bluuebunny/crossref_metadata_2025 huggingface dataset:
An evaluation of the nature and level of musculoskeletal imaging training in physiotherapy educational programme in Nigeria
Authors: Onyeso Ogochukwu Kelechi , Umunnah Joseph O , Ezema Charles Ikechukwu , Balogun Joseph A , Uchenwoke Chigozie , Nwankwo Maduabuchukwu Joseph , Oke Kayode Israel , Bello Bashir , Nwosu Ifeoma Blessing , Adje Mishael E.
Published: January 2020

Background: Previous studies have shown that deficiency in training may lead to inappropriate utilisation of diagnostic imaging among healthcare professionals, thus, raising concerns about patient safety and economic cost. This study aimed to evaluate the nature and level of musculoskeletal imaging (MI) training received by physiotherapists who graduated from Nigerian universities and completed the one-year mandatory internship. Methods: An online version of the Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ), which was previously validated, was administered to all eligible physiotherapists identified through the database of the Medical Rehabilitation Therapist Board’s (MRTBN). Data were obtained on demographics, nature, and level of training on various MI modalities using the PMIPQ. Descriptive statistics, Friedman’s ANOVA, and Kruskal-Wallis tests were used for the data analysis at P ≤ 0.05. Results: The results showed that only 10.0% of the respondents had a standalone undergraduate course in MI, 92.8% did not have any MI clinical posting exposure during the internship, and 67.3% had never attended any MI workshop. There was a significant difference in the level of training received across various MI modalities [χ2 (15) = 1285.899; P = 0.001]. However, there was no significant difference in the level of MI training across the institutions (P = 0.36). The study participants with Doctor of Physiotherapy (DPT) education were better trained in MI than their counterparts with a bachelor’s degree (P = 0.047). Conclusions: The self-reported level of MI training among the respondents was deficient, but the knowledge of X-ray was significantly higher than other MI modalities. Based on the overall findings in this study, we recommend that diagnostic imaging contents be introduced early in the current and future physiotherapy training programmes.
Identifying and selecting implementation theories, models and frameworks: a qualitative study to inform the development of a decision support tool
Authors: Strifler Lisa , Barnsley Jan M. , Hillmer Michael , Straus Sharon E.
Published: January 2020

Background: Implementation theories, models and frameworks offer guidance when implementing and sustaining healthcare evidence-based interventions. However, selection can be challenging given the myriad of potential options. We propose to develop a decision support tool to facilitate the appropriate selection of an implementation theory, model or framework in practice. To inform tool development, this study aimed to explore barriers and facilitators to identifying and selecting implementation theories, models and frameworks in research and practice, as well as end-user preferences for features and functions of the proposed tool.Methods: We used an interpretive descriptive approach to conduct semi-structured interviews with implementation researchers and practitioners in Canada, the United States and Australia. Audio recordings were transcribed verbatim. Data were inductively coded by a single investigator with a subset of 20% coded independently by a second investigator and analyzed using thematic analysis.Results: Twenty-four individuals participated in the study. Categories of barriers/facilitators, to inform tool development, included characteristics of the individual or team conducting implementation and characteristics of the implementation theory, model or framework. Major barriers to selection included inconsistent terminology, poor fit with the implementation context and limited knowledge about and training in existing theories, models and frameworks. Major facilitators to selection included the importance of clear and concise language and evidence that the theory, model or framework was applied in a relevant health setting or context. Participants were enthusiastic about the development of a decision support tool that is user-friendly, accessible and practical. Preferences for tool features included key questions about the implementation intervention or project (e.g., purpose, stage of implementation, intended target for change) and a comprehensive list of relevant theories, models and frameworks to choose from along with a glossary of terms and the contexts in which they were applied.Conclusions: An easy to use decision support tool that addresses key barriers to selecting an implementation theory, model or framework in practice may be beneficial to individuals who facilitate implementation practice activities. Findings on end-user preferences for tool features and functions will inform tool development and design through a user-centered approach.
The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China
Authors: Zhang Ting , Wang Huien , Wang Xinling , Yang Yue , Zhang Yingkui , Tang Zengjun , Wang Li
Published: January 2020

Background The adverse pregnancy outcomes caused by teenage pregnancy are major public health problems with significant social impact, especially in developing countries. While China is the most populous country in the world, and 8.5% of the women aged 10-50 years are adolescent women, we aimed to analyze the adverse maternal and perinatal outcomes of the adolescent pregnant women in Hebei Province, China.Methods There were 238,598 singleton pregnant women aged 10-34 years from January 1, 2013 to December 31, 2017 in the database of Hebei Province Maternal Near Miss Surveillance System (HBMNMSS). The 238,598 pregnant women were divided into two groups: adolescent group (aged 10-19 years) and adult group (aged 20-34 years), the adolescent group was divided into two subgroups (aged 10-17 years, aged 18-19 years). The information that was collected included sociodemographic characteristics, obstetric history, place and mode of delivery, pregnancy outcome, complications during pregnancy. We compared the risk of adverse pregnancy outcomes between the two groups and two subgroups using univariate and multivariate Logistic regression. Results Compared with women aged 20-34 years, women aged 10-19 years had lower risk of cesarean delivery [adjusted risk ratio (aRR): 0.75, 95% confidence interval (CI): 0.70-0.80], gestational diabetes mellitus (GDM) (aRR: 0.55, 95% CI: 0.41-0.73). The women aged 10-19 years had higher risk of preterm birth (aRR: 1.76, 95% CI: 1.54-2.01), small for gestational age (SGA) (aRR: 1.19, 95% CI: 1.08-1.30), stillbirth (aRR: 2.58, 95% CI: 1.83-3.62), neonatal death (aRR: 2.63, 95% CI: 1.60-4.32). The adolescent women aged 10-17 years had significantly higher risk of stillbirth (aRR: 4.83, 95% CI: 2.86-8.14) and neonatal death (aRR: 6.35, 95% CI: 3.16-12.77) compared with the women aged 20-34 years, but there was no association with the risk of incidence of GDM (aRR: 1.03, 95% CI: 0.63-1.68) and SGA (aRR: 1.11, 95% CI: 0.89-1.39). Conclusions The adolescent pregnancy was related to adverse perinatal (fetal and neonatal) outcomes, such as preterm birth, stillbirth and neonatal death, especially in younger adolescent pregnancies (aged 10-17 years).
First evidence of the deletion in the Pfhrp2 and Pfhrp3 genes in P. falciparum from Equatorial Guinea
Authors: Berzosa Pedro , González V , Taravillo L , Mayor A , Romay-Barja M , Garcia L , Ncogo P , Riloha M , Benito A
Published: January 2020

Background WHO recommends RDTs as a good alternative malaria-diagnosis method in remote parts of sub-Saharan Africa. The majority of commercial RDTs currently available detect the P. falciparum protein histidine-rich protein 2 (PfHRP2). There have also been recent reports of Pfhrp2 deletions being found in parasites collected from several African countries. WHO has concluded that the lacking the Pfhrp2 gene must be monitored in Africa. The purpose of the study was to analyze why the samples that were positive by PCR were negative by RDTs; and, therefore, to determine whether there have been deletions in the Pfhrp2 and/or Pfhrp3 genes. Methods Malaria NM-PCR was carried out to all the samples collected in the field. A group of 128 samples was positive by PCR but negatives by RDT, these samples were classified as RDT false-negatives. It was carried out a PCR for exon2 of Pfhrp2 and Pfhrp3 genes to detect the presence or absence of these two genes. Frequencies with 95% confidence intervals (CIs) were used for prevalence estimates. Associations were assessed by the chi-square test or Fisher´s exact test. The level of significance was set at p ≤ 0.05. Statistical analyses were performed using the software package SPSSv.15.0. Results After the PCR, 81 samples were identified (4.7%, 95%CI: 3.8-5.8) which had deletion in both genes, Pfhrp2 and Pfhrp3 . Overall, however, 11 samples (0.6%, 95%CI: 0.36-1.14) had deletion only in Pfhrp2 but not in Pfhrp3 , and 15 (0.9%, 95%CI: 0.6-1.5) presented with deletion only in Pfhrp3 but not in Pfhrp2 . Considering the Pfhrp2 gene separately, within the total of 1,724 samples, 92 (5.3%, 95%CI: 4.37-6.5) had evidence of deletion. Conclusion The present study provides the first evidence of deletion in the Pfhrp2 and Pfhrp3 genes in P. falciparum isolates from Equatorial Guinea. However, larger studies across different regions within the country and across different seasonal profiles are needed to determine the full extent of Pfhrp2 and Pfhrp3 deletion. It would be strongly recommendable to implement an active surveillance program in order to detect any increases in Pfhrp2 and Pfhrp3 deletion frequencies.
Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda
Authors: Kigozi Simon P. , Kigozi Ruth N. , Epstein Adrienne , Mpimbaza Arthur , Sserwanga Asadu , Yeka Adoke , Nankabirwa Joaniter I. , Halliday Katherine , Pullan Rachel L , Rutazaana Damian , Sebuguzi Catherine M , Opigo Jimmy , Kamya Moses R , Staedke Sarah G , Dorsey Grant , Greenhouse Bryan , Rodriguez-Barraquer Isabel
Published: January 2020

Background: Malaria control using long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide (IRS) has been associated with reduced transmission throughout Africa. However, the impact of transmission reduction on the age distribution of malaria cases remains unclear.Methods: Over a 10-year period (January, 2009 to July, 2018), outpatient surveillance data from four health facilities in Uganda were used to estimate the impact of control interventions on temporal changes in the age distribution of malaria cases using multinomial regression. Interventions included mass distribution of LLINs at all sites and IRS at two sites.Results: Overall, 896,550 patient visits were included in the study; 211,632 aged <5 years, 171,166 aged 5-15 years, and 513,752 >15 years. Over time, the age distribution of patients not suspected of malaria and those malaria negative either declined or remained the same across all sites. In contrast, the age distribution of suspected and confirmed malaria cases increased across all four sites. In the two LLINs-only sites, the proportion of malaria cases in <5 years decreased from 31% to 16% and 35% to 25%, respectively. In the two sites receiving LLINs plus IRS, these proportions decreased from 58% to 30% and 64% to 47%, respectively. Similarly, in the LLINs-only sites, the proportion of malaria cases >15 years increased from 40% to 61% and 29% to 39%, respectively. In the sites receiving LLINs plus IRS, these proportions increased from 19% to 44% and 18% to 31%, respectively.Conclusions: These findings demonstrate a shift in the burden of malaria from younger to older individuals following implementation of successful control interventions, which has important implications for malaria prevention, surveillance, case management and control strategies.
Keap1-targeting microRNA-941 protects endometrial cells from oxygen and glucose deprivation-re-oxygenation via activation of Nrf2 signaling
Authors: Li Shu-ping , Cheng Wei-nan , Li Ya , Xu Hong-bin , Li Ping , Zhang Deng-Xia , Han Hui
Published: January 2020

Background: Mimicking ischemia-reperfusion injury, oxygen and glucose deprivation (OGD)-re-oxygenation (OGDR) applied to endometrial cells produces significant oxidative stress and programmed necrosis, which can be inhibited by nuclear-factor-E2-related factor 2 (Nrf2) signaling. MicroRNA (miRNA)-induced repression of Keap1, a Nrf2 suppressor protein that facilitates Nrf2 degradation, is novel strategy to activate Nrf2 cascade. Methods: MicroRNA-941 (miR-941) was exogenously expressed in HESC and primary human endometrial cells, and the Nrf2 pathway examined by Western blotting and real-time quantitative PCR analysis. The endometrial cells were treated with OGDR, cell programmed necrosis and apoptosis were tested. Results: MiR-941 is a novel Keap1-targeting miRNA that regulates Nrf2 activity. In T-HESC cells and primary human endometrial cells, ectopic overexpression of miR-941 suppressed Keap1 3’-UTR (untranslated region) expression and downregulated its mRNA/protein expression, leading to activation of the Nrf2 cascade. Conversely, inhibition of miR-941 elevated Keap1 expression and activity in endometrial cells, resulting in suppression of Nrf2 activation. MiR-941 overexpression in endometrial cells attenuated OGDR-induced oxidative stress and programmed necrosis, whereas miR-941 inhibition enhanced oxidative stress and programmed necrosis. MiR-941 overexpression and inhibition were completely ineffective in Keap1-/Nrf2-KO T-HESC cells (using CRISPR/Cas9 strategy). Restoring Keap1 expression, using an UTR-depleted Keap1 construct, abolished miR-941-induced anti-OGDR activity in T-HESC cells. Thus Keap1-Nrf2 cascade activation is required for miR-941-induced endometrial cell protection. Conclusions: Targeting Keap1 by miR-941 activates Nrf2 cascade to protect human endometrial cells from OGDR-induced oxidative stress and programmed necrosis.
The impact of Clonorchis sinensis infection on immune response in mice with type II collagen-induced arthritis
Authors: li xiangyang , Yang Ying , Qin Su-Ping , Kong Fan-Yun , Yan Chao , Cheng Wan-Peng , Pan Wei , Yu Qian , Hua Hui , Zheng Kui-Yang , Tang Ren-Xian
Published: January 2020

Background: Clonorchis sinensis infection could trigger strong immune responses in mice and humans. However, whether the C.sinensis infection has an impact on arthritis is unknown. Here we investigated the effect of C.sinensis infection on type II collagen-induced arthritis in BALB/c mice.
Results: The mice were firstly infected with 45 C.sinensis metacercariae by oral gavage. Four weeks later, arthritis in mice was induced by type II collagen. Joint inflammation with severe redness and swelling in hind paws was observed in type II collagen-induced arthritis (CIA) mice. Besides, the physical activity was significantly reduced, but the respiratory exchange ratio was increased in CIA mice. Compared with CIA mice, C.sinensis infection could increase the severity of arthritis in CIA mice, based on the results of disease score and pathological changes. Compared to CIA mice, increased neutrophils and Ly6Chi monocytes, decreased B cells and CD4+T cells, were found in C.sinensis infected CIA mice. Besides these, C.sinensis infected mice also displayed significantly higher levels of serum IL-4 and IL-17 than those in CIA mice.
Conclusions: Taken together, our data suggest that C.sinensis infection have a bad effect on arthritis, and could induce the abnormality of the immune response in mice with CIA.
The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction
Authors: Zhang Shuning , Deng Xin , Yang Wenlong , Xia Liping , Yao Kang , Lu Hao , Ge Lei , Li Shen , Sun Aijun , Zou Yunzeng , Qian Juying , Ge Junbo
Published: January 2020

Background The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI). Methods Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI)at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed. Results A total of 392 patients (mean age of 63.9years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n=69) and no loss (TIMI grade2-3, n=323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p=0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p<0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI. Conclusion Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
The DELLA Proteins Interact with MYB21 and MYB24 to Regulate Filament Elongation in Arabidopsis
Authors: Huang Huang , Gong Yilong , Liu Bei , Wu Dewei , Zhang Min , Xie Daoxin , Song Susheng
Published: January 2020

Background: Gibberellin (GA) and jasmonate (JA) are two essential phytohormones for filament elongation in Arabidopsis . GA and JA trigger degradation of DELLAs and JASMONATE ZIM-domain (JAZ) proteins through SCF SLY1 and SCF COI1 separately to activate filament elongation . In JA pathway, JAZs interact with MYB21 and MYB24 to control filament elongation. However, little is known how DELLAs regulate filament elongation. Results: Here we showed that DELLAs interact with MYB21 and MYB24, and that R2R3 domains of MYB21 and MYB24 are responsible for interaction with DELLAs. Furthermore, we demonstrated that DELLA and JAZ proteins coordinately repress the transcriptional function of MYB21 and MYB24 to inhibit filament elongation . Conclusion: We discovered that DELLAs interact with MYB21 and MYB24, and that DELLAs and JAZs attenuate the transcriptional function of MYB21 and MYB24 to control filament elongation. This study reveals a novel cross-talk mechanism of GA and JA in the regulation of filament elongation in Arabidopsis .
The Bipedicle Advancement Flap on Skin Coverage After Mucous Cyst Excision:A Retrospective Study of 18 Cases.
Authors: Ma Yanming , Meng Xiangjun , Su Yun , Yan Zuofa , Shao Quansheng , Chen Yiqing
Published: January 2020

Background : Many patients have skin defects after digital mucous cyst (DMC) excision, and this study aimed to assess the clinical outcomes of using a bipedicle advancement flap to cover such defects. Methods : From January 2016 to January 2018, DMCs on 18 fingers of 15 patients (4 males and 11 females, with a mean age of 64 years) were treated with cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect in this retrospective study. Postoperative flap survival, healing and infection were evaluated. The pre- and postoperative ranges of motion (ROMs) of the distal interphalangeal (DIP) or thumb interphalangeal (IP) joints were recorded. Postoperative patients’ satisfaction was assessed by the visual analogue scale (VAS; 0～10). Results : The patients were followed up for 12-36 months (mean, 20 months). All the flaps survived, the incisions healed well without infection, and no cyst recurrence occurred. The postoperative ROM of the affected fingers was restored to the preoperative ROM by two months after surgery. No difference was found between the preoperative and postoperative ROMs. The score of patients’ satisfaction for surgery by means of VAS was 8.5±1.0. Conclusions : The bipedicle advancement flap is a simple and effective technique for covering skin defects following DMC excision.
Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials
Authors: Lopez Albert Macaire Chua Ong , Tan Charles Jeffrey L. , II Antonio S. Yabon , Masbang Armin N.
Published: January 2020

Background: Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates still rise.
Objectives: This meta-analysis aims to determine whether NSAIDs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics.
Data Sources: PUBMED,MEDLINE,EMBASE,CENTRAL,ACP databases and other grey literature sources from inception to June 2019 were sought in the relevant search.
Study Eligibility Criteria, Participants and Intervention: Randomized controlled trials that compare the use of NSAIDs versus antibiotics in non-pregnant women ≥ 18 years old with uncomplicated urinary tract infection.
Methods: Primary outcomes were symptom resolution of UTI at Day 3 or 4 of intervention,and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis with substantial heterogeneity.
Results: The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment(RR: 0.69; 95% CIs [0.55, 0.86], I 2 =73).The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], I 2 =0%).Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77; 95% CIs [1.95, 3.94], I 2 =36%).Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.10; 95% Cis [2.17, 4.43], I 2 =53%).
Conclusion: This meta-analysis could not prove non-inferiority of NSAIDs over antibiotics. However,the authors would still recommend maintaining the use of empiric antibiotic therapy as the primary treatment for UTI because of limited NSAID benefits with complication risks.
A predictive model for early diagnosis of keratoconus
Authors: CASTRO-LUNA GRACIA , PÉREZ-RUEDA ANTONIO
Published: January 2020

Background: The diagnosis of keratoconus in the early stages of the disease is necessary to initiate an early treatment of keratoconus. Furthermore to avoid possible refractive surgery that could produce ectasias. This study aims to describe the topographic, pachymetric and aberrometry characteristics in patients with keratoconus, subclinical keratoconus and normal corneas. Additionally to propose a diagnostic model of subclinical keratoconus based in binary logistic regression models
Methods: The design was a cross-sectional study. It included 205 eyes from 205 patients distributed in 82 normal corneas, 40 subclinical keratoconus and 83 established keratoconus The rotary Scheimpflug camera (Pentacam® type) analyzed the topographic, pachymetric and aberrometry variables. It performed a descriptive and bivariate analysis of the recorded data. A diagnostic and predictive model of subclinical keratoconus was calculated with the statistically significant variables
Results: Statistically significant differences were observed when comparing normal corneas with subclinical keratoconus/ in variables of the vertical asymmetry to 90º and the central corneal thickness. The binary logistic regression model included the minimal corneal thickness, the anterior coma to 90º and posterior coma to 90º. The model properly diagnosed 92% of cases
Conclusions: The differential diagnosis between normal cases and subclinical keratoconus depends on the mínimum corneal thickness, the anterior coma to 90º and the posterior coma to 90º.
Reablement through time and space: A scoping review of how the concept of ‘reablement’ for older people has been defined and operationalised
Authors: Clotworthy Amy , Kusumastuti Sasmita , Westendorp Rudi GJ
Published: January 2020

Background While the field of rehabilitation has determined a common definition of professional practice, legislators and healthcare professionals in various Western countries have been struggling to reach consensus about how the newer offer of ‘reablement’ should be organised, operationalised, and understood as a health service for older adults. International research indicates that a great deal of confusion, ambiguity, and disagreement has arisen regarding the terminology and the structure of these programmes, and they may not be adequately supporting older people. Could a clarification of the concept help reablement become more effective in theory and in practice? Methods We conducted a qualitative and quantitative scoping review to determine how reablement has developed through time and space. Eligible articles (n=86) had to focus on any of the defined features of current reablement programmes; there were no restrictions on study designs or publication dates. In articles published from 1947–2019, we identified themes and patterns, commonalities, and differences in how various countries described and defined reablement. We also performed an analysis using computer software to construct and visualise term maps based on significant words extracted from the article abstracts. Results The fundamental principles of reablement have a long history. However, these programmes have undergone a widespread expansion since the early 2000s with an intention to reduce costs related to providing long-term care services and in-home assistance to growing elderly populations. As reablement programmes have developed internationally, they have begun to overemphasise training older people to (re)gain their skills and confidence in maintaining or improving functional ability related to activities of daily living (ADLs). Conclusions Reablement programmes are fundamentally intended to be person-centred and should support older people in attaining their self-defined goals to be both more physically independent at home and socially involved in their communities. However, the rapid implemention of these programmes without clear evidence for the full scope of their potential effects and impact means that they may not adequately support older people’s needs. A continued lack of agreement about what reablement is (and what it should achieve) may lead to ineffective programmes and unclear guidance on which outcomes to measure.
Is there any relationship between role stressors, job tasks, and job satisfaction among Health Surveillance Assistants in Malawi? A cross-sectional study
Authors: Ntopi Simon Willard , Chirwa Ellen , Maluwa Alfred
Published: January 2020

Background: Health Surveillance Assistants (HSAs) are community-based health workers in Malawi, responsible for health services delivery at the community level. They are reported to be overloaded in their work, and anecdotal evidence suggests they are stressed. The purpose of this study was to explore the role stressors among the HSAs with the view to identify factors for role stressors and suggest some measures for the effective management of the HSAs to alleviate the problem of role stressors. Methods: A descriptive cross-sectional study design and multistage stage sampling were used in this study. Data were collected from 430 HSAs from the districts of Mangochi, Lilongwe and Mzimba. A self-administered questionnaire was hand delivered to a total of 455 HSAs with a response rate of 94.5%. The data collected were analyzed with the aid of the computer software package Statistical Package for the Social Sciences (SPSS) version 23. Statistics used for the analysis included: Mean, Standard Deviation, correlations and principal component analysis (PCA). Results: The key findings of this study are that role ambiguity ( r = -.238, P< 0.001) and role overload ( r =-.159, P< 0.01) were significantly negatively related to job satisfaction, while role conflict ( r = -.004, P= 0.472) was insignificantly related to job satisfaction. Additionally, the HSAs curative role was negatively related to role ambiguity ( r = -.108, P= 0.013) and positively related to role conflict ( r = .118, P= 0.008) and role overload ( r = .105, P= 0.015) while the HSAs overall preventive task was positively related to role overload. Conclusion: Since the HSAs clinical tasks were significantly related to all role stressors there is need by the government of Malawi to design strategies to control the role stressors to ensure increased job performance and job satisfaction among HSAs. Keywords : Relationship, role ambiguity, role conflict, role overload, job satisfaction, role stressors
Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review
Authors: Erdrich Sharon , Hawrelak Jason A , Myers Stephen P , Harnett Joanna E
Published: January 2020

Background The association between fibromyalgia and irritable bowel syndrome is well-established. Alterations in the composition and diversity of the gut microbiome in irritable bowel syndrome have been reported, however, this association is poorly understood in fibromyalgia. Our aim was to summarise the research reporting on the gastrointestinal microbiome and its biomarkers in people with fibromyalgia.Methods A systematic review of published original research reporting on the gastrointestinal microbiota and its biomarkers in adults with a diagnosis of fibromyalgia was undertaken.Results From 4771 studies, 11 met our inclusion criteria and were separated into four main groups: papers reporting Helicobacter pylori ; other gut bacterial markers; metabolomics and other biomarkers, which included intestinal permeability and small intestinal bacterial overgrowth.Conclusion The results suggest there is a paucity of quality research in this area, with indications that the gut microbiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis. Further investigations into the relationship between the gut microbiota, gut dysfunction and fibromyalgia are warranted.
Pullout strength of adjusting pedicle screw with or without self-bone grafting in the previous trajectory using an osteoporotic human vertebral body
Authors: Liu Sen , Li Jia , Gao Hong-Yang , Wang Wei , Dong Wei , Zhao Feng , Liu Guo-Bin
Published: January 2020

Objectives The aim of this study is to explore the pullout strength of adjusting pedicle screw with or without self-bone grafting in the previous trajectory using an osteoporotic human vertebral body. Methods Thirty vertebrae from six cadavers were collected and all of the vertebrae were divided into two groups according to bone mineral density: control group with normal bone mineral density; osteoporosis group with osteoporosis. The osteoporosis group was randomly and evenly divided into five subsamples according to direction of reinsert pedicle screw: the normal angle, sagittal angle, sagittal bone grafting, horizontal angle, horizontal bone grafting. Axial pullout strength testing of the pedicle screw was performed and the maximum axial pullout force (Fmax) was applied to analyse. Result The bone mineral density of the control group was 1.115±0.065 g/cm3, and the bone mineral density of the osteoporosis group was 0.678±0.055 g/cm3, presenting significantly different between the two group (P<0.001). Compared with the control group, the Fmax of the normal angle group was smaller (600.64±43.10 vs 1100.74±49.08 N, P<0.001). Compared with the normal angle group, the Fmax of the sagittal angle group (339.13±38.90 vs 600.64±43.10 N, P<0.001) and the horizontal angle group (342.06±33.01 vs 600.64±43.10 N, P<0.001) were smaller. The Fmax in sagittal bone grafting group was higher than that with non-implanted bone in primary screw canal (492.30±42.06 vs 342.06±33.01 N, P<0.001), and the Fmax of the horizontal bone grafting group was higher than that with non-implanted bone in primary screw canal (502.02± 50.26 vs 342.06±33.01 N, P<0.001). Conclusion The pullout strength of adjusting pedicle screw is seriously decreased in osteoporotic human vertebral body and self-bone grafting in the previous trajectory is an effective remedial measure.
Assessing the Effects of Maternal HIV Infection on Child Birth Weight and Knowledge of HIV status on Breastfeeding using Observational Data in Malawi
Authors: Twabi Halima Sumayya , Manda Samuel O , Small Dylan S
Published: January 2020

Background : Evidence has shown that maternal HIV infection has adverse effect on pregnancy outcomes including childbirth weight and that knowledge of mothers HIV status affects practice of exclusive breastfeeding for the first six month. Using methods for matching possible confounders, the purpose of this study were twofold: a) to assess whether or not the association of maternal HIV on childbirth weight was moderated by use of ART drugs and b) to determine if indeed knowledge of HIV status among mothers was associated with exclusive breastfeeding. Methods: Data on over 18,000 and 16,000 children still alive and born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) were analysed. A set of methods for confounder balance namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting the propensity score (PS) were used. Results: Using the 2010 data, maternal HIV infection had a negative effect on infant birth weight -149.0 (-324.2, -26.2) and -154.3 (-295.4, -13.3), under PS matching and PS inverse weighting respectively. Infant birth weights from HIV-infected mothers on ART and uninfected mothers were the same (mean: 3121.3, 95% CI: 3021.9, 3220.7) and (3273.7, 95% CI: 3259.1, 3288.3), respectively) and differed significantly from those HIV-infected mothers (3193.9, 95% CI: 3122.2, 3265.6). For the 2015-16 data, mothers who were HIV-infected gave birth to infants who significantly weighted more than infants from HIV-uninfected mothers 144.7 (40.4, 249.1) and 115.4 (11.6, 219.2), under PS matching and PS inverse weighting respectively. Knowledge of HIV status among mothers was not associated with their behaviour concerning exclusive breastfeeding for the 2010 and 2015-16 data. Conclusion: The association between maternal HIV infection and birth weight depended on the data used, with the 2010 data showing adverse effect. The higher birth weight among infants born to HIV infected mothers in 2015-16 maybe indicative of successes of policies and interventions within the PMTCT program in Malawi. The observed mitigating effect of ART usage by HIV infected mothers on child birth weight further confirms that PMTCT interventions should continue to be supported among antenatal clinics in Malawi.
Impact of Chinese Respiratory Physicians Participating in Smoking Cessation and Mobile Health:Methodological Assessment and Effectiveness Comparison
Authors: Wang Yizhe , Li Rong , Zhang Li , Kang Jian , Xiao Dan , Hu Xuejun , Wang Xiaonan
Published: January 2020

Background People who are eager to quit smoking often lack long-term, daily smoking cessation guidance. Besides, advances in mobile communication technology offer promising ways to provide tobacco dependence treatment. However, it is unclear whether doctors-WeChat network can improve the smoking cessation rate of nicotine-dependent patients. Methods In this prospective single-blind cohort study, we recruited 250 smokers from April, 2018 to August, 2018. They were randomly divided into two groups with or without doctors' active smoking cessation service and followed-up for 6 months. The smoking cessation rate and the characteristics of successful smoking cessation groups were compared. The reasons for relapse were also analyzed. Results After beginning quit for 3months, the success rate of the group with respiratory physicians actively involved was 65.0% (80/123) ; the success rate of control group was 34.7% (34/98). Quit for 6 months, the success rate of the group with respiratory physicians actively involved was 55.3% (68/123) ; the control group was 11.2% (11/98). There was no difference in weight change between the two groups. Subgroup analysis showed that among men who were younger than 45 years old or unemployment, doctors' participation has a greater impact on the success of smoking cessation. Conclusions Doctors in mobile-smoking cessation services plays a very important role to improve quit rates. Our research provides methodological guidance for further clinical trials and provides a template for further real-world application of smoking cessation services.
Elucidation of the Molecular Consequences of Two Unique p6Gag Mutations Derived from HIV-1 CRF07_BC-infected Patients
Authors: Cheng Zetao , Ablan Sherimay D. , Freed Eric O. , Wang Haiying , Tang Shixing
Published: January 2020

Background We previously observed that individuals infected with HIV-1 CRF07_BC showed slower disease progression than those infected with HIV-1 subtype B or CRF01_AE. CRF07_BC viruses carry two unique mutations in the p6 Gag protein: insertion of PTAPPE sequences downstream of the original Tsg101 binding domain, and deletion of a seven-amino-acid sequence ( 30 PIDKELY 36 ) that partially overlaps with the Alix binding domain. To further define the role of these mutations in virus release and replication, we introduced them into the HIV-1 proviral clone pNL4-3 for functional characterization. Results We found that the seven-amino-acid deletion, but not the PTAPPE insertion, significantly decreased virus release, Gag processing, and virus infectivity. The seven-amino-acid deletion also resulted in a virus replication defect in both T-cell lines and peripheral blood mononuclear cells. We found that these defects were caused by the seven-amino-acid deletion in p6 Gag , especially deletion of Tyr-36 of p6 Gag , not the deletion of the overlapping p6* sequence in the HIV-1 GagPol protein. The p6 Gag deletion mutant was resistant to a dominant-negative Alix fragment, suggesting a loss of binding between p6 Gag and Alix. Conclusions Our results indicate that the patient-derived seven-amino-acid deletion in p6 Gag of HIV-1 CRF07_BC virus affects virus release, infectivity and replication capacity by disrupting the interaction between HIV-1 p6 Gag and host protein Alix. These results may explain the slower disease progression observed in the subjects infected with HIV-1 CRF07_BC bearing this unique mutation.
Long-term Survival among Patients with Gastrointestinal Stromal Tumors Diagnosed after Another Malignancy: A SEER Population-Based Study
Authors: Shen Chaoyong , Wang Chengshi , He Tao , Cai Zhaolun , Yin Xiaonan , Yin Yuan , Lu Donghao , Zhang Bo , Zhou Zongguang
Published: January 2020

BACKGROUND: To explore overall survival (OS) and GISTs-specific survival (GSS) among cancer survivors developing a second primary gastrointestinal stromal tumors (GISTs). METHODS: We conducted a cohort study, where patients with GISTs after another malignancy (AM-GISTs, n=851) and those with only GISTs (GISTs-1, n=7660) were identified from the Surveillance, Epidemiology, End Results registries (1988-2016). Clinicopathologic characteristics and survival were compared between the two groups. RESULTS: The most commonly diagnosed first primary malignancy was prostate cancer (27.7%), followed by breast cancer (16.2%). OS among AM-GISTs was significantly inferior to that of GISTs-1: 10-year OS was 40.3% vs. 50.0%, (p<0.001); A contrary finding was observed for GSS (10-year GSS: 68.9% vs. 61.8%, p=0.002). In the AM-GISTs group, a total of 338 patients died, of which 26.0% died of their initial cancer and 40.8% died of GISTs. Independent of demographics and clinicopathological characteristics, mortality from GISTs among AM-GISTs patients was decreased compared with their GISTs-1 counterparts (HR, 0.71; 95% CI, 0.59-0.84; p<0.001); whereas OS was inferior among AM-GISTs (HR, 1.11; 95% CI, 0.99-1.25; p=0.085). CONCLUSIONS: AM-GISTs patients have decreased risk of dying from GISTs compared with GIST-1. Although another malignancy history does not seemingly affect OS for GISTs patients, clinical treatment of such patients should be cautious.
Correlation between UGT1A1 gene polymorphism and irinotecan chemotherapy in metastatic colorectal cancer: a study from Guangxi Zhuang
Authors: Chen Shaojun , Hua Li , Feng Chenjun , Mo Qia , Wei Mengzhuan , Shen Yongqi , Lin Zhan , Li Guisheng , Xu Junyi , Guo Chengxian , huang haixin
Published: January 2020

Background: UGTlA1 gene polymorphism has different distribution in different ethnicities, geographical regions and ethnic groups, which may lead to different toxicity and efficacy of irinotecan. The study aimed to explore the correlation of UGT1A1 gene polymorphism of Guangxi Zhuang metastatic colorectal cancer (mCRC) with irinotecan -based chemotherapy to develop an individualized irinotecan regimen. Methods: From June 2013 and June 2015, a total of 406 patients of Guangxi who were histologically diagnosed as metastatic colorectal cancer and 86 patients of this with three generations of Zhuang who were accorded with inclusion and exclusion criteria were enrolled. The distribution of UGT1A1 gene polymorphism was analyzed retrospectively in all patients. Pyrosequencing method was used to detect the UGT1A1 * 28 and * 6 gene polymorphism in the 86 Guangxi Zhuang mCRC patients. After first-line chemotherapy with FOLFIRI regimen, the relationship between gene polymorphism of UGT1A1 and adverse reactions, and efficacy of Irinotecan were analyzed with χ2 test and Kaplan-Meier method. Results: UGT1A1 * 28 wild-type (TA6 / 6), heterozygous mutant (TA6 /7) and homozygous mutant (TA7 / 7) accounted for 69.8%, 30.2%and 0%, respectively. UGT1A1 * 6 wild type (G / G), heterozygous mutation type (G / A) and homozygous mutant (A / A) accounted for 76.7% ，20.9%and 2.3%，respectively。UGT1A1 * 28 TA6 / 7 type could increase the risk of grade 3-4 diarrhea (P=0.027), which did not increase the risk of grade 3-4 neutropenia (P=0.092). UGT1A1 * 6 G / A and A / A type could increase the risk of grade 3-4 diarrhea and neutropenia (P=0.001; P=0.017). After chemotherapy with FOLFIRI, there was no significant difference in response rate (RR) (P=0.729; P=0.745). The median progression-free survival (mPFS) between the wild-type, mutant treatment of UGT1A1 * 28 and UGT1A1 * 6 (7.0m vs 7.4 m, P=0.427; 6.9mvs 7.0m P=0.408). Conclusions: The distribution of UGT1A1*28 and UGT1A1* 6 gene polymorphism in Guangxi Zhuang patients were differed from the existing reported of European people,Chinese Han population. The UGT1A1 gene polymorphism with irinotecan chemotherapy-associated diarrhea and neutropenia were closely related. There was no significant association between UGT1A1 gene polymorphism and therapeutic efficacy of irinotecan.
Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis
Authors: Sadatmahalleh Shahideh Jahanian , youseflu samaneh , Khomami Mahnaz Bahri , Nasiri Malihe
Published: January 2020

Background: Endometriosis have a negative influence on women’s sexual life. The aim of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, BMI, stage of endometriosis, the intensity of dyspareunia and pelvic pain on sexual function (SF) in infertile women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression. Method: In the present cross-sectional study, 220 infertile women with a laparoscopically confirmed endometriosis were recruited. Data were collected using a socio-demographic checklist, Female Sexual Function Index (FSFI), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS). Results: We found that anxiety, depression, sleep quality, BMI, level of education, stage of endometriosis, and dyspareunia have a direct effect on women’s SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with an effect on sleep quality and dyspareunia change women’s SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and sleep quality can worsen SF. Also, a higher level of anxiety leads to poor sleep quality and depression. Anxiety with both direct and indirect effect impress women’s SF. Conclusion: It seems that the main risk factors for sexual dysfunction in women with endometriosis are higher rates of anxiety, depression, poor sleep quality, pelvic pain, and dyspareunia. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered.
Associations of laboratory parameters and genetic polymorphisms with ischemic stroke in Chinese Han population
Authors: Wang Jiayong , Sun Zujun , Yang Yibao , Wu Junlu , Quan Wenqiang , Shang Anquan , Ji Ping , Chen Xingcai , Ni Peihua , Li Dong
Published: January 2020

Background Many genetic polymorphisms and clinical laboratory parameters have been shown to be associated with ischemic stroke (IS). However, these results are often inconsistent. Therefore, the aim of the study was to evaluate the correlation between clinical laboratory parameters, the risk genetic polymorphisms and IS in Shanghai population.Methods The clinical laboratory parameters were measured by automatic biochemical analyzer. The genotype frequencies and allelic frequencies of the polymorphisms gene encoding angiotensin-converting enzyme ( ACE D/I), gene encoding methylene tetrahydrofolate reductase ( MTHFR C677T), gene encoding β-fibrinogen 455/148 ( β-Fg -455/148) were characterized by restricted fragment length polymorphisms-polymerase chain reaction (RFLP-PCR). The gene encoding plasminogen activator inhibitor ( PAI -1 4G/5G) and gene encoding apolipoprotein E 2,3,4 ( ApoE ε2,3,4) were characterized by allele specific PCR. The genotype frequency and allele frequency of the 6 risk genes of IS were analyzed by chi-square test in different groups of laboratory indexes. The distribution maps of the polymorphisms ACE D/I, MTHFR C677T, β-Fg -455 A/G, β-Fg -148 T/C, PAI -1 4G/5G, ApoE ε2,3,4 and clinical laboratory paramaters were compared between healthy people and patients with IS.Results The laboratory parameters were related to ACE I/D, β-Fg -455 A/G, and PAI -1 4G/5G genes. D allele of ACE I/D was associated with high levels of total cholesterol (TC) and Low-density lipoprotein (LDL). High levels of fasting blood glucose (FBG), triglyceride (TG), and LDL were risk factors for IS. There were significant differences in genotype frequencies of ACE I/D, β-Fg -455 A/G, and β-Fg- 148 T/C genes between IS and control group.Conclusions Clinical laboratory paramaters are associated with the risk genes polymorphisms of IS. It is suggested that control value of clinical laboratory paramaters should be determined according to the genotype carried by the patients with diabetes and hyperlipidemia when preventing IS.