bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart Disease in a Mutant Mouse Model of Spontaneous Eosinophilic Myocarditis Maps to Three Loci
Authors: Zimmermann Nives , Gibbons William J. , Homan Shelli M. , Prows Daniel R
Published: October 2019

Background: Heart disease (HD) is the major cause of morbidity and mortality in patients with hypereosinophilic diseases. Due to a lack of adequate animal models, our understanding of the pathophysiology of eosinophil-mediated diseases with heart complications is limited. We have discovered a mouse mutant, now maintained on an A/J inbred background, that spontaneously develops hypereosinophilia in multiple organs. Cellular infiltration into the heart causes an eosinophilic myocarditis, with affected mice of the mutant line ( i.e., A/J HD ) demonstrating extensive myocardial damage and remodeling that leads to HD and premature death, usually by 15-weeks old.

Results: Maintaining the A/J HD line for many generations established that the HD trait was heritable and implied the mode of inheritance was not too complex. Backcross and intercross populations generated from mating A/J HD males with females from four different inbred strains produced recombinant populations with highly variable rates of affected offspring, ranging from none in C57BL/6J intercrosses, to a few mice with HD using 129S1/SvImJ intercrosses and C57BL/6J backcrosses, but nearly 8% of intercrosses and >17% of backcrosses from SJL/J related populations developed HD. Linkage analyses of these SJL/J derived recombinants identified three highly significant loci: a recessive locus mapping to distal chromosome 5 (LOD=4.88; named Emhd1 for E osinophilic m yocarditis to h eart d isease- 1 ); and two dominant variants mapping to chromosome 17, one ( Emhd2 ; LOD=7.51) proximal to the major histocompatibility complex, and a second ( Emhd3 ; LOD=6.89) that includes the major histocompatibility region. Haplotype analysis identified the specific crossovers that defined the Emhd1 (2.65Mb), Emhd2 (8.46Mb) and Emhd3 (14.59Mb) intervals.

Conclusions: These results indicate the HD trait in this mutant mouse model of eosinophilic myocarditis is oligogenic with variable penetrance, due to multiple segregating variants and possibly additional genetic or nongenetic factors. The A/J HD mouse model represents a unique and valuable resource to understand the interplay of causal factors that underlie the pathology of this newly discovered eosinophil-associated disease with cardiac complications.
Recovery of non-reference sequences missing from the human reference genome
Authors: Li Ran , Tian Xiaomeng , Yang Peng , Fan Yingzhi , Li Ming , Zheng Hongxiang , Wang Xihong , Jiang Yu
Published: October 2019

Background
The non-reference sequences (NRS) represent structure variations in human genome with potential functional significance. However, besides the known insertions, it is currently unknown whether other types of structure variations with NRS exist.
Results
Here, we compared 31 human de novo assemblies with the current reference genome to identify the NRS and their location. We resolved the precise location of 6,113 NRS adding up to 12.8 Mb. Besides 1,571 insertions, we detected 3,041 alternate alleles, which were defined as having less than 90% (or none) identity with the reference alleles. These alternate alleles overlapped with 1,143 protein-coding genes including a putative novel MHC haplotype. Further, we demonstrated that the alternate alleles and their flanking regions had high content of tandem repeats, indicating that their origin was associated with tandem repeats.
Conclusions
Our study detected a large number of NRS including many alternate alleles which are previously uncharacterized. We suggested that the origin of alternate alleles was associated with tandem repeats. Our results enriched the spectrum of genetic variations in human genome.
Effect of lymph node dissection on stage-specific survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy
Authors: Zhai Ting-Shuai , Jin Liang , Zhou Zhen , Liu Xiang , Liu Huan , Chen Wei , Lu Jing-Yi , Yao Xu-Dong , Feng Li-Ming , Ye Lin
Published: October 2019

Objectives To estimate the stage-specific impact of lymph node dissection (LND) on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).
Methods Overall, 7278 UTUC patients undergoing NU within the SEER database from 2004 to 2015 were identified. Kaplan-Meier plots illustrated overall survival (OS) and cancer-specific survival (CSS) rates according to LND status. Multivariable Cox regression analyses assessed the effect of LND on OS and CSS rates stratified by pathological tumor stage.
Results LND was performed in 26.9% of patients, and in 18.6, 23.3, 31.2 and 45.9% for pT1, pT2, pT3 and pT4 patients, respectively (P < 0.001). In multivariable Cox regression analyses, LND was associated with a higher OS or CSS in UTUC patients with pT3 and pT4 disease (all P < 0.05), but failed to achieve independent predictor status in patients with pT1 and pT2 disease (all P > 0.05). LND with 1 to 3 regional lymph nodes removed was prone to a higher OS or CSS only in pT4 compared to no LND (both P < 0.01). LND with 4 or more regional lymph nodes removed predisposed to a higher OS or CSS in pT3 or pT4 (all P < 0.05).
Conclusion The beneficial effect of LND especially LND with 4 or more regional lymph nodes removed on survival was evident in pT3/4 patients. LND can be considered for pT3 and pT4, for pT1/2 remains to be seen, both of which will be verified by further prospective studies.
Prevalence and Associated Factors of Bronchial Asthma among Adult Patients in Debre Berhan Referral Hospital, Ethiopia 2018: A cross-sectional study
Authors: Tegegnework Sisay , Muhamud Sindew , Demelash Alebachew
Published: October 2019

Abstract
Objective
Bronchial asthma is one of the major public health challenges throughout the world that negatively impact patients, families and community. The objective of this study was to assess the prevalence and associated risk factors of bronchial asthma among patients in adult emergency department of Debre Berhan Referral Hospital. A hospital based cross-sectional study design was used among 257 study participants. A systematic sampling technique was used to select the study participants. Data was collected by using pretested and structured questionnaire and analyzed by using SPSS version 20.0. Both bivariate and multivariate logistic regression model was used to identify the predictors of asthma.
Results
Prevalence of bronchial asthma among adult patients was 29.6%. Being an urban resident (AOR: 1.5: 95%CI: 1.3 - 3.9), income of household less than 1000 EBr/ month (AOR: 1.7: 95%CI: 1.6 - 4.1), having family history of asthma (AOR: 2.7: 95%CI: 1.3 - 5.8), and presence of vermin in the house (AOR: 2.4: 95%CI: 1.2 – 4.7) were significantly associated with bronchial asthma. The authors concluded that the prevalence of bronchial asthma among adult patients was high. Therefore, educational program about the risk factors and preventive measures of asthma is highly recommended.
Objectively-measured physical activity patterns and longitudinal weight category status in a rural setting
Authors: Cook Ian
Published: October 2019

Objectives: To investigate the relationship between longitudinal weight-change and objectively-measured physical activity (PA) in a rural African setting in 143 adults (≥30 years), using data from two cross-sectional surveys, separated by approximately ten years. Participants were categorised into three weight-change groups (Weight-loss: ≥25 kg.m-2→<25 kg.m-2; Weight-gain: <25 kg.m-2→≥25 kg.m-2; Weight-stability: remained <25 kg.m-2 or ≥25 kg.m-2). Daily ambulation and activity energy expenditure (AEE), measured in the 2005-7 health survey, was examined across the weight-change groups. Using the daily AEE data, the proportion of those in the weight-change groups, meeting or not meeting two PA guidelines (150- and 420 min.wk-1), was examined.
Results: Weight-change was found in 18.2% of the sample. There was no significant overall body mass change (+1.2 kg, p=0.1616). However, there was significant change in body mass in the weight-gain (+15.2 kg) and weight-loss (-10.8 kg) groups (p≤0.0011). Nearly 90% of those who gained weight met the 150 min.wk-1 guideline. A significantly greater proportion of the weight-stable group (<25 kg.m-2) met the 420 min.wk-1 guideline (p<0.05). Ambulatory level was high irrespective of weight group, although the weight-stable group (<25 kg.m-2) approached 15 000 steps.day-1. There was an inconsistent and weak association between PA and weight-change in this group.
HCV and HBV prevalence based on home blood self-sampling and screening history in the general population in 2016: contribution to the new French screening strategy
Authors: Brouard Cécile , Saboni Leïla , Gautier Arnaud , Chevaliez Stéphane , Rahib Delphine , Richard Jean-Baptiste , Barin Francis , Larsen Christine , Sommen Cécile , Pillonel Josiane , Delarocque-Astagneau Elisabeth , Lydié Nathalie , Lot Florence
Published: October 2019

Background: The advent of effective direct-acting antivirals (DAAs), has prompted an assessment of the French Hepatitis C virus (HCV) screening strategy, which historically targeted high-risk groups. One of the options put forward is the implementation of combined (i.e., simultaneous) HCV, Hepatitis B virus (HBV) and HIV screening for all adults at least once during their lifetime (“universal combined screening”). However, recent national survey-based data are lacking to guide decision-making regarding which new strategy to implement. Accordingly, we aimed to provide updated data for both chronic hepatitis C (CHC) and B (CHB) prevalence and for HCV and HBV screening history, using data from the BaroTest and 2016 Health Barometer (2016-HB) studies, respectively.

Methods: 2016-HB was a national cross-sectional phone based health survey conducted in 2016 among 20,032 randomly selected individuals from the general population in mainland France. BaroTest was a virological sub-study nested in 2016-HB. Data collected for BaroTest were based on home blood self-sampling on dried blood spots (DBS).

Results: From 6,945 analyzed DBS, chronic hepatitis C (CHC) and B (CHB) prevalence was estimated at 0.30% (95% Confidence Interval (CI): 0.13-0.70) and 0.30% (95% CI: 0.13-0.70), respectively. The proportion of individuals aware of their status was estimated at 80.6% (95% CI: 44.2-95.6) for CHC and 17.5% (95% CI: 4.9-46.4) for CHB. Universal combined screening would involve testing between 32.6% and 85.3% of 15-75 year olds according to whether we consider only individuals not previously tested for any of the three viruses, or also those already tested for one or two of the viruses.

Conclusions: Our data are essential to guide decision-making regarding which new HCV screening recommendation to implement in France. They also highlight that efforts are still needed to achieve the WHO’s targets for eliminating these diseases. Home blood self-sampling may prove to be a useful tool for screening and epidemiological studies.
A battery of self-screening instruments and self-reported body frame could not detect eating disorders among college students
Authors: Hayakawa Norika , Tanaka Satoshi , Hirata Naoko , Ogino Sachiko , Ozaki Norio
Published: October 2019

Objective: Although studies have shown inconsistent results in terms of prevalence of eating disorders, the Eating Attitudes Test (EAT-26) was used to screen students for abnormal eating behaviors. The results of the self-reported EAT-26 and body frame, as well as the efficacy of using self-administered questionnaires (SAQs) were examined to detect eating disorders in new college students.
Results: An anonymous questionnaire (EAT-26) was provided to 7738 new students; 4552 (58.8%) responders were included in the final analysis. Semi-structured interviews were conducted for 131 (1.7%) students. Among them, 6 students showed a high EAT-26 score, but were not diagnosed with an eating disorder based on the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Three students were diagnosed with an eating disorder using SCID-I, but their EAT-26 scores were below the threshold. From these results, in a non-clinical population, findings on EAT-26 do not agree with those on SCID-I in terms of the diagnosis of eating disorders, and this battery is not appropriate for detecting eating disorders.
Distribution of cervical lesions in high-risk HPV (hr-HPV) positive women with ASC-US: A retrospective single-center study in China
Authors: Wang Zhiling , Gu Ying , Wang Hui , Chen Junyu , Zheng Yawen , Jia Lin , Cui Baoxia , Yang Xingsheng
Published: October 2019

Objective

To investigate distributions of cervical lesions and factors associated with the severity of the cervical lesions in high-risk HPV (hr-HPV) positive women with ASC-US cytology.Methods

Clinical information of 250,000 women who underwent HPV and cytological test was collected from January 2012 to January 2019. The association between the severity of the cervical lesions and hr-HPV genotypes, hr-HPV viral load, and ages, were analyzed in hr-HPV-positive/ASC-US women.Results

3459 hr-HPV-positive/ASC-US women were enrolled in this study. Overall, 43.51% of women with ASC-US had normal histological results, 34.35% had high-grade squamous intraepithelial lesion (HSIL), and 1.30% had cervical cancer. The rate of HSIL or worse (HSIL+) in women with single HPV16 infection (63.09%) was the highest, followed by HPV33 (57.50%), HPV51 (36.11%), HPV58 (36.11%), HPV52 (28.28%), HPV18(26.37%), HPV66 (19.35%), HPV39 (18.92%), HPV53 (15.00%), and HPV56 (8.51%). Detection rate of HSIL+ in low, intermediate and high viral-load groups were 15.87% (n=30), 34.91% (n=74) and 40.68% (n=214) (Cochran-Armitage Trend test χ2=35.03, P<0.0001). Compared with the 51-60-year-old group (21.65%), the women in ≤30 (40.52%), 31-40 (39.67%), and 41-50 (34.22%) year-old groups had significantly higher risk of HSIL+. The women in ≤51-60 (2.68%) and >60 (3.41%) year-old groups were at increased risk for cervical cancer, compared with the ≤30-year-old group (0.61%).Conclusion

ASC-US women with HPV 16/18/33/51/52/58 single infection and multiple infections, as well as high HPV viral loads, have high risk of HSIL+. Young women and older women have higher HSIL+ detection rates, while the latter has a higher cervical cancer detection rate.
Post-Traumatic Stress Disorder in Italy: a comprehensive evaluation of all the ICD comorbidities and gender-related differences
Authors: Ferretti Fabio , Pozza Andrea , Bossini Letizia , Desantis Serena , Olivola Miriam , Matto Laura Del , Gualtieri Giacomo , Gusinu Roberto , Bezzini Daiana , Fagiolini Andrea , Coluccia Anna
Published: October 2019

Objectives: The association between Post-Traumatic Stress Disorder (PTSD) and physical comorbidities is controversial since most studies focused on specific comorbidity and victim types. In Italy, data on this issue are scarce. A comprehensive evaluation of all the ICD medical categories co-occurring in PTSD may orient assessment and treatment during clinical and forensic practice. This is the first study evaluating all the ICD physical comorbidities and gender-related differences in Italian PTSD patients. Eighty-four PTSD patients (36 females, 48 males) were included. The Clinician-Administered PTSD Scale, Mini International Neuropsychiatric Interview and Davidson Trauma Scale were administered.
Results: Most patients had a PTSD consequent to an accident and half of them presented extreme severity. No gender differences emerged on symptom severity/duration and age at the event. Metabolic (39.29%), circulatory (20.24%) and musculoskeletal diseases (17.86%) were the most frequent comorbidities. Metabolic/circulatory diseases were more frequent among males (p =0.019 and p = 0.027, respectively) while females more frequently showed neoplasms (p =0.039). Physical comorbidities represent a serious complication in PTSD patients and are more prevalent than in general population. While gender is not associated with symptom presentation, it seems to play a key role in specific comorbidities including metabolic, circulatory and neoplastic diseases.
Navigating complexity through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners
Authors: Erisman Jetske Charlotte , de Sabbata Kevin , Zuiderent-Jerak Teun , Syurina Elena V
Published: October 2019

Background: Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of all children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. They use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are needed in healthcare. This study aims to understand how Dutch CYHC-practitioners perceive the role of intuition in their work and in relation to evidence-based medicine, in the case of child abuse.Methods: A sequential exploratory mixed-methods design. In-depth semi-structured interviews with CYHC-practitioners focused on perceptions on intuition, which was followed by a survey amongst CYHC-professionals on the recognition and use of the concept.Results: The majority of CYHC-practitioners and professionals recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition: 1) to sense that something is off, 2) to differentiate between ‘normal’ and ‘abnormal’, 3) to assess risks, 4) to weigh secondary information and 5) to communicate with parents. At the same time, they warn for its dangers as it may lead to tunnel vision and false accusations. Their ways of working with intuition show parallels to the practices that evidence-based guidelines try to support.Conclusion: Intuition is experienced as an integral part of the work of CYHC-practitioners. It is stated to be particularly useful in the case of child abuse, which is inherently complex as signs and evidence of abuse are hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. As there is a lack of guidance on how to practice intuition, there is a need for support through guidelines.
Lifetime risk assessment in cholesterol management among hypertensive patients: Observational cross-sectional study based on electronic health record data.
Authors: Tahkola Aapo , Korhonen Päivi , Kautiainen Hannu , Niiranen Teemu , Mäntyselkä Pekka
Published: October 2019

Background In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control. Methods In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting. Results More than half (54% of women and 53 % of men) of untreated patients did not meet the LDL-C target of <3 mmol/l and one third (35% of women and 33 % of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p<0.001) and lower LDL-C level (p<0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p<0.001). In total, about half of the patients were on LLM (53% of women and 51 % of men). Conclusions Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
A computer-aided diagnosis system based on computed tomography images of pancreatic head adenocarcinoma applied for identifying pancreatoduodenectomy resection
Authors: Hui Bei , Qiu Jia-Jun , Liu Jin-Heng , Ke Neng-Wen
Published: October 2019

Background: In a pathological examination of pancreaticoduodenectomy for pancreatic head adenocarcinoma, resection margins have no cancer cells within 1 mm, the resection is considered as R0 resection; resection margins have cancer cells within 1 mm, the resection is recognized as R1 resection. The pathological examinations of the resection margins are complicated and depend on the subjective experiences of physicians to some extent. This study aims to design a computer-aided diagnosis (CAD) system based on texture features of preoperative computer tomography (CT) images to evaluate a resection margin was R0 or R1.Methods: This study retrospectively analyzed 86 patients who were diagnosed as pancreatic head adenocarcinoma by preoperative abdominal CT examination. These patients underwent pancreaticoduodenectomies, then their resection margins were pathologically diagnosed as R0 or R1. The CAD system consists of five stages: (i) delineate and segment regions of interest (ROIs); (ii) by solving discrete Laplacian equations with Dirichlet boundary conditions, fit ROIs to rectangular regions; (iii) enhance textures of ROIs combining wavelet transform and fractional differential; (iv) extract texture features combining wavelet transform and statistical analysis methods; (v) reduce features using principal component analysis (PCA) and perform classification using support vector machine (SVM), use a linear kernel function and leave-one-out cross-training and testing to reduce overfitting. Mann-Whitney U-test is used to explore associations between texture features and histopathological characteristics.Results: The developed CAD system achieved an AUC (area under receiver operating characteristic curve) of 0.8614 and an accuracy of 84.88%. Setting p-value ≤ 0.01 in the Mann-Whitney U-test, two features of run-length matrix, which derived from diagonal subbands in wavelet decomposition, showed statistically significant differences between R0 and R1.Conclusions: It indicates that the developed CAD system is rewarding for discriminating R0 from R1. Texture features can potentially enhance physicians' diagnostic ability.
Outcomes of children with hepatoblastoma managed at a tertiary hospital in China
Authors: Li Jiahao , Li Huixian , Wu Huiying , Niu Huilin , Li Haibo , Pan Jing , Yang Jiliang , Tan Tianbao , Hu Chao , Xu Tao , Zhang Xiaohong , Zheng Manna , Li Kuanrong , Zou Yan , Yang Tianyou
Published: October 2019

Objective: To summarise our experiences in hepatoblastoma management in South ChinaMethods: We diagnosed 135 children with hepatoblastoma at our institution between January 2010 and December 2017. Information regarding demographics, clinical data, and outcomes were retrospectively collected and analysed. Results: Ninety-three patients underwent liver resection and were enrolled in this study. Thirty-six, 23, 3, and 31 patients had PRETEXT stages II, III, IV, and unspecified tumours, respectively. Seven patients had ruptured tumour, 9 had lung metastasis, and 1 had portal vein thrombosis. Sixteen patients underwent primary liver resection, 22 received neoadjuvant chemotherapy and delayed surgery, 25 received preoperative transarterial chemoembolisation and delayed surgery, and 30 received a combination of neoadjuvant chemotherapy, transarterial chemoembolisation, and delayed surgery. Forty patients had both PRETEXT and POST-TEXT information available for analysis. Twelve cases were downstaged after preoperative treatment: 2 from stage IV to III, 8 from stage III to II, and 2 from stage II to I. Ten patients with unspecified PRETEXT stage were confirmed to have POST-TEXT stages II (n=8) and I (n=2) tumours. The PRETEXT and POST-TEXT stages were significantly different. Seven tumours were associated with positive surgical margins, and 12 patients had microvascular involvement. During a median follow-up period of 30.5 months, 84 patients survived without relapse, 9 experienced tumour recurrence, and 4 died. The two-year EFS and OS rates were significantly better among patients without metastasis. The two-year EFS and OS rates were similar among patients treated with different preoperative strategies.Conclusion: The outcomes of hepatoblastoma after resection were excellent.
Increased plasma levels of relaxin-2 in liver cirrhotic patients
Authors: Ma Xiao , Pan Yu , Xu Ruiling , Liu Mingna , Zhang Xiaohui
Published: October 2019

Background: Relaxin-2 has been found to alleviate fibrosis in liver cirrhosis, and our previous study showed that relaxin-3 inhibits ROS-induced hepatic cell apoptosis. In this study, we investigated the levels of plasma relaxin-2 or relaxin-3 in patients with liver cirrhosis and their relationship to component traits in patients with liver cirrhosis. Aims: To determine the levels of plasma relaxin-2 or relaxin-3 in patients with liver cirrhosis and their relationship to component traits in patients with liver cirrhosis. Methods: A total of 75 patients with liver cirrhosis and 41 age-matched healthy control subjects were enrolled in this study. Relaxin-2 and relaxin-3 expression levels in plasma were investigated by radioimmunoassay. Results: Plasma relaxin-2 levels were significantly higher in patients with liver cirrhosis than in control subjects (p=0.004). Specifically, plasma relaxin-2 levels were significantly positively correlated with Child-Pugh classification, white blood cell, activated partial thromboplastin time and indirect bilirubin. Plasma relaxin-2 levels were significantly negatively correlated with albumin. There were no significant differences in plasma relaxin-3 concentrations between the two groups (p=0.932). Receiver operating characteristic curve analysis yielded an area under the curve for relaxin-2 of 0.665 in liver cirrhosis. Conclusions: Plasma relaxin-2 levels were higher in patients with liver cirrhosis than in control subjects, and plasma relaxin-2 levels were significantly positively correlated with Child-Pugh classification, and negatively correlated with albumin.
No man is an Island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches.
Authors: Nascimento Miguel , Lourenço Beatriz , Coelho Ines , Aguiar Joana , Lázaro Mariana , Silva Mariana , Marinho Monica , Pereira Camila , Caldas Inês , Gomes Filipe , Garcia Sara , Nascimento Sandra , Pereira Guilherme , Nogueira Violeta , Costa Pedro , Nobre Alice
Published: October 2019

Purpose: to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). Methods: spatial autocorrelation statistics regarding all patients observed at CHPL in 2017, at the census subsection level, considering a queen criterion of contiguity, regarding not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000m. Results: All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. Conclusions: as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.
Multi-drug Resistant (MDR) and Extended Spectrum β-lactamase (ESBL) Producing Salmonella species isolated from fresh chicken liver samples
Authors: Adhikari Sanjib , Khadka Sujan , Sapkota Sanjeep , Sharma Biplove Raj , Ghimire Anjita , Chalise Muna , Gurung Devika , Kunwar Sujan
Published: October 2019

Objective: Emergence of antibiotic resistance among microbes contaminating the fresh meat and meat products is a global public health concern as they can be easily transmitted to humans through their consumption and contact. The current study aimed to isolate and identify Salmonella sp. from fresh chicken liver samples and determine their antibiotic susceptibility patterns with special emphasis on multidrug resistance (MDR) and extended spectrum beta-lactamase (ESBL) production. Results: Out of 200 samples analyzed, 61 (30.5%) samples harbored Salmonella species among which 15 (7.5%) samples showed the presence of Salmonella Typhi isolates. A significant association was noted in the incidence of Salmonella with various factors pertaining to the butchers such as age, sex and literacy rate. Salmonella isolates were highly sensitive to amikacin (82.0%) and least sensitive to tetracycline (3.3%). All the isolates were resistant to colistin. Moreover, 56 isolates were identified as multidrug-resistant. The total number of ESBL producers reported among Salmonella isolates was 29 (47.5%). The study reported the presence of antibiotic-resistant Salmonella species in fresh chicken liver samples sold in Bharatpur metropolis suggesting a need of serious attention by the concerned authorities. Keywords: Salmonella , Fresh chicken liver samples, Antibiotic Susceptibility Test, Multi-drug Resistance, Extended Spectrum β-lactamase
Spectrophotometric Analysis Evaluating Apical Microleakage in Retrograde Filling using GIC, MTA and Biodentine: An in-vitro study
Authors: Nepal Manisha , Shubham Snigdha , Tripathi Rupam , Khadka Jwolan , Kunwar Deepa
Published: October 2019

Background The present study compares the apical microleakage of three different root-end filling materials in which the retrograde cavity is prepared by two different burs.Methods Eighty extracted single rooted maxillary and mandibular premolars were taken. Root canal treatment was completed. Apical 3 mm of all the teeth were resected with diamond disk. The tooth were divided into four groups with two subgroups for each group containing 10 tooth (N= 10) as: Group IA (Negative Control and IB (Positive Control); Group IIA and IIB: Prepared with round carbide bur and round diamond bur respectively, filled with GIC; Group IIIA and IIIB: Prepared with round carbide bur and round diamond bur respectively, filled with MTA; Group IVA and IVB: Prepared with round carbide bur and round diamond bur, filled with Biodentine. After applying two coats of nail varnish leaving apical 3 mm (except for negative control group) all teeth were immersed in 2% methylene blue for 3 days and again in 65% nitric acid for next 3 days for extraction of dye. The obtained solution was then transferred to eppendorf tube and centrifuged in microcentrifuges at 14,000 revolution per minutes (RPM) for 5 minutes. Optical density or absorbance of the supernatant solution was measured with UV spectrophotometer at 550 nm.Results The absorbance of the supernatant solution after dye extraction is decreasing in the order of positive control> GIC> MTA> Biodentine> negative control group. The significant difference was observed between GIC and MTA (p=0.0001) and GIC and Biodentine (p=0.0001) with two different burs but statistically non-significant difference was observed between MTA and Biodentine with Carbide bur (p=0.127) and Diamond bur (p=0.496) respectively.Conclusions Within the limitations of the present study, it can be concluded that Biodentine and MTA showed less microleakage as compared to GIC. There is no significant difference between mean microleakage of MTA and Biodentine. However, the mean OD of the Biodentine was least of all evaluated materials. Preparation of the root-end using round carbide bur as well as round diamond burs showed comparable microleakage for all three filling materials.
Influence of femoral implant design modification on anterior knee pain and patellar crepitus in patients who underwent total knee arthroplasty without patella resurfacing
Authors: Huang Yifan , Gao Yuhang , Ding Lu , Liu Bo , Liu Jianguo , Qi Xin
Published: October 2019

Background: The incidence of dissatisfaction that due to multiple factors especially anterior knee pain (AKP) and patellar crepitus after total knee arthroplasty (TKA) are still required concern. Improvements of femoral component in traditional prosthesis could reduce the incidence of these complications in TKA with patella resurfacing. This study aimed to explore whether TKA without patella resurfacing benefit from this femoral implant design modification in the aspects of AKP and patellar crepitus.Methods: Sixty-two patients (85 knees) using the modern prosthesis and 62 age-matched and sex-matched patients (90 knees) using the traditional prosthesis were enrolled in this study. The incidences of AKP and patellar crepitus, Knee Society Scores were recorded. Statistical analyses were accomplished to determine if there were differences between the two groups. Results: The incidence of AKP was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (4.7% vs. 13.3%, p = 0.048; 3.5% vs. 13.3%, p = 0.021, respectively). The incidence of patellar crepitus was significantly lower in the study group compared with those in the control group at 3-month and 1-year follow-up (34.4% vs. 15.3%, p = 0.004; 28.9% vs. 10.6% at 1 year, p = 0.002, respectively). There was no significant difference in Knee Society Scores between two groups.Conclusion: The results showed that TKA without patella resurfacing benefited from this femoral implant design modification in the aspects of AKP and patellar crepitus. This study may provide meaningful information for surgeons who use the modern prosthesis and selectively not resurfacing the patella in their patients.
Association between motoric cognitive risk syndrome and frailty among Chinese older adults
Authors: Shen Shanshan , Zeng Xingkun , Xu Liyu , Chen Lingyan , Liu Zixia , Chu Jiaojiao , Yang Yinghong , Wu Xiushao , Chen Xujiao
Published: October 2019

Background: Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome incorporating subjective cognitive complaints and slow gait. Previous studies have shown that subjective cognitive complaints and slow gait are reported to be associated with frailty in cognitively unimpaired older adults, but little is known giving attention to the link between MCR and frailty in older adults. Therefore, the aim of the study was to explore the associations of MCR and its components and frailty in Chinese older adults. Methods: In an observation cross-sectional study, a total of 429 older adults aged 60 years and older were admitted to the geriatric department. According to MCR criteria, all participants were classified to 4 groups: 1) MCR group; 2) subjective cognitive complaints group; 3) slow gait group; 4) healthy control group. Physical frailty was assessed by Clinical Frailty Scale (CFS). The multivariate logistic regression analysis was used to examine the association between MCR and frailty in older adults. Results: The prevalence of subjective cognitive complaints, slow gait and MCR was 15.9%, 10.0% and 4.0%, respectively. After adjusting for confounding variables, the logistic regression analysis showed that slow gait (odds ratio [OR] 3.40, 95% confidence interval [CI] 1.40-8.23, P=0.007) and MCR (odds ratio [OR] 5.53, 95% confidence interval [CI] 1.46-20.89, P=0.012) were independently associated with frailty, but not subjective cognitive complaints. Conclusions: MCR and slow gait were significantly associated with frailty in Chinese older adults. Further study should prospectively determine the causal relationship between MCR and frailty.
Maternal Health Service Utilization and Associated Factors among Mothers with Children under one Year in Ambo District, West Shoa Zone, Central Ethiopia, 2018
Authors: Mengistu Mulugeta Mekuria , Beyene Tesfaye , Desta Habtamu oljira , Bayeta Adamu Birhanu
Published: October 2019

Background: Maternal health service is the service provided to mothers during pregnancy, delivery and postpartum. It is a useful indicator in assessing women’s health status and the accessibility, adequacy and effectiveness of a country’s health service system. The aim of this study was to assess the proportion of maternal health service utilization and factors influence it in Ambo district, West Ethiopia.Methods: Community based cross-sectional study design with quantitative and qualitative methods of data collection was employed place from 15 th August to15th October, 2018 at Ambo District among 561 women with children less than one year. Single population proportion formula was utilized to calculate the sample size and simple random sampling technique was employed to select the study subjects. Data were collected by trained data collectors using a pretested structured questionnaire. The data was entered into Epi Data version 3.1 and transported to SPSS version 21 for analysis. Bivariate and multivariate logistic regression was done at 95 % confident interval and variables with P value < 0.05 to shows significant association. Qualitative data was transcribed carefully and analyzed thematically.Result: All 561 study subjects were participated in the survey and considered for analysis. The proportion of mothers who used ANC at least once was 89%., 64% of them delivered at health institutional and 47.2% of the mothers used early postnatal care. Mothers occupation [AOR=0.24(95% CI: 0.08-0.69)] and mother and her husband’s decision making power [AOR=4.12(95% CI: 2.12-8.00)] were significantly associated with ANC use. Mother’s education level [AOR=1.56(95% CI: 1.03-2.38)], time of traveling to health facilities, decision making power [AOR=5.91(95% CI: 3.79-9.22)] of both mother and husband, and having ANC follow up [AOR=14.54(95% CI: 6.23-33.96)] were factors significantly associated to institutional delivery whereas mothers age [AOR=2.65(95% CI: 1.29-5.46)], marital status [AOR=0.14(95% CI: 0.03-0.69)], attending ANC service [AOR=3.51(95% CI: 1.15-10.71)] and place of delivery [AOR=14.98(95% CI: 4.23-52.88)] were significantly associated factors for PNC utilization. Conclusion: The prevalence of maternal health services utilization were far behind the national target to be achieved by the end of 2020. Therefore, much work is expected from stakeholders in order to achieve the national target.
Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study
Authors: Goossens Bart , Sevenants Aline , Declercq Anja , Audenhove Chantal Van
Published: October 2019

Background Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently.Methods The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.Results At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ=16.09) and 81.11/100 (σ=19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ=10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ=0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ=0.51) and competence (x̄=3.76/5, σ=0.27) with which these skills were practiced (P<0.001).Conclusions Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the tree-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.
Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis
Authors: Maidment Ian , Lawson Sally , Wong Geoff , Booth Andrew , Watson Anne , Zaman Hadar , Mullan Judy , McKeown Jane , Bailey Sylvia
Published: October 2019

Background Increasing numbers of older people are living in the community with multiple diagnoses and medications. Managing multiple medications produces issues of unrivalled complexity for those involved. Despite a growing body of literature on the subject, gaps remain in understanding how, why and for whom complex medication management works, and therefore how best to improve practice and outcomes. MEMORABLE, MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation, aimed to address these gaps. Methods MEMORABLE, a National Institute of Health Research funded project, used a realist approach to understand causal paths within medication management. Informed by RAMESES guidelines, MEMORABLE involved three overlapping work packages: 1) Realist Review of the literature (specifically 24 articles on medication management exploring causality); 2) Realist Evaluation (50 realist-informed interviews with older people, family carers and health and care practitioners, explaining their experiences); and 3) data synthesis and theorising from 1) and 2). Results The complexity of medication management was viewed from the perspective of ‘implementation’. This enabled the researchers to structure the medication management process into five iterative Stages; three individual Stages carried out by the older person on their own or with family carer support in which they are balancing routines, coping and risk; and two interpersonal Stages where the older person works with a practitioner-prescriber-reviewer, perhaps with carer involvement. Applying Normalisation Process Theory to this process, four steps were identified within each Stage: 1) sense making - information, clarification; 2) action - shared decision making; 3) reflection/monitoring; and 4) relationships that are enduring, based on collaboration and mutual trust. In a detailed analysis of Stage 5: Reviewing/reconciling medications, adopting the lens of ‘burden’, MEMORABLE identified five burdens amenable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Two initial improvement propositions were then set out for development through further research: a risk screening tool and individualised information.Conclusions By adopting a realist approach and synthesising rich data from evidence and experiential accounts, MEMORABLE has established a transferable evidence and experience-based, theoretical framework, focused on burden, to explore and explain the real world complexity of medication management for and with older people.
Accuracy of intraocular lens power calculation formulas after laser refractive surgery in myopic eyes: A meta-analysis
Authors: Li Hongyu , Li Jun , Song Hui
Published: October 2019

Background: To compare the accuracy of intraocular lens power calculation formulas after refractive surgery in myopic eyes. Methods: We searched the databases on the PubMed, EMBASE, Web of science and Cochrane library to select relevant studies published between Jan 1, 2009 and Aug 11, 2019. Primary outcomes were the percentages of refractive prediction error within ±0.5D and ±1.0D. Results: The results of this meta-analysis were investigated from 16 studies, including 7 common methods (Haigis-L, Shammas-PL, Double-K SRK/T, Barrett true K no history, Wang-Koch-Maloney, ASCRS average and OCT formula). ASCRS average yielded significantly higher percentage of refractive prediction error within ±0.5D than Haigis-L, Shammas-PL and W-K-M (P=0.009, 0.01, 0.008, respectively). Barrett true K no history also yielded significantly higher percentage of refractive prediction error within ±0.5D than Shammas-PL and W-K-M (P=0.01, <0.0001, respectively), and the same result was found by comparing OCT formula with Hiaigi-L and Shammas-PL (P=0.03, 0.01, respectively). Only the Haigis-L had significantly higher percentages than W-K-M method in the ±1.0D group (P = 0.04). Conclusion: We suggest that the ASCRS average and Barrett true K no history formula should be used to calculate the IOL power in eyes after myopic refractive surgery.