bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study
Authors: Thorell Kristine , Midlöv Patrik , Fastbom Johan , Halling Anders
Published: October 2019

Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time.

Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1) or on the 31st December 2013 (cohort 2) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy.

Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80 to ≤ 85 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables.

Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.
Post-Stroke Patients with Moderate Function Have the Greatest Risk of Falls: A National Cohort Study
Authors: Wei Wycliffe Enli , De Silva Deidre Anne , Chang Hui Meng , Yao Jiali , Matchar David Bruce , Young Sherry Hsueh Yi , See Siew Ju , Lim Gek Hsiang , Wong Ting Hway , Venketasubramanian Narayanaswamy
Published: October 2019

Background Stroke patients have increased risks of falls. We examined national registry data to evaluate the association between post-stroke functional level and the risk of low falls among post-stroke patients. Methods This retrospective cohort study analyzed data from national registries to examine the risk factors for post-stroke falls. Data for patients who suffered ischemic strokes and survived the index hospital admission was obtained from the Singapore National Stroke Registry and matched to the National Trauma Registry, from 2011 to 2015. The primary outcome measure was a low fall (fall height ≤0.5m). Competing risk analysis was performed to examine the association between functional level (by modified Rankin score [mRS] at discharge) and the risk of subsequent low falls. Results In all, 2,255 patients who suffered ischemic strokes had recorded mRS. The mean age was 66.6 years and 58.5% were men. By the end of 2015, 54 (2.39%) had a low fall while 93 (4.12%) died. After adjusting for potential confounders, mRS was associated with fall risk with an inverted U-shaped relationship. Compared to patients with a score of zero, the sub-distribution hazard ratio (SHR) increased to a maximum of 3.42 (95%CI:1.21-9.65, p=0.020) for patients with a score of 2. The SHR then declined to 2.45 (95%CI:0.85-7.12, p=0.098), 2.86 (95%CI:0.95-8.61, p=0.062) and 1.93 (95%CI:0.44-8.52, p=0.38) for patients with scores of 3, 4 and 5 respectively. Conclusions An inverted U-shaped relationship between functional status and fall risk was observed. This is consistent with the complex interplay between decreasing mobility (hence decreased opportunity to fall) and increasing susceptibility to falls. Fall prevention intervention could be targeted accordingly.
Relationship between performance on the progress test and selection for medical residency
Authors: Ferreira Ricardo Correa , Velho Paulo Eduardo Neves Ferreira , Bicudo Angélica Maria , Passeri Silvia Maria Riceto Ronchim
Published: October 2019

Background: The Progress Test (PT) is a formative evaluation used to analyze student progress throughout medical undergraduate studies. Further, classificatory summative assessments are carried out by graduates of medical programs worldwide, either to acquire a practicing license or to obtain a vacancy in the Medical Residency (MR) selection processes. We aimed to identify whether PT performance is related to performance in the MR selection process.

Methods: Physicians who attended and graduated from a public university in the state of São Paulo, Brazil, between 2011 and 2014 were assessed on the basis of voluntary participation in the PTs throughout their undergraduate program, performance in the PT in their last year, performance in the multiple-choice test of MR, convocation in the first classificatory list, and approval for the MR selection. Descriptive statistics and comparison of scores were performed using student’s t-test for independent and paired samples and the Pearson correlation coefficient.

Results: Of the 424 students, 374 participated in the PTs throughout their undergraduate program and in the MR selection process. These graduates performed better in the PT than the 22 who did not go on to MR (p < 0.05). Students who participated in all the PTs throughout their undergraduate program demonstrated superior performance in MR than those 22 who did not participate regularly (p < 0.0001). Among the 374 trainees, the average performance level for the PT was lower than that for their multiple-choice test for MR, both overall (p < 0.05) and separately by year (p < 0.0001); moreover, there was a strong correlation between PT performance and performance on the multiple-choice test. There was greater approval in MR among graduates whose mean score on the multiple-choice test was above that in the PT (p < 0.0001).

Conclusions: PT performance was related to performance in the MR selection process for the study period; there was a strong correlation between student performance in the PT and the multiple-choice test in MR. Students with multiple-choice test results for MR that were below the average performance level in the PT were less frequently approved in the MR selection process.
Satisfaction With Use Of Public Health And Peer-Led Facilities For Hiv Prevention Services By Key Populations In Nigeria
Authors: Ochonye Bartholomew , Folayan Morenike Oluwatoyin , Fatusi Adesegun O , Emmanuel Godwin , Adepoju Tomi , Ajidagba Babatunde , Jaiyebo Toluwanimi , Umoh Paul , Yusuf Ayo
Published: October 2019

Background: The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers.
Methods: A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted
Results: Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p=0.007),privacy and confidentiality (p=0.04) and respect of rights of service recipients (p=0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p=0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p=0.01), confidentiality (p=0.002), waiting time (p<0.01) and staff attitude (p=0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p=0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law.
Conclusion: Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.
Influence of CMTM8 polymorphisms on Lung cancer susceptibility in the Chinese Han population
Authors: Wu Jiamin , Sun Yao , Xiong Zichao , Niu Fanglin , Liu Yuanwei , Li Haiyue , Liu Jianfeng , Liu Qiufang , jin tianbo
Published: October 2019

Abstract
Background: Lung cancer is the leading cause of cancer-related mortality worldwide and CMTM8 is a potential tumor suppressor gene, which is down-regulated in lung cancer. The objective of this research was to assess the association of CMTM8 genetic polymorphisms with lung cancer risk in Chinese Han population.
Methods: To evaluate the correlation between CMTM8 polymorphisms and lung cancer risk, Agena MassArray platform was used for genotype determination among 509 lung cancer patients and 506 controls. Multiple genetic models, stratification analysis and haploview analysis were used by calculating odds ratio (OR) and 95% confidence intervals (CIs).
Results: Significant associations were detected between CMTM8 rs6771238 and an increased lung cancer risk (p < 0.05). In stratified analysis, rs6771238 was related to an increased risk of lung squamous cell carcinoma (p < 0.05), rs6771238 was associated with an increased risk of lung adenocarcinoma (p < 0.05), rs9835916 and rs1077868 were correlated with lung cancer staging (p < 0.05), and rs9835916 was correlated with an increased risk of lymph node metastasis in lung cancer patients (p < 0.05). Additionally, Haplotype analysis illuminated that haplotypes GG and AG were closely correlated with lung cancer staging, and haplotype AG was correlated with an increased lung cancer risk among individuals older than 50 years (p < 0.05).
Conclusions: Our study firstiy reported that the CMTM8 polymorphisms were risk factors for lung cancer in Chinese Han population. These findings also suggested the potential roles of CMTM8 in the development of lung cancer.
Molecular characterization of carbapenem-resistant Klebsiella pneumoniae isolates with focus on antimicrobial resistance
Authors: Yu Xiaoling , Zhang Wen , Zhao Zhiping , Ye Chengsong , Zhou Shuyan , Wu Shaogui , Han Lifen , Han Zhaofang , YE HANHUI
Published: October 2019

Ba ckgrou nd The enhancing incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP)-mediated infections in Mengchao Hepatobiliary Hospital of Fujian Medical University in 2017 is the motivation behind this investigation to study gene phenotypes and resistance-associated genes of emergence regarding the CRKP strains. In current study, seven inpatients are enrolled in the hospital with complete treatments. The carbapenem-resistant K. pneumoniae whole genome is sequenced using MiSeq short-read and Oxford Nanopore long-read sequencing technology. Prophages are identified to assess genetic diversity within CRKP genomes. Results The investigation encompassed eight CRKP strains that collected from the patients enrolled as well as the environment, which illustrate that bla KPC-2 is responsible for phenotypic resistance in six CRKP strains that K . pneumoniae sequence type (ST11) is informed. The plasmid with IncR, ColRNAI and pMLST type with IncF[F33:A-:B-] co-exist in all ST11 with KPC-2-producing CRKP strains. Along with carbapenemases, all K. pneumoniae strains harbor two or three extended spectrum β-lactamase (ESBL)-producing genes. f osA gene is detected amongst all the CRKP strains. The single nucleotide polymorphisms (SNP) markers are indicated and validated among all CRKP strains, providing valuable clues for distinguishing carbapenem-resistant strains from conventional K. pneumoniae . Co nclusions ST11 is the main CRKP type, and bla KPC-2 is the dominant carbapenemase gene harbored by clinical CRKP isolates from current investigations. The SNP markers detected would be helpful for characterizing CRKP strain from general K. pneumoniae. The data provides insights into effective strategy developments for controlling CRKP and nosocomial infection reductions.
Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer
Authors: Shiraishi Takuya , Sasaki Takeshi , Ikeda Koji , Tsukada Yuichiro , Nishizawa Yuji , Ito Masaaki
Published: October 2019

Background: Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy.
Methods: We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated.
Results: The cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p =0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p =0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate <60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36–5.50, p =0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57–7.72, p =0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0% and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4% and 50.0%, respectively).
Conclusions: Reductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.
Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: A single-blinded randomised clinical trial.
Authors: Yelland Michael , Rabago David , Ryan Michael , Ng Shu-Kay , Vithanachchi Dinusha , Manickaraj Nagarajan , Bisset Leanne
Published: October 2019

Background

Lateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aimed to compare the short- and long-term clinical effectiveness, cost effectiveness, and safety of prolotherapy used singly and in combination with physiotherapy.

Methods

Using a single-blinded randomised clinical trial design, 120 participants with lateral epicondylalgia of at least six weeks’ duration were randomly assigned to prolotherapy (4 sessions, monthly intervals), physiotherapy (weekly for 4 sessions) or combined (prolotherapy+physiotherapy). The Patient-Rated Tennis Elbow Evaluation (PRTEE) and participant global impression of change scores were assessed by blinded evaluators at baseline, 6, 12, 26 and 52 weeks. Success rate was defined as the percentage of participants indicating elbow condition was either 'much improved' or 'completely recovered.’ Analysis was by intention-to-treat.

Results

88% completed the 12-month assessment. At 52 weeks, there were substantial, significant improvements compared with baseline status for all outcomes and groups, but no significant differences between groups. The physiotherapy group exhibited greater reductions in PRTEE at 12 weeks than the prolotherapy group (p = 0.014).

Conclusion

There were no significant differences amongst the Physiotherapy, Prolotherapy and Combined groups in PRTEE and global impression of change measures over the course of the 12-month trial.
Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care
Authors: Lee Garden , Kim Han Sang , Lee Si Won , Kim Eun Hwa , Lee Bori , Hu Youn Jung , Kang Beodeul , Choi Hye Jin
Published: October 2019

Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.
Prevalence of dental caries and oral health related quality of life among preschool children aged 4-6 years in Kisarawe, Tanzania.
Authors: Masumo Ray Mrisho , Ndekero Tumaini S. , Carneiro Lorna C.
Published: October 2019

Background Preschool years are a critical period in the development of a healthy child. The consequences of poor oral health in preschool children reach beyond dental problems, with oral health-related quality of life (OHRQoL) being associated with overall systematic health as well as one’s quality of life. The purpose of this study was to explore the level to which dental caries impacts the OHRQoL in a sample of preschooler children in Kisarawe.Methods A cross-sectional based study was conducted in 2017. A total of 1,106 preschool children completed a face-to-face interview, using a translated Kiswahili version of the Michigan Oral Health-related Quality of Life Scale–Child Version (2003), and underwent clinical oral examination using WHO (1997) criteria.Results The decayed component was the most prevalent (dft = 2.08) and the Significant Caries Index (SiC) was 5.54 double of the (dft), showing polarization of dental caries in the studied population. After adjusting for appropriate covariates, preschool children of age 5 and 6 years old were more likely to have decayed tooth [Adjusted OR = 3.02, (95% CI =2.01-4.54)] and [Adjusted OR=2.23, (95% CI= 1.55-3.20)] respectively. Preschool children without visible plaque on the buccal surface of upper anterior teeth were less likely to have decayed teeth [Adjusted OR=0.21, (95% CI=0.09-0.45)]. Regarding measurements of oral health-related quality of life using the MOHRQoL, only preschool children who reported on ‘does your teeth hurt you now?’ and ‘do kids make fun of your teeth?’ were more likely to have a decayed tooth [Adjusted OR=1.74, (95% CI=1.12-2.71)] and [Adjusted OR=1.87, (95% CI=1.11-3.15)], respectful.Conclusion The findings suggest that dental caries, affecting a significant portion of preschoolers, was associated with both poor oral hygiene and the age of the child. The MOHRQoL appear to be able to discriminate between groups, and preschool children of 4-6 years of age are reliable informants to answer the MOHRQoL in this group of Tanzanian children.
Adaptation and validation of a questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia
Authors: Azraii Ahmad Baihaqi , Ramli Anis Safura , Ismail Zaliha , Abdul-Razak Suraya , Badlishah-Sham Siti Fatimah , Mohd-Kasim Noor Alicezah , Ali Norsiah , Watts Gerald F , Nawawi Hapizah
Published: October 2019

Background: Primary care physicians (PCP) play an important role in early detection of Familial Hypercholesterolaemia (FH). However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Therefore, this study aimed to adapt an FH KAP questionnaire and to determine its validity and reliability among Malaysian PCP. Methods: This cross-sectional validation study involved PCP with ≥1-year working experience in the Malaysian primary care settings. In Phase 1, the original 19-item FH KAP questionnaire was content validated and adapted by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was distributed via e-mail to 1500 PCP for self-administration. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. PCP with postgraduate qualification (PCP-PG-Qual) were hypothesized to have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). The internal consistency reliability was tested using Kuder Richardson formula-20 (KR-20) and test-retest reliability was tested on 26 PCP using kappa statistics. Results: During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire contained 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (53.5, SD±13.9 vs. 35.9, SD±11.79), t(128)=6.90, p<0.001. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR±23.08 vs. 7.7, IqR±15.38), p=0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (69.2, SD±17.62 vs. 54.4, SD±19.28), t(128)=3.79, p<0.001. The KR-20 was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). Conclusion: The robust validation methods and findings suggest that the adapted 25-item questionnaire is a valid and reliable tool to measure FH KAP among Malaysian PCP. This would aid to improve FH care in the community.
Molecular evolution of GDP-L-galactose phosphorylase (GGP), a key regulatory gene in plant ascorbate biosynthesis
Authors: Tao Junjie , Hao Zhuan , Huang Chunhui
Published: October 2019

Background Ascorbic acid (AsA) is a multi-functional molecule and plays essential roles in maintaining the normal life activities of living organisms. Although widely present in plants, the concentration of AsA varies greatly in different plant species. The GDP-L-galactose phosphorylase (GGP) is a key regulatory gene in plant AsA biosynthesis that can regulate the concentration of AsA at the transcriptional and translational levels. The function and regulation mechanisms of GGP have been well understood in previous works. However, the molecular evolutionary patterns of the gene remain unclear.Results In this study, a total of 149 homologous sequences of GGP were sampled from 71 plant species covering the major groups of Viridiplantae, including angiosperms, gymnosperms, lycophytes, bryophytes and chlorophytes, and their phylogenetic relationships, gene duplication and molecular evolution analyses were investigated. Phylogenetic analysis showed that GGP exists widely in various plants, and five major duplication events and several taxon-specific duplications were found, which led to the rapid expansion of GGP genes in seed plants, especially in angiosperms. The structure of GGP genes were more conserved in land plants, but varied greatly in green algae, indicating that GGP may have undergone great differentiation in the early stages of plant evolution. Most GGP proteins have a conserved motif arrangement and composition, suggesting that plant GGPs have similar catalytic functions. Molecular evolutionary analyses showed that plant GGP genes was predominated by strong purifying selection, indicating the functional importance and conservativeness of plant GGP genes during evolution. Most of the branches under positive selection identified by branch-site model were mainly in the chlorophytes lineage, indicating the evolutionary innovation of GGP genes also mainly occurred in the early stages of plant evolution and episodic diversifying selection contributed to the evolution of plant GGP genes.Conclusions The molecular evolutionary patterns of GGP were first systematically explored in this study. The conservative function of GGP and its rapid expansion in angiosperms may be one of the reasons for the increase of AsA content in angiosperms, enabling angiosperms to adapt to changing environments.
An Endostatin-Lentivirus (ES-LV)-EPC Gene Therapy Agent for Suppression of Neovascularization in Oxygen-Induced Retinopathy Rat Models
Authors: Ai Jing , Ma Jian , Chen Zhi-Qing , Sun Jun-Hui , Yao Ke
Published: October 2019

Background: Transplantation of gene transfected endothelial progenitor cells (EPCs) has provided novel methods for neovascularization but not ocular disease therapy. This study aimed to investigate the efficacy of endostatin transfected EPCs in retinal neovascularization therapy. Results: Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) showed high expression of endostatin in endostatin-lentivirus-EPCs. The neovascularization leakage area and the number of preretinal neovascular cell nuclei were significantly decreased in the endostatin-lentivirus and endostatin-lentivirus-EPC groups, and the effects of these two treatments on inhibiting retinal neovascularization were almost the same. These two groups also showed greater retinal distribution of endostatin. Intravitreal injections of endostatin-lentivirus-EPCs inhibited retinal neovascularization, vascular endothelial growth factor (VEGF), and CD31 expression and increased endostatin expression in vivo. Endostatin-lentivirus-EPCs targeted and prevented pathologic retinal neovascularization. Conclusions: Gene-combined EPCs represent a potential new therapeutic agent for the treatment of neovascular eye diseases.
Impact of Educational and Visual Sign Interventions on Noise Reduction in Neonatal Intensive Care Units (NICUs)
Authors: Faal Gholamreza , Davodi Afsaneh , Taheri Fatemeh , Abolhasnnezhad Vahideh
Published: October 2019

Background High levels of sound have several negative impacts such as noise-induced hearing loss and delayed growth and development on newborn in NICUs. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA. The aim of this research is to determine the effect of educational and visual sign interventions on noise reduction in Neonatal Intensive Care Units.Methods This Quasi-experimental study (before-after study) was conducted in the NICU of Vali-e-Asr Hospital, Birjand in 2016. A total of 21 participants including NICU doctors and hospital staff could enter the NICU. The sound levels in the NICU were measured by a calibrated digital sound-level meter and placed at a height of 1.5 meters at various stations and three different working shifts. Subsequently, the post-training and visual signs (flags and posters) were utilized at the NICU.Results There was a significant difference in the means of the sound levels between stages 2 and 3 of the study (P=0.009) as well as a significant decrease in the level of sound between stages 2 and 3. The means of the minimum sound level in the morning and night shifts in the three different study periods indicated a significant decline (P<0.05), while in the afternoon shifts the minimum sound levels showed a significant increase which was also significant before and after the intervention (P=0.046). The maximum sound level dropped significantly (P=0.045) in the night shift compared to the three different study periods, as well as in the pre- and post-intervention phases (P=0.04).Conclusions Noise in our NICU was more than the recommended sound levels of 45 dBA. However, educational interventions and warning visual signs seemed effective in reducing sound levels, particularly in the night shift in the NICU station.
Aerobic exercise training improves mitochondrial biogenesis and oxidative status in obese mice with nonalcoholic fatty liver disease: a non-randomized experimental study
Authors: Fernandes Matheus Santos de Sousa , Silva Lucas de Lucena Simões e , Kubrusly Márcia Saldanha , Lima Talitta Ricarlly Lopes de Arruda , Muller Cynthia Rodrigues , Américo Anna Laura Viacava , Fernandes Mariana Pinheiro , Cogliati Bruno , Stefano Jose Tadeu , Lagranha Claudia J , Evangelista Fabiana Sant´Anna , Oliveira Claudia P
Published: October 2019

Non-alcoholic fatty liver disease (NAFLD) is one of the most common forms of liver disease. Lifestyle modifications, such as a reduction in body weight (BW) and aerobic exercise training (AET), are effective treatments for NAFLD. The aim of the present study was to evaluate the effect of AET on hepatic oxidative metabolism in ob/ob mice. Male ob/ob mice were separated into two groups: the sedentary group (S), n=7, and the trained group (T), n=7. The T mice were submitted to an 8-week protocol of AET at 60% of the maximum velocity achieved in the running test. Before AET, no difference was observed in running capacity between the groups (S=10.4 ± 0.7 min vs. T= 13 ± 0.47 min). However, after AET, the running capacity was increased in the T group (12.8 ± 0.87 min) compared to the S group (7.2±0.63 min). Skeletal muscle in the T group (26.91±1.12 U/mg of protein) showed higher citrate synthase activity compared with the S group (19.28±0.88 U/mg of protein) (p =0.004) . BW and food consumption were significantly reduced in the T group compared to the S group (p=0.008 and p=0.001, respectively). The analysis of hepatic gene expression showed an increase in PGC-1a levels (p=0.002) and a reduction in CPT-1a levels (p=0.03). The levels of TBARs and carbonyls, as well as SOD, CAT and GST, were not different between the groups. In the nonenzymatic antioxidant system, we found that the T group had higher sulfhydryl (p = 0.02), GSH (p=0.001) and GSH/GSSG (p=0.02) activity. The activity of the metabolic enzymes citrate synthase (p=0.004) and β-HAD (p=0.01) was also increased in the T group. Besides improve in metabolism, no differences were observed in the histological analyses. In conclusion, our data demonstrate that AET improves BW control, mitochondrial functionality and oxidative metabolism in ob/ob mice.
Perception Towards National Health Insurance Scheme among Enrollees of Central Terai: A qualitative Study
Authors: Thapa Sailendra , Acharya Puspa , Mishra Durga Khadka
Published: October 2019

Background Out of Pocket Expenditure has always been a primary means of financing health care service in Nepal. National Health Insurance Scheme ensures universal health coverage by addressing the unregulated out-of-pocket spending and providing quality of health service.Methods A descriptive cross-sectional study was conducted among the enrollees of the National Health Insurance Scheme (NHIS) in Bharatpur Metropolitan City of Chitwan district. Focused Group Discussions were conducted among enrollees to assess the perception towards National Health Insurance Scheme. The qualitative data were analyzed as thematic analysis technique. Results: Perception towards National Health Insurance Scheme was categorized as perceived quality of care, perceived benefit and provider’s behavior. Respondents were fully satisfied with the premium charge. Availability of drugs was improved but the waiting time and the process of registration was lengthy and full of jargons. Most of the participants perceived that due to less number of service providers or due to inability of allocating separate provider for ensured persons, the consultation time was very less which further affects the quality of care. Enrollment Assistants were considered as primary source of information regarding the NHIS.Conclusion Long waiting time, difficulty during registration and less number of service providers remain challenge to receive quality of care under NHIS. Participants perceived that the benefit package under affordable premium charge is in favor of them. Addressing these factors in expansion of this program in other district might leads for success of this scheme.
Effectiveness of a Community Health Worker(CHW) training in monitoring and care of patients with Chronic Obstructive Pulmonary Disease(COPD) in rural Gujarat, India.
Authors: Gupta Ashish , Phatak Ajay , Patel Meha , Das Neha , Vaghela Nirav , Prakash Harihara , Raithatha Shyamsundar J
Published: October 2019

Background- COPD is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician based approach. Community Health Workers(CHWs) can play an effective role in making COPD care accessible and effective. Findings of an assessment of a training program for CHWs on COPD are reported here.Methods- 90 CHWs were exposed to a series of 5 training sessions designed and administered jointly by a team of public health experts and physiotherapists in the year 2017-18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes and 5 skill assessments through Objectively Structured Clinical Examination(OSCE). Mean percentage scores were calculated for each domain of assessment to make it comparable.Results 70 CHWs with a mean age of 42.2 years completed all the trainings and underwent the assessment. Mean percentage score(SD) for knowledge was 62%(16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration(92.1%) and the least in dyspnoea relieving positions(59.2%). The CHWs had difficulties in identifying signs of respiratory distress(score – 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile.Conclusion The results were encouraging and the program may be pilot tested in a Government setting.
Community-based management and care of people with dementia: A training needs assessment among village health teams in Uganda based on WHO guidelines
Authors: Karungi Christine , Obua Celestino , Rukundo Godfrey Z. , Maling Samuel , Haberer Jessica E. , Wakida Edith K.
Published: October 2019

Background Dementia is a public health problem worldwide with approximately 47 million people living with the disease. Although the symptoms are known and named, dementia remains a hidden problem in low and middle income countries (LMICs) as most people perceive it be a normal aging process. In a bid to improve healthcare, the Uganda government adopted a model of recruiting community-based health assistants known as village health teams (VHTs). These individuals helped in linking the community health units with community members with a goal of promoting health services. However, there is paucity of information about how the VHTs provide community-based management and care for people with dementia and their ability to perform the task. The purpose of this study was to identify the training needs of the VHTs in caring for people with dementia in rural communities of southwestern Uganda.Methods This study utilized a cross-sectional qualitative design conducted with the help of semi-structured interview guide. The WHO guide was adopted in developing interviews on dementia care and management in LMICs.Results From the study, VHTs reported the need for training with specific to dementia care to equip them with knowledge and skills on early detection and management, care and referral system. Results also show that VHTs were not able to detect dementia early since they perceive it as normal aging process. There was no community engagement in helping people with dementia since most people in the community do not take dementia to be a medical condition. Also there was little support for dementia in these areas as VHTs only referred people with dementia to health facilities in an event of physical ailment. Other organisations like churches only offered prayers only to the aged persons who are very close to the church.Conclusions The study found that there is an urgent need for training VHTs on caring for individuals with dementia in rural communities of southwestern Uganda. The identified gaps helped in designing the strategies for capacity building through training of VHTs on dementia care in rural communities of southwestern Uganda.
The effects of c-Src kinase on EMT signaling pathway in human lens epithelial cells associated with lens diseases
Authors: Li Xing-Yu , Wang Fang , Ren Mei-Xia , Du Min-Juan , Zhou Jian
Published: October 2019

Background: The signaling pathway of epithelial to mesenchymal transition (EMT) is regulated by c-Src kinase in many cells. The purpose of this study was to investigate the effects of c-Src kinase on EMT of human lens epithelial cells in vivo stimulated by different factors.
Methods: Human lens epithelial cells, HLE-B3, were exposed to either an inflammatory factor, specifically IL-1α, IL-6, TNF-α or IL-1β, at 10 ng/mL or high glucose (35.5 mM) for 30 mins. Activity of c-Src kinase was evaluated by the expression of p-Src 418 with western blot assay. To investigate the effects of activation of c-Src on EMT, HLE-B3 cells were transfected with pCDNA3.1-Src Y530F to upregulate activity of c-Src kinase, and pSlience4.1-ShSrc to knock it down. The expressions of c-Src kinase and molecular markers of EMT such as E-cadherin, ZO-1, α-SMA, and vimentin were examined at 48 hours by RT-PCR and western blot. At 48 hours and 72 hours of transfection, cell proliferation was detected by MTT, and cell mobility and migration were determined by scratch and transwell assay.
Results: Activity of c-Src kinase, which causes the expression of p-Src 418 , was upregulated by different inflammatory factors and high glucose in HLE-B3 cells. When HLE-B3 cells were transfected with pCDNA3.1-Src Y530F , the expression of c-Src kinase was upregulated on both mRNA and protein levels, and activity of c-Src kinase, expression of p-Src 418 increased. The expression of both E-cadherin and ZO-1 was suppressed, while the expressions of vimentin and α-SMA were elevated on both mRNA and protein levels at the same time. Cell proliferation, mobility and migration increased along with activation of c-Src kinase. Conversely, when HLE-B3 cells were transfected with pSlience4.1-ShSrc, both c-Src kinase and p-Src 418 expression were knocked down. The expression of E-cadherin and ZO-1 increased, but the expression of vimentin and α-SMA decreased; meanwhile, cell proliferation, mobility and migration reduced.
Conclusions: The c-Src kinase in lens epithelial cells is easily activated by external stimuli, resulting in the induction of cell proliferation, mobility, migration and EMT.
The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults： A randomized controlled trial
Authors: Jiang Lianxiang , Qiu Shulin , Zhang Peng , Yao Weidong , Chang Yan , Dai Zeping
Published: October 2019

Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation.
Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups.
Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05).
Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation.
Trial registration: The study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).
Venir a la palabra
Authors: Jaramillo Restrepo Víctor Raúl
Published: October 2019

Después de varios años dedicado a otras maneras de hacerle un quite a la muerte, de prender fuego en altares que no he buscado por decisión propia, varios amigos y otras personas me han dicho que quisieran venir a una cita conmigo para hablar de sus vidas, de la vida en general. Y no sé si esté en condiciones de aceptar un compromiso como este. No obstante, esta solicitud ha dado pie para repensar condiciones que podrían haber sido mal adoptadas o, al menos, mal construidas por mi inmadurez teórica y vivencial. Por tal motivo, retomo palabras ya publicadas para darles nuevos sentidos, quizás, y hacerlas más cercanas. Esa es mi intención ahora.
El Ometeotl: la dualidad como fundamento metafísico trascendental
Authors: Hernández Rodríguez Juan Camilo
Published: October 2019

En el presente trabajo me propongo realizar una exposición general del concepto metafísico del Ometeotl (Absoluto dual) de la filosofía náhuatl a partir del problema metafísico del acceso a la realidad. Sostendré que la metafísica náhuatl no es inmanente, ni trascendente, sino trascendental. Además, es panenteísta, henoteísta y existencial. Por último, en un ejercicio comparativo con algunas teorías metafísicas occidentales y no occidentales realizaré algunos paralelos para mostrar similitudes entre estás como sugerencia para posibles trabajos posteriores.
Una investigación acerca de historia de la filosofía en la civilización andina prehispánica
Authors: Palacios Liberato Lucas
Published: October 2019

En esta investigación se demuestra que no existe oposición antagónica entre la filosofía andina prehispánica y el desarrollo de la filosofía en general, ni con la filosofía occidental griega en particular, salvo en las formas de su temática especial o la profundización del problema filosófico concreto, por cuanto en ningún caso es contraria a la ley del desarrollo filosófico en general, y de ella debemos entender que los nombres, los términos o los vocablos con que designan los conceptos siendo distintos tienen el mismo contenido y sigue igual lógica de desarrollo. Por ejemplo, “Pacha” resulta una formulación más cercana al concepto científico de espacio/tiempo, por cuanto adelanta la imposibilidad de separar el espacio y el tiempo de los objetos o fenómenos de la realidad objetiva, logrado no como un descubrimiento científico sino como una necesidad de formular el pensamiento acerca de dicho fenómeno, tan semejante a la ciencia moderna. O Cay y Camac, los conceptos de “materia” y de “realidad ideal”, perdidos u ocultos en los textos prehispánicos, son categorías que resuelven los problemas fundamentales de la filosofía, como acerca de “¿Cuál es el “verdadero ser”?”, o acerca de la relación ser y pensar. De igual modo consideramos que el idealismo andino prehispánico no difiere antagónicamente del idealismo griego clásico, contrariamente es posible discutir en el mismo nivel con Platón o con cualquier idealista de la filosofía clásica griega.