bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal profiling of gut microbiome among tuberculosis patients under anti-tuberculosis treatment in China: protocol of a prospective cohort study
Authors: Shi Wenpei , Hu Yi , Zheng Xubin , Ning Zhu , Wu Meiying , Xia Fan , Prast-Nielsen Stefanie , Hu Yue O. O. , Xu Biao 
Published: November 2019

Abstract

Background
Anti-tuberculosis therapy requires at least six-month treatment with continuous administration of combined antibiotics, including isoniazid, rifampicin, pyrazinamide, and ethambutol. The long-term exposure to antibiotics could cause consequent changes in gut microbiota, which may alter the gastrointestinal function and drug absorption in patients, thereby affect the outcome of treatment. The study aims to characterize the longitudinal changes of gut microbiota among tuberculosis (TB) patients under standardized first-line treatment and provide an understanding of the association between alterations in gut microbiota composition and unfavorable clinical outcomes.

Methods
The study is a multicenter, observational prospective cohort study. Three study sites are purposively selected in the western (Sichuan Province) and eastern (Jiangsu Province and Shanghai) parts of China. Three-hundred patients with bacteriologically confirmed pulmonary TB are enrolled. All eligible patients should be investigated using structured questionnaires before treatment initiation; and be followed up during the treatment at Day-14, Month-2, Month-5, the end of treatment and the sixth month after ending therapy. Stool samples are to be collected at each visit, consisting of six stool samples from each patient. Additionally, 60 healthy volunteers from Sichuan province and Shanghai city will be recruited as healthy controls to form the baseline of patient gut microbiota in the Chinese population. The dynamic changes of gut microbiota in terms of alpha diversity, beta diversity, taxonomic composition are to be illustrated individually from the time at diagnosis until the sixth month after therapy is completed. Furthermore, the diversity and component of gut microbiota will be compared between the groups with and without unfavorable treatment outcome in terms of adverse effect and treatment failure.

Discussion
Studies on the clinical manifestations, adverse reactions, and gut microbiota alterations will provide scientifically-sound evidence on the impact of gut microbiota alterations on TB treatment outcomes. The study is not only useful for guiding personalized TB treatment but also sheds light on the effects of continuous antibiotics administration on gut microbiota.

Trial registration
Chinese Clinical Trial Registry, trial ID: ChiCTR1900023369, May 24, 2019. Retrospectively registered.
Relations between the Crowe classification and the 3D femoral head displacement in patients with developmental dysplasia of the hip
Authors: Cheng Rongshan , Zhang Henghui , Kernkamp Willem Alexander , Zheng Jingmao , Dai Kerong , Yao Yifei , Wang Liao , Tsai Tsung-Yuan 
Published: November 2019

Abstract

Background
The purpose of this study was to investigate the relationship between the three dimensional (3D) femoral head displacement in patients with developmental dysplasia of the hip (DDH) and Crowe classification.

Methods
Retrospectively, CT scans of 60 DDH patients and 55 healthy demography-matched healthy control subjects were analyzed. Using the anterior pelvic plane a pelvic anatomic coordinate system was established. The center coordinates of the femoral heads of both the DDH patients and control subjects were quantified relative to the pelvic coordinate system and were mapped proportionally to a representative normal pelvis for comparison.

Results
In the anteroposterior (AP) direction, the center of the femoral head was significantly more anterior in the DDH patients (type I, II, and III, respectively45.0 ± 5.5, 42.9 ± 7.1, and 43.9 ± 4.6 mm) when compared to the controls (50.0 ± 5.2 mm) (p < 0.001 for all). In the medial-lateral (ML) direction, the center of the femoral head was significantly more lateral in the DDH patients (type I, II, and III =103.5 ± 8.6, 101.5 ± 6.6, 102.1 ± 11.2 mm) when compared to the controls (87.5 ± 5.1 mm) (p < 0.001 for all). In the superior-inferior (SI) direction, the center of the femoral head was significantly more proximal in the DDH patients (type I, II, and III =62.4 ± 7.3, 50.0 ± 6.3, and 43.2 ± 6.6 mm) when compared to the controls (66.0 ± 6.2 mm) (p < 0.001 for all).

Conclusions
The severity of DDH using the Crowe classification was related to the degree of the femoral head displacement in the SI direction, but not in the ML or AP directions. By assessing the 3D femoral head displacement in DDH patients, individualized component positioning might benefit surgical outcome.
Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation
Authors: Lotzien Sebastian , Hoberg Clemens , Rausch Valentin , Rosteius Thomas , Schildhauer Thomas Armin , Gessmann Jan 
Published: November 2019

Abstract

Background
Fractures of the humeral shaft represent 2–4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications.

Methods
We conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery.

Results
Between 2006 and 2014, 58 patients (mean age, 59.9; range, 19–97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented.

Conclusions
Open reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.
Important work demands for reducing sickness absence among workers with neck or upper back pain: a prospective cohort study
Authors: Oliv Stefan , Gustafsson Ewa , Baloch Adnan Noor , Hagberg Mats , Sandén Helena 
Published: November 2019

Abstract

Background
The aim of this study was to investigate what exposure to work demands, physical and psychosocial, is associated with lower levels of sickness absence among workers with neck or upper back pain in different groups, by age, gender, duration of sickness absence and work ability score.

Methods
This study was a prospective study of 4567 workers with neck or upper back pain. Data on neck or upper back pain, work demand and work ability were obtained from the Swedish Work Environment survey over a 3–year period (2009–2013). Register data on sickness absence, 1 year after each survey was conducted, were obtained from the Swedish health insurance database. Analyses were performed to estimate the association between self-reported work demands and registered sick days > 14 days. The analyses were stratified for gender, age group and work ability score.

Results
Lower numbers of sick days were found for workers reporting low exposure to lifting ≥15 kg and twisted or forward-leaning work postures. Lower numbers of sick days were found for workers reporting high work control and seated work. The associations were generally stronger in the older age groups for the physical work demands.

Conclusions
The findings in this study suggest that certain physical work demands and having high control over one’s work can result in lower sickness absence, especially among middle-aged and older workers with neck or upper back pain.
Language of written medical educational materials for non-English speaking populations: an evaluation of a simplified bi-lingual approach
Authors: Alsuliman Tamim , Alasadi Lugien , Mouki Angie , Alsaid Bayan 
Published: November 2019

AbstractBackgroundDebates have arisen in various non-English speaking countries over the chosen language of instruction in medical education, whether it has to be the English language or the mother tongue. English-based education supporters argue that English is the leading international language of medicine and research, and a crucial tool for Continuing Medical Education (CME), as well as for students who seek practice abroad. On the other hand, mother-tongue-based medical education supporters present it as a way to endorse communication and comprehension between medical practitioners and health care system users, to bridge the gap between practitioners and the paramedical staff, and to overcome linguistic dualism and the language thinking disparity while studying in another. This study aimed to evaluate one of the simplified bi-lingual approaches in terms of medical-educational-written texts for a non-English speaking population: Arabic speaking medical students in specific.Methods1546 Arabic-speaking-medical students from different countries participated in a one-step-interactive-experimental-online test. The test assessed participants’ scientific comprehension of three distinct written paragraphs: The first paragraph used conventional mother tongue (Arabic), the second combined English terminology and simplified mother tongue (hybrid), and the third used an English excerpt (English). Two multiple-choice questions (First question in Arabic, second in English) followed each paragraph. Response time was communicated for each paragraph. Participants were asked to select their favorable method.Repeated Measures ANOVA models and Paired Samples t-Test were used for statistical analysis.ResultsParticipants scored a mean of [0.10] for the Arabic paragraph, [0.72] for the hybrid paragraph, and [0.24] for the English paragraph (P <  0.001). Results showed a significantly higher mean of points and correct answers within the fastest time for the hybrid paragraph [0.68] compared to the Arabic [0.08] and English [0.18] paragraphs (P <  0.001). Moreover, 50% of participants preferred the hybrid paragraph over the other two paragraphs.ConclusionsTaking into consideration the large number of participants and the statistically significant results, authors propose that simplified Arabic combined with English terminology may present a viable alternative method for medical-educational-written texts in Arabic-speaking population.
Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial
Authors: Duijzer Geerke , Bukman Andrea J. , Meints-Groenveld Aafke , Haveman-Nies Annemien , Jansen Sophia C. , Heinrich Judith , Hiddink Gerrit J. , Feskens Edith J. M. , de Wit G. Ardine 
Published: November 2019

AbstractBackgroundAlthough evidence is accumulating that lifestyle modification may be cost-effective in patients with prediabetes, information is limited on the cost-effectiveness of interventions implemented in public health and primary health care settings. Evidence from well-conducted pragmatic trials is needed to gain insight into the realistic cost-effectiveness of diabetes prevention interventions in real-world settings. The aim of this study is to assess the cost-effectiveness of the SLIMMER lifestyle intervention targeted at patients at high risk of developing type 2 diabetes compared with usual health care in a primary care setting in the Netherlands.MethodsThree hundred and sixteen high-risk subjects were randomly assigned to the SLIMMER lifestyle intervention or to usual health care. Costs and outcome assessments were performed at the end of the intervention (12 months) and six months thereafter (18 months). Costs were assessed from a societal perspective. Patients completed questionnaires to assess health care utilisation, participant out-of-pocket costs, and productivity losses. Quality Adjusted Life Years (QALY) were calculated based on the SF-36 questionnaire. Cost-effectiveness planes and acceptability curves were generated using bootstrap analyses.ResultsThe cost-effectiveness analysis showed that the incremental costs of the SLIMMER lifestyle intervention were €547 and that the incremental effect was 0.02 QALY, resulting in an incremental cost-effectiveness ratio (ICER) of €28,094/QALY. When cost-effectiveness was calculated from a health care perspective, the ICER decreased to €13,605/QALY, with a moderate probability of being cost-effective (56% at a willingness to pay, WTP, of €20,000/QALY and 81% at a WTP of €80,000/QALY).ConclusionsThe SLIMMER lifestyle intervention to prevent type 2 diabetes had a low to moderate probability of being cost-effective, depending on the perspective taken.Trial registrationThe SLIMMER study is retrospectively registered withClinicalTrials.gov(IdentifierNCT02094911) since March 19, 2014.
Value-based genomic screening: exploring genomic screening for chronic diseases using triple value principles
Authors: Dombrádi Viktor , Pitini Erica , van El Carla G. , Jani Anant , Cornel Martina , Villari Paolo , Gray Muir , Bíró Klára 
Published: November 2019

Abstract

Background
Genomic screening has unique challenges which makes it difficult to easily implement on a wide scale. If the costs, benefits and tradeoffs of investing in genomic screening are not evaluated properly, there is a risk of wasting finite healthcare resources and also causing avoidable harm.

Main text
If healthcare professionals – including policy makers, payers and providers – wish to incorporate genomic screening into healthcare while minimizing waste, maximizing benefits, and considering results that matter to patients, using the principles of triple value (allocative, technical, and personal value) could help them to evaluate tough decisions and tradeoffs. Allocative value focuses on the optimal distribution of limited healthcare resources to maximize the health benefits to the entire population while also accounting for all the costs of care delivery. Technical value ensures that for any given condition, the right intervention is chosen and delivered in the right way. Various methods (e.g. ACCE, HTA, and Wilson and Jungner screening criteria) exist that can help identify appropriate genomic applications. Personal value incorporates preference based informed decision making to ensure that patients are informed about the benefits and harms of the choices available to them and to ensure they make choices based on their values and preferences.

Conclusions
Using triple value principles can help healthcare professionals make reasoned and tough judgements about benefits and tradeoffs when they are exploring the role genomic screening for chronic diseases could play in improving the health of their patients and populations.
Hypoxia and therapeutic treatment of EV-A71 with an immune modulator TLR7 agonist in a new immunocompetent mouse model
Authors: Liou An-Ting , Liao Chun-Che , Chou Shu-Fan , Chang Ya-Shu , Chang Chih-Shin , Shih Chiaho 
Published: November 2019

Abstract

Background
Enterovirus 71 (EV71 or EV-A71) was first identified in California about half a century ago. In recent years, outbreaks of EV-A71 were prevalent worldwide, including Taiwan, Malaysia, Singapore, Japan, and China. Between 2008 and 2011, China alone reported 1894 deaths associated with EV-A71 infection. In mild cases, EV-A71 can cause herpangina and hand-foot-and-mouth disease (HFMD). However, in severe cases, it could cause neurological disorders, including meningitis and encephalitis. Cardiopulmonary failure is common among hospitalized children with EV-A71 infection. No effective FDA-approved therapeutics against EV-A71 are clinically available.

Methods
We report the establishment of an immunocompetent wild type strain 129 (wt-129) mouse model, which can be cross-species infected with human EV-A71 clinical isolates via an intraperitoneal route.

Results
One intriguing disease phenotype of this new model is the development of characteristic “White-Jade” patches in the muscle, which lost sporadically the normal pink color of uninfected muscle. Viral VP1 protein and massive leukocyte infiltration were detected in muscles with or without white-jades. We demonstrated further that hypoxia is a general phenomenon associated with white-jades in both immunocompetent and immunodeficient mouse models. Therefore, hypoxia appears to be a feature intrinsic to EV-A71 infection, irrespective of its host’s immunogenetic background. To date, no effective treatment for EV-A71 is available. Here, using this new wt-129 mouse model, we showed that timely treatment with compound R837 (a TLR7 immune modulator) via oral or intraperitoneal routes, rescued the hypoxia, limb paralysis, and death at a high therapeutic efficacy.

Conclusions
In this new immunocompetent mouse 129 model, we observed an unexpected white-jade phenotype and its associated hypoxia. The successful treatment with TLR7 immune modulators via an oral route, provide us a new research direction for EV-A71 basic science and translational research. It remains an open issue whether R837 or its related compounds, will be a promising drug candidate in clinical trials in EV-A71 endemic or epidemic areas in the future.
Aliivibrio wodanis as a production host: development of genetic tools for expression of cold-active enzymes
Authors: Söderberg Jenny Johansson , Grgic Miriam , Hjerde Erik , Haugen Peik 
Published: November 2019

AbstractBackgroundHeterologous production of cold-adapted proteins currently represents one of the greatest bottlenecks in the ongoing bioprospecting efforts to find new enzymes from low-temperature environments, such as, the polar oceans that represent essentially untapped resources in this respect. In mesophilic expression hosts such asEscherichia coli, cold-adapted enzymes often form inactive aggregates. Therefore it is necessary to develop new low-temperature expression systems, including identification of new host organisms and complementary genetic tools. Psychrophilic bacteria, includingPseudoalteromonas haloplanktis,ShewanellaandRhodococcus erythropolishave all been explored as candidates for such applications. However to date none of these have found widespread use as efficient expression systems, or are commercially available. In the present work we explored the use of the sub-Arctic bacteriumAliivibrio wodanisas a potential host for heterologous expression of cold-active enzymes.ResultsWe tested 12 bacterial strains, as well as available vectors, promoters and reporter systems. We used RNA-sequencing to determine the most highly expressed genes and their intrinsic promoters inA. wodanis. In addition we examined a novel 5′-fusion to stimulate protein production and solubility. Finally we tested production of a set of “difficult-to-produce” enzymes originating from various bacteria and one Archaea. Our results show that cold-adapted enzymes can be produced in soluble and active form, even in cases when protein production failed inE. colidue to the formation of inclusion bodies. Moreover, we identified a 60-bp/20-aa fragment from the 5′-end of the AW0309160_00174 gene that stimulates expression of Green Fluorescent Protein and improves production of cold-active enzymes when used as a 5′-fusion. A 25-aa peptide from the same protein enhanced secretion of a 25-aa-sfGFP fusion.ConclusionsOur results indicate the use ofA. wodanisand associated genetic tools for low-temperature protein production and indicate thatA. wodanisrepresents an interesting platform for further development of a protein production system that can promote further cold-enzyme discoveries.
Changes in inequality in utilization of preventive care services: evidence on China’s 2009 and 2015 health system reform
Authors: Xu Yongjian , Zhang Tao , Wang Duolao 
Published: November 2019

Abstract

Background
Ensuring equal access to preventive care has always been given a priority in health system throughout world. This study aimed to decompose inequality in utilization of preventive care services into its contributing factors and then explore its changes over the period of China’s 2009–2015 health system reform.

Methods
The concentration index (CI) and decomposition of the CI was performed to capture income-related inequalities in preventive services utilization and identify contribution of various determinants to such inequality using data from China Health and Nutrition Survey. Then, changes in inequality from 2009 to 2015 were estimated using Oaxaca-type decomposition technique.

Results
The CI for preventive services utilization dropped from 0.2240 in 2009 to 0.1825 in 2015. Residential location and household income made the biggest contributions to income-related inequalities in these two years. Oaxaca decomposition revealed changes in residential location, regions and medical insurance made positive contributions to decline in inequality. However, alternation in household income, age and medical services utilization pushed the equality toward deterioration.

Conclusion
The pro-rich inequality in preventive healthcare services usage is evident in China despite a certain decline in such inequality during observation period. Policy actions on eliminating urban-rural and income disparity should be given the priority to equalize preventive healthcare.