bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and Factors Associated With Intimate Partner Violence Among Women With Abortion at Mulago Hospital, Kampala City, Uganda
Authors: TABULEY JACKSON JOSEPH , Katusiime Nekemiah , Kakaire Othman
Published: January 2021

Background: Intimate partner violence (IPV) is a global health problem causing ill health among women especially of reproductive age. Its global prevalence is estimated to be 30-71%. The prevalence is higher among African and Asian populations compared to American and European populations. In Uganda, the prevalence of IPV among women with abortion was 56.4% in 2005. Since then, the Domestic Violence Act was enacted in 2010; sexual and gender based violence desks initiated in hospitals and a number of agencies working to prevent violence against women have sprung up. The objective of this study was to determine the current prevalence and factors associated with IPV among women with abortion at Mulago National Referral Hospital in Kampala city.Methods: A hospital based cross-sectional study was conducted over 4 months on 480 women. Data were collected using an interviewer-administered questionnaire and analyzed using STATA 13.0. Those variables with a p-value ≤0.05 were considered statistically significant at multi-variate analysis.Results: The prevalence of IPV among women with abortion was 71.3%. The factors that were significantly associated with intimate partner violence were: being divorced/widowed/separated (aOR 8.7, CI 1.1997-38.268, and p-value= 0.004), being never married (aOR 5.5, CI 2.700-11.138, and p-value <0.001), number of children (aOR 1.2, CI 1.053-1.411 and p-value =0.008) and witnessing abuse as an adult (aOR 6.1, CI 2.678-13.727, and p-value <0.001).Conclusion: This study has shown that the prevalence of IPV among women with abortion is still high despite interventions. More concerted effort needs to be directed toward improving contraceptive services, marriage and family support systems and community awareness on the effects of IPV on women and society.
Causative Factors in Using Medicinal Plants among Type 2 Diabetic Patients: A Qualitative Study
Authors: Salahshouri Arash , Namiranian Nasim , Aradakani Mojtaba Fattahi , Khodaei Seyed-Ali , Sotoudeh Ahmad
Published: January 2021

Background: Type 2 diabetes is a global problem, and most of people suffering from it are faced with problems caused by it. The use of medicinal plants is increasing among type 2 diabetic patients. Reasons and factors leading to the use of these plants have not yet been fully known. Thus, the present study aims to identify experiences of patients who use medicinal plants to discover factors determining the use of them.The present qualitative study was conducted using a content analysis approach.Methods: This qualitative study was conducted from April 2020 to May 2020 in Yazd City located in Central Iran. The data were collected by conducting in-depth unstructured interviews with 16 type 2 diabetic patients. Convenience sampling was used for selecting participants. In addition, data collection and analysis were conducted simultaneously. To extract categories and themes, the thematic analysis method was employed using MAXQDA 10. The COREQ (consolidated criteria for reporting qualitative research) checklist was employed to ensure the method of conducting the study.Results: Data analysis showed that factors determining the use of medicinal plants fell into six categories. These categories included beliefs about medicinal plants, psychological factors, accessibility and economic barriers, patients' knowledge and awareness, pressure imposed by the society, and the role of family culture.Conclusion: It is essential to promote patients’ information and skills of the proper use of medicinal plants. For this purpose, it is recommended to provide proper counselling and referrals to specialists. Moreover, strengthening pharmaceutical infrastructures of drug storage and distribution in deprived areas could play a significant role in facilitating patient access to common drugs and preventing the use of medicinal plants.
Factors Affecting Implementation and Pass Rates of Moistening Surgical Instruments
Authors: Huang Yongdeng , Hu Juan , Chen Yanhua , Pan Wei , Hu Ruixue , Yi Liangying
Published: January 2021

Background: Under influences of count, handover, transport and other procedures, surgical instruments might not be cleaned immediately after use, and they were not kept moist before cleaning, which allowed contaminants to dry on the instruments and become difficult to remove. Therefore, surgical instruments should be kept moist immediately after use. However, implementation and pass rates of moistening surgical instruments have been rarely studied. We aimed to investigate the factors affecting implementation and pass rates of moistening surgical instruments.Methods: We carried out on-site investigations for keeping surgical instruments moist at the 22 clinical departments using reusable surgical instruments in August 2019 in the West China Second University Hospital, Sichuan University. During the investigations, the survey utilising an interviewer-administrated questionnaire was conducted among nurses and workers from the 22 clinical departments. Data about implementation and pass rates of moistening surgical instruments was analysed in SPSS20.0.Results: Implementation and pass rates of moistening surgical instruments were 57.49% and 31.98%, respectively. Factor analysis showed that implementation rates of moistening were affected by instrument structure (χ2 = 143.670; P = 0.001), the number of instruments inside the pack (χ2 = 140.135; P = 0.001), and the person responsible for keeping surgical instruments moist (χ2 = 8.052; P = 0.005). Correlation analysis showed that instrument structure and the number of instruments inside the pack were negatively correlated with implementation rates of moistening. The more complex the structure and the greater the number of the instruments inside the pack, the lower implementation rates of moistening surgical instruments.Conclusion: Implementation and pass rates of moistening surgical instruments were low, which meant that moistening failed to meet the applicable industrial standard for central sterile supply department and there was a potential risk of hospital-acquired infection. It was necessary to provide more training about keeping surgical instruments moist for nurses and workers of the clinical departments, and regulate the procedure of keeping surgical instruments moist.
Resting heart rate is associated with the risk of metabolic syndrome and its components among Dong adults in southwest China: The China Multi-Ethnic Cohort (CMEC) Study
Authors: Zhang Xiao , Hong Feng , Qin Zixiu , Liu Leilei , Yang Jun , Tang Xuejie , Li Xi , Zhang Jiangping , Luo Peng
Published: January 2021

Background

High resting heart rate (RHR), one abnormal manifestation of autonomic nervous system, was associated with metabolic disorders. However, the association between RHR and metabolic syndrome (MetS) and its components remains controversial. This study aimed to explore the link between RHR and MetS and its components.
Methods

The study included 6,589 Dong adults (1,434 patients) from the China Multi-Ethnic Cohort (CMEC) Study. Logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and assess the association between RHR and MetS, clustered metabolic risk, and MetS components. Restricted cubic splines model was used to evaluate the dose–response relationship between RHR and MetS and its components.
Results

A positive association existed between RHR and MetS, and people in the highest RHR quartile had a higher MetS risk (OR 1.75 [95% CI 1.42–2.15]) than those in the lowest quartile. The clustered metabolic risk associated with RHR (P < 0.05). Furthermore, RHR was related to elevated blood pressure (BP), elevated triglycerides (TG), and elevated fasting plasma glucose (FPG), the ORs (95% CIs) for the highest versus lowest RHR quartile were 2.06 (1.75–2.43), 1.37 (1.17–1.62), and 2.53 (2.04–3.14), respectively. Similar results were found in sensitivity and subgroup analyses. Also, non-linear dose-response relationship existed between RHR and MetS and elevated levels of BP, TG, and FPG (P < 0.001).
Conclusions

RHR was related to the risk of MetS and three MetS components (elevated BP, elevated TG, and elevated FPG). RHR may be a useful indicator for MetS.
Association between central non-dipping pattern and platelets morphology in adults with type 1 diabetes without cardiovascular disease: a cross-sectional study
Authors: Kulecki Michal , Naskret Dariusz , Kaminski Mikolaj , Kasprzak Dominika , Lachowski Pawel , Klause Daria , Kozlowska Maria , Uruska Aleksandra , Zozulinska-Ziolkiewicz Dorota , Flotynska Justyna
Published: January 2021

BackgroundPeople with type 1 diabetes mellitus (T1DM) have higher cardiovascular risk (CVR) compared to those from the general population. One of the markers of elevated CVR is a non-dipping pattern. Mean platelet volume (MPV) and platelet distribution width (PDW) are related to platelets' activation. Aortic systolic blood pressure (SBP Ao) has a better predictive value for cardiovascular disease than brachial systolic blood pressure (SBP Br). Hypertensives with non-dipping pattern have higher MPV than dippers. However, this relationship was never investigated among people with T1DM. This study aimed to investigate the association between central dipping pattern and platelets morphology in subjects with T1DM.MethodsWe measured SBPAo and SBPBr with a validated non-invasive brachial oscillometric device - Arteriograph 24 (TensioMed Ltd., Budapest, Hungary) - during twenty-four-hour analysis in T1DM subjects without diagnosed hypertension. The non-dipping pattern was defined as a nocturnal SBP Ao fall of less than 10%. We collected medical history, anthropometrical features, and laboratory results. The group was divided based on the dipping pattern for dippers and non-dippers. ResultsFrom total 62 subjects (32 males) aged 30.1 (25.7-37) years with T1DM duration 15.0 (9.0-20) years, 36 were non-dippers based on SBP Ao. Non-dipper group had significantly higher MPV (10.4 [10-10.7] fl vs 10.9 [10.3-11.5] fl; p = 0.03) and PDW (12.3 [11.7-12.8] fl vs 13.95 [11.7-15.1] fl; p=0.02) than dipper group. The groups did not differ in classic risk factors. Multivariate logistic regression revealed that MPV (OR: 3.74; 95% CI =1.48-9.45; p = 0.005) and daily insulin intake (OR: 445.11; 95% CI = 4.25 - 46597.42; p = 0.01) were independently positively associated with non-dipping pattern based on SBP Ao. PDW was also independently positively related to central non-dipping pattern (OR: 1.91; 95% CI = 1.22 - 3.00; p = 0.005).ConclusionsT1DM subjects with central non-dipping pattern have higher values of MPV and PDW than dippers. MPV and PDW are independently positively associated with SBP Ao non-dipping pattern among people with T1DM.
Efficacy of Acupuncture and Related Techniques on Delirium: Protocol of a Systematic Review and Meta-analysis
Authors: Tan Sulan , Zhang Yu , Bai Yiping , Yang Shuting , Luan Liming , Zhou Jun
Published: January 2021

Background: Delirium, contributing to subsequent increased morbidity and mortality, is common in hospitalized patients, especially in patients undergoing major surgery. Published systematic reviews suggest that certain medications for delirium management may decrease pain scores and analgesic requirements, at the expense of troublesome side effects. People are urgently seeking non-medication strategies for delirium. Acupuncture and related techniques (ART) are increasingly used to provide medical care and have potential to prevent delirium, however, the efficacy of ART on delirium remains controversial.Methods: In accordance with the PRISMA-P guidelines, we will search PubMed, Embase, the Cochrane Library (Cochrane Central Register of Controlled Trials (CENTRAL)), Web of Science, Medline and the Cochrane Library for clinical trials on ART use in people, without language restrictions. The incidence of delirium will be defined our primary outcome. Additional outcomes will be the incidence of adverse events, pain score, consumption of analgesics, number of cumulative delirious days, hemodynamics, length of hospital stay. Two researchers independently complete further review work and data abstraction based on pre-specified inclusion and exclusion criteria. Any discrepancy will be solved by negotiation or a third investigators. Cochrane Risk of Bias tool will be used to assess the methodological quality of all the studies that are finally included. Statistical heterogeneity was assessed by forest plots, confidence intervals (CI) and I² statistic. If feasible, a meta-analysis of included results will be performed.Conclusions: This protocol will be favorable to bridge the gap between non-medication strategies and clinical diseases, and potential to help future guideline development in management of preventing delirium.Systematic review registration: The protocol was prospectively registered on the homepage of the International Prospective Register of Systematic Reviews (PROSPERO): https://www.crd.york.ac.uk/PROSPERO.
Predictors of Recurrence and Survival in Malignant Triton Tumours: A Case Report and Systematic Review Systematic Review of Malignant Triton Tumours
Authors: Pumputis Allison Elizabeth , Callan Laura , Branch Anna , Boldt R. Gabriel , Warner Andrew , Logan Diane , Read Nancy , Siddiqi Fawaz , Ross Douglas , Dubois Luc , Fortin Dalilah , Palma David A. , Nichols Anthony C.
Published: January 2021

Background: Malignant triton tumours (MTTs) are a rare and aggressive subset of malignant peripheral nerve sheath tumours (MPNSTs). A systematic review was conducted to better understand the prognosis and prognostic factors of this tumour in adult patients, and to provide treatment guidance for clinicians encountering this rare tumour. Methods: A PubMed search was conducted using the keywords “rhabdomyoblastic,” “rhabdomyosarcomatous,” “triton,” “case series” and “case report”. A reference list search was also completed. Two independent investigators completed abstract and full-text reviews. Articles were restricted to peer-reviewed articles in English language only containing adult MTT cases (≥ 18 years), and excluding articles with insufficient treatment/outcome data. Univariable and multivariable Cox proportional hazards regression was performed to identify significant predictors of overall survival (OS) and progression-free survival (PFS). Results: A total of 123 cases from the literature and 1 case from our institution were included in the final analysis. The 2-year and 5-year OS was 46.2% and 32.2%, and the 2-year and 5-year PFS was 27.1% and 21.3%, respectively. On multivariable analysis for OS, prior radiation exposure (hazard ratio [HR]: 3.99, p = 0.027), central nervous system or spine disease site (HR: 5.86, p < 0.001) and positive neurofibromatosis 1 (NF1) status (HR: 3.42, p < 0.001) were associated with worse survival. Adjuvant radiotherapy (HR: 0.58, p = 0.038) was associated with improved survival. Positive NF1 status (HR: 2.34, p < 0.001) and positive margins (HR: 3.28, p < 0.001) were associated with worse PFS. Conclusion: MTTs are rare and have poor long-term survival. Negative surgical margins and adjuvant radiation were found to be associated with improved outcomes.
Global Survey-based Assessment of Lifestyle Changes During the COVID-19 Pandemic
Authors: Agarwal Poonam , Kaushik Abhinav , Sarkar Sutapa , Rao Deepti , Mukherjee Nilanjan , Bharat Vinita , Das Subhamoy , Saha Amit
Published: January 2021

Along with the major impact on public health, the COVID-19 outbreak has caused unprecedented concerns ranging from sudden loss of employment to mental stress and anxiety. We implemented a survey-based data collection platform to characterize how the COVID-19 pandemic has affected the socio-economic, physical and mental health conditions of individuals. We focused on three broad areas, namely, changes in social interaction during home confinement, economic impact and their health status. We identified a substantial increase in virtual interaction among individuals, which might be a way to alleviate the sudden unprecedented mental health burden, exacerbated by general awareness about viral infections or other manifestations associated with them. The majority of participants (85%) lived with one or more companions and unemployment issues did not affect 91% of the total survey takers, which was one of the crucial consequences of the pandemic. Nevertheless, measures such as an increased frequency of technology-aided distant social interaction, focus on physical fitness and leisure activities were adopted as coping mechanisms during this period of home isolation. Collectively, these metrics provide a succinct and informative summary of the socio-economic and health impact of the COVID-19 pandemic on the individuals. Findings from our study reflect that continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide. Given the limitations of analyzing the large number of variables, we have made the raw data publicly available on the OMF ME/CFS Data Center server to facilitate further analyses. (Public URL will be added after acceptance).
The Effect of Coarctation Degrees on Wall Shear Stress Indices: An FSI Study
Authors: Rafieianzab Deniz , Abazari Mohammad Amin , Soltani Madjid , Alimohammadi Mona
Published: January 2021

Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid-solid interaction (FSI) models are developed. Since there is no specific routine for managing the CoA regarding its severity, this study investigates haemodynamics in regions where clinicians do not have any information that would help physicians introduce a framework when and where initiating the intervention.
Risk Factors and Neurologic Outcomes in Patients With Traumatic Brain Injury and Coagulopathy Within 72 Hours Post-operatively
Authors: Chang Tao , Yan Xigang , Zhao Chao , Zhang Yufu , Wang Bao , Gao Li
Published: January 2021

Background There are few studies on the development and effect of coagulopathy in patients with a traumatic brain injury (TBI) during the early post-operative period. We determined the risk factors and neurologic outcomes of in patients with a TBI and coagulopathy diagnosed by routine laboratory tests within 72 hours post-operatively. Methods The baseline characteristics, intra-operative management, and follow-up results of 462 patients with TBIs were obtained and retrospectively analyzed by multivariate logistic regression from January 2015 to June 2019. Coagulopathy was defined as an activated partial thromboplastin time > 40 seconds, international normalized ratio >1.4, or a platelet count < 100×109 /L.Results Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) at the time of admission, Injury Severity Score (ISS) at the time of admission, pupil mydriasis, duration of surgery, intra-operative blood loss, and intra-operative crystalloid resuscitation were independent risk factors for patients who developed a coagulopathy post-operatively. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed a trend for higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Furthermore, coagulopathy and contusion expansion in the early post-operative period were independent risk factors for TBI mortality after surgery. Intra-operative crystalloid resuscitation had a substantial diagnostic accuracy in predicting coagulopathy within 72 h post-operatively (area under the curve [AUC] = 0.972).Conclusion Coagulopathy within 72 h post-operatively in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes. Hence, we should take practical and reasonable measures to manage these risk factors, which may protect patients with a TBI from post-operative coagulopathy.
Bayesian Updating: Increasing Sample Size During the Course of A Study
Authors: Moerbeek Mirjam
Published: January 2021

Background: A priori sample size calculation requires an a priori estimate of the size of the effect. An incorrect estimate may result in a sample size that is too low to detect effects or that is unnecessarily high. An alternative to a priori sample size calculation is Bayesian updating, a procedure that allows increasing sample size during the course of a study until sufficient support for a hypothesis is achieved. This procedure does not require and a priori estimate of the effect size. This paper introduces Bayesian updating to researchers in the biomedical field and presents a simulation study that gives insight in sample sizes that may be expected for two-group comparisons. Methods: Bayesian updating uses the Bayes factor, which quantifies the degree of support for a hypothesis versus another one given the data. It can be re-calculated each time new subjects are added, without the need to correct for multiple interim analyses. A simulation study was conducted to study what sample size may be expected and how large the error rate is, that is, how often the Bayes factor shows most support for the hypothesis that was not used to generate the data. Results: The results of the simulation study are presented in a Shiny app and summarized in this paper. Lower sample size is expected when the effect size is larger and the required degree of support is lower. However, larger error rates may be observed when a low degree of support is required and/or when the sample size at the start of the study is small. Furthermore, it may occur sufficient support for neither hypothesis is achieved when the sample size is bounded by a maximum. Conclusions: Bayesian updating is a useful alternative to a priori sample size calculation, especially so in studies where additional subjects can be recruited easily and data become available in a limited amount of time. The results of the simulation study show how large a sample size can be expected and how large the error rate is.
Contextual attributes to promote positive social interdependence in problem-based learning: a qualitative study
Authors: Shimizu Ikuo , Matsuyama Yasushi , Duvivier Robbert , Vleuten Cees van der
Published: January 2021

Background:Problem-based learning (PBL) is classified as a collaborative learning approach, wherein students learn while contributing meaning to experiences and interactions with others. An important theoretical fundament of PBL is social interdependence theory (SIT) because positive social interdependence within a group has been found to be key to better learning performance and future attitudes towards team practice. However, most previous studies in health professions education focused on cognitive outcomes, and few studies have focused on collaborative behaviors in PBL groups. The lack of this empirical insight makes implementation of PBL difficult, especially in contexts where there is limited experience with collaborative learning. Therefore, the aim of this study was to elucidate what promotes or hinders positive social interdependence and how the attributes work during PBL. Methods:We conducted four focus groups among clinical year medical students (n=24) who participated in PBL tutorials in the formal curriculum. We asked semi-structured questions that corresponded with the overall concept of SIT. We analyzed the transcript using constructivist grounded theory and developed a model to explain contextual attributes that promote or hinder positive social interdependence in PBL. Results:Two contextual attributes of “academic inquisition” and “work efficiency” affect social interdependence among a student group in PBL. Academic inquisition is students’ desire to engage in their academic learning, and work efficacy is students’ attitude toward learning as an imposed duty and desire to complete it as quickly as possible. These attributes are initially mutually conflicting and constructing social interdependence through multiple steps including inquisition from a case, seeking efficient work, sharing inquisition for problem solving, expecting mutual contributions, and complementing learning objectives. Conclusion:These findings will contribute to understanding collaborative learning environments in PBL and may help explain contexts where PBL is less successful. The model can also be used as a tool to support innovation of PBL as collaborative learning.
Proteome Study of Cutaneous Lupus Erythematosus (CLE) and Dermatomyositis Skin Lesions Reveals IL-16 Is Differentially Upregulated in CLE
Authors: Niewold Timothy B. , Meves Alexander , Lehman Julia S. , Popovic-Silwerfeldt Karin , Häyry Aliisa , Söderlund-Matell Therese , Charlesworth Cristine M. , Madden Benjamin , Lundberg Ingrid E. , Wahren-Herlenius Marie , Svenungsson Elisabet , Oke Vilija
Published: January 2021

Background: The objective of the study was to explore disease pathways activated in the inflammatory foci of skin lesions in cutaneous lupus erythematosus (CLE) and dermatomyositis (DM). Methods: Skin biopsies acquired from active CLE and DM lesions, patient (PC) and also healthy controls (HC) were investigated. Biopsy sections were examined by a pathologist and inflammatory foci were laser micro-dissected, captured and proteins within captured tissue were detected in a hypothesis free manner by mass-spectrometry. Protein pathway analysis was performed by string-db.org platform. Findings of interest were confirmed by immunohistochemistry (IHC).Results: Proteome investigation identified interleukin (IL)-16 to be the only detectable and abundant cytokine differentially expressed in CLE compared to DM. Caspase-3, enzyme that cleaves IL-16 into its active form, was detected in low levels. Significantly higher proportion of IL-16 and Caspase-3 positive cells were identified in CLE lesions in comparison to DM, PC and HC. Interferon-regulated proteins (IRP) were abundant in both CLE and DM. Proteomic results indicate more abundant complement deposition in CLE skin lesions. Conclusions: Using hypothesis free mass-spectrometry investigation of CLE inflammatory infiltrates, we identified that IL-16 is the only detectable and highly abundant cytokine, while IRP was a common feature of both CLE and DM. IHC confirmed high expression of IL-16 and caspase-3 in CLE. Our novel molecular findings indicate that IL-16 detection could be useful in differential diagnostics between the two conditions that can display similar histopathological appearance. Potentially, IL-16 could be of interest as a future therapeutic target for CLE.
Open Surgery Retrieval Of A Missing Guidewire Causing Cerebral Infarctions After Cerebral Angiography: A Case Report
Authors: Luo Chaodi , Li Jing , Yan Yang , Han Dan
Published: January 2021

Background: Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guide wire fragments, intravascular clipping of the guide wire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions.Case presentation: A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful.Conclusion: It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.
Individualized Strategy of Minimally Invasive Cardiac Surgery in Congenital Cardiac Septal Defects
Authors: Zhu Jiaquan , Zhang Yunjiao , Bao Chunrong , Ding Fangbao , Mei Ju
Published: January 2021

Background: Intracardiac septal defect tends to be repaired by minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods: Four hundred and seventy-two patients who underwent minimally invasive repair of intracardiac septal defects (Atrial septal defect, ASD; ventricular septal defect, VSD; atrioventricular septal defect, AVSD) between January 2012 and June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups. First, right sub-axillary vertical incision group (RSAVI group, N=335, 192 ASDs, 135 VSDs and 8 AVSDs; Second, right anterolateral thoracotomy group (RALT group, N=132, 77 ASDs, 51 VSDs and 4 AVSDs; Third, left anterolateral thoracotomy group (LALT group, N=5, all of them were sub-pulmonary VSDs).Results: Concomitant surgeries included 9 cases of right ventricular outflow tract obstruction relief, 9 mitral repairs and 37 tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (2 residual shunts and 1 mitral regurgitation). The age and body weight of RSAVI group were significantly lower than those of RALT and LALT groups. The mean cardiopulmonary bypass time was 67.3±11.3 min and cross clamp time was 38.1±8.9 min. There was no post-operative death, and complications included 1 chest exploration for bleeding, 1 redo operation due to patch dehiscence during the same admission, 1 transient neural dysfunction, 3 diaphragmatic paresis and 13 atelectasis. The median stay in ICU was 2 days, while the median post-operative hospitalization was 6 days. The echocardiography results before discharge indicated no significant residual lesions. There was no reoperation, no new onset of chest deformities and no sclerosis during the follow up. Conclusions: The commonly seen intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. Right sub-axillary vertical incision is suitable in infants and young children, while right anterior mini-thoracotomy is more commonly used in adolescents and adults. Left anterior mini-thoracotomy is an alternative incision to repair sub-pulmonary artery VSD.
Permanent Stoma: A Quality Outcome in Treatment of Rectal Cancer and Its Impact on Length of Stay
Authors: Lemini Riccardo , Jabbal Iktej Singh , Stanek Krystof , Borkar Shalmali R. , Spaulding Aaron C. , Kelley Scott R. , Colibaseanu Dorin T.
Published: January 2021

Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility.MethodsRectal cancer patients were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic, and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients.ResultsOf 2,630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, residing in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p<0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p<0.001). ConclusionsPatients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Additionally, the payer type significantly affected the length of stay and odds of receiving a permanent stoma.
Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes
Authors: Xie Xiuqiao , Wang Jie , Huang Xueyuan , Gui Rong , Huang Yuanshuai
Published: January 2021

Background: Orthopaedic definitive stabilization surgeries are conducted when pelvic fracture patients are stabilized and blood transfusion is usually inevitable for patients undergo major surgeries and few studies provide insight into the influence of the intraoperative transfusion of packed red blood cells (PRBCs) on the outcomes of pelvic patients . As it presents a risk to the recipient by inducing uncertain morbidity and mortality, this study was aiming at the influence of PRBCs during such surgeries on clinical outcomes of pelvic fracture patients.Methods: 300 patients were collected and 103 patients were analyzed after exclusion. According to the units of intraoperative transfused PRBCs, 52 patients were in the <3U PRBCs group, 39 patients were in the 3-6U group and 12 patients were in the >6U group. Their characteristics, blood tests, details during surgeries, and outcomes were evaluated.Results: Patients in the>6U PRBCs group were more likely admitted with hemorrhagic shock, lower blood platelet count (BPC) and higher Abbreviated Injury Scale (AIS) (all p<0.05). Blood tests of them at admission revealed higher levels of serum creatinine (Scr), prothrombin time (PT) and thromboplastin time (APTT), lower level of total serum protein (TSP), serum albumin (SA), and serum globulin (SG) (all p<0.05). They underwent more subsequent surgeries and intensive care unit (ICU) stays (all p<0.001). No significant differences between complications and clinical outcomes were observed among three groups. Increased intraoperative transfusion of PRBCs was an independent factor for increased numbers of subsequent surgeries after orthopaedic surgeries, and prolonged ICU days.Conclusions: More intraoperative transfusion during orthopedic fixation surgeries indicated patients with more possibilities of hemorrhagic shock, severe pelvic injury, renal injury, and coagulopathy at admission. Increased intraoperative blood transfusion was associated with more ICU days and increased re-operations, whereas it wouldn’t increase the risk of more complications or worsen clinical outcomes.
The Impact of Unmeasured Confounding in Observational Studies: a Plasmode Simulation Study of Targeted Maximum Likelihood Estimation
Authors: Amusa Lateef , Zewotir Temesgen , North Delia
Published: January 2021

Unmeasured confounding can cause considerable problems in observational studies and may threaten the validity of the estimates of causal treatment effects. There has been discussion on the amount of bias in treatment effect estimates that can occur due to unmeasured confounding. We investigate the robustness of a relatively new causal inference technique, targeted maximum likelihood estimation (TMLE), in terms of its robustness to the impact of unmeasured confounders. We benchmark TMLE’s performance with the inverse probability of treatment weighting (IPW) method. We utilize a plasmode-like simulation based on variables and parameters from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). We evaluated the accuracy and precision of the estimated treatment effects. Though TMLE performed better in most of the scenarios considered, our simulation study results suggest that both methods performed reasonably well in estimating the marginal odds ratio, in the presence of unmeasured confounding. Nonetheless, the only remedy to unobserved confounding is controlling for as many as available covariates in an observational study, because not even TMLE can provide safeguard against bias from unmeasured confounders.
Simultaneous Measurement of Tadehaginoside and its Principal Metabolite in Rats by HPLC–MS/MS and its Application in Pharmacokinetics and Tissue Distribution Study
Authors: Zhang Cai-Yun , Lu Ya-Ting , Tan Yin-Feng , Dong Lin , Su Zhi-Heng , Zhang Xiao-Po
Published: January 2021

Background Tadehaginoside, an active ingredient isolated from Tadehagi triquetrum L., exhibited various biological activities. However, the pharmacokinetics and tissue-distribution which affects tadehaginoside’s therapeutic actions and application remain elusive.MethodsTo clarify the metabolism of tadehaginoside in vivo, a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was established to detect the level of tadehaginoside in plasma and eleven tat tissues (brain, heart, liver, spleen, lungs, kidneys, stomach, small intestine, skeletal muscle, body fat, and testes). Besides, this validated method was also successfully applied to the quantitative determination of its metabolite, p-hydroxycinnamic acid (HYD) in plasma. The pharmacokinetic and tissue-distribution of tadehaginoside were investigated by this developed method. ResultsThe pharmacokinetic study indicated that tadehaginoside in plasma of rats with intragastric administration showed relatively low concentration may be due to the formation of its metabolite, and the quick absorption of tadehaginoside was detected following intravenous administration. Tissue-distribution study indicated that kidney and spleen were the major distribution organs for tadehaginoside in rats. ConclusionsThese results could provide clues for exploring the bioactivity of tadehaginoside based on its pharmacokinetic characteristics.
An Operator-theoretical Study on the BCS-Bogoliubov Model of Superconductivity Near Absolute Zero Temperature
Authors: Watanabe Shuji
Published: January 2021

In the BCS-Bogoliubov model of superconductivity, no one gave a proof of the statement that the solution to the BCS-Bogoliubov gap equation is differentiable with respect to the temperature. But, without such a proof, one differentiates the solution and the thermodynamic potential with respect to the temperature twice, and one obtains the entropy and the specific heat at constant volume of a superconductor. In the preceding papers, the present author showed that the solution is indeed differentiable with respect to the temperature twice. Thanks to these results, we in this paper differentiate the thermodynamic potential with respect to the temperature twice so as to obtain the entropy and the specific heat at constant volume from the viewpoint of operator theory. Here, the potential in the BCS-Bogoliubov gap equation is a function and need not be a constant. We then show the behavior near absolute zero temperature of the entropy, the specific heat, the solution and the critical magnetic field. Mathematics Subject Classification 2020. 45G10, 47H10, 47N50, 82D55.
Differential Transcriptomic Profiling Between Patients With Sepsis-Induced Ards And Sepsis Without Ards 
Authors: Kasotakis George , Chen Wei , Corcoran David L. , Howrylak Judie A. , Englert Joshua , Sullenger Bruce A. , Kangelaris Kirsten , Eikermann Matthias , Purves J. Todd , Haines Krista , Palmer Scott M. , Agarwal Suresh , Stanfield Brent A
Published: January 2021

Introduction: Acute Respiratory Distress Syndrome (ARDS) develops in the lungs as a response to potent inflammatory triggers, and sepsis represents one of the most common causes of ARDS. It is a highly lethal syndrome with no effective therapies, and little is known about the pathways that trigger it. In this project we combine publicly available sepsis and ARDS patient datasets to identify early transcriptomic changes that may be targeted therapeutically in the future. Hypothesis: Proinflammatory, neutrophil-centric pathways are central to the pathogenesis of ARDS in septic patients.Methods: The GEO dataset repository was searched and available human transcriptomic data from patients with Sepsis and Sepsis+ARDS were combined and analyzed. Genes, gene sets and significant pathways that were differentially expressed or activated at a statistically significant level between the two groups were identified.Results: No independent genes were identified to be differentially expressed across the three studies. There were 6 gene sets that were up- or down-regulated across all studies (four and two respectively), and the Sphingosine-1-Phophate (S1P) pathway was the only pathway seen to become activated in septic patients with ARDS compared to those with sepsis alone. Conclusions: Limited consistent gene and gene set transcription hinders our ability to identify viable biomarkers or therapeutic targets in ARDS in the setting of sepsis, but S1P pathway intermediaries may be viable candidates.
Clinical and Subclinical Bovine Mastitis and Associated Risk factors in Small-scale Dairy Farms in Bahir Dar and its envirion, Amhara region
Authors: Hailemelekot Mussie , Chalachew Melaku , Laiju Sam
Published: January 2021

Background

Cross-sectional study was conducted from June 2017 to January 2018 with the objective of determining the prevalence of mastitis and identify the associated risk factors in and around Bahir dar dairy farms. Totally 302 lactating cows were selected using simple random sampling method. Initially, mastitis cases were diagnosed based on California Mastitis Test (MCT) results and the nature of gel formation. Then positive samples were subjected to bacterial culture and isolation using blood agar, MacConkey agar, colony morphology, Gram stain, and biochemical tests. Statistical analysis was carried out using STATA software and association of mastitis with risk factors was analyzed using chi square test. The association was considered as significant when p-value was less than 0.05.
Result

The overall cow level prevalence of mastitis using CMT was 25.16% (76/302) with clinical and sub clinical mastitis of 3.64% and 21.52%, respectively. Similarly, the quarter level mastitis was 10.43% (126/1208) with clinical and sub clinical cases of 1.49% and 8.94%, respectively. Bacteria identified were Staphylococci Spp, Escherichia coli, Bacillus Spp, and Streptococcus Spp. with a proportion of 66.07% .94%, 8.0% and 7.14%, respectively. Body condition score, cow Hygiene, Parity, history of mastitis, stage of lactation, teat lesion, use of same clothing, lactating mastitis positive animal last were found to be significant risk factors.
Conclusion

The current study revealed moderate prevalence of mastitis warranting application of appropriate hygienic practices during milking and awareness creation to the dairy farmers.
Tanzanian primary healthcare workers’ experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: A qualitative phenomenographic study
Authors: Emgård Matilda , Mwangi Rose , Mayo Celina , Mshana Ester , Nkini Gertrud , Andersson Rune , Msuya Sia E. , Lepp Margret , Muro Florida , Skovbjerg Susann
Published: January 2021

BackgroundAntibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under five years of age and their conceptions of antibiotic resistance in Northern Tanzania.MethodsA qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach.FindingsFour conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics.ConclusionsTo increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship.
An Appropriate Method of Measuring Bone Metastatic Subtypes by In Vivo Advanced Imaging from Clinical to Preclinical Study
Authors: Fan Limin , Shi Meiping , Cao Jie , Fu Hongchao , Su Jianzhong , Zhao Lanxiang , Tao Guangyu , Guo Baofeng , Chen Mingcang , Li Qiong , Chen Liang , Lei Bei , Chang Cheng , Zhang Jianping , Ye Jianding , Liu Sheng , Xie Wenhui , yang shunfang
Published: January 2021

Purpose: Bone metastasis (BM) lesions are always considered to be non-measurable. In this study, we established a method that proved to be measurable the subtypes of BM by in vivo advanced imaging including bone scintigraphy (BS) and single-photon emission computed tomography (SPECT) with 99mTechnetium-methylene diphosphonate (99mTc-MDP) fused computed tomography (CT), combined with skeletal radiography (XR). Methods: One retrospective clinical audit was investigated on lung cancer patients who suffer from BM. The audit includes early static planar, later Whole-body skeleton images and a random sample of 198 patients who were performed on fusion of SPECT/CT scanners. Among them, 108 patients with BM were definite histologic diagnosed with lung cancer and 257 bone lesions were classified. A preclinical precision study developed a procedure of hot spot-based bone imaging screening experimental BM clone by performing anesthesia, intracardiac injection of five human lung cancer cells on the immunodeficient mice, reanimate, in vivo imaging and in vitro experiments (cell culture, histology, karyotype analysis, microarrays, real-time polymerase chain reaction assay (RT-PCR), and immunohistochemistry (IHC)). An osteolytic metastatic clone MDA-MB-231Bo (231Bo) was compared. Irradiation damage was tested. Results: The clinical reports showed the incidence was primarily osteoblastic lesions, followed by mixed lesions and osteolytic. This study does not only confirmed the in vivo advanced imaging could be used to monitor and measure the subtypes of BM from clinical and preclinical data but also have ideal images (including movies), unique cell lines same as homo-sapiens, two markers associated with BM, TMEM100 and CDH1, as well as data from five pairs (BM clones and their parental cells) of lung cancer cells that released into GEO for further research. Ionizing radiation is controlled at its best. Conclusion: The studies have demonstrated that bone lesions of 1mm or larger can be detected in mouse models. Osteolytic lesions were revealed that a flow of metastatic cells out of the destroying cortical bone gap to form a soft tissue tumor. This study and GEO data are applicable to the development of relevant research and treatments.