bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic impact of the ELN2017 risk classification in patients with AML receiving allogeneic transplantation
Authors: Grimm Juliane , Jentzsch Madlen , Bill Marius , Goldmann Karoline , Schulz Julia , Niederwieser Dietger , Platzbecker Uwe , Schwind Sebastian
Published: August 2020

In 2017, an updated European LeukemiaNet (ELN) risk classification was published allocating patients with acute myeloid leukemia (AML) to 3 risk groups on the basis of certain cytogenetic and molecular aberrations. To date, studies of the prognostic significance of the ELN2017 risk classification in the context of an allogeneic hematopoietic stem cell transplantation (HSCT) are lacking. We performed risk stratification according to the ELN2017 classification in 234 patients with AML who underwent allogeneic HSCT as a consolidation therapy. In our cohort, the risk of 39.7% of the patients was classified as favorable, that of 12.8% as intermediate, and that of 47.4% as adverse. In the context of allogeneic HSCT, the assignment to the 3 ELN2017 risk groups retained its prognostic significance, with patients with favorable risk having the best prognosis and those with adverse risk having the worst one. Subgroup analyses showed that patients with a monosomal karyotype or TP53 mutation had considerably increased relapse rates, even in the adverse-risk group. When we analyzed the impact of digital droplet PCR–based measurable residual disease (MRD) before allogeneic HSCT, MRD+ patients had impaired prognoses, with cumulative incidence of relapse and overall survival comparable to those of patients classified as having an ELN2017 adverse genetic risk. This study is the first to demonstrate that the ELN2017 classification distinguishes the 3 risk groups with significantly distinct prognoses, even after allogeneic HSCT, and emphasizes the dismal prognosis of patients with AML with TP53 mutations, monosomal karyotype, or MRD positivity after allogeneic HSCT.
Discovery of the possible mechanisms in kouyanqing granule for treatment of oral ulcers based on network pharmacology
Authors: Chen Pan , Yao Hongliang , Yuan Qing , Li Panlin , Wang Xinning , Su Weiwei , Wang Yonggang , Li Peibo
Published: August 2020

Background

Oral ulcer diseases are complex inflammatory diseases caused by multi-factors, which severely impact patient quality of life. Kouyanqing Granule (KYQG) has been used to treat inflammatory diseases of the mouth and throat, including recurrent aphthous stomatitis (RAS), traumatic ulcers, oral leukoplakia and so on. However, the underlying molecular mechanisms of KYQG in treating these diseases are still unclear. We aimed to explore the possible mechanisms in KYQG for the treatment of oral ulcers.

Methods

An innovative network pharmacology method was established by incorporating targets searching and fishing, network analysis, and silico validation to discover the pharmacological mechanisms of action of KYQG for the treatment of oral ulcers. Then, we verified the reliability of this method by an animal experiment.

Results

Our data indicated that a total of 47 key targets were screened, which mainly involved in three function modules including the inhibition of inflammation, the regulation of immunological response, and the suppression of oxidative stress. The implementation of these functions relies on the complex multi-pathways network, especially TNF signaling pathway and HIF-1 signaling pathway. The results of the experimental verification indicated that KYQG significantly inhibited the serum levels of cyclooxygenase-2 (COX2), matrix metalloproteinase 9 (MMP9) and tumor necrosis factor-alpha (TNF-α) in rats with oral ulcer.

Conclusion

KYQG exhibited the therapeutic effects on oral ulcers probably by inhibiting inflammation, regulating immunological response, and suppressing oxidative stress through a complex multi-pathways network. Particularly, TNF signaling pathway and HIF-1 signaling pathway may play crucial roles in the protection of KYQG against oral ulcers. This work not only offers a method for understanding the functional mechanisms of KYQG for treating oral ulcer diseases from a multi-scale perspective but also may provide an efficient way for research and development of complex composition formula.
Challenges in health service delivery under public-private partnership in Tanzania: stakeholders’ views from Dar es Salaam region
Authors: Nuhu Said , Mpambije Chakupewa Joseph , Ngussa Kinamhala
Published: August 2020

Background

Public-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania. Contrary, the expected outcomes have not been fully realised. This study aimed at investigating challenges encountered in implementing public-private partnership institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania.

Methods

A qualitative case study design was employed, where in-depth interviews with stakeholders were held and document reviews conducted. Fourteen (n = 14) participants engaged in this study. Eight (n = 8) and six (n = 6) of the fourteen participants were from the public and private sector respectively. The thematic approach was used to analyse data, and ethical principles in the research process were upheld.

Results

Findings revealed that although public-private partnerships are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. Several challenges encumber smooth provision of health services and these include inadequate resources, ineffective monitoring and evaluation, and insufficient consultations between partners.

Conclusion

Inadequate legal and policy framework, or ineffective implementation practices may influence challenges facing institutional arrangements for public-private partnerships. Therefore, strengthening of public-private partnerships is recommended to improve implementation mechanisms and practices such as adherence to partnership agreements and compliance to the policies, laws and regulations.
Intranasal exposure of African green monkeys to SARS-CoV-2 results in acute phase pneumonia with shedding and lung injury still present in the early convalescence phase
Authors: Cross Robert W. , Agans Krystle N. , Prasad Abhishek N. , Borisevich Viktoriya , Woolsey Courtney , Deer Daniel J. , Dobias Natalie S. , Geisbert Joan B. , Fenton Karla A. , Geisbert Thomas W.
Published: August 2020

We recently reported the development of the first African green monkey (AGM) model for COVID-19 based on a combined liquid intranasal (i.n.) and intratracheal (i.t.) exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we followed up on this work by assessing an i.n. particle only route of exposure using the LMA mucosal atomization device (MAD). Six AGMs were infected with SARS-CoV-2; three animals were euthanized near the peak stage of virus replication (day 5) and three animals were euthanized during the early convalescence period (day 34). All six AGMs supported robust SARS-CoV-2 replication and developed respiratory disease. Evidence of coagulation dysfunction as noted by a transient increases in aPTT and circulating levels of fibrinogen was observed in all AGMs. The level of SARS-CoV-2 replication and lung pathology was not quite as pronounced as previously reported with AGMs exposed by the combined i.n. and i.t. routes; however, SARS-CoV-2 RNA was detected in nasal swabs of some animals as late as day 15 and rectal swabs as late as day 28 after virus challenge. Of particular importance to this study, all three AGMs that were followed until the early convalescence stage of COVID-19 showed substantial lung pathology at necropsy as evidenced by multifocal chronic interstitial pneumonia and increased collagen deposition in alveolar walls despite the absence of detectable SARS-CoV-2 in any of the lungs of these animals. These findings are consistent with human COVID-19 further demonstrating that the AGM faithfully reproduces the human condition.
Targeting EphA2 in cancer
Authors: Xiao Ta , Xiao Yuhang , Wang Wenxiang , Tang Yan Yan , Xiao Zhiqiang , Su Min
Published: August 2020

Eph receptors and the corresponding Eph receptor-interacting (ephrin) ligands jointly constitute a critical cell signaling network that has multiple functions. The tyrosine kinase EphA2, which belongs to the family of Eph receptors, is highly produced in tumor tissues, while found at relatively low levels in most normal adult tissues, indicating its potential application in cancer treatment. After 30 years of investigation, a large amount of data regarding EphA2 functions have been compiled. Meanwhile, several compounds targeting EphA2 have been evaluated and tested in clinical studies, albeit with limited clinical success. The present review briefly describes the contribution of EphA2-ephrin A1 signaling axis to carcinogenesis. In addition, the roles of EphA2 in resistance to molecular-targeted agents were examined. In particular, we focused on EphA2’s potential as a target for cancer treatment to provide insights into the application of EphA2 targeting in anticancer strategies. Overall, EphA2 represents a potential target for treating malignant tumors.
Unveiling the immunomodulatory properties of Haemonchus contortus adhesion regulating molecule 1 interacting with goat T cells
Authors: Lu Mingmin , Tian Xiaowei , Zhang Yang , Aimulajiang Kalibixiati , Wang Wenjuan , Ehsan Muhammad , Li Charles , Yan Ruofeng , Xu Lixin , Song Xiaokai , Li Xiangrui
Published: August 2020

Background

Gastrointestinal nematodes could release excretory-secretory (ES) proteins into the host environment to ensure their survival. These ES proteins act as immunomodulators to suppress or subvert the host immune responseviathe impairment of immune cell functions, especially in chronic infections. In our preliminary study,Haemonchus contortusadhesion-regulating molecule 1 (HcADRM1) was identified fromH. contortusES proteins (HcESPs) that interacted with host T cellsvialiquid chromatography-tandem mass spectrometry analysis. However, little is known about HcADRM1 as an ES protein which may play a pivotal role at the parasite-host interface.

Methods

Based on bioinformatics approaches, multiple amino acid sequence alignment was conducted and the evolutionary relationship of HcADRM1 with ADRM1 orthologues was extrapolated. Employing RT-qPCR and immunohistochemistry assays, temporal transcriptional and spatial expression profiles of HcADRM1 were investigated. Using immunostaining approaches integrated with immunological bioassays, the immunomodulatory potentials of HcADRM1 on goat T cells were assessed.

Results

We hereby demonstrated that HcADRM1 with immunodiagnostic utility was a mammalian ADRM1 orthologue abundantly expressed at all developmental stages ofH. contortus. Given the implications of ADRM1 proteins in cell growth, survival and development, we further investigated the immunomodulatory property of HcADRM1 as an individual ES protein acting at the parasite-host interface. The rHcADRM1 stimuli notably suppressed T cell viability, promoted intrinsic and extrinsic T cell apoptosis, inhibited T cell proliferation and induced cell cycle arrest at G1 phase. Simultaneously, rHcADRM1 stimuli exerted critical controls on T cell cytokine secretion profiles, predominantly by restraining the secretions of interleukin (IL)-4, IL-10 and interferon-gamma.

Conclusions

Importantly, HcADRM1 protein may have prophylactic potential for anti-H. contortusvaccine development. Together, these findings may contribute to the clarification of molecular and immunomodulatory traits of ES proteins, as well as improvement of our understanding of parasite immune evasion mechanism inH. contortus-host biology.
Dose-effect relationship and molecular mechanism by which BMSC-derived exosomes promote peripheral nerve regeneration after crush injury
Authors: Zhao Jiuhong , Ding Yali , He Rui , Huang Kui , Liu Lu , Jiang Chaona , Liu Zhuozhou , Wang Yuanlan , Yan Xiaokai , Cao Fuyang , Huang Xueying , Peng Yanan , Ren Rui , He Yuebin , Cui Tianwei , Zhang Quanpeng , Zhang Xianfang , Liu Qibing , Li Yunqing , Ma Zhijian , Yi Xinan
Published: August 2020

Background

The development of new treatment strategies to improve peripheral nerve repair after injury, especially those that accelerate axonal nerve regeneration, is very important. The aim of this study is to elucidate the molecular mechanisms of how bone marrow stromal cell (BMSC)-derived exosomes (EXOs) participate in peripheral nerve regeneration and whether the regenerative effect of EXOs is correlated with dose.

Method

BMSCs were transfected with or without an siRNA targeting Ago2 (SiAgo2). EXOs extracted from the BMSCs were administered to dorsal root ganglion (DRG) neurons in vitro. After 48 h of culture, the neurite length was measured. Moreover, EXOs at four different doses were injected into the gastrocnemius muscles of rats with sciatic nerve crush injury. The sciatic nerve functional index (SFI) and latency of thermal pain (LTP) of the hind leg sciatic nerve were measured before the operation and at 7, 14, 21, and 28 days after the operation. Then, the number and diameter of the regenerated fibers in the injured distal sciatic nerve were quantified. Seven genes associated with nerve regeneration were investigated by qRT-PCR in DRG neurons extracted from rats 7 days after the sciatic nerve crush.

Results

We showed that after 48 h of culture, the mean number of neurites and the length of cultured DRG neurons in the SiAgo2-BMSC-EXO and SiAgo2-BMSC groups were smaller than that in the untreated and siRNA control groups. The average number and diameter of regenerated axons, LTP, and SFI in the group with 0.9 × 1010particles/ml EXOs were better than those in other groups, while the group that received a minimum EXO dose (0.4 × 1010particles/ml) was not significantly different from the PBS group. The expression of PMP22, VEGFA, NGFr, and S100b in DRGs from the EXO-treated group was significantly higher than that in the PBS control group. No significant difference was observed in the expression of HGF and Akt1 among the groups.

Conclusions

These results showed that BMSC-derived EXOs can promote the regeneration of peripheral nerves and that the mechanism may involve miRNA-mediated regulation of regeneration-related genes, such as VEGFA. Finally, a dose-effect relationship between EXO treatment and nerve regeneration was shown.
Treatment of severe COVID-19 with human umbilical cord mesenchymal stem cells
Authors: Shu Lei , Niu Changming , Li Ruyou , Huang Tingrong , Wang Yan , Huang Mao , Ji Ningfei , Zheng You , Chen Xiaolin , Shi Lei , Wu Mingjing , Deng Kaili , Wei Jing , Wang Xueli , Cao Yang , Yan Jiaxin , Feng Ganzhu
Published: August 2020

Background

COVID-19 is a highly infectious respiratory disease. No therapeutics have yet been proven effective for treating severe COVID-19.

Objectives

To determine whether human umbilical cord mesenchymal stem cell infusion may be effective and safe for the treatment of severe COVID-19.

Methods

Patients with severe COVID-19 were randomly divided into 2 groups: the standard treatment group and the standard treatment plus hUC-MSC infusion group. The incidence of progression from severe to critical illness, 28-day mortality, clinical symptom improvement, time to clinical symptom improvement, hematologic indicators including C-reactive protein, lymphocyte number, and interleukin 6, and imaging changes were observed and compared between the two groups.

Measurements and main results

The incidence of progression from severe to critical illness and the 28-day mortality rate were 0 in the hUC-MSC treatment group, while 4 patients in the control group deteriorated to critical condition and received invasive ventilation; 3 of them died, and the 28-day mortality rate was 10.34%. In the hUC-MSC treatment group, the time to clinical improvement was shorter than that in the control group. Clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation obviously improved beginning on the third day of stem cell infusion and reached a significant difference on day 7. CRP and IL-6 levels were significantly lower from day 3 of infusion, the time for the lymphocyte count to return to the normal range was significantly faster, and lung inflammation absorption was significantly shorter on CT imaging in the hUC-MSC group than in the control group.

Conclusions

Intravenous transplantation of hUC-MSCs is a safe and effective method that can be considered a salvage and priority treatment option for severe COVID-19.

Trial registration

Chinese Clinical Trial Registration; ChiCTR2000031494; Registered on 2 April 2020; http://www.medresman.org
MicroRNA-1179 suppresses the proliferation and enhances vincristine sensitivity of oral cancer cells via induction of apoptosis and modulation of MEK/ERK and PI3K/AKT signalling pathways
Authors: Gao Yanmei , Xu Hanmei , Pu Tiemin
Published: August 2020

The role of miR-1179 in the development of cancer has been proved by different studies. However, the expression profile and role of miR-1179 is yet to be explored in human oral cancer. Consistently, this study was undertaken to explore the molecular role of miR-1179 in regulation of the human oral cancer development and progression. The results showed miR-1179 to be significantly (p < 0.05) overexpressed in all the oral cancer cell lines relative to normal cells. The repression of miR-1179 transcript levels not only suppressed the proliferation of oral cancer cells but also increased their sensitivity to vincristine. The decline in proliferative rates was attributed to induction of autophagy in oral cancer cells as confirmed by transmission electron microscopic analysis. Western blot analysis showed that the expression of LC3B-II increased and that of beclin 1 decreased while LC3B-I expression remained constant upon miR-1179 inhibition. Inhibition of miR-1179 caused significant decrease in the migration and invasion of the oral cancer cells. The migration and invasion found to be 47% and 32% for SCC-9 and 24% and 28% for SCC-25 cells upon miR-1179 inhibition. At molecular level, the miR-1179 was shown to exert its anticancer effects via deactivation of MEK/ERK and PI3K/AKT signalling cascades. In conclusion, the findings point towards the potential of miR-1179 in the treatment of oral cancer.
Wavelet based algorithm for numerical study of $(1+2)$-dimensional time fractional diffusion problems
Authors: Ghafoor Abdul , Haq Sirajul , Hussain Manzoor , Kumam Poom
Published: August 2020

An effective and robust scheme is developed for solutions of two-dimensional time fractional heat flow problems. The proposed scheme is based on two-dimensional Haar wavelets coupled with finite differences. The time fractional derivative is approximated by an $L_{1}$

L
1

-formula while spatial part is approximated by two-dimensional Haar wavelets. The proposed methodology first converts the problem to a discrete form and then with collocation approach to a system of linear equations which is easily solvable. To check the efficiency of the scheme, two error norms, $E_{\infty }$

E
∞

an $E_{\mathrm{rms}}$

E
rms

, have been computed. The stability of the scheme has been discussed which is an important part of the manuscript. It is also observed that the spectral radius of the amplification matrix satisfies a stability condition. From computation it is clear that computed results are comparable with the exact solution.
Difference equations related to majorization theorems via Montgomery identity and Green’s functions with application to the Shannon entropy
Authors: Siddique Nouman , Imran Muhammad , Khan Khuram Ali , Pečarić Josip
Published: August 2020

In this paper we give generalized results of a majorization inequality by using extension of the Montgomery identity and newly defined Green’s functions (Mehmood et al. in J. Inequal. Appl. 2017(1):108, 2017). We obtain a generalized majorization theorem for the class ofn-convex functions. We use Csiszárf-divergence and generalized majorization-type inequalities to obtain new generalized results. We further discuss our obtained generalized results in terms of the Shannon entropy and the Kullback–Leibler distance.
On the new type of degenerate poly-Genocchi numbers and polynomials
Authors: Lee Dae Sik , Kim Hye Kyung
Published: August 2020

Kim and Kim (J. Math. Anal. Appl. 487:124017, 2020) introduced the degenerate logarithm function, which is the inverse of the degenerate exponential function, and defined the degenerate polylogarithm function. They also studied a new type of the degenerate Bernoulli polynomials and numbers by using the degenerate polylogarithm function. Motivated by their research, we subdivide this paper into two parts. In Sect. 2, we construct a new type of degenerate Genocchi polynomials and numbers by using the degenerate polylogarithm function, called the degenerate poly-Genocchi polynomials and numbers, deriving several combinatorial identities related to the degenerate poly-Genocchi numbers and polynomials. Then, in Sect. 3, we also consider the degenerate unipoly Genocchi polynomials attached to an arithmetic function by using the degenerate polylogarithm function. In particular, we provide some new explicit computational identities of degenerate unipoly polynomials related to special numbers and polynomials.
Reducing human pressure on farmland could rescue China’s declining wintering geese
Authors: Si Yali , Wei Jie , Wu Wenzhao , Zhang Wenyuan , Hou Lin , Yu Le , Wielstra Ben
Published: August 2020

Background

While goose populations worldwide benefit from food provided by farmland, China’s threatened wintering goose populations have failed to capitalize on farmland. It has been proposed that, due to an exceptionally intense human pressure on Chinese farmland, geese cannot exploit farmland in their wintering sites and hence are confined to their deteriorating natural habitat. If this were true, locally decreasing this human pressure on farmland ‘refuges’ would represent a promising conservation measure.

Methods

We investigate habitat use of two declining migratory goose species in their core wintering (Yangtze River Floodplain) and stopover (Northeast China Plain) regions, compare the human pressure level at both regions, and adopt a mixed-effect resource selection function model to test how human pressure, food resource type (farmland or wetland/grass), distance to roosts, and their interaction terms influence the utilization of food resources for each species and region. To this aim we use satellite tracking of 28 tundra bean geese Anser serrirostris and 55 greater white-fronted geese A. albifrons, a newly produced 30 m land cover map, and the terrestrial human footprint map.

Results

Geese use farmland intensively at their stopover site, but hardly at their wintering site, though both regions have farmland available at a similar proportion. The human pressure on both farmland and wetland/grass is significantly lower at the stopover region compared to the wintering region. At both sites, the two goose species actively select for farmland and/or wetland/grass with a relatively low human pressure, positioned relatively close to their roosting sites.

Conclusions

Our findings suggest that if human pressure were to decrease in the farmlands close to the roost, China’s wintering geese could benefit from farmland. We recommend setting aside farmland near roosting sites that already experiences a relatively low human pressure as goose refuges, and adopt measures to further reduce human pressure and increase food quality and quantity, to help counter the decline of China’s wintering goose populations. Our study has important conservation implications and offers a practical measure for migratory waterfowl conservation in areas of high human-wildlife conflict.
Cervicofacial and mediastinal emphysema following minor dental procedure: A case report and review of the literature
Authors: Busuladzic Adnan , Patry Melissa , Fradet Laurent , Turgeon Valérie , Bussieres Marie
Published: August 2020

Background

Subcutaneous cervical emphysema is a clinical sign associated with many conditions, including laryngotracheal trauma, pneumothorax and necrotizing deep tissue infections.

Case presentation

We discuss a case of a 76-year-old man presenting with extensive cervical emphysema a few hours after a minor dental filling procedure. The CT-scan revealed a significant amount of air within the cervical and mediastinal spaces, reaching lobar bronchi. Vitals were within normal values Bloodwork demonstrated an elevation of creatinine kinase (3718; normal < 150) and mild leukocytosis (WBC = 11.6). We decided to proceed to an urgent cervical exploration to exclude necrotizing fasciitis. This revealed air but no tissue necrosis nor abnormal fluid. The patient improved clinically and was discharged two days later with oral antibiotics. Although cervicofacial subcutaneous emphysema following dental procedures has been reported, it is usually less extensive and involving more invasive procedures using air-driven handpieces.

Conclusion

As an otolaryngologist confronted with extensive subcutaneous emphysema following a potential entry route for an aggressive infection, given the seriousness of this diagnosis, the decision of whether or not to perform a diagnostic surgical exploration should remain.
An alternative approach to mapping pigments in paintings with hyperspectral reflectance image cubes using artificial intelligence
Authors: Kleynhans Tania , Schmidt Patterson Catherine M. , Dooley Kathryn A. , Messinger David W. , Delaney John K.
Published: August 2020

Spectral imaging modalities, including reflectance and X-ray fluorescence, play an important role in conservation science. In reflectance hyperspectral imaging, the data are classified into areas having similar spectra and turned into labeled pigment maps using spectral features and fusing with other information. Direct classification and labeling remain challenging because many paints are intimate pigment mixtures that require a non-linear unmixing model for a robust solution. Neural networks have been successful in modeling non-linear mixtures in remote sensing with large training datasets. For paintings, however, existing spectral databases are small and do not encompass the diversity encountered. Given that painting practices are relatively consistent within schools of artistic practices, we tested the suitability of using reflectance spectra from a subgroup of well-characterized paintings to build a large database to train a one-dimensional (spectral) convolutional neural network. The labeled pigment maps produced were found to be robust within similar styles of paintings.
Self-administration of medication during hospitalization—a randomized pilot study
Authors: Sørensen Charlotte Arp , Olesen Charlotte , Lisby Marianne , Enemark Ulrika , de Thurah Annette
Published: August 2020

Background

Self-administration of medication (SAM) during hospitalization is a complex intervention where patients are involved in their course of treatment. The study aim was to pilot test the SAM intervention. The objectives were to assess the feasibility of conducting a randomized controlled trial on the safety and cost-consequences of SAM during hospitalization.

Methods

The study was performed in a Danish cardiology unit.

Patients ≥ 18 years capable of self-administering medication during hospitalization were eligible. Patients were excluded if they did not self-administer medication at home, were incapable of self-administering medication, were not prescribed medication suitable for self-administration, did not bring their medication, or were unable to speak Danish.

Feasibility was assessed as part of the pilot study. A future randomized controlled trial was considered feasible if it was possible to recruit 60 patients within 3 months, if outcome measurement method was capable of detecting dispensing errors in both groups, and if patients in the intervention group were more satisfied with the medication management during hospitalization compared to the control group.

Forty patients were recruited to gain experience about the intervention (self-administration). Additionally, 20 patients were randomized to the intervention or control group (nurse-led dispensing) to gain experience about the randomization procedure.

Dispensing error proportions were based on data collected through disguised observation of patients and nurses during dispensing. The error proportion in the control group was used for the sample size calculation. Patient acceptability was assessed through telephone calls.

Results

Of the 60 patients recruited, one withdrew and 11 were discharged before observation resulting in analysis of 39 patients in the intervention group and nine in the control group. A dispensing error proportion of 3.4% was found in the intervention group and 16.1% in the control group. A total of 91.7% of patients in the intervention group and 66.7% in the control group were highly satisfied with the medication management during hospitalization. The overall protocol worked as planned. Minor changes in exclusion criteria, intervention, and outcome measures were considered.

Conclusions

It may be feasible to perform a pragmatic randomized controlled trial of the safety and cost-consequences of self-administration of medication during hospitalization.

Trial registration

ClinicalTrials.gov, NCT03541421, retrospectively registered on 30 May 2018.
COVID-19 pandemic preparation: using simulation for systems-based learning to prepare the largest healthcare workforce and system in Canada
Authors: Dubé Mirette , Kaba Alyshah , Cronin Theresa , Barnes Sue , Fuselli Tara , Grant Vincent
Published: August 2020

Healthcare resources have been strained to previously unforeseeable limits as a result of the COVID-19 pandemic of 2020. This has prompted the emergence of critical just-in-time COVID-19 education, including rapid simulation preparedness, evaluation and training across all healthcare sectors. Simulation has been proven to be pivotal for both healthcare provider learning and systems integration in the context of testing and integrating new processes, workflows, and rapid changes to practice (e.g., new cognitive aids, checklists, protocols) and changes to the delivery of clinical care. The individual, team, and systems learnings generated from proactive simulation training is occurring at unprecedented volume and speed in our healthcare system. Establishing a clear process to collect and report simulation outcomes has never been more important for staff and patient safety to reduce preventable harm. Our provincial simulation program in the province of Alberta, Canada (population = 4.37 million; geographic area = 661,848 km2), has rapidly responded to this need by leading the intake, design, development, planning, and co-facilitation of over 400 acute care simulations across our province in both urban and rural Emergency Departments, Intensive Care Units, Operating Rooms, Labor and Delivery Units, Urgent Care Centers, Diagnostic Imaging and In-patient Units over a 5-week period to an estimated 30,000 learners of real frontline team members. Unfortunately, the speed at which the COVID-19 pandemic has emerged in Canada may prevent healthcare sectors in both urban and rural settings to have an opportunity for healthcare teams to participate in just-in-time in situ simulation-based learning prior to a potential surge of COVID-19 patients. Our coordinated approach and infrastructure have enabled organizational learnings and the ability to theme and categorize a mass volume of simulation outcome data, primarily from acute care settings to help all sectors further anticipate and plan. The goal of this paper is to share the unique features and advantages of using a centralized provincial simulation response team, preparedness using learning and systems integration methods, and to share the highest risk and highest frequency outcomes from analyzing a mass volume of COVID-19 simulation data across the largest health authority in Canada.
Quantitative structure-activity relationship (QSAR) modelling study of some novel carboxamide series as new anti-tubercular agents
Authors: Abdullahi Mustapha , Adeniji Shola Elijah , Arthur David Ebuka , Musa Shuaibu
Published: August 2020

Background

QSAR modelling was performed on thirty-five (35) newly discovered compounds of N-(2-phenoxy) ethyl imidazo[1,2-a] pyridine-3-carboxamide (IPA) to predict their biological activities against Mycobacterium tuberculosis (MTB-H37Rv strain) by using some numerical data derived from structural and chemical features (descriptors) of the compounds.

Results

At first, the structure of the compounds was accurately drawn and optimized using the Spartan 14 software at DFT level of theory with B3LYP/6-31G** basis set in a vacuum. The diverse chemometric descriptors were computed from the optimized structures using the PaDEL descriptors software, and the division of the dataset into training and test sets was done based on Kennard-Stone’s algorithm. Five (5) models were generated from the training set using genetic function approximation, and model 1 was chosen as the best due to its robust internal and external validation metrics (R2train = 0.8563, R2adjusted = 0.8185, PRESS = 3.5724, average $$ {\overline{R}}_m^2 $$

R
¯

m
2

(LOO-train) = 0.6751, Q2cv = 0.7534, $$ {R}_{\mathrm{pred}}^2= $$

R
pred
2

=
0.7543, R2test = 0.6993) which passed the model criteria of acceptability. 6-Bromo-N-(2-(4-bromophenoxy) ethyl)-2-ethylimidazo[1,2-a] pyridine-3-carboxamide (compound 13) was used as the structural template for the in silico design due to its high pMIC, and it is within the model’s chemical space.

Conclusion

Based on the information obtained from model 1, six (6) designed compounds with higher anti-tubercular activity were obtained. Furthermore, the ADME and drug-likeness prediction of the designed molecules showed good pharmacokinetic properties which indicate the application prospect of these compounds as novel MTB-H37Rv inhibitors. This research could help the medicinal chemists and pharmaceutical practitioners in future designing and development of more potent drug candidates.

Graphical abstract
Amplatzer vascular plug in renal artery embolization: case report and review of the literature
Authors: Catelli Antonio , Loiudice Giovanni , Corvino Antonio , Bracale Umberto Marcello , Quarantelli Mario , Venetucci Pietro
Published: August 2020

Background

Arterial embolization constitutes a safe and effective therapeutic possibility in the treatment of numerous renal pathologies in election and in urgency. Over the years, numerous embolizing materials have been proposed: fibrin (temporary occlusion), glues, coils, and microspheres. The use of St. Jude Amplatzer vascular plug (AVP) constitutes a more recent and less widespread therapeutic choice, and its use in the renal district is not yet widespread although potentially very valid.

Case presentation

We present 3 renal arterial embolizations performed with AVP performed between January 2019 and February 2020: two patients had a very bulky renal heteroplastic lesion and were candidates for nephrectomy, and a third patient instead was affected by a high-flow FAV post-biopsy. In our experience, the use of AVP for the treatment of renal arteriovenous fistula and neoplastic masses has given excellent results without any complications during and after the treatment. In all cases, a single plug was used which perfectly adapted to the target artery resulting in complete occlusion of the vessel in a short time.

Conclusion

Renal artery embolization performed with AVP has growing potential and numerous advantages in terms of the time of the procedure, speed of embolization, and precision of occlusion, but with a relative increase in costs.
The health and economic impact of implementation strategies for improving detection of hereditary cancer patients—protocol for an in-depth cost-effectiveness evaluation with microsimulation modelling
Authors: Morrow April , Parkinson Bonny , Kang Yoon-Jung , Hogden Emily , Canfell Karen , Taylor Natalie
Published: August 2020

Background

Patients with Lynch syndrome (an inherited cancer predisposition syndrome) remain largely underdiagnosed despite clinically and cost-effective testing strategies to detect patients. This is largely due to poor referral rates for high-risk patients for consideration of genetic testing. Targeted approaches to improve the implementation of guidelines and thus uptake rates of genetic testing require the use of limited and valuable healthcare resources. Decision makers must carefully balance the potential health impacts of implementation approaches against the associated costs, similar to when assessing the direct impact of health interventions. This protocol outlines the methods used to conduct an economic evaluation of different implementation approaches aimed at improving referral rates of high-risk patients, including estimating implementation approach costs.

Methods

A cluster randomised controlled trial (the Hide and Seek Project, HaSP) is underway to compare two different implementation approaches aimed at improving referral rates, and thus detection, of Lynch syndrome among colorectal cancer patients across eight Australian hospital networks. An in-depth process evaluation is being conducted alongside the trial and includes measures to collect comprehensive data on both implementation and intervention costs. These costs, in addition to HaSP outcome data, will be incorporated as inputs into an existing microsimulation model—Policy1-Lynch—to project the downstream economic and health impacts and determine the more cost-effective implementation approach from the Australian healthcare perspective.

Discussion

The ability to model the impact of different implementation approaches will enable the most efficient way of improving Lynch syndrome detection. The approach used in this study could also be applied to assess other implementation approaches aimed at increasing the uptake of cost-effective health interventions.

Trial registration

ANZCTR, ACTRN12618001072202. Registered on 27 June 2018.
Premigration social adversity and autism spectrum disorder
Authors: Augereau Natacha , Lagdas Ines , Kermarrec Solenn , Gicquel Ludovic , Martin Virginie , Xavier Jean , Cohen David , Bouvet Michel , Rolland Anne-Catherine , Tordjman Sylvie
Published: August 2020

Background

Several studies suggest significant relationships between migration and autism spectrum disorder (ASD) but there are discrepant results. Given that no studies to date have included a pathological control group, the specificity of the results in ASD can be questioned.

Aims

To compare the migration experience (premigration, migratory trip, postmigration) in ASD and non-ASD pathological control groups, and study the relationships between migration and autism severity.

Method

Parents’ and grandparents’ migrant status was compared in 30 prepubertal boys with ASD and 30 prepubertal boys without ASD but with language disorders, using a questionnaire including Human Development Index (HDI)/Inequality-adjusted Human Development Index (IHDI) of native countries. Autism severity was assessed using the Child Autism Rating Scale, Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised scales.

Results

The parents’ and grandparents’ migrant status frequency did not differ between ASD and control groups and was not associated with autism severity. The HDI/IHDI values of native countries were significantly lower for parents and grandparents of children with ASD compared with the controls, especially for paternal grandparents. Furthermore, HDI/IDHI levels from the paternal line (father and especially paternal grandparents) were significantly negatively correlated with autism severity, particularly for social interaction impairments.

Conclusions

In this study, parents’ and/or grandparents’ migrant status did not discriminate ASD and pathological control groups and did not contribute either to autism severity. However, the HDI/IHDI results suggest that social adversity-related stress experienced in native countries, especially by paternal grandparents, is potentially a traumatic experience that may play a role in ASD development. A ‘premigration theory of autism’ is then proposed.
Afrocentrism, national interest and citizen welfare in Nigeria’s foreign policy maneuvers
Authors: Mbara George Chimdi , Gopal Nirmala
Published: August 2020

Background: Nigeria’s former Prime Minister, Sir Abubakar Tafawa Balewa, in his addresses of August and October 1, 1960, declared Africa as the centrepiece of Nigeria’s foreign policy. This policy thrust has remained a constant variable in the country’s diplomatic engagements over the years. The doctrine of Afrocentrism is predicated on the supposed manifest leadership role placed on Nigeria by nature. This made her leaders define Africa’s interest as Nigeria’s national interest, a development that has been contended to have no empirical bearing on the welfare of Nigerians thereby generating intense scrutiny. Consequently, this study evaluates the impact of Nigeria’s Afrocentric foreign policy thrust on the welfare of the ordinary Nigerians. The study further analyses the country’s gravitation towards citizen-centred diplomacy in 2007. These will help in comprehending the interaction between national interest and foreign policy in Nigeria, and to identify whose interests have been protected the most in Nigeria’s foreign policy pursuit – that of the ordinary citizens or the elites?

Methods: Through the qualitative research method, in-depth interviews (IDIs) were conducted with Key Informants (KIs) for data collection. Responses from field study are merged with other primary and secondary sources of data to provide an incisive and balanced analysis that is premised on political realism.

Results: Findings indicate that Nigeria’s international generosity and leadership role has never been predicated on a clear vision of national interest. Notwithstanding the flaws in Nigeria’s foreign policy over the years, this study also discovered that the outcome has not been a total failure as some respondents maintain.

Conclusions: With the nation’s gravitation towards citizen-centred diplomacy, it is hoped that the country will put the interest of its citizens first in her policy pursuits.
Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis
Authors: Davey S , Rajaretnem N , Harji D , Rees J , Messenger D , Smart NJ , Pathak S
Published: August 2020

Introduction

Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions.

Methods

A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken.

Findings

Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as ‘other’. The pooled incidence of IH was 6.0% (2.0–10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0–19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group (p = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups.

Conclusion

Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.
Improving pain management for children having dental extractions under general anaesthesia
Authors: Marshall S , Ondhia A , Mearns C , Kandiah T
Published: August 2020

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles.

This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.
Perfil sistêmico dos usuários do Serviço de Cirurgia da Faculdade de Odontologia da Universidade Federal da Bahia
Authors: Borges Eduardo Francisco Deus , De Sousa Beatrice Caroline Medeiros Bandeira , Amaral Ingrid Esteves de Villemor , Cangussu Maria Cristina Teixeira , Cavalcante Weber Ceo
Published: August 2020

Introdução: Doenças sistêmicas não controladas podem acarretar complicações durante procedimentos cirúrgicos ambulatoriais como, extrações dentárias. Objetivo: Avaliar doenças sistêmicas mais prevalentes e traçar um perfil dos pacientes atendidos no ambulatório de cirurgia da Faculdade de Odontologia da Universidade Federal da Bahia. Método: Estudo transversal com 454 pacientes que procuraram o serviço de cirurgia da Faculdade de Odontologia, as informações foram coletadas a partir de um questionário. Resultados: Predomínio pela faixa etária de 31-50 anos, sexo feminino, melanodermas, solteiros. 14,7% eram tabagistas, 35,9% etilistas, 55,2% com Índice de Massa Corporal indicando sobrepeso ou algum grau de obesidade, 65,9% com circunferência abdominal indicando risco de comprometimento metabólico e 55,9% dos entrevistados alegaram não possuir doenças sistêmicas. As doenças mais prevalentes foram: hipertensão arterial sistêmica (24,1%), gastrite (13,5%) e diabetes (9,4%). Conclusão: Devido à alta prevalência de doenças sistêmicas muitas vezes não controladas associadas aos usuários do ambulatório de cirurgia da Faculdade de Odontologia, os pacientes se beneficiariam de um referencial para atendimento médico ambulatorial afim de que os auxiliassem com seus problemas clínicos para seguir o tratamento odontológico.