bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Dimensional (3D) Magnetic Resonance Volume Assessment and Loco-regional Failure in Anal Cancer: early evaluation case-control study
Authors: Sekhar Hema , Kochhar Rohit , Carrington Bernadette , Kaye Thomas , Tolan Damian , Saunders Mark , Sperrin Matthew , Sebag-Montefiore David , Herk Marcel van , Renehan Andrew
Published: October 2020

Background: The primary aim was to test the hypothesis that deriving pre-treatment 3D magnetic resonance tumour volume (mrTV) quantification improves performance characteristics for the prediction of loco-regional failure compared with standard maximal tumour diameter (1D) assessment in patients with squamous cell carcinoma of the anus undergoing chemoradiotherapy.Methods: We performed an early evaluation case-control study at two UK centres (2007-2014) in 39 patients with loco-regional failure (cases), and 41 patients disease-free at 3 years (controls). mrTV was determined using the summation of areas method (Volsum). Reproducibility was assessed using intraclass concordance correlation (ICC) and Bland-Altman limits of agreements. We derived receiver operating curves using logistic regression models and expressed accuracy as area under the curve (ROCAUC).Results: The median time per patient for Volsum quantification was 7.00 (inter-quartile range, IQR: 0.57-12.48) minutes. Intra and inter-observer reproducibilities were generally good (ICCs from 0.79 to 0.89) but with wide limits of agreement (intra-observer: -28% to 31%; inter-observer: -28% to 46%). Median mrTVs were greater for cases (32.6 IQR: 21.5-53.1 cm3) than controls (9.9 IQR: 5.7-18.1 cm3, p <0.0001). The ROCAUC for mrT-size predicting loco-regional failure was 0.74 (95% CI: 0.63-0.85) improving to 0.82 (95% CI: 0.72-0.92) when replaced with mrTV (test for ROC differences, p = 0.024).Conclusion: Preliminary results suggest that the replacement of mrTV for mrT-size improves prediction of loco-regional failure after chemoradiotherapy for squamous cell carcinoma of the anus. However, mrTV calculation is time consuming and variation in its reproducibility are drawbacks with the current technology.
The Relationship between Clinical Placement Duration and Students’ Satisfaction with the Quality of Supervision and Learning Environment: A Mediation Analysis.
Authors: González-García Alberto , Strandell-Laine Camilla , Díez-Fernández Ana , Leino-Kilpi Helena , Martínez-Vizcaíno Vicente , Saarikoski Mirko
Published: October 2020

Background: Multiple factors that influence the learning experience of nursing students while they are in clinical training have been identified. Nevertheless, there is no evidence on what is the optimum time a nursing student should remain in the different practice settings for achieving the required competencies nor how this duration of the placement may be influenced by other variables.The aim of the study was examine whether the relationship between the clinical placement duration and total satisfaction with clinical training is mediated by supervisory relationship and learning environment.Method: A mediation analysis was conducted using the data from a cross-sectional study conducted in 17 higher educational institutions from nine European countries with the CLES+T scale (n=1903 pre-registration nursing students). Besides, ANCOVA models were used to assess mean differences in total satisfaction by categories of supervision factors, clinical placement duration and participants’ characteristics.Results: A significant increase of total satisfaction was found as better learning environment participant’s perceived, as well as better was their satisfaction with their supervisor (both p<0.001). Students that considered the supervisor the most important person in practical training were significantly more satisfied as compared with those who considered the nurse teacher as the most important [mean 4.15 (0.89) vs 3.23 (1.16)]; p=0.001]. The satisfaction with the supervisor (IE= 0.101 [95% CI 0.016; 0.183]) and a good learning environment (IE= 0.088 [95% CI 0.003; 0.170]) mediated the relationship between clinical placement duration and total satisfaction perceived by the students.Conclusion: Nursing students with longer clinical placement duration were more satisfied with clinical training as a result of both their satisfaction with their supervisor and the good learning environment perceived. The optimal duration a nursing student should remain in the different practice settings to reach a balance between the achievement of fully competent nurses and the maximum level of satisfaction at the practicum ward should be around seven weeks. The role of nurse teachers and supervisors in contributing the acquisition of competences of nursing students needs to be clarified.
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.
Use of the sagittal cobb* angle to guide the rod bending in the treatment of thoracolumbar fractures: a retrospective clinical study
Authors: Shi Zongpo , Wang Gang , Jin Zhen , Wu Tao , Wang Haoran , Sun Jinpeng , Nicolas Yap San Min , Rupesh KC , Yang Kaixiang , Liu Jun
Published: October 2020

Background: Pedicle screw fixation is a well-established technique for thoracolumbar fracture. A large number of studies have shown that the bending angle of the connecting rod has a significant correlation with the postoperative spinal stability. However, no studies have confirmed an objective indicator to guide the bending angle of the connecting rod during the operation. Our study aims to define a sagittal Cobb* angle to guide the bending angle of the connecting rod during surgery.Methods: The frontal and lateral X-ray films in 150 cases of normal thoracolumbar spine were included to measure the normal spinal sagittal Cobb* angle in each segment. The patients who underwent single segment thoracolumbar fractures and pedicle screw internal fixation surgery were included. The radiological parameters included lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA) and sacral slope (SS) were measured. The incidence of adjacent segment degeneration（ASD）two years after surgery were measured.Results: The average values of normal sagittal Cobb* angle in each segment were -5.196±3.318 degrees (T12), 2.279±3.324 degrees (L1), 7.222±2.798 degrees (L2) and 12.417±11.962 degrees (L3) respectively. The LL in the three groups was 35.20±9.12 degrees，46.26±9.68 degrees and 54.24±15.31 degrees, respectively. Comparing with the normal group, there were significant differences in group A and group C respectively (P< 0.05). The results were similar in the parameters of TL, PT and SS. The incidences of SVA>50mm in group A, group B and group C were 23.33%,12.50% and 19.23%, respectively. The parameter of PI in three groups were 41.36±12.69, 44.53±15.27 and 43.38±9.85 degrees，respectively. The incidences of ASD in group A, group B and group C 2 years after surgery were 21.67%，13.75% and 17.95%, respectively.Conclusions: The study confirmed that the sagittal Cobb* angle can be used as a reference angle for bending rods. When the bending angle of the connecting rod is 4 to 8 degrees greater than the corresponding segment sagittal Cobb* angle, the patient's spinal sagittal stability is the best two years after the operation.
BMI, waist to height ratio and waist circumference as a screening tool for hypertension in hospital out patients: a cross-sectional study
Authors: Shrestha Rajan , Khatri Bijay , Upadhyay Madan P. , Bhattarai Janak R. , Kayastha Manish , Upadhyay Sanjib K.
Published: October 2020

BackgroundObesity has become a global epidemic and an important risk factor for non-communicable diseases. Earlier thought to be a problem of developed world, it has now become a problem of low- and middle-income countries like Nepal. In absence of a routine surveillance or a registry system, the actual burden and trend of obesity in Nepal is unknown. Obesity and overweight are recognized risk factors for hypertension and associated with cardiovascular disease. The aim of the study was to find out burden of obesity, using three commonly employed metrics in hospital outpatient setting of a low-income country as predictors of hypertension, and compare ability of different anthropometric measurements through a non-inferiority study to predict hypertension.MethodsThis cross-sectional study was conducted among 40-69 years outpatients in a tertiary Eye and ENT hospital in a semi-urban area of Nepal among randomly selected 2,256 participants from 6,769 outpatients who were evaluated in Health Promotion and risk factor screening service. We did correlation analysis to determine the relationship between anthropometric measurement and blood pressure. The area under the Receiver Operating characteristic curve of Body Mass Index (BMI), Waist to Height Ratio (WHtR) and Waist Circumference (WC) was calculated and compared. ResultsThe prevalence of obesity and overweight by BMI was 16.09% and 42.20% respectively; by Waist-to-Height-Ratio was 32.76% which is two times higher than obesity measured by BMI. High waist circumference was observed among 66.76% participants. Female participants had greater prevalence of high WC (77.46%) than male (53.73%) (p<0.001). Prevalence of hypertension and pre-hypertension was 40.67% and 36.77% respectively. The areas under the curve were significantly higher than 0.5 for BMI (0.593), WHtR (0.602) and WC (0.610).ConclusionWaist circumference correlated well with obesity and hypertension. It also had higher predicting ability than WHtR and BMI to predict hypertension. Waist circumference thus proved to be non-inferior to two other commonly used metrics. It proved superior in detecting obesity in female. This simple and inexpensive tape measurement may play an important role in future diagnosis of obesity and prediction of HTN in resource constrained settings of developing countries.
All-solid-state Ion Synaptic Transistor for Wafer-scale Integration with Electrolyte of a Nanoscale Thickness
Authors: Yu Ji-Man , Lee Chungryeol , Kim Da-Jin , Park Hongkeun , Han Joon-Kyu , Hur Jae , Kim Jin-Ki , Kim Myung-Su , Seo Myungsoo , Im Sung Gap , Choi Yang-Kyu
Published: October 2020

Neuromorphic hardware computing is a promising alternative to von Neumann computing by virtue of its parallel computation, and low power consumption. To implement neuromorphic hardware based on deep neural network (DNN), a number of synaptic devices should be interconnected with neuron devices. For ideal hardware DNN, not only scalability and low power consumption, but also a linear and symmetric conductance change with the large number of conductance levels are required. Here an all-solid-state polymer electrolyte-gated synaptic transistor (pEGST) was fabricated on an entire silicon wafer with CMOS microfabrication and initiated chemical vapor deposition (iCVD) process. The pEGST showed good linearity as well as symmetry in potentiation and depression, conductance levels up to 8,192, and low switching energy smaller than 20 fJ/pulse. Selected 128 levels from 8,192 used to identify handwritten digits in the MNIST database with the aid of a multilayer perceptron, resulting in a recognition rate of 91.7 %.
Lusutrombopag is Effective and Safe in Patients with Chronic Liver Disease and Severe Thrombocytopenia: A Multicenter Retrospective Study
Authors: Nomoto Hiroaki , Morimoto Naoki , Miura Kouichi , Watanabe Shunji , Takaoka Yoshinari , Maeda Hiroshi , Sasaki Takahiro , Koyashiki Yohei , Kurata Hidekazu , Numao Norikatsu , Isoda Norio , Yamamoto Hironori
Published: October 2020

Background: Chronic liver disease (CLD) is often complicated by severe thrombocytopenia (platelet count <50,000/µL). Platelet transfusion has been a gold standard for increasing the platelet count to prevent hemorrhagic events in such patients. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count in such patients when invasive procedures are scheduled. However, we have little information on the effect of lusutrombopag in CLD patients with severe thrombocytopenia in real-world settings.Methods: To investigate the efficacy and safety of lusutrombopag in patients with chronic liver disease and severe thrombocytopenia, we retrospectively investigated 26 CLD patients with a platelet count of <50,000/µL. Lusutrombopag, 3 mg once daily, was administered 8-15 days before scheduled invasive procedures.Results: Among 26 patients who received lusutrombopag, 19 patients (73.1%) patients showed a platelet count of ≥50,000/µL (Group A) and did not require platelet transfusion. The remaining 7 patients (26.9%) did not reached platelet ≥50,000/µL (Group B). The means of platelet increase were 36,000/µL and 13,000/µL in groups A and B, respectively. A low platelet count at baseline was a characteristic of patients in group B. Among 13 patients who repeatedly used lusutrombopag, lusutrombopag significantly increased the platelet count as the initial treatment. No adverse events were noted during or after lusutrombopag treatment. In addition, the degree of platelet increase with lusutrombopag was larger than that in their previous platelet transfusion.Conclusions: Lusutrombopag is effective and safe for CLD patients with a platelet count of <50,000/µL.
Role of Critical Size on Adult life History Traits in Drosophila Melanogaster.
Authors: Sharma Khushboo , Shakarad Mallikarjun N.
Published: October 2020

BackgroundSilver-spoon hypothesis suggests that fitness of individuals is high under good adult conditions provided their development itself has been in good conditions and those who have grown in resource-poor conditions are at a permanent disadvantage. Using two types of Drosophila melanogaster populations grown under two conditions we tested the validity of silver-spoon hypothesis. Three populations were selected for faster pre-adult development as a result of which they had access to food for a shorter duration while the three control populations had access to food for longer duration as growing larvae. In the second set-up the access to food was curtailed immediately on attainment of critical size. We assessed biomolecule levels, copulation latency, copulation duration, life-time realized oviposition and longevity to validate the silver-spoon hypothesis. ResultsRestricted feeding duration as a consequence of selection for faster per-adult development had no fitness consequences in selected populations. However, starvation during post-critical duration resulted in reduced fitness. ConclusionOur results show that the silver-spoon model is applicable only under extreme nutrition curtailment and not applicable to biological systems that have genetically evolved to limit food intake.
Improving the Quality of Nursing Documentation at A Residential Care Home: A Clinical Audit
Authors: Moldskred Preben Søvik , Snibsøer Anne Kristin , Espehaug Birgitte
Published: October 2020

Background: Quality in nursing documentation holds promise to increase patient safety and quality of care. While high-quality nursing documentation implies a comprehensive documentation of the nursing process, nursing records do not always adhere to these documentation criteria. The aim of this quality improvement project was to assess the quality of electronic nursing records in a residential care home using a standardized audit tool and, if necessary, implement a tailored strategy to improve documentation practice.Methods: A criteria-based clinical audit was performed in a residential care home in Norway. Quantitative criteria in the N-Catch II audit instrument was used to give an assessment of electronic nursing records on the following: nursing assessment on admission, nursing diagnoses, aims for nursing care, nursing interventions, and evaluation/progress reports. Each criterium was scored on a 0 - 3 point scale, with standard (complete documentation) coinciding with the highest score. A retrospective audit was conducted on 38 patient records from January to March 2018, followed by the development and execution of an implementation strategy tailored to local barriers. A re-audit was performed on 38 patient records from March to June 2019. Results: None of the investigated patient records at audit fulfilled standards for recommended nursing documentation practice. Mean scores at audit varied from 0.4 (95% confidence interval 0.3 - 0.6) for “aims for nursing care” to 1.1 (0.9 - 1.3) for “nursing diagnoses”. After implementation of a tailored multifaceted intervention strategy, an improvement (p < 0.001) was noted for all criteria except for “evaluation/progress reports” (p = 0.6). The improvement did not lead to standards being met at re-audit, where mean scores varied from 0.9 (0.8 - 1.1) for “evaluation/progress reports” to 1.9 (1.5 - 2.2) for “nursing assessment on admission”.Conclusions: A criteria-based clinical audit with multifaceted tailored interventions that addresses determinants of practice may improve the quality of nursing documentation, but further cycles of the clinical audit process are needed before standards are met and focus can be shifted to sustainment of knowledge use.
Pituitary Adenomas Associated with Intracranial Aneurysms – The Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors
Authors: Ogawa Yoshikazu , Watanabe Mika , Tominaga Teiji
Published: October 2020

Objective: Pituitary adenoma coexists with intracranial aneurysms in 2.3% to 3.6%, and intracranial aneurysms is thought to be incidental. On the other hand higher age and cavernous sinus invasion are reported to increase the coexistence rate, so these two diseases may be related. Ten males and 14 females with coexistence of pituitary adenomas and intracranial aneurysms were retrospectively investigated among 923 patients (2.6%). Patients were subdivided into two groups with/without direct attachment of cerebral aneurysms to the pituitary adenomas. The clinical characteristics, therapeutic strategies, and possible effects of vascular remodeling factors were investigated.Results: Twelve patients had functioning pituitary adenomas, and cavernous sinus invasion was identified in 7 of 24 patients. Five of these 7 patients were treated with priority for the cerebral aneurysms until 2007, whereas 14 of 17 patients without involvement of the aneurysm tip in the tumor were treated with priority for pituitary adenomas in the later period. Among vascular remodeling factors strong expression of vascular endothelial growth factor (VEGF) was significantly associated with coexistence of pituitary adenoma and cerebral aneurysm (p < 0.05). So VEGF-induced arterial wall remodeling may be part of the mechanism of association between pituitary adenomas and cerebral aneurysms, suggesting possible causative mechanism.
Causally Associations of Blood Lipids Levels with COVID-19 Risk: Mendelian Randomization Study
Authors: Zhang Kun , Guo Yan , Wang Zhuoxin , Ding Jingmiao , Yao Shi , Chen Hao , Zhu Dongli , Zhang Kun , Xue Hanzhong , Huang Wei , Dong Shanshan , Yang Tielin
Published: October 2020

BackgroundCoronavirus disease 2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). It has been found that coronary artery disease (CAD) is a comorbid condition for COVID-19. As the risk factors of CAD, whether blood lipids levels are causally related to increasing susceptibility and severity of COVID-19 is still unknown.ObjectiveWe aim to measure the causal effects between blood lipids and COVID-19 using two-sample Mendelian Randomization (MR) methods.MethodsWe performed two-sample MR analyses to explore whether dyslipidemia, low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), triglyceride (TG) and total cholesterol (TC) were causally related to COVID-19 risk and severity. The GWAS summary data of blood lipids involving in 312571 individuals and dyslipidemia in a total of 53991 individuals were used as exposures, respectively. Two COVID-19 GWASs including 1221 infected patients and 1610 severe patients defined as respiratory failure were employed as outcomes. ResultsThe MR results showed that dyslipidemia was casually associated with the susceptibility of COVID-19 and induced 27% higher odds for COVID-19 infection (MR-IVW OR = 1.27, 95% CI: 1.08 to 1.49, p-value = 3·18 × 10-3). For blood lipids, the increasing level of TC will raise 18 % higher odds for the susceptibility of COVID-19 (MR-IVW OR = 1.18, 95% CI: 1.06 to 1.31, p-value = 3.08 × 10-3). Based on MR estimates, we further carried out gene-based analysis and found that ABO gene was associated with TC.Conclusions Dyslipidemia is casually associated with the susceptibility of COVID-19 and the blood TC level is a risk factor for the susceptibility of COVID-19. In addition, the different susceptibility of COVID-19 in specific blood group may be partly explained by the TC concentration in diverse ABO blood groups.
Comparison of Prognostic Value of Early Phase 1H Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging With Neuron-Specific Enolase at 72 Hours in Comatose Survivors of Out-of-hospital Cardiac Arrest – A Sub-Study of the Xe-Hypotheca Trial
Authors: Koskensalo Kalle , Virtanen Sami , Saunavaara Jani , Parkkola Riitta , Laitio Ruut , Arola Olli , Hynninen Marja , Silvasti Päivi , Nukarinen Eija , Martola Juha , Silvennoinen Heli M , Tiainen Marjaana , Roine Risto O. , Scheinin Harry , Saraste Antti , Maze Mervyn , Vahlberg Tero , Laitio Timo
Published: October 2020

BackgroundGuidelines recommend brain imaging for neurological prognostication after out-of-hospital cardiac arrest (OHCA). We aimed to evaluate the predictive accuracy of early phase diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1H-MRS) combined with neuron-specific enolase (NSE) and selected clinical variables for poor neurological outcome after OHCA.MethodsIn 92 patients with complete data set, the predictive accuracy of DTI, 1H-MRS, and NSE at 72h for poor neurological outcome (mRS 3-6) at six months were assessed by area under the receiver operating characteristic (ROC) curve as predetermined in the protocol. Additional post-hoc analyses were also performed to find a model with the best predictive power for poor neurological outcome. The brain imaging was performed in a median (IQR) time of 53 hours (47-64) after OHCA.ResultsAt six-months, 31 patients had mRS 3-6, considered to reflect a poor neurological outcome. There was no significant difference between area under ROC curve of 0.73 (95% CI 0.62-0.84) for DTI, 0.78 (0.68-0.88) for 1H-MRS and 0.85 (0.76-0.93) for NSE at 72h for predicting poor outcome at 6 months. In the post-hoc analysis, the combination of DTI, 1H-MRS, and NSE with motor score at 72 hours and epileptic seizures provided the best predictive power with area under ROC curve of 0.98 (95% CI 0.96 – 1.00) as compared to 0.92 (0.86 − 0.97) for DTI, 1H-MRS and NSE at 72 hours alone (p = 0.009).ConclusionsNeither early stage DTI nor 1H-MRS imaging was better than NSE at 72h in predicting poor outcome in this patient group. Although the addition of neuroimaging to the best model using current clinical and laboratory parameters improved the diagnostic performance, the costs and challenges of MR imaging of critically ill patients may outweigh this small benefit. Trial registrationClinicalTrials.gov NCT00879892. Registered on 13 April 2009.
Maintenance Treatment With Vaginal Progesterone or Placebo Delayed Preterm Birth More Efficiently Than Intravenous Tocolysis Alone – A Randomized Controlled Trial
Authors: Stjernholm Ylva Vladic , Marchini Giovanna
Published: October 2020

Objective To evaulate the efficacy of maintenance treatment with vaginal progesterone gel compared to placebo in women after the onset of preterm labor.Material and Methods A randomized controlled trial at a university hospital in Sweden in 2009 − 18. Healthy women with singleton pregnancy and early preterm labor were randomized to daily progesterone gel 90 mg (n = 29) or placebo (n = 29) after standard intravenous tocolysis. Women with intravenous tocolysis alone (n = 29) served as a reference group. Results The latency to delivery was 58 ± 34 days with progesterone, 64 ± 51 days with placebo and 2 ± 2 days in the reference group (p < 0.0001 respectively). The rate of preterm birth < 34 weeks was 34% after progesterone, 38% after placebo and 100% in the reference group (progesterone vs reference p = 0.01 and placebo vs reference p = 0.02). The composite neonatal morbidity and length of neonatal intensive care were lower after progesterone and placebo compared to the reference group (p < 0.0001 respectively).Conclusion Maintenance treatment with vaginal progesterone gel or placebo delayed preterm birth more efficiently than intravenous tocolysis alone, suggesting an effect of the placebo gel rather than of progesterone. We conclude, that the placebo gel reinforced the physiological barrier at the uterine cervix which protects the pregnancy from pathogen invasion and uterine infection leading to preterm birth.
Longitudinal Use of The Consolidated Framework For Implementation Research To Evaluate The Creation of A Rural Center of Excellence in Transgender Health 
Authors: Tinc Pamela Jane , Wolf-Gould Christopher , Wolf-Gould Carolyn , Gadomski Anne
Published: October 2020

Background: Transgender people face numerous barriers to accessing care, particularly in rural settings. Transportation, travel time, a lack of providers offering transgender care, and discrimination all contribute to these barriers. The Gender Wellness Center was established to fill a gap in rural transgender care, and was subsequently awarded a Robert Wood Johnson Foundation grant to establish a Center of Excellence. This study examines the implementation of the Center of Excellence, a complex intervention, over the course of 18 months. Methods: The Consolidated Framework for Implementation Research was used to develop baseline and follow-up surveys. These were distributed to members of the core implementation team at the Gender Wellness Center at the midpoint and conclusion of the Robert Wood Johnson Foundation grant. Responses were largely open-ended and analyzed qualitatively. Results: Results are presented in terms of Consolidated Framework domains and constructs, as well as the relative outlook (positive or negative) of implementation. Overall, there were improvements over time, with more encouraging feedback and examples of success at follow-up. Though true, organizational culture and individual beliefs about the provision of transgender care challenged implementation of the Center of Excellence throughout the project. Conclusions: This study highlights the importance of organizational culture on implementation efforts, as well as the need for complex, multi-faceted interventions to overcome such challenges in order to improve care for marginalized populations. Trial registration: Not applicable
TNF-α differentially modulates the level of subunits of respiratory electron transport complexes of ER/PR +ve/-ve breast cancer cells to regulate mitochondrial complex activity and tumorigenic potential
Authors: Shinde Anjali , Jung HyeRyeon , Lee Hayun , Singh Kritarth , Roy Milton , Gohel Dhruv , Kim Han Byeol , Mane Minal , Vasiyani Hitesh , Currim Fatema , Seo Yuri , Yang Seojin , Yi Eugene C , Rajesh Singh
Published: October 2020

Background: Tumor necrosis factor-α (TNF-α) is a immunostimulatory cytokine which is consistently high in the breast tumor microenvironment (TME) however its differential role in mitochondrial functions and cell survival in ER/PR +ve and ER/PR-ve breast cancer cells is not well understood. Methods: In the current study, we investigated TNF-α modulated mitochondrial proteome using high-resolution mass spectrometry and identified the differentially expressed proteins of two different breast cancer cell lines: ER/PR positive cell line, luminal: MCF-7 and ER/PR negative cell line, basal-like: MDA-MB-231and explored their implication in tumorigenic potential of breast cancer cells. We compared the mitochondrial complex activity, ATP and ROS levels between MCF-7 and MDA-MB-231 in presence of TNF-α. We used Tumor Immune Estimation Resource (TIMER) database to analyze the correlation between TNF-α and mitochondrial proteins in basal and luminal breast cancer patients. KM plotter analysis was used to understand the relation between mitochondrial protein expression and survival of breast cancer patients. Results: The proteomics experiment showed TNF-α differentially altered the level of critical proteins of mitochondrial respiratory chain complexes both in MCF-7 and MDA-MB-231, which correlated with differential assembly of mitochondrial ETC complexes and activity. The inhibition of glycolytic pathway in presence of TNF-α showed that glycolysis is indispensable for proliferation and clonogenic abilities of MDA-MB-231 (ER/PR –ve) as compared to MCF-7 (ER/PR +ve). The TIMER database showed highly significant negative correlation of TNF-α with key regulators of OXPHOS complexes in basal breast carcinoma as compared to lobular. KM plotter analysis showed improved relapse-free survival with increased expression of identified protein and survival of the breast cancer patients. Conclusion: Collectively, the results here strongly suggest that TNF-α differentially regulates metabolic adaptation in ER/PR +ve(MCF-7) and ER/PR –ve (MDA-MB-231) cells by modulating the mitochondrial supercomplex assembly and activity hence may be critical factor for determining the tumor progression and survival of the breast cancer patients.
Quadriceps Muscle Strength Recovery With the Use of High Tone Power Therapy After ACL Reconstruction: a Randomized Controlled Trial
Authors: Ogrodzka-Ciechanowicz Katarzyna , Głąb Grzegorz , Ślusarski Jakub , Gądek Artur
Published: October 2020

BackgroundA relatively new method of electrotherapy is High Tone Power Therapy. It directly affects cell metabolism, improving metabolic processes in tissues, and pain relief. It can also be used to obtain stimulating effects of the current, in this case also for electro stimulation of the quadriceps. The aim was to assess the effectiveness of electro stimulation of the quadriceps muscle in patients after ACL reconstruction, with the use of High Tone Power Therapy.MethodsIn pre post treatment randomized controlled trial took part thirty-five patients after anterior cruciate ligament reconstruction. The tests were carried prior to and 6 months following the ACL reconstruction. After the surgery, the patients were randomly divided into two research groups – experimental group (17 patients) had the High Tone Power Therapy included in rehabilitation, while the control group (18 patients) was without the High Tone Power Therapy. All patients were subjected to 6-month rehabilitation. Research tools included the measurement of muscle strength torque, ROM, knee and thigh circumference measurements, the Lysholm and the VAS scale ResultsThe analysis showed that there were no statistically significant differences in the measurement of maximum muscle torque of knee extensors between groups and measurements. The analysis did not show any statistically significant differences in other analyzed variables.ConclusionsHigh Tone Power Therapy used in the rehabilitation of patients after ACL reconstruction does not significantly affect the strength of the quadriceps muscle and the function of the knee joint.Trail Registration This study was registered retrospectively in the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number: ACTRN12616001416482.
Probiotic Alleviate Fluoride-Induced Memory Impairment by Reconstructing Gut Microbiota in Mice
Authors: Xin Jinge , Wang Hesong , Zeng Dong , Sun Ning , Li Lianxin , Sun Ye , Khalique Abdul , Zeng Yan , Pan Kangcheng , Jing Bo , Bai Yang , Ni XueQin
Published: October 2020

BackgroundFluoride which is widespread in our environment and food due to geological origin and industrial pollution has been identified as developmental neurotoxicants. Gut-brain axis provide new sight to the brain-derived injury. We hypothesized that fluoride-induced memory impairment was associated with gut dysbiosis, which could be prevented by improving the gut microbiota. MethodsMice were given fluoridated drinking water (sodium fluoride, 100 mg/L) for 70 days and administered with PBS or a probiotic strain, Lactobacillus johnsonii BS15 for 28 days prior to and throughout a 70 day exposure to sodium fluoride. ResultsResults showed that fluoride reduces the exploration ratio in Novel object recognition (NOR) test and the spontaneous exploration during the T-maze test in mice following an hour water avoidance stress (WAS), which were significantly improved by the probiotic. 16S rRNA sequencing showed a significant seperation in ileal microbiota between the fluoride-treated mice and control mice. Lactobacillus was the mainly targeting bacteria and significantly reduced in fluoride-treated mice. BS15 reconstructed the fluoride-post microbiota and increased the relative abundance of Lactobacillus. D-lactate contant and diamine oxidase (DAO) activity, two biomarkers of the gut permeability were reduced in the serum of probiotic-inocluated mice. ZO-1, an intestinal tight junction protein, which was reduced by fluoride in mRNA and protein levels were increased by the probiotic treatment. Moreover, in the hippocampus which is essential to learning and memory, the probiotic increased the down-regulated mRNA levels of myelinassociated glycoprotein (MAG) level, Bcl-xl and decreaed up-regulated mRNA levels of Bad in fluoride-treated mice. The probiotic applied in this study also increased down-regulated mRNA and protein levels of brain-derived neurotrophic factor (BDNF) and cAMP response element-binding protein (CREB), and balanced the inflammatory cytokines in mRNA and protein levels in hippocampus of fluoride-treated mice. ConclusionsThese results suggested that there may be some correlations between the fluoride-induced memory dysfunction and alteration of gut microbiota, and reconstruction of gut microbiota is a potential method to prevent the memory dysfunction.
Domestic Violence and Abuse Related Emergency Room Visits in Ontario, Canada
Authors: Singhal Sonica , Orr Sarah , Singh Harkirat , Shanmuganantha Menaka , Manson Heather
Published: October 2020

Background: Hospitals’ emergency rooms (ERs), are generally the first point of contact of domestic violence and abuse (DVA) victims to the health care system. For efficient management and resource allocation for ERs to manage DVA-related emergencies in Canada, it is important to quantify and assess the pattern of these visits.Methods: Aggregate DVA-related ER visits data, using relevant ICD-10-CA codes, from 2012 to 2016 were retrieved from IntelliHealth Ontario. The 2011 ON-Marg (Ontario Marginalization) indices were linked at the Dissemination Area level to ER data. Descriptive analyses including total number and rate of visits per 100,000 people were calculated, stratified by age and sex. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were also assessed. Results: From 2012-2016, 10,935 (81.2% by females and 18.8% by males) DVA-related visits were made to ERs in Ontario. An annual average of 25.5 visits per 100,000 females and 6.1 visits per 100,000 males was observed. Residential instability and deprivation were significant predictors of DVA-related ER visits. No particular site of injury was indicated in 38.5% of visits, 24.7% presented with cranio-maxillofacial (CMF) trauma in isolation, 28.9% presented with non-CMF injuries, and 7.9% visits presented with both CMF and non-CMF injuries.Conclusion: This study identified that the burden of DVA-related ER visits is large enough to warrant timely public health interventions, and observed that certain populations in Ontario experience more DVA and/or are more prone to its impact. Our findings have important implications for various stakeholders involved in planning and implementing relevant policies and programs.
Novel multiparametric nomogram for overall survival prediction in complicated intra-abdominal infection: A multicenter study in China
Authors: Huang Sisi , Chen Limin , Liu Jiao , Zhang Sheng , Zhang Lidi , Wen Zhenliang , Chen Yizhu , Chen Dechang
Published: October 2020

Background: Complicated Intra-abdominal infections (cIAIs) in the abdominal cavity or within an abdominal organ are numerous and frequent dangerous entities in the treatment of critically ill patients. Early clinical evaluation is necessary. Methods: This retrospective multi-center study included patients from ten intensive care units (ICUs). Risk factors for the overall survival (OS) of patients with cIAI were selected using least absolute shrinkage and selection operator regression, a nomogram was constructed subsequently. Calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discriminative ability.Results: In total, 544 patients diagnosed with cIAI were enrolled and divided into the study (n = 276) and validation (n = 268) sets. Sex, acute gastrointestinal injury, acute kidney injury, rare bacterium infection, Charlson score, and APACHE II score were identified as independent risk factors and were constructed for the nomogram. The nomogram showed marked calibration capability with a concordance index (C- index) of 0.909 and 0.831 in the study and validation set. Comparing with common clinical prognostic scoring system, the nomogram achieved the highest discrimination ability with an area under the curve (AUC) value of 0.91 and 0.83 in the study set and validation set, respectively.Conclusions: Our newly constructed nomogram provides a useful tool for risk stratification and prognosis evaluation of cIAI.
The Effect of the Resection Distance from the Pylorus on the Short-Term Outcome of Laparoscopic Sleeve Gastrectomy
Authors: Hussein Ahmed H , Khaled Islam , Faisal Mohammed
Published: October 2020

Background: Laparoscopic sleeve gastrectomy (LSG) was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus (DP). We conducted this study to elucidate any potential difference in the short-term outcome between 2 cm and 6 cm DP in LSG.Methods: This was an interventional, prospective, randomized study aimed at assessing the effect of the resection DP on the weight loss outcome as expressed by the excess weight loss percentage (%EWL) after LSG carried out from January 2018 to March 2020 in 96 patients with morbid obesity who had LSG performed at the Surgical Department, Suez Canal University. The patients were randomly separated into two equal groups; Group 1 (48 patients) underwent LSG with a 2 cm DP resection distance and Group 2 (48 patients) underwent LSG with a 6 cm DP resection distance. Body weight, body mass index, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and postoperatively for a duration of 12 months.Results: Statistically, there was no significant difference between the two study groups regarding the %EWL, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 vs. 25% in Group 2, p > 0.05).Conclusion: LSG was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The DP resection distance did not affect the short-term effects of LSG with regard to %EWL, resolution of comorbidities, change in quality of life, and occurrence of complications.
Knowledge, Attitude, Practices and Associated Factors Towards Colostrum Feeding among Mothers of Infants in Ambo District of West Shewa Zone, Oromiya Region, Ethiopia
Authors: Gela Jiregna Darega , Minase Dereje , Teferi Elias , Tesfaye Tamiru
Published: October 2020

Background: Colostrum is the first breast milk produced after birth and is important for promotion of health and prevention of infections of the newborn. Though breastfeeding practices are well known but the necessity of colostrum feeding is still poorly understood by mothers.Objective: To assess Knowledge, Attitude, Practices and associated factors towards colostrum feeding among mothers of infants in ambo district of west Shoa zone, Oromia, Ethiopia.Methods: A community-based cross-sectional study was conducted from March to April 2019 among 429 mothers of infants selected by simple random sampling technique. The data were collected using structured questionnaire, focus group discussion & key informant interview by semi structured guiding questionnaire. Descriptive analysis like frequency, percentage, & mean were performed. Binary and multiple logistic regression analysis were employed to identify associated factors. Variables with p-value <0.05 with 95% confidence interval identified statistically significant.Results: Among the respondents, 278 (64.8%) mothers had good knowledge & 250 (58%) had favorable attitude. But colostrum feeding was practiced only by 227(56.5%). Mothers of neonates without any illness/finding at birth (AOR =14.87 [ 95% CI: 5.00-44.27]) & postnatal care within the first 2-3 days (AOR = 3.48 [95% CI: 1.23-9.85]) were positively associated factors; but unwanted pregnancy/birth (AOR = 0.243 [95% CI: .113-.527]), mothers suffering from any health problems during pregnancy/birth (AOR = 0.380 [95% CI: .161-.903]), lack of counseling (AOR = 0.264 [95% CI: .103-.675]), home delivery (AOR = 0.239 [95% CI: .111-.516]), & lack of information on colostrum (AOR = 0.040 [95% CI: .013-.125]) were negatively associated with colostrum feeding practices. Conclusions: Majority of respondents had good knowledge & favorable attitude but with poor practices of colostrum feeding. Good neonatal health at/soon after birth & postnatal care attendance within two to three days were positively associated with colostrum feeding practices. But, unwanted pregnancy/birth, any sickness of mother at birth/during pregnancy, lack of counseling on colostrum feeding, home delivery, & lack of information on colostrum feeding were less likely to feed colostrum.Strengthening family planning service, antenatal care, institutional delivery, postnatal care, information provision for counseling & the revision of DHIS2 for inclusion of colostrum feeding indicators were recommended interventions.
Functional conservation and divergence of five AP1/FUL-like genes in Marigold (Tagetes erecta)
Authors: Zhang Chunling , Sun Yalin , Wei Ludan , Wang Wenjing , Li Hang , Bao Manzhu , He Yanhong
Published: October 2020

Background: Members of AP1/FUL subfamily genes play an essential role in the regulation of floral meristem transition, floral organ identity, and fruit ripping. At present, there have been insufficient studies to explain the function of the AP1/FUL-like subfamily genes in Asteraceae. Results: Here, we cloned two euAP1 clade genes TeAP1-1 and TeAP1-2, and three euFUL clade genes TeFUL1, TeFUL2, and TeFUL3 from marigold (Tagetes erecta). Expression profile analysis demonstrated that TeAP1-1 and TeAP1-2 were mainly expressed in receptacles, sepals, petals, and ovules. TeFUL1 and TeFUL3 were expressed in floral buds, stems and leaves as well as in productive tissues, while TeFUL2 was mainly expressed in floral buds and vegetative tissues. Transgenic Arabidopsis lines showed that overexpression TeAP1-2 or TeFUL2 resulted in early flowering, implying that these two genes might regulate the floral transition. Yeast two-hybrid analysis indicated that TeAP1/FUL proteins only interacted with TeSEP proteins to form heterodimers, and that TeFUL2 could also form a homodimer.Conclusion: In general, TeAP1-1 and TeAP1-2 might play a conserved role in regulating sepal and petal identity, just like the role of MADS-box class A genes, while TeFUL genes might display divergent functions. This study provides an insight into molecular mechanism of AP1/FUL-like genes in Asteraceae species.
Fit for Surgery – Effects of short-course multimodal individualized prehabilitation in high-risk frail colon cancer patients prior to surgery: A feasibility study
Authors: Bojesen Rasmus Dahlin , Jørgensen Lars Bo , Grube Camilla , Skou Søren Thorgaard , Johansen Christoffer , Dalton Susanne Oksbjerg , Gögenur Ismail
Published: October 2020

Background Prehabilitation is a promising modality for improving patient-related outcomes after major surgery, however, very little research has been done for those who may need it the most; the elderly and the frail. The study aimed to investigate if high risk, frail patients with colorectal cancer and WHO performance status I and II could adhere to a short course multimodal prehabilitation intervention prior to surgery.Methods The study was conducted as a single-center, prospective one-arm feasibility study with limited-efficacy testing of eight patients. The intervention consisted of a physical training program tailored to the patients with both high-intensity interval training and resistance training three times a week, nutritional support with protein and vitamins, a consultation with a dietician, and medical optimization prior to surgery. The primary outcomes were the increase in maximum oxygen intake (VO2 peak) during the intervention and per-protocol compliance and adherence. Secondary outcomes were: increase in body weight, increase in albumin, adverse events during the intervention, postoperative length of stay, and complications within 30 days after surgery. Results The mean age vas 80 (range: 66-88). Seven completed the intervention. The mean increase in maximum oxygen intake (VO2 peak) was 17 % (range: 0.6% - 28 %), with two patients being non-responders. All patients who had a prediagnostic weight loss increased their body weight with a mean of 2.5 kg (range: 1.3 – 4.0 kg). Adherence to high-intensity interval training was 87 %, whereas adherence to nutritional support was 57 %. The median postoperative length of stay was 3 days (range: 1-26).Conclusions This one-arm feasibility study indicates that multimodal prehabilitation including high-intensity interval training can be performed with high adherence to the program in patients with colorectal cancer and WHO performance status I and II Clinical trial registration Clinicaltrials.gov: NCT04167436, Date of registration November 18 2019. Retrospectively registered.