bluuebunny/crossref_metadata_2025 huggingface dataset:
Type I Error Control for Cluster Randomized Trials Under Varying Small Sample Structures
Authors: Nugent Joshua , Kleinman Ken
Published: December 2019

Background: Linear mixed models (LMM) are a common approach to analyzing data from cluster randomized trials (CRTs). Inference on parameters can be performed via Wald tests or likelihood ratio tests (LRT), but both approaches may give incorrect Type I error rates in common finite sample settings. The impact of interactions of cluster size, number of clusters, intraclass correlation coefficient (ICC), and analysis approach on Type I error rates have not been well studied. Reviews of published CRTs find that small sample sizes are not uncommon, so the performance of different inferential approaches in these settings can guide data analysts to the best choices. Methods: Using a random-intercept LMM stucture, we use simulations to study Type I error rates with the LRT and Wald test with different degrees of freedom (DF) choices across different combinations of cluster size, number of clusters, and ICC.Results: Our simulations show that the LRT can be anti-conservative when the ICC is large and the number of clusters is small, with the effect most pronouced when the cluster size is relatively large. Wald tests with the Between-Within DF method or the Satterthwaite DF approximation maintain Type I error control at the stated level, though they are conservative when the number of clusters, the cluster size, and the ICC are small. Conclusions: Depending on the structure of the CRT, analysts should choose a hypothesis testing approach that will maintain the appropriate Type I error rate for their data. Wald tests with the Satterthwaite DF approximation work well in many circumstances, but in other cases the LRT may have Type I error rates closer to the nominal level.
Two-step transurethral resection of bladder tumor improves surgical quality and decreases disease recurrence: a retrospective study
Authors: Huang Wei-Lun , Huang Chao-Yuan , Huang Kuo-How , Pu Yeong-Shiau , Chang Hong-Chiang , Chow Po-Ming
Published: December 2019

Background: Two-step transurethral resection of bladder tumor (TURBT) is a method of TURBT that is performed in two steps- exophytic tumors first and tumor bases second. The purpose is to improve tumor clearance. In current study, we evaluated outcomes of two-step TURBT in patients with non-muscle invasive bladder cancer (NMIBC). Methods: We retrospectively reviewed a prospective database. Patients who had newly diagnosed NMIBC with at least a 2-year follow-up period during Jan. 1, 2012 and Dec. 31, 2017 were enrolled. Patients with concomitant or subsequent upper urinary tract urothelial carcinoma (UTUC) were excluded. Patients were categorized into the two-step TURBT (TR) group and the conventional TURBT (CR) group. The primary endpoints were the recurrence rate and the progression rate. The secondary endpoints were the recurrence-free survival (RFS), the progression-free survival (PFS), and the detrusor muscle sampling rate. Results: A total of 205 patients were included, with 151 patients in the TR group and 54 patients in the CR group. The median follow-up period was 40.5 months. There were lower recurrence rate (29.8% vs 48.1%, P = 0.015), higher detrusor muscle sampling rate (70.7% vs 55.6%, P = 0.043), and longer RFS ( P= 0.007) in the TR group. TR was also associated with longer RFS in both univariate (HR=0.524, p =0.009) and multivariate (HR=0.426, p =0.003) analysis. Conclusions: Two-step TURBT results in lower recurrence rate and longer RFS for NMIBC, especially for Ta disease. Two-step TURBT also improves detrusor muscle sampling rate, which is essential for adequate resection and accurate staging.
Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)?
Authors: Lin Diwei , O'Callaghan Michael E , David Rowan , Fuller Andrew , Wells Richard , Sutherland Peter , Foreman Darren
Published: December 2019

Purpose Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP).Methods We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score.Results The observed median MUL in this study was 14.6mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p=0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p=0.006). MUL was also associated with change in continence after surgery (β=1.22, p=0.002).Conclusions MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.
Medication Discrepancies Involving Hospitalized Children At A High-Complexity Public Hospital
Authors: Lyra Divaldo Pereira de , Alcântara Thaciana dos Santos , Neto Fernando Castro de Araújo , Lima Helena Ferreira , Araújo Dyego Carlos S. Anacleto de , Sanchez Júlia Mirão , Junior Divaldo P. de Lyra
Published: December 2019

Background: Children are more susceptible to medication errors and adverse reactions. In addition, variation in body mass and medication discrepancies are the major causes of medication errors, which pose a risk of harm to children. When unresolved, these issues can lead to longer hospital stays, increased hospital readmissions, and emergency room care that burden the healthcare system. Many organizations have struggled to implement medication reconciliation. In this context, studies demonstrated that reliability and improvement science methods can be used to implement a successful and sustained medication reconciliation process. One of the initial steps involved in medication reconciliation process is determining the sector for implementation. Therefore, the aim of this study was to determine the prevalence of medication discrepancies occurring throughout the course of a hospital stay and describe the types of discrepancies and medications most commonly involved in pediatric cases. Methods: A cross-sectional study was carried out from July 2017 to March 2018 in the pediatric department of a high-complexity public hospital in Brazil. Data collection consisted of: collection of sociodemographic data, clinical interview with the patient's caregiver, registration of patient prescriptions, and evaluation of medical records. Discrepancies were classified as intentional or unintentional and included omission of medication, therapeutic duplicity, different dose, frequency, route of administration than prescribed. Study approved by the Research Ethics Committee (CAAE: 36927014.4.0000.5546). Results: During care transitions, 114 children were followed. Patients presented unintentional discrepancies, of which 16 (14.0%) presented discrepancies at hospital admission, 42 (36.8%) during ward transfer, and 52 (45.6%) during discharge. Omission represented 74% (n=20) ofthe errors at admission, 38% (n=26) at ward transfer, and 100% (n=80) at discharge. The most frequent discrepancies in the three transitions were related to antimicrobials, representing 43.3% of discrepancies at admission, 38.8% at internal transfer, and 61.2% during discharge. Conclusion: The results demonstrated that the main transition levels when unintentional discrepancies occurred in children in this hospital were during internal transfer and discharge and indicated difficulties in interprofessional communication and poor documentation. Evaluation of all transition points is essential for determining the most critical point in the quality of care provided at hospitals.
Setting-up of natural delivery centers; an affordable policy to improve the quality of maternity care
Authors: Aghazadeh-Attari Javad , Alinia Cyrus , Entezar-Mahdi Rasool , Mirza‐Aghazadeh-Attari Mohammad , Mohebbi Iraj
Published: December 2019

Background: Since there is no comprehensive model to measure the quality of maternity care and also health systems are facing the challenge of increasing the cost of such care, We developed a quality of maternity care model, measured the quality of care in a normal delivery center (NDC) compared to a mixed delivery center (MDC). It also compared the performance of midwives against gynecologists for uncomplicated pregnant mothers.Methods: A theory-based maternity care model is used to compare the quality of maternity care for the delivery centers. This model consists of three dimensions of the structure, process, and output. Mothers who have given birth in the delivery centers were the primary data source in Urmia city, Iran in 2018. A total of 164 mothers from the NDC and 215 mothers from MDC were randomly selected and interviewed.Results: The mean age of mothers in the NDC and MDC was 24.7 and 27.1 years, respectively. The findings show that NDC significantly had better performance compared to MDC in all three dimensions. However, we observed significant differences in some outcome variables (the experience of pain and follow-up) in favor of MDC.Conclusions: Midwives in NCD provide a higher quality of care than gynecologists in general hospital. The policy of setting up natural childbirth centers run by trained midwives can have positive effects, such as decreasing cesarean rates and cost of care and also increasing the quality of childbirth care.
The Geriatric Nutrition Risk Index versus the Mini-Nutritional Assessment Short Form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: a prospective cohort study
Authors: Zhao Yanli , Ge Ning , Xie Dongmei , Gao Langli , Wang Yanyan , Liao Yulin , Yue Jirong
Published: December 2019

Backgrounds: Malnutrition has been shown to be associated with a poor prognosis in older surgical patients. Several tools are available for detecting malnutrition. But little is known about their ability to assess risks of postoperative adverse outcomes. The study aimed to compare the ability of the Geriatric Nutritional Risk Index (GNRI) and the Mini-Nutritional Assessment Short Form (MNA-SF) in predicting postoperative delirium (POD) and length of stay (LOS) among older non-cardiac surgical patients. Methods : Prospective study of 288 older non-cardiac surgical patients from the West China Hospital of Sichuan University. Preoperative nutritional status was assessed using the GNRI and MNA-SF, and patients were followed for the occurrence of POD and LOS. Multivariate logistic regression and linear regression analyses were used to identify predictors of these outcomes. The relative performance of the GNRI and MNA-SF as predictors of these outcomes were determined by Receive Operator Characteristic curves (ROC) analyses and the area under the curve (AUC). Results : Multivariate analysis revealed that high nutritional risk (GNRI < 92) and malnutrition/ risk of malnutrition (MNA-SF < 8 and MNA-SF=8-11) were significantly associated with POD. Linear regression analysis showed that low/high nutritional risk (GNRI=92-98 and GNRI < 92) and malnutrition (MNA-SF < 8) were independent predictors of prolonged LOS. Moreover, the area under the curve (AUC) of MNA-SF scores (AUC=0.718, P <0.001, 95%CI: 0.64-0.80) for POD was better than GNRI scores (AUC=0.606, P= 0.019, 95%CI: 0.52-0.69), whereas, GNRI scores (AUC=0.611, P= 0.006, 95%CI: 0.54-0.69) had larger AUC when predicting prolonged LOS as compared to MNA-SF scores (AUC=0.533, P= 0.421, 95%CI: 0.45-0.62). Conclusion : The GNRI was more effective than the MNA-SF at predicting prolonged LOS, but the MNA-SF was a superior predictor of POD in older non-cardiac surgical patients.
Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study
Authors: Manis Derek R. , McArthur Caitlin , Costa Andrew P.
Published: December 2019

Background Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients.Methods We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1 – March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument – Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls.Results Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism.Conclusions Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.
Increasing prevalence of anticholinergic medication use in older people in England over 20 years: Cognitive Function and Ageing Study I and II
Authors: Grossi Carlota , Richardson Kathryn , Savva George , Fox Chris , Arthur Antony , Loke Yoon , Steel Nicholas , Brayne Carol , Matthews Fiona , Robinson Lousie , Myint Phyo , Maidment Ian
Published: December 2019

Background: Anticholinergic medication use is linked with increased cognitive decline, dementia, falls and mortality. The characteristics of the population who use anticholinergic medication are not known. Here we estimate the prevalence of anticholinergic use in England’s older population in 1991 and 2011, and describe changes in use by participant’s age, sex, cognition and disability. Methods: We compared data from participants aged 65+ years from the Cognitive Function and Ageing Studies (CFAS I and II), collected during 1990-1993 (N=7,635) and 2008-2011 (N=7,762). We estimated the prevalence of potent anticholinergic use (Anticholinergic Cognitive Burden [ACB] score=3) and average anticholinergic burden (sum of ACB scores), using inverse probability weights standardised to the 2011 UK population. These were stratified by age, sex, Mini-Mental State Examination score, and activities of daily living (ADL) or instrumental ADL (IADL) disability. Results: Prevalence of potent anticholinergic use increased from 5.7% (95% Confidence Interval [CI] 5.2-6.3%) of the older population in 1990-93 to 9.9% (9.3-10.7%) in 2008-11, adjusted odds ratio of 1.90 (95%CI 1.67 – 2.16). People with clinically significant cognitive impairment (MMSE [Mini Mental State Examination] 21 or less) were the heaviest users of potent anticholinergic in CFAS II (16.5% [95%CI 12.0-22.3%]). Large increases in the prevalence of the use medication with ‘any’ anticholinergic activity were seen in older people with clinically significant cognitive impairment (53.3% in CFAS I to 71.5% in CFAS II). Conclusions: Use of potent anticholinergic medications nearly doubled in England’s older population over 20 years with some of the greatest increases amongst those particularly vulnerable to anticholinergic side-effects. Key words: cognitive impairment, anticholinergic burden, polypharmacy
Diagnostic accuracy of Xpert Xpress Flu/RSV for detection of Influenza and Respiratory syncytial virus: systematic review and meta-analysis
Authors: Guo Xu-Guang , Liu Ye-Ling , Xie Tian-Ao , Lin Geng-Ling , Lin Qin-Rong , Fan Shu-Jin , Li Zhen-Xing , Ouyang Shi , Zhu Guo-Dong , Ji Tian-Xing , Pan Zhi-Yong , Xia Yong , Wu Li-Juan
Published: December 2019

Background: Xpert Xpress Flu/RSV assay is a fast and automated real-time nucleic acid amplification method, recently approved by the USA, Europe and China for detection and differentiation of influenza (Flu) A, Flu B and RSV virus from nasopharyngeal swabs. Nevertheless, there are still no systematic reviews and meta-analysis on the accuracy of identification of influenza virus by The Xpert Xpress Flu/RSV assay. The aim of this meta-analysis was to verify the accuracy of Xpert Xpress Flu/RSV for detecting Flu and RSV.Materials and Methods: The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched using the following keywords: Xpert Xpress Flu/RSV, Flu and RSV up to April 2019. Four researchers screened and extracted documents according to inclusion and exclusion criteria. The quality of original research was assessed using the QUADAS-2 guidelines. Meta-DiSc 1.4 software was used to analyze the sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic ratio (DOR), and Summary receiver operating characteristic curves (SROC). Deek’s funnel plot asymmetry test was used to evaluate the publication bias by Stata 12.0.Results: Nine studies with 22 fourfold tables were included in this meta-analysis. The sensitivity of Xpert Xpress Flu/RSV for detection of Flu A, Flu B, and RSV was 0.96, 0.98, 0.98; the specificity was 0.97, 0.99, 0.99; +LR was 80.65, 163.74, 237.35; -LR was 0.02 , 0.03, 0.05；DOR was 4806.90, 6266.78, 5254.41, respectively. AUC was all over 0.9. In addition, no publication bias for FluA, Flu B, and RSV was found. Conclusions: Compared to the traditional PCR approach, Xpert Xpress Flu/RSV resulted as a valuable method for Flu and RSV diagnosis in the clinic, offering high sensitivity and specificity. Nonetheless, further research is necessary to determine whether Xpert Xpress Flu/RSV can be used as a clinical diagnostic standard for the identification of Flu and RSV. Keywords: Xpert Xpress Flu/RSV; influenza virus; respiratory syncytial virus; PCR
Assessing the determinants of Ebola Virus Disease Transmission in Baka Community of the Tropical Rainforest of Cameroon
Authors: Wirsiy Frankline Sevidzem , Bock Alphonse Um , Akoachere Jane-Francis Kihla Tatah
Published: December 2019

Background: Ebola virus disease (EVD) is a severe, often fatal illness in humans and nonhuman primates caused by the Ebola virus. Treatment and vaccine are under development, hence prevention is paramount. Design of effective prevention interventions requires an understanding of the factors that expose communities at risk. It was based on this that we investigated the Baka community (Pygmies) of Abong-Mbang Health District in tropical rain forest of Cameroon.Methods: A cross-sectional study was conducted with participants randomly selected from13 villages in Abong-Mbang by multi-stage cluster sampling. A questionnaire was administered to them to collected demographic information, data on knowledge of EVD, their feeding and health-seeking behaviour. Data was analyzed using the chi-square test. Knowledge of EVD was assessed using an 8 item Morisky Scale. An adapted Threat Capability Basic Risk Assessment Guide was used to determine their risk of exposure to infection.Results: A total of 510 participants, most of who were hunters (31.4%), farmers (29.8%), and had primary education (62.7%), were included in this study. Although 83.3% participants had heard of EVD, most did not know its cause. Their source of information was mainly informal discussions in the community (49%). Misconceptions were identified with regards to knowledge on the cause and mode of transmission. Only 43.1% accepted EVD could be transmitted from human-to-human. Generally, participants’ knowledge on EVD was poor. Demographic factors such as level of education, occupation and ethnic group significantly affected knowledge on EVD. The majority of participants were at a very high risk of exposure to infection as they consumed various forms of bush meat and were involved in other risky practices as scarification and touching of corpses. Although over half of participants seek medical care, most of them preferred traditional medicine. Socio-cultural and service related factors were deterrent factors to medical care. Conclusion: Participants generally had poor knowledge of EVD and were at high risk of to infection. We recommend rigorous sensitization campaigns in study area to educate the population on EVD and clarify the misconceptions identified. EVD surveillance is recommended particularly as outbreaks continue to be reported in the Congo Basin
Value of mNGS in guiding clinical prognosis of ARDS caused by severe pneumonia
Authors: Zhang Peng , Chen Yan , Li Shuyun , Li Chaoliang , Zhang Shuang , Zheng Weihao , Chen Yantang , Ma Jie , Zhang Xin , Huang Yanming , Liu Shengming
Published: December 2019

Background ARDS caused by severe pneumonia develops rapidly, causes complex pathogens, and has high morbidity and mortality. Convenient and efficient methods are needed in clinical practice for the detection of pathogen of ARDS caused by severe pneumonia.Methods This study retrospectively assessed the data of 105 patients with ARDS caused by severe pneumonia. Patients were divided into NGS group and no-NGS group. Clinical characteristics, laboratory examination, ICU cost and prognosis in the two groups were compared. Meanwhile, compared patients in NGS group, mNGS and routine detection methods had different detection efficiency for bacteria, fungi, viruses, unusual pathogens and co-infections.Results The mortality rate of NGS group was significantly lower than that of no-NGS group (21.43% VS 49.06%, P<0.05). In NGS group, the pathogen detected by Metagenomics NGS (mNGS) method was consistent with sputum culture by 31.1%. More than half (62.5%) of the inconsistencies were caused by negative sputum culture. The efficiency of mNGS method for unusual pathogens, only bacteria or co-infection is better than that of serological antibody test plus PCR. The positive rate of mNGS detection of unusual pathogens was significantly higher than that of sputum culture (22.22% vs 0, P <0.01). The overall positive rate of mNGS detection of ARDS caused by severe pneumonia (91.11%) was greater than that of serological antibody test plus PCR (31.11%) and sputum culture (62.22%). The clinical data of immunosuppressive patients in the two groups were compared, and it was found that the ICU time (P< 0.01), ventilator time (P < 0.05) and ICU cost (P < 0.01) in NGS group were significantly lower than those in no-NGS group.Conclusion mNGS technology has special significance for the treatment and prognosis of ARDS caused by severe pneumonia. MNGS technology is superior to routine pathogen detection methods for the detection of unusual pathogens and co-infection. For patients with severe disease, immunosuppression, or cases that cannot be diagnosed by routine methods, mNGS technology can be used to provide more diagnostic evidence for clinical diagnosis and to guide clinical medication.
The impact of Clonorchis sinensis infection on immune response in mice with type II collagen-induced arthritis
Authors: li xiangyang , Yang Ying , Qin Su-Ping , Kong Fan-Yun , Yan Chao , Cheng Wan-Peng , Pan Wei , Yu Qian , Hua Hui , Zheng Kui-Yang , Tang Ren-Xian
Published: December 2019

Background Clonorchis sinensis infection could trigger strong immune responses in mice and human. However, whether the C.sinensis infection has an impact on arthritis is unknown. Here we investigated the effect of C.sinensis infection on type II collagen-induced arthritis in BALB/c mice.Results The mice were firstly infected with 45 C.sinensis metacercariae by oral gavage. Four weeks later, the arthritis in mice was induced by type II collagen. Joint inflammation with severe redness and swelling in hind paws were observed in type II collagen-induced arthritis (CIA) mice. In addition, the physical activity was significantly reduced, but the respiratory exchange ratio was increased in CIA mice. Compared with CIA mice, C.sinensis infection could increase the severity of arthritis in CIA mice, based on the results of disease score and pathological changes. Compared to CIA mice, increased neutrophils and Ly6C hi monocytes, decreased B cells and CD4+T cells were found in C.sinensis infected CIA mice. Besides these, C.sinensis infected mice also displayed significant higher levels of serum IL-4 and IL-17 than those in CIA mice. Taken together, our data suggest that C.sinensis infection have a bad effect on arthritis, and could induce the abnormality of immune response in mice with CIA.
Meeting Psychosocial Needs to Improve Health: A Prospective Cohort Study
Authors: Snowden Austyn , Young Jenny , Savinc Jan
Published: December 2019

Background Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention. Method Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service ‘Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, approximately 4 months later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models. Results Participants were White British with median age between 50-64 years. Cancer type and stage were varied. There was a statistically significant improvement in EQ-5D scores over time (t(330)=7.48, p<.001). The strongest predictor of change was a decrease in severity of concerns. Cancer stage ‘palliative care’ contributed to a reduction in health status. Conclusion This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants has a statistically and meaningful impact on participants’ health-related quality of life. The mean change in EQ-5D scores was more than the ‘minimally important clinical difference’ described in the literature. This is important because while quality of life has multiple determinants this study has reported that it is possible to capture a meaningful improvement as a function of reducing someone’s personally identified concerns.
Complete genome sequencing and comparative genomic analyses of Bacillus sp. S3, a novel hyper Sb(III)-oxidizing bacterium
Authors: Li Jiaokun , Gu Tianyuan , Zeng Weimin , Yu Runlan , Liu Yuandong , Wu Xueling , Shen Li , Qiu Guanzhou , Li Liang Zhi
Published: December 2019

Background: Antimonite [Sb(III)]-oxidizing bacterium have great potential in the environmental bioremediation of Sb-polluted sites. Bacillus sp. S3 isolated from antimony-contaminated soil showed high Sb(III) resistance and Sb(III) oxidation efficiency. However, very little genomic information and evolutionary relationships that bacterial oxidation of Sb(III) is available. Results: Here, we identified a 5579638 bp chromosome with 40.30% GC content and a 241339 bp plasmid with 36.74% GC content in the complete genome of Bacillus sp. S3. Genomic annotation showed that Bacillus sp. S3 contains key aioB gene potentially encoding As(III)/Sb(III) oxidase, is not shared with other Bacillus strains. Further, a series of genes associated with Sb(III) and other heavy metal(loid) were also ascertained, reflecting adaptive advantage for growth in the harsh eco-environment. It is noteworthy that Bacillus sp. S3 is a novel species within the Bacillus genus as indicated by phylogenetic relationship and the average nucleotide identities (ANI) analysis. The presence of genomic plasticity demonstrated a high number of mobile genetic elements (MGEs) that were mainly distributed on chromosomes within the Bacillus genus. The core genome contained 554 core genes and many unique genes were dissected in analyzed genomes, indicating a conserved core but adaptive pan repertoire. Whole genomic alignment indicates that frequently genomic reshuffling and rearrangements, genetic gain and loss, and other recombination events occurred during the evolutionary history of Bacillus genus. In addition, the origin and evolution analysis of Sb(III)-resistance genes revealed that evolutionary relationships and events of horizontal gene transfer (HGT) among the Bacillus genus. The assessment of functionality of heavy metal(loid) resistance genes emphasized its indispensable roles in the harsh eco-environment of Bacillus genus. The real-time Quantitative PCR(RT-qPCR) results of Sb(III)-related genes indicated that the Sb(III) resistance was constantly increased under the Sb(III) stress. Conclusions: The insights provided in this study shed light on the molecular details of Bacillus sp. S3 coping with Sb(III), which extended our understanding on the evolutionary relationship between Bacillus sp. S3 and other closely related species and will enrich the Sb(III) resistance genetic data sources.
Identification and characteristics of a novel cecropin from the armyworm, Mythimna separata
Authors: Lian Kaiqi , Zhang Mingliang , Liang Xiuli , Zhou Lingling , Shi Zhiqi , Tang Yajie , Wang Xueping , Song Yuwei , Zhang Yuanchen
Published: December 2019

Background: The recent emergence of antibiotic-resistant strains of bacteria has increased the need to develop effective alternatives to antibiotics. Antimicrobial peptides have been considered as a promising product with several advantages.Results: In this present study, we identified a novel cecropin from the armyworm, Mythimna separata (armyworm cecropin 1, AC-1) by transcriptome sequencing and multi-sequence alignment analysis. The AC-1 precursor comprised 63 amino acid residues, containing a conserved cleavage site of the signal peptide, Ala23-Pro24, while the mature AC-1 included 39 amino acid residues. Chemically-synthesized AC-1 exhibited low hemolytic activity against chicken red blood cells and low cytotoxicity against swine testis cells, but effective antimicrobial activity against Salmonella, Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa. Its antimicrobial activity against Salmonella remained after incubation for 1 h at 100 °C or in 250 mM NaCl solution, implying good thermal- and salt-resistant stabilities.Conclusions: This study identified a novel antimicrobial peptide that may represent a potential alternative to antibiotics.
Is Mycoplasma pneumonia a potential factor for hemoptysis related to pulmonary vascular malformations? A retrospective cohort study of 27 children
Authors: Kuang Hongyu , Li Qiang , Yi Qijian , Lu Tiewei
Published: December 2019

Background: To summarize characteristics of hemoptysis in children associated with pulmonary vascular malformations, and to identify the pathological mechanism, potentially.
Methods: Children were recruited who were diagnosed with hemoptysis for pulmonary vascular malformations without congenital heart disease (CHD). The demographics, history, clinical characteristics, laboratory findings, pathogens testing, imaging outcomes and prognosis were systemically reported. The nonparametric Mann-Whitney U test using SPSS 24.0 was employed to compare the continuous laboratory variables, and Fisher’s exact test was applied for data enumeration. A P-value of <0.05 was considered statistically significant.
Results: In sum, 27 children were enrolled in this retrospective study with a medium age of 9.1 years old, among whom 9.1% were in preschool-group, 72.7% in school-group, and 18.2% in adolescent-group. Different hemoptysis degrees were observed from individuals, and the moderate and severe conditions were commonly in elder children. Meanwhile some antecedent symptoms were recorded, mainly cough and fever before hemoptysis occurrence. Pathogens testing indicated proofs for infection of MP in 68.2% patients, and 37.5% were further identified with MP-DNA-PCR. Images revealed interstitial changes in most hemoptysis cases, especially in the inferior lobe of right lung for cases with MP infection, and endovascular contrast detected 24 patients with abnormal bronchial arteries (BAs) causing bronchial artery-pulmonary artery fistula and 3 patients suffered from pulmonary arteriovenous fistula (PAVF). After the transcatheter plug closure, a recurrent hemoptysis occurred in 8 patients suffered from an infection of MP initially, and the OR of clinical worsening in Group 1 where cases were considered with an infection of MP, was 2:1.
Conclusions: Pulmonary vascular malformations can be commonly detected in elder children. An infection of MP possibly acts as a potential trigger inducing the rupture of affected vessels, which could take a higher risk of clinical worsening.
Intracranial-to-Central Venous Pressure Gap Predicts the Responsiveness of ICP to PEEP in Patients with Traumatic Brain Injury
Authors: Peng Li Hong , Ning Lin Ying , Hui Cheng Zhi , Wei Qu , Liu Zhang , Yun Li Qing
Published: December 2019

Background: Mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) is commonly applied in patients with severe traumatic brain injury (sTBI). However, non-indicators to predict the influence of PEEP on intracranial pressure (ICP) prevent the optimal use of PEEP. As the central venous pressure (CVP) could act as an intermediary to transduce the pressure from PEEP to ICP, we set up a new indicators PICGap (representing the gap between the baseline ICP and baseline CVP). The aim of the study was to explore the relationship between PICGap and the ICP responsiveness to PEEP.
Methods: Total 112 patients with sTBI undergoing MV were finally enrolled. ICP, CVP, cerebral perfusion pressure (CPP), static compliance of respiratory system (Cst), and end-tidal carbon dioxide pressure (PetCO2) were recorded at initial level of PEEP (3 cmH2O) and adjusted levels of PEEP (15 cmH2O). PICGap was calculated by baseline ICP - baseline CVP (when PEEP=3 cmH2O). The patients enrolled were classified into either an ICP responder group or a non-responder group based on whether the increment of ICP when PEEP adjustment from 3 cmH2O to 15 cmH2O was greater than or less than 20% of baseline ICP. Parameters recorded above were compared between two groups and the prediction of ICP responsiveness to PEEP adjustment were evaluated by receiver operating characteristic (ROC).
Results: Responder group had lower PICGap, lower baseline ICP, and higher baseline CVP compared with non-responder group. ROC analysis suggested that PICGap could act as a strongest predictive indicator for the ICP responsiveness to PEEP (AUC = 0.957, 95% CI: 0.918 - 0.996, p <0.001) compared with baseline ICP and baseline CVP, with a favorable sensitivity of 95.24% (95% CI: 86.91% - 98.70%) and specificity of 87.6% (95% CI: 75.76% - 94.27%) when the cut off value of 2.5mmHg was determined.
Conclusion: The impact of PEEP on ICP depends on the GAP of between baseline ICP and baseline CVP, i.e. PICGap. The PICGap could be a potential predictor for ICP responsiveness to PEEP adjustment in patients with sTBI.
Is Percutaneous Endoscopic Gastrostomy (PEG) tube feeding Beneficial for Improving Survival in Patients with Dementia? A systematic review and meta- analysis of current evidences
Authors: Raeesi Shima , Hashemi Rezvan , Vahabi Zahra , Abdolahi Mina , Sedighiyan Mohsen
Published: December 2019

Background Dementia is a progressive disabling neurogenic disease resulted in serious nutritional deficiencies included dysphagia, malnutrition and weight loss. The Percutaneous Endoscopic Gastrostomy (PEG) which is a long-term enteral feeding method that routinely use in demented patients with poor food intake as a standard protocol. However, most of the evidences have not shown beneficial effects of PEG feeding on complications or survival rates in these patients. Some studies have even reported an increase in mortality. The current systematic review and meta-analysis aimed to evaluate the mortality rate and survival in primary demented patients with PEG.Methods A systemically search conducted on Pubmed and Scopus databases up to Aug 2019 without language restriction. The data were reviewed according to Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE). Based on random-effects model, mortality rate and median survival were expressed as risk ratio and weighted mean difference (WMD) and 95% CI respectively.Results Among 13 included studies, PEG insertion in patients with primary dementia has no significant effect on 30-day, 90-day, 180-day, 1-year and 2- year mortality rate or median survival (WMD: 9.77; 95% CI: -22.43 to 41.98; P= 0.55). It seems that naso-gastric tube (NGT) feeding in compared to PEG in this population is more effective.Conclusion Further prospective studies are needed to comprehensive evaluation of mortality or survival regarding to comorbidities, underlying disease, cognitive and physical performance and nutritional problems in demented patients.
The extent of loss to follow among patients initiated on antiretroviral treatment, Pakistan 2017-2018: a retrospective cross-sectional study
Authors: Paracha Saima Iqbal , Hafeez Fahad , Habib Hammad , Yaqoob Aashifa , Fatima Raazia , Saeed Quaid , Achakzai Abdul Baseer Khan
Published: December 2019

Background The HIV epidemic in Pakistan is concentrated in key populations and is one of the fastest growing epidemics in South Asia. Over the years the number of people infected with the human immunodeficiency virus initiated on antiretroviral therapy has gradually increased. The effectiveness of the treatment programmes depends on retention in care and treatment adherence. The aim of the study is to the explore the sociodemographic characteristics and magnitude of loss to follow-up in patients initiated on ART in three provinces of Pakistan.Methods A retrospective cross-sectional study was conducted in the National AIDS Control Programme. Case-based data (n=5,215) of 16 treatment centres for all patients initiated on anti-retroviral therapy from 1 st January 2017 to 31 st December 2018 was extracted from the national management information system. Loss to follow-up was defined as a patient who has not visited/attended the ART clinic for >180 days (6 months) and has not been reported dead or transferred out to another ART clinic. Descriptive statistics were applied to study the sociodemographic characteristics and level of lost to follow up in patients initiated on treatment.Results Of the 5,215 patients, 3,097 (59.4%) were aged between 15-49 years. About 4,069 (78%) were male. Around 1,686 (34.3%) of the patients on ART were defined as lost to follow up. Age, gender, and patients with undisclosed identity were identified as the key characteristics of patients lost to follow-up. A greater proportion of the patients were lost to follow-up within the first year of initiation of treatment.Conclusions The loss to follow in the study is high. Efforts need to be focussed on linking people infected with human immunodeficiency virus to treatment, retaining them in care, and increasing patient time on treatment. Patient tracing mechanisms should be strengthened.
Comparison of 22G Standard and Franseen Needles in Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Diagnosing Pancreatic Mass Lesions: Study Protocol for a Controlled Trial
Authors: Itonaga Masahiro , Yasukawa Satoru , Shimokawa Toshio , Takenaka Mamoru , Fukutake Nobuyasu , Ogura Takeshi , Sakagami Junichi , Shiomi Hideyuki , Okura Yasushi , Inatomi Osamu , Matsumoto Hisakazu , Kurita Akira , Suzuki Azumi , Tanaka Kiyohito , Kitano Masayuki
Published: December 2019

Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was developed with the aim of further improving the diagnostic performance of endoscopic ultrasound. Although novel puncture needles have been specifically designed for collecting sufficient tissue specimens, clinical studies have indicated no clear difference in diagnostic performance between these novel needles and conventional puncture needles. Recently, a needle with Franseen geometry was developed specifically for EUS-FNA biopsy. Due to the characteristic shape of its tip, the Franseen needle is expected to be effective for scraping tissues, thus potentially increasing the diagnostic accuracy of EUS-FNA biopsy. We plan to carry out a prospective, multicenter, open-labeled, controlled trial to compare conventional and Franseen needles in terms of the diagnostic accuracy of EUS-FNA for evaluating the malignancy of pancreatic mass lesions. Methods/design The study will enroll 520 patients with pancreatic mass managed at any of 21 participating endoscopic centers. Lesion samples obtained using 22G conventional and Franseen needles will be assessed to compare the efficacy and safety of these two types of needles in EUS-FNA for evaluating the malignancy of mass lesions in the pancreas. Tissue samples will be fixed in formalin and processed for histologic evaluation. For the purpose of this study, only samples obtained with the first needle pass will be used for comparing the: (i) accuracy of the malignancy diagnosis, (ii) sensitivity and specificity for the malignancy diagnosis, (iii) procedure completion rate, (iv) sample cellularity, and (v) incidence of complications. Discussion The outcomes of this study may provide insight into the optimal needle choice for evaluating the malignancy of pancreatic solid lesions, thus aiding in the development of practice guidelines for pancreatic diseases.
Internal limiting membrane insertion technique combined with nerve growth factor injection for large macular hole
Authors: Zhang Luyi , Li Xiaoxia , Yang Xiaoli , Shen Yu , Wu Miaoqin
Published: December 2019

Background: The study was proposed to determine whether nerve growth factor (NGF) combined with an internal limiting membrane (ILM) insertion was effective in the large idiopathic full-thickness macular hole (iFTMH) therapy.
Methods: A subset of 18 eyes (July 2015-October 2017) diagnosed as the large iFTMH were enrolled in this study. The subjects were treated using ILM insertion technique alone (ILM group) or ILM combined with NGF injection (NGF group) and the follow-up period was 6 months. Macular hole closure rates, best-corrected visual acuity (BCVA, improvements using ETDRS), and optical coherence tomography (OCT) findings were analyzed at 1st, 3rd, and 6th months postoperatively.
Results: We found that macular holes in both groups fully closed. In comparison to ILM insertion group, the NGF group had better BCVA at the 3rd month (48.00 ± 2.392 vs 58.22 ± 2.957, 95% confidence interval (CI): 2.159 to 18.29). The mean external limiting membrane (ELM, 422.2 ± 96 vs 674.9 ± 103.6, 95% CI: -47.26 to 552.8) and ellipsoid zone (EZ, 496.7 ± 101.6 vs 766.7 ± 111.8, 95% CI: -50.29 to 590.4) defects were significantly smaller in the NGF group at the 6th month in the follow-up examination. Complete recovery of ELM and EZ was observed in the NGF group in one eye of a patient and two eyes of two patients, respectively. In comparison, one eye’s ELM and another eye’s EZ were completely recovered in the ILM insertion group.
Conclusion: Our results indicated that ILM insertion with NGF injection might be an effective technique for the initial surgical treatment of eyes with large MHs. The proposed approach yielded better recovery of the photoreceptor layers and consequently might have superior postoperative visual acuity.
THE INFLUENCES OF THE DIGITAL REVOLUTION ON THE EDUCATIONAL SYSTEM OF THE EU
COUNTRIES
Authors: Cosmulese Cristina Gabriela , Grosu Veronica , Hlaciuc Elena , Zhavoronok Artur
Published: December 2019

In the context of the information skills development programs that are being developed by the EU, there is an increasing interest in the acquisition and use of digital competences as an impact factor on the educational system at all its was levels. The present study aims to analyze the evolution of digital specializations generated by the digital evolution, in parallel with the development of the educational system, through a statistical analysis of the main indicators that have been reported at EU level on early education abandonment, employment rate of graduates, employment of IT specialists by gender, adult participation in gender-based learning, and other impact indicators that demonstrate the capacity of the population in the digital domain through the use of ICT solutions. The object of research were the statistical indicators reported for 2017 by Eurostat at the level of the European Union, for each member state of the union, obtaining a total of 29 statistical observations. The data were modelled through the GRETL statistical program, obtaining a model based on the smallest squares method in 2 phases. This paper shows that there is a need to assimilate the European approaches in the field of digital evolution, a necessity which varies according to the economic development of each member state, Romania being ranked in the chapter of assimilation of the objectives of the open education agenda in the second part of the
European ranking, including based on the low absorption rates provided for Union programs in this area. The study theoretically proves and empirically confirms that the function obtained through modelling can be assimilated to the service demand function and can be integrated into the offer function harmonized with the information factor. This research study represents a contribution to the field of management of public utility companies and can be useful for educational institutions, students, the labour market and the general public, providing a starting point for further indepth research in this area.
Keywords: educational system, digital revolution, economic development, EU Agenda.
New Mineral Names*,†
Authors: Belakovskiy Dmitriy I. , Cámara Fernando , Uvarova Yulia
Published: December 2019

In this issue

This New Mineral Names has entries for 11 new minerals, including cesiodymite, cryptochalcite, feodosiyite, fluoro-tremolite, itelmenite, ozerovaite, ramazzoite, redcanyonite, selivanovite, vanderheydenite, and wrightite.