bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Survival Prognosis for Spinal Metastasis From Cancer of Unknown Primary: Derivation and Validation of a Nomogram Model
Authors: Yang Minglei , Ma Xiaoyu , Wang Pengru , Yang Jiaxiang , Zhong Nanzhe , Liu Yujie , Shen Jun , Wan Wei , Jiao Jian , Xu Wei , Xiao Jianru
Published: May 2022

Study Design

Retrospective and prospective cohort study.

Objectives

Survival estimation is necessary in the decision-making process for treatment in patients with spinal metastasis from cancer of unknown primary (SMCUP). We aimed to develop a novel survival prediction system and compare its accuracy with that of existing survival models.

Methods

A retrospective derivation cohort of 268 patients and a prospective validation cohort of 105 patients with SMCUP were performed. Univariate and multivariable survival analysis were used to generate independently prognostic variables. A nomogram model for survival prediction was established by integrating these independent predictors based on the size of the significant variables’ β regression coefficient. Then, the model was subjected to bootstrap validation with calibration curves and concordance index (C-index). Finally, predictive accuracy was compared with Tomita, revised Tokuhashi and SORG score by the receiver-operating characteristic (ROC) curve.

Results

The survival prediction model included six independent prognostic factors, including pathology ( P < .001), visceral metastases ( P < .001), Frankel score ( P < .001), weight loss ( P = .005), hemoglobin ( P = .001) and serum tumor markers ( P < .001). Calibration curve of the model showed good agreement between predicted and actual mortality risk in 6-, 12-, and 24-month estimation in derivation and validation cohorts. The C-index was .775 in the derivation cohort and .771 in the validation cohort. ROC curve analysis showed that the current model had the best accuracy for SMCUP survival estimation amongst 4 models.

Conclusions

The novel nomogram system can be applied in survival prediction for SMCUP patients, and furtherly be used to give individualized therapeutic suggestions based on patients’ prognosis.
State Union Density Effects on Workers’ Support for Reducing Income Inequality, 1973-2016
Authors: Perron Shawn
Published: May 2022

Research often borrows on common yet somewhat unsubstantiated beliefs that unions influence inequality attitudes among unionized and nonunionized workers. This paper draws on inequality attitude data from the General Social Survey and state-level union data from the Current Population Survey and County Business Patterns between 1973 and 2016 to test this hypothesis. Linear probability, fixed-effects, and marginal structural models estimate that a large increase in state union density moderately increases workers’ support for reducing income inequality by three to 12 percentage points. Findings lend some empirical support for the capacity of unions to influence redistributive policy and market attitudes.
From Invisible to Structural Power to Address Immigrant Farmworkers’ Challenges Through New Assemblages in the U.S. Dairy Industry
Authors: Thompson Diego
Published: May 2022

Latinx immigrant workers on U.S. dairy farms experience multiple challenges. During recent decades, a myriad of stakeholders from the civil society and the food system have worked together to address struggles experienced by immigrant farmworkers and other marginalized groups. Meanwhile, assemblage and governance perspectives have gained the attention of scholars and practitioners addressing power relations and social challenges in the food system. Based on interviews with members of an immigrant organization in Vermont, this study examines how Latinx immigrant farmworkers and their allies created and leveraged opportunities to transform relations of power and address needs and problems through the creation of new assemblages. Results show how members of this organization were able to exercise and transform different forms of power. The construction of new social relationships and assemblages enabled Latinx immigrant farmworkers to transform invisible power into hidden and visible power, leading to structural changes, such as the creation of the first fair food program in the U.S. dairy industry.
Did Worship Attendance During Lockdown Promote COVID-19 Infection? Evidence from National Panel Data
Authors: Perry Samuel L. , Grubbs Joshua B.
Published: May 2022

During late spring 2020, when states were issuing stay-at-home orders, the majority of congregations and Americans followed protocols and avoided in-person worship. Yet a vocal minority of Americans defied protocols and gathered in worship. The authors use national panel data collected in mid-May and August 2020 to assess whether Americans who attended worship more frequently during lockdown restrictions were more likely to report testing positive for coronavirus disease 2019 (COVID-19) three months later. Accounting for relevant correlates including mask use, general attendance at large gatherings, and knowing others who had tested positive, the likelihood that Americans tested positive for COVID-19 between May and August 2020 grew almost linearly as Americans attended in-person worship more frequently during lockdown. However, interactions indicate that this increase was limited primarily to those who were not regular attenders previously. The results suggest that worship attendance during lockdown substantially increased COVID-19 infections for the minority who attended possibly as a form of protest.
A real-world study of combined modality therapy for early-stage Hodgkin lymphoma: too little treatment impacts outcome
Authors: Chohan Karan L. , Young Jason R. , Lester Scott , Alhaj Moustafa Muhamad , Rosenthal Allison , Tun Han W. , Hoppe Bradford S. , Johnston Patrick B. , Micallef Ivana N. , Habermann Thomas M. , Ansell Stephen M.
Published: May 2022

Multiple clinical trials have assessed de-escalation strategies from combined modality therapy (CMT) to chemotherapy-alone for the treatment of early-stage classical Hodgkin lymphoma (cHL), confirming similar outcomes. The application of these data to the real-world is limited, however. We conducted a retrospective, multicenter cohort study comparing CMT vs chemotherapy-alone in patients with early-stage cHL (stage IA-IIB) treated between January 2010 and December 2020. Positron emission tomography (PET) scans after chemotherapy cycle 2 (PET2) were independently reviewed by a nuclear radiologist (Deauville score ≥4, positive; ≤3, negative). Patient outcomes were compared by using an intention-to-treat analysis. Among 125 patients (CMT, n = 63; chemotherapy-alone, n = 62) with a median follow-up of 59.8 months (95% CI, 48.6-71.0), no differences in overall survival were observed (5-year overall survival, CMT 98.0% vs chemotherapy-alone 95.1%; log-rank test, P = .38). However, there was reduced progression-free survival (PFS) with chemotherapy-alone among all patients (2-year PFS, CMT 95.1% vs chemotherapy-alone 75.3%; log-rank test, P = .005) and in those with bulky (n = 43; log-rank test, P < .001), unfavorable (n = 81; log-rank test, P = .002), or PET2-positive (n = 15; log-rank test, P = .02) disease. No significant differences in PFS were seen for patients with non-bulky (log-rank test, P = .35), favorable (log-rank test, P = .62), or PET2-negative (log-rank test, P = .19) disease. Based on our real-world experience, CMT seems beneficial for patients with early-stage cHL, especially those with PET2-positive and unfavorable disease. Chemotherapy-alone regimens can lead to comparable outcomes for patients with favorable, non-bulky, or PET2-negative disease. We conclude that although results seen in clinical trials are replicated in certain patient subgroups, other subgroups not fitting trial criteria do poorly when radiotherapy is excluded.
Real-life omalizumab exposure and discontinuation in a large nationwide population-based study of paediatric and adult asthma patients
Authors: Humbert Marc , Bourdin Arnaud , Taillé Camille , Kamar Driss , Thonnelier Céline , Lajoinie Audrey , Rigault Alexandre , Deschildre Antoine , Molimard Mathieu
Published: May 2022

Background

This real-life study aimed to assess omalizumab treatment patterns in adult and paediatric asthma patients, and to describe asthma control and healthcare resource use (HCRU) at omalizumab initiation and discontinuation.

Methods

The French healthcare database system (Système National des Données de Santé (SNDS)) was used to identify asthma patients aged ≥6 years who initiated omalizumab for at least 16 weeks from 2009 to 2019. We examined omalizumab treatment patterns using dispensation records.

Results

We identified 16 750 adults and 2453 children initiating omalizumab. Median treatment persistence before discontinuation (TSTOP) was 51.2 (95% CI 49.3–53.4) months in adults and 53.7 (95% CI 50.6–56.4) months in children. At 2 years of omalizumab exposure, rate of hospitalisation for asthma decreased by 75% and use of oral corticosteroids (OCS) by 30%, in adults and children. Among adults who discontinued omalizumab while asthma was controlled, 70%, 39% and 24% remained controlled and did not resume omalizumab at 1, 2 and 3 years after discontinuation, respectively. These proportions were higher in children (76%, 44% and 33%, respectively). Over 2 years of follow-up after discontinuation, HCRU remained stable in adults and children, notably rate of hospitalisations for asthma (none before TSTOP, 1.3% and 0.6% at 2 years) and use of OCS (in adults and children, respectively: 20.0% and 20.2% before TSTOP, 33.3% and 24.6% at 2 years).

Conclusion

This is the first large-scale study describing omalizumab real-life exposure patterns in adult and paediatric asthma patients in France with >10 years of follow-up. We showed the long-term maintenance of low HCRU in adults and children who discontinued omalizumab while asthma was controlled, notably for OCS use and hospitalisations for asthma.
Clinical and electrocardiogram presentations of patients with high serum potassium concentrations within emergency settings: a prospective study
Authors: Raffee Liqaa A. , Alawneh Khaled Z. , Ababneh Muhannad J. , Hijazi Heba H. , Al abdi Rabah M. , Aboozour Mahmoud M. , Alghzawi Fadi A. , Al-Mistarehi Abdel-Hameed
Published: May 2022

Background

Elevated potassium level is a common and reversible peri-arrest condition. Diagnosis and management of hyperkalemia in a short time is critical, where electrocardiogram (ECG) alterations might be helpful. We aimed to investigate the role of clinical features and ECGs in early diagnosing and treating hyperkalemia.

Methods

Prospectively, adult patients who presented to the emergency department (ED) from July 2019 to March 2020 with hyperkalemia (serum potassium ≥5.5mmol/L) were included. History was obtained, and laboratory investigations and ECGs were performed at the presentation and before initiating hyperkalemia therapy. Hyperkalemia severity was divided into mild (5.5–5.9mmol/L), moderate (6.0–6.4mmol/L), and severe (≥6.5mmol/L). A cardiologist and emergency physician blinded to laboratory values, study design, and patients’ diagnoses interpreted ECGs and presenting symptoms independently to predict hyperkalemia.

Results

Sixty-seven hyperkalemic patients with a mean (±SD) serum potassium level of 6.5±0.7mmol/L were included in this study. The mean age was 63.9±15.1, and 58.2% were females. Hyperkalemia was mild in 10.4%, moderate in 40.3%, and severe in 49.3%. Almost two thirds of patients (71.6%) had hypertension, 67.2% diabetes, and 64.2% chronic kidney disease. About one-quarter of patients (22.4%) were asymptomatic, while fatigue (46.3%), dyspnea (28.4%), and nausea/vomiting (20.9%) were the most common presenting symptoms. Normal ECGs were observed in 25.4% of patients, while alterations in 74.6%. Atrial fibrillation (13.4%), peaked T wave (11.9%), widened QRS (11.9%), prolonged PR interval (10.5%), and flattening P wave (10.5%) were the most common. Peaked T wave was significantly more common in severe hyperkalemia (87.5%) than in mild and moderate hyperkalemia (12.5%, 0.0%, respectively) (p=0.041). The physicians’ sensitivities for predicting hyperkalemia were 35.8% and 28.4%, improved to 51.5% and 42.4%, respectively, when limiting the analyses to severe hyperkalemia. The mean (±SD) time to initial hyperkalemia treatment was 63.8±31.5 min. Potassium levels were positively correlated with PR interval (r=0.283, p=0.038), QRS duration (r=0.361, p=0.003), peaked T wave (r=0.242, p=0.041), and serum levels of creatinine (r=0.347, p=0.004), BUN (r=0.312, p=0.008), and CK (r=0.373, p=0.039).

Conclusions

The physicians’ abilities to predict hyperkalemia based on ECG and symptoms were poor. ECG could not be solely relied on, and serum potassium tests should be conducted for accurate diagnosis.
Early life vitamin D depletion and mechanical loading determine methylation changes in the RUNX2, RXRA, and osterix promoters in mice
Authors: Krstic Nevena , Bishop Nick , Curtis Beth , Cooper Cyrus , Harvey Nick , Lilycrop Karen , Murray Robert , Owen Robert , Reilly Gwen , Skerry Tim , Borg Steph
Published: May 2022

Background

Early life vitamin D exposure is linked to later skeletal health with maternal vitamin D status in pregnancy associated with neonatal bone mass. The MAVIDOS study has demonstrated that vitamin D supplementation leads to reduced RXRA DNA methylation. Mice exposed to early life vitamin D deficiency have reduced bone mass and bone accrual in response to mechanical loading. Using the tibiae of these mice, we have examined the effect of diet and mechanical loading on the DNA methylation of promoters of genetic loci important for bone growth and development and their association with bone strength.

Results

Mechanical loading of mouse tibiae leads to a reduction of RXRA DNA methylation. Early life vitamin D deficiency is associated with altered methylation of osterix and Runx2 in these bones. Tibia strength was also demonstrated to be associated with a change in DNA methylation status in CpGs of the vitamin D receptor (VDR), ostrix, and RXRA genes.

Conclusions

We have shown for the first time that mechanical loading of bone and early life vitamin D deficiency leads to changes in the epigenome of this tissue in key genes in the vitamin D and osteoblast differentiation pathway.
Genetic variants associated with two major bovine milk fatty acids offer opportunities to breed for altered milk fat composition
Authors: Knutsen Tim Martin , Olsen Hanne Gro , Ketto Isaya Appelesy , Sundsaasen Kristil Kindem , Kohler Achim , Tafintseva Valeria , Svendsen Morten , Kent Matthew Peter , Lien Sigbjørn
Published: May 2022

Background

Although bovine milk is regarded as healthy and nutritious, its high content of saturated fatty acids (FA) may be harmful to cardiovascular health. Palmitic acid (C16:0) is the predominant saturated FA in milk with adverse health effects that could be countered by substituting it with higher levels of unsaturated FA, such as oleic acid (C18:1cis-9). In this work, we performed genome-wide association analyses for milk fatty acids predicted from FTIR spectroscopy data using 1811 Norwegian Red cattle genotyped and imputed to a high-density 777k single nucleotide polymorphism (SNP)-array. In a follow-up analysis, we used imputed whole-genome sequence data to detect genetic variants that are involved in FTIR-predicted levels of C16:0 and C18:1cis-9 and explore the transcript profile and protein level of candidate genes.

Results

Genome-wise significant associations were detected for C16:0 on Bos taurus (BTA) autosomes 11, 16 and 27, and for C18:1cis-9 on BTA5, 13 and 19. Closer examination of a significant locus on BTA11 identified the PAEP gene, which encodes the milk protein β-lactoglobulin, as a particularly attractive positional candidate gene. At this locus, we discovered a tightly linked cluster of genetic variants in coding and regulatory sequences that have opposing effects on the levels of C16:0 and C18:1cis-9. The favourable haplotype, linked to reduced levels of C16:0 and increased levels of C18:1cis-9 was also associated with a marked reduction in PAEP expression and β-lactoglobulin protein levels. β-lactoglobulin is the most abundant whey protein in milk and lower levels are associated with important dairy production parameters such as improved cheese yield.

Conclusions

The genetic variants detected in this study may be used in breeding to produce milk with an improved FA health-profile and enhanced cheese-making properties.
Paired guide RNA CRISPR-Cas9 screening for protein-coding genes and lncRNAs involved in transdifferentiation of human B-cells to macrophages
Authors: Arnan Carme , Ullrich Sebastian , Pulido-Quetglas Carlos , Nurtdinov Ramil , Esteban Alexandre , Blanco-Fernandez Joan , Aparicio-Prat Estel , Johnson Rory , Pérez-Lluch Sílvia , Guigó Roderic
Published: May 2022

CRISPR-Cas9 screening libraries have arisen as a powerful tool to identify protein-coding (pc) and non-coding genes playing a role along different processes. In particular, the usage of a nuclease active Cas9 coupled to a single gRNA has proven to efficiently impair the expression of pc-genes by generating deleterious frameshifts. Here, we first demonstrate that targeting the same gene simultaneously with two guide RNAs (paired guide RNAs, pgRNAs) synergistically enhances the capacity of the CRISPR-Cas9 system to knock out pc-genes. We next design a library to target, in parallel, pc-genes and lncRNAs known to change expression during the transdifferentiation from pre-B cells to macrophages. We show that this system is able to identify known players in this process, and also predicts 26 potential novel ones, of which we select four (two pc-genes and two lncRNAs) for deeper characterization. Our results suggest that in the case of the candidate lncRNAs, their impact in transdifferentiation may be actually mediated by enhancer regions at the targeted loci, rather than by the lncRNA transcripts themselves. The CRISPR-Cas9 coupled to a pgRNAs system is, therefore, a suitable tool to simultaneously target pc-genes and lncRNAs for genomic perturbation assays.
Microarray analysis of potential biomarkers of brachial plexus avulsion caused neuropathic pain in male rat
Authors: Wang Le , Lao Jie
Published: May 2022

The present study aimed to investigate the expression of mRNA in the brachial plexus avulsion neuropathic pain model and analyze biological functions. Microarray mRNA assay and reverse transcriptase quantitative polymerase chain reaction (RT-PCR) were conducted. The whole blood was collected from two groups for Microarray mRNA analysis. The predicted mRNA targets were studied by gene ontology analysis and pathway analysis. We identified 3 targeted mRNAs, including PIK3CB, HRAS, and JUN. The results showed that PIK3CB, HRAS, and JUN gene expression was increased in the control group but decreased in the neuropathic pain group. These findings indicate that certain genes may be important biomarkers for the potential targets for the prevention and treatment of brachial plexus avulsion caused neuropathic pain.
Introducing Advanced Paramedics into the rural general practice team in Ireland – general practitioners attitudes
Authors: Feerick F. , Connor C. O. , Hayes P. , Kelly D.
Published: May 2022

Introduction

As Ireland's population increases and chronic disease becomes more prevalent, demand on limited general practice services will increase. Nursing roles within general practice are now considered to be standard, yet alternative allied health professional roles are under explored within an Irish context. Allied health personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.

Aim

To explore General Practitioners’ (GPs) attitudes and opinions of integrating Advanced Paramedics (APs) into rural general practice in Ireland.

Methods

A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analysed.

Results

In totaln = 27 GPs responded to the survey andn = 13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes and even roles within the general practice surgery.

Conclusion

General Practitioner and Advanced Paramedic clinical practice dovetail within many facets of primary care and emergency care. GPs recognise that current rural models are unsustainable and realise the potential of integrating APs into the general practice team to help support and sustain the future of rural general practice services in Ireland. These interviews provided an exclusive, detailed insight into the world of general practice in Ireland that has not been previously documented in this way.
Development and validation of a risk score to predict the frequent emergency house calls among older people who receive regular home visits
Authors: Sun Yu , Iwagami Masao , Sakata Nobuo , Ito Tomoko , Inokuchi Ryota , Uda Kazuaki , Hamada Shota , Ishimaru Miho , Komiyama Jun , Kuroda Naoaki , Yoshie Satoru , Ishizaki Tatsuro , Iijima Katsuya , Tamiya Nanako
Published: May 2022

Background

The demand for home healthcare is increasing in Japan, and a 24-hour on-call system could be a burden for primary care physicians. Identifying high-risk patients who need frequent emergency house calls could help physicians prepare and allocate medical resources. The aim of the present study was to develop a risk score to predict the frequent emergency house calls in patients who receive regular home visits.

Methods

We conducted a retrospective cohort study with linked medical and long-term care claims data from two Japanese cities. Participants were ≥ 65 years of age and had newly started regular home visits between July 2014 and March 2018 in Tsukuba city and between July 2012 and March 2017 in Kashiwa city. We followed up with patients a year after they began the regular home visits or until the month following the end of the regular home visits if this was completed within 1 year. We calculated the average number of emergency house calls per month by dividing the total number of emergency house calls by the number of months that each person received regular home visits (1–13 months). The primary outcome was the “frequent” emergency house calls, defined as its use once per month or more, on average, during the observation period. We used the least absolute shrinkage and selection operator (LASSO) logistic regression with 10-fold cross-validation to build the model from 19 candidate variables. The predictive performance was assessed with the area under the curve (AUC).

Results

Among 4888 eligible patients, frequent emergency house calls were observed in 13.0% of participants (634/4888). The risk score included three variables with the following point assignments: home oxygen therapy (3 points); long-term care need level 4–5 (1 point); cancer (4 points). While the AUC of a model that included all candidate variables was 0.734, the AUC of the 3-risk score model was 0.707, suggesting good discrimination.

Conclusions

This easy-to-use risk score would be useful for assessing high-risk patients and would allow the burden on primary care physicians to be reduced through measures such as clustering high-risk patients in well-equipped medical facilities.
Factors associated with prolonged hospital stay of imported malaria cases in Chengdu, China: a retrospective study
Authors: Huang Liang , Jin Hong , Zhang Hong , Liu Yang , Shi Xinxing , Kang Xintong , Zeng Yilan , Wang Lin
Published: May 2022

Background

Although China has entered the post-malaria-elimination era, imported cases remain a public health concern in China.

Methods

We retrospectively analyzed data from cases of imported malaria from January 2017 to December 2020 in Chengdu Public Health Clinical Center. We assessed potential clinical, epidemiological, geographical, and seasonal effects on duration of hospital stay. Cox proportional hazards model was used to identify predictive factors for prolonged hospital stay. Multivariate logistic regression was used to assess the potential risk factors associated with severe cases.

Results

The highest number of imported cases of malaria were from the Democratic Republic of the Congo (23%, 34/150) and most patients (74%, 26/34) were infected by Plasmodium falciparum. The Edwards test indicated no significant seasonality in imported cases of malaria (χ2 = 2.51, p = 0.28). Bacterial infection (adjusted hazard ratio [aHR] for discharge = 0.58, p = 0.01) and thrombocytopenia (aHR = 0.66, p = 0.02) were risk factors for prolonged hospital stay. The C-reactive protein (OR = 1.02, p = 0.01) and procalcitonin (OR = 1.03, p = 0.01) were risk factors for severe cases.

Conclusions

Bacterial infection and thrombocytopenia are risk factors for prolonged hospital stay among imported malaria cases. The C-reactive protein and procalcitonin level were risk factors for severe cases.
A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behaviour
Authors: Koh Yen Sin , Asharani P. V. , Devi Fiona , Roystonn Kumarasan , Wang Peizhi , Vaingankar Janhavi Ajit , Abdin Edimansyah , Sum Chee Fang , Lee Eng Sing , Müller-Riemenschneider Falk , Chong Siow Ann , Subramaniam Mythily
Published: May 2022

Background

Physical inactivity and sedentary behaviour have detrimental consequences to the individual and the economy. Our study examined the prevalence of perceived barriers to physical activity in Singapore’s adult population and their associations with physical activity and sedentary behaviour.

Methods

This cross-sectional analysis utilised data from a nationwide survey in Singapore. Participants (n = 2867) were recruited from February 2019 to March 2020. The independent variables were internal (e.g. fatigue, age) and external (e.g. weather, cost) perceived barriers to physical activity. The outcomes were domain-specific physical activity (work, transport and leisure) and sedentary behaviour, all of which were assessed using the Global Physical Activity Questionnaire. The associations were examined using zero-inflated negative binomial regressions for physical activity and linear regression for sedentary behaviour.

Results

The median (Interquartile range) for work-related, transport-related and leisure-related physical activity were 0 (0 – 1440), 600 (160 – 1120) and 360 (0 – 1080) MET (metabolic equivalent)-minutes per week. The median sedentary behaviour (IQR) was 360 (240 – 540) minutes per day. The top three barriers were lack of time (65.3%), fatigue (64.7%) and pollution (56.1%). After adjustment, the level of transport-related physical activity was lower for respondents who cited lacking pavement or parks as a barrier, but higher for those who indicated cost and safety concerns. Respondents who reported pollution as a barrier were more likely to engage in transport-related physical activity. The level of leisure-related physical activity was lower for respondents indicating weather, lack of time and age as barriers, but higher for those reporting safety concerns. The odds of engaging in leisure-related physical activity was lower for those citing age, cost and fatigue as barriers, but higher for those indicating the weather. Sedentary behaviour was positively associated with work and limited accessibility to exercise facilities, but negatively with safety concerns.

Conclusion

Individuals can be motivated to overcome internal barriers (fatigue, lack of time, cost and age) through social support and emphasis on exercise benefits. External barriers (weather and lack of pavements or parks) can be reduced by raising awareness of existing infrastructure. Sedentary behaviour can be improved by implementing workplace measures, such as reducing the time spent sitting.
Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos
Authors: Kaplan Robert C. , Song Rebecca J. , Lin Juan , Xanthakis Vanessa , Hua Simin , Chernofsky Ariel , Evenson Kelly R. , Walker Maura E. , Cuthbertson Carmen , Murabito Joanne M. , Cordero Christina , Daviglus Martha , Perreira Krista M. , Gellman Marc , Sotres-Alvarez Daniela , Vasan Ramachandran S. , Xue Xiaonan , Spartano Nicole L. , Mossavar-Rahmani Yasmin
Published: May 2022

Background

Non-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly.

Methods

Clinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments.

Results

Four independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50–70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults.

Conclusions

The same four independent predictors – age, body mass index, hypertension and employment status – were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.
An individual nomogram can reliably predict tumor spread through air spaces in non-small-cell lung cancer
Authors: Wang Shuai , Shou Huankai , Wen Haoyu , Wang Xingxing , Wang Haixing , Lu Chunlai , Gu Jie , Xu Fengkai , Zhu Qiaoliang , Wang Lin , Ge Di
Published: May 2022

Background

Tumor spread through air spaces (STAS) has been shown to adversely affect the prognosis of lung cancer. The correlation between clinicopathological and genetic features and STAS remains unclear.

Method

We retrospectively reviewed 3075 NSCLC patients between2017-2019. We evaluated the relationship between STAS and patients’ clinicopathological and molecular features. The chi-square test was performed to compare categorical variables. Univariate analysis and multivariate logistic regression analysis were performed to investigate the association of clinical factors with STAS. A nomogram was formulated to predict the presence of STAS.

Results

STAS was identified in 617 of 3075 patients (20.07%). STAS was significantly related to sex (p < 0.001), smoking (p < 0.001), CEA (p < 0.001), differentiation (p < 0.001), histopathological type (p < 0.001), lymphatic vessel invasion (p < 0.001), pleural invasion (p < 0.001), T stage (p < 0.001), N stage (p < 0.001), M stage (p < 0.001), and TNM stage (p < 0.001). STAS was frequently found in tumors with wild-type EGFR (p < 0.001), KRAS mutations (p < 0.001), ALK rearrangements (p < 0.001) or ROS1 rearrangements (p < 0.001). For programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1), STAS was associated with PD-L1 expression level in tumor cells (p < 0.001) or stromal cells (p < 0.001), while PD-1 only in stromal cells (p < 0.001). Multivariable analyses demonstrated significant correlations between STAS and CEA level (p < 0.001), pathological grade (p < 0.001), lymphatic vessel invasion (p < 0.001), pleural invasion (p = 0.001), and TNM stage (p = 0.002). A nomogram was formulated based on the results of the multivariable analysis.

Conclusions

Tumor STAS was associated with several invasive clinicopathological features. A nomogram was established to predict the presence of STAS in patients with NSCLC.
Comparison of survival between patients receiving general outpatient palliative care and patients receiving other palliative care - analysis of data of a statutory health insurance data
Authors: Moon Kilson , Rehner Laura , Hoffmann Wolfgang , van den Berg Neeltje
Published: May 2022

Background

The care of palliative patients takes place as non-specialized and specialized care, in outpatient and inpatient settings. However, palliative care is largely provided as General Outpatient Palliative Care (GOPC). This study aimed to investigate whether the survival curves of GOPC patients differed from those of the more intensive palliative care modalities and whether GOPC palliative care was appropriate in terms of timing.

Methods

The study is based on claims data from a large statutory health insurance. The analysis included 4177 patients who received palliative care starting in 2015 and who were fully insured 1 year before and 1 year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with GOPC, and group B including patients who received inpatient or specialized outpatient palliative care. Group A was further divided into two subgroups. Patients who received GOPC on only 1 day were assigned to subgroup A1, and patients who received GOPC on two or more days were assigned to subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test.

Results

The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n = 2763) than in group B (47 days, n = 1424, p < 0.0001) and shorter in group A1 (35 days, n = 986) than in group A2 (217 days, n = 1767, p < 0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%).

Conclusions

The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received GOPC for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life.
Locally advanced rectal cancer receiving total neoadjuvant therapy combined with nivolumab: a case report and literature review
Authors: Mori Ryota , Uemura Mamoru , Sekido Yuki , Hata Tsuyoshi , Ogino Takayuki , Takahashi Hidekazu , Miyoshi Norikatsu , Mizushima Tsunekazu , Doki Yuichiro , Eguchi Hidetoshi
Published: May 2022

Background

The standard treatment for locally advanced rectal cancer (LARC) is preoperative chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy. However, it has been suggested that intensification of neoadjuvant treatment with polychemotherapy in addition to CRT instead of as an adjuvant chemotherapy is better tolerated and associated with a higher pathological complete response (pCR) rate. This concept is known as total neoadjuvant therapy (TNT).

Recently, the addition of immunotherapy to preoperative CRT has been reported to be useful in LARC patients with mismatch-repair-deficiency and high levels of microsatellite instability (MSI-H), but there are no reports showing the therapeutic effect of nivolumab in combination with TNT.

Case presentation

A 23-year-old man had frequent diarrhea. Preoperative examination revealed two adenocarcinomas in the rectum. His maternal grandmother had a rectal cancer patient who developed the disease at age 70s. The larger tumor was located at the peritoneal reflection, and its anterior border close to the prostate (<1 mm); there were eight enlarged pararectal lymph nodes. Considering the size and depth of the tumor, it was judged that radical resection with sufficient margins would be difficult. Therefore, it was decided that TNT would be performed. At first, CAPOX (capecitabine and L-OHP) was administered, followed by preoperative CRT (RT:50.4 Gy and capecitabine). During this period, genetic testing diagnosed this patient as MSI-H, so additional nivolumab was administered after CRT. Colonoscopy revealed that the larger tumor was no longer detectable, so robot-assisted intersphincteric resection and bilateral lateral lymph node dissection was performed. The diagnosis of pCR was made for the larger tumor and partial response was achieved for the smaller tumor, and no lymph node metastasis was found. Major complications were not observed and the patient was discharged on the 14th day after surgery. He was followed up without adjuvant chemotherapy and is alive and recurrence-free after 9 months.

Conclusion

A case of LARC with MSI-H was treated with TNT with nivolumab, resulting in pCR and complete radical resection. This result suggests that nivolumab in addition to TNT can be an option as a preoperative strategy for LARC with MSI-H.
Markers of systemic inflammation are positively associated with influenza vaccine antibody responses with a possible role for ILT2(+)CD57(+) NK-cells
Authors: Picard Emilie , Armstrong Sarah , Andrew Melissa K. , Haynes Laura , Loeb Mark , Pawelec Graham , Kuchel George A. , McElhaney Janet E. , Verschoor Chris P.
Published: May 2022

Background

With increasing age, overall health declines while systemic levels of inflammatory mediators tend to increase. Although the underlying mechanisms are poorly understood, there is a wealth of data suggesting that this so-called “inflammaging” contributes to the risk of adverse outcomes in older adults. We sought to determine whether markers of systemic inflammation were associated with antibody responses to the seasonal influenza vaccine.

Results

Over four seasons, hemagglutination inhibition antibody titres and ex vivo bulk peripheral blood mononuclear cell (PBMC) responses to live influenza viruses assessed via interferon (IFN)-γ/interleukin (IL)-10 production, were measured pre- and 4-weeks post-vaccination in young adults (n = 79) and older adults randomized to standard- or high-dose inactivated vaccine (n = 612). Circulating tumour necrosis factor (TNF), interleukin (IL)-6 and C-reactive protein (CRP) were also measured pre-vaccination. Post-vaccination antibody titres were significantly associated with systemic inflammatory levels; specifically, IL-6 was positively associated with A/H3N2 titres in young adults (Cohen’s d = 0.36), and in older high-dose, but not standard-dose recipients, all systemic inflammatory mediators were positively associated with A/H1N1, A/H3N2 and B titres (d = 0.10–0.45). We further show that the frequency of ILT2(+)CD57(+) CD56-Dim natural killer (NK)-cells was positively associated with both plasma IL-6 and post-vaccination A/H3N2 titres in a follow-up cohort of older high-dose recipients (n = 63). Pathway analysis suggested that ILT2(+)CD57(+) Dim NK-cells mediated 40% of the association between IL-6 and A/H3N2 titres, which may be related to underlying participant frailty.

Conclusions

In summary, our data suggest a complex relationship amongst influenza vaccine responses, systemic inflammation and NK-cell phenotype in older adults, which depends heavily on age, vaccine dose and possibly overall health status. While our results suggest that “inflammaging” may increase vaccine immunogenicity in older adults, it is yet to be determined whether this enhancement contributes to improved protection against influenza disease.
Ankle–foot orthosis with an oil damper versus nonarticulated ankle–foot orthosis in the gait of patients with subacute stroke: a randomized controlled trial
Authors: Yamamoto Sumiko , Motojima Naoyuki , Kobayashi Yosuke , Osada Yuji , Tanaka Souji , Daryabor Aliyeh
Published: May 2022

Background

Gait improvement in patients with stroke has been examined in terms of use or non-use of an ankle–foot orthosis (AFO), but the effects of different kinds of AFOs remain unclear. In this study, the effect on gait of using an AFO with an oil damper (AFO-OD), which has plantarflexion stiffness without dorsiflexion resistance, was compared with a nonarticulated AFO, which has both dorsiflexion and plantarflexion stiffness, in a randomized controlled trial.

Methods

Forty-one patients (31 men, 10 women; mean age 58.4 ± 11.3 years) in the subacute phase of stroke were randomly allocated to two groups to undergo gait training for 1 h daily over 2 weeks by physiotherapists while wearing an AFO-OD or a nonarticulated AFO. A motion capture system was utilized to measure shod gait without orthosis at baseline and after training with the allocated AFO. Data analysis focused on the joint kinematics and kinetics, spatial and temporal parameters, ground reaction force, and shank-to-vertical angle. Unpaired t-test or Mann–Whitney U test was performed to clarify the difference in gait with an AFO between the two AFO groups after training, with a significance level of p = 0.05.

Results

Thirty-six patients completed the study (17 in the AFO-OD group and 19 in the nonarticulated AFO group). The ankle joint was more dorsiflexed in single stance (p = 0.008, effect size r = 0.46) and peak ankle power absorption was larger in stance (p = 0.007, r = 0.55) in the AFO-OD group compared with the nonarticulated AFO group. Peak power absorption varied among patients in the AFO-OD group. Increased dorsiflexion angles were also found at initial contact (p = 0.008, r = 1.51), pre-swing (p = 0.045, r = 0.91), and the swing phase (p = 0.045, r = 0.91) in the AFO-OD group. There was no difference in peak plantarflexion moment, ankle power generation, spatial or temporal parameters, ground reaction force, or shank-to-vertical angle between the two groups.

Conclusions

The results of this study showed that an AFO with plantarflexion stiffness but without dorsiflexion resistance produced greater improvement in ankle joint kinematics and kinetics compared with the nonarticulated AFO, but the results of peak power absorption varied greatly among patients.

Trial registration UMIN000028126, Registered 1 August 2017, https://upload.umin.ac.jp/cgi-bin/icdr/ctr_menu_form_reg.cgi?recptno=R000032197
Lobbying and nutrition policy in Canada: a quantitative descriptive study on stakeholder interactions with government officials in the context of Health Canada’s Healthy Eating Strategy
Authors: Gaucher-Holm Alexa , Mulligan Christine , L’Abbé Mary R. , Potvin Kent Monique , Vanderlee Lana
Published: May 2022

Background

The political activities of industry stakeholders must be understood to safeguard the development and implementation of effective public health policies.

Methods

A quantitative descriptive study was performed using data from Canada’s Registry of Lobbyists to examine the frequency and governmental target of lobbying that occurred between various types of stakeholders (i.e., industry versus non-industry) and designated public office holders (DPOH) regarding Health Canada’s Healthy Eating Strategy, from September/2016 to January/2021. Initiatives of interest were revisions to Canada’s Food Guide, changes to the nutritional quality of the food supply, front-of-pack nutrition labelling and restrictions on food marketing to children.

Results

The majority of registrants (88%), and corporations and organizations (90%) represented in lobbying registrations had industry ties. Industry-affiliated stakeholders were responsible for 86% of communications with DPOH, interacting more frequently with DPOH of all ranks, compared to non-industry stakeholders. Most organizations and corporations explicitly registered to lobby on the topic of marketing to children (60%), followed by Canada’s Food Guide (48%), front-of-pack nutrition labelling (44%), and the nutritional quality of the food supply (23%). The food and beverage industry, particularly the dairy industry, was the most active, accounting for the greatest number of lobbying registrations and communications, followed by the media and communication industry.

Conclusions

Results suggest a strategic advantage of industry stakeholders in influencing Canadian policymakers. While some safeguards have been put in place, increased transparency would allow for a better understanding of industry discourse and help protect public health interests during the policy development process.
Detection of Cucumber green mottle mosaic virus in low-concentration virus-infected seeds by improved one-step pre-amplification RT-qPCR
Authors: Xinying Yin , Xin Li , Lili Yang , Qiuyue Zheng , Yongzhe Piao , Jijuan Cao
Published: May 2022

Background

Seeds were an important medium for long-distance transmission of plant viruses. Therefore, appropriate, more sensitive methods for detecting low concentrations of virus-infected in seeds were crucial to ensure the quality of seed lots. In this study, we have developed a one-step pre-amplification reverse transcription quantitative PCR (RT-qPCR) assay based on the TaqMan technology to detect Cucumber green mottle mosaic virus (CGMMV) in zucchini seeds.

Result

Seed powder samples with simulated CGMMV-infected at a low concentration were prepared (the mass ratio 1:900 and 1:1000), and their uniformity were verified using one-step pre-amplification RT-qPCR. We used one-step pre-amplification RT-qPCR to detect CGMMV in low-concentration virus-infected seeds and compared this method with universal RT-qPCR and double antibody sandwich–enzyme-linked immunosorbent (DAS–ELISA) assay, the main methods used for virus detection in seeds. The minimum limit of detection (LOD) of the improved one-step pre-amplification RT-qPCR assays for simulated CGMMV-infected seeds in large lots seeds samples were 0.1%.

Conclusions

One-step pre-amplification RT-qPCR assays could reliably and stably detected a single CGMMV-infected seed in 1000 seeds and demonstrated a higher detection sensitivity than universal RT-qPCR (infected seeds versus healthy seeds 1:900) and DAS–ELISA assay (infected seeds versus healthy seeds 1:500). Our improved one-step pre-amplification RT-qPCR assay have proved to be very suitable for the analysis of large seed lots.

Graphical Abstract