bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preliminary study of the mechanism underlying how Jianshen Granules ameliorate renal failure in 5/6 nephrectomy model rats
Authors: Wu Yan , Zhang Xianxie , Kong Jian , Qiu Haiying , Lu Hongjie , Du Lina , Yuan Hailong 
Published: August 2020

Abstract
Background: Chronic renal failure (CRF) is a worldwide public health concern, and at present, there are limited treatment options available. Jianshen Granules, a traditional Chinese herbal medicine, have been used clinically in the treatment of renal diseases for a large number of years in the Air Force Medical Center of the Chinese People's Liberation Army (PLA), and have shown great efficacy. In the present study, both the effectiveness and the mechanism of action of Jianshen Granules to treat CRF were investigated. Methods: A rat model of CRF was established by 5/6 nephrectomy. Rats were administered with distilled water, Uremic Clearance Granules (UCGs), or Jianshen Granules. During the administration period, the physiological state of the rats was observed, and the biochemical parameters of interest were measured. The pathology of the kidney tissues were assessed using hematoxylin and eosin (H.E.), and Masson’s staining. In addition, the expression level of transforming growth factor‑β1 (TGF‑β1) was detected. Human kidney cells (HKC cells) were used to investigate the effects of Jianshen Granules on apoptosis induced by hydrogen peroxide (H2O2), whereas cell viability was assessed by Cell Counting Kit‑8 (CCK‑8) assay. The level of apoptosis, the mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) and Ca2 + levels were measured using a flow cytometry. Results: The results revealed that Jianshen Granules could reduce the levels of serum creatinine, blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase, and the volume of urine in CRF rats. Renal histopathological examinations revealed that Jianshen Granules had an ameliorative effect on renal injury. In addition, Jianshen Granules led to a marked decrease in TGF‑β1 levels in CRF rats. Following treatment with Jianshen Granules, cell viability and the level of the MMP increased, whereas the levels of ROS and Ca2+ were reduced significantly. The increased level of TGF‑β1 was detected in the H2O2‑treated group, although this increase was attenuated by treatment with Jianshen Granules. Conclusion: Taken together, the results of the present study have shown that Jianshen Granules are able to ameliorate renal failure in CRF rats, and to inhibit apoptosis of HKC cells induced by H2O2 via downregulation of TGF‑β1.
Social gradient in health-related quality of life among urban residents in Limassol, Cyprus: Research article
Authors: Ellina Panagiota , Middleton Nicos , Lambrinou Ekaterini , Kouta Christiana 
Published: August 2020

Abstract
Background: Social inequalities in health threaten social cohesion and, therefore, their investigation is an important research field. Monitoring the health of the population is necessary to identify health needs, design programs focused in people’s needs and to evaluate the effectiveness of health policies.Methods: A cross-sectional survey using primary data was applied. The study investigates the size and the extent of social inequalities in quality of life and health behaviours in Limassol, Cyprus. Data collection was done by door-to-door survey, in the form of interviews. The sample consisted of 450 residents aged 45-64 across 45 randomly selected neighbourhoods, that met the selection criteria. The tools used were: Demographic questionnaire, SF 36 Questionnaire, IPAQ- International Physical Activity Questionnaire short form.Results: The social gradient appears in all social indicators. As for the physical dimension of health has a strong relationship between health-related quality of life with the education index. Specifically, the difference between the two poles is 12 points for men and 14 points for women (p = 0.16). Profession systematically appears to have a stronger relationship with men than with women, and is present in both physical and mental dimensions. Specifically, the difference between the two poles is 13 points for men and 10 points for women (p = 0.31).Conclusions: Exploring social inequalities in health-related quality of life, is a complex situation influencing social, physical and psychological health state. It seems that young male individuals, who are highly educated, employed full time, earning high incomes and engaging in mild physical activity, have significantly higher level of health-related life quality, compared to other middle age adult groups, living in Limassol. This finding is in agreement with other studies that show correlations between gender and the patterns of risk factors.
Point Prevalence Survey of antimicrobial use in three hospitals in North-eastern Tanzania
Authors: Horumpende Pius Gerald , Mshana Stephen Eliatosha , Mouw Elise F , Mmbaga Blandina Theophil , Chilongola Jaffu Othniel , de Mast Quirijn , deMast Quirijn 
Published: August 2020

Abstract
Background: Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods: A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 hours and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results: A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n=94, 29.8%), metronidazole (n=79, 23.9%) and other antibiotics belonging to the penicillin class (n=89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases.Conclusion: Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.
Expanding the reach. Ethnobotanical knowledge and technological intensification in beekeeping among the Ogiek of the Mau Forest, Kenya
Authors: Zocchi Dauro Mattia , Volpato Gabriele , Chalo Duncan , Mutiso Patrick , Fontefrancesco Michele Filippo 
Published: August 2020

Abstract
Background Initiatives for beekeeping intensification across the tropics can foster production and income, but the changes triggered by the introduction of modern beehives might permeate traditional knowledge and practices in multiple ways, and as such should be investigated and understood. We conducted an ethnobotanical study in the Eastern part of the Mau Forest among Ogiek beekeepers who customarily practice forest beekeeping and who are involved in a project aimed at the modernization of their beekeeping activities. We aimed to document the beekeeping-associated ethnobotanical knowledge, exploring the relationships and complementarity between modern and traditional knowledge and practices. Methods Field research was carried out through semi-structured interviews with 30 Ogiek beekeepers and 10 additional stakeholders. We collected ethnobotanical data about plants used for beekeeping purposes, and ethnographic information on traditional and modern beekeeping systems. Results We report 66 plant species, distributed across 36 botanical families representing 58 genera, important as melliferous, for the construction and placing of hives, attracting bees, and harvesting and storing honey. Dombeya torrida (J.F.Gmel.) Bamps, Juniperus procera Hochst. ex Endl., and Podocarpus latifolius (Thunb.) R.Br. ex Mirb are the species with the most mentions and the highest number of uses. Our study reveals that the Ogiek possess a detailed knowledge of the forest’s flora, its importance and uses, and that this knowledge underpins beekeeping practices. Under the influence of external actors, the Ogiek have progressively adopted modern versus traditional log hives and moved beekeeping out of the forest into open areas of pastures and crop fields. Beekeepers are also experimenting with combinations of practices borrowed from modern and traditional beekeeping systems, particularly in the field of hive construction and in the criteria to set up apiaries. Conclusions The study indicates a complementarity and an incipient hybridization of traditional and modern beekeeping, in a way that suggests that modern beehives are instrumental in expanding the reach of beekeeping into deforested and cultivated areas. The study also points to the existence of a rift in the effects of beekeeping intensification on the livelihoods of the Ogiek and on their relationship with the forest. We argue that this intensification might be improving the former but weakening the latter, carrying the associated risk of erosion of traditional forest-based ethnobotanical knowledge.
Hydroxyurea Optimization through Precision Study (HOPS): Study Protocol for a Randomized, Multicenter Trial in Children with Sickle Cell Anemia
Authors: Meier Emily R. , Creary Susan E. , Heeney Matthew M. , Dong Min , Appiah‐Kubi Abena O , Nelson Stephen C. , Niss Omar , Piccone Connie , Quarmyne Maa-Ohui , Quinn Charles T. , Saving Kay L. , Scott John P. , Talati Ravi , Latham Teresa S. , Pfeiffer Amanda , Shook Lisa M. , Vinks Alexander A. , Lane Adam , McGann Patrick 
Published: August 2020

Abstract
Background : Sickle cell disease (SCD) is a severe and devastating hematological disorder that affects over 100,000 persons in the United States and millions worldwide. Hydroxyurea is the primary disease-modifying therapy for the SCD, with proven benefits to reduce both short-term and long-term complications. Despite the well-described inter-patient variability in pharmacokinetics (PK), pharmacodynamics and optimal dose, hydroxyurea is traditionally initiated at a weight-based dose with a subsequent conservative dose escalation strategy to avoid myelosuppression. Because the dose escalation process is time consuming and requires frequent laboratory checks, many providers default to a fixed dose, resulting in inadequate hydroxyurea exposure and suboptimal benefits for many patients. Results from a single-center trial of individualized, PK-guided dosing of hydroxyurea for children with SCD suggest that individualized dosing achieves the optimal dose more rapidly and provides superior clinical and laboratory benefits than traditional dosing strategies. However, it is not clear whether these results were due to individualized dosing, the young age that hydroxyurea treatment was initiated in the study, or both. The Hydroxyurea Optimization through Precision Study (HOPS) aims to validate the feasibility and benefits of this PK-guided dosing approach in a multi-center trial. Methods : HOPS is a randomized, multicenter trial comparing standard vs. PK-guided dosing for children with SCD as they initiate hydroxyurea therapy. Participants (ages 6 months through 21 years), recruited from 11 pediatric sickle cell centers across the United States, are randomized to receive hydroxyurea either using a starting dose of 20 mg/kg/day (Standard Arm) or a PK-guided dose (Alternative Arm). PK data will be collected using a novel sparse microsampling approach requiring only 10μL of blood collected at 3 time-points over 3 hours. A protocol-guided strategy more aggressive protocols is then used to guide dose escalations and reductions in both arms following initiation of hydroxyurea. The primary endpoint is the mean %HbF after 6 months of hydroxyurea. Discussion: HOPS will answer important questions about the clinical feasibility, benefits, and safety of PK-guided dosing of hydroxyurea for children with SCD with potential to change the treatment paradigm from a standard weight-based approach to one that safely and effectively optimize the laboratory and clinical response. Trial registration: ClinicalTrials.gov, NCT03789591. Registered on December 28, 2018.
Severe Pantothenic Acid Deficiency Induces Alterations in The Intestinal Mucosal Proteome of Starter Pekin Ducks
Authors: Tang Jing , Feng Yulong , Zhang Bo , Wu Yongbao , Guo Zhanbao , Liang Suyun , Zhou Zhengkui , Xie Ming , Hou Shuisheng 
Published: August 2020

Abstract
Background: Pantothenic acid deficiency (PAD) results in growth depression and intestinal hypofunction of animals. However, the underlying mechanisms remain to be established. We investigated intestinal mucosal proteome changes induced by PAD in ducks to explain its effects on growth and intestine. Results: A total of 128 one-day-old Pekin ducks were divided into two groups, with 8 replicates and 8 birds per replicate. All the ducks were fed either a PAD or a pantothenic acid adequate (control, CON) diet for 16 days. High mortality, growth retardation, fasting hypoglycemia, reduced plasma insulin, and oxidative stress were observed in the PAD group compared to the CON group. Furthermore, PAD induced morphological alterations of the small intestine indicated by reduced villus height and villus surface area of duodenum, jejunum, and ileum. The duodenum mucosal proteome of ducks showed that 198 proteins were upregulated and 223 proteins were downregulated (> 1.5-fold change) in the PAD group compared to those in the CON group. Pathway analysis of these proteins exhibited the suppression of glycolysis and gluconeogenesis, fatty acid beta oxidation, tricarboxylic acid cycle, oxidative phosphorylation, oxidative stress, and intestinal absorption in the PAD group, indicating impaired energy generation and abnormal intestinal absorption. We also show that nine out of eleven proteins involved in regulation of actin cytoskeleton were upregulated by PAD, probably indicates reduced intestinal integrity. Conclusion: PAD leads to growth depression and intestinal hypofunction of ducks, which are associated with impaired in energy generation, abnormal intestinal absorption, and regulation of actin cytoskeleton processes. These findings have important implications for understanding the effect of PAD on intestines.
Exploring Current Iran’s Primary Healthcare System: Challenges and Solutions
Authors: Shirjang Ahmad , Doshmangir Leila , Assan Abraham 
Published: August 2020

Abstract
Background: Since 1980s, establishing Primary Healthcare (PHC) network in Iran to promote health care delivery and population’s health, the PHC system has experienced various achievements and changes. This study aimed to explore current PHC in Iran focusing on challenges and solutions.Methods: Documentary review and interviews were used to collect qualitative data. The interviews were conducted with 26 stakeholders in various levels of the health system including health policymakers, academics, health managers and staffs are expert in public health and the PHC. National upstream documents including the Five Year Development Plans, General Health Policies, and the Iran’s 20 year national vision were reviewed. Data analysis was done using deductive content analysis assisted by MAXQDA 12 software. Results: Although Iranian PHC has enjoyed significant successes, it does not match with the changing populations’ health needs especially during the last years. The current workforce cannot respond to new public health challenges, health data are not collected and analyzed in a consistent manner, modern appropriate technologies in the PHC are not used and electronic service delivery are not provided yet. PHC financial difficulties and the current rigid structure of the health system cannot satisfy the new emerging needs of the population.Conclusion: Given the challenges and the new health needs, the current PHC structure and services should use the private sector involvement for better respond to the public health needs and flexible structure and services while dealing with the changes. The workforce needs to be updated, and the referral system should be established for providing the health care services based on FP plan.
The use of Peripheral Blood-Mononuclear Cells in Scleroderma patients: an observational preliminary study
Authors: Carella Sara , Rossi Caterina , Ribuffo Diego , Onesti Maria Giuseppina 
Published: August 2020

Abstract
Background

Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by vasculopathy and excessive production of collagen, which lead to skin and visceral fibrosis. The aim of our study is to assess the potential benefits of peripheral blood mononuclear cells (PB-MNCs) implants in the treatment of clinical manifestations such as mouth impairment, hand disability, digital ulcers and Raynaud’s phenomenon in Scleroderma patients.
Methods

From February 2016 to May 2019, 10 female patients were enrolled from the outpatient clinic of the Plastic Surgery Unit of Sapienza University of Rome. Parameters evaluated were: patients’ disability, using the Health Assessment Questionnaire (HAQ) disability index (DI) and the scleroderma HAQ (sHAQ); mouth opening capacity, by measuring the maximum interincisal distance and the mouth perimeter; hand mobility, assessed with clinical exam and the Hand Mobility in Scleroderma (HAMIS) scale; Raynaud’s phenomenon, evaluated through nailfold capillaroscopy; digital ulcers, examined through their features and incidence of appearance. SPSS software was used for a simple descriptive statistical analysis performed by the Student's paired t-test. P values less than 0.05 were considered statistically significant.
Results

The treatment showed a significant improvement of all the parameters evaluated at 1-year follow-up, it was well-tolerated by all the patients and the only complications noticed were small areas of ecchymosis.
Conclusions

Our results suggest that PB-MNCs injection could represent a treatment option to take into account for SSc patients. The procedure we used is easy and fast to perform, minimally invasive and not-operator dependent. We hope our observational and preliminary study could be considered as a starting point for further research studies.
The Prevalence, Risk Factors and Prognosis of Acute Kidney Injury after Lung Transplantation: A Single-center Cohort Study in China
Authors: Sang Ling , Chen Sibei , Nong Lingbo , Xu Yonghao , Zheng Haichong , Zhou Liang , Liang Wenhua , Sun Huadong , He Jianxing , Liu Xiaoqing , Li Yimin 
Published: August 2020

Abstract
Background
To evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx).
Methods
Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The impact of AKI and CRRT on short-term outcomes and long-term survival was measured.
Results
148 patients were included with 67 cases developed post-operative AKI. 31 patients underwent CRRT; the percentage of CRRT was 6.2%, 0%, 10% and 86.2% in no-AKI, and stage 1, 2 and 3 AKI, respectively. Patients with AKI had significantly higher ICU mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without (74.1%). There was no difference in the 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs. 76.1%, P < 0.05). We found that higher APACHE II score (OR 1.082, P = 0.009), and higher intraoperative fluid balance (OR 1.001, P = 0.012) were independent risk factors, and female (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a C-index of 0.76 (95% CI, 0.66–0.87).
Conclusion
Severe AKI which needed CRRT had a negative impact on the short-term and long-term outcomes.
Evaluation of Carbapenem-Resistant Enterobacteriaceae (CRE) Guideline Implementation in the Veteran’s Affairs Medical Centers Using the Consolidated Framework for Implementation Research
Authors: Goedken Cassie Cunningham , Guihan Marylou , Brown Charnetta R. , Ramanathan Swetha , Vivo Amanda , Suda Katie J. , Fitzpatrick Margaret A. , Poggensee Linda , Perencevich Eli N. , Rubin Michael , Reisinger Heather Schacht , Evans Martin , Evans Charlesnika T. 
Published: August 2020

Abstract
Background Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to examine contextual factors and identify best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs).Methods Qualitative interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE positive cultures was conducted with a Fisher’s exact test.Results Forty-three semi-structured interviews were conducted between 10/2017-8/2018 with laboratory staff (47%), Multi-Drug Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants cited the need for more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified the following CFIR constructs as being significantly associated with CRE screening or presence of CRE: Leadership Engagement, Relative Priority Available Resources, Team Communication, and Access to Knowledge & Information.Conclusions Effective CRE identification, prevention and treatment requires ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including increasing healthcare worker’s awareness of infection control and prevention for emerging pathogens, access to resources, improving communication and facilitating successful implementation of the CRE guidelines.