bluuebunny/crossref_metadata_2025 huggingface dataset:
Titles: Facilitators and Barriers of Active Participation of caregivers of Children with Cerebral Palsy in their Rehabilitation: An Exploratory Study
Authors: Isah Auwal , Abdullahi Auwal
Published: October 2019

Background : Cerebral Palsy (CP) is a group of permanent disorders of movement and posture, attributed to non-progressive disturbance that occurred in the developing fetal or infant brain. The condition results in long term disability in carrying out activities of daily living (ADL). Thus, it most times required active participation of the caregivers of the children affected in their rehabilitation. Objective: The aim of the study was to explore the facilitators and barriers of active participation of caregivers in the rehabilitation of these children. Materials and Methods: The study design used was qualitative indepth interview. The participants consisted of caregivers of children with CP attending Hasiya Bayero Paediatric Specialists Hospital, Kano. The caregivers were sampled and interviewed by one of the researchers until theoretical saturation was attained. A note taker wrote down and recorded responses of the participants using a tape recorder. The data generated from the interview was then transcribed, coded and analyzed using matrix analysis using constant comparative analysis. Results: Forty caregivers with mean age, 27.17±4.46 years participated in the study. The results of the study showed that, the factors that facilitate active participation of caregivers of children with CP in the rehabilitation of their children are improvement in the child’s condition, family support, improvement in the conditions of other children with CP, encouragement from the therapist managing the child, empathy, and cooperation of the child during home programs. The barriers are number of children the caregiver has, caregiver’s occupation and financial resources. Conclusion: Therapists need to help reinforce these facilitators, and devise strategies to help caregivers overcome barriers during rehabilitation of children with CP. For example, since lack of finance is one of the barriers to the caregivers’ active participation in the rehabilitation of their children, there should be a policy on CP rehabilitation that will make rehabilitation services accessible to all children with CP. Similarly, since family support is a facilitator, sharing caregiving rehabilitation tasks among member of the family could help facilitate caregiver activation participation in the rehabilitation of their children with CP.
Co-producing childbirth knowledge: A qualitative study of birth stories in antenatal sessions
Authors: de Quattro Leah
Published: October 2019

Background Birth stories surround pregnant women. Existing research on childbirth knowledge suggests that personal accounts from family and friends play a foundational role upon which other information builds. However, among the handful of studies that specifically address the educational role of birth stories, stories appeared to have little impact on knowledge creation. This paper engages with this discussion by exploring how birth stories contributed to the co-construction of birth knowledge within the specific context of antenatal sessions. Findings draw from the pilot study of a project which seeks to understand how participants use collective approaches to co-produce birth knowledge. Method Research data drew from participant observation of group-led Homebirth sessions (25 participants) and teacher-led National Childbirth Trust classes (18 participants). The researcher analysed transcripts using template analysis, a form of thematic content analysis, with principles from feminist ethnography and narrative analysis. Results Storytelling proved central to mother-to-mother antenatal group practices, providing not only information, but also a means for understanding. This educational work took place through various mechanisms: Stories (re)shaped expectations, shared practical techniques, navigated different truth claims and approaches to knowledge, and helped build supportive communities of parents. These findings emerged more prominently in group-led sessions compared to teacher-led sessions. Conclusion Compared to teacher-led norms, storytelling and other collective approaches to antenatal education provide additional resources to childbearing women. As dialogic, complex and flexible learning tools, stories offer uniquely diverse, credible and supportive messages. The next phase of this project will further investigate these findings, explore informal collective practices, and seek to evaluate the impact of collective knowledge on childbirth experiences.
Neuromuscular shoulder activity during exercises with different combinations of stable and unstable weight mass
Authors: Baritello Omar , Khajooei Mina , Engel Tilman , Kopinski Stephan , Quarmby Andrew , Mueller Steffen , Mayer Frank
Published: October 2019

Background Recent shoulder injury prevention programs have utilized resistance exercises combined with different forms of instability, with the goal of eliciting functional adaptations and thereby reducing the risk of injury. However, it is still unknown how an unstable weight mass affects the muscular activity of the shoulder stabilizers (ST). Aim of the study was to analyzed the neuromuscular activity of the dynamic ST under four combinations of stable and unstable weight mass during three shoulder exercises. It was hypothesized that a combined condition of weight with unstable mass would elicit significantly greater activation due to the increased stabilization demand.
Methods Sixteen participants (7 m/9 f) were included in this cross-sectional study and prepared with an EMG-setup for the: Mm. upper/lower trapezius (U.TA/L.TA), lateral deltoid (DE), latissimus dorsi (LD), serratus anterior (SA) and pectoralis major (PE). A maximal voluntary isometric contraction test (MVIC; 5 sec.) was performed on an isokinetic dynamometer. Next, internal/external rotation (In/Ex), abduction/adduction (Ab/Ad) and diagonal flexion/extension (F/E) exercises (5 reps.) were performed with four custom-made-pipes representing different training conditions. First, the empty-pipe (P; 0.5 kg) and then, randomly ordered, water-filled-pipe (PW; 1 kg), weight-pipe (PG; 4.5 kg) and weight + water-filled-pipe (PWG; 4.5 kg), while EMG was recorded. Raw root mean square values (RMS) were normalized to MVIC (%MVIC). Differences between conditions for RMS%MVIC, scapular stabilizer (SR: U.TA/L.TA; U.TA/SA) and contraction (CR: concentric/eccentric) ratios were analyzed (paired t-test;Bonferroni adjusted α=0.008)
Results PWG showed significantly greater activation for all exercises and all muscles except for PE compared to P and PW. Condition PG elicited muscular activity comparable to PWG (p>0.008) with significantly lower activation of L.TA and SA in the In/Ex rotation. The SR ratio was significantly higher in PWG compared to P and PW. No significant differences were found for the CR ratio in all exercises and for all muscles.
Conclusion Higher weight generated greater muscle activation whereas an unstable weight mass behavior raised the neuromuscular activity, increasing the stabilization demands. Especially in the In/Ex rotation, an unstable weight mass increased the RMS%MVIC and SR ratio. This might improve training effects in shoulder prevention and rehabilitation programs.
Metagenomic next-generation sequencing for mixed pulmonary infection diagnosis
Authors: Wang Jiahui , Han Yelei , Zhou Yang , Feng Jing
Published: October 2019

Background. Metagenomic next-generation sequencing (mNGS) is emerging as a promising technique for pathogens detection. However, reports on the application of mNGS in mixed pulmonary infection remain scarce.
Methods. From July 2018 to March 2019, 55 cases were enrolled in this retrospective analysis. Cases were classified into mixed pulmonary infection (36 [65.5%]) and non-mixed pulmonary infection (19 [34.5%]) according to primary diagnoses. The performances of mNGS and conventional test on mixed pulmonary infection diagnosis and pathogen identification were compared.
Results. The sensitivity of mNGS in mixed pulmonary infection diagnose was much higher than that of conventional test (97.2％ vs 13.9％; P< 0.01) , but the specificity was the opposite (63.2％ vs 94.7％; P= 0.07) . The positive predictive value of mNGS was 83.3% (95% CI: 68.0-92.5%) , and the negative predictive value was 92.3% (95% CI: 62.1-99.6%) . A total of 5 (9.1%) cases were identified as mixed pulmonary infection by both conventional tests and mNGS, however, the pathogens identification results were consistent between these two methods in only 1(1.8%) case. In summary, the pathogens detected by mNGS in 3 (5.5%) cases were consistent with those by conventional test, and only 1(1.8%) case was mixed pulmonary infection. According to our data, mNGS had a broader spectrum for pathogen detection than conventional tests. In particular, application of mNGS improved the diagnosis of pulmonary fungal infections. Within the 55 cases, mNGS detected and identified fungi in 31 (56.4%) cases, of which only 10 (18.2%) cases were positive for the same fungi by conventional test. The most common pathogen detected was H uman cytomegalovirus in our study, which was identified in 19(34.5%) cases of mixed pulmonary infection . Human cytomegalovirus and Pneumocystis jirovecii, which were detected in 7(12.7%) cases, were the most common co-pathogens in the group of mixed pulmonary infection.
Conclusions. mNGS is a promising technique to detect co-pathogens in mixed pulmonary infection, with potential benefits in speed and sensitivity.
Moderating Role of Job Satisfaction on Turnover Intention and Burnout among Workers in Primary Care Institutions: A Cross-Sectional study
Authors: Chen Xuyu , Ran Li , Zhang Yuting , Yang Jinru , Yao Hui , Zhu Sirong , Tan Xiaodong
Published: October 2019

Background: Global countries are suffering from a shortage of health professionals. Turnover intention is closely related to job satisfaction and burnout, making good use of these relationship could alleviate the crisis. The research aims to examine the mediating role of job satisfaction in the relationship between burnout and turnover intention. Methods: This research was conducted in Huangpi, China. Convenience sampling methods and self-administereded questionnaires were used. 1370 of valid samples were collected with 97.72% effective rate. Descriptive analyses were conducted to describe social demographic factors. The structural equation model (SEM) was performed to adjust model fitting, and the mediation effect test was carried out by using the bootstrap method. Sobel-Z test was used to verify the significance of mediation effect. Results: The mean age was 36.98 (SD=9.84). The fitting indices of hypothetical model is not good. After the adjustments, c 2 /df =5.590, GFI=0.932, AGFI=0.901, CFI=0.977, NFI=0.973, IFI=0.977, TLI=0.970, RESEA=0.058. The revised model fitted well, and the SEM was put up by using the bootstrap method. The mediating effect is partial, and Soble-Z test indicates that the mediation effect is significant. Burnout is negatively correlated with job satisfaction (p<0.01) and the standardized path coefficient is -0.41. Job satisfaction is also negatively correlated with turnover intention (p<0.01) and the standardized path coefficient is -0.18. Burnout is positively correlated with turnover intention (p<0.01) and the standardized path coefficient is 0.83. Conclusions: Job satisfaction is a mediating variable that affects the relationship between burnout and turnover intention. The mediating effect was a partial mediating effect and has a low impact of 7.4%. Improving treatment and giving more promotion opportunities for workers to improve job satisfaction, conducting career planning courses and paying attention to employee psychological health to reduce job burnout. The above measures may be helpful to reduce employee turnover rate and alleviating the current situation of shortage of health personnel in China.
Staff expectations for the implementation of an electronic health record system: A qualitative study using Normalisation Process Theory
Authors: Mccrorie Carolyn , Benn Jonathan , Johnson Owen , Scantlebury Arabella
Published: October 2019

Background
Global evidence suggests benefits of introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR into healthcare organisations is complex and in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK.
Methods
Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings.
Results
Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care.
Conclusions
Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.
The Prognostic Significance of Different Bleeding Classifications in Off-pump Coronary Artery Bypass Grafting
Authors: Xi Ziwei , Gao Yanan , Yan Zhenxian , Zhou Yujie , Liu Wei
Published: October 2019

Background: Perioperative bleeding during cardiac surgery are known to make patients susceptible to adverse outcomes and several bleeding classifications have been developed to stratify the severity of bleeding events. Further validation of different classifications was needed. The aim of present study was to validate and explore the prognostic value of different bleeding classifications in patients undergoing off-pump coronary artery bypass grafting (OPCAB).
Methods: Data on baseline and operative characteristics of 3,988 patients who underwent OPCAB in Beijing Anzhen Hospital from February 2010 to December 2014 were available. The primary endpoint was a composite of in-hospital death and nonfatal postoperative myocardial infarction (MI). The secondary endpoint was postoperative acute kidney injury (AKI). We explored the association of major bleeding defined by the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Bleeding Academic Research Consortium (BARC) classification and Study of Platelet Inhibition and Patient Outcomes (PLATO) with primary endpoints by multivariable logistic regression analysis and investigated their significance of adverse event prediction using goodness-of-fit tests of -2 log likelihood.
Results: In-hospital mortality was 1.23% (n=49) and postoperative MI was observed in 4.76% (n=190) of patients, AKI in 24.69% (n=985). The incidence of the primary outcome was 5.99% (n=239). Multivariable logistic regression analysis showed that BARC type 4 (OR=2.64, 95% CI: 1.66–4.19, P<0.001), UDPB class 4 (OR=3.52, 95% CI: 2.05–6.02, P<0.001) and E-CABG class 2-3 (class 2: OR=2.24, 95% CI: 1.36–3.70, P=0.001; class 3: OR=12.65, 95% CI: 2.74–18.43, P=0.002) bleeding but not PLATO bleeding were associated with an increased risk of in-hospital death and postoperative MI. Major bleeding defined by all the four classifications mentioned above was an independent risk factor of AKI after surgery. Inclusion of major bleeding defined by these four classifications improved the predictive performance of the multivariable model with baseline characteristics.
Conclusions: Bleeding assessed by BARC, E-CABG and UDPB classifications were significantly associated with poorer immediate outcomes. These classifications seemed to be valuable tool in the assessment of prognostic effect of perioperative bleeding.
A Systematic review: Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer
Authors: Sun Haitao , Zhang Guohua , Ai Bolun , Zhang Huimin , kong xiangyi , Lee Wan-Ting , Yan Tao , Zheng Hui , Sun Li
Published: October 2019

Background The potential risk for cognitive-impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung-cancer.
Methods This study is a meta-analysis for controlled-clinical-studies. Public - available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed.
Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001).
Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.
Pattern of nucleotide variants of TP53 and their correlation with the expression of p53 and its downstream proteins in a Sri Lankan cohort of breast and colorectal cancer patients
Authors: Manoharan Vahinipriya , Karunanayake Eric Hamilton , Tennekoon Kamani Hemamala , De Silva Sumadee , Imthikab Ahamed Ilyas Ahamed , De Silva Kanishka , Angunawela Preethika , Lunec John , Vishwakula Sameera
Published: October 2019

Background
Breast cancer (BC) is known to be the most common malignancy in females whereas colorectal cancer (CRC) incidence also higher in both genders in Sri Lanka. TP53 is an important tumour suppressor gene and its somatic mutations are reported in approximately 27% of BC and 43% of CRC cases. Analysis of TP53 gene variants not only provides clues for the aetiology of the tumour formation, but also has an impact on treatment efficacy. The current study was conducted to investigate the pattern of TP53 variants in patients with BC and CRC from Sri Lanka.

Methods

30 patients with BC, 21 patients with CRC and an equal number of healthy controls were screened for mutational status of TP53 by polymerase chain reaction (PCR) followed by direct sequencing. In addition, a subset of these samples were analysed for the protein expression of p53 and comparison made with the mutational status of TP53. We also analysed the protein expression of p21 and MDM2 as potential indicators of p53 functional status and compared it with the protein expression of p53. Additionally, hotspot codons of the KRAS, BRAF and PIK3CA genes were also analysed in a subset of CRC patients.

Results

Twenty seven sequence variants, including several novel variants in the TP53 gene were found. Nine BC and seven CRC tumour samples carried pathogenic TP53 variants. Pathogenic point missense variants were associated with strong and diffuse positive staining for p53 by immunohistochemistry (IHC), whereas, wild type TP53 showed complete absence of positive IHC staining or rare positive cells, regardless of the type of cancer. There was no direct correlation between p21 or MDM2 expression and p53 expression in either BCs or CRCs. Four of the CRC patients had pathogenic hotspot variants in KRAS; three of them were on codon 12 and one was on codon 61.

Conclusion

The prevalence of pathogenic somatic TP53 variants was 31% and 33.33% in the studied BC and CRC cohorts respectively. All of them were located in exons 5 – 8 and the pathogenic missense variants were associated with strong immuno-positive staining for p53.
The Drivers of Antibiotic Use and Misuse: The Development and Investigation of a Theory Driven Community Measure
Authors: Byrne Mitchell K. , Miellet Sebastien , McGlinn Anica , Fish Janaye , Meedya Shahla , Reynolds Nina , Oijen Antoine M. van
Published: October 2019

Background: Antimicrobial resistance is a global public health concern, with extensive associated health and economic implications. Actions to slow and contain the development of resistance are imperative. Despite the fact that overuse and misuse of antibiotics are highlighted as major contributing factors to this resistance, no sufficiently validated measures aiming to investigate the drivers behind consumer behaviour amongst the general population are available. The objective of this study was to develop and investigate the psychometric properties of an original, novel and multiple-item questionnaire, informed by the Theory of Planned Behaviour, to measure factors contributing to self-reported antibiotic use within the community.

Method: A three-phase process was employed, including literature review and item generation; expert panel review; and pre-test. Investigation of the questionnaire was subsequently conducted through a cross-sectional, anonymous survey. Orthogonal principal analysis with varimax rotation, cronbach alpha and linear mixed-effects modelling analyses were conducted. A 60 item questionnaire was produced encompassing demographics, social desirability, three constructs of the Theory of Planned Behaviour including: attitudes and beliefs; subjective norm; perceived behavioural control; behaviour; and a covariate–knowledge.

Results: 373 participants completed the survey. 80 participants (21%) were excluded due to social desirability concerns, with data from the remaining 293 participants analysed. Results showed modest but acceptable levels of internal reliability, with high inter-item correlations within each construct. All four variables and the outcome variable of antibiotic use behaviour comprised four items with the exception of social norms, for which there were two items, producing a final 18 item questionnaire. Perceived behavioural control, social norms, the interaction between attitudes and beliefs and knowledge, and the presence of a healthcare worker in the family were all significant predictors of antibiotic use behaviour. All other predictors tested produced a nonsignificant relationship with the outcome variable of self-reported antibiotic use.

Conclusion: This study successfully developed and validated a novel tool which assesses factors influencing community antibiotic use and misuse. The questionnaire can be used to guide appropriate intervention strategies to reduce antibiotic misuse in the general population. Future research is required to assess the extent to which this tool can guide community-based intervention strategies.
Metabolic alterations provide insights into Stylosanthes roots responding to phosphorus deficiency
Authors: Luo Jiajia , Liu Yunxi , Zhang Huikai , Wang Jinpeng , Chen Zhijian , Luo Lijuan , Liu Guodao , Liu Pandao
Published: October 2019

Background: Phosphorus (P) deficiency is one of the major constraints limiting plant growth, especially in acid soils. Stylosanthes (stylo) is a pioneer tropical legume with excellent adaptability to low P stress, but its underlying mechanisms remain largely unknown.
Results: In this study, the physiological, molecular and metabolic changes in stylo responding to phosphate (Pi) starvation were investigated. Under low P condition, the root growth in stylo was significantly enhanced, which was accompanied with up-regulation of expansin genes participating in cell wall loosening. Metabolic profiling analysis showed that a total of 256 metabolites with differential accumulation were identified in stylo roots responding to P deficiency, which mainly include flavonoids, sugars, nucleotides, amino acids, phenylpropanoids and phenylamides. P deficiency led to significant reduction in the accumulation of phosphorylated metabolites (e.g., P-containing sugars, nucleotides and cholines), suggesting that internal P utilization was enhanced in stylo roots. However, flavonoid metabolites, such as kaempferol, daidzein and their glycoside derivatives, were significantly increased in P-deficient stylo roots. Furthermore, the transcripts of various genes involved in flavonoids synthesis were found to be up-regulated by Pi starvation in stylo roots. In addition, the abundance of phenolic acids and phenylamides was significantly increased in stylo roots during P deficiency. The enhanced accumulation of the metabolites in stylo roots, such as flavonoids, phenolic acids and phenylamides, might facilitate P solubilization and cooperate with beneficial microorganisms in rhizosphere, and thus contributing to P acquisition and utilization in stylo.
Conclusions: These results suggest that stylo plants cope with P deficiency by modulating root morphology, scavenging internal Pi from phosphorylated metabolites and enhancing accumulation of flavonoids, phenolic acids and phenylamides. This study provides valuable insights into the complex responses and adaptive mechanisms of stylo to P deficiency.
On the use of the Trans-Theoretical Model for Blood Donation among Spanish Adults
Authors: Sardi Lamyae , Idri Ali , de Gea Juan Manuel Carrillo , Toval Ángel , Fernández-Alemán José Luis
Published: October 2019

Background Relying solely on altruistic appeals may fail to fulfil the increasing demand for blood supplies. Current research has largely been attempted to determine and understand motives that serve as blood donation drivers. The Trans-Theoretical Model of behaviour change (TTM) can be used to conceptualise the process of intentional blood donation behaviour. Methods A cross sectional survey of Spanish adults was conducted. The final sample consisted of 504 individuals who were administered a self-report questionnaire including the measures of demographic characteristics, Stages of Change, Processes of Change, Self-efficacy and Decisional Balance. Data were analysed by frequency analysis, MANOVA/ANOVA and correlation analysis. Results Findings indicated that most of the behavioural and cognitive processes of change, self-efficacy and physical cons differentiated participants across the stages of change of blood donation. In contrast, eligibility cons and pros were less influential in stage transitions. Furthermore, significant correlations were observed between TTM constructs except for the physical cons and the processes of change. Conclusions The present study extensively supports and replicates the applicability of the TTM to blood donation behaviour change and offers important implications for the development of effective stage-matched interventions to increase blood donation.
Serum platelet-derived growth factor is a novel biomarker for the prediction of vulnerable plaque in patients with NSTE-ACS
Authors: Zhang Hong , Zhang Ying , Liu Yujie , Ma Kejing , Zhou Jia , Guan Jingjing
Published: October 2019

Objective

To investigate the relationship between serum platelet-derived growth factor (PDGF) and vulnerable plaque in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).Methods

A total of 65 patients with coronary artery disease were divided into vulnerable plaque group (n=46) and vulnerable plaque and stable plaque group (n=19) according to intravascular ultrasound (IVUS) examinations. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and serum PDGF were measured. Plaque characteristics and components were analyzed using gray-scale and iMap-IVUS. Correlation was performed between plaque characteristics and ACS markers. Logistic regression analysis was applied to determine risk factors. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value.Results

Patients in vulnerable plaque group had visible higher levels of TG, LDL-C and PDGF ( P < 0.05). There were significant differences in minimal lumen area (MLA), plaque area, plaque burden, fibrotic (FI), clipidic (LI) and necrotic core (NC) between the two groups ( P < 0.05). PDGF was weakly correlated with plaque burden (R=0.428, P < 0.05), as well as moderately correlated with NC (R=0.669, P < 0.05). Multivariate analysis showed that serum PDGF (OR 4.751, [95% CI 1.534-29.543], P =0.05) was an independent risk factor of vulnerable plaque. The area under the curve (AUC) was 0.876 (95% CI 0.804-0.948, P =0.001).Conclusion

Serum PDGF could be used as a novel biomarker for the prediction of vulnerable plaque in patients with NSTE-ACS.
The mutational spectrum of Hunter syndrome reveals correlation between biochemical and clinical profiles in Tunisian patients
Authors: chkioua latifa , Grissa Oussama , Leban Nadia , Gribaa Moez , Boudabous Hela , Turkia Hadhami Ben , Ferchichi Salima , Tebib Neji , Laradi Sandrine
Published: October 2019

Background: Mucopolysaccharidosis type II (MPS II) or Hunter syndrome is an X-linked recessive lysosomal storage disorder resulting from deficient activity of iduronate 2-sulfatase ( IDS ) and the progressive lysosomal accumulation of sulfated glycosaminoglycans (GAGs). Methods : A diagnosis of MPS II or Hunter syndrome was performed based on the following approach after a clinical and paraclinical suspicion. Two biochemical and molecular tests were carried out separately and according to the availability of the biological material. Results : All patients in this cohort presented the most common MPS II clinical features. Electrophoresis of GAGs on a cellulose acetate plate in the presence of a high concentration of heparane sulfate showed an abnormal dermatan sulfate band in the patients compared with that in a control case. Furthermore, leukocyte IDS activity ranged from 0.00 to 0.75 nmol/h/mg of proteins in the patients. Five previously reported mutations were identified in the study patients: one splice site mutation, c.240+1G>A; two missense mutations, p.R88P and p.G94D; a large deletion of exon 1 to exon 7; and one nonsense mutation, p.Q396*. In addition, two novel alterations were identified in the MPS II patients: one frame shift mutation, p.D450Nfs*95 and one nonsense mutation, p.Q204*. Additionally, five known IDS polymorphisms were identified in the patients: IVS3-16 (c.419-16 delT), p.T214 M (c.641C>T), p.T146T (c.438 C>T), IVS5-87 (c.709-87G>A), and IVS7+38 (c.1006+38T>C). Conclusions : The high level of urine GAGs and the deficiency of iduronate 2-sulfatase activity was associated with the phenotype expression of Hunter syndrome. Molecular testing was useful for the patients’ phenotypic classification and the detection of carriers.
Proximal Anal Sinus Resection as an Advanced Operation to Fistulectomy and Seton for Reducing Recurrence Rate
Authors: Lei Chao , Li Chao , Liu Ting , Liu Min , Li Chen , Li Xiaomei , Sun Ning , Liu Zhihua
Published: October 2019

Background The recurrence rate of classic surgery for anal fistula has always been one of the troublesome problems. The purpose of this study was to mainly compare the recurrence rate between classic surgery (fistulectomy or seton) and proximal anal sinus resection (PASR) in case-control study.Methods 106 patients who suffered from anal fistula were taken into classic surgery group (n=74) and PASR group (n=32), Then we analyzed the recurrence rate, wound healing time, surgical complications, and duration of the pain.Results There was a significant difference in the recurrence rate between classic surgery group and PASR group (16.2% vs 0%). The duration of pain, mean healing time and surgical complications in the two groups had no significant difference (P>0.05).Conclusion PASR had shown lower recurrence rate and did not increase the risk of complications, and could be considered as a first line of treatment for patients at risk of recurring for anal fistula.
Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?
Authors: Oe Kenichi , Sawada Masahiro , Kawamura Hiroshi , Ueda Narumi , Nakamura Tomohisa , Iida Hirokazu , Saito Takanori
Published: October 2019

Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (p < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.
Bioinformatics analysis of prognostic value genes in colorectal cancer microenvironment
Authors: Yue Taohua , Zhu Jing , Wang Xin , Pan Yisheng , Liu Yucun , Chen Shanwen , wang pengyuan
Published: October 2019

Colorectal cancer (CRC) is one of the most deadly gastrointestinal malignancies. The openness of the Cancer Genome Atlas (TCGA) allows us to perform correlation analysis between large-scale transcriptome data and overall survival (OS) of multiple malignancies. Previous literature reports that the infiltration of immune cells and stromal cells in the tumor microenvironment (TME) significantly associate with the prognosis of cancers. Based on the ESTIMATE algorithm, the immune and stromal components in TME can be quantified by immune and stromal scores. To determine the effects of immune and stromal cell associated genes on CRC prognosis, we divided the CRC cases into high- and low-groups based on the immune/stromal scores and identified 999 differentially expressed genes (DEGs). Heatmaps, functional enrichment analysis and protein‐protein interaction (PPIs) networks further indicated that 999 DEGs mainly participated in stromal composition and immune response. Finally, we obtained 56 genes that were significantly associated with CRC prognosis from 999 DEGs and identified the PPIs networks. The role of 41 genes in CRC has been reported in previous literature, and the other 15 genes have never been reported. Therefore, we found 15 novel TME genes associated with CRC prognosis waiting for more researches.
Temporal Cross-Correlations between air pollutants and outpatient visits for respiratory and circulatory system diseases in coastal area of China
Authors: Jiang Yu , Chen Jiedong , Wu Chuancheng , Lin Xin , Zhou Quan , Ji Shumi , Yang Shuangfeng , Zhang Xiaoyang , Liu Baoying
Published: October 2019

Background Some previous studies have suggested that there is an association between air pollutants and circulatory and respiratory diseases. However, the association of air pollutants and outpatient visits considering mortality, hospitalization rates, etc. has been analyzed in relatively few studies.Methods We used a generalized linear Poisson model was constructed to study the association between air pollution and outpatient visits for respiratory and circulatory diseases during 2016-2018 in coastal area of China.Results In the single pollutant model, NO 2 had a significant effect. For lag day 0 to lag day 5, the effect decreased with every 10 µg/L increase in NO 2 . O 3 and upper respiratory outpatient visits were positively associated in the cold period [lag2, ER (95%CI): 1.68% (0.44%-2.94%)], while O 3 and respiratory disease were positively associated in the warm period [lag5, ER (95%CI): 1.10% (0.11%-2.10%) and lag4, ER (95%CI): 1.02% (0.032%-2.02%)]. Similarly, PM 10 and lower respiratory diseases were positively associated in the warm period [lag0, ER (95%CI): 1.68% (0.44%-2.94%)]. When the concentration of O 3 was higher than 100 μg/L, there was a positive effect on circulatory [lag5, ER (95%CI): 2.83% (0.65%-5.06%)], respiratory [lag5, ER (95%CI): 2.47% (0.85%-4.11%)] and upper respiratory [lag5, ER (95%CI): 3.06% (1.38%-4.77%)] outpatient visits. The variation in O 3 changed slightly when we adjusted for the other air pollutants, and after adjusting for O 3 , the ERs of the other air pollutants changed slightly. After adjusting for PM 2.5 , the ER of the other air pollutants increased, and after adjusting for NO 2 , the ER of particulate matter (PM) decreased.Conclusion Exposure to ambient NO 2 , O 3 , PM 2.5 and PM 10 was associated with an increase in respiratory and circulatory system outpatient visits in coastal area of China.
Clinical value of endometrial histological dating for personalized frozen-thawed embryo transfer (pFET) in patients with repeated implantation failure (RIF) in natural cycle
Authors: Li Yuan , Li Xiaofeng , liao Jingnan , Fan Xiangxiu , Hu Yongbin , Gan Runxin , Lu Guangxiu , Lin Ge , Gong Fei
Published: October 2019

Background: The displacement of window of implantation (WOI) has been proposed as an important factor contributed to RIF. However, endometrial histological dating as the diagnostic tool of endometrial receptivity has been questioned.
Methods : This is a prospective intervention trial including 205 infertile patients from July 2017 to December 2017.Endometrial biopsies from 50 good prognosis patients were conducted on day 3(n=6), 5(n=6), 7(n=26), 9(n=6) or 11(n=6) of post-ovulation (PO+3/5/7/9/11) in the previous natural cycle before their conventional frozen-thawed embryo transfer (FET) cycle. The endometrial biopsies of 155 RIF patients were conducted on day of PO +7.
Results: The verification of Noyes criterion for endometrial dating was conducted in different time (PO +3/+5/+7/+9/+11) from 41 good prognosis patients achieving ongoing pregnancy in the first conventional FET cycle after the endometrial biopsies. The agreement between two pathologists for endometrium dating in infertile patients was determined to be good (weighted kappa = 0.672; P < 0.001). The rate of out-of-phase dating on the day of PO+7 was significantly higher in RIF patients than good prognosis patients (31.6% vs 3.8%, P=0.003).pFET was performed in 47 RIF patients diagnosed to be out of phase, and the accumulative live birth rate was 55.7%.
Conclusions: The endometrial histological dating in RIF patients in natural cycle may be a endometrial receptive biomarker for diagnosing the displacement of WOI.
Diagnosis of Rare Diseases: A scoping review of clinical decision support systems
Authors: Schaaf Jannik , Sedlmayr Martin , Schaefer Johanna , Storf Holger
Published: October 2019

Background
Rare Diseases (RD), which are defined as diseases affecting not more than 5 out of 10,000 people, are often severe, chronic, degenerative and life-threating. A main problem is the delay in diagnosis of RD. Clinical Decision Support Systems (CDSS) for RD are software-systems to support physicians in the diagnosis of patients with RD. It would therefore be useful to get a comprehensive overview of which CDSS are available and can be used under what conditions. In this work we provide a review of current CDSS in RD and which functionality and data are used by the CDSS.
Methods
We searched Pubmed and Cochrane for CDSS in RD published between December 1, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference paper describing a clinical prototype or a routine use of CDSS where included. A total of 2076 articles were found and following a screening step 16 articles (describing 13 different CDSS) were considered as relevant for the final analysis. We then described and compared the CDSS using the defined categories “functionality”, “development status”, “type of clinical data” and “system availability”.
Results
Three types of CDSS for RD were identified: “Machine Learning and Information retrieval”, “Web Search”, and “Phenotypic and genetic matching”. 8 of the 13 reviewed CDSS are publicly available and for use by physicians. The other remaining CDSS are clinical prototypes which have been applied in clinical studies but are not accessible to others. Only one clinical prototype online.
The approaches of the CDSS differ depending on what type of clinical data is used. “Machine Learning and information retrieval” can show recommendations for a diagnosis, while Web “search CDSS” will retrieve articles from literature databases (e.g. case reports), which may provide hints for a possible Diagnosis. CDSS in “Phenotypic and genetic matching” can identify similar patients based on genetic or phenotypic data.
Conclusions
Different CDSS for different purposes have been established and physicians have to decide which CDSS is more accurate for a particular patient case. It remains to be seen which of the CDSS will be used and maintained in the future.
The effect of initial lens diopter on myopia control by orthokeratology in Teenagers A retrospective Beijing Study
Authors: Yu Jifeng , Shi Wei , Liu Xue , Li Si-Yuan , Li Li
Published: October 2019

Background To investigate the effect of initial refractive error on the control of myopia by orthokeratology. Methods Retrospective study. Data were analyzed from 78 patients (156 eyes) who underwent orthokeratology in Beijing Children's Hospital from January 2014 to April 2018. The changes of axial length and diopter after wearing the lenses were measured. Patients were divided into six groups according to refractive error: <-1.00D, -1.00~ -2.00D, -2.00D~ -3.00D, -3.00D~ -4.00D, -4.00D~ -5.00D and -5.00~ -6.00D. A mixed-effect model was used to analyze the relevant data. At the same time, the interaction item between diopter and wearing time was analyzed, and the influence of gender was corrected. Results Patients averaged 12.9±2.161 years old. Two years after wearing orthokeratology lenses, there was a statistically significant difference with the interaction item between refractive error and wearing time in each group. The estimated values ​​were 0.0631 for the right eye and 0.053 for the left eye. Orthokeratology lenses controlled the progression of myopia well, but the reduction depended on the initial diopters. Binocular axial length examination didn’t show statistically significant difference with the interaction item. Axial length increased with time, and the magnitude of increase did not differ among groups. However, the increase in the axial length of the male more than that of the female.Conclusion Initial refractive errors have a significant impact on the control of myopia by orthokeratology. The less severe myopia patient demonstrated a more pronounced benefits after wearing orthokeratology lenses. Key words: refractive error; myopia; orthokeratology
Volume of Tidal Gas Movement in Nonventilated Lung During One-lung Ventilation and its Relevant Factors
Authors: Wei Jionglin , Gao Lei , Zhang Mengting , Sun Fafa , Gu Weidong
Published: October 2019

BACKGROUND: Effective collapse of the nonventilated lung is important for exposure of critical structures during thoracoscopic surgery. The passive ventilation of nonventilated lung results in tidal gas movement (TGM) and thus affects the lung collapse. The present study aimed to measure the volume of TGM and to establish a mathematical model to predict the volume of TGM.METHODS: One hundred and sixty-five patients scheduled for elective thoracoscopic surgeries were enrolled. Lung isolation was achieved with a double-lumen endobronchial tube (DLT). The pediatric spirometry sensor was connected to the double-lumen connector of the non-ventilated lung to measure the volume of the TGM during one-lung ventilation (OLV) in lateral position. Other variables were also recorded: 1) age, gender, height, the deviation between actual body weight and ideal body weight (ABW-IBW); 2) forced vital capacity (FVC), FEV 1 /FVC, minute ventilation volume (MVV); 3) dynamic lung compliance (Cdyn) and airway resistance (Raw) during dual lung ventilation; 4) the side of OLV; 5) whether lung puncture for localization of pulmonary nodule was performed on the surgery day. RESULTS: The volume of tidal gas movement in the nonventilated lung during one-lung ventilation was 78 ± 26 mL. Gender, side of OLV, FVC and Cdyn independently correlated with the volume of TGM (P<0.05). The linear regression model for the volume of TGM was deduced: TGM (mL)=C+16.452×a-8.371×b+14.017×c+0.206×d. C: Constant=26.915 mL; a: male=1, female=－1; b: right OLV=1, left OLV=－1; c: FVC (L); d: Cdyn (mL/cmH 2 O). CONCLUSIONS: The tidal gas movement of the nonventilated lung during one-lung ventilation does exist. Gender, FVC, side of OLV and Cdyn independently correlate with the volume of TGM. Trial registration: This clinical research was registered at the Chinese Clinical Trial Registry ( www.chictr.org.cn , ChiCTR1900024220, date of registration: July 1 st , 2019). Key Words: tidal gas movement, one-lung ventilation, lung collapse, double-lumen endobronchial tube, dynamic lung compliance, thoracoscopy