bluuebunny/crossref_metadata_2025 huggingface dataset:
Profiling of Koumiss Microbiota and Organic Acids and their Effects on Koumiss Taste
Authors: Tang Hai , Ma Huimin , Hou Qiangchuan , Li Weicheng , Xu Haiyan , Liu Wenjun , Sun Zhihong , Haobisi Halatu , Menghe Bilige
Published: March 2020

Background Koumiss is a naturally fermented mare’s milk. Over recent decades, numerous studies have revealed the diversity of lactic acid bacteria in koumiss. However, there is limited information available regarding its secondary major component yeast profile. Results A total of 119 bacterial and 36 yeast species were identified among the 14 koumiss samples. The dominant bacterial species in koumiss were Lactobacillus helveticus , Lactobacillus kefiranofaciens , Lactococcus lactis , Lactococcus raffinolactis , and Citrobacter freundii. The main yeast species were Dekkera anomala , Kazachstania unispora , Meyerozyma caribbica , Pichia sp.BZ159 , Kluyveromyces marxianus , and uncultured Guehomyces . The bacterial and yeast Shannon diversity of the Xilinhaote-urban group were higher than those of the Xilingol-rural group. The most dominant organic acids were lactic, acetic, tartaric, and malic acids. Lactic acid bacteria species were mostly responsible for the accumulation of those organic acids, although Kazachstania unispora , Dekkera anomala , and Meyerozyma caribbica may also have contributed. Redundancy analysis suggested that both bacteria and yeast respond to koumiss flavor, such as Lactobacillus helveticus and Dekkera anomala are associated with sourness, astringency, bitterness, and aftertaste, whereas Lactococcus lactis and Kazachstania unispora are associated with umami. Conclusions Our results suggest that differences were observed in koumiss microbiota of Xilinhaote-urban and Xilingol-rural samples. The biodiversity of the former was higher than the latter group. Positive or negative correlations between bacteria and yeast microbiota and taste also were found.
Agrobacterium tumefaciens mediated transformation of the aquatic carnivorous plant Utricularia gibba
Authors: Oropeza-Aburto Araceli , Cervantes-Perez Sergio Alan , Albert Victor A , Herrera-Estrella Luis Rafael
Published: March 2020

Background The genus Utricularia belongs to Lentibulariaceae, the largest family of carnivorous plants, which includes terrestrial, epiphytic and aquatic species. The development of specialized structures that evolved for carnivory is a feature of this genus that has been of great interest to biologists since Darwin‘s early studies. Utricularia gibba is itself an aquatic plant with sophisticated bladder traps having one of the most complex suction mechanisms for trapping prey. However, the molecular characterization of the mechanisms that regulate trap development and the biophysical processes involved in prey trapping are still largely unknown due to the lack of a simple and reproducible gene transfer system. Results Here, we report the establishment of a simple, fast and reproducible protocol for genetic transformation of U. gibba based on the T-DNA of Agrobacterium tumefaciens . An in vitro selection system using Phosphinotricin as a selective agent was established for U. gibba . Plant transformation was confirmed by histochemical GUS assays and PCR and qRT-PCR analyses. We report on the expression pattern of the 35S promoter and of the promoter of a trap-specific ribonuclease gene in transgenic U. gibba plants. Conclusions The genetic transformation protocol reported here is an effective method for studying developmental biology and functional genomics of this genus of carnivorous plants and advances the utility of U. gibba as a model system to study developmental processes involved in trap formation.
Health-Related Quality of Life Among Children With Transfusion-Dependent Thalassemia: A Cross-Sectional Study in Malaysia
Authors: Shafie Asrul Akmal , Chhabra Irwinder Kaur , Yi Jacqueline Wong Hui , Mohammed Noor Syahireen , Ibrahim Hishamshah Mohd , Alias Hamidah
Published: March 2020

Background: The treatment of children with transfusion-dependent thalassemia (TDT) in Malaysia has progressed since 2005. This study provides an updated health-related quality of life (HRQoL) assessment for children with the disorder and the factors affecting the HRQoL.Methods: A cross-sectional HRQoL survey of Malaysian children with TDT was conducted using the PedsQL™ 4.0 Generic Core Scales. Patients with non-transfusion dependent thalassemia and other haemoglobinopathies were excluded. Parent-proxy and self-reported HRQoL scores were obtained using a multi-stage convenient sampling. The relationship between HRQoL scores and demographic factors were tested using association, correlation and regression analysis. Results: A total of 368 patients were recruited. The mean (SD) Total Summary Score (TSS) was 80.12(13.87). Predictors for a lower TSS was an increasing age group and the use of dual chelating agents (R2 = 0.057, F (4, 359) = 5.40, p = <0.001). The mean (SD) Physical Health Summary Score (PHSS) was 82.21 (16.82). Predictors of a higher PHSS score was being male, while predictors of a lower score was an increasing age group and parent-proxy reports(R2 = 0.075, F (5,358) = 5.80, p = <0.001). The mean (SD) Psychosocial Health Summary Score (PCHS) was 79.39 (14.81). Predictors for a lower PCHS was the use of dual chelating agents(R2 = 0.041, F (1, 362) = 15.60, p = <0.001). The school functioning score had the lowest mean (SD) score of 69.52(20.92) in the psychosocial dimension.Conclusion: The HRQoL of TDT children in Malaysia has improved over the last decade owing to the better access in treatment. However, further effort is needed to improve the school functioning dimension.
Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study
Authors: Mondragón Oscar Victor Hernández , Mottu Raul Antonio Zamarripa , Pineda Omar Michell Solórzano , Aguilar Raul Antonio Gutierrez , Contreras Luis Fernando Garcia
Published: March 2020

Background and aims: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures.Patients and Methods: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed.Results: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7±14.3 and 43.7±10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range[IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100% and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3±10.8 to 9.5±4.1 mmHg (p<0.001); retention percentage at 4 hours also improved. LP was successfully placed and adequate myotomy confirmed including 14.2% and 17.8% of POEM and G-POEM difficult patients. Conclusions: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.
Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty.
Authors: Kijima Eiji , Kayama Tomohiro Thomas , Saito Mitsuru , Kurosaka Daisaburo , Ikeda Ryo , Hayashi Hiroteru , Kubota Daisuke , Hyakutake Takashi , Marumo Keishi
Published: March 2020

Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%.Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.
Clinical and microbiological characteristics of Cryptococcus gattii isolated from 7 hospitals in China
Authors: Jin Liang , Cao Jingrong , Xue Xinying , Wu Hua , Wang Lifeng , Guo Ling , Shen Dingxia
Published: March 2020

Background: Infection, even outbreak, caused by Cryptococcus gattii (C. gattii ) has been reported in Canada and the United States, but there were sparsely-reported cases of C. gattii in China. Our interest in occurrence, clinical manifestation, laboratory identification and molecular characterization of Chinese C. gattii strains leads us to this research.Methods: A total of 254 clinical isolates primarily identified as Cryptococcus neoformans (C. neoformans ) were collected. VITEK 2 compact, canavanine glycine bromothymol blue (CGB) agar and Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were used for strain identification. Multi-locus sequence typing (MLST) was performed for genotyping. Antifungal susceptibility test was carried out with commercial kits of both ATB fungus 3 and Yeast one. Clinical information of patients was reviewed retrospectively. Label-free proteome technique was used to quantitatively analyze the differential proteins of C. gattii. Results: Out of 254 clinical isolates, we identified eight strains as C. gattii. MLST showed genotype VGI accounted for the most (6 / 8), the other two strains were genotype VGII（VGIIa and VGIIb respectively）with 3 specific spectra of molecular weight about 4342, 8686, 9611 Dalton by MALDI-TOF MS. The minimal inhibitory concentrations (MICs) of Fluconazole with Yeast one was 2～4 times higher than that with ATB fungus 3. Higher MICs of antifungal agents were exhibited against VGII strains than against VGI strains. C. gattii genotype VGI and VGII possessed 418 and 774 specific proteins respectively. Comparative proteome analysis showed that 329 and 180 proteins were highly expressed in C. gattii VGI and VGII. The enrichment of differentially expressed proteins was directed to Golgi complex.Conclusions: Infection by C. gattii in China might have been underestimated because of initial mis-identification. Genotype VGI was predominant but VGII was more resistant to antifungal agents. There was significant difference in protein expression profile between VGI and VGII C. gattii.
Community-Based Cluster Randomized Controlled Trial: Empowering Households to Identify and Provide Appropriate Care for Low-Birthweight Newborns in Nepal
Authors: Hodgins Stephen , Rajbhandari Binamra , Joshi Deepak , Ban Bharat , Khatry Subarna , Mullany Luke
Published: March 2020

Background: Most newborn deaths occur among those of low birthweight (LBWt), due to prematurity &/or impaired fetal growth. Simple practices can mitigate this risk. In low-income country settings where many births occur at home, strategies are needed that empower mothers to determine if their babies are higher risk and take protective measures. Earlier studies suggest that foot-length may be a good proxy for birthweight. An earlier Nepal study found a 6.9cm cut-off performed relatively well, differentiating normal from low birthweight.Methods: Community-based, cluster-randomized controlled trial. Objective: to determine whether family-administered screening, with targeted messages improves care practices known to mitigate LBWt risks. Participants: pregnant women participating in a parent trial in rural Nepal. Women were given a 6.9cm card to assess whether the baby’s foot is small; if so, to call number on the card for advice. Follow-up visits were made over 2 weeks following the birth, assessing for: reported skin-to-skin thermal care, and care-seeking outside the home; restricting to low birthweight (using 2 cutoffs: 2,500g and 2,000g). Randomization: 17 clusters intervention, 17 control. The study also documented steps along the presumed causal chain from intervention through behavioral impact.Results: 2,022 into intervention, 2,432 into control. Intervention arm: 519 with birthweight <2,500g (vs. 663 among controls), of which 503 were available for analysis (vs. 649 among controls). No significant difference on care-seeking; for those <2,500g RR 1.13 (95%CI: 0.97-1.131). More of those in the intervention arm reported skin-to-skin thermal care than among controls; for those <2,500g RR 2.50 (95%CI: 2.01-3.1). Process measures suggest this apparent effect cannot be attributed to the intervention; the card performed poorly as a proxy for LBWt, misclassifying 84.5% of those <2,000 as normal.Conclusions: Although the trial found an apparent effect on one key behavioral outcome, this cannot be attributed to the intervention; most likely it was a result of pure chance. Other approaches are needed for identifying at-risk babies in such settings, and targeting them for appropriate care messaging.Trial registration : clinicaltrials.gov identifier: NCT02802332, registered 16 June 2016, https://clinicaltrials.gov/ct2/show/NCT02802332
Distinct clinicopathological differences between early gastric cardiac and non-cardiac carcinomas: A single-center retrospective study of 329 radical resection cases
Authors: Wang Yaohui , Li Xiu Qing , Gao Li Li , Wang Chen Xi , Zhang Yi Fen , Huang Qin
Published: March 2020

Background Early gastric carcinoma is heterogeneous and can be divided into early gastric cardiac carcinoma (EGCC) and early gastric non-cardiac carcinoma (EGNCC) groups. At present, differences in clinicopathology remains obscure between EGCC and EGNCC fundus-corpus and antrum-angularis-pylorus subgroups, especially between EGCC with and without esophageal invasion.Methods In this study, we studied 329 consecutive early gastric carcinoma radical gastrectomies with 70 EGCCs and 259 EGNCCs.Results Compared to the EGNCC antrum-angularis-pylorus (n=181), but not fundus-corpus (n=78), sub-group, EGCC showed significantly older age, lower prevalence of the grossly depressed pattern, better tumor differentiation, higher percentage of tubular/papillary adenocarcinoma, but lower frequency of mixed poorly cohesive carcinoma with tubular/papillary adenocarcinoma, and absence of LNM in tumors with invasion up to superficial submucosa (SM1). In contrast, pure poorly cohesive carcinoma was less frequently seen in EGCCs than in EGNCCs, but mixed poorly cohesive carcinoma with tubular/papillary adenocarcinomas was significantly more common in the EGNCC antrum-angularis-pylorus sub-group than in any other group. No significant differences were found between EGCC and EGNCC sub-groups in gender, tumor size, H. pylori infection rate, and lymphovascular/perineural invasion. EGCC with oesophageal invasion (n=22), compared to EGCC without (n=48), showed no significant differences in the H. pylori infection rate and oesophageal columnar, intestinal, or pancreatic metaplasia, except for a higher percentage of the former in size > 2 cm and tubular differentiation.Conclusions There exist distinct clinicopathologic features between EGCC and EGNCC sub-groups; EGCC was indeed of gastric origin. Further investigations with larger samples are needed to validate these findings.
Gene Expression Profiling of Inflammatory Cytokines in Esophageal Biopsies of Different Phenotypes of Gastroesophageal Reflux Disease: a cross-sectional study
Authors: Zavala-Solares Monica , Fonseca-Camarillo Gabriela , Valdovinos Miguel , Granados Julio , Grajales-Figueroa Guido , Zamora-Nava Luis , Aguilar-Olivos Nancy , Valdovinos-García Luis , Yamamoto-Furusho Jesus K.
Published: March 2020

Background: Patients clinical phenotypes in gastroesophageal reflux disease (GERD) are classified as: Barrett's esophagus (BE), erosive esophagitis (EE) and non-erosive gastroesophageal reflux disease (NERD). The aim of this study was to characterize genes involved in the pathophysiology and immune response of GERD.Methods: This is an observational and cross-sectional study. All patients with BE, EE, NERD and the control group were subjected to a superior endoscopy (with biopsies of esophageal mucosa). The cytokine mRNA relative quantification of target genes was conducted by RT-PCR. Changes in gene expression were assessed of the genes associated with inflammation in each disease phenotype. Statistical analysis of differential gene expression was performed by using Dunn's Test for Multiple Comparisons. A p value < 0.05 was considered as significant. Results: A Total of 98 patients were included and they were divided into the following groups: Group BE 16 (16.33%), Group EE 23 (23.47%), Group NERD 42 (42.86%) and Control Group 17 (17.35%). When comparing with control group we found: patients with BE showed an increased expression of IL-8 (P<0.005) and higher levels of: IL-1β, NF-κβ, IL-10 and MMP-3, MMP-9 as well; patients with EE had higher levels of IL-1B, IL-6, IL-8 and IL-10 (P<0.005) and patients with NERD showed a differential gene expression of cytokines Th1, particularly TNF-α and IL-1B (P<0.005) and decreased gene expression of Th2 cytokines such as IL-10, IL-8 and MMP9. Conclusions: This study demonstrates the differential expression of mediators of inflammation in the esophageal mucosa of patients with the EE and BE phenotype.
Dissecting the phenotypic heterogeneity in sensory features in Autism Spectrum Disorder: a factor mixture modelling approach
Authors: Tillmann Julian , Uljarevic Mirko , Crawley Daisy , Dumas Guillaume , Loth Eva , Murphy Declan , Buitelaar Jan , Charman Tony
Published: March 2020

Background Heterogeneity in the phenotypic presentation of Autism Spectrum Disorder (ASD) is apparent in the profile and the severity of sensory symptoms. Here we applied Factor Mixture Modelling (FMM) to test a multidimensional factor model of sensory processing in ASD. We aimed to identify homogeneous sensory subgroups in ASD that differ intrinsically in their severity along continuous factor scores. We also investigated sensory subgroups in relation to clinical variables: sex, age, IQ, social communication symptoms, restricted and repetitive behaviours, adaptive functioning and symptoms of anxiety and Attention-Deficit/Hyperactivity Disorder. Methods 332 children and adults with ASD between the ages of 6 and 30 years with IQs varying between 40 and 148 were included. First, three different confirmatory factor models were fit to the 38 items of the Short Sensory Profile. Then, latent class models (with two-to-five subgroups) were evaluated. The best performing factor model, the 7-factor structure, was subsequently used in two FMMs that varied in the number of subgroups: a two-subgroup, seven-factor model and a three-subgroup, seven-factor model. Results The ‘three-subgroup/seven-factor’ FMM was superior to all other models based on different fit criteria. Identified subgroups differed in sensory severity from severe, moderate to low. Accounting for the potential confounding effects of age and IQ, participants in these sensory subgroups had different levels of social-communicative symptoms, restricted and repetitive behaviours, adaptive functioning skills and symptoms of inattention and anxiety. Limitations Results were derived using a single parent-report measure of sensory symptoms, the SSP, which has some notable construct limitations that constrain the generalisability of findings. Conclusion Sensory features can be best described by three homogeneous sensory subgroups that differ in sensory severity gradients along seven continuous factor scores. Identified sensory subgroups were further differentiated by the severity of core and co-occurring symptoms, and level of adaptive functioning, providing novel evidence on the associated clinical correlates of sensory subgroups. These sensory subgroups provide a platform to further interrogate the neurobiological and genetic correlates of altered sensory processing in ASD.
Identification of ATP2C1 mutations in the patients of Hailey-Hailey disease
Authors: li xiaoli , zhang dingwei , ding jiahui , li li , wang zhenghui
Published: March 2020

Background: Familial benign chronic pemphigus (OMIM 169600), also known as Hailey-Hailey disease (HHD), is a clinically rare bullous Dermatosis. However the mechanism has not been clarified. Objective: To detect novel mutations in exons of ATP2C1 gene in HHD patients; to explore the mechnism of HHD pathogenesis by examining the expression profile of hSPCA1, Mir-203, p63, Notch1 and HKⅡ proteins in the skin lesions of HHD patients. Methods: Genomic DNA was extracted from peripheral blood of HHD patients. All exons of ATP2C1 gene in HHD patients were amplified by PCR and the products were purified and sequenced. All related signaling proteins of interest were stained by using skin lesion tissues from HHD patients and Mir-203 levels were also determined. Results: In this study, one synonymous mutation c.G2598A (in exon 26), one nonsense mutation c.C635A and two missense mutations c.C1286A (p.A429D) and c. A1931G (p. D644G) were identified. The nonsense mutation changed codon UCG to stop codon UAG, causing a premature polypeptide chain of the functional region A. The two missense mutations were located in the region P (phosphorylation region) and the Mn binding site of hSPCA1. The calcium pump was not no longer functional due to impaired protein structures. The level of hSPCA1 was significantly decreased in HHD patients compared to the normal human controls, accompanied by an increase of Mir-203 level and a decrease of p63 and HKⅡ levels. Conclusion: In HHD patients, these factors may be involved in the signaling pathways of HHD pathogenesis. In addition, Notch1, which was negatively regulated p63, is downregulated. Our data showed that both p63 and Mir-203 may have significant regulatory effects on Notch1 in the skin.
Experiences of participation in bereavement groups from significant others’ perspectives
Authors: Näppä Ulla , Randström Kerstin Björkman
Published: March 2020

Background When death ends a life, the impact of caring for person who suffered a period of illness or disease continues for significant others who are left to grieve. They should be offered support to avoid complicated grief. This can be provided in different ways and individually or in groups. This study aims to describe significant others’ experiences of participation in bereavement groups. Methods Ten bereavement groups that each met five times offered support for the significant others of deceased loved ones who had been cared for by a palliative-care team. After the five meetings, the grieving members completed written comments about the role of the groups; they also commented one year after participating. Comments were analyzed qualitatively using the theory of a good death according to the 6S’s: self-image, self-determination, social relationships, symptom control, synthesis and summation, and surrender. Results Bereavement groups were found to be a source for alleviating grief for some significant others, but not all experienced relief. Moreover, grief was found to persist during participation. Another finding involved the impact of the role of the palliative home-care team on bereavement support. To evaluate the experience of participating in a bereavement group, the use the 6S’s as a model was a strength of the analysis. Bereavement groups could enhance the self and offer relief from grief. Participation was described as social relationships that offered a sense of coherence and understanding in grief. The effects of participation were more meaningful close to the loss and could lose efficacy over time. Bereavement support provided before a loved one’s death was seen as valuable. Conclusion Overall, the bereavement groups eased the grief of significant others close to the death of their loved one. However, moving forward, several of the significant others were not sure that their participation eased their grief. To identify persons who may remain in a state of complicated grief, a routine of planned contacts with the bereaved should begin before death and be followed up later than six months after the death of a loved one.
Corticosteroid Treatment Guided by Peripheral Blood Mononuclear Cell Counts in Cerebral Amyloid Angiopathy-related Inflammation: A Case Report
Authors: Li Ya , Liu ChunTing , Guo ShiPeng , Zhang AnNi , Wu XuLing , He Dian
Published: March 2020

Background: Cerebral amyloid angiopathy-related inflammation (CAA-I), a rare variant of cerebral amyloid angiopathy, is one of treatable causes of rapidly progressive dementia. CAA-I usually occurs in the elderly and corticosteroids are most often used for treatment. Thus it is more necessary to develop an individualized dosing regimen to maximize efficacy yet minimize adverse effects of corticosteroids. We report a CAA-I patient successfully treated by corticosteroid therapy guided by dynamic monitoring of peripheral blood mononuclear cell (PBMC) count. Case presentation: A 68-year-old female presented with subacute step-wise cognitive decline. Medical history and current examination revealed multiple risk factors for cerebral amyloid angiopathy, including apolipoprotein E ε4/ε4 genotype, hyperhomocysteinemia, hypertension, and chronic renal failure, while brain susceptibility-weighted magnetic resonance imaging revealed diffuse lobar microbleeds associated with extensive lesions disturbed throughout cerebral grey and white matter on T1- and T2-weighted MRI. The CD19+ B-cell fraction of PBMCs was markedly elevated, as were inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein. Cerebrospinal fluid total protein and T-tau levels were also elevated, while Aβ42 was low and P-tau levels were normal. Corticosteroid treatment guided by dynamic CD19+ B-cell number monitoring reversed these inflammatory signs, imaging manifestations, and acute cognitive decline. Conclusions: Corticosteroid treatment individualized by dynamic monitoring of PBMC CD19+ B-cell fraction may provide for maximum therapeutic efficacy with minimal adverse effects in patients with CAA-I.
Knowledge, attitudes, and practices of primary health care physicians regarding the pre-travel counselling of patients with type 2 diabetes in Riyadh, Saudi Arabia
Authors: Alduraibi Rabia , Almigbal Turky H , Alrasheed Abdullah A , Batais Mohammed Ali
Published: March 2020

Background Travel has become an integral part of Saudi life. People with diabetes face many challenges while travelling that can have detrimental effects on glycaemic control. However, no previous studies have investigated pre-travel counselling in Saudi Arabia. This study aims to assess the knowledge, attitudes and practices of primary health care (PHC) physicians regarding pre-travel counselling for patients with type 2 diabetes. Methods This cross-sectional study was conducted in PHC centres under the Ministry of Health in Riyadh, Saudi Arabia, during the period 2018-2019. A cluster multistage random sampling technique was used to recruit physicians. The data were collected through a self-administered questionnaire. Results Three hundred and eighty-five primary health care physicians were recruited. This study showed that more than half (57.9%) of PHC physicians had poor knowledge scores. Additionally, the following characteristics were significantly associated with poor knowledge: being younger in age, being male, being Saudi, being a general practitioner, and having limited (0-5 years) experience. A total of 183 (47.5%) subjects showed disagreement attitudes towards the importance of pre-travel counselling among patients with diabetes. Furthermore, these disagreement attitudes were significantly associated with being older and having more years of experience. The majority (62.6%) of the physicians had poor practice scores. Poor practices were detected among physicians who were younger, male, and Saudi and who had a general practitioner specialty and degree. Conclusions It could be concluded that a gap was detected in the knowledge and practices of primary health care physicians regarding pre-travel counselling for people with type 2 diabetes. Therefore, it is necessary to create easily accessible travel medicine education programmes for Saudi PHC prosviders to improve the management of travellers with diabetes.
Compositional and functional characterisation of biomass-degrading microbial communities in guts of plant fibre- and soil-feeding higher termites
Authors: Marynowska Martyna , Goux Xavier , Sillam-Dusses David , Rouland-Lefevre Corinne , Halder Rashi , Wilmes Paul , Gawron Piotr , Roisin Yves , Delfosse Philippe , Calusinska Magdalena
Published: March 2020

Background: Termites are among the most successful insect lineages on the globe and are responsible for providing numerous ecosystem services. They mainly feed on wood and other plant material at different stages of humification. Lignocellulose is often a principal component of such plant diet and termites largely rely on their symbiotic microbiota and associated enzymes to decompose their food efficiently. While lower termites and their gut flagellates were given larger scientific attention in the past, the gut lignocellulolytic bacteria of higher termites remain less explored. Therefore, in this study, we investigated the structure and function of gut prokaryotic microbiomes from 11 higher termite genera representative of Syntermitinae, Apicotermitinae, Termitidae and Nasutitermitinae subfamilies, broadly grouped into plant fibre- and soil-feeding termite categories. Results: Despite the different compositional structures of the studied termite gut microbiomes, reflecting well the diet and host lineage, we observed a surprisingly high functional congruency between gut metatranscriptomes from both feeding groups. The abundance of transcripts encoding for carbohydrate active enzymes as well as expression and diversity profiles of assigned glycoside hydrolase families were also similar between plant fibre- and soil-feeding termites. Yet, dietary imprints highlighted subtle metabolic differences specific to each feeding category. Roughly 0.18 % of de novo re-constructed gene transcripts were shared between the different termite gut microbiomes, making each termite gut a unique reservoir of genes encoding for potentially industrially applicable enzymes, e.g. relevant to biomass degradation. Taken together, we demonstrated the functional equivalence in microbial populations across different termite hosts. Conclusions: Our results provide valuable insight into the bacterial component of the termite gut system and significantly expand the inventory of termite prokaryotic genes participating in the deconstruction of plant biomass.
HbA1c and Blood Pressure Levels in Type 2 Diabetes: How Many Patients are on Target?
Authors: de Farias Camila Bergonsi , Zelmanovitz Themis , Coelli Sabrina , Satler Fabíola , Duarte Camila Kümmel , Brondani Letícia , Silveiro Sandra Pinho
Published: March 2020

Background: Achieving HbA1c and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. The aim of this paper was to determine the proportion of type 2 diabetes patients who meet the recommended HbA1c and arterial blood pressure targets and the determinants of failure to do so.Methods: A cross-sectional study was conducted in an outpatient endocrine clinic at a university hospital. HbA1c was measured with a certified HPLC method, with a goal of 7%, except for patients with advanced chronic complications where 8% was the goal. Blood pressure was measured with a validated device after a 5-minute rest, and the overall expected target was 140/90 mmHg. Results: A total of 602 type 2 diabetes patients were analyzed: 62% were female, 14% self-reported as black, the mean age was 63±11 years, the mean diabetes duration was 17±9 years, and the median (IQR) HbA1c was 8.0% (7.0-9.5%). Macrovascular disease was present in 198 (33%) patients, diabetic retinopathy in 283 (47%), peripheral neuropathy in 258 (43%) and diabetes kidney disease in 337 (56%). Regarding metabolic control, 403 (67%) patients were not at the adjusted target HbA1c level, and the main determinants of poor glycemic control were female gender, black skin color, younger age, and insulin use. Regarding blood pressure, 348 (58%) patients were not at the recommended targets, and a more advanced age was the main associated factor. Conclusions: Since more than half of Brazilian type 2 diabetes outpatients do not meet the recommended HbA1c and blood pressure target values, there is a major call to overcome therapeutic inertia and treat to target each individual patient. Female, black and younger individuals seem to be associated with a worse glycemic profile.
Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: A cross-sectional study
Authors: Gils Tinne , Laxmeshwar Chinmay , Duka Marve , Malakyan Khachatur , Siomak Olga Valentinovna , Didik Vitaly Stephanovich , Lytvynenko Natalia , Terleeva Yana , Isaakidis Petros , Donchuk Dimitri
Published: March 2020

Background: Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder (AUD), are common comorbidities. One in five DR-TB patients has Human Immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting outpatient care for DR-TB-patients on all-oral short DR-TB-regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine to provide good quality ambulatory care. Methods: This is a retrospective analysis of routinely collected program data. Before discharge of every patient from the hospital, MSF teams assess outpatient facilities available using a standardised checklist. The assessment evaluates access, human-resources, availability of medicines, infection control, laboratory and diagnostic services, and psychosocial support. Results: We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-medicines and storage space were available in all facilities, but only five (8%) stored ancillary medicines. HIV-patients had to visit a separate facility to access HIV-care. Personal protective equipment for infection control was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only 4 (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) psychiatric support. Conclusion: Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with TB-training, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
The fraction of Nitrous Oxide in oxygen for facilitating Lung collapse During One-Lung Ventilation with double lumen tube
Authors: liang chao , Lv Yuechang , Shi Yu , Cang Jing , Xue Zhanggang
Published: March 2020

Backgroud To the best of our knowledge, it is still unclear what is the proper fraction of nitrous oxide(N 2 O) in oxygen(O 2 ) for fast lung collapse. Therefore, we designed this prospective trial to determine the 50% effective concentration (EC 50 ) and 95% effective concentration (EC 95 ) of N 2 O in O 2 for fast lung collapse. Methods We studied 38 consecutive patients undergoing video-assisted thoracoscopic surgery(VATS). The lung collapse score(LCS) of each patient during one lung ventilation was evaluated by the same surgeon. The first patient received 30% N 2 O in O 2 , and subsequent N 2 O fraction in O 2 was determined by the LCS of previous patient using Dixon up-and-down method. The testing interval was set at 10%, and the lowest concentration was 10% (10%, 20%, 30%, 40%, or 50%). The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were analyzed using probit test. Results The N 2 O fraction in O 2 at which all patients showed success lung collapse was 50%, according to the up-and-down method. The EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% (95% confidence interval, 19.9%–35.7%) and 48.7% (95% confidence interval, 39.0%–96.3%), respectively. Conclusions In patients undergoing VATS, the EC 50 and EC 95 of N 2 O in O 2 for fast lung collapse were 27.7% and 48.7%, respectively.
Sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation: An exploratory randomized controlled trial
Authors: Li Chunzhu , Peng Jiali , Sun Yu , Hu Rong , Wang Hao , Yan Jia , Jiang Hong
Published: March 2020

Background: Awake fiberoptic bronchoscope intubation (AFOBI) is the gold standard technique for the management of patients with difficult airways. Adequate sedation and analgesia are essential for successful AFOBI. The aim of this study was to evaluate the sedative and analgesic validity and administration routes of dexmedetomidine and fentanyl combined with ketamine in awake fiberoptic intubation. Methods: Patients undergoing head and neck surgery under general anesthesia with predicted difficult airways were included. Participants were randomly assigned to 6 different groups (n=6): groups 1-3 were intravenous (IV), while groups 4-6 were intranasal(IN) (group 1: dexmedetomidine (DEX) 1 μg/kg + fentanyl (FEN) 1 μg/kg; groups 2-3: DEX 1 μg/kg+ FEN 0.7 μg/kg + ketamine (KTM) 0.1/0.2 mg/kg; group 4: DEX 1.5 μg/kg + FEN 1.4 μg/kg; and groups 5-6: DEX 1 μg/kg + FEN 1 μg/kg + KTM 0.4/0.6 mg/kg). The visual analog scale (VAS) score during intubation, time required for the modified observer’s assessment of alertness/sedation scale (OAA/S) score to reach above 2 and for the bispectral index (BIS) to decrease to 60-80, motor activity assessment scale (MAAS) score, changes in vital signs and adverse effects were recorded. Results: Among the IV groups, the VAS score of group 1 (5.65±2.11) was higher than those of group 2 (1.89±2.16, P =0.012) and group 3 (1.15±0.98, P =0.001). Among the IN groups, the VAS score was lower in group 6 (0.86±1.27) than in group 4 (7.20±2.70, P <0.001) and group 5 (3.93±2.73, P =0.031). Participants in group 5 and group 6 were less likely to cough when intubated than those in group 4 ( P =0.002), while the differences among IV groups were not significant. There were no significant differences in the other endpoints. Conclusions: Our study indicates that the addition of subanesthetic doses of ketamine, either intravenous or intranasal, could reduce the fentanyl and dexmedetomidine consumption used in AFOBI and provide better sedative and analgesic effects. Trial registration: Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR1900021185), prospectively registered on February 1st, 2019.
The effects of dialysis modalities on the progression of coronary artery calcification in dialysis patients
Authors: NIU Qingyu , ZHAO Huiping , ZUO Li , WANG Mei , GAN Liangying
Published: March 2020

Objective Hemodialysis (HD) tend to have more hemodynamic changes than peritoneal dialysis (PD), which aggravates inflammation and oxidative stress. Whether HD and PD have different effects on the progression of vascular calcification? Therefore, we produced a study to explore the relationship of dialysis modalities and coronary artery calcification (CAC) progression. Methods This was a prospective cohort study. CT scans were performed at enrollment and 2 years later for each patient. Demographic and clinical data were collected. Tobit regression was used to compare delta CAC score between HD and PD patients. Results (1) 155 patients were enrolled, including 69 HD and 86 PD patients. (2) The baseline CAC scores were 97 (1, 744) in HD and 95 (0, 324) in PD; the follow-up CAC scores were 343 (6, 1379) in HD and 293 (18, 997) in PD. There were no significant differences in baseline, follow-up and delta CAC scores between 2 groups (P>0.05). (3) In Tobit regression, after adjusted for variables, there was no significant difference of CAC progression in HD and PD groups (P>0.05). (4) Logistic regression showed that older patients with diabetes and higher time-averaged serum phosphate (P) had faster progression of CAC (P<0.05), but HD wasn’t associated with faster CAC progression comparing with PD (P=0.091). Conclusions There was no evidence that different modalities have different effect on CAC progression. Older, DM and higher time-averaged P were associated with fast CAC progression.
Impact of Breath-Hold Level on Positional Error in Hepatobiliary Radiotherapy with Breath-Hold Respiratory Control
Authors: Huang Tzu-Jie , Tien Yun , Wu Jian-Kuen , Huang Wen-Tao , Cheng Jason Chia-Hsien
Published: March 2020

Background : Respiratory motion management with breath hold for patients with hepatobiliary cancers remains a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control. Methods : Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors. Results : Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL >1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p=0.03) and heavier (67.1 kg vs. 57.4 kg, p=0.02), and had different positional error in the craniocaudal direction (-0.26 cm [caudally] vs. +0.09 cm [cranially], p=0.01) than those with mean BHL <1.4 L. Positional errors were similar for patients with ΔBHL<0.03 L and >0.03 L. Conclusion : Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.
RLC-Score (R-status, Lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer
Authors: Struck Julian , Hupe Marie C. , Heinisch Annika , Ozimek Tomasz , Hennig Martin J. P. , Klee M. , von Klot Christoph A. J. , Kalogirou Charis , Kuczyk Markus A. , Merseburger Axel S. , Kramer Mario W.
Published: March 2020

Background:The TNR-C score (tumor stage, lymph node density, resection margin status, and serum CRP) correlates with cancer specific survival (CSS) in patients with bladder cancer (BCa) undergoing radical cystectomy (RC). Our retrospective single center study aimed to evaluate CRP as a prognostic parameter in patients with BCa undergoing RC, to externally validate the TNR-C score, and based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC that can identify patients with a high risk of progression. Material and methods:In total, 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed. The clinicopathologic parameters assessed included age; co-morbidities; pre-/postoperative serum levels of CRP; leucocytes; hemoglobin; creatinine; urinary diversion; tumor grading, staging, and lymph node status; lymph node density (LND); lymphovascular invasion (LVI); metastases; and resection margin status. Regarding outcome, overall survival (OS) was assessed. Results:Single parameters of the TNR-C-score, such as T-stage (p=0.012) and R-status (p=0.002), were independent prognostic parameters for overall survival (OS). Univariate analysis showed a significant association of OS with the T-stage (pT2, p=0.001), R-status (p<0.001), LVI (p=0.011), and preoperative CRP level (p=0.02). The multivariate analysis excluding lymph node (LN) positive and metastatic patients showed a significant association of the R-status (R; p<0.001), LVI (L; p=0.021), and preoperative CRP level >5 mg/L (C; p=0.008) with OS. Based on these parameters, the RLC-score was developed. The median OS in the low, intermediate, and high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752.Conclusion:The RLC-score identifies BCa patients at a higher risk of disease progression and overall mortality after RC. Regarding the TNR-C score, only T-stage and R-status were independent prognostic factors for OS. Nevertheless, the survival curves showed a significantly lower OS for TNR-C high risk group members than low and intermediate risk group members. Overall, our study supports the role of CRP in prognostic score models for BCa.