bluuebunny/crossref_metadata_2025 huggingface dataset:
PEMBELAJARAN IPA TERPADU DENGAN PENDEKATAN PENEMUAN (DISCOVERY) MELALUI METODE DEMONSTRASI DAN EKSPERIMEN DITINJAU DARI KEMAMPUAN BERFIKIR KRITIS DAN KREATIVITAS SISWA
Authors: Abidin Syahrul Nur , Sarwanto Sarwanto , Sunarno Widha
Published: July 2019

Tujuan penelitian ini adalah untuk mengetahui: pengaruh pendekatan penemuan melalui metode demonstrasi dan eksperimen, kemampuan berfikir kritis, kreativitas terhadap hasil belajar siswa. Penelitian ini menggunakan metode eksperimen dan dilaksanakan dari bulan Januari-Mei 2016. Populasi penelitian ini adalah semua siswa kelas VII SMP Negeri 1 Karas tahun pelajaran 2015/2016. Sampel diperoleh dengan teknik cluster random sampling yang terdiri dari dua kelas, VII-1 dan VII-2.  Kelas VII-1 diberi pembelajaran dengan metode eksperimen dan kelas VII-2 diberi pembelajaran dengan metode demonstrasi. Data dikumpulkan dengan metode tes untuk hasil belajar, angket untuk kemampuan berfikir kritis dan kreativitas. Hipotesis diuji meggunakan ANAVA dengan desain faktorial 2x2x2 sel tak sama dengan bantuan software SPSS versi 21.Dari hasil analisis data disimpulkan: 1) Ada perbedaan hasil belajar fisika terhadap penggunaan metode eksperimen dan metode demonstrasi, maka  metode pembelajaran  memberikan perbedaan yang signifikan terhadap hasil belajar, 2) Ada perbedaan hasil belajar terhadap kemampuan berpikir kritis tinggi dan kemampuan berpikir kritis rendah, yang berarti bahwa kemampuan berpikir kritis memberikan perbedaan yang signifikan terhadap hasil belajar, 3) Ada perbedaan hasil belajar terhadap kreativitas tinggi dan kreativitas rendah, yang berarti bahwa kreativitas memberikan perbedaan yang signifikan terhadap hasil belajar, 4) Tidak ada interaksi antara metode pembelajaran dengan cara berpikir kritis siswa yang berarti metode pembelajaran dan cara berpikir kritis siswa secara bersama-sama tidaklah memberikan hasil yang signifikan terhadap prestasi belajar, 5) Ada interaksi antara metode pembelajaran dengan kreativitas siswa yang berarti bahwa metode pembelajaran dan kreativitas siswa secara bersama-sama memberikan hasil yang signifikan terhadap prestasi belajar siswa, 6) Tidak ada interaksi antara cara berpikir kritis siswa dengan kreativitas siswa yang berarti cara berpikir kritis siswa dan kreativitas siswa secara bersama-sama tidaklah memberikan hasil yang signifikan terhadap prestasi belajar, 7) Ada interaksi antara metode pembelajaran, cara berpikir kritis siswa, dan kreativitas siswa yang berarti metode pembelajaran, cara berpikir kritis siswa, dan kreativitas siswa secara bersama-sama memberikan hasil yang signifikan terhadap prestasi belajar siswa.
PEMBELAJARAN KIMIA DENGAN MODEL INKUIRI TERBIMBING MENGGUNAKAN MEDIA LABORATORIUM RIIL DAN VIRTUIL DITINJAU DARI GAYA BELAJAR DAN KEMAMPUAN AWAL
Authors: Diastono Diastono , Ashadi Ashadi , Haryono Haryono
Published: July 2019

Penelitian ini bertujuan untuk melihat pengaruh penggunaan metode pembelajaran inkuiri terbimbing dengan menggunakan media laboratorium riil dan laboratorium virtuil berupa media animasi, gaya belajar dan kemampuan awal serta interaksinya terhadap prestasi belajar.  Penerapan inovasi pembelajaran sain yang lebih menarik, melibatkan siswa dalam proses inkuiri. Metode ini diterapkan juga sebagai upaya untuk memilih media pembelajaran yang sesuai untuk pokok bahasan tertentu. Sampel diambil dengan menggunakan metode random sampling yang terdiri dari empat kelompok, yaitu dua kelompok yang belajar dengan metode inkuiri terbimbing menggunakan media laboratorium riil dan dua kelompok yang belajar dengan metode inkuiri terbimbing menggunakan media laboratorium virtuill.  Data yang terkumpul berupa gaya belajar dan kemampuan awal serta hasil belajar kimia. Hipotesis dianalisa dengan Uji Anava tiga jalan dengan desain faktorial 2 x 2 x 2. Dari analisis data dapat disimpulkan : (1) Siswa yang belajar dengan metode pembelajaran inkuiri terbimbing menggunakan media laboratorium virtuil dengan media animasi mencapai prestasi belajar yang lebih baik dari siswa yang belajar dengan metode inkuiri terbimbing menggunakan media laboratorium riil. (2) Siswa yang memiliki gaya belajar visual memiliki prestasi belajar yang lebih baik dari siswa yang memiliki gaya belajar kinestetik. (3) Prestasi belajar siswa yang memiliki kemampuan awal tinggi lebih baik dari siswa yang memiliki kemampuan awal rendah. (4) Tidak ada interaksi antara media pembelajaran dengan gaya belajar terhadap prestasi belajar siswa. (5) Tidak ada interksi antara media pembelajaran dengan kemampuan awal terhadap prestasi belajar siswa. (6) Tidak ada interaksi gaya belajar dengan kemampuan awal terhadap prestasi belajar siswa. (7) Tidak adanya interaksi antara media pembelajaran, gaya belajar dan kemampuan awal terhadap prestasi belajar siswa.
THE EFFECT OF CURRENT VARIATION ON MICRO STRUCTURE AND HARDNESS IN ALLOYSTEEL SS400 WELDING PROCESS USING SMAW METHOD
Authors: Wibowo Irfan Adi
Published: July 2019

This research aims to find out the effect of current on microstructure and hardness value in Alloy Steel SS400 before (raw material) and after welding using Shielded Metal Arc Welding (SMAW). This research uses experiment methods. Technique of analyzing data used was a descriptive comparative research. The instruments used for testing microstructure and hardness were Olympus Metallurgical Microscope and Vikers Hardness Tester. Base on the result of research, it could be concluded that the result of microstructure testing showed the improved  ferrite structure after welding. In raw material, ferrite structure seemed to looks evenly, but the result of welding using SMAW welding method with current of I20 A, 130 A, and 140A showed that ferrite structure reduced in each specimen, so that  perlite structure was very dominant. The hardness value of hardness result showed the different hardness level. The specimen with current of 140 A had higher hardness level of 231,055 VHN than the specimen with current of 120 A (219.222 VHN) and 130 A (223,333 VHN). The result of hardness testing on raw material was 182,333 VHN. This research showed that the welding using varying current changed microstructure and affected the hardness value of Alloy Steel SS400.
KONTEKSTUALISASI MAKNA JIHAD DI ERA MILENIAL
Authors: Hartini Dwi
Published: July 2019

Abstract: It has already believed that Jihad has recently become an issue to be debated in East and West. However, the concept of jihad is misinterpreted narrowly as he activities dealing with warfare and murder. Jihad in broader sense can be defined as the efforts to support the religion of Allah SWT. This paper is intended to highlight several verses and hadith from the Prophet concerning the jihad concept. It is essential to be done in order to prove that jihad in Islam is not only conquest of the city, seizing property and Islamizing city residents, but also jihad in the Islamic state has a function in supporting Allah and the liberation of humans from the life of "ignorance". Therefore, this article focus on the broad concept of jihad in various aspect by employing contextualization theory.The results revealed that the contextualization of the concept of jihad in the millennial era is based on the Qur'an and hadith, consequently, there are no repeated faults in interpreting it.الملخص: الخطاب حول الجهاد هو مشكلة في الإسلام التي أصبحت قضية غالبا ما تناقشه في الشرق والغرب في الآونة الأخيرة. ومع ذلك، يساء مفهوم الجهاد بتفسيره بشكل ضيق، بينما للجهاد معنى أوسع من أنشطة الحرب والقتل. يمكن أن يكون الجهاد في شكل كل الجهود لدعم دين الله سبحانه وتعالى. في هذا البحث، يذكر الباحث العديد من الآيات والأحاديث النبوية المتعلقة بالجهاد. وذلك لإثبات أن الجهاد في الإسلام ليس مجرد غزو للمدينة، والاستيلاء على الممتلكات وأسلمة سكان المدينة على أساس الهوى. لكن المزيد من الجهاد في نظام الدولة الإسلامية هو التبشير لإعلاء كلمة الله وتحرير البشر من حياة "الجهل". وهكذا، فإن استخدام نظرية السياق يحاول هذا البحث وصف مفهوم الجهاد القائم على نطاق واسع على جوانب مختلفة. تتضح نتائج هذا البحث سياق مفهوم الجهاد في العصر الألفي بناءً على القرآن والحديث بحيث لا توجد أخطاء متكررة في تفسيره.Abstrak: Wacana tentang Jihad adalah masalah dalam Islam yang akhir-akhir ini menjadi isu yang sering dibahas di Timur maupun Barat. Namun, konsep jihad banyak disalahpahami dengan menafsirkannya secara sempit, sedangkan jihad memiliki makna yang lebih luas daripada kegiatan perang dan pembunuhan. Jihad bisa dalam bentuk semua upaya untuk mendukung agama Allah Swt. Dalam tulisan ini, penulis menyebutkan beberapa ayat dan hadist Rasulullah yang berkenaan dengan jihad. Hal ini dilakukan untuk membuktikan bahwa jihad dalam Islam tidak sekedar penaklukan kota, merampas harta benda dan mengIslamkan penduduk kota yang dilandasi hawa nafsu. Namun jihad dalam tata negara Islam lebih untuk berdakwah meninggikan kalimat Allah dan pembebasan manusia dari kehidupan “jahiliyah”. Sehingga, dengan menggunakan teori kontekstualisasi artikel ini mencoba untuk mengekspresikan konsep jihad secara luas berdasarkan berbagai aspek. Hasil penelitian ini menggambarkan kontekstualisasi konsep jihad di era milenial berdasarkan Al-Qur'an dan hadits sehingga tidak ada kesalahan berulang dalam menafsirkannya.
The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Study
Authors: Žunić Miodrag Vojislav , Škvarč Nevenka Krčevski , Kamenik Mirt
Published: July 2019

ABSTRACT
Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.
Design: A prospective, randomized, double-blind, placebo-controlled study.
Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR).
Results
70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements.
Conclusions
Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia.

Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine

Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.
Retroclavicular vs Infraclavicular block For Upper Limb Anesthesia: A Multi-Centric Randomized Trial
Authors: Blanco Andres Felipe Gil , Laferriere-Langlois Pascal , Jessop David , D’Aragon Frederick , Sansoucy Yanick , Albert Natalie , Tétreault Pascal , Echave Pablo
Published: July 2019

Background: The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization.
Methods: This randomized, controlled, non-inferiority trail conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed.
Results: We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 7.1% shorter than ICB (retro: 4.8 ± 2.0 min; infra: 5.2 ± 2.3 min, p=0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis.
Conclusion: In patients undergoing distal upper limb surgery with an infraclavicular anesthesia, performance time with RCB approach was deemed clinically similar to ICB approach while improving needle visibility.
Clinical Trial Registration: ClinicalTrials.gov (NCT02913625), registered 26 September 2016
Completion rate of Physician Orders for Life-Sustaining Treatment for patients with metastatic or recurrent cancer: A cross-sectional study
Authors: Kim Ju Won , Choi Jung Yoon , Jang Won Jin , Choi Yoon Ji , Choi Youn Seon , Shin Sang Won , Kim Yeul Hong , Park Kyong Hwa
Published: July 2019

Background: “End of life” is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of “Physician Orders for Life-Sustaining Treatment,” was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients’ general attitudes toward end-of-life care.
Methods: We conducted a cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor’s suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients’ decisions.
Results: Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of “life-sustaining care” or “Physician Orders for Life-Sustaining Treatment.” Participants’ reasons for Physician Orders for Life-Sustaining Treatment completion were diverse.
Conclusions: We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.
Loss-of-function mutation of soybean R2R3 MYB transcription factor reduces flavone content and dilutes tawny pubescence color
Authors: Yan Fan , Githiri Stephen M. , Sang Yu , Wang Qingyu , Takahashi Ryoji
Published: July 2019

Background

Pubescence color of soybean is controlled by two genes, T and Td. In the presence of a dominant T allele, dominant and recessive alleles of the Td locus generate tawny and light tawny (or near-gray) pubescence, respectively. Flavones, responsible for pubescence color, are catalyzed by two copies of flavone synthase II genes (FNS II-1 and FNS II-2). This study was conducted to map and clone the Td gene.

Results

Genetic and linkage analysis using an F2 population and F3 families derived from a cross between a Clark near-isogenic line with light tawny pubescence (genotype: TT tdtd) and a Harosoy near-isogenic line with tawny pubescence (TT TdTd) revealed a single gene for pubescence color around the end of chromosome 3. Genome sequence alignment of plant introductions revealed an association between premature stop codons in Glyma.03G258700 (R2R3 MYB transcription factor) and recessive td allele. Cultivars and lines having near-gray or light tawny pubescence and a gray pubescence cultivar with td allele had premature stop codons in the gene. These results suggest that Glyma.03G258700 corresponds to the Td gene. It was predominantly expressed in pubescence. Compared to a tawny pubescence line, a near-isogenic line with td allele produced extremely small amounts of transcripts of Glyma.03G258700, FNS II-1, and FNS II-2 in pubescence. The promoter of FNS II-1 and FNS II-2 shared cis-acting regulatory elements for binding of MYB proteins. These results suggest that the wild-type of Glyma.03G258700 protein binds to the promoter of FNS II genes and upregulates their expression, resulting in increased flavone content and deeper pubescence color. In contrast, mutated Glyma.03G258700 protein fails to upregulate the expression of FNS II genes, resulting in decreased flavone content and dilute pubescence color.

Conclusions

This study revealed that soybean Glyma.03G258700 encoding the R2R3 MYB transcription factor corresponds to the Td gene. The wild type of MYB protein binds to the promoter of FNS II genes and upregulates their expression, resulting in higher flavone content and deeper pubescence color. Loss-of-function mutation of the gene fails to promote expression of FNS II genes, resulting in lower flavone content and dilute pubescence color.
Genome-wide analysis of RopGEF gene family to identify genes contributing to pollen tube growth in rice (Oryza sativa)
Authors: Kim Eui-Jung , Park Sung-Wook , Hong Woo-Jong , Silva Jeniffer , Jung Ki-Hong , Kim Yu-jin
Published: July 2019

Background: In plants, the key roles played by RopGEF-mediated ROP signaling in diverse processes, including polar tip growth, have been identified. Despite their important roles in reproduction, a comprehensive analysis of RopGEF members has not yet been performed in rice (Oryza sativa). To determine whether RopGEF regulators are involved in rice pollen tube growth, we performed genome-wide analysis of this family in rice.
Results: Phylogenomic and meta-expression analysis of eleven RopGEFs in rice showed that four genes were preferentially expressed in mature pollen. These four genes contain the plant-specific Rop nucleotide exchanger (PRONE) domain and possible phosphorylated residues, suggesting a conserved role in polar tip growth with Arabidopsis. In subcellular localization analysis of the four RopGEFs through tobacco (Nicotiana benthamiana) infiltration was identified in various cellular organelles, indicating their diverse roles during pollen germination in rice. Moreover, these candidate genes possessing unique cis-acting elements in their promoters compared with the other genes.
Conclusions: In this study, four RopGEF genes were identified as pollen-specific gene in eleven members of rice, and the expression pattern, promoter analysis, and evolutionary relationship of the RopGEF family were studied compared with Arabidopsis. Our study indicated that four RopGEF genes might function during pollen germination in distinct subcellular localization. Our study could provide valuable information on the functional study of RopGEF in rice.
A MYB-related Transcription Factor from Sheepgrass, LcMYB2, Promotes Seed Germination and Root Growth under Drought Stress
Authors: guo xiufang , Zhao Pincang , Hou Shenglin , Jia Junting , Yang Weiguang , Liu Zhujiang , Chen Shuangyan , Li Xiaoxia , Qi Dongmei , Liu Gongshe , Cheng Liqin
Published: July 2019

Background

Drought is one of the most serious factors limiting plant growth and production. Sheepgrass can adapt well to various adverse conditions, including drought. However, during germination, sheepgrass young seedlings are sensitive to these adverse conditions. Therefore, the adaptability of seedlings is very important for plant survival, especially in plants that inhabit grasslands or the construction of artificial grassland.

Results

In this study, we found a sheepgrass MYB-related transcription factor, LcMYB2 that is up-regulated by drought stress and returns to a basal level after rewatering. The expression of LcMYB2 was mainly induced by osmotic stress and was localized to the nucleus. Furthermore, we demonstrate that LcMYB2 promoted seed germination and root growth under drought and ABA treatments. Additionally, we confirmed that LcMYB2 can regulate LcDREB2 expression in sheepgrass by binding to its promoter, and it activates the expression of the osmotic stress marker genes AtDREB2A, AtLEA14 and AtP5CS1 by directly binding to their promoters in transgenic Arabidopsis.

Conclusions

Based on these results, we propose that LcMYB2 improves plant drought stress tolerance by increasing the accumulation of osmoprotectants and promoting root growth. Therefore, LcMYB2 plays pivotal roles in plant responses to drought stress and is an important candidate for genetic manipulation to create drought-resistant crops, especially during seed germination.
Ocular biomarkers for cognitive impairment in nonagenarians; a prospective cross-sectional study
Authors: de Kreeke Jacoba Alida van , Legdeur Nienke , Badissi Maryam , Nguyen H. Ton , Konijnenberg Elles , Tomassen Jori , Kate Mara ten , Braber Anouk den , Maier Andrea B. , Tan H. Stevie , Verbraak Frank D. , Visser Pieter Jelle
Published: July 2019

Background: Ocular imaging receives much attention as a source of potential biomarkers for dementia. In the present study, we analyze these ocular biomarkers in cognitively impaired and healthy participants in a population aged over 90 years (= nonagenarian), and elucidate the effects of age on these biomarkers.
Methods: For this prospective cross-sectional study, we included individuals from the EMIF-AD 90+ study, consisting of a cognitively healthy (N=67) and cognitively impaired group (N=33), and the EMIF-AD PreclinAD study, consisting of cognitively healthy controls aged ≥60 (N=198). Participants underwent Optical Coherence Tomography (OCT) and fundus photography of both eyes. OCT was used to asses total and individual inner retinal layer thickness in the macular region (Early Treatment Diabetic Retinopathy Study circles) as well as peripapillary retinal nerve fiber layer thickness, fundus images were analyzed with Singapore I Vessel Assessment to obtain 7 retinal vascular parameters. Values for both eyes were averaged. Differences in ocular biomarkers between the 2 nonagenarian groups were analyzed using linear regression, differences between the individual nonagenarian groups and controls were analyzed using generalized estimating equations.
Results: Ocular biomarkers did not differ between the healthy and cognitively impaired nonagenarian groups. Both nonagenarian groups differed in most ocular biomarkers from the younger controls.
Conclusion: Ocular biomarkers were not associated with cognitive impairment in nonagenarians, making their use as a screening tool for dementing disorders in this group limited. However, ocular biomarkers were significantly associated with chronological age, which were very similar to those ascribed to occur in Alzheimer’s Disease.
Exploring factors associated with self-treatment among different elder subgroups in rural China: a cross-sectional study
Authors: Xu Wanchun , Li Zhong , Pan Zijing , He Ruibo , Zhang Liang
Published: July 2019

Background

Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in the current rural China remain unclear. This study aims to explore the determinants of self-treatment among elders in rural China, focusing on context-specific and multi-dimensional factors.

Methods

Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, Guizhou Province in western China. Data were collected through a self-administered questionnaire on the healthcare needs of residents. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 338 (individuals). Pearson’s chi-squared test and binary logistic regression analysis were performed among the whole sample group and four subgroups.

Results

Approximately 25.94% of the 1303 elders reported illness within the last 2 weeks, of whom 34.4% indicated self-treatment. The variables independently associated with a greater probability of self-treatment in the whole sample group were better health status, no recent alcohol consumption and no utilisation of family practice services; the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (TCM) and drinking alcohol recently were less likely to self-treat. Non-empty-nest elders who were no less than 75 years old and at better health status were more likely to self-treat.

Conclusion

Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Advanced age and self-care habits in TCM also play roles in some subgroups. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for developing improvement strategies of the family practice system in China.
MEDICATION BURDEN AND INAPPROPRIATE PRESCRIPTION RISK AMONG ELDERLY WITH ADVANCED CHRONIC KIDNEY DISEASE
Authors: Roux-Marson Clarisse , Baranski Jean-Baptiste , Fafin Coraline , Extermann Guillaume , Vigneau Cecile , Couchoud Cecile , Moranne Olivier
Published: July 2019

Background
Elderly patients with chronic kidney disease (CKD) frequently present comorbidities that put them at risk of polypharmacy and medication-related problems. This study aims to describe the overall medication profile of patients aged ≥ 75 years with advanced CKD from a multicenter French study and specifically the renally (RIMs) and potentially inappropriate-for-the-elderly medications (PIMs) that they take.
Methods
This is a cross-sectional analysis of medication profiles of individuals aged ≥ 75 years with eGFR < 20 ml/min/1.73m2 followed by a nephrologist, who collected their active prescriptions at the study inclusion visit. Medication profiles were analyzed according to route of administration, therapeutic classification, and their potential inappropriateness for these patients, according to Beers' criteria.
Results
We collected 5196 individual medication prescriptions for 556 patients, for a median of 9 daily medications [7-11]. Antihypertensive agents, antithrombotics, and antianemics were the classes most frequently prescribed. Moreover, 88% of patients had at least 1 medication classified as a RIM, and 21% of those were contraindicated drugs. At least 1 PIM was taken by 68.9%. The prescriptions most frequently requiring reassessment due to potential adverse effects were for proton pump inhibitors and allopurinol. The PIMs for which deprescription is especially important in this population are rilmenidine, long-term benzodiazepines, and anticholinergic drugs such as hydroxyzine.
Conclusion
We showed potential drug-related problems in elderly patients with advanced CKD. Healthcare providers must reassess each medication prescribed for this population, particularly the specific medications identified here.
Slow gait speed is associated with reduction in health status in older ambulatory Chinese: A study for comprehensive geriatric assessment
Authors: Zeng Ping , Dai Yalun , Han Yiwen , Pang Jing , Gong Huan , Li Jian , Zhang Tiemei
Published: July 2019

Background:
Gait speed (GS) is well recognized as a comprehensive index of health status in older people. Nationwide survey data in China have been used to measure the association between slow GS and health status in order to emphasize the importance of measuring GS to detect a decline in health status in older ambulatory Chinese.

Methods:
A group of 2677 male and 2668 female older (aged ≥60) adults, who could perform the GS test, were selected as study subjects.GS was measured by subjects walking across and back over a 10-m course. Gait speed less than 20% that of a reference population (<0.7 m/s) was used as the threshold of slow GS.

Results:
Slow GS was associated with higher co-morbidity, polypharmacy, more medical expenses, increased needs for care and hospitalization, worse ranking on the Geriatric Depression Scale (GDS), and decreased physical and cognitive functions. In logistic regression model, higher education level (OR=0.93, 0.88-0.98), alcohol drinking (OR=0.82, 0.71-0.95), scores on Mini-mental State Examination (OR=0.95, 0.93-0.96), doing housework (OR=0.51, 0.45-0.57), and having a regular daily routine (OR=0.71, 0.51-0.98) were independently associated with faster GS; while co-morbidity (OR=1.79, 1.59-2.03), expressed disinterest in life (OR=1.22, 1.12-1.32), and dissatisfaction with personal health (OR=1.22, 1.13-1.33) were associated with slow GS. The AUC value on ROC analysis was 0.72 for the selected variables.

Conclusions:
Slow GS is associated with poorer health status in Chinese older people. Measuring GS may be a quick and inexpensive tool to help identify individuals with declines in health status and who might benefit from targeted intervention.
Statin prescription among patients with type 2 diabetes in Botswana: findings and implications
Authors: Mwita Julius Chacha , Godman Brian , Esterhuizen Tonya M
Published: July 2019

Background
There is evidence of statin benefit among patients with diabetes regardless of their cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana.
Methods
The study was a secondary data analysis of 374 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescription.
Results
Overall, 356 (95.2%) participants were eligible for a statin prescription. Clinicians prescribed statins in 162 (45.5%%; 95% confidence interval [CI]: 40.4% - 50.7%)) of eligible participants, and only one (5.5%) ineligible participant. The probability of statin prescription was high in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17 - 1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00 - 1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06 - 1.74).
Conclusion
Most patients with type 2 diabetes are not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescription. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.

Key words: statin, type 2 diabetes mellitus, prescription and Botswana
Central obesity, not BMI explains cardio-metabolic risks among university employees, Ethiopia – a cross-sectional study
Authors: Janakiraman Balamurugan , Abebe Solomen Mekonnen , Chala Mulugeta Bayisa , Demissie Solomon Fasika
Published: July 2019

Background: Evidence suggests that the middle and low-income countries such as Ethiopia are facing the growing epidemic of both communicable and non-communicable diseases creating burden on the healthcare system. The increasing prevalence is attributed to sedentarism, lifestyle changes and the presence of other cardio-metabolic risk factors. Therefore this study was designed to assess the prevalence and association of overweight, obesity, and cardio metabolic risks and to explore if there was any agreement among the anthropometric measurements among the academic employees of the University of Gondar, Ethiopia.
Methods: An institutional based cross-sectional study was conducted using the WHO stepwise approach and recommendations on 381 academic staff of the university. In addition, physical measurements such as weight, height, waist and hip circumferences, and biochemical measures such as blood pressure and fasting blood glucose level (peripheral blood samples by finger puncture) were measured using standardized tools.
Result: The mean age of the participants was 33.5 years. The prevalence of obesity among the study participants defined by body mass index, waist circumference, waist height ratio and waist hip ratio was 13.1%, 33.6%, 51.9% and 58.5% respectively. The prevalence of diabetes was 4.7% among which 1.3% was not diagnosed prior to this study. About 53 (13.9%) of the study sample were found to be hypertensive (6.3% known versus 29 7.6% newly diagnosed). Among the participants 39.4% and 23.4% were found to be pre hypertensive and pre diabetic respectively. WC was significantly associated with HTN (AOR = 5.14; 2.50, 9.72), pre-DM (AOR = 4.03; 2.974, 5.96), DM (AOR = 3.29; 1.09, 6.01). In addition, WHtR was significantly associated with Pre-HTN (AOR = 2.69; 1.49, 4.58), HTN (AOR = 2.06; 1.01, 6.31), and DM (AOR = 1.85; .76, 4.32).
Conclusion: This study results revealed the variable prevalence between general obesity and the anthropometric indices (IDF cutoff) defining central obesity; WC, WHtR, and WHR among the participants. The result of this study suggests that the constructs of central obesity, not BMI has to be used to screen risks of cardio-metabolic risks among Ethiopians.
Keywords: Diabetes mellitus, Hypertension, pre-hypertension, pre-diabetes, Ethiopia
Serum levels of soluble programmed death-ligand 1 (sPD-L1) in patients with primary central nervous system diffuse large B-cell lymphoma
Authors: Cho Inju , Lee Hansang , Yoon Sang Eun , Ryu Kyung Ju , Ko Young Hyeh , Kim Won Seog , Kim Seok Jin
Published: July 2019

Background

The interaction of programmed death-1 (PD-1) and programmed death-1 ligand (PD-L1) produces immunosuppressive activity, protecting tumor cells from anti-tumor immunity and possibly releasing soluble PD-L1 (sPD-L1) from PD-L1 expressing tumor cells. Therefore, we measured serum levels of sPD-L1 in patients with primary central nervous system lymphoma (PCNSL) and explored its clinical implications.

Methods

Sixty-eight patients with newly diagnosed PCNSL had diffuse large B-cell lymphoma and were treated with high-dose methotrexate-containing chemotherapy. The measurement of sPD-L1 and cytokines was performed using serum samples archived at diagnosis, and the tissue expression of PD-L1 was also analyzed from archived paraffin-embedded tissue blocks. Disease relapse, progression-free survival (PFS), and overall survival (OS) were analyzed according to the extent of sPD-L1 in serum and PD-L1 in tissue.

Results

The median level of serum sPD-L1 (0.429 ng/mL) was higher than in healthy control patients (0.364 ng/mL). The occurrence of relapse was more frequent in the high sPD-L1 (78%) than the low sPD-L1 group (50%), though the groups did not have different clinical or pathological characteristics at diagnosis. As a result, the OS and PFS for the high sPD-L1 group were significantly lower than those in the low group. PD-L1-positive tumor cells were found in 35 patients (67%), and the extent of PD-L1-postive tumor cells was positively associated with serum sPD-L1 levels (r = 0.299, P = 0.031). Among the 34 cytokines analyzed, only the serum level of IL-7 correlated with the serum level of sPD-L1 (r = 0.521, P < 0.001).

Conclusions

Serum levels of sPD-L1 could reflect the expression of PD-L1 in PCNSL tumor cells and predict patient survival outcomes. Therefore, sPD-L1 in serum could be a feasible biomarker for determining a risk-adapted treatment strategy for PCNSL patients.
AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study
Authors: KOFFI Kouassi Gustave , Silué DA , Laurent C , Boidy K , Koui S , Compaci G , Adeba ZH , Kamara I , Botty RP , Bognini A.S , Sanogo I , Despas F , Laurent G
Published: July 2019

Background

Previous studies have indicated that accompanying socially undeserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improve adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC.

Methods

This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. Hundred African patients were randomly assigned to either AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy.

Results

We found that AMA was feasible and has significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CRR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources.

Conclusion

Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.
Improved Clinical Outcome Using Transarterial Chemoembolization Combined with Radiofrequency Ablation for Patients in Barcelona Clinic Liver Cancer Stage A or B Hepatocellular Carcinoma Regardless of Tumor Size: Results of a Single-center Retrospective Case Control Study
Authors: Ren Yanqiao , Cao Yanyan , Ma Hong , Kan Xuefeng , Zhou Chen , Liu Jiacheng , Shi Qin , Feng Gansheng , Xiong Bin , Zheng Chuansheng
Published: July 2019

Background

To determine the safety and efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (hereafter, TACE-RFA) in treating Barcelona Clinic Liver Cancer (BCLC) Stage A or B (hereafter, BCLC A/B) hepatocellular carcinoma (HCC) patients, and to explore the range of tumor sizes suitable for combination therapy.

Methods

This retrospective study assessed the consecutive medical records of HCC patients with BCLC A/B who received TACE-RFA or TACE from September 2009 to September 2018. Progression-free survival (PFS), overall survival (OS), therapeutic response, and complications were compared between the two groups.

Results

Among 2447 patients who received TACE-RFA or TACE, 399 eligible patients were enrolled in our study, including 128 patients in the TACE-RFA group and 271 patients in the TACE group. Compared with the TACE group, the PFS and OS rates of 1,3,5,8 years in the TACE-RFA group were significantly better, with higher objective tumor regression rate and better disease control rate. RFA treatment did not increase the risk of death in patients with HCC, and both liver subcapsular hematoma and bile duct injury were improved by symptomatic treatment.. Serum α-fetoprotein level and treatment method were important independent prognostic factors for OS, whereas albumin, hepatitis B and treatment method were important independent prognostic factors for PFS. Subgroup analysis showed that patients in the TACE-RFA group always showed better OS and PFS.

Conclusions

TACE-RFA had an advantage over TACE alone in prolonging PFS and improving OS in HCC patients with BCLC A/B, and can benefit patients regardless of tumor size.
The prognosis of cancer patients undergoing liposomal doxorubicin-based chemotherapy: a systematic review and meta-analysis
Authors: Zhang Kaiping , Sun Zhi , Zhang Yin , Liang Chaozhao , Zhang Li , Chao Min
Published: July 2019

Background

It is well known that liposome-based delivery of cytotoxic chemotherapeutics has been proposed as a putative strategy to enhance drug tolerability and efficacy compared to the conventional chemotherapy. However, its potential effects on improving cancer patients prognosis remain largely unknown. The current meta-analysis is to explore the prognosis of cancer patients undergoing liposomal doxorubicin-based chemotherapy.

Methods

A detailed review of English and Chinese literature was conducted from PubMed, Embase, Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI) up to March 21st, 2019. We evaluate its possible correlations using hazard ratios (HRs) with 95% confidence intervals (CIs). The pooled data were calculated by STATA software and Review Manager 5.3 software.

Results

Consequently, 26 studies including 7943 patients were satisfied in current analysis. We found that there were no significant differences between liposomal and conventional chemotherapy in OS (HR=0.98, 95%CI: 0.93-1.04, P=0.544) and PFS (HR=1.00, 95%CI: 0.92-1.10, P=0.945). Likewise, subgroup-analysis regarding country, cancer type and sample sizes also showed the similar results of the two paired groups.

Conclusion

Taken together, our findings have demonstrated that there was no association of undergoing liposomal doxorubicin-based chemotherapy with cancer prognosis. However, detailed and further studies are needed to confirm these conclusions.
Treatment Outcome and Clinical Characteristics of HER2 Mutated Advanced Non-Small Cell Lung Cancer Patients in China
Authors: Xu Fei , Yang Guangjian , Xu Haiyan , Yang Lu , Qiu Weini , Li Junling , Wang Yan
Published: July 2019

Background: HER2 mutation is found in 1-2% of lung cancer patients. Chemotherapy remains the standard of care for patients harboring HER2 mutations, while many HER2 targeted tyrosine kinase inhibitors (TKIs) have been applied to them in practice in recent years. Studies comparing chemotherapy to HER2-TKIs were limited. This study was aimed to investigate the molecular and clinical patterns of HER2 mutations in advanced non-small cell lung cancer, and compare the different outcomes between chemotherapy and HER2-TKIs.
Methods: Advanced or recurrent non-small cell lung cancer patients with de novo HER2 mutations (N=75) were included in this study. Molecular information, clinical features, and treatment outcomes were retrospectively collected from a web-based patient registry and hospital chart review.
Results: Between October 2012 and December 2018, 65 patients with in-frame insertion mutations, 8 with point mutations and 2 with gene amplification were found. The most common subtypes of insertion mutations were A775_G776insYVMA, G776delinsVC, and V777_G778insGSP. HER2 mutated patients were mostly young-aged, females, never or light smokers, and adenocarcinoma. For HER2 mutated advanced NSCLC, chemotherapy achieved better outcomes than HER2-TKIs (median PFS: 5.5 vs 3.7 months in the first line setting and 4.2 vs 2.0 months in the second line setting, P=0.001 and 0.031, respectively). Especially for the most common subtype, YVMA insertions, PFS was significantly longer in chemotherapy than HER2-TKIs both in the first line (6.0 vs 2.6 months, P=0.008) and the second line (4.2 vs 2.6 months P<0.001).
Conclusions: HER2 mutated lung cancer patients were younger, mostly females, never or light smokers, histologically adenocarcinomas dominated. Compared to existed HER-TKIs, chemotherapy might bring more benefit to HER2 mutated advanced lung cancer patients, especially the most common type of HER2 exon 20 insertions, A775_G776insYVMA subtype.
Trial registration: ChiCTR1800017709. Registered 10 August 2018.
Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana
Authors: Smith-Togobo Cecilia , Pedersen Mette Ø , Jensen Steffen G , Duduyemi Babatunde , Gyasi Richard K , Ofori Michael F , Paintsil Vivian , Renner Lorna , Nørgaard Peter , Hviid Lars
Published: July 2019

Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs).

The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N=55) or non-eBL (N=56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements

We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.