bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the Gh4CL gene family reveals a role of Gh4CL7 in drought tolerance
Authors: Sun Shichao , Xiong Xianpeng , Zhang Xiaoli , Feng Hongjie , Zhu Qianhao , Sun Jie , Li Yanjun
Published: March 2020

Background: The function of 4-coumarate-CoA ligases (4CL) under abiotic stresses has been studied in plants, however, limited is known about the 4CL genes in cotton (G. hirsutum L.) and their roles in response to drought stress.Results: We performed genome-wide identification of the 4CL genes in G. hirsutum and investigated the expression profiles of the identified genes in various cotton tissues and in response to stress conditions with an aim to identify 4CL gene(s) associated with drought tolerance. We identified 34 putative 4CL genes in G. hirsutum that were clustered into three classes. Genes of the same class usually share a similar gene structure and motif composition. Many cis-elements related to stress and phytohormone responses were found in the promoters of the Gh4CL genes. Of the 34 Gh4CL genes, 26 were induced by at least one abiotic stress and 10 (including Gh4CL7) were up-regulated under the polyethylene glycol (PEG) simulated drought stress conditions. Virus-induced gene silencing (VIGS) in cotton and overexpression (OE) in Arabidopsis thaliana were applied to investigate the biological function of Gh4CL7 in drought tolerance. The Gh4CL7-silencing cotton plants showed more sensitive to drought stress, probably due to decreased relative water content (RWC), chlorophyll content and antioxidative enzyme activity, increased stomatal aperture, and the contents of malondialdehyde (MDA) and hydrogen peroxide (H2O2). Arabidopsis lines overexpressing Gh4CL7, however, were more tolerant to drought treatment, which was associated with improved antioxidative enzyme activity, reduced accumulation of MDA and H2O2 and up-regulated stress-related genes under the drought stress conditions. In addition, compared to their respective controls, the Gh4CL7-silencing cotton plants and the Gh4CL7-overexpressing Arabidopsis lines had a ~20% reduction and a ~10% increase in lignin content, respectively. The expression levels of genes related to lignin biosynthesis, including PAL, CCoAOMT, COMT, CCR and CAD, were lower in Gh4CL7-silencing plants than in controls. Taken together, these results demonstrated that Gh4CL7 could positively respond to drought stress and therefore might be a candidate gene for improvement of drought tolerance in cotton.Conclusion: We characterized the 4CL gene family in upland cotton and revealed a role of Gh4CL7 in lignin biosynthesis and drought tolerance.
Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China?Characteristics of vulnerable groups and failure links.
Authors: Ma Meiyan , Li Ye , Wang Nianshi , Wu Qunhong , Shan Linghan , Jiao Mingli , Fu Xuelian , Li Heng , Sun Tao , Yi Bin , Tian Wanxin , Xia Qi , Shi Baoguo , Hao Yanhua , Yin Hui , Ning Ning , Gao Lijun , Liang Libo , Wang Jiahui
Published: March 2020

objective ： We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods: A national representative sample from the 2015 China Health and Pension Tracking Survey (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results ： The rate of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The rate of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the rate of IME. Conclusion ： The original poverty -promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance. Keywords: medical insurance, poverty alleviation, healthy poverty, catastrophic health expenditure, impoverishment by medical expenses.
Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure
Authors: Ozga Ann-Kathrin , Rauch Bernhard , Palm Frederick , Urbanek Christian , Grau Armin , Becher Heiko , Rauch Geraldine
Published: March 2020

Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were those listed above. Results : None of these risk factors, most probably being treated after the first stroke, remained to be associated with subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2, 0.9), 0.8 (0.4, 2.2), 1.3 (0.5, 2.5), 1.2 (0.3, 2.7), 1.6 (0.8, 3.6), respectively]. Cause-specific effects sometimes point into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke, e.g. in our study diabetic patients even showed a decreased risk for recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio and can thus be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.
Managerial competences in public organisations: the healthcare professionals’ perspective
Authors: Fanelli Simone , Lanza Gianluca , Enna Cristiana , Zangrandi Antonello
Published: March 2020

Background: Human resources play a critical role in encouraging efficient performance within organisations, especially for public healthcare organisations, where competences of staff are key aspects of the quality of services provided. In this context, the enhancement of competences are strategic objectives for Human Resources Management (HRM) in order to achieve excellent and lasting results. However, competences of healthcare professionals are both clinical and managerial. This study identifies specific managerial competences perceived as crucial by healthcare professionals in order to improve their performance and develop suitable HRM practices.
Methods: The research methodology was divided into three main phases using mixed methods, commencing with literature review to identify the initial framework about managerial competences. Focus groups were then used to discuss evidence from the literature. Feedback from focus groups was used to draft the final questionnaire. Finally, the answers to the questionnaire were analysed through statistical software.
Results: The results show that managers and professionals share a view of what specific managerial competences for healthcare organisations should be. Main competences are: quality evaluation based on outcomes; enhancement of professional competences; programming based on process management; project cost assessment; informal communication style; and participatory leadership.
Conclusions: Although the issue of managerial skills in healthcare is widely discussed in literature, findings are often fragmentary. Our work includes a systematic literature review useful for more empirical studies. Furthermore, our results can support public managers who want to set up positive HRM practices for healthcare professionals.
Towards Improving the Identification of Anterior Cruciate Ligament Tears in Primary Point-of-Care Settings
Authors: Whittaker Jackie L , Chan Michelle , Pan Bo , Hassan Imran , Defreitas Terry , Hui Catherine , Macedo Luciana , Otto David
Published: March 2020

Background: Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool.Methods: Electronic medical records (EMRs) of individuals aged 15-45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL+) or denied (ACL-) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n=17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI).Results: Of 1,512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15-45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated variables (Lachman test result) were superior for ACL tear diagnosis [accuracy; 0.95 (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)].Conclusions: A high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.
Characterization of a potential probiotic bacterium Lactococcus raffinolactis WiKim0068 isolated from fermented vegetable using genomic and in vitro analyses
Authors: Jung Min Young , Lee Changsu , Seo Myung-Ji , Lee Se Hee , Roh Seong Woon
Published: March 2020

Background: Lactococcus members belonging to lactic acid bacteria are widely used as starter bacteria in the production of fermented dairy products. From kimchi, a Korean food made of fermented vegetables, Lactococcus raffinolactis WiKim0068 was isolated and its genome was analyzed.
Results: The complete genome of the strain WiKim0068 consists of one chromosome and two plasmids that comprises 2,292,235 bp, with a G+C content of 39.7 mol%. Analysis of orthoANI values among Lactococcus genome sequences showed that the strain WiKim0068 has > 67% sequence similarity to other species and subspecies. In addition, it displayed no antibiotic resistance and can metabolize nicotinate and nicotinamide (vitamin B3).
Conclusion: These results augments our understanding of the genus Lactococcus and suggest that this new strain has potential industrial applications.

Keywords: Lactococcus raffinolactis, genome sequence, kimchi, probiotics, vitamin B3
A Five-Year Trend Analysis of Malaria Surveillance Data in Selected Zones of Amhara Region, Northwest Ethiopia
Authors: Lankir Damtie , Solomn Samrawit , Gize Addisu
Published: March 2020

Background: Trend analysis of malaria surveillance data is essential to inform stakeholders on progress towards malaria control. From the total 387,096 cases of malaria reported in Amhara region in 2017, 167,079 (43.2%) cases were in Central, North and West Gondar zones. From this total figure of zones, 15,445 (9.2%) were ≤5 years which contributes 4 % of cases in the region. So, the purpose of this study was to analyze trends of malaria parasite in Selected Zones of Amhara Region, Northwest Ethiopia
Methods: A Retrospective study was conducted in Central, North and West Gondar zones from July 1- 30/ 2018. Data were collected, entered, cleaned, analyzed and interpreted using Microsoft Excel-2010. Different tables, figures and maps were used to present results.
Result: A total of 2,827,722 cases have been received a diagnostic test of; Microscopy 1,712,193(60.56%) and Rapid Diagnostic Test (RDT) 1,115,529(39.44%). Trends of total patients treated as confirmed and clinical malaria cases in July 2017- June 2018 were decreased to 139297 (14%) as compared from July 2015- June 2016, 249571(25%). From total cases received diagnostic tests only 1,003,391 (36%) were confirmed and clinical cases treated with antimalaria. Of these Plasmodium falciparum and vivax malaria cases were confirmed to be 1,002,946 (99.96%) and clinical malaria cases were 445(0.04%), respectively.
Conclusion: Risk of infection and diagnostic effort were high in West Gondar Zone. The Amhara public health institute including health Bureau, stakeholders and all responsible bodies should give special standing to highest malaria districts of West Gondar zone.
Keywords: Malaria Surveillance, Data Analysis, West Gondar Zones, Northwest Ethiopia.
A novel anatomical titanium plate versus the reconstruction plate for quadrilateral plate fractures of the acetabulum: A propensity-matched cohort study
Authors: Wu Haiyang , Shang Ranran , Liu Ximing , Song Chengjing , Chen Yanzhao , cai xianhua
Published: March 2020

Background Surgical treatment of acetabular fractures involving quadrilateral plate is a challenge to orthopaedic surgeons. We have developed a novel fixation technique using a special shaped reconstruction plate combined with several buttress screws of quadrilateral plate which was also called Dynamic Anterior Plate-Screw System for Quadrilateral plate (DAPSQ) to treat acetabular fractures involving quadrilateral plate since 2005(RP group). And the long-term follow-up results have confirmed the effectiveness and safety of this technique. After 2016, anatomical titanium plate (ATP group) of DAPSQ have been designed and applied. The aim of the study was to compare the clinical efficacy of anatomical plate and the reconstruction plate of DAPSQ in the treatment of quadrilateral plate fractures.
Methods We led a propensity-matched cohort study of quadrilateral plate fractures. Twenty-two patients were included in the ATP group during the inclusion period (2016-2018), and were matched to 22 cases in our database of RP group (2008-2016). The primary outcome measures were quality of reduction and functional outcomes. Intraoperative conditions were also compared.
Results Of these 22 consecutive patients in ATP group, the mean age was 46.7 years and the most common fracture pattern was a both-column fracture (12cases, 54.5%) according to Letournel-Judet classification. The mean follow-up period was 23.1 months (range 12-37). There were no significant differences between the two groups with regards the quality of reduction using the Matta radiological criteria and functional outcomes evaluated by the modified Merle d’Aubigné score( P > 0.05). Compared with the RP group, the ATP group has a shorter operation time(245.1 minutes vs. 286.8 minutes, P = 0.020), less intraoperative blood loss (1136.4 mL vs. 1777.3mL, P = 0.014) and transfusion (780.9 vs. 1256.8mL, P = 0.035). The complication rate was 18.2% in ATP group, and there was no significantly difference compared with the RP group (36.4%)( P > 0.05). None of the cases in the two groups had quadrilateral screws entering the hip or implant failure.
Conclusion s The fixation of anatomical titanium plate in quadrilateral plate fractures showed a similar result to the reconstruction plate, in terms of quality of reduction and functional outcome. The anatomical titanium plate of DAPSQ has the advantages of short operation time, less intraoperative bleeding and blood transfusion, and it is worth further promotion and research.
Impact of perioperative hemodynamic optimization therapies in surgical patients: Economic study and Meta-analysis
Authors: Silva João M , Menezes Pedro Ferro L , Lobo Suzana M , Carvalho Flavia Helena S , Oliveira Mariana Augusta N , Filho Francisco Nilson F Cardoso , Fernando Bruna N , Carmona Maria Jose C , Teich Vanessa D , Malbouisson Luiz Marcelo S
Published: March 2020

Background: Several studies suggest that hemodynamic optimization therapies can reduce complication, length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system.
Method: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients submitted to standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis.
Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR=0.66; 95% CI=0.58-0.74), renal (RR=0.68; 95% CI=0.54-0.87), and cardiovascular complications (RR=0.87; 95% CI=0.76-0.99) and a non-statistically significant lower rate of respiratory complications (RR=0.82; 95% CI=0.67-1.02). There was no difference in mortality (RR=1.02; 95% CI=0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer day in the ICU and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated.
Conclusions: Hemodynamic optimization therapy is cost-effective and would increase efficiency and decrease the burden of the Brazilian public health system.
The fiscal value of human lives lost from coronavirus disease (COVID-19) in China
Authors: Kirigia Joses M. , Muthuri Rosenabi Deborah Karimi
Published: March 2020

Objective: According to the WHO coronavirus disease (COVID-19) situation report 35, as of 24 th February 2020, there was a total of 77,262 confirmed COVID-19 cases in China. That included 2,595 deaths. The specific objective of this study was to estimate the fiscal value of human lives lost due to COVID-19 in China as of 24 th February 2020.
Results: The deaths from COVID-19 had a discounted (at 3%) total fiscal value of Int$ 924,346,795 in China. Out of which, 63.2% was borne by people aged 25-49 years, 27.8% by people aged 50-64 years, and 9.0% by people aged 65 years and above. The average fiscal value per death was Int$ 356,203. Re-estimation of the economic model alternately with 5% and 10 discount rates led to a reduction in the expected total fiscal value by 21.3% and 50.4%, respectively. Furthermore, the re-estimation of the economic model using the world’s highest average life expectancy of 87.1 years (which is that of Japanese females), instead of the national life expectancy of 76.4 years, increased the total fiscal value by Int$ 229,456,430 (24.8%).
Predictors of seizure outcome for vagus nerve stimulation in children
Authors: Yang Jeyul , Kim Seung‐Ki , Kim Ki Joong , Chae Jong Hee , Lim Byung Chan , Phi Ji Hoon
Published: March 2020

Purpose Vagus nerve stimulation (VNS) is a palliative treatment for intractable epilepsy. While the expected outcome of VNS is well known, the clinical predictors of outcome are not clearly defined. We investigated the predictors and seizure reduction rates of VNS in pediatric patients. Methods We retrospectively reviewed medical records, radiological data, EEG, and clinical outcomes of 47 pediatric patients who underwent VNS implantation in our institution. Chi-squared tests and Fisher’s exact tests were used for categorical variables, and Student’s t test was applied for continuous variables. A paired T test was used for the comparison of pre- and post-insertion for each variable. Results The mean age at the time of VNS surgery was 14.7 years (range, 5–26 years). The mean interval from seizure onset to surgery was 8.3 years (range, 2–16 years). Responders (≥50% reduction in seizure frequency) included 22 patients (47%) at six months postoperatively and 25 patients (53%) at one year postoperatively. The overall mean seizure frequency was reduced from 8.0 per week to 5.1 per week 12 months after implantation (36%, p=0.006). Patients with focal onset epilepsy on electroencephalography (EEG) had 7.5 seizures per week preoperatively, which was reduced to 5.1 seizures per week postoperatively (32%, p=0.009). Patients who did not undergo resection surgery prior to VNS insertion had a reduction rate of 43% (p=0.006). Conclusions Pediatric patients with intractable epilepsy who have focal lesions in eloquent areas or unmatched ictal zones on EEG with multifocal lesions could be good candidates for VNS.
Life negative events and depressive symptoms: the China Longitudinal Ageing Social Survey
Authors: Wang Zhenjie , Yang Hanmo , Zheng Pianpian , Liu Bei , Guo Zhanyuan , Geng Shen
Published: March 2020

Background Although some studies have reported the association between life negative events and depressive disorders, very limited studies have examined the association between life negative events exposure and depressive symptoms risk among Chinese older adults.Methods : Data were obtained from the China Longitudinal Ageing Social Survey (CLASS) conducted in 2014. General linear regression and logistic regression were used to examine the association between life negative events exposure and depressive symptoms.Results The prevalence of depressive symptoms was 43% among current Chinese old population. Life negative events showed statistical dose-response association with depressive symptoms risk after adjustment for the confounding factors (Ptrend <0.001). Participants who lived in rural areas, without a spouse or live alone were vulnerable to depressive symptoms.Conclusions Life negative events played a risk role of depressive symptoms among Chinese older adults, especially among those in rural areas, females or without a spouse. Our current study is valuable for the development of special prevention depressive symptoms programs among elderly individuals, especially those who have experienced negative events.
Adverse influence of multilevel socioeconomic status on physical activity: results from a national survey in Vietnam
Authors: Vu Lan , Bui Quyen , Nguyen Ngan , Hoang Minh
Published: March 2020

Background: This study aims to explore associations of individual- and provincial-level socioeconomic status (SES) and the combined interaction among these SES with individual physical activity (PA). Method: This analyze used data of 3068 Vietnamese people aged 18-65 years from the national representative STEPS survey in 2015 (STEPS2015). The survey collected PA-related data using the Global PA Questionnaire Version 2 and those on provicial-level characteristics from two surveys in 2014, namely the Intercensal Population and Housing Survey (IPHS) and The Vietnam Household Living Standard Survey (VLSS2014). Multilevel linear analyze was performed with individual and provincial characteristics as independent variables and the metabolic equivalent (MET) score – the indicator of individual PA – as the dependent variable. Results: Male and female participants with insufficient PA accounted for 20.2% and 35.7%, respectively. Both individual- and provicial-level SES were inversely associated with the individual PA level . As the provincial-level monthly income increased by 1 million Vietnam Dongs, the total PA score of individuals residing in that province reduced by 1,900 METS. A buffering effect was reported between provincial and individual SES, as the provincial average income increased, the differences in PA scores between different SES groups decreased Conclusion: Our data suggest that Vietnamese individuals in low SES groups tended to be more physically active than those in high SES groups because their PA was largely related to work. Keywords: Physical activity, socioeconomic, multilevel, Vietnam, work-related PA.
Acceptability of the “MOVEdiabetes” physical activity intervention in diabetes primary care settings in Oman: findings from participants and practitioners
Authors: Alghafri Thamra S , Harthi Saud Al , Farsi Yahya Al , Al-Ajmi Fatma , Craigie Angela M. , Bannerman Elaine , Anderson Annie S.
Published: March 2020

Background Adequate physical activity (PA) is considered essential in diabetes management. However, evidence on the best method of promoting PA within diabetes care is inconclusive. The current work identifies perceptions on the acceptability of Intervention Group Participants (IGP) and Project Officers (POs) about the “MOVEdiabetes” intervention programme aimed at increasing PA in adults with type 2 diabetes in Oman. Methods The “MOVEdiabetes” programme (PA consultations, pedometers and WhatsApp messages) was delivered by the POs (primary health care practitioners) in four primary care centres within a one-year cluster randomised control trial. Recruitment and retention were measured from trial attendance records. Programme satisfaction, appropriateness, and content suitability were assessed using exit surveys for both the IGP (interview based) and POs (self-administered). Open text questions on perceptions to the study programme were also included. Results Participants were randomised to an intervention group (IG, n= 122) or comparison group (CG, n=110). The overall retention rate at three and 12 months was 92.7% [110(90.2%) IG vs 105(95.5%) CG] and 75% [82(67.2%) IG vs 92(83.6%) CG] respectively. Most (87.5%) POs and more than half (59.8%) IGP perceived the programme as acceptable and many reported that they were “very satisfied/satisfied” with the programme (100% PO’s and 86.6% IGP). Two thirds (67.1%) of IGP would recommend the programme to others. PA consultations, use of pedometers and Whatsapp messages were well perceived by all. Participants recommended the inclusion of dietary advice and PA promotion for the general public. Exploring PA facilities within the community was suggested by POs. Conclusions The “MOVEdiabetes” programme achieved a high retention rate and was perceived as satisfactory and appropriate. Results from this study suggest that it is worthwhile exploring the use of the “MOVEdiabetes” programme in clinical practice and further community links.
The transtheoretical model is effective for weight management: A randomized controlled trial Intervention for Weight Management
Authors: de Freitas Patrícia Pinheiro , de Menezes Mariana Carvalho , Santos Luana Caroline dos , Pimenta Adriano Marçal , Ferreira Adaliene Versiani Matos , Lopes Aline Cristine
Published: March 2020

Background: Given the current worldwide epidemic of obesity, interventions with higher impact, such as those carried out in the primary health care (PHC) setting, are needed. Considering that, this study aimed to evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. Methods: Randomized controlled trial in Brazilian PHC that offers free physical exercise and nutrition education. The participants were women aged 20 years or older who were obese or overweight in PHC service. The intervention group (IG, n=51) received the same orientation as the comparison group (CG, n==35) plus individual health counselling based on the TTM aiming weight loss, which lasted six months. The outcome measures were anthropometric, food and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated and analysis of covariance (ANCOVA) used to assess intervention effectiveness, using intention-to-treat analysis. Results: There was a difference between groups of -1.4 kg (CI95%: -2.5; -0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of intervention and presented positive changes in diet, biochemical markers and anthropometry. The IG showed a better BMI, resistine and blood glucose result when compared to CG during follow-up. Conclusion: The individualized TTM-based intervention combined with usual care was effective strategy in PHC. These results encouragement of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obesity low-income women.
The Challenges of Ethical Behaviors for Drug Supply in the Iran Pharmacies by Deontological Approach
Authors: Iranmanesh Mahla , Yazdi-Feyzabadi Vahid , Mehrolhassani Mohammad Hossein
Published: March 2020

Background: Pharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a deontological approach in the area of drug supply in pharmacies.Methods: This qualitative content analysis study was conducted in Kerman in 2018. A range of key players in the field of medication supply were selected by snowball sampling to be interviewed. An effort was made to select samples with maximum variation. Exclusion criteria were; having less than 3 years of experience in pharmacy and supervision, not willing to participate in the interview, and canceling the interview for 3 times. The participants in this study consisted of pharmacy technicians (n=5), patients (n=6), pharmacists (n=8), inspectors of insurance companies (n = 4) and inspectors of food and drug administration (n = 3). Data were analyzed by MAXQDA- 10 software using guided content analysis. The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles. Results: Data analysis in this study revealed 8 main categories and 26 subcategories. The main categories included; patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural and interactive justice. These categories also had some subcategories, including increasing patient awareness, culturizing prescription and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the biggest ethical challenges in the area of drug supply at pharmacies. Conclusions: According to the deontological approach, two principles of autonomy and beneficence had the greatest challenges. The emphasis of policymakers in health care system should be on patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool for introducing ethical challenges to policymakers and developing educational contents, charter of professional ethics in pharmacies, and measures of pharmacy accreditation.
HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana?
Authors: nacher mathieu , Adenis Antoine , Abboud Philippe , Djossou Felix , Demar Magalie , Epelboin Loïc , Couppié Pierre
Published: March 2020

ObjectiveDespite scaling-up testing and antiretroviral treatment in Latin America, advanced HIV remains a significant public health problem. The objective of the present study was look for historical risk factors for death in French Guiana’s HIV cohort taking into account the immunological status, the main opportunistic infections, and their treatment. A retrospective cohort study was conducted on data collected between 1992 and 2008 to look at factors associated with death in a cohort 2323 patients. Results There were 370 deaths for a total 9608 patient-years. Being on tuberculosis treatment was associated with a greater hazard of death. The diagnosis of confirmed tuberculosis, of histoplasmosis, of toxoplasmosis, and pneumocystosis were independently associated with death. Interactions terms between cotrimoxazole treatment and pneumocystosis, or between confirmed tuberculosis and tuberculosis treatment showed a protective treatment-effect. All patients having received antituberculosis treatment (n=347) did not have a final diagnosis of tuberculosis (n=93). For histoplasmosis, 199 patients received antifungal treatment while 141 were diagnosed as having histoplasmosis. The number of patients on antituberculosis drugs was far greater that the number of patients with confirmed tuberculosis, and these patients on treatment without confirmed tuberculosis had a two fold increase in the risk of dying.
Effect of human chorionic gonadotropin injection before frozen embryo transfer on pregnancy outcomes in endometriosis infertility
Authors: Du Yanbo , Yan Lei , Sun Mei , Sheng Yan , Li Xiufang , Feng Zhenhua , Tang Rong
Published: March 2020

Purpose To investigate the effect of hCG in hormone replacement regime for frozen thawed embryo transfer in women with endometriosis. Methods We performed a retrospective, database-searched cohort study. The data of endometriosis patients who underwent frozen embryo transfer between 1/1/2009-31/8/2018 were collected. According to the protocols for frozen embryo transfer cycle, these patients were divided into two groups: Control group(n=305), and hCG group(n=362). And clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate and ectopic pregnancy rate were compared between the two groups. Results There was a significant increase in clinical pregnancy rate in hCG group (56.6% vs. 48.2%, p=0.035) compared to the control group. And the live birth rate in hCG group (43.5% vs. 37.4%, p=0.113) also elevated, but the difference is statistically insignificant. Conclusion hCG administration in hormone replacement regime for FET increase the pregnancy rate in women with endometriosis.
Identification of motives and barriers to physical activity of Polish young mothers
Authors: Soroka Andrzej , Godlewska Agnieszka , Krzęcio-Nieczyporuk Elżbieta , Kozioł Paulina
Published: March 2020

Background The aim of the study was to determine the level of physical activity of young mothers living in rural and urban areas and their free time budget, as well as to indicate motivating factors and barriers encountered during physical activity. Methods In the study a diagnostic survey method was applied, including two survey IPAQ questionnaires – the long version and author’s questionnaire. A representative sample consisted of 1 064 young mothers giving birth in 2017. Student T test and discriminate function analysis were used in statistical analysis. Results The level of physical activity of young mothers from rural areas did not differ from that of young mothers from urban areas. However, certain differences appeared while taking into account different aspects of physical activity. The main motives for participation in physical activity of young mothers from rural areas were to improve their physical condition and reduce pain complaints. Young mothers from towns emphasized such motives as strengthening self-confidence and improving their position in the family. While the main barriers for both group of respondents in physical activity were the lack of money and interest in occasional events. Conclusions The main conclusion that arise from the study is to need to make efforts which aim to reduce the burden of daily duties of young mothers, strengthen family support, strengthen material status of young families, eliminate barriers related to infrastructure especially of villages in order to facilitate the access to physical activity, raise awareness among population on the importance of health education, create specialized educational programs to promote healthy lifestyle, and finally, to introduce systematic monitoring in order to understand determinants of physical activity of young mothers.
Majocchi’s Granuloma on the Forearm Caused by Trichophyton tonsurans in an Immunocompetent Patient
Authors: Zheng Yun-yan , Li Yue , Chen Ming-yan , Mei Qian-yun , Zhang Ru-zhi
Published: March 2020

Majocchi’s granuloma is a rare fungal infection of the dermis. The most frequently identified cause of Majocchi’s granuloma is anthropophilic Trichophyton rubrum , and it is frequently seen on the anterior aspect of the legs of women. Here, we report a case of Majocchi’s granuloma on the forearm, a site that is rarely involved, in a 62-year-old woman who had been bitten by a dog. Histological examination revealed hyphae in the dermis with a diffuse dermal infiltrate consisting of lymphoplasmacytic cells and neutrophils. Mycological examination confirmed the presence of the fungus, Trichophyton rubrum. Therefore, the diagnosis of Majocchi’s granuloma was confirmed by histological and mycological examination. The patient was treated with local moxibustion and itraconazole, 200 mg/day, for 60 days, which promoted a complete regression of the lesions.
Nontuberculous Mycobacterial Endophthalmitis: Case Series and Review Literature
Authors: Pinitpuwadol Warinyupa , Tesavibul Nattaporn , Boonsophon Sutasinee , Sakiyalak Darin , Sarunket Sucheera , Choopong Pitipol
Published: March 2020

Background : To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature of NTM endophthalmitis. Methods : Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. Results : We reported three cases of NTM endophthalmitis caused by M. haemophilum , M. fortuitum and M. abscessus and a summarized review of 95 additional cases previously published. Of 98 patients, there were 85 exogenous endophthalmitis (86.7%) and 13 endogenous endophthalmitis (13.3%). The patients’ age ranged from 13 to 89 years with mean of 61.1±18.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (62.4%). In contrast, almost all endogenous endophthalmitis patients were either primary or secondary immunocompromised, previous history of disseminated NTM infection was identified in 38.5% of cases. Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Initial and final vision were generally worse than 6/60. There were no significant differences of initial and final vision between exogenous and endogenous causes (p=1.000, 0.446, respectively). Conclusions : NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.
Nasal carriage of Staphylococcus aureus in livestock in North of Morocco
Authors: Mourabit Nadira , Arakrak Abdelhay , Bakkali Mohammed , Zian Zeineb , Bakkach Joaira , Laglaoui Amin
Published: March 2020

Background : In Morocco, data of LA-MRSA nasal carriage are still limited. The objectives of this study were to determine for the first time the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of S aureus isolated from animals and breeders in close contact. Methods : From 2015 to 2016, 480 nasal swab samples were collected from 27 different Livestock areas in Tangier. The antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2016. The presence of nuc , mec A and his homologue mec C, lukS/F-PV, and tst genes were determined by PCR for all isolates. Results : The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR = 14.321; 95% CI = 7.484- 27.405; p< 0.0001). In general, S. aureus strains were susceptible to the majority of antibiotics and the higher resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No MRSA was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been found only in animals (11.9% and 16.7%, respectively). Conclusion : Despite the lower colonization rate of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV of virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for implementing adequate approaches for prevention. Further larger and multi-center studies are needed to validate and confirm our findings. Keywords: Staphylococcus aureus , nasal carriage, animals, breeders, MRSA, Morocco
Intra-articular Delivery of Celastrol by Hollow Mesoporous Silica Nanoparticles for pH-sensitive Anti-inflammatory Therapy against Knee Osteoarthritis
Authors: Jin Tian , Wu Di , Liu Xiao-Ming , Xu Jiang-Tao , Ma Bing-Jie , Ji Yun , Jin Yu-Ying , Wu Si-Yin , Wu Tao , Ke Ma
Published: March 2020

Celastrol, like other natural drugs, has proven effective in anti-inflammatory but was limited in clinic because of the poor solubility and side effects induced by low bioavailability. In recent years, hollow mesoporous silica nanoparticles (HMSNs) have received extensive attention in biomedical field due to their outstanding biocompatibility and multiple modification. Osteoarthritis has acidic and inflammatory environment. In this study, celastrol was loaded in HMSNs and capped with chitosan to construct a pH-responsive nanoparticle medicine(CSL@HMSNs-Cs) with high solubility for osteoarthritis intra-articular injection treatment. Methods: The CSL@HMSNs-Cs were assembled and the characteristics were measured. The CSL@HMSNs-Cs was applied in vitro in the chondrocytes collected from rats cartilage tissue and in vivo in the MIA induced knee osteoarthritis rats via intra-articular injection. Cytotoxicity assay, pH-responsive release, pain behavior, MRI, safranin o fast green staining, ELISA and western blot analysis were applied to evaluate the bioavailability and therapeutic effect of CSL@HMSNs-Cs. Results: CSL@HMSNs-Cs was stable due to the protection of the chitosan layers in alkaline environment(pH=7.7) but revealed good solubility and therapeutic effect in acidic environment(pH=6.0). The cytotoxicity assay showed no cytotoxicity at relatively low concentration(200 μg/mL) and the cell viability of chondrocytes stimulated by IL-1β was increased in CSL@HMSNs-Cs group. Paw withdrawal threshold in CSL@HMSNs-Cs group is increased, and MRI and Safranin O Fast Green staining showed improvements in articular surface erosion and joint effusion. The upregulated expression levels of IL-1β, TNF-α, IL-6, MMP-3 and MMP-13 and NF-κB signaling pathway of chondrocytes were inhibited in CSL@HMSNs-Cs group. Conclusion: Hollow mesoporous silica nanoparticles were idea carrier for natural drug with poor solubility and were of high biocompatibility for intra-articular injection. These intra-articular injectable CSL@HMSNs-Cs with improved solubility present a pH-responsive therapeutic strategy against osteoarthritis.
Encapsulation of the dual FLAP/mPEGS-1 inhibitor BRP-187 into acetalated dextran and PLGA nanoparticles improves its cellular bioactivity
Authors: Shkodra-Pula Blerina , Kretzer Christian , Jordan Paul M. , Klemm Paul , Koeberle Andreas , Pretzel David , Banoglu Erden , Lorkowski Stefan , Wallert Maria , Höppener Stephanie , Stumpf Steffi , Vollrath Antje , Schubert Stephanie , Werz Oliver , Schubert Ulrich
Published: March 2020

Background: Dual inhibitors of the 5-lipoxygenase-activating protein (FLAP) and the microsomal prostaglandin E2 synthase-1 (mPGES-1) may exert better anti-inflammatory efficacy and lower risks of adverse effects versus non-steroidal anti-inflammatory drugs. Despite these advantages, many dual FLAP/mPGES-1 inhibitors are acidic lipophilic molecules with low solubility and strong tendency for plasma protein binding that limit their bioavailability and bioactivity. Here, we present the encapsulation of the dual FLAP/mPGES-1 inhibitor BRP-187 into the biocompatible polymers acetalated dextran (Acdex) and poly(lactic-co-glycolic acid) (PLGA) via nanoprecipitation. Results: The nanoparticles containing BRP-187 were prepared by the nanoprecipitation method and analyzed by dynamic light scattering regarding their hydrodynamic diameter, by scanning electron microscopy for morphology properties, and by UV-VIS spectroscopy for determination of the encapsulation efficiency of the drug. Moreover, we designed fluorescent BRP-187 particles, which showed high cellular uptake by leukocytes, as analyzed by flow cytometry. Finally, BRP-187 nanoparticles were tested in human polymorphonuclear leukocytes and macrophages to determine drug uptake, cytotoxicity, and efficiency to inhibit FLAP and mPGES-1.Conclusion: Our results demonstrate that encapsulation of BRP-187 into Acdex and PLGA is feasible, and both PLGA- and Acdex-based particles loaded with BRP-187 are more efficient in suppressing 5-lipooxygenase product formation and prostaglandin E2 biosynthesis in intact cells as compared to the free compound, particularly after prolonged preincubation periods.