bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce
Authors: Gupta Surabhi , Ngo Hanh , Burkitt Tessa , Puddey Ian , Playford Denese 
Published: December 2019

Abstract
Objective –Deficits in the size of the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of retention is not yet established. This paper summarises rural retention over a 10-year period. Methods –Rural Clinical School graduates of STATE NAME were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as “tours of service”, where a tour was either a period of ≥1 year, or a period of at ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. Results – Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5 – 69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69 – 2.10 years), and a total of 227 years’ rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p=0.022), but no significant difference between 2002-06 and 2010-11. Rural origin, age and gender were not statistically significant. Conclusions – PGY3 – 12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, which have not previously been described, while 26% contributed whole years of service. There was an apparent peak in entry and retention for the middle cohort and decline thereafter, likely attributable to lack of rural advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural postgraduate vocational training in the rural context as a key element of a successful rural retention strategy.
Predictive risk factors for postoperative pneumonia after heart transplantation
Authors: Vidal Charles , Pasqualotto Romain , James Arthur , Dureau Pauline , Rasata Julie , Coutance Guillaume , Varnous Shaida , Leprince Pascal , Amour Julien , Bouglé Adrien 
Published: December 2019

Abstract
Background: Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients. Methods: In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P<0.05 was necessary to reject the null hypothesis. Results: A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12-1.80], P<0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20-1.70], P<0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3 - 12.4], P=0.01) and 1 year (OR: 6.8 [2.5-8.4], P<0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP. Conclusion: After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP
Qualitative investigation of the factors that generate ambivalent feelings in women who give birth after receiving negative results from non-invasive prenatal testing
Authors: Yotsumoto Junko , Sekizawa Akihiko , Inoue Satomi , Suzumori Nobuhiro , Samura Osamu , Yamada Takahiro , Miura Kiyonori , Masuzaki Hideaki , Sawai Hideaki , Murotsuki Jun , Hamanoue Haruka , Kamei Yoshimasa , Endo Toshiaki , Fukushima Akimune , Katagiri Yukiko , Takeshita Naoki , Ogawa Masaki , Nishizawa Haruki , Okamoto Yoko , Tairaku Shinya , Kaji Takashi , Maeda Kazuhisa , Matsubara Keiichi , Ogawa Masanobu , Osada Hisao , Ohba Takashi , Kawano Yukie , Sasaki Aiko , Sago Haruhiko 
Published: December 2019

Abstract
Background: Women who receive negative results from non-invasive prenatal genetic testing (NIPT) may find that they later have mixed or ambivalent feelings, for example, feelings of accepting NIPT and regretting undergoing the test. This study aimed to investigate the factors generating ambivalent feelings among women who gave birth after having received negative results from NIPT.
Methods: A questionnaire was sent to women who received a negative NIPT result, and a contents analysis was conducted focusing on ambivalent expressions for those 1562 women who responded the questionnaire. The qualitative data gathered from the questionnaire were analyzed using the N-Vivo software package.
Results: Environmental factors, genetic counseling-related factors, and increased anticipatory anxiety, affected the feeling of ambivalence among pregnant women. Furthermore, pregnant women desired more information regarding the detailed prognosis for individuals with Down syndrome and living with them and/or termination, assuming the possibility that they were positive.
Conclusions: Three major interrelated factors affected the feeling of ambivalence in women. Highlighting and discussing such factors during genetic counseling may resolve some of these ambivalences, thereby enhancing the quality of decisions made by pregnant women.
Activating the interleukin-6-Gp130-STAT3 pathway ameliorates ventricular electrical stability in myocardial infarction rats by modulating neurotransmitters in the paraventricular nucleus
Authors: Gao Meng , Yin Dechun , Chen Jugang , Qu Xiufen 
Published: December 2019

Abstract
Background: Malignant ventricular arrhythmias are the most common cause of death in acute myocardial infarction. Recent studies have revealed direct paraventricular nucleus (PVN) involvement in occurrence of ventricular arrhythmias (VAs)，however, the mechanisms are incompletely understood. In this study we investigated the changes of Interleukin-6 (IL-6)-glycorprotein130-STAT3 pathway in the PVN during acute myocardial infarction and its effect on ventricular stability.
Methods: The rats were divided into control group, myocardial infarction group, and paraventricular injected anti-IL-6 antibody group and paraventricular injected SC144 group to observe how interleukin-6 and its downstream glycoprotein130-STAT3 pathway in paraventricular nucleus effect the ventricular stability. Left anterior descending coronary artery was ligated to make myocardial infarction. After that, anti-Interleukin-6 antibody and SC144 were injected into the paraventricular. All data are expressed as the mean ± SEM and were analyzed by ANOVA by a post-hoc LSD test. p<0.05 was considered statistically significant.
Results: After myocardial infarction (MI), the concentration of inflammatory factor interleukin-6 increased and its downstream glycorprotein130-STAT3 pathway was activated in the PVN. After anti-interleukin-6 antibody and glycorprotein130 inhibitor (SC144) injection into the PVN in MI rats, glutamate increased and γ-aminobutyric acid (GABA) decreased in the PVN. We also observed a higher plasma norepinephrine concentration, which increased the vulnerability to ventricular arrhythmias.
Conclusions: In summary, interleukin-6 in the PVN plays a protective role in MI rats, and the glycorprotein130-STAT3 pathway plays a key role in this process. We anticipate that our findings will provide new ideas for the prevention and treatment of arrhythmia after MI.
Smokeless tobacco use: its prevalence and relationships with dental symptoms, nutritional status and blood pressure among rural women in Burkina Faso
Authors: Diendéré Jeoffray , Zeba N. Augustin , Nikiéma Leon , Kaboré Ahmed , Sawadogo W. Paul , Tougouma Somnoma Jean Baptiste , Tinto Halidou , Ouédraogo Arouna 
Published: December 2019

Abstract
Introduction: Sub-Saharan women use smokeless tobacco (SLT) more than smoked tobacco. Among Western Africa countries, the estimated weighted prevalence of SLT use in rural women was the highest in Burkina Faso (after Sierra Leone). This study aimed to assess the prevalence of SLT use and its associated factors among rural women in Burkina Faso by using nationally representative data.
Methods: We used data from the 2013 STEPwise approach to Surveillance (STEPS) study, which provided sociodemographic, clinical (anthropometric, systolic blood pressure [SBP], diastolic blood pressure [DBP], dental symptoms), biological (total and high-density lipoprotein cholesterol and fasting blood sugar), and tobacco and alcohol consumption data. Data for 1730 rural women were used, and we performed Student’s, chi-squared, and Fisher’s exact tests and logistic regression.
Results: The prevalence of current SLT use was 13.8% (95% CI: 12.2-15.5). Significant risks for SLT use were the presence of dental symptoms (adjusted odds ratio [aOR] = 2.59; p = 0.0001), undernourishment (aOR = 1.78; p = 0.002), a decrease in waist circumference (aOR = 0.98; p = 0.023), a decrease in DBP (aOR = 0.97; p = 0.006), increase in the unit of SBP (aOR = 1.01; p = 0.017), and an increase in differential blood pressure (aOR = 1.01; p = 0.041). The co-use of alcohol was also a significant risk factor (aOR = 2.80; p = 0.0001).
Conclusion: The prevalence of current SLT use was high among rural women in Burkina Faso, and significant concerns for users included alcohol co-use, the occurrence of dental symptoms, undernourishment, and an increase in differential blood pressure. National Public Health interventions are needed to reduce SLT use and its health-related concerns.
Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda
Authors: Izudi Jonathan , Tamwesigire Imelda K , Bajunirwe Francis 
Published: December 2019

Abstract
Background. Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors influencing the low and high TSR across four districts in rural eastern Uganda. Methods. We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in Eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. Results. The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities, and a poor implementation of community-based directly observed therapy short course. Conclusion. This study shows that several factors influence the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.
Spiral artery blood flow during pregnancy: a systematic review and meta-analysis.
Authors: Schiffer Veronique , Evers Laura , de Haas Sander , Ghossein Chahinda , Al-Nasiry Salwan , Spaanderman Marc 
Published: December 2019

Abstract
Background: Downstream remodeling of the spiral arteries (SpA) decreases utero-placental resistance drastically, allowing sustained and increased blood flow to the placenta at all circumstances. We systematically evaluated available reports to visualize adaptation of spiral arteries throughout pregnancy by ultra-sonographic measurements and evaluated when this process is completed.Methods: A systematic review and meta-analysis of spiral artery flow (pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV)) was performed. English articles were obtained from Pubmed, EMBASE and Cochrane Library and included articles were assessed on quality and risk of bias. Weighted means of Doppler indices were calculated using a random-effects model. Results: In healthy pregnancies, PI and RI decreased from 0.75 (95% CI: 0.67-0.83) and 0.49 (95% CI: 0.46-0.53) in the first trimester to 0.52 (95% CI: 0.48-0.56, p=0.003) and 0.40 (95% CI: 0.38-0.42, p=0.080) in the second trimester and to 0.49 (95% CI: 0.44-0.53, p=0.510) and 0.36 (95% CI: 0.35-0.37, p=0.307) in the third trimester, respectively. In parallel, PSV altered from 0.24 m/s (95% CI: 0.17-0.31 m/s) to 0.28 m/s (95% CI: 0.22-0.34 m/s, p=0.377) and to 0.25 m/s (95% CI: 0.21-0.28 m/s, p=0.919) in the three trimesters. In absence of second and third trimester Doppler data in complicated gestation, only a difference in PI was observed between complicated and healthy pregnancies during the first trimester (1.49 vs 0.76, p<0.001). Although individual studies have identified differences in PI between SpA located in the central part of the placental bed versus those located at its periphery, this meta-analysis could not confirm this (p=0.349).Conclusions: This review and meta-analysis concludes that an observed decrease of SpA PI and RI from the first towards the second trimester parallels the physiological trophoblast invasion converting SpA during early gestation, a process completed in the midst of the second trimester. Higher PI and RI were found in SpA of complicated pregnancies compared to healthy pregnancies, possibly reflecting suboptimal utero-placental circulation. Longitudinal studies examining comprehensively the predictive value of spiral artery Doppler for complicated pregnancies are yet to be carried out.
Icarisid I specifically facilitates ATP or nigericin-induced NLRP3 inflammasome activation and causes idiosyncratic hepatotoxicity
Authors: Gao Yuan , Bai Zhaofang , Xiao Xiaohe , Xu Guang , Niu Ming , Wang Jiabo , Zhan Xiaoyan , Guo Yuming , Wang Zhilei , Ma Li , He Tingting , Qin Nan , Shi Wei 
Published: December 2019

Abstract
Background Epimedii Folium(EF) is commonly used for treating bone fractures and joint diseases, but the potential hepatotoxicity of EF limits its clinical application. Our previous study confirms that EF could lead to idiosyncratic drug-induced liver injury (IDILI) and hepatocyte apoptosis, but the mechanism remains unknown. Studies have shown that NLRP3 inflammasome plays an important role in the development of various inflammatory diseases such as IDILI. Specific stimulus-induced NLRP3 inflammasome activation may has been a key strategy for lead to liver injury. Therefore, main compounds derived from EF were chosen to test whether the ingredients in EF could activate the NLRP3 inflammasome and to induce IDILI.Methods Mouse were treated with Icarisid I, and then stimulated with inflammasome stimuli and assayed for the production of caspase-1 and interleukin 1β (IL-1β) and the release of lactate dehydrogenase (LDH). Determination of intracellular potassium, ASC oligomerization as well as reactive oxygen species (ROS) production were used to evaluate the stimulative mechanism of Icarisid I on inflammasome activation. Mouse models of NLRP3 diseases were used to test whether Icarisid I has hepatocyte apoptosis effects and promoted NLRP3 inflammasome activation in vivo.Results Icarisid I specifically enhances NLRP3 inflammasome activation triggered by ATP or nigericin but not SiO2, poly(I:C) or cytosolic LPS. Additionally, Icarisid I does not alter the activation of NLRC4 and AIM2 inflammasomes. Mechanically, Icarisid I alone does not induce mitochondrial reactive oxygen species (mtROS), which is one of the critical upstream events of NLRP3 inflammasome activation; however, Icarisid I increases mtROS production induced by ATP or nigericin but not SiO2. Importantly, Icarisid I leads to liver injury and NLRP3 inflammasome activation in an LPS-mediated susceptibility mouse model of IDILI, but the effect of Icarisid I is absent in the LPS-mediated mice model pretreated with MCC950, which is used to mimic knockdown of NLRP3 inflammasome activation.Conclusions Our study reveals that Icarisid I specifically facilitates ATP or nigericin-induced NLRP3 inflammasome activation and causes idiosyncratic hepatotoxicity. The findings suggest that Icarisid I or EF should be avoided in patients with diseases related to ATP or nigericin-induced NLRP3 inflammasome activation, which may be risk factors for IDILI.
Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials
Authors: Li Li-Qin , Zhang Hou-Zhong , Fang Mei-Dan , Wang Cong , Lu Hong-Liu , Wang Li-Xue , Xu Hong-Yu 
Published: December 2019

Abstract
Background The comparative efficacy of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia remains controversial.Methods We searched Mediline (OvidSP), EMBASE (OvidSP) and Cochrane Central Register of Controlled Trials (CENTRAL) to identify trials that compared epidural bupivacaine and magnesium sulfate combination (intervention) with bupivacaine alone (control). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to assess the quality of evidence.Results Eleven studies fulfilled our inclusion criteria after screening. We found that epidural bupivacaine combined with magnesium sulfate could prolong the time for first rescue analgesics (SMD 4.96; 95% CI [2.75, 7.17], P<0.00001, I 2 = 98%), reduce the number of patients who need rescue analgesics (RR 0.38; 95% CI [0.20, 0.74], P = 0.004, I 2 = 75%) and requirement for rescue analgesics (SMD -2.65; 95% CI [-4.23, -1.06], P=0.001, I 2 = 96%).Conclusions Magnesium suifate as an adjuvant of epidural bupivacaine improved postoperative analgesia. However, we rated the quality of evidence to be very low because of high heterogeneity, imprecise of results and small sample sizes. Furthermore, further large high-quality trials are still needed to confirm the effects of magnesium sulfate on postoperative analgesia.
Anticholinergics and Benzodiazepines on Cognitive Impairment among Elderly with Alzheimer’s Disease: a One year Follow-Up Study
Authors: Jenraumjit Rewadee , Chinwong Surarong , Chinwong Dujrudee , Kanjanarach Tipaporn , Kshetradat Thanat , Wongpakaran Tinakon , Wongpakaran Nahathai 
Published: December 2019

Abstract
Objective Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer’s disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months. Results A total of 133 (80% women, mean age 78.38 years, SD 7.4) were recruited. No difference in sex, age and comorbid diseases was observed between participants who took ACs, Benzodiazepines (BZDs) and AChEIs. The most common prescribed ACs was quetiapine, being used for behavioral and psychological symptoms (BPSD). Multilevel analysis showed that the change of mental state examination scores were significantly predicted in the group using ACs (t (169), -2.52, p = .020) but not with the groups using BZD (t (162), 0.84, p = .440). Evidence showed that older adults with Alzheimer’s disease and exposed to ACs exhibited lower global cognitive scores than those without AC exposure. Using ACs could be a trade-off between controlling BPSD and aggravating cognitive impairment. Highlighting the awareness of the potential anticholinergic effect is important and may be the best policy.
Comparison of the results of sputum culture and bronchoscopic lavage fluid culture:an analysis report of large sample size data from the Clinical Microbiology Laboratory
Authors: Tian Lei , Zhang Zhen , He Feng , sun ziyong 
Published: December 2019

Abstract
Background Sputum specimens were the most common for Clinical Microbiology Laboratory in China. For the results of sputum culture, it was difficult for clinicians to evaluate the significance, and even more difficult for laboratory physicians. At present, most Clinical Microbiology Laboratories in China executed quality assessment of sputum specimens. But how to evaluate the results of sputum culture was still very confusing. To solve this problem, we conducted a series of retrospective studies.Methods Based on the culture results of bronchoscopic lavage fluid (BALF), the differences of sputum culture results before (2013-2015) and after (2016-2018) quality control of sputum samples in our hospital were compared.Results Pseudomonas aeruginosa , Acinetobacter baumannii , Klebsiella pneumoniae and Staphylococcus aureus were the four most common pathogens in sputum and BALF culture, both in 2013-2015 years and 2016-2018 years. Antimicrobial susceptibility test from 2013-2015 and 2016-2018 both showed for P. aeruginosa and K. pneumoniae , the susceptibility rates of BALF isolates to all commonly used antibiotics were higher than those from sputum. For A. baumannii and S. aureus , the sensitivity rates of BALF isolates to most antibiotics were higher than those from sputum. After quality control of sputum samples, there was still a difference between the results of sputum culture and those of BALF.Conclusions Even though the quality control of sputum specimens had been carried out, the results of culture and antimicrobial resistance of pathogens from qualified sputum samples were still different from those of BALF.