bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender differences in mortality and long-term functional outcomes after first-ever ischemic stroke: A prospective cohort study
Authors: Yun Sang Moon , Shin Seyoung , Chang Won Hyuk , Kim Deog Young , Lee Jongmin , Sohn Min Kyun , Song Min-Keun , Shin Yong-Il , Lee Yang-Soo , Joo Min Cheol , Lee So Young , Han Junhee , Ahn Jeonghoon , Oh Gyung-Jae , Kim Yun-Hee
Published: February 2023

Background:

Although many studies about survival rates and functional outcomes after stroke have been published, studies on gender differences have reported conflicting results.

Aims:

To determine whether there are differences in mortality and functional outcomes during the first 5 years after a first-ever ischemic stroke in Korean males and females.

Method:

This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation, a prospective multicenter cohort study. Multifaceted functional assessments were performed repeatedly from 7 days to 60 months after stroke onset to test motor, ambulatory, cognitive, language, and swallowing functions as well as activities of daily living (ADLs) in patients with first-ever stroke. Of 10,636 first-ever-stroke patients admitted to nine representative hospitals in Korea, 8210 were ischemic stroke patients included in the mortality analysis. Among them, 6258 patients provided informed consent and 3508 completed functional assessments for 60 months. Gender-related differences in 5-year mortality and functional recovery were analyzed.

Result:

Women showed a significantly higher 5-year mortality rate than men after correction for possible covariates ( p  < 0.05). In terms of functional outcomes, women showed worse ambulatory, cognitive, language, and ADL outcomes than men after adjusting for covariates (all p  < 0.05). The 5-year recovery pattern differed significantly between genders only for ADL function (β-coefficient estimate = 0.34; p  = 0.03).

Conclusion:

Five-year mortality rate, functional outcomes, and recovery patterns after first-ever ischemic stroke differed significantly by gender. These results suggest the need for gender-specific stroke care and long-term management strategies.
Popular media, war propaganda and retroactive continuity: The construction of the enemy in Marvel comics (1942–1981)
Authors: Pineda Antonio , Jiménez-Varea Jesús
Published: February 2023

The construction of the enemy is a technique whose potential effects are of outmost consequence for the relationships between the media, war and propaganda. In World War II, in addition to the official media, psychological warfare also relied on non-official propaganda conveyed through comic books whose levels of hatred for the enemy are hardly matched. This article aims to shed light on how superhero and war comic books mirror the construction and depiction of World War II enemies in American culture. The authors’ research compares the original wartime comics published by Marvel Comics with the representation of the war enemy conveyed by Marvel between the 1960s and the early 1980s. To test whether changes occurred, the authors conduct a diachronic content analysis of comic-book covers from both periods.
Knee pain in adults
Authors: Jones Clare , Rai Paul
Published: February 2023

Musculoskeletal complaints account for approximately 25% of consultations in general practice, with the knee being the second most common cause for consultation after the lumbosacral spine. A robust system for evaluation of knee pain in GP consultations is important for diagnostic and management strategies. The time limitations in primary care mean that a focused history and examination is appropriate. This article will take the form of a consultation, beginning with important points to be covered in history taking, discussing examination techniques and findings before considering diagnostic and management strategies.
Teaching primary care theory to promote general practice among medical students
Authors: Cooper Maxwell , Heath Jason , Fernandes Carl , Sornalingam Sangeetha , Jegatheesan Menaka
Published: February 2023

Here we describe and reflect upon teaching primary care theory within a fourth-year longitudinal module in general practice at Brighton and Sussex Medical School (2012 to 2021). Primary care theory teaching adopts a ‘hearts and minds’ approach towards promoting general practice. It appeals to students’ ‘hearts’ by highlighting the social justice function of general practice: tackling health inequalities by ensuring patients are treated in the right place, reducing cost and widening access to healthcare. These benefits also point to the place of general practice in promoting environmentally sustainable healthcare. By presenting evidence for the role of general practice in tackling health inequalities, we believe that our teaching also appeals to students' ‘minds’. Both approaches are important in order to counter the ‘hidden curriculum’ in undergraduate medicine which conveys negative messages about general practice.
Is Helicobacter pylori infection associated with pancreatic cancer? A systematic review and meta-analysis of observational studies
Authors: Zhou Ben-Gang , Mei Yu-Zhou , Wang Jing-Shu , Xia Jian-Lei , Jiang Xin , Ju Sheng-Yong , Ding Yan-Bing
Published: February 2023

Background and Objectives:

Recent observational studies have investigated the association between Helicobacter pylori ( H. pylori) infection and pancreatic cancer with conflicting data. Therefore, we conducted a systematic review and meta-analysis to assess the potential association.

Design:

This is a systematic review and meta-analysis.

Methods:

We searched three databases (PubMed, Embase, and Web of Science) from inception to 30 August 2022. The summary results as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) were pooled by generic inverse variance method based on random-effects model.

Results:

A total of 20 observational studies involving 67,718 participants were included in the meta-analysis. Meta-analysis of data from 12 case–control studies and 5 nested case–control studies showed that there was no significant association between H. pylori infection and the risk of pancreatic cancer (OR = 1.20, 95% CI = 0.95–1.51, p = 0.13). Similarly, we also did not find significant association between cytotoxin-associated gene A (CagA) positive strains, CagA negative strains, vacuolating cytotoxin gene A (VacA) positive strains H. pylori infection, and the risk of pancreatic cancer. Meta-analysis of data from three cohort studies showed that H. pylori infection was not significantly associated with an increased risk of incident pancreatic cancer (HR = 1.26, 95% CI = 0.65–2.42, p = 0.50).

Conclusion:

We found insufficient evidence to support the proposed association between H. pylori infection and increased risk of pancreatic cancer. To better understand any association, future evidence from large, well-designed, high-quality prospective cohort studies that accounts for diverse ethnic populations, certain H. pylori strains, and confounding factors would be useful to settle this controversy.
Preconception care in sub-Saharan Africa: A systematic review and meta-analysis on the prevalence and its correlation with knowledge level among women in the reproductive age group
Authors: Woldeyohannes Demelash , Tekalegn Yohannes , Sahiledengle Biniyam , Hailemariam Zeleke , Erkalo Desta , Zegeye Abraham , Tamrat Habtamu , Habte Akililu , Tamene Aiggan , Endale Fitsum , Ertiban Biruk , Ejajo Tekle , Kelbiso Lolamo , Liranso Lombamo , Desta Fikreab , Ermias Dejene , Mwanri Lillian , Enticott Joanne C.
Published: February 2023

Objective:

Preconception care is aimed to promote optimal health in women before conception to reduce or prevent poor pregnancy outcomes. Although there are several published primary studies from sub-Saharan African countries on preconception care, they need to quantify the extent of preconception care utilization, the knowledge level about preconception care, and the association among women in the reproductive age group in this region. This systematic review and meta-analysis aimed to estimate the pooled utilization of preconception care, pooled knowledge level about preconception care, and their association among women in the reproductive age group in sub-Saharan Africa.

Methods:

Databases including PubMed, Science Direct, Hinari, Google Scholar, and Cochrane library were systematically searched for relevant literature. Additionally, the references of included articles were checked for additional possible sources. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of preconception care, knowledge level of preconception care, and their correlation among reproductive-aged women in sub-Saharan African countries.

Results:

Of the identified 1593 articles, 20 studies were included in the final analysis. The pooled utilization of preconception care and good knowledge level about preconception care among women of reproductive age were found to be 24.05% (95% confidence interval: 16.61, 31.49) and 33.27% (95% confidence interval: 24.78, 41.77), respectively. Women in the reproductive age group with good knowledge levels were greater than two times more likely to utilize the preconception care than the women with poor knowledge levels in sub-Saharan African countries (odds ratio: 2.35, 95% confidence interval: 1.16, 4.76).

Conclusion:

In sub-Saharan African countries, the utilization of preconception care and knowledge toward preconception care were low. Additionally, the current meta-analysis found good knowledge level to be significantly associated with the utilization of preconception care among women of reproductive age. These findings indicate that it is imperative to launch programs to improve the knowledge level about preconception care utilization among women in the reproductive age group in sub-Saharan African countries.
Effect of transcranial magnetic stimulation on postural control of individuals with major depressive disorder: A case report
Authors: Bateni Hamid , Soltani Elham , Ali Kishwar , Zhou Haiming , Shad Mujeeb U
Published: February 2023

Accidental falls and major depressive disorder (MDD) are two common conditions associated with aging. Initial treatment of MDD often starts with administering antidepressants, followed by transcranial magnetic stimulation (TMS) for treatment-resistant individuals. The purpose of this case study was to determine the effect of repetitive TMS (rTMS) on postural control of an individual with MDD. A 44-year-old male with recurrent severe MDD was assessed for postural balance during eyes closed and eyes open conditions, pre and post three consecutive sessions receiving high-frequency rTMS (NeuroStar). Total excursion and velocity of sway significantly decreased following rTMS treatment when eyes were closed (p < 0.05). Power of the sway changed, but the changes were not statistically significant. The fractal dimension confidence circle area decreased significantly in eyes closed trials (p < 0.05). It appears that rTMS application can potentially impact postural steadiness in individuals with MDD. Our results warrant further studies with larger study samples.
Reassessment of Treatments in a Long-Term Care Unit
Authors: Ladjouzi Nadia , Romdhani Ahmed , Zouloumis Georges , Ould Ouali Cid , Jhouri Aziza , Schlatter Joël
Published: February 2023

The risks of iatrogenic medication related adverse events are high among older patients. Assessing prescriptions is critical to prevent overusing, underusing, or misusing medications. The aim of this study is to evaluate the prescription reassessment in older patients hospitalized in long-term care unit. Among the 30 patients ( Mage = 83 years, woman 66%), polymedication was present, patients taking 5 to 18 drugs (mean 11 drugs). The length of stay varied from 92 days to 4.5 years (mean 564 ± 430 days). The prescription reassessment of the patients hospitalized in our long-term care unit varied from 1 to 125 days with a mean of 16 days. Plan the prescription reassessment could reduce the iatrogenic medication in weakened patients.
Treatment of non-infectious retinal vasculitis
Authors: Rivera Paola A. , Gupta Akash , Kombo Ninani
Published: February 2023

Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.
People are the target: Urban destruction in the 21st century
Authors: Konvitz Josef
Published: February 2023

Urban destruction in the 21st century has already turned out to be different from 20th century experience. Aerial bombardment, which destroyed so many cities in Europe and Asia during two world wars, was based on assumptions about how cities collapse, bringing down economies and regimes with them, and about the superiority of air power as the means of destruction. Both were flawed. In World War II, the destruction of cities was intended to shorten a conflict; in the 21st century, military tactics which concentrate the increased weight, firepower, and effectiveness of military units in urban battles on the ground actually prolong conflict. Evacuation and exile appear to be the main objective: depopulation lowers the human capital of countries and depresses their economies; moreover, the increased number of refugees can be turned into an instrument to exert leverage on other countries, destabilizing regions far removed from the war zone. Cities destroyed in world wars were rebuilt; cities destroyed in today’s urban battles, often in fragile, unstable states, may be left in ruins for years, to be replaced by new cities with a change of population. Urban destruction in the 21st century raises questions about how to make cities safer, and about urban relocation and reconstruction.
Macroscale ecology in the 21st century: Toward multidisciplinary integration in advancement for scientific solutions of sustainable development
Authors: Lü Yihe , Luo Ying
Published: February 2023

Ecology research has continuously expanded over the last several decades, and is recently experiencing rapid development at the macroscale. Both the number and scope of macro-ecological studies have increased significantly since the beginning of the 21st century. There is a need to reveal the recent hotspotsand challenges of macroscale ecology research, and the macro-ecology and macrosystems ecology were proposed as a way to do this, with global and regional sustainability recognized. Through scientometric analyses, we highlighted common research frontiers and challenges: (1) increased research on ecological functions and processes; (2) taking developmental issues as the core at the macroscale; and (3) continually refined data, scaling methods and models. It is time to solve these existing and possible future problems with multidisciplinary integration to materialize a strong base for ecological sciences to achieve goals of regional and global sustainable development.
How I diagnose and treat neonatal thrombocytopenia
Authors: Stanworth Simon J , Mumford Andrew D.
Published: February 2023

Neonatal thrombocytopenia defined as the presence of a circulating platelet count <150x109/L is a common abnormality in babies admitted to Neonatal Intensive Care Units. Thrombocytopenia that is typically mild and self-limiting often accompanies neonatal stress in scenarios such as premature delivery or intrauterine growth restriction. However, the differential diagnosis of neonatal thrombocytopenia is wide and includes potential life-threatening disorders such as bacterial sepsis, viral infection and necrotizing enterocolitis. Distinguishing these causes of thrombocytopenia from entities such as genetic thrombocytopenia and fetal and neonatal alloimmune thrombocytopenia is critical for the accurate quantitation of significant adverse events such as intracranial bleeding and for the selection of treatments such as platelet transfusion. In this review, we focus on common differential diagnoses of neonatal thrombocytopenia and highlight how the landscape of diagnosis and management is changing with recent advances in genomic technology and the completion of pivotal clinical trials of platelet transfusion practice. Increasing evidence highlights the need for judicious and restrictive use of platelet transfusions in neonates.
The potentiality of biostimulant (Lawsonia inermis L.) on some morpho-physiological, biochemical traits, productivity and grain quality of Triticum aestivum L.
Authors: Maksoud Salwa A. , Gad Khaled I. , Hamed Eman Y. M.
Published: February 2023

Background

In conformity with the international trend to substitute the artificial agro-chemicals by natural products to improve growth and productivity of crops, there is a necessity to focus on the environment sustainable and eco-friendly resources to increase crops productivity per unit area. One of these resources is the use of biostimulants. The aim of this study is to allow the vertical expansion of wheat crop by improving its growth and productivity per unit area as well as enhancing its grain quality using henna leaf extract as a biostimulant.

Results

Field study was conducted to evaluate the potentiality of different doses of henna leaf extract (HLE) for improving the performance of wheat plants (Triticum aestivum L.) at three development stages. Results revealed that the response was dose dependent hence both 0.5 and 1.0 g/L doses significantly enhanced the growth of shoot and root systems, biochemical traits, yield and yield related components with being 1.0 g/L the most effective one. Furthermore, 1.0 g/L HLE markedly enhanced the quality of the yielded grains as revealed by increasing the content of soluble sugars (23%), starch (19%), gluten (50%), soluble proteins (37%), amylase activity (27%), total phenolics, flavonoids and tannins (67, 87 and 23%, respectively) as well as some elements including Ca (184%), Na and Fe (10%). Also, HPLC analysis of grains revealed that 1.0 g/L dose significantly increased the level of different phytohormones, soluble sugars and flavonoids (quercetin, resveratrol and catechin).

Conclusion

Application of Henna (Lawsonia inermis) leaf extract at 1.0 g/L dose as a combination of seed priming and foliar spray can be recommended as a nonpolluting, inexpensive promising biostimulant, it can effectively enhance wheat growth, biochemical traits and productivity as well as improving the quality of the yielded grains.
The effectiveness of atrial fibrillation special clinic on oral anticoagulant use for high risk atrial fibrillation patients managed in the community
Authors: Lau Ka Man , Leung To Fung , Li Yim Chu , Chen Catherine Xiao Rui
Published: February 2023

Background

Service gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.

Method

Quasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥ 2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.

Results

Among the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P < 0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P = 0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P = 0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.

Conclusion

AFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run.
Determining the key performance indicators of human resource management of military hospital managers; a TOPSIS study
Authors: Fanaei Sadegh , Zareiyan Armin , Shahraki Saeid , Mirzaei Abasat
Published: February 2023

Background

Proper human resource management in military health centers leads to long-term development and improved health-care quality. As a result, the purpose of this research is to identify the key performance indicators of human resource management for military hospital managers, and the unique indicators of military hospitals were obtained.

Methods

This cross-sectional study was performed by the TOPSIS method in the fall of 2021. This study used a checklist consisting of 20 performance indicators of human resource management, which were scored by 20 senior military hospital managers based on two criteria: "importance" and "measurability in military hospitals". The Shannon entropy method was used to weight the indicators, and the BT-TOPSIS Solver software was used to analyze and prioritize them.

Results

Among the 20 indicators in human resource management, the staff satisfaction index in military hospitals, the competitiveness rate of salaries in military hospitals relative to the national sector, the number of permanent staff in military hospitals, and the percentage of contract labor costs in military hospitals have the highest coefficient, respectively.

Conclusions

The importance of human resource management and organizational performance is due to their influence on each other. As a result, human resource management should pay special attention to the professional and personal development of human resources, as this has an impact on the performance of the organization in the long run. In light of the sensitive nature of human resource management and its crucial role in achieving any organization's strategic goals, selecting appropriate indicators is essential.

The Department of Military Health requires indicators unique to the military sector to assess the human resource management of the military hospital, since according to the existing circumstances, the indicators of the military sector and those of the civilian sector are different.
Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study
Authors: Yang Qing , Zhou Chen-Chen , Chen Ying , Pei Jin-Dan , Hua Xiao-Lin , Yao Li-Ping
Published: February 2023

Background

The use of cervical strain elastography for nulliparous women during late-term pregnancy remains unclear. This study assesses the predictive value of late-term cervical strain elastography for successful induction of labor (IOL) in nulliparous women.

Methods

This single-centered, prospective study included 86 patients undergoing IOL between January 2020 and March 2022. Univariate and multivariate analyses were conducted to identify predictive factors for successful IOL. The predictive values were assessed using the area under receiver operating characteristic (ROC) curves.

Results

IOL was successful in 58 patients. The hardness ratio and cervical length were significantly associated with successful late-term IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.

Conclusions

The hardness ratio and cervical length assessed by cervical strain elastography during late-term pregnancy are predictors of the success of IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.
Disparities and determinants of maternal health services utilization among women in poverty-stricken rural areas of China: a cross-sectional study
Authors: Yang Yuxuan , Yu Min
Published: February 2023

Background

Reducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson’s Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China.

Methods

A cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson’s model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization.

Results

Place of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC.

Conclusions

Inequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization.

We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women’s health literacy.
Single-copy Snail upregulation causes partial epithelial-mesenchymal transition in colon cancer cells
Authors: Junaid Fatima , Tomic Goran , Kemp Richard , Winton Doug J.
Published: February 2023

Background

Epithelial-mesenchymal transition (EMT) is an embryonic programme implicated in cancer stem cells, metastasis and therapeutic resistance. Its role in cancer progression remains controversial because the transition can be partial or complete in different models and contexts.

Methods

Using human colon cancer DLD-1 cells, we engineered a cell line with a single-copy of Snail that was doxycycline-inducible and compared it to existing EMT models in DLD-1. The effect of Snail upregulation was characterised functionally, morphologically, and by transcriptional profiling and protein expression.

Results

Induction with doxycycline increased Snail expression to a level similar to that observed in cancer cell lines spontaneously expressing Snail and results in partial EMT. In comparison, higher levels of overexpression arising from introduction of episomal-Snail, results in complete EMT. DLD-1 cells with partial EMT show chemoresistance in vitro, increased tumour growth in vivo and decreased apoptosis.

Conclusions

These findings highlight that the amount of bioavailable Snail can dictate phenotypic outcome and that partial EMT may be a preferred outcome of models operating within a natural range of Snail overexpression.
Socioeconomic inequalities in diabetes prevalence: the case of South Africa between 2003 and 2016
Authors: Sidahmed Sahar , Geyer Siegfried , Beller Johannes
Published: February 2023

Background

Diabetes is a growing epidemic worldwide and the effect of socioeconomic status (SES) is frequently acknowledged in the literature. This study aims to compare the effect of SES on diabetes prevalence in South Africa between 2003 and 2016. In addition, vulnerable groups regarding diabetes development in 2016 will be identified.

Methods

Using DHS data there were 8,006 participants (59.19% women) in 2003 and 10,292 participants (59.42% women) in 2016. Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for diabetes by age, gender, educational level and place of residence. To identify vulnerable groups with high risk of developing diabetes in 2016, the method of p-value based regression tree analysis was applied using “wealth index” and “weight perception” as additional variables.

Results

There was an increase in diabetes prevalence from 3.86% in 2003 to 4.46% in 2016. Women had more risk of developing diabetes at both time points (27% in 2003 and 24% in 2016 more risk). Increase in age and living in urban areas were associated with more risk of developing diabetes at both time points. There was no specific pattern regarding risk of developing diabetes and educational level in case of women. However, men who completed secondary school or had a higher diploma or above had more risk of developing diabetes in 2016 (OR = 2.24 and 4.67 respectively). Vulnerable groups who have higher risk of developing diabetes in 2016 were participants aged “60 years or older” with a wealth index of “rich” or “richer”, followed by participants from the same age group who were “poor” or “poorer” and participants aged “40–59 years” with a wealth index of “rich” or “richer”. Subsequently were participants from the age group “15–39 years” with a weight perception of “overweight” or “obese”.

Conclusion

Diabetes prevalence increased in South Africa between 2003 and 2016. Main risk factors were age, gender and living in urban areas. Men with high educational level were more at risk of developing diabetes in 2016. Vulnerable groups in 2016 were participants 40 years and older, particularly with high SES. This was followed by younger participants who were obese or overweight.
Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany
Authors: Buchmann Maike , Jordan Susanne , Loer Anne-Kathrin Mareike , Finger Jonas David , Domanska Olga Maria
Published: February 2023

Background

Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy.

Methods

Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status.

Results

High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39–1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75–0.95). The associations persisted after adjusting for covariates.

Conclusion

High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.
Epithelial senescence in idiopathic pulmonary fibrosis is propagated by small extracellular vesicles
Authors: Asghar Sabha , Monkley Susan , Smith David J. F. , Hewitt Richard J. , Grime Ken , Murray Lynne A. , Overed-Sayer Catherine L. , Molyneaux Philip L.
Published: February 2023

Background

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease that affects 3 million people worldwide. Senescence and small extracellular vesicles (sEVs) have been implicated in the pathogenesis of IPF, although how sEVs promote disease remains unclear. Here, we profile sEVs from bronchial epithelial cells and determine small RNA (smRNA) content.

Methods

Conditioned media was collected and sEVs were isolated from normal human bronchial epithelial cells (NHBEs) and IPF-diseased human bronchial epithelial cells (DHBEs).

Results

Increased sEV release from DHBEs compared to NHBEs (n = 4; p < 0.05) was detected by nanoparticle tracking analysis. NHBEs co-cultured with DHBE-derived sEVs for 72 h expressed higher levels of SA-β-Gal and γH2AX protein, p16 and p21 RNA and increased secretion of IL6 and IL8 proteins (all n = 6–8; p < 0.05). sEVs were also co-cultured with healthy air–liquid interface (ALI) cultures and similar results were observed, with increases in p21 and p16 gene expression and IL6 and IL8 (basal and apical) secretion (n = 6; p < 0.05). Transepithelial electrical resistance (TEER) measurements, a reflection of epithelial barrier integrity, were decreased upon the addition of DHBE-derived sEVs (n = 6; p < 0.05). smRNA-sequencing identified nineteen significantly differentially expressed miRNA in DHBE-derived sEVs compared to NHBE-derived sEVs, with candidate miRNAs validated by qPCR (all n = 5; p < 0.05). Four of these miRNAs were upregulated in NHBEs co-cultured with DHBE-derived sEVs and three in healthy ALI cultures co-cultured with DHBE-derived sEVs (n = 3–4; p < 0.05).

Conclusions

This data demonstrates that DHBE-derived sEVs transfer senescence to neighbouring healthy cells, promoting the disease state in IPF.
Plasma extracellular vesicles reveal early molecular differences in amyloid positive patients with early-onset mild cognitive impairment
Authors: Cano Amanda , Esteban-de-Antonio Ester , Bernuz Mireia , Puerta Raquel , García-González Pablo , de Rojas Itziar , Olivé Claudia , Pérez-Cordón Alba , Montrreal Laura , Núñez-Llaves Raúl , Sotolongo-Grau Óscar , Alarcón-Martín Emilio , Valero Sergi , Alegret Montserrat , Martín Elvira , Martino-Adami Pamela V. , Ettcheto Miren , Camins Antonio , Vivas Assumpta , Gomez-Chiari Marta , Tejero Miguel Ángel , Orellana Adelina , Tárraga Lluís , Marquié Marta , Ramírez Alfredo , Martí Mercè , Pividori María Isabel , Boada Mercè , Ruíz Agustín
Published: February 2023

In the clinical course of Alzheimer’s disease (AD) development, the dementia phase is commonly preceded by a prodromal AD phase, which is mainly characterized by reaching the highest levels of Aβ and p-tau-mediated neuronal injury and a mild cognitive impairment (MCI) clinical status. Because of that, most AD cases are diagnosed when neuronal damage is already established and irreversible. Therefore, a differential diagnosis of MCI causes in these prodromal stages is one of the greatest challenges for clinicians. Blood biomarkers are emerging as desirable tools for pre-screening purposes, but the current results are still being analyzed and much more data is needed to be implemented in clinical practice. Because of that, plasma extracellular vesicles (pEVs) are gaining popularity as a new source of biomarkers for the early stages of AD development. To identify an exosome proteomics signature linked to prodromal AD, we performed a cross-sectional study in a cohort of early-onset MCI (EOMCI) patients in which 184 biomarkers were measured in pEVs, cerebrospinal fluid (CSF), and plasma samples using multiplex PEA technology of Olink©proteomics. The obtained results showed that proteins measured in pEVs from EOMCI patients with established amyloidosis correlated with CSF p-tau181levels, brain ventricle volume changes, brain hyperintensities, and MMSE scores. In addition, the correlations of pEVs proteins with different parameters distinguished between EOMCI Aβ( +) and Aβ(-) patients, whereas the CSF or plasma proteome did not. In conclusion, our findings suggest that pEVs may be able to provide information regarding the initial amyloidotic changes of AD. Circulating exosomes may acquire a pathological protein signature of AD before raw plasma, becoming potential biomarkers for identifying subjects at the earliest stages of AD development.

Graphical Abstract
The first wave of COVID-19 and mental distress of physician residents in Brazil: a comparison between two cohorts
Authors: de Mélo Silva Júnior Mário Luciano , Sapia Arthur Violante , Cavalcanti Neto Jonas Marques , Barbosa Nathallya Maria Gomes , Neiva Victória Beatriz Costa , Sauaia Filho Euler Nicolau
Published: February 2023

Introduction

The reorganization of healthcare systems to face the COVID-19 pandemic has led to concerns regarding psychological distress of healthcare workers, and training requirements of physician residents.

Objective

To assess the influence of COVID-19 pandemic on depression, anxiety, burnout and training schedules of residents.

Methods

Two independent cross-sectional studies (the first in November 2019 [control], the second in June 2020, during the first wave of COVID-19 pandemic) enrolling physician residents from Brazil, using online surveys. In each of them, we collected demographic and training program data, and assessed depression, anxiety and burnout through PHQ-2, GAD-2 and MBI (2-item version) scales, respectively. We controlled confounding variables with logistic regression analysis.

Results

The COVID-19 cohort (n = 524) presented a briefer workload and had at least 1 day off per week more frequently, in relation to the control cohort (n = 1 419). The majority of residents (464/524, 89.5%) had a reduction in their duty hours, and believed they would need an extra training period after the end of the pandemic (399/524, 76.2%). The frequency of depression increased (46.0% vs. 58.8%, aOR = 1.64, 95% CI = 1.32–2.05), anxiety did not change (56.5% vs. 56.5%, aOR = 1.24, 95% CI = 0.99–1.55) and burnout decreased (37.0% vs. 26.1%, aOR = 0.77, 95% CI = 0.60–0.99). Sensitivity analysis did not change these results.

Conclusion

Mental distress is frequent among residents and associated with both training program and social environments. The consequences of the COVID-19 pandemic on training requirements should be specifically addressed by supervisors and policymakers, in a case-by-case basis. Psychological support must be provided to healthcare workers.
Mesenchymal stromal cell-associated migrasomes: a new source of chemoattractant for cells of hematopoietic origin
Authors: Deniz Ilker A. , Karbanová Jana , Wobus Manja , Bornhäuser Martin , Wimberger Pauline , Kuhlmann Jan Dominik , Corbeil Denis
Published: February 2023

Background

Multipotent mesenchymal stromal cells (MSCs) are precursors of various cell types. Through soluble factors, direct cell–cell interactions and other intercellular communication mechanisms such as extracellular vesicles and tunneling nanotubes, MSCs support tissue homeostasis. In the bone marrow microenvironment, they promote hematopoiesis. The interaction between MSCs and cancer cells enhances the cancer and metastatic potential. Here, we have demonstrated that plastic-adherent MSCs isolated from human bone marrow generate migrasomes, a newly discovered organelle playing a role in intercellular communication.

Results

Migrasomes are forming a network with retraction fibers behind the migrating MSCs or surrounding them after membrane retraction. The MSC markers, CD44, CD73, CD90, CD105 and CD166 are present on the migrasome network, the latter being specific to migrasomes. Some migrasomes harbor the late endosomal GTPase Rab7 and exosomal marker CD63 indicating the presence of multivesicular bodies. Stromal cell-derived factor 1 (SDF-1) was detected in migrasomes, suggesting that they play a chemoattractant role. Co-cultures with KG-1a leukemic cells or primary CD34+ hematopoietic progenitors revealed that MSC-associated migrasomes attracted them, a process intercepted by the addition of AMD3100, a specific CXCR4 receptor inhibitor, or recombinant SDF-1. An antibody directed against CD166 reduced the association of hematopoietic cells and MSC-associated migrasomes. In contrast to primary CD34+ progenitors, leukemic cells can take up migrasomes.

Conclusion

Overall, we described a novel mechanism used by MSCs to communicate with cells of hematopoietic origin and further studies are needed to decipher all biological aspects of migrasomes in the healthy and transformed bone marrow microenvironment.
Siponimod ameliorates experimental autoimmune neuritis
Authors: Uchi Takafumi , Konno Shingo , Kihara Hideo , Fujioka Toshiki
Published: February 2023

Background

Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) are human autoimmune peripheral neuropathy. Besides humoral immunity, cellular immunity is also believed to contribute to these pathologies, especially CIDP. Sphingosine-1-phosphate receptor 1 (S1PR1) regulates the maturation, migration, and trafficking of lymphocytes. As of date, the therapeutic effect of sphingosine-1-phosphate receptor (S1PR) agonists on patients with GBS or CIDP remains unclear.

Methods

To evaluate the effect of siponimod, an agonist of S1PR1 and S1PR5, on experimental autoimmune neuritis (EAN), an animal model of autoimmune peripheral neuropathy, was used. Lewis rats were immunized with 125 μg of synthetic peptide from bovine P2 protein. Rats in the siponimod group were orally administered 1.0 mg/kg siponimod and those in the EAN group were administrated the vehicle on days 5–27 post-immunization (p.i.) daily. The symptom severity was recorded daily. The changes in the expression of cytokines and transcription factors in the lymph nodes and cauda equina (CE) which correlate with the pathogenesis of EAN and recovery of injured nerve were measured using reverse transcription quantitative PCR. Histological study of CE was also performed.

Results

Flaccid paralysis developed on day 11 p.i. in both groups. Siponimod relieved the symptom severity and decreased the expression of interferon-gamma and IL-10 mRNAs in lymph nodes and CE compared with that in the EAN group. The expression of Jun proto-oncogene (c-Jun) mRNA increased from the peak to the recovery phase and that of Sonic hedgehog signaling molecule (Shh) and Glial cell line-derived neurotrophic factor (Gdnf) increased prior to increase in c-Jun with no difference observed between the two groups. Histologically, siponimod also reduced demyelinating lesions and inflammatory cell invasion in CE.

Conclusions

Siponimod has a potential to ameliorate EAN. Shh and Gdnf, as well as C-Jun played a significant role during the recovery of injured nerves.
Using mesh in capsule anatomical reconstruction to enhance the stability of high-dislocation-risk hip arthroplasty: a randomized controlled trial
Authors: Xin Peng , Ni Ming , Ji Quanbo , Yang Xiaoxi , Geng Lei , Wang Yan , Zhang Guoqiang
Published: February 2023

Background

Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA.

Methods

This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction.

Results

A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P < 0.001). There were minor differences in acetabular anteversion and abduction angle, and the other data showed no differences. MRI results indicated that the success rate of capsular repair was higher in the mesh group (50 hips, 98%) than in the conventional group (37 hips, 67%) (P < 0.001), and the others failed the repair. Three dislocations occurred in the conventional group, while none occurred in the mesh group. The preoperative HHS (30 points) and postoperative HHS (82 points) of the mesh group were similar to those (35 points, 83 points) of the conventional group (P = 0.164, P = 0.328). Satisfaction had no difference (P = 0.532).

Conclusions

Compared to conventional repair, mesh reconstruction can effectively maintain capsular integrity and decrease dislocation risk after THA without increasing complications.

Level of evidence: Therapeutic study, Level IA.