bluuebunny/crossref_metadata_2025_split huggingface dataset:
High index of suspicion for brucellosis in a highly cosmopolitan city in southern China
Authors: Ye Hai-Yan , Xing Fan-Fan , Yang Jin , Lo Simon Kam-Fai , Lau Ricky Wing-Tong , Chen Jonathan Hon-Kwan , Chiu Kelvin Hei-Yeung , Yuen Kwok-Yung 
Published: January 2020

Abstract
Background
Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China.

Methods
A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared.

Results
A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain.

Conclusions
Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
Length of hospital stay is associated with a decline in activities of daily living in hemodialysis patients: a prospective cohort study
Authors: Kamitani Tsukasa , Fukuma Shingo , Shimizu Sayaka , Akizawa Tadao , Fukuhara Shunichi 
Published: January 2020

Abstract
Background
The impact of length of hospital stay on activities of daily living (ADLs) has not specifically been investigated among dialysis patients. Therefore, we attempt to verify the association between the length of hospital stay and the decline in ADLs among hemodialysis patients.

Methods
This prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). We included 2442 hemodialysis patients aged ≥40 years from the J-DOPPS phase V (2012–2015) and subsequently excluded those who had already lost basic activities of daily living (BADLs) as demonstrated by dependency in at least three of the five BADLs at baseline and for whom changes in ADLs had been evaluated for less than 90 days. The main exposure was the cumulative length of hospital stay during the follow-up period. The primary outcomes were a decline in at least one of the five BADLs and eight instrumental activities of daily living (IADLs). We compared risk ratios (RRs) for 30-day increments for hospital stays with 10-year increments for age and having diabetes.

Results
A total of 849 patients were included in the statistical analysis. The cumulative length of hospital stay was significantly associated with a risk of decline in ADLs (adjusted RRs [95% confidence intervals] per 30-day increments: 1.42 [1.15 to 1.75] for BADLs, 1.38 [1.13 to 1.68] for IADLs). The adjusted RRs [95% CI] for 10-year increments in age were 1.20 [0.96 to 1.50] and 1.21 [1.00 to 1.47]. The adjusted RRs [95% CI] for having diabetes were 1.36 [0.97 to 1.91] for BADLs and 1.38 [1.04 to 1.84] for IADLs.

Conclusion
The impact of a 30-day increment in the cumulative length of hospital stay on the decline in ADLs was comparable to that of a 10-year increase in age and having diabetes.
Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review
Authors: Omenka Ogbonnaya I. , Watson Dennis P. , Hendrie Hugh C. 
Published: January 2020

AbstractBackgroundAfricans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the “black” category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps.MethodsLiterature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format.ResultsCulture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers.ConclusionKnowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.
A randomized controlled efficacy trial of an electronic screening and brief intervention for alcohol misuse in adolescents and young adults vulnerable to HIV infection: step up, test up study protocol
Authors: Kuhns Lisa M. , Karnik Niranjan , Hotton Anna , Muldoon Abigail , Donenberg Geri , Keglovitz Kristin , McNulty Moira , Schneider John , Summersett-Williams Faith , Garofalo Robert 
Published: January 2020

Abstract
Background
Young people account for more than a quarter of new HIV infections in the US, with the majority of cases among young men who have sex with men; young transgender women are also vulnerable to infection. Substance use, particularly alcohol misuse, is a driver of sexual transmission and a potential barrier to engagement in the HIV prevention and care continuum, however vulnerable youth are difficult to reach for substance use services due, in part, to complex social and structural factors and limited access to health care. The Community Prevention Services Task Force recommends electronic screening and brief intervention as an evidence-based intervention for the prevention of excessive alcohol consumption; however, no prior studies have extended this model to community-based populations of youth that are susceptible to HIV infection. This paper describes the study protocol for an electronic screening and brief intervention to reduce alcohol misuse among adolescents and young adults vulnerable to HIV infection in community-based settings.

Methods
This study, Step Up, Test Up, is a randomized controlled trial of an electronic alcohol screening and brief intervention among youth, ages 16–25, who are vulnerable to HIV infection. Individuals who present for HIV testing at one of three community-based locations are recruited for study participation. Eligibility includes those aged 16–25 years, HIV-negative or unknown HIV status, male or trans female with a history of sex with men, and English-speaking. Participants who screen at moderate to high risk for alcohol misuse on the Alcohol Use Disorders Identification Test (AUDIT) are randomized (1:1) to either an electronic brief intervention to reduce alcohol misuse or a time-and attention-matched control. The primary outcome is change in the frequency/quantity of recent alcohol use at 1, 3, 6 and 12-month follow-up.

Discussion
Testing of evidence-based interventions to reduce alcohol misuse among youth vulnerable to HIV infection are needed. This study will provide evidence to determine feasibility and efficacy of a brief electronically-delivered intervention to reduce alcohol misuse for this population.

Trial registration
ClinicalTrials.gov number, NCT02703116, registered March 9, 2016.
The challenges of making informed decisions about treatment and trial participation following a cancer diagnosis: a qualitative study involving adolescents and young adults with cancer and their caregivers
Authors: Hart Ruth I. , Cameron David A. , Cowie Fiona J. , Harden Jeni , Heaney Nicholas B. , Rankin David , Jesudason Angela B. , Lawton Julia 
Published: January 2020

Abstract
Background
Limited attention has been paid to adolescents and young adults’ (AYA's) experiences in the aftermath of a cancer diagnosis, despite this being a time when potentially life-changing decisions are made. We explored AYA’s and caregivers’ experiences of, and views about, making treatment and trial participation decisions following a cancer diagnosis, in order to understand, and help facilitate, informed treatment decision-making in this age group.

Methods
Interviews were undertaken with 18 AYA diagnosed, or re-diagnosed, with cancer when aged 16–24 years, and 15 parents/caregivers. Analysis focused on the identification and description of explanatory themes.

Results
Most AYA described being extremely unwell by the time of diagnosis and, consequently, experiencing difficulties processing the news. Distress and acceleration in clinical activity following diagnosis could further impede the absorption of treatment-relevant information. After referral to a specialist cancer unit, many AYA described quickly transitioning to a calm and pragmatic mind-set, and wanting to commence treatment at the earliest opportunity. Most reported seeing information about short-term side-effects of treatment as having limited relevance to their recovery-focused outlook at that time. AYA seldom indicated wanting to make choices about front-line treatment, with most preferring to defer decisions to health professionals. Even when charged with decisions about trial participation, AYA reported welcoming a strong health professional steer. Parents/caregivers attempted to compensate for AYA’s limited engagement with treatment-relevant information. However, in seeking to ensure AYA received the best treatment, these individuals had conflicting priorities and information needs.

Conclusion
Our study highlights the challenging context in which AYA are confronted with decisions about front-line treatment, and reveals how their responses make it hard to ensure their decisions are fully informed. It raises questions about the direct value, to AYA, of approaches that aim to promote decision-making by improving understanding and recall of information, though such approaches may be of value to caregivers. In seeking to improve information-giving and involvement in treatment-related decision-making at diagnosis, care should be taken not to delegitimize the preference of many AYA for a directive approach from trusted clinicians.
Combining health insurance funds in a fragmented context: what kind of challenges should be considered?
Authors: Bazyar Mohammad , Rashidian Arash , Alipouri Sakha Minoo , Vaez Mahdavi Mohammad Reza , Doshmangir Leila 
Published: January 2020

Abstract
Background
Iran’s Parliament passed a Law in 2010 to merge the existing health insurance schemes to boost risk pooling. Merging can be challenging as there are differences among health insurance schemes in various aspects. This qualitative prospective policy analysis aims to reveal key challenges and implementation barriers of the policy as introduced in Iran.

Methods
A qualitative study of key informants and documentary review was conducted. Sixty-seven semi-structured face-to-face interviews were conducted, with key informants from relevant stakeholders. Purposive and snowball sampling techniques were used for selecting the interviewees. The related policy documents were also reviewed and analyzed to supplement interviews. Data analysis was conducted through an existing health financing World Bank framework.

Results
This study demonstrated that for combining health insurance funds, operational challenges in the following areas should be taken into account: financing mechanisms, population coverage, benefits package, provider engagement, organizational structure, health service delivery and operational processes. It is also important to have adequate cogent reasons to “the justification of the consolidation process” in the given context. When moving towards combining health insurance funds, especially in countries with a purchaser-provider split, it is critical for policy makers to make sure that the health insurance system is aligned with the policies and Stewardship of the broader health care system.

Conclusions
Implementation of major reforms in a health system with fragmented insurance schemes with different target populations, prepayment structures, benefit packages and history of development is inherently difficult, especially when different stakeholders have vetoing powers over the proposed reforms. Solving the differences and operational challenges in the main areas of health insurance system generated in this study may provide a platform for the designing and implementing merging process of social health insurance schemes in Iran and other countries with similar situations.
Moderate and deep sedation for non-invasive paediatric procedures in tertiary maternity and children’s hospitals in China: a questionnaire survey from China
Authors: Li Bo , Zhang Ruidong , Huang Yue , Zhang Kan , Wat Chun Yin , Bai Jie , Zhang Mazhong , Zheng Jijian 
Published: January 2020

AbstractBackgroundModerate and deep sedation are well-established techniques in many developed countries, and several guidelines have been published. However, they have received attention in China only in recent years. The aim of this study is to investigate current paediatric sedation practices in tertiary children’s hospitals and tertiary maternity and children hospitals in China.MethodsAll tertiary children’s hospitals and tertiary maternity and children hospitals registered with the National Health Commission of the People’s Republic of China were invited to participate in an electronic survey, which included information on the sedation caseload, facility availability, staff structure, clinical skill requirements for sedation providers, fasting guidelines, patient-monitoring practices, and choice of sedatives.ResultsFifty-eight of the 63 hospitals that completed the survey (92.1%) provided moderate and deep sedation. Dedicated sedation rooms and post-sedation recovery rooms were found in 14 (24.1%) and 19 (32.8%) hospitals, respectively. Sedation for non-invasive procedures was primarily performed by anaesthesiologists (69.0%); however, 75.9% of the sedation providers had not received paediatric basic or advanced life-support training. Children were asked to fast from clear liquids for at least 2 h in 44.8% of hospitals and up to 6 h in 5.2% of hospitals; they were asked to fast from solid food/milk for at least 4 h in 27.6% of hospitals and more than 8 h in 1.7% of hospitals. The most commonly used sedative in all groups was chloral hydrate. For rescue, propofol was the most widely used sedative, particularly for children older than 4 years.ConclusionsModerate and deep sedation practices vary widely in tertiary children’s hospitals and tertiary maternity and children hospitals in China. Optimised practices should be established to improve the quality of moderate and deep sedation.
Duck enteritis virus UL21 is a late gene encoding a protein that interacts with pUL16
Authors: Yang Linjiang , Wang Mingshu , Zeng Chunhui , Shi Yong , Cheng Anchun , Liu Mafeng , Zhu Dekang , Chen Shun , Jia Renyong , Yang Qiao , Wu Ying , Zhang Shaqiu , Zhao Xinxin , Huang Juan , Liu Yunya , Ou Xumin , Mao Sai , Yu Yanling , Zhang Ling , Tian Bin , Pan Leichang , Rehman Mujeeb Ur , Chen Xiaoyue 
Published: January 2020

Abstract
Background
pUL21 is a conserved protein of Alphaherpesvirinae that performs multiple important functions. The C-terminus of pUL21 in other members of this subfamily has RNA-binding ability; this domain contributes to pseudorabies virus (PRV) retrograde axonal transport in vitro and in vivo and participates in newly replicated viral DNA packaging and intracellular virus transport. However, knowledge regarding duck enteritis virus (DEV) pUL21 is limited.

Results
We verified that DEV UL21 is a γ2 gene that encodes a structural protein. Moreover, we observed that pUL21 localized to the nucleus and cytoplasm. DEV pUL21 interacted with pUL16 and formed a complex in transfected human embryonic kidney (HEK) 293 T cells and DEV-infected duck embryo fibroblasts (DEFs). These results were further confirmed by CO-IP assays.

Conclusions
The DEV UL21 gene is a late gene, and pUL21 localizes to the nucleus and cytoplasm. DEV UL21 is a virion component. In addition, pUL21 can interact with pUL16. These findings provide insight into the characteristics of UL21 and the interaction between pUL21 and its binding partner pUL16. Our study enhances the understanding of DEV pUL21.
Systemic activation of NLRP3 inflammasome and plasma α-synuclein levels are correlated with motor severity and progression in Parkinson’s disease
Authors: Fan Zheng , Pan Yu-Ting , Zhang Zhi-Yuan , Yang Hui , Yu Shu-Yue , Zheng Yan , Ma Jing-Hong , Wang Xiao-Min 
Published: January 2020

Abstract
Background
Emerging evidence indicates that inflammasome-induced inflammation plays a crucial role in the pathogenesis of Parkinson’s disease (PD). Several proteins including α-synuclein trigger the activation of NLRP3 inflammasome. However, few studies examined whether inflammasomes are activated in the periphery of PD patients and their possible value in the diagnosis or tracking of the progress of PD. The aim of this study was to determine the association between inflammasome-induced inflammation and clinical features in PD.

Methods
There were a total of 67 participants, including 43 patients with PD and 24 controls, in the study. Participants received a complete evaluation of motor and non-motor symptoms, including Hoehn and Yahr (H-Y) staging scale. Blood samples were collected from all participants. The protein and mRNA expression levels of inflammasomes subtypes and components in peripheral blood mononuclear cells (PBMCs) were determined using western blotting and RT-qPCR. We applied Meso Scale Discovery (MSD) immunoassay to measure the plasma levels of IL-1β and α-synuclein.

Results
We observed increased gene expression of NLRP3, ASC, and caspase-1 in PBMCs, and increased protein levels of NLRP3, caspase-1, and IL-1β in PD patients. Plasma levels of IL-1β were significantly higher in patients with PD compared with controls and have a positive correlation with H-Y stage and UPDRS part III scores. Furthermore, plasma α-synuclein levels were also increased in PD patients and have a positive correlation with both UPDRS part III scores and plasma IL-1β levels.

Conclusions
Our data demonstrated that the NLRP3 inflammasome is activated in the PBMCs from PD patients. The related inflammatory cytokine IL-1β and total α-synuclein in plasma were increased in PD patients than controls, and both of them presented a positive correlation with motor severity in patients with PD. Furthermore, plasma α-synuclein levels have a positive correlation with IL-1β levels in PD patients. All these findings suggested that the NLRP3 inflammasome activation-related cytokine IL-1β and α-synuclein could serve as non-invasive biomarkers to monitor the severity and progression of PD in regard to motor function.
Functional relevance of the multi-drug transporter abcg2 on teriflunomide therapy in an animal model of multiple sclerosis
Authors: Thiele née Schrewe Lisa , Guse Kirsten , Tietz Silvia , Remlinger Jana , Demir Seray , Pedreiturria Xiomara , Hoepner Robert , Salmen Anke , Pistor Maximilian , Turner Timothy , Engelhardt Britta , Hermann Dirk M. , Lühder Fred , Wiese Stefan , Chan Andrew 
Published: January 2020

AbstractBackgroundThe multi-drug resistance transporter ABCG2, a member of the ATP-binding cassette (ABC) transporter family, mediates the efflux of different immunotherapeutics used in multiple sclerosis (MS), e.g., teriflunomide (teri), cladribine, and mitoxantrone, across cell membranes and organelles. Hence, the modulation of ABCG2 activity could have potential therapeutic implications in MS. In this study, we aimed at investigating the functional impact of abcg2 modulation on teri-induced effects in vitro and in vivo.MethodsT cells from C57BL/6 J wild-type (wt) andabcg2-knockout (KO) mice were treated with teri at different concentrations with/without specific abcg2-inhibitors (Ko143; Fumitremorgin C) and analyzed for intracellular teri concentration (HPLC; LS-MS/MS), T cell apoptosis (annexin V/PI), and proliferation (CSFE). Experimental autoimmune encephalomyelitis (EAE) was induced in C57BL/6J by active immunization with MOG35–55/CFA. Teri (10 mg/kg body weight) was given orally once daily after individual disease onset.abcg2-mRNA expression (spinal cord, splenic T cells) was analyzed using qRT-PCR.ResultsIn vitro, intracellular teri concentration in T cells was 2.5-fold higher inabcg2-KO mice than in wt mice. Teri-induced inhibition of T cell proliferation was two fold increased inabcg2-KO cells compared to wt cells. T cell apoptosis demonstrated analogous results with 3.1-fold increased apoptosis after pharmacological abcg2-inhibition in wt cells.abcg2-mRNA was differentially regulated during different phases of EAE within the central nervous system and peripheral organs. In vivo, at a dosage not efficacious in wt animals, teri treatment ameliorated clinical EAE inabcg2-KO mice which was accompanied by higher spinal cord tissue concentrations of teri.ConclusionFunctional relevance of abcg2 modulation on teri effects in vitro and in vivo warrants further investigation as a potential determinant of interindividual treatment response in MS, with potential implications for other immunotherapies.