bluuebunny/crossref_metadata_2025 huggingface dataset:
Resection of retrohepatic inferior vena cava without reconstruction in ex vivo liver resection and autotransplantation: a retrospective study
Authors: Yang Xianwei , Wang Tao , Kong Junjie , Huang Bin , Wang Wentao
Published: March 2020

Background: Retrohepatic inferior vena cava (RIVC) resection without reconstruction in ex vivo liver resection and autotransplantation (ERAT) for advanced alveolar echinococcosis (HAE) is unclear.
Methods: This is a retrospective study of consecutive patients referred to our hospital from 2014 to 2018. Depending on the presence of a rich collateral circulation and stable blood volume in ERAT, patients did not rebuild the RIVC. Then, patients were selected some appropriate revascularization techniques for the hepatic and renal veins. Finally, all ERAT procedures were completed, and short- and long-term outcomes were observed.
Results: Five advanced HAE patients underwent ERAT without RIVC reconstruction. One patient died of circulatory failure 1 day after surgery. Another four patients, with a median follow-up duration of 18 months (range, 10-25 months), demonstrated normal liver and kidney function, no thrombosis and no HAE recurrence.
Conclusions: Through the long-term results of ERAT, the pros and cons of not reconstructing the RIVC need to be re-examined. In cases with a rich collateral circulation, the RIVC cannot be reconstructed. However, in cases requiring the resection of multiple organs, RIVC without reconstruction was prudential.
Prognostic value of pretreatment platelet count in lung cancer: a systematic review and meta-analysis
Authors: Yuan Yuan , Zhong Hai , Ye Liang , Li Qian , Fang rong su , Gu Wei , Qian Ying Ying
Published: March 2020

Background : The prognostic value of elevated pretreatment platelet count s remains controversial in lung cancer patients. We performed the present meta-analysis to determine its precise role in these patients. Methods: We employed a multiple search strategy in the PubMed, EMBASE and Cochrane Library databases to identify eligible studies. Disease-free survival (DFS)/progression-free survival (PFS)/time to progression (TTP) and overall survival (OS) were used as outcomes with hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity among the studies and publication bias were also evaluated. Results : A total of 40 studies including 16696 lung cancer patients were eligible for the analysis. Overall, the pooled analysis showed that compared with normal platelet counts, elevated pretreatment platelet counts were associated with poorer OS (HR= 1.54, 95% CI: 1.37-1.72, P<0.001) and poorer DFS/PFS/TTP (HR=1.62, 95% CI: 1.33-1.98, P<0.001) in patients with lung cancer. In subgroup analyses, elevated pretreatment platelet counts were also associated with poorer OS and DFS/PFS/TTP in most subgroups. There was no evidence of publication bias. Conclusions : This meta-analysis revealed that elevated pretreatment platelet counts were an independent predictor of OS and DFS/PFS/TTP in lung cancer patients. Large-scale prospective studies and a validation study are warranted.
Bacillus subtilis and Bacillus licheniformis reduce faecal protein catabolites concentration and odour in dogs
Authors: Bastos Tais Silvino , de Lima Daniele Cristina , Souza Camilla Mariane Menezes , Maiorka Alex , de Oliveira Simone Gisele , Bittencourt Letícia Cardoso , Félix Ananda Portella
Published: March 2020

Background: Direct-fed microbials (DFM), such as Bacillus subtilis and Bacillus licheniformis , may improve gut functionality of the host by favouring non-pathogenic bacteria and reducing the formation of putrefactive compounds. The aim of this study was to assess the nutrient digestibility, faecal characteristics and intestinal-fermentation products in dogs fed diets with Bacillus subtilis and Bacillus licheniformis . Sixteen dogs were randomly divided into two groups. Every eight dogs were fed with the control diet or the diet with the addition of 62.5 g of DFM ( B. subtilis and B. licheniformis )/ton. Diets were provided throughout a twenty-day adaptation period, followed by five days of total faecal collection. Nutrient digestibility and the metabolisable energy of the diets, plus the dogs’ faecal characteristics and intestinal fermentation products were assessed.
Results: There were no differences in nutrient digestibility ( P > 0.05). However, DFM supplementation improved faecal score and resulted in less fetid faeces ( P < 0.001). DFM inclusion reduced ( P < 0.05) the biogenic amines concentration: putrescine, spermidine and cadaverine, besides the concentration of phenols and quinoline.
Conclusions: The use of B. subtillis and B. licheniformis as DFM reduce the concentration of nitrogen fermentation products in faeces and faecal odour, but the digestibility of nutrients is not altered in dogs.
The impact of the duration of the palliative care period on cancer patients with regard to the use of hospital services and the place of death: a retrospective cohort study
Authors: Hirvonen Outi Maaria , Leskelä Riikka-Leena , Grönholm Lotta , Haltia Olli , Voltti Samuli , Tyynelä-Korhonen Kristiina , Rahko Eeva K. , Lehto Juho T. , Saarto Tiina
Published: March 2020

Background

In order to avoid unnecessary use of hospital services at the end-of-life, palliative care should be initiated early enough in order to have sufficient time to initiate and carry out good quality advance care planning (ACP). This single center study assesses the impact of the PC decision and its timing on the use of hospital services at EOL and the place of death.

Methods

A randomly chosen cohort of 992 cancer patients treated in a tertiary hospital between Jan 2013 –Dec 2014, who were deceased by the end of 2014, were selected from the total number of 2737 identified from the hospital database. The PC decision (the decision to terminate life-prolonging anticancer treatments and focus on symptom centered palliative care) and use of PC unit services were studied in relation to emergency department (ED) visits, hospital inpatient days and place of death.

Results

A PC decision was defined for 82% of the patients and 37% visited a PC unit. The earlier the PC decision was made, the more often patients had an appointment at the PC unit (>180 days prior to death 72% and <14 days 10%). The number of ED visits and inpatient days were highest for patients with no PC decision and lowest for patients with both a PC decision and an PC unit appointment (60 days before death ED visits 1.3 vs 0.8 and inpatient days 9.9 vs 2.9 respectively, p<0.01). Patients with no PC decision died more often in secondary/tertiary hospitals (28% vs. 19% with a PC decision, and 6% with a decision and an appointment to a PC unit).

Conclusions

The PC decision to initiate a palliative goal for the treatment had a distinct impact on the use of hospital services at the EOL. Contact with a PC unit further increased the likelihood of EOL care at primary care.
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: A population-based study
Authors: Hirayama Atsushi , Goto Tadahiro , Hasegawa Kohei
Published: March 2020

Background and Aim : Little is known about the relationship between acute kidney injury (AKI) and outcomes after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We aimed to investigate associations between AKI and readmission risks after hospitalization for AECOPD.
Methods : A retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. We identified all adults (aged ≥40 years) hospitalized for AECOPD during the study period. Among them, we further identified patients with a concurrent diagnosis of new AKI. The outcome measures were any-cause readmissions within 30 days and 90 days after hospitalization for AECOPD. To determine associations between AKI and readmission risk, we constructed Cox proportional hazards models examining the time-to-readmission. We also identified the primary reason of readmission.
Results: We identified 356,990 patients hospitalized for AECOPD. The median age was 71 years and 41.9% were male. Of these, 24,833 (7.0%) had a concurrent diagnosis of AKI. Overall, patients with AKI had significantly higher risk of 30-day all-cause readmission compared to those without AKI (hazard ratio 1.47; 95% CI 1.43-1.51; P<0.001). Likewise, patients with AKI had significantly higher risk of 90-day all-cause readmission (hazard ratio 1.35; 95% CI 1.32-1.38; P<0.001). These associations remained significant after adjustment for confounders (both P<0.05). Additionally, patients with AKI were likely to be readmitted for non-respiratory reasons including sepsis, acute renal failure, and congestive heart failure.
Conclusions : Among patients hospitalized for AECOPD, patients with AKI were at higher risk of 30-day and 90-day readmission, particularly with non-respiratory reasons.
Imaging study of coronal structural matching of the distal radius in normal adults
Authors: Zhang Xin , Yuan Feng , Yin Yong , Fan Jian
Published: March 2020

Background: As an important anatomical basis, coronal structural position matching of the distal radius has long been lacking in terms of a quantitative understanding, and such matching is correlated with the postoperative functional recovery of patients with distal radius fracture. The purpose of this study was to explore the degree of coronal structural matching of the distal radius in a normal population and to improve the detailed anatomical knowledge of the distal radius.
Methods: The reconstructed 3D data were analysed using 3-matic research software from thin-film CT images of 80 normal adults, and the coronal structural matching of the distal radius was studied from two aspects: 1) self-matching of the distal radius; and 2) matching between the distal radius and ulna (i.e., the joint space of the distal radioulnar joint). Specific research methods: 1) The relative position of the medial wall of the distal radius with respect to the lunate was determined as the percentage (%) of the vertical distance from the medial wall of the radius to the most prominent ulnar point of the lunate in the corresponding plane from the ulna to the radius. 2) A total of 9 sets of data were collected for evaluating the palmar lateral spacing, median spacing, and dorsal lateral spacing at the distal, middle, and proximal levels of the radius.
Results: In the study, 9 sets of data were obtained. And the data of self-matching of the coronal structural of distal radius was also obtained, was 45.0%±16.2%. The P values in the above data were all greater than 0.05, showing no statistical significance. Finally, data of coronal bone structural matching of distal radius in 80 normal adults were obtained.
Conclusions: Our study refines the anatomical data of the degree of coronal bone structural matching of the distal radius in a normal population. To explore the relationship between coronal alignment and function in cases of distal radius fracture, a standardized approach was established. Thin- film CT may help diagnose patients with dysplasia around the lunate and radioulnar joint that is difficult to diagnose on MRI.
Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition. Results from a retrospective comparative study.
Authors: Gennaro Giovanni Luigi Di , Stallone Stefano , Olivotto Eleonora , Zarantonello Paola , Magnani Marina , Tavernini Tullia , Stilli Stefano , Trisolino Giovanni
Published: March 2020

Background: The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC.Methods: We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis. Results: Thirty-four Children (47 feet) in the nonoperative group and twenty-one children (34 feet) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9-17): 11.6 (9-17) for the nonoperative group, 12.2 (10-15) for the operative group. The mean follow-up averaged 6.6 (3-12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years.There were no complications in either groups, but 6 patients (7 feet) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables.Conclusion: The operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.
Small intestinal microbiota composition and the prognosis of infants with ileostomy resulting from distinct primary diseases
Authors: Qian Tian , Zhu Haitao , Zhu Li , Chen Chao , Shen Chun , Zhang Rong
Published: March 2020

Background: Studies of microbiota composition of infants with small intestinal ostomy due to various etiologies are limited. Here, we characterized the intestinal microbiota of neonates with ileostomy resulting from distinct primary diseases. Methods: Fifteen patients with necrotizing enterocolitis, eight patients with meconium peritonitis, and seven patients with Hirschsprung's disease were included in the study. The small intestinal microbiota composition in infants with ileostomy caused by these diseases was studied. Results: Microbial diversity in neonatal ileostomy fluid was generally low, and was dominated by members of the Proteobacteria and Firmicutes phyla. At the genus level, the most abundant were Klebsiella, Escherichia-Shigella, Streptococcus, Clostridium sensu stricto 1, Enterococcus, and Lactobacillus. Streptococcus and Veillonella are related to carbohydrate metabolism and immunity, and breastfeeding can increase the proportion of these potentially beneficial bacteria. The proportion of Bifidobacterium in the breastfeeding group was higher than that in the non-breastfeeding group, and incidence of colitis and sepsis was reduced in the breastfeeding group. The increase in body weight in the breastfeeding group was observed to be higher than in the non-breastfeeding group. Conclusions: Excessive Klebsiella and Escherichia-Shigella and low abundance of Streptococcus, Veillonella and Faecalibacterium suggests that the small intestinal microbiota is in an unhealthy state after ileostomy. However, Streptococcus, Faecalibacterium, and Veillonella species were frequently present, suggesting that expansion of these bacteria might assist the development of the immune system after surgery.
Methicillin-resistant Staphylococcus aureus nasal colonization among HIV-infected patients in Taiwan: prevalence, molecular characteristics and associated factors with nasal carriage
Authors: Hsu Yi-Yu , Wu David , Hung Chien-Ching , Huang Shie-Shian , Yuan Fang-Hsueh , Lee Ming-Hsun , Huang Ching-Tai , Shie Shian-Sen , Huang Po-Yen , Yang Chien-Chang , Cheng Chun-Wen , Leu Hsieh-Shong , Wu Ting-Shu , Huang Yhu-Chering
Published: March 2020

Background: To evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan.Methods: From September 2014 to November 2015, HIV-infected patients seeking outpatient care at four hospitals were eligible for this study. A nasal specimen was obtained from each subject for the detection of S. aureus and a questionnaire was completed by each subject. MRSA isolates once identified were characterized.Results: Of 553 patients surveyed, methicillin-susceptible S. aureus (MSSA) was detected in 119 subjects (21.5%) and MRSA in 19 subjects (3.4%). Female gender, injection drug use, smoking, hepatitis C virus carrier, cancer and antibiotic use within one year were positively associated with MRSA colonization. By multivariate analysis, only cancer (adjust odds ratio (aOR) 7.78, [95% confidence interval (CI), 1.909-31.731]) and antibiotic use within one year (aOR 3.89, [95% CI, 1.219-12.433]) were significantly associated with MRSA colonization. Ten isolates were characterized as sequence type (ST) 59/staphylococcal chromosome cassette (SCC) IV or VT, endemic community strains in Taiwan, four isolates as ST 8/SCCmec IV (USA 300) and one isolate as ST 239/SCCmec IIIA, a hospital strain. All the community-associated MRSA isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). Conclusions: Nasal MRSA carriage in HIV-infected patients seeking outpatient care was low (3.4%) in northern Taiwan. Most of the colonizing isolates were genetically endemic community strains and exhibited high susceptibility to TMP-SMX and fluoroquinolones. Cancer and antibiotic use within one year were associated with MRSA colonization.
Shoulder imbalance treated with scapuloplasty surgery in scoliosis patients:a clinical retrospective study
Authors: Rui Zhong , Zhengjun Hu , Deng Zhao , Fei Wang , Hehong Zhao , Yijian Liang
Published: March 2020

Background

To discuss the clinical efficacy and safety of scapuloplasty treating the shoulder imbalance in scoliosis patients.

Methods

A retrospective analysis was made on 21 patients who underwent scoliosis corrective surgery combined with scapuloplasty from September 2013 to March 2015. The average follow-up was 31.4±5.3 months (24-42 months). The shoulder vertical difference (SVD), adjusted Constant-Murley score, range of shoulder motion function, Cavendish grade and the overall satisfaction were compared among the pre-surgery, post-surgery and the final follow-up periods.

Results

The Shoulder vertical difference (SVD) significantly decreased at the time of post-surgery and the final follow-up, comparing the score of the pre-surgery. The SVD of all patients were decreased from preoperatively 3.2±1.1cm to 0.4±0.3cm, with the Cavendish grade improved to grade 1 at the final follow-up. The adjusted Constant-Murley score and range of shoulder motion function showed no significant difference during the three time periods (P>0.05). And no severe complications had occurred over 2 years follow-up.

Conclusion

The scapuloplasty surgery shows to be an effective and safety procedure to improve the shoulder imbalance, cosmetic appearance and the overall satisfaction in scoliosis patients without impairing the shoulder function, which can be widely applied in clinic.
Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology
Authors: Lindblad Marléne , Unbeck Maria , Nilsson Lena , Schildmeijer Kristina , Ekstedt Mirjam
Published: March 2020

Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare.Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.
Study determinants of increased Z-Score of Body Mass Index in preschool-age children
Authors: El-Gamal Fathi Mahmoud , Babader R , Al-Shaikh M , Al-Harbi A , Al-Kaf J , Al-Kaf W
Published: March 2020

Objective : To determine the association between socioeconomic level, gender, stunting and other characteristics with the presence of overweight/obesity in the preschool children.Result : BMI/Age Z score > + 2 SD was found in 19.5% of the children. It was more common among the children from areas with high socio-economic level (OR: 2.43; 95% CI 1.54, 3.84, and p < 0.000) . obesity was higher among the males (OR 1.76; 95% CI 1.09, 2.8, and p < 0.02) compared to females. The increased duration of breast feeding, was significantly associated with increased BMI/Age Z-score (b= 0.027, p < 0.004). Decreased age of the child was significantly associated with increased BMI/Age Z-score (b= - 0.013, p < 0.004). The children with stunted growth were 6.7 times fold likely to have BMI/Age Z Score > + 2 SD compared to the normal children (OR 6.73; 95% CI 3.79, 10.80, and p < 0.000), after allowing for other factors. No significant association was found between allergic disorders and BMI/Age Z score > + 2 SD. Thus male gender, high socioeconomic condition, increased duration of breast feeding and stunting were significantly associated with overweight/obesity in preschool children
Proteomic analysis of human synovial fluid reveals potential diagnostic biomarkers for ankylosing spondylitis
Authors: Lee Ji Hyun , Jung Jae Hun , Kim Jeesoo , Baek Won-Ki , Rhee Jinseol , Kim Tae-Hwan , Kim Sang-Hyon , Kim Kwang Pyo , Son Chang-Nam , Kim Jong-Seo
Published: March 2020

Background Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease affecting the axial skeleton and peripheral joints. The etiology of this disease remains poorly understood, but interactions between genetic and environmental factors have been implicated. The present study identified differentially expressed proteins in the synovial fluid (SF) of AS patients to elucidate the underlying cause of AS. Methods A cohort of 40 SF samples from 10 AS and 10 each of rheumatoid arthritis (RA), gout, and osteoarthritis (OA) patients were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) to identify differentially expressed proteins specific to AS. The label-free LC-MS/MS results were verified by western blotting. Results We identified 8 proteins that were >1.5-fold upregulated in the SF of AS patients compared to that of the disease control groups, including HP, MMP1, MMP3, serum amyloid P-component (APCS), complement factor H-related protein 5 (CFHR5), mannose-binding lectin 2 (MBL2), complement component C9 (C9), and complement C4-A (C4A). CFHR5 and C9 were previously found in serum from AS patients, while APCS was previously found in SF as well as in serum. However, the present study has identified C4A, and MBL2 as potential AS biomarkers for the first time. The expression levels of MMP3, C9, and CFHR5 were verified in AS SF using western blotting. Conclusion We performed quantitative comparative proteomic analysis using by LC-MS/MS of the SF from four disease states: RA, gout, and OA. This systematic comparison revealed novel differentially expressed proteins in AS SF, as well as two previously reported candidate biomarkers. We further verified the expression of MMP3, C9 and CFHR5 by western blot. These proteins may serve as diagnostic or prognostic biomarkers in patients with AS, and may thus improve the clinical outcomes of this serious disease.
Value of T1 Mapping on Gadoxetic acid-enhanced MRI for Microvascular Invasion of Hepatocellular Carcinoma: A Retrospective Study
Authors: Rao chenyi , Wang Xinquan , Li Minda , Zhou Guofeng , Gu Hongmei
Published: March 2020

Background:
To evaluate the utility of non-invasive parameters derived from T1 mapping and diffusion-weighted imaging (DWI) on gadoxetic acid-enhanced MRI for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).
Methods:
A total of 94 patients with single HCC undergoing partial hepatectomy was analyzed in this retrospective study. Preoperative T1 mapping and DWI on gadoxetic acid-enhanced MRI was performed. The parameters including precontrast, postcontrast and reduction rate of T1 relaxation time and apparent diffusion coefficient (ADC) values were measured for differentiating MVI-positive HCCs (n=38) from MVI-negative HCCs (n=56). The receiver operating characteristic curve (ROC) was analyzed to compare the diagnostic performance of the calculated parameters.
Results:
MVI-positive HCCs demonstrated a significantly lower reduction rate of T1 relaxation time than that of MVI-negative HCCs (39.4% vs 49.9, P <0.001). The areas under receiver operating characteristic curve (AUC) were 0.587, 0.728, 0.824, 0,690 and 0.862 for the precontrast, postcontrast, reduction rate of T1 relaxation time, ADC and the combination of reduction rate and ADC, respectively. The cut-off value of the reduction rate and ADC calculated through maximal Youden index in ROC analyses was 44.9% and 1553.5 s/mm 2 . To achieve a better diagnostic performance, the criteria of combining the reduction rate lower than 44.9% and the ADC value lower than 1553.5 s/mm 2 was proposed with a high specificity of 91.8% and accuracy of 80.9%.
Conclusions:
The proposed criteria of combining the reduction rate of T1 relaxation time lower than 44.9% and the ADC value lower than 1553.5 s/mm 2 on gadoxetic acid-enhanced MRI holds promise for evaluating MVI status of HCC.
Expanding the Role of Paralegals: Supporting Realization of the Right to Health for Vulnerable Communities
Authors: Wirya Albert , Larasati Ajeng , Gruskin Sofia , Ferguson Laura
Published: March 2020

Background
All around the world, the paralegal program prepares members of marginalized communities to face the legal system. Having a common background with their clients and being capable of conducting flexible work, paralegals’ role moves beyond enlarging the beneficiaries of legal aid to addressing intersectional issues around health-related rights. This study assesses the health and other impacts of paralegals recruited by Lembaga Bantuan Hukum Masyarakat (LBHM), a human rights organization which provides legal assistance and operates in Jakarta, Indonesia. The positive results these paralegals can bring in the specific context can contribute to the development of community-based paralegals elsewhere.

Methods
This mixed methods research was carried out in 2016-2018. In 2016, a quantitative survey was administered to LBHM-trained paralegals and a sub-set of paralegals who completed the survey were then also interviewed. Quantitative data were analysed using SPSS, and, for the qualitative data, thematic analysis was conducted.

Results
The paralegals make important contributions to health-related rights in four distinct ways. Firstly, most of the paralegals checked their clients’ health in all stages of detention, especially regarding their drug dependency status and checking for signs of torture. Secondly, paralegals help clients to be more aware of their health-related rights, especially regarding their rights to obtain health services inside detention. Thirdly, paralegals can ensure that their clients obtain health services by taking medicines directly to the clients or encouraging the law enforcement agencies to refer the clients to health services. Lastly, in drug cases, paralegals help their clients to obtain alternative sentences besides imprisonment.

Conclusions
These four contributions verify the positive impacts paralegals, recruited from marginalized communities, can deliver for community members facing criminal justice processes. The shifting role of paralegals from merely an intermediary between clients and lawyers to champions of the health-related rights of their clients can happen as a result of adequate training, support, and networks with other agents in criminal justice system.
Misoprostol administered sublingually at a dose of 12.5 µg versus vaginally at a dose of 25 µg for the induction of full-term labor: a randomized controlled trial
Authors: Gattas Daniele Sofia de Moraes Barros , de Amorim Melania MR , Feitosa Francisco EL , Junior José R da Silva , Ribeiro Lívia CG , Souza Gustavo FA , Souza Alex S Rolland
Published: March 2020

Background: Labor induction is defined as any procedure that stimulates uterine contractions before labor begins spontaneously. The vaginal and oral routes of administration of misoprostol are those most used for the induction of labor in routine practice, with the recommended dose being 25 μg. Nevertheless, the sublingual route may reduce the number of vaginal examinations required, increasing patient comfort and lowering the risk of maternal and fetal infection. Based on a previous systematic review, the objective of this study was to compare the frequency of tachysystole as the main outcome measure when misoprostol is administered sublingually at the dose of 12.5μg versus vaginally at a dose of 25μg to induce labor in a full-term pregnancy with a live fetus. Methods: A randomized, placebo-controlled, triple-blind clinical trial was conducted at two maternity hospitals in northeastern Brazil. Two hundred patients with a full-term pregnancy, a live fetus, Bishop score ≤6 and an indication for induction of labor were included. Following randomization, one group received 12.5μg misoprostol sublingually and a vaginal placebo, while the other group received a sublingual placebo and 25μg misoprostol vaginally. The primary outcome was the frequency of tachysystole. Student’s t-test, the chi-square test of association and Fisher’s exact test were used, as appropriate. Risk ratios and their 95% confidence intervals were calculated. Results: The frequency of tachysystole was lower in the group using 12.5μg misoprostol sublingually compared to the group using 25μg misoprostol vaginally (RR=0.15; 95%CI: 0.02-0.97; p=0.002). Failure to achieve vaginal delivery within 12 and 24 hours was similar in both groups. Sublingual administration was preferred to vaginal administration by women in both groups; however, the difference was not statistically significant. Conclusion: The effectiveness of labor induction with low-dose sublingual misoprostol was similar to that achieved with vaginal administration of the recommended dose; however, the rate of tachysystole was lower in the sublingual group, and this route of administration may prove a safe alternative. Trial registration: Registration number: NCT01406392, ClinicalTrials.gov. Date of registration: August 1, 2011.
Valgus Stability is Enhanced by Flexor Digitorum Superficialis Muscle Contraction of the Index and Middle Fingers
Authors: Hoshika Shota , Nimura Akimoto , Takahashi Norimasa , Sugaya Hiroyuki , Akita Keiichi
Published: March 2020

Background: Flexor digitorum superficialis (FDS) muscle provides dynamic stabilization and medial elbow support for ulnar collateral ligament (UCL). The FDS contraction significantly affects the medial joint distance (MJD) through grip contraction. However, it remains unclear whether FDS activity alone contributes to medial elbow stability, or together with the activation of the flexor digitorum profundus during grip contraction, and which finger’s FDS is the main contributor to elbow stability. We investigated the resistive effects of isolated FDS contraction in individual fingers against valgus stress in the elbow joint using stress ultrasonography (US).Methods: We investigated 17 healthy males (mean age, 27 ± 5 years). Valgus stress US was performed using the Telos device, with the elbow at 30° flexion. MJD was measured for each arm during 3 separate conditions: at rest (unloaded), under valgus load (50 N) (loaded), and under valgus load with FDS contracted in individual fingers (loaded-contracted). Results: MJD was significantly longer when loaded (5.4 ± 0.4 mm) than unloaded (4.1 ± 0.2 mm, P = .007) or loaded-contracted (4.6 ± 0.3 mm, P = .003) for each finger. When loaded-contracted, MJD differed statistically between the index and ring fingers (P = .03) and between the middle and ring fingers (P = .04). However, the difference between the index and middle fingers was not statistically significant (P = .08).  Conclusions: Individual FDS contraction, particularly of the index and middle fingers contributes most to stabilization against valgus stress. Thus, injury care programs should incorporate FDS exercises of these fingers.
Impact of perioperative hemodynamic optimization therapies in surgical patients: Economic study and Meta-analysis
Authors: Silva João M , Menezes Pedro Ferro L , Lobo Suzana M , Carvalho Flavia Helena S , Oliveira Mariana Augusta N , Filho Francisco Nilson F Cardoso , Fernando Bruna N , Carmona Maria Jose C , Teich Vanessa D , Malbouisson Luiz Marcelo S
Published: March 2020

Background: Several studies suggest that hemodynamic optimization therapies can reduce complications, the length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system.Method: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients who underwent standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis.Results: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR=0.66; 95% CI=0.58-0.74), renal (RR=0.68; 95% CI=0.54-0.87), and cardiovascular (RR=0.87; 95% CI=0.76-0.99) complications and a nonstatistically significant lower rate of respiratory complications (RR=0.82; 95% CI=0.67-1.02). There was no difference in mortality (RR=1.02; 95% CI=0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer days in the intensive care unit and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated.Conclusions: Hemodynamic optimization therapy is cost-effective and would increase the efficiency of and decrease the burden of the Brazilian public health system.
Repair of alveolar cleft bone defects by bone collagen particles combined with hUC-MSCs in rabbit
Authors: Sun Xue-Cheng , Wang Hu , Li Jian-Hui , Zhang Dan , Ma Xu , Xia Hong-Fei
Published: March 2020

Background: Alveolar cleft is a kind of cleft lip and palate, which seriously affects the physical and mental health of patients. In this study, a similar model of human alveolar cleft phenotype was established in rabbits to evaluate the effect of bone collagen particles combined with human umbilical cord mesenchymal stem cells (hUC-MSCs) on the repair of alveolar cleft bone defects. Methods: In this study, 24 adult Japanese white rabbits (JWRs) were selected and randomly divided into 4 groups. Including normal group, control group, materials group and MSCs group. The model of alveolar clefts was established by removing the incisors on the left side of the upper jaw. The normal group did nothing. In the control group, the incisors were removed and sutured directly. In the material group, the incisor were removed, then filled with bone collagen particles, and finally sutured. In the MSCs group, the incisors were first removed, then filled with bone collagen particles incubated by hUC-MSCs, and then stitched. Blood biochemical analysis was performed 3 months after the operation. Skull tissues were collected for gross observation, and micro-focus computerized tomography (micro-CT) analysis. Paraffin sections were prepared for histological and immunohistochemical staining. Results: The bone collagen particles and hUC-MSCs are not biotoxic and can promote alvenlus regeneration. Bone collagen particles combined with hUC-MSCs were much better than those used alone in inducing bone repair and regeneration. Conclusions: HUC-MSCs can be used as a bone generation inducer combined with bone collagen materials for bone regeneration and repair.
Intra-carotid arterial transfusion of circulatory-derived autologous endothelial progenitor cells in rodent after ischemic stroke — evaluating the impact of therapeutic time points on prognostic outcomes
Authors: Lin Kun-Chen , Chai Han-Tan , Chen Kuan-Hung , Sung Pei‐Hsun , Chiang John Y. , Shao Pei-Lin , Huang Chi-Ruei , Li Yi-Chen , Ko Sheung-Fat , Yip Hon-Kan
Published: March 2020

Background: This study tested the optimal time point for left intra-carotid arterial (LICA) administration of circulatory-derived autologous endothelial progenitor cells (EPCs) for improving the outcome in rat after acute ischemic stroke (IS). Methods and Results: Adult-male SD rats (n=70) were equally categorized into group 1 (sham-operated control), group 2 (IS), group 3 (IS+EPCs/1.2x106 cells/by LICA administration 3h after IS), group 4 (IS+EPCs/LICA administration post-day-3 IS), group 5 (IS+EPCs/LICA administration post-day-7 IS), group 6 (IS+EPCs/LICA administration post-day-14 IS) and group 7 (IS+EPCs/LICA administration post-day-28 IS). The brain-infarct volume (BIV) (at day 60/MRI) was lowest in group 1, highest in group 2 and significantly progressively increased from groups 3 to 7, whereas among the IS animals, the neurological function was significantly preserved in groups 3 to 6 than in groups 2 and 7 post-day-60 IS (all p<0.0001). By day 60, the endothelial cell markers at protein and cellular levels, and number of small vessels exhibited an opposite pattern of BIV among the groups (all p<0.0001). The protein and cellular levels of inflammation, and protein levels of oxidative stress, autophagy and apoptosis, were highest in group 2, lowest in group 1 and progressively increased from groups 3 to 7 (all p<0.0001). The angiogenesis biomarkers at protein and cellular levels were significantly progressively increased from groups 1 to 3, then significantly progressively decreased from groups 4 to 7 (all p<0.0001). Conclusion: Early EPC administration provided better benefits on improving functional/image/molecular-cellular outcomes after acute IS in rat.
Whole genome resequencing reveals an association of ABCC4 variants with preaxial polydactyly in pigs
Authors: Ma Cheng , Khederzadeh Saber , Adeola Adeniyi C. , Han Xu-Man , Xie Hai-Bing , Zhang Ya-Ping
Published: March 2020

Background: Polydactyly is one of the most common congenital limb dysplasia in many animal species. Although preaxial polydactyly (PPD) has been comprehensively studied in humans as a common abnormality, the genetic variations in other animals have not been fully understood. Herein, we focused on the pig, as an even-toed ungulate mammal model with its unique advantages in medical and genetic researches, two PPD families consisting of four affected and 20 normal individuals were sequenced. Results: Our results showed that the PPD in the sampled pigs were not related to the variants reported in earlier studies. A strong association was identified at ABCC4 and it encodes a transmembrane protein involved in ciliogenesis. We found that the affected and normal individuals were highly differentiated at ABCC4, and all the PPD individuals shared long haplotype stretches as compared with the unaffected individuals. A highly differentiated missense mutation (I85T) in ABCC4 was observed at a residue from a transmembrane domain highly conserved among a variety of organisms. Conclusions: This study reports ABCC4 as a new candidate gene for PPD in pigs and identifies a missense mutation. Our results illustrate a putative role of ciliogenesis process in PPD, coinciding with an earlier observation of ciliogenesis abnormality resulting in pseudo-thumb development in pandas. These results expand our knowledge on the genetic variations underlying PPD in animals.
Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis
Authors: xiao yuhan , Qin Yichun , Yu Haiyang
Published: March 2020

Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement (MD) with different adjunctive therapies has been applied in the treatment of peri-implant diseases. This systematic review aimed to deduce the optimal adjunctive therapy. Methods Two independent authors screened the literature using MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) about adjunctive therapies for non-surgical treatment of peri-implant diseases were included in this review. Studies selected were published before February 2020. The clinical outcomes were compared in this meta-analysis. Results: A total of 31 RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modification of the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; and enamel matrix derivative. Follow-up ranged from 3 months to 1 year. A statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up ( P < 0.01). However, such a difference was not detected between MD with chlorhexidine and MD alone at 3 months follow-up ( P = 0.61), between MD with probiotics and MD alone ( P = 0.47), and between systemic antibiotics and MD alone ( P = 0.96). Conclusion Currently, the optimal non-surgical intervention is not known. Also, among the interventions with similar efficiency, that with fewer side effects, easy to use, and cost-effective is yet to be identified. Thus, well-designed RCTs with prolonged follow-ups to assess the accurate effectiveness of therapies are imperative.
Using Osmotic Stress to Stabilize Mannitol Production in Synechocystis sp. PCC6803
Authors: Wu Wenyang , Du Wei , Gallego Ruth Perez , Hellingwerf Klaas J. , Woude Aniek D. van der , Santos Filipe Branco dos
Published: March 2020

Background Mannitol is a C(6) polyol that is used in the food and medical sector as a sweetener and antioxidant, respectively. The sustainable production of mannitol, especially via the direct conversion of CO 2 by photosynthetic cyanobacteria, has become increasingly appealing. However, previous work aiming to achieve mannitol production in the marine Synechococcus sp. PCC 7002 via heterologous expression of mannitol-1-phosphate-5-dehydrogenase ( mtlD ) and mannitol-1-phosphatase ( m1p , in short: a ‘mannitol cassette’), proved to be genetically unstable. Results Here, we explore the stabilizing effect that mannitol production may have on cells faced with osmotic stress, in the freshwater cyanobacterium Synechocystis sp. PCC 6803. We first validated that mannitol can function as a compatible solute in Synechocystis sp. PCC 6803, and in derivative strains in which the ability to produce one or both of the native compatible solutes was impaired. Wild type Synechocystis , complemented with a mannitol cassette, indeed showed increased salt tolerance, which was even more evident in Synechocystis strains in which the ability to synthesize the endogenous compatible solutes was impaired. Next we tested the genetic stability of all these strains with respect to their mannitol productivity, with and without salt stress, during prolonged turbidostat cultivations. The obtained results show that mannitol production under salt stress conditions in the Synechocystis strain that cannot synthesize its endogenous compatible solutes is remarkably stable, while the control strain completely loses this ability in only 6 days. DNA sequencing results of the control groups that lost the ability to synthesize mannitol revealed that multiple types of mutation occurred in the mtlD gene that can explain the disruption of mannitol production. Conclusions Mannitol production in freshwater Synechocsytis sp. PCC6803 confers it with increased salt tolerance. Under this strategy, genetically instability which was the major challenge for mannitol production in cyanobacteria is tackled. This paper marks the first report of both stable mannitol production directly from CO 2 in cyanobacteria, and of the utilization of the response to salt stress as a factor that can stabilize production in a cyanobacterial cell factory.
LINC00152 promotes Ovarian tumor progression and Predicts Poor Prognosis by inhibiting the ubiquitination of BCL6
Authors: Wang Shunni , Weng Weiwei , Chen Tingting , Xu Midie , Wei Ping , Li Jing , Lu Linghui , Wang Yiqin
Published: March 2020

Background : Long non-coding RNA 00152 (LINC00152) has been found oncogenic in multiple somatic malignancies. But its roles in the ovarian cancer remain elusive. We aim to investigate its functions and mechanism in the ovarian tumor progression. Methods: We used RNAscope and RT-qPCR assays to detect the LINC00152 levels in 152 pairs of ovarian tumor and paratumorous tissues, conducted in vitro and in vivo experiments to evaluate its biological functions, and performed RNA immunoprecipitation, RNA-pulldown, MS/LS analysis, mutant construction and ubiquitination assays to explore the LINC00152-BCL6 binding and regulation. Results: LINC00152 was abnormally increased in the ovarian tumor tissues and its high expression predicted poorer survivals of patients; overexpression of LINC00152 promoted ovarian tumor proliferation and metastasis both in vitro and in vivo ; LINC00152 bond to Serine333 and Serine343 of BCL6 and then suppressed its ubiquitination; Finally, LINC00152 facilitated its oncogenic functions in a BCL6-mediated manner in ovarian cancer. Conclusions: LINC00152 is the independent prognostic predictor of ovarian cancer; and the abnormal expression of LINC00152 facilitates ovarian tumor proliferation and invasion by suppress the ubiquitination of BCL6. Our data might be helpful in exploring the molecular mechanisms of lncRNA-protein interactions, and might provide the potential target for the tumor pharmacology of ovarian cancer.