bluuebunny/crossref_metadata_2025 huggingface dataset:
MicroRNA‐3064‐3p regulates the differentiation of cementoblasts through targeting DKK1
Authors: Wang C. , Liao H. , Sun H. , Zhang Y. , Cao Z.
Published: April 2018

Background and Objective

MicroRNAs (miRNAs) are short, noncoding RNAs that interfere with translation of target mRNAs and thereby play a pivotal role in a variety of biological processes. Cementoblasts are the cells that build up cementum. They share a similar gene expression pattern with osteoblasts. Recent studies have suggested that miRNAs are able to control osteoblast‐mediated bone formation. However, the effects of miRNA on cementoblast differentiation still remain unsolved. Herein, we wanted to elucidate the role of miR‐3064‐3p in cementoblast differentiation.

Material and Methods

A miRNA microarray was operated to explore the miRNA expression patterns during cementoblast differentiation. miR‐3064‐3p agomir/antagomir was used to promote or inhibit, respectively, the expression of miR‐3064‐3p. In order to measure the differentiation level of cementoblasts, quantitative RT‐PCR (qRT‐PCR), Alizarin red staining, and assessment of alkaline phosphatase activity were performed. Luciferase assays, qRT‐PCR, and western blotting were used to identify the target gene of miR‐3064‐3p.

Results

miR‐3064‐3p showed persistently decreased expression during cementoblast differentiation. Overexpression of miR‐3064‐3p suppressed cementoblast differentiation, while inhibition of miR‐3064‐3p promoted cementoblast differentiation. Target prediction‐analysis tools and dual‐luciferase assay identified Dickkopf WNT signaling pathway inhibitor 1 (DKK1) as a direct target of miR‐3064‐3p. Results from qRT‐PCR and western blotting showed that inhibition of miR‐3064‐3p led to a remarkable increase in DKK1/Dickkopf related protein 1 (Dkk‐1) expression. In addition, pretreatment with recombinant Dickkopf related protein 1 (Dkk‐1) rescued the miR‐3064‐3p‐mediated suppression of cementoblast differentiation.

Conclusion

This study demonstrates, for the first time, that miR‐3064‐3p suppresses cementoblast differentiation via the regulation of DKK1.
Characteristics of hemostasis during experimentalEhrlichia canisinfection
Authors: Shropshire Sarah , Olver Christine , Lappin Michael
Published: April 2018

Background

Ehrlichia canisinfection in dogs can cause thrombocytopenia and clinical evidence of bleeding. It is unknown why some dogs show signs of bleeding whereas others do not despite clinically relevant thrombocytopenia.

Hypothesis/Objectives

Activated platelets, decreased fibrinolysis or both mitigate bleeding tendency. Assess standard hemostatic variables, platelet dynamics, and specialized coagulation testing in dogs experimentally infected withE. canisto evaluate this clinical discrepancy.

Animals

Four healthy laboratory beagles.

Methods

Dogs were given blood infected withE. canisIV. Platelet indices of activation, platelet aggregometry, antiplatelet antibodies (percent IgG), complete coagulation panel, and thromboelastography (TEG) were measured before inoculation and on weeks 1‐8. Dogs were treated with doxycycline at approximately 5 mg/kg PO q12h between weeks 3 and 4 (day 24). For each variable, 1‐way repeated measures analysis (1‐way ANOVA) with post‐hoc analysis was performed with statistical significance set atP < .05.

Results

Dogs had significantly lower platelet counts, evidence of activated platelets, and antiplatelet antibodies duringE. canisinfection. Dogs also appeared hypercoagulable and hypofibrinolytic using TEG as compared with baseline, changes that persisted for variable amounts of time after doxycycline administration. No overt signs of bleeding were noted during the study.

Conclusions and Clinical Importance

Activated platelets and a hypercoagulable, hypofibrinolytic state could explain the lack of a bleeding phenotype in some dogs despite clinically relevant thrombocytopenia. Findings from our pilot study indicate that additional studies are warranted.
Saccadic oscillations in 4 dogs and 1 cat
Authors: Ives Edward J. , MacKillop Edward , Olby Natasha J.
Published: April 2018

Disorders affecting the control of saccadic eye movements result in involuntary saccadic oscillations and are widely reported in human medicine. Information regarding the occurrence and potential importance of saccadic oscillations in veterinary medicine is currently limited. The clinical histories of three dogs and one cat displaying involuntary eye movements consistent with opsoclonus are presented, with final diagnoses including idiopathic generalized tremor syndrome and neuronal ceroid lipofuscinosis (NCL). A dog with eye movements closely resembling macrosaccadic oscillations is also presented, for which a final diagnosis of NCL was made. All animals had clinical signs of cerebellar disease. As in human medicine, recognition of these forms of involuntary eye movement might suggest a cerebellar neuroanatomic localization. Opsoclonus and macrosaccadic oscillations are forms of involuntary saccadic eye movement that are both unrecognized and under‐reported in veterinary medicine.
Diagnostic accuracy of SCCA and SCCA‐IgM for hepatocellular carcinoma: A meta‐analysis
Authors: Liu Chang‐Hai , Gil‐Gómez Antonio , Ampuero Javier , Romero‐Gómez Manuel
Published: April 2018

Background & Aims

Squamous cell carcinoma antigen (SCCA) and its immune complex (SCCA‐IgM) have been proposed for use in the screening of hepatocellular carcinoma (HCC). We conducted a meta‐analysis to evaluate the diagnostic performance of SCCA and SCCA‐IgM and of both combined with alpha‐foetoprotein.

Methods

After a systematic review of the relevant studies, the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio (DOR) and area under curve (AUC) for the diagnosis of HCC were pooled using bivariate meta‐analysis. Hierarchic summary receiver operating characteristic curves were used to summarize the overall test performance. Bivariate boxplots were used to confirm whether the threshold effect existed. A Fagan nomogram was used to assess the clinical utility. Heterogeneity was explored by sensitivity analysis, univariable meta‐regression and subgroup analysis.

Results

Eleven studies that had HCC diagnosis as their purpose were ultimately included in the quantitative analysis. The summary estimates were as follows: SCCA (AUC: 0.80 [95% CI: 0.76‐0.83]) and SCCA‐IgM (AUC: 0.77 [95% CI: 0.74‐0.83]) demonstrated similar diagnostic performance, while a combination of AFP and SCCA‐IgM had an AUC of 0.90 (95% CI: 0.87‐0.92) and a DOR of 22.87 (95% CI: 8.38‐62.40). Meta‐regression showed that patient selection, cut‐off values, reference standards and tumour biopsy as the diagnostic method significantly influenced the heterogeneity of the included studies.

Conclusions

Both SCCA and SCCA‐IgM showed a moderate diagnostic accuracy for HCC screening; the combination of SCCA‐IgM and AFP is the best diagnostic option.
Perceptive of the pyroxene‐bearing micrometeorites and their relation to chondrites
Authors: Rudraswami N. G. , Fernandes D. , De Araujo Agnelo , Shyam Prasad M. , Taylor S.
Published: April 2018

We studied 149 pyroxenes from 69 pyroxene‐bearing micrometeorites collected from deep‐sea sediments of the Indian Ocean and South Pole Water Well at Antarctica, Amundsen‐Scott South Pole station. The minor elements in pyroxenes from micrometeorites are present in the ranges as follows: MnO ~0.0–0.4 wt%, Al2O3 ~0.0–1.5 wt%, CaO ~0.0–1.0 wt%, Cr2O3 ~0.3–0.9 wt%, and FeO ~0.5–4 wt%. Their chemical compositions suggest that pyroxene‐bearing micrometeorites are mostly related to precursors from carbonaceous chondrites rather than ordinary chondrites. The Fe/(Fe+Mg) ratio of the pyroxenes and olivines in micrometeorites shows similarities to carbonaceous chondrites with values lying between 0 and 0.2, and those with values beyond this range are dominated by ordinary chondrites. Atmospheric entry of the pyroxene‐bearing micrometeorites is expected to have a relatively low entry velocity of <16 km s−1 and high zenith angle (70–90°) to preserve their chemical compositions. In addition, similarities in the pyroxene and olivine mineralogical compositions between carbonaceous chondrites and cometary particles suggest that dust in the solar system is populated by materials from different sources that are chemically similar to each other. Our results on pyroxene chemical compositions reveal significant differences with those from ordinary chondrites. The narrow range in olivine and pyroxene chemical compositions are similar to those from carbonaceous chondrites, and a small proportion to ordinary chondrites indicates that dust is largely sourced from carbonaceous chondrite‐type bodies.
Transgene‐independent heredity of RdDM‐mediated transcriptional gene silencing of endogenous genes in rice
Authors: Wakasa Yuhya , Kawakatsu Taiji , Harada Takeo , Takaiwa Fumio
Published: April 2018

To induce transcriptional gene silencing (TGS) of endogenous genes of rice (Oryza sativa L.), we expressed double‐strand RNA of each promoter region and thus induced RNA‐directed DNA methylation (RdDM). We targeted constitutively expressed genes encoding calnexin (CNX), protein disulphide isomerase (PDIL1‐1) and luminal binding protein (BiP1); an endoplasmic reticulum stress‐inducible gene (OsbZIP50); and genes with seed‐specific expression encoding α‐globulin (Glb‐1) and glutelin‐B4 (GluB4). TGS of four genes was obtained with high efficiency (CNX, 66.7% of regenerated plants; OsBiP1, 67.4%; OsbZIP50, 63.4%; GluB4, 66.1%), whereas the efficiency was lower for PDIL1‐1 (33.3%) and Glb‐1 TGS lines (10.5%). The heredity of TGS, methylation levels of promoter regions and specificity of silencing of the target gene were investigated in some of the TGS lines. In progeny of CNX and OsbZIP50 TGS lines, suppression of the target genes was preserved (except in the endosperm) even after the removal of trigger genes (T‐DNA) by segregation. TGS of CNX was reverted by demethylation treatment, and a significant difference in CG and CHG methylation levels in the −1 to −250 bp region of the CNX promoter was detected between the TGS and revertant lines, suggesting that TGS is closely related to the methylation levels of promoter. TGS exhibited specific suppression towards the target gene compared with post‐transcriptional gene silencing when GluB4 gene from glutelin multigene family was targeted. Based on these results, future perspectives and problems to be solved in the application of RdDM to new plant breeding techniques in rice are discussed.
Alteration of S‐adenosylhomocysteine levels affects lignin biosynthesis in switchgrass
Authors: Bai Zetao , Qi Tianxiong , Liu Yuchen , Wu Zhenying , Ma Lichao , Liu Wenwen , Cao Yingping , Bao Yan , Fu Chunxiang
Published: April 2018

Methionine (Met) synthesized from aspartate is a fundamental amino acid needed to produce S‐adenosylmethionine (SAM) that is an important cofactor for the methylation of monolignols. As a competitive inhibitor of SAM‐dependent methylation, the effect of S‐adenosylhomocysteine (SAH) on lignin biosynthesis, however, is still largely unknown in plants. Expression levels of Cystathionine γ‐synthase (PvCGS) and S‐adenosylhomocysteine hydrolase 1 (PvSAHH1) were down‐regulated by RNAi technology, respectively, in switchgrass, a dual‐purpose forage and biofuel crop. The transgenic switchgrass lines were subjected to studying the impact of SAH on lignin biosynthesis. Our results showed that down‐regulation of PvCGS in switchgrass altered the accumulation of aspartate‐derived and aromatic amino acids, reduced the content of SAH, enhanced lignin biosynthesis and stunted plant growth. In contrast, down‐regulation of PvSAHH1 raised SAH levels in switchgrass, impaired the biosynthesis of both guaiacyl and syringyl lignins and therefore significantly increased saccharification efficiency of cell walls. This work indicates that SAH plays a crucial role in monolignol methylation in switchgrass. Genetic regulation of either PvCGS or PvSAHH1 expression in switchgrass can change intracellular SAH contents and SAM to SAH ratios and therefore affect lignin biosynthesis. Thus, our study suggests that genes involved in Met metabolism are of interest as new valuable targets for cell wall bioengineering in future.
Chromosome‐level assembly, genetic and physical mapping of Phalaenopsis aphrodite genome provides new insights into species adaptation and resources for orchid breeding
Authors: Chao Ya‐Ting , Chen Wan‐Chieh , Chen Chun‐Yi , Ho Hsiu‐Yin , Yeh Chih‐Hsin , Kuo Yi‐Tzu , Su Chun‐Lin , Yen Shao‐Hua , Hsueh Hao‐Yen , Yeh Jen‐Hau , Hsu Hui‐Lan , Tsai Yi‐Hui , Kuo Tzu‐Yen , Chang Song‐Bin , Chen Kai‐Yi , Shih Ming‐Che
Published: April 2018

The Orchidaceae is a diverse and ecologically important plant family. Approximately 69% of all orchid species are epiphytes, which provide diverse microhabitats for many small animals and fungi in the canopy of tropical rainforests. Moreover, many orchids are of economic importance as food flavourings or ornamental plants. Phalaenopsis aphrodite, an epiphytic orchid, is a major breeding parent of many commercial orchid hybrids. We provide a high‐quality chromosome‐scale assembly of the P. aphrodite genome. The total length of all scaffolds is 1025.1 Mb, with N50 scaffold size of 19.7 Mb. A total of 28 902 protein‐coding genes were identified. We constructed an orchid genetic linkage map, and then anchored and ordered the genomic scaffolds along the linkage groups. We also established a high‐resolution pachytene karyotype of P. aphrodite and completed the assignment of linkage groups to the 19 chromosomes using fluorescence in situ hybridization. We identified an expansion in the epiphytic orchid lineage of FRS5‐like subclade associated with adaptations to the life in the canopy. Phylogenetic analysis further provides new insights into the orchid lineage‐specific duplications of MADS‐box genes, which might have contributed to the variation in labellum and pollinium morphology and its accessory structure. To our knowledge, this is the first orchid genome to be integrated with a SNP‐based genetic linkage map and validated by physical mapping. The genome and genetic map not only offer unprecedented resources for increasing breeding efficiency in horticultural orchids but also provide an important foundation for future studies in adaptation genomics of epiphytes.
Sugars en route to the roots. Transport, metabolism and storage within plant roots and towards microorganisms of the rhizosphere
Authors: Hennion Nils , Durand Mickael , Vriet Cécile , Doidy Joan , Maurousset Laurence , Lemoine Rémi , Pourtau Nathalie
Published: April 2018

In plants, the root is a typical sink organ that relies exclusively on the import of sugar from the aerial parts. Sucrose is delivered by the phloem to the most distant root tips and, en route to the tip, is used by the different root tissues for metabolism and storage. Besides, a certain portion of this carbon is exuded in the rhizosphere, supplied to beneficial microorganisms and diverted by parasitic microbes. The transport of sugars toward these numerous sinks either occurs symplastically through cell connections (plasmodesmata) or is apoplastically mediated through membrane transporters (MST, mononsaccharide tranporters, SUT/SUC, H+/sucrose transporters and SWEET, Sugar will eventually be exported transporters)
that control monosaccharide and sucrose fluxes. Here, we review recent progresses on carbon partitioning within and outside roots, discussing membrane transporters involved in plant responses to biotic and abiotic factors.
Beyond the species pool: modification of species dispersal, establishment, and assembly by habitat restoration
Authors: Török Péter , Helm Aveliina , Kiehl Kathrin , Buisson Elise , Valkó Orsolya
Published: April 2018

Species dispersal, establishment, and assembly are crucial stages of the life history of plants, and clear understanding of the governing forces and rules that shape species composition in a particular community is vital for successful ecological restoration. In this article, we focus on five aspects of seed dispersal and plant establishment, which should be considered during habitat restoration actions. In the first two sections, we discuss the success of spontaneous dispersal and establishment on restoration based on either spatial dispersal or local seed banks. In the third section, we assess the possibilities of species introduction and assisted dispersal. In the fourth section, we introduce some possibilities for the improvement of establishment success of spontaneously dispersed or introduced species. Finally, we highlight issues influencing long‐term persistence and sustainability of restored habitats, related to the alteration of management type and intensity, climate change, and spread of non‐native species. With the present article, we introduce the special issue entitled “Seed dispersal and soil seed banks – promising sources for ecological restoration” containing 15 papers by 62 authors from 10 countries arranged in the abovementioned five topics.
Identification of uterine pacemaker regions at the myometrial–placental interface in the rat
Authors: Lutton E. Josiah , Lammers Wim J. E. P. , James Sean , van den Berg Hugo A. , Blanks Andrew M.
Published: April 2018

Key Points

Coordinated contraction of the uterine smooth muscle is essential to parturition.

Histologically and physiologically defined pacemaker structures have not been identified in uterine smooth muscle.

Here we report combined electrophysiological and histological evidence of zones associated with pacemaker activity in the rat myometrium.

Our method relies crucially on the integration of histological and electrophysiological data in an in silico three‐dimensional reconstruction of the rat myometrium at 10 μm resolution.

We find that myometrial/placental pacemaking zones are closely related with placental sites and the area of disruptive myometrial remodelling surrounding such sites.

If analogues of the myometrial/placental pacemaking zone are present in the human, defining their histology and physiology will be important steps towards treatment of pre‐term birth, pre‐eclampsia, and postpartum haemorrhage.

Coordinated uterine contractions are essential for delivering viable offspring in mammals. In contrast to other visceral smooth muscles, it is not known where excitation within the uterus is initiated, and no defined pacemaking region has hitherto been identified. Using multi‐electrode array recordings and high‐resolution computational reconstruction of the three‐dimensional micro‐structure of late pregnant rat uterus, we demonstrate that electrical potentials are initiated in distinct structures within the placental bed of individual implantation sites. These previously unidentified structures represent modified smooth muscle bundles that are derived from bridges between the longitudinal and circular layers. Coordinated implantation and encapsulation by invading trophoblast give rise to isolated placental/myometrial interface bundles that directly connect to the overlying longitudinal smooth muscle layer. Taken together, these observations imply that the anatomical structure of the uterus, combined with site‐specific implantation, gives rise to emergent patterns of electrical activity that drive effective contractility during parturition.
Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts
Authors: Siddiqi Arjumand , Rajaram Akshay , Miller Steven P
Published: April 2018

Introduction

Decades of research unequivocally demonstrates that no matter the society, socioeconomic resources are perhaps the most fundamental determinants of health throughout the life course, including during its very earliest stages. As a result, societies have implemented ‘cash transfer’ programmes, whichprovide income supplementation to reduce socioeconomic disadvantage among the poorest families with young children. Despite this being a common approach of societies around the world, research on effects of these programmes in low-income/middle-income countries, and those in high-income countries has been conducted as if they are entirely distinct phenomena. In this paper, we systematically review the international literature on the association between cash transfer programmes and health outcomes during the first year of life.

Methods

We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Using a variety of relevant keywords, we searched MEDLINE, EMBASE, CINAHL, Cochrane Reviews, EconLit and Social Sciences Citations Index.

Results

Our review yielded 14 relevant studies. These studies suggested cash transfer programmes that were not attached to conditions tended to yield positive effects on outcomes such as birth weight and infant mortality. Programmes that were conditional on use of health services also carried positive effects, while those that carried labour-force participation conditionalities tended to yield no positive effects.

Discussion

Given several dynamics involved in determining whether children are healthy or not, which are common worldwide, viewing the literature from a global perspective produces novel insights regarding the tendency of policies and programmes to reduce or, to exacerbate, the effects of socioeconomic disadvantage on child health.
Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often
Authors: Sheean Andrew J , Musahl Volker , Slone Harris S , Xerogeanes John W , Milinkovic Danko , Fink Christian , Hoser Christian
Published: April 2018

Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon’s armamentarium.
Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study
Authors: Burns Richeal M , Wolstenholme Jane , Jawad Sena , Williams Nicola , Thompson Matthew , Perera Rafael , Hay Alastair D , Heneghan Carl , Little Paul , Moore Michael , Hayward Gail
Published: April 2018

Objectives

To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat.

Design

A UK-based, multicentre, two arm, individually randomised, double blind trial.

Setting and population

Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. Intervention: a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit.

Main outcome

Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost–utility analysis performed on an intention-to-treat cohort adopting a health payers perspective.

Results

Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was −0.00005 (95% CI −0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was −£6440 (95% CI −£132 151 to £126 335) and the median ICER was −£304 (IQR-£5816 to £3877); suggesting considerable uncertainty.

Conclusions and relevance

The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice.

Trial registration number

ISRCTN17435450; Post-results.
Systematic review of prediction models for delirium in the older adult inpatient
Authors: Lindroth Heidi , Bratzke Lisa , Purvis Suzanne , Brown Roger , Coburn Mark , Mrkobrada Marko , Chan Matthew T V , Davis Daniel H J , Pandharipande Pratik , Carlsson Cynthia M , Sanders Robert D
Published: April 2018

Objective

To identify existing prognostic delirium prediction models and evaluate their validity and statistical methodology in the older adult (≥60 years) acute hospital population.

Design

Systematic review.

Data sources and methods

PubMed, CINAHL, PsychINFO, SocINFO, Cochrane, Web of Science and Embase were searched from 1 January 1990 to 31 December 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and CHARMS Statement guided protocol development. Inclusion criteria: age >60 years, inpatient, developed/validated a prognostic delirium prediction model. Exclusion criteria: alcohol-related delirium, sample size ≤50. The primary performance measures were calibration and discrimination statistics. Two authors independently conducted search and extracted data. The synthesis of data was done by the first author. Disagreement was resolved by the mentoring author.

Results

The initial search resulted in 7,502 studies. Following full-text review of 192 studies, 33 were excluded based on age criteria (<60 years) and 27 met the defined criteria. Twenty-three delirium prediction models were identified, 14 were externally validated and 3 were internally validated. The following populations were represented: 11 medical, 3 medical/surgical and 13 surgical. The assessment of delirium was often non-systematic, resulting in varied incidence. Fourteen models were externally validated with an area under the receiver operating curve range from 0.52 to 0.94. Limitations in design, data collection methods and model metric reporting statistics were identified.

Conclusions

Delirium prediction models for older adults show variable and typically inadequate predictive capabilities. Our review highlights the need for development of robust models to predict delirium in older inpatients. We provide recommendations for the development of such models.
Vietnamese medical students and binge drinking: a qualitative study of perceptions, attitudes, beliefs and experience
Authors: Nguyen Thi Thu Huong , Sendall Marguerite C , White Katherine M. , Young Ross McD
Published: April 2018

Objectives

To explore the perceptions, attitudes, beliefs, and experiences related to Vietnamese medical students’ binge drinking.

Design

A qualitative study comprising semi-structured focus groups/interviews with medical students and semi-structured interviews with key informants. Thematic analysis of data.

Setting

Participants were a convenience sample of usual volunteers from a medical university in Viet Nam.

Participants

19 medical students from year 1 to 6 and 4 key informants agreed to participate in the study.

Results

The study found participants believe medical students drink less than other students and are not binge drinkers yet they experience and/or witness many binge drinking occasions among medical students. Participants consider alcohol use as culturally acceptable in Vietnamese society and a way for medical students to create and improve relationships with their friends, teachers, or work colleagues. Group affiliation and peer pressure to drink excessive alcohol are identified among medical students, especially male students.

Conclusion

The culture of drinking behaviour was explored among medical students in Viet Nam. This study reveals a dichotomy between the belief of not being binge drinkers and the experience of many binge drinking occasions among medical students. This tension suggests future research about binge drinking behaviour of Vietnamese medical students is required.
Quality of evidence considered by Health Canada in granting full market authorisation to new drugs with a conditional approval: a retrospective cohort study
Authors: Lexchin Joel
Published: April 2018

Objectives

This study examines the characteristics of studies that Health Canada uses to grant full marketing authorisation for products given a conditional approval between 1 January 1998 and 30 June 2017.

Design

Cohort study.

Data sources

Journal articles listing drugs that fulfilled their conditions and received full marketing authorisation, Notice of Compliance database, Notice of Compliance with conditions website, Qualifying Notices listing required confirmatory studies, clinicaltrials.gov, PubMed, Embase, companies making products being analysed, journal articles resulting from confirmatory studies.

Interventions

None.

Primary and secondary outcome measures

Characteristics of studies—study design (randomised controlled trials, observational), primary outcome used (clinical, surrogate), blinding, number of patients in studies, patient median age, number of men and women.

Results

Eleven companies confirmed 36 publications for 19 products (21 indications). Twenty-nine out of the 36 studies were randomised controlled trials (RCTs) but only 10 stated if they were blinded. Twenty used surrogate outcomes. The median age of patients was 56 (IQR 44–61). The median number of men per study/trial was 184 (IQR 58–514) versus women 141 (IQR 46–263).

Conclusions

Postmarket studies required by Health Canada had more rigorous methodology than those required by either the Food and Drug Administration or the European Medicines Agency. There were still deficiencies in these studies. The absence of blinding in the majority of RCTs may introduce bias in their results. The use of surrogate outcomes especially in oncology trials means that improvements in survival are not available. The relatively young age of patients, even for products for cancer, means that predicting how the elderly will respond is often unknown. The almost universal finding that men outnumbered women may make it hard to differentiate responses by sex. These results raise potential concerns about the quality of evidence that Health Canada accepts.
Should surgery be delayed in patients taking direct oral anticoagulants who suffer a hip fracture? A retrospective, case-controlled observational study at a UK major trauma centre
Authors: Mullins Barry , Akehurst Harold , Slattery David , Chesser Tim
Published: April 2018

Objective

To determine whether not waiting for the elimination of direct oral anticoagulants (DOACs) has an effect on the amount of perioperative bleeding in patients who undergo operative treatment of a hip fracture.

Design

Observation, retrospective case–control study.

Setting

A single UK major trauma centre.

Participants

Patients who sustained a hip fracture were identified using the National Hip Fracture Database (NHFD). All those found to be taking a DOAC at the time of fracture were identified (n=63). A matched group not taking a DOAC was also identified from the NHFD (n=62).

Main outcome

Perioperative drop in haemoglobin concentration.

Results

There was no relationship between admission to operation interval and perioperative change in haemoglobin concentration in patients taking DOACs (regression coefficient=−0.06 g/L/hour; 95% CI −0.32–0.20; p=0.64). No relationship was found between the time from admission to operation interval and the probability of transfusion (OR=0.94; 95% CI 0.85 to 1.90; p=0.16) or reoperation (OR=1.04; 95% CI 0.93 to 1.16; p=0.49). One mortality was recorded in the DOAC group within 30 days of admission, and this compared with five in the matched group of patients (p=0.2).

Conclusions

Delaying surgery in patients who sustain a hip fracture who are taking a DOAC drug has not been shown to reduce perioperative bleeding or affect their mortality in this study.
Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions?: a cross-sectional study in the East of England
Authors: Fleetcroft Robert , Hardcastle Antonia , Steel Nicholas , Price Gill M , Purdy Sarah , Lipp Alistair , Myint Phyo Kyaw , Howe Amanda
Published: April 2018

Objectives

To use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS) list of ambulatory care sensitive conditions (ACSCs).

Design

Analysis of unplanned medical admissions randomly identified in secondary care.

Setting

Primary care in the East of England.

Participants

20 general practice teams trained to use SEA on unplanned admissions to identify potentially preventable factors.

Interventions

SEA of admissions.

Main outcome measures

Level of agreement between those admissions identified as potentially preventable by SEA and the NHS ACSC list.

Results

132 (26%) of randomly selected patients with unplanned admissions gave consent and an SEA was performed by their primary practice team. 130 SEA reports had sufficient data for our analysis. Practices concluded that 17 (13%) admissions were potentially preventable. The NHS ACSC list identified 36 admissions (28%) as potentially preventable. There was a low level of agreement between the practices and the NHS list as to which admissions were preventable (kappa=0.253). The ACSC list consisted mainly of respiratory admissions whereas the practice list identified a wider range of cases and identified context-specific factors as important.

Conclusions

There was disagreement between the NHS list and practice conclusions of potentially avoidable admissions. The SEAs suggest that the pathway into unplanned admission may be less dependent on the condition than on context-specific factors, and the assumption that unplanned admissions for ACSCs are reasonable indicators of performance for primary care may not be valid.
Soil-transmitted helminth infections and nutritional status in Ecuador: findings from a national survey and implications for control strategies
Authors: Moncayo Ana L , Lovato Raquel , Cooper Philip J
Published: April 2018

Objective

The estimation of prevalence and intensity of soil-transmitted helminth (STH) infections at a country-level is an essential prerequisite for the implementation of a rational control programme. The aim of this present study was to estimate the prevalence and distribution of STH infections and malnutrition in school-age children in rural areas of Ecuador.

Design

Cross-sectional study from October 2011 to May 2012.

Setting

Eighteen rural schools were randomly selected from the three ecological regions of Ecuador (coastal, highlands and Amazon basin).

Participants

920 children aged 6–16 years.

Main outcome measures

Prevalence and intensity of STH infections associated with malnutrition (thinness/wasting or stunting).

Results

The results showed that 257 (27.9%) children were infected with at least one STH parasite. The prevalence ofTrichuris trichiura,Ascaris lumbricoidesand hookworm was 19.3%, 18.5% and 5.0%, respectively. Malnutrition was present in 14.2% of children and most common was stunting (12.3%). Compared with other regions, schoolchildren in the Amazon region had the highest STH prevalence (58.9%) of which a greater proportion of infections were moderate/heavy intensity (45.6%) and had the highest prevalence of malnutrition (20.4%). A positive association was observed between moderate to heavy infections withA. lumbricoidesand malnutrition (adjusted OR 1.85, 95% CI 1.04 to 3.31, p=0.037).

Conclusions

Our estimate of the prevalence of STH infections of 27.9% at a national level in Ecuador is lower than suggested by previous studies. Our data indicate that schoolchildren living in the Amazon region have a greater risk of STH infection and stunting compared with children from other regions. The implementation of school-based preventive chemotherapy and nutritional supplement programmes within the Amazon region should be prioritised. Long-term control strategies require improvements in water, sanitation and hygiene.
Post-treatment surveillance testing of patients with colorectal cancer and the association with survival: protocol for a retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database
Authors: Hines Robert B , Jiban Md Jibanul Haque , Choudhury Kanak , Loerzel Victoria , Specogna Adrian V , Troy Steven P , Zhang Shunpu
Published: April 2018

Introduction

Although the colorectal cancer (CRC) mortality rate has significantly improved over the past several decades, many patients will have a recurrence following curative treatment. Despite this high risk of recurrence, adherence to CRC surveillance testing guidelines is poor which increases cancer-related morbidity and potentially, mortality. Several randomised controlled trials (RCTs) with varying surveillance strategies have yielded conflicting evidence regarding the survival benefit associated with surveillance testing. However, due to differences in study protocols and limitations of sample size and length of follow-up, the RCT may not be the best study design to evaluate this relationship. An observational comparative effectiveness research study can overcome the sample size/follow-up limitations of RCT designs while assessing real-world variability in receipt of surveillance testing to provide much needed evidence on this important clinical issue. The gap in knowledge that this study will address concerns whether adherence to National Comprehensive Cancer Network CRC surveillance guidelines improves survival.

Methods and analysis

Patients with colon and rectal cancer aged 66–84 years, who have been diagnosed between 2002 and 2008 and have been included in the Surveillance, Epidemiology, and End Results-Medicare database, are eligible for this retrospective cohort study. To minimise bias, patients had to survive at least 12 months following the completion of treatment. Adherence to surveillance testing up to 5 years post-treatment will be assessed in each year of follow-up and overall. Binomial regression will be used to assess the association between patients’ characteristics and adherence. Survival analysis will be conducted to assess the association between adherence and 5-year survival.

Ethics and dissemination

This study was approved by the National Cancer Institute and the Institutional Review Board of the University of Central Florida. The results of this study will be disseminated by publishing in the peer-reviewed scientific literature, presentation at national/international scientific conferences and posting through social media.
Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol
Authors: Rousham Emily , Unicomb Leanne , Wood Paul , Smith Michael , Asaduzzaman Muhammad , Islam Mohammad Aminul
Published: April 2018

Introduction

Increasing antibiotic resistance (ABR) in low-income and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic-resistant bacteria and concentrations of antibiotic-resistant genes from a ‘One Health’ perspective. The holistic assessment of ABR in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk.

Methods and analysis

The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: (1) rural poultry-owning households, (2) commercial poultry farms and (3) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and food-producing animals are potential sources of transmission to humans.Escherichia coliis used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract.

Ethics and dissemination

The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences.
Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management
Authors: Rickard Annette C , Vassallo James , Nutbeam Tim , Lyttle Mark D , Maconochie Ian K , Enki Doyo G , Smith Jason E
Published: April 2018

Aims

Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.

Methods

An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.

Results

73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation.

Conclusion

This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.
Man with hand pain
Authors: Jansson Paul S , Lee Stella J , Samuels-Kalow Margaret E
Published: April 2018

Clinical introduction

A right-hand dominant man was transferred to our institution for evaluation by the hand surgery service. He reported that the day prior he had been sliding a sheet of plywood across the ground when he lost his grip, causing the board to slide across his left hand. He presented to an outside hospital where local exploration of the wound did not reveal any foreign body. On arrival, he complained only of mild pain in his hand. Physical examination revealed erythema and swelling over the thenar eminence and a small open area without any drainage. Radiographs (figure 1) and ultrasonography (figures 2 and 3, online supplementary video 1 and 2) were performed.

Supplementary data

Figure 1

Radiograph of the hand.

Figure 2

Long-axis ultrasonography of the hand.

Figure 3

Short-axis ultrasonography of the hand.

Question

What is you diagnosis?

Fracture of the metacarpal of the thumb.

Cellulitis of the thenar eminence.

Abscess of the thenar eminence.

Retained foreign body.
Chairing an academic pathology department: challenges and opportunities
Authors: Gao Zu-hua
Published: April 2018

Understanding the heterogeneity of departmental structure, service model and job descriptions for different pathology chairs, this review highlights some common challenges and opportunities facing most pathology chairs in academic institutions. The review is divided into three sections: clinical service, academic development and administration. The views and insights from this review may provide guidance to new chairs and emerging leaders in pathology and other relevant specialties.
Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis
Authors: Kaesmacher Johannes , Mordasini Pasquale , Arnold Marcel , López-Cancio Elena , Cerdá Neus , Boeckh-Behrens Tobias , Kleine Justus F , Goyal Mayank , Hill Michael D , Pereira Vitor Mendes , Saver Jeffrey L , Gralla Jan , Fischer Urs
Published: April 2018

Background

Whether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate.

Methods

This study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI). Sensitivity analysis was performed by distinguishing between studies including dMTE patients eligible for IVT (IVT-E) or ineligible for IVT (IVT-IN). Primary outcome measures were functional independence (modified Rankin Scale≤2) and mortality at day 90, successful reperfusion, and symptomatic intracerebral hemorrhage.

Results

Twenty studies, incorporating 5279 patients, were included. There was no evidence that rates of successful reperfusion differed in dMTE and IVT+MTE patients (sOR 0.93, 95% CI 0.68 to 1.28). In studies including IVT-IN dMTE patients, patients undergoing dMTE tended to have lower rates of functional independence and had higher odds for a fatal outcome as compared with IVT+MTE patients (sOR 0.78, 95% CI 0.61 to 1.01 and sOR 1.45, 95% CI 1.22 to 1.73). However, no such treatment group effect was found when analyses were confined to cohorts with a lower risk of selection bias (including IVT-E dMTE patients).

Conclusion

The quality of evidence regarding the relative merits of IVT+MTE versus dMTE is low. When considering studies with lower selection bias, the data suggest that dMTE may offer comparable safety and efficacy as compared with IVT+MTE. The conduct of randomized-controlled clinical trials seems justified.