bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Effectiveness of Transvaginal Mesh Placement in Treating Pelvic Organ Prolapse
Authors: Chen Zeyu , Du Wensheng , Zhu Haitao
Published: November 2019

To observe the clinical effect and complications of transvaginal mesh (TVM) placement on treating pelvic organ prolapse (POP).Methods From May 2014 to June 2017, 89 patients with moderate to severe pelvic organ prolapse and pelvic floor defect (PFD) had received TVM pelvic reconstruction at our hospital. The operation time, intraoperative blood loss and intraoperative complications of all patients were recorded, and the incidence of postoperative complications was also observed. In addition, the POP-Q was utilized to evaluate the severity of POP in patients before surgery, as well as at 6 weeks, 6 months, 12 months and 24 months after surgery, respectively; besides, the Pelvic Floor Influence Questionnaire-7 (PFIQ-7), Pelvic Floor Dysfunction Inventory 20 (PFDI-20), and Patient Global Impression of Improvement (PGI-I) were adopted to evaluate the quality of life of patients.Results All the 89 cases had successfully completed the surgery, with the operation time of 60.0±13.0 min and the intraoperative blood loss of 57.2±21.9 mL. All patients had no bladder or rectal injury during the surgery. 2 patients displayed asymptomatic recurrence ,10 cases had postoperative fever, while 3 had mesh exposure, and all of them were improved after symptomatic treatment. Upon discharge, the lumbosacral and pubic discomfort, as well as pelvic organ dragging sensation had disappeared in all patients. In the final follow-up, the PFIQ-7 and PFDI-20 scores in the 89 cases were reduced compared with those before surgery (Ps<0.05).Conclusions TVM placement is effective on treating moderate to severe POP, which is associated with a lower complication rate and higher postoperative satisfaction.
Urinary angiotensinogen as a surrogate marker predicting the antiproteinuric effects of angiotensin receptor blockers in patients with overt proteinuria: a multicenter prospective study
Authors: Jeon Junseok , Kim Do Hee , Jang Hye Ryoun , Lee Jung Eun , Huh Wooseong , Kim Hye-Young , Kim Dae Joong , Kim Yoon-Goo
Published: November 2019

Although urinary angiotensinogen (AGT) and renin reflect intrarenal renin-angiotensin system activity and are enhanced in proteinuric chronic kidney disease, the clinical value of urinary AGT and renin levels during antiproteinuric treatment has yet to be determined. We investigated the clinical usefulness of initial urinary AGT or renin to determine the antiproteinuric effects of angiotensin receptor blockers (ARBs). Methods: This multicenter, prospective, single-arm study included 205 patients with overt proteinuria (urinary protein/creatinine ratio [uPCR] ≥ 1 mg/mg) enrolled between April 2009 and December 2011. All patients were treated with valsartan. The urinary AGT/creatinine ratio (uAGT/Cr) was measured at the baseline and 24 weeks, and the renin/creatinine ratio (uR/Cr) was measured at the baseline. Fifty-six patients were followed-up for 5 years. Results: The mean age was 47.6 years and 51.2% were male. The mean uPCR was 2.32 mg/mg and the mean eGFR was 63.2 mL/min/1.73m 2 . Natural logarithms (ln) (uAGT/Cr), ln(uR/Cr), and diabetes mellitus were associated with proteinuria decrement (decrease in uPCR ≥ 1 mg/mg). Ln(uAGT/Cr) was an independent predictor for proteinuria decrement (OR 1.372, 95% CI, 1.068–1.762, P = 0.013). Among the 56 patients followed-up for 5 years, Δln(uAGT/Cr) at 24 weeks was an independent predictor for uPCR < 1 mg/mg at 5 years (OR 0.379, 95% CI, 0.20–0.715, P = 0.003). Conclusions: Our study demonstrates the potential role of both baseline urinary AGT and changes in urinary AGT during the initial 24 weeks as surrogate markers predicting the antiproteinuric effects of ARBs in patients with overt proteinuria.
CUTseq is a versatile method for preparing multiplexed DNA sequencing libraries from low-input samples
Authors: Zhang Xiaolu , Garnerone Silvano , Simonetti Michele , Harbers Luuk , Nicoś Marcin , Mirzazadeh Reza , Venesio Tiziana , Sapino Anna , Hartman Johan , Marchiò Caterina , Bienko Magda , Crosetto Nicola
Published: November 2019

Current multiplexing strategies for massively parallel sequencing of genomic DNA mainly rely on library indexing in the final steps of library preparation. This procedure is costly and time-consuming because a single library must be produced separately for each sample. Furthermore, library preparation is challenging in the case of low-input fixed samples, such as DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissues. Here, we describe CUTseq, a method that uses restriction enzymes and in vitro transcription to barcode and amplify genomic DNA prior to library construction. We thoroughly validate CUTseq and demonstrate its applicability to both genome and exome sequencing, enabling multi-region genome profiling within single stained FFPE tissue sections, to assess intratumor heterogeneity at high spatial resolution. In conclusion, CUTseq is a versatile and cost-effective method for multiplexed DNA sequencing library preparation that can find numerous applications in research and diagnostics.
DNA methylation and miRNA-1296 act in concert to mediate spatiotemporal expression of KPNA7 during bovine oocyte and early embryonic development
Authors: Wang Lei , Hand Jacqelyn M. , Fu Liyuan , Smith George W. , Yao Jianbo
Published: November 2019

Background Epigenetic regulation of oocyte-specific maternal factors is essential for oocyte and early embryonic development. KPNA7 is an oocyte-specific maternal factor, which controls transportation of nuclear proteins important for early embryonic development. To elucidate the epigenetic mechanisms involved in the controlled expression of KPNA7, both DNA methylation associated transcriptional silencing and miRNA-mediated mRNA degradation of KPNA7 were examined. Results Comparison of DNA methylation profiles at the proximal promoter of KPNA7 gene between oocyte and 6 different somatic tissues identified 3 oocyte-specific differentially methylated CpG sites. Expression of KPNA7 mRNA was reintroduced in bovine kidney-derived CCL2 cells after treatment with the methylation inhibitor, 5-aza-2-deoxycytidine (5-Aza). Analysis of the promoter region of KPNA7 gene in CCL2 cells treated with 5-Aza showed a lighter methylation rate in all the CpG sites. Bioinformatic analysis predicted 4 miRNA-1296 binding sites in the coding region of KPNA7 mRNA. Ectopic co-expression of miRNA-1296 and KPNA7 in HEK293 cells led to reduced expression of KPNA7 protein. Quantitative real time PCR analysis revealed that miRNA-1296 is expressed in oocytes and early stage embryos, and the expression reaches a peak level in 8-cell stage embryos, coincident with the time of embryonic genome activation and the start of declining of KPNA7 expression. Conclusions These results suggest that DNA methylation may account for oocyte-specific expression of KPNA7, and miRNA-1296 targeting the coding region of KPNA7 is a potential mechanism for KPNA7 transcript degradation during the maternal-to-zygotic transition.
Electrochemical oxidation as a post treatment for biologically tannery wastewater in batch reactor
Authors: Le Luu Tran , Stephane Djeuga Djeuga Franck , Minh Nguyen Hoang , Canh Nguyen Duc , Thanh Bui Xuan
Published: November 2019

Tannery wastewater is known to contain high concentrations of organic compounds, heavy metals, nitrogen, sulphur, chromium, and many other chemicals. Both aerobic and anaerobic biological approaches have proven ineffective in the treatment of tannery wastewater due to the high salinity and toxic chemicals contained within the medium. Electrochemical oxidation presents a promising method for solving this problem. High pollutant removal efficiency, low energy consumption, and high electrode stability are three important factors supporting the feasibility of an efficient electrochemical treatment process. In the present study, electrochemical oxidation was performed as a post treatment for tannery wastewater (after biological pre-treatment) in a batch reactor using Ti/RuO2, Ti/IrO2, and Ti/BDD anodes. The effects of pH, current density, stirring rate and treatment time were studied to assess the treatment efficiency as well as the energy consumption of the process. The results showed that colour, chemical oxygen demand (COD), total organic carbon (TOC), and total nitrogen (TN) removal efficiencies on the electrodes were: Ti/RuO2 (88.8%, 88.40%, 64.0%, 96.4%), Ti/IrO2 (85.40%, 85.9%, 52.3%, 51.4%), Ti/BDD (90.60%, 94.7%, 90.5%, 82.7%) respectively, at a current density of 80 mA/cm2. All three electrodes demonstrated optimal performance at a pH of 8, a stirring rate of 400 rpm, a current density of 80 mA/cm2, and an electrolysis time of 5 h. The concentration of tri-chloromethane by-product was detected with limiting value. Electrochemical oxidation thus offers a feasible method for removing organic compounds and nutrients from tannery wastewater.
Purification, Biochemical Characterization and Decolorization Efficiency of Laccases from Peach and Cherry Cultures of Pleutorus eryngii: A Comparative Study
Authors: Akpinar Merve , Urek Raziye Ozturk
Published: November 2019

Background::

Laccases (Lacs) are used potentially in industrial and biotechnological
applications such as decolorization of dyes, degradation of industrial effluents, delignification, etc.
thanks to their large varieties of substrate specificities and excellent catalytic efficiencies. The
efficient utilizations of Lacs in these applications mostly depend on the identifying their
biochemical properties.

Objective:

The goal of this research is to investigate the purification, biochemical characterization
and decolorization efficiencies of Lacs.

Methods:

Pleurotus eryngii was incubated on peach (PC) and cherry (CC) wastes under optimized
solid state fermentation conditions. Then, the enzymes extracts were purified by ammonium sulfate
precipitation, anion exchange chromatography, gel filtration, respectively. Lacs fractions were
subjected to electrophoretic analyses as well as their structural and kinetic characteristics. Also, the
effects of selected chemical agents on purified Lacs activities and determination of decolorization
efficiencies were studied.

Results:

As the results of purification processes of Lacs from both cultures, 3.94-fold purification
was obtained for PC, while it was 5.34 for CC. The electrophoretic results of purified Lacs
illustrated the single bands of protein (30±1 kDa) in accordance with the results after gel filtration.
The Km values of Lacs from PC and CC were respectively detected as 1.1381 and 0.329 mM for
ABTS. The selected agents partially/completely inhibited Lac activities. The highest decolorization
efficiencies of purified Lacs from PC and CC were separately obtained as 53 and 11.8%.

Conclusion:

The results clearly indicated that the performances of Lacs from both cultures in
decolorization application are different from each other depending their activities, biochemical and
kinetic characteristics.
Genetic Signatures of Centenarians: Implications for Achieving Successful Aging
Authors: Caruso Calogero , Aiello Anna , Accardi Giulia , Ciaglia Elena , Cattaneo Monica , Puca Annibale
Published: November 2019

The extraordinary rise in the old population in the Western world underscores the importance of studies
on aging and longevity to decrease the medical, economic and social problems associated with the increased
number of non-autonomous individuals affected by invalidating pathologies. Centenarians have reached the extreme
limits of the human life span. They are the best example of extreme longevity, representing selected individuals
in which the appearance of major age-related diseases has been consistently delayed or avoided. There is
growing evidence that the genetic component of longevity becomes higher with survival at the age of over 90
years. For centenaries, it reaches up to 33% for women and 48% for men. Therefore, exceptional longevity is a
complex, hereditable trait that runs across generations. Longevity should correlate either with the presence of
protective alleles or the absence of detrimental alleles. The aim of this review is to discuss the possible attainment
of successful aging in the context of the lessons learned from centenarian genetics.
Wnt-β-catenin Signaling Pathway, the Achilles' Heels of Cancer Multidrug Resistance
Authors: Ghandadi Morteza , Valadan Reza , Mohammadi Hamidreza , Akhtari Javad , Khodashenas Shabanali , Ashari Sorour
Published: November 2019

Background:

Most of the anticancer chemotherapies are hampered via the development of multidrug resistance (MDR), which is the resistance of tumor cells against cytotoxic effects of multiple chemotherapeutic agents. Overexpression and/or over-activation of ATP-dependent drug efflux transporters is a key mechanism underlying MDR development. Moreover, enhancement of drug metabolism, changes in drug targets and aberrant activation of the main signaling pathways, including Wnt, Akt and NF-κB are also responsible for MDR.

Methods:

In this study, we have reviewed the roles of Wnt signaling in MDR as well as its potential therapeutic significance. Pubmed and Scopus have been searched using Wnt, β-catenin, cancer, MDR and multidrug resistance as keywords. The last search was done in March 2019. Manuscripts investigating the roles of Wnt signaling in MDR or studying the modulation of MDR through the inhibition of Wnt signaling have been involved in the study. The main focus of the manuscript is regulation of MDR related transporters by canonical Wnt signaling pathway.

Result and Conclusion:

Wnt signaling has been involved in several pathophysiological states, including carcinogenesis and embryonic development. Wnt signaling is linked to various aspects of MDR including P-glycoprotein and multidrug resistance protein 1 regulation through its canonical pathways. Aberrant activation of Wnt/β- catenin signaling leads to the induction of cancer MDR mainly through the overexpression and/or over-activation of MDR related transporters. Accordingly, Wnt/β-catenin signaling can be a potential target for modulating cancer MDR.
Pharmacokinetic Evaluation of 99mTc-radiolabeled Solid Lipid Nanoparticles and Chitosan Coated Solid Lipid Nanoparticles
Authors: Gharibkandi Nasrin Abbasi , Molavipordanjani Sajjad , Akbari Jafar , Hosseinimehr Seyed Jalal
Published: November 2019

Background:

Solid Lipid Nanoparticles (SLNs) possess unique in vivo features such as high resistivity,
bioavailability, and habitation at the target site. Coating nanoparticles with polymers such as chitosan greatly affects
their pharmacokinetic behavior, stability, tissue uptake, and controlled drug delivery. The aim of this study was to
prepare and evaluate the biodistribution of 99mTc-labeled SLNs and chitosan modified SLNs in mice.

Methods:

99mTc-oxine was prepared and utilized to radiolabel pre-papered SLNs or chitosan coated SLNs. After
purification of radiolabeled SLNs (99mTc-SLNs) and radiolabeled chitosan-coated SLNs (99mTc-Chi-SLNs) using
Amicon filter, they were injected into BALB/c mice to evaluate their biodistribution patterns. In addition, nanoparticles
were characterized using Transmission Electron Microscopy (TEM), Fourier-transform Infrared Spectroscopy
(FTIR), Differential Scanning Calorimetry (DSC), X-ray Powder Diffraction (XRD) and Dynamic Light Scattering
(DLS).

Results:

99mTc-oxine with high radiochemical purity (RCP~100%) and stability (RCP > 97% at 24 h) was used to
provide 99mTc-SLNs and 99mTc-Chi-SLNs with high initial RCP (100%). TEM image and DLS data suggest 99mTc-
SLNs susceptibility to aggregation. To that end, the main portion of 99mTc-SLNs radioactivity accumulates in the
liver and intestines, while 99mTc-Chi-SLNs sequesters in the liver, intestines and kidneys. The blood radioactivity of
99mTc-Chi-SLNs was higher than that of 99mTc-SLNs by 7.5, 3.17 and 3.5 folds at 1, 4 and 8 h post-injection. 99mTc-
Chi-SLNs uptake in the kidneys in comparison with 99mTc-SLNs was higher by 37.48, 5.84 and 11 folds at 1, 4 and
8h.

Conclusion:

The chitosan layer on the surface of 99mTc-Chi-SLNs reduces lipophilicity in comparison with 99mTc-
SLNs. Therefore, 99mTc-Chi-SLNs are less susceptible to aggregation, which leads to their lower liver uptake and
higher kidney uptake and blood concentration.
In-Vitro and In-Vivo Evaluation of Supersaturable Self-Nanoemulsifying Drug Delivery System (SNEDDS) of Dutasteride
Authors: Subramanian Poonguzhali , Rajnikanth P. S. , Kumar Manish , Chidambram Kumarappan
Published: November 2019

Objective:

A novel, Supersaturable Self-Nanoemulsifying Drug Delivery System (S-SNEDDS)
has been prepared to improve the Dutasteride's poor aqueous solubility.

Methods:

By adding Hydroxy Propyl Methyl Cellulose (HPMC) as a precipitation inhibitor to conventional
SNEDDS, a supersaturable system was prepared. Firstly, the prepared SNEDDS played an important
role in increasing the aqueous solubility and hence oral absorption due to nano-range size. Secondly,
the S-SNEDDS found to be advantageous over SNEDDS for having a higher drug load and inhibition
of dilution precipitation of Dutasteride. Formulated S-SNEDDS (F1-F9) ranged from 37.42 ±
1.02 to 68.92 ± 0.09 nm with PDI 0.219-0.34 and drug loading of over 95 percent.

Results:

The study of in-vitro dissolution revealed higher dissolution for S-SNEDDS compared to
SNEDDS and Avodart soft gelatin capsule as a commercial product. In addition, higher absorption was
observed for S-SNEDDS showing approximately 1.28 and 1.27 fold AUC (0-24h) and Cmax compared to
commercial products. Therefore, S-SNEDDS has proven as a novel drug delivery system with a higher
drug load, higher self-emulsification efficiency, higher stability, higher dissolution and pronounced
absorption.

Conclusion:

In conclusion, S-SNEDDS could be a new emerging approach to enhance aqueous solubility in many folds for drugs belonging to BCS Class II and IV and thus absorption and oral bioavailability.
In Silico Insights on GD2 : A Potential Target for Pediatric Neuroblastoma
Authors: Limaye Akanksha , Sweta Jajoriya , Madhavi Maddala , Mudgal Urvy , Mukherjee Sourav , Sharma Shreshtha , Hussain Tajamul , Nayarisseri Anuraj , Singh Sanjeev Kumar
Published: November 2019

Background:

Originating from the abnormal growth of neuroblasts, pediatric neuroblastoma affects the age group below 15 years. It is an aggressive heterogenous cancer with a high morbidity rate. Biological marker GD2 synthesised by the GD2 gene acts as a powerful predictor of neuroblastoma cells. GD2 gangliosides are sialic acid-containing glycosphingolipids. Differential expression during brain development governs the function of the GD2. The present study explains the interaction of the GD2 with its established inhibitors and discovers the compound having a high binding affinity against the target protein. Technically, during the development of new compounds through docking studies, the best drug among all pre-exist inhibitors was filtered. Hence in reference to the best docked compound, the study proceeded further.

Methodology:

The In silico approach provides a platform to determine and establish potential inhibitor against GD2 in Pediatric neuroblastoma. The 3D structure of GD2 protein was modelled by homology base fold methods using Smith-Watermans’ Local alignment. A total of 18 established potent compounds were subjected to molecular docking and Etoposide (CID: 36462) manifested the highest affinity. The similarity search presented 336 compounds similar to Etoposide.

Results:

Through virtual screening, the compound having PubChem ID 10254934 showed a better affinity towards GD2 than the established inhibitor. The comparative profiling of the two compounds based on various interactions such as H-bond interaction, aromatic interactions, electrostatic interactions and ADMET profiling and toxicity studies were performed using various computational tools.

Conclusion:

The docking separated the virtual screened drug (PubChemID: 10254934) from the established inhibitor with a better re-rank score of -136.33. The toxicity profile of the virtual screened drug was also lesser (less lethal) than the established drug. The virtual screened drug was observed to be bioavailable as it does not cross the blood-brain barrier. Conclusively, the virtual screened compound obtained in the present investigation is better than the established inhibitor and can be further augmented by In vitro analysis, pharmacodynamics and pharmacokinetic studies.
Herbal Medicine of the 21st Century: A Focus on the Chemistry, Pharmacokinetics and Toxicity of Five Widely Advocated Phytotherapies
Authors: Suroowan S. , Mahomoodally M.F.
Published: November 2019

Widely advocated for their health benefits worldwide, herbal medicines (HMs) have evolved into a billion dollar generating industry. Much is known regarding their wellness inducing properties, prophylactic and therapeutic benefits for the relief of both minor to chronic ailment conditions given their long-standing use among various cultures worldwide. On the other hand, their equally meaningful chemistry, pharmacokinetic profile in humans, interaction and toxicity profile have been poorly researched and documented. Consequently, this review is an attempt to highlight the health benefits, pharmacokinetics, interaction, and toxicity profile of five globally famous HMs. A systematic literature search was conducted by browsing major scientific databases such as Bentham Science, SciFinder, ScienceDirect, PubMed, Google Scholar and EBSCO to include 196 articles. In general, ginsenosides, glycyrrhizin and curcumin demonstrate low bioavailability when orally administered. Ginkgo biloba L. induces both CYP3A4 and CYP2C9 and alters the AUC and Cmax of conventional medications including midazolam, tolbutamide, lopinavir and nifedipine. Ginsenosides Re stimulates CYP2C9, decreasing the anticoagulant activity of warfarin. Camellia sinensis (L.) Kuntze increases the bioavailability of buspirone and is rich in vitamin K thereby inhibiting the activity of anticoagulant agents. Glycyrrhiza glabra L. displaces serum bound cardiovascular drugs such as diltiazem, nifedipine and verapamil. Herbal medicine can directly affect hepatocytes leading to hepatoxicity based on both intrinsic and extrinsic factors. The potentiation of the activity of concurrently administered conventional agents is potentially lethal especially if the drugs bear dangerous side effects and have a low therapeutic window.
Feasibility of Targeting Glioblastoma Stem Cells: From Concept to Clinical Trials
Authors: Tarasov Vadim V. , Svistunov Andrey A. , Chubarev Vladimir N. , Zatsepilova Tamara A. , Preferanskaya Nina G. , Stepanova Olga I. , Sokolov Alexander V. , Dostdar Samira A. , Minyaeva Nina N. , Neganova Margarita E. , Klochkov Sergey G. , Mikhaleva Liudmila M. , Somasundaram Siva G. , Kirkland Cecil E. , Aliev Gjumrakch
Published: November 2019

Objective:

Glioblastoma is a highly aggressive and invasive brain and Central Nervous System (CNS) tumor. Current treatment options do not prolong overall survival significantly because the disease is highly prone to relapse. Therefore, research to find new therapies is of paramount importance. It has been discovered that glioblastomas contain a population of cells with stem-like properties and that these cells are may be responsible for tumor recurrence.

Methods:

A review of relevant papers and clinical trials in the field was conducted. A PubMed search with related keywords was used to gather the data. For example, “glioblastoma stem cells AND WNT signaling” is an example used to find information on clinical trials using the database ClinicalTrials.gov.

Results:

Cancer stem cell research has several fundamental issues and uncertainties that should be taken into consideration. Theoretically, a number of treatment options that target glioblastoma stem cells are available for patients. However, only a few of them have obtained promising results in clinical trials. Several strategies are still under investigation.

Conclusion:

The majority of treatments to target cancer stem cells have failed during clinical trials. Taking into account a number of biases in the field and the number of unsuccessful investigations, the application of the cancer stem cells concept is questionable in clinical settings, at least with respect to glioblastoma.
TRPV1 Activation Prevents Renal Ischemia-Reperfusion Injury-Induced Increase in Salt Sensitivity by Suppressing Renal Sympathetic Nerve Activity
Authors: Yu Shuang-Quan , Ma Shuangtao , Wang Donna H.
Published: November 2019

Background:

Salt sensitivity is increased following renal Ischemia-Reperfusion (I/R)
injury. We tested the hypothesis that high salt intake induced increase in Renal Sympathetic Nerve
Activity (RSNA) after renal I/R can be prevented by activation of Transient Receptor Potential
Vanilloid 1 (TRPV1).

Methods:

Rats were fed a 0.4% NaCl diet for 5 weeks after renal I/R, followed by a 4% NaCl diet
for 4 more weeks in four groups: sham, I/R, I/R +High Dose Capsaicin (HDC), and I/R+Low Dose
Capsaicin (LDC). The low (1mg/kg) or high (100mg/kg) dose of capsaicin was injected subcutaneously
before I/R to activate or desensitize TRPV1, respectively.

Results:

Systolic blood pressure was gradually elevated after fed on a high-salt diet in the I/R and
I/R+HDC groups but not in the I/R+LDC group, with a greater increase in the I/R+HDC group.
Renal function was impaired in the I/R group and was further deteriorated in the I/R+HDC group
but was unchanged in the I/R+LDC group. At the end of high salt treatment, afferent renal nerve
activity in response to unilateral intra-pelvic administration of capsaicin was decreased in the I/R
group and was further suppressed in the I/R+HDC group but was unchanged in the I/R+LDC group.
RSNA in response to intrathecal administration of muscimol, a selective agonist of GABA-A receptors,
was augmented in the I/R group and further intensified in the I/R+HDC group but was unchanged
in the I/R+LDC group. Similarly, urinary norepinephrine levels were increased in the I/R
group and were further elevated in the I/R+HDC group but unchanged in the I/R+LDC group.

Conclusion:

These data suggest that TRPV1 activation prevents renal I/R injury-induced increase
in salt sensitivity by suppressing RSNA.
Prevalence and Resistance Profiles of Vancomycin-resistant Enterococcal Isolates in Iran; An Eight-month Report from Nine Major Cities
Authors: Armin Shahnaz , Zahedani Shahram Shahraki , Rahbar Mohammad , Azimi Leila
Published: November 2019

Background:

Enterococcal infections comprise a wide range of diseases with increasing
importance due to the growing frequency of health-care-associated infections and the increasing
incidence of antimicrobial resistance. Vancomycin-resistant Enterococcus (VRE) is an emerging
drug-resistant organism responsible for increasing numbers of nosocomial infections in both
adults and children. Few data are available on the epidemiology and impact of VRE infections in
Iranians. In the present study, attempts were made to evaluate the prevalence and molecular characterization
of VRE isolates from patients referred to several hospitals in Iran.

Materials and Methods:

Eight hundred and fourteen enterococcal clinical isolates from different
patients were selected for this cross-sectional study during June 2018 and February 2019. Antimicrobial
susceptibility testing was performed by standard methods according to the Clinical Laboratories
Standards Institute (CLSI) guidelines. The vanA and vanB genes in VRE isolates were
amplified by PCR.

Results:

Our findings indicated that 20.7% of the isolates were collected from hospitalized patients
in the ICU. Among all the isolates, 254 (30%) were identified as VRE strains. All of the
VRE isolates were sensitive to linezolid. Moreover, only 39.9% of the VRE isolates harbored the
vanA gene, while none of them carried the vanB gene.

Conclusion:

The present study reports the highest range of VRE infections in Iran. The constant
surveillance and monitoring of VRE strains are recommended to limit the occurrence and spread
of VRE clones within and among hospitals and community settings.
Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis
Authors: Vallée Alexandre , Blacher Jacques , Cariou Alain , Sorbets Emmanuel
Published: November 2019

Background

Blended learning, which combines face-to-face learning and e-learning, has grown rapidly to be commonly used in education. Nevertheless, the effectiveness of this learning approach has not been completely quantitatively synthesized and evaluated using knowledge outcomes in health education.

Objective

The aim of this study was to assess the effectiveness of blended learning compared to that of traditional learning in health education.

Methods

We performed a systematic review of blended learning in health education in MEDLINE from January 1990 to July 2019. We independently selected studies, extracted data, assessed risk of bias, and compared overall blended learning versus traditional learning, offline blended learning versus traditional learning, online blended learning versus traditional learning, digital blended learning versus traditional learning, computer-aided instruction blended learning versus traditional learning, and virtual patient blended learning versus traditional learning. All pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies.

Results

A total of 56 studies (N=9943 participants) assessing several types of learning support in blended learning met our inclusion criteria; 3 studies investigated offline support, 7 studies investigated digital support, 34 studies investigated online support, 8 studies investigated computer-assisted instruction support, and 5 studies used virtual patient support for blended learning. The pooled analysis comparing all blended learning to traditional learning showed significantly better knowledge outcomes for blended learning (standardized mean difference 1.07, 95% CI 0.85 to 1.28, I2=94.3%). Similar results were observed for online (standardized mean difference 0.73, 95% CI 0.60 to 0.86, I2=94.9%), computer-assisted instruction (standardized mean difference 1.13, 95% CI 0.47 to 1.79, I2=78.0%), and virtual patient (standardized mean difference 0.62, 95% CI 0.18 to 1.06, I2=78.4%) learning support, but results for offline learning support (standardized mean difference 0.08, 95% CI –0.63 to 0.79, I2=87.9%) and digital learning support (standardized mean difference 0.04, 95% CI –0.45 to 0.52, I2=93.4%) were not significant.

Conclusions

From this review, blended learning demonstrated consistently better effects on knowledge outcomes when compared with traditional learning in health education. Further studies are needed to confirm these results and to explore the utility of different design variants of blended learning.
Health Researchers’ Use of Social Media: Scoping Review (Preprint)
Authors: Dol Justine , Tutelman Perri R , Chambers Christine T , Barwick Melanie , Drake Emily K , Parker Jennifer A , Parker Robin , Benchimol Eric I , George Ronald B , Witteman Holly O
Published: November 2019

BACKGROUND

Health researchers are increasingly using social media in a professional capacity, and the applications of social media for health researchers are vast. However, there is currently no published evidence synthesis of the ways in which health researchers use social media professionally, and uncertainty remains as to how best to harness its potential.

OBJECTIVE

This scoping review aimed to explore how social media is used by health researchers professionally, as reported in the literature.

METHODS

The scoping review methodology guided by Arksey and O’Malley and Levac et al was used. Comprehensive searches based on the concepts of health research and social media were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and Web of Science databases, with no limitations applied. Articles were screened at the title and abstract level and at full text by two reviewers. One reviewer extracted data that were analyzed descriptively to map the available evidence.

RESULTS

A total of 8359 articles were screened at the title and abstract level, of which 719 were also assessed at full text for eligibility. The 414 articles identified for inclusion were published in 278 different journals. Studies originated from 31 different countries, with the most prevalent being the United States (52.7% [218/414]). The health discipline of the first authors varied, with medicine (33.3% [138/414]) being the most common. A third of the articles covered health generally, with 61 health-specific topics. Papers used a range of social media platforms (mean 1.33 [SD 0.7]). A quarter of the articles screened reported on social media use for participant recruitment (25.1% [104/414]), followed by practical ways to use social media (15.5% [64/414]), and use of social media for content analysis research (13.3% [55/414]). Articles were categorized as celebratory (ie, opportunities for engagement, 72.2% [299/414]), contingent (ie, opportunities and possible limitations, 22.7% [94/414]) and concerned (ie, potentially harmful, 5.1% [21/414]).

CONCLUSIONS

Health researchers are increasingly publishing on their use of social media for a range of professional purposes. Although most of the sentiment around the use of social media in health research was celebratory, the uses of social media varied widely. Future research is needed to support health researchers to optimize their social media use.
A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial (Preprint)
Authors: Ramsey Susan , Ames Evan , Uber Julia , Habib Samia , Clark Seth
Published: November 2019

BACKGROUND

Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence.

OBJECTIVE

The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes.

METHODS

This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations.

RESULTS

Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020.

CONCLUSIONS

This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus.

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/15356
Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care (Preprint)
Authors: MacKenna Brian , Bacon Sebastian , Walker Alex J , Curtis Helen J , Croker Richard , Goldacre Ben
Published: November 2019

BACKGROUND

In England, national safety guidance recommends that ciclosporin, tacrolimus, and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health record (EHR) system interfaces can affect prescribing choices.

OBJECTIVE

Our objectives were to assess variation by EHR systems in breach of safety guidance around prescribing of ciclosporin, tacrolimus, and diltiazem, and to conduct user-interface research into the causes of such breaches.

METHODS

We carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective EHR systems. The main outcome measures were (1) the variation in ratio of safety breaches to adherent prescribing in all practices and (2) the description of observations of EHR system usage.

RESULTS

A total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus, and diltiazem (over 60 mg); of these, 316,119 prescriptions breached NHS guidance (12.27%). Breaches were most common among users of the EMIS EHR system (breaches in 18.81% of ciclosporin and tacrolimus prescriptions and in 17.99% of diltiazem prescriptions), but breaches were observed in all EHR systems.

CONCLUSIONS

Design choices in EHR systems strongly influence safe prescribing of ciclosporin, tacrolimus, and diltiazem, and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system; further quantitative research into the effect of EHR system design on clinical practice is long overdue.
Evaluating the Applications of Health Information Technologies in China During the Past 11 Years: Consecutive Survey Data Analysis (Preprint)
Authors: Liang Jun , Li Ying , Zhang Zhongan , Shen Dongxia , Xu Jie , Yu Gang , Dai Siqi , Ge Fangmin , Lei Jianbo
Published: November 2019

BACKGROUND

To achieve universal access to medical resources, China introduced its second health care reform in 2010, with health information technologies (HIT) as an important technical support point.

OBJECTIVE

This study is the first attempt to explore the unique contributions and characteristics of HIT development in Chinese hospitals from the three major aspects of hospital HIT—human resources, funding, and materials—in an all-around, multi-angled, and time-longitudinal manner, so as to serve as a reference for decision makers in China and the rest of the world when formulating HIT development strategies.

METHODS

A longitudinal research method is used to analyze the results of the CHIMA Annual Survey of Hospital Information System in China carried out by a Chinese national industrial association, CHIMA, from 2007 to 2018. The development characteristics of human resources, funding, and materials of HIT in China for the past 12 years are summarized. The Bass model is used to fit and predict the popularization trend of EMR in Chinese hospitals from 2007 to 2020.

RESULTS

From 2007 to 2018, the CHIMA Annual Survey interviewed 10,954 hospital CIOs across 32 administrative regions in Mainland China. Compared with 2007, as of 2018, in terms of human resources, the average full time equivalent (FTE) count in each hospital’s IT center is still lower than the average level of US counterparts in 2014 (9.66 FTEs vs. 34 FTEs). The proportion of CIOs with a master’s degree or above was 25.61%, showing an increase of 18.51%, among which those with computer-related backgrounds accounted for 64.75%, however, those with a medical informatics background only accounted for 3.67%. In terms of funding, the sampled hospitals’ annual HIT investment increased from ¥957,700 (US $136,874) to ¥6.376 million (US $911,261), and the average investment per bed increased from ¥4,600 (US $658) to ¥8,100 (US $1158). In terms of information system construction, as of 2018, the average EMR implementation rate of the sampled hospitals exceeded the average level of their US counterparts in 2015 and their German counterparts in 2017 (85.26% vs. 83.8% vs. 68.4%, respectively). The results of the Bass prediction model show that Chinese hospitals will likely reach an adoption rate of 91.4% by 2020 (R2=0.95).

CONCLUSIONS

In more than 10 years, based on this top-down approach, China’s medical care industry has accepted government instructions and implemented the unified model planned by administrative intervention. With only about one-fifth of the required funding, and about one-fourth of the required human resources per hospital as compared to the US HITECH project, China’s EMR coverage in 2018 exceeded the average level of its US counterparts in 2015 and German counterparts in 2017. This experience deserves further study and analysis by other countries.
Internet Use, eHealth Literacy, and Dietary Supplement Use Among Young Adults in Pakistan: Cross-Sectional Study (Preprint)
Authors: Tariq Amina , Khan Shanchita R , Basharat Amna
Published: November 2019

BACKGROUND

Increased access to the internet has facilitated widespread availability of health information. Thus, electronic health (eHealth) literacy—the ability to seek, find, understand, and appraise health information from electronic resources and apply that knowledge in making a health-related decision—is a crucial skill. Despite the increasing use of the internet as a source of health information in developing countries, only a few studies have examined the eHealth literacy of young adults, who frequently use the internet to access health information in these developing countries.

OBJECTIVE

The aim of this study was to assess the patterns of internet use and eHealth literacy levels among university students pursuing a non–health-related degree in Pakistan. We also examined the association of the eHealth literacy levels of these young adults with their physical activity levels and dietary supplement intake.

METHODS

Students from 2 leading engineering universities in Pakistan were invited to participate in a cross-sectional anonymous web-based survey in order to collect data on their internet use, eHealth literacy, and dietary supplement intake. Of the 900 eligible university students who were invited to participate, 505 (56.1%) students who completed the questionnaire were included in the analysis. The findings were converted to median values and frequency analyses were performed. The associations between the variables were determined using the chi-square test; P≤.05 was considered significant.

RESULTS

In this study, the median eHealth literacy scale (eHEALS) score was 29, which did not vary across gender. The most common type of health-related information that was searched by the participants was that related to maintaining a healthy lifestyle (305/505, 60.4%). Participants with high eHEALS scores were those who used the internet frequently for finding people with similar health issues (P<.001). The use of specific social media platforms was not associated with the perceived eHealth literacy levels. Neither the frequency of physical activity nor the dietary supplement use was associated with the eHealth literacy of the participants.

CONCLUSIONS

University students in non–health-related disciplines in Pakistan expressed high confidence in their skills to find health-related information on the internet, as indicated by the aggregate eHEALS scores. However, the findings of our study show that the perceived eHealth literacy was not associated with health behaviors such as physical activity and dietary supplement intake. Further research is necessary to investigate the extent to which eHealth literacy can be considered as a panacea for solving public health challenges in developing countries.
Enhanced Ambulatory Electronic Health Record Training for Residents: Prospective Cohort Study. (Preprint)
Authors: Ong Shawn Y. , O'Shea Jesse , Rosenbaum Julie R.
Published: November 2019

BACKGROUND

Physicians spend a significant amount of time with Electronic Health Record (EHR) systems but receive inadequate training. Prior studies have shown benefit from intern orientation programs such as “boot camps” for clinical knowledge or skills but few have examined courses for enhanced EHR orientation.

OBJECTIVE

To improve EHR clinic workflow processes and assess the impact of a structured course on intern confidence and preparedness.

METHODS

One faculty and two resident physicians spent approximately 30 hours creating a four-hour course curriculum, which was taught to a group of incoming Internal Medicine interns in June and July 2017. The interns completed a course feedback survey along with self-reported outpatient EHR workflow process confidence surveys at 1, 6, and 12 months. A control group also completed the same confidence surveys at the same intervals.

RESULTS

A total of 15 out of 18 Internal Medicine interns (83%) took the course. All 15 reported they learned useful information and had increased overall confidence. A majority (93%) agreed the course would allow them to provide better care for their patients and that the course content was best delivered by a physician. Most interns (80%) agreed the course should be a required part of internship. Confidence scores in eight major workflow areas significantly increased after the course and persisted throughout intern year. A control group of interns had low initial confidence scores that increased at 6 and 12 months.

CONCLUSIONS

A 4-hour targeted EHR ambulatory training course was feasible, highly rated, and increased workflow confidence scores for the first 6 months.
Clustering topic groups of documents using K-Means algorithm: Australian Embassy Jakarta media releases 2006-2016
Authors: Hardi Wishnu , Kusuma Wisnu Ananta , Basuki Sulistyo
Published: November 2019

Introduction. The Australian Embassy in Jakarta is storing a wide array of media release document. Analyzing particular and vital patterns of the documents collection is imperative as it will result in new insights and knowledge of significant topic groups of the documents.Methodology. K-Means was used algorithm as a non-hierarchical clustering method which partitioning data objects into clusters. The method works through minimizing data variation within cluster and maximizing data variation between clusters. Data Analysis.  Of the documents issued between 2006 and 2016, 839 documents were examined in order to determine term frequencies and to generate clusters. Evaluation was conducted by nominating an expert to validate the cluster result.Results and discussions. The result showed that there were 57 meaningful terms grouped into 3 clusters. “People to people links”, “economic cooperation”, and “human development” were chosen to represent topics of the Australian Embassy Jakarta media releases from 2006 to 2016.Conclusions. Text mining can be used to cluster topic groups of documents. It provides a more systematic clustering process as the text analysis is conducted through a number of stages with specifically set parameters.