bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China
Authors: Li Shengde , Cui Li-Ying , Anderson Craig , Gao Chunpeng , Yu Chengdong , Shan Guangliang , Wang Longde , Peng Bin
Published: October 2019

Background: As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40–74- and 75–99-year-old adults.
Methods: Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40–74 and 75–99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke.
Results: In the 40–74 and 75–99 age groups, the rates of participants who chose “Self-observation at home” were 3.0% (3912) and 3.5% (738), respectively; the rates of “Wait for family, then go to hospital” were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40–74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75–99 age group.
Conclusions: Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population. Different strategies that mainly focus on changing the “Wait for family” behavior and emphasize on immediately calling EMS are recommended for both age groups.
RNA-Seq reveals differential expression profiles and functional annotation of genes involved in retinal degeneration in Pde6c mutant Danio rerio
Authors: Saddala Madhu Sudhana , Lennikov Anton , Bouras Adam , Huang Hu
Published: October 2019

Retinal degenerative diseases affect millions of people and represent the leading cause of vision loss around the world. Retinal degeneration has been attributed to a wide variety of causes, such as disruption of genes involved in phototransduction, biosynthesis, folding of the rhodopsin molecule, and the structural support of the retina. The molecular pathogenesis of the biological events in retinal degeneration is unclear; however, the molecular basis of the retinal pathological defect can be potentially determined by gene-expression profiling of the whole retina. In the present study, we analyzed the differential gene expression profile of the retina from a wild-type zebrafish and phosphodiesterase 6C (pde6c) mutant. The datasets were downloaded from the Sequence Read Archive (SRA), and adaptors and unbiased bases were removed, and sequences were checked to ensure the quality. The reads were further aligned to the reference genome of zebrafish, and the gene expression was calculated. The differentially expressed genes (DEGs) were filtered based on the false discovery rate (FDR) (±4) and p-values (p < 0.001). We performed gene annotation (molecular function [MF], biological process [BP], cellular component [CC]) and determined the functional pathways Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway for the DEGs. Our result showed 216 upregulated and 3,527 downregulated genes between normal and pde6c mutant zebrafish. These DEGs are involved in various KEGG pathways, such as the phototransduction (12 genes), mRNA surveillance (17 genes), phagosome (25 genes), glycolysis/gluconeogenesis (15 genes), adrenergic signaling in cardiomyocytes (29 genes), ribosome (20 genes), the citrate cycle (TCA cycle; 8 genes), insulin signaling (24 genes), oxidative phosphorylation (20 genes), and RNA transport (22 genes) pathways. Many more of all the pathway genes were downregulated, while fewer were upregulated in the retina of mutant zebrafish. Our data strongly indicate that, among these genes, the abovementioned pathways’ genes—as well as calcium-binding, neural damage, peptidase, immunological, and apoptosis proteins—are mostly involved in the retinal and neural degeneration that cause abnormalities in photoreceptors or retinal pigment epithelium (RPE) cells.
Effect of Acupuncture on Lung Cancer-Related Fatigue: Study Protocol for a Multi-center Randomized Controlled Trial
Authors: Wang Zhaoqin , Li Shanshan , Wu Luyi , Qi Qin , Liu Huirong , Jin Xiaoming , Tian Jianhui , Zhang Ming , Ma Xiaopeng , Sun Deli , Xu Shifen , Wu Huangan
Published: October 2019

Background Fatigue is one of the primary symptoms of lung cancer patients, with a prevalence of 88.0% in cancer survivors, and even higher post resection surgery. Effective fatigue control after lung cancer surgery is important for patient recovery and quality of life. Some studies have shown that acupuncture might be effective in treating cancer-related fatigue, however, randomized controlled trials of suitable sample size are limited. Method/Design This is a multi-center, patient-blind, randomized controlled trial (RCT). A total of 320 eligible patients will be recruited in four centers (Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai Chest Hospital and LongHua Hospital Shanghai University of Traditional Chinese Medicine) and randomly assigned to either the acupuncture group or the sham acupuncture group in a 1:1ratio. Treatment will be given twice per week for 12 sessions. Treatment will consist of acupoints GV20, GV29, CV12, CV6, CV4, and bilateral LI4, LR3, SP6, ST36. The primary outcome will be assessed using the Chinese version of Brief Fatigue Inventory-Chinese (BFI-C), the secondary outcomes will be measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Hamilton Rating Scale for Depression (HAMD). The primary outcome will be assessed at all main points (baseline, the 3rd week, the 6th week and follow-ups), the secondary outcomes will be assessed at baseline and the 6th week. Intention-to-treat (ITT) analysis will be used in this RCT. Discussion This trial protocol provides an example of clinical application for the management of lung cancer-related fatigue using acupuncture treatment. If the acupuncture treatment protocol confirms that acupuncture is an effective and safe option for lung cancer-related fatigue, it can be adopted as a standardized treatment.
Kawasaki Disease In Infants Less Than One Year Of Age: An Italian Cohort From A Single Center
Authors: Mastrangelo Greta , Cimaz Rolando , Calabri Giovan Battista , Simonini Gabriele , Lasagni Donatella , Resti Massimo , Trapani Sandra
Published: October 2019

Background and aims Few data are currently available for Kawasaki disease (KD) below 12 months especially in Caucasians. This study aims to analyze clinical and laboratory features of KD among an Italian cohort of infants. Methods A retrospective chart review of KD children aged less than one year at time of disease onset between January 2008-December 2017 was performed. Clinical data, laboratory parameters, instrumental findings, treatment and outcome were collected in a customized database. Results Among 113 KD patients, 32 (28.3%) were younger than 1 year. Nineteen patients aged below 6 months, and three below 3 months. The median age was 5.7 ±2.7 months. The mean time to diagnosis was 7±3 days and was longer in the incomplete forms (8 ± 4 vs 6 ± 1 days). Conjunctival injection was present in 26 patients (81.2%); rash in 25 (78.1%); extremity changes in 18 (56.2%); mucosal changes in 13 (40.6%,) and lymphadenopathy only in 7 (21.8%). Mucosal changes were the least common features in incomplete forms (18.2%). Twenty-two patients (68.7%) had incomplete KD. Nineteen (59.4%) had cardiac involvement, of whom 13 (59.0%) had incomplete form. ESR, PCR and platelet values were higher in complete KD; especially, ESR resulted significantly higher in complete forms (80 ± 25.7 mm/h vs 50 ± 28.6 mm/h; p = 0.01). Conversely, AST level was statistically significant higher in patients with incomplete forms (95.4 ± 132.7 UI/L vs 29.8 ± 13.2 UI/L; p = 0.03). All patients received IVIG. Response was reported in 26/32 patients; 6 cases needed a second dose of IVIG and one required a dose of anakinra. Conclusion In our cohort, incomplete disease was commonly found, resulting in delayed diagnoses and poor cardiac prognosis. Infants with incomplete KD seem to have a more severe disease and a greater predilection for coronary involvement than those with complete KD. AST was significantly higher in incomplete forms, thus AST levels might be a new finding in incomplete forms’ diagnosis. Eventually, we highlight a higher resistance to IVIG treatment. To our knowledge this is the first study involving an Italian cohort of patients with KD below 12 months.
A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial
Authors: Yu Junma , Hu Rui , Wu Lining , Sun Peng , Zhang Zhi
Published: October 2019

Background: Nasotracheal intubation (NTI) is frequently performed in oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy. Methods: Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time, which was deﬁned as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was recorded using direct laryngoscopy ﬁve minutes after completing NTI and was scored as one of four grades according to the following modiﬁed criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis. Results: The time to complete NTI was significantly longer in the fibreoptic group than that in the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% confidence interval (CI), 10.4 to 18.1). In addition, mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9). No moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported at any time point after extubation in the two groups (P = 0.74). Conclusion: NTI can be completed successfully using either fibreoptic bronchoscopy or a Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, the Disposcope endoscope requires less execution time (the NTI time).
Distribution of hepatitis B virus genotypes in general population of Myanmar via Nation wide study
Authors: Kyaw Yi Yi , Lwin Aye Aye , Aye Khin Saw , Thu Hlaing Myat , Htun Moh Moh , Soe Hnin Ohmar , Aye Kay Thi , Thant Kyaw Zin , Hwang Hyeon Jeong , Cheong JaeHun
Published: October 2019

Background Hepatitis B virus (HBV) infection is a severe health concern worldwide. HBV is a DNA virus with a rapid rate of mutation. Based on the heterogeneity of the HBV nucleotide sequence, the HBV strains are divided into ten genotypes, A to J, with a characteristic geographical distribution. Identifying and tracking the changes of HBV genotypes is important in epidemiological and transmission studies, predicting the risk for the development of severe liver disease and response to antiviral treatment. The present study was conducted to detect HBV genotypes and sub-genotypes in general population of different states and regions in Myanmar. Methods A total of 5,547 general adult population who residing at seven states, seven regions and Nay Pyi Taw Union Territory were screened for Hepatitis B Surface antigen (HBsAg) by Immunochromatgraphic test (ICT) in 2015. Of 353 HBsAg positive samples, HBV DNA were detected by using polymerase chain reactions (PCR) targeting the DNA sequences encoding the Pre-S region. A total of 153 PCR positive samples were preceded for genotyping by partial genome sequencing of both directions. The resulting sequences were then edited, aligned and compared with reference sequences using National Centre for Biotechnology Information (NCBI) web based genotyping tool. Results Three HBV genotypes; HBV/ C, HBV/ D and HBV/ B were detected in Myanmar, in which genotype HBV/ C (66.7%) was the most prevalent genotype followed by HBV/ D (32%) and HBV/ B (1.3%) respectively. Sub-genotyping revealed a total of 7 sub-genotypes within genotypes B, C and D: two (B4 and B5) in HBV/ B, three (C1, C5 and C7) in HBV/C and two (D3 and D6) in HBV/ D. Conclusion Genotype HBV/C, sub-genotype C1 was the most predominant genotype distributed in all states and regions of Myanmar. This study was first report on Nation- wide distribution of HBV genotype and sub-genotypes in Myanmar and the findings will be a huge support for hepatitis disease surveillance programme which is the one of the National Priority Diseases in Myanmar.
Identifying asymptomatic Leishmania infections in non-endemic villages in Gedaref state, Sudan.
Authors: Mohamed Nouh Saad , Osman Hussam A. , Muneer Mohamed S. , Samy Abdallah M. , Ahmed Ayman , Mohammed Anwar O. , Siddig Emmanuel Edwar , Hamid Muzamil M. Abdel , Ali Mohamed Siralkhatim , Omer Rihab Ali , Elaagip Arwa H.
Published: October 2019

Objectives: Infection with the causative agent of visceral leishmaniasis (VL) may be either symptomatic or asymptomatic. In this study we aimed at investigating the prevalence of asymptomatic infections of leishmania in non-endemic villages in Gedaref state, Sudan. A descriptive cross-sectional study conducted during September and October 2014. Blood samples were collected for serological and molecular analysis. Sticky-traps, knockdown spray and CDC-miniature light traps were used for the collection of sandflies.
Results: Ninety-Five participants were included; 52 from Abukishma, 15 Algadamblia Tirfa, 25 Abualnaja and 3 were from Algadamblia Aljabal . Females constituted 56 (58.9%) of the study participants while males were 39 (41.1%). The most frequent age group was >40-years (54.7%). Balanites/Acacia trees were the most planted tree inside the houses; 78 (82.1%). Also, 85 (89.5%) of the participants breed animals inside the house. DAT test revealed 5 positive participants (5.2%). 4/5 DAT positive were past VL infection. PCR detected 35 (36.8%) positive participants. A total of 31/35 was considered asymptomatic infections based on PCR. Households planted Balanites/Acacia trees or breed domestic animals were found in high percentages with L. donovani PCR positive participants (60.1%, 91.4%). No statistically significant was found for VL associated risk factors and VL asymptomatic participants.
Blood donors’ knowledge and attitude towards blood donation at North Gondar district blood bank, Northwest Ethiopia: a cross-sectional study
Authors: Enawgaw Bamlaku , Yalew Aregawi , Shiferaw Elias
Published: October 2019

Objective: Blood transfusion saves millions of lives. In Ethiopia, the need and the actual number of donations are not balanced. The actual reason is not clearly assessed; however, level of knowledge and attitude may be the main contributing factors. Thus, the current study aimed to assess blood donors’ knowledge and attitude towards blood donation at North Gondar district blood bank.
Results: Of 401 blood donors, 142 (35.4%) and 379 (94.5%) of them had adequate knowledge and positive attitude, respectively. About 343 (85.5%) of study participants had no previous experience of blood donation. Perceptions of fear of pain, medically unfitness to donate and lack of information on when, where and how to donate blood were mentioned as reason for not donating blood. Educational status and residence were significantly associated with knowledge while participants with secondary and higher education were more likely to have good attitude towards blood donation. Thus, blood banks and others should design strategies for health education about blood donation and transfusion.
Keywords: Blood donation, Blood donors, Knowledge, Attitude, Gondar, Northwest Ethiopia
Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review
Authors: Antipova Daria , Eadie Leila , Macaden Ashish , Wilson Philip
Published: October 2019

Introduction: Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities.
Methods: Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected.
Results: Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23% to 99% whereas specificity was 24% to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44% to 91%, and specificity of 27% to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies.
Conclusions: A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.
Mild water stress-induced priming enhance tolerance to Rosellinia necatrix in susceptible avocado rootstocks
Authors: Martínez-Ferri Elsa , Moreno-Ortega Guillermo , Berg Noelani van den , Prieto Clara Pliego
Published: October 2019

Background: White root rot (WRR) disease caused by Rosellinia necatrix is one of the most important threats affecting avocado orchards in temperate regions. The eradication of WRR is a difficult task and environmentally friendly control methods are needed to lessen its impact. Priming plants with a stressor (biotic or abiotic) can be a strategy to enhance plant defense/tolerance against future stress episodes but, despite the known underlying common mechanisms, few studies use abiotic-priming for improving tolerance to forthcoming biotic-stress and vice versa (‘ cross-factor priming’ ). To assess whether cross-factor priming can be a potential method for enhancing avocado tolerance to WRR disease, ‘Dusa’ avocado rootstocks, susceptible to R. necatrix , were subjected to two levels of water stress (mild-WS and severe-WS) and, after drought-recovery, inoculated with R. necatrix . Physiological response and expression of plant defense related genes after drought-priming as well as the disease progression were evaluated.
Results: Water-stressed avocado plants showed lower water potential and stomatal limitations of photosynthesis compared to control plants. In addition, NPQ and q N values increased, indicating the activation of energy dissipating mechanisms closely related to the relief of oxidative stress. This response was proportional to the severity of the water stress and was accompanied by the deregulation of pathogen defense-related genes in the roots. After re-watering, leaf photosynthesis and plant water status recovered rapidly in both treatments, but roots of mild-WS primed plants showed a higher number of overexpressed genes related with plant defense than severe-WS primed plants. Disease progression after inoculating primed plants with R. necatrix was significantly delayed in mild-WS primed plants.
Conclusions: These findings demonstrate that mild-WS can induce a primed state in the WRR susceptible avocado rootstock ‘Dusa’ and reveal that ‘ cross-factor priming’ with water stress (abiotic stressor) is effective for increasing avocado tolerance against R. necatrix (biotic stressor), underpinning that plant responses against biotic and abiotic stress rely on common mechanisms. Potential applications of these results may involve an enhancement of WRR tolerance of current avocado groves and optimization of water use via low frequency deficit irrigation strategies.
Methodology for sampling women at high maternal risk in administrative data
Authors: Vanderlaan Jennifer , Dunlop Anne , Rochat Roger , Williams Bryan , Shapiro Susan E.
Published: October 2019

Background In population level studies, the conventional practice of categorizing women into low and high maternal risk samples relies upon ascertaining the presence of various comorbid conditions in administrative data. Two problems with the conventional method include variability in the recommended comorbidities to consider and inability to distinguish between maternal and fetal risks. High maternal risk sample selection may be improved by using the Obstetric Comorbidity Index (OCI), a system of risk scoring based on weighting comorbidities associated with maternal end organ damage. The purpose of this study was to compare the net benefit of using OCI risk scoring vs the conventional risk identification method to identify a sample of women at high maternal risk in administrative data. Methods This was a net benefit analysis using linked delivery hospitalization discharge and vital records data for women experiencing singleton births in Georgia from 2008-2012. We compared the value identifying a sample of women at high maternal risk using the OCI score to the conventional method of dichotomous identification of any comorbidities. Value was measured by the ability to select a sample of women designated as high maternal risk who experienced severe maternal morbidity or mortality. Results The high maternal risk sample created with the OCI had a small but positive net benefit (+ 0.6), while the conventionally derived sample had a negative net benefit indicating the sample selection performed worse than identifying no woman as high maternal risk. Conclusions The OCI can be used to select women at high maternal risk in administrative data. The OCI provides a consistent method of identification for women at risk of maternal morbidity and mortality and avoids confounding all obstetric risk factors with specific maternal risk factors. Using the OCI may help reduce misclassification as high maternal risk and improve the consistency in identifying women at high maternal risk in administrative data.
Weight Management Merits Attention in women with infertility: A Cross-Sectional Study on the Association of Anthropometric Indices with Hormonal Imbalance in a Ghanaian Population
Authors: Owiredu William K.B.A. , Ofori Peter Ntim , Turpin Cornelius Archer , Obirikorang Christian , Acheampong Emmanuel , Anto Enoch Odame , Owiredu Eddie-Williams , Adu Evans Asamoah
Published: October 2019

Objective: This study determined the association of anthropometric indices with hormonal imbalance among infertile women in a Ghanaian population.
Results: Follicle stimulating hormone (FSH) levels (18.47 vs 8.67, p-value =0.002), and luteinizing hormone (LH) (12.43 vs 8.01, p-value =0.044) were higher in women with primary infertility compared with women presenting with secondary infertility. Waist circumference (WC) and waist-to-height ratio (WHtR) showed significant negative partial correlation with prolactin in both primary and secondary infertile women. Also a significant negative partial correlation was observed between BMI and prolactin in secondary infertile women only. Waist-to-hip ratio (WHR) showed a positive association with LH in both primary and secondary infertility. WHR also showed significant positive correlation to LH/FSH ratio in secondary infertility whereas body adiposity index (BAI) showed a negative correlation to LH/FSH ratio. In a correlation analysis of anthropometric measures with hormonal profile and causes of infertility as a fixed factor, the association between anthropometric indices and fertility hormones was largely dependent on the underlying causes of infertility.
Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial
Authors: Lima Amana M. , Werneck André O. , Cyrino Edilson , Farinatti Paulo
Published: October 2019

Background: Public health strategies to increase physical activity in low-income communities may reduce cardiovascular risk in these populations. This controlled trial compared the cardiovascular risk estimated by the Framingham Risk Score (FRS) over 12 months in formally active (FA), declared active (DA), and physically inactive (PI) patients attended by the ‘Family Health Strategy’ in low-income communities at Rio de Janeiro City, Brazil (known as ‘favelas’). Methods: Patients were matched for age and assigned into three groups: a) FA (supervised training, n=53; 60.5±7.7 yrs); b) DA (self-reported, n=43; 57.0±11.2 yrs); c) PI (n=48; 57.0±10.7 yrs). FA performed twice a week a 50-min exercise circuit including strength and aerobic exercises, complemented with 30-min brisk walking on the third day, whereas DA declared to perform self-directed physical activity twice a week. Comparisons were adjusted by sex, chronological age, body mass index, and use of anti-hypertensive/statin medications. Results: At baseline, groups were similar in regards to body mass, body mass index, triglycerides, and LDL-C, as well to FRS and most of its components (age, blood pressure, hypertension prevalence, smoking, HDL-C, and total cholesterol; P>0.05). However, diabetes prevalence was 10-15% lower in DA vs. FA and PI (P<0.05). Intention-to-treat analysis showed significant reductions after intervention (P<0.05) in FA for total cholesterol (~10%), LDL-C (~15%), triglycerides (~10%), systolic blood pressure (~8%), and diastolic blood pressure (~9%). In DA, only LDL-C decreased (~10%, P < 0.05). Significant increases were found in PI (P<0.05) for total cholesterol (~15%), LDL-C (~12%), triglycerides (~15%), and systolic blood pressure (~5%). FRS lowered 35% in FA (intention-to-treat, P<0.05), remained stable in DA (P>0.05), and increased by 20% in PI (P<0.05). Conclusions: A supervised multi-modal exercise training developed at primary care health units reduced the cardiovascular risk in adults living in very low-income communities. The risk remained stable in patients practicing self-directed physical activity and increased among individuals who remained physically inactive. These promising results should be considered within public health strategies to prevent cardiovascular disease in communities with limited resources.
Towards Developing a Model for the Evaluation of Hospital Disaster Resilience: A Systematic Review
Authors: Aliabadi Saeed Fallah , Ostadtaghizadeh Abbas , Ardalan Ali , Fatemi Farin , Khazaei Bijan , Mirjalili Mohammad Reza
Published: October 2019

Background: Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. The aim of this paper was to obtain the indicators required for the evaluation of hospital resilience.
Methods: This systematic review was conducted in 2018. Through this systematic review, the international electronic databases were investigated for the researches published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators were used in order to develop a model to keep the system performance at an acceptable level during disasters.
Results: Out of 1794 researches that were published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected researches. We suggested a model including three domains and twenty seven subdomains. The three domains were constructive, infrastructural and administrative resilience. The relevant indicators were designed for each subdomain to measure the HDR.
Conclusion ; Since diverse indicators affect hospital resilience, therefore, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazard approach.
Key words : Disaster; Hospital; Resilience; Structural and non-structural systems; Indicators;
Perceptions and experiences with District Health Information System software to collect and utilize health data in Bangladesh: A qualitative exploratory study
Authors: Begum Tahmina , Khan Shaan Muberra , Adamou Bridgit , Ferdous Jannatul , Parvez Muhammad Masud , Islam Mohammad Saiful , Kumkum Feroza Akhter , Rahman Aminur , Anwar Iqbal
Published: October 2019

Background: Accurate and high-quality data are important for improving program effectiveness and informing policy. Bangladesh Health Management information System (HMIS) has adopted District Health Information software 2 (DHIS) in 2009 to capture real-time health service utilization data. However, routinely collected data are being underused because of poor data quality. We aim to understand the facilitators and barriers on implementing DHIS2 as a way to retrieve meaningful and accurate data for the Reproductive, Maternal and Child Health (RMCAH) services. Methods: This qualitative study was done among two districts of Bangladesh from September 2017 to 2018. Data collection method were key informant interview (n=11); in-depth interview (n=23); focus group discussion (n=2). Study participants were individuals involved with DHIS2 implementation from the community level to the national level. The data were analyzed thematically. Results: DHIS 2could improve the timeliness and completeness of data reporting over time. The reported facilitating factors were strong government commitment, extensive donor support and positive attitude of staffs. Quality checks and feedback loops at multiple levels of data gathering points was helpful to minimize data errors. Introducing dashboard makes the DHIS2 compatible to use as monitoring tool. However, the barriers to DHIS 2 implementation were lack of human resources, slow Internet connectivity, and frequent change of DHIS 2 versions, maintaining both manual and electronic system side by side. The collected data remains incomplete as private health facilities are not covered. The parallel presence of two MISs to report same RMNCAH indicators is a threat to achieve quality data and increases workload. Conclusion: The overall insights from this study are expected to contribute to the development of effective strategies for successful DHIS 2 implementation and building responsive HMIS. To sustain the achievements of digital data culture, focused strategic direction is needed. Periodic refresher trainings, incentives for increased performance, automated single reporting system for multiple stakeholders could make the system more user friendly. A national electronic health strategy and implementation framework can facilitate creating a culture of DHIS 2 use for planning, setting priorities, and decision making among stakeholder groups
A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial
Authors: Lin Wendong , Sun Jiehao , Fu Shuying
Published: October 2019

Background: Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia.
Methods: This prospective, randomized, controlled trial was conducted from January 10, 2019 to March 01, 2019. A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n=42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 µg/kg (diluted to 2 ml) 1 minute before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 seconds. Then, sufentanil 0.5 µg/kg was injected within 5 seconds and the number of coughs that occurred within 1 minute after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 minutes after administration (T1), 1 minute after intubation (T2), and 3 minutes after intubation (T3) were recorded.
Results: The incidence of cough in patients in the R group and C group was 4.8% and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P <0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P> 0.05).
Conclusion: Pretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil.
CD45dimCD34+CD38-CD133+ cells function as leukemic stem cells in acute myeloid leukemia
Authors: Heo Sook-Kyoung , Noh Eui-Kyu , Jeong Yoo Kyung , Cheon Jaekyung , Koh SuJin , Min Young Joo , Choi Yunsuk , Jo Jae-Cheol
Published: October 2019

Leukemia stem cells (LSCs) in acute myeloid leukemia (AML) played important roles in development of leukemia, chemotherapeutic drug resistance, and disease relapse and progression. The identification of LSCs and targeting therapies for them has been under investigation. We examined the CD45 dim CD34 + CD38 - CD133 + cells on bone marrow samples of hematologic malignancies and healthy controls using four-color flow cytometry experiments. Interestingly, the CD45 dim CD34 + CD38 - CD133 + cells were highly expressed in bone marrow of patients with AML compared to that of healthy controls (HC). Moreover, the proportions of CD45 dim CD34 + CD38 - CD133 + cells were also examined in diverse hematology malignancies including AML, CML, DLBCL, MM, MDS, HL, ALL and CLL. These cells were prominently detected in BMCs of AML and CML, but rarely in DLBCL, MM, MDS, ALL, CLL and HL. Additionally, the high levels of the CD45 dim CD34 + CD38 - CD133 + cells in AML patients were an independently significant poor risk factor for overall survival and event free survivals. Therefore, our results suggest that CD45 dim CD34 + CD38 - CD133 + cells in AML might have the potential of leukemia stem cells. In addition, this cell population might be a novel therapeutic target for AML.
Genetic diversity of C4 photosynthesis pathway genes in Sorghum bicolor (L.)
Authors: Tao Yongfu , George-Jaeggli Barbara , Bouteille-Pallas Marie , Tai Shuaishuai , Cruickshank Alan , Jordan David , Mace Emma
Published: October 2019

Background C4 photosynthesis has evolved in over 60 different plant taxa and is an excellent example of convergent evolution. Plants using the C4 photosynthetic pathway have an efficiency advantage, particularly in hot and dry environments. They account for 23% of global primary production and include some of our most productive cereals. While previous genetic studies comparing phylogenetically related C3 and C4 species have elucidated the genetic diversity underpinning the C4 photosynthetic pathway, no previous studies have described the genetic diversity of the genes involved in this pathway within a C4 crop species. Enhanced understanding of the allelic diversity and selection signatures of genes in this pathway may present opportunities to improve photosynthetic efficiency, and ultimately yield, by exploiting natural variation. Results Here, we present the first genetic diversity survey of 8 known C4 gene families in an important C4 crop, Sorghum bicolor (L.) Moench using sequence data of 48 genotypes covering wild and domesticated sorghum accessions. Average nucleotide diversity of C4 gene families varied more than 20-fold from the NADP-MDH gene family (θπ =0.2×10-3) to the PPDK gene family (θπ = 5.21×10-3). Genetic diversity of C4 genes was reduced by 22.43% in cultivated sorghum compared to wild and weedy sorghum, indicating that the group of wild and weedy sorghum may constitute an untapped reservoir for alleles related to the C4 photosynthetic pathway. A SNP-level analysis identified purifying selection signals on C4 PPDK and CA genes, and balancing selection signals on C4 PPDK-RP and PEPC genes. Allelic distribution of these C4 genes was consistent with selection signals detected.Conclusions Domestication of sorghum has reshaped diversity of C4 pathway. A better understanding of the genetic diversity of this pathway in sorghum paves the way for mining the natural allelic variation for the improvement of photosynthesis.
Sero-positivity and associated intrinsic and extrinsic drivers of Rift Valley fever occurrence in pastoral herds of Nigeria: A cross sectional survey
Authors: Alhaji Nma Bida , Aminu Jibrin , Lawan Mohammed Kabir , Babalobi Olutayo Olajide , Ghali-Mohammed Ibrahim , Odetokun Ismail Ayoade
Published: October 2019

Background: Rift Valley fever (RVF) is a vector-borne emerging zoonotic disease of animals and humans characterized by major socioeconomic losses to livestock farmers, with potential global public health threat. The study assessed herders’ existing knowledge, sero-prevalence and factors influencing the occurrence of RVF in cattle herds. Methods: A cross-sectional study using questionnaire and determination of IgM was conducted among pastoral herds. Frequencies and proportions were used for descriptive analysis. Categorical variables were presented as proportions and their associations determined by Chi-square tests. Associations were analyzed by univariable tests and multivariable logistic regressions analysis at 95% confidence level. Results: All 403 pastoralists (50.5±15.5 years) participated in this study with the majority of respondents being male, married and had no formal education. The majority of the pastoralists reported low knowledge about zoonotic RVF infections. The within-herd seropositivity of RVF in Nigeria is 5.6% which was higher under nomadic (7.4%) than agro-pastoral (3.8%) settings. All animal demographic characteristics of age, sex and breeds were not significantly (p>0.05) associated with occurrence of RVF in pastoral cattle herds. However, all the socio-ecological factors significantly (p<0.05) influenced RVF occurrence in pastoral settlements. However, availability of mosquitoes in the pastoral environments (OR=7.81; 95% CI: 4.85, 12.37), presence of rivers and streams in grazing fields (OR=10.80; 95% CI: 6.77, 17.34), high rainfall (OR=4.30; 95% CI: 2.74, 6.59), irrigated rice fields (OR=5.14; 95% CI: 3.21, 7.79) and bushy vegetation and (OR=6.11; 95% CI: 3.96, 9.43), animal movement (OR=2.2; 95% CI: 1.45, 3.25) and seasonal variations (OR=2.34; 95% CI: 1.55, 3.51) were more likely to influence RVF occurrence in pastoral herds. Conclusions: This study highlighted low levels of knowledge about RVF among surveyed pastoralists as well as socio-ecological factors contributory to RVF occurrence. This study illustrates recent circulation of RVFV in Nigeria and needs urgent interventions. This challenging gap calls for health education of these vulnerable populations on the socio-economic and health threats of RVF in the remote rural areas of developing countries, especially Africa.
Males are more sensitive to reward and less sensitive to loss than females among people with internet gaming disorder: fMRI evidence from a card-guessing task
Authors: Zhang Jialin , Hu Yan , Wang Ziliang , Du Xiaoxia , Dong Guangheng
Published: October 2019

Background Many studies have found an interesting issue in the Internet gaming disorder (IGD): males are always observed to be the majority. Explore why males are more vulnerable to IGD than females could help in understanding the underlying neural mechanism of IGD. Methods Data from functional magnetic resonance imaging (fMRI) were collected from 111 subjects (IGD: 29 male, 25 female; recreational gaming use (RGU): 36 male, 21 female) while they were performing a card-guessing task. We collected and compared their brain features when facing the win and loss conditions in different groups. Results For winning conditions, the gender × addiction group interaction results showed hyperactivity in the thalamus, parahippocampal gyrus and hypoactive inferior frontal gyrus (IFG) in the males with IGD relative to females. For lossing conditions, the gender × addiction group interaction results showed that compared to females with IGD, males with IGD showed decreased brain activities in the IFG and lingual gyrus. Conclusions Males and females showed opposite activation patterns in IGD degree and rewards/losses processing. And male IGD subjects are more sensitive to reward and less sensitive to loss than females, which might be the reason for the gender different rates on IGD. Keywords: Internet gaming disorder; Gender; Reward processing; Loss processing
Intraoperative electroencephalographic burst suppression may help to identify patients at risk for long-term adverse outcome: Findings from a homozygous twins case
Authors: Linassi Federico , Maran Eleonora , Kreuzer Matthias , Mazzarolo Anna Paola , Rosellini Edoardo , Zanatta Paolo , Carron Michele
Published: October 2019

Background: Postoperative cognitive dysfunction (POCD) presents a risk factor after general anesthesia, especially for old or cognitively impaired patients. Hence, strategies to identify possible patients at risk could help to decrease the rate of POCD. In this case report we relate the occurrence of electroencephalographic burst suppression and low bispectral indices to the development of neurocognitive decline after 12 months in one homozygous twin, whereas the other twin exhibited neither burst suppression nor neurocognitive decline. Case presentation: Two 68-year-old homozygous twins underwent the same surgical procedure with the same anesthetic regimens in comparable concentrations. For cognitive assessment, we applied a battery of neurocognitive tests at baseline (one day before surgery), at hospital discharge (three days after surgery), and 12 months after the procedure. The twins performed similarly in preoperative and discharge testing, but one twin showed worse test performance after 12 months. During surgery, we tested for possible connected consciousness by applying the isolated forearm technique (IFT). For assessment of the level of anesthesia and visual inspection of the EEG, we used the bispectral index (BIS). Neither of the twins showed signs of connected consciousness during anesthesia and the emergence tone to the return of a positive IFT response were similar. We observed lower intraoperative BIS indices for one twin. Furthermore, this twin also had two episodes of Burst Supppression. Vital parameters, particularly mean blood pressure, were stable and comparable during the entire duration of anaesthesia. The twin who exhibited Burst Suppression and lower BIS indices showed distinctly worse cognitive test scores after 12 months compared to baseline and discharge testing, indicating serious neurocognitive decline. The other twin’s cognitive performance did not decrease. Conclusions: We present findings from a unique scenario of homozygous twins with comparable lifestyles undergoing the same surgical intervention. The twin with neurocognitive decline had lower BIS values and multiple episodes of BSupp. These findings suggest that EEG monitoring under general anesthesia could help to identify frail brains that may be at increased risk of developing cognitive impairments.
Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study
Authors: Li Nan , Qiao Hong , Guo Jing-Fei , Yang Hong-Yun , Li Xue-Ying , Li Shuangling , Wang Dong-Xin , Yang Li
Published: October 2019

Background:
Acute kidney injury (AKI) is a common complication following non-cardiac surgery with adverse short- and long- term morbidity and mortality. Evidence shows that hypoalbuminemia is associated with increased AKI risk in patients with infectious diseases and cancer and following cardiac surgery and transplant surgery. However, little evidence is available on non-cardiac surgery population. Thus, we investigated the association between preoperative hypoalbuminemia and AKI following non-cardiac surgery.
Methods:
We retrospectively assessed perioperative risk factors and preoperative serum albumin concentration in 729 consecutive adult patients who underwent non-cardiac surgery from July 1, 2017, to June 30, 2018. Each patient was categorized according to maximal Kidney Disease Improving Global Outcomes criteria based on creatinine changes and urine output within the first week after surgery. Multivariate Logistic regression models were used to analyze the association between preoperative hypoalbuminemia and postoperative AKI.
Results:
Of 729 patients, 188 (25.8%) developed AKI. AKI incidence was higher in patients with preoperative serum albumin <37.5 g/L than in those with preoperative serum albumin ≥37.5 g/L [35.9% (98/273) vs. 19.7% (90/456), P<0.001]. Multivariate logistic regression analysis showed that preoperative serum albumin <37.5 g/L (odds ratio 1.892; 95% confidence interval 1.238-2.891; P=0.003) was independently associated with postoperative AKI. Patients with preoperative serum albumin <37.5 g/L tended to have a higher but not significant ratio in AKI stage 2 (2.6% vs 1.1%, P=0.144) and much higher ratio in AKI stage 3 (4.8% vs 0.7%, P<0.001) than those with preoperative serum albumin ≥37.5 g/L. AKI patients had a higher in-hospital mortality rate [6.9% (13/188) vs. 0.2% (1/541), P<0.001]. Kaplan-Meier analysis revealed that the cumulative survival rate decreased with increasing AKI severity (P<0.001). Postoperative AKI was also associated with other worse outcomes, such as prolonged mechanical ventilation [53.4 (33.0, 73.8) vs 14.7 (11.1, 18.3) hours, P<0.001], intensive care unit stay [4.0 (3.1, 4.9) vs 2.0 (1.8, 2.3) days, P<0.001], postoperative hospital stay [17.8 (14.8, 20.9) vs 12.3 (11.3, 13.3) days, P<0.001], and higher total cost [13,453 (8,538, 20,228) vs 11,306 (6,277, 16,400) dollars, P<0.001].
Conclusions
Preoperative hypoalbuminemia was independently associated with AKI after non-cardiac surgery, and postoperative AKI was associated with poor outcomes.