bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acupuncture for relief of gag reflex in patients undergoing transesophageal echocardiography – a protocol for a randomized sham-controlled trial
Authors: Usichenko Taras , Mueller-Kozarez Irina , Knigge Stephan , Hahnenkamp Klaus , Busch Raila , Busch Mathias 
Published: September 2019

Abstract
Background Gagging during transesophageal echocardiography examination (TEE) can be both distressing and even dangerous for patients. Needling of acupuncture point CV24 was described to be effective in reducing of gag reflex during TEE in patients with ischemic stroke or transient ischemic attack.Methods/Design We describe a proposal for a prospective randomized, patient, practitioner and assessor-blinded, single-center trial with two arms/groups: real acupuncture will be compared to placebo acupuncture. A total of 60 (30 per group) patients scheduled for elective TEE in order to exclude a cardiac embolic source, endocarditis or for valve failure evaluation will be recruited according to patients’ selection criteria and receive either indwelling fixed intradermal needles at acupoints CV24 and bilateral PC6 or sham acupuncture at the same sites. Patients undergoing TEE, practitioners performing TEE, and the outcome assessors will be unaware of group (real or placebo) allocation. The primary outcome is the intensity of gagging, measured using verbal rating scale (VRS-11) from 0 = no gagging to 10 = intolerable gagging. Secondary outcomes include the incidence of gagging, the use of rescue medication, patients’ satisfaction with relief of unwanted side effects during the TEE procedure, success of patients’ blinding (patients’ opinion to group allocation), heart rate and oxygen saturation measured by pulse oxymetry.Discussion To study the effects of acupuncture to reduce gagging during TEE we test needling of the acupoints CV24 and PC6 bilaterally. Placebo acupuncture is used for the control group.
Inhalational Aesthetic Sevoflurane Exacerbates Eye Phenotype of SCA3 Transgenic Drosophila Model
Authors: Chen Chia-Wen , Lin Wei-Yong , Cheng Jack , Chen Kuen-Bao , Kuo Yu-Cheng , Li Chi-Yuan , Hsin-Ping Liu 
Published: September 2019

Abstract
Background: Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominant inherited neurodegenerative disease. The features of SCA3 include extremely short life expectancies, motor functions, and eye phenotypes. Sevoflurane is one of the most frequently used inhalational anesthetics and shows both neuroprotective and neurotoxic effects. Previous studies showed neurotoxicity of sevoflurane exposure to Alzheimer’s disease models. However, the effect of sevoflurane inhalation on SCA3 is not clear. Materials and Methods: Here, we exposed sevoflurane to SCA3-transgenic Drosophila model with clinically relevant concentrations and observed the consequent change of survival, motor function, and eye phenotype of the flies. Results: We found that sevoflurane exposure exacerbated eye phenotype but not survival or motor function of male SCA3-transgenic flies. The percentage of ommatidium retinal cell number of male SCA3-transgenic flies with 0%, 2.1%, or 3% of sevoflurane exposure was 70.2 ± 4.8%, 64.8 ± 4.5%, or 46.8 ± 2.9% respectively (ANOVA F = 27.86, total df = 10, p = 0.0002), while sevoflurane exposure did not show any harm to the control flies. Conclusions: Our results may acknowledge the need for caution of the potential hazard of sevoflurane application on patients with SCA3 or other poly-Q related neurodegenerative diseases.
Design of high specificity and sensitive sequencing primers to detect the bifidobacterial population in biological samples
Authors: Bai Xiaoye , Shen Lingling , Yu Zhongjie , Gao Xu , Kwok Lai-Yu , Sun Zhihong , Zhang Heping 
Published: September 2019

Abstract
Background : Bifidobacteria were poorly represented or even totally absent in many of the currently published microbiota/metagenomics datasets. This work designed Bifidobacterium -targeting primers that were suitable for use in high-throughput sequencing to characterized the feature of Bifidobacterium . Results : After multiple steps of in silico prediction, phylogenetic analysis, polymerase chain reaction and single-molecule real-time sequencing (SMRT) experiments, the Bif-6 primer pair was confirmed to be optimal for such purpose. Up to 99.42% and 99.32% of the detected sequences in human stool and breast milk samples represented up to 6 and 8 different Bifidobacterium species, respectively. Additionally, the Bif-6 primer pair detected the species Bifidobacterium catenulatum and Bifidobacterium kashiwanohense , which have not previously been reported in human breast milk to our knowledge. The high specificity of Bif-6 could be explained by the lower average nucleotide identity of 78.42% (versus 93.91% for the universal primers 27f/1492r). Moreover, to optimize the process of microbiota annotation, here a Bifidobacterium -specific database was constructed that largely reduced the time required for annotation compared with using the NCBI nucleotide (nt) database. The two databases generated highly consistent profiles of bifidobacteria when tested on the same samples. Conclusion : this work designed a highly reliable primer and database specific for detecting the bifidobacterial population in complex biological samples, which will facilitate future studies of this group of bacteria.
Effects of parental genetic divergence on gene expression patterns in interspecific hybrids of Camellia
Authors: Zhang Min , Tang Yi-Wei , Qi Ji , Liu Xin-Kai , Yan Dan-Feng , Zhong Nai-Sheng , Tao NAi-Qi , Gao Ji-Yin , Wang Yu-Guo , Song Zhi-Ping , Yang Ji , Zhang Wen-Ju 
Published: September 2019

Abstract
Background: The merging of two divergent genomes during hybridization can result in the remodeling of parental gene expression in hybrids. A molecular basis underling expression change in hybrid is regulatory divergence, which may change with the parental genetic divergence. However, there still no unanimous conclusion for this hypothesis. Results : Three species of Camellia with a range of genetic divergence and their F 1 hybrids were used to study the effect of parental genetic divergence on gene expression and regulatory patterns in hybrids by RNA-sequencing and allele-specific gene expression analysis. We found that though the proportion of differentially expressed genes (DEGs) between the hybrids and their parents did not increase, a greater proportion of DEGs would be non-additively (especially transgressively) expressed in the hybrids as genomes between the parents become more divergent . In addition, the proportion of genes with significant evidence of cis -regulatory divergence increased , whereas with trans -regulatory divergence decreased with parental genetic divergence. Conclusions : The discordance within hybrid would intensify as the parents become more divergent, manifesting as more DEGs would be non-additively expressed. Trans -regulatory divergence contributed more to the additively inherited genes than cis , however, its contribution to expression difference would be weakened as cis mutations accumulated over time; and this might be an important reason for that the more divergent the parents are, the greater proportion of DEGs would be non-additively expressed in hybrid.
Prevalence rate of skin manifestations in NICU-admitted neonates
Authors: Mehrpisheh Shahrokh , Memarian Azadeh 
Published: September 2019

Abstract
Background Skin disorders in neonates can be regarded as determining concepts for prognosis and genetic counseling. Few studies have so far been conducted on determining and recording the relative frequency of skin disorders. The present study was therefore conducted to investigate skin manifestations and their relationship with other variables in the neonates hospitalized in the neonatal intensive care unit (NICU).Methods The present cross-sectional study was conducted on 403 neonates, hospitalized in the NICU of Rasoul Akram Hospital in 2014 and selected using convenience sampling. The data collected from the profiles of the neonates were recorded in a data collection form.Results Of the 403 study neonates, 366 (90.8%) had no skin manifestations, while 37 (9.2%) had skin manifestations, 18 (48.6%) of which were pathological. According to the results obtained, gender, type of delivery, gestational age and reasons for hospitalization were found not to be correlated with skin manifestations and their pathological status (P>0.05). Moreover, gender, gestational age and reasons for hospitalization had no significant relationships with the lesion type (P>0.05). Type of delivery was however found to have a statistically significant relationship with the type of skin manifestation (P=0.043).Conclusion Skin manifestations in the neonates hospitalized in the NICU are found to be less frequent in the present study compared to those in other studies, which can be attributed to the retrospective type of study using profiles and the lack of direct medical examination of patients.
Prognostic value of perioperative NT-proBNP after corrective surgery for pediatric congenital heart defects
Authors: Lin Fangqin , Zheng Lingling , Cui Yanqin , Chen Weidan , Gupta Ramit Kumar , Li Huixian , Chen Xinxin , Xia Huimin , Liang Huiying 
Published: September 2019

Abstract
Background: It is critically important to assess the prognostic value of NT-proBNP in the form of repeated measures among children undergoing surgery for congenital heart defects (CHD). The aim of the present study is to assess the value of repeated perioperative NT-proBNP in evaluating the time dependent and temporal trajectory in prognostics diagnosis during the perioperative period in a large series of children with CHD.Methods: Repeated measures of NT-proBNP from 329 consecutive children with CHD were obtained before and 1, 12, and 36 hours after surgery, respectively. For fully utilizing longitudinal characteristics, we employed parallel cross-sectional logistic regression, a two stage mixed effect model and trajectories over time analysis to mine the predictive value of perioperative NT-proBNP on the binary outcome of prolonged intensive care unit (ICU) stay.Results: The two stage mixed effects model confirmed that both the mean NT-proBNP level (aOR=1.46, P=0.001) and the time trends had prognostic value on the prediction of prolonged ICU stay. In the fully adjusted logistic regression analyses based on gaussian distributions, “rapidly rising NT-proBNP” put the subjects at 5.4-times higher risk of prolonged ICU stay compared with “slowly rising” group (aOR=5.40, P=0.003).Conclusions: Comprehensive assessment of the time dependent and temporal trajectory in perioperative NT-proBNP, indicated by repeated measurements, can provide more accurate identification of children with higher risk of prolonged ICU stay after CHD surgery.
Outcome of robot-assisted pancreaticoduodenectomy during initial learning curve versus laparotomy
Authors: Zhou Jiangjiao , Zou Heng , Xiong Li , Miao Xiongying , Liu Zhongtao , Liu Juan , Wen Yu 
Published: September 2019

Abstract
Background : To analyze the initial learning curve (LC) for robot-assisted pancreaticoduodenectomy (RAPD) and compare RAPD during the initial LC with open pancreaticoduodenectomy (OPD) in terms of outcome. Methods : This study is a retrospective review of patients who consecutively underwent RAPD between October 2015 and May 2019 in our hospital. Experiences from 30 initial consecutive RAPD cases, considered the initial LC of a single surgeon team, were compared with those from laparotomy cases during the same period in terms of outcome. Preoperative demographic and comorbidity data were obtained. Perioperative data on operation time, blood transfusion, numbers of harvested lymph nodes, 90-day mortality and readmission, surgery-related complications, postoperative hospital stay, and total costs were acquired for analysis. The operation time for RAPD was evaluated using the cumulative sum(CUSUM) method. Results : Seventy-eight patients, including 30 consecutive RAPD cases and 48 consecutive open cases, were enrolled for review. The demographic and comorbidity characteristics of the two groups were similar. Compared with OPD, RAPD required a significantly longer operative time (423.67 ± 137.627 min vs. 228.75 ± 44.988 min, P < 0.001) and higher cost (185700 ± 54500 RMB vs. 120600 ± 41700 RMB, P < 0.001). Moreover, compared with the OPD group, the RAPD group revealed a significantly smaller mean number of lymph nodes harvested in malignant cases (8.72 ± 4.9 vs 14.26 ± 7.633, P = 0.007). No statistically significant differences were observed between the two groups in terms of incidence of Clavien–Dindo grade III–V morbidities and 90-day mortality and readmission. In the CUSUM graph, one peak point was observed at the 8th case, after which the operation time began to decrease. Conclusions : RAPD is safe when performed in well-selected patients by well-trained teams with extensive experience in open pancreaticoduodenectomy during the initial LC,and the LC of RAPD may be shorten less than 30 cases.
General Healthcare Utilization and Out-of-Pocket Expenditures Associated with Depression in Adults: A Cross-Sectional Analysis in Nepal
Authors: Rajan Selina , Rathod Sujit D , Luitel Nagendra P , Murphy Adrianna , Roberts Tessa , Jord Mark JD 
Published: September 2019

Abstract
Background: Despite attempts to improve universal healthcare coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand general healthcare utilization and OOP expenditure patterns in people with depression. Aims: We examined associations between symptoms of depression and frequency and type of general healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. Methods: We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about general healthcare utilization. We modelled associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared sector-specific utilization of outpatient healthcare and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. Results: We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of general healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7%-22%, p<0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p<0.0001). People with depression sought most general healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). Conclusions: In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Strengthening UHC to include early detection and treatment for people affected by depression as an integrated component of general healthcare should lead to a reduction in financial pressures on families, which is likely to reduce the incidence of depression in Nepal.
A Needs Assessment for Postgraduate Training in Selected Public Health Disciplines at the University of Zambia
Authors: Bulawayo Maio , Silumbwe Adam , Munakampe Margarate Nzala , Mukumbuta Nawa , Musabula Juliet , Chewe Mwimba , Mweemba Chriss , Michelo Charles , Hangoma Peter 
Published: September 2019

Abstract
Background As most low and middle-income countries seek to achieve universal health coverage targets, there is an ever-increasing need to train human resources with the required core skills and competencies. This study reports on the needs assessment conducted to understand postgraduate training needs for three selected public health disciplines – Health Policy and Systems, Health Economics, and Healthcare Management and Planning – at the University of Zambia. Methods The study adopted a cross sectional survey design. Data were collected through semi-structured interviews administered to 32 participants, identified through a comprehensive stakeholder mapping process, holding selected management positions in public and private health service organisations across Zambia. The organisations included regulatory authorities, research institutions, government ministries, insurance firms, multilateral and health services organisations. Results Overall, more than 68% of the stakeholders reported that they had no employees that were formally trained in the three disciplines. More than 90% of the stakeholders opined that training in these disciplines would be beneficial in providing competencies to strengthen service provision. The horizontal skills mismatch for health economics, and health services management and planning were found to be 93% and 100%, respectively. Among the key public health training needs were: policy development and analysis, economic evaluation, and strategic management. Conclusions This study confirms that introducing post graduate training in the proposed public health discipline of study will not only benefit Zambian health services organisations, but also help strengthen the health systems in general. However, there is need for further understanding of local context to ensure that training needs are matched with local priorities and service delivery.
Association of timed up and go test outcomes with future incidence of cardiovascular disease and mortality in adults aged 66 years: a national representative longitudinal study
Authors: Son Ki Young , Shin Dong Wook , Lee Ji Eun , Kim Sang Hyuck , Yun Jae Moon , Cho Belong 
Published: September 2019

Abstract
Background The timed up and go test (TUG) is one of the most widely used tests of mobility. We aimed to examine whether the TUG is associated with cardiovascular (CV) events, CV mortality, and all-cause mortality.Methods Subjects in the senior cohort database of the Korean National Health Insurance Service (2002–2013) who completed the TUG as part of the National Screening Program for Transitional Ages (NSPTA) during 2007–2008 were identified. An abnormal TUG result was defined as a time ≥10 seconds. Cox proportional hazard models were used to assess the associations between TUG results and CV events, CV mortality, and all-cause mortality.Results The mean follow-up period was 5.7 years. Incidence rates of CV events in the normal and abnormal TUG groups were 7.93 and 8.98 per 1,000 person-years, while CV mortality rates were 0.96 and 1.51 per 1,000 person-years, respectively. In a fully adjusted model, we found that abnormal TUG results were not associated with the incidences of CV events and CV mortality. However, abnormal TUG results (>10 sec) resulted in a 2.9-fold increase in CV mortality in women (adjusted hazard ratio 2.90, 95% confidence interval 1.15 – 7.30). Further, participants lacking certain CV risk factors, such as current cigarette smoking, obesity, or diabetes, had a higher CV mortality rate when TUG results were abnormal.Conclusions Abnormal TUG results in subjects aged 66 years were associated with future CV mortality in women and in subjects without obesity, diabetes, or cigarette smoking.
An immune-centric exploration of BRCA1 and BRCA2 germline mutation related breast and ovarian cancers
Authors: Przybytkowski Ewa , Davis Thomas , Hosny Abdelrahman , Eissmann Julia , Matulonis Ursula A. , Wulf Gerburg M. , Nabavi Sheida 
Published: September 2019

Abstract
Background: This study was a hypothesis generating exploration of genomic data collected at diagnosis for patients participating in a clinical trial (#NCT01623349). The cohort consisted of hereditary and sporadic breast and ovarian cancers. Methods: Mining and statistical analyses of the original DNA and RNA sequencing data and data available from The Cancer Genome Atlas (TCGA) were performed using the R computing environment. To interpret the data, we have used published literature and web available resources such as Gene Ontology Tools, The Cancer immunome Atlas (TCIA) and the Cancer Research Institute iAtlas. Results: We found that a prominent tumor mutation burden (TMB) in hereditary breast and ovarian cancers is not correlated with high global immune activity in their microenvironments. We also found that BRCA1/2 germline related breast and ovarian cancers do not represent a unique phenotypic identity, but that they express a range of phenotypes similar to sporadic cancers. Importantly, BRCA2 germline mutation related breast tumors have a different profile of genomic instability compared to those related to BRCA1. However, all breast and ovarian BRCA1/2 related tumors are characterized by high homologous recombination deficiency (HRD) and low aneuploidy. Interestingly, all sporadic high grade serous ovarian cancers (HGSOC) and most of the subtypes of triple negative breast cancers (TNBC), but not other types of breast cancer, also express a high degree of HRD. Conclusions: TMB is not associated with the magnitude of the immune response in hereditary BRCA1/2 related breast and ovarian cancers or in sporadic TNBC and sporadic HGSOC. Hereditary tumors express phenotypes as heterogenous as sporadic tumors with various degree of “BRCAness” and various characteristics of the immune microenvironments. The subtyping criteria developed for sporadic tumors can be applied for the classification of hereditary tumors and possibly also characterization of their immune microenvironment. A high HRD score may be a good candidate biomarker for response to platinum, and potentially PARP-inhibition. Trial registration: Phase I Study of the Oral PI3kinase Inhibitor BKM120 or BYL719 and the Oral PARP Inhibitor Olaparib in Patients With Recurrent Triple Negative Breast Cancer or High Grade Serous Ovarian Cancer. ClinicalTrials.gov Identifier: NCT01623349.