bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ckd. Qld fabRy Epidemiology (aCQuiRE) study protocol: identifying the prevalence of Fabry disease amongst patients with kidney disease in Queensland, Australia
Authors: Mallett Andrew , Kearey Phoebe , Cameron Anne , Healy Helen , Denaro Charles , Thomas Mark , Lee Vincent W. , Stark Samantha , Fuller Maria , Hoy Wendy E.
Published: February 2020

Background

Fabry disease (FD) is a rare, lysosomal storage disorder caused by the absence or deficiency of the enzyme alpha-galactosidase A (α-Gal A) that leads to the abnormal accumulation of the lipid globotriaosylceramide (GB3) in a variety of cell types and tissues throughout the body. FD has an x-linked inheritance pattern. Previously thought to be only carriers, females can also experience FD symptomatology. Symptoms vary in type and severity from patient to patient and tend to increase in severity with age. FD symptoms are non-specific and may be shared with those of other diseases. Misdiagnoses and diagnostic delays are common, often resulting in progressive, irreversible tissue damage. The estimated prevalence of FD in the general population is 1:40,000 to 1:117,000 individuals. However, it is estimated that the prevalence of FD in the dialysis population is 0.12 to 0.7%. Little is known about the prevalence of FD in the broader Chronic Kidney Disease (CKD) population.

Methods

This is an epidemiological study of the prevalence of FD in CKD patents identified from the public renal speciality practices in Queensland, Australia. A cascade approach to screening is being employed with dried blood spot testing for blood levels of alpha-galactosidase A (Alpha-Gal), with follow-up testing for patients with abnormal results by plasma levels of globotriaosylsphingosine (Lyso-GB3) for females and non-definitive cases in males. A diagnosis of FD is confirmed through genetic testing of the GLA gene in cases suspected of having FD based upon Alpha-Gal and Lyso-GB3 testing.

Discussion

Expected outcomes of this study include more information about the prevalence of FD at all stages of CKD, including for both males and females. The study may also provide information about common characteristics of FD to assist with diagnosis and optimal management/treatment. Screening is also available for family members of diagnosed patients, with potential for early diagnosis of FD and intervention for those individuals.

Trial registration

Queensland Health Database of Research Activity (DORA, https://dora.health.qld.gov.au) pj09946 (Registered 3rd July 2017).
Membranoproliferative glomerulonephritis related to a streptococcal infection in a girl with IgA deficiency: a case report
Authors: Sugimoto Keisuke , Enya Takuji , Miyazaki Kohei , Miyazawa Tomoki , Takemura Tsukasa , Okada Mitsuru
Published: February 2020

Background

IgA deficiency associated with glomerulonephritis is rare. In particular, there is no prior report regarding the association between IgA deficiency and membranoproliferative glomerulonephritis (MPGN) in children. Herein, we describe the case of a 5-year-old girl with selective IgA deficiency and MPGN.

Case presentation

The patient presented with persisting urinary abnormality and hypocomplementemia following a group A treptococcal infection. Renal biopsy revealed the presence of diffuse mesangial hypercellularity, endocapillary proliferation, and focal thickening of the walls of the glomerular capillaries using light microscopy, with IgG and moderate C3 deposits observed using immunofluorescence. Electron microscopy images revealed nodular deposits in the subendothelial areas, with hump-shaped subepithelial deposits. The pathological diagnosis was confirmed as MPGN. Treatment using oral prednisolone (PSL), mizoribine (MZR), and angiotensin-converting enzyme inhibitors reduced the proteinuria. The PSL dose was gradually tapered, with the low dose of PSL and MZR continued for 4 years. Histological findings were improved on repeated renal biopsy, and PSL and MZR administration was discontinued.

Conclusions

We report a rare case of MPGN related to a streptococcal infection in a child. The clinical presentation included selective IgAD, with several pathological findings and a clinical course typical of glomerulopathy. The patient was successfully treated using multidrug therapy.
Sleep complaints in early pregnancy. A cross-sectional study among women attending prenatal care in general practice
Authors: Ertmann Ruth K. , Nicolaisdottir Dagny R. , Kragstrup Jakob , Siersma Volkert , Lutterodt Melissa C.
Published: February 2020

Background

Sleep problems in late pregnancy are common, but sleep in early pregnancy is less well described. The aim of this study was to describe the occurrence and severity of sleep complaints in early pregnancy. We asked the women about worries due to sleep problems. Furthermore, we investigated the associations between sleep complaints and pregnancy-related symptoms. This association was studied taking into account physical and mental health, sociodemographic characteristics, and reproductive history of the women.

Methods

Cross-sectional study in Danish general practice based on an electronic questionnaire completed by pregnant women and a Pregnancy Health Record filled in by the general practitioner (GP). The questionnaire measured three sleep complaints and 11 common physical pregnancy-related symptoms. The sleep complaints were measured as mild, moderate or severe, and it was recorded how much they worried the women. The associations between the physical pregnancy-related symptoms and sleep complaints were assessed by odds ratios from multivariable logistic regression models.

Results

The questionnaire was completed by 1338 out of 1508 eligible women before the end of gestation week 16. The gestational age ranged from 5 to 16 weeks (median 11 weeks) among the included women. On average, more than one third of the women reported to have at least one of the three sleep complaints in the questionnaire. Problems “taking a long time to fall asleep” was reported by 312 women (23%), “waking up too early” was reported by 629 (47%), and 183 (14%) had been “lying awake most of the night”. One sleep complaint was reported by 38%, two by 16, and 4% had all three symptoms. The majority were not at all or only mildly worried because of their sleep disturbances, but moderate or severe worries were found among 46% of those“ taking a long time to fall asleep” and among 40% of those “lying awake most of the night”. “Moderate or severe complaints” were reported by 277 (21%) women “Moderate or severe complaints” were associated with pregnancy-related physical symptoms, such as back pain, pelvic girdle pain and pelvic cavity pain, but only the association with pelvic cavity pain stayed significant after adjustment for depression.

Conclusion

This study showed that sleep complaints in early pregnancy are common, and sleep complaints showed association with physical as well as mental symptoms. It may be important for pregnant patients that clinicians address depression, and mood in relation to sleep problems during pregnancy.
Magnitude and determinants of obstetric case fatality rate among women with the direct causes of maternal deaths in Ethiopia: a national cross sectional study
Authors: Geleto Ayele , Chojenta Catherine , Taddele Tefera , Loxton Deborah
Published: February 2020

Background

In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications.

Methods

In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05.

Results

Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58–0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20–0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42–8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate.

Conclusions

The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.
Paravertebral catheter versus EPidural analgesia in Minimally invasive Esophageal resectioN: a randomized controlled multicenter trial (PEPMEN trial)
Authors: Kingma B. F. , Eshuis W. J. , de Groot E. M. , Feenstra M. L. , Ruurda J. P. , Gisbertz S. S. , ten Hoope W. , Marsman M. , Hermanides J. , Hollmann M. W. , Kalkman C. J. , Luyer M. D. P. , Nieuwenhuijzen G. A. P. , Scholten H. J. , Buise M. , van Det M. J. , Kouwenhoven E. A. , van der Meer F. , Frederix G. W. J. , Cheong E. , al Naimi K. , van Berge Henegouwen M. I. , van Hillegersberg R.
Published: February 2020

Background

Thoracic epidural analgesia is the standard postoperative pain management strategy in esophageal cancer surgery. However, paravertebral block analgesia may achieve comparable pain control while inducing less side effects, which may be beneficial for postoperative recovery. This study primarily aims to compare the postoperative quality of recovery between paravertebral catheter versus thoracic epidural analgesia in patients undergoing minimally invasive esophagectomy.

Methods

This study represents a randomized controlled superiority trial. A total of 192 patients will be randomized in 4 Dutch high-volume centers for esophageal cancer surgery. Patients are eligible for inclusion if they are at least 18 years old, able to provide written informed consent and complete questionnaires in Dutch, scheduled to undergo minimally invasive esophagectomy with two-field lymphadenectomy and an intrathoracic anastomosis, and have no contra-indications to either epidural or paravertebral analgesia. The primary outcome is the quality of postoperative recovery, as measured by the Quality of Recovery-40 (QoR-40) questionnaire on the morning of postoperative day 3. Secondary outcomes include the QoR-40 questionnaire score Area Under the Curve on postoperative days 1–3, the integrated pain and systemic opioid score and patient satisfaction and pain experience according to the International Pain Outcomes (IPO) questionnaire, and cost-effectiveness. Furthermore, the groups will be compared regarding the need for additional rescue medication on postoperative days 0–3, technical failure of the pain treatment, duration of anesthesia, duration of surgery, total postoperative fluid administration day 0–3, postoperative vasopressor and inotrope use, length of urinary catheter use, length of hospital stay, postoperative complications, chronic pain at six months after surgery, and other adverse effects.

Discussion

In this study, it is hypothesized that paravertebral analgesia achieves comparable pain control while causing less side-effects such as hypotension when compared to epidural analgesia, leading to shorter postoperative length of stay on a monitored ward and superior quality of recovery. If this hypothesis is confirmed, the results of this study can be used to update the relevant guidelines on postoperative pain management for patients undergoing minimally invasive esophagectomy.

Trial registration

Netherlands Trial Registry, NL8037. Registered 19 September 2019.
Nutritional assessment and prognosis of oral cancer patients: a large-scale prospective study
Authors: Bao Xiaodan , Liu Fengqiong , Lin Jing , Chen Qing , Chen Lin , Chen Fa , Wang Jing , Qiu Yu , Shi Bin , Pan Lizhen , Lin Lisong , He Baochang
Published: February 2020

Background

To evaluate and compare the prognostic performance of four nutritional indicators body mass index (BMI), serum albumin (ALB), prognostic nutritional index (PNI) and nutritional risk index (NRI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status.

Methods

This prospective study which involved 1395 oral cancer patients was conducted in Fujian, China from September 2007 to November 2018. The BMI, PNI and NRI were calculated according to the following formulas: BMI = weight / height2(kg/m2), PNI = albumin (g/l) + 0.005 × lymphocyte (count/μl) and NRI = (1.519 × albumin, g/l) + (41.7× present/ideal body weight), respectively. The univariate and multivariate Cox proportional hazards models were used to compare the prognostic value of BMI, ALB, PNI and NRI in overall survival (OS) in oral cancer.

Results

Patients with BMI < 18.5 kg/m2(VS 18.5 kg/m2 ≤ BMI < 24 kg/m2) had a poor survival outcome (HR = 1.585; 95% CI: 1.207–2.082 ). ALB, PNI, NRI were inversely correlated with OS of oral cancer (HR = 0.716; 95% CI: 0.575–0.891; HR = 0.793; 95% CI: 0.633–0.992; HR = 0.588; 95% CI: 0.469–0.738, respectively). In addition, the prognostic predictive performance of NRI was superior to BMI or ALB or PNI. Interestingly, compared with patients with better nutritional status, chemotherapy was significantly associated with poorer OS in malnourished oral cancer patients.

Conclusions

BMI, ALB, PNI and NRI are of prognostic value in patients with oral cancer and the prognostic performance of NRI was superior to BMI or ALB or PNI. Malnutrition (BMI < 18.5 kg/m2or ALB< 40 g/l or PNI < 49.3 or NRI < 97.5) could predict an unfavorable response to chemotherapy in oral cancer patients.
miRNA expression profiling of hereditary breast tumors from BRCA1- and BRCA2-germline mutation carriers in Brazil
Authors: Pessôa-Pereira Danielle , Evangelista Adriane Feijó , Causin Rhafaela Lima , da Costa Vieira René Aloisio , Abrahão-Machado Lucas Faria , Santana Iara Viana Vidigal , da Silva Vinicius Duval , de Souza Karen Cristina Borba , de Oliveira-Silva Renato José , Fernandes Gabriela Carvalho , Reis Rui Manuel , Palmero Edenir Inêz , Marques Márcia Maria Chiquitelli
Published: February 2020

Background

MicroRNAs (miRNAs) are small non-coding RNAs involved in post-transcriptional gene expression regulation and have been described as key regulators of carcinogenesis. Aberrant miRNA expression has been frequently reported in sporadic breast cancers, but few studies have focused on profiling hereditary breast cancers. In this study, we aimed to identify specific miRNA signatures in hereditary breast tumors and to compare with sporadic breast cancer and normal breast tissues.

Methods

Global miRNA expression profiling using NanoString technology was performed on 43 hereditary breast tumors (15 BRCA1, 14 BRCA2, and 14 BRCAX), 23 sporadic breast tumors and 8 normal breast tissues. These normal breast tissues derived fromBRCA1- andBRCA2- mutation carriers (n = 5) and non-mutation carriers (n = 3). Subsequently, we performed receiver operating characteristic (ROC) curve analyses to evaluate the diagnostic performance of differentially expressed miRNAs. Putative target genes of each miRNAs considered as potential biomarkers were identified using miRDIP platform and used for pathway enrichment analysis.

Results

miRNA expression analyses identified several profiles that were specific to hereditary breast cancers. A total of 25 miRNAs were found to be differentially expressed (fold change: > 2.0 andp < 0.05) and considered as potential biomarkers (area under the curve > 0.75) in hereditary breast tumors compared to normal breast tissues, with an expressive upregulation among BRCAX cases. Furthermore, bioinformatic analysis revealed that these miRNAs shared target genes involved in ErbB, FoxO, and PI3K-Akt signaling pathways.

Conclusions

Our results showed that miRNA expression profiling can differentiate hereditary from sporadic breast tumors and normal breast tissues. These miRNAs were remarkably deregulated in BRCAX hereditary breast cancers. Therefore, miRNA signatures can be used as potential novel diagnostic biomarkers for the prediction ofBRCA1/2- germline mutations and may be useful for future clinical management.
A case of bi-ventricular extensive calcification caused by multiple factors
Authors: Tu Xiaoyan , Hu Zhihui , Yang Kevin , Hu Zhuoqing , Jiang Yi
Published: February 2020

Background

Extensive myocardial calcification has a low incidence rate, but when the patients do have extensive myocardial cases, the prognosis is usually poor. Several sepsis-related extensive myocardial calcification cases have been reported, but there are cases of biventricular calcifications that are caused by multiple cases besides bacteremia and the treatment for it has a low percentage of success.

Case presentation

A 9 year old girl had an extensive biventricular calcification which is caused by multiple factors including multiple organ failure (heart, lung, liver, and kidney), aseptic cardiomyopathy, systemic inflammatory response syndrome, pulmonary hemorrhage, viral encephalitis. In this case study, the massive myocardial calcification present in the patient was classified as dystrophic. After the patient was transferred to the Intensive care unit, a series of rescue treatments such as anti-inflammatory factor storm were implemented to protect the organs. In the end, the patient was rescued from the rescue treatment procedure. After 18 months of follow-up, it was observed that the patient’s heart function returned to normal and it was observed that there was no change in myocardial calcification in the patient.

Conclusion

In this case study, it showcased a case of the diffused biventricular calcification that caused by multiple factors. Furthermore, the precise role of calcification on cardiac function was largely unknown and there has to be further follow-up observation on the patient.
Human fertility in relation to education, economy, religion, contraception, and family planning programs
Authors: Götmark Frank , Andersson Malte
Published: February 2020

Background

The world population is expected to increase greatly this century, aggravating current problems related to climate, health, food security, biodiversity, energy and other vital resources. Population growth depends strongly on total fertility rate (TFR), but the relative importance of factors that influence fertility needs more study.

Methods

We analyze recent levels of fertility in relation to five factors: education (mean school years for females), economy (Gross Domestic Product, GDP, per capita), religiosity, contraceptive prevalence rate (CPR), and strength of family planning programs. We compare six global regions: E Europe, W Europe and related countries, Latin America and the Caribbean, the Arab States, Sub-Saharan Africa, and Asia. In total, 141 countries are included in the analysis. We estimate the strength of relationships between TFR and the five factors by correlation or regression and present the results graphically.

Results

In decreasing order of strength, fertility (TFR) correlates negatively with education, CPR, and GDP per capita, and positively with religiosity. Europe deviates from other regions in several ways, e.g. TFR increases with education and decreases with religiosity in W Europe. TFR decreases with increasing strength of family planning programs in three regions, but only weakly so in a fourth, Sub-Saharan Africa (the two European regions lacked such programs). Most factors correlated with TFR are also correlated with each other. In particular, education correlates positively with GDP per capita but negatively with religiosity, which is also negatively related to contraception and GDP per capita.

Conclusions

These results help identify factors of likely importance for TFR in global regions and countries. More work is needed to establish causality and relative importance of the factors. Our novel quantitative analysis of TFR suggests that religiosity may counteract the ongoing decline of fertility in some regions and countries.
LncRNA TUG1 alleviates sepsis-induced acute lung injury by targeting miR-34b-5p/GAB1
Authors: Qiu Nan , Xu Xinmei , He Yingying
Published: February 2020

Background

Sepsis-induced acute lung injury (ALI) is a clinical syndrome characterized by the injury of alveolar epithelium and pulmonary endothelial cells. This study aimed to investigate the regulation of long noncoding RNA (lncRNA) taurine up-regulated gene 1 (TUG1) in a murine ALI model and in primary murine pulmonary microvascular endothelial cells (PMVECs) stimulated with lipopolysaccharide (LPS).

Methods

Adult C57BL/6 mice were intravenously injected with or without TUG1-expressiong adenoviral vector or control vector 1 week before the establishment of ALI model. PMVECs were transfected with TUG1-expressiong or control vectors followed by LPS stimulation. MiR-34b-5p was confirmed as a target of TUG1 using dual-luciferase reporter assay. GRB2 associated binding protein 1 (GAB1) was confirmed as a downstream target of miR-34b-5p using the same method. In the rescue experiment, PMVECs were co-transfected with TUG1-expressing vector and miR-34b-5p mimics (or control mimics) 24 h before LPS treatment.

Results

ALI mice showed reduced levels of TUG1, pulmonary injury, and induced apoptosis and inflammation compared to the control group. The overexpression of TUG1 in ALI mice ameliorated sepsis-induced pulmonary injury, apoptosis and inflammation. TUG1 also showed protective effect in LPS-treated PMVECs. The expression of MiR-34b-5p was negatively correlated with the level of TUG1. TUG1-supressed apoptosis and inflammation in LPS-stimulated PMVECs were restored by miR-34b-5p overexpression. GAB1 was inversely regulated by miR-34b-5p but was positively correlated with TUG1 expression.

Conclusion

TUG1 alleviated sepsis-induced inflammation and apoptosis via targeting miR-34b-5p and GAB1. These findings suggested that TUG1 might be served as a therapeutic potential for the treatment of sepsis-induced ALI.
Pharmacokinetic incompatibility of the Huanglian-Gancao herb pair
Authors: Zhang Ji-Quan , Wang Rui , Zhou Ting , Zhao Qing , Zhao Chun-Cao , Ma Bing-Liang
Published: February 2020

Background

Pharmacokinetic interaction is one of the most important indices for the evaluation of the compatibility of herbal medicines. Both Gancao (Glycyrrhizae Radix et Rhizoma) and Huanglian (Coptidis Rhizoma) are commonly used traditional Chinese medicines (TCMs). In this study, the influence of Gancao on the pharmacokinetics of Huanglian was systematically studied by using berberine as a pharmacokinetic marker.

Methods

Extracts of the herbal pieces of Huanglian and the herb pair (Huanglian plus Gancao) were prepared with boiling water. The concentration of berberine in the samples was analyzed using liquid chromatography-mass spectrometry. The total amounts of berberine in all extract samples were compared. Comparative pharmacokinetic studies of Huanglian and the herb pair were conducted in ICR mice. In vitro berberine absorption and efflux were studied using mice gut sacs. The equilibrium solubility of berberine in the extracts was determined. The in vitro dissolution of berberine was comparatively studied using a rotating basket method.

Results

Gancao significantly reduced berberine exposure in the portal circulation (425.8 ng·h/mL vs. 270.4 ng·h/mL) and the liver (29,500.8 ng·h/mL vs. 15,422.4 ng·h/mL) of the mice. In addition, Gancao decreased the peak concentration (Cmax) of berberine in the portal circulation (104.3 ng·h/mL vs. 76.5 ng·h/mL) and liver (4926.1 ng·h/mL vs. 2642.8 ng·h/mL) of mice. Significant influences of Gancao on the amount of berberine extracted (32% reduction), the solubility of berberine (34.7% compared with the control group), and dissolution (88.7% vs. 66.1% at 15 min in acid buffer and 68% vs. 51.8% at 15 min in phosphate buffer) were also revealed. Comparative pharmacokinetic studies in ICR mice indicated that the formation of sediment was unfavorable in terms of berberine absorption (345.3 ng·h/mL vs. 119.8 ng·h/mL).

Conclusions

Gancao was able to reduce intestinal absorption and in vivo exposure of berberine in Huanglian via the formation of sediment, which caused reductions in the extracted amount, solubility, and dissolution of berberine.
Design and implementation of a mobile health electronic data capture platform that functions in fully-disconnected settings: a pilot study in rural Liberia
Authors: Kenny Avi , Gordon Nicholas , Downey Jordan , Eddins Owen , Buchholz Kathleen , Menyon Alvin , Mansah William
Published: February 2020

Background

Mobile phones and personal digital assistants have been used for data collection in developing world settings for over three decades, and have become increasingly common. However, the use of electronic data capture (EDC) through mobile phones is limited in many areas by inconsistent network connectivity and poor access to electricity, which thwart data transmission and device usage. This is the case in rural Liberia, where many health workers live and work in areas without any access to cellular connectivity or reliable power. Many existing EDC mobile software tools are built for occasionally-disconnected settings, allowing a user to collect data while out of range of a cell tower and transmit data to a central server when he/she regains a network connection. However, few tools exist that can be used indefinitely in fully-disconnected settings, where a user will never have access to the internet or a cell network. This led us to create and implement an EDC software tool that allows for completely offline data transfer and application updating.

Results

We designed, pilot-tested, and scaled an open-source fork of Open Data Kit Collect (an Android application that can be used to create EDC systems) that allows for offline Bluetooth-based bidirectional data transfer, enabling a system in which permanently-offline users can collect data and receive application updates. We implemented this platform among a cohort of 317 community health workers and 28 supervisors in a remote area of rural Liberia with incomplete cellular connectivity and low access to power sources.

Conclusions

Running a fully-offline EDC program that completely bypasses the cellular network was found to be feasible; the system is still running, over 4 years after the initial pilot program. The users of this program can theoretically collect data offline for months or years, assuming they receive hardware support when needed. Fully-offline EDC has applications in settings where cellular network coverage is poor, as well as in disaster relief settings in which portions of the communications infrastructure may be temporarily nonfunctional.
Associations between utilization rates and patients’ health: a study of spine surgery and patient-reported outcomes (EQ-5D and ODI)
Authors: Rudolfsen Jan Håkon , Solberg Tore K. , Ingebrigtsen Tor , Olsen Jan Abel
Published: February 2020

Background

A vast body of literature has documented regional variations in healthcare utilization rates. The extent to which such variations are “unwarranted” critically depends on whether there are corresponding variations in patients’ needs. Using a unique medical registry, the current paper investigated any associations between utilization rates and patients’ needs, as measured by two patient-reported outcome measures (PROMs).

Methods

This observational panel study merged patient-level data from the Norwegian Patient Registry (NPR), Statistics Norway, and the Norwegian Registry for Spine Surgery (NORspine) for individuals who received surgery for degenerative lumbar spine disorders in 2010–2015. NPR consists of hospital administration data. NORspine includes two PROMs: the generic health-related quality of life instrument EQ-5D and the disease-specific, health-related quality of life instrument Oswestry Disability Index (ODI). Measurements were assessed at baseline and at 3 and 12 months post-surgery and included a wide range of patient characteristics. Our case sample included 15,810 individuals. We analyzed all data using generalized estimating equations.

Results

Our results show that as treatment rates increase, patients have better health at baseline. Furthermore, increased treatment rates are associated with smaller health gain.

Conclusion

The correlation between treatment rates and patients health indicate the presence of unwarranted variation in treatment rates for lumbar spine disorders.
Factors associated with the use of maternal health services by mothers in a post-conflict area of western Côte d’Ivoire in 2016
Authors: Samba Mamadou , Attia-Konan Akissi Régine , Sangaré Abou Dramane , Youan Gotré Jules , Kouadio Luc Philippe , Bakayoko-Ly Ramata
Published: February 2020

Background

In Côte d’Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d’Ivoire.

Methods

We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted.

Results

The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI95% = 1.4–7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI95% = 1.5–6.1).

Conclusion

Improving the use of maternal health services in western Côte d’Ivoire requires taking into account women’s socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.
Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses
Authors: Nilsen Per , Seing Ida , Ericsson Carin , Birken Sarah A. , Schildmeijer Kristina
Published: February 2020

Background

Health care organizations are constantly changing as a result of technological advancements, ageing populations, changing disease patterns, new discoveries for the treatment of diseases and political reforms and policy initiatives. Changes can be challenging because they contradict humans’ basic need for a stable environment. The present study poses the question: what characterizes successful organizational changes in health care? The aim was to investigate the characteristics of changes of relevance for the work of health care professionals that they deemed successful.

Methods

The study was based on semi-structured interviews with 30 health care professionals: 11 physicians, 12 registered nurses and seven assistant nurses employed in the Swedish health care system. An inductive approach was applied using questions based on the existing literature on organizational change and change responses. The questions concerned the interviewees’ experiences and perceptions of any changes that they considered to have affected their work, regardless of whether these changes were “objectively” large or small changes. The interviewees’ responses were analysed using directed content analysis.

Results

The analysis yielded three categories concerning characteristics of successful changes: having the opportunity to influence the change; being prepared for the change; valuing the change. The interviewees emphasized the importance of having the opportunity to influence the organizational changes that are implemented. Changes that were initiated by the professionals themselves were considered the easiest and were rarely resisted. Changes that were clearly communicated to allow for preparation increased the chances for success. The interviewees did not support organizational changes that were perceived to be implemented unexpectedly and/or without prior communication. They conveyed that it was important for them to understand the need for and benefits of organizational changes. They particularly valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.

Conclusions

Organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients.
Colonic mucosal and serum expression of microRNAs in canine large intestinal inflammatory bowel disease
Authors: Konstantinidis Alexandros Ο. , Pardali Dimitra , Adamama-Moraitou Katerina K. , Gazouli Maria , Dovas Chrysostomos I. , Legaki Evangelia , Brellou Georgia D. , Savvas Ioannis , Jergens Albert E. , Rallis Timoleon S. , Allenspach Karin
Published: February 2020

Background

Canine inflammatory bowel disease (IBD) is a group of chronic gastrointestinal (GI) disorders of still largely unknown etiology. Canine IBD diagnosis is time-consuming and costly as other diseases with similar signs should be initially excluded. In human IBD microRNA (miR) expression changes have been reported in GI mucosa and blood. Thus, there is a possibility that miRs may provide insight into disease pathogenesis, diagnosis and even treatment of canine IBD. The aim of this study was to determine the colonic mucosal and serum relative expression of a miRs panel in dogs with large intestinal IBD and healthy control dogs.

Results

Compared to healthy control dogs, dogs with large intestinal IBD showed significantly increased relative expression of miR-16, miR-21, miR-122 and miR-147 in the colonic mucosa and serum, while the relative expression of miR-185, miR-192 and miR-223 was significantly decreased. Relative expression of miR-146a was significantly increased only in the serum of dogs with large intestinal IBD. Furthermore, serum miR-192 and miR-223 relative expression correlated to disease activity and endoscopic score, respectively.

Conclusion

Our data suggest the existence of dysregulated miRs expression patterns in canine IBD and support the potential future use of serum miRs as useful noninvasive biomarkers.
MicroRNA-4316 inhibits gastric cancer proliferation and migration via directly targeting VEGF-A
Authors: Mousa Haithm , Yuan Menglang , Zhang Xinsheng , Li Xiaomeng , Shopit Abdullah , Almoiliqy Marwan , Alshwmi Mohammed , Al-Dherasi Aisha , Xu Yue , Zuo Yunfei
Published: February 2020

Background and aims

microRNAs (miRNAs) have been reported to regulate proliferation and migration by down-regulating the expression of target genes. The aims of this study were to investigate whether miR-4316 inhibited proliferation and migration by downregulating vascular endothelial growth factor A (VEGF-A) and its clinical significance in gastric cancer (GC).

Methods

The clinical tissues of the GC patients for miR-4316 and VEGF-A were detected by qRT-PCR. The protein levels of VEGF-A and c-Met were determined by western blotting. Cell Proliferation, migration, and colony forming assays were conducted to show whether miR-4316 affects proliferation by CCK-8, migration by transwell, wound healing and colony formation assays. The bioinformatic methods and luciferase reporter assay were applied to detect the relationship between miRNA and VEGF-A on its targeting 3-untranslated regions (3-UTRs). CCK-8, colony formation, wound healing, and transwell assay were performed to explore the function of miR-4316.

Results

The results of qRT-PCR indicated that miR-4316 expression level was significantly downregulated in human GC tissues and GC cell lines compared with their control. miR-4316 inhibited proliferation, migration and colony formation in GC cell lines by reducing VEGF-A. And western blot results indicated that miR-4316 significantly inhibited GC through repressing VEGF-A and c-Met. The investigation of Luciferase assay indicated that VEGF-A is a direct target gene of miR-4316.

Conclusions

miR-4316 suppressed proliferation and migration of GC through the VEGF-A gene. MiR-4316 acts as a tumor suppressor by targeting VEGF-A and this indicated that MiR-4316 might be a potential therapeutic target for GC.
Long non-coding RNA DANCR promotes cervical cancer growth via activation of the Wnt/β-catenin signaling pathway
Authors: Tian Wanjia , Lei Ningjing , Guo Ruixia , Yuan Zhongfu , Chang Lei
Published: February 2020

Background

Long non-coding RNAs (lncRNAs) are implicated in many pathophysiological processes, including cancers. In particular, lncRNA DANCR is regarded as a cancer-associated lncRNA exerting various regulatory mechanisms. However, the expressions, functions, and mechanisms of action of DANCR in cervical cancer are still unclear.

Methods

The expressions of DANCR in cervical cancer tissues and cell lines were evaluated using qRT-PCR. Correlations between DANCR expression and clinicopathological features and prognosis were analyzed. The roles of DANCR in cervical cancer growth were evaluated by in vitro CCK-8 and EdU assay, and in vivo xenograft assay. The regulatory effects of DANCR on Wnt/β-catenin signaling pathway were evaluated using nuclear proteins extraction, western blot, and qRT-PCR.

Results

DANCR is increased in cervical cancer tissues and cell lines. Increased expression of DANCR is associated with large tumor size, advanced FIGO stage, and poor overall survival of cervical cancer patients. Functional experiments showed that enhanced expression of DANCR promotes cervical cancer cell proliferation in vitro and xenograft growth in vivo. Conversely, DANCR knockdown inhibits cervical cancer cell proliferation in vitro and xenograft growth in vivo. Mechanistic investigation demonstrated that DANCR upregulates the expressions of FRAT1 and FRAT2 and activates the Wnt/β-catenin signaling pathway. Blocking the Wnt/β-catenin signaling pathway abolishes the pro-proliferative roles of DANCR overexpression and anti-proliferative roles of DANCR knockdown.

Conclusions

Our findings suggest DANCR as an oncogenic lncRNA in cervical cancer through activating the Wnt/β-catenin signaling pathway, and imply that DANCR may be a promising prognostic biomarker and therapeutic target for cervical cancer.
Detecting focal cortical dysplasia lesions from FLAIR-negative images based on cortical thickness
Authors: Feng Cuixia , Zhao Hulin , Tian Maoyu , Lu Miaomiao , Wen Junhai
Published: February 2020

Background

Focal cortical dysplasia (FCD) is a neuronal migration disorder and is a major cause of drug-resistant epilepsy. However, many focal abnormalities remain undetected during routine visual inspection, and many patients with histologically confirmed FCD have normal fluid-attenuated inversion recovery (FLAIR-negative) images. The aim of this study was to quantitatively evaluate the changes in cortical thickness with magnetic resonance (MR) imaging of patients to identify FCD lesions from FLAIR-negative images.

Methods

We first used the three-dimensional (3D) Laplace method to calculate the cortical thickness for individuals and obtained the cortical thickness mean image and cortical thickness standard deviation (SD) image based on all 32 healthy controls. Then, a cortical thickness extension map was computed by subtracting the cortical thickness mean image from the cortical thickness image of each patient and dividing the result by the cortical thickness SD image. Finally, clusters of voxels larger than three were defined as the FCD lesion area from the cortical thickness extension map.

Results

The results showed that three of the four lesions that occurred in non-temporal areas were detected in three patients, but the detection failed in three patients with lesions that occurred in the temporal area. The quantitative analysis of the detected lesions in voxel-wise on images revealed the following: specificity (99.78%), accuracy (99.76%), recall (67.45%), precision (20.42%), Dice coefficient (30.01%), Youden index (67.23%) and area under the curve (AUC) (83.62%).

Conclusion

Our studies demonstrate an effective method to localize lesions in non-temporal lobe regions. This novel method automatically detected FCD lesions using only FLAIR-negative images from patients and was based only on cortical thickness feature. The method is noninvasive and more effective than a visual analysis for helping doctors make a diagnosis.
TIMs, TAMs, and PS- antibody targeting: implications for cancer immunotherapy
Authors: Dayoub Adam S. , Brekken Rolf A.
Published: February 2020

Immunotherapy for cancer is making impressive strides at improving survival of a subset of cancer patients. To increase the breadth of patients that benefit from immunotherapy, new strategies that combat the immunosuppressive microenvironment of tumors are needed. Phosphatidylserine (PS) signaling is exploited by tumors to enhance tumor immune evasion and thus strategies to inhibit PS-mediated immune suppression have potential to increase the efficacy of immunotherapy. PS is a membrane lipid that flips to the outer surface of the cell membrane during apoptosis and/or cell stress. Externalized PS can drive efferocytosis or engage PS receptors (PSRs) to promote local immune suppression. In the tumor microenvironment (TME) PS-mediated immune suppression is often termed apoptotic mimicry. Monoclonal antibodies (mAbs) targeting PS or PSRs have been developed and are in preclinical and clinical testing. The TIM (T-cell/transmembrane, immunoglobulin, and mucin) and TAM (Tyro3, AXL, and MerTK) family of receptors are PSRs that have been shown to drive PS-mediated immune suppression in tumors. This review will highlight the development of mAbs targeting PS, TIM-3 and the TAM receptors.
Household fuel use and adverse pregnancy outcomes in a Ghanaian cohort study
Authors: Weber Eartha , Adu-Bonsaffoh Kwame , Vermeulen Roel , Klipstein-Grobusch Kerstin , Grobbee Diederick E. , Browne Joyce L. , Downward George S.
Published: February 2020

Background

Accruing epidemiological evidence suggests that prenatal exposure to emissions from cooking fuel is associated with increased risks of adverse maternal and perinatal outcomes including hypertensive disorders of pregnancy, low birth weight, stillbirth and infant mortality. We aimed to investigate the relationship between cooking fuel use and various pregnancy related outcomes in a cohort of urban women from the Accra region of Ghana.

Methods

Self-reported cooking fuel use was divided into “polluting” (wood, charcoal, crop residue and kerosene) and “clean” fuels (liquid petroleum gas and electricity) to examine 12 obstetric outcomes in a prospective cohort of pregnant women (N = 1010) recruited at < 17 weeks of gestation from Accra, Ghana. Logistic and multivariate linear regression analyses adjusted for BMI, maternal age, maternal education and socio-economic status asset index was conducted.

Results

34% (n = 279) of 819 women with outcome data available for analysis used polluting fuel as their main cooking fuel. Using polluting cooking fuels was associated with perinatal mortality (aOR: 7.6, 95%CI: 1.67–36.0) and an adverse Apgar score (< 7) at 5 min (aOR:3.83, 95%CI: (1.44–10.11). The other outcomes (miscarriage, post-partum hemorrhage, pre-term birth, low birthweight, caesarian section, hypertensive disorders of pregnancy, small for gestational age, and Apgar score at 1 min) had non-statistically significant findings.

Conclusions

We report an increased likelihood of perinatal mortality, and adverse 5-min Apgar scores in association with polluting fuel use. Further research including details on extent of household fuel use exposure is recommended to better quantify the consequences of household fuel use.

Study registration

Ghana Service Ethical Review Committee (GHS-ERC #: 07–9-11).
Unsupervised Bayesian learning for rice panicle segmentation with UAV images
Authors: Hayat Md Abul , Wu Jingxian , Cao Yingli
Published: February 2020

Background

In this paper, an unsupervised Bayesian learning method is proposed to perform rice panicle segmentation with optical images taken by unmanned aerial vehicles (UAV) over paddy fields. Unlike existing supervised learning methods that require a large amount of labeled training data, the unsupervised learning approach detects panicle pixels in UAV images by analyzing statistical properties of pixels in an image without a training phase. Under the Bayesian framework, the distributions of pixel intensities are assumed to follow a multivariate Gaussian mixture model (GMM), with different components in the GMM corresponding to different categories, such as panicle, leaves, or background. The prevalence of each category is characterized by the weights associated with each component in the GMM. The model parameters are iteratively learned by using the Markov chain Monte Carlo (MCMC) method with Gibbs sampling, without the need of labeled training data.

Results

Applying the unsupervised Bayesian learning algorithm on diverse UAV images achieves an average recall, precision andF1score of 96.49%, 72.31%, and 82.10%, respectively. These numbers outperform existing supervised learning approaches.

Conclusions

Experimental results demonstrate that the proposed method can accurately identify panicle pixels in UAV images taken under diverse conditions.