bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis
Authors: Feng Xiaoran , Wen Yueqiang , Peng FenFen , Wang Niansong , Zhan Xiaojiang , Wu Xianfeng 
Published: January 2020

Abstract
Objectives Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002).Conclusions PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.
Effects of royal jelly and tocotrienol rich fraction in obesity treatment of calorie-restricted obese rats: a focus on white fat browning properties and thermogenic capacity
Authors: Alamdari Naimeh Mesri , Irandoost Pardis , Roshanravan Neda , Vafa Mohammadreza , Jafarabadi Mohammad Asghari , Alipour Shahriar , Roshangar Leila , Alivand Mohammad Reza , Farsi Farnaz , Shidfar Farzad 
Published: January 2020

Abstract
Background: Obesity has reached an alarming rate worldwide. Promoting thermogenesis via increasing brown adipose tissue (BAT) function or white adipose tissue (WAT) browning has been propounded as a new approach to fight against obesity. The goal of the study was to evaluate the effect of Royal Jelly (RJ) and tocotrienol rich fraction (TRF) on BAT activation and WAT browning during calorie restriction diet (CRD) in obesity model. Methods: In this experimental study 50 obese Wistar rats were randomly divided into 5 groups and received one of the following treatments for 8 weeks: High-fat diet (HFD), CRD, RJ+CRD, TRF+CRD, RJ+TRF+CRD. Effects of RJ and TRF, individually and their combination on body weight and the expression of key thermoregulatory genes in WAT, BAT were examined by quantitative real-time (qRT-PCR). Morphological alterations were assessed by hematoxylin and eosin staining. Results: RJ (-67.21g ±4.84g) and RJ+TRF (-73.29g ±4.51g) significantly reduced weight gain relative to the CRD group (-40.70g ±6.50g, P<0.001). Compared with the CRD group, RJ and RJ+TRF remarkably enhanced the uncoupling protein1 (UCP1) expression in WAT (5.81, 4.72 fold, P<0.001) and BAT (4.99, 4.75 fold, P<0.001). The expression of PR domain containing 16(PRDM 16), cAMP response element-binding protein1 (CREB1), P38 mitogen-activated protein kinases (P38MAPK), Bone morphogenetic protein8B (BMP8B) increased significantly following RJ and RJ+TRF treatment (P<0.001).However, the expression levels of CCAAT/enhancer-binding protein beta (CEBPβ) and Bone morphogenetic protein7 (BMP7) did not change remarkably. Multilocular beige cells in WAT and compacted dense adipocytes in BAT of RJ and RJ+TRF received groups were observed. TRF did not demonstrate substantial effects on the expression of mentioned thermoregulatory genes and brown fat-like phenotype. Conclusion: Our results suggest that Royal Jelly promotes thermogenesis and browning of WAT, contributing to an increase in energy expenditure. Thus, Royal Jelly may give rise to a novel dietary choice to attenuate obesity.
A cross-sectional study on caregivers’ perspective of the quality of life and adherence of paediatric HIV patients to highly active antiretroviral therapy
Authors: Lahai Michael , James Peter Bai. , Wannang Noel N. , Wurie Haja R. , Conteh Sorie , Bah Abdulai Jawo , Samai Mohamed H 
Published: January 2020

Abstract
Background Poor compliance to highly active antiretroviral therapy (HAART) can result in poor quality of life in children living with HIV/AIDS because of low plasma drug concentration and the possibility of drug resistance. This study evaluates the response of caregivers for determination of adherence and the four quality of life domains in children (aged 14 years and under) on HAART. Methods Cross-sectional study of 188 children accompanied by their caregivers’ at Ola During Children’s Hospital and Makeni Government Hospital between September and November 2016, with ethical approval obtained from the Sierra Leone Ethics and Scientific Review Committee. Adherence to HAART and Quality of life was assessed using the WHO Quality of life summary questionnaire (WHOQOL-BREF). Results The study revealed 5.9% adherence amongst pediatric patients. Caregiver HIV status and caregiver type was also found to be associated with quality of life domains with high mean values for HIV positive caregivers and caregiver type that includes any member of the nuclear family (father, mother or siblings). Conclusion This study showed strong association for involvement of caregiver that includes the nuclear family, caregiver’s knowledge of their HIV status and adherence to HAART. Therefore, involvement of any member of the nuclear family, HIV positive parents living positively with HIV/AIDS and good adherence to therapy can improve the quality of life of pediatric HIV/AIDS patients on highly active antiretroviral therapy.
Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China
Authors: Liu Xin , Li Zhankui , Chen Xiaohui , Cao Bei , Yue Shaojie , Yang Changyi , Liu QiongYu , Yang Chuanzhong , Zhao Gengli , Feng Qi 
Published: January 2020

Abstract
Background To describe the utilization of kangaroo mother care (KMC) in eight self-selected neonatal intensive care units (NICUs) participating in premature birth and infant’s intervention program. Methods A cross-sectional study of preterm infants discharged from eight NICUs in April 2018. For infants was collected this included postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. Results 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. Conclusion After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by medical staff and parents.
Impact of Geographic Access to Primary Care provider on Pediatric Behavioral Health Screening
Authors: Upadhyay Navneet , Aparasu Rajender , Rowan Paul J , Fleming Marc L. , Balkrishnan Rajesh , Chen Hua 
Published: January 2020

Abstract
Objective : To assess the impact of geographic access to primary care providers (PCPs) on the receipt of behavioral disorder screening among children and adolescents from different racial/ethnic groups. Data Sources/Study Setting: The primary data source was 2013-2016 administrative claims data from a large pediatric Medicaid Managed Care Plan linked to the US Census data and the National Provider Identifier (NPI) Registry. Study Design: The study was a retrospective cohort design which was conducted using data obtained from multiple sources. Data Collection/Extraction Methods : Geographic access was measured as one way travel distance to the nearest PCP estimated based on google map, and the PCP density per 10,000 population within a 10-mile travel radius from the population weighted centroid of each individual’s zip code. Multivariate logistic regression was conducted to examine the association between the geographic access measures and the likelihood of receiving behavioral disorder screening within each racial/ethnic group. Principal Findings : Behavioral disorder screening rate was 12.6% among 457,870 children and adolescents who met the inclusion criteria. Multivariable analyses revealed that the travel distance to the nearest PCP was negatively associated with the screening uptake among Hispanics (10-20 vs. 0-10 miles: OR=0.78, 95%CI [0.71-0.86]; 20-30 vs. 0-10 miles: OR=0.35, 95%CI [0.23-0.54]). Similar effects associated with the travel distance were not observed in Blacks and Whites. Among those having access to ≥1 PCP within 10 miles of travel distance, the increase in PCP density had a greater positive impact on the receipt of behavioral disorder screening in minorities than that in Whites. Conclusion : Minorities, especially Hispanics, were more sensitive than Whites to the geographic access barriers to PCPs for pediatric behavioral disorder screening.
Small for Gestational Age is a Risk Factor for Thyroid Dysfunction in Preterm Newborns
Authors: Liu Chunhua , Wang Kaiyan , Guo Jizhong , Chen Jiru , Chen Mei , Xie Zhexi , Chen Pu , Wu Beiyan , Lin Niyang 
Published: January 2020

Abstract
Background Thyroid hormones play an important role in the normal growth and maturation of the central nervous system. However, few publications addressed the altered thyroid hormone levels in preterm small for gestational age (SGA) newborns. We hypothesized preterm SGA infants have higher thyroid-stimulating hormone (TSH) concentrations than appropriate for gestational age (AGA) ones within the normal range and an increased incidence of thyroid dysfunction. Methods The study was designed to compare thyroid hormone levels within the normal range and the incidence of thyroid dysfunction in the SGA and AGA groups to test the hypothesis. Blood samples were collected between 72 and 96 hours of life and analyzed with TSH, free thyroxine (FT4) and free triiodothyronine (FT3) assays. Thyroid function test (TFT) results, and neonatal demographic and clinical factors were analyzed to identify the associations between SGA birth and altered thyroid concentrations and thyroid dysfunction. Results TSH and FT4 concentrations were significantly higher in the SGA group than the AGA group ((4.89(interquartile range (IQR): 2.62~7.59) vs. 3.15(IQR: 1.86~5.42) mU/L, p=0.015), and (18.64±4.39 vs. 17.40±3.70 pmol/L, p=0.037), respectively). The higher TSH levels were associated with being SGA or Z-score of birth weight (BW) for GA after adjusting for potential confounders (( β SGA =1.28 (95% confidence interval (CI) 0.45~2.12), p=0.003) or ( β Z-score =-0.25 (95%CI -0.48~-0.03), p=0.028), respectively). However, we did not find a significant association between SGA birth and altered FT4 concentrations. Furthermore, compared with the AGA group, the SGA group presented an increased incidence of transient hypothyroxinemia with delayed TSH elevation (dTSHe) (odds ratio (OR) =8.75(95%CI 0.71~78.02)), a higher percentage receiving levothyroxine (L-T4) therapy (OR=1.80 (95%CI 0.98~3.21)), and a higher rate of follow-up within the first 6 months of life (OR=1.82 (95%CI 0.93~3.39)). Conclusions Preterm SGA newborns had significantly higher TSH concentrations within the normal range and an increased incidence of thyroid dysfunction. The SGA newborns with these features should be closely followed up with periodical TFTs and endocrinologic evaluation.
The burden of traditional neonatal uvulectomy among admissions to neonatal intensive care units, North Central Ethiopia, 2019: A triangulated crossectional study
Authors: Bayih Wubet Alebachew , Minuye Biniam , Yeshambel Abebaw , Mesfin Demeke 
Published: January 2020

Abstract
Background Traditional neonatal uvulectomy is unsupervised, unscientific and potentially dangerous cultural malpractice. This malpractice is often accompanied with life threatening neonatal morbidities such as infection, anemia, aspiration and oropharyngeal injury. However, there is no current regional and even national data about the burden, associated factors and perception of traditional uvulectomy among neonatal admissions to neonatal intensive care units. Methods A quantitative cross sectional study supplemented with phenomenological study was employed on 422 mother-neonate pairs admitted to Debre Tabor General Hospital from September 2018 to August 2019. Eight women who were not included in the quantitative part were involved for the qualitative study. Systematic and purposive sampling methods were used to select study participants for the quantitative and qualitative study respectively. Binary logistic regression models were fitted to declare statistical significance at p-value ≤ 0.05 and 95% CI. Result Complications of traditional uvulectomy contributed 15.90% of the overall neonatal admissions. At admission, most of the victim neonates had septic presentation (88.1%) followed by anemia (55.2%). From multivariable analysis, having male neonate [AOR= 4.87; 95% CI: 1.10, 21.59], antenatal couple counseling about traditional neonatal uvulectomy [AOR=0.053; 95% CI: 0.01, 0.35], home delivery [AOR= 6.02 ; 95% CI: 1.15, 31.61], postnatal couple counseling about traditional neonatal uvulectomy [AOR= 0.101; 95% CI: 0.02, 0.65], prior history of traditional neonatal uvulectomy [AOR= 7.15; 95% CI: 1.18, 43.21] and knowing at least one disadvantage of traditional neonatal uvulectomy [AOR= 0.068; 95% CI: 0.01, 0.44] were independent predictors of the malpractice. Furthermore, maternal perception of no modern medicine to treat elongated uvula was the most explained reason to do the malpractice. Conclusion The burden of traditional uvulectomy was high. Fortunately, its predictors are modifiable. Therefore, different community groups including women health development armies, elders, religious fathers, health professionals and criminal prosecutors should be actively mobilized against this malpractice. Besides, parental couple counseling about the key message of no traditional neonatal uvulectomy should be properly implemented in the routine antenatal and postnatal programs of the health care delivery system at south Gondar zone.
Patients’ confidence in treatment decisions for early stage non-small cell lung cancer (NSCLC)
Authors: Pompili Cecilia , Holch Patricia , Rogers Zoe , Absolom Kate , Clayton Beverly , Franks Kevin , Bekker Hilary , Velikova Galina 
Published: January 2020

Abstract
Background In early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions. Methods In the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Karnofsky Performance Status, gender, age and treatment received (VATS or SABR) difference. Results Two subscales within the DSE were identified: the main factor accounting for almost 72% of the variance related to overcoming barriers to decision making (seven items) and a second factor explaining an additional 9.1% of the variance was related to information seeking processes (four items). We calculated a value of 0.96 for Cronbach’s alpha for the total DSE score, 0.94 for Factor 1 and 0.95 for Factor 2. DSE scores did not differ by gender ( p =0.37), between the two treatment groups (p=0.09) and between younger and older patients ( p =0.4). However, patients with a Karnofsky performance score (PS) >1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0-1 who have a DSE mean of 85.8 (SD 20.3 p =0.002). Conclusion Findings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.
Determination of efficacy and toxicity of diclofenac microemulsion formulation for musculoskeletal pain: an observational study
Authors: Banh Hoan Linh , Cave Andrew 
Published: January 2020

Abstract
OBJECTIVE: Musculoskeletal pain is often caused by injury to the bones, muscles, tendons, ligaments or nerves. Symptoms can be localized or generalized. Mild-moderate symptoms are treated with topical/oral over the counter drugs. Microemulsion delivery formulations are thermodynamically stable, have superior bioavailability and better penetration of lipophilic and hydrophilic drug into the dermis. A prospective observational study in patients: 18 years or older, with mild-moderate musculoskeletal pain; with severe pain without adequate pain control; with severe pain could not tolerate oral agents; with renal impairment were invited to try diclofenac 2% in microemulsion foam. They were followed up every 2 weeks for a month. A 50% reduction on a visual analog pain scale is considered success. Adverse events were defined as irritation, gastrointestinal upset/bleed, rectal bleed, and hematemesis. The objective is to determine the efficacy and toxicity of diclofenac 2% in microemulsion foam. RESULTS: Thirteen consecutive patients with musculoskeletal pain consented to participate. Two patients were lost to follow up. Two of the 11 patients reported minimal improvement, while nine patients reported minimum 50% reduction. No adverse effects were reported. Diclofenac 2% in microemulsion foam is effective in the treatment of mild to moderate musculoskeletal pain and well tolerated.
Differences in Expression of Peroxisome Proliferator-activated Receptor-γ in Early-onset Preeclampsia and Late-onset Preeclampsia
Authors: Permadi Wiryawan , Mantilidewi Kemala , Khairani Astrid Feinisa , Lantika Uci Ary , Ronosulistyo Ayu Angelina , Bayuaji Hartanto 
Published: January 2020

Abstract
Objective: Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Peroxisome Proliferator-activated Receptor-γ (PPAR-γ) has been reported to be implicated in key functions in cell that were also important to ensure normal pregnancy development. In this study, we conducted primary culture of trophoblastic cells from normal pregnant women in the third trimester (n =3), and from patients with EOPE (n=3), and LOPE (n=3). Expression of PPAR-γ was determined by Western Blot. Data are the means ±S.E. from three separate experiments. Statistical analysis was performed by SPSS software,version 20.0, a p<0.05 was considered significant (one-way ANOVA and Bonferroni’s test) versus normal serum pregnancy. Results: Serum from normal pregnant women and those with EOPE did not induce any difference in the expression of PPAR-γ (p>0.05). In contrast, expression of PPAR-γ was increased in those cells with serum from LOPE (p<0.001). Therefore, we conclude that hypothetically PPAR-γ might play role in the pathophysiology of LOPE but not in EOPE. Other possibility is the activity of PPAR-γ in EOPE is inversely correlated with the expression, therefore the high enzymatic activity of PPAR-γ is tightly regulated by attenuating its expression.
Improving the efficiency of reactive case detection for malaria elimination in southern Zambia: A cross-sectional study
Authors: Bhondoekhan Fiona R.P. , Searle Kelly M. , Hamapumba Harry , Lubinda Mukuma , Matoba Japhet , Musonda Michael , Katowa Ben , Shields Timothy M. , Kobayashi Tamaki , Norris Douglas , Curriero Frank C , Stevenson Jennifer C. , Thuma Philip E. , Moss William J. 
Published: January 2020

Abstract
Background: Reactive case detection (RCD) seeks to enhance malaria surveillance and control by identifying and treating parasitemic individuals residing near index cases. In Zambia, this strategy starts with passive detection of symptomatic incident malaria cases at local health facilities or by community health workers, with subsequent home visits to screen-and-treat residents in the index case and neighboring (secondary) households within a 140-meter radius using rapid diagnostic tests (RDTs). However, a small circular radius may not be the most efficient strategy to identify parasitemic individuals in low-endemic areas with hotspots of malaria transmission. To evaluate if RCD efficiency could be improved by increasing the probability of identifying parasitemic residents while screening fewer houses, we incorporated environmental risk factors and a larger screening radius (250 meters) in a region of low malaria endemicity. Methods: Between January 12, 2015 and July 26, 2017, 4,170 individuals (residing in 158 index and 531 secondary households) were enrolled and completed a baseline questionnaire in the catchment area of Macha Hospital in Choma District, Southern Province, Zambia. Plasmodium falciparum prevalence was measured using PfHRP2 RDTs and qPCR. A Quickbird™ high-resolution satellite image of the catchment area was used to create environmental risk factors in ArcGIS, and generalized estimating equations were used to evaluate associations between risk factors and secondary households with parasitemic individuals. Results: The overall parasite prevalence in secondary (non-index case) households was 0.7% by RDT and 1.8% by qPCR. 8.5% (45) of secondary households had at least one resident with parasitemia by qPCR or RDT. The risk of a secondary household having a parasitemic resident was significantly increased in proximity to higher order streams and marginally with increasing distance from index households. The adjusted OR for proximity to third- and fifth-order streams were 2.97(95% CI: 1.04 – 8.42) and 2.30 (95% CI: 1.04 – 5.09), respectively, and that for distance to index households for each 50 meters was 1.24 (95% CI: 0.98– 1.58). Conclusion: Applying proximity to streams as a screening tool, 16% (3) more malaria-positive secondary households were identified than using a 140 m circular screening radius. This analysis highlights the potential use of environmental risk factors as a screening strategy to increase RCD efficiency.