bluuebunny/crossref_metadata_2025 huggingface dataset:
Inverse Relationship Between Serum Cystatin C and Sudomotor Function Detected by SUDOSCAN in Chinese Patients With Type 2 Diabetes Mellitus
Authors: Guo Qingyu , Lu Bin , Wang Liping , Guo Zhanhong , Song Wenjing , Zang Pu , Gu Ping , Li Ling , Shao Jiaqing
Published: December 2020

Background and aims:To explore the relationship between serum cystatin C and sudomotor function produced by the SUDOSCAN in subjects with type 2 diabetes mellitus.Methods:The research incorporated 917 Chinese individuals with type 2 diabetes mellitus from May 2017 to May 2019. All patients underwent SUDOSCAN and examined cystatin C. SUDOSCAN was evaluated with electrochemical skin conductance in hands (HESC) and feet (FESC), asymmetry ratio in hands (HASYM) and feet (FASYM). Average FESC <60 µS was defined as sudomotor dysfunction. 917 patients were classified into 791 diabetic patients without sudomotor dysfunction, and 126 diabetic patients complicated with sudomotor dysfunction. The difference of cystatin C between two groups was compared firstly, the difference of SUDOSCAN metrics among tertiles of serum cystatin C was also compared. The spearman and multiple linear regression analyses were applied to analyze the association between serum cystatin C and SUDOSCAN metrics. Results:The total prevalence of sudomotor dysfunction was 13.74%. Patients with sudomotor dysfunction had a higher level of cystatin C (P<0.001). With increasing tertiles of serum cystatin C, ESC declined, ASYM elevated, and the prevalence of sudomotor dysfunction increased (P<0.001).The spearman analysis performed an association between serum cystatin C and SUDOSCAN metrics including HESC (r=-0.143, P<0.001), FESC(r=-0.178, P<0.001), HASYM (r=0.169, P<0.001), FASYM (r=0.174, P<0.001). Multivariate regression linear analyses demonstrated cystatin C was independently linked with HESC (B=-14.657, P<0.001) and FESC (B=-10.015, P=0.022) levels after controlling for potential confounders. Conclusions:Serum cystatin C is inversely linked with sudomotor function detected by SUDOSCAN in Chinese patients with type 2 diabetes mellitus.
Effect of sodium-glucose co-transporter-2 inhibitors on the levels of serum asprosin in patients with newly diagnosed type 2 diabetes mellitus
Authors: Jiang Aijun , Feng Zhanrong , Yuan Lu , Zhang Ying , Li Qian , She Yuqing
Published: December 2020

BackgroundAsprosin, a novel adipokine which raises glucose levels and stimulates appetite, has been proved to be pathologically increased in populations predisposed to type 2 diabetes mellitus (T2DM), obesity and cardiovascular diseases. The mechanisms of sodium-glucose co-transporter-2 (SGLT2) inhibitors for hypoglycemic effect and cardiovascular protection have not been fully clarified. Therefore, we conducted this study to assess change in the levels of serum asprosin after treatment with SGLT2 inhibitors in patients with newly diagnosed T2DM.MethodsThis study was a randomized, double-blind, placebo-controlled trial. A total of 29 participants with newly diagnosed T2DM with body mass index (BMI) ≥ 23.0 kg/m² and haemoglobin A1c (HbA1c) levels of 58 ~ 85 mmol/mol (7.5%~10%) were randomized to SGLT2 inhibitors dapagliflozin 10 mg/d (n = 19) or placebo (n = 10) treatment for 24 weeks. We analyzed asprosin concentrations by an enzyme-linked immunosorbent assay. In addition, body weight, BMI, HbA1c, fasting plasma glucose (FPG), and lipid levels were measured at baseline and at 24 weeks.ResultsAt 24 weeks, participants with SGLT2 inhibitors treatment exhibited lower the levels of serum asprosin (22.87 vs 45.06 ng/ml in the placebo group; P < 0.001) after adjusting for baseline values. The levels of body weight, BMI, HbA1c, FPG and triglyceride (TG) were decreased, while high density lipoprotein-cholesterol (HDL-C) was increased after SGLT2 inhibitors dapagliflozin treatment compared with placebo (P < 0.05 for all). Low density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) levels were unchanged in SGLT2 inhibitors group and placebo group. No statistical correlation was found between the levels of serum asprosin and body weight, BMI, HbA1c, FPG, and lipid levels during the SGLT2 inhibitor dapagliflozin treatment.ConclusionsThis study shows that SGLT2 inhibitors can decrease the levels of serum asprosin in patients with newly diagnosed T2DM, which may be involved in SGLT2 inhibitors mechanisms of improving glucose levels and reducing cardiovascular diseases risk factors.Trial registrationISRCTN, ISRCTN2013L01573. Registered 29 august 2013. http://www.icmje.org/search/?q=ISRCTN+2013L01573ISRCTN, ISRCTN2014L00001.Registered 4 January http://www.icmje.org/search/?q=ISRCTN+2014L00001
Messenger RNA levels of enzymes involved in glycerolipid synthesis in the brain of the mouse and its alterations in Agpat2-/- and db/db mice
Authors: Gonzalez-Hodar Lila , Agarwal Anil K. , Cortés Víctor
Published: December 2020

Background and Aims:

Expression of genes encoding enzymes involved in glycerolipid and monoacylglycerol pathways in specific brain regions is poorly known and their alterations in insulin resistance (IR) and type 2 diabetes (T2D) remain unreported. We determined the mRNA levels of enzymes involved in glycerolipid synthesis in specific regions of the mouse brain and their changes in two models of severe IR, the lipodystrophic Agpat2−/− and the obese Leprdb/db mice.
Methods

Cerebral cortex, hypothalamus, hippocampus and cerebellum were dissected from adult Agpat2−/− mice, Leprdb/db mice and their respective wild type littermates. Total RNA was isolated and the relative mRNA abundance of enzymes was determined by RT-qPCR.
Results

GPAT1, AGPAT1-4, LIPIN1/2, DGAT1/2 and MOGAT1 mRNAs were detected in all studied brain regions, whereas GPAT2, LIPIN3 and MOGAT2 were undetectable. Abundance of GPAT1, AGPAT1, AGPAT2, AGPAT4, LIPIN1, and MOGAT1, was higher in the hypothalamus. AGPAT3 and DGAT1 were higher in cortex and cerebellum, and LIPIN2 and DGAT2 were higher in cortex and hippocampus. In Agpat2−/− mice, LIPIN1 levels were increased in all the brain regions. By contrast, GPAT1 and AGPAT4 in hypothalamus, AGPAT3 in hippocampus and hypothalamus, and MOGAT1 in cortex, hypothalamus and cerebellum were lower in Agpat2−/− mice. Leprdb/db mice showed fewer and milder changes, with increased levels of GPAT1 and LIPIN1 in cerebellum, and AGPAT3 in hypothalamus.
Conclusions

Enzymes involved in glycerolipids synthesis are differentially expressed across regions of the mouse brain and IR and T2D determine altered gene expression of these enzymes in the mouse brain.
Short-term effectiveness of safety decompression via double percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral lumbar spinal canal stenosis: a prospective cohort study
Authors: Wang Yu , Deng Mingyan , Wu Hao , Wu Ye , Guo Chuan , Zhang Dongfeng , Kong Qingquan
Published: December 2020

Purpose This prospective cohort study reports on a modified technique, namely precise safety decompression via double percutaneous lumbar foraminoplasty (DPLF) and percutaneous endoscopic lumbar decompression (PELD) for lateral lumbar spinal canal (LLSC) stenosis, and its short-term clinical outcomes.Methods The study analyzed 69 patients with single-level LLSC stenosis simultaneously occurring in both zones 1 and 2 (defined as retrodiscal space and upper bony lateral recess respectively by new LLSC classification) who underwent DPLF–PELD from November 2018 to April 2019. Clinical outcomes were evaluated according to preoperative, three months postoperatively, and last follow-up, via leg pain/low back pain (LBP) visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and the Macnab criteria. The postoperative MRI and CT were used to confirm the complete decompression, and flexion-extension x-rays at the last follow-up were used to observe lumbar stability.Results All patients successfully underwent DPLF–PELD, and the stenosis was completely decompressed, confirmed by postoperative MRI and CT. The mean follow-up duration was 13 months (range: 8–17 months). The mean preoperative leg pain VAS score is 7.05 ± 1.04 (range 5–9), which decreased to 1.03 ± 0.79(range: 0–3) at three months postoperatively and to 0.75 ± 0.63 (range: 0–2) by the last follow-up visit(p < 0.05). The mean preoperative ODI was 69.8 ± 9.05 (range: 52–85), which decreased to 20.3 ± 5.52 (range: 10–35) at the third month postoperatively and to 19.6 ± 5.21 (range: 10–34) by the final follow-up visit(p < 0.05). The satisfactory (excellent or good) results were 94.2%. There was one patient with aggravated symptoms, which were relieved after an open surgery. Two patients had a dural tear, and two patients suffered postoperative LBP. No recurrence or segmental instability was observed at the final follow-up.Conclusion DPLF–PELD could be a good alternative for the treatment of LLSC stenosis patients whose stenosis occurred in both zones 1 and 2.Trial registration Chinese Clinical Trial Registry (ChiCTR1800019551). Registered 18 November 2018.
Prevalence of heavy episodic drinking and associated factors among adults residing in Arba Minch health and demographic surveillance site: a cross sectional study
Authors: Gutema Befikadu Tariku , Chuka Adefris , Ayele Gistane , Tariku Eshetu Zerhun , Aschalew Zeleke , Baharu Alazar , Degefa Nega , Gurara Mekdes Kondale
Published: December 2020

Background: Alcohol consumption is associated with different types of illnesses; particularly heavy episodic drinking is one of the risk factors for the disease burden of alcohol intake. The aim of the study was to assess the prevalence of heavy episodic drinking and associated factors in Arba Minch Health and Demographic Surveillance Site (HDSS).Methods: A community-based cross-sectional study was conducted in 2017 among adult residents of Arba Minch HDSS. Using Arba Minch HDSS database, 3368 individuals were selected by simple random sampling techniques. From WHO STEPS instruments, step one was applied for this study. Variables with a p-value of less than 0.10 for bivariate analysis entered into a multivariable logistic regression model to outline the independent predictors of the heavy episodic drinking. To assess the presence of an association between dependent and independent variables, a p-value of less than 0.05 was considered.Results: The prevalence of heavy episodic drinking was 13.7% (95% CI: 12.6–14.9). The study has shown that heavy episodic drinking was significantly associated with occupation (daily laborer [AOR=0.49; 95% C.I: 0.29–0.85] and housewives [AOR=0.63; 95% C.I: 0.45–0.88] compared with farmers), wealth index (2nd quintiles [AOR =0.55; 95% C.I: 0.41–0.74) and 3rd quintiles [AOR = 0.66; 95% C.I: 0.46–0.93] compared with 1st quintiles), and climatic zone (midland [AOR=1.80;95% CI: 1.11–2.93), highland [AOR=1.95;95% CI: 1.19–3.18] compared with lowland). In addition, tobacco use [AOR=4.28;95% CI: 3.38–5.43], and khat use [AOR=4.75; 95% CI: 2.66–8.50) were also associated with heavy episodic drinking among the study participants. Conclusions: More than one in ten adults reported heavy episodic drinking in the study area. Intervention programs that aim to prevent heavy episodic drinking should be designed appropriately for individuals from lower wealth status, and for highlander.
Oral health status of 12-year-old children in Lisu minority ethnic group in China: a cross-sectional study
Authors: Chen Kitty Jieyi , Liu Juan , Xu Biao , Li Yuexiao , Li Yanhong , Zhang Shinan , Chu Chun Hung
Published: December 2020

Background: Lisu is an ethnic minority group and most of them are living in Yunnan, China. This study investigated the oral health status among 12-year-old Lisu children in Yunnan.Method: This survey employed a multistage sampling method to recruit 12-year-old Lisu children. Two calibrated dentists performed the oral examinations in the primary schools. They examined dental caries, gingival bleeding and dental fluorosis using the diagnosis criteria recommended by the World Health Organization. A self-administrated questionnaire was distributed to the children to collect their sociodemographic background information and oral health-related behaviours. A chi-square test, the Mann-Whitney U test, zero-inflated negative binomial (ZINB) regression and multivariate logistic regression were used for statistical analysis.Results: This survey invited 512 children, and 482 children (48% boys) participated in the study (response rate: 94%). Their caries prevalence was 35% and their caries experience in mean (SD) DMFT scores was 0.63 (0.10). The mean (SD) DT score was 0.60 (1.10), consisting 95% of the mean DMFT scores. No dental fluorosis was observed; whereas 426 children (88%) had gingival bleeding. Results of ZINB model indicated sex and sugary-snacking habits were related to the dental caries experience (p<0.05). The gingival-bleeding prevalence was associated with the mother’s education level, the child’s monthly-pocket money and daily toothbrushing frequency (p<0.05).Conclusion: Dental caries and gingival bleeding were prevalent among 12-year-old Lisu children in the Yunnan province in China, and most of the decayed teeth were unrestored. Dental fluorosis was not observed in the children.
Sudden death in the young adult: A Tunisian autopsy-based series
Authors: Saadi Said , Jomaa Sami Ben , Hadj Mariem Bel , Oualha Dorra , Salem Nidhal Haj
Published: December 2020

Background: We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. Methods: We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done (August 1990 to December 2018). In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 years and 35 years.Results: We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%.Conclusion: In this series, sudden death in young adults occurs mainly in a smoking male, aged between 18 and 24 years old, occurring at rest, in the morning, and early in the week. It is more common, especially in summer. Sudden death is most often the first manifestation of pathologies, especially unsuspected heart diseases. The predominance of cardiovascular causes is the common denominator of almost all studies reported in the literature. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.
The association between life satisfaction, emotional support and perceived health among Intimate Partner Violence (IPV) survivors
Authors: Hui Vivian , Constantino Rose
Published: December 2020

Background: Intimate partner violence (IPV) is a pressing phenomenon whose consequences are associated with severe physical and mental health outcomes. Every minute, around 24 people in the United States are raped, physically harmed, or emotionally abused by their intimate partner. Although having experienced IPV is not modifiable, emotional support is believed to be a protective factor to prevent victims from committing suicide. The psychological state of IPV victims is critical in post-traumatic events and this is evidenced in numerous qualitative interviews. Therefore, the objective of this study is to explore the association between IPV with emotional support, life satisfaction, and perceived health status in the United States. Methods: This study analyzed the data from the 2007 Behavioral Risk Factor Surveillance System. Univariate analyses, multivariable logistic regression analyses, and ordinal logistic regression analyses were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV. Analyses were conducted using SPSS version 25. Results: The analyses show that there is a strong association between IPV experience and emotional support (AOR:1.810; 95% CI = 1.626 -2.015). Participants who had unwanted sex with an intimate partner in the past 12 months have 2.28 higher odds to receive less emotional support and 2.05 higher odds to perceive poor life satisfaction. Also, participants who reported experiencing IPV were associated with (AOR: 3.12; 95% CI =2.68 – 3.62) times the odds of having ≥ 6 days more mentally unhealthy days in a month. For perceived health outcomes, people who had been threatened with violence by a sex partner have 1.74 (95% CI =1.54 – 1.96) times the odds of having poor perceived general health status. IPV survivors have 3.12 (95% CI =2.68 – 3.62) times the odds of having ≥ 6 days more mentally unhealthy days in a month. Conclusions: People reported with any IPV experience are more likely to receive less emotional support, perceive dissatisfaction in life, and poor health outcomes. This study shows the need for policies centered on the development of interventions that focus on mental health for those who have experienced IPV.
Factors influencing early initiation of breastfeeding among mothers in Rajshahi district, Bangladesh
Authors: Ayesha Ummay , M Abu Sayed Md. Al , Islam Md. Nurul , Hossain Md. Ripter , Tasmia Samme Amena , Hossain Md. Golam
Published: December 2020

Background: Early initiation of breastfeeding (EIBF) act as the first immunization for the newborns, fortify their immune defense system and eventually reduce the mortality rate. This study aimed to identify the influential factors of EIBF among mothers in Rajshahi district, Bangladesh.Methods: A total number of 421 mothers living in Rajshahi district who had at least one child aged 6-24 months were considered as sample. Mothers were selected using multistage random sampling. This study was conducted from January to March, 2019. The EIBF was measured by a principal question, “Did you provide your breast milk to your newborns within one hour after delivery?” Frequency distribution and Chi-square test and multivariable binary logistic regression model were utilized in this study for getting prevalence and influential factors of EIBF respectively. Results: This study revealed that the prevalence of EIBF among mothers in Rajshahi district was 88.4%. Multivariable logistic model provided eight influential factors of EIBF: (i) husbands’ education level, (ii) husbands’ occupation, (iii) family monthly income, (iv) mothers’ age, (v) mothers’ BMI, (vi) place of delivery, (vii) getting pregnancy with planning, and (viii) mothers taking advice regarding the benefit of breastfeeding during their pregnancy. Conclusions: This study identified several modifiable influential factors of EIBF. The customs, culture and other characteristics are almost the same across the country. These factors could be considered to increase the rate of EIBF among mothers in Bangladesh.
“The kind of support that matters to exclusive breastfeeding” a qualitative study
Authors: Dasheka Zukiswa Theodorah , Rala Ntombana Mc'Deline
Published: December 2020

Background Worldwide, only 41% of infants are exclusively breastfed for the first six months while South Africa has an alarming figure of only 12%. First-time mothers are inexperienced in the initiation and maintenance of exclusive breastfeeding, hence a need for support. Data on forms and quality of exclusive breastfeeding support as experienced by first-time mothers is minimal. The study explored the exclusive breastfeeding support available to first-time mothers in the Buffalo City Metro, South Africa.Methods A qualitative explorative, descriptive and contextual study, and a non-probability, purposive sampling was used with 10 first-time mothers within the first six months postpartum. The in-depth face-to-face semi-structured individual interviews for data collection and Creswell's steps of thematic analysis were used.Results Two themes emerged; challenges, empowerment, support and resilience during initiation of exclusive breastfeeding, and diverse support and resilience during maintenance of exclusive breastfeeding. First- time mothers received practical support majorly from nurses and other mothers during the initiation; social support was from family members, friends, and community members for the maintenance of exclusive breastfeeding. Sometimes there was a disjuncture between practical support from nurses and that from family members and community. There were instances where the support was needed but not given or not supportive of exclusive breastfeeding.Conclusion These findings illustrate that professional, practical and social support for first-time mothers is crucial in the initiation and maintenance of exclusive breastfeeding for the first six months. Timing and the kind of support given to these mothers is crucial for successful exclusive breastfeeding.
Use of masks in public places in Poland during SARS-Cov-2 epidemic: a covert observational study
Authors: Ganczak Maria , Pasek Oskar , Duda-Duma lukasz , Świstara Dawid , Korzeń Marcin
Published: December 2020

Background: Face masks protect against SARS-Cov-2, however, if used incorrectly masks may increase transmission risk. Many countries, including Poland, recommend masks in pandemic control plans. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020 [18]; a relaxation of previous universal measures was announced on May 29th, 2020, limiting use to indoor public spaces.Objective: to assess use of masks or other protective devices in public spaces in Poland during the SARS-Cov-2 epidemic and to evaluate influencing determinants.Methods: A non-participatory covert observational study was conducted on three dates, (10.05/18.05/ 25.05.2020) at public spaces in 13 regions with different risks. Ten consecutive individuals were observed by each of 82 medical students (n=2460 observations), using a structured checklist.Results: Among 2353 observed persons, the female/male ratios were 1.0, 1.1, and 1.0 on the three dates. As for age, 21-60-year-olds predominated at 70.8%, 71.9%, and 70.2%; 73.6% (n=552/750) were using masks on date 1, 66.5% (544/818) on date 2; and 65.7% (516/785) on date 3. Cloth masks predominated on all dates (64.7%-62.3%-62.6%), followed by medical (23.4%-28.5%-26.9%). Being female (OR=1.75-1.47-1.53 respectively), aged >40 years (OR=1.46-1.48 respectively), and location in a closed space (OR=2.56-2.63-2.36) were each associated with higher usage. Participants in sports were about two times less likely to use masks (OR=0.64-0.54-0.5) as compared to other activities. The proportion using masks correctly decreased gradually over time (364/552; 65.9%; 339/544; 62.3% and 304/516; 58.9%). More females wore masks correctly (date 1: 205/294; 69.7% vs 159/258; 61.6%, and date 3: 186/284; 65.5% vs 118/232; 50.9%; p=0.045; p=0.0008 respectively). Uncovered noses (47.3%-52.7%) and masks around the neck (39.2%-42.6%) were the most frequent incorrect practices. Conclusions: Practices were not in line with official recommendations, especially among young males, and deteriorated over time. Cloth masks were predominantly used in public spaces. Health promotion, through utilizing all available communication channels, would be helpful to increase compliance.
Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: A multicenter retrospective study
Authors: Wen Xue-song , Jiang Dan , Gao Lei , Zhou Jian zhong , Xiao Jun , Cheng Xiao-cheng , He Bin , Chen Yue , Lei Peng , Tan Xiao-wei , Qin Shu , zhang dongying
Published: December 2020

Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. And, it has become a global pandemic. This is of great value for describing the patient's clinical symptoms in detail and looking for markers which are significant to predict the prognosis of patients with COVID-19.MethodsIn this multicenter, retrospective study, 476 patients with COVID-19 were recruited from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.ResultsThe dominant symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes. Compared with patients with higher CD4+T cell level, patients with lower CD4+T cell level were older and mostly males. The reduction of CD8+T cell level is an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients. ConclusionsReductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe COVID-19 cases. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient’s disease. Only the reduction in CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients.
Quality of life of children with spinal muscular atrophy and their caregivers from the perspective of caregivers : a Chinese cross-sectional study
Authors: Yao Mei , Ma Ying , Qian Ruiying , Xia Yu , Yuan Changzheng , Bai Guannan , Mao Shanshan
Published: December 2020

Background: Spinal muscular atrophy (SMA) is an autosomal-recessive motor neuron disease leading to dysfunction of multiple organs. SMA can impair the quality of life (QoL) of patients and family. We aimed to evaluate the QoL of children with SMA and their caregivers and to identify the factors associated with QoL in a cross-sectional study conducted in China.Methods: We recruited 101 children aged 0-17 years with SMA and their caregivers from a children’s hospital in China. Twenty-six children had type I SMA, 56 type II and 19 type III. Each child’s QoL was measured by the Pediatric Quality of Life Inventory 3.0 Neuromuscular Module (PedsQL NMM), which was completed by the child’s caregivers. The caregiver’s QoL was measured by the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM). Information on sociodemographic characteristics, disease-specific characteristics, and treatments were collected using the proxy-reported questionnaire. Two-sample t-tests and one-way ANOVA were used to compare differences in average scores of QoL across subgroups.Results: Children with type III SMA had a higher average Total score of PedsQL NMM and higher average scores in domains Neuromuscular disease and Family resources than children with type I or type II SMA (p < 0.001). Caregivers of children with type III SMA reported higher average scores in the domains of Physical, Emotional, Social, and Cognitive functioning of the PedsQL FIM than those of children with types I or II SMA (p < 0.05). In addition, disease-related characteristics (e.g. limited mobility, stable course of disease, skeleton deformity, and digestive system dysfunction) and respiratory support were associated with lower average scores of PedsQL NMM and PedsQL FIM (p < 0.05). Exercise training, multidisciplinary team management and use of the medication Nusinersen were each associated with higher average scores in both PedsQL NMM and FIM (p < 0.05). Conclusion: Our study has demonstrated factors that may impair or improve QoL of children patients with SMA and their parents. Particularly, QoL was relatively poor in children with type I and type II SMA as well as in their caregivers compared to those with type III SMA. We strongly recommend that standard of care in a multidisciplinary team (MDT) be strengthened to improve the QoL of SMA patients. Our study called for increased attention from clinical physicians on measuring QoL in their clinical practices in order to enhance the understanding of impacts of SMA and to make better decisions regarding treatment.
Comparisons of Simulation Results between Passive and Active Fluid Structure Interaction Models for Left Ventricle in Hypertrophic Obstructive Cardiomyopathy
Authors: Huang Xueying , Deng Long , Zuo Heng , Yang Chun , Song Yunhu , Lesperance Mary , Tang Dalin
Published: December 2020

Background. Patient-specific active Fluid-Structure Interactions (FSI) model is a useful approach to non-invasively investigate the hemodynamics in the heart. However, it takes a lot of effort to obtain the proper external force boundary conditions for active models, which heavily restrained the time-sensitive clinical applications of active computational models. Methods. The simulation results of 12 passive FSI models based on 6 patients’ pre-operative and post-operative CT images were compared with corresponding active models to investigate the differences in hemodynamics and cardiac mechanics between these models. Results. In comparing the passive and active models, it was found that there was no significant difference in pressure difference and shear stress on mitral valve leaflet (MVL) at the pre-SAM time point, but a significant difference was found in wall stress on the inner boundary of left ventricle (Endocardium). It was also found that pressure difference on the coapted MVL and the shear stress on MVL were significantly decreased after successful surgery in both active and passive models. Conclusion. Our results suggested that the passive models may provide good approximated hemodynamic results at 5% RR interval, which is crucial for analyzing the initiation of systolic anterior motion (SAM). Comparing to active models, the passive models decrease the complexity of the modeling construction and the difficulty of convergence significantly. These findings suggest that, with proper boundary conditions and sufficient clinical data, the passive computational model may be a good substitution model for the active model to perform hemodynamic analysis of the initiation of SAM.
Treatment Preference among Patients with Spinal Muscular Atrophy (SMA): A Discrete Choice Experiment
Authors: Monnette Alisha , Chen Er , Hong Dongzhe , Bazzano Alessandra , Dixon Stacy , Arnold W. David , Shi Lizheng
Published: December 2020

OBJECTIVE: To examine patient/caregiver preference for key attributes of treatments for spinal muscular atrophy (SMA). BACKGROUND: In the rapidly evolving SMA treatment landscape, it is critically important to understand how attributes of potential treatments may impact patient/caregiver choices.DESIGN/METHODS: A discrete choice experiment survey was developed based on qualitative interviews. Patients with SMA (³18 years) and caregivers of patients were recruited through a U.S. patient organization. Respondents made choices in each of 12 sets of hypothetical treatments. The relative importance of five treatment characteristics was compared (measured by regression coefficients [RC] of conditional logit models): (1) improvement or stabilization of motor function, (2) improvement or stabilization of breathing function, (3) indication for all ages or pediatric patients only, (4) route of administration (repeated intrathecal [IT] injections, one-time intravenous [IV] infusion, daily oral delivery) and (5) potential harm (mild, moderate, serious/life threatening).RESULTS: Patient ages ranged from less than 1 to 67 years (n=101, 65 self-reported and 36 caregiver-reported) and 64 were female. Total SMA subtypes included: type 1 (n=21), type 2 (n=48), type 3 (n=29), other (n=3). Prior spinal surgery was reported in 47 patients. Nusinersen and onasemnogene abeparvovec-xioi use were reported in 59 and 10 patients, respectively. Improvement in motor and breathing function was highly valued (RC: 0.65, 95% confidence interval [CI]: 0.47–0.83 and RC: 0.79, 95% CI: 0.60–0.98, respectively). Oral medication and one-time infusion were strongly preferred over repeated IT injections (RC: 0.80, 95% CI: 0.60–0.98 and RC: 0.51, 95% CI: 0.30–0.73, respectively). Patients least preferred an age-restricted label/approved use (£ 2 years of age) (RC: -1.28, 95% CI: -1.47 to -1.09). Cross-attributes trade-off decision suggested a lower willingness for a high-risk therapy despite additional efficacy gain. For some patients, there may be willingness to trade off additional gains in efficacy for a change in route of administration from repeated intrathecal administration to oral medication.CONCLUSIONS: Improvements in motor/breathing function, broad indication, oral or one-time infusion, and minimal risk were preferred treatment attributes. Treatment decisions should be made in clinical context and be tailored to patient needs.
TMEFF2 Promoter Hypermethylation Is an Unfavorable Prognostic Marker in Gliomas
Authors: Xie Sidi , Zhang Yunxiao , Peng Tao , Guo Jinglin , Cao Yongfu , Guo Jing , Shi Xiaofeng , Li Yaqin , Liu Yawei , Qi Songtao , Wang Hai
Published: December 2020

Background Transmembrane protein with EGF-like and two follistatin-like domains 2 (TMEFF2) is a transmembrane protein in the tomoregulin family. Little research has been performed to determine whether TMEFF2 methylation is a prognostic marker in adult diffuse gliomas. Methods In this study, we investigated TMEFF2 expression in surgical glioma tissue samples. In addition, we conducted bisulfite amplicon sequencing (BSAS) and methylation-specific PCR (MSP) to evaluate TMEFF2 methylation in glioblastoma (GBM) cells. Subsequently, we investigated the biological function of TMEFF2 in GBM cells. Moreover, we explored the prognostic significance of TMEFF2 in gliomas by analysing a cohort dataset from TCGA. Results Immunohistochemistry analysis of 75 paired glioma tumour and peritumoural tissues demonstrated that glioma tumour tissues expressed lower TMEFF2 levels than peritumoural tissues (P<0.001). TMEFF2 promoter methylation levels were increased in glioblastoma cells compared with SVG p12 cells (P<0.001). Inhibition of methylation reduced TMEFF2 methylation and increased its expression in LN229 and T98G cells (P<0.05). Knockdown of TMEFF2 expression significantly promoted the proliferation of U87MG cells and primary GBM cells (P<0.05). TMEFF2 methylation is negatively associated with IDH1, ATRX and TP53 mutations, and the subtype of glioma harbouring combined IDH1/ATRX/TP53 mutations was associated with low TMEFF2 methylation levels. Survival analysis confirmed that low TMEFF2 methylation levels are associated with good prognosis in glioma patients. Conclusions Our results suggest that TMEFF2 DNA methylation might be associated with glioma tumour progression and could serve as a valuable prognostic marker for adult diffuse gliomas.
The coArtHA Trial - Identifying the Most Effective Treatment Strategies to Control Arterial Hypertension in Sub-Saharan Africa: Study Protocol for a Randomized Controlled Trial
Authors: Mapesi Herry , Gupta Ravi , Wilson Herieth Ismael , Lukau Blaise , Amstutz Alain , Lyimo Aza , Muhairwe Josephine , Senkoro Elizabeth , Byakuzana Theonestina , Mphunyane Madavida , Bresser Moniek , Glass Tracy Renée , Lambiris Mark , Fink Günther , Gingo Winfrid , Battegay Manuel , Paris Daniel Henry , Rohacek Martin , Vanobberghen Fiona , Labhardt Niklaus Daniel , Burkard Thilo , Weisser Maja
Published: December 2020

Background Arterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa. MethodsIn this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤130/80 mmHg and ≤140/90 mmHg among those aged <65 years and ≥65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints. DiscussionThis trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region. Trial registrationClinicaltrials.gov, NCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).
Relationships with caregivers and mental health outcomes among adolescents living with HIV: A prospective cohort study in South Africa
Authors: Shenderovich Yulia , Boyes Mark , Esposti Michelle Degli , Casale Marisa , Toska Elona , Roberts Kathryn J. , Cluver Lucie
Published: December 2020

Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities ( n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n =926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, p<.0001) and anxiety (0.91, 95% CI 0.89-0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.
Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation.
Authors: Lane Mercedes Yanes , Trajman Anete , Bastos Mayara Lisboa , Oxlade Olivia , Valiquette Chantal , Rufino Nathalia , Fregonese Federica , Menzies Dick
Published: December 2020

BACKGROUND: Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives.METHODS: In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. RESULTS: In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, -15) but the number starting latent TB infection treatment was sustained (difference 2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment.CONCLUSION: In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment.
Analysis of cesarean section rates using Robson Ten Group Classification System in a tertiary teaching hospital, Addis Ababa, Ethiopia: a cross-sectional study
Authors: Abubeker Ferid A. , Gashawbeza Biruck , Gebre Thomas Mekuria , Wondafrash Mekitie , Teklu Alula M. , Degu Demis , Bekele Delayehu
Published: December 2020

Background Cesarean section (CS) is an important indicator of access to, and quality of maternal health services. The World Health Organization recommends the Robson ten group classification system as a global standard for assessing, monitoring and comparing CS rates at all levels. This study aimed to assess the rate of CS and perform an analysis based on Robson classification system. Methods A facility-based cross-sectional study was conducted at a tertiary hospital in Addis Ababa, Ethiopia. Data were collected from medical charts of all women who delivered from January-June 2018. The overall CS rate was calculated then women were categorized into one of the ten Robson groups. Relative size of each group, contribution of each group to the overall CS rate, and CS rate within each group were calculated. Results A total of 4,200 deliveries were analyzed. Of these 1,459 (34.7%) were CS. The largest contributors to the overall CS rate were Group 10 (19.1%), Group 2 (18.3%), Group 5 (17.1%), and Group 4 (15.8%). There was also a high rate of pre-labor CS in Group 2, Group 4, and Group 10. Conclusion Through implementation of the Robson ten group classification system, we identified the contribution of each group to the overall CS rate as well as the CS rate within each group. Group 10 was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low-risk groups. These target groups require more in-depth analysis to identify possible modifiable factors and to apply specific interventions to reduce the CS rate. Evaluation of existing management protocols and further studies into indications of CS and outcomes are needed to design tailored strategies and improve outcomes.
Curbing Adolescent Illicit Drug use in Owerri Metropolis, Nigeria: A Public Perceptive.
Authors: U. Ogu Udochukwu , Ezumah Nkoli , Odii Aloysius , Uguru Nkolika P.
Published: December 2020

Background: To reduce the rate of illicit drug use, the public has an important role to play, therefore how they perceive illicit drug use among youths must be ascertained. This study seeks to ascertain the public perception of strategies for curbing adolescent drug use.Methods: A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods. The study population consisted of members of the public aged 18 years and above, residing in Owerri metropolis at the time of the study. A total of 10 communities were selected randomly in all: four communities from the 16 communities that make up Owerri West, five communities from the 18 communities that make up Owerri North and one community from the five communities that make up Owerri Municipal. A total of 16 respondents were purposively selected for in-depth interviews.Results: The quantitative findings show that 70.7% of respondents believe that the use of illicit drugs by adolescents can be controlled. The findings also show that one of the public’s perception to control adolescent drug use is to establish stringent anti-illicit drugs consumption laws/policies (20.4%) amongst others. The qualitative findings report that in order to curb the use of drugs by adolescents, the following activities and bodies need to be implored: health promotion, raising more awareness and sensitization campaigns, creation of remand homes for juveniles, the involvement of parents, school authorities and religious organizations and rehabilitation programmes. However, raising awareness, according to the study was reported as a reliable way of eliminating drug use among adolescents.Conclusion: To curb illicit drug use, proper funding of drug enforcement agencies, sensitization campaigns, strict laws on drug prescription, provision and use and health education etc. are very necessary for reducing adolescents’ illicit drug consumption.
Analytic Hierarchy Process-Based Decision-Making Framework for Formwork System Selection by Contractors
Authors: Hansen Seng , Siregar Pratama HR , Jevica
Published: December 2020

This article presents a study of the contractors' preference for formwork system selection in Indonesian context. As decision makers, contractors are faced with challenges in choosing the formwork system for a particular project. While conventional timber formwork has been the most used formwork system in Indonesia, aluminium formwork is present although it has not been widely used. Thus, this research investigates the current practices of available formwork systems and its selection criteria in Indonesia. A decision-making framework (DMF) is developed by considering the appropriate assessment criteria for formwork system selection. This framework is then implemented through analytic hierarchy process technique. The result shows that contractors tend to choose aluminium formwork with a preference at 79% compared to conventional timber formwork with a preference at 21%. These findings can be used as considerations for contractors to start using aluminium formwork due to its excellence compared to conventional timber formwork. This study also proves that the proposed DMF can be applied and provides a sound decision related to formwork system selection.