bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of drug resistance in Helicobacter pylori by complete genome sequencing in Bama County, Guangxi, China
Authors: huang yanqiang , Li Xiao-Hua , Huang Yong-Yi , Luo Xian-ke , Zhao Li-juan , Li Ru-Jia , Qin Yan-Chun , Dai Yuan-Yuan , Qin Chun , Chen Hao
Published: November 2020

The resistance rate of clinical Helicobacter pylori (Hp) isolates has increased, however, the mechanism of drug resistance is unclear. In this study, we isolated drug-resistant Hp strains isolated from different areas and different populations of China for genomic analysis. The aim of this study was to investigate drug resistance in Hp from Bama County, Guangxi, China. Minimal inhibitory concentrations (MICs) of clarithromycin, metronidazole and levofloxacin were determined and complete genome sequencing was performed with annotation. The presence of hp1181 and hp1184 genes was detected by RT-PCR. The relationships between hp1181, hp1184 and clarithromycin resistance were confirmed by gene mutation and drug-resistant strains. Three drug-resistant Hp strains were isolated from patients with gastritis in Bama County. The strains showed a high degree of homology with hp26695 through complete genome detection and identification. Differences in genome sequences, gene quantity and gene characteristics were detected amongst the three strains. Prediction and analysis of the function on drug-resistant genes indicated that the RNA expression of hp1181 and hp1184 increased in the three strains that were the same in the artificially induced clarithromycin-resistant bacteria. After gene knockout, the drug sensitivity of the strains increased significantly. In summary, The expressions of the genes hp1184 and hp1181 were associated with clarithromycin resistance in the Hp from Bama, Guangxi.
Clinical effect of 3.0% hydrogen peroxide containing bleaching patch with primer in a double-blind randomized controlled trial
Authors: Kim Jin-Kyoung , Youn Ha-Young , Jin Myoung-Uk , Ahn Jae-Hyun , Bang Seung-Eun , Choi Youn-Hee , Song Keunbae
Published: November 2020

Background: To clinically evaluate the efficacy and safety of a primer that contains taurine and self-bleaching patches containing 3.0% hydrogen peroxide.Methods: Overall, 55 participants were selected in this double-blinded randomized clinical trial between March and May 2019. Bleaching patches containing 3.0% hydrogen peroxide were attached using the primer on the labial surface of the upper six anterior teeth for 30 min once daily. △E* values of color changes were measured using Shade Eye NCC for determining the efficacy of bleaching on days 3, 5, 7, and 10 before and after attachment. The safety was assessed using gingival index and visual analog scale for tooth sensitivity and gingival irritation, respectively.Results: △E* values were visibly detected from day 7 after the attachment of patches, and the bleaching effect was identifiable. No statistically significant difference was observed in the gingival index (p = 0.069), tooth sensitivity (p = 0.983), and gingival irritation (p = 0.518).Conclusions: When the self-bleaching patches using 3.0% hydrogen peroxide with the primers were attached for 30 min once daily, visible bleaching effect was observed from day 7 of attachment, and it was verified to be safe for use without any significant adverse effect.Clinical Relevance: This study was conducted after securing safety for clinical trials.Trial registration: ISRCTN63650330
Establishment of narrow root fracture models using modified temperature cycling method and diagnosis using different cone-beam CT units
Authors: Liang Jiahao , Wang Tiemei , Cao Dantong , Cao Ya , Gao Antian , Xie Xin , Wang Zhiyong , Lin Zitong
Published: November 2020

AimUsing modified thermal cycling method to establish narrow root fracture models and evaluate the diagnosis efficiency of them using four different cone-beam CT (CBCT) units.MethodologyFifty-six intact teeth were selected and the crowns of the teeth were embedded using general purpose acrylic resin. 50 VRF models were established by soaking these teeth in liquid nitrogen and hot water cyclically; 6 teeth were used as negative control. All the 56 teeth were scanned with the smallest voxel size of four different CBCT units (NewTom VGi, Planmeca Promax 3D Max, Kavo 3D eXam and Soredex Scanora3D). The CBCT images were evaluated for the presence or absence of fracture lines. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) were calculated for the diagnosis of FLs using the four CBCT units. After that, 10 VRF teeth were randomly selected and the roots were sliced using slow-speed saw to obtain horizontal root sections with thickness of 2mm from enamel-cemental junction to the root apex and 25 root sections were finally obtained. Scanning electron microscope (SEM) was used to measure the width of the fracture lines (FLs) for each root section at one side.ResultsFifty narrow root fracture models were successfully established. There were totally 50 positive VRF models with 83 FLs and 6 negative VRF models. The diagnosis sensitivity was 0.24, 0.38, 0.29 and 0.19, the diagnosis specificity was 0.45, 0.16, 0.55, and 0.75, and the AUC was 0.60, 0.52, 0.59 and 0.61 for NewTom VGi, Planmeca Promax 3D Max, Soredex Scanora-3D and Kavo 3D eXam respectively. Randomly selected 10 models were sliced and 25 root sections with 45 FLs were acquired. The width of FLs was from 3.43μm to 143μm; 32.06% were less than 25μm, only 9.6% were from 75 to 150μm with SEM.ConclusionsThe modified temperature cycling method is a simple and effective method to establish narrow root fracture models, the diagnosis efficiency for these narrow fracture lines were quite poor using all the four different CBCT units.
Prevalence Of Bacterial Urinary Tract Infection And Antimicrobial Susceptibility Patterns Among Diabetes Mellitus Patients Attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia
Authors: Worku Gebremedhin Yenehun , belete Yerega alamneh , Abegaz Woldaregay Erku
Published: November 2020

Background: Urinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial urinary tract infections due to impaired host defense and high glucose concentration in urine. Surveillance of urinary tract pathogens and their antibiogram is a key to patient management. The aim of this study was to determine the prevalence of bacterial UTI and antimicrobial susceptibility patterns (AST) among diabetes patients. Methods: Hospital-based cross-sectional study was conducted from May to July, 2018. Two hundred twenty-five mid-stream urine samples were collected for culture and identification based on the standard protocol. Antimicrobial susceptibility test was done for all positive urine cultures by Kirby Bauer's disk diffusion method based on CLSI guidelines. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20 statistical software. Binary and multiple logistic regression test results were used.Results: The study result revealed 9.8% overall UTI prevalence. Five species of bacterial uropathogens were isolated. Among these, E. coli (63.6%) was the leading followed by K. pneumoniae (13.6%). In this study, significant bacteriuria was strongly associated with duration of diabetics, previous UTI and symptomatic UTI. Gram-negative bacterial isolates showed high level of sensitivity (100%) to nitrofurantoin and meropenem. On the contrary, high level of resistance (100 %) for ampicillin, doxycycline, cefuroxime, and (94.4 %) amoxacillin-clavulanate were observed. No resistance was observed among gram positive bacterial isolates except penicillin (100 % resistance). Over all prevalence of MDR was 100 % For Gram-negative bacteria.Conclusion: Presence of previous urinary tract infection and duration of diabetes were found as important factors that increase the prevalence of UTI among diabetes patients. This study also showed high prevalence of drug resistance to doxycycline, amoxacillin-clavulanate, cefuroxime and penicillin for both Gram- negative and Gram- positive bacteria. Therefore, since therapeutic selection for empirical treatment and management should be based on the knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.
Engineered Butyrate-producing Bacillus Subtilis Alleviated Ethanol-induced Intestinal and Liver Damage in Mice
Authors: Lu Xing , Zhao Meiqi , Duan Yitao , Wang Fengmei , Chen Chuanai
Published: November 2020

Ethanol-induced intestinal and liver injury are closely associated with intestinal dysbiosis and altered short-chain fatty acid (SCFA) metabolites which is crucial for intestinal health. Bacillus subtilis (BS) strains with biotherapeutic potential can benefit the host through maintaining intestinal homeostasis and regulating systematic immunity via producing small molecules, although these molecules do not include butyrate. To combine the advantages of butyrate and BS, we evaluated the bioactivity of an engineered butyrate-producing Bacillus subtilis (BPBS) strain against ethanol exposure in a chronic-binge ethanol feeding mouse model. Our findings suggested that prophylactic BPBS supplementation restored eubiosis of the gut microbiota and intestinal barrier function, which obviously reduced bacterial translocation of microbial products especially lipopolysaccharide (LPS) to the circulatory system. Additionally, the decrease of serum LPS is responsible for the relief of hepatic inflammation via the Toll-like receptor 4 (TLR4) pathway, resulting in improved hepatic structure and function. Collectively, these results demonstrated that engineered BPBS intervention imparted novel hepatoprotective functions by improving intestinal barrier function and reducing systematic inflammation under ethanol exposure, as well as paving the way for further exploration of engineered probiotics in improving human health care.
MTDH Inhibits K48-Linked Degradation of TAK1 and Promotes Sorafenib Resistance in Hepatocellular Carcinoma
Authors: Xia Shunjie , Ji Lin , Wan Zhe , Pan Yu , Tao Liye , Lin Zhongjie , Pan Haoqi , Zhao Jie , Cai Liuxin , Xu Junjie , Cai XiuJun
Published: November 2020

BackgroundIdentifying novel and actional targets in hepatocellular carcinoma (HCC) remains an unmet medical need. TAK1 was originally identified as a TGF-β-activated kinase and was further proved to phosphorylate and activate numerous downstream targets and promote cancer progression. Although TAK1 depletion leads to early onset of hepatocarcinogenesis in mice, the role of TAK1 in developed HCC progression and targeted therapy resistance is poorly understood. MethodsThe expression of TAK1 and MTDH in HCC cell lines and patients and sorafenib-resistant models was analyzed by in silico analysis, quantitative real-time PCR, western blotting and immunohistochemistry. In vivo and In vitro experiments was introduced to examine the function of TAK1 or MTDH in HCC and sorafenib resistance using small interfering RNA and pharmacological inhibitors in combination with or without sorafenib. Co-immunoprecipitation and RNA immunoprecipitation was carried out to determine the binding between TAK1 and FBXW2 or between MTDH and FBXW2 RNA.ResultsOur findings unraveled the clinical significance of TAK1 in promoting HCC and sorafenib resistance. We identified a novel E3 ubiquitin ligase, FBXW2, targeting TAK1 for K48-linked polyubiquitylation and subsequent degradation. We also found that MTDH contributes to TAK1 upregulation in HCC and sorafenib resistance, through binding to FBXW2 mRNA and accelerate its degradation. Moreover, combination of TAK1 inhibitor and sorafenib suppressed the growth of sorafenib-resistant HCCLM3 xenograft in mouse models.ConclusionThese results revealed novel mechanism underlying TAK1 protein degradation and highlighted the therapeutic value of targeting TAK1 in suppressing HCC and overcoming sorafenib resistance.
Production, Purification and Characterization of Mannanase Obtained from Pichia Kudriavzevii Strain AUMC 10190 Isolated from Citrus Wastes
Authors: Afolabi Folake Titilayo , JIMOH YETUNDE ZAINAB
Published: November 2020

Microorganisms are now the main sources of industrial enzymes, with fungi and yeasts that have contributed about 50%, bacteria has contributed about 35%, whereas the remaining 15% are also of phytopathogenic fungi while some are plant parasitic nematodes or animal origin. The prospective of using these microorganisms as sources of biotechnological and industrial relevant enzymes motivated interest in the study of extracellular enzymes from numerous microorganisms which include various fungi, bacteria, actinomycetes and yeasts. The aim of this study was to isolate and screen for mannanase-producing yeasts from citrus wastes and to produce, optimize, purify and characterize the enzyme. One hundred and two (102) yeasts were isolated from different citrus wastes obtained from five different markets and screened for their mannanase producing ability. Gum Arabic was used as a substrate for the production of mannanase enzyme by yeasts isolates using submerged fermentation. Candida sp. LES2, Candida sp. OS12, Pichia sp. and Pichia kudriavzevii (AUMC 10190) were the yeast isolates with the best potential of mannanase production. Incubation period, pH, temperature, carbon and nitrogen source were optimized under submerged fermentation for the production of mannanase. The mannanase produced by Pichia kudriavzevii (AUMC 10190) was optimally active at pH 7.0 (202.10 U/ml) and its temperature is stable at 600C. Pichia kudriavzevii (AUMC 10190) was optimally active at 350C (147.91U/ml). Mannanase enzyme produced by Pichia kudriavzevii (AUMC 10190) had a purification fold of 2.14 with a specific activity of 134.53U/ml proving that yeasts obtained from citrus wastes have the ability to produce mannanase enzyme under optimized conditions. Therefore, it can be concluded that Pichia kudriavzevii (AUMC 10190) isolated from citrus waste is potential yeast for the production of mannanase under suitable condition for higher yield.
Quantifying productivity at landscape scale using remotely-sensed foliar traits and canopy structure
Authors: Wieczynski Daniel , Diaz Sandra , Duran Sandra M. , Fyllas Nikolaos , Salinas Norma , Martin Roberta , Shenkin Alexander , Silman Miles , Asner Gregory , Bentley Lisa P. , Malhi Yadvinder , Enquist Brian , Savage Van
Published: November 2020

Forests are integral to global carbon cycling but are threatened by anthropogenic degradation and climate change. Assessing this global threat has been hindered by a lack of clear, flexible, and easy-to-use productivity models along with a lack of functional trait and productivity data for parameterizing and testing those models. Current productivity models are either extremely complex requiring up to hundreds of parameters, many sub-models, and considerable computational expense or rely on statistical trait-growth relationships that can be hard to extrapolate to new systems or climates. Here we provide a simple alternative: a remote sensing canopy functional model (RS-CFM) that uses remotely-sensed foliar traits and canopy structure data to efficiently map productivity at high-resolution and large spatial scales. We test this model by quantifying net primary productivity (NPP) at 0.01-ha resolution in 30,040 hectares of Peruvian tropical rainforest along a 3,322-m Amazon-to-Andes elevation gradient. Our model predicts local NPP and elevational shifts in NPP much more accurately and in greater detail than a prominent alternative method—NASA’s MODIS NPP product. Furthermore, we show how NPP estimates depend on light competition and identify the appropriate spatial resolution for remote productivity estimation. Our framework opens up possibilities to fully harness remote sensing data and reliably scale up from traits to map regional or global productivity in a more direct, efficient, and cost-effective manner.
Understanding the Family Doctor Concept in Public Primary Care Clinics in Malaysia: Objectives, Initiatives, Resources, and Expected Outcomes
Authors: Ismail Aniza , Reffien Muhammad Alimin Mat , Sulong Saperi , Bahanuddin Tengku Putri Zaharah Tengku , Salleh Noridah Mohd , Nasir Nazrila Hairizan
Published: November 2020

IntroductionFamily Doctor Concept (FDC) was a program introduced at selected public primary care clinics to strengthen family practice in Malaysia. It is a healthcare delivery system approach that strives to achieve “One Family, One Doctor” concept so that the physicians can provide the population with comprehensive, continuous, collaborative, personal, family- and community-oriented services.Methods and materials We collected qualitative data collection via semi-structured interviews with stakeholders (Policymakers, healthcare providers, state- and clinic-level implementers). The data were analyzed using thematic analysis according to the Consolidated criteria for Reporting Qualitative Studies (COREQ) guideline for reporting the findings.ResultsThe 16 stakeholders who participated in this research agreed that the FDC is an approach to deliver integrated, personalized, family-centered, and comprehensive care to clients. However, there were other macro-level and longer-term objectives, such as mapping diseases and improving accessibility. FDC components were related to the objectives, and variation in the implementation was expected to suit different settings. Generally, the stakeholders disagreed on the input requirement, but all cited human resources as a significant limiting factor. There were numerous expected outcomes, which could be divided into short-, intermediate-, and long-term.ConclusionFDC consists of several change initiatives in a complex health care system whereby the capacity building of human resources is critical in achieving the desired outcomes. Thus, there is an urgent need for multiple stakeholders to reach common understanding and building a workable roadmap for successful implementation.
Knowledge of First aid in Nepalese School Students and Teachers.
Authors: Dahal Geha Raj , Vaidya Pradeep
Published: November 2020

BackgroundBasic knowledge on first aid is required to every citizen. School children are best target group for giving such training. School teachers have duel responsibility on this regard. They should have adequate knowledge on first aid so that they can provide when necessary and to train students. This study was conducted to assess the knowledge of school teachers and students and effect of first aid training. MethodsThis study was conducted in school teachers and high school students of 6 schools in Kathmandu. Two days training on first aid was given to all participants. Knowledge on first aid was assessed through self administered 10 questionnaires before and after training. Response was recorded as ‘correct’ or ‘incorrect’ of individual question and total score obtained by individual. Responses were compared before and after training and between students and teachers also. ResultsA total of 152 participants (121 students and 31 teachers) were included in the study. Average score in pretest and posttest was 5.1 ±1.56 and 8.01 ±1.49 respectively with P value 0.001. Majority were aware of meaning of first aid, time to perform CPR, and first aid knowledge on fracture and electric shock. First aid knowledge on other incidents was not satisfactory. The training improved overall knowledge of participants. There was no difference of knowledge in students and teachers. ConclusionFirst aid knowledge of school teachers and students was similar and not satisfactory. Training improves knowledge significantly.
Normalization of Blood Clotting Characteristics Using Prothrombin Complex Concentrate, Fibrinogen and Fxiii In an Albumin Based Fluid: Experimental Studies In Thromboelastometry.
Authors: Koller Tobias , Kinast Nadia , Castellanos Andres Guilarte , Garcia Sergio Perez , Iglesias Pilar Paniagua , Vintro Xavi León , Arranz Jose Mateo , Seto Noelia Vilalta , García Maria Victoria Moral , Moreno-Castaño Ana Belén , Aznar-Salatti Jose , Albaladejo Gines Escolar , Ricart Maribel Diaz
Published: November 2020

Background: Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with capability to restore coagulation could be a desirable future treatment component in massive transfusion.Methods: Starting from a coagulation factor and blood cell free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under presence of platelets was performed for comparability to whole blood conditions.Results: Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 minutes and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 minutes and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.Conclusions: Combinations of coagulation factor concentrates suspended in albumin solutions have the capacity to restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.Trial registration: Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.
Can Intersectionality Help with Understanding and Tackling Health Inequalities? Perspectives of Professional Stakeholders
Authors: Holman Daniel , Salway Sarah , Bell Andrew , Beach Brian , Adebajo Adewale , Ali Nuzhat , Butt Jabeer
Published: November 2020

Background: The concept of ‘intersectionality’ is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the UK and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field. In this paper we seek to address that gap. Methods: drawing upon a consultation survey and workshop undertaken in the UK. The survey included both researchers (n=53) and practitioners (n=20) with varied roles and levels of engagement in research and evaluation. Topics included: familiarity with the term and concept ‘intersectionality’, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions; targeting and tailoring interventions to intersectional sub-groups, and evaluating the intersectional effects of policies. 23 people attended the face-to-face workshop. The aims of the workshop were to: share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approachesResults: Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalised methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them.Conclusions: In the UK health inequalities policy and practice context there are a number of potential ways forward for intersectionality in helping to understand and tackle such inequalities.
Effect of Space Allowance and Mixing on Growth Performance and Body Lesions of Grower-finisher Pigs in Pens With a Single Wet-dry Feeder
Authors: Montoro Jordi Camp , Boyle Laura Ann , Solà-Oriol David , Muns Ramon , Gasa Josep , Manzanilla Edgar García
Published: November 2020

Background: Low space allowance (SA) and mixing may result in reduced growth performance (GP) and animal welfare issues because of adverse social behaviours directed to pen mates. This could be exacerbated in pens with single space feeders owing to social facilitation of feeding behaviour. The present study aimed to investigate the effect of SA and mixing on GP and body lesions (BL) in pens with one single space wet-dry feeder. Results: Two experiments were conducted on grower-finisher pigs from 10 to 21 weeks of age. In Exp1, pigs (N=216) were assigned to three SA; 0.96 m2/pig (n=6 pens; 10 pigs/pen; SA96), 0.84 m2/pig (n=6; 12 pigs/pen; SA84) and 0.72 m2/pig (n=6; 14 pigs/pen; SA72), in a randomized design. In Exp2, pigs (N=230) were used in a 2×2 factorial randomized design considering SA and mixing as treatments. Pigs were assigned to two SA; 0.96 m2/pig (n=10 pens; 10 pigs/pen; SA96) and 0.78 m2/pig (n=10; 13 pigs/pen; SA78) and were either mixed or not at the entry to the finishing facility. GP was not affected by SA (P > 0.05) in either experiment. In Exp2, non-mixed pigs were 5.4 kg heavier (P < 0.001), gained 74 g more per day (P = 0.004), consumed 101.8 g more of feed per day (P = 0.007) and tended to have higher feed efficiency (P = 0.079) than mixed pigs from 11 to 21 weeks of age. Number of BL was affected by SA in both experiments. In Exp1, SA72 pigs had 74.4% and 97.4% more BL than SA96 and SA84 pigs at 20 weeks of age respectively (P = 0.003). In Exp2, SA78 pigs had 48.6, 43.6 and 101.3% more BL than SA96 pigs at 12, 16 and 21 weeks of age respectively (P < 0.05). Mixing did not affect the number of BL from 12 to 21 weeks of age in Exp2 (P > 0.05).Conclusion: Mixing had a considerable effect on growth performance thus, strategies to avoid or mitigate mixing should be considered. Although space allowance had no effect on growth performance, high number of body lesions in the lower space allowance indicates that space allowances equal or below 0.78 m2/pig are detrimental to the welfare of pigs despite following the EU legislation.
An Atypical Presentation of Multidermatomal Herpes Zoster: A Case Report
Authors: Alhayyas Mohammed , Chaudhry Mehmood , Berdouk Sabrina
Published: November 2020

Background: Herpes Zoster (HZ) also known as shingles is common dermatological pathology seen in in the emergency department. Multidermatomal involvement is an uncommon presentation and usually is linked to individuals with compromised immune systems. However it is rarely reported in the immunocompetent population. Case presentation: We report a 30-year-old Emirati male complaining of low-grade fever for 3 days, sore throat and discomfortable pruritic erythematous rash over his chest and back for 2 days. He was treated the day preceding his presentation in another facility for a presumed allergic reaction after taking ibuprofen. On physical examination, he was found to have exudative tonsillitis and Influenza and was treated for both and discharged. He returned again reporting increasing pain and was referred to be seen in the dermatology clinic where a biopsy was obtained and he was discharged with a steroid topical cream. 14 days later, he returned to the clinic reporting crusting of the rash, the biopsy results were positive for Herpes Zoster. The diagnosis of multidermatomal herpes Zoster was made and he was then treated with antivirals. Conclusions: Herpes Zoster can present with atypical manifestations. Multidermatomal HZ is a rare dermatological manifestation in the immunocompetent adult. It is characterised by a rash spread over two or more adjacent dermatomes. This case highlights the challenging diagnosis of this dermatological presentation.
Prevalence of Hepatitis B Virus Genotypes Among Patients with Liver Disease in Eritrea
Authors: Hamida Mohammed Elfatih A. , Raja Saud Mohammed , Petros Yodahi , Wahab Munir , Seyoum Yemane , Elkhidir Isam Mohammed , Tekle Freweini
Published: November 2020

BackgroundHepatitis B virus (HBV) is a blood-borne hepatotrophic virus and a major causative agent of liver disease. The virus is highly endemic in African countries, and five genotypes (A–E) have been identified. This study aimed to establish the most prevalent genotypes of HBV among liver disease patients from different geographical regions of Eritrea, an East African multi-ethnic country.MethodsThis study included 293 Eritrean liver disease patients who were hepatitis B surface antigen (HBsAg)-positive. Enzyme-linked immunosorbent assay (ELISA)-based serological screening and multiplex-nested PCR using type-specific primer-based genotyping were performed to determine the prevalence of genotypes in the Eritrean population.ResultsThe mean (± standard deviation) age was 41.66 ± 13.84 years; 213 (72.7%) patients were males and 80 (27.3%) were females. The median (interquartile range) of HBV DNA and alanine aminotransferase levels were 3.47 (1.66) log IU/ml and 28 (15.3) IU/L, respectively. All patients’ sera were HBsAg- and anti-HBc-total positive; 20 (6.8%) were HBeAg-positive/anti-HBe-negative, 242 (82.6%) were HBeAg-negative/anti-HBe-positive, and 31 (10.6%) had neither HBeAg nor anti-HBe according to the ELISA screening test. Of the 293 patients, only 122 (41.6%) were positive for HBV DNA, 57.38% had a single genotype, and 42.62% had a mixed HBV genotype infection. Irrespective of mode of occurrence, HBV genotype D (n = 26; 21.3%) was the predominant circulating genotype, followed by genotypes C (n = 21; 17.2%), E (n = 19; 15.6%), C/D (n = 16; 13.1%), and C/E (n = 13; 10.7%). Genotypes C/D/E (n = 9; 7.4%), A/D (n = 6; 4.9%), D/E (n = 5; 4.1%), A (n = 3; 2.5%), and B, A/E, B/E, and A/D/C (each with n = 1; 0.8%) were also present.ConclusionHBV in Eritrea is comprised of a mixture of genotypes A, B, C, D, and E separately or in combinations. Our findings demonstrated that in Eritrea, the most prevalent HBV genotype in Eritrea is genotype D among theliver disease patients with higher HBeAg positivity. This is the first study of HBV genotyping based on PCR methods in Eritrea.
A Novel Quality Control Methodology on Screening out for Human Osteosarcoma Cell Adaptor Based on the Cell-SELEX Technique
Authors: Wang Hua , Liang Ji , Ma Yan , Zhou Lei , Zhang Yufei , Li Mingcheng
Published: November 2020

Background: We have successfully developed a novel molecular probe for recognition of human osteosarcoma cell using the cell-SELEX method. The study aims to establish an accurate, time-saving quality-monitoring method in screening for tumour cell adaptors in order to shorten the screening process and ensure the accurate preparation of the adaptor. Methods: Two kinds of human osteosarcoma cells (U2-OS, HOS) were selected as the forward screening target cells and human fibrosarcoma cells (HT-1080) as the reverse screening cells to screen the adaptors from the candidate oligonucleotide library. In each round of preparation of the library, PCR was optimised by using quantitative template concentration instead of percentage volume. Each round of forward screening was conducted with reverse screening; Fluorescence spectroscopy and flow cytometry were used to monitor and compare the aptamer libraries. Results: During quantitative PCR for U2-OS and HOS template, the results showed that the bands obtained from 14 cycles were bright and no non-specific amplification within the optimal template concentrations between 19.0 and 21.0ng/µl. Each round of forward screening was accompanied by reverse screening to accelerate the elimination of non-specific single-strand DNA (ssDNA). In the meanwhile, the adaptor groups were effectively purified specifically bounding to target cells. Besides, we observed that the fluorescence spectroscopy is more accurate, time-saving, and convenient for quality control compared with flow cytometry. Conclusion: The method proposed in the study is appropriate for the rapid screening out for human osteosarcoma cell adaptor. The quantitative template concentration, forward screening with back screening, and fluorescence spectroscopy are important methods for accurate preparation and quality control of tumour cell aptamers. It can provide scientific reference data for the amplification of dsDNAs in other sub-libraries.
A Novel Anatomic Titanium Mesh Cage for Reducing the Subsidence Rate After Anterior Cervical Corpectomy: A Finite Element Study
Authors: Wang Yuhang , Zhang Haiping , Zhao Qinpeng , Zhang Yongyuan , Sun Honghui , Hao Dingjun , Wang Biao
Published: November 2020

Background: Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. This finite element study aims to investigate the anti-subsidence performance of a novel anatomic TMC and provide a theoretical basis for clinical application. Methods: According to the test process specified in the ASTM F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Abaqus software was used for the mesh, and the modulus of elasticity, Poisson's ratio and other material coefficients of each part were input into the model. Solidworks software was used to establish the TTMC and NTMC models and construct the two three-dimensional finite element models of TMC subsidence testing mentioned above. Through analysis, the relationships between the stiffness of the intervertebral body fusion device (Kd) and the stiffness of the polyurethane foam blocks (Ks) of the TTMC and NTMC were derived, respectively. Results: After fitting the linear segment, the Kd values of the TTMC and NTMC were 37314 N/mm and 89124 N/mm, respectively. After calculation, the Ks values of the TTMC and NTMC were 653.83 N/mm and 995.95 N/mm, respectively. The Kp values of the TTMC and NTMC were calculated to be 665.5 N/mm and 1007.2 N/mm according to the formula. Conclusion: The reported novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after ACCF, which was approximately 51.3% higher than that of the traditional titanium mesh cage.
Bosworth Fracture-dislocation of the Ankle: A Case Report and Literature Review
Authors: Wang Zhi-qiang , Feng Qiu-xiang , Dai Yu-xiang , Jiang Hong , Yu Peng-fei , Yao Yun-juan , Lu Zhen , Li Xiao-chun , Liu Jin-tao
Published: November 2020

Introduction: Bosworth fracture-dislocation is an unusual variant of ankle joint fracture and dislocation, which has a high clinically missed diagnosis rate due to poor visibility on X-ray. At the same time, successful closed manipulations in an ankle joint fracture and dislocation are difficult because of the fibula attachment at the posterolateral ridge of the tibia or at the fractured end of the posterior tibia.Patient concerns: A 56-year-old man visited the hospital for further evaluation of a swollen, deformed right ankle resulting from a tumble 4 hours ago. There were no obvious complications such as skin damage or blood vessel and nerve damage at the time of treatment.Diagnosis: The patient was diagnosed with Bosworth fracture-dislocation according to clinical history and X-ray examination and computed tomography (CT), which indicated posterolateral talus dislocation; the distal end of the proximal fibular fragment was inserted behind the tibia.Interventions and outcomes: The patient initially failed to receive twice manipulative reductions. After the first attempt, roentgenograms and CT scan still showed a dislocated ankle and the proximal end of the fibula fracture was still inserted at the fractured end of the posterior tibia although the sound of the joint mounted into the acetabulum was heard. Then the inferior tibiofibula joint was fully exposed and locked with an inferior tibiofibula screw. Review roentgenograms and CT suggested that the ankle was manipulated successfully, and the broken end achieved perfect alignment, leading to a satisfactory function restoration.Lessons: Early diagnosis and reduction of Bosworth fracture-dislocation is recommended, which can significantly decrease complications. The characteristic clinical manifestations of Bosworth fracture-dislocation are worthy of attention, including extreme external rotation of the ankle and difficulty in reduction. Simultaneously, the axilla sign on mortise roentgenograms, posterior dislocation of the talus on the lateral roentgenogram and fibular position relative to the talus on the external oblique roentgenogram are intrinsically valuable. During the surgery, the floating position can better expose the broken fracture end and allow standard lateral roentgenograms. For the reduction of Bosworth fracture-dislocation, it is important to avoid repeated attempts at closed reduction. Intraoperative reduction of the fibula is the key.
Clinical Outcomes Comparison of C2 Dome-like Expansive Laminoplasty Versus C2 Open-door Laminoplasty for Multilevel Cervical Ossification of the Posterior Longitudinal Ligament Involving C2
Authors: Zhou Xin , Xia Bo , Chen Fei , Yang Jun , Guo Xiang , Han Zhao , Lu Xuhua , Guo Qunfeng , ni bin
Published: November 2020

Background: Cervical laminoplasty is a well-established surgical treatment for patients with cervical myelopathy due to OPLL. However, for cases with OPLL involving C2 segment, some surgeon preferred C2EL technique, but destruction of muscles attaching at C2 spinous process and lamina is inevitable. While C2DEL technique was also available which cause less destruction to the structures associated with C2. Nevertheless, it is still not confirmed whether it can achieve similar outcomes as C2EL. This study aimed to compare the clinical and radiographic outcomes of C2 dome-like expansive laminoplasty technique(C2DEL) and C2 extended laminoplasty technique(C2EL) applied in the treatment of cervical ossification of posterior longitudinal ligament (OPLL)involving C2 segment.Methods: Data of 56 patients with OPLL involving C2 segment who underwent cervical laminoplasty were retrospectively reviewed. 26 patients received C2EL technique while C2DEL technique was applied in another 30 patients. Functional outcomes evaluated by visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score and Health-Related Quality-of-Life Short Form-36 Physical Component Summary (SF-36 PCS) were recorded and compared pre- and postoperatively. The radiographic outcomes assessed by the Cobb angle and range of motion (ROM) of cervical spine at C2-C7, as well as decompression effect at C2 level evaluated by space available for spinal cord (SAC) were measured in two groups. The intraoperative parameters including total blood loss and operation time were documented and compared between 2 groups.Results: At the final follow-up, JOA scores, NDI, and SF-36 PCS were significantly improved in both groups(all P＜0.05), but no significant differences were identified between two groups. VASSNP was reduced significantly in both groups(P＜0.05), but the cases in C2EL group experienced more severe neck pain than that of C2EL group(P＜0.05). Cobb angle at C2 and C7 and the cervical ROM in both groups reduced greatly, the SAC at C2 improved postoperatively and no significant difference was identified intergroup. No serious complications related to the surgical approach and instrumentation were observed in either group.Conclusion: C2DEL was comparable to C2EL for treating OPLL involving C2 segment. C2DEL was an ideal alternative treatment strategy for OPLL involving the C2 segment.
Attempted Development of a Clinical Decision-making Model to Assist in Femoral Neck Stress Fracture Screening in Military Trainees
Authors: Zimmerman Justin S , Deyle Gail D. , Lester Mark E , Morris Jamie B , Allen Christopher S
Published: November 2020

Background: Femoral neck stress fractures (FNSF) are serious injuries prevalent throughout the military, particularly within the initial entry training (IET) population. Delay in diagnosis and management can lead to complications secondary to fracture progression and displacement. Effective screening and identification of FNSF can reduce patient risk, mitigate costs associated with treatment, and prevent the potential medical discharge of IET personnel. There is currently no validated testing to assist in decisions for ordering advanced imaging to rule out FNSF. Military healthcare providers, therefore, must rely on advanced imaging of patients with hip region complaints to rule out suspected FNSF resulting in potential MRI over utilization. The purpose of this project was to determine if a clinical decision model can be developed from clinical findings to assist clinicians in deciding when magnetic resonance imaging (MRI) is warranted for FNSF screening in IET personnel with hip or groin pain. Methods: This was a prospective observational cross-sectional cohort process improvement project. We screened all IET Soldiers presenting to a medical clinic with hip or groin pain and evaluated 18 clinical variables. The reference standard was a FNSF diagnosed using fast-sequence MRI. Statistical analyses included correlation, receiver operating characteristic (ROC) curve assessments, and regression.Results: Final statistical analysis included 184 IET Soldiers, of which 49 had a FNSF. Frequency analysis observed the highest occurrence of FNSF in non-Hispanic white females. Ten subjective and physical examination variables had a weak correlation to positive MRI findings for FNSF. Regression analysis revealed six variables with positive MRI outcome predictive abilities; however, small to medium effect sizes, low ability to account for MRI outcome variance, and poor estimated sensitivity on ROC curve analysis limit this regression model’s clinical usefulness utilizing the identified variables. Conclusions: The regression models evaluating the clinical variables within this project failed to demonstrate adequate predictability and clinical usefulness when screening for the high-risk injury FNSF in an IET population. Clinicians should maintain a low threshold for ordering an MRI to screen for FNSF in this population. Clinicians also cannot rely on subject-reported pain locations or objective testing as definitive assessment signs to distinguish between IET Soldiers with and without a FNSF.Trial Registration: This study was deemed as a process improvement project by the Brooke Army Medical Center Institutional Review Board on 7 August 2017. A trial registration was not needed.
A Protocol of Process Evaluation of Interventions for the Prevention of Type 2 Diabetes in Women with Gestational Diabetes Mellitus: A Systematic Review
Authors: Sa’id Iklil Iman Mohd , Nadal Iliatha Papachristou , Forbes Angus , Goldsmith Kimberley , Ismail Irmi Zarina , Hassan Faezah , Ching Siew Mooi , Guess Nicola , Murphy Helen , Prina Matthew , Yusof Barakatun Nisak Mohd , Basri Nurul Iftida , Salim Mazatulsafura Sf , Sobri Nur Hafizah Mahamad , Ma'ruf Choiriyatul 'Azmiyaty Amar , Yap Pamela Phui Har , Ismail Khalida , Chew Boon How
Published: November 2020

Background: Process evaluations of randomized controlled trials (RCTs) can provide insight and inform us on the intervention implementation, causal mechanisms and the contextual factors; whether an intervention is effective or ineffective due to implementation failure or failure of the intervention itself. Hence, we aim to consolidate the methodology from previous process evaluations of complex interventions in healthcare services upon their findings on facilitators and barriers to address the prevention of type 2 diabetes among women with gestational diabetes mellitus (GDM). Methods: Comprehensive search will be conducted on electronic databases, trial registers, and reference lists of recent reviews for RCTs of complex interventions which address process evaluations of diabetes prevention intervention (DPI) for women with GDM in healthcare settings. There are no restriction on the year of publication and language of the papers. Data from each study will be extracted by two reviewers independently using standardized forms. Data extracted include descriptive items on the study design and the outcomes of process evaluations from the three dimensions: (1) implementation (theoretical framework, reach, dose delivered, dose received, fidelity, behaviour change techniques and competency in delivering them); (2) mechanistic (format of delivery either digital, non-digital or hybrid, participant and healthcare provider experience and feedback; (3) contextual (socio-cultural context, the organisational factors, local and national policy factors as barriers, facilitators, contamination and adoption for the DPI and the control as well as the conflict of interest). The quality of the studies will be assessed using mixed methods appraisal tool (MMAT) which designed for the appraisal stage of systematic mixed studies reviews. A narrative and thematic synthesis of the findings will be presented to inform the contents of a new DPI for women with GDM. Discussion: The findings from this process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other contexts in future plan. Publishing this protocol could benefit our understanding on how the process evaluation have been conducted thus far and give deeper input in understanding potential challenges and solutions to aid in the implementation of effective DPIs for GDM in Malaysia. Systematic Review Registration: CRD42020208212
Massive Open Online Courses (MOOCs) Dropout Rate in the World: A Systematic Review Protocol
Authors: Mehrabi Manoosh , Safarpour Ali Reza , Keshtkar Abbas Ali
Published: November 2020

BackgroundRecently, massive open online courses (MOOCs) have received increasing popularity throughout the world. Regardless of the subject taught and the university providing the course, the dropout rate of MOOCs is one of the most important challenges ahead.Methods This systematic review will search MEDLINE/PubMed, Scopus, Web of Science (Clarivate Analytics), Embase (Embase.com), ASSIA, CINAHL, Education Research, BEI, and Eric databases systematically according to predefined criteria without language restrictions to retrieve prospective and retrospective observational studies conducted between the 1st of January 2000 and 30th of March 2020 which evaluated the frequency of leaving MOOCs throughout the world. In the absence of severe methodological heterogeneity, the data will be combined and a meta-analysis will be performed. DiscussionAs dropout rate is one of the most challenges that universities may encounter, this systematic review will help universities extend their view, save their resources or maybe design their MOOCs differently.RegistrationRegistered in Open Science Framework, available at: https://osf.io/jgyqx/