bluuebunny/crossref_metadata_2025 huggingface dataset:
Disruption of a primary health care domestic violence and abuse service in two London boroughs: interrupted time series evaluation
Authors: Panovska-Griffiths Jasmina , Sohal Alex Hardip , Martin Peter , Capelas Estela Barbosa , Johnson Medina , Howell Annie , Lewis Natalia , Feder Gene , Griffiths Chris , Eldridge Sandra
Published: April 2020

Background
Domestic violence and abuse (DVA) is experienced by about 1/3 of women globally and remains a major health concern worldwide. IRIS (Identification and Referral to Improve Safety of women affected by DVA) is a complex, system-level, training and support programme, designed to improve the primary healthcare response to DVA. Following a successful trial in England, since 2011 IRIS has been implemented in eleven London boroughs. In two boroughs the service was disrupted temporarily. This study evaluates the impact of that service disruption.
Methods
We used anonymised data on daily referrals received by DVA service providers from general practices in two IRIS implementation boroughs that had service disruption for a period of time (six and three months). In line with previous work we refer to these as boroughs B and C. The primary outcome was the number of daily referrals received by the DVA service provider across each borough over 48 months (March 2013-April 2017) in borough B and 42 months (October 2013-April 2017) in borough C. The data were analysed using interrupted-time series, non-linear regression with sensitivity analyses exploring different regression models. Incidence Rate Ratios (IRRs), 95% confidence intervals and p-values associated with the disruption were reported for each borough.
Results
A mixed-effects negative binomial regression was the best fit model to the data. In borough B, the disruption, lasted for about six months, reducing the referral rate significantly (p=0.006) by about 70% (95%CI=(23%,87%)). In borough C, the three-month service disruption, also significantly (p=0.005), reduced the referral rate by about 49% (95% CI=(18%,68%)).
Conclusions
Disrupting the IRIS service substantially reduced the rate of referrals to DVA service providers. Our findings are evidence in favour of continuous funding and staffing of IRIS as a system level programme.
Funding
National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames.
Keywords
domestic violence and abuse, interrupted time-series, non-linear regression
Stopping smoking advice given by practice assistants after routine cervical screening in general practice: a qualitative exploration of potential barriers and enablers.
Authors: Mansour Marthe B.L. , Crone Matty R. , Weert Henk C. van , Chavannes Niels H. , Asselt Kristel M. van
Published: April 2020

The authors have withdrawn this preprint due to author disagreement.
Multivariate joint modeling to identify markers of growth and lung function decline that predict cystic fibrosis pulmonary exacerbation onset
Authors: Andrinopoulou Eleni-Rosalina , Clancy John Paul , Szczesniak Rhonda
Published: April 2020

Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a multi-system disease and the extent to which simultaneously modeling growth and nutrition markers improves PE predictive accuracy is unknown. Furthermore, it is unclear which routinely collected clinical indicators of growth and nutrition in early life predict PE onset in CF. Methods: Using a longitudinal cohort of 17,100 patients aged 6-20 years (US Cystic Fibrosis Foundation Patient Registry; 2003-2015), we fit a univariate joint model of lung-function decline and PE onset and contrasted its predictive performance with a class of multivariate joint models that included combinations of growth markers as additional submodels. Outcomes were longitudinal lung function (forced expiratory volume in 1 s of % predicted), percentiles of body mass index, weight-for-age and height-for-age and PE onset. Relevant demographic/clinical covariates were included in submodels. We implemented a univariate joint model of lung function and time-to-PE and four multivariate joint models including growth outcomes. Results: All five joint models showed that declining lung function corresponded to slightly increased risk of PE onset (hazard ratio from univariate joint model: 0.97, P < 0.0001), and all had reasonable predictive accuracy (cross-validated area under the receiver-operator characteristic curve > 0.70). None of the growth markers alongside lung function as outcomes in multivariate joint modeling appeared to have an association with hazard of PE. Jointly modeling only lung function and PE onset yielded the most accurate (area under the receiver-operator characteristic curve = 0.75) and precise (narrowest interquartile range) predictions. Dynamic predictions were accurate across forecast horizons (0.5, 1 and 2 years) and precision improved with age. Conclusions: Including growth markers via multivariate joint models did not yield gains in prediction performance, compared to a univariate joint model with lung function. Individualized dynamic predictions from joint modeling could enhance physician monitoring of CF disease progression by providing PE risk assessment over a patient’s clinical course.
Exploration of Anti-inflammatory Mechanism of Forsythiaside A and Forsythiaside B in CuSO4-Induced Inflammation in Zebrafish by Metabolomic and Proteomic Analyses
Authors: Gong Lihong , Yu Linyuan , Gong Xiaohong , Wang Cheng , Hu Naihua , Dai Xuyang , Li Yunxia
Published: April 2020

Background: Inflammation is a general pathological phenomenon during severe disturbance of homeostasis. Forsythiaside A (FA) and Forsythiaside B (FB) are phenylethanoid components isolated from dried fruits of Forsythia suspensa (Thunb.) Vahl., which show a significant effect against inflammation. However, the anti-inflammatory properties and therapeutic mechanisms of FA and FB have not yet been systematically clarified. Methods: In this study, the anti-inflammatory effects of FA and FB were investigated in CuSO4-induced inflammation in zebrafish. Intracellular ROS and NO generation in zebrafish were investigated using fluorescent probes. Metabolomics and proteomics analyses using liquid chromatography mass spectrometry were carried out to identify the expressions of metabolites and proteins associated with the treatment of FA and FB in CuSO4-induced inflammation in zebrafish larvae. Quantitative polymerase chain reaction (PCR) was performed to detect the progressive changes in genes. Results: FA and FB inhibited neutrophils migration to the damaged neuromasts and remarkably reduced CuSO4-induced ROS and NO generation in zebrafish. Metabolomic analysis indicated that Nicotinate and nicotinamide metabolism, Energy metabolism, Pyrimidine metabolism and Purine metabolism were mainly involved. Proteomic analysis identified 146 differentially expressed proteins between control and model group. The changed expressions of Collagen (collagen type II alpha 1b precursor (col2a1b), collagen alpha-2(IX) chain precursor (col9a2), collagen type IX alpha I precursor (col9a1b)), nucleoside diphosphate kinase 3 isoform X1 (Nme3), WD repeat-containing protein 3 (Wdr3), 28S ribosomal protein S7 mitochondrial precursor (Mrps7) in model group were all reversed after being treated by FA or FB. FA and FB could reverse the abnormal expressions of potential metabolite and protein biomarkers to alleviate CuSO4 damage to the neuromasts in the lateral line of zebrafish. Conclusions: Our results indicated that FA and FB possessed remarkable anti-inflammatory activities against CuSO4-induced neuromasts damage in zebrafish larvae, and suggested a multi-component and multi-regulatory therapeutic mechanism of FA and FB.
Cytokine profile in the sputum of subjects with post-tuberculosis airflow obstruction and in those with tobacco related chronic obstructive pulmonary disease
Authors: Guiedem Elise , Pefura-Yone Eric Walter , Ikomey George Mondinde , Nkenfou Céline , Mesembe Martha , Mbanyamsig Yivala Mispa , Bih Chende Hycenta , Greame Jacobs Brendon , Chegou Novel Njweipi , Okomo Marie Claire Assoumou
Published: April 2020

Background: Previous studies have shown that tuberculosis (TB) is a risk factor for chronic airflow limitation. Chronic obstructive pulmonary disease (COPD) is recognized as the result of chronic inflammation, usually related to noxious particles. Post-TB airflow obstruction and tobacco-related COPD have the same functional pathway characterized by persistent airflow limitation. We sought to compare the profile of 29 cytokines in the sputum of subjects with post-TB airflow obstruction and those with COPD related to tobacco.Results: The forced expiratory volume in the first second (FEV1) and forced expiratory volume/forced vital capacity (FEV/FVC) ratio were lower in the COPD patients with the history of smoking compared to the post-TB airflow obstruction subgroup. The stages of the disease were more advanced in COPD / tobacco patients. Among the cytokines, IL-1α, IL-1β, MIP-1β, sCD40L and VEGF levels were higher in COPD patients, compared to the controls with p values ​​of 0.003, 0.0001, 0.03, 0.0001 and 0.02 respectively. When the two COPD subgroups were compared, IL-1α, IL-6, TNF-α and IL-8 levels were higher in the COPD patients with the history of tobacco compared to the COPD patients with the history of TB with p-values ​​of 0.031, 0.05, 0.021 and 0.016, respectively. Conclusion: COPD related to tobacco is more severe than post-TB airflow obstruction. The pathogenesis of post-TB airflow obstruction appears to involve the cytokines IL-1RA, IL-1α, IL-1β, IL-17, GRO and sCD40L, while COPD related to tobacco involves more cytokines.
The Role of NMDA receptors in rat propofol self-administration
Authors: Chen Bei ping , Huang Xi-xi , Dong Dong-mei , Wu Hui , Zhu Tian-qi , WANG Ben-fu
Published: April 2020

Aim Propofol is among the most frequently used anesthetic agents, and it has the potential for abuse. The N-methyl-D-aspartate (NMDA) receptors are key mediators of both neural plasticity and development, as well as of addiction and neurodegeneration. Herein we explored the role of these receptors in rat propofol self-administration. Methods Rats were trained to self-administer propofol (1.7 mg/kg/infusion) using an FR fixed ratio schedule of the course of 14 sessions (3 h/day). After training, rats were intraperitoneally administered the non-competitive NDMA receptor antagonist MK-801, and then 10 minutes later were subjected to a propofol self-administration session. Results: After training, rats had acquired the ability to self-administer propofol successfully, as evidenced by a significant and stable rise in active nose-pokes leading to propofol administration relative to control nose-pokes (P<0.01) and became stable. Relative to control rats, rats that had been injected with 0.2 mg/kg MK-801 exhibited significantly more propofol infusions (F(3, 28)=4.372, P<0.01), whereas infusions were comparable in the groups administered 0.1 mg/kg and 0.4 mg/kg. In addition, MK-801 failed to alter numbers of active (F(3, 28)=1.353, P>0.05) or inactive (F(3, 28)=0.047, P>0.05) responses in study groups. Animals administered 0.4 mg/kg MK-801 exhibited significantly fewer infusions than animals administered 0.2 mg/kg (P=0.006, P<0.01). In contrast, however, animals in the 0.4 mg/kg MK-801 group exhibited a significant reduction in the number of active nose poke responses (F(3, 20)=20.8673, P<0.01) and the number of sucrose pellets (F(3, 20)=23.77, P<0.01), with increased locomotor activity (F(3, 20)=22.812, P<0.01). Conclusion These findings indicate that NMDA receptors may play a role in regulating rat self-administration of propofol.
The Relationship between Clinical Dishonesty and Perceived Clinical Stress among Nursing Students in Southeast of Iran
Authors: Rafati Foozieh , Bagherian Behnaz , Mangolian Parvin , Imani-Goghary Zahra
Published: April 2020

Background: Clinical dishonesty is a complex problem that threatens the health and safety of patients. This study aimed to investigate the relationship between clinical dishonesty and perceived clinical stress in nursing students. Method: This cross-sectional correlational study was conducted among 395 nursing students from 4 nursing colleges. Data were collected using a demographic information questionnaire, Nursing Student ' s Perception of Clinical Stressors, and a 12-item researcher-made questionnaire to evaluate the frequency of clinical dishonesty in the previous semester, the frequency of witnessing dishonest behavior among peers, and the perceived severity of behavior as unethical behavior. Results: In this study, 89.1% of the students had at least one dishonest clinical behavior in the previous semester. The frequency of clinical dishonesty was significantly correlated with the frequency of observing dishonesty among peers(r=0.053, p˂0.01), perceived severity of behaviors as unethical behavior(r=-0.4, p˂0.01), and perceived stress of students in the clinical setting(r=0.28, p˂0.01). Also, there was significant differences in the frequency of clinical dishonesty by gender (p=0.006), interest in the field of study (p=0.004) and academic year (p=0.002). Conclusion: The frequency of clinical dishonesty among nursing students is high and needs attention. Also, considering the positive relationship between dishonesty and perceived clinical stress, it is essential to teach effective strategies to nursing students to empower them to cope with clinical stress.
Building a Model for Predicting Target Gene Expression in Rice T-DNA Insertional Mutants by Machine Learning Approaches
Authors: Liao Chi-Chou , Chen Liang-Jwu , Lo Shuen-Fang , Chen Chi-Wei , Chen Jia-Jyun , Chu Yen-Wei
Published: April 2020

Background

T-DNA activation-tagging technology is widely used to enhance flanking gene expression near the site of insertion for functional genomics research in rice. However, whether the expression of a gene of interest is enhanced must be validated experimentally.
Results

In this study, we built a model to predict gene expression in T-DNA mutants by machine learning approaches, thereby improving the efficiency of screening for activated genes. We gathered experimental consisting of gene expression data in T-DNA mutants and captured the PROMOTER and MIDDLE sequences for encoding. In first-layer models, SVM models were constructed with nine features consisting of information about biological function and local and global sequences. Feature-encoding based on the PROMOTER sequence was weighted by logistic regression. The second-layer models integrated 16 first-layer models with feature selection and the algorithm, which were selected from nine feature selection methods and 65 classified methods, respectively. The accuracy of the final two-layer machine learning model, referred to as was 99.3% based on five-fold cross-validation, and 85.6% based on independent-testing.
Conclusion

We discovered that the information within the local sequence had a greater contribution than the global sequence with respect to classification had a good predictive ability for target genes within 20 from the 35S enhancer. Based on the analysis of significant sequences, the G-box regulatory sequence may also play an important role in the mechanism of activation of the 35S enhancer.
Roles of HDAC3-Orchestrated Circadian Clock Gene Oscillations in Diabetic Rats Following Myocardial Ischemia/Reperfusion Injury
Authors: Qiu Zhen , Ming Hao , Lei Shaoqing , Zhou Bin , Zhao Bo , Yu Yanli , Xue Rui , Xia Zhong-yuan
Published: April 2020

Background: Circadian clock has been closely related to the development of diabetes mellitus and cardiovascular disease; the disruption of circadian clock exacerbates myocardial ischemia/reperfusion injury (MI/RI). HDAC3 is a key component of the circadian negative feedback loop by recruitmenting the expression pattern of circadian nuclear receptor Rev-erbα, then to maintain the stability of circadian gene such as BMAL1. In this research, we explored the mechanism of HDAC3-orchestrated Rev-erbα/BMAL1 pathway in increasing MI/RI vulnerability of diabetes, and its relationship with mitophagy.Methods and results: Streptozocin (STZ) was used to establish type 1 diabetes by intraperitoneal injection. After 8 weeks, the diabetic and non-diabetic rats were exposed to MI/RI by ligating the left anterior descending coronary artery (LDA) for 30 minutes and reperfusion for 120 minutes at four time points of zeitgeber (ZT) 0, 6, 12 and 18. Circadian clock gene oscillations were rapidly attenuated in diabetic I/RI hearts, versus sham and/or the non-diabetic I/RI hearts, in accord with circadian mitophagy. By utilizing AAV-HDAC3 to knockdown HDAC3 expression, HDAC3 deficiency significantly attenuated diabetic MI/RI associated with increased autophagy activation. In vitro experiments, primary cardiomyocytes with or without HDAC3 siRNA and Rev-erbα siRNA exposed to hypoxia/reoxygenation (H/R). The expression of HDAC3 and Rev-erbα in cardiomyocytes was increased under high glucose condition with decreased BMAL1 expression and autophagy level. After H/R stimulation, the cell injury was obviously increased with upregulated HDAC3 and Rev-erbα expression and decreased BMAL1 level. Moreover, high glucose aggravated H/R injury compared with low glucose by reducing autophagy level, increasing the levels of HDAC3 and Rev-erbα and down-regulating BMAL1 expression. HDAC3 and Rev-erbα siRNA can alleviate high glucose and H/R-induced injury by up-regulating BMAL1 expression and mitophagy levels.Conclusion: These findings suggest that in diabetic rat MI/RI , the circadian clocks were rapidly impaired then to inhibit mitophagy; cardiac-targeted manipulation of HDAC3-orchestrated Rev-erbα/BMAL1 pathway may be the mechanism of the decreased toleration to ischemia with a circadian dependent variability.
Sex Differences in Stress Reactivity to the Trier Social Stress Test in Virtual Reality
Authors: Liu Qing , Zhang Wenjuan
Published: April 2020

Background: The aim of the present study is to investigate the sex differences in stress reactivity to the Trier Social Stress Test (TSST) in a virtual reality(TSST-VR). Methods: Healthy young male (n = 30) and female (n = 30) undergraduates were randomly assigned to a psychosocial stress protocol (TSST) condition or to a non-stressful control condition (Placebo-TSST) under VR. Electrodermal activity (EDA), heart rate (HR) and heart rate variability (HRV) were measured throughout the study. The subjective scales of stress and emotion were also conducted. Results: The results showed that after VR, the stress group reported higher stress perceptions than the non-stress group. Compared with females, the males stronger EDA and higher HRV before the VR, and lower HR during VR as well as higher HRV after VR. The correlation between subjective and objective reactivity demonstrated that HRV during VR was negatively correlated to depression and negative affect. The HRV after VR was negatively correlated to the positive coping but was positively correlated to the depression. Conclusions: These findings suggest that the TSST-VR could be used as an available tool for testing gender differences to social stress induction in experimental settings. Compared with females, males were more sensitive to stress.
Estimated treatment effects of tight glycaemic targets in mild gestational diabetes mellitus: a multiple cut-off regression discontinuity study design.
Authors: Song David , Hurley James C , Lia Maryanne
Published: April 2020

Background
We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups/World Health Organisation gestational diabetes mellitus (GDM) guidelines.
Methods
A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (n = 1178). Treatment of GDM women with the targets: fasting glucose of ≤ 5.0 mmol/L and the 2-hour post-prandial glucose of ≤ 6.7 mmol/L.
Results
Treated GDM women had lower rates of large for gestational age 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16–0.85); reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56–1.01). The subgroup analysis suggested that treatment of GDM women with BMI ≥ 30 kg/m2 drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4–0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA (p = 0.001) and caesarean sections (p = 0.015).
Conclusions
Tight glycaemic targets reduced rates of large for gestational age and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and insulin usage.
School trajectory disruption among adolescents living with perinatal HIV receiving antiretroviral treatments: a case-control study in Thailand
Authors: Merville Ophélie , Puangmala Patcharee , Suksawas Pranee , Kliangpiboon Woranut , Keawvilai Waraporn , Tunkam Chorkanikar , Yama Suvimon , Sukhaphan Usa , Sathan Somporn , Marasri Siriporn , Rolland-guillard Louise , Sirirungsi Wasna , Coeur Sophie Le
Published: April 2020

Background: In the HIV/AIDS pandemic, the perinatally HIV-infected children, who are surviving to adolescence, constitute a particular group, with specific needs to manage HIV disease and to prepare their future. Adolescents living with perinatal HIV (ALPHIV) often experience difficult living circumstances that can impact educational achievement and thus, insertion in the adult life. We explore the school trajectories of ALPHIV and determine the relative contribution of HIV-infection and the contextual environment to their schooling situations.Methods: We used data from the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional case-control study, conducted from 2011 to 2014 in Thailand. We analysed data for 707 ALPHIV (cases) aged 12–19 years, receiving antiretroviral therapy in 20 hospitals throughout Thailand and 689 HIV-uninfected adolescents (controls) living in the same institutions or, for those living in family settings, randomly selected in the general population and individually matched for sex, age and residence. Schooling disruption was defined as ≥1 year academic delay or early school dropout. Logistic regression was used to assess factors independently associated with schooling disruption and to estimate the attributable fraction of school disruption related to HIV-infection. We used multivariate imputations by chained equations to manage missing data and we performed two sensitivity analyses to evaluate the reliability of our main model.Results: ALPHIV were 5 times more likely to experience schooling disruption than controls after adjustment on sociodemographic factors ( ORA=5.2 [3.7-7.2]). About 50% of schooling disruption could be attributed to HIV-infection. Boys and adolescents living in institutions were more likely to experience schooling disruption (ORA =1.8 [1.3-2.4] and ORA =11.0 [7.7-15.8], respectively). Among ALPHIV, mental and growth delays were significantly associated with schooling disruption (ORA =3.3 [2.1-5.2] and =1.8 [1.3-2.6], respectively). For ALPHIV living in family, schooling disruption was also associated with stigmatization experiences (ORA =1.9 [1.2-3.1]) and caregiver’s low education (ORA =2.1 [1.1-3.9]). Conclusions: HIV and contextual factors combine to aggravate ALPHIV educational disadvantage. Further research is needed to clarify the pathways leading to a disrupted school trajectory among ALPHIV. The impact of this educational disadvantage on their life prospects, especially regarding access to higher education and professional achievement, should be explored in future research.
Loss of p53 expression in the gastric epithelial cells of Helicobacter pylori infected Jordanian patients
Authors: Abu-Lubad Mohammad A. , Helaly Ghada F. Helaly , Haddadin Weliam J. , Jarajreh Dua’a AK. , Aqel Amin A. , Al-Zeer Munir A.
Published: April 2020

Background: Helicobacter pylori infection is one of the most common chronic infections worldwide. Around half of the global population is chronically infected with this stomach bacterium. H. pylori infection is a strong risk factor for gastric cancer development. It is well-established that infection of the gastric epithelium with H. pylori induces the production of reactive oxygen species, DNA damage and accelerates the degradation of the tumor suppressor protein p53. This p53 dysregulation induced by H. pylori infection contributes to gastric carcinogenesis through complex processes including but not limited to cell proliferation and apoptosis. Methods: In the current study, we examined whether the epithelium of the gastric glands express p53 in subjects infected, chronically, with H. pylori. Seventy-five samples from Jordanian patients were analyzed for the presence of H. pylori as well as the p53 expression levels in the mucosa and submucosa by immunohistochemical analyses. Results: In H. pylori positive-specimens, p53-positive cells in the gastric mucosa were found significantly lower than in H. pylori negative-specimens. Conclusion: We demonstrated that p53 expression level is downregulated in gastric mucosa of patients from Jordan infected with H. pylori and this alteration may predispose individuals for possible tumor initiation in individuals chronically infected with H. pylori.
Derivation and validation of a novel and parsimonious prognosis prediction score for ischemic stroke patients: The S2AFI Score
Authors: Liu Xiaochuan , Luo Yunhe , Liu Yang , Li Xiaofan , Yan Zhimin , Zhao Jing
Published: April 2020

Background To develop and validate a novel and integer-based score to predict the unfavorable outcome at 3-month after ischemic stroke using a dataset from the Chinese population. Methods We retrospectively included 394 patients presented to our stroke center within 24 hours after symptom onset. 70% of them were randomly selected as the model derivation dataset and the remaining 30% as the model validation dataset. Step-wise logistic regression were applied to identify the strong predictors of the unfavorable outcome, which was defined as modified Rankin Scale (mRS) >2. Results We identified 4 strong predictors in the final prediction model: stroke severity, age, serum fibrinogen level and intravenous thrombolytic therapy. 2 points were assigned when patients with NIH stroke scale higher than 6 at admission. 1 point was assigned to patients older than 71 years old and serum fibrinogen level higher than 2.98g/L respectively. For patients miss the opportunity of intravenous thrombolysis therapy, 1 point was assigned. We called our score system as S2AFI score and it ranges from 0 to 5. The Youden index of the S2AFI score was 2 which means patients with 3 points or higher tend to have unfavorable outcome in the future. The discriminative ability of the S2AFI score as dichotomized predictor achieved an area under the curve of 0.72 (95% Confidence Internal 0.66-0.79) in the derivation dataset, 0.72 (95% Confidence Internal 0.61-0.83) in the validation dataset and 0.68 (95% Confidence Internal 0.63-0.74) in all patients. While for the S2AFI score as continuous predictor, the score achieved an area under the curve of 0.76 (95% Confidence Internal 0.69-0.83) in the derivation dataset, 0.74 (95% Confidence Internal 0.62-0.87) in the validation dataset and 0.74 (95% Confidence Internal 0.68-0.80) in all patients. There was a strong correlation between the S2AFI score and the risk of unfavorable outcome at 3-month (P for trend <0.001). Conclusions Our novel and parsimonious S2AFI score had good performance in the prediction of unfavorable outcome at 3-month after ischemic stroke.
Antibiotics prescreption pattern and resistance profile of common isolates at Soba university hospital in Khartoum, Sudan, a retrospective cross sectional study
Authors: Ahmed Fatima , Koko Abubaker , Mohamed Ola , Elhag Reem , Khalifa Sufian , Mohamed Mohamed , Abdelaziz Hind , Ahmed Almegadad , Abdelrahman Ihab
Published: April 2020

Introduction: Antimicrobial resistance (AMR) is an incrrasingly global public health threat. An average of 45% of all patients are prescribed antibiotics. Nearly 50% of these prescribed antibiotics are unnecessary and they may promote the emergence of resistant strains. Antimicrobial stewardship programs have been introduced to tackle this problem. In this study we aim to determine the pattern of antibiotics prescription and resistance profile of common bacterial isolates at Soba university hospital , Sudan. Methods: A retrospective cross sectional study that was conducted at the medicine and surgery wards in a tertiary care hospital . Records of all patients who were admitted during the study period were included. A presented data collection form was used to collect information. Results: Records of 269 inpatients were reviewed. The mean age of patients was 49.5±18.7 years. The most frequently reported diagnoses on admission included cerebrovascular accidents and chronic liver disease, with 10.6% and 7.1% respectively. Je mean duration of stay at the hospital was 6.6 ± 6 days. Almost 81.8% of admitted patients recieved antibiotics. The majority (38.7% and 34.2%) were given one, and two antibiotics, respectively. Most of the antibiotics were administered intravenously (82.1%). Third generation cephalosporin antibiotcs (38%) and metronidazole (21.7%) were the most frequently prescribed. No documented indication for antibiotic prescriptio was found in 40.5% of cases. The main reason for stopping antibitics was the patients discharge (63.6%). Of patients recieving antibiotics, only 5 (1.9%) had undergone culture. Complete blood count (CBC) was requesed in nearly all patients (99.2%). A total of 100 cultures were performed during the study time. Most of them were urine cultures (64%). Escherichia Coli was isolated from 14 (29.2%) cultures. Resistance percentage was highest for erythromycin, and oxacillin (100% for both). Conclusion: The study shows a trend of antibiotic misuse. Most patients recieved antibiotics without documented indication. Antibiotics sensitivity results showed high levels of resistance among isolated organisms. We recommended a wider study and formulation and impementation of clear guidlines to regulate antibiotics use.
External validation of the European risk assessment tool for cardio metabolic disease in a Middle Eastern population
Authors: Asgari Samaneh , Moosaie Fatemeh , Khalili Davood , Azizi Fereidoun , Hadaegh Farzad
Published: April 2020

Background: High burden of chronic cardio-metabolic disease (CCD) including type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD) have been reported in the Middle East and North Africa region. We aimed to externally validate a Europoid risk assessment tool designed by Alssema et al, including non-laboratory measures, for the prediction of the CCD in the Iranian population. Methods: The predictors included age, body mass index, waist circumference, use of antihypertensive, current smoking, and family history of cardiovascular disease and or diabetes. For external validation of the model in the Tehran lipids and glucose study (TLGS), the Area under the curve (AUC) and the Hosmer-Lemeshow (HL) goodness of fit test were performed for discrimination and calibration, respectively. Results: Among 1310 men and 1960 women aged 28-85 years, 29.5% and 47.4% experienced CCD during the 6 and 9-year follow-up, respectively. The model showed acceptable discrimination, with an AUC of 0.72(95% CI: 0.69-0.75) for men and 0.73(95% CI: 0.71-0.76) for women. The calibration of the model was good for both genders (min HL P=0.5). Considering separate outcomes, AUC was highest for CKD (0.76(95% CI: 0.72-0.79)) and lowest for T2DM (0.65(95% CI: 0.61-0.69)), in men. As for women, AUC was highest for CVD (0.82(95% CI: 0.78-0.86)) and lowest for T2DM (0.69(95% CI: 0.66-0.73)). The 9-year follow-up demonstrated almost similar performances compared to the 6-year follow-up. Conclusion: This model showed acceptable discrimination and good calibration for risk prediction of CCD in short and long-term follow-up in the Iranian population.
Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: A perspective from a developing country.
Authors: James Vinson , Prakash Anand , Mehta Kayur , Durugappa Tarangini
Published: April 2020

Background: This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly.Methods: A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. Children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS.Results: One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 52.2% gram negative isolates followed 35.8% gram positive isolates, 6.5% fungal isolates and 5.5% poly-microbial cultures. Lactose fermenting gram negative bacteria (29 isolates, 31.5%) were the most frequently isolated in the gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst gram positive coagulase negative staphylococcus (CONS) was the most common (29%). Escherichia coli and NFGNB had only 36%, 25% sensitivity to ceftazidime respectively. Most gram negative bacteria were found to have better sensitivity to amikacin (mean: 57). There was a higher prevalence of extended spectrum beta lactamase producing organisms. 36 out of 48 GNB were found to be either multi/extremely/pan drug resistant. Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with gram negative isolates (61.5%)Conclusions: In view of higher prevalence of gram negative isolates and emergence of multi drug resistance, frequent audits of resistance patterns should guide the choice of antimicrobials in febrile neutropenia management. Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant gram negative bacteria, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.
Elevated cord blood oxidative stress biomarkers negatively affect neonatal outcomes of mothers with severe preeclampsia: A case-control study
Authors: liu linli , Zheng Beihong , Jiang ZhongQing , Wu SanShan , Jin Qiong , Lin PeiHong , Lin Zhou
Published: April 2020

Background

To determine the relationship between the levels of stress biomarkers in cord blood and preeclampsia in a hospital-based population of pregnant patients, and to evaluate the resulting effects on pregnancy outcomes.
Measures:

This prospective case-control study included a total of 282 severe preeclamptic and 534 normal pregnant women. Fetal blood was collected from the umbilical cord at delivery and was utilized for Malonaldehyde (MDA), reactive oxygen species (ROS, superoxide dismutase (SOD) and homocysteine (Hcy) analysis. For a better assessment, we performed a univariate general linear regression model to control for potential confounders and determined the underlying influencing factors for high MDA and ROS. Moreover, a receiver operating characteristic curve analysis was conducted to determine the cutoff values for identifying severe preeclampsia. Further, the severe PE group was divided into the low or high MDA and low or high ROS subgroups according to their cut-off values. Finally, we created logistic regression models to estimate the adjusted odds ratio for each perinatal outcome in high-MDA and -ROS subgroup.
Results

MDA and ROS levels are higher in women with severe preeclampsia than in normotensive pregnant patients. However, when adjusted for cord blood Hcy levels, the difference is insignificant. Additionally, both MDA (r = 0.359, p < 0.001) and ROS (r = 0.473, p < 0.001) are positively correlated with cord blood Hcy level. The AUCs of MDA and ROS levels were 0.65 (95% CI: 0.60–0.69) and 0.88 (95% CI: 0.86–0.90), respectively, for predicting severe PE. Higher MDA and ROS levels are associated with increased risks of low Apgar score, admission to the NICU, and assisted ventilation for the newborn.
Conclusion

Increased levels of cord blood oxidative stress markers are significantly associated with negative effects on newborns. High cord blood Hcy levels might be involved in the observed elevated MDA and ROS concentrations in women with severe PE.
Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings
Authors: Fischer Joachim E , Genser Bernd , Nauroth Peter , Litaker David , Mauss Daniel
Published: April 2020

Background Absence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates. MethodsWe aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work conditions as the best proxy to an “objective” assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics. Results Data from 3992 eligible participants from 29 work groups were analyzed (39 percent participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1% to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70 percent of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target. Conclusions Psychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.
Predictive factors for pleural drainage volume after uniportal video-assisted thoracic surgery lobectomy for non-small cell lung cancer: a single-institution retrospective study
Authors: Tang Ming-bo , Li Jia-lin , Tian Su-yan , Gao Xin-liang , Liu Wei
Published: April 2020

Objective: To identify predictive factors associated with pleural drainage volume (PDV) after uniportal video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC).Methods: A total of 440 consecutive NSCLC patients who underwent uniportal VATS lobectomy were enrolled in this study between November 2016 and July 2019. Twenty-eight parameters, including patients’ clinicopathological characteristics and other potential predictors were collected. Daily drainage volume was summed up as PDV. Univariate analysis and multivariate regression models were fitted to identify independent predictive factors for PDV.Results: The median PDV was 840 ml during the median drainage duration of 4 days. A strong correlation was observed between PDV and drainage duration (correlation coefficient = 0.936). On univariate analysis, age, forced expiratory volume in 1 second % predicted (FEV1%), left ventricular ejection fraction (LVEF), operation time, serum total protein (TP), and body mass index (BMI) showed a significant correlation with PDV (P value, ＜ 0.001, ＜ 0.001, 0.003, 0.008, 0.028 and 0.045, respectively). Patients with smoking history (P = 0.030) or who underwent lower lobectomy (P = 0.015) showed significantly increased PDV than never smokers or those who underwent upper or middle lobectomy, respectively. On multivariate regression analysis, older age (P ＜ 0.001), lower FEV1% (P ＜ 0.001), lower LVEF (P = 0.011), lower TP (P = 0.013), and lower lobectomy (P = 0.016) were independent predictors of increased PDV.Conclusions: Predictive factors of PDV can be identified. Based on these predictors, patients can be treated with tailored individualized safe chest tube management.
Interferon Regulatory Factor 5 Mediates Lipopolysaccharide Induced Neuroinflammation
Authors: Fan Ziqi , Zhao Shuai , Zhu Yueli , Li Zheyu , Liu Zhirong , Yan Yaping , Chen Yanxing , Zhang Baorong
Published: April 2020

Background

Activated microglia plays a vital role in neuroinflammation in central nervous system (CNS), which is associated with the pathogenesis and the progression of neurological diseases. Interferon regulatory factor 5 (IRF5) has been well established participating in inflammatory responses and is highly expressed in M1 macrophage in periphery, the role of which in the CNS remains elusive.
Methods

Lipopolysaccharide (LPS) was employed to induce neuroinflammation. Down-regulation of IRF5 in C57/BL6 mice and BV2 microglial cells were achieved by IRF5 siRNA transfection. The levels of pro-inflammatory cytokines were evaluated by ELISA and quantitative real-time PCR. The expression levels of IRF5 were examined by immnunofluorescence and Western blot.
Results

LPS induced significantly elevated expression of IRF5 in mouse brain, which co-localized with CD11b positive microglia. Down-regulation of IRF5 quenched the pro-inflammatory responses. The levels of pro-inflammatory cytokines TNF-α, IL-1β and IL-6 were up-regulated at 4 h after LPS treatment, which were significantly down-regulated with the knockdown of IRF5. LPS-induced pro-inflammatory responses were transient, which returned to basal level at 24 h after LPS treatment. However, LPS did not up-regulate the expression of IRF5 in BV2 microglial cells, indicating that LPS-induced inflammation in BV2 cells does not involve IRF5 signaling.
Conclusions

IRF5 mediates the inflammatory responses in the CNS, which might serve as a therapeutic target for CNS inflammatory diseases. LPS-induced inflammation does not involve IRF5 signaling in BV2 microglia.
Investigating host and parasite factors surrounding seasonal malaria chemoprevention in Bama, Burkina Faso
Authors: Somé Anyirékun , Bazié Thomas , Y. Ehrlich Hanna , Goodwin Justin , Lehane Aine , Neya Cathérine , Kabre Zakary , Wade Martina , OUATTARA Jean-Marie , Foy Brian , Dabiré K. Roch , Parikh Sunil , Ouédraogo Jean-Bosco
Published: April 2020

Background: Since 2014, seasonal malaria chemoprevention (SMC) with amodiaquine-sulfadoxine-pyrimethamine (AQ-SP) has been implemented on a large scale during the high malaria transmission season in Burkina Faso. We report in this paper the prevalence of microscopic and submicroscopic malaria infection at the outset and after the first round of SMC in children under five years old in Bama, Burkina Faso, as well as host and parasite factors involved in mediating the efficacy and tolerability of SMC. Methods: Two sequential cross-sectional surveys were carried out in the first month of SMC in a rural area in southwest Burkina Faso. Blood smears and dried blood spots were collected from 106 and 93 children under five, respectively, at the start of SMC and again three weeks later. Malaria infection was detected by microscopy and by PCR from dried blood spots. For all children, day 7 plasma concentrations of desethyl-amodiaquine (DEAQ) were measured and CYP2C8 genetic variants influencing AQ metabolism were genotyped. Samples were additionally genotyped for pfcrt K76T and pfmdr1 N86Y, molecular markers associated with reduced amodiaquine susceptibility. Results: 2.8% (3/106) of children were positive for Plasmodium falciparum infection by microscopy and 13.2% (14/106) by nested PCR within 2 days of SMC administration. Three weeks after SMC administration, in the same households, 4.3% (4/93) of samples were positive by microscopy and 14.0% (13/93) by PCR (p=0.0007). CYP2C8*2, associated with impaired amodiaquine metabolism, was common with an allelic frequency of 17.1% (95%CI=10.0-24.2). Day 7 concentration of DEAQ ranged from 0.48 to 362.80 ng/mL with a median concentration of 56.34 ng/mL. Pfmdr1 N86 predominated at both time points, whilst a non-significant trend towards a higher prevalence of pfcrt 76T was seen at week 3. Conclusion: This study showed a moderate prevalence of low-level malaria parasitemia in children 3 weeks following SMC during the first month of administration. Day 7 concentrations of the active DEAQ metabolite varied widely, likely reflecting variability in adherence and possibly metabolism. Our findings highlight factors that may contribute to the effectiveness of SMC in children in a high transmission setting.
Microstructure and fracture behaviour of composite structured Ti( C , N ) based cermets
Authors: Liu Aijun , Chen kebei , Liu Ning , Zhang Xialing , Chen Jigui
Published: April 2020

Microstructure and fracture behavior of composite structured Ti(C,N) based cermets were investigated, and compared to that of conventional Ti(C,N)-based cermets. Composite structure of the Ti(C,N) based cermets consists of cobalt enriched area,cobalt poor area and coarse granule. The fracture toughness of composite structured Ti(C,N) based cermets have higher than that of conventional Ti(C,N)-based cermets. The fracture morphology of the cermets were clearly observed, suggesting the effective load transfer between cobalt enriched area and cobalt poor area. Load transfer toughening mechanisms of composite structured Ti(C,N) based cermets can be deduced in this paper.