bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Service Utilization and Out-Of-Pocket Health Expenditure Among Insured and Uninsured: A Comparative Study in Baglung District, Nepal
Authors: Bhatt Laxman Datt , Dhami Shankar Singh , Yadav Dipendra Kumar
Published: December 2019

Background Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias.Method A community based cross-sectional comparative study was conducted in Baglung district of Nepal to find out and compare the health service utilization and direct out-of-pocket health care expenditure among the 225 insured and 225 uninsured households under the national health insurance program of Nepal. Insured households were randomly chosen from study area and uninsured households were selected by using neighborhood method.Result The study focused that insurance status was strongly associated with heath service utilization with odds ratio 1.774 (95% CI = 1.127-2.791, P = 0.013). The study also depicts that insurance status was major determinants of out of pocket health expenditure. The median out-of-pocket health expenditure among insured households Nepalese Rupees 200 while among uninsured was 1225, which was statistically significant (p = <0.001 MW-U test). Among uninsured group, non-dalit were 2.846 times more likely to utilize health services compared to the dalit (p = 0.003) but it was not significant (p = 0.47) among insured group.Conclusion Nepal’s Health Insurance Board is responsible for purchasing the quality health care service and make available at possible nearest point of its member. Our study reveals that Occupation, perceived health status, wealth status played significant role with health service utilization among uninsured group while it was not significant among insured group. Among both insured and uninsured group none of the study variables were found significant with out-of-pocket health expenditure.
Knowledge, Attitude and Practice of Mothers on Prevention and Control of Intestinal Parasitic Infestations in Sekota Town, Waghimra Zone, Ethiopia
Authors: Kassaw Mesfin Wudu , Abebe Ayele Mamo , Abate Biruk Beletew , Zemariam Alemu Birara , Kassie Ayelign Mengesha
Published: December 2019

Background: Intestinal parasites are a major public health problem in several developing countries. It accounts for 1.5 billion infections with one or more intestinal parasitic agents. The prevalence of helminthiases in Ethiopia was 29.8%. Specially, young children have a high infestation rate and suffer from a substantial burden of Ascaris lumbricoides, Trichuris trichiura, and Schistosomes.Therefore, this study was intended to assess mother’s knowledge, attitude and practice on prevention and control of intestinal parasitic infestations among their pre-school children in Sekota town, Ethiopia, 2019.Methods: A community based cross-sectional study was designed to be conducted on 384 mothers using simple random sampling method. But the data were collected from 378 mother-child pairs which gave a response rate of 98.4% using an interview-based questionnaire in the urban villages, Sekota town. The findings were presented in percentage, frequency and tables. In order to assure the quality of data, in all of the data collection, data analysis, and write up, a standard operational procedure was followed. Results: The overall level of good maternal knowledge, positive attitude, and good practice in preventing and controlling intestinal parasitic infection with a considering of their pre-school children was 45.2%, 55.3%, and 51.1% respectively. Seventy-seven (20.4%) respondents reported that they knew Ascaris lumbricoides, 62 (16.4%) participants wash vegetables as a means of intestinal prevention, and 252 (66.7%) of participants stated that their children had at least one history of stool examination.Conclusions: The overall level of optimum knowledge, attitude and practice of mothers on prevention and control of intestinal parasites is low. In particular, the level of optimal knowledge is significantly low. Therefore, community awareness about intestinal parasitic infestations prevention and control should be created through campaign or well-designed training and health education.Keywords: Knowledge, Attitude, Practice, Parasites, Infestation, Mothers, Children, Sekota, Ethiopia
Germline whole exome sequencing of a family with appendiceal mucinous tumours presenting with pseudomyxoma peritonei
Authors: Lung Mei Sim , Mitchell Catherine A. , Doyle Maria A. , Lynch Andrew C. , Gorringe Kylie L. , Bowtell David D.L. , Campbell Ian G. , Trainer Alison H.
Published: December 2019

Background Familial cases of appendiceal mucinous tumours (AMTs) are extremely rare and the underlying genetic aetiology uncertain. We identified potential predisposing germline genetic variants in a father and daughter with AMTs presenting with pseudomyxoma peritonei (PMP) and correlated these with regions of loss of heterozygosity (LOH) in the tumours. Methods Through germline whole exome sequencing, we identified novel heterozygous loss-of-function (LoF) (i.e. nonsense, frameshift and essential splice site mutations) and missense variants shared between father and daughter, and validated all LoF variants, and missense variants with a Combined Annotation Dependent Depletion (CADD) scaled score of ≥10. Genome-wide copy number analysis was performed on tumour tissue from both individuals to identify regions of LOH. Results Fifteen novel variants in 15 genes were shared by the father and daughter, including a nonsense mutation in REEP5. None of these germline variants were located in tumour regions of LOH shared by the father and daughter. Four genes ( EXOG , RANBP2, RANBP6 and TNFRSF1B ) harboured missense variants that fell in a region of LOH in the tumour from the father only, but none showed somatic loss of the wild type allele in the tumour. The REEP5 gene was sequenced in 23 individuals with presumed sporadic AMTs or PMP; no LoF or rare missense germline variants were identified. Conclusion Germline exome sequencing of a father and daughter with AMTs identified novel candidate predisposing genes. Further studies are required to clarify the role of these genes in familial AMTs.
Cytological evidence of BSD2 functioning in both chloroplast division and dimorphic chloroplast formation in maize leaves
Authors: Li Heying , Bai Mei , Jiang Xingshan , Shen Rongxin , Wang Huina , Wang Haiyang , Wu Hong
Published: December 2019

Background: Maize bsd2 ( bundle sheath defective2 ) is a classical C 4 mutant with defective C 4 photosynthesis, accompanied with reduced accumulation of Rubisco (ribulose bisphosphate carboxylase oxygenase) and aberrant mature chloroplast morphology in the bundle sheath (BS) cells. However, as a hypothetical chloroplast chaperone, the effects of BSD2 on C 4 chloroplast development have not been fully examined yet, which precludes a full appreciation of BSD2 function in C 4 photosynthesis. The aims of our study are to find out the role of BSD2 in regulating chloroplasts development in maize leaves, and to add new insights into our understanding of C 4 biology.
Results: We found that at the chloroplast maturation stage, the thylakoid membranes of chloroplasts in the BS and mesophyll (M) cellsbecame significantly looser, and the granaof chloroplasts in the M cells became thinner stacking in the bsd2 mutant when compared with the wildtype plant. Moreover, at the early chloroplast development stage, the number of dividing chloroplasts and the chloroplast division rate are both reduced in the bsd2 mutant, compared with wild type. Quantitative reverse transcriptase-PCR analysis revealed that the expression of both thylakoid formation-related genesand chloroplast division-related genes is significantly reduced in the bsd2 mutants. Further, we showed that BSD2 interacts physically with the large submit of Rubisco (LS) in Bimolecular Fluorescence Complementation assay.

Conclusions: Our combined results suggest that BSD2 plays an essential role in regulating the division and differentiation of the dimorphic BS and M chloroplasts, and that it acts at a post-transcriptional level to regulate LS stability or assembly of Rubisco.
Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies
Authors: Li Hao , Duan Ming-da , Zhang Yun-liang , You Shao-hua , Song Yu-xiang , Zhang Xuan , Liu Min , Liu Wen-gang , Hou Ai-sheng , cao jiangbei
Published: December 2019

Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.
Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, resuscitation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.
Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the resuscitation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant.
Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.
A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention
Authors: Kneis Sarah , Wehrle Anja , Dalin Daniela , Wiesmeier Isabella Katharina , Lambeck Johann , Gollhofer Albert , Bertz Hartmut , Maurer Christoph
Published: December 2019

Background
Postural instability presents a common and disabling consequence of chemotherapy-induced peripheral neuropathy (CIPN). However, knowledge about postural behavior of CIPN patients is sparse. With this pilot study, we used a new approach to i) characterize postural impairments as compared to healthy subjects, ii) allocate possible abnormalities to a set of parameters describing sensorimotor function, and iii) evaluate the effects of a balance-based exercise intervention.
Methods
We analyzed spontaneous and externally perturbed postural control in eight CIPN patients before and after a balance-based exercise intervention by using a modification of an established postural control model. These findings were compared to 15 matched healthy subjects.
Results
Spontaneous sway amplitude and velocity were larger in CIPN patients compared to healthy subjects. CIPN patients’ reactions to external perturbations were smaller compared to healthy subjects, indicating that patients favor vestibular over proprioceptive sensory information. The balance-based exercise intervention up-weighted proprioceptive information in patients.
Conclusions
CIPN patients’ major postural deficit may relate to underuse of proprioceptive information that results in a less accurate posture control as spontaneous sway results indicate. The balance-based exercise intervention is able to partially correct for this abnormality. Our study contributes to a better understanding of postural impairments in CIPN patients and suggests an effective treatment strategy.
Cumulative Incidence of Hepatocellular Carcinoma and Hepatitis B Surface Antigen Seroclearance after Nucleos(t)ide analogue-induced Hepatitis B e Antigen Seroclearance
Authors: Lee Hyun Woong , Lee Jung Il , Kim Saein , Kim Sora , Chang Hye Young , Lee Kwan Sik
Published: December 2019

Background: Hepatitis B e antigen (HBeAg) seroclearance has been considered as the treatment endpoint in HBeAg-positive patients with chronic hepatitis B (CHB). Although HBeAg seroclearance has been accomplished, some aspects are yet unclear. We investigated the cumulative incidence of hepatocellular carcinoma (HCC) and evaluated hepatitis B surface antigen (HBsAg) seroclearance in patients undergoing nucleos(t)ide analogue (NA)-induced HBeAg seroclearance.
Methods: In this retrospective cohort study, 203 patients with CHB were HBsAg and HBeAg seropositive before NA (entecavir or tenofovir) treatment. All patient who experienced NA -induced HBeAg seroclearance were recruited. Patients with documented HBeAg seroclearance were followed-up every 6 months. Baseline characteristics and laboratory results were recorded.
Results: The mean age at HBeAg seroclearance was 40 years (range, 20-84), and the mean follow-up duration was 5 years (range, 2-11). The cumulative incidence of HCC was 1.5% to 11.5% at 1 to 8 years after HBeAg seroclearance. Cirrhosis was the only significant factor for HCC development (hazard ratio [HR], 24.651; confidence interval [CI], 3.018 to 201.365; P = 0.003). The cumulative incidence of HBsAg seroclearance was 3.5% to 18.7% after 1 to 8 years from HBeAg seroclearance.
Conclusions: A significant proportion of patients developed HCC after NA-induced HBeAg seroclearance. The presence of liver cirrhosis at the time of HBeAg seroclearance serves as an independent factor for HCC development. Some patients with NA-induced HBeAg seroclearance achieved HBsAg seroclearance.
Keywords: hepatitis B virus; hepatitis B e antigen seroclearance; hepatitis B s antigen seroclearance; hepatocellular carcinoma
Is Procalcitonin (PCT) a reliable biomarker for preoperative diagnosing of low grade Periprosthetic Joint Infection? A Prospective Study
Authors: Busch André , Jäger Marcus , Engler Harald , Haversath Marcel , Bielefeld Charlotte , Landgraeber Stefan , Wegner Alexander
Published: December 2019

Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT levels were quantified under the use of immunoassay (Centaur, Siemens, Germany). SF- PCT levels were measured using a standard quantitative PCT enzyme immunoassay kit, according to the manufacturers' instructions (Anti-Procalcitonin antibody ab166963, ABCAM, Cambridge,UK). Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher than those in the aseptic group (PJI 0.05 ng/mL (0.0-1.03) vs. aseptic 0.02 ng/mL (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL (0.53-9.7) vs. aseptic 8.7 ng/mL (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specifity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specifity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Lapatinib in combination with capecitabine versus continued use of trastuzumab in breast cancer patients with trastuzumab-resistance: a retrospective study for Chinese population
Authors: Yang fan , Huang Xiang , Sun Chunxiao , Li Jianbin , Wang Biyun , Yan Min , Jin Feng , Wang Haibo , Zhang Jin , Fu Peifen , Zeng Tianyu , Wang Jian , Li Wei , Li Yongfei , Yang Mengzhu , Li Jun , Wu Hao , Fu Ziyi , Yin Yongmei , jiang zefei
Published: December 2019

Background: The efficacy and safety of lapatinib plus capecitabine (LC or LX) versus trastuzumab plus chemotherapy in patients with HER-positive metastatic breast cancer who were resistant to trastuzumab is largely unknown. Methods: we retrospectively analyzed breast cancer patients who began the treatment with regimen of lapatinib plus capecitabine (LC or LX) or trastuzumab beyond progression (TBP) at eight hospitals between May 2010 and October 2017. Results: Among 554 patients who had developed resistance to trastuzumab, the median PFS was 6.77 months in the LX group compared with 5.6 months in the TBP group (hazard ratio 0.804; 95% CI, 0.67 to 0.96; P=0.019). The central nervous system progression rate during treatment was 5.9% in LX group and 12.5% in TBP group, respectively (P=0.018). Conclusion: The combination of lapatinib and capecitabine has shown a prolonged PFS compared with TBP in patients who had progressed on trastuzumab.
Successful Control of an Extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae ST307 Outbreak in a Neonatal Intensive Care Unit
Authors: Baek Eun-Hwa , Kim Se-Eun , Kim Sunjoo , Lee Seungjun , Cho Oh-Hyun , Hong Sun In , Do Hyun Jeong , Park Chan-Hoo , Shin Jeong Hwan , Hwang Inyeong , Park Eunhee
Published: December 2019

Background : In this study, we evaluated the genetic relatedness of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) isolates from an outbreak in a neonatal intensive care unit in August 2017 using pulse-field gel electrophoresis (PFGE) and sequence typing, we implemented an active countermeasure to control this outbreak successfully.
Methods: The incidence of healthcare-associated ESBL-KPN bacteremia was evaluated before and after initiating enhanced infection control (IC) practices in January 2018. Surveillance cultures were set up and monitored for neonates, medical personnel, and NICU environmental samples. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains.
Results: After implementing the enhanced IC procedures, the healthcare-associated bacteremia rate decreased from 6.0 to 0.0 per 1,000 patient-days. Samples from neonates (n = 11/15, 73.3%), medical personnel (n = 1/41, 2.4%), and medical devices and the environments (6/181, 3.3%) tested positive for ESBL-KPN in the surveillance cultures in December 2017. Active surveillance cultures revealed that 23 of 72 neonates who were screened (31.9%) were colonized with ESBL-KPN between January and March 2018. All the isolates demonstrated closely related PFGE patterns and were identified as ST307 strain carrying the CTX-M-15 gene.
Conclusions: Contaminated neonate environments and medical devices, as well as transmission by medical personnel, appeared to be the source of the outbreak of ESBL-KPN infection. We employed an enhanced IC strategy during January-March 2018 and successfully controlled the clonal outbreak of CTX-M-15-positive KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be carefully monitored.
Identification of subclinical tuberculosis in household contacts. The relevance of tuberculosis exposure scores and contact investigations.
Authors: Bekken Gry Klouman , Ritz Christian , Selvam Sumithra , Nelson Jesuraj , Hesseling Anneke C , Doherty Timothy Mark , Grewal Harleen MS , Vaz Mario , Jenum Synne
Published: December 2019

Background The goal of tuberculosis elimination put forward in the End TB Strategy prioritizes diagnosis and treatment of incipient and subclinical TB, recently defined by key stakeholders as an “asymptomatic, early pre-clinical disease during which pathology evolves”. Regarded as indicative of a high risk of TB progression, considerable efforts have been made to identify these cases through exploration of biomarkers. The present study aimed to evaluate simple scoring systems for TB exposure as screening tools for subclinical TB, the only identifiable of the incipient and subclinical disease states, in a contact investigation (CI) setting of low HIV-prevalence. Methods Nested within a large prospective study in household contacts (HHCs) of smear positive pulmonary TB cases in South-India conducted 2010-2012, we assessed 1) the association between the Tuberculosis Contact Score (TCS) and the Infectivity Score with established tools for Mycobacterium tuberculosis (Mtb) infection corrected for established TB risk factors and 2) the capability of the TB exposure scores to identify subclinical TB defined by Mtb-culture positivity in sputum or gastric aspirate (subjects <5 years) specimen. Results Of 525 HHCs, 29 were Mtb-culture positive and 96.6% of these asymptomatic. The TCS and the Infectivity Score associated with positive Tuberculin Skin Test and QuantiFeron TB-Gold In-tube assay (QFT) results in multivariate analyses (TCS: ORTST 1.16, 95%CI: 1.01, 1.33; ORQFT 1.33 95%CI: 1.16, 1.51. Infectivity Score: ORTST 1.39, 95%CI: 1.10, 1.76; ORQFT 1.41 95%CI: 1.16, 1.71). The Infectivity Score showed a moderate capability to identify subclinical TB (AUC of 0.61, 95%CI: 0.52, 0.70). Conclusion Although our results did not identify an easily applicable screening tool for subclinical TB, the present study indicates that focusing on TB-related symptoms in CI settings may be of limited value for early identification of HHCs with high risk for TB progression, one of the goals of the End TB Strategy.
Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis
Authors: xu hanyue , Qin Ling , Zhang Yifan , Zhang Ming
Published: December 2019

Background:
To compare the visual outcomesand rate of restored ellipsoid zone (REZ) after surgery of lamellar macular hole (LMH) with and without lamellar hole-associated epiretinal proliferation (LHEP). To determine whether all patients with LMH need surgery.
Method:
Publications up to November 2019 that compared the outcomes of LMH patients with and without LHEP who were managed by surgery were included. Forest plots were created using a weighted summary of proportion meta-analysis. A random effects mode was used and I2 heterogeneity estimates were calculated. Sensitivity analysis was carried out to evaluate the stability of the meta-analysis.
Result:
Four pertinent publications studying a total of 157 patients were identified. They were all retrospective studies and had a mean follow-up of at least 6 months. In all studies, the best corrected visual acuity (BCVA) had no significant differences before surgery and improved in both groups, and in two studies the post-operative BCVA had no significant differences between two groups. The rate of REZ were different among studies included. Meta-analytic pooling of the improved BCVA between with and without LHEP groups was 0.15 (95 % CI, 0.02 to 0.27; p=0.02), and the pooled data revealed an odd ratio of 5.79 (95% CI, 1.15 to 29.18; p = 0.03) in the rate of restored ellipsoid zone, comparing the group without LHEP and the group with LHEP.
Patients with LHEP were more likely to gain restored ellipsoid zone after surgery but had lower postoperative BCVA. The surgery of LMH with LHEP appeared to be useless for improving visual acuity.
Improving production of Streptomyces griseus trypsin for its application in processing insulin precursor
Authors: Zhang YunFeng , Liang Qixing , Zhang Chuanzhi , Zhang Juan , Du Guocheng , Kang Zhen
Published: December 2019

Background: Trypsin has a plenty application in food and pharmaceutical manufacture. While, the commercial trypsin is usually extracted from pork pancreas, which has the risk of infectious and immunogenicity. Therefore, the microbial Streptomyces griseus trypsin (SGT) is a prior alternation because it processes efficient hydrolysis activity without the aforementioned risk. The remarkable hydrolysis efficiency of SGT caused its autolysis, and five autolysis sites R21, R32, K122, R153, and R201 were identified from its' autolysate. Results: The tbcf (K101A, R201V) mutant was screened by directed selection approach for improved activity in flask culture (60.85 ± 3.42 U·mL -1 , increased 1.5-fold). From the molecular dynamics simulation, the K101A/R201V mutation shortened the distant between catalytical residues D102 and H57 from 6.5 Å vs 7.0 Å, which afforded the improved specific activity 1527.96 ± 62.81 U·mg -1 . Further, the production of trypsin was increased 302.8% (689.47 ± 6.78 U·mL −1 ) in 3-L bio-reactor, with co-overexpression of chaperones SSO2 and UBC1 in Pichia pastoris. Conclusions: The SGT protein could be an adequate trypsin for insulin production. When working with hydrolysates analysis and direction selection, the tbcf (K101A, R201V) mutant increased 1.5-fold activity. Further, the production of trypsin was improved 3-fold by overexpressing chaperone protein in Pichia pastoris . The future study should be emphasized on the application of SGT in insulin manufacture and pharmaceutical.
Elucidating the mechanism by which regulating spleen and lipid method improves the state of hyperlipidaemic rats
Authors: Liu Guirong , Pan Linlin , Sun Qihui , Wang Song
Published: December 2019

Backgound Hyperlipidemia has been highlighted as global chronic conditions of our time, the regulating spleen and lipid decoction (RSLD) is a traditional Chinese medicine preparation for hyperlipidemia with good therapeutic effect. This study used urinary metabolomics combined with network pharmacology to elucidate the mechanism of RSLD in treating hyperlipidemia.Methods In this study, the network pharmacology was used to dissect the impacts of RSLD on the hyperlipidemia network. Serum samples from hyperlipidaemic rats were collected to quantify biochemical indices, urinary metabolomics was used to evaluate urine samples from control, model, xuezhikang and RSLD groups to shed light on a metabolic mechanism of action.Results The component- target-disease network suggested that the low density lipoprotein receptor (LDLR) target protein, which is associated with hyperlipidemia, is regulated by RSLD. A metabolomics analysis suggested that RSLD can significantly regulates taurine, citric acid, leucine, valine and linoleic acid in amino acid metabolism, fatty acid metabolism and tricarboxylic acid cycle, and that the overall metabolic mechanism is closely related to the target protein LDLR.Conclusions Metabolomics combined with network pharmacology suggested that RSLD can improve hyperlipidemia by enhancing LDLR protein expression to regulate disordered biomarkers and their metabolic pathways. Therefore, we believe that RSLD represents an interesting candidate for further characterization as a treatment for hyperlipidemia.
Magnitude of obesity/overweight and its associated factors among HIV/AIDS patients on antiretroviral therapy in Jimma University Specialized and Teaching hospital, south west Ethiopia: Hospital based Crossectional study
Authors: Yitbarek Getachew Yideg , Engidaw Melaku Tadege , Ayele Belete Achamyelew , Tiruneh Sofonyas Abebaw , Alamir Melkamu Tilahun
Published: December 2019

Background: Obesity is on the rise worldwide, not only in the general population but also in PLWHA. Being overweight and obese are themselves a risk factors for cardiovascular and other diseases. Despite this few studies have been conducted to determine the magnitude of obesity/overweight and its associated factors among HIV/AIDS patients in Ethiopia. This study aimed at determining the magnitude of obesity/overweight and its associated factors among HIV/AIDS patients on HAART at JUSTH, Ethiopia 2019. Method: hospital based cross-sectional study was conducted from January to February in 2019 at JUSTH. WHO STEP wise approach to chronic disease risk factor surveillance (STEPS) questionnaire and document review for HIV related clinical factors was applied. Weight, height and waist circumference and hip circumference were measured. BMI ≥25 kg/m2 was considered overweight, while abdominal obesity was referred to males with waist to hip ratio of greater than 0.95 and greater than 0.85 for females. Data was analyzed using SPSS version 20. Results: A total of 252 participants with a response rate of 95.8% were included. The prevalence of obesity/overweight was 21%. After adjusting for these variables, age category of greater than 50 years [AOR = 0.4, 95%CI (0.2, 0.9), p = 0.03],WHO clinical stage III and above [AOR = 0.04,95% CI (0.002,0.6) ), p = 0.02], presence of mild to moderate physical activity [AOR = 1.3,95% CI,(5.5,33.3)),p=0.00), plasma CD4 count between 351-500 copies/ml [AOR=0.15,95% CI, (0.04,0.6) p=0.024], female sex [AOR = 2.6,95% CI,(1.25,10)p=0.03)] were significantly associated with obesity/overweight Conclusion: There was a high prevalence of obesity/overweight among HIV/AIDS patients. It was found that older age , female sex , early stage of the disease, lower CD4 cunt and absence of mild to moderate physical activity were significant predictor of obesity/overweight. Clinicians should be aware of the health consequence of obesity and consider instituting targeted weight management programs as part of routine HIV care. It is, therefore, vital to encourage intervention strategies that focus on promotion of physical activity among people living with HIV/AIDS.
Household Food Insecurity, Coping Strategies and Adolescent Girls’ Dietary Diversity Status in Hossana Town, Ethiopia.
Authors: Bancha Belay , Petrose Legese , Fanta Begidu Bashe , Endale Ashebir , Delil Romedan , Lodebo Mengistu
Published: December 2019

Background Globally there are 1.8 billion adolescents, comprised of 10-19 years old, represent approximately 20% of the world’s population. In Ethiopia this group represents 20-26% of general population. Despite the fact that this period is a window of opportunity to break intergenerational cycle of malnutrition, macro and micronutrient deficiencies are among leading health problems in this vulnerable age groups. Moreover, there is scarcity of data on the status of dietary diversity in this segments of the population.Methods a community based cross sectional study design was employed from May 21-June 20, 2019. Pre-tested structured questionnaire was used for data collection using cluster sampling technique to approach 451 households with adolescent girls. Data was entered in to Epi-Data version 3.1 then exported to SPSS version 23 for analysis. Descriptive and logistic regression analysis were performed. Adjusted Odd Ratios (AOR), along with corresponding 95% confidence interval (CI) were used and the level of statistical significance was declared at a p-value of <0.05.Results a total of 434 households with adolescent girls were involved in the study. We found that 41.7% of households were food insecure, only 57.8%, (C.I.53.5-62.2) of adolescent girls consumed diversified diet, with the mean DDS of 5.38 (SD=1.75). After adjusting for potential confounders, occupational status of the adolescents’ father, (AOR= 0.56, 95% C.I. 0.32-0.99 and AOR=0.26, 95% C.I. 0.17-0.47), exposure to televised media (AOR=3.36, 95% C.I. =1.55-7. 3) and household food security status (AOR=5.09, 95% C.I. =3.2-8.08) were significant predictors of dietary diversity among adolescent girls.Conclusion Significant portion of households were food insecure; practicing ranges of coping strategies which further compromised dietary diversity of adolescent girls. Poor dietary diversity adversely affects micronutrient reserves of to-be a-mother girls; the vicious cycles of malnutrition continues its far fetching effect. Given that adolescence is the second period in life with rapid growth and development, improving dietary status of this sensitive segments of the population are to be an agenda of all concerned bodies.
Explaining the impact of mHealth on maternal and child health care in low- and middle-income countries: A theory-driven scoping review
Authors: Kabongo Eveline Muika , Mukumbang Ferdinand , Delobelle Peter N/A , Nicol Edward N/A
Published: December 2019

Introduction Despite the growing global application of mobile health (mHealth) technology in maternal and child health, the contextual factors and mechanisms by which interventional outcomes are generated have not been subjected to extensive review. In this study, we sought to identify context, mechanisms and outcome elements from implementation and evaluation studies of mHealth interventions to formulate theories or models explicating how mHealth interventions work (or not) both for health care providers and for pregnant women and new mothers.Method An electronic search of six online databases (Medline, Pubmed, Google Scholar, Scopus, Academic Search Premier and Health Systems Evidence) was performed. Using appropriate MeSH terms and selection procedure, 32 articles were considered for analysis. A theory-driven approach, narrative synthesis, was applied to synthesise the data. Thematic content analysis was used to delineate the elements of the intervention, including its context, actors, mechanism and outcomes. Retroduction was applied to link these elements using a realist evaluation heuristic to form generative theories.Results Mechanisms that promote the implementation of mHealth by community health workers/health care providers include motivation, perceived skill and knowledge improvement, improved self-efficacy, improved confidence, improved relationship between community health workers and clients, perceived support of community health workers, perceived ease of use and usefulness of mHealth, For pregnant women and new mothers, mechanisms that trigger the uptake of mHealth and use of maternal and child health services included: perceived service satisfaction, perceived knowledge acquisition, support and confidence, improved self-efficacy, encouragement, empowerment and motivation. Information overload was identified as a potential negative mechanism for the uptake of maternal and child health services.Conclusion The models developed in this study provide a detailed understanding of the implementation and uptake of mHealth interventions and how they improve maternal and child health services in low and middle income countries. These models provide a foundation for the ‘white box’ or theory-driven evaluation of mHealth intervention and can improve the rollout and implementation where required.
Clinical Outcomes among Hemodialysis Patients with Atrial Fibrillation: A Korean Nationwide Population-based Study
Authors: Kang Yeunmi , Choi Hyung Yun , Kwon Young Eun , Shin Ji Hyeon , Won Eun Mi , Yang Ki Hwa , Oh Hyung Jung , Ryu Dong-Ryeol
Published: December 2019

Background: The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD investigating how AF affects outcomes, for example, in terms of all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System (NHIS) to determine how AF affects these outcomes. Methods: In 2013, the Health Insurance Review and Assessment (HIRA) service, a Korean national health insurance scheme, collected data from 21,839 HD patients for evaluating the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between patients receiving and not receiving warfarin. Results: Cox regression analysis found that AF was a significant risk factor for death from any cause (HR, 1.356; 95% CI, 1.222-1.506, P < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225-1.430, P < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050-2.141, P = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075-2.360, P = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusions: This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.
Predictive Role of Hypernatremia for Acute Kidney Injury in Patients with Sepsis
Authors: Zhi Deyuan , Lin Jin , Dong Lei , Ji Xiaojun , Zhuang Haizhou , Liu Zhuang , Liu Jingfeng , Duan Meili
Published: December 2019

Introduction Septic acute kidney injury (AKI), identified when both sepsis and AKI present, is a syndrome of acute function impairment and organ damage, accounting for ~50% AKI in ICU (Intensive Care Unit)Method This study retrospectively reviewed 591 patients who were diagnosed of sepsis and admitted to the ICU of Beijing Friendship Hospital from January 2009 to December 2014. According to the concentration of serum sodium, the 591 patients were further divided into three groups: normal group, hyponatremia group and hypernatremia group.Result PaCO 2 (P=0.014), concentration of Na + (P<0.001) and Cl - (P<0.001), BUN (P<0.001), APACHE score (P<0.001), SOFA score (P<0.001) and Glasgow score (P<0.001) showed significant differences. CK (P=0.012; OR=1.000), BUN (P=0.002; OR=1.047), Cl - (P<0.001;OR=1.255), lactic acid (P=0.001;OR=1.244), and HCO 3 - (P<0.001;OR=1.180) may be risk factors for hypernatremia in patients with sepsis. APACHE score (P=0.028;OR=1.222) and CK (P=0.014;or=1.003) may be risk factors for AKI in patients with hypernatremia. Na + suggested a good predictive ability for AKI (P<0.001; AUC: 0.586) but not for death (P=0.104)Conclusion Hypernatremia is independently associated with an increased risk and has a predictive ability of AKI in patients with sepsis.
Potential Trauma Events and the psychological consequences of Yazidi Women after ISIS Captivity
Authors: Kizilhan Jan Ilhan , Friedl Nadine , Neumann Johanna , Traub Leonie
Published: December 2019

Background Traumatic war experiences, like the ones the Yazidi had to undergo due to the attack of the so-called Islamic State (ISIS) in August 2014, are often followed by psychological consequences such as posttraumatic stress disorder (PTSD) and depression. A more detailed analysis of such specific survivor groups is needed, to develop and implement appropriate reparation and support measures.MethodsIn this study, 194 Yazidi women were examined. PTSD was assessed using the Essen Trauma Inventory (ETI) and depression using Beck’s Depression Inventory (BDI-II). The potential traumatic event (PTE) and further influential factors were compared between participants with PTSD and those with PTSD and depression, using inferential statistics.Results Participants showed high rates in prevalence and comorbidity for PTSD and depression. Those diagnosed with comorbid PTSD and depression experienced a higher number of PTEs and had been captured more often and for longer compared to those with PTSD. The number of PTEs experienced was then used to predict comorbid PTSD and depression.Conclusion Further research should consider the specific situation and the cultural expression of the Yazidi.
Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: A qualitative study
Authors: Berg Siv Hilde , Rørtveit Kristine , Walby Fredrik. A. , Aase Karina
Published: December 2019

Background. Safe clinical practice for patients during a suicidal crisis is situated within a complex, non-linear and uncertain context. It involves a complex set of practices in which adaptation is perceived as a source of safety. This study aims to develop a deeper understanding of safe clinical practice and the capacity to adapt to challenges and changes in clinical care for patients hospitalised in mental health wards during a suicidal crisis. Methods. This study applied a qualitative design based on focus group and individual interviews. Twenty-five health care professionals (HCPs) participated in the focus groups, and 18 HCPs were individually interviewed. The study was conducted at open and locked wards in a university hospital in Norway that provides specialised mental health services for adults.Findings. Adaptive capacities for clinical practice were described in relation to three themes. 1) HCPs described using expertise to make sense of suicidal behaviour to support complex decision-making. Their strategies relied on setting the checklist aside to prioritise trust and making judgements beyond spoken words. They improved their understanding by seeking others’ perspectives through a collaborative sense-making process involving the health care team and the patient. 2) HCPs reported individualising the therapeutic milieu to address the diversity of patients with suicidal behaviour. Safe clinical practice was provided by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations 3) It was necessary for HCPs manage uncertainty to provide safe clinical practice. They did so as a team by developing mutual collegial trust, support and shared understanding. Conclusion. HCPs’ adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacity to adapt to challenges and changes in clinical care. Safe clinical practice cannot easily be ensured by following standards; it depends on HCP adaptations. Ward systems ensuring collegial trust and support are needed, as are arenas supporting shared understanding and collaborative sense-making. Keywords: Adaptation, sense-making, situational awareness, shared understanding, trade-offs, mental health, suicide, uncertainty
Exon Sequencing Mutation Detection Algorithm Based on PCR Matching
Authors: Chen Guobin , Xie Xanzhong
Published: December 2019

Background: With the development of second-generation sequencing technology, more and more DNA sequence variations have been detected. Exon sequencing is the first choice for sequencing many cancer genes, and it can be better used to identify disease status by detecting gene variants. PCR sequence is an effective method to capture that sequence of an exon in the process of sequencing. Exon sequencing sequence contains PCR primer sequence, the correct position of the sequence can be determined by PCR primer sequence, which can be found in SNP, Indel mutation point by comparing the sequence of PCR primer sequence. Results: In this paper, a matching algorithm based on the PCR primer sequence is proposed, which can effectively sequence the position of PCR primer sequence and find out the key position sequence. Then the sequencing sequence is sorted and the number of the same sequence is counted to reduce the matching times. Then, the sequenced sequence was matched with PCR primer sequence, so that the DNA position could be accurately matched and the variation in the sequenced sequence could be found more quickly. Conclusions: Compared with the traditional sequence matching method, PCR primer sequence matching method can match many sequences and find more variation. It also showed a high recall rate in the recall rate.
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: December 2019

Background: Lactococcus members belonging to lactic acid bacteria are distributed in fermented foods and widely used as starter bacteria in the production of fermented dairy products. Lactococcus raffinolactis WiKim0068 was isolated from a Korean fermented vegetable (kimchi) and its genome was analyzed. Results: The complete genome of strain WiKim0068 comprised one chromosome and two plasmids and contained 2,292,235 bp, with a G+C content of 39.7 mol%. Analysis of orthoANI values among Lactococcus genome sequences showed that strain WiKim0068 has > 67% genome sequence similarity to other species and subspecies. In addition, strain WiKim0068 displayed no antibiotic resistance and possessed nicotinate (vitamin B3) and nicotinamide (vitamin B3 amide) metabolism. Conclusion: These results add to our understanding of the genus Lactococcus and suggest that this new strain that is beneficial to human health has potential industrial applications Keywords: Lactococcus raffinolactis, genome sequence, kimchi, probiotics, vitamin B3
Association of plasma apolipoprotein B with cerebrospinal fluid Alzheimer’s disease biomarkers in patients with subjective cognitive decline
Authors: Hu Hao , Tan Lan , Bi Yan-Lin , Xu Wei , Tan Lin , Shen Xue-Ning , Hou Xiao-He , Ma Ya-Hui , Dong Qiang , Yu Jin-Tai
Published: December 2019

BackgroundThe preclinical stage of Alzheimer's disease (AD) has become a key target stage for future AD prevention trials. Plasma apolipoprotein, an important lipid-related factor, has been found to be involved in the pathogenesis of AD. This study was to examine whether apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA1) or the ratio of ApoB and ApoA1 (ApoB/A1) were associated with early changes of cerebrospinal fluid (CSF) AD biomarkers in elderly adults with subjective cognitive decline.MethodsThis study finally included 201 cognitive normal (CN) elderly adults and 101 participants with subjective cognitive decline (SCD) from the Chinese Alzheimer’s Biomarker and Lifestyle (CABLE) database. The One-way analysis of variance, t-test, Kruskall-Wallis test and Chisquare test were applied in the intergroup comparisons. Multiple linear regression models were used to examine the cross-sectional associations of plasma ApoB, ApoA1 and ApoB/A1 levels with CSF AD-related biomarkers.ResultsCompared with the control group, SCD participants with significant AD biological characteristics had lower ApoB levels. In the total participants, higher level of plasma ApoB was associated with increases in CSF Aβ42 (p = 0.0009) and Aβ42/40 (p = 0.0038) as well as decreases in CSF t-tau/Aβ42 (p < 0.0001) and p-tau/Aβ42 (p < 0.0001), independent of APOEɛ4 status. In the further subgroup analysis, these associations were much more significant in the SCD participants. In addition, higher levels of plasma ApoB were also found associated with decreases in CSF t-tau (p = 0.0224), p-tau (p = 0.0086) and Aβ40 (p = 0.0297) in the SCD subgroup. Furthermore, we found that these protective associations between plasma ApoB and CSF AD core biomarkers were much more significant in the overweight participants. Results showed no association between ApoA1 and all CSF biomarkers in either total participants or subgroups. ConclusionsThis study is the first to find protective associations of plasma ApoB, but not ApoA1, with CSF AD core biomarkers in elderly adults, and these associations were more significant in SCD individuals. This finding indicated that ApoB may play a protective role in the preclinical stage of AD. Identifying the underlying mechanisms may contribute to the discovery of new pathogenic mechanisms and therapeutic targets.