bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategi Kepala Sekolah dalam Meningkatkan Manajemen Pelayanan Khusus Madrasah (Studi Kasus Madrasah Ibtidaiyah Ma’arif Lengkong Sukorejo Ponorogo)
Authors: Ghafar Muhammad , Rochmawati Pryla , Ahmadi  , Kharisul Wathoni  , Aris Nurbawani
Published: January 2020

Artikel ini ingin menganalisi tentang strategi kepala sekolah dalam meningkatkan manajemen pelayanan khusus madrasah, konteks penelitian yang mendasari penelitian ini ialah karena Kualitas sekolah salah satunya ditentukan oleh peran dan kepemimpinan kepala sekolah, disamping karena ada kualitas guru dan manajemen organisasi yang baik yang menentukan sekolah berkualitas. Sekolah yang berkualitas diperlukan inovasi dalam manajemen pelayanan pendidikan, salah satu inovasi pelayanan pendidikan di MI Ma’arif Lengkong Sukorejo Ponorogo ialah adanya manajemen pelayanan khusus madrasah yaitu pelayanan khusus perpustakaan dan pelayanan khusus kesehatan di madrasah. Keberhasilan dari pelaksanaan manajemen pelayanan khusus ini salah satunya adalah adanya strategi kepala sekolah yang tepat sasaran.

Metode penelitian menggunakan pendekatan penelitian kualitatif dengan jenis penelitian studi kasus, sedangkan teknik pengambilan data  peneliti menggunakan teknik wawancara, observasi, dan dokumentasi. Selanjutnya analisis data peneliti menggunakan teknik analisis domain, analisis taksonomi, analisis komponen, dan analisis tema.

Temuan penelitian ini pertama, strategi kepala sekolah dalam meningkatkan manajemen pelayanan khusus perpustkaan melalui membangun budaya literasi sejak dini ialah 1) efektifitas manajemen pengelolaan perpustakaan sekolah, 2) pembuatan pedoman dan peraturan perpustakaan sekolah, 3) pekan berkunjung perpustakaan sekolah untuk menarik minat pengunjung dan pembaca di perpustakaan, 4) hiburan mencerdaskan melalui lomba bercerita yang diadakan di akhir setelah ujian tengah semester maupun setelah ujian akhir semester. Kedua, strategi kepala sekolah dalam meningkatkan manajemen pelayanan khusus kesehatan melalui kelas sehat adalah sebagaimana berikut: 1) memasang poster menjaga kesehatan setiap kelas, 2) kerjasama dengan puskesmas untuk memberikan penyuluhan pendidikan kesehatan, 3) membentuk unit kesehatan sekolah sebagai pusat pelayanan pertama bagi siswa dan guru, 4) mengadakan lomba kesehatan dan kebersihan setiap tahun sekali untuk membangun kesadaran dan motivasi dalam menjaga kesehatan
Peran Kepala Sekolah dalam Implementasi Pendidikan Karakter di MI Ma’arif Singosaren Jenangan Ponorogo
Authors: Muhammad Shulthon Rachmandhani
Published: January 2020

Artikel ini ingin menganalisis tentang peran kepala sekolah dalam implementasi pendidikan karakter di MI Ma’arif Singosaren Jenangan Ponorogo, dimana  MI Ma’arif Singosaren Jenangan Ponorogo merupakan satu-satunya MI yang terletak di lingkungan Singosaren. Madrasah ini didirikan karena semakin tingginya kesadaran masyarakat akan pentingnya Pendidikan Agama Islam.

Metode penelitian yang digunakan ialah pendekatan kualitatif dengan jenis penelitian studi kasus, dalam pengambilan data peneliti menggunakan metode wawancara, observasi, dan dokumentasi, sedangkan analisis data menggunakan teknik analisis data menggunakan teknik reduksi data, dan penyajian kesimpulan

Hasil penelitiannya ialah 1) peran kepala sekolah sebagai administrator adalah menentukan kurikulum yang diterapkan di MI Ma’arif Singosaren Jenangan Ponorogo. Kepala sekolah juga berupaya untuk terlibat dalam pengelolaan sarana prasarana di sekolah, yang mendukung dalam penerapan pendidikan karakter di MI Ma’arif Singosaren Jenangan Ponorogo. 2) peran kepala sekolah sebagai leader dengan mengadakan rapat melalui rapat. Kepala sekolah juga berusaha untuk meningkatkan kemauan siswa-siswi dalam menerapkan pendidikan karakter di sekolah, dengan mengingatkan kepada siswa-siswi akan pentingnya sikap saling menghormati kepada orang tua dan guru, serta saling berkasih sayang kepada sesama teman
The Relationship between Dietary Patterns and Depression is mediated by Serum Level of Folate and Vitamin B12: A Case-Control Study
Authors: Khosravi Maryam , Sotoudeh Gity , Amini Maryam , Raisi Firoozeh , Mansoori Anahita , Hosseinzadeh Mahdieh
Published: January 2020

Background: Major depressive disorder is among main worldwide causes of disability. The low medication compliance rates in depressed patients as well as the high recurrence rate of the disease can bring up the nutrition-related factors as a potential preventive or treatment agent for depression. The aim of this study was to investigate the association between dietary patterns and depression via the intermediary role of the serum folate and vitamin B12, total homocysteine, tryptophan, and tryptophan/competing amino acids ratio. Methods This was an individually matched case-control study in which 110 patients with depression and 220 healthy individuals, who completed a semi-quantitative food frequency questionnaire were recruited. In addition, to measure the serum biomarkers 43 patients with depression and 43 healthy people were randomly selected from the study population. To diagnose depression the criteria of Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were utilized. Results The findings suggest that the healthy dietary pattern was significantly associated with a reduced odds of depression (OR: 0.75; 95% CI: 0.61-0.93) whereas the unhealthy dietary pattern increased it (OR: 1.382, CI: 1.116–1.71). The mediation analysis showed that the healthy dietary pattern was associated with a reduced risk of depression via increased serum levels of the folate and vitamin B12; however, the unhealthy dietary pattern was associated with increased risk of depression via decreased serum levels of folate and vitamin B12, based on tree adjusted logistic regression models. Conclusion Dietary patterns may be associated with depression by changing the serum levels of folate and vitamin B12. Further studies are required to confirm the mechanism.
Admission pattern, Clinical outcomes and associated factors among patients admitted in medical intensive care unit at University of Gondar Comprehensive and specialized hospital, Northwest Ethiopia, 2019. A retrospective cross-sectional study.
Authors: Tessema Hailemariam Getachew , Lema Girmay Fitiwi , Mesfin Nebiyu , Fentie Demeke Yilkal , Arefaynie Nurhussien Rizke
Published: January 2020

The authors have withdrawn this preprint from Research Square
Therapeutic Iloprost for the treatment of acute respiratory distress syndrome (ARDS) (the ThIlo-Trial): a prospective, randomized, multicenter phase II study
Authors: Haeberle Helene Anna , Prohaska Stefanie , Martus Peter , Straub Andreas , Zarbock Alexander , Marx Gernot , Zago Monica , Giera Martin , Koeppen Michael , Rosenberger Peter
Published: January 2020

Background Acute respiratory distress syndrome (ARDS) is caused by rapid onset (within hours) acute inflammatory processes in lung tissue, and it is a life-threatening condition with high mortality. The treatment of ARDS to date is focused on the prevention of further iatrogenic damage of the lung rather than the treatment of the initial inflammatory process. Several preclinical studies have revealed a beneficial effect of iloprost on the control of pulmonary inflammation, and in a small number of ARDS patients, iloprost treatment resulted in improved oxygenation. Therefore, we plan to conduct a large multicenter trial to evaluate the effect of iloprost on ARDS. Methods The Therapeutic Iloprost during ARDS ( ThIIo-Trial) is a multicenter, randomized, clinical phase II trial assessing the efficacy of inhaled Iloprost for the prevention of the development and progression of ARDS in critically ill patients. One hundred fifty critically ill patients suffering from acute ARDS will be treated either by nebulized iloprost or NaCl 0.9% for 5 days. Blood samples will be drawn at defined time points to elucidate the serum levels of iloprost and inflammatory markers during treatment. Mechanical ventilation will be standardized. In follow-up visits at days 28 and 90 as well as 6 months after enrollment, functional status according to the Barthel Index, a health care-related questionnaire and frailty (Vulnerable Elderly Survey) will be evaluated. The primary endpoint is the improvement of oxygenation, defined as the ratio of PaO 2 /FiO 2 . Secondary endpoints include 90-day all-cause mortality, SOFA scores during the study period up to day 90, the duration of mechanical ventilation, the length of ICU stay, ventilator-associated pneumonia, delirium, ICU-acquired weakness and discharge localization. The study will be conducted in three university ARDS centers in Germany. Discussion The results of the ThIlo-Trial will highlight the anti-inflammatory effect of iloprost on early inflammatory processes during ARDS, resulting in the improvement of outcome parameters in ARDS patients.
Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population
Authors: Xing Xiufang , Bai Yongyu , Sun Kai , Yan Min
Published: January 2020

Background: Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS. Methods: Twenty-eight single nucleotide polymorphisms (SNPs) among 18 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia. Results: The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPs among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 (SCN11A), rs6795970 (SCN10A), and 3312G>T (SCN9A) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 (SCN11A) have lower risk experiencing inadequate analgesia. Conclusions: We identified that SNPs in SCN9A, SCN10A, and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.Trial registration: This study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03916120) on April 16, 2019.
A nurse-led health coaching intervention for stroke survivors and their family caregivers in hospital to home transition care in Chongqing, China: a study protocol for a randomized controlled trial
Authors: Xiao Lily , Lin Shuanglan , Chamberlain Diane
Published: January 2020

Background Hospital to home transition care is a most stressful period for stroke survivors and their caregivers to learn self-management of stroke-related health conditions and to engage in rehabilitation. Health coaching has been identified as a strategy to enhance self-management of poststroke care at home. However, interventions in this field that are informed by a health coaching framework are scarce. This study will address a gap in research by testing the hypothesis that a nurse-led health coaching intervention can improve health outcomes for stroke survivors and their family caregivers in hospital to home transition care. Methods This is a single-blind, two-arm parallel randomized controlled trial of a nurse-led health coaching program versus routine care situated in two tertiary hospitals in Chongqing, China. Stroke survivors and their primary family caregivers will be recruited together as “participant dyads”, and the estimated sample size is 140 (70 in each group). The intervention includes a 12-week nurse-led health coaching program in hospital to home transition care commencing at discharge from the hospital. The primary outcomes are changes in self-efficacy and quality of life of stroke survivors at 12 weeks from the baseline. The secondary outcomes are changes in stroke survivors’ functional ability, stroke-related knowledge, the number of adverse events, and unplanned hospital admissions, and caregivers’ self-efficacy and caregiver-related burden at 12 weeks from the baseline. The outcomes will be measured at 12 weeks and 24 weeks from the baseline. Discussion This study will examine the effect of nurse-led health coaching on hospital to home transition care for stroke survivors and their caregivers. It is anticipated that findings from this trial will provide research evidence to inform policy, and resource and practice development to improve hospital to home transition care for stroke survivors and their caregivers.
How many words are Australian children hearing in the first year of life?
Authors: Brushe Mary E , Lynch John W. , Reilly Sheena , Melhuish Edward , Brinkman Sally A.
Published: January 2020

Background: There is evidence that parents from more socioeconomically disadvantaged backgrounds engage in fewer verbal interactions with their child than more advantaged parents. This leads to the so-called, ‘30 million-word gap’. Methods: We used improved technology to investigate the number of words children hear in their first year of life. Mothers were recruited into a five-year prospective cohort study and categorized into either high or low maternal education groups. Data was derived from the first two waves of the study, when the children were six and twelve months old. At both waves, children were involved in day-long audio recordings using the Language Environment Analysis software that provided automatic counts of adult words spoken to the child, child vocalizations and conversational turns. Descriptive results are presented by maternal education groups. Results: There was large variation within each maternal education group, with the number of adult words spoken to the child ranging from 2,958 to 39,583 at six months and 4,389 to 45,849 at twelve months. There were no meaningful differences between adult words, child vocalizations or conversational turns across maternal education groups at either wave of data collection. Conclusions: These results show that a word gap related to maternal education is not apparent up to twelve months of age. The large variability among both maternal education groups suggests that universal interventions that encourage all parents to talk more to their child may be more appropriate than interventions targeted towards disadvantaged families during the first year of life.
Patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma after first-line treatment with surgery and/or intensity-modulated radiotherapy
Authors: Wang Dongqing , Yu Shui , Zhai Limin , Xu Jin , Li Baosheng
Published: January 2020

Background: To identify the spatial patterns of regional lymph node failure of locally advanced hypopharyngeal squamous cell carcinoma (SCC) after first-line treatment with surgery and/or intensity-modulated radiotherapy (IMRT).Methods: We retrospectively obtained the clinicopathological characters of 123 hypopharyngeal SCC patients, and investigated the patterns of regional lymph node failure. Univariate and multivariate logistic regression were used to determine the risk factors of regional lymph node failure.Results: Forty patients (32.5% of total patients) were suffered regional lymph node failure. In these patients, the ipsilateral neck level II nodal failure account for 55.0% (22/40) followed by level III 30.0% (12/40), level VIb 15.0% (6/40), level VII 15.0% (6/40), and level IV 5.0% (2/40). In addition, 17.5% (7/40) patients suffered contralateral neck level II nodal failure and 7.5% (3/40) patients suffered level III nodal failure. The common failure levels were the II (7/46, 15.2%), III (4/46, 8.7%), VIb (4/46, 8.7%), and VII (5/46, 10.9%) for treatment by surgery. The lymph node recurrence and persistent disease at levels II (19/77, 24.7%) and III (10/77, 13.0%) remained the major cause of failure following curative intent of IMRT. The postoperative radiation significantly decreased the risk of regional lymph node failure (OR=0.082, 95% CI: 0.007–1.000, P=0.049); and the radiologic extranodal extension significantly increased the risk of regional lymph node failure (OR=11.07, 95% CI: 2.870–42.69, P<0.001).Conclusions: Whatever the treatment modality, the lymph node failure at level II and III was the most popular pattern for hypopharyngeal SCC. Moreover, for patients who underwent surgery, the nodal failure at level VIb and VII was frequent. Thus, postoperative radiation of level VIb and VII may give rise to benefit to locally advanced hypopharyngeal SCC patients.
Primary care service use by end-of-life cancer patients: a nationwide population-based cohort study in the United Kingdom
Authors: Gao Wei , Gulliford Martin , Morgan Myfanwy , Higginson Irene J
Published: January 2020

Background End of life(EoL) care becomes more complex and increasingly takes place in the community, but there is little data on the use of general practice(GP) services to guide care improvement. This study aims to determine the trends and factors associated with GP consultation, prescribing and referral to other care services amongst cancer patients in the last year of life. Methods A retrospective cohort study of cancer patients who died in 2000-2014, based on routinely collected primary care data(the Clinical Practice Research DataLink, CPRD) covering a representative sample of the population in the United Kingdom. Outcome variables were number of GP consultations(primary), number of prescriptions and referral to other care services(yes vs no) in the last year of life. Explanatory variables included socio-demographics, clinical characteristics and the status of palliative care needs recognised or not. The association between outcome and explanatory variables were evaluated using multiple-adjusted risk ratio(aRR). Results Of 68,523 terminal cancer patients, 70% were aged 70+, 75% had comorbidities and 45.5% had palliative care needs recognised. In the last year of life, a typical cancer patient had 43 GP consultations(Standard deviation(SD): 31.7; total=3,031,734), 71.5 prescriptions(SD: 68.0; total=5,074,178), and 21(SD: 13.0) different drugs; 58.0% of patients had at least one referral covering all main clinical specialities. More comorbid conditions, prostate cancer and having palliative care needs recognised were associated with more primary care consultations, more prescriptions and a higher chance of referral(aRRs 1.07-2.03). Increasing age was related to fewer consultations(aRRs 0.77-0.96), less prescriptions(aRR 1.09-1.44), and a higher chance of referral(aRRs 1.08-1.16) but less likely to have palliative care needs recognised(aRRs 0.53-0.89). Conclusions GPs are very involved in end of life care of cancer patients, most of whom having complex care needs, i.e. older age, comorbidity and polypharmacy. This highlights the importance of enhancing primary palliative care skills among GPs and the imperative of greater integration of primary care with other healthcare professionals including oncologists, palliative care specialists, geriatricians and pharmacists. Research into the potential of deprescribing is warranted. Older patients have poorer access to both primary care and palliative care need to be addressed in future practices.
Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis
Authors: Tenorio Carmen Hidalgo , Gálvez Juan , Martínez-Marcos Francisco Javier , Plata-Ciezar Antonio , Torre-Lima Javier De La , López-Cortés Luis Eduardo , Noureddine Mariam , Reguera José M. , Vinuesa David , García Maria Victoria , Ojeda Guillermo , Luque Rafael , Lomas José Manuel , Lepe Jose Antonio , de Alarcón Arístides
Published: January 2020

Background: S. aureus(SA) infective endocarditis (IE)has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistantversusmethicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values >1 ug/mL to MRSA. Methods: Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results: We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41-7.23), invasive procedures, or recognized infection focus in the three months before IE onset (OR 2.9; 95% CI 1.14-7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64-9.5) was observed in patients with MRSA versusMSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985-1999) (OR 8.391; 95% CI (2.82-24.9); 2000-2009 (OR 6.4; 95% CI 2.92-14.06); active neoplasm (OR 6.63; 95% CI 1.7-25.5) and sepsis (OR 2.28; 95% CI 1.053-4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p= 0.32). Conclusion:MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin.Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.
Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.
Authors: Iflaifel Mais HM , Lim Rosemary , Ryan Kath M , Crowley Clare
Published: January 2020

Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups) and indirect (e.g. observations). Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, as well as in the methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
Astrocyte-derived exosomes enriched with miR-873a-5p inhibit neuroinflammation via microglia phenotype modulation after traumatic brain injury
Authors: long xiaobing , Yao Xiaolong , Jiang Qian , Yang Yiping , He Xuejun , Tian Weidong , zhao kai , Zhang Huaqiu
Published: January 2020

Background: The interaction between astrocytes and microglia plays a vital role in the damage and repair of brain lesions due to traumatic brain injury (TBI). Recent studies have shown that exosomes act as potent mediators involved in intercellular communication. Methods: In the current study, the expression of inflammatory factors and miR-873a-5p in the lesion area and edema area was evaluated in 15 patients with traumatic brain injury. Exosomes secreted by astrocytes were detected by immunofluorescence, Western blot, and electron microscopy. A mouse model of TBI and an in vitro model of lps-induced primary microglia were established to study the protective mechanism of exosomes from miR-873a-5p-overexpressing in TBI-induced nerve injury.Results: We discovered that exosomes derived from activated astrocytes promote microglial M2 phenotype transformation following TBI. More than 100 miRNAs were detected in these astrocyte-derived exosomes. miR-873a-5p is a major component that was highly expressed in human traumatic brain tissue. Moreover, miR-873a-5p significantly inhibited LPS-induced microglial M1 phenotype transformation and the subsequent inflammation through decreased phosphorylation of ERK and NF-κB p65. This effect also greatly improved the mNSS score and attenuated brain injury in a strictly controlled cortical impact mouse model. Conclusions: Taken together, our research indicates that miRNAs in the exosomes derived from activated astrocytes play a key role in the astrocyte-microglia interaction. miR-873a-5p, as one of the main components of these astrocyte-derived exosomes, attenuated microglia-mediated neuroinflammation and improved neurological deficits following TBI by inhibiting the NF-kB signalling pathway. These findings suggest a potential role for miR-873a-5p in treating traumatic brain injury.
Urological Aspects (Dynamic Bladder and Urethral Function, Urinary Tract Stones and Calcifications) in Patients with Alkaptonuria: A Case Control Study
Authors: Suoub Mohammed , Al-Sbou Mohammed , Sawaqed Fadi
Published: January 2020

Background The main objective of this study is to evaluate bladder, prostate and proximal urethral dynamic function and also to evaluate urinary tract stones and calcifications in patients with alkaptonuria.Methods Thirty-eight patients were prospectively divided into two groups. Study group (A) involved 17 patients of an average age of 42 years (30–63 years). Control group (B) involved 21 patients of an average age of 37 years (31–62 years). All patients from the two groups underwent uroflowmetry assessment (peak flow rate, shape of the flow rate chart and voided volume) and ultrasonography for the kidneys and urinary bladder for two phases (full bladder and empty bladder). Finally, all patients had their prostate gland assessed in regard to calcification, prostatic stones and prostatic urethral stones.Results Group A—Bladder volume ranged between 400 and 520 cc. The peak flow rate was between 7 and 23 ml/sec, with an average of 18.6 ml/sec. Flow rate curves shape were acceptable to normal bell shape curve in 11 patients. Seven patients (41%) had prostate calcification of 5–35% of prostate size.Group B Bladder volume ranged between 290 and 510 cc. The peak flow rate was 8–27 cc/sec with an average of 20 ml/sec. Normal bill shape voiding curves were observed in 17 patients (80%). Four patients (19%) had prostate calcification of 2–12% of prostate size. Renal measurements on ultrasonography were the same in both groups.Conclusion Patients with Alkaptonuria had a slightly reduced peak urinary flow rate compared to the normal control group, but this was not statistically significant. The incidence of prostatic calcification was higher in alkaptonuria patients and they tended to develop prostate calcification at an earlier age than the control group. Regular urological assessment is recommended for all patients with alkaptonuria over the age of 30 years to detect early urological symptoms of the disease.
Cefaclor as a first-line treatment for acute uncomplicated cystitis
Authors: Koguchi Dai , Murakami Yasukiyo , Ikeda Masaomi , Dobashi Masato , Ishii Junichiro
Published: January 2020

Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli-ESBL.Conclusion: Cefaclor showed an excellent efficacy in AUC patients, even in those with resistance to cefazolin or levofloxacin. Cefaclor has the potential to be the first-line and second-line therapies for patients with levofloxacin treatment failure.
Diagnosis of vascular invasion in pancreatic ductal adenocarcinoma using endoscopic ultrasound elastography
Authors: Yamada Kenta , Kawashima Hiroki , Ohno Eizaburo , Ishikawa Takuya , Tanaka Hiroyuki , Nakamura Masanao , Miyahara Ryoji , Ishigami Masatoshi , Hirooka Yoshiki , Fujishiro Mitsuhiro
Published: January 2020

Background Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC. Methods The subjects were 58 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. Results In 58 subjects (62 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.787 and 0.774 on dynamic CT (62 sites); 0.733, 0.787 and 0.774 in EUS B-mode (62 sites); and 0.917, 0.889 and 0.897 in EUS-EG (39 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG. Conclusions These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.
The efficacy of Bifidobacterium bifidum G9-1 in improving quality of life in patients with chronic constipation
Authors: Fuyuki Akiko , Higurashi Takuma , Kessoku Takaomi , Ashikari Keiichi , Yoshihara Tsutomu , Misawa Noboru , Iwaki Michihiro , Kobayashi Takashi , Ohkubo Hidenori , Yoneda Masato , Usuda Haruki , Wada Koichiro , Nakajima Atsushi
Published: January 2020

Background: Chronic constipation is a functional disorder that decreases patient’s quality of life (QOL). Because dysbiosis has been associated with constipation, we aimed to investigate the efficacy of Bifidobacterium bifidum G9-1 (BBG9-1) in improving QOL in constipated patients. Methods: This was a prospective, single-center, non-blinded, single-arm, feasibility trial. A total of 31 patients received BBG9-1 treatment for 8 weeks, followed by a 2-week washout period. The primary endpoint was the change in the overall Patient Assessment of Constipation of QOL (PAC-QOL) score relative to that at the baseline after probiotic administration. Secondary endpoints included changes in intestinal flora, stool consistency, frequency of bowel movement, degree of straining, sensation of incomplete evacuation, and frequency of rescue drug use. Results: The overall PAC-QOL scores and frequency of bowel movement were significantly improved after BBG9-1 administration compared to those at baseline (p < 0.05, p < 0.05, respectively). There were no statistically significant changes in other clinical symptoms. Subset analysis revealed that patients with the initial Bristol Stool Form Scale of < 4 had improvements in stool consistency, a significant increase in the frequency of their bowel movements, and a significant alleviation in their degree of straining following BBG9-1 administration. Sarcina at the genus level and Sarcina maxima at the species level were significantly increased. Functional analysis showed that butanoate metabolism increased significantly, whereas methane metabolism decreased significantly. Conclusions: BBG9-1 is safe and improves the QOL of constipated patients. The underlying improvements may be due to changes in stool consistency. Trial registration: UMIN 000029969. Registered 15 November 2017, https://www.umin.ac.jp/
The Effect of On-site CT-derived Fractional Flow Reserve on the Management of Decision Making for Patients with Stable Chest Pain (TARGET Trial): Objective, Rationale and Design
Authors: yang junjie , shan dongkai , wang zhiqiang , dong mei , ma xiang , hu xinyang , zeng hesong , chen yundai
Published: January 2020

Background: The diagnostic accuracy of CT-derived Fractional Flow Reserve (CT-FFR) in clinical application has been well validated. This advanced technology focus on evaluating anatomical stenosis and functional ischemia simultaneously. However, the effect of CT-FFR on the management of decision making has not been fully evaluated in randomized controlled design. Method/design: TARGET study is a pragmatic, multicentre, prospective, open-label and randomized controlled trial evaluating the effect of a CTA/CT-FFR strategy (Group A) versus usual care (Group B) on intermediate-to-high risk patients with suspected CAD who undergo clinically indicated diagnostic evaluation. A total sample size of 1216 subjects will be enrolled and followed up for 12 months. This study will be performed in 6 Chinese hospitals, and the primary endpoint is the planned ICA without significant obstructive CAD within 90 days. The secondary endpoints include major adverse cardiovascular event, quality of life, medical expenditure, and cumulative radiation exposure during 1-year follow-up. Conclusion: The study will provide information to patients, health care providers and other stakeholders in China about which strategy could be more effective in the management of intermediate-to-high risk patients with suspect CAD. Trial registration: ClinicalTrials.gov, NCT03901326, Registered on 03 April 2019.
Association of Subclinical Hypothyroidism and Dyslipidemia in Children and Adolescents
Authors: Habib Ashkan , Habib Asadollah
Published: January 2020

Background: Correlation of higher levels of TSH and dyslipidemia in children is controversial. This study was designed to assess the relation between lipid profile components and TSH levels in children. Method: This cross-sectional study was performed in a growth assessment clinic in Shiraz. Children aged between 2 to 18 years that came to the clinic from January till April 2018 were considered. TSH levels equal or above 5 and lower than 10 mIU/L with normal FT4 were considered as subclinical hypothyroidism. Results: 666 children were euthyroid while 181 had subclinical hypothyroidism. Mean total cholesterol in euthyroid children was 160.50 ± 29.070 mg/dl and in SH group 161.39 ± 28.694 mg/dl (P=0.713). Mean LDL-C in euthyroid children was 90.96 ± 24.996 mg/dl and in SH group 89.10 ± 23.852 mg/dl (P=0.369). Mean HDL-C in euthyroid children was 47.94 ± 10.560 mg/dl and in SH group 49.04 ± 10.361 mg/dl. (P=0.211). Mean non HDL-C in euthyroid children was 112.56 ± 27.696 mg/dl and in SH group 112.35 ± 28.136 mg/dl. (P=0.929). Mean triglyceride in euthyroid children was 104.98 ± 54.934 mg/dl and in SH group 113.83 ± 91.342 mg/dl (P=0.215). There was no significant difference in mean serum total cholesterol, LDL, HDL, non-HDL and triglyceride levels between euthyroid and subclinical hypothyroid. Adjusted correlation was not significant between TSH levels and any lipid profile component. Conclusion: By comparing the results of this study with other studies, it is evident that lipid disorder in subclinical hypothyroid children does not have a specific pattern.
Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa
Authors: Kigozi Gladys , Heunis Christo , Engelbrecht Michelle
Published: January 2020

BackgroundSouth Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing deficiencies. In addition to facilitating linkages between communities and primary health care (PHC) facilities, CHWs are entrusted with a range of crucial tuberculosis (TB), HIV/AIDS and maternal health services. As increased access to quality service delivery hinges upon their motivation, this study investigated CHWs’ motivation to deliver systematic household contact TB investigation (SHCI).MethodsIn 2017, a cross-sectional survey was conducted among CHWs enrolled in the ward-based PHC outreach teams in the Mangaung Metropolitan District. Descriptive, exploratory factor analysis and multiple linear regression analysis were conducted to establish the dimensions, levels and determinants of CHW motivation. Statistical significance was determined at p ≤ 0.05.ResultsOut of 235 participants, the majority were female (89.2%). Participants’ median age was 39 (inter-quartile range: 33-45) years. Job satisfaction, burnout and team commitment characterised CHW motivation or lack thereof, together explaining 56.04% of the total variance, with a mean score of 51.59 (standard deviation: 5.14) out of 64. The full scale showed satisfactory internal consistency (Cronbach α: 0.734). The individual sub-scales also had acceptable internal consistency (Cronbach α—job satisfaction: 0.83; burnout: 0.83; and team commitment: 0.73). CHW category (i.e. formal — with at least phase 1 of standardised training vs. informal — with non-standardised training) and TB SHCI training and knowledge significantly influenced CHW motivation. Formal CHWs scored twice higher (β = 2.020; p = 0.009) than informal CHWs on the motivation scale. Motivation scores increased by 0.841 (p = 0.007) times with every unit increase in CHW TB SHCI knowledge. Scores were more than twice lower (β = -2.289; p = 0.003) among CHWs who did not attend TB SHCI training than those who did.ConclusionThe high mean score implies that the CHWs were motivated to perform TB SHCI. The TB programme in the Free State should ensure sustained CHW motivation to effect improved access to quality TB SHCI service provision. To this end, the TB programme should pay close attention to the CHWs’ formalisation, TB knowledge and training.
MicroRNA-21 inhibitor (miR-21i) and Simvastatin-loaded poly (D,L-lactide-co-glycolide)/polyethylenimine (PLGA/PEI) nanoparticles for synergistic anticancer effect in Gastric Cancers
Authors: Liu Yuxia , Yang Bin , Zhang Lirong , Cong Xianling , Liu Hongyu , Yu Mengxi , Song Bin
Published: January 2020

In this study, we have successfully developed a simvastatin (SMV) and miR-21i-loaded poly (D,L-lactide-co-glycolide)/polyethylenimine (PLGA/PEI) nanoparticles (NP) to enhance the therapeutic efficacy in gastric cancers. The nanoparticles were characterized for in vitro physicochemical and biological assays and pharmacokinetic study was performed in rats. CLSM/FACS results clearly showed the ability of SMV/miR-21i-loaded PLGA/PEI NP (PPN-S21i) to deliver the combinational therapeutics of SMV and miR-21i to the cancer cells. Combination of SMV+miR-21i showed significantly lower cell viability compared to that of free SMV. Our results clearly highlight the importance of simultaneous interaction of SMV+miR-21i and that it could significantly decrease the cell proliferation in BGC-823, SGC-7901 and HGC-27 gastric cancer cells while it was significantly less cytotoxic to normal gastric mucosa cells (GES-1). Cell apoptosis of SMV+miR-21i was significantly higher compared to that of individual drug or miRNA. Finally, pharmacokinetic analysis revealed that PPN-S21i significantly prolonged the blood circulation time of SMV compared to that of free SMV indicating the potential of carrier system. Overall, results clearly indicate that the combination of SMV+miR-21i (gene + drug therapy) might provide a valuable strategy for the clinical management of gastric cancers.
Immunogenicity analysis of conserved fragments in Plasmodium ovale merozoite surface protein 4
Authors: Juliette Uwase , Chu Ruilin , Kassegne Kokouvi , Lei Yao , Shen Feihu , Fu Haitian , Sun Yifan , Xuan Yinghua , Cao Jun , Cheng Yang
Published: January 2020

Background: An effective vaccine to control and eradicate malaria, one of the most serious global infectious diseases, is an urgent need. Plasmodium merozoite surface protein 4 (MSP4) has been listed as a blood-stage subunit vaccine candidate for malaria. Plasmodium ovale infection is also a source of malaria burden in tropical regions where it is sometimes mixed with other Plasmodium species. However, little is known about P. ovale MSP4. Methods: The msp4 gene was amplified through polymerase chain reaction using genomic DNA extracted from blood samples of 46 patients infected with P. ovale and then sequenced. Open reading frames predicted as immunogenic peptides consisting of 119 and 97 amino acids of P. ovale curtisi MSP4 (PocMSP4) and P. ovale wallikeri MSP4 (PowMSP4), respectively, were selected for protein expression. Recombinant proteins (rPoMSP4) were expressed in Escherichia coli, purified, analyzed, and immunized in BALB/c mice. The specificity of anti-MSP4-immunoglubulin (Ig) G antibodies was evaluated by Western blot and enzyme-linked immunosorbent assays, and cellular immune responses were analyzed via lymphocyte proliferation assays.Results: Full peptide sequences of PocMSP4 and PowMSP4 were completely conserved in all clinical isolates, except in the epidermal growth factor-like domain at the carboxyl terminus where only one mutation was observed in one P. ovale wallikeri isolate. Furthermore, we successfully expressed the truncated pocmsp4 and powmsp4 and purified as ~32 kDa proteins. Our results showed that PocMSP4 and PowMSP4 induced high antibody responses with end-point titers ranging from 1:2,560,000 to 1:10,000 in all immunized mouse groups and with high IgG avidity to PocMSP4 (80.5%) and PowMSP4 (92.3%). Furthermore, rPocMSP4 and rPowMSP4 cross-reacted with anti-PowMSP4-specific or anti-PocMSP4-specific antibodies. Additionally, anti-PoMSP4 IgG antibodies showed broad immuno-specificity in reacting against rPoMSP1 and rPoAMA1. Lastly, PocMSP4- and PowMSP4-immunized mice induced cellular immune responses with PocMSP4 (36%) and PowMSP4 cells (15.8%) as observed through splenocyte proliferation assays. Conclusion: Our study suggested conservation in PoMSP4 protein sequences with high immunogenicity. Furthermore, PocMSP4- and PowMSP4-immunized mice induced cellular immune responses, suggesting that both humoral and cellular immune responses play crucial roles in the protection against any antigen.
Revisiting the Plant CLE Gene Family with a New Method for Predicting and Clustering Short Amino Acid Sequences
Authors: Zhang Zhe , Liu Lei , Kucukoglu Melis , Tian Dongdong , Larkin Robert M. , Shi Xueping , Zheng Bo
Published: January 2020

Background: The CLV3 / ESR-RELATED ( CLE ) gene family encodes small secreted peptides (SSPs) and plays vital roles in plant growth and development through cell-to-cell communication. The prediction and classification of CLE genes is challenging because of their low sequence similarity. Results: We developed a machine learning-aided method for predicting CLE genes by using a CLE motif-specific residual score matrix and a novel clustering method based on the Euclidean distance of the 12 amino acid residues from CLE motifs in a site-weight dependent manner. In total, 2156 CLE candidates—including 627 novel candidates—were predicted from 69 plant species. The results from our CLE motif-based clustering are consistent with previous reports using the entire pre-propeptide. Characterization of CLE candidates provided systematic statistics on protein lengths, signal peptides, relative motif positions, amino acid compositions of different parts of the CLE precursor proteins, and decisive factors of CLE prediction. The approach taken here provides information on the evolution of the CLE gene family and provides evidence that the CLE and IDA/IDL genes share a common ancestor. Conclusions: Our new approach is applicable to SSPs or other proteins with short conserved domains and hence, provides a useful tool for gene prediction, classification and evolutionary analysis.
Enhancement of nursing students’ moral competencies through support the formation of professional identity
Authors: Haghighat sahar , borhani fariba , ranjbar hadi
Published: January 2020

Background: Moral care provision is an essential part of nursing work. Nursing schools are responsible for developing moral competencies in nursing students. The aim of this study was to assess the relationship between the formation of professional identity and development of morality in nursing students. Methods: This study was designed as a descriptive-correlational study. The study population consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS). Results: The mean (SD) of MDSP and PISNS scores were 45.69±5.90 and 55.61±12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p<0.05). A significant equation was found (f (2, 218) = 16.68, p<0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students. Conclusions: There was a significant correlation between the formation of professional identity and development of morality in nursing students. By supporting the formation of professional identity, nursing schools can help the development of moral competencies in nursing students.