Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders.

OBJECTIVE

This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women's satisfaction, women's knowledge on birth preparedness and complication readiness, maternal and child health service use, men's involvement in maternal health service utilization, and women's contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis.

METHODS

This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy.

RESULTS

The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024.

CONCLUSIONS

The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso.

TRIAL REGISTRATION

Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37136.

Resilience of anammox application from sidestream to mainstream: A combined system coupling denitrification, partial nitritation and partial denitrification with anammox

Anaerobic ammonium oxidation (anammox) is a potential process to achieve the neutralization of energy and carbon. Due to the low temperature and variation of municipal sewage, the application of mainstream anammox is hard to be implemented. For spreading mainstream anammox in practice, several key issues and bottlenecks including the start-up, stable NO₂^--N supply, maintenance and dominance of AnAOB with high activity, prevention of NO₃^--N buildup, reduction of sludge loss, adaption to the seasonal temperature and alleviation of COD impacts on AnAOB are discussed and summarized in this review in order to improve its startup, stable operation and resilience of mainstream anammox. Hence a combined biological nitrogen removal (CBNR) system based on conventional denitrification, shortcut nitrification-denitrification, Partial Nitritation and partial Denitrification combined Anammox (PANDA) process through the management of organic matter and nitrate is proposed correspondingly aiming at adaptation to the variations of seasonal temperature and pollutants in influent.

Down-regulation of MEG3, PANDA and CASC2 as p53-related lncRNAs in breast cancer

TP53 encodes a major tumor suppressor protein which blocks carcinogenesis process in a variety of tissues including breast tissue. Expression and function of this gene is regulated by a number of long non-coding RNAs (lncRNAs) among them are PANDA, MEG3 and CASC2. We measured expression of TP53 and these transcripts in a cohort of Iranian breast cancer patients. Expression levels of TP53, MEG3, CASC2 and PANDA were significantly lower in tumoral samples compared with non-tumoral samples (Posterior mean differences =  -4.26, -1.66, -5.98 and -3.13, respectively; P values < 0.0001). Expression of CASC2 was higher in Her2 1+ cases compared with Her2 negative cases (Beta = 1.85, P value = 0.037). Expression levels of MEG3 and TP53 were lower in grade 2 samples compared with grade 1 (Beta = -1.86, P value = 0.006 and Beta = -2.24, P value = 0.003, respectively). There was no other significant association between expression of genes and clinical variables. CASC2 had the best performance among these genes with area under curve value of 0.78 and sensitivity and specificity values of 56.33% and 88.73%, respectively (P value < 0.0001). The current investigation supports the role of TP53-related lncRNAs in the pathogenesis of breast cancer.

Exploring the changes of brain immune microenvironment in Alzheimer's disease based on PANDA algorithm combined with blood brain barrier injury-related genes

Studies have shown that the specific entry of peripheral cells into the brain parenchyma caused by BBB injury and the imbalance of the immune microenvironment in the brain are closely related to the pathogenesis of Alzheimer's disease (AD). Because of the difficulty of obtaining data inside the brain, it is urgent to find out the relationship between the peripheral and intracerebral data and their influence on the development of AD by machine learning methods. However, in the actual algorithm design, it is still a challenge to extract relevant information from a variety of data to establish a complete and accurate regulatory network. In order to overcome the above difficulties, we presented a method based on a message passing model (Passing Attributes between Networks for Data Assimilation, PANDA) to discover the correlation between internal and external brain by the BBB injury-related genes, and further explore their regulatory mechanism of the brain immune environment for AD pathology. The Biological analysis of the results showed that pathways such as immune response pathway, inflammatory response pathway and chemokine signaling pathway are closely related to the pathogenesis of AD. Especially, some significant genes such as RELA, LAMA4, PPBP were found play certain roles in the injury of BBB and the change of permeability in AD patients, thus leading to the change of immune microenvironment in AD brain.

[Acceptability and satisfaction with pregnancy and newborn diagnostic assessment (PANDA) system providing prenatal care in Burkina Faso]

Introduction

les technologies mobiles en santé sont de plus en plus utilisées comme solutions innovantes pour améliorer les services de soins prénatals (SPN) dans les soins de première ligne. Cette étude a évalué l´acceptabilité et la satisfaction de l´utilisation du système Pregnancy and Newborn Diagnostic Assessment (PANDA) lors des SPN au Burkina Faso.

Méthodes

une étude transversale utilisant une approche mixte a été menée auprès de 35 utilisatrices des SPN et de 35 agents de santé dans le district sanitaire de Koupéla, dans la région du Centre-Est du Burkina Faso en septembre 2017. Des entretiens et 4 focus groups ont été réalisés auprès des utilisatrices des SPN et des d´entretiens semi-structurés auprès des professionnels de soin. Une analyse descriptive des données quantitatives a été effectuée avec le logiciel SPSS et les données qualitatives ont fait l’objet d´une analyse thématique avec NVivo 10.

Résultats

le système PANDA a été très bien accepté et très apprécié par les utilisatrices et les prestataires de soins. Les motifs de satisfaction chez les utilisatrices étaient l´amélioration des échanges avec les prestataires de soin et l´accès à des soins de meilleure qualité à moindre coût. Les agents de santé ont apprécié la pertinence du système PANDA et l´amélioration des prestations fournies, du suivi et de la prise en charge des femmes enceintes.

Conclusion

le système PANDA est très bien accepté et apprécié au niveau des soins primaires aussi bien par les prestataires de soins que par les utilisatrices de services de soins prénataux au Burkina Faso.

Nitrogen removal from water resource recovery facilities using partial nitrification, denitratation-anaerobic ammonia oxidation (PANDA)

Nitrogen removal from wastewater is an energy and chemical intensive process that is becoming increasingly more common around the world. To address the cost and complexity issues associated with biological nitrogen removal from wastewater, an alternative approach for achieving next generation nitrogen removal via partial nitrification, denitratation and anaerobic ammonia oxidation (PANDA) has been developed. The PANDA process relies on converting 50% of influent ammonia load to nitrate via aerobic ammonia (AerAOB) and nitrite oxidizing bacteria (NOB). The nitrate is reduced to nitrite (denitratation), followed by the removal of ammonia and nitrite by heterotrophic denitrifiers and anaerobic ammonia oxidizing biomass (AnAOB). Results from a pilot-scale sidestream PANDA demonstration at nitrogen loadings of 0.2-0.25 kg N/m³-day illustrated that up to 80% ammonia removal could be achieved. Testing in the mainstream process at initial ammonia concentrations of ~25 mg N/L indicated that 90% removal of total inorganic nitrogen could be achieved and that nitrogen removal was ultimately dependent on operating factors including aeration time, supplemental carbon dosing, hydraulic retention time and nitrate concentrations. Results cumulatively indicated that there was inherent resiliency within the PANDA systems when responding to variable environmental and operational conditions. This is hypothesized to be due to the fact that nitrogen removal is due to the combined synergistic activity of AerAOB, NOB, heterotrophic denitrifiers and AnAOB. Accordingly, utilization of PANDA based treatment processes may allow Water Resource Recovery Facilities (WRRFs) to achieve more sustainable and cost effective nitrogen removal in sidestream and mainstream processes without the need for NOB suppression and complex operational controls.

P21-Associated ncRNA DNA Damage-Activated Expression in Bladder Cancer

Úvod: Dlouhé nekódující ribonukleové kyseliny (long non-coding ribonucleic acids - lncRNA) jsou v poslední dob&#283; vzhledem ke své úloze v procesu karcinogeneze p&#345;edm&#283;tem zkoumání v&#283;dc&#367; zabývajících se nádory. Tyto transkripty regulují kritické kroky v normálních bun&#283;&#269;ných procesech, tak&#382;e dysregulace jejich exprese se ú&#269;astní patogeneze karcinom&#367;. Z d&#367;vodu své blízkosti k lokusu CDKN1A má ncRNA spojená s P21 aktivovaná po&#353;kozením DNA (P21-associated ncRNA DNA damage activated - PANDA) v tomto ohledu zvlá&#353;tní pozici. Podílí se na regulaci reakce na po&#353;kození DNA, stárnutí bun&#283;k a proliferace. Materiály a metody: V této studii jsme metodou kvantitativní polymerázové &#345;et&#283;zové reakce hodnotili expresi této lncRNA ve tkáních karcinomu mo&#269;ového m&#283;chý&#345;e, sousedních nerakovinných tkání (adjacent non-cancerous tissues - ANCT) a v normálních vzorcích mo&#269;ového m&#283;chý&#345;e. Výsledky: Nebyl detekován &#382;ádný významný rozdíl v expresi PANDA, a to ani mezi nádorovými tkán&#283;mi a ANCT (pom&#283;r exprese = 1,75; p = 0,11) nebo mezi nádorovými tkán&#283;mi a normálními tkán&#283;mi (pom&#283;r exprese = 2,72; p = 0,57). Úrove&#328; exprese této lncRNA nebyla spojena s &#382;ádnými demografickými ani klinickými údaji o pacientech, jako je grade nádoru nebo recidiva, ani s rizikovými faktory souvisejícími s rakovinou, mezi n&#283;&#382; pat&#345;í nap&#345;. kou&#345;ení cigaret nebo závislost na opiu. Záv&#283;r: Tato studie tedy nazna&#269;uje, &#382;e PANDA není zapojena do patogeneze karcinomu mo&#269;ového m&#283;chý&#345;e. Hodnocení exprese jiných lncRNA by mohlo pomoci p&#345;i identifikaci biomarker&#367; pro tyto karcinomy.

Peripheral expression of long non-coding RNAs in bipolar patients

BACKGROUND

Long non-coding RNAs (lncRNAs) have established roles in the pathogenesis of diverse human disorders including neuropsychiatric disorders.

METHODS

In the current study, we evaluated expression levels of six apoptosis-related lncRNAs (CCAT2, TUG1, PANDA, NEAT1, FAS-AS1 and OIP5-AS1) in the peripheral blood of bipolar disorder (BD) patients and healthy subjects to assess their contribution in the pathogenesis of BD.

RESULTS

CCAT2, TUG1 and PANDA were up-regulated in total BD patients compared with total healthy subjects (P values = 0.006, <0.001 and 0.004 respectively) while OIP5-AS1 was down-regulated (P = 0.001). When expression levels of these genes were compared between patients and sex-matched healthy subjects, CCAT2 and TUG1 expression levels were only different in male subgroups; while PANDA expression was different in both male and female subgroups compared with the corresponding control subgroups. Transcript levels of lncRNAs were not correlated with any of demographic or clinical parameters of BD patients or controls after adjustment for gender. Pairwise correlations between expression levels of lncRNAs followed a disease-dependent manner. Based on receiver operating characteristic curves, among the assessed lncRNAs TUG1 had the highest diagnostic power in BD. Combination of transcript levels of CCAT2, TUG1, PANDA and OIP5-AS1 improved both sensitivity and specificity resulting in diagnostic power of 0.96.

CONCLUSION

Our data demonstrated a possible role of certain lncRNAs in the pathogenesis of BD and potentiated them as diagnostic markers in this disorder.

Expression of Long Non-Coding RNAs in Placentas of Intrauterine Growth Restriction (IUGR) Pregnancies

BACKGROUND

Intrauterine growth restriction (IUGR), a pathologic diminution of the rate of fetal growth, has been associated with alterations in expression of several genes. However, the role of long non-coding RNAs (lncRNAs) in its pathogenesis has not been studied.

METHODS

In this study we evaluated the expression of four lncRNAs namely, nuclear paraspeckle assembly transcript (NEAT1), taurine up-regulated 1 (TUG1), p21-associated ncRNA DNA damage-activated (PANDA), and metastasis-associated lung adenocarcinoma transcript-1 (MALAT1) in placenta samples obtained from IUGR and normal pregnancies to determine their possible contributions in the pathogenesis of IUGR.

RESULTS

We found no significant differences in expression levels between cases and controls. We also found no correlation between expression and clinical data of study participants; however, we found significant correlations between expression levels of all the assessed lncRNAs in both cases and controls.

CONCLUSION

These results imply the existence of a possible shared regulatory mechanism for the expression of these transcripts in placenta. Future studies are needed to perform such evaluations in larger sample sizes or in animal models in earlier stages of pregnancy.

The Expression of CCAT2, UCA1, PANDA and GHET1 Long Non-coding RNAs in Lung Cancer

BACKGROUND

Long non-coding RNAs (lncRNAs) have been considered to be prospective biomarkers for diagnosing lung cancer due to the fundamental roles they hold in the regulating several cancer-related pathways.

METHODS

Using the quantitative real-time polymerase chain reaction method, we evaluated the expression of CCAT2, UCA1, PANDA and GHET1 lncRNAs in 32 lung cancer tissue samples and their corresponding adjacent non-cancerous tissues (ANCTs) from lung cancer patients admitted to the Labbafi-Nejad Hospital from 2015 to 2016.

RESULTS

No significant differences were found in the expression of lncRNAs within the tumoral and non-tumoral tissue samples. Bayesian Multilevel analysis showed no association between the expression of lncRNAs and the patient's tumor node metastasis (TNM) stage following adjustments for age. Spearman correlation analysis revealed an inverse correlation between the expression of PANDA in tumoral tissues and age. Additionally, the difference in CCAT2 expression among the tumoral and non-tumoral tissues was inversely correlated with patients' age. Significant pairwise correlations were found between the expression of lncRNAs in both the tumoral and non-tumoral tissues.

CONCLUSION

Despite the findings supporting a role for the lncRNAs, CCAT2, UCA1, PANDA and GHET1 in the pathogenesis of lung cancer, our data suggests no relationship for expression of these lncRNAs in lung cancer, questioning their potential as lung cancer biomarkers.

Dysregulation of long non-coding RNA profile in peripheral blood of multiple sclerosis patients

Multiple sclerosis (MS) is a chronic autoimmune disorder in which dysregulation or aberrant expressions of several immune-related genes have been noted. More recently, the participation of long non-coding RNAs (lncRNAs) in regulation of immune responses has been highlighted. In the present study, we evaluated expression levels of three lncRNAs named Nuclear Paraspeckle Assembly Transcript 1 (NEAT1), P21 associated ncRNA DNA damage activated (PANDA) and Taurine-up-regulated gene 1 (TUG1) in peripheral blood of 50 relapsing-remitting MS patients and 50 matched healthy subjects. All three lncRNAs have been significantly over-expressed in MS patients compared with healthy subjects. In addition, significant correlations were found between expression levels of these three lncRNAs in the patients group. NEAT1 expression was inversely correlated with age at onset and disease duration in female patients. Moreover, TUG1 expression was inversely correlated with disease duration in female patients. The present study provides further evidences for the role of lncRNAs in pathogenesis of MS.

Long Noncoding RNA PANDA Positively Regulates Proliferation of Osteosarcoma Cells

BACKGROUND

A long noncoding RNA, p21-associated ncRNA DNA damage-activated (PANDA), associates with nuclear transcription factor Y subunit alpha (NF-YA) and inhibits its binding to promoters of apoptosis-related genes, thereby repressing apoptosis in normal human fibroblasts. Here, we show that PANDA is involved in regulating proliferation in the U2OS human osteosarcoma cell line.

MATERIALS AND METHODS

U2OS cells were transfected with siRNAs against PANDA 72 h later and they were subjected to reverse transcription-polymerase chain reaction (RT-PCR), quantitative RT-PCR and cell-cycle analysis.

RESULTS

PANDA was highly expressed in U2OS cells, and its expression was induced by DNA damage. Silencing PANDA caused arrest at the G₁ phase of the cell cycle, leading to inhibition of cell proliferation. Quantitative RT-PCR showed that silencing PANDA increased mRNA levels of the cyclin-dependent kinase inhibitor p18, which caused G₁ phase arrest.

CONCLUSION

These results suggest that PANDA promotes G₁-S transition by repressing p18 transcription, and thus promotes U2OS cell proliferation.

Long Non-coding RNA, PANDA, Contributes to the Stabilization of p53 Tumor Suppressor Protein

BACKGROUND

P21-associated noncoding RNA DNA damage-activated (PANDA) is induced in response to DNA damage and represses apoptosis by inhibiting the function of nuclear transcription factor Y subunit alpha (NF-YA) transcription factor. Herein, we report that PANDA affects regulation of p53 tumor-suppressor protein.

MATERIALS AND METHODS

U2OS cells were transfected with PANDA siRNAs. At 72 h post-transfection, cells were subjected to immunoblotting and quantitative reverse transcription-polymerase chain reaction.

RESULTS

Depletion of PANDA was associated with decreased levels of p53 protein, but not p53 mRNA. The stability of p53 protein was markedly reduced by PANDA silencing. Degradation of p53 protein by silencing PANDA was prevented by treatment of MG132, a proteasome inhibitor. Moreover, depletion of PANDA prevented accumulation of p53 protein, as a result of DNA damage, induced by the genotoxic agent etoposide.

CONCLUSION

These results suggest that PANDA stabilizes p53 protein in response to DNA damage, and provide new insight into the regulatory mechanisms of p53.

Oncogenic Ras influences the expression of multiple lncRNAs

Recent ultrahigh-density tiling array and large-scale transcriptome analysis have revealed that large numbers of long non-coding RNAs (lncRNAs) are transcribed in mammals. Several lncRNAs have been implicated in transcriptional regulation, organization of nuclear structure, and post-transcriptional processing. However, the regulation of expression of lncRNAs is less well understood. Here, we show that the exogenous and endogenous expression of an oncogenic form of small GTPase Ras (called oncogenic Ras) decrease the expression of lncRNA ANRIL (antisense non-coding RNA in the INK4 locus), which is involved in the regulation of cellular senescence. We also show that forced expression of oncogenic Ras increases the expression of lncRNA PANDA (p21 associated ncRNA DNA damage activated), which is involved in the regulation of apoptosis. Microarray analysis demonstrated that expression of multiple lncRNAs fluctuated by forced expression of oncogenic Ras. These findings indicate that oncogenic Ras regulates the expression of a large number of lncRNAs including functional lncRNAs, such as ANRIL and PANDA.

Long noncoding RNAs: Novel insights into hepatocelluar carcinoma

Recent advances in non-protein coding part of human genome analysis have discovered extensive transcription of large RNA transcripts that lack of coding protein function, termed long noncoding RNAs (lncRNAs). It is becoming evident that lncRNAs may be an important class of pervasive genes involved in carcinogenesis and metastasis. However, the biological and molecular mechanisms of lncRNAs in diverse diseases are not yet fully understood. Thus, it is anticipated that more efforts should be made to clarify the lncRNAs world. Moreover, accumulating studies have demonstrated that a class of lncRNAs are dysregulated in hepatocellular carcinoma(HCC) and closely related with tumorigenesis, metastasis, prognosis or diagnosis. In this review, we will briefly discuss the regulation and functional role of lncRNAs in HCC, therefore evaluating the potential of lncRNAs as prospective novel therapeutic targets in HCC.

PANDA: a pipeline toolbox for analyzing brain diffusion images

Diffusion magnetic resonance imaging (dMRI) is widely used in both scientific research and clinical practice in in-vivo studies of the human brain. While a number of post-processing packages have been developed, fully automated processing of dMRI datasets remains challenging. Here, we developed a MATLAB toolbox named “Pipeline for Analyzing braiN Diffusion imAges” (PANDA) for fully automated processing of brain diffusion images. The processing modules of a few established packages, including FMRIB Software Library (FSL), Pipeline System for Octave and Matlab (PSOM), Diffusion Toolkit and MRIcron, were employed in PANDA. Using any number of raw dMRI datasets from different subjects, in either DICOM or NIfTI format, PANDA can automatically perform a series of steps to process DICOM/NIfTI to diffusion metrics [e.g., fractional anisotropy (FA) and mean diffusivity (MD)] that are ready for statistical analysis at the voxel-level, the atlas-level and the Tract-Based Spatial Statistics (TBSS)-level and can finish the construction of anatomical brain networks for all subjects. In particular, PANDA can process different subjects in parallel, using multiple cores either in a single computer or in a distributed computing environment, thus greatly reducing the time cost when dealing with a large number of datasets. In addition, PANDA has a friendly graphical user interface (GUI), allowing the user to be interactive and to adjust the input/output settings, as well as the processing parameters. As an open-source package, PANDA is freely available at http://www.nitrc.org/projects/panda/. This novel toolbox is expected to substantially simplify the image processing of dMRI datasets and facilitate human structural connectome studies.