bluuebunny/crossref_metadata_2025 huggingface dataset:
Khaul and Maqam Thariqath in Sufism: the Analysis of Implementation Inside the Live of Sufi Thariqath Naqshabandiyah at Dawe Kudus Boarding School
Authors: Masturin M
Published: July 2019

The core of all religions are surrender to The God, as the Creator of all universe. The term of surrender generically called Islam in the Arabic terminology. Personal surrender to God The Ultimate Being, as the most right a part of self religious attitude. This attitude do not consider which any form of the people religious formation. Furthermore, apart form from this religious personality really rejected. According to the conceptualization of religious personality above, the sufism prosecuted to spell out all it’s doctrines related to cultural and social analysis. The sufism assumpt about religious multiculturality as the only form of religion in the world, while the nature it’s similar, that worship in source of anything. The Sufi as they stay in some stage on viewing about God, he will look at Him as essence not as the outer side of His perception. This reasearch stand by qualitative approach. The result of research aim about correlation between religion and society are creates the influence of the two sides. The religion influence the society otherwise the society influence the religion. This reciprocal influences, between the development of society and the improvement of religion, as social and cultural realities that’s need to be wider understand and deep perception.
Effects of Temperature on Crude-Oil-Rock-Brine Interactions During Controlled Salinity Biosurfactant Flooding
Authors: Udoh Tinuola , Vinogradov Jan
Published: July 2019

The effect of temperature and brine composition on Crude-Oil-Rock-Brine (CORB) interactions during controlled salinity brine and biosurfactant injection process were investigated and reported in this study. Comprehensive core flooding experiments were carried out using formation brine, controlled salinity brine and combined controlled salinity biosurfactant brine injection in carbonate core samples at 23 °C and 70 °C. Effluent analyses and oil recovery from each flooding experiment were used to interpret the temperature and brine composition effect on the CORB interactions. The results of this study show that increased temperature makes no significant impact on CORB interactions during high salinity brine flooding. Increased temperature however, enhances CORB interactions through increased reactivity during controlled salinity brine and controlled salinity biosurfactant brine flooding thereby, resulting in increased oil production. Furthermore, the results of this study demonstrated the enhanced oil recovery potential of combined controlled salinity brine and biosurfactant application in condition relevant to hydrocarbon reservoirs.
Egina Deep Water Development: Isolation Barrier Valve Case Study
Authors: Okpalla C. , Chaloupka V. , Okengwu V. , MacMillan M. , Ezugworie D. , Nwankwo U. , Akinniyi T.
Published: July 2019

A major operator manages multiple deep water projects in the Gulf of Guinea. This paper describes the latest 44-well project in Nigeria. The operator required an ISO 28781 qualified bi-directional subsurface isolation barrier valve (IBV) (Fig. 1) to be installed in each well. This work presents results of IBV deployment in the field.

The wells were drilled and completed from sixth generation drillships. To comply with the operator's dual barrier policy, a bi-directional IBV was installed in each well to help ensure reservoir isolation for temporary well suspension or before running upper completion and tree installation. Careful attention to well fluid cleanliness, sound quality assurance/quality control (QA/QC), and operational procedures were considered paramount to successful remote opening of the IBVs and were identified as best practices by both parties.

The IBV is run in the open position as an integral part of the lower completion. A collet shifting tool closes the ball isolating the formation, enabling inflow and positive pressure testing to be performed. The reservoirs are isolated by the closed ball in the IBV, allowing safe installation of the upper completion from a floating rig or well suspension without a subsea tree. The use of an ISO 28781 Type CC V1 qualified IBV provides both zonal isolation and fluid-loss control. Once a well is completed and the subsea tree installed, the IBV is remotely functioned to the open position by applying multiple tubing pressure cycles.

The first batch of wells were drilled and completed with lower completions and suspended while waiting for subsea tree deliveries. Later, wells were drilled and completed with both lower and upper completions, and trees were installed later from an offshore inspection maintenance and repair (OIMR) vessel. IBVs were successfully closed and inflow and pressure tested during the lower completion phase.

IBVs are run in sieved non-aqueous based mud (NABM). Filtered high viscosity pills are spotted across the IBV before closing. Once closed, the casing above the IBV is displaced to filtered completion brine at a rate ensuring any debris is lifted to the surface. The wells remain suspended with IBVs closed until the operator performs flowback and injectivity testing from a drillship. Additional injectivity testing was also performed from an OIMR vessel. Well suspension duration with IBVs closed varied between two months and 2.5 years. All valves cycled opened without issues. Four coiled tubing (CT) interventions were performed in the field, passing through the open ball without issue, confirming the IBVs were in the fully open position.

This paper describes full QA/QC and operational procedures, which led to successful deployment and excellent functionality of the IBVs.
Effect of a rescue or recurrence dose of lasmiditan on efficacy and safety in the acute treatment of migraine: Findings from the Phase 3 trials (SAMURAI and SPARTAN)
Authors: Loo Li Shen , Plato Brian , Turner Ira , Case Michael , Raskin Joel , dowsett sherie , Krege John
Published: July 2019

Background

We studied the efficacy and safety of a second dose of lasmiditan for acute treatment of migraine.

Methods

SAMURAI and SPARTAN were double-blind, placebo-controlled Phase 3 studies in which individuals with migraine were randomized to oral lasmiditan 50mg (SPARTAN only), 100mg, 200mg, or placebo. Study drug was to be taken within 4 hours (h) of onset of a migraine attack (moderate or severe pain). A second dose of study drug was provided for rescue (patient not pain-free at 2h and took a second dose 2-24h post-first dose) or recurrence (patient pain-free at 2h, but experienced recurrence of mild, moderate, or severe migraine pain and took a second dose 2-24h after first dose). Randomization to second dose occurred at baseline; patients originally assigned lasmiditan were randomized to the same lasmiditan dose or placebo (2:1 ratio), and those originally assigned placebo received placebo. Data from SAMURAI and SPARTAN were pooled for efficacy and safety assessment of a second dose of lasmiditan.

Results

The proportion of patients taking a second dose was lower with lasmiditan versus placebo, and decreased with increasing lasmiditan dose; the majority who took a second dose did so for rescue. In patients taking lasmiditan as first dose, outcomes (pain free, most bothersome symptom [MBS] free) at 2h after a second dose for rescue were similar whether the second dose was lasmiditan or placebo (p>0.05 in all cases). In patients taking lasmiditan for first dose, outcomes at 2h after a second dose for recurrence were as follows: lasmiditan pooled versus placebo - pain free, 50% vs 32% (p>0.05); MBS free, 71% vs 41% (p=0.02); pain relief, 77% vs 52% (p=0.03). In patients whose first dose was lasmiditan, the incidence of treatment emergent adverse events (TEAEs) reported after the second dose was similar whether second dose was lasmiditan or placebo.

Conclusions

A second dose of lasmiditan showed some evidence of efficacy when taken for headache recurrence. There was no clear benefit of a second dose of lasmiditan for rescue treatment. The incidences of TEAEs were similar whether the second dose was lasmiditan or placebo.
The tidal volume challenge improves the reliability of dynamic preload indices during robot-assisted laparoscopic surgery in the Trendelenburg position with lung-protective ventilation
Authors: Jun Joo-Hyun , Chung Rack Kyung , Baik Hee Jung , Chung Mi Hwa , Hyeon Joon-Sang , Lee Young-Goo , Park Sung-Ho
Published: July 2019

Background: The reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) is controversial under pneumoperitoneum. In addition, the usefulness of these indices is being called into question with the increasing adoption of lung-protective ventilation using low tidal volume (VT) in surgical patients. A recent study indicated that changes in PPV or SVV obtained by transiently increasing VT (VT challenge) accurately predicted fluid responsiveness even in critically ill patients receiving low VT. We evaluated whether the changes in PPV and SVV induced by a VT challenge predicted fluid responsiveness during pneumoperitoneum.
Methods: We performed an interventional prospective study in patients undergoing robot-assisted laparoscopic surgery in the Trendelenburg position under lung-protective ventilation. PPV, SVV, and the stroke volume index (SVI) were measured at a VT of 6 mL/kg and 3 minutes after increasing the VT to 8 mL/kg. The VT was reduced to 6 mL/kg, and measurements were performed before and 5 minutes after volume expansion (infusing 6% hydroxyethyl starch 6 ml/kg over 10 minutes). Fluid responsiveness was defined as ≥ 15% increase in the SVI.
Results: Twenty-four of the 38 patients enrolled in the study were responders. In the receiver operating characteristic curve analysis, an increase in PPV > 1% after the VT challenge showed excellent predictive capability for fluid responsiveness, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI), 0.83–0.99, P < 0.0001; sensitivity 92%, specificity 86%]. An increase in SVV > 2% after the VT challenge predicted fluid responsiveness, but showed only fair predictive capability, with an AUC of 0.76 (95% CI, 0.60–0.89, P < 0.0006; sensitivity 46%, specificity 100%). The augmented values of PPV and SVV following VT challenge also showed the improved predictability of fluid responsiveness compared to PPV and SVV values (as measured by VT) of 6 ml/kg.
Conclusions: The change in PPV following the VT challenge has excellent reliability in predicting fluid responsiveness in our surgical population. The change in SVV and augmented values of PPV and SVV following this test are also reliable.
ANTIBIOGRAMS AND RISK FACTORS OF SALMONELLA ISOLATES FROM LAYING HENS AND EGGS IN JIMMA TOWN, SOUTH WESTERN ETHIOPIA
Authors: Taddese Diriba , Tolosa Tadele , Deresa Benti , lakow Matios , Olani Abebe , Shumi Eshetu
Published: July 2019

Objectives

Salmonella is the most important causes of foodborne illness especially from poultry and poultry products. So the aim of this study was to carryout phenotypic characterization, antimicrobials susceptibility pattern and risk factors of salmonella isolates from farms and markets eggs, cloacae swabs of chickens and stool of egg collectors. A cross-sectional study was conducted from January 2018 to September 2018. Samples were, processed; salmonella was isolated, Phenotypically identified by OmniLog and antimicrobials susceptibility were carried out.

Result

Over all; 11(2.65%) of salmonella enterica were phenotipically characterized out of 415 samples from farms egg content (n=83), farms eggshell (n=83), cloacae (n=83), market eggshell (n=83) and market egg contents (n=83) with 2.4%, 0%, 2.4%, 4.8% and 3.6% prevalence, respectively. Out of isolates, 8(72.72%) displayed multidrug resistance. All isolates showed susceptibility to Gentamicin, Kanamycin and Streptomycin. Lack of separating cracked eggs, washing hand, eggs stay longer unsold, and mixing excreta with feed were associated risk factors for salmonella presence (p-value<0.05). The presence of drug resistant salmonella enterica within egg/and chicken can pose serious health problem. Good hygienic practices are important to reduce risk factors of salmonella contamination.
Knowledge and practice of immediate new-born care among midwives in central zone public health Facilities, Tigray, Ethiopia: cross sectional study.
Authors: Gebru Tesfay Tsegay , Murugan Rajalakshmi , Abrha Alem Gebremariam , Goyteom Mekonnen Haftom
Published: July 2019

Objective

The objective of this study was to assess knowledge and practice of immediate newborn care among midwives in governmental health facilities of central zone of Tigray regional state, 2016.

Results

The mean age of the study participants was 34.1 years. Majority of the participants (83%) were diploma midwives. The score of knowledge of participants on immediate newborn care was 17.7% good and 25.2% poor. More than half (52.4%) of midwives practiced immediate newborn care. Midwives working in health center have 82% lower odds of newborn care compared to those working in hospital (p=0.000, OR=0.18 (0.07, 0.43).
PET-CT Standard uptake value predict bevacizumab-containing chemotherapy response and prognosis for unresectable colorectal cancer liver metastasis
Authors: Lv Yang , Feng QingYang , Tang WenTao , Xu YuQiu , Lin SongBin , Mao YiHao , Zheng Peng , Yang LiangLiang , He GuoDong , Xu JianMin
Published: July 2019

Background: Standard uptake value (SUV) of PET-CT is an indicator of tumor metabolic response. In this paper, we aim to explore the clinical value of SUV on the unresectable colorectal cancer liver metastasis (CRLM) patients receiving bevacizumab-containing chemotherapy.
Method: This study was performed retrospectively. A total of 185 CRLM patients between April 2011 to December 2015 with complete clinical data were included in this study. All the enrolled patients were assigned into two treatment cohorts (bevacizumab plus first-line chemotherapy cohort and chemotherapy only cohort). A blindly, independent radiologist evaluated images for RECIST and morphologic response. All clinical variables, and various PET/CT parameters were statistically compared with progression-free survival (PFS) and overall survival (OS). Primary and Metastatic tumor SUV were selected for analysis.
Results: Among the 185 patients, 101 patients received first line chemotherapy plus bevacizumab (beva cohort), 84 patients only received first-line chemotherapy (CMT cohort). Baseline characteristics of two cohorts showed no statistical difference (P>0.05). Primary SUV level was correlated with primary tumor size, while metastatic SUV was statistically correlated with metastatic tumor number and tumor size (P=0.000). Primary lesion, metastatic lesion SUV and elevation of SUV demonstrated prognostic role for OS (P<0.05). SUV gap were statistically associated with optimal response in bevacizumab cohort (P=0.03) and no-PD status in chemotherapy cohort (P=0.019), respectively. After multivariate analysis, elevated SUV is an independent risk factor for OS (P=0.000). Besides, elevation of SUV between metastatic and primary lesion can be a predictive factor for bevacizumab survival benefit.
Conclusion: PET-CT scan is important for CRLM patients. Our study demonstrated that an elevation of SUV was a better prognostic and predictive marker for CRLM patients.
Relationship of possible biomarkers with malignancy of thymic tumors: a meta-analysis
Authors: Zeng Huilan , Yang Weilin , Xu Bo , Zou Jianyong , Su Chunhua , Zhong Beilong , Zhu Haoshuai , Chen Zhenguang
Published: July 2019

Introduction

Role of biomarkers for promotion of tumor proliferation (BPTPs) and for promotion of apoptosis (BPAs) in thymic malignant tumors is still unclear. The purpose of this study was to evaluate the relationship between BPTPs and/or BPAs and malignancy of thymic malignant tumors.

Materials and Methods

Studies on thymic malignant tumors and biomarkers were searched in PubMed, ISI Web of Knowledge, and Embase databases, and all statistical analyses were conducted using Review Manager.

Results

Twelve articles related to biomarkers and thymic malignant tumors were selected and analyzed. A relationship between BPAs and Masaoka stage was demonstrated for four markers, included 138 stage I/II patients and 74 stage III/IV patients, and BPAs were significantly correlated with high Masaoka staging (P = 0.005). We further found a relationship between BPAs and degree of malignancy for four markers, included 176 thymoma patients and 36 thymic carcinoma patients, and BPAs were significantly correlated with thymic carcinoma (P = 0.010). In addition, a relationship between BPTP and Masaoka staging was demonstrated for eight markers, included 374 patients with stage I/II and 282 patients with stage III/IV, and BPTPs were significantly correlated with high Masaoka staging (P < 0.001). We also found BPTPs were significantly correlated with thymic carcinoma (P < 0.001).

Conclusion

These findings show that high levels of BPTPs or BPAs are more closely related to thymic carcinoma and Masaoka stage III/IV, suggesting that BPTPs and BPAs may play an important role in the occurrence and development of thymic malignant tumors.
Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy.
Authors: Zhai Ting-Shuai , Jin Liang , Zhou Zhen , Liu Xiang , Liu Huan , Feng Li-Ming , Chen Wei , Lu Jing-Yi , Yao Xu-Dong , Ye Lin
Published: July 2019

Objectives To estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).
Methods Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage.
Results LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05).
Conclusion LND was more frequently performed in locally advanced UTUC patients. The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was more significant in these patients than those with pT1 or pT2 disease. LND at UN should always be contemplated, regardless of tumor stage.
Using the serum lactate dehydrogenase level to predict prognosis in the patients with soft tissue sarcoma: a retrospective case-control study
Authors: Fujibuchi Taketsugu , Miyawaki Joji , Kidani Teruki , Imai Hiroshi , Miura Hiromasa
Published: July 2019

Background
Several studies have reported the prognostic factors for soft tissue sarcoma. Although serum lactate dehydrogenase (LDH) levels are reportedly associated with poor prognosis in several cancers, its role in sarcomas, especially in non-small-round cell sarcomas, remains unclear. This study aimed to evaluate the correlation between the clinical features, prognosis, and serum LDH level in soft tissue sarcoma.
Methods
A total of 67 patients with primary soft tissue sarcoma diagnosed between 2003 and 2014 were retrospectively reviewed. The serum LDH level at the first visit was stratified as >253 IU/L vs. ≤253 IU/L according to the standard values at our institution. The correlation between the stratified serum LDH level and clinical characteristics and the survival according to clinical characteristics including the serum LDH level were analyzed.
Results
A total of 15 patients showed high serum LDH level at the first visit. The presence of metastasis was significantly correlated with high serum LDH level (p = 0.010). In patients of all histologic types and even in those with non-small-round cell sarcoma without distant metastasis, the disease-specific survival was significantly worse in patients with high serum LDH level than those with normal serum LDH level (p < 0.001 and p = 0.018, respectively).
Conclusion
Elevated serum LDH level was found to be correlated with the presence of metastatic lesion. Moreover, in all soft tissue sarcomas and even in non-small-round cell sarcoma, high LDH level was one of the predictive factors for poor prognosis. Serum LDH level appeared to be associated with tumor cell activity and metastatic potential.
Relapse after conservative surgery combined with Triptorelin Acetate versus conservative surgery only in women with focal adenomyosis: study protocol for a multicenter, prospective, randomized controlled trial
Authors: Wang Wenwen , Ma Xiangyi , Zhang Wei , Li Zhiying , Wang Yan , Yu Zhiying , Zhang Chunlian , Hong Li , Luo Ruoyu , Xing Hui , Wang Wuliang , Yue Qingfen , Wei Jia , Zhang Minli , Wang Shixuan
Published: July 2019

Background: To preserve fertility or integrity of organs was on the rise for the most women with adenomyosis. Adenomyomectomy is now a widely applied conservative surgery, however relapse is a serious problem after operation. Postoperative treatment, such as gonadotropin-releasing hormone agonist (GnRHa) has been suggested to result in reducing the recurrence rate in patients. However, there is still a lack of evidence from randomized clinical trials comparing the efficacy of GnRHa for decreasing the postoperative recurrence rate.
Method/Design：Relapse after conservative surgery combined with Triptorelin Acetate versus conservative surgery only in women with focal adenomyosis is a multicenter, prospective, randomized controlled trial. The primary outcome is relapse accessed with Visual Analogue Scale (VRS) and Numeric Rating Scale (NRS), Pictorial blood loss assessment chart (PBAC) score and the size of uterus and lesion are measured by two/three-dimensional color doppler ultrasonography (2D/3D-CDUS) or magnetic resonance imaging (MRI). The secondary outcomes include quality of life, clinical pregnancy, ovarian reserve, and adverse events, assessing by Short Form (36) Health Survey and Female Sexual Function index, serum follicle-stimulating hormone, estradiol levels and anti-muellerian hormone and so on. All these indexes are measured at 3, 6, 12, 18, 24, 30, 36 months after conservative surgery.
Discussion：The result of this large multicenter randomized trial will provide evidence for one of the strategies of long-term management in focal adenomyosis after conservative operation.
Successful implementation of ChicaEducation system for Oncology Residency Standardized Training
Authors: Yao Quan , Wu Hong , Zou Lian , Lan Haitao , Luo Shuchun , Lu Shun , Li Xianfu , Lang Jinyi , Xu Chuan
Published: July 2019

The ability to access knowledge and skills of radiation oncology is fundamental for oncology residency standardized training. This study evaluates whether or not the ChicaEducation system for oncology residency standardized training contributes to training radiation oncology medical students. As a virtual reality system for radiotherapy training, ChicaEducation system was successfully implemented. We compared the ChicaEducation system training module with a traditional training module. Whether the integration of ChicaEducation into medical teaching was intended to enhance students’ autonomic learning and comprehensive analysis were also evaluated. The integration of ChicaEducation system into oncology residency standardized training was valuable compared to traditional training methods and could improve radiation oncology medical students’ perceptions and understanding. ChicaEducation system training module was positive and could enhance radiation oncology medical students’ level of confidence in radiation oncology. The role of ChicaEducation system training module in delivering an efficient quantity of oncology medical education was ascertained because of its ability to visualize conceptual information within a simulated clinical environment. ChicaEducation system may alleviate economic burdens in some hospitals and be used for training for doctors in rural areas.
Do USMLE Steps and ITE Results Predict Performance in the American Board of Internal Medicine Certifying Exam?
Authors: Rayamajhi Supratik , Dhakal Prajwal , Wang Ling , Rai Manoj P , Shrotriya Shiva
Published: July 2019

Objective

To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2, USMLE Step 3, and residency third-year in-service training exam (ITE) results predict performance of Internal Medicine (IM) residents in American Board of Internal Medicine Certifying Exam (ABIM-CE).

Methods

A retrospective review of USMLE Step 1, USMLE Step 2, USMLE Step 3 scores, residency third year ITE and ABIM-CE of IM residents at Michigan State University from 2004 through 2017 was conducted. Pearson correlation coefficient and two sample t-tests were used to assess the relationship between various scores and pass or fail results in ABIM-CE.

Results

Among 114 MD residents included in the study; 92% (n=105) passed the ABIM-CE. There was a significant correlation of passing ABIM-CE with USMLE Step 1 (OR 1.042; 95% CI 1.004- 1.082), Step 2 (OR 1.043; 95% CI 1.004-1.085) and Step 3 (OR 1.046; 95% CI 1.004- 1.089) independently, with the combined odds of all USMLE exams being 1.044 (p=0.031). Increase in ITE percentage increased the likelihood of passing ABIM-CE (OR 1.28, 95% CI 1.160-1.419). The increase in the gap was associated with decreased chances of passing ABIM-CE (OR 0.774; 95% CI 0.670-0.893). All residents who failed ABIM-CE had Step 1 scores <220. Among 31 residents with Step 2 score <220, 20% (n=6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score less than 220 failed ABIM-CE; all residents who failed had scores less than 220. The probability curve predicted that the chance of passing ABIM- CE was around 80% with USMLE scores greater than 200 and increased to almost 100% with USMLE scores of 250 or more.

Conclusion

There is a strong correlation between ABIM-CE results with scores of USMLE Steps and third-year ITE. Thus, performance in these exams may identify the internal medicine residents who might need more help in ABIM-CE. This helps the residents as well as the program to plan and implement various measures to improve the pass rate.
SPS-neutralization in tissue samples for efficacy testing of antimicrobial peptides
Authors: Dijksteel Gabrielle , Nibbering Peter , Ulrich Magda , Middelkoop Esther , Boekema Bouke
Published: July 2019

Background
Accurate determination of the efficacy of antimicrobial agents requires neutralization of residual antimicrobial activity in the samples before microbiological assessment of the number of surviving bacteria. Sodium polyanethol sulfonate (SPS) is a known neutralizer for the antimicrobial activity of aminoglycosides and polymyxins. In this study, we evaluated the ability of SPS to neutralize residual antimicrobial activity of antimicrobial peptides [SAAP-148 and pexiganan; 1% (wt/v) in PBS], antibiotics [mupirocin (Bactroban) and fusidic acid (Fucidin) in ointments; 2% (wt/wt))] and disinfectants [2% (wt/wt) silver sulfadiazine cream (SSD) and 0.5% (v/v) chlorhexidine in 70% alcohol].

Methods
Homogenates of human skin models that were exposed to various antimicrobial agents for 1 h were pipetted on top of Methicillin-resistant Staphylococcus aureus (MRSA) on agar plates to demonstrate the presence of residual antimicrobial activity in tissue samples.
To determine the efficacy of SPS in neutralization, various antimicrobial agents were mixed with PBS, 0.05%, 0.1%, 0.5% or 1% (wt/v) SPS in PBS. Subsequently, 10^5 colony forming units (CFU) MRSA were added to the mixtures and these were incubated for 30 min to determine the antimicrobial effect.
Ex vivo excision wound models were inoculated with 10^5 CFU MRSA for 1 h and exposed to SAAP-148, pexiganan, chlorhexidine or PBS for 1 h to study the effect of SPS-neutralization on the bacterial killing of these antimicrobials.
To quantify the number of surviving bacteria, 10-fold serial dilutions of the homogenates were cultured overnight on agar plates.

Results
All tested antimicrobials displayed residual activity in tissue samples, resulting in a lower recovery of surviving bacteria on agar. SPS concentrations at ≥0.05% (wt/v) were able to neutralize the antimicrobial activity of SAAP-148, pexiganan and chlorhexidine, resulting in the complete recovery of bacteria. However, SPS did not neutralize the activity of SSD, Bactroban and Fucidin. Finally, SPS-neutralization in ex vivo efficacy tests of SAAP-148 (p<0.001), pexiganan (p<0.05) and chlorhexidine (p<0.01) resulted in at least 10-fold higher numbers of MRSA compared to control samples without SPS-neutralization.

Conclusion
SPS can be used for the neutralization of residual activity of different antimicrobials, including SAAP-148, pexiganan and chlorhexidine and this prevents an overestimation of their efficacy.
The first serosurvey of equine coxiellosis in Iran
Authors: Mozaffari Ali Asghar , Jaferi Mehdi , Khalili Mohammad , Alinia Zahra
Published: July 2019

Background: Q fever is a hyper endemic zoonosis in middle east countries. In Iran, serologic studies have been done in cattle, sheep, goat, camel and human. There is any report of Q fever in horse populations and this study is the first serosurvey in this area.
Results: A total of 177 serum samples from North and South of Iran were randomly collected and were analyzed for Q fever by a commercial ELISA kit. Anti C.burnetii antibodies were detected in 5.64% of sera samples. Results of this study indicated that there was no significant difference in seroprevalence in different sexes, ages and breed groups.
Conclusions: This is the first report of Q fever in horses of Iran and our study shows that the impact of Q fever disease on horses' health status in the studied area appears to be important. However, Additional studies are needed to assess whether the horse can be used as a relevant transmission risk indicator for Q fever in this area.
Keywords: Coxiella burnetii, Horse, Iran, Q fever, Serology.
Interpreter proxy versus healthcare interpreter for administration of patient surveys following arthroplasty: a pilot study
Authors: Xue Daniel , Churches Timothy , Armstrong Elizabeth , Mittal Rajat , Naylor Justine M. , Harris Ian A.
Published: July 2019

Purpose: Clinical quality registries and other systems that conduct routine post-discharge surveillance of patient outcomes following surgery may have difficulty surveying patients who have limited proficiency in the language of the healthcare provider. Interpreter proxies (family and carers) are often used due to limited access to certified healthcare interpreters (due to cost or availability). The aim of this study was to assess the reliability of engaging interpreter proxies compared with certified healthcare interpreters for the administration of patient-reported health-related surveys for people with limited English proficiency (LEP).

Methods: People with LEP and due for a routine 6-month telephone follow-up post knee or hip arthroplasty were invited to participate. Participants were randomly allocated to having their first interview with an interpreter proxy or a certified healthcare interpreter followed by the second (crossover) interview within 2 weeks (range: 4 to 12 days) after the first interview using the alternative method. Agreement between the two methods was assessed using quadratic weighted Cohen's kappa, intraclass correlation and concordance correlation co-efficient where appropriate for EQ-5D health domains, total Oxford hip and knee scores, patient satisfaction, operation success, readmission, reoperation, and post-surgical complication responses. The mean of the differences between the same data items collected by each of the two methods was also calculated.

Results: 85 participants (96%) completed the study. There was substantial to excellent inter-rater agreement (kappa=0.69-0.87 and ICCs above 0.74) for all but one measure. The mean differences between family proxy and healthcare interpreter scores for each participant were small, ranging from 0.01 (score range of 1-5) to 0.72 (score range of 0-100).

Conclusion: Using interpreter proxies is a reliable alternative to certified healthcare interpreters in conducting patient-reported health surveys, potentially making this process easier and cost effective for researchers and registries.
Demyelinating Syndrome in Systemic Sclerosis and Neuromyelitis Optica
Authors: Deeb khaled , Eby Jessika , Labault-Santiago Jose
Published: July 2019

INTRODUCTION: The objective of this study is to report a case of a 44-year-old female who presented with intractable hiccups, vomiting, and later complicated with paraplegia. Imaging and sero/immunological studies were consistent with Neuromyelitis Optica (NMO) based on NMO-IgG sero-positivity and transverse myelitis on MRI. Further investigation revealed positive ANA, anti-RNA polymerase III autoantibodies, and Scl-70, leading to a concurrent diagnosis of systemic sclerosis (SSc). The coexistence of these two disease processes, namely systemic sclerosis and neuromyelitis optica, and their underlying clinical manifestations and therapeutic interventions, are seldom reported in literature and are worth reporting.

CASE REPORT: The patient was treated with high dose steroids, and subsequently developed malignant hypertension and acute renal failure, later identified as steroid induced scleroderma renal crisis on renal biopsy. Although Neuromyelitis Optica spectrum disorder (NMOSD) has often been associated with various collagen and autoimmune diseases, the coexistence of NMOSD and SSc presented a challenge where patient underwent aggressive physical therapy and necessitated an intervention with Rituximab to achieve an appropriate clinical response. We have received consent forms from the participant in our study, and we have them on file in case they are requested. We have also received patient’s consent for the data presented in this article and Figure 1.

CONCLUSION: This report expands on NMOSD associated autoimmune diseases. Systemic Sclerosis is an insidious disease that is often diagnosed late as not all patients often report skin manifestation. The finding suggests that patients presenting with acute neurological manifestations get tested for NMO-IgG/AQP-4 antibodies and other immunological studies based on clinical findings.
Human metapneumovirus prevalence and patterns of genotype persistence identified through surveillance of pediatric pneumonia hospital admissions in coastal Kenya, 2007-2016
Authors: Oketch John W , Kamau Everlyn , Otieno Grieven P , Otieno James R , Agoti Charles N , Nokes James D
Published: July 2019

Background

Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities is limited.

Methods

We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV genotype was assessed using Chi-square test for independence.

Results

Over 10 years, 274/6756 (4.10%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2% to 8.7% and lowest in the recent years (2014-2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing A2b (41.0%), A2c (10.7%), B1 (23.4%) and B2 (24.9%). The dominance patterns were: genotype A2b between 2007-11, B1 between 2012-14, and A2c in more recent epidemics. Genotype B2 viruses were present in all the years. These patterns mirrored the global picture. Temporal phylogenetic clustering within the genotypes for both local and global sequence data was seen. Genotypes occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by genotype (p=0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection.

Conclusion

Genotype and strain patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated.
Retinal relaxation following membrane peeling: Effect on vision, central macular thickness, and vector analysis of motion
Authors: Smet Marc D. de , Julian Karina , Maurin Jerick , Jolissaint Laurent P. , Mura Marco
Published: July 2019

Purpose

Removal of an epiretinal membrane (ERM) leads to the outward displacement of retinal vessels and visual improvement. The direction and extent of displacement in the form of a vector analysis over the posterior pole can provide a better understanding of the dynamics and duration of this process, while the magnitude might have implications in terms of visual outcome.

Methods

Scanning laser ophthalmoscope images of the retina of eyes undergoing ERM peeling were compared before and 6 months after surgery. Stratification was made between prominent and limited displacement, with assessment of visual acuity (VA), and central macular thickness (CMT). In three cases, using the optic nerve as reference, 50 landmarks were chosen within the posterior pole along large and small vascular structures allowing the construction of a vector map of displacement over 1 year.

Results

Nine eyes with prominent and 6 with limited displacement were assessed. Improvement in VA was similar for both groups, while CMT drop was greatest for the worst group. Vector analysis showed that most vascular movement occurs over the first 6 months, covers most of the posterior retina, is centered around distinct nodes, may lead to several hundred microns of displacement.

Conclusions

Retinal relaxation has no direct implication on visual recovery. It originates in nodes of retinal contraction. Its extent can be significant
Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE
Authors: Maus Volker , Styczen Hanna , Liman Jan , Maier Ilko , Brehm Alex , Tsogkas Ioannis , Psychogios Marios Nikos
Published: July 2019

Background

Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes. We present our experience with SAVE for large vessel occlusions (LVO) of the posterior circulation.

Methods

We retrospectively analyzed 66 consecutive MT patients suffering from LVO of the posterior circulation. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints contained number of passes, time interval from groin puncture to reperfusion and rate of postinterventional symptomatic intracranial hemorrhage (sICH).

Results

Median age was 75 years (interquartile range (IQR) 54 – 81 years). Baseline median National Institutes of Health stroke scale (NIHSS) was 13 (IQR 8 – 21). Fifty-five (83%) patients had LVO of the basilar artery and 11 (17%) of the posterior cerebral artery. Eighteen (27%) patients were treated with SAVE and 21 (32%) with aspiration only. First pass mTICI2c or 3 and overall mTICI2c or 3 were documented in 11/18 (61%) and 14/18 (78%) with SAVE and in 4/21 (19%) and 13/21 (33%) with aspiration only. Median attempt was 1 (IQR 1 – 2) with SAVE and 2 (IQR 1 – 4) with aspiration (p=0.0249). Median groin to reperfusion time did not differ significantly between groups. The rate of sICH was 5% without any complications in the SAVE cohort.

Conclusion

Mechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.
Managing uncertain recovery for patients nearing the end of life in hospital; a mixed-method, feasibility cluster randomised controlled trial of the AMBER care bundle
Authors: Koffman Jonathan Simon , Yorganci Emel , Yi Deok Hee , Gao Wei , Murtagh Fliss E , Pickles Andrew , Barclay Stephen , Johnson Halle , Wilson Rebecca , Sampson Liz , Droney Joanne , Farquhar Morag , Prevost Toby , Evans Catherine
Published: July 2019

Background: The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. However, it has yet to be evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms.
Aim: To investigate the feasibility of a cluster RCT of the AMBER care bundle.
Methods: Mixed-method, feasibility cluster RCT. Prospective, quantitative data collected from patients (or proxies lacking capacity) to (i) examine recruitment, retention and follow-up rates; (ii) test trial data collection tools and determine their optimum timing; (iii) test methods to identify use of financial resources; (iv) explore the acceptability of study procedures for health professionals and patients. Descriptive statistical analyses and thematic analysis using the Framework approach.
Results: 894 patients were screened, of whom, 220 were eligible and 19 (8.6%) declined to participate. Recruitment to the control arm was challenging; of the 728 patients screened, 647 (88.9%) were excluded. 65 (81.3% of the recruitment target) patients were recruited. Many were elderly (≥80 years 46.2%, n=30, mean-77.8 years SD=12.3 years). Over half (53.8%) had a non-cancer diagnosis, with a mean of 2.3 co-morbidities. 24.6% patients (n=16) died during their hospital stay and 35.4%, (n=23) within 100 days of discharge. In both trial arms, baseline IPOS subscale scores identified ‘moderate’ patient anxiety (mean 13.3 (SD 4.8) control, 13.3 (SD 5.1) intervention), and howRwe identified a ‘good’ care experience (mean 13.1 (SD 2.5) control, 11.5 (SD 2.1) intervention). Collection of quantitative service use/quality of life data was feasible. No patient participants regarded study involvement negatively. Focus groups with health professionals identified concerns regarding (i) subjectivity of the intervention eligibility criteria; (ii) the need to prognosticate to identify potential patients; (iii) consent procedures and questionnaire length.
Conclusions: A full trial of the AMBER care bundle is technically feasible but impractical due to fundamental issues in operationalising the intervention’s eligibility criteria preventing optimal recruitment. Since this complex intervention continues to be used in clinical care and advocated in policy, alternative research approaches must be considered and tested.
Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) Register, ISRCTN36040085
Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study
Authors: Guinot Pierre-Grégoire , Spitz Alexandra , Berthoud Vivien , Ellouze Omar , Missaoui Anis , Constandache Tiberiu , Grosjean Sandrine , Radhouani Mohamed , Anciaux Jean-Baptiste , Parthiot Jean-Philippe , Merle Jean-Pierre , Nowobilski Nicolas , Nguyen Maxime , Bouhemad Belaid
Published: July 2019

Background: No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course.
Methods: After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 hours after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS).
Results: 110 patients were matched (OFA: n=55; OA: n=55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) vs 5 mg (2-18), p=0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66-115) vs 77 mmol/l (IQR: 69-95), p=0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p=0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1-5) vs 5 (3-6) hours, p=0.001 and 2 (1-3) vs 3 (2-5) days, p=0.037).
Conclusion: The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results.
Phylogeny, Sequence-typing and virulence profile of uropathogenic E. coli (UPEC) strains from Pakistan
Authors: Ali Ihsan , Rafaque Zara , Ahmed Ibrar , Tariq Faiza , Graham Sarah E. , Salzman Elizabeth , Foxman Betsy , Dasti Javid Iqbal
Published: July 2019

Background

Escherichia coli lineage ST131 predominates across various spectra of extra-intestinal infections, including urinary tract infection (UTI). The distinctive resistance profile, diverse armamentarium of virulence factors and rapid global dissemination of ST131 E. coli makes it an intriguing pathogen. However, not much is known about the prevalence and genetic attributes of ST131 lineage in Pakistan.

Methods

We estimated the prevalence and genetic attributes of E. coli ST131 isolates causing UTI among 155 randomly selected samples. Samples were analyzed by phylogenetic grouping, O-typing, fumC/fimH typing. Isolates were further tested for ESBL and virulence factors using PCR.

Results

Overall, 59% of the UPEC isolates belonged to the phylogenetic group B2, followed by D=28%, B1= 8% and A= 5%. Among 18 different Sequence-types, ST131 was the dominant lineage (n=71; 46%) out of which 72% of the isolates were assigned to phylogenetic group B2 while 61% adhered to serogroup O25b. FumC/fimH typing confirmed 49% of the ST131 as H30 sub-types. In this study, significant numbers of the identified ST131 isolates were MDR and 42% showed ESBL phenotypes, out of which 57% carried blaCTX-M-15. Moreover, different virulence factors were detected in following percentages: fimH,155 (100%), iutA 86 (55%), feoB 76 (49%), papC 75 (48%), papGII 70 (45%), kpsMTII 40 (26%), papEF 37 (24%), fyuA 37 (24%), usp 22 (14%), papA 20 (13%), sfa/foc 20 (13%), hlyA 18 (12%), afa 15 (10%), cdtB 11 (7%), papGI 6 (4%), papGIII 6 (4%), kpsMTIII 4 (3%) and bmaE2 (1%).

Conclusion

Conclusively, this study provides important insights into the genetic and virulence attributes of pandemic MDR ST131 strains involved in UTIs. It also highlights high prevalence of ST131-O25b-H30 UPEC isolates in local population, which was previously unreported from this part of globe. Keywords: ST131, VF genes, ESBL, UPEC, MDR