bluuebunny/crossref_metadata_2025 huggingface dataset:
A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admission and bed days in people nearing the end of their life: Much innovation but limited supporting evidence
Authors: Taylor Ros , Ellis Jonathan , Gao Wei , Searle Liz , Heaps Kate , Davies Robert , Hawksworth Claire , Garcia-Perez Angela , Colclough Giles , Walker Steven , Wee Bee
Published: February 2020

Objectives Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent.
Structure and surgical dissection layers of the bare area of the liver
Authors: Ishii Takamichi , Seo Satoru , Ito Takashi , Ogiso Satoshi , Fukumitsu Ken , Taura Kojiro , Kaido Toshimi , Uemoto Shinji
Published: February 2020

Background: The bare area was reportedly formed by direct adhesion between the liver and diaphragm, meaning that the bare area lacked serosal components. This study aimed to analyze the structure of the bare area by an integrated study of surgical and laparoscopic images and pathological studies and describe surgical procedures focusing on the multilayered structure.Methods: Several surgical specimens of hepatectomy were analyzed histologically to evaluate the macroscopic structure of the bare area. Laparoscopic images and cadaver anatomy of the bare area were also examined.Results: The multilayered structure of the bare area comprised the liver, sub-serosal connective tissue, liver serosa, parietal peritoneum, retroperitoneal connective tissue, epimysium of the diaphragm, and diaphragm, in order from the liver to the diaphragm. The liver serosa and the parietal peritoneum fused with each other. This multilayered structure of the bare area is observed almost constantly. There are two layers in the dissection of the bare area in surgical procedures, an outer layer of the fused peritoneum (near the diaphragm) and an inner layer of the fused peritoneum (near the liver). Laparoscopic images enabled us to recognize the multilayered structure of the bare area.Conclusions: Histopathological findings showed the bare area to be a multilayered structure. In cases where tumors are located underneath the bare area, it could be important to dissect the bare area, with careful attention to its multilayered structure. Surgical dissection of the bare area in the outer layer of the fused peritoneum could allow a sufficient safety margin.
Predictive value of gamma-glutamyl transpeptidase to lymphocyte count ratio in hepatocellular carcinoma patients with microvascular invasion
Authors: Zhang Hongxing , Zhou Yu , Li Yicheng , Qin Wanying , Zi Yunhua , Liu Yulan , Qiu Xiaoying , Xu Hongyuan , Liao Weijia , Huang Zhaoquan
Published: February 2020

Background: Microvascular invasion (MVI) is an independent risk factor for poor prognosis in hepatocellular carcinoma (HCC). However, there is still a lack of preoperative markers to predict MVI in HCC. This study intends to explore the potential application value of the gamma-glutamyl transpeptidase (GGT) to lymphocyte count ratio (GLR) in predicting MVI in HCC and provide guidance for clinical diagnosis and treatment.

Methods: From March 2010 to December 2015, 230 HCC patients who underwent surgical treatment in the Affiliated Hospital of Guilin Medical University were selected. Clinicopathological parameters between the MVI group (n = 115) and the non-MVI group (n = 115) were comparatively analyzed. The GLR was used as the potential risk factor for HCC with MVI, and its optimal cut-off value was estimated by using the receiver operating characteristic (ROC) curve. The Kaplan-Meier method was used to analyze the survival of HCC patients, and univariate and multivariate Cox regression analyses were used to establish independent predictors affecting postoperative HCC patients.

Results: The GLR levels in the MVI group and non-MVI group were 84.83 ± 61.84 and 38.42 ± 33.52 (p < 0.001), respectively. According to ROC curve analysis, the optimal cut-off value of GLR was 56.0, and the area under the ROC curve (AUC) was 0.781 (95% CI, 0.719-0.833) for the risk prediction of MVI in HCC patients. Multivariate analysis showed that tumor size > 5 cm, HCC combined with MVI and GLR > 56.0 were independent risk factors for poor prognosis in HCC patients. In addition, compared with the non-MVI group, patients in the MVI group had shorter progression-free survival (PFS) and overall survival (OS).

Conclusion: GLR could be a predictive biomarker of HCC after operation and a potential predictor of HCC combined with MVI.

Keywords: Hepatocellular carcinoma, Microvascular invasion, GLR, Predictive
Association Between Cytomegalovirus End-organ Diseases and Moderate-to-Severe Dementia: A Population-Based Cohort Study
Authors: Lee Kyoung Hwa , Kwon Da Eun , Han Kyung Do , La Yeonju , Han Sang Hoon
Published: February 2020

Background: The association between cytomegalovirus (CMV) and dementia remains controversial. Previous studies have suggested that CMV serostatus, as assessed by serum immunoglobulin G, plays a role in neurodegeneration with cognitive impairment. We aimed to evaluate the association between CMV tissue-invasive end-organ diseases and moderate-to-severe dementia. Methods: The ICD 10th revision codes from the National Health Insurance Database covering the entire population of the Republic of Korea were used to classify patients into exposed (n = 687, age ≥40 years, with CMV disease) and unexposed (n = 3,435, without CMV disease) groups, matched by age and sex at a 1:5 ratio of exposed: unexposed. All non-HIV-1-infected subjects selected during 2010–2014 with a washout period of the previous 4 years were followed up until December 2016 to identify newly diagnosed cases of moderate-to-severe dementia. Results: Multivariate regression model (M3) adjusted for age, sex, low income, body mass index, transplantation status, malignant neoplasms, end-stage renal disease on dialysis, type 2 diabetes mellitus, hypertension, and dyslipidaemia showed a significantly higher incidence of dementia (odds ratio: 1.9; 95% confidence interval: 1.2–2.8) in the exposed group than that in the unexposed group. The risk of vascular dementia (2.9, 1.1–7.5) was higher than that of Alzheimer’s disease (1.6, 1.0–2.6) in the exposed group in M3. In M3, patients aged 40–59 years with CMV diseases had a significantly higher risk of all kinds of dementia than those aged 60-79 and ≥80 years (11.7, 2.5–49.4 vs. 1.8, 1.1–3.2 vs. 1.3, 0.5–2.8; P =0.025). Conclusions: CMV diseases may be associated with the risk of moderate-to-severe dementia.
Fatty liver index and development of cardiovascular disease in Koreans without pre-existing cardiovascular disease: a large population-based study
Authors: Kim Jun Hyung , Moon Jin Sil , Byun Seok Joon , Lee Jun Hyeok , Kang Dae Ryong , Sung Ki Chul , Kim Jang Young , Huh Ji Hye
Published: February 2020

Background Despite the known association between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease (CVD), it remains uncertain whether NAFLD predicts future CVD events, especially CVD mortality. We evaluated the relationship between fatty liver index (FLI), a validated marker of NAFLD, and risk of major adverse cardiac events (MACE) in a large population-based study. Methods We identified 3,011,588 subjects without a history of CVD who underwent health examinations from 2009 to 2011 in the Korean National Health Insurance System cohort. The primary endpoint was a composite of cardiovascular deaths, non-fatal myocardial infarction (MI), and ischemic stroke. Cox proportional hazards regression analysis was performed to assess the independent association between FLI and the primary endpoint. Results During the median follow-up of 6 years, there were 46,010 cases of MACE (7,148 cases of cardiovascular death, 16,574 non-fatal MI, and 22,228 ischemic stroke). There was a linear association between higher FLI values and higher incidence of the primary endpoint. In the multivariable models adjusted for factors including body weight and cholesterol levels, the hazard ratio (95% CIs) for the primary endpoint comparing the highest vs. lowest quartiles of FLI was 1.99 (1.91–2.07). The corresponding odds ratios (95% CIs) for cardiovascular death, non-fetal MI, and ischemic stroke were 1.98 (1.9-2.06), 2.16 (2.01-2.31), and 2.01 (1.90-2.13), respectively. The results were similar when we stratified analysis by age, sex, dyslipidemia medication, obesity, diabetes, and hypertension. Conclusions Our findings indicate that FLI, a surrogate marker of NAFLD, has prognostic value for detecting individuals at higher risk of cardiovascular events.
The pathogenic role of stem cell-like memory T cells in rheumatoid arthritis
Authors: Lee Ye Ji , Park Eun Hye , Park Jun Won , Jung Kyeong Cheon , Lee Eun Bong
Published: February 2020

Background: Stem cell-like memory T cells (Tscm) are a subset of memory T cells that have the characteristics of stem cells. The role of Tscm cells in rheumatoid arthritis (RA) is not well characterized. Methods: After measuring percentages of CD4+ and CD8+ Tscm cells within the peripheral blood and synovial mononuclear cell populations in RA and health controls (HCs), we confirmed the stem cell nature of Tscm cells from RA patients. The association of Tscm cells with disease activity was also analyzed. Next, the pathogenicity of Tscm cells was examined in RA patients by assessing T cell activation markers and cytokine secretion after stimulation with IL-6 and anti-CD3/CD28 beads. Finally, the transcriptomes of Tscm cells from RA patients were compared with those from HCs. Results: The percentages of CD4+ and CD8+ Tscm cells among total T cells were significantly higher in RA patients than in HCs. Upon stimulation, Tscm cells from RA patients differentiated into daughter T cell subsets with self-renewal capacity. The percentage of CD4+ Tscm cells correlated with expression of RA disease activity markers. Tscm cells from RA patients were more easily activated by IL-6 and anti-CD3/CD28 beads than those from HCs. Transcriptome analysis revealed that Tscm cells from RA patients showed patterns distinct from those of HCs. Conclusion: The percentage of transcriptionally distinct and potentially pathogenic Tscm cells are higher in RA patients than in HCs; these cells may be a continuous source of pathogenic T cells, which perpetuate RA.
Self-made adjustable external fixation device with progressive compression for the management of open fracture with bone defects of the distal hallux phalanx: a case report
Authors: YANG Ying-Guo , Tong Da-Ke , Liu peizhao
Published: February 2020

Background: Open fractures with bone defects of the distal phalanx of the hallux are both rare and complicated, and these conditions pose great clinical challenge to orthopedists as improper handling can lead to distal tissue necrosis, osteomyelitis, malunion, non-union and even amputation. Due to the lack of soft tissue and bone and the blocking effect caused by un-disconnected soft tissue, it is relatively difficult to achieve effective reduction and fixation of the fracture by traditional methods. Methods: we present a patient, diagnosed with open fracture combined with bone defects of the distal segment of the great toe, who was treated using a self-made adjustable external fixation device by complete debridement, effective closed reduction and continuous adjustment. Complications were registered and clinical outcome was measured at the follow-up periods. Results: The device was simple to make with a low cost and practicality, and this technique resulted in effective maintenance of reduction and progressive compression in the fracture ends. The patient finally obtained optimal fracture healing and satisfactory function of the injured toe at last follow-up. Conclusions: The self-made adjustable external fixation device is reliable in maintaining reduction and fixation, which provides an alternative for the management of open fracture associated with bone absence of the distal phalanx of the hallux.
Immediate Accelerated Shoulder Rehabilitation (IASR) vs. Standard Protocol following Reverse Total Shoulder Arthroplasty: A Randomized Controlled Trial.
Authors: DeVito Paul , Hatch Ryan , Raja Avias , Smudge Lauren , Cambronne Travis , Walsh Michael
Published: February 2020

Background: Recently, the reverse total shoulder arthroplasty (rTSA) became the most frequently performed form of shoulder replacement in the United States and abroad. While physical therapy is universally accepted and routinely practiced, published postoperative rehabilitation guidelines and modifications are based on protocols developed in 1975. Since then, the principle components and temporal concepts of timing and intensity of postoperative rehabilitation and protected immobilization have been controversially applied and expertly discussed without a prevailing consensus. Comparative literature that prospectively addresses treatment differences, influences on outcomes, and superiority or inferiority versus control does not exist. Thus, the objective of this pilot study is to compare an accelerated and immediate active shoulder rehabilitation (IASR) rehabilitation program with standard care in patients following rTSA.Methods: A prospective, randomized, controlled, parallel-designed, two-armed, non-blinded, superiority pilot trial. The comparator arms are an accelerated rehabilitation (IASR) strategy versus standardized care following rTSA (CPT: 23472). The primary outcome measures will be the change from pre-surgical baseline to 52 weeks post-surgery in the American Shoulder and Elbow (ASES) score, Simple Shoulder Test (SST), and global health assessment (PROMIS-10. Secondary and tertiary outcomes will assess subscapularis integrity, implant status, and overall rehabilitation costs compared to formal control. Patients will be recruited from a single site (TRIA Orthopaedic Center, Bloomington, MN) neighboring the fourteenth largest US metropolitan area.Discussion: This trial will be the first study to compare the efficacy and safety of two different postoperative rehabilitation strategies for patients following rTSA. Further, this will be the first study to investigate an accelerated rehabilitation program without a period of protected immobilization following rTSA. Finally, the results will assist in the shared clinical and surgical treatment decision-making process.
Genomic diversity in pearl millet inbred lines derived from landraces and improved varieties
Authors: Serba Desalegn D. , Kanfany Ghislain , Rhodes Davina , Amand Paul St. , Bernardo Amy , Gangashetty Prakash , Kane Ndjido Ardo , Bai Guihua
Published: February 2020

Background: Genetic improvement of pearl millet is lagging behind most of the major crops. Development of genomic resources is expected to expedite breeding for improved agronomic traits, stress tolerance, yield, and nutritional quality. Genotyping a breeding population with high throughput markers enables exploration of genetic diversity, population structure, and linkage disequilibrium (LD) which are important preludes for marker-trait association studies and application of genomic-assisted breeding. Results: Sequencing the genotyping-by-sequencing (GBS) libraries of 309 inbred lines derived from landraces and improved varieties from Africa and India generated 54,770 high quality single nucleotide polymorphism (SNP) markers. On average one SNP per 29 Kb was mapped in the reference genome, with the telomeric regions more densely mapped than the pericentromeric regions of the chromosomes. Population structure analysis using 30,208 SNPs evenly distributed in the genome divided 309 accessions into five subpopulations with different levels of admixture. Pairwise genetic distance (GD) between accessions varied from 0.09 to 0.33 with the average distance of 0.28. Rapid LD decay implied low tendency of markers inherited together. Genetic differentiation estimates were the highest between subgroups 4 and 5, and the lowest between subgroups 1 and 2. Conclusions: Population genomic analysis of pearl millet inbred lines derived from diverse geographic and agroecological features identified five subgroups mostly following pedigree differences with different levels of admixture. It also revealed the prevalence of high genetic diversity in pearl millet, which is very useful in defining heterotic groups for hybrid breeding, trait mapping, and holds promise for improving pearl millet for yield and nutritional quality. The short LD decay observed suggests an absence of persistent haplotype blocks in pearl millet. The diverse genetic background of these lines and their low LD make this set of germplasm useful for traits mapping.
Impacts of stigma and discrimination in the workplace on people living with psychosis
Authors: Hampson Margaret E , Watt Bruce D , Hicks Richard Edward
Published: February 2020

Background. Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would an Australian qualitative sample reveal similar results and if so, what would be the main impacts of such stigma and discrimination? Method. This analysis used data from a qualitative study that had investigated the employment barriers and support needs of people living with psychosis, including the views of multiple stakeholder groups (such as those living with mental health conditions, health professionals, and employers). Results. The analyses confirmed the most frequently referenced barriers to employment were stigma and discrimination. The main impacts of workplace stigma and discrimination on people living with psychosis included five areas: work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment. Conclusions. As in overseas studies, the main barriers to employment for those living with psychosis were stigma and discrimination, and there were significant impacts from such stigma and discrimination. The findings indicate a need to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.
Three-dimensional induced pluripotent stem-cell models of human brain angiogenesis
Authors: Linville Raleigh M. , Arevalo Diego , Maressa Joanna C. , Zhao Nan , Searson Peter
Published: February 2020

Background: During brain development, chemical cues released by developing neurons, cellular signaling with pericytes, and mechanical cues within the brain extracellular matrix (ECM) promote angiogenesis of brain microvascular endothelial cells (BMECs). Angiogenesis is also associated with diseases of the brain due to pathological chemical, cellular, and mechanical signaling. Existing in vitro and in vivo models of brain angiogenesis have key limitations. Methods: Here, we develop a high-throughput in vitro blood-brain barrier (BBB) bead assay of brain angiogenesis utilizing 150 μm diameter beads coated with induced pluripotent stem-cell (iPSC)-derived human BMECs (dhBMECs). After embedding the beads within a 3D matrix, we introduce various chemical cues and extracellular matrix components to explore their effects on angiogenic behavior. Based on the results from the bead assay, we generate a multi-scale model of the human cerebrovasculature within perfusable three-dimensional tissue-engineered blood-brain barrier microvessels.Results: A sprouting phenotype is optimized in confluent monolayers of dhBMECs using chemical treatment with vascular endothelial growth factor (VEGF) and wnt ligands, and the inclusion of pro-angiogenic ECM components. As a proof-of-principle that the bead angiogenesis assay can be applied to study pathological angiogenesis, we show that oxidative stress can exert concentration-dependent effects on angiogenesis. Finally, we demonstrate the formation of a hierarchical microvascular model of the human blood-brain barrier displaying key structural hallmarks. Conclusions: We develop two in vitro models of brain angiogenesis: the BBB bead assay and the tissue-engineered BBB microvessel model. These platforms provide a tool kit for studies of physiological and pathological brain angiogenesis, with key advantages over existing two-dimensional models.
Designing a new bi-specific tandem single-chain variable fragment antibody against tumor necrosis factor-α and interleukin-23 via in silico studies for the treatment of Rheumatoid arthritis
Authors: Barkhordaria Asgar , Mahnam Karim , Sadeghi Hamid Mir Mohammad
Published: February 2020

Background: Rheumatoid arthritis disease is a chronic autoimmune inflammatory disease that mainly causes synovial joint inflammation and cartilage destruction. Tumor necrosis factor-α (TNF-α) is a pivotal cytokine that plays an important role in rheumatoid arthritis. The treatments focusing on a single cytokine' inhibition, are able to clinically produce meaningful responses in only about half of the treated patients due to multiple cytokines involved in this disease. In the present study, a bi-specific tandem single-chain variable fragment was designed in order to suppress both human tumor necrosis factor-α and interleukin-23 (IL23) as a potential therapeutic drug candidate for this disease. To do so, at first, eight bi-specific tandem single-chain variable fragment models were built against tumor necrosis factor-α and interleukin-23 cytokines with different domain orders and then 50 ns molecular dynamics simulation was performed for each one and thereafter structural properties were exploited.
Results: MD simulation results indicate that the domains' order strongly affects tandem single-chain variable fragment properties and in overall, the fragment VLIL23+Linker+VHIL23+linker+VLTNF+Linker+VHTNF +His6 (VL is variable light and VH is variable heavy fragments and His6 is six histidine) not only separated antibody domains but also had better stability and solvation energy.
Conclusions: Hence, this structure can be considered as a potential drug for rheumatoid arthritis. It is hoped that this research could shed a light for the treatment of Rheumatoid arthritis disease.
Chemotherapy and Targeted Therapy Near the end of life Affects Aggressiveness of Palliative Care
Authors: Cheng Wen-Wu , Zhang Zhe , Chen Meng-Lei , Gu Xiao-Li
Published: February 2020

Background: In patients with advanced cancer, considering the increased application of targeted therapy and immunotherapies, we explored the difference between indicators of chemotherapy and targeted therapy in the last month of life.Methods: Electronic medical data of patients who died from metastatic cancer and received targeted therapy and palliative chemotherapy from April 2007 to December 2018 at the Department of Integrated Therapy, Fudan University Shanghai Cancer Center were analyzed retrospectively. To determine those variables that were judged to be independent predictors of the use of palliative chemotherapy and targeted therapy, and the differences between them, univariate and multivariate analyses were used.Results: Of the 585 patients included in the study, 87 (14.9%) received palliative chemotherapy and 125 (21.3%) underwent targeted therapy during the last month. Patients who received continued chemotherapy within the last month were subjected to more intensive treatment (admitted to an intensive care unit (ICU) in the last month of life (OR, 2.33; CI [1.91–2.92], P < 0.001), and received cardiopulmonary resuscitation(OR, 4.18; CI [2.91–5.40],P < 0.001)), than those who did not. Analysis of subgroups showed that the lung cancer was independently associated with targeted therapy, and admission to an ICU was independently associated with palliative chemotherapy.Conclusions: Younger patients without complications and with better performance status were more likely to receive chemotherapy. Lower rates of cardiopulmonary resuscitation and admission to ICU correlated with receipt of targeted therapy at the end of life compared with those who received chemotherapy in the last 30 days.
AChE-activity in critically ill patients with suspected septic encephalopathy: a prospective, single-centre study
Authors: Zujalovic Benedikt , Mayer Benjamin , Hafner Sebastian , Balling Florian , Barth Eberhard
Published: February 2020

BackgroundIn consequence of systemic inflammation, up to 70% of septic patients develop a diffuse brain dysfunction, accompanying with an increase in mortality, which is referred to as “septic associated encephalopathy”. Subsuming septic associated encephalopathy as a category of delirium, there is a common pathophysiology (neuroinflammation and cholinergic transmitter imbalance). This can be approximated by measuring the acetylcholinesterase activity as a surrogate parameter of cholinergic activity. However, conflicting results for acetylcholinesterase activity exists, if singlepoint measurements have been done. Therefore, we wanted to test the hypothesis, whether longitudinal analysis of acetylcholinesterase activity in Intensive Care Unit patients displays septic associated encephalopathy/delirium in septic patients and reveals significant differences in comparison with non-septic, critically ill patients. MethodsIn this prospective, observational, single-center study, 175 patients, admitted to the operative Intensive Care Unit of the University hospital Ulm, Germany, were included. Patients were divided into septic (n = 45) and non-septic (n = 130) patients and were screened for delirium/cognitive dysfunction. Subgroups for patients with delirium and altered acetylcholinesterase activity were built, dependent if an increase/decrease of the acetylcholinesterase activity was observed. Acetylcholinesterase activity was analysed over the course of time by using a linear regression model accounting for repeated measures. By using a time adjusted model, the effect of further possible predictors of acetylcholinesterase activity was analyzed. For nonparametric distributions, quantitative data were compared using Wilcoxon matched-pairs test. For the analysis of the independent samples, we used the Mann-Whitney test. ResultsThere was a statistically significant, time-dependent change in acetylcholinesterase activity (decrease/increase) over a period of at least 5 days in septic patients which revealed septic associated encephalopathy/delirium in about 90%. ConclusionThe longitudinal measurement of acetylcholinesterase activity over several consecutive days revealed a shift compared to baseline values exclusively in septic patients with septic associated encephalopathy/delirium. Acetylcholinesterase activity alteration compared to baseline values at the onset of sepsis may help to detect and differentiate septic associated encephalopathy from other delirium entities. Trial registrationRetrospectively registered at German Clincial Trials Register, registration number DRKS 00020542, date of registration: January 27, 2020
Molecular identification of severe fever with thrombocytopenia syndrome viruses from tick and bitten patient in Southeast China
Authors: Tong Yongxi , wang qiujing , Fu Yongfeng , Li Shibo , Zhang Zhao , Zhang Zheen , Yu Xuewen
Published: February 2020

Background Severe fever and thrombocytopenia bunyavirus (SFTSV) infection causes severe fever and thrombocytopenia syndrome with high mortality. It is extremely rare that the transmitting tick can be directly captured in the bitten wound and SFTSV can be isolated from both the captured tick and patient’s serum for establishing solid pathogen diagnosis. Case presentation We report a case infected with severe fever and thrombocytopenia bunyavirus. The 69-year-old male patient presented fever and tenderness on two lymph nodes in right groin. A visible tick bitten mark appeared on right upper quadrant of the patient’s abdomen and an alive tick was captured in the bitten wound upon physical examination. The virus was detected in both the captured tick that stayed in the bitten wound for seven days. The phylogenetic analysis indicated that the SFTSV isolated from the tick and the patient’s serum sample belonged to type B, in which the L/S segment of these two isolates shared 100% homology, while the M segment had 99.9% homology. the bitten patient was given various supportive cares and eventually died of multiple organ failure. Conclusions The present case provides direct evidence of SFTSV transmission from H. longicornis to humans and suggests that direct cross-species transmission can occur without additional intermediate hosts.
Comparing the Effects of Ketorolac and Paracetamol on Postoperative Pain in Coronary Artery Bypass Graft surgery. A randomized clinical trial
Authors: zadeh Fatemeh Javaherforoosh , Abdalbeygi Hasan , Janatmakan Farahzad , Gholizadeh Behnam
Published: February 2020

Introduction Pain management after coronary artery bypass graft (CABG) surgery remains challenging. Objective This study aimed to compare the effects of Ketorolac and Paracetamol on postoperative CABG pain management. Method This double-blind randomized clinical trial study was conducted in Ahvaz, Iran, from September 2018-December 2019. Two consecutive groups of 60 patients undergoing elective on-pump coronary artery bypass graft surgery. Intervention The patients were divided into 0.5 mg/kg of ketorolac mg/dl and 10 mg/kg of Paracetamol after surgery for pain management. Primary outcomes were: visual analog pain scale (VAS) at the time point immediately after extubation (baseline) and at 6, 12, 24 and 48 hours and the total dose of morphine consumption. Secondary outcomes included the hemodynamic variables, weaning time, chest tube derange, in-hospital mortality and myocardial infarction. Statistical analysis The data were analyzed using SPSS version 22(SPSS, Chicago, IL). The Mann-Whitney U-test was used to compare demographic data, VAS scores, vital signs, and side effects. Repeated measurements were tested within groups using Friedman's ANOVA and the Wilcoxon rank-sum test. Values were expressed as means ± standard deviations. Statistical significance was defined as a p-value < 0.05. Results Compared with baseline scores, there were significant declines in VAS scores in both groups throughout the time sequence (P< 0.05). The statistical VAS score was slightly higher in the Paracetamol group at most time points, except for the time of 6 h. However, at 24 and 48 hours, the VAS score in group Paracetamol was significantly higher than in group Ketorolac. There were no significant differences between groups about hemodynamic variables. Conclusion: The efficacy of ketorolac is comparable to that of Paracetamol in postoperative CABG pain management.
The magnitude of dexamethasone-induced hyperglycemia in cataract surgical patients with normal glucose metabolism: a continuous glucose monitoring based study
Authors: Zhang Wen-li , Gao Gu , Sun Xiao-juan , Ye Lei , Ma Jian-hua , Li Feng-fei
Published: February 2020

Background To determined 24-hrs glycemic variations using continuous glucose monitoring (CGM) in cataract surgical patients with normal glucose metabolism receiving dexamethasone therapy. Methods This was a single-center, randomized, observational and prospective trial. Between June 2017 and December 2018, cataract surgical patients with normal glucose toleration were recruited, and were randomized assigned at a ratio of 1:2 to either receiving 10 mg dexamethasone daily for 3 days after cataract surgical (dexamethasone group) or without dexamethasone therapy (control group). A retrospective CGM was performed at afternoon on -1 day before cataract operation performed for at least 3 days. The primary endpoint was the difference in mean amplitude of glycemic excursions (MAGE) between the two groups. Results We observed that patients receiving 10 mg dexamethasone daily showing mild increase in mean glucose and hourly mean glucose throughout 24-hrs compared to control group. We also detected that dexamethasone leading to a significant increase in glycemic variation, in term of standard deviation, and a number increase in MAGE and CV%.Conclusion Our data reveal that short period administration of dexamethasone leading a mild increase in glycemic variations (GV). However, the increased GV may have not clinically relevant. Our data indicates that short duration of 10 mg dexamethasone once daily may be a safe therapy regarding glycemic metabolism in subjects without diabetes.
Lipoprotein (a) is a residual risk of atherosclerotic renal artery stenosis in hypertensive patients: a population-based cross-sectional study.
Authors: Hu Xiangming , Yang Xing , Li Xida , Luo Demou , Zhou Yingling , Dong Haojian
Published: February 2020

Background: Low-density lipoprotein cholesterol (LDL-c) has been proven to be a risk factor for atherosclerotic cardiovascular disease (CVD), while lipoprotein (a) (Lp(a)) is a residual risk factor for CVD, even though LDL-c is well controlled by statin use. Importantly, the role of Lp(a) in atherosclerotic renal artery stenosis (ARAS) is still unknown.Methods: For this cross-sectional population-based study, patients who simultaneously underwent coronary and renal angiography were examined. ARAS was defined as a 50% reduction in the cross-sectional (two-dimensional plane) area of the renal artery. Data were collected and compared between ARAS and non-ARAS groups, including clinical history and metabolite profiles. Univariate analysis, three tertile LDL-c-based stratified analysis, and multivariate-adjusted logistic analysis were conducted, revealing a correlation between Lp(a) and ARAS.Results: A total of 170 hypertensive patients were included in this study, 85 with ARAS and 85 non-RAS. Baseline information indicated comparability between the two groups. Univariate analysis showed that systolic blood pressure and peripheral arterial disease were positively correlated with ARAS while coronary artery disease was negatively associated. Stratified analysis of LDL-c revealed a significant increase in the incidence of ARAS in patients who had high Lp(a) concentrations at low LDL-c levels (OR: 4.77, 95%CI:1.04-21.79, P = 0.044). Further logistic analysis with adjusted covariates also confirmed the result, indicating that high Lp(a) levels were independently associated with ARAS (OR: 8.16, 95%CI 1.12-59.12, P = 0.037). This relationship increased with increasing Lp(a) concentration based on a curve fitting graph. These results were not present in the low and intermediate LDL-c-level groups.Conclusion: In hypertensive patients who present low LDL-c, high Lp(a) was significantly associated with atherosclerotic renal artery stenosis and thus is a residual risk factor.
OSA-induced multi-organ dysfunction after elective coronary artery bypass surgery in coronary heart disease patients
Authors: Wang Jiayang , Wang Xinxin , Yu Wenyuan , Zhang Kui , Wei Yongxiang
Published: February 2020

Background The aim of this study was to explore the underlying impact of obstructive sleep apnea (OSA) on postoperative parameters of multi-organ function, including cardiac and cerebral vascular, respiratory as well as renal postoperative complications, among coronary heart disease (CHD) patients following elective coronary artery bypass grafting (CABG). Methods Electronic literature databases, including PubMed, ISI Web of Science, Directory of Open Access Journals, and the Cochrane Library electronic databases, were searched manually and automatically for relevant English articles. All of the selected articles focused on a comparison of the incidence of primary and secondary outcomes in CHD patients undergoing elective CABG with and without OSA. Results A total of 13 articles met our inclusion criteria. The current study demonstrated OSA significantly increased the incidence of major adverse cardiac and cerebrovascular events (MACCEs) in CHD patients undergoing elective CABG compared with the controls (odds risk (OR), 1.97; 95% confidence interval (CI), 1.50 to 2.59, p <0.0001). In addition, OSA was associated with an increased risk of new revascularization in CHD patients undergoing elective CABG (OR, 9.47; 95% CI, 2.69 to 33.33, p <0.0001). Moreover, reintubation and tracheostomy in the OSA group was increased (OR, 3.43; 95% CI, 1.35 to 8.71; p =0.009) and 372% (OR, 4.72; 95% CI, 1.23 to 18.13; p=0.024), respectively, compared with the control group. Besides, we also confirmed OSA significantly increased the acute kidney injury (AKI) incidence by 124% (OR, 2.24; 95% CI, 1.07 to 4.72; P < 0.0001). Finally, our results demonstrated that OSA increased medical resource utilization including length of postoperative hospital stay and ICU stay. Conclusions OSA may contribute to postoperative multi-organ dysfunction among CHD patients undergoing elective CABG by increasing the incidence of MACCEs, especially new revascularization, as well as respiratory, and renal complications. Peri- and postoperative management of CHD patients with OSA may be optimized to minimize the rate of postoperative parameters of multi-organ dysfunction, further reducing the consumption of limited medical resources.
Repeated trips by patients seeking medical treatment overseas from the United Arab Emirates: Results from the Dubai Health Authority during 2009–2016
Authors: Alnakhi Wafa K. , Alfarisi Omamh A. , Nonyane Bareng A. S , Morlock Laura L. , Ahmed Saifuddin
Published: February 2020

Background: The Dubai Health Authority (DHA) spends millions of dollars to cover United Arab Emirates (UAE) nationals seeking healthcare overseas each year. Many patients undertake multiple visits following their initial trip. This paper analyzes repeated trips following an initial medical trip overseas so that the DHA can more effectively address patients’ needs and reduce the risks associated with multiple trips overseas.Methods: Administrative data were obtained from the DHA for the UAE nationals who sought treatment overseas during 2009–2016. We examined the match of the medical specialty between the initial and subsequent trips. Medical specialty was the key independent variable and other covariates included gender, age group, travel season, treatment destination and trip order. A mixed-effects logistic regression model with subject specific random intercept was used to assess the relationship of the outcome with the key variables of interest.Results: The analysis included 2,344 UAE nationals who had at least one trip following the initial medical visit. Oncology was the most common medical specialties sought by patients who travelled for repeated visits (18%). Patients in the age group 13-18 years had the highest odds of subsequent visits matching the medical specialty at the initial trip relative among age groups (OR 1.93, 95% CI:1.351,2.757). Patients travelling for oncology, orthopedic surgery, neurosurgery, ophthalmology, obstetrics/gynecology and otolaryngology had higher odds of subsequent trips matching the specialty of initial trips. The odds of subsequent trips matching the medical specialty of the initial trip increased with each additional trip (OR 1.73, 95%CI: 1.533,1.94).Conclusions: This is the first longitudinal study that examines the repeated medical trips among UAE nationals supported by the DHA. The results demonstrated that age group, medical specialty sought at the time of the initial trip, and number of trips were significant factors for understanding the match of the medical specialty between the initial and subsequent trips. The study results may help the DHA to establish an overseas treatment registry to collect information about patients seeking medical treatment overseas. In addition, the study will support establishing follow-up care programs to improve patients’ outcome and the clinical care for those patients.
Treatment experienced persons living with HIV on atazanavir based second line regimens are not highly adherent to therapy: a report from a tertiary referral hospital in Kenya.
Authors: Mugendi George , Nyamweya Nasser Nyambane , Okalebo Faith Apolot
Published: February 2020

Background Adherence to antiretroviral therapy is necessary for positive treatment outcomes. The objectives of this study were to determine adherence levels and their determinants in persons living with HIV on second line therapy. Methods A cross-sectional study was undertaken at a HIV clinic within Kenyatta National Hospital in October, 2017. Data were collected through interviews and application of the Morisky Medication Adherence and then analyzed in R. Results One hundred and ten patients were enrolled; 46 (41.8%) males and 64 (58.2%) females. The mean age was 39.8 years (± 11.8). Most participants, 96 (87.3%), had moderate adherence while 14 (12.7%) had low adherence. None were highly adherent. Age (aOR = 1.10, 95% CI; 1.04, 1.19) and depression (aOR =0.17, 95% CI 0.04, 0.64) were independently associated with adherence. Conclusion None of the treatment experienced patients on second line regimens were highly adherent to therapy. Younger patients and those with depression require additional adherence counselling.
Multi-Level, Multi-Scale Modeling and Predictive Mapping for Jaguars in the Brazilian Pantanal.
Authors: Bohnett Eve , Hoctor Thomas , Hulse David , Ahmad Bilal , Niebuhr Bernardo , Morato Ronaldo
Published: February 2020

Background Machine learning (ML) methods and remote sensing data were used to build multi-level multi-scale resource selection models and predictive maps onto the extended landscape for jaguars (Panthera onca) in the Brazilian Pantanal. Objectives were to compare multiple predictive modeling and exploratory modeling approaches. Included in the analysis, multi-scale raster grains (30m, 90m, 180m, 360m, 720m, 1440m), GPS collaring temporal levels (point, path, and step) and model data structural levels (group, individual, case-control).Methods Multi-scale multi-level data subsets were fit with explanatory and predictive statistical methods. Conditional logistic regression, generalized additive modeling (GAM), and classification regression trees, such as random forests (RF) and gradient boosted regression tree (GBM) were compared for their utility to the study. Model evaluation, using training and testing data in a k-fold cross-validation approach, determined the AUC, Kappa, and TSS for model evaluation and comparison. · Results Results indicated that the multi-level, multi-scale techniques improved model outputs. Overall, larger level models and those that used multi-scale raster grains showed the best model evaluation. The highest-ranked model was the multi-scale path selection function GBM and was one of the broadest levels of data. ·Conclusions Results indicated that multi-level, multi-scale models produced mixed results of applicability across models and levels. The identification of the appropriate temporal scale and statistical model needs careful consideration in predictive mapping efforts.
The correlation between Ro-52 antibody and interstitial lung disease in dermatomyositis
Authors: Xing Xiaojing , Li Anqi , Hao Yonghong , Li Chengxin
Published: February 2020

Background Recent studies have shown that Ro-52 antibody is associated with interstitial lung disease(ILD) in children with dermatomyositis(DM) and with the degree of disease severity. Moreover, we found that 50% or more cases of adult patients with DM tested positive for antibody Ro-52. Here, we analyzed the correlation between antibody Ro-52 and ILD in inpatients with DM. Objective To explore the correlation between Ro-52 antibody and ILD of DM. Methods A total of 153 patients with DM were collected, who met the classification criteria of idiopathic inflammatory myositis. Immunoblotting was used to detect 16 myositis-specific autoantibodies (MSAs) and myositis-associated autoantibodies (MAAs) from patient serum samples. High-resolution computed tomography (HRCT) was used to calculate the ILD severity score, and the tumors were screened. The clinical data and CT scores were analyzed retrospectively. Results Our data showed that antibodies of Ro-52 and MDA5 were risk factors for ILD development in patients with DM. Antibody Ro-52 was the most commonly occurring (52.9%) antibody in DM patients. The presence of Ro-52 in DM patients strongly suggested the possibility for the occurrence of ILD (86.4%). The severity of Ro-52-positive cases was higher than that of the Ro-52-negative cases.Ro-52 may increase the incidence of ILD when combined with other antibodies of PM-Scl75, PM-Scl100, TIF1-𝛾,Mi-2β,and MDA5. Conclusions The occurrence of ILD is highly likely in patients with DM having the antibody Ro-52. Thus, Ro-52 is a risk factor for ILD in DM.
Double reverse traction repositor versus traction table for the treatment of intertrochanteric femur fracture: A comparative Study
Authors: Yan Mingming , kuang letian , ni jiangdong , ding muliang , huang jun , wang junjie , song deye
Published: February 2020

Background The aim of this study was to compare the clinical results between double reverse traction repositor and traction table used for the treatment of unstable intertrochanteric femur fracture. Methods This retrospective study included 95 patients with AO/OTA 31- A2 and A3 proximal femur fracture, who underwent double reverse traction repositor or traction table facilitated Asian proximal femoral nail antirotation (PFNA-II) nailing. The demographics, duration of operation, blood loss, part loading time after surgery, the period of union of fracture, complication were assessed. Clinical and radiological outcomes were evaluated. Results There were no significant differences in respect to demographics and fracture characteristics. Duration of patient positioning and total operative time were significant longer in traction table group than that in double reverse traction repositor group(p<0.001). No differences were found intraoperative blood loss, part loading time after surgery, fracture healing time and Harris Hip Score between two groups. Conclusion When treating unstable intertrochanteric fractures, double reverse traction repositor is superior to tract table in respect to operative time and duration of patient position, despite an additional ipsilateral anterior superior iliac spine (ASIS)incision and drilling of ASIS and femur condyle.