bluuebunny/crossref_metadata_2025 huggingface dataset:
Presentation Intervals and the Impact of Delay on Breast Cancer Progression in a Black African Population
Authors: Agodirin Olayide , Olatoke Samuel , Rahman Ganiyu , Olaogun Julius , Olasehinde Olalekan , Katung Aba , Kolawole Oladapo , Ayandipo Omobolaji , Etonyeaku Amarachukwu , Habeeb Olufemi , Adeyeye Ademola , Agboola John , Akande Halimat , Oguntola Adetunji , Akanbi Olusola , Fatudimu Oluwafemi
Published: May 2020

BACKGROUND: The help-seeking interval and primary-care interval are points of delays in breast cancer presentation. To inform future intervention targeting early diagnosis of breast cancer, we described the contribution of each interval to the delay and the impact of delay on tumor progression. METHOD: We conducted a multicentered survey from June 2017 to May 2018 hypothesizing that most patients visited the first healthcare provider within 60 days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression. RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230 (60%, 95% CI 53-63). Most had long primary-care (237 of 377 (64% 95% CI 59-68) and detection-to-specialist (293 (73% (95% CI 68-77)) intervals. The primary care interval (median 106 days, IQR 13-337 ) was longer than the help-seeking interval ( median 42 days, IQR 7-150 ) Wilcoxon signed-rank test p= 0.001. There was a strong correlation between the length of primary care interval and the detection-to-specialist interval (r= 0.9, 95% CI 0.88- 0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor (>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm (95% CI 4.0-5.0). The hazard of progressing from early to locally advanced disease was least in the first 30 days (3%). The hazard was 31% in 90 days. CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.
Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection
Authors: Wang Zhigang , Ge Min , Chen Tao , Chen Cheng , Zong Qiuyan , Lu Lichong , Wang Dongjin
Published: May 2020

Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement therapy (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed postoperative CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Results: Before propensity score matching, univariate analysis showed that there were significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (P <0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr and CPB time were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P <0.001) and long-term overall cumulative survival (P <0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003). Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.
Allowing more time to ILCOR Step A of neonatal resuscitation leads to better residents’ task completion in simulated scenarios. A problem of time pressure?
Authors: Boithias Claire , Jule Laure , Foulgoc Stephanie Le , Jourdain Gilles , Benhamou Dan
Published: May 2020

Background: Roughly 10% of newborns need help to complete the transition of birth. For these infants, international guidelines recommend supporting them using a 4-step procedure (A to D). Step A is an assessment time, which includes eight tasks and finishes by starting the positive pressure ventilation (PPV), if necessary (step B). The guidelines changed in 2015 and the allotted time was raised from 30 to 60 seconds for step A completion. Objectives: This study aimed to assess if the reduced time constraint in step A could have an impact on 1st-year pediatric residents' performance to complete step A and if could lead to later initiation of step A. Methods: Using video recordings of standardized neonatal scenarios over 6 years (3 before the change and 3 after), we assessed the ability of 1st-year pediatric residents of the Paris region to complete step A and initiate PPV in the allotted time in each period. Among the sessions, including at least five scenarios we evaluated all the PPV required scenarios executed for the first time by a dyad of 1st-year pediatric residents.Results: Among 52 sessions, we included 104 scenarios (25 sessions and 50 scenarios before the change and 27 sessions and 54 scenarios after). PPV started roughly at 1-minute resuscitation in both periods, but completion of the tasks before PPV-start was significant. Only 12% of the dyad of residents executed the eight tasks before PPV initiation in the first period versus 56% in the second period (p < 0.0001). Additionally, the completion of the eight tasks of step A was significantly better during the second period (6 [6-7] vs. 8 [7-8] p < 0.001).Conclusions: These results could suggest that a reduced time constraint for step A imposed by the new Guidelines was associated with better performance.
Nurses Practice and Influencing Factors regarding Physical Restraint use in the Intensive Care Units in Northwest Ethiopia
Authors: Kassew Tilahun , Tilahun Ambaye Dejen , Liyew Bikis
Published: May 2020

Background: Physical restraint is a common clinical practice in intensive care units. Even though physical restraint is used to prevent the removal of life support tubes and risk of a patient’s falling injure; complications such as edema, laceration, and pain at the restrained site, restricted circulation, worsening of agitation or delirium that may end with death are frequently encountered. Despite the sensitivity of the problem, there are gaps in nurses’ evidence-based practice in Ethiopia. Before developing protocols and guidelines relevant evidence-based practices of nurses are required. So, this study aimed to assess the practice and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted from July to August 2019 at Amhara regional state referral hospitals, Northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff Regarding Physical Restraints Questionnaire was used to assess the nurses’ knowledge, attitude, and practice. Linear regression analysis was computed to examine the influencing factors of nurses' practice. An adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association. Statistical significance was declared at p-value<0.05. Result: The mean score of the nurses’ practice regarding physical restraint use among critically ill patients was 30.94±5.44. This mean score is above the scale midpoint nearer to the higher range that implies the majority of nurses have a satisfactory practice regarding physical restraint. Less than or equal to 2 years of work experience [β= -1.34, 95% CI (-2.47, -0.21)] was significantly associated with poor nurses practice; received training regarding restraints [β= 1.49, 95% CI (0.16, 2.82)], higher level of knowledge [β=0.40, 95% CI (0.03, 0.78)] and better attitude scores [β=0.37, 95% CI (0.27, 0.47)] were associated with good nurses practice regarding physical restraint use.Conclusion: Nurses working in the intensive care units had a satisfactory practice regarding physical restraint use on critically ill patients. So developing and providing educational and in-service training to the nurses on the alternative strategies, complications, and risks of physical restraint are important to strengthening the quality of nursing care for critically ill patients.
Micromorphology analysis and compare bond strength of two adhesives to different degrees of dental fluorosis
Authors: Liu Shuangfeng , Zhu Yanxia , Gegen Tana
Published: May 2020

Objectives: The aim of this study was to evaluate bond strength and morphological analysis of the all-etching bonding system and self-etching bonding system to different degrees of fluorosed enamel. Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. The collected teeth were mainly extracted due to orthodontic or periodontal disease. According to the Dean’s index and the Thylstrup and Fejerskov (TF) index, 180 extracted teeth were divided into three groups of mild, moderate and severe dental fluorosis, 60 teeth in each group. The teeth in each group were randomly divided into 2 subgroups (n=30) that were subjected to the all-etching bonding system (Prime & Bond NT) and self-etching bonding system (SE-Bond). Each group of adhesives was used to bond Z350 universal resin (3M) to the etched dental enamel. Tensile and shear testing were used to determine the bond strength. After the tensile testing, the fractured specimens were examined under scanning electron microscopy (SEM) and confocal laser scanning microscopic(CLSM). Results: The Prime & Bond NT had statistically significant on tensile and shear strength for mild fluorosis enamel (P<0.05), but it had no significant difference for moderate and severe dental fluorosis (P>0.05). Self-etching bonding system (SE-Bond) had no statistical significance on the tensile and shear strength for mild, moderate and severe dental fluorosis (P>0.05). SEM and CLSM showed that the mild fluorosis enamel crystals were relatively dense and a small amount of resin remained. The moderate fluorosis enamel crystals were loosely arranged and the gaps were widened. The severe fluorosis enamel crystals were irregularly arranged. The disorder was aggravated, and the dentinal orifice exposed by partial enamel exfoliation can be seen. Conclusions The bonding strength of mild fluorosis enamel to Prime & Bond NT was better than that of SE-Bond, cohesive failure is the most common failure method in this study. And there is no difference in the bonding strength of SE-Bond to different degrees of DF. Therefore, we suggested that the all -etching adhesive system was used to treat mild fluorosis teeth in the clinic. For moderate to severe fluorosis teeth, we may prolong the application time of self-etching adhesion to enhance enamel-etching pattern and promoted similar results in terms of adhesive enamel bond strength.
Low Cost Simulator for Cardiopulmonary Resuscitation in Infants: a Proof-of-Concept Study.
Authors: Targino Ailton do Nascimento , Patricio Alan , de Oliveira Adriana Gonçalves , Echeimberg Jorge de Oliveira , de Abreu Luiz Carlos , Raimundo Rodrigo Daminello
Published: May 2020

Background: Realistic simulation methodology is used in various learning scenarios, allowing students to participate directly in problematic situations that require immediate professional action. The objective of this proof-of-concept study was to develop a low-cost simulator for cardiopulmonary resuscitation procedures in infants.Findings: The prototype was developed successfully with accessories to simulate cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the Basic Life Support guidelines of the American Heart Association to test the instrument. The prototype was used as a learning object for the teaching-learning process as a low-cost resource.Conclusion: A low-cost prototype was developed, and its application was obtained from the simulation of the training activity in Basic Life Support and from the performance of procedures in the positioning and simulation of cardiopulmonary resuscitation.
Multiple HPV 16 infection with two strains: a possible marker of neoplastic progression
Authors: Bruno Maria Teresa , Scalia Guido , Cassaro Nazario , Boemi Sara
Published: May 2020

Background. We studied the cases of single and multiple HPV infection and analyzed the correlation with negative cases, and preneoplastic and neoplastic lesions of the uterine cervix with the aim of making a contribution to the prognostic factor under discussionMethods: 909 women undergoing second level screening because they had been positive at cervical cytology were enrolled. All the patients underwent colposcopy and cervical biopsy with viral genotyping. We divided mHPV infection based on the number of genotypes present: infections with 2 strains, 3 strains, 4 strains and 5 or more strains. Statistical analysis The analysis of the data was made using the χ2 test. Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p <0.05 were considered statistically significant.Results: The presence of genotype HPV16 in our study was associated with a 12 times greater risk of developing a high-grade lesion, OR = 12.70. The patients with single infections had the highest incidence of CIN2+ (34.1 %) with respect to those with multiple infections (10.6%).When we studied in the mHPV infection the prevalence of the combinations between the genotypes, we found that in mHPV16 infections, the combinations HPV16, 18 and HPV16, 31 were the most frequent (55.5%) in CIN3 lesion.ConclusionsOur results suggest that single HPV infections have a greater risk of developing SCC with respect to multiple infections. Multiple HPV infections are relevant only in the first phase of the lesion (CIN1-CIN2), while they are absent in carcinomas, where infections are of a single genotype. In particular, among multiple infections, HPV16 infection with 2 HR genotypes is associated significantly with CIN2 / CIN3 (21/30) and has 4 times greater risk of developing a high-grade lesion. Thus, it is probable that only specific combinations of HPV (HPV16,18 - HPV 16,31) can be associated with a clinically significant impact, while other combinations can simply be correlated because of a common infection or diagnostic method used. Therefore, multiple HPV16 infections with two high-risk genotypes is a major risk of CIN2/CIN3.
Contextual Effects of Social Integration and Disintegration on Health Status: Evidence from South Korea
Authors: Jo Eun-Bi , Kwon Rang Hee , Jung Minsoo
Published: May 2020

Background: Many studies have shown that various social integration variables represented by social capital are beneficial to communities, including collective health. However, the rapid decline in fertility rates and the breakup of familyism in developed countries require a new approach to social disintegration, but the literature is insufficient. Here, we explored the contextual effects of social integration and social disintegration on the health of individuals.Methods: The research data consist of merged datasets of 6909 respondents who were quota-sampled by approximately 30 people from 229 local governments in Korea. The individual-level independent variable is a social integration measure consisting of 26 questions in four areas. The community-level independent variables are five integral and aggregate variables extracted from 81 indicators. The dependent variable is self-rated health status. Potential confounders are gender, age, annual income, educational attainment, district type, and the number of beds in medical institutions per 1,000 people.Results: The results showed that at the individual level, the higher the inclusive attitude of in- and out-of-networks, after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p <0.001). At the community level, the higher the proportion of single-person households in a community after adjusting for potential confounders, the less likely the respondent belongs to the unhealthy group (p <0.05). The effect size was 0.22.Conclusion: Thus far, social integration has been preferred, with the positive aspects of social capital being emphasized. However, this study shows that in some cases, social disintegration can instead positively influence an individual's health. Therefore, further studies of the various conditions of social context effects on health are necessary.Keywords: Social integration, Social disintegration, Contextual
General and Tuberculosis-Specific Service Readiness in two states in Nigeria
Authors: Oluwasanu Mojisola , Hassan Abiodun , Adebayo Ayodeji , Ogbuji Queen Chidinma , Adeniyi Bamidele Olaiya , Adewole David , Ladipo Oladapo Alabi , Ajuwon Grace , Ajuwon Ademola
Published: May 2020

Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria. This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary and tertiary healthcare facilities in two TB high burden states. Data was collected using key informant interviews, facility assessment using a semi-structured tool adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions. The domain score for basic amenities in both states is 48.8% (SE:2.8); 47.0% (SE:4.0) in Anambra and 50.8% (SE:3.9) in Oyo state. In Oyo, only half of the facilities (50%) have access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states is 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (P = 0.56). The domain score for availability of staff and TB guidelines is 57.1% (SE:3.4) for both states. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states is 75%; this is higher in Oyo state (P = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing and gaps with continuing education on TB management. The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.
Impact of three methods of ischemic preconditioning on ischemia-reperfusion injury in a pig model of liver transplantation
Authors: Belon Alessandro Rodrigo , Tannuri Ana Cristina Aoun , Moreira Daniel Albuquerque , Silva Alessandra Matheus , Serafini Suellen , Guimarães Raimundo Renato , Faria Caroline Silverio , Alexandre Alcione Sanches , Gonçalves Josiane de Oliveira , Paes Vitor Ribeiro , Tannuri Uenis
Published: May 2020

Background. Ischemic preconditioning (IPC), either direct (DIPC) or remote (RIPC), is a procedure aimed at reducing the harmful effects of ischemia-reperfusion injury. Aims. To assess the local and systemic effects of DIPC, RIPC, and both combined, in the pig liver transplant model. Methods. Twenty-four pigs underwent orthotopic liver transplantation and were divided into 4 groups according to the procedures applied: direct donor preconditioning; indirect preconditioning at the recipient and a group with direct donor and indirect recipient preconditioning. The following parameters were recorded: donor and recipient weight, graft-to-recipient weight ratio (GRWR), surgery time, hot and cold ischemia time, and intraoperative hemodynamic values. Blood samples were collected before native liver removal (BL) and at 0h, 1h, 3h, 6h, 12h, 18h, and 24h post-reperfusion and the following biochemical tests were performed: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), creatinine, BUN (blood urea nitrogen), lactate, total and direct bilirubin. Histopathological examination of liver, gut, kidney, and lung fragments were performed, as well as molecular analyses for expression of the apoptosis-related BAX (pro-apoptotic) and Bcl-XL (anti-apoptotic) genes, eNOS (endothelial nitric oxide synthase) gene, and IL-6 gene related to inflammatory ischemia-reperfusion injury, using real-time polymerase chain reaction (RT-PCR). Results. There were no differences between the groups regarding biochemical and histopathological parameters. We found a reduced ratio between the expression of the pro-apoptotic BAX gene and the expression of the anti-apoptotic Bcl gene in the livers of animals with IPC versus the control group. Conclusions. DIPC, RIPC or a combination of both produce local beneficial effects only at the molecular level but do not translate into biochemical or histological changes.
HPV16-E6 but not E7 inhibits the antitumor activity of LKB1 in lung cancer cells by down regulating the expression of KIF7
Authors: Hu Yue , Wu Ming-Zhe , Gu Na-Jin , Qiu Xue-Shan , Wang En-Hua , Wu Guang-Ping
Published: May 2020

Background: The E6 and E7 proteins in HPV16 are the main oncogenes in the occurrence of lung cancer. In recent studies, we had found that E6 and E7 downregulated the expression of LKB1 in lung cancer cells. However, it is not clear how E6 and E7 regulate LKB1 in lung cancer cells. Methods: The double directional genetic manipulation and Nuclear plasma separation technology were performed to explore the molecular mechanism of E6 and E7 inhibiting the antitumor activity of LKB1 in well-established lung cancer cell lines. Results: E6 but not E7 significantly downregulated the expression of tumor suppressor KIF7 at protein level, and the inhibition of KIF7 further reduced the expression of LKB1 both in the nuclei and in the cytoplasm, whereas reduced the expression of p-LKB1 in the cytoplasm only. Therefore, we suggested that HPV16 E6 but not E7 downregulates the antitumor activity of LKB1 by down regulating the expression of p-LKB1 in the cytoplasm only. Conclusion: We demonstrated for the first time that E6 but not E7 inhibits the antitumor activity of LKB1 in lung cancer cells by downregulating the expression of KIF7. Our findings provided new evidence to support the important role of KIF7 in the pathogenesis of lung cancer and suggested new therapeutic targets.
Gut Dysbacteriosis Is Associated with an Imbalanced Cytokines Network in Women with Unexplained Miscarriage
Authors: Liu Yongjie , Chen Hainan , Chen Dan , Feng Liping , Zhang Jun
Published: May 2020

Background: A dysregulation of cytokine networks has been suggested to be involved in the pathogenesis of unexplained pregnancy loss. Gut microbiota affects host immune response and induces an imbalance in cytokine levels. However, how gut microbial dysbiosis affects the disturbance of cellular immune function in spontaneous abortion (SA) patients remains inconclusive.Results: Serum proinflammatory cytokine levels were significantly increased in SA patients. Microbial diversity in patients with SA was reduced compared with that in the controls, as were the relative abundances of Prevotella_1, Prevotellaceae_UCG_003, and Selenomonas_1 were significantly reduced in the cases. Fecal metabolites profiles were altered in SA patients, and the correlation analyses indicated that some microbe-associated metabolites, which were significantly enriched in bile secretion and histidine metabolism pathways, were positively associated with changes in levels of IL-17A, IL-17F, TNF-α, and IFN-γ in the SA group. Moreover, the microbial-associated metabolites, imidazolepropionic acid and 1, 4-Methylimidazoleacetic acid, are associated with recurrent pregnancy loss.Conclusions: Our study highlights the network among gut microbiota, fecal metabolites and Th1/Th17-mediated immune response in miscarriage patients and identifies potential novel biomarkers and an intervention target for recurrent miscarriage.
Transcriptional and Free Radical Responses to LVAD Therapy
Authors: Dhar Kajari , Asmini KC , Qiu Fang , Basma Hesham , Savalia Krupak , Jones Jocelyn , Moulton Alexandra M. , Zimmerman Matthew C. , Um John , Anderson Daniel , Hyden Marshall , Lowes Brian D.
Published: May 2020

Background: Myocardial recovery with Left ventricular assistant device (LVAD) therapy is dichotomous with some patients obtaining remission from end-stage heart failure whereas most require transplantation or remain on pump support long term. Our goal was to determine transcriptional and free radical responses to LVAD treatment. Methods: Tissues were collected from patients before and after LVAD placement in non-ischemic dilated cardiomyopathy patients (n=14) along with controls (n=3). RNA sequencing (RNASeq) analysis quantified transcriptional profiles by using a custom targeted panel of heart failure related genes on the PGM sequencer. The differential expression analysis between groups was conducted using edgeR (Empirical analysis of digital gene expression data in R) package in Bioconductor. Ingenuity Pathway Analysis (IPA) was carried out on differentially expressed genes to understand the biological pathways involved. Electron Paramagnetic Resonance (EPR) Spectroscopy was utilized to measure levels of free radicals in whole blood collected pre- and post-LVAD implantation (n=16). Results: 35 genes were differentially expressed in pre-LVAD failing hearts compared to controls. In response to LVAD therapy, only Pyruvate dehydrogenase kinase 4 (PDK4) and period circadian protein homolog 1 (PER1) were altered with 34 heart failure related genes still differentially expressed post-LVAD compared to controls. IPA showed that DNA methylation-related genes were upregulated in both pre- and post-LVAD and was persistent with a Z-score of 2.00 and 2.36 for DNA Methyltransferase 3A (DNMT3A) and DNA methyltransferase 3B (DNMT3B), respectively. Inhibition of micro RNA21 (mir21) was also significant on pathway analysis in the post-LVAD population with a Z-score of -2.00. Levels of free radicals in blood of pre- and post-LVAD patients did not change significantly. Conclusion: LVAD therapy does not reverse many of the transcriptional changes associated with heart failure. Persistent changes in gene expression may be related to ongoing oxidative stress, continued DNA methylation, or changes in metabolism. PDK4 is a key regulator of glucose metabolism and its increased expression by LVAD therapy inhibited pyruvate metabolism.
A transient CRISPR/Cas9 expression system for genome editing in Trypanosoma brucei
Authors: Shaw Sebastian , Knüsel Sebastian , Hoenner Sarah , Roditi Isabel
Published: May 2020

Objective Generation of knockouts and in situ tagging of genes in Trypanosoma brucei has been greatly facilitated by using CRISPR/Cas9 as a genome editing tool. To date, this has entailed using a limited number of cell lines that are stably transformed to express Cas9 and T7 RNA polymerase (T7RNAP). It would be desirable, however, to be able to use CRISPR/Cas9 for any trypanosome cell line. Results We describe a sequential transfection expression system that enables transient expression of the two proteins, followed by delivery of PCR products for gRNAs and repair templates. This procedure can be used for genome editing without the need for stable integration of the Cas9 and T7RNAP genes.
Genome-wide Association Mapping Reveals Potential Novel Loci Controlling Stripe-rust Resistance in a Chinese Wheat Landrace Diversity Panel From the Southern Autumn-sown Spring Wheat Zone
Authors: Wang Yuqi , Yu Can , Cheng Yukun , Yao Fangjie , Long Li , Wu Yu , Li Jing , Li Hao , Wang Jirui , Jiang Qiantao , Li Wei , Pu Zhien , Qi Pengfei , Ma Jian , Deng Mei , Wei Yuming , Chen Xianming , Chen Guoyue , Kang Houyang , Jiang Yunfeng , Zheng Youliang
Published: May 2020

Background:Stripe rust, caused by the fungal pathogen Puccinia striiformis f. sp. tritici (Pst), is a serious foliar disease of wheat. Identification of novel stripe-rust resistance genes and cultivation of resistant varieties are considered to be the most effective approaches to control this disease. In this study, we evaluated the infection type (IT), disease severity (DS) and area under the disease progress curve (AUDPC) of 143 Chinese wheat landrace accessions for stripe-rust resistance. Assessments were undertaken in five environments at the adult-plant stage with Pst mixture races under field conditions, in addition, IT was assessed at the seedling stage with two prevalent Pst races (CYR32 and CYR34) under controlled greenhouse conditions. Results:Seventeen accessions showed stable high-level resistance to stripe rust across all environments under field tests,while four accessions showed resistance to the Pst races CYR32 and CYR34 at the all-stage.Combining phenotypic data from the field and greenhouse trials with 6404 markers covering the whole genome, we detected 17quantitative trait locus(QTLs) on 11 chromosomes for IT associated with seedling resistance and 15 QTLs on seven chromosomes for IT, final disease severityor AUDPC associated with adult-plant resistance. Four stable QTLs detected on four chromosomes, which explained 9.99%–23.30% of the phenotypic variation, were simultaneously associated with seedling and adult-plant resistance. Integrating a linkage map of stripe-rust resistance in wheat, 29 QTLs overlapped with previously reported genes or QTLs, while two and oneQTLs conferring seedling and adult-plant resistancerespectively were mapped distantly from previously reported stripe rust resistance genes or QTLs and may be novel resistantloci. Conclusions:Our results provided an integrated view of stripe rust resistance resources in a Chinese wheat landrace diversity panel from the southern autumn-sown spring wheat zone.The identified resistant accessions and resistance loci will be useful in the ongoing effort to develop new wheat cultivars with strong resistance to stripe rust.
The role of midwives in improving breastfeeding practices in protracted crises: The Gaza Strip example
Authors: Iellamo Alessandro , Monaghan Emily , Moghany Samar AL , Latham Jonathan , Nassereddin Nihal
Published: May 2020

Background: The protection, promotion and support of breastfeeding is the most effective intervention to prevent child morbidity and mortality in all contexts. During the Palestine-Israel conflict that started in the middle of the 20th century, healthcare services are understaffed and lack basic resources, with frequent power cuts and stock-outs of essential drugs and equipment. This case study seeks to answer the questions: (1) How does the protracted crisis in Gaza affect the breastfeeding practices of the most vulnerable population; and (2) What is the role that midwives can play in improving breastfeeding practices?A mixed method (qualitative and quantitative) study was used to collect data. A total of 1044 respondents had a child less than 24 months at the time of the study. A total of 62.75 percent practice early initiation of breastfeeding and 42 percent confirmed that their new-borns were given liquids other than breast milk during the first three days of life. Fifty percent of mothers addressed breast milk insufficiency by drinking additional fluids and 40 percent by using infant formula. Discussion:This study confirms the need to a) implement the IYCF-E operational guidance in the Gaza strip and b) review the pre-service and in-service training for midwives. For vulnerable populations in humanitarian contexts, the impact of this cannot be underestimated. Conducting research in humanitarian settings is particularly challenging. Our experience included integration and linkage with international organizations security officers on the ground, co-ordination of activities with authorities and communities, regular supportive supervision during data collection, allocation of buffer days and geographical areas and in-country and remote assistance to data collection teams Conclusions:This research focuses on a protracted emergency in insecure populated areas. The unpredictable security situation meant that the team adopted a flexible approach during data collection. Lessons learned throughout this process include the importance of a) allocating additional research time, to account for potential interruption b) daily coordination with security officers to ensure safe access to localities c) identification of extra sites, in case escalation of conflict d) training of additional enumerators in case conflict escalation e) negotiation with authorities to ensure compliance with requirements.
Azithromycin added to Hydroxychloroquine for Patients Admitted to Intensive Care due to Coronavirus Disease 2019 (COVID-19) – Protocol of Randomized Controlled Trial AZIQUINE-ICU
Authors: Duška František , Waldauf Petr , Halačová Milada , Zvoníček Václav , Bala Jakub , Beneš Jan , Balík Martin , Klementová Olga , Kozáková Irena , Kubricht Viktor , Roy Anne Le , Řehořová Veronika , Vymazal Tomáš , Černý Vladimír
Published: May 2020

• Background: Novel coronavirus SARS-CoV-2 is known to be susceptible in vitro to exposure to hydroxychloroquine and its effect have been found to be potentiated by azithromycin. We hypothesize, that early administration of hydroxychloroquine alone or in combination with azithromycin can prevent respiratory deterioration in patients admitted to intensive care due to rapidly progressive COVID-19 infection. • Methods: Design: Prospective, multi-centre, double blind, randomised, controlled trial (RCT). Participants: Adult (>18 years) within 24 hours of admission to intensive care unit with proven or suspected COVID-19 infection, whether or not mechanically ventilated. Exclusion criteria include duration symptoms of febrile disease for ≥1 week, treatment limitations in place or moribund patients, allergy or intolerance of any study treatment, pregnancy. Interventions: Patients will be randomized in 1:1:1 ratio to receive Hydroxychloroquine 800mg orally in two doses followed by 400mg daily in two doses and Azithromycin 500 mg orally in one dose followed by 250 mg in one dose for a total of 5 days (HC-A group) or Hydroxychloroquine+ placebo (HC group) or placebo + placebo (C-group) in addition to best standard of care, which may evolve during the trial period but will not differ between groups. Primary outcome is the composite percentage of patients alive and not on end-of-life pathway who are free of mechanical ventilation at day 14. Secondary outcomes: The percentage of patients who were prevented from needing intubation until day 14; ICU length of stay; mortality (in hospital) at day 28 and 90.• Discussion: Although both investigational drugs are often administered off label to patients with severe COVID-19, at present, there is no data from RCTs on their safety and efficacy. In vitro and observational trial suggest their potential to limit viral replication and the damage to lungs as the most common reason for ICU admission. Therefore, patients most likely to benefit from the treatment are those with severe, but early disease. This trial is designed and powered to investigate whether the treatment in this cohort of patients leads to improved clinical patients-centered outcomes, such as mechanical ventilation-free survival. Trial registration: Clinical trials.gov: NCT04339816 (Registered on 9th April 2020); Eudra CT number: 2020-001456-18 (Registered on 29th March 2020)
Motivational Interviewing to Improve Self-efficacy in Type 2 Diabetes Management
Authors: Maslakpak Masumeh Hemmati , Parizad Naser , Ghahremani Amir , Alinejad Vahid
Published: May 2020

Background: Self-efficacy predicts adherence to treatment in patients with diabetes. Motivational interviewing could be a promising intervention to increase the patients’ motivation to follow therapeutic recommendations. The present study aimed to assess the effects of motivational interviewing on self-efficacy in type 2 diabetes management. Methods: This quasi-experimental study with a pretest-posttest design was conducted on 60 patients with type 2 diabetes, who were members of the Bukan Diabetes Association in Iran. The patients were selected using a random number table and were randomly allocated into intervention (n=30) and control (n=30) groups. Five motivational interviewing sessions (30-45 minutes) were held for the intervention group (two sessions per week). Data were collected using a demographic questionnaire and the diabetes management self-efficacy scale (DMSES). Data were analyzed with SPSS software version 14.0 using descriptive and inferential statistics.Results: Sixty patients entered the analysis. A significant difference was observed in the mean score of diabetes management self-efficacy between the two groups before and after the intervention (P=0.014). The mean score of self-efficacy in diabetes management was increased significantly in the intervention group after MI (P=0.001).Conclusions: Motivational interviewing improved self-efficacy in diabetes management. Thus, this approach is recommended to be used in patients with type 2 diabetes in order to increase their self-efficacy.
Temperature, Air Pollution and Fatal Unintentional Injuries in Jiangsu Province China, 2015-2017
Authors: Robertson Leon , Zhou Lian , Chen Kai
Published: May 2020

Background The correlation of unintentional injury mortality to rising temperatures found in several studies could result from changes in behavior that increases exposure to hazards or risk when exposed. An increase of .82 degrees (C) daily maximum temperature in Jiangsu Province, China from 2015 through 2017 provides the opportunity to study further this phenomenon including a potential effect of air pollution. Air pollutants may cause symptoms and distractions that increase risk and avoidance behavior that reduces risk. This study examines data that allows estimates of the potential effects of temperature, precipitation and five air pollutants on injury mortality risk, each corrected statistically for the potential effects of the others. Methods Daily data on unintentional injury deaths and exposures to temperature, precipitation and pollutants from 9 cities in Jiangsu Province, China during 2015-2017 were analyzed using logistic regression. Application of the regression equations to 2016 and 2017 data substituting 2015 values for each of the predictor variables respectively was used to estimate year-to-year changes in deaths related to changes in the risk factors. Results Unintentional injury death risk was unrelated to temperature when temperatures were below 25 degrees (C) but increased substantially in relation to higher temperatures. The correlations mainly occurred for non-transport injuries. Fatal injury risk was higher in relation to higher concentrations of PM10, NO2 , and SO2 in certain temperature ranges but lower in relation to higher concentrations of CO in the lowest and highest temperature ranges. Lower risk was associated with O3 at low temperatures but higher risk at high temperatures. Risk was lower on weekends but higher on holidays when temperatures were moderate. Conclusions The increase in fatal unintentional injuries from 2015 through 2017 was substantially related to the rise in average maximum daily temperature. Negative associations of certain pollutants, particularly O3, with injury risk suggests the possibility that changes in behavior to avoid those pollutants also results in lower injury risk. Most pollutants, however, are related to increased risk.
Identification of long noncoding RNA RP11-89K21.1 and RP11-357H14.17 as prognostic signature of endometrial carcinoma via integrated bioinformatics analysis
Authors: Gao Lingling , Nie Xin , Zhang Wenchao , Gou Rui , Hu Yuexin , Qi Yue , Li Xiao , Liu Qing , Liu Juanjuan , Lin Bei
Published: May 2020

Background: Endometrial carcinoma (EC) is one of the most common malignant tumors in gynecology. The potential functions and mechanisms of long noncoding RNAs (lncRNAs) in the occurrence and progression of EC remains unclear. It’s meaningful to explore lncRNAs signature for providing prognostic value of EC. Methods：The differentially expressed lncRNAs and their prognostic values in EC were investigated based on The Cancer Genome Atlas (TCGA) database; the transcriptional factors (TFs), the competing endogenous RNA (ceRNA) mechanism, functional regulatory network and immune infiltration of RP11-89K21.1 and RP11-357H14.17 were further explored by various bioinformatics tools and databases. Results: We first identified high expression of RP11-89K21.1 and RP11-357H14.17 were closely associated with shorten overall survival (OS) and poor prognosis in patients with EC. We also elucidated the networks of transcription factor and co-expression genes associated with RP11-89K21.1 and RP11-357H14.17. Furthermore, the ceRNA network mechanism was successfully constructed through 2 lncRNAs (RP11-89K21.1 and RP11-357H14.17), 11 miRNAs and 183 mRNAs. Functional enrichment analysis revealed that the targeting genes of RP11-89K21.1 and RP11-357H14.17 were strongly associated with microRNAs in cancer, vessel development, growth regulation, growth factor and cell differentiation, and involved in pathways including pathways in cancer, microRNAs in cancer and apoptotic signaling pathway. Conclusions: We demonstrated for the first time that RP11-89K21.1 and RP11-357H14.17 may play crucial roles in the occurrence, development and malignant biological behavior of EC, and can be regarded as potential prognostic biomarkers for EC.
Young women’s autonomy and information needs in the schools-based HPV vaccination programme: A qualitative study
Authors: Fisher Harriet , Evans Karen , Ferrie Jo , Yates Julie , Roderick Marion , Audrey Suzanne
Published: May 2020

Background Until 2019, the English schools-based human papillomavirus (HPV) vaccination programme was offered only to young women aged 12 to 13 years to reduce HPV-related morbidity and mortality. The aim of this study is to explore the extent to which young women were able to exercise autonomy within the HPV vaccination programme and how this was influenced by the content and form of information provided. Methods Recruitment was facilitated through a healthcare organisation, schools and community organisations in a local authority in the south-west of England. Researcher observations of the delivery of the HPV vaccination session were carried out in three schools. Semi-structured interviews took place with 53 participants (young women, parents of adolescent children, school staff and immunisation nurses) during the 2017/18 and 2018/19 programme years. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVivo software. Results Young women’s active participation and independence within the HPV vaccination programme was constrained by the setting of vaccination and the primacy of parental consent procedures. The authoritarian school structure influenced the degree to which young women were able to actively participate in decisions about the HPV vaccination programme. Young women exercised some power, either to avoid or receive the vaccine, by intercepting parental consent forms and procedures. Reliance on leaflets to communicate information led to unmet information needs for young women and their families. Communication may be improved by healthcare professional advocacy, accessible formats of information, and delivery of educational sessions. Conclusions Strategies to improve communication about the HPV vaccine may increase young people’s autonomy in consent procedures, clarify young people’s rights and responsibilities in relation to their health care services, and result in higher uptake of the HPV vaccination programme. Trial registration: ISRCTN registry number 49086105
The Magnitude and associated factors of Helicobacter pylori infection among adult dyspeptic patients attending Bokoji Hospital, Southeast Ethiopia
Authors: Kenea Dagaga Goboto , Negawo Mesfin , Lemessa Firaol Kitila , Tejineh Solomon
Published: May 2020

Background: Helicobacter pylori infection is the most common chronic bacterial infection and there were approximately 4.4 billion individuals with H pylori infection worldwide. Among those, hundreds of millions of people develop peptic ulcer disease during their lifetime and still tens of millions might progress to gastric cancer. Hence, early information is very important to prevent upper gastrointestinal complications. Consequently, the current study aimed to assess the magnitude and associated risk factors of Helicobacter pylori infection among adult dyspeptic patients attending Bokoji hospital, Southeast Ethiopia.Methods: A hospital-based cross-sectional study involving 348 adult dyspeptic patients attending Bokoji hospital was carried out from July 16 to October 31, 2019. About 50 mg of fresh stool and 60 µl of capillary blood were collected from each dyspeptic patient and analyzed for detection of Helicobacter pylori antigens, presence of intestinal parasites and ABO blood grouping respectively. Data were entered using Epi Info 7 and Statistical analysis was done using SPSS version 21 and a p-value less than 0.05 was considered as statistically significant.Results: The overall magnitude of Helicobacter pylori infection was 47.7%. The magnitude of H. pylori infection was almost two times higher in patients who do not have a habit of handwashing after toilet visit than those who wash their hand's habit of handwashing after visiting toilet (AOR 2.241, 95% CI (1.410, 3.563) and alcohol drinking habit (AOR 1.796, 95% CI (1.087, 2.968). Conclusions: The magnitude of H. pylori was high in the study area and associated with handwashing habits after toilet use and alcohol drinking habits. Therefore, the community could be educated on the handwashing habit to minimize H. pylori infections.