bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Posterior Glenoid Bone-Grafting in Anatomical Total Shoulder Arthroplasty
Authors: Gates Stephen , Cutler Holt , Khazzam Michael
Published: September 2019

Background:

Total shoulder arthroplasty offers a reliable means with which to treat glenohumeral joint arthritis. Posterior glenoid bone loss presents a unique challenge with an increased risk of glenoid component failure. The use of posterior bone-grafting is one method to address glenoid bone loss in patients undergoing anatomical total shoulder arthroplasty. The purpose of the present study was to assess the outcome and survival of the glenoid component following the use of bone graft to address posterior glenoid bone loss in patients undergoing anatomical total shoulder arthroplasty.

Methods:

A systematic review of posterior glenoid bone-grafting in patients undergoing anatomical total shoulder arthroplasty was performed. Studies evaluating patient-reported outcomes, complications, and imaging assessments of the glenoid component as well as of bone graft structural healing and integrity following posterior glenoid bone-grafting were included. Data extracted included demographic characteristics, Walch classification, bone-grafting method, clinical outcomes measures, complications, radiolucency around the glenoid component, graft failure, posterior humeral head subluxation, and time of the latest follow-up.

Results:

Six studies met the inclusion and exclusion criteria. Ninety-four patients from these 6 studies underwent posterior glenoid bone-grafting with anatomical total shoulder arthroplasty. The mean age was 59.7 years, and the mean duration of follow-up was 5.7 years. Overall, 57% of the patients had an excellent postoperative Neer score. At the time of the latest follow-up, 28.7% had evidence of radiolucency and 35% had humeral head subluxation or instability. Thirteen patients (14%) underwent revision of the glenoid component by the time of the latest follow-up.

Conclusions:

The present study demonstrated a 28.7% complication rate, a 14% revision rate, a 17% graft failure rate, and a 35% rate of recurrence of posterior humeral head subluxation. Posterior glenoid bone-grafting to correct bone loss is associated with a substantial risk of postoperative complications. The treatment of posterior glenoid bone loss remains a challenge in patients undergoing anatomical total shoulder arthroplasty.

Level of Evidence:

TherapeuticLevel IV. See Instructions for Authors for a complete description of levels of evidence.
Awareness of Myopia: A Survey Among Parents Residing in Singapore
Authors: Salim Arief Tjitra , Keel Stuart , Foreman Joshua , Dirani Mohamed
Published: September 2019

Background: Given the rising public health burden of myopia, population-based data on the level of awareness about myopia amongst parents in Singapore are required for planning future awareness campaigns and public health interventions. This study aimed to evaluate the level of awareness of myopia amongst a group of parents residing in Singapore.
Methods: This study was a cross-sectional survey. A sample of 326 participants aged 19 to 69 years with at least 1 child were recruited at The Kidz Academy (TKA) 2018 exhibition in Singapore. Socio-demographic characteristics, smart device use and awareness of myopia (prevalence and mitigation strategies) were collected via an interviewer-administered online questionnaire.
Results: 56.7% (185/326) of survey respondents were aware of the high prevalence of myopia amongst secondary school-going Singaporean children. 18.1% (59/326) of the respondents reported that an eye-to-screen distance of less than 30 cm was acceptable and 27.0% (88/326) were unaware of the importance of regular eye examinations among children. Less than half of the respondents [46.6% (152/326)] correctly identified that Singaporean children spend at least 6.5 hours a day on digital screens. 87.7% (286/326) were aware of the importance of outdoor activity as an intervention to slow the progression of myopia, with female respondents significantly more likely to be aware of its importance [odds ratio (OR) = 2.12, 95% confidence interval = 1.09 – 4.13, χ2 = 4.86, P = .03].
Conclusion: Survey respondents demonstrated a good level of awareness of the high prevalence of myopia in Singapore and the protective role of outdoor activity in its development and progression. Awareness campaigns may be beneficial for promoting regular eye examinations amongst children and educating the public on the risk of excessive time spent on smart devices.
Ability of Real-time PCR for Differential Diagnosis of Various Forms of Cutaneous Leishmaniasis: A Comparative Study with Histopathology
Authors: Abadi Maryam Fekri Soofi , Fekri Meisam , moradabadi alireza , Vahidi Reza , Meymandi Simin Shamsi , Dabiri Donya , dabiri shahriar
Published: September 2019

objective: Histopathological studies suggest that parasite load is different between acute and chronic forms of cutaneous leishmaniasis (CL). However, highly sensitive detection methods are still needed to distinguish different forms of leishmaniasis. In the present study, we developed a quantitative real-time polymerase chain reaction (PCR) to detect and quantify leishmania tropica parasites in paraffin-embedded tissue samples.
Results: The ability of real-time PCR for leishmania detection was higher than histopathological evaluation. The parasite loads were quantified by qPCR assay and microscopic evaluation were highly correlated ( r =0.598; P <0.001). Among patients, the parasite load was inversely correlated with disease duration (acute CL lesions had very higher parasite loads than chronic CL lesions), but there was no difference in parasite load according to the patients’ age and sex as well as location of the lesions. In contrast to Ridley scoring system (P<0.001), there were no statistically significant differences in the relative number of parasites among the lupoid and non-lupoid forms of chronic lesions in real-time PCR (P=0.549), which indicates the superiority of histopathological evaluation in CL forms differentiation.
Fetal pulmonary valvuloplasty in fetuses with right ventricular outflow tract obstructive disease: experience and outcome of the first five cases in China
Authors: Pang Chengcheng , Pan Wei , Zhang Zhiwei , Zhou Chengbin , Li yufan , Zhang Xu , Han Fengzhen , Sun Yunxia , Wang Cheng , Zhuang Jian
Published: September 2019

Background To report our initial experience of fetal pulmonary valvuloplasty (FPV) in fetuses with pulmonary atresia with intact ventricular septum (PA/IVS) or critical pulmonary stenosis (CPS), including the experiences of case selection, technical feasibility, post-FPV effects in utero and the postnatal outcome. Methods Two cases with fetal PA/IVS and three cases with fetal CPS were enrolled between September 2016 and April 2018, and all cases were diagnosed with severe right ventricular dysplasia and growth arrest by fetal echocardiogram. Parameters of right heart structure development and hemodynamics from echocardiography included tricuspid /mitral annulus ratio (TV/MV), right ventricle/left ventricle long-axis ratio (RV/LV), tricuspid valve inflow duration/cardiac cycle ratio (TVI/CC), degree of tricuspid regurgitation (TR), blood flow direction of arterial duct and ductus venosus. FPV procedure was performed trans-abdominally under ultrasound-guidance. Echocardiography was performed post-procedure immediately and every 2-4 weeks until delivery. Results Seven FPV have been performed in the five fetuses with PA/IVS or CPS. The median gestational age at the time of FPV was 28 weeks. From technical perspective, pulmonary balloon valvuloplasty was successfully performed in all cases. The opening of pulmonary valve improved in these five cases in 2-4 weeks. However, progressive restenosis was detected in four fetuses during advancing gestation and re-atresia occurred in two PA/IVS cases at 36 weeks and 37 weeks gestation, respectively. The growth trajectories of TV/MV, RV/LV, and TVI/CC improved in the first weeks, and then slowed down along with the pulmonary valve restenosis. All fetuses were born alive and underwent postnatal interventions, including pulmonary balloon valvuloplasty in 3 cases and surgical procedures in 2 cases. During the follow-up, three fetuses became biventricular, one case became one and a half ventricular at one year of age and the other one died of neonatal infection. Conclusion FPV is feasible and safe for fetuses during the second and third trimester of pregnancy. PV restenosis may occur as pregnancy advances, but overall, FPV still improved the growth trajectories of fetal right heart structures and has the potential to alter the natural history of PA/IVS and CPS.
The effect of Liv-52 on liver ischemia reperfusion damage in rats
Authors: Cimen Orhan , Eken Huseyin , Cİmen Ferda Keskin , Cekic Arif Burak , Kurt Nezahat , Bilgin Asli Ozbek , Suleyman Bahadir , Suleyman Halis , Mammadov Renad , Pehlivanoglu Kamil , Kurnaz Eray
Published: September 2019

Background: Liver ischemia reperfusion (I/R) damage is frequently seen in clinical hepatobiliary surgeries and there is no effective treatment for it. Liv-52, known to have hepatoprotective effects, is a natural antioxidant drug licensed by Ministry of Health of India. Therefore, the aim of our study is to investigate the effect of Liv-52 on liver damage induced by I/R in rats.Methods: Albino Wistar male rats were divided into three groups; liver I/R (IR), 20 mg/kg Liv-52 + liver ischemia reperfusion (LIR) and sham operation applied to control group (HG). Liv-52 was administered to the LIR group (n-6) one hour prior to I/R application and distilled water was given orally to IR (n-6) and HG (n-6) groups as a solvent. In animals, ischemia was determined as one hour, and reperfusion was identified as six hours.Results: Increased levels of alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase, malondialdehyde, myeloperoxidase, and decreased levels of superoxide dismutase, and glutathione related enzymes caused by I/R application have been converged to healthy group level with Liv-52 treatment and the damage occurred in liver tissue has been improved histopathologically.Conclusions: Liv-52 may be beneficial for preventing liver I/R damage in pre-surgery application.
Three Easily-Implementable Changes Reduce Median Door-To-Needle Time for Intravenous Thrombolysis by 23 Minutes
Authors: Tran Demi , Zhu Zhu , Shafie Mohammad , Abcede Hermelinda , Stradling Dana , Yu Wengui
Published: September 2019

Background:The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 minutes at the U.S. stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT.
Methods: This is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IV tPA in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups.
Results: Ninety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p=0.007).The median DNT with interquartile range (IQR) was reduced significantly by 23 minutes (63[53-81] versus 40[29-53],p<0.001) with more patients in the post-intervention group receiving IVT within 60 minutes (81.6% versus 46.7%) and 45 minutes (64.0% versus 17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs 1.1%), functional independence at discharge (mRS 0-1, 29.4% vs 23.3), and hospital mortality (7.4% vs 6.7%) between the 2 groups.
Conclusions:Three easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly. It is safe and can be easily adopted at other stroke centers.
Factors determining recurrence in transient global amnesia
Authors: Tynas Rebecca , Panegyres Peter K
Published: September 2019

Aetiology of transient global amnesia (TGA) remains uncertain, though many have been proposed, including ischaemic, migrainous or epileptic pathologies. We attempted to determine risk factors for TGA, as well as prognostic factors that may cause recurrence. We evaluated clinical history, family history and magnetic resonance diffusion-weighted imaging (DWI) studies of 93 prospective patients with TGA. Patients were followed up regarding recurrence and prognostic factors. Fifteen of 93 (16%) patients experienced a recurrence of TGA. Among precipitating events, physical activities inducing Valsalva-like manoeuvres were most common, followed by emotional stress. Eighty-four patients had possible comorbidities or risk factor for TGA, though no single risk factor was ubiquitous. Risk factors associated with recurrence were head injury (isolated vs. recurrent, 16,7% vs. 53.5%, p < 0.01), depression (isolated vs. recurrent, 15.4% vs 46.7%, p = 0.01) and family history of dementia (isolated vs. recurrent, 20.5% vs 46.7%, p = 0.03). Of 15 patients with confirmed recurrent TGA, two developed dementia and four subjective memory impairment. DWI lesions were observed in 24 patients and located anywhere within the hippocampus. DWI lesions were not significantly associated with outcomes (recurrence, subjective memory impairment, dementia). Findings suggest TGA is a heterogeneous syndrome. Among those with recurrence, depression, previous head injury and family history of dementia may be predictive factors. Encouraging primary prevention of head injury, managing depression and assisting in development of adequate coping mechanisms may decrease incidence. Education of healthcare works will also increase diagnostic rates, allowing for improved education and comfort for patients and families.
Gray matter abnormalities in pediatric focal and generalized epilepsy: A voxel-based morphometry study with MRI at 3.0 T
Authors: zhang huanrui , Liu Hongsheng , Chen Wenxiong , Liu Guangjian , Zhou Baosen , Liang Huiying
Published: September 2019

Background : Our aims were to explore gray matter volume (GMV) abnormalities in focal and generalized epilepsy children compared to healthy group using a voxel-based morphometry (VBM) methodology, and to determine whether the regions of any observed structural changes are correlated with clinical characteristics.
Methods: Thirty-two epilepsy children ( 18 with focal epilepsy, 14 with generalized epilepsy) and 18 control subjects were recruited. All participants were imaged structural MRI scans with a 3.0 T MR system. VBM analysis using statistical parametric mapping 8 (SPM8) was first performed to detect gray matter reduction in focal and generalized epilepsy children compared to controls. Then we analyzed the correlations between GMV changes and clinical features of epilepsy patients.
Results: In the patient-control group comparison of VBM, the left hippocampus, left thalamus, left paraHippocampal and bilateral putamen exhibited a significantly GMV decreased. In stratified analysis, the focal epilepsy children showed GMV reductions in left thalamus, left hippocampus and bilateral putamen relative to controls; the GMV exhibited extensive reductions in left parahippocampal, left putamen, and right supplementary motor area in generalized epilepsy children compared to controls. No significant difference was found in regions of GMV abnormalities correlated with disease durationand age of onset in both the focal and generalized epilepsy groups.
Conclusions: By performing VBM to detect GMV changes in children, our study demonstrates the GMV reductions exist in different regions in focal and generalized epilepsy patients. Our study further provides structural neuroimaging evidence on the pathophysiology of focal and generalized epilepsy children.
Transcriptomic analysis of the testicular fusion in Spodoptera litura
Authors: Liu Lin , Chen Yaqing , Ou Jun , Liu Yucheng , Wu Qiong , Wen Liang , Zheng Sichun , Li Sheng , Feng Qili
Published: September 2019

Background Lepidoptera is one group of the largest plant-feeding insects and Spodoptera litura (Lepidoptera: Noctuidae) is one of the most serious agricultural pests in Asia countries. An interesting and unique phenomenon for gonad development of Lepidoptera is the testicular fusion. Two separated testes fused into a single one during the larva-to-pupa metamorphosis, which is believed to contribute to sperm production and the prevalence in field. To study the molecular mechanism of the testicular fusion, RNA sequencing (RNA-seq) experiments of the testes from 4-day-old sixth instar larvae (L6D4) (before fusion), 6-day-old sixth instar larvae (L6D6, prepupae) (on fusing) and 4-day-old pupae (P4D) (after fusion) of S. litura were performed.Results RNA-seq data of the testes showed that totally 12,339 transcripts were expressed at L6D4, L6D6 and P4D stages. A large number of differentially expressed genes (DEGs) were up-regulated from L6D4 to L6D6, and then more genes were down-regulated from L6D6 to P4D. The DEGs mainly belongs to the genes related to the 20E signal transduction pathway, transcription factors, chitin metabolism related enzymes, the families of cytoskeleton proteins, extracellular matrix (ECM) components, ECM-related protein, its receptor integrins and ECM-remodeling enzymes. The expression levels of these genes that were up-regulated significantly during the testicular fusion were verified by qRT-PCR. The matrix metalloproteinases (MMPs) were found to be the main enzymes related to the ECM degradation and to contribute to the testicular fusion. The testis was not able to fuse if MMPs inhibitor GM6001 was injected into the 5th abdomen region.Conclusions The transcriptome and DEGs analysis of the testes at L6D4, L6D6, P4D stages provided genes expression information related to the testicular fusion in S. litura . These results indicated that cytoskeleton proteins, ECM-integrin interaction genes and ECM-related proteins was involved in cell migration, adhesion and fusion during the testicular fusion. The ECM degradation enzymes MMPs probably play a critical role in the fusion of testis.
Perceptions and practices of general practitioners on providing oral health care to people with diabetes - A qualitative study
Authors: Poudel Prakash , Griffiths Rhonda , Wong Vincent W , Flack Jeff R , Arora Amit , Khoo Chee L , George Ajesh
Published: September 2019

Background

Poorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes.

Methods

We employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from the Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes.

Results

A majority of participants were males (n=10), working in group practices (n=11) with a mean±SD age of 55±11.4 years and 25±13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and diabetes care provider’s role in promoting oral health.

Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20-30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited.

GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health.

Conclusions

Despite current recommendations, GPs' current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.
Analysis of cumulative fluid balance impact on the stability of gastrointestinal tract anastomoses
Authors: Orhalmi Julius , Turek Z. , Čečka F. , Páral J. , Dolejš J. , Kallarackal A.P. , Kaška M. , Sotona O. , Malý Ondřej , Mynář M. , Černý V.
Published: September 2019

Background Anastomotic leakage is a serious post-operative complication after rectal resection. The main objective of this study was to gauge the impact of cumulative fluid balance on microcirculatory changes at anastomotic sites in the wall of the large bowel. Methods The study was performed using 14 female domestic pigs. Rectal resection was performed on all of them. During the operation and post-operative period they received IV crystalloids at constant rates 5,10 and 15ml/h. Large bowel micro-perfusion was observed at several points during the experiment using LDF. Each subject was observed for six hours after surgery.The measured LDF values for each group was statistically analyzed using Levene’s test and Welch’s ANOVA. Results The primary findings of this study found that the group mean values agreed at baseline; i.e., prior to intervention, as well as at the end of the study(p > 0.05). The same result was also confirmed for the second measurement, and the next to last measurement(p > 0.05). Conversely, differences in group mean values were demonstrated at the 2 intermediate time points (p <0.05). Conclusions The original hypothesis of a blood perfusion disorder developing in the large bowel region after administration of large fluid volumes was not confirmed. However, a 10 fold decrease in blood supply to the large bowel was observed after inferior mesenteric artery ligation. Secondarily, LDF was found to have high accuracy in measuring tissue microcirculation and has the potential to be used in clinical practice.
Long-term Tracing of Carbon Nanoparticles for Axillary Lymph Node Dissection in Patients with Fusion Lymph Nodes before Neoadjuvant Chemotherapy
Authors: Li Jian-Yi , Jia Shi , Wang Yi-Tong , Zhang Yang , Kong Lin-Na , Qi Ji , Cao Ya-Nan , Liu Yu-Shi , Zhang Yan , Chen Bo
Published: September 2019

Background: The regression model of positive nodes in breast cancer after neoadjuvant chemotherapy (NAC) remains controversial. This study aimed to investigate this regression model by injecting and tracing carbon nanoparticles (CNs) into the fusion node prior to NAC in patients with breast cancer. Methods: Guided by ultrasound, 0.3 mL of CNs suspension was injected in a fusion node prior to NAC in 110 patients with local advanced breast cancer. Patients underwent breast surgery and total axillary lymph node dissection following 2-6 cycles of NAC. The distribution by intercostobrachial nerves (ICBN) of positive nodes, black-stained nodes and lymphovascular invasion was investigated by response to NAC. Results: When patients were ranked by response to NAC (from sensitive to resistance), the number of positive nodes increased, as did the proportion of lymphovascular invasion, the number of black-stained nodes decreased. A significantly negative relationship was found between the number of positive nodes and the number of black-stained nodes (p < 0.001). The positive nodes in patients with sensitive consequence followed the rule from under the ICBN to above the ICBN. However, there was counter-example (skip metastasis) in the patients with resistance result. Conclusion: The regression model of positive nodes follows the rule from upper to under, inner to outer in the patients with sensitive consequence to NAC. Long-term staining and tracing by CNs might provide an acceptable and feasible technique to investigate the regression model of positive nodes, and would be a potential method for NAC-treated patients by using of ICBN. Trial registration: NCT 03355261. Retrospectively registered on November 28, 2017.
Prevalence and associated factors of Tardive dyskinesia among psychiatric patients on first-generation antipsychotics at Jimma University specialized hospital, psychiatric clinic, Ethiopia: Institution based a cross-sectional study
Authors: Abdeta Tilahun , Tolessa Daniel , Tsega Wondale
Published: September 2019

Background Tardive Dyskinesia is described as a movement disorder that can be caused by the prolonged use of antipsychotics. It is a permanent condition that affects quality of life. However, studies on TD among psychiatric patients in Ethiopia are limited. The objective of this study was to determine the prevalence and associated factors of Tardive dyskinesia among psychiatric patients on first-generation antipsychotics at Jimma University specialized hospital (JUSH) psychiatric clinic, Jimma, South west Ethiopia.Method Hospital based cross-sectional study was conducted using Abnormal Involuntary Movement Scale (AIMS) and Schooler and Kane research criteria to identify cases of first-generation antipsychotic-induced TD among 151 psychiatric outpatients on first-generation antipsychotics at Jimma University Specialized Hospital psychiatric clinic. Simple random sampling method was employed to select subjects from a total of 912 patients on follow-up and logistic regression analysis was employed to identify associated factorsResult In our study the prevalence of first-generation antipsychotic induced TD was 14.6% (95%CI: 10.76%, 18.4%). In the final model multivariate logistic regression analysis revealed that age (AOR 4.5, 95%CI: 9.7, 20.4), current smoking cigarettes (AOR 1.4, 95%CI: 2.6, 7.8) and chlorpromazine equivalent dose (AOR 6.5, 95%CI: 2.6, 26.8) had statistically significant association with first-generation antipsychotic induced TD.Conclusions Considerable number of psychiatric patients were suffered from first-generation antipsychotic induced TD. Age and current smoking cigarettes and chlorpromazine equivalent dose had significant association with first-generation antipsychotic induced TD. Therefore, stakeholders should consider and appropriately address these statistically identified associated factors in order to reduce antipsychotic induced TD.
Etiology analysis of lower gastrointestinal bleeding in children
Authors: liu yun , Chen XiuWen , Wan ShengHua
Published: September 2019

Background: In a clinical setting, the common causes of lower gastrointestinal bleeding are often easy to identify, but some cases require detailed examinations to make a diagnosis. At present, the cause of lower gastrointestinal bleeding is unclear. The aim of this study was to review cases of children hospitalized for lower gastrointestinal bleeding in the past 5 years at our hospital and analyze the etiologies according to age group.Methods: In this study, we statistically analyzed the etiologies of lower gastrointestinal bleeding in children of different ages and sexes from Jiangxi Province, China. From January 2013 to August 2018, 8,036 patients hospitalized for lower gastrointestinal bleeding in Jiangxi Provincial Children’s Hospital were divided into groups to analyze the etiologies.Results: Of these 8,036 patients, 7,827 were clearly diagnosed. Etiologies included intussusception (4,741 cases, 60.6%), infectious diarrhea (2,171 cases, 27.7%), colon polyps (405 cases, 5.2%), Meckel’s diverticulum (292 cases, 3.7%), allergic colitis (113 cases, 1.4%), anal fissures (34 cases, 0.4%), Henoch-Schönlein purpura (27 cases, 0.3%), eosinophilic gastrointestinal disease (27 cases, 0.3%), and inflammatory bowel disease (17 cases, 0.2%). Generally, the condition presents with blood in the stool, bloody diarrhea, or fecal occult blood. Abdominal color Doppler ultrasonography, colonoscopy, computed tomography, 99 m Tc pertechnetate imaging, and other blood tests can aid in the diagnosis.Conclusions: We found that the type of lower gastrointestinal bleeding in children is related to age. Intussusception was the most common cause of intestinal obstruction overall and in infants between 6 and 36 months of age. Treatment of children with lower gastrointestinal bleeding should be based on prevention. Medical staff should actively raise awareness of the condition, identify the severity of the disease in a timely manner, make early diagnoses, provide prompt treatment, and cooperate with providers in multiple disciplines to save patients’ lives. Keywords: lower gastrointestinal bleeding, children, etiology, intussusception
Antimicrobial susceptibility pattern of Salmonella enterica, blood-stream isolates, among febrile children: a prospective study from Nepal
Authors: Khadka Priyatam , Thapaliya Januka , Thapa Shovana
Published: September 2019

Background Still, in developing the children are being treated empirically and irrationally with accessible antibiotic without susceptibility testing and minimal lethal dose calculations, defying the probable MDR (multi-drug resistance) isolates. This study was undertaken in the febrile children to determine the antimicrobial susceptibility pattern of Salmonella enterica against commonly prescribed antibiotics. Method All isolates were identified by biotyping and serotyping standard protocols then tested against antibiotics by modified Kirby disk-diffusion method. Minimum Inhibitory Concentration (MIC) of isolates were determined by agar dilution method and compared with disk diffusion results and on nalidixic-acid sensitive/resistant strains. Result Among 1815 enteric-fever-suspects, 90(4.9%) isolates of Salmonella enterica [serovar: 62(68.8%) Salmonella Typhi and 28 (31.1%) Salmonella Paratyphi A] were recovered. The incidence of infection was higher among male, age group 5 to 9, and patient from the out-patient department (OPD). On disk-diffusion test most isolates, were sensitive against first-line drugs, cephalosporins, and macrolides. However, against quinolone, a huge percentile i.e. 93.3%, of isolates were resistant [including 58 Typhi and 26 Paratyphi serovar], and nearly 14% against fluoroquinolones. When MIC breakpoint was adjusted 4µg/ml for azithromycin, ≥1 µg/ml for ciprofloxacin, 2µg/ml for ofloxacin, 8µg/ml for nalidixic acid, 1µg/ml for cefixime, higher sensitivity and specificity achieved while screening decreased susceptibility. Among tested antibiotics, low rate of resistant strain observed on MIC of azithromycin. Also, higher resistance against fluoroquinolones observed on NARS strain. Conclusion Higher susceptibility of Salmonella enterica to first-line drugs (the conventional antityphoidal drugs), third-generation cephalosporins, and azithromycin; advocates for its reconsideration in the implicated therapy. However, lower susceptibility against fluoroquinolones among nalidixic-acid resistant Salmonella (NARS) strain negates its empirical use in children. Keywords Enteric fever, Nepal, children, Salmonella enterica
Analysis of related factors of recurrence in pediatric hepatoblastoma-A single center retrospective study
Authors: Yang Wei , Chen Yiwei , Huang Yijin , Wang Huanmin
Published: September 2019

Introduction This study was performed in order to find out the relevant factors of the recurrence of hepatoblastoma .Materials and Methods 28 patients that presenting with recurrent hepatoblastoma in our hospital from 2012 to 2015 were included in the investigation. The pathological subtype,clinical stage, serum levels of alpha fetoprotein (AFP), the change trend of the tumor volume and AFP value of each case after they received neoadjuvant chemotherapy and after surgical resection were recorded. The χ2 test was used to analyze the relationship between tumor recurrence and the aforementioned factors.Results The results showed that in the recurrence group, the patients were in higher clinical stage than that in the non-recurrence group. In the patients with recurrent tumors, the rate of tumor volume reduction, the extent of AFP level decrease and the proportion of those in the group whose AFP level fell to normal range in one month after tumor resection were all apparently lower than those in the non-recurrence patients.Conclusion The main risk-altering factors involved in the recurrence of hepatoblastoma were: clinical stage, reduction in tumor size after neoadjuvant chemotherapy, and the rate of descent of AFP levels to within normal range after tumor resection. These indicators can be used as important biomarkers for personalized treatment, assessment of treatment efficacy and prognostic indicators.
How many words are Australian children hearing in the first year of life?
Authors: Brushe Mary E , Lynch John W. , Reilly Sheena , Melhuish Edward , Brinkman Sally A.
Published: September 2019

Background: There is evidence that parents from more socioeconomically disadvantaged backgrounds engage in fewer verbal interactions with their child than more advantaged parents. This leads to the so-called, ‘30 million-word gap’. We used improved technology to investigate the number of words children hear in their first year of life. Methods: Mothers were recruited into a five-year prospective cohort study and categorized into either high or low maternal education groups. Data was derived from the first two waves of the study, when the children were six and twelve months old. At both waves, children were involved in day-long audio recordings using the Language Environment Analysis software that provided automatic counts of adult words spoken to the child, child vocalizations and conversational turns. Descriptive results are presented by maternal education groups. Results: There was large variation within each maternal education group, with the number of adult words spoken to the child ranging from 2,958 to 39,583 at six months and 4,389 to 45,849 at twelve months. There were no meaningful differences between adult words, child vocalizations or conversational turns across maternal education groups at either wave of data collection. Conclusions: These results show that a word gap related to maternal education is not apparent up to twelve months of age. The large variability among both maternal education groups suggests that universal interventions that encourage all parents to talk more to their child may be more appropriate than interventions targeted towards disadvantaged families during the first year of life.
Laparoscopic orchiopexy of palpable undescended testes - experience of a single tertiary institution with over 773 cases
Authors: You Jia , Li Gang , Li Shuang , Chen Haitao
Published: September 2019

Background To discuss the feasibility and superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended Testicles. Methods Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension. Results There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral occult hernia, and the hernia sac is ligated during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination. Conclusion Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. It could detect and treat contralateral patent processus vaginalis at the same time and avoid the occurrence of metachronous inguinal hernia.
Drusen Characteristics of Type 2 Macular Neovascularization in Age-related Macular Degeneration
Authors: Ahmed Daniel , Stattin Martin , Haas Anna-Maria , Graf Alexandra , Krepler Katharina , Ansari-Shahrezaei Siamak
Published: September 2019

Background
To assess the relationship between drusen characteristics and type 2 macular neovascularization (MNV) in age-related macular degeneration (AMD).
Methods
Retrospective data analysis of eyes previously diagnosed with neovascular AMD in a tertiary eye care center (Medical Retina Unit, Rudolf Foundation Hospital, Vienna, Austria) between June 2008 and December 2017. Drusen subtypes, fibrosis, atrophy and subfoveal choroidal thickness (SFCT) of both eyes in patients with type 2 MNV lesions were categorized based on multimodal imaging.
Results
Type 2 MNV was diagnosed in 27 (3.2%) of 835 eyes (749 patients). Drusen characteristics in type 2 MNV were observed as followed: drusen < 63 m in 2 eyes (7.4%), drusen ≥ 63 mm in 10 eyes (37%), subretinal drusenoid deposits (SDD) in 8 eyes (29.6%), cuticular drusen in 2 eye (7.4%) and no drusen were evident in 10 eyes (37%). Drusen distribution in 23 fellow eyes was detected as followed: drusen < 63 mm in 2 eyes (8.7%), drusen ≥ 63 mm in 9 eyes (39.1%), SDD in 5 eyes (21.7%), cuticular drusen in 1 eye (4.3%) and no drusen were evident in 8 eyes (34.8%). Mean SFCT was 140 ± 49 mm in affected eyes and 152 ± 41 mm in the fellow eyes.
Conclusions
Type 2 MNV remains a rare entity in AMD. It was frequently seen in the absence of
drusen, a hallmark of AMD. These findings suggest other biological pathways related
to pure type 2 lesions.
Evaluation of vitrectomy combined preoperative intravitreal ranibizumab and postoperative intravitreal triamcinolone acetonide for proliferative diabetic retinopathy
Authors: Du Zhaodong , Hu Liting , Wang Wenying , Zhang Lina , Chen Qiulu , Lin Jing , Zhao Guiqiu
Published: September 2019

Background: To explore the treatment efficacy of the combination of preoperative intravitreal ranibizumab (IVR) and postoperative intravitreal triamcinolone acetonide (IVTA) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR).

Methods: A retrospective comparative study was performed on 128 eyes of 128 patients who had PDR and underwent PPV. Patients who received a single PPV were assigned to Group A. Those who received PPV with preoperative IVR were assigned to Group B. Patients in Group C underwent PPV combined preoperative IVR and postoperative IVTA. Intraoperative findings, changes in mean best-corrected visual acuity (BCVA) and postoperative adverse events were retrospectively evaluated at 6-month follow-up.

Results: The incidences of iatrogenic breaks, severe intraoperative bleeding, using long-term internal tamponade agents, recurrent vitreous hemorrhage (VH) and duration of surgery were statistically significantly less in Group B and Group C than in Group A. The postoperative BCVA was statistically significantly better in Groups B and Group C than in Group A respectively at 1 month after surgery. The mean 3-month postoperative visual acuity was better in Group C. The incidence of high intraocular pressure (IOP) was significantly higher in Group C at the first postoperative week. There were no statistically significant differences in the incidence of exudative retinal detachment and choroidal detachment among the three groups.

Conclusion: In patients undergoing PPV for PDR, preoperative IVR significantly reduced the occurrence of intraoperative and postoperative complications, and the combination of preoperative IVR and postoperative IVTA can better improve the postoperative visual outcome.
Differences in factors influencing the use of eRehabilitation after stroke; a comparison between Brazilian and Dutch healthcare professionals
Authors: Brouns Berber , Bodegom-Vos Leti van , de Kloet Arend J. , Vlieland Thea P.M. Vliet , Gil Ingrid L.C. , Souza Lígia M.N. , Braga Lucia W. , Meesters Jorit J.L.
Published: September 2019

Introduction: To improve the use of eRehabilitation after stroke, the identification of barriers and facilitators influencing this use in different healthcare contexts around the world is needed. Therefore, this study aims to investigate differences and similarities in factors influencing the use of eRehabilitation after stroke among Brazilian Healthcare Professionals (BHP) and Dutch Healthcare Professionals (DHP). Method: A cross-sectional survey study including 88 statements about factors related to the use of eRehabilitation (4-point Likert scale; 1-4; unimportant-important/disagree-agree). The survey was conducted among BHP and DHP (physical therapists, rehabilitating physicians and psychologists). Descriptive statistics were used to analyse differences and similarities in factors influencing the use of eRehabilitation. Results: ninety-nine (response rate 27%) BHP and 105 (response rate 37%) DHP participated. Differences were found in the top-10 most influencing statements between BHP and DHP; top-10 least influencing statements were mostly similar. Discussion: The results indicate that the use of eRehabilitation after stroke by BHP and DHP is influenced by different factors. A tailored implementation strategy for both countries needs to be developed; BHP were most influenced by support from the organization and the potential benefits of the use of eRehabilitation, DHP by the feasibility of the use of eRehabilitation for the patient. Statements with low influence like problems caused by patient characteristics or problems with resources, were comparable for both groups and should have less priority in the implementation strategies.
Missense mutations in a transmembrane domain of the Komagataeibacter xylinus BcsA lead to changes in cellulose synthesis
Authors: Salgado Luis , Blank Silvia , Esfahani Reza Alipour Moghadam , Strap Janice L. , Bonetta Dario
Published: September 2019

Background Cellulose is synthesized by an array of bacterial species. Komagataeibacter xylinus is the best characterized as it produces copious amounts of the polymer extracellularly. Despite many advances in the past decade, the mechanisms underlying cellulose biosynthesis are not completely understood. Elucidation of these mechanisms is essential for efficient cellulose production in industrial applications. Results In an effort to gain a better understanding of cellulose biosynthesis and its regulation, cellulose crystallization was investigated in K. xylinus mutants resistant to an inhibitor of cellulose I formation, pellicin. Through the use of forward genetics and site-directed mutagenesis, A449T and A449V mutations in the K. xylinus BcsA protein were found to be important for conferring high levels of pellicin resistance. Phenotypic analysis of the bcsAA449T and bcsAA449V cultures revealed that the mutations affect cellulose synthesis rates and that cellulose crystallinity is affected in wet pellicles but not dry ones. Conclusions A449 is located in a predicted transmembrane domain of the BcsA protein suggesting that the structure of the transmembrane domain influences cellulose crystallization either by affecting the translocation of the nascent glucan chain or by allosterically altering protein-protein interactions.
Molecular characterization of human isolates of Strongyloides stercoralis and Rhabditis spp. based on mitochondrial cytochrome c oxidase subunit 1 (cox1)
Authors: Tehrani Mandana Fadaei , Sharifdini Meysam , Zahabiun Farzaneh , Latifi Robabeh , Kia Eshrat bigom
Published: September 2019

Abstract
Background: Due to the similarity of Strongyloides stercoralis with free-living nematodes of Rhabditis species they might be miss-diagnosed with each other in microscopical examination of stool samples. The aim of this study was molecular characterization and differentiation of human derived isolates of S. stercoralis and Rhabditis species based on the mitochondrial gene of cytochrome c oxidase subunit 1 ( cox1 ) amplification.
Methods: Using parasitological methods, ten isolates of S. stercoralis and three isolates of Rhabditis spp. were obtained from fresh stool samples of patients and the genomic DNA of the samples were extracted. PCR amplification of cox1 gene was carried out for all the isolates and the products were sequenced.
Results: The phylogenetic analysis illustrated that S. stercoralis and Rhabditis spp. isolates were placed in two distinguishable separate clades. Inter-species genetic variation between isolates of S. stercoralis and Rhabditis spp . were ranged from 13.5 to 14.5%.
Conclusions: Cox1 gene was a suitable marker for discrimination of S. stercoralis from Rhabditis spp. retrieved from human in the current study. The availability of gene sequence information will be helpful in the future development and validation of discriminatory PCR-based assays of these nematodes.
Chinampas: An Urban Farming Model of the Aztecs and a Potential Solution for Modern Megalopolis
Authors: Ebel Roland
Published: September 2019

Urban horticulture is not as new as many people think. Throughout history, different techniques have been used to ensure sustainable urban agricultural production. A good example of this is the chinampa system, which was developed during the time of the Aztecs in the region of Lake Xochimilco, south of Mexico City. A chinampa is a raised field on a small artificial island on a freshwater lake surrounded by canals and ditches. Farmers use local vegetation and mud to construct chinampas. Fences made of a native willow [bonpland willow (Salix bonplandiana)] protect the chinampa from wind, pests, and erosion. The dominating crops are vegetables and ornamentals. The canal water that rises through capillarity to the crops reduces the need for additional irrigation. A considerable portion of the fertility in the soils is system-immanent and generated in the aquatic components of the chinampa. Complex rotations and associations allow up to seven harvests per year. Chinampas also provide ecosystem services, particularly greenhouse gas sequestration and biodiversity diversification, and they offer high recreational potential. Recently, research and community initiatives have been performed to try to recover the productive potential of chinampas and align this sustainable system with the needs of the 21st century. In other parts of the world, some with a history of raised field agriculture, similar efforts are being made. The chinampa model could help supply food and ecosystem services in large cities on or near swamplands, large rivers, or lakes.