bluuebunny/crossref_metadata_2025 huggingface dataset:
Talking the talk in junior interprofessional education: Is healthcare terminology a barrier or facilitator?
Authors: Nadarajah Shamara , Azim Arden , Yılmaz Derya Uzelli , Sibbald Matthew
Published: June 2020

Background
Use of jargon and complex healthcare terminology is a potential barrier to interprofessional education (IPE). Healthcare terminology can be separated into two categories: inclusive terminology shared amongst professions, and exclusive terminology unique to one profession. We sought to understand how complex terminology is perceived by junior learners in an IPE setting.
Methods
We conducted a mixed methods study involving medical, nursing, and physician assistant students attending IPE simulation workshops. Students reviewed scenarios used in the workshops and identified terminology they considered “inclusive” or “exclusive”. Then, students participated in focus group discussions surrounding attitudes/perceptions towards healthcare terminology.
Results
23 students analyzed 14 cases, identifying on average 21 terms per case as healthcare terminology (29% of overall word count). Of the 290 terms identified, 113 terms were classified as healthcare terminology, 46 as inclusive and 17 as exclusive by > 50% of participants. Analysis of focus group transcripts revealed 4 themes: abbreviations were commonly perceived as complex terminology, unfamiliarity with terminology was often attributed to being early in training even if exclusive, simulation was considered a safe space for learning, and learning terminology was a valued objective in early IPE.
Conclusions
Students perceive a lot of healthcare terminology in learning materials, which is recognized as a valuable learning objective in their early IPE experiences, but also a challenge. Categorization of healthcare language is inconsistent among students and may reflect individual differences in prior experiences. Overall, healthcare terminology is a valued desirable difficulty among junior learners, and should not be avoided in IPE.
Specialty Career Preferences among Final Year Medical Students at the School of Medicine, Makerere University College of Health Sciences, Uganda
Authors: Kuteesa Job , Musiime Victor , Munabi Ian G. , Mubuuke Aloysius G. , Opoka Robert , Mukunya David , Kiguli Sarah
Published: June 2020

Background : Uganda has an imbalanced distribution of the health workforce, which may be influenced by the specialty career preferences of medical students. In spite of this, there is inadequate literature concerning the factors influencing specialty career preferences in our setting. We aimed to determine the specialty career preferences and the factors influencing the preferences among final year medical students in the School of Medicine, Makerere University College of Health Sciences (MakCHS). Methods: A sequential explanatory mixed methods study design with a descriptive cross-sectional study followed by a qualitative study was used. A total of 135 final year medical students in MakCHS were recruited using consecutive sampling. Self-administered questionnaires and three focus group discussions were conducted. Quantitative data was analysed in STATA version 13 (StataCorp, College Station, Tx, USA) using descriptive statistics, chi-square tests and logistic regression. Qualitative data was analysed in NVIVO version 12 (QRS International, Cambridge, MA) using content analysis. Results: Of 135 students 91 (67.4%) were male and their median age was 24 years (IQR: 24, 26). As a first choice, the most preferred specialty career was obstetrics and gynecology (34/135, 25.2%), followed by surgery (27/135, 20.0%), pediatrics (18/135, 13.3%) and internal medicine (17/135, 12.6%). Non-established specialties such as anesthesia and Ear Nose and Throat (ENT) were not selected as a first choice by any student. Female students had 63% less odds of selecting surgical related specialties compared to males (aOR=0.37, 95%CI: 0.17-0.84) . The focus group discussions highlighted controlled lifestyle, assurance of a good life through better financial remuneration and inspirational specialists as facilitators for specialty preference. Bad experience during the clinical rotations, lack of career guidance plus perceived poor and miserable specialists were highlighted as barriers to specialty preference. Conclusion. Obstetrics and Gynecology, Surgery, Pediatrics and Internal Medicine are well-established disciplines, which were dominantly preferred. Females were less likely to select surgical disciplines given the perceived effects on lifestyle by these disciplines for example interruption of family life. Therefore, a need to formulate career guidance and mentorship programs is required, to attract students to the neglected disciplines.
A WISH questionnaire to measure the faculty perceptions of the medical simulation environment as their workplace
Authors: Torres Kamil , Mamcarz Izabela , Radczuk Natalia , Mamcarz Piotr , Torres Anna
Published: June 2020

Background

The medical simulation environment is a specific type of work environment. It would seem essential for educators to have a tool with which they could identify its features to maximize the effectiveness of medical simulation – teachers’ workplace - and optimize their work efforts. The purpose of this research study was to construct a proprietary tool, which would help to characterize the medical simulation environment as a type of work environment and also to identify particular factors that are important in organizing the educational environment in simulation.
Methods

At first, six faculty members took part in semi-structured interviews, whose findings were used to develop a standardized questionnaire consisting of 30 items. The authors then validated the questionnaire in a survey among the other 32 academic teachers involved in teaching with the use of medical simulation.
Results

The Work In Simulation Healthcare questionnaire addresses the aspects of teaching in a simulation environment referring to technical-administrative conditions, teacher development, and the overall score. The Cronbach's alpha reliability index for the overall result of the questionnaire is α = 8.22 based on standardized items; the reliability index for the scale of ‘the technical and administrative conditions’ and ‘the professional development of teachers’ is α = 0,57 and α = 0,76, respectively. The questionnaire allowed the authors to know the ratings of academic teachers for the two scales.
Conclusions

The Work In Simulation Healthcare questionnaire allows educators to identify the traits of the simulation-teaching environment. It provides the potential to optimize the conditions of medical simulation, improve the quality of teaching and the overall educational process, as well as design effective faculty development programs. The authors of this study consider the WISH questionnaire the first method of this type.
LncRNA SBF2-AS1 Promotes Malignant Phenotypes and Radioresistance of Glioblastoma Cells by Impairing miR-338-3p-targeted MAP4K3 Inhibition
Authors: Pan Hong , XU Jiajun , Wang Guodong , Wang Zheng , Yao Zhigang , Zheng Zhiming
Published: June 2020

Background: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumors in adults. LncRNA SBF2-AS1 has been reported to promote malignant progression in multiple human cancers. However, the roles and underlying mechanisms of SBF2-AS1 in GBM are still unknown.Methods: The levels of SBF-AS1 were identified in GBM tissues and normal brain tissues, and in GBM cell lines and normal human astrocytes. The effect of SBF2-AS1 on proliferation, invasion and radiosensitivity was evaluated by CCK-8 assay, transwell assay, γ-H2AX foci assay and clonogenic survival assay in vitro and in vivo. The interactions among SBF2-AS1, miR-338-3p and MAP4K3 were validated through luciferase report, RNA immunoprecipitation and western blot assays. Results: In the present study, we comfirmed that SBF2-AS1 was highly upregulated in GBM tissues and cell lines, and its levels were markedly higher in WHO stage III-IV gliomas compared with WHO stage I-II gliomas. Kaplan-Meier survival analysis revealed that glioma patients with high SBF2-AS1 expression had shorter overall survival than those with low SBF2-AS1 expression. SBF2-AS1 inhibition suppressed the proliferation of GBM cells by down-reguating of Ki-67 and CyclinD1. Moreover, silencing SBF2-AS1 increased the proportion of cells in G1 phase and decreased the proportion of cells in S phase. In addition, SBF2-AS1 inhibition suppressed the invasion of GBM cells by down-reguating of MMP2 and MMP9. Xenograft tumor models revealed that the silencing of SBF2-AS1 inhibited tumor growth in vivo. Moreover, the silencing of SBF2-AS1 significantly sensitized GBM cells to radiation in vitro and in vivo. Indeed, we observed a persistence of γ-H2AX staining after ionizing radiation, leading to enhanced DNA repair and radioresistance. Mechanistically, SBF2-AS1 inhibition reduced the expression of MAP4K3 by directly binding with miR-338-3p in GBM cells. Conclusions: Our study demonstrated that SBF2-AS1 enhanced cell proliferation, invaison and radioresistance via modulating miR-338-3p/MAP4K3 axis, and it is an attractive therapeutic target to overcome radioresistance of GBM.
Screening of Klebsiella Pneumoniae for Carbapenem Resistance and MIC of Imipenem
Authors: Saud Sarada , Agrawal Ashwani , Pokhrel Soniya , Subedi Sushma , Shrestha Sanjit , Amatya Niroj Man
Published: June 2020

Background: Klebsiella pneumoniae is a common opportunistic pathogen causing a wider range of infections, pneumonia, urinary tract infection, bacteremia, and liver abscesses; primarily in immunocompromised as well as immunocompetent individuals. This bacterium presents itself as an antibiotic resistant one especially in third generation cephalosporins and carbapenem, creating serious global challenges. Therefore, this cross-sectional study was conducted in B & B Hospital, Lalitpur with the aim to screening the distribution of carbapenem resistance Klebsiella pneumoniae through ertapenem and assess the minimum inhibitory concentration of imipenem for screened carbapenem positive K. pneumoniae. Methods: From 3447 different clinical samples collected according to standard guidelines, Klebsiella pneumoniae was identified through conventional microbiological techniques, staining and a panel of biochemical tests. The antibiotic susceptibility test of isolates was performed by the Kirby-Bauer disc diffusion method as per CLSI 2018 guidelines. Screening of carbapenem resistant was assessed by using ertapenem disc and the MIC of imipenem for carbapenem resistant and intermediate was done through epsilometer. Results: A total of 85 nonduplicate Klebsiella pneumoniae were identified and their antibiotic susceptibility test revealed that ceftriaxone was the least effective antibiotic. The number of MDR, carbapenem resistant and intermediate isolates was 51, 46 and 3, respectively. The MIC of imipenem through epsilometer from resistant and intermediate ertapenem isolates revealed that 31, 5 and 13 isolates were resistant, intermediate and sensitive, respectively.Conclusion: These findings showed the inconsistency in detection of carbapenem resistant isolates in routine microbiology laboratories and further support the other tests for detection of carbapenem resistance as suggested by CLSI.
Integrated analysis identifies a pathway-related competing endogenous RNA network in the progression of Pancreatic cancer
Authors: Tan Xiaodong , Zu Fuqiang , Liu Peng , Wang Huaitao , Zhu Ting , Sun Jian , Sheng Weiwei
Published: June 2020

Background
It is well acknowledged that cancer-related pathways play pivotal roles in the progression of pancreatic cancer (PC). Employing multi-omics analysis, we aim to identify the pathway-related ceRNA network associated with PC progression.
Methods
We divided eight GEO datasets into three groups according to their platform, and combined TCGA and GTEx databases as a group. Additionally, we screened out the differentially expressed genes (DEGs) and performed functional enrichment analysis in each group, and recognized the top hub genes in the most enriched pathway. Furthermore, the upstream of miRNAs and lncRNAs were predicted and validated according to their expression and prognostic roles. Finally, the co-expression analysis was applied to identify a pathway-related ceRNA network in the progression of PC.
Results
A total of 51 significant pathways that common enriched in all groups were spotted. Enrichment analysis indicated that pathway in cancer was greatly linked with tumor formation and progression. Next, the top 20 hug genes in this pathway were recognized, and stepwise prediction and validation from mRNA to lncRNA, including 11 hub genes, 4 key miRNAs, and 2 key lncRNAs, were applied to identify a meaningful ceRNA network according to ceRNA rules. Ultimately, we identified the PVT1/miR-20b-/CCND1 axis as a promising pathway-related ceRNA axis in the progression of PC.
Conclusion
Overall, we elucidate the pathway-related ceRNA regulatory network of PVT1/miR-20b-/CCND1 in the progression of PC, which can be considered as therapeutic targets and encouraging prognostic biomarkers for PC.
miR-105-3p acts an oncogene to promote proliferation and metastasis of breast cancer cell by targeting GOLIM4miR-105-3p acts an oncogene to promote proliferation and metastasis of breast cancer cell by targeting GOLIM4
Authors: Lin Bo , Shi Enyi , Jin Qiu , Zhao Wenhui , Wang Juan , Ji Runyuan
Published: June 2020

Background: Dysregulation of miRNAs is involved in carcinogenesis of breast cancer and may be used to prognostic biomarkers and therapeutic target during cancer process. The purpose of this study was to explore the effects of miR-105-3p on tumourigenicity of breast cancer and its underlying molecular mechanisms.Methods: Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to detect the miR-105-3p in breast cancer tissues. The impacts of miR-105-3p on proliferation, migration, invasion and apoptosis of human breast cancer lines (MCF-7 and ZR-75-30) were evaluated by CCK-8, transwell chamber assay, TUNEL assay and western blot assay, respectively. Besides, bioinformatics and luciferase reporter assay were used find out the targeted gene of miR-105-3p.Results: The expression of miR-105-3p was elevated in breast cancer tissues and increased with tumor severity. Downregulation of miR-105-3p could inhibit cell proliferation, suppress cell migration/invasion, and promote cell apoptosis in MCF-7 and ZR-75-30 cells. Furthermore, Golgi integral membrane protein 4 (GOLIM4) was identified to be the direct target gene of miR-105-3p by bioinformatics and luciferase reporter assay. In addition, silencing of GOLIM4 could restore the anti-breast cancer effects induced by miR-105-3p downregulation.Conclusions: miR-105-3p acts an oncogene to promote proliferation and metastasis of breast cancer cell by targeting GOLIM4, which provides a new target for the prevention and treatment of breast cancer.
Suppression of FoxO3a Increases Responsiveness of Glioma Cells to Radiation Treatment
Authors: Wang Zhihan , Chen Binghong , Liao Keman , Xu Hao , Xing Jin , Wei Zilong , Liu Chaobo , Lin Yingying , Ren Li
Published: June 2020

Background Glioblastoma multiforme (GBM) is the most deadly and common cerebral malignant tumors in adults. Radiotherapy is one of the major treatments for GBM patients. Further work is urgently required to discover the mechanisms conferring GBM radioresistance.Methods Reverse transcription-quantitative PCR was applied to detect the relative expression of FoxO3a in glioma cell lines after radiation. Lentivirus mediated FoxO3a knockdown cells were constructed and were confirmed by RT-qPCR and western blot. Plate clone formation assay and flow cytometry was used to determine the colony formation ability and cell apoptosis following radiotherapy, respectively. DNA damage and levels of apoptotic proteins were determined by comet assay and western blot.Results FoxO3a was significantly up-regulated in GBM cells in response to radiation. Knockdown of FoxO3a enhances the responsiveness of glioma cells to radiotherapy, the cell clonogenic formation and DNA repair process with elevated the percentage of apoptotic cells. Moreover, suppression of FoxO3a increased pro-apoptotic proteins Caspase 3, Caspase 7 and Bax levels after radiotherapy.Conclusions The study indicated that suppression of FoxO3a increased radiosensitivity in glioma cells, which might be a potential diagnostic and therapeutic target. Inhibition of FoxO3a expression enhances the responsiveness of glioma cells to radiotherapy, and its proliferation ability is weaker than that of normal Foxo3 cells
Prevalence and Determinants of Substance Use Among a Sample of Iranian Adolescents with Ease of Access to Drugs: An Application of Social Development Model
Authors: Bami Roya Shahsavari , Khoshab Hadi , Davarani Mohammad Mehdi Fadakar , Jahani Yunes , Nakhaee Nozar , Nadrian Haidar , Iranpour Abedin
Published: June 2020

Background Explaining the risk and protective factors of substance use (SU) is the most important principle while designing preventive interventions. The aim of this study was to investigate the prevalence rate and determinants of SU in adolescents based on the social development model (SDM). Method In 2018, applying a cross-sectional design, cluster multistage random sampling was employed to recruit 600 adolescents in Bam County, Iran, to participate in the study. A valid and reliable SDM-based instrument was used to collect data.Results The prevalence rate of using at least one substance was 42% (in girls 33.6% and in boys 50.3%). Having close friends with SU was found as the riskiest factor. A score increase in involvement in prosocial activities and interactions, attachment and commitment to prosocial others (family and school), and skills for interaction/involvement among adolescents reduced the probability of ever use of SU by 53%, 37% and 49%, respectively. Also, one score increase in perceived rewards for antisocial interaction/involvement, belief in antisocial values and situational perception among the participants increased the probability of ever use SU by 2.22, 2.24 and 1.22 times. Conclusion The SDM was helpful in determining the predictors of SU among Iranian adolescents. In community-based interventions to prevent SU among adolescents, a great focus should be firstly on identifying the probability of SU in close friends. Moreover, the involvement of adolescents in prosocial activities and interactions, attachment and commitment to prosocial others (family and school), and skills for interaction/involvement should be core categories while designing community-based interventional studies.
Clemastine Attenuates AD-like Pathology in an AD Model Mouse via Enhancing mTOR-Mediated Autophagy
Authors: Li Zhen-Yu , Chen Li-Hua , Zhao Xiu-Yun , Chen Hong , Lu Mei-Hong , Sun Yan-Yun , Wang Zhao-Tao , Chen Mei , Lu Li , Huang Wenhui , Xu De-En , Xu Ru-Xiang , Ma Quanhong
Published: June 2020

Background: Alzheimer’s disease (AD) is a neurodegenerative disorder with limited available drugs for treatment. Enhancing autophagy attenuates AD pathology in various AD model mice. Thus, development of potential drugs enhancing autophagy may bring beneficial effects in AD therapy. Methods: In the present study, we showed clemastine, a first-generation histamine H1R antagonist and being originally marketed for the treatment of allergic rhinitis, ameliorates AD pathogenesis in APP/PS1 transgenic mice. Chronic treatment with clemastine orally reduced amyloid-β (Aβ) load, neuroinflammation and cognitive deficits of APP/PS1 transgenic mice as shown by immunohistochemistry and behavioral analysis. We further analyzed the mechanisms underlying the beneficial effects of clemastine with using the combination of both in vivo and in vitro experiments. We observed that clemastine decreased Aβ generation via reducing the levels of BACE1, CTFs of APP. Clemastine enhanced autophagy concomitant with a suppression of mTOR signaling. Conclusion: Therefore, we propose that clemastine attenuates AD pathology via enhancing mTOR-mediated autophagy.
A DROP-IN Beta Probe for Robot-Assisted 68Ga-PSMA Radioguided Surgery: First Ex Vivo Technology Evaluation Using Prostate Cancer Specimens
Authors: Collamati Francesco , OOsterom Matthias van , De Simoni Micol , Faccini Riccardo , Fischetti Marta , Mancini-Terracciano Carlo , Mirabelli Riccardo , Moretti Roberto , Heuvel Judith olde , Solfaroli-Camillocci Elena , Beurden Florian van , Poel Henk van der , Valdes-Olmos Renato , Leeuwen Pim van , Leeuwen Fijs van , Morganti Silvio
Published: June 2020

Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET-isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET-tracers during robot-assisted tumor-receptor-targeted. In this study, we’ve engineered and validated the performance of a novel DROP-IN beta-particle (DROP-INb) detector.Methods: Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INb probe prototype, with merged a scintillating detector with a housing optimized for a 12 mm trocar and prograsp instruments. Results: After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INb probe prototype was tested in a robotic setting. In the ex vivo setting, the probe – positioned by the robot- was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INb probe (S/B>3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta tracing. Conclusions: This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INb detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.
A Simple and Effective Guide Device for Femoral Neck Fracture Fixed With Cannulated Screw Fixation
Authors: Ren bufang , ma quanping , gao jian , lv xin
Published: June 2020

Background: Accurate placement of cannulated screws is the key to stable fixation of the femoral neck fracture. A simple guide device was developed to improve the accuracy of screw placement.Methods: 40 synthetic femoral bones were divided into conventional technique group and the experimental group. Three Kirschner wire were inserted into the femoral neck fracture by conventional technique or by the simple guide device. The operative time, total drilling times and fluoroscopic frequency were evaluated.Results: By using the guide device, the fluoroscopy and operation time of the experimental group were shorter that of the conventional method. The total drilling times with the simple guide device were significantly lower than the conventional technique group. Conclusions: The use of this guide device can make screw fixation for femoral neck fracture easier. This is helpful for an inexperienced hand.
Reliability of Simulation-Based Assessment for Practicing Physicians: Performance is Context-Specific
Authors: Sinz Elizabeth , Banerjee Arna , Steadman Randolph , Shotwell Matthew S , Slagle Jason , McIvor William R , Torsher Laurence , Burden Amanda , Cooper Jeffrey , DeMaria Samuel , Levine Adam I , Park Christine , Gaba David M , Weinger Matthew B , Boulet John R
Published: June 2020

Introduction: Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established.Methods: Standardized complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities. A subset of the study population agreed to participate as the primary responder in a second scenario for this study. The physicians were assessed independently by trained raters on both teamwork/behavioral and technical performance measures. Analysis using Generalizability and Decision studies were completed for the two scenarios with two raters.Results: The technical score was not more reliable than the behavioral score. With two raters > 20 scenarios would be required to achieve a reliability estimate of 0.7. Increasing the number of raters would have little effect on reliability.Discussion: The performance of practicing physicians on simulated critical events may be highly context-specific. Realistic simulation-based assessment for practicing physicians is resource-intensive and may be best-suited for individualized formative feedback. Moreover, aggregate data from a population of participants may yield even higher impact if used to identify skill or knowledge gaps to be addressed by training programs and continuing education improvements across the profession.
Lung Mechanics in Type L CoVID-19 Pneumonia: A Pseudo-Normal ARDS.
Authors: Viola Lorenzo , Russo Emanuele , Benni Marco , Gamberini Emiliano , Circelli Alessandro , Bissoni Luca , Santonastaso Domenico Pietro , Scognamiglio Giovanni , Bolondi Giuliano , Mezzatesta Luca , Agnoletti Vanni
Published: June 2020

Since its outbreak, in January, 2020, it has been clear that CoVID-19 pneumonia is atypical. Despite a full concordance to Berlin criteria for Acute Respiratory Distress Syndrome (ARDS), respiratory system mechanics is preserved [1]. Mechanical ventilation and muscular paralysis are recommended in worsening respiratory insufficiency [2]; in a substantial number of cases, prone positioning significantly improves oxygenation.
An Open Label Study of the Safety and Efficacy of a Single Dose of Weekly Chloroquine and Azithromycin Administered for Malaria Prophylaxis in Healthy Adults Challenged with 7G8 Chloroquine-Resistant Plasmodium falciparum in a Controlled Human Malaria Infection (CHMI) Model
Authors: Livezey Jeffrey , Twomey Patrick , Morrison Meshell , Cicatelli Susan , Duncan Elizabeth H , Hamer Melinda , Lee Christine , Hutter Jack , Mills Kristen , DeLuca Jesse , Poon Lucas , Selig Daniel , Vuong Chau , Sousa Jason , Oliver Thomas , Bennett Jason , Moon James E , Sikaffy April , Sedegah Martha , Tosh Donna ,   Mara Kreishman-Deitrick2, Waterman Paige
Published: June 2020

Background: Malaria remains the top infectious disease threat facing the U.S. military in many forward operating environments. Compliance with malaria chemoprophylaxis remains a critical component in preventing malaria in the deployed Service Member. Studies of previous military operations show that compliance is consistently higher with weekly versus daily dosing regimens. Current FDA approved weekly chemoprophylaxis options have contraindications that can limit prescribing. The combination of chloroquine (CQ) with azithromycin (AZ) has previously been shown to be an efficacious treatment option for malaria, has pharmacokinetics compatible with weekly dosing, and has shown synergy when combined in vitro. Methods: In this open label study 18 healthy volunteers, aged 18-50 years (inclusive), were randomly assigned to receive either 300 mg CQ or 300 mg CQ and 2 gm azithromycin (CQAZ) of directly observed therapy, weekly for 3 weeks prior to undergoing mosquito bite challenge with chloroquine-resistant Plasmodium falciparum. Volunteers that remained asymptomatic and had no evidence of parasitemia continued to receive weekly post-exposure chemoprophylaxis for 3 weeks following malaria challenge. The primary endpoint was the number of volunteers that remained asymptomatic and had no evidence of parasitemia 28 days after the malaria challenge.Results: All 6 (100%) volunteers randomized to the CQ control group became symptomatic with parasitemia during the 28 day post-challenge period. Only 1/12 (8.3%) of volunteers in the CQAZ group developed symptoms and parasitemia during the 28-day post-challenge period. However, after chemoprophylaxis was discontinued an additional 6 volunteers developed parasitemia between days 28-41 after challenge, with 4 of 6 experiencing symptoms. 80% of subjects in the CQAZ group experienced treatment related gastrointestinal adverse events (including 13 % that experienced severe nausea) compared to 38% in the CQ group. A comparison of the pharmacokinetics in the CQAZ group demonstrated higher azithromycin Cmax (p0.03) and AUC (p0.044) levels in those volunteers who never became parasitemic compared to those who did. Conclusion: Given the high rate of side effects and poor efficacy when administered for 3 weeks before and after challenge, the combination of weekly chloroquine and azithromycin is a suboptimal regimen combination for weekly malaria chemoprophylaxis.Trial registration: ClinicalTrials.gov NCT03278808
Socioecological Factors Associated with Hypertension Awareness and Control Among Older Adults in Brazil and Colombia: Correlational analysis from the International Mobility in Aging Study
Authors: Pirkle Catherine , Guo Mary W. , Guerra Ricardo O , Gomes Fernando , Belanger Emmanuelle , Sentell Tetine L
Published: June 2020

Background

Hypertension awareness and control are understudied among older adults in middle-income countries, particularly contextualized according to interpersonal, institutional, and community factors. Research on hypertension in Latin America is acknowledged as insufficient.
Methods

We analyzed International Mobility in Aging Study data of 803 community-dwelling adults 65–74 years from study sites in the two most populous countries in South America: Brazil and Colombia. The study framework was the socioecological model, positing individual health outcomes are influenced by various behavioral, interpersonal, institutional, and community factors. Logistic regression models identified factors associated with hypertension awareness and control.
Results

At over 70% of participants, hypertension was prevalent in both samples, and awareness was high (> 80%). In contrast, blood pressure control among diagnosed respondents was low: 30% in Brazil and 51% in Colombia. Factors across the socioecological model were associated with awareness and control. Those with diabetes (OR 4.19, 95%CI 1.64–10.71) and with insufficient incomes (OR: 1.85, 95%CI 1.03–3.31) were more likely to be aware of their hypertension. In Colombia, those reporting no community activity engagement were less likely to be aware of their condition compared to those reporting community activities. In Brazil, it was the opposite. Women (OR 1.66, 95%CI 1.12–2.46) and those reporting strolling shops and stores (OR 1.80, 95% CI 1.09-3.00) were significantly more likely to have their hypertension under control. In Brazil, those 70–75 were significantly less likely to have their hypertension under control compared to their younger counterparts. In Colombia, there was no significant difference in the likelihood of hypertension control by age group.
Conclusions

There were notable differences in some factors across countries, highlighting the importance of theory-based studies within unique Latin American contexts on hypertension and other critical public health problems. Potential solutions for countries in the LAC region to improve hypertension outcomes for older adults include continuing to build access to health care to increase awareness and emphasizing social activities, including strolling in shops, that may support hypertension control as well as other desirable public health outcomes (e.g., exercise, social networks).
Exoproteome from Leptospira interrogans and Host Cells during Infection: Leptospiral Virulence Factors and Cellular Proteins Involved in Stress and Inflammation
Authors: Hu Weilin , Imran Muhammad , Li Kai-Xuan , Ojcius David M. , Sun Ai-Hua , Li Shi-Jun , Ge Yu-Mei , Dong Shi-Lei , Yan Jie
Published: June 2020

Background: Leptospirosis, caused mainly by Leptospira interrogans, is a global zoonotic infectious disease. Macrophages and vascular endothelial cells are the main host cells for L. interrogans during infection, but the proteins released from the pathogen and the two host cells during infection remain mostly unknown.Results: Cellular supernatant proteins (CSPs) from human THP-1 macrophages or umbilical vein endothelial cells (HUVECs) infected with L. interrogans strain Lai were extracted by TCA/FASP methods. The exoproteins in the CSPs were identified by LC-MS/MS. Viability of the leptospires and host cells during infection was confirmed by confocal microscopy and MTT. The results showed that higher co-culture temperature (from 28°C to 37°C) and different biochemical environments cause a large change in the exoproteome of the spirochete. L. interrogans increased levels of leptospiral exoproteins related to stress, signal transduction and virulence factors, while the lipoprotein antigens LipL41, LipL21 and/or Loa22 were not detected. During infection of macrophages and endothelial cells, there was a large increase in host-cell exoproteins involved in stress response, complement pathways (C4/5/7/8), inflammatory cytokines (IL-6, TNF-α, MIF, MCP-1 and GM-CSF), extracellular matrix proteins (FN, LN and COLs), and blood coagulation factors. One-third of the leptospires and infected THP-1 macrophages died during macrophage infection, but nearly all the leptospires and endothelial cells remained viable during endothelial cell infection.Conclusions: Infection causes stress reponses for both leptospires and human macrophages and vascular endothelial cells and release of virulence factors, alteration of surface leptospiral lipoprotein antigens and secretion of complement components and inflammatory cytokines from host cells.
Evaluation of an exercise-enabling control interface for powered wheelchair users: a feasibility study with Duchenne muscular dystrophy
Authors: Lobo-Prat Joan , Enkaoua Aure , Rodríguez-Fernàndez Antonio , Sharifrazi Nariman , Medina-Cantillo Julita , Font-Llagunes Josep M. , Torras Carme , Reinkensmeyer David J.
Published: June 2020

Background: Powered wheelchairs are an essential technology to support mobility, yet their use is associated with a high level of sedentarism that can have negative health effects for their users. People with Duchenne muscular dystrophy (DMD) start using a powered wheelchair in their early teens due to the loss of strength in their legs and arms. There is evidence that low-intensity exercise can help preserve the functional abilities of people with DMD, but options for exercise when sitting in a powered wheelchair are limited.
Methods: In this paper, we present the design and the feasibility study of a new version of the MOVit device that allows powered-wheelchair users to exercise while driving the chair. Instead of using a joystick to drive the wheelchair, users move their arms through a cyclical motion using two powered, mobile arm supports that provide controller inputs to the chair. The feasibility study was carried out with a group of five individuals with DMD and five unimpaired individuals. Participants performed a series of driving tasks in a wheelchair simulator and on a real driving course with a standard joystick and with the MOVit 2.0 device.
Results: We found that driving speed and accuracy were significantly lowered for both groups when driving with MOVit compared to the joystick, but the decreases were small (speed was 0.26 m/s less and maximum path error was 0.1 m greater). Driving with MOVit produced a significant increase in heart rate (7.5 bpm) compared to the joystick condition. Individuals with DMD reported a high level of satisfaction with their performance and comfort in using MOVit.
Conclusions: These results show for the first time that individuals with DMD can easily transition to driving a powered wheelchair using cyclical arm motions, achieving a reasonable driving performance with a short period of training. Driving in this way elicits cardiopulmonary exercise at an intensity found previously to produce health-related benefits in DMD.
Iatrogenic Dissemination Of initially Resectable Lung Cancer After Transthoracic Fine-needle Biopsy : who is to Be Blamed?
Authors: Liu Yuan-Yuan , Gong Longbo , Wu Wenbin , Zhang Miao
Published: June 2020

Background: Percutaneous fine-needle biopsy is a well-established procedure for the diagnosis of lung lesions. However, tumor dissemination after transthoracic biopsy is potentially unpreventable.For radiographical malignant localized tumors, the optimal choice (a timely surgery or preoperative biopsy) is debatable.Case Presentation: A 57-year-old male patient was admitted due to a radiographical malignant but initially resectable lung tumor in the chest images. Although lobectomy, instead of biopsy, was recommended by the multidisciplinary consultation team, the patient declared that he would ask for compensation if the pulmonary lesion was benign. He developed pleural and pericardial effusion about 9 months after the first biopsy, which failed to yield a definite diagnosis.Chest tube drainage revealed malignant tumor cells. Finally, unresectable stage Ⅳ primary lung adenocarcinoma was confirmed by another biopsy. Therefore, chemotherapy plus targeted agents was administered.The patient was lost to follow up 1 month later.Conclusions: A timely resection rather than biopsy of the lung lesion suspicious for cancer should be considered when appropriate. In addition,how to avoid the negative effect of patient-physician relationship in medical decision making warrants further ethical and clinical studies.
Research on Sports Fitness Management Based on Blockchain and Internet of Things
Authors: Shan Yu , Mai Yuehui
Published: June 2020

The amount of exercise and fitness level of sports athletes can be quantitatively evaluated through the measurement of health and sports information, thereby ensuring effective fitness effects. The development of blockchain and Internet of Things technology provides a new perspective and technical means for fitness management technology. In view of the current problems in the field of sports fitness, this paper designs and implements a dynamic management technology for sports fitness based on the concept of Internet of Things and blockchain. First, based on an in-depth analysis of the current status of theoretical research and application of the Internet of Health at home and abroad, the theories and methods of sports information and health information collection are studied. A temperature sensor and an acceleration sensor are used to collect human body temperature and exercise steps, respectively, and then estimate human health and exercise conditions. Second, solve the privacy problem in the collection and transmission of the Internet of Things by adding blockchain technology. Finally, the machine learning method is used to clean and manage the information and data to realize the real-time detection and management of the athlete's fitness status. The actual case test shows that the functions and technical performance indicators of the dynamic fitness management technology can meet the needs of users in indoor and outdoor fitness management, and promote the development of the sports industry and provide a scientific reference.
Phenotypic characterization of X-linked hypophosphatemia in pediatric Spanish population.
Authors: Rodríguez-Rubio Enrique , Gil-Peña Helena , Chocrón Sara , Madariaga Leire , Cerda-Ojeda Francisco De la , Fernández-Fernández Marta , de Lucas-Collantes Carmen , Gil Marta , Luis-Yanes Mª Isabel , Vergara Inés , González-Rodríguez Juan David , Ferrando Susana , Gamero Montserrat Antón , Hidalgo-Barquero Marta Carrasco , Fernández-Escribano Angustias , Fernández-Maseda Mª Ángeles , Espinosa Laura , Oliet Aniana , Vicente Antonio , Ariceta Gema , Santos Fernando
Published: June 2020

BACKGROUNDX-Linked hypophosphatemia (XLH) is a hereditary rare disease caused by loss-of-function mutations in PHEX gene leading to hypophosphatemia and high renal loss of phosphate. Rickets and growth retardation are the major manifestations of XLH in children, but there is a broad phenotypic variability. Few publications have reported large series of patients. Current data on the clinical spectrum of the disease, the correlation with the underlying gene mutations, and the long-term outcome of patients on conventional treatment are needed, particularly because of the recent availability of new specific medications to treat XLH. RESULTSThe RenalTube database was used to retrospectively analyze 48 Spanish patients (15 men) from 39 different families, ranging from 0 to 9 years of age at the time of diagnosis, and with XLH confirmed by genetic analysis. Bone deformities, radiological signs of active rickets and growth retardation were the most common findings at diagnosis. Mean (± SEM) height was -1.89 ± 0.19 SDS and 55% of patients had height SDS below - 2. All cases had hypophosphatemia, serum phosphate being -2.81 ± 0.11 SDS. Clinical manifestations and severity of the disease were similar in both genders. No genotype – phenotype correlation was found. Conventional treatment did not attenuate growth retardation after a median follow up of 7.42 years (IQR = 11.26; n=26 patients) and failed to normalize serum concentrations of phosphate. Eleven patients had mild hyperparathyroidism and 8 patients nephrocalcinosis. CONCLUSIONSThis study shows that growth retardation and rickets were the most prevalent clinical manifestations at diagnosis in a large series of Spanish pediatric patients with XLH confirmed by mutations in the PHEX gene. Traditional treatment with phosphate and vitamin D supplements did not improve height or corrected hypophosphatemia and was associated with a risk of hyperparathyroidism and nephrocalcinosis. The severity of the disease was similar in males and females.
Secondary Hemophagocytic Syndrome: Differences between the etiologies autoimmunes and hematological malignancies subgroup
Authors: Dubuc César Antonio Egües , Calvo-Alen Jaime , Cabrera-Miranda Lizbeth Patricia , Sola Andrea De Diego , Salsamendi José Ramon Furundarena , Lorenzo Nerea Alcorta , Jaimes Jesús Alejandro Valero , Dominguez Luis María López , Fanlo Jorge Jesús Cancio , Alonso Olga Maiz , Isacelaya Esther Uriarte , Otano Joaquín María Belzunegui
Published: June 2020

Background: Hemophagocytic Syndrome (HPS) is an uncommon disorder with high mortality. HPS is reported to be usually related to some underlying conditions; autoimmune (AI) and hematological malignancies (HM) are two main underlying conditions. Here, we attempted to determine the clinical characteristics/differences of HPS according to underlying conditions; AI vs. HM, based on our experience. Methods: We studied all adult patients with HPS diagnosed at our institution from 2005 to 2019. Demographic, clinical characteristics, laboratory findings, underlying disorders, hospital stay and prognosis variables were examined and related to the underlying conditions. Results: 30 patients (median age of 55 years and male/female of 14/16) met the inclusion criteria which we analyzed: HM: 12 (40%), AI: 10 (33%), and others: 8 (27%). HM group, compared with AI group, showed a significantly longer length hospital stay (HM vs AI: 61.5 vs 30.5 (median)), more severe thrombocytopenia, leukocytopenias, and neutropenia, and importantly, higher mortality (with overall mortality and HM-related HPS-mortality being 43.3 and 66.7%, respectively). Contrarily, HM group, compared with AI group, showed less severe liver abnormalities (AST; 106 vs 457 (median): ALT; 109 vs 457 (median)). Conclusions : The HM subgroup presented a greater mortality and a higher number and severe cytopenias but lower elevation of transaminases.
Dietary iron intake and anemia: Food frequency questionnaire in patients with hereditary hemorrhagic telangiectasia.
Authors: Cavalcoli Federica , Gandini Alberto , Matelloni Irene Aglaia , Catalano Francesca , Alicante Saverio , Manfredi Guido , Brambilla Gianfranco , Menozzi Fernanda , Perolini Federica , Costi Egon , Bertè Roberto , Buscarini Elisabetta
Published: June 2020

Background: Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular disease characterized by a heterogeneous clinical presentation and prognosis. Dietary evaluation is relevant in HHT patients to provide adequate iron and nutrient intake. Additionally, different dietary items have been reported to precipitate epistaxis in this setting. Our primary aim was to investigate the dietary habits of HHT patients through a food-frequency questionnaire (FFQ) to evaluate the presence of precipitants and/or protective factors for epistaxis and the occurrence of possible dietary modifications. The secondary aims were to evaluate the nutritional intake of iron in HHT patients and the self-reported effect of iron treatments on epistaxis.From April 2018 to October 2018, a 138-item FFQ was provided to HHT patients followed up at the HHT Referral Center of Crema Maggiore Hospital. The relationship between food items and epistaxis was ascertained on a separate form. Daily iron intake was calculated to establish the mean iron content of food items reported in the FFQ.Results: One hundred forty-nine questionnaires were evaluated [72 females, median age 54 years (12-76). Overall, 26 (18%) patients reported dietary items that improved epistaxis (mostly blueberries and red fruits, green vegetables and legumes), while 38 (26%) reported some dietary items that exacerbated epistaxis (spices, chocolate, alcohol, strawberries and ginger). Dietary modifications were reported in up to 58% of cases. In HHT patients, the mean daily iron intake was 8.46 ± 2.78 mg, and no differences were observed in the iron intake of patients reporting a diet modification and those who did not.Conclusions: Dietary evaluation is advisable in the management of HHT patients. HHT patients should be encouraged to follow a healthy and balanced diet with increased consumption of dietary items with a high iron content.