bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating Venous Thromboembolism Risk in Foot and Ankle Surgical Patients: A Base-Population Case-Control Study
Authors: Zambelli Roberto , Nemeth Banne , Touw Carolina , Rezende Suely , Cannegieter Suzanne
Published: October 2019

Category:

Complications

Introduction/Purpose:

Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery and therefore some form of prophylactic therapy is usually recommended here. In contrast, the risk for VTE following foot and ankle surgery is less clear and so are guidelines on VTE prophylaxis in these patients. The purpose is to estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery.

Methods:

Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (5129 cases; 5882 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj) were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date).

Results:

286 cases and 96 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3.7 (95%CI 2.9-4.8) The ORadj in the first 90-days was 11.4 (95%CI 7.3-17.7). 57 cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3.3, 95% CI 1,9-5.5). VTE risk was highest in the first 30 (ORadj 10.2,95%CI 3.0-33.9) and 90-days following surgery (ORadj 12.4, 95% CI 4.4-34.8). In 34 patients the surgery was trauma related while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk compared with elective surgery for an OR of 13.9 (95%CI 1.8-108.4) and 8.3 (95%CI 1.9-36.9), respectively at 30-days.

Conclusion:

Foot and ankle procedures were associated with an increased VTE risk which was highest in the first 90-days following surgery. Trauma related surgery was associated with a higher VTE risk than elective surgery. These results are important to decide on thromboprophylactic measures following foot and ankle surgery.
Replication timing alterations in leukemia affect clinically relevant chromosome domains
Authors: Rivera-Mulia Juan Carlos , Sasaki Takayo , Trevilla-Garcia Claudia , Nakamichi Naoto , Knapp David J. H. F. , Hammond Colin A. , Chang Bill H. , Tyner Jeffrey W. , Devidas Meenakshi , Zimmerman Jared , Klein Kyle N. , Somasundaram Vivek , Druker Brian J. , Gruber Tanja A. , Koren Amnon , Eaves Connie J. , Gilbert David M.
Published: October 2019

Key Points

DNA replication timing of >100 pediatric leukemic samples identified BCP-ALL subtype-specific genome alteration signatures. Comparative analyses identified features of specific stages of B-cell differentiation and potential associations with clinical outcome.
The fracture mechanism of softwood via hierarchical modelling analysis
Authors: Wang Dong , Lin Lanying , Fu Feng , Fan Mizi
Published: October 2019

A hierarchical model of softwood was developed to effectively analyze stress concentration and predict initial fracture of the wood cell wall under different loading scenarios. The results indicated that the simulated stress concentration regions of the tracheid wall approximately matched the experimental initial fracture locations. The stress concentration and initial fracture of the tracheid wall under longitudinal tensile stress occurred in the S2 layer. In the cases of pure longitudinal–radial (LR) or longitudinal–tangential (LT) in-plane shear loading, the highest stresses are observed in the S1/S2 interface and the S3 layer, but the initial fractures of the tracheids of the neutral layer under the LR or LT shear stress only occurred in the S1/S2 interface. Furthermore, the tracheids of the tensile parts outermost of bending specimen were subjected to the longitudinal tension and shear coupling stresses that led to the two kinds of cracks occurring, including trumpet-shaped cracks in the S2 layer, and S1/S2 interface debonding.
Computational prediction of MoRFs based on protein sequences and minimax probability machine
Authors: He Hao , Zhao Jiaxiang , Sun Guiling
Published: October 2019

Background

Molecular recognition features (MoRFs) are one important type of disordered segments that can promote specific protein-protein interactions. They are located within longer intrinsically disordered regions (IDRs), and undergo disorder-to-order transitions upon binding to their interaction partners. The functional importance of MoRFs and the limitation of experimental identification make it necessary to predict MoRFs accurately with computational methods.

Results

In this study, a new sequence-based method, named as MoRFMPM, is proposed for predicting MoRFs. MoRFMPM uses minimax probability machine (MPM) to predict MoRFs based on 16 features and 3 different windows, which neither relying on other predictors nor calculating the properties of the surrounding regions of MoRFs separately. Comparing with ANCHOR, MoRFpred and MoRFCHiBi on the same test sets, MoRFMPM not only obtains higher AUC, but also obtains higher TPR at low FPR.

Conclusions

The features used in MoRFMPM can effectively predict MoRFs, especially after preprocessing. Besides, MoRFMPM uses a linear classification algorithm and does not rely on results of other predictors which makes it accessible and repeatable.
Modeling allele-specific expression at the gene and SNP levels simultaneously by a Bayesian logistic mixed regression model
Authors: Xie Jing , Ji Tieming , Ferreira Marco A. R. , Li Yahan , Patel Bhaumik N. , Rivera Rocio M.
Published: October 2019

Background

High-throughput sequencing experiments, which can determine allele origins, have been used to assess genome-wide allele-specific expression. Despite the amount of data generated from high-throughput experiments, statistical methods are often too simplistic to understand the complexity of gene expression. Specifically, existing methods do not test allele-specific expression (ASE) of a gene as a whole and variation in ASE within a gene across exons separately and simultaneously.

Results

We propose a generalized linear mixed model to close these gaps, incorporating variations due to genes, single nucleotide polymorphisms (SNPs), and biological replicates. To improve reliability of statistical inferences, we assign priors on each effect in the model so that information is shared across genes in the entire genome. We utilize Bayesian model selection to test the hypothesis of ASE for each gene and variations across SNPs within a gene. We apply our method to four tissue types in a bovine study to de novo detect ASE genes in the bovine genome, and uncover intriguing predictions of regulatory ASEs across gene exons and across tissue types. We compared our method to competing approaches through simulation studies that mimicked the real datasets. The R package, BLMRM, that implements our proposed algorithm, is publicly available for download at https://github.com/JingXieMIZZOU/BLMRM.

Conclusions

We will show that the proposed method exhibits improved control of the false discovery rate and improved power over existing methods when SNP variation and biological variation are present. Besides, our method also maintains low computational requirements that allows for whole genome analysis.
Genomic characteristics and comparative genomics analysis of the endophytic fungus Sarocladium brachiariae
Authors: Yang Yang , Liu Xiaobao , Cai Jimiao , Chen Yipeng , Li Boxun , Guo Zhikai , Huang Guixiu
Published: October 2019

Background

Sarocladium brachiariaeis a newly identified endophytic fungus isolated fromBrachiaria brizantha. A previous study indicated thatS. brachiariaehad antifungal activity; however, limited genomic information restrains further study. Therefore, we sequenced the genome ofS. brachiariaeand compared it with the genome ofS. oryzaeto identify differences between aSarocladiumplant pathogen and an endophyte.

Results

In this study, we reported a gapless genome sequence of a newly identified endophytic fungusSarocladium brachiariaeisolated fromBrachiaria brizantha. The genome ofS. brachiariaeis 31.86 Mb, with a contig N50 of 3.27 Mb and 9903 protein coding genes. Phylogenomic analysis based on single copy orthologous genes provided insights into the evolutionary relationships ofS. brachiariaeand its closest species was identified asS. oryzae. Comparative genomics analysis revealed thatS. brachiariahas 14.9% more plant cell wall degradation related CAZymes toS. oryzae, and 33.3% more fungal cell wall degradation related CAZymes, which could explain the antifungal activity ofS. brachiaria. Based on Antibiotics & Secondary Metabolite Analysis Shell (antiSMASH) analysis, we identified a contact helvolic acid biosynthetic gene cluster (BGC) for the first time inS. oryzae. However,S. brachiariahad seven fewer terpene gene clusters, including helvolic acid BGC, compared withS. oryzaeand this may be associated with adaptation to an endophytic lifestyle. Synteny analysis of polyketide synthases (PKS), non-ribosomal peptide synthetases (NRPS), and hybrid (PKS-NRPS) gene clusters betweenS. brachiariaeandS. oryzaerevealed that just 37.5% of tested clusters have good synteny, while 63.5% have no or poor synteny. This indicated that theS. brachiariaecould potentially synthesize a variety of unknown-function secondary metabolites, which may play an important role in adaptation to its endophytic lifestyle and antifungal activity.

Conclusions

The data provided a better understanding of theSarocladium brachiariaegenome. Further comparative genomic analysis provided insight into the genomic basis of its endophytic lifestyle and antifungal activity.
Correction to: 24-Epibrassinolide promotes NO3− and NH4+ ion flux rate and NRT1 gene expression in cucumber under suboptimal root zone temperature
Authors: Anwar Ali , Li Yansu , He Chaoxing , Yu Xianchang
Published: October 2019

In the original publication of this article [1], the author pointed out there is an error in Figs. 4 and 5.
Experiences of accreditation impact in general practice – a qualitative study among general practitioners and their staff
Authors: Kousgaard Marius Brostrøm , Thorsen Thorkil , Due Tina Drud
Published: October 2019

Background

Accreditation is a widespread tool for quality management in health care. However, there is lack of research on the impact of accreditation, particularly in general practice. This study explores how general practitioners and their staff experienced the impact of a mandatory accreditation program in Denmark.

Methods

Qualitative interviews with general practitioners and staff from 11 clinics. The respondents were interviewed twice: during preparation and after the survey visit. The interviews were analyzed using thematic analysis, and all specific changes and other types of impact were extracted from the transcribed interview data from each clinic.

Results

The impact of accreditation varied markedly among the clinics as did the participants’ overall assessments of accreditation. Concerning specific changes in behavior and physical infrastructure, some clinics had only implemented a few minor changes in response to accreditation, some had made a relatively moderate number of changes, and a few clinics had made relatively many changes including a few pronounced ones. Further, some participants experienced that accreditation had enhanced knowledge sharing or upgraded competencies, and increased job satisfaction. However, the workload related to accreditation was emphasized as a problem by a majority of the professionals and for a few, accreditation had influenced job satisfaction negatively.

Conclusion

Accreditation may affect general practice clinics in very different ways. In spite of several examples of positive impact, the results suggest that it is difficult to design a mandatory accreditation program for general practice in which most professionals experience that the benefits of accreditation equal the resources used in the process.
Clinical characteristics of acute Q fever patients in South Korea and time from symptom onset to serologic diagnosis
Authors: Heo Jung Yeon , Choi Young Wha , Kim Eun Jin , Lee Seung Hun , Lim Seung Kwan , Hwang Seon Do , Lee Ju Young , Jeong Hye Won
Published: October 2019

Background

Acute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment.

Methods

Data of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics.

Results

Forty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340).

Conclusions

Most acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever.
HCV and HBV prevalence based on home blood self-sampling and screening history in the general population in 2016: contribution to the new French screening strategy
Authors:   the 2016 Health Barometer Group, Brouard Cécile , Saboni Leïla , Gautier Arnaud , Chevaliez Stéphane , Rahib Delphine , Richard Jean-Baptiste , Barin Francis , Larsen Christine , Sommen Cécile , Pillonel Josiane , Delarocque-Astagneau Elisabeth , Lydié Nathalie , Lot Florence
Published: October 2019

Background

The advent of effective direct-acting antivirals (DAAs), has prompted an assessment of the French Hepatitis C virus (HCV) screening strategy, which historically targeted high-risk groups. One of the options put forward is the implementation of combined (i.e., simultaneous) HCV, Hepatitis B virus (HBV) and HIV screening for all adults at least once during their lifetime (“universal combined screening”). However, recent national survey-based data are lacking to guide decision-making regarding which new strategy to implement. Accordingly, we aimed to provide updated data for both chronic hepatitis C (CHC) and B (CHB) prevalence and for HCV and HBV screening history, using data from the BaroTest and 2016 Health Barometer (2016-HB) studies, respectively.

Methods

2016-HB was a national cross-sectional phone based health survey conducted in 2016 among 20,032 randomly selected individuals from the general population in mainland France. BaroTest was a virological sub-study nested in 2016-HB. Data collected for BaroTest were based on home blood self-sampling on dried blood spots (DBS).

Results

From 6945 analyzed DBS, chronic hepatitis C (CHC) and B (CHB) prevalence was estimated at 0.30% (95% Confidence Interval (CI): 0.13-0.70) and 0.30% (95% CI: 0.13-0.70), respectively. The proportion of individuals aware of their status was estimated at 80.6% (95% CI: 44.2-95.6) for CHC and 17.5% (95% CI: 4.9-46.4) for CHB. Universal combined screening would involve testing between 32.6 and 85.3% of 15-75 year olds according to whether we consider only individuals not previously tested for any of the three viruses, or also those already tested for one or two of the viruses.

Conclusions

Our data are essential to guide decision-making regarding which new HCV screening recommendation to implement in France. They also highlight that efforts are still needed to achieve the WHO’s targets for eliminating these diseases. Home blood self-sampling may prove to be a useful tool for screening and epidemiological studies.
A steroid-resistant nephrotic syndrome in an infant resulting from a consanguineous marriage with COQ2 and ARSB gene mutations: a case report
Authors: Wu Xia , Wang Wenhong , Liu Yan , Chen Wenyu , Zhao Linsheng
Published: October 2019

Background

Treatment of steroid-resistant nephrotic syndrome (SRNS) remains a challenge for paediatricians. SRNS accounts for 10~20% of childhood cases of nephrotic syndrome (NS). Individuals with SRNS overwhelmingly progress to chronic kidney disease (CKD) and end-stage kidney disease (ESRD). Genetic research is of great significance for diagnosis and treatment. More than 39 recessive or dominant genes have been found to cause human SRNS, including COQ2. COQ2 gene mutations not only cause primary coenzyme Q10 deficiency but also cause SRNS without extrarenal manifestations. The concept of COQ2 nephropathy has been proposed for a long time. Mutations in the COQ2 gene have rarely been reported. Worldwide, only 5 cases involving 4 families have been reported.

Case presentation

We present the case of a 6-month-old girl with steroid-resistant glomerulopathy due to a COQ2 defect with no additional systemic symptoms. The patient was identified as a homozygote for the c.832 T > C (p. Cys278Arg) missense mutation and a single base homozygous mutation in ARSB gene in c.1213 + 1G > A. The father and mother were heterozygous mutation carriers in both COQ2 and ARSB, and her healthy sister was only a heterozygous mutation carrier in COQ2. In this case, hormone therapy was ineffective, and progressive deterioration of renal function occurred within 1 week after onset, leading to acute renal failure and eventual death.

Conclusions

We reported a consanguinity married family which had COQ2 and ARSB dual mutant. Kidney diseases caused by COQ2 gene mutations can manifest as SRNS, with poor prognosis. The C. 832 T > c (p.csc 278arg) is a new mutation site. Genetic assessment for children with steroid-resistant nephrotic syndrome, especially in infancy, is very important. Families with a clear family history should receive genetic counselling and prenatal examinations, and children without a family phenotype should also receive genetic screening as early as possible.
Clinical practice guideline management of blood borne viruses within the haemodialysis unit
Authors: Garthwaite Elizabeth , Reddy Veena , Douthwaite Sam , Lines Simon , Tyerman Kay , Eccles James
Published: October 2019

Some people who are receiving dialysis treatment have virus infection such as hepatitis B, hepatitis C and/or HIV that is present in their blood. These infections can be transmitted to other patients if blood is contaminated by the blood of another with a viral infection. Haemodialysis is performed by passing blood from a patient through a dialysis machine, and multiple patients receive dialysis within a dialysis unit. Therefore, there is a risk that these viruses may be transmitted around the dialysis session. This documents sets out recommendations for minimising this risk.

There are sections describing how machines and equipment should be cleaned between patients. There are also recommendations for dialysing patients with hepatitis B away from patients who do not have hepatitis B. Patients should be immunised against hepatitis B, ideally before starting dialysis if this is possible. There are guidelines on how and when to do this, for checking whether immunisation is effective, and for administering booster doses of vaccine. Finally there is a section on the measures that should be taken if a patient receiving dialysis is identified as having a new infection of hepatitis B, hepatitis C or HIV.
Urinary cell-free mitochondrial and nuclear deoxyribonucleic acid correlates with the prognosis of chronic kidney diseases
Authors: Chang Chia-Chu , Chiu Ping-Fang , Wu Chia-Lin , Kuo Cheng-Ling , Huang Ching-Shan , Liu Chin-San , Huang Ching-Hui
Published: October 2019

Introduction

Cell-free deoxyribonucleic acid DNA (cf-DNA) in urine is promising due to the advantage of urine as an easily obtained and non-invasive sample source over tissue and blood. In clinical practice, it is important to identify non-invasive biomarkers of chronic kidney disease (CKD) in monitoring and surveillance of disease progression. Information is limited, however, regarding the relationship between urine and plasma cf-DNA and the renal outcome in CKD patients.

Methods

One hundred and thirty-one CKD patients were enrolled between January 2016 and September 2018. Baseline urine and plasma cell-free mitochondrial DNA (cf-mtDNA) and cell-free nuclear DNA (cf-nDNA) were isolated using quantitative real-time PCR. Estimated glomerular filtration rate (eGFR) measurement was performed at baseline and 6-month follow-up. Favorable renal outcome was defined as eGFR at 6 months minus baseline eGFR> = 0. Receiver operator characteristics (ROC) curve analysis was performed to assess different samples of cf-DNA to predict favorable renal outcomes at 6 months. A multivariate linear regression model was used to evaluate independent associations between possible predictors and different samples of cf-DNA.

Results

Patients with an advanced stage of CKD has significantly low plasma cf-nDNA and high plasma neutrophil gelatinase-associated lipocalin (NGAL) levels. Low urine cf-mtDNA, cf-nDNA levels and low plasma NGAL were significantly correlated with favorable renal outcomes at 6 months. The urine albumin-creatinine ratio (ACR) or urine protein-creatinine ratio (PCR) level is a robust predictor of cf-mtDNA and cf-nDNA in CKD patients. Baseline urine levels of cf-mtDNA and cf-nDNA could predict renal outcomes at 6 months.

Conclusions

Urinary cf-mtDNA and cf-nDNA may provide novel prognostic biomarkers for renal outcome in CKD patients. The levels of plasma cf-nDNA and plasma NGAL are significantly correlated with the severity of CKD.
Burden of relapsing-remitting multiple sclerosis on workers in the US: a cross-sectional analysis of survey data
Authors: Nicholas Jacqueline A. , Electricwala Batul , Lee Lulu K. , Johnson Kristen M.
Published: October 2019

Background

Multiple sclerosis (MS) is prevalent among working age individuals (20–60 years), leading to high burden on work productivity. Few data are available about the absenteeism and presenteeism in employed individuals with MS in comparison to non-MS personnel. This study aimed to quantify the burden of illness of employed US adults with relapsing-remitting multiple sclerosis (RRMS) and examine burden by levels of work impairment.

Methods

A retrospective cross-sectional analysis was conducted using patient-reported responses from the US National Health and Wellness Survey (NHWS). Data from NHWS 2015–2016 were analyzed from 196 employed RRMS respondents who were matched 1:4 to employed respondents without MS based on demographic and general health characteristics. Demographic and general health characteristics for employed RRMS individuals were analyzed by levels of work impairment (none, 1–30%; 31–68%; 69–100%). Work productivity (absenteeism, presenteeism, and work impairment), decrements in health-related quality of life (HRQoL) (short form-36, EQ-5D), and healthcare resource utilization (HCRU) were compared to determine the burden of RRMS.

Results

After propensity score matching, the levels of absenteeism and presenteeism were 2 and 1.8 times higher in the employed RRMS population than the employed non-MS population, respectively (P < 0.001 for both). HRQoL was significantly lower in employed respondents with RRMS than those without MS (P < 0.001 for all). Employed respondents with RRMS had significantly more HCRU over 6 months compared to those without MS (P < 0.001). Furthermore, among employed RRMS respondents, greater levels of impairment were associated with increasing disease severity, greater healthcare resource use, fatigue, and cognitive impairment and inversely associated with mental and physical HRQoL (P < 0.0001 for all).

Conclusions

Among employed individuals, respondents with RRMS had lower, work productivity, HRQoL, and higher HCRU as compared with those without MS. Given the large impact RRMS has on work impairment, a need exists to manage individuals on therapies that improve HRQoL, reduce symptoms, and improve their ability to perform in the workforce.
Policymaker, health provider and community perspectives on male involvement during pregnancy in southern Mozambique: a qualitative study
Authors: Galle Anna , Cossa Helio , Griffin Sally , Osman Nafissa , Roelens Kristien , Degomme Olivier
Published: October 2019

Background

Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men’s involvement in maternal health in southern Mozambique.

Methods

Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis.

Results

Results show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity.

Conclusion

A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.
Comprehensive transcriptomic analyses of tissue, serum, and serum exosomes from hepatocellular carcinoma patients
Authors: Mjelle Robin , Dima Simona O. , Bacalbasa Nicolae , Chawla Konika , Sorop Andrei , Cucu Dana , Herlea Vlad , Sætrom Pål , Popescu Irinel
Published: October 2019

Background

The expression of microRNAs (miRNAs) is a promising prognostic and diagnostic tool in hepatocellular carcinoma (HCC). Here we performed small RNA sequencing (sRNA-seq) of tissue, serum and serum exosomes to investigate changes in miRNA expression between the different sample types and correlated the expression with clinical parameters. We also performed gene expression arrays on tumor and normal tissue.

Results

Paired tissue, serum and serum exosomes sequencing revealed consistent positive correlation of miR-21 between serum exosomes and tumor tissue, indicating that miR-21 could be exported from tissue to circulation via exosomes. We found that let-7 miRNAs are generally upregulated in serum exosomes compared to whole serum, indicating that these miRNAs could be preferentially loaded into exosomes. Comparing serum from HCC patients with serum from healthy individuals revealed a global increase of miRNAs in serum from HCC patients, including an almost 4-fold increase of several miRNAs, including the liver-specific miR-122. When correlating miRNA expression with clinical parameters we detected significant association between hepatitis B virus (HBV) infection and miR-122 in serum as well as several serum and tissue-miRNAs that correlated with surgery type. We found that miR-141 and miR-146 correlated with cirrhosis in tumor tissue and normal tissue, respectively. Finally, high expression of miR-21 in tumors were associated with poor survival. Focusing on gene expression we found several significant messenger RNAs (mRNAs) between tumor and normal tissue and a Gene Ontology (GO) analysis revealed that these changes were mainly related to cell cycle and metabolism. Further, we detected mRNAs that correlated with cirrhosis and HBV infection in tissue. Finally, GO analysis of predicted targets for miRNAs down-regulated in tumor found that these were enriched for functions related to collagen synthesis.

Conclusions

Our combined data point to altered miRNA and mRNA expression contributing to both generally impaired lipid metabolism and increased cell proliferation and a miRNA-driven increase in collagen synthesis in HCC. Our results further indicate a correlation in miRNA expression between exosomes, serum, and tissue samples suggesting export from tumors via exosomes. This correlation could provide a basis for a more tumor-specific miRNA profile in serum.
Determinants of shisha use among secondary school students in Sudan
Authors: Othman Mohammed , Aghamohammadi Nasrin , Nik Farid Nik Daliana
Published: October 2019

Background

Shisha smoking has re-emerged in the Middle East in the last two decades and has spread rapidly in these communities. Information about shisha smoking in adolescents in Sudan is deficient. Hence, the aim of this study is to estimate the prevalence of shisha smoking among adolescents and determine the associated factors.

Methods

This study is a school based cross sectional study among secondary school students in Khartoum State - Sudan that targets both male and female students aged 14–17 years. A total of 3387 students from 29 public and private schools were selected by multi stage random sampling. The participants completed an anonymous self-administered questionnaire which was based on Arabic version of the Global Youth Tobacco Survey (GYTS).

Results

The response rate was 100% in schools and among participants, 57.3% were females and 51.6% were from public schools. The overall prevalence of those who had ever smoked shisha was 13.4%, and among male students the prevalence was 16.8%, while it was 10.9% in females.

The associated factors were poor academic performance OR 2.90 CI 95% (1.21–6.94), friends smoking shisha OR 2.39 CI 95% (1.65–3.45), friends smoking cigarettes OR 2.76 CI 95% (1.90–4.01), peer pressure to smoke shisha OR 13.76 CI 95% (7.86–24.07) and unexpectedly restriction of selling shisha to minors OR 2.21 CI 95% (1.28–3.82).

Conclusion

The prevalence of those who had ever smoked shisha is among the lowest in Middle East region; therefore, regular surveillance system is needed. A well-structured peer based comprehensive tobacco control programmes that are supported by strict and rigorous anti-tobacco regulations which control both commercial and social resources of tobacco are needed to contain this issue among adolescents.
Alcohol use and sexual risk behaviors in the Armed Forces of the Democratic Republic of the Congo
Authors: Tran Bonnie Robin , Davis Anthony , Sloan Margo , Macera Carol , Mbuyi Anthony Mutombe , Kabanda Gilbert Kurhgnga
Published: October 2019

Background

Alcohol misuse is an important contributor to sexual acquisition and transmission of HIV in military communities. This cross-sectional study quantified the prevalence of probable problematic alcohol use among male service members in the Armed Forces of the Democratic Republic of the Congo (FARDC), identified associated factors, and investigated associations of alcohol misuse with risky sexual behaviors.

Methods

Participants included 2549 active duty male soldiers ≥ 18 years old. Data were collected via computer-assisted personal-interview from October 2013–April 2014. The Alcohol Use Disorders Identification Test (AUDIT) was used to identify probable problematic alcohol use (AUDIT score ≥ 8) compared to no/low-risk alcohol use (AUDIT score ≤ 7). Bivariate logistic regressions were used to identify factors associated with probable problematic alcohol use. Several multivariable logistic regressions (adjusted for age, marital status, education level) were used to examine associations of probable problematic alcohol use with risky sexual behaviors. Tests were two sided; statistical significance was defined as p < 0.05.

Results

Fifteen percent of men screened positive for probable problematic alcohol use. The odds of probable problematic alcohol use were elevated among men who were single and living with a partner (OR = 1.66; 95% CI = 1.24–2.21), ranked as a non-commissioned officer [NCO] (OR = 1.40; 95% CI = 1.10–1.77), and in the 30–39 and 40–49 age groups (OR 30–39 age group = 2.17; 95% CI = 1.56–3.02; OR 40–49 age group = 1.79; 95% CI = 1.26–2.55). Probable problematic alcohol use was associated with increased odds of having sex with a sex worker (SW), having multiple sexual partners, and participating in transactional sex (aOR sex with a SW = 2.36; 95% CI = 1.78–3.13; aOR multiple sexual partners = 2.08; 95% CI = 1.66–2.60; aOR transactional sex = 1.99; 95% CI = 1.59–2.50).

Conclusions

Results emphasize the need to address alcohol use in the FARDC and integrate alcohol abuse education into HIV prevention programs among male service members. Alcohol abuse prevention efforts should target men who are 30–49 years of age, unmarried, and ranked as a NCO. Messages and interventions to reduce alcohol misuse in relation to risky sexual behaviors are needed.
The costs of traumatic head injury and associated factors at University of Gondar Specialized Referral Hospital, Northwest Ethiopia
Authors: Asmamaw Yilak , Yitayal Mezgebu , Debie Ayal , Handebo Simegnew
Published: October 2019

Background

Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital.

Method

An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI.

Results

The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63–1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173,p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31–45 years were 252.504 ETB (Standardized coefficient = − 0.066,p = 0.046) lower than costs for those 5–14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648,p < 0.001).

Conclusion

Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.
Outcomes of colorectal cancer surgery in the nonagenarians: 20-year result from a tertiary center
Authors: Chan Toi Yin , Foo Chi Chung , Law Wai Lun , Lo Oswens
Published: October 2019

Background

There is a foreseeable trend that life expectancy is on the rise in many parts of the world. More and more patients will present with colorectal cancer at extreme old age and advanced age is a well-known risk factor for adverse outcomes after surgery. The aim of this study is to evaluate the outcomes of colorectal cancer surgery in patients aged 90 or above.

Method

A retrospective analysis of consecutive patients aged 90 or above who underwent operations for colorectal cancer between January 1996 and December 2015 was performed. The primary outcomes were the complications rate, 30-day and 180-day mortality rates.

Results

A total of 57 patients were included in the analysis. The majority of them were women (64.9%). The median age was 92 years. Most of the surgery was of curative intent (77.2%), performed under elective setting (57.9%) and with open approach (78.9%). 36.8% of patients had postoperative complications, with pneumonia being the commonest. The 30-day and 180-day mortality rate was 7 and 31.6% respectively. History of ischemic heart disease and surgery under emergency setting were predictors of postoperative complications. Pneumonia, preoperative leukocytosis and Charlson comorbidity score ≥ 9 were predictors of 180-day mortality. The one and two-year survival rate for elective surgery was 69.7 and 54.5% respectively.

Conclusion

The outcomes of colorectal cancer surgery for nonagenarians could be favorable in a selected group of patients. Future study on better risk profiling and ways to improve outcomes is warranted.
Laparoscopic adrenalectomy - is it safe in hands of residents in training?
Authors: Dworak Jadwiga , Wysocki Michał , Rzepa Anna , Natkaniec Michał , Pędziwiatr Michał , Budzyński Andrzej , Major Piotr
Published: October 2019

Background

Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery.

Methods

A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”.

Results

We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741).

Conclusions

Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches - a single center preliminary study
Authors: Huang Guan-Lin , Kang Chih-Hsiung , Lee Wei-Ching , Chiang Po-Hui
Published: October 2019

Background

Prostate biopsy remains the gold standard approach to verify prostate cancer diagnosis. Transrectal (TR) biopsy is a regular modality, while transperineal (TP) biopsy is an alternative for the patients who display persistently high levels of prostate-specific antigen (PSA) and thus have to undergo repeat biopsy. This study aimed to compare the cancer detection rates between TR and TP approaches and assess the post-bioptic complications of the two procedures. Besides, the feasibility of performing TP biopsies under local anesthesia was also evaluated.

Methods

A total of 238 outpatient visits meeting the criteria for prostate cancer biopsy were enrolled for this study. They were divided into two groups: the TP group (n = 130) consists of patients destined to undergo local anesthetic TP biopsy; and the TR group (n = 108) contained those who received TR biopsy as comparison. Age, PSA level, digital rectal exam (DRE) finding, prostate volume, and biopsy core number were used as the parameters of the multivariable analyses. The comparable items included cancer detection rate, complication rate, admission rate and visual analog scale (VAS) score.

Results

The cancer detection rates between TP and TR groups were quite comparable (45% v.s. 49%) (p = 0.492). However, the TP group, as compared to the TR group, had significantly lower incidence of infection-related complications (except epididymitis and prostatitis) that commonly occur after biopsies. None of the patients in the TP group were hospitalized due to the post-bioptic complications, whereas there was still a minor portion of those in the TR group (7.4%) requiring hospitalization after biopsy. Medians (25–75% quartiles) of visual analog scale (VAS) were 3 [3, 4] and 4 [3–5] respectively for the TP and TR procedures under local anesthesia, but no statistical significance existed between them (p = 0.085).

Conclusions

Patients receiving TP biopsy are less likely to manifest infection-related complications. Therefore, TP biopsy is a more feasible local anesthetic approach for prostate cancer detection if there are concerns for infectious complications and/or the risk of general anesthesia.
Sinensetin regulates age-related sarcopenia in cultured primary thigh and calf muscle cells
Authors: Kim Jin-A , Kim Seong Min , Ha Sang Eun , Vetrivel Preethi , Saralamma Venu Venkatarame Gowda , Kim Eun Hee , Kim Gon Sup
Published: October 2019

Background

Sarcopenia, the decline of skeletal muscle tissue attributed to primary aging is a major concern in older adults. Flavonoids might have potential benefits by modulating the regulation of satellite cells, thus preventing muscle loss. Sinensetin (SIN), a citrus methylated flavone with anti-inflammatory and anti-proliferative activity, can enhance lipolysis. The objective of the present study was to investigate whether SIN might have sarcopenia-suppressing effect on satellite cells from thigh and calf muscle tissues of young and old rats.

Methods

Primary muscle cells were obtained from thigh and calf tissues of young and old group rats by dissection. Obtained satellite cells were incubated with indicated concentrations of SIN (50 and 100 μM) treated and untreated condition in differentiation medium. Morphological changes of cells were examined using a phase-contrast microscope. Protein expression levels of myoD and myogenin were analyzed by Western blot. Cells treated with or without SIN under differentiation condition were also immunocytochemically stained for myogenin and 4′,6-diamidino-2-phenylindole (DAPI).

Results

Morphologically, the differentiation extracted satellite cells was found to be more evident in SIN treated group of aged rat′s cells than that in SIN untreated group. Expression levels of myoD and myogenin proteins involved in myogenesis were increased upon treatment with SIN.

Conclusions

Collectively, our results indicate that SIN can alleviate age-related sarcopenia by increasing differentiation rate and protein levels of myoD and myogenin.
Computationally approximated solution for the equation for Henssge’s time of death estimation
Authors: Schweitzer Wolf , Thali Michael J.
Published: October 2019

Background

Time of death estimation in humans for the benefit of forensic medicine has been successfully approached by Henssge, who modelled body cooling based on measurements of Marshall and Hoare. Thereby, body and ambient temperatures are measured at the death scene to estimate a time of death based on a number of assumptions, such as initial body temperature and stable ambient temperature. While so far, practical use of the method resorted to paper print outs or copies of a nomogram using a ruler, increasingly, users are interested in computer or mobile device applications. We developed a computational solution that has been available online as a web accessible PHP program since 2005. From that, we have received numerous requests not so much to detail our code but to explain how to efficiently approximate the solution to the Henssge equation.

Methods

To solve Henssge’s double exponential equation that models physical cooling of a body, it is sufficient to determine a difference term of the equation that will be close to zero for the correct time of death using a discrete set of all sensible possible solutions given that the modelled time frame has practical upper limits. Best post-mortem interval approximation yields minimal difference between equation terms

Results

The solution is approximated by solving the equation term difference for a discrete set of all possible time of death intervals that are sensibly found, and by then determining the particular time of death where equation term difference is minimal.

Conclusions

The advantage of a computational model over the nomogram is that the user is also able to model hypothermia and hyperthermia. While mathematically impossible to solve in a straightforward way, solutions to the Henssge equation can be approximated computationally.