bluuebunny/crossref_metadata_2025 huggingface dataset:
‘I know those people will be approachable and not mistreat us’: a qualitative study of inspectors and private drug sellers’ views on peer supervision in rural Uganda
Authors: Bagonza Arthur , Peterson Stefan , Mårtensson Andreas , Mutto Milton , Awor Phllis , Kitutu Freddy Eric , Gibson Linda , Wamani Henry
Published: October 2020

BackgroundPeer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than five years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda.MethodsIn this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with one hundred and thirty drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management.Results A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. Conclusion Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
Sudden death in the young adult: An autopsy-based series
Authors: Saadi Said , Jomaa Sami Ben , Hadj Mariem Bel , Oualha Dorra , Salem Nidhal Haj
Published: October 2020

Background: We aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention. Methods: We performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done. In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 years and 35 years.Results: We collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%.Conclusion: There are several potential causes of sudden unexplained death such as structural abnormalities, ion channel abnormalities. Unexplained deaths, presumed to result from sudden primary arrhythmogenic causes, occur in a young adult with structurally normal hearts. That underlying disease-causing genetic defects may be involved has clinical implications for family members. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.
The Clinical Relevance of Luteal Phase Progesterone Support in True Natural Cycle Cryopreserved Blastocyst Stage Embryo Transfers: A Retrospective Cohort Study
Authors: Waldman Ian , Racowsky Catherine , Disler Emily , Thomas Ann , Andrea Lanes , Hornstein Mark
Published: October 2020

Background: More than 67% of all embryos transferred in the United States involve frozen-thawed embryos. Progesterone supplementation is necessary in medicated cycles in order to luteinize the endometrium and prepare it for implantation, but little data is available if this is necessary in true natural cycles. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in natural cycles not using an ovulatory trigger.Methods: Retrospective cohort study in a single academic medical center. We studied the use of luteal phase progesterone supplementation in patients undergoing true natural cycle cryopreserved blastocyst embryo transfers. Our primary outcome measure was ongoing pregnancy rate, with other pregnancy outcomes being evaluated (i.e. implantation rate, miscarriage rate, ectopic rate, and multifetal gestation). Categorical data were analyzed utilizing Fisher’s exact test and non-parametric data were analyzed using the Wilcoxon rank sum test. Results: 229 patients were included in the analysis with 149 receiving luteal phase progesterone supplementation and 80 receiving no luteal phase support. Patient demographic and cycle characteristics, and embryo quality were similar between the two groups. No difference was seen in ongoing pregnancy rate (49.0% vs. 47.5%, p=0.8738), clinical pregnancy rate (50.3% vs. 47.5%, p= 0.7483), positive HCG rate (62.4% vs. 57.5%, p=0.5965), miscarriage/abortion rate (5.4% vs. 2.5%, p=0.2622), ectopic pregnancy rate (0% vs. 1.3%, p=0.3493), or multifetal gestations (7.4% vs. 3.8%, p=0.3166).Conclusion(s): The addition of luteal phase progesterone support in true natural cycle cryopreserved blastocyst embryo transfers did not improve pregnancy outcomes and therefore the routine use in practice cannot be recommended based on this study, but the utilization should not be discouraged without further studies. Capsule: Progesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
Hair cortisol-a method to detect chronic cortisol levels in patients with Prader-Willi syndrome
Authors: Shukur Hasanain Hamid , de Rijke Yolanda B , Rossum Elisabeth FC van , Hussain-Alkhateeb Laith , Höybye Charlotte
Published: October 2020

Background: Prader-Willi syndrome (PWS) is a multisymptomatic, rare, genetic, neurodevelopmental disorder in adults mainly characterized by hyperphagia, cognitive dysfunction, behavioral problems and risk of morbid obesity. Although endocrine insufficiencies are common, hypocortisolism is rare and knowledge on long-term cortisol concentrations is lacking. The aim of this study was to evaluate long-term cortisol levels in PWS by measurements of hair cortisol. Methods: Twenty-nine adults with PWS, 15 men and 14 women, median age 29 years, median BMI 27 kg/m2, were included. Scalp hair samples were analyzed for cortisol content using liquid-chromatography tandem-mass spectrometry. In addition, a questionnaire on auxology, medication and stress were included. For comparison, 105 age- and sex-matched participants from the population-based Lifelines Cohort study were included as controls. The mean hair cortisol between the groups were compared and associations between BMI and stress were assessed by a generalized linear regression model. Results: In the PWS group large variations in hair cortisol was seen. Mean hair cortisol was 12.8±25.4 pg/mg compared to 3.8±7.3 pg/mg in controls (p=0.001). The linear regression model similarly showed higher cortisol levels in patients with PWS, which remained consistent after adjusting for BMI and stress (p=0.023). Furthermore, hair cortisol increased with BMI (p=0.012) and reported stress (p=0.014). Conclusion: Long-term cortisol concentrations were higher in patients with PWS compared to controls and increased with BMI and stress, suggesting an adequate cortisol response to chronic stress. Hair cortisol demonstrate promising applications in the context of PWS treatment and disease management.
Mechanism of Multi-loop Edgewise Archwire technique in correcting Class II anterior open bites with temporomandibular disorders – a retrospective cephalometric study in Chinese patients 
Authors: Liu Huanye , Suh Heeyeon , Jung Young-Eun , Xu Kaiyuan , Zhang Dan , Oh Heesoo
Published: October 2020

Background: An anterior open bite is considered challenging to treat because of its multifactorial etiology. Condylar resorption, which is one of the temporomandibular disorders (TMD) symptoms, has been identified as an etiologic factor of anterior open bites. It is essential to find an effective and efficient method to correct open bites while reducing the risk of exacerbating TMD during orthodontic treatment.Objectives: To evaluate the effect of the multi-loop edgewise archwire (MEAW) technique in correcting anterior open bite in patients with TMD. Materials and Methods: In this retrospective study, 20 patients with anterior open bites and TMD were included. 19 cephalometric measurements and 2 open bite indices were evaluated. A paired t-test was used to assess changes between pre- and post-treatments. Results: There were statistically significant changes after the treatment using the MEAW technique. The cephalometric measurements, including vertical positions of the incisors and molars, changed significantly. The maxillary and mandibular regional superimpositions for a subgroup of non-extraction patients showed slight intrusion of the upper molars (-0.6±1.0mm, p=0.04) and slight extrusion of the lower molars (1.0±1.1mm, p<0.01). Open bite correction was achieved predominantly through retraction and extrusion of the upper and lower incisors. Conclusions: The MEAW technique can be an effective method in correcting anterior open bites in Class II patients with TMD. Anterior open bites were corrected mainly by extrusion and retraction of the anterior teeth. The vertical dimension was maintained for the upper molars, but the mandibular molars were extruded. During treatment, the patients who had TMD did not show evident recurrence or worsening of their TMD conditions, indicating that orthodontic treatment can be performed when required.
Role of demographic variables in investigating occupational stress of disaster and emergency medical management center 115
Authors: lebni Javad Yoosefi , Abbas Jaffar , Gheshlaghi Parvin Abdi , Toghroli Razie , Garosi Vahid Hatami , Kalhori Reza Pourmirza , Salahshoor Mohammad Reza , Kianipour Neda , ziapour arash
Published: October 2020

Background: The Emergency Medical Services (EMS) Center is a community-centric that coordinates with the entire health care system. Employees are the most crucial asset of this medical center. This present study investigates the role of demographic variables associated with 115 disasters and the occupational stress of emergency medical management center personnel in 2019.Methods: This present descriptive study selected a statistical population based on 200 medical personnel associated with disaster and emergency medical management center 115 in Iran, according to inclusion chosen criteria. The review used a scale consisting of two parts, including demographic information and HSE standard questionnaire. The study selected respondents through Cochran's Sample Size Formula using stratified random sampling with a cross-sectional research design for data collection. The study has analyzed received data by using SPSS version 24 and performed the descriptive and inferential statistics (t-test and one-way ANOVA) at a significance level p<0.05.Results: The study results showed the mean score of total occupational stress 3.41±0.26. The results showed the highest (4.34±0.35) and the lowest stress levels (2.72±0.86) related to role dimensions. The study findings revealed a significant relationship between stress level and participants’ age, marital status, educational level, type of base, workplace, and the number of work hours per month. There was no relationship between the type of employment and work experience with stress levels. Conclusion: Emergency medical personnel experience a high level of occupational stress. Senior managers can use similar studies to implement measures to reduce the experience of employees' stress.
Systematic Development and Refinement of a Contextually Relevant Strategy for Undergraduate Medical Ethics Education: a qualitative study
Authors: Shamim Muhammad Shahid , Torda Adrienne , Baig Lubna , Zubairi Nadeem , Balasooriya Chinthaka
Published: October 2020

Background Delivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia.Methods The study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy. Results The analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context.Conclusion The study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.
Patterns of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke patients with motor impairment
Authors: Cao Xuejin , Wang Zan , Chen Xiaohui , Liu Yanli , Wang Wei , Abdoulaye Idriss Ali , Yang Xi , Zhang Shiyao , Guo Xiaoying , Wu Shanshan , Guo Yijing
Published: October 2020

Background: Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristics of the brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrated extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we further investigated the structural changes from a global level using DTI data through multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods: Ten ischemic stroke patients with basal ganglia lesions and motor dysfunctions and eleven demographically matched adults as controls underwent brain Magnetic Resonance Imaging scans. DTI data were processed to obtain fractional anisotropy (FA) maps and MVPA was used to explore brain regions that play an important role in classification based on FA maps. The white matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences in structural networks between groups.Results: MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P≤0.001). Compared with the controls, the study patients showed FA reductions in the perilesional basal ganglia and brainstem, with a few showing reductions in bilateral frontal lobes. Using NBS, we found a significant decrease in FA-weighted WM subnetwork in stroke patients. Conclusions: We identified some patterns of WM degeneration affecting brain areas remote to the ischemic lesion, revealing the abnormal organization of WM network in stroke patients, which may be helpful for the understanding of the neural mechanisms of stroke sequela.
Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules
Authors: Shen Yan , He Jie , Liu Miao , Hu Jiaojiao , Wan Yonglin , Zhang Tingting , Ding Jun , Dong Jiangnan , Fu Xiaohong
Published: October 2020

Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with the Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This retrospective study aimed to evaluate the use of CEUS and SWE for the differentiation of benign from malignant small (≤ 2 cm) breast nodules.Methods: We reviewed the medical records and imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. The BI-RADS classification values of the nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison of the pathology results. Receiver operating characteristic (ROC) curves were analyzed based on the CEUS patterns and shear-wave velocity values of the nodules. The sensitivity, specificity, positive and negative predictive values, accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign and malignant small breast nodules were investigated.Results: CEUS was effective at diagnosing malignant nodules when at least two out of nine suspicious features were present. ROC analysis revealed that the best cut-off value for SWE was at 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both, CEUS and SWE were used, and remained unchanged when either one, CEUS or SWE was used; the highest and lowest levels were of category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A classification avoided the need for coarse needle biopsies.Conclusions: CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of the breast nodules, and a combination of these techniques may provide more diagnostic efficacy for identifying malignancy in small breast nodules.Trial registration: Retrospectively registered.
Cost-utility analysis of pralatrexate for relapsed or refractory peripheral T-cell lymphoma based on a case-matched historical control study along with single arm clinical trial
Authors: Park Seonyoung , Kim Ah-Young , Cho Hyeonseok , Baik Deborah , Lee Hankil , Cho Sunghwa , Kang Hye-young
Published: October 2020

Background: Patients with relapsed or refractory peripheral T-cell lymphoma (R/R PTCL) treated with pralatrexate have previously shown superior overall survival (OS) compared to those who underwent conventional chemotherapy (CC, 15.4 vs. 4.07 months). We conducted an economic evaluation of pralatrexate from a societal perspective in Korea based on data from the PROPEL phase II study. Methods: Using a Markov model with a weekly cycle, we simulated the experience of patients with R/R PTCL receiving pralatrexate or CC for 15 years. The model consists of five health states; initial treatment, treatment pause, subsequent treatment, stem cell transplantation (SCT) success, and death. Comparative effectiveness was based on PROPEL phase II single-arm study and its matched historical control analysis. Costs included drug, drug administration, monitoring, adverse event management, and SCT costs. Results: The incremental cost-effectiveness ratio of the base case was $39,153 per quality-adjusted life-year (QALY) gained. The results of one-way sensitivity analysis ranged from $33,949 to $51,846 per QALY gained, which remained within an implicit willingness-to-pay (WTP) threshold of anticancer drugs in Korea. Conclusions: Pralatrexate is a cost-effective intervention with improved OS and incremental costs within the WTP limit. Pralatrexate could function as a new therapeutic option for patients suffering from life-threatening R/R PTCL.
COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study.
Authors: Mokkink Lidwine B. , Boers Maarten , Vleuten CPM van der , Bouter LM , Alonso Jordi , Patrick Donald L , de Vet HCW , Terwee CB
Published: October 2020

Background: Scores on an outcome measurement instrument depend on the type and settings of the instrument used, how instructions are given to patients, how professionals administer and score the instrument, etc. The impact of all these sources of variation on scores can be assessed in studies on reliability and measurement error, if properly designed and analyzed. The aim of this study was to develop standards to assess the quality of studies on reliability and measurement error of clinician-reported outcome measurement instruments, performance-based outcome measurement instrument, and laboratory values. Methods: We conducted a 3-round Delphi study involving 52 panelists. Results: Consensus was reached on how a comprehensive research question can be deduced from the design of a reliability study to determine how the results of a study inform us about the quality of the outcome measurement instrument at issue. Consensus was reached on components of outcome measurement instruments, i.e. the potential sources of variation. Next, we reached consensus on standards on design requirements (n=5), standards on preferred statistical methods for reliability (n=3) and measurement error (n=2), and their ratings on a four-point scale. There was one term for a component and one rating of one standard on which no consensus was reached, and therefore required a decision by the steering committee. Conclusion: We developed a tool that enables researchers with and without thorough knowledge on measurement properties to assess the quality of a study on reliability and measurement error of outcome measurement instruments.
The clinical characteristics and outcome of cryptococcal meningitis with AIDS in a tertiary hospital in China: An observational cohort study
Authors: Wu Liang , Xiao Jiang , Song Yangzi , Gao Guiju , Zhao Hongxin
Published: October 2020

Background Despite the profound impact of antiretroviral therapy in the control of AIDS mortality, central nervous system opportunistic infections remains a significant burden in AIDS patients. This retrospective study aims to elucidate the clinical characteristics, outcome and risk factors of cryptococcal meningitis (CM) poor prognosis in AIDS patients from a tertiary hospital in China.Methods Clinical data from 128 patients admitted in Beijing Ditan Hospital, Capital Medical University from November 2008 to November 2017 was collected. The cohort was stratified based on treatment outcome (effective 79%, and ineffective 21%), and Multivariate Logistic regression analysis used to identify risk factors of poor disease prognosis.Results Age, incidence of cerebral infarction, the proportion of consciousness disorder, and fasting plasma glucose was higher in the ineffective treatment group than the effective treatment group. The duration of treatment in the induction period of the ineffective group was significantly shorter than that of the effective group. Multivariate Logistic regression analysis indicated that the occurrence of cerebral hernia and consciousness disorder were risk factors for the prognosis of AIDS patients with CM infection, while the duration of treatment in the induction period was a indicative of a better prognosis in AIDS with CM infection complications. Finally, shunt decompression therapy correlated with a better disease outcome. Conclusions This retrospective study exposes the main risk factors associated with worse disease prognosis in AIDS patients with CM infection complications.
REV3L gene variants rs1002481, rs462779, and rs465646 lead to increased susceptibility towards non-small cell lung cancer in the population of Jammu and Kashmir.
Authors: Jamwal Rajeshwer Singh , Mahajan Nikita , Bhat Gh. Rasool , Bhat Amrita , Sharma Bhanu , Shah Ruchi , Sharma Minerva , Verma Sonali , Bakshi Divya , Sharma Rahul , Abrol Deepak , Bhat Audesh , Kumar Rakesh
Published: October 2020

Background: Non-small cell lung cancer (NSCLC) is the most prevalent type of lung cancer accounting for 80–85% of all lung cancer cases. Various genetic studies have tried to reveal the association of REV3L (Protein reversion less 3-like) gene mutations with cancer, including lung cancer but no such study has been carried out in the population of Jammu and Kashmir (J&K).Methods: Four selected REV3L single nucleotide variants were genotyped using the TaqMan allele discrimination assay in 550 subjects (203 NSCLC patients and 347 healthy controls). The association of variants was evaluated by logistic regression.Results: Out of the four REV3L variants genotyped, we found rs1002481, rs462779, and rs465646 significantly associated with NSCLC risk with an Odds Ratio (OR) of 3.5 (1.98–6.3 at 95% CI ), p-value = 0.00002; OR = 4.4 (1.8–10.4 at 95% CI ), p-value = 0.00075; and OR = 2.4 (1.47–4.008 at 95% CI ), p-value = 0.00053, respectively. The analysis of rs465646/rs462779/rs1002481 haplotypic combinations revealed a significant association of AGT, AGA, GGT, and AAA haplotypes with NSCLC. Conclusion: The analysed data suggest a strong association of variants rs1002481, rs462779, rs465646 with NSCLC. This association is indicative of a potential role of mutations in the REV3L gene as risk factor for the development of NSCLC in the studied population. Although a first report from any Indian population, these variants have been previously reported to be associated with lung and colorectal cancers in different world populations. These data along with the analysed data supports the notation that these variants can be used as potential prognostic biomarker.
Relationship between medial meniscus extrusion and cartilage measurements in the knee by fully automatic three-dimensional MRI analysis
Authors: Aoki Hayato , Ozeki Nobutake , Katano Hisako , Hyodo Akinobu , Miura Yugo , Matsuda Junpei , Takanashi Kimiko , Suzuki Kenji , Masumoto Jun , Okanouchi Noriya , Fujiwara Takeo , Sekiya Ichiro
Published: October 2020

BackgroundWe developed a fully automatic three-dimensional knee MRI analysis software that can quantify meniscus extrusion and cartilage measurements, including the projected cartilage area ratio (PCAR), which represents the ratio of the subject’s actual cartilage area to their ideal cartilage area. We also collected 3D MRI knee data from 561 volunteers (aged 30–79 years) from the “Kanagawa Knee Study.” Our purposes were to verify the accuracy of the software for automatic cartilage and meniscus segmentation using knee MRI and to examine the relationship between medial meniscus extrusion measurements and cartilage measurements from Kanagawa Knee Study data.MethodsWe constructed a neural network for the software by randomly choosing 10 healthy volunteers and 103 patients with knee pain. We validated the algorithm by randomly selecting 108 of these 113 subjects for training, and determined Dice similarity coefficients from five other subjects. We constructed a neural network using all data (113 subjects) for training. Cartilage thickness, cartilage volume, and PCAR in the medial femoral, lateral femoral, medial tibial, and lateral tibial regions were quantified by using the trained software on Kanagawa Knee Study data and their relationship with subject height was investigated. We also quantified the medial meniscus coverage ratio (MMCR), defined as the ratio of the overlapping area between the medial meniscus area and the medial tibial cartilage area to the medial tibial cartilage area. Finally, we examined the relationship between MMCR and PCAR at middle central medial tibial (mcMT) subregion located in the center of nine subregions in the medial tibial cartilage.ResultsDice similarity coefficients for cartilage and meniscus were both approximately 0.9. The femoral and tibial cartilage thickness and volume at each region correlated with height, but PCAR did not correlate with height in most settings. PCAR at the mcMT was significantly correlated with MMCR.ConclusionsOur software showed high segmentation accuracy for the knee cartilage and meniscus. PCAR was more useful than cartilage thickness or volume since it was less affected by height. A relationship was observed between the medial tibial cartilage measurements and the medial meniscus extrusion measurement in our cross-sectional study.Trial registration: UMIN, UMIN000032826; 1 September 2018,https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037299
Genetic diversity of circumsporozoite protein in Plasmodium knowlesi isolates from Malaysian Borneo and Peninsular Malaysia
Authors: Chong Eric Tzyy Jiann , Neoh Joveen Wan Fen , Lau Tiek Ying , Lim Yvonne Ai-Lian , Chai Hwa Chia , Chua Kek Heng , Lee Ping Chin
Published: October 2020

Background: Understanding the genetic diversity of candidate genes for malaria vaccines such as circumsporozoite protein (csp) may enhance the development of vaccines for treating Plasmodium knowlesi. Hence, the aim of this study is to investigate the genetic diversity of non-repeat regions of csp in P. knowlesi from Malaysian Borneo and Peninsular Malaysia. Methods: A total of 46 csp genes were subjected to polymerase chain reaction amplification. The genes were obtained from P. knowlesi isolates collected from different divisions of Sabah, Malaysian Borneo, and Peninsular Malaysia. The targeted gene fragments were cloned into a commercial vector and sequenced, and a phylogenetic tree was constructed while incorporating 168 csp sequences retrieved from the GenBank database. The genetic diversity and natural evolution of the csp sequences were analysed using MEGA6 and DnaSP ver. 5.10.01. A genealogical network of the csp haplotypes was generated using NETWORK ver. 4.6.1.3. Results: The phylogenetic analysis revealed indistinguishable clusters of P. knowlesi isolates across different geographic regions, including Malaysian Borneo and Peninsular Malaysia. Nucleotide analysis showed that the csp non-repeat regions of zoonotic P. knowlesi isolates obtained in this study underwent purifying selection with population expansion, which was supported by extensive haplotype sharing observed between humans and macaques. Novel variations were observed in the C-terminal non-repeat region of csp. Conclusions: The csp non-repeat regions are relatively conserved and there is no distinct cluster of P. knowlesi isolates from Malaysian Borneo and Peninsular Malaysia. Distinctive variation data obtained in the C-terminal non-repeat region of csp could be beneficial for the design and development of vaccines to treat P. knowlesi.
The predictive value of D-dimer test for venous thromboembolism during puerperium in women age 35 or older：A prospective cohort study
Authors: Hu Wen , Xu Dong , Li Juan , Chen Cheng , Chen Yuan , Xi Fangfang , Zhou Feifei , Guo Xiaohan , Zhao Baihui , Luo Qiong
Published: October 2020

Background: This study aimed to investigate the predictive value of the D-dimer level for venous thromboembolism (VTE) events during puerperium of women age at 35 years or older, as well as to identify other risk factors associated with the occurrence of VTE.Methods: It was a prospective observational cohort study, from January 2014 to December 2018, which involved 12451 women age 35 or older who delivered at least 28 weeks of gestation at Women’s Hospital of Zhejiang University, School of Medicine. The maternal and fetal demographic characteristics, pregnancy complications, imaging finding and results of laboratory test within postpartum 24 hours including D-dimer level, platelet counts and fibrinogen level were collected for analyses.Results: 30(2.4‰) women were identified as VTE, including 1 pulmonary embolism event and 29 deep venous thrombosis events. The receiver operating characteristic (ROC) curve analysis suggested the best cutoff point for D-dimer level within postpartum 24 hours of women age 35 or older was 5.545 mg/L, with a specificity of 70.0% and a sensitivity of 75.4%. Besides, there was no statistical correlation between platelet counts and VTE, as well as between fibrinogen level and VTE. On multivariate analysis, D-dimer≥5.50 mg/L (OR=5.874, 95%CI: 2.678-12.886) and emergency cesarean section (OR=11.965, 95%CI: 2.732-52.401) were independently associated with VTE in puerperium of women age 35 or older.Conclusions: We concluded that D-dimer≥5.50 mg/L was an independent predictor of VTE in puerperium with maternal age 35 or older and D-dimer testing was a necessary examination for perinatal women.
Transcriptome analysis identifies genes involved in the somatic embryogenesis of Eucalyptus
Authors: Xiao Yufei , Li Junji , Zhang Ye , Zhang Xiaoning , Liu Hailong , Qin Zihai , Chen Bowen
Published: October 2020

Background: Eucalyptus, a highly diverse genus of the Myrtaceae family, is the most widely planted hardwood in the world due to its increasing importance for fiber and energy. Somatic embryogenesis (SE) is one large-scale method to provide commercial use of the vegetative propagation of Eucalyptus and dedifferentiation is a key step for plant cells to become meristematic. However, little is known about the molecular changes during the Eucalyptus SE.Results: We compared the transcriptome profiles of the differentiated and dedifferentiated tissues of two Eucalyptus species – E. camaldulensis (high embryogenetic potential) and E. grandis x urophylla (low embryogenetic potential). Initially, we identified 18,777 to 20,240 genes in all samples. Compared to the differentiated tissues, we identified 9,229 and 8,989 differentially expressed genes (DEGs) in the dedifferentiated tissues of E. camaldulensis and E. grandis x urophylla, respectively, and 2,687 up-regulated and 2,581 down-regulated genes shared. Next, we identified 2,003 up-regulated and 1,958 down-regulated genes only in E. camaldulensis, including 6 somatic embryogenesis receptor kinase, 17 ethylene, 12 auxin, 83 ribosomal protein, 28 zinc finger protein, 10 heat shock protein, 9 histone, 122 cell wall related and 98 transcription factor genes. Genes from other families like ABA, arabinogalactan protein and late embryogenesis abundant protein were also found to be specifically dysregulated in the dedifferentiation process of E. camaldulensis. Further, we identified 48,447 variants (SNPs and small indels) specific to E. camaldulensis, including 13,434 exonic variants from 4,723 genes (e.g., annexin, GN, ARF and AP2-like ethylene-responsive transcription factor). qRT-PCR was used to confirm the gene expression patterns in both E. camaldulensis and E. grandis x urophylla. Conclusions: This is the first time to study the somatic embryogenesis of Eucalyptus using transcriptome sequencing. It will improve our understanding of the molecular mechanisms of somatic embryogenesis and dedifferentiation in Eucalyptus. Our results provide a valuable resource for future studies in the field of Eucalyptus and will benefit the Eucalyptus breeding program.
Clinical warning of hemophagocytic syndrome caused by Epstein-Barr virus
Authors: Shi Jinjin , Chu Chu , Yu Min , Zhang Dandan , Li Yuqin , Fan Yujie , Yu Yixue , Luo Yali , Zhou Wei-fang
Published: October 2020

Objectives: This study aimed to compare the clinical features and laboratory tests of infectious mononucleosis (IM) and hemophagocytic syndrome (HLH) caused by Epstein-Barr virus (EBV) in 1-3-year-old children and to explore the risk factor of HLH caused by EBV (EBV-HLH).Methods: The clinical data of 92 children with EBV infection admitted in our hospital from 2011 to 2019 were collected; 61 cases were diagnosed as EBV-IM, and 31 cases were diagnosed as EBV-HLH. The subjects’ clinical manifestations and laboratory tests were analyzed retrospectively.Results: Compared with EBV-IM patients, EBV-HLH patients had longer durations of fever, both before hospitalization and overall, and a higher probability of hepatomegaly. The levels of ALT, AST, LDH, TG, SF, D-Dimer and the plasma EBV DNA load of EBV-HLH patients were significantly higher than those of EBV-IM patients. The absolute values of CD3+, CD4+, CD8+, NK, and CD3-CD19+ cells and IgA and IgM levels of EBV-HLH patients were significantly lower than those of EBV-IM patients. The plasma EBV DNA load was positively correlated with the PT, TT, α-HBDH, AST, LDH, CK, Scr, BUN, UA, TG, and CRP levels in EBV-HLH patients, and the plasma EBV DNA load was positively correlated with the D-Dimer level in the EBV-IM patients. Among the 10 different potential markers, at the cut-off point of 1721.500 µg/L, the sensitivity and specificity of D-Dimer was 88.90% and 90.20%, respectively.Conclusion: The D-Dimer level may be a good prognostic indicator of EBV-HLH caused by EBV.
Associations between pre-pregnancy body mass index, gestational weight gain and preterm birth: a cohort study in Wuhan, China
Authors: Guo Yiyang , Xiong Chao , Zhou Aifen , Hu Ronghua , Yang Rong , Du Yukai
Published: October 2020

Background Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity worldwide. Methods This cohort study aims to investigate the associations between pre-pregnancy BMI, total gestational weight gain (GWG), and the GWG during early pregnancy with PTB utilizing data of 83,096 Chinese women from the Wuhan Maternal and Children Healthcare Information Tracking System in China. Results Women who were underweight, overweight or obese before pregnancy had an higher overall risk of PTB compared with the normal group. Women who with a total GWG below the IOM recommendation had an increased risk of PTB compared to women who had GWG within the recommendation, whereas increased weekly early pregnancy GWG had a significant impact on the increasing risk of PTB. When stratified by subtypes of PTB, pre-pregnancy underweight was associated with higher risk of spontaneous PTB, and pre-pregnancy overweight /obese increased the risk of both spontaneous PTB and medically indicated PTB. Women with total GWG below the IOM recommendation had elevated risk for spontaneous PTB and PROM, and women with GWG above the recommendation had decreased risk for all three subtypes of PTB, whereas risk for the three subtypes of PTB increased along with increasing weekly GWG of early pregnancy. Conclusions Maternal underweight, overweight/obesity, total GWG, and GWG during early pregnancy should be considered in combination to reduce the risk of PTB, women should modify their weight gains during pregnancy according to the results.
Incidence and predictors of diabetic ketoacidosis among children with diabetes in West and East Gojjam zone referral hospitals Northern Ethiopia, 2019
Authors: assefa birtukan , Zeleke Haymanot , Murugan Rajalakshmi , Wondwossen Kalkidan
Published: October 2020

Background: Recurrent diabetic ketoacidosis in patients with known diabetes mellitus remains a relevant problem in pediatrics with an incidence of 1–10% per patient. Children may die because of cerebral edema and had a significant mortality (24%) and morbidity (35%).Objective: We assessed the incidence and predictors of diabetic ketoacidosis among diabetes children at East and West Gojjam zone referral hospitals, North West Ethiopia, 2019. Methods: An institution-based retrospective follow up study was conducted on children who were registered from January 1, 2014, to January 1, 2019. Epi data version 3.1 & Stata 14 were used for data entering and analysis respectively.Result: Out of 354 children included in the study, 207 (58.5%) developed diabetic ketoacidosis. The overall incidence rate of diabetic ketoacidosis was 2.27/100 children/month of observation. Age <5 years (AHR: 3.52, 95% CI (2.25, 5.49), non-adherence (AHR: 1.54, 95% CI (1.11, 2.14), inappropriate insulin storage (AHR: 1.36, 95% CI (1.008, 1.85), presence of upper respiratory tract infections during diabetic ketoacidosis diagnose (AHR: 2.22, 95% CI (1.11, 4.45) and preceding gastroenteritis (AHR: 2.18, 95% CI (1.07, 4.44) were significant predictors. Conclusion: Age < 5 years old, non-adherence, inappropriate insulin placement at home, preceding gastroenteritis, and presence of upper respiratory tract infections at the time of diabetic ketoacidosis development were significant predictors. Hence, assessing and close monitoring as well as strengthened diabetic education should be given for the above predictors.
Flexor Hallucis Longus Hypertrophy Secondary to Achilles Tendon Tendinopathy: An MRI-based Case-Control Study
Authors: Wirth Stephan , Andronic Octavian , Aregger Fabian , Jungwirth-Weinberger Anna , Jentzsch Thorsten , Hecker Andreas
Published: October 2020

Background: The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL).Methods: MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, whilst the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4 to 5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cut-off points to differentiate between the groups.Results: A total of 60 patients for each study group were included. Both ratios, Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p<0.001). There were strong to very strong intraclass correlation coefficients (ICC=0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.Conclusion: In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.
Reamputation in patients with diabetic-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study
Authors: Imaoka Shinsuke , Sato Koji , Furukawa Masahide , Okita Minoru , Higashi Toshio
Published: October 2020

Background: Diabetic foot lesions are a major cause of non-traumatic lower limb amputations; they can interfere with daily life, reduce physical function and lower a patient’s quality of life. Physical therapy is necessary to prevent such social disadvantage. Patients at high risk of reamputation may require physical therapy to prevent reamputation. The purpose of this study was to elucidate the factors that influence re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods: This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records (to surgical and physical therapy units) stored in the electronic medical records. We examined reamputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was１year. We used Cox proportional hazards analysis to examine factors affecting the risk of reamputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent reamputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with reamputation were a requirement for hemodialysis, ankle dorsiflexion angle, and ambulation Functional Independence Measure score.Conclusions: We identified a requirement for hemodialysis, ankle dorsiflexion angle, and functional independence measure (FIM) ambulation as the factors associated with reamputation in patients with diabetes who had undergone minor amputation. In the future, developing a physical therapy program that focuses on these factors could help reduce reamputations.
Discriminative validity of the Lower and Upper Quarter Y Balance Test performance: A comparison between healthy trained and untrained youth
Authors: Schwiertz Gerrit , Beurskens Rainer , Muehlbauer Thomas
Published: October 2020

Background: The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test have been widely used for the assessment of dynamic balance and shoulder mobility/stability, respectively. However, investigations on the validity of the two tests in youth are lacking. Therefore, we performed two studies to determine discriminative validity of the YBT-LQ (study 1) and the YBT-UQ (study 2) in healthy youth.Methods: Sixty-nine male soccer players (age: 14.4 ± 1.9 yrs) and 69 age-matched untrained male subjects (14.3 ± 1.6 yrs) participated in study 1 and 37 young swimmers (age: 12.3 ± 2.1 yrs) as well as 37 age-/sex-matched individuals (age: 12.5 ± 2.0 yrs) took part in study 2. Absolute (cm) and relative (% leg/arm length) maximal reach distances per reach direction and the composite score of the YBT-LQ/UQ were used as outcome measures. One-way analysis of variance and the receiver operator characteristic curve analysis (i.e., calculating the area under the curve [AUC]) were conducted to assess discriminative validity.Results: Concerning the relative values, youth athletes showed significantly better YBT-LQ (study 1: p < 0.001, d = 0.86-1.21) and YBT-UQ (study 2: p < 0.001, d = 0.88-1.48) test performances compared to age- and sex-matched untrained subjects. Further, AUC-values indicated a chance of ≥74% (YBT-LQ) and ≥71% (YBT-UQ) to discriminate between youth athletes and controls. These findings were confirmed when using the absolute data for analysis.Conclusions: According to our results, the YBT-LQ and the YBT-UQ seem to be useful test instruments to discriminate trained and untrained healthy youth performance for dynamic balance and shoulder mobility/stability, respectively.