noting the absence of an adequate e-health readiness assessment framework (eHRAF) suitable for use in developing countries, the authors conceptualised, designed, and created a developing country specific eHRAF to aid in e-health policy planning. The aim of this study was to validate the developed eHRAF and to determine if it required further refinement before empirical testing. Methods Published options for a framework validation process were adopted, and fifteen globally located e-health experts engaged. Botswana experts were engaged using saturation sampling, while international experts were purposively selected. Responses were collated in an Excel spreadsheet, and NVivo 11 software used to aid thematic analysis of the open ended questions. Results Analysis of responses showed overall support for the content and format of the proposed eHRAF. Equivocal responses to some open ended questions were recorded, most of which suggested modifications to terms within the framework. One expert from the developed world had alternate views. Conclusions The proposed eHRAF provides guidance for e-health policy development and planning by identifying, in an evidence based manner, the major areas to be considered when preparing for an e-health readiness assessment in the context of developing countries.
The cumulative duration of bispectral index less than 40 concurrent with hypotension is associated with 90-day postoperative mortality: a retrospective study
Authors: Yoon Soohyuk , Yoo Seokha , Hur Min , Park Sun-Kyung , Lee Hyung-Chul , Jung Chul-Woo , Bahk Jae-Hyon , Kim Jin-Tae
Published: March 2020

Background The relationship between intraoperative low bispectral index (BIS) values and poor clinical outcomes has been controversial. Intraoperative hypotension is associated with postoperative complication. The purpose of this study was to investigate the influence of intraoperative low BIS values and hypotension on postoperative mortality in patients undergoing major abdominal surgery. Methods This retrospective study analyzed 1,862 cases of general anesthesia. We collected the cumulative time of BIS values below 20 and 40 as well as electroencephalographic suppression and documented the incidences in which these states were maintained for at least 5 minutes. Durations of intraoperative mean arterial pressures (MAP) less than 50 mmHg were also recorded. Multivariable logistic regression was used to evaluate the association between suspected risk factors and postoperative mortality. Results Ninety-day mortality and 180-day mortality were 1.5% and 3.2% respectively. The cumulative time in minutes for BIS values falling below 40 coupled with MAP falling below 50 mmHg was associated with 90-day mortality (odds ratio, 1.26; 95% confidence interval, 1.04-1.53; P = .019). We found no association between BIS related values and 180-day mortality. Conclusions Delicate adjustment of anesthetic depth is important to avoid excessive brain suppression and hypotension, which could be associated with postoperative mortality.
Disinfectant Wipes with Nonsporicidal Claims Transfer Clostridioides difficile Spores from Contaminated Surfaces to Uncontaminated Surfaces during the Disinfection Process
Authors: Nkemngong Carine A. , Chaggar Gurpreet K. , Li Xiaobao , Teska Peter J. , Oliver Haley F
Published: March 2020

Background: Pre-wetted disinfectant wipes are increasingly being used in healthcare facilities to help address the risk of healthcare associated infections (HAI). However, HAIs are still a major problem in the US with Clostridioides difficile being the most common cause, leading to approximately 12,800 deaths annually in the US. An underexplored risk when using disinfectant wipes is that they may cross-contaminate uncontaminated surfaces during the wiping process. The objective of this study was to determine the cross-contamination risk that pre-wetted disinfectant towelettes may pose when challenged with C. difficile spores. We hypothesized that although the tested disinfectant wipes had no sporicidal claims, they will reduce spore loads. We also hypothesized that hydrogen peroxide disinfectant towelettes would present a lower cross-contamination risk than quaternary ammonium products. Methods: We evaluated the risk of cross-contamination when disinfectant wipes are challenged with C. difficile ATCC 43598 spores on Formica surfaces. A disinfectant wipe was used to wipe a Formica sheet inoculated with C. difficile. After the wiping process, we determined log10 CFU on previously uncontaminated pre-determined distances from the inoculation point and on the used wipes. Results: We found that the disinfectant wipes transferred C. difficile spores from inoculated surfaces to previously uncontaminated surfaces. We also found that wipes physically removed C. difficile spores and that hydrogen peroxide disinfectants were more sporicidal than the quaternary ammonium disinfectants. Conclusion: Regardless of the product type, all disinfectant wipes had some sporicidal effect but transferred C. difficile spores from contaminated to otherwise previously uncontaminated surfaces. Disinfectant wipes retain C. difficile spores during and after the wiping process.
Differential Influences of Social Support on App Use for Diabetes Self-Management – a Mixed Methods Approach
Authors: Brew-Sam Nicola , Chib Arul , Rossmann Constanze
Published: March 2020

Background The impact of social support on diabetes management and health outcomes has been investigated comprehensively, with recent studies examining social support delivered via digital technologies. This paper argues that social support has an impact on the use of diabetes technologies. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management.Methods This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N= 21, Study 1) and an online survey (N= 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory.Results The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on the medical specialty of attending physicians. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the specialty of the physician significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). In addition, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with lower family/friend support increasing the likelihood of app use.Conclusion The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from existing literature. In particular, we found that the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and that use of diabetes apps may decrease when support is high (e.g., no perceived need to use technology). Implications for practice are discussed.
Small extracellular vesicles derived from mesenchymal stromal cells mitigate intestinal toxicity in a mouse model of acute radiation syndrome.
Authors: Accarie Alison , L'homme Bruno , Benadjaoud Mohamedamine , Lim Sai Kiang , Guha Chadan , Benderitter Marc , Tamarat Radia , SEMONT Alexandra
Published: March 2020

Background: Human exposure to high doses of radiation resulting in acute radiation syndrome and death could rapidly escalate to a mass casualty catastrophe in the event of nuclear accidents or terrorism. The primary reason is that there is presently no effective treatment option, especially for radiation-induced gastrointestinal syndrome. This syndrome results from disruption of mucosal barrier integrity leading to severe dehydration, blood loss and sepsis. In this study, we tested whether small extracellular vesicles/exosomes derived from mesenchymal stromal cells (MSC) could reduce radiation-related mucosal barrier damage and reduce radiation-induced animal mortality. Methods: Human MSC-derived small extracellular vesicles/exosomes were intravenously administered to NUDE mice, 3, 24 and 48 hours after lethal whole-body irradiation (10 Gy). Integrity of the small intestine epithelial barrier was assessed by morphologic analysis, immunostaining for tight junction protein (claudin-3) and in vivo permeability to 4 kDa FITC-labeled dextran. Renewal of small intestinal epithelium was determined by the quantification of epithelial cell apoptosis (TUNEL staining) and proliferation (Ki67 immunostaining). Statistical analyses were performed using one-way ANOVA followed by a Tukey test. Statistical analyses of mouse survival were performed using the methods of Kaplan-Meier and Cox. Results: We demonstrated that MSC-derived small extracellular vesicles/exosomes treatment reduced by 85% the instantaneous mortality risk in mice subjected to 10 Gy whole-body irradiation and thus increased their survival time. This effect could be attributed to the efficacy of MSC-derived small extracellular vesicles/exosomes in reducing mucosal barrier disruption. We showed that MSC-derived small extracellular vesicles/exosomes improved renewal of the small intestinal epithelium by stimulating proliferation and inhibiting apoptosis of the epithelial crypt cells. MSC-derived small extracellular vesicles/exosomes also reduced radiation-induced mucosal permeability as evidenced by the preservation of claudin-3 immunostaining at the tight junctions of the epithelium. Conclusions: MSC-derived small extracellular vesicles/exosomes promote epithelial repair and regeneration and preserve structural integrity of the intestinal epithelium in mice exposed to radiation-induced gastrointestinal toxicity. Our results suggest that the administration of MSC-derived small extracellular vesicles/exosomes could be a treatment modality to limit acute radiation syndrome.
LncRNA H19 Promotes Odontoblastic Differentiation of Human Dental Pulp Stem Cells by Regulating miR-140-5p and BMP-2/FGF9
Authors: Zhong Jialin , Tu Xinran , Kong Yuanyuan , Guo Liyang , Li Baishun , Zhong Wenchao , Cheng Ying , Jiang Yiguo , Jiang Qianzhou
Published: March 2020

Background: Increasing evidence has revealed that long non-coding RNAs (lncRNAs) exert critical roles in biological mineralization. As a critical process for dentin formation, odontoblastic differentiation is regulated by complex signaling networks. The present study aimed to investigate the biological role and regulatory mechanisms of lncRNA-H19 (H19) in regulating the odontoblastic differentiation of human dental pulp stem cells (hDPSCs). Methods: We performed lncRNA microarray assay to reveal the expression patterns of lncRNAs involved in odontoblastic differentiation. H19 was identified and verified by qRT-PCR. The gain- and loss-of-function studies were performed to investigate the biological role of H19 in regulating odontoblastic differentiation of hDPSCs in vitro and in vivo. Odontoblastic differentiation was evaluated through qRT-PCR, Western blot and Alizarin Red S staining. Bioinformatics analysis identified that H19 could directly interact with miR-140-5p, which was further verified by luciferase reporter assay. After overexpression of miR-140-5p in hDPSCs, odontoblastic differentiation was determined. Moreover, the potential target genes of miR-140-5p were investigated and the biological functions of BMP-2 and FGF9 in hDPSCs were verified. Co-transfection experiments were conducted to validate miR-140-5p was involved in H19-mediated odontoblastic differentiation in hDPSCs.Results: The expression of H19 was significantly up-regulated in hDPSCs undergoing odontoblastic differentiation. Overexpression of H19 stimulated odontoblastic differentiation in vitro and in vivo, whereas down-regulation of H19 revealed the opposite effect. H19 binds directly to miR-140-5p and overexpression of miR-140-5p inhibited odontoblastic differentiation of hDPSCs. H19 acted as a miR-140-5p sponge, resulting in regulated the expression of BMP-2 and FGF9. Overexpression of H19 abrogated the inhibitory effect of miR-140-5p on odontoblastic differentiation.Conclusion: Our data revealed that H19 plays a positive regulatory role in odontoblastic differentiation of hDPSCs through miR-140-5p/BMP-2/FGF9 axis, suggesting that H19 may be a stimulatory regulator of odontogenesis.
Dietary ω-3 fatty acids reduced atrial fibrillation vulnerability via attenuating myocardial endoplasmic reticulum stress and inflammation in a canine model of atrial fibrillation
Authors: Tu Tao , Li Biao , Li Xuping , Zhang Baojian , Xiao Yichao , Li Jiayi , Qin Fen , Liu Na , Sun Chao , Liu Qiming , Zhou Shenghua
Published: March 2020

Background: It is known that dietary consumption of ω-3 fatty acids is correlated with a reduced incidence of cardiovascular events. Here, we investigated the effect of dietary ω-3 fatty acids on atrial fibrillation (AF) vulnerability in a canine model of AF and explored the related mechanisms. Methods: 24 male beagle dogs (weight, 8-10 kg) were randomly divided into four groups: (a) sham-operated group (normal chow), (b) AF group ( AF with normal chow), (c) AF+FO (AF and chow supplemented with fish oil (FO, 0.6 g ω-3 PUFA/kg/day)), (d) FO (chow supplemented with FO). Daily oral administration FO was initiated 1 week before surgery and continued throughout the study period. Results: Dietary FO significantly reversed atrial electric remodeling post rapid atria pacing (RAP). FO treatment also attenuated the elevated levels of biomakers for ER stress (all P<0.05 vs. AF). RAP-induced upregulation of inflammation factors IL-1β, IL-6, TNF-α in LA were significantly attenuated by FO treatment (all p<0.05 vs. AF). In addition, Masson staining revealed increased interstitial fibrosis in LA was significantly reduced in AF+FO group as compared to AF group (P<0.01). FO treatment also alleviated RAP-induced myocardial apoptosis (p<0.05). Conclusions: Dietary ω-3 fatty acids reduced RAP-induced AF vulnerability, possibly via attenuating myocardial ER stress and inflammation in this canine model of AF.
Effectiveness of preoperative bath using Chloroxylenol antiseptic soap on the incidence of post emergency Cesarean section surgical site infection at Mbarara Regional Referral hospital, Uganda: a Randomized Controlled trial
Authors: Lukabwe Henry , Kajabwangu Rogers , Mugisha Dale , Kizito Horace , Munyanderu Baraka , Baluku Asanairi , Manyang Anthony , Lapat Jolly Joe , Banya Francis , Kayondo Musa , Mayanja Ronald , Muhumuza Joy , Bajunirwe Francis , Ngonzi Joseph
Published: March 2020

Introduction: Surgical Site Infections (SSIs) are infections that occur at or near the surgical incision within 30 days of the surgery. SSIs are the commonest form of hospital acquired infections in sub Saharan Africa with estimates between 15%-45%. Cesarean section (CS) is the single most important risk factor for postpartum infections, carrying a 5 to 20-fold increase in the risk of developing sepsis, with an even higher risk when the operation is an emergency. In sub Saharan Africa, the leading cause of maternal mortality is puerperal sepsis. There is a need for simple interventions that can reduce this burden of SSI in the limited resource settings. Therefore, the purpose of this study was to measure the effectiveness of chloroxylenol in reducing the incidence of post Cesarean section surgical site infections at Mbarara Regional Referral Hospital (MRRH).Methods: We conducted a single blinded randomized controlled trial at MRRH maternity ward in which women due for CS were randomized into either control or intervention arms. The intervention was a complete body bath with chloroxylenol antiseptic soap before the operation, while the control arm study participants received a standard pre-operative preparation procedures according to the existing ward protocol. All participants were followed up for 30 days and assessed using a standard SSI screening tool. Results: Ninety-six women were randomized, and 48 were assigned to either arm. The overall incidence of SSI was 30.21%. The incidence of SSI was significantly lower in the intervention compared to the control arm, at 6.25% in the intervention arm versus 54.17% in the control arm (p value<0.001). Chloroxylenol bath was protective of SSI with a 90% risk reduction for SSI (95% confidence interval of 67% – 97%). Conclusion: A preoperative bath with chloroxylenol for pregnant mothers is associated with a significantly lower risk of post Cesarean section surgical site infections. Health facilities with a high burden of post SSI should consider adding this simple and effective intervention to the existing infection prevention measures. Clinical Trials.gov registration (NCT03544710).
Use of 18F-FDG PET/CT to differentiate ectopic adrenocorticotropic hormone-secreting lung tumours from tumour-like pulmonary infections in patients with ectopic Cushing syndrome
Authors: Hou Guozhu , Jiang Yuanyuan , Li Fang , Cheng Xin
Published: March 2020

Purpose: Ectopic adrenocorticotropic hormone (ACTH)-secreting lung tumours represent the most common cause of ectopic Cushing syndrome (ECS). Pulmonary opportunistic infections are associated with ECS and occasionally difficult to differentiate from tumours by using computed tomography (CT) alone. The aim of the present study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (18F-FDG PET/CT) for differentiating ectopic ACTH-secreting lung tumours from tumour-like pulmonary infections in patients with ECS.Methods: We retrospectively reviewed the imaging data for 24 patients with ECS who were suspected to have ACTH-secreting lung tumours and underwent 18F-FDG PET/CT between 2008 and 2019.Results: In total, 18 patients had lung tumours (17 carcinoids and 1 small cell lung cancer) and six had pulmonary infections (cryptococcosis, n = 3; aspergillosis, n = 4; pulmonary abscess, n = 1). The primary source of ECS remained occult in the six patients with pulmonary infections. The maximum standardized uptake value (SUVmax) for pulmonary infections was significantly higher than that for tumours (P = 0.008). Receiver operating characteristic analysis was performed, and it was found that a cut-off SUVmax of 4.95 helped in differentiating lung tumours from infections with 75% sensitivity and 94.4% specificity. In subgroup analysis of 12 typical and five atypical carcinoids, there was no significant between-group difference with respect to SUVmax, the lesion size, the ACTH level, and the prevalence of regional lymph node metastasis.Conclusions: Our findings suggest that pulmonary infections exhibit significantly higher FDG uptake than do ACTH-secreting lung tumours in 18F-FDG PET/CT. Therefore, SUVmax (cut-off 4.95) may be useful for differentiating the two conditions. Typical and atypical ACTH-secreting lung carcinoids may show a similar clinical behaviour and appearance on 18F-FDG PET/CT.
CT findings of patients infected with SARS-CoV-2
Authors: Wang Xiaoyang , Liu Chenbin , Hong Liang , Yuan Cuiyun , Ding Jiguang , Jia Qing , Sun Gangqiang , Peng Wenxian , Sun Qingfeng
Published: March 2020

Objective: we aimed to describe the chest CT findings in sixty-seven patientsinfected by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Method and material: We retrospectively reviewed 67 patients hospitalized in Ruian People's Hospital. All the patients received the positive diagnosis of SARS-CoV-2 infection. The CT and clinical data were collected between January, 23 and February, 10, 2020. The CT images were analyzed by the radiologists.Conclusion: There are 54 patients with positive CT findings and 13 patients with negative CT findings. The common CT findings in hospitalized patients with SARS-CoV-2 infection were ground glass opacities (42/54), lesions located in the peripheral area (50/54), multiple lesions(46/54), and lesions located in the lower lobes (42/54). There were some less common CT findings: air bronchogram (n=18), pleural thickening or pleural effusion (14/54), consolidation (12/54), lesions in the upper lobes (12/54), interlobular septal thickening (11/54), reversed halo sign (9/54), single lesion (8/54), cavitaties (4/54), bronchial wall thickening (3/54), intrathoracic lymph node enlargement (2/54).