bluuebunny/crossref_metadata_2025 huggingface dataset:
Are restricted mean survival time methods especially useful for noninferiority trials?
Authors: Freidlin Boris , Hu Chen , Korn Edward L
Published: February 2021

Background:

Restricted mean survival time methods compare the areas under the Kaplan–Meier curves up to a time [Formula: see text] for the control and experimental treatments. Extraordinary claims have been made about the benefits (in terms of dramatically smaller required sample sizes) when using restricted mean survival time methods as compared to proportional hazards methods for analyzing noninferiority trials, even when the true survival distributions satisfy proportional hazardss.

Methods:

Through some limited simulations and asymptotic power calculations, the authors compare the operating characteristics of restricted mean survival time and proportional hazards methods for analyzing both noninferiority and superiority trials under proportional hazardss to understand what relative power benefits there are when using restricted mean survival time methods for noninferiority testing.

Results:

In the setting of low-event rates, very large targeted noninferiority margins, and limited follow-up past [Formula: see text], restricted mean survival time methods have more power than proportional hazards methods. For superiority testing, proportional hazards methods have more power. This is not a small-sample phenomenon but requires a low-event rate and a large noninferiority margin.

Conclusion:

Although there are special settings where restricted mean survival time methods have a power advantage over proportional hazards methods for testing noninferiority, the larger issue in these settings is defining appropriate noninferiority margins. We find the restricted mean survival time methods lacking in these regards.
Commoning Against the Corona Crisis
Authors: Lijster Thijs , De Tullio Maria Francesca
Published: February 2021

The Covid-19 crisis has highlighted the ‘precarity’ of human life in general, and particularly that of certain groups in society. It has debunked the myth of the autonomous, self-sufficient individual, and shows the extent to which we always already live ‘in common’, thereby also emphasizing the necessity of commons (of care, nurture, and economic resources). This research explores what role commons, as an antidote to precarity and a form of resistance against governmental precarization, can play in the current situation.

We start by analyzing the relationship between precarity and commons in light of the Covid-19 crisis. On the basis of participant observation in Naples (Italy) we will describe the commoning activities during the pandemic, their governmental invisibilization, and the way in which they could be institutionally recognized as a vital action of care and solidarity, also beyond the emergency. Finally, in the last part, we draw on the work of Roberto Esposito, and his use of the terms community and immunity, arguing that precisely because of the impossibility of fully immunizing ourselves from the virus (and from each other) we have to consider ourselves as part of a community, bound not by shared properties but by a shared obligation.
Pain-dependent learning in healthy volunteers
Authors: Del Sordo Giovanna C , Simon Dominic A
Published: February 2021

A state-dependent learning paradigm was studied in which healthy adult volunteers studied/encoded and recalled information from short passages, neutral in their content, in one of the following conditions: (1) Pain during study-Pain during both recall sessions; (2) Pain during study-No Pain during both recall sessions; (3) No Pain during study-Pain during both recall sessions; and (4) No Pain during study-No Pain during both recall sessions. Pain was experimentally induced using the cold pressor technique. In this study, we looked at evidence for state-dependent learning when the context of learning is not emotionally driven, but neutral. The memory task consisted of encoding detailed information about short stories, then recalling as many details as possible 20 min and 48 hr later. The results indicated no occurrence of a state-dependent learning and retrieval effect in this sample: Participants in the pain-no pain and no pain-pain conditions did not significantly perform differently than participants in the pain-pain and no pain-no pain conditions. However, a main effect of the state during study/encoding was significant, suggesting that being in pain during study had a detrimental effect on performance on the memory tests regardless of the state at retrieval. These results oppose previous studies’ findings and shed new light on possible implications in various research areas.
Trace elements in patients with aortic valve sclerosis
Authors: Al-Taesh Hataw , Çelekli Abuzer , Sucu Murat , Taysi Seyithan
Published: February 2021

Background:

Aortic valve sclerosis (AVSc) is defined as the thickening and calcification of aortic valve cusps, in the absence of obstruction of ventricular outflow. AVSc is linked with a clear imbalance in some trace elements.

Aims:

The objective of this study was to investigate the relationship between AVSc and serum levels of iron (Fe), zinc (Zn), selenium (Se), and copper (Cu). Additionally, this research aimed to explore the clinical significance of human serum zinc, selenium, copper, and iron concentrations as a potential new biomarker for AVSc patients and to clarify the pathophysiological role in individuals at risk of developing AVSc.

Patients and methods:

The study included 40 subjects with AVSc (25% male and 75% female) who were compared with a healthy control group with the same gender ratio. AVSc was based on comprehensive echocardiographic assessments. Blood samples were taken and Zn and Cu concentrations were determined through the use of atomic absorption spectroscopy. Se was measured using an inductively coupled plasma mass spectrometry device and Fe was measured using a Beckman Coulter instrument.

Results:

There was a significant difference in the prevalence of diabetes, blood pressure levels, and body mass index between the patients and the healthy subjects ( p < 0.05). The differences between the serum Fe, Se, and Cu levels of the AVSc patients and the healthy subjects ( p > 0.05) were recorded. The serum Zn of AVSc patients when compared was significantly lower compared with that of the control group ( p < 0.01).

Conclusion:

Patients with AVSc had an imbalance in some of the trace elements in their blood. The patient group’s valves had higher serum Cu levels and lower serum Se, Zn, and Fe concentrations compared with the healthy group’s valves. In the valve patients as compared, AVSc had a high prevalence of obesity, hypertension, and diabetes.
Optimization of Microwave-Assisted Extraction of Phlorotannin From Sargassum swartzii (Turn.) C. Ag. With Ethanol/Water
Authors: Toan Tran Quoc , Phong Tran Duy , Tien Dam Duc , Linh Nguyen Manh , Mai Anh Nguyen Thi , Hong Minh Pham Thi , Duy Le Xuan , Nghi Do Huu , Pham Thi Hai Ha , Nhut Pham Tri , Tung Ho Sy , Tung Nguyen Quang
Published: February 2021

Sargassum is a genus of brown macroalgae in the class Phaeophyta, distributed widely in all oceans, including those of Vietnam. Species of this genus have been proven to possess diverse biological activities, such as antioxidant, anti-fungal, and anti-inflammatory, along with many benefits and applications for human health, including anti-diabetic, obesity, and thrombosis. These benefits arise from a diverse chemical composition, with compounds such as fucoidan, mannitol, and especially phlorotannin—a group of phenolic derivatives found predominantly in brown algae. In this study, we evaluated and optimized the factors that affected the extraction process of phlorotannins from Sargassum swartzii (Turn.) C. Ag., a common species of brown macroalgae in Vietnam. The process utilized ethanol and water as the solvent system, and the extraction process was assisted with the use of microwaves. To carry out optimization studies, Response Surface Methodology (RSM) was adopted according to a Central Composite Desisgn (CCD), taking four processing factors into consideration, ethanol concentration (%, v/v), extraction time (minutes), solvent/material ratio (v/w), and microwave output power (W) as independent variables. Phlorotannin concentration (mgPhE/g) and extract mass (mg) were regarded as optimization outcomes. Experimental conditions that produced the highest phlorotannin yield from 10 g of S. swartzii are as follows: Extraction time of 65 minutes, ethanol concentration of 52%, microwave output power of 613 W, and solvent/material ratio of 33/1 (v/w). These conditions corresponded to a phlorotannin concentration of 5.59 ± 0.11 mg PhE/g, and a total extract content of 27.88 ± 0.13 mg/g.
Circular RNA‐HIPK3 regulates human pulmonary artery endothelial cells function and vessel growth by regulating microRNA‐328‐3p/STAT3 axis
Authors: Hong Liuqing , Ma Xiaoying , Liu Jiyuan , Luo Yinzhu , Lin Jincai , Shen Ying , Zhang Liyan
Published: February 2021

The proliferation and migration of pulmonary artery endothelial cells are the pathological basis of pulmonary vascular remodeling with pulmonary hypertension. Recent studies have shown that circular RNA (circRNA) regulates biological processes in various vascular diseases, including pulmonary arterial hypertension. It has been reported that circRNA regulates the vascular endothelial cells’ function. Therefore, circRNA may have crucial roles in human pulmonary artery endothelial cells (hPAECs) proliferation, migration, and tube formation in pulmonary arterial hypertension. In this study, we aimed to discover the role and mechanism of circular RNA HIPK3 (circHIPK3) in the proliferation and migration of pulmonary hypertension hPAECs. First, we used platelet‐derived growth factor—stimulated hPAECs as a cellular model of pulmonary arterial hypertension. The results showed that platelet‐derived growth factor promoted hPAECs proliferation, migration, and tube formation. Notably, platelet‐derived growth factor upregulated the expression of circHIPK3 in hPAECs and regulated their proliferation, migration, and angiogenesis. Mechanistically, we confirmed miR‐328‐3p was copiously pulled down by circHIPK3 in hPAECs. Luciferase reporter and RNA immunoprecipitation assays further indicated the cytoplasmic interactions between circHIPK3 and miR‐328‐3p. Subsequently, we found that circHIPK3 might increase the expression of STAT3 by sponging miR‐328‐3p. Collectively, our results demonstrated that the circHIPK3‐miR‐328‐3p‐STAT3 axis contributed to the pathogenesis of pulmonary arterial hypertension by stimulating hPAECs proliferation, migration, and angiogenesis. The circHIPK3 has an accelerated role in pulmonary arterial hypertension development, implicating the potential values of circHIPK3 in pulmonary arterial hypertension therapy.
Adolescents’ and young adults’ experiences of a prototype cancer smartphone app
Authors: Hanghøj Signe , Boisen Kirsten A , Hjerming Maiken , Pappot Helle
Published: February 2021

Objective

Smartphone cancer-related apps have been shown to meet some of the needs of adolescents and young adults (AYAs) during their cancer trajectory. However, there is a lack of apps evaluated by AYAs; thus, the quality of many of these apps has been contested. The aim of this study was to investigate the usefulness of a cancer smartphone app called Kræftværket. The AYA participants reflected on their first experiences of the app and whether it was a relevant and useful tool during and after their cancer trajectory.

Methods

A total of 20 AYA cancer patients aged 16-29 years (n = 10 on treatment, n = 10 in follow up) were provided with a prototype of the Kræftværket app during a 6-week test period (April-May 2018). After the test period, n = 17 participated in focus group interviews, which were analyzed thematically.

Results

The following themes were found: Sharing personal information (anonymity, safe communication, tough topics, videos and YouTube clips, tracking statistics); Normalcy (Seeing oneself reflected in in others, not alone, general and specific communities); Need for interaction (response from the app, information provided by the app, the app should give more back); and An everyday tool (integrating the app into daily routines, competition between app and Facebook group, temporary needs).

Conclusions

The app was perceived to be most relevant at disease onset. During the treatment period, both diagnosis-specific information and communities were requested. There was a call for a clearer distinction between the purpose of the app and other Facebook communities and for a notification function.
Multiliteracies for Combating Information Disorder and Fostering Civic Dialogue
Authors: Damasceno Cristiane S.
Published: February 2021

Widespread misleading stories circulating in networked public spheres have raised debates about their potential harm to democracies, organizations, and individuals. In the face of this challenge, educators have been rightly questioning how to prepare students to thrive in this so-called post-truth era. Scholarship on media and information literacies has often focused on incorporating new topics to address the issue and re-articulating learning goals. This body of work, however, does not address the question of how to deal with fast-paced changes that surround information disorder in the digital age. Based on Stuart Selber’s multiliteracies, this article proposes a set of competencies in combination with an analysis of the factors that contribute to the creation and circulation of false information. My argument focuses on students’ need to effectively identify misleading stories, thoughtfully question the role of technology in society, and ethically engage in civic dialogues. Taken together, these skills and knowledge provide a framework that they can expand upon as the landscape of information disorder shifts.
Relationship of Anterior Cruciate Ligament Volume and T2* Relaxation Time to Anterior Knee Laxity
Authors: Wang Hsin-Min , Shultz Sandra J. , Ross Scott E. , Henson Robert A. , Perrin David H. , Schmitz Randy J.
Published: February 2021

Background:

High anterior knee laxity (AKL) has been prospectively identified as a risk factor for anterior cruciate ligament (ACL) injuries. Given that ACL morphometry and structural composition have the potential to influence ligamentous strength, understanding how these factors are associated with greater AKL is warranted.

Hypothesis:

Smaller ACL volumes combined with longer T2* relaxation times would collectively predict greater AKL.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

College-aged active male (n = 20) and female (n = 30) participants underwent magnetic resonance imaging (MRI) and AKL testing. T2-weighted MRI scans were used to assess ACL volumes, and T2* relaxation times were used to assess ACL structural composition. AKL was measured via a commercial knee arthrometer. Forward stepwise linear regression with sex and weight (first step; suppressor variables) as well as ACL volume and T2* relaxation time (second step; independent variables) was used to predict AKL (dependent variable).

Results:

After initially adjusting for sex and weight ( R 2 = 0.19; P = .006), smaller ACL volumes combined with longer T2* relaxation times collectively predicted greater AKL ( R 2 = 0.52; P < .001; R 2 Δ = 0.32; P Δ < .001). A smaller ACL volume was the primary predictor of greater AKL ( R 2 Δ = 0.28; P < .001), with a longer T2* relaxation time trending toward a significant contribution to greater AKL ( R 2 Δ = 0.04; P = .062). After adjusting for ACL volume and T2* relaxation time, sex (partial r = 0.05; P = .735) and weight (partial r = 0.05; P = .725) were no longer significant predictors.

Conclusion:

AKL was largely predicted by ACL volume and to a lesser extent by T2* relaxation time (and not a person’s sex and weight). These findings enhance our understanding of how AKL may be associated with a structurally weaker ACL. The current study presents initial evidence that AKL is a cost-effective and clinically accessible measure that shows us something about the structural composition of the ACL. As AKL has been consistently shown to be a risk factor for ACL injuries, work should be done to continue to investigate what AKL may tell a clinician about the structure and composition of the ACL.
“Teachers Act Like We’re Robots”: TikTok as a Window Into Youth Experiences of Online Learning During COVID-19
Authors: Literat Ioana
Published: February 2021

Social media, and especially popular youth-focused platforms like TikTok, can offer a valuable window into youth experiences, including their perceptions of online learning. Building on a large-scale thematic analysis of 1,930 TikTok videos posted in March-June 2020, this study examines how young people shared their experiences of online learning during the COVID-19 pandemic. Findings indicate that youth portrayed online coursework as overwhelming and relentless against the traumatic background of the pandemic. They sought support, empathy, and authenticity from teachers, and both received and provided emotional and educational support to peers on the platform. Students’ home contexts emerged as particularly salient, making visible the intersections between young people’s home, school and social lives. By facilitating a grounded, bottom-up understanding of students’ experiences and perceptions—shared in their preferred spaces and modes of expression—this research stresses the need to attend to youth perspectives to craft more equitable and empowering educational futures.
Classification and effectiveness of different oxygenation goals in mechanically ventilated critically ill patients: network meta-analysis of randomised controlled trials
Authors: Zhao Xu , Xiao Huaping , Dai Feng , Brodie Daniel , Meng Lingzhong
Published: February 2021

Background

The optimal oxygenation in mechanically ventilated critically ill patients remains unclear.

Methods

We performed a systematic review of randomised controlled trials (RCTs) with the aim to classify oxygenation goals and investigate their relative effectiveness. RCTs investigating different oxygenation goal-directed mechanical ventilation in critically ill adult patients were eligible for the analysis. The trinary classification classified oxygenation goals into conservative (partial pressure of arterial oxygen (PaO2) 55–90 mmHg), moderate (PaO290–150 mmHg) and liberal (PaO2>150 mmHg). The quadruple classification further divided the conservative goal from the trinary classification into far-conservative (PaO255–70 mmHg) and conservative (PaO270–90 mmHg) goals. The primary outcome was 30-day mortality. The secondary outcomes included intensive care unit, hospital and 90-day mortalities. The effectiveness was estimated by the relative risk and 95% credible interval (CrI) using network meta-analysis and visualised using surface under the cumulative ranking curve (SUCRA) scores and survival curves.

Results

We identified eight eligible studies involving 2532 patients. There were no differences between conservative and moderate goals (relative risk 1.08, 95% CrI 0.85–1.36; moderate quality), between moderate and liberal goals (relative risk 0.83, 95% CrI 0.61–1.10; low quality) or between conservative and liberal goals (relative risk 0.89, 95% CrI 0.61–1.30; low quality) based on the trinary classification. There were no differences in secondary outcomes among the different goals. The results were consistent between the trinary and quadruple classifications. The SUCRA scores and survival curves suggested that the moderate goal in the trinary and quadruple classifications and the conservative goal in the quadruple classification may be superior to the liberal and far-conservative goals.

Conclusions

Different oxygenation goals do not lead to different mortalities in mechanically ventilated critically ill patients. The potential superiority of maintainingPaO2in the range 70–150 mmHg remains to be validated.
Correction to: CXCL9 secreted by tumor-associated dendritic cells up-regulates PD-L1 expression in bladder cancer cells by activating the CXCR3 signaling
Authors: Xiu Weigang , Luo Jingjing
Published: February 2021

An amendment to this paper has been published and can be accessed via the original article.
Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial
Authors: Niknam Sarabi Hojjat , Farsi Zahra , Butler Samantha , Pishgooie Amir Hosein
Published: February 2021

Background

Prolonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA.

Methods

This randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention.

Results

There was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention.

Conclusions

Position change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications.

Trial registration

Iranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020
Muscle quantity and function measurements are acceptable to older adults during and post- hospitalisation: results of a questionnaire-based study
Authors: Welch Carly , Greig Carolyn , Masud Tahir , Jackson Thomas A.
Published: February 2021

Background

To evaluate the acceptability of handgrip strength, gait speed, quadriceps ultrasound, and Bioelectrical Impedance Analysis (BIA) to older adults conducted during and following hospitalisation.

Methods

Questionnaire-based study conducted upon completion of prospective cohort study, with follow-up in either Queen Elizabeth Hospital Birmingham (QEHB), UK, or participant’s own home following recent admission to QEHB. Outcome measures were acceptability as defined by total multi-domain score for each test (maximum score 35), and by frailty status.

Results

Forty adults aged 70 years and older admitted for emergency abdominal surgery, elective colorectal surgery, or acute bacterial infections (general medicine) participated. Handgrip strength (median 33, IQR 30–35; p = 0.001), gait speed (median 32, IQR 30–35; p = 0.002), ultrasound quadriceps (median 33, IQR 31–35; p = 0.001), and BIA (median 33.5, IQR 31–35; p = 0.001) were considered highly acceptable. Participants responded positively that they enjoyed participating in these tests, and considered these tests of importance. There was no difference in scores between tests (p = 0.166). Individual total test scores did not differ between patients with and without frailty. Qualitative data are also presented on drivers for research participation.

Conclusions

Handgrip strength, gait speed, ultrasound quadriceps, and BIA are acceptable tests to older adults during and following hospitalisation. Our results may serve as standards when evaluating acceptability of other tests.

Trial registration

Prospectively registered February 2019: https://clinicaltrials.gov/ct2/show/NCT03858192
A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation
Authors: Mezaache Salim , Briand-Madrid Laélia , Rahni Linda , Poireau Julien , Branchu Fiona , Moudachirou Khafil , Wendzinski Yourine , Carrieri Patrizia , Roux Perrine
Published: February 2021

Background

Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID.

Methods

A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study.

Results

Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention.

Conclusions

ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection.
Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs
Authors: de Melo Ladjane Santos Wolmer , de Abreu Maria Verônica Monteiro , de Oliveira Santos Bernuarda Roberta , das Graças Washington Casimiro Carr Maria , de Souza Maria Fernanda Aparecida Moura , de Albuquerque Maria Carolina Andrade Lins , de Lacerda Vidal Claudia Fernanda , Lacerda Heloisa Ramos
Published: February 2021

Background

Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs.

Methods

A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI “Improvement Model”, during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project).

Result

A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation.

Conclusions

Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.
Discovery of breast cancer risk genes and establishment of a prediction model based on estrogen metabolism regulation
Authors: Zhao Feng , Hao Zhixiang , Zhong Yanan , Xu Yinxue , Guo Meng , Zhang Bei , Yin Xiaoxing , Li Ying , Zhou Xueyan
Published: February 2021

Background

Multiple common variants identified by genome-wide association studies have shown limited evidence of the risk of breast cancer in Chinese individuals. In this study, we aimed to uncover the relationship between estrogen levels and the genetic polymorphism of estrogen metabolism-related enzymes in breast cancer (BC) and establish a risk prediction model composed of estrogen-metabolizing enzyme genes and GWAS-identified breast cancer-related genes based on a polygenic risk score.

Methods

Unrelated BC patients and healthy subjects were recruited for analysis of estrogen levels and single nucleotide polymorphisms (SNPs) in genes encoding estrogen metabolism-related enzymes. The polygenic risk score (PRS) was used to explore the combined effect of multiple genes, which was calculated using a Bayesian approach. An independent sample t-test was used to evaluate the differences between PRS scores of BC and healthy subjects. The discriminatory accuracy of the models was compared using the area under the receiver operating characteristic (ROC) curve.

Results

The estrogen homeostasis profile was disturbed in BC patients, with parent estrogens (E1, E2) and carcinogenic catechol estrogens (2/4-OHE1, 2-OHE2, 4-OHE2) significantly accumulating in the serum of BC patients. We then established a PRS model to evaluate the role of SNPs in multiple genes. PRS model 1 (M1) was established from SNPs in 6 GWAS-identified high risk genes. On the basis of M1, we added SNPs from 7 estrogen metabolism enzyme genes to establish PRS model 2 (M2). The independent sample t-test results showed that there was no difference between BC and healthy subjects in M1 (P = 0.17); however, there was a significant difference between BC and healthy subjects in M2 (P = 4.9*10− 5). The ROC curve results showed that the accuracy of M2 (AUC = 62.18%) in breast cancer risk identification was better than that of M1 (AUC = 54.56%).

Conclusion

Estrogen and related metabolic enzyme gene polymorphisms are closely related to BC. The model constructed by adding estrogen metabolic enzyme gene SNPs has a good predictive ability for breast cancer risk, and the accuracy is greatly improved compared with that of the PRS model that only includes GWAS-identified gene SNPs.
A geospatiotemporal and causal inference epidemiological exploration of substance and cannabinoid exposure as drivers of rising US pediatric cancer rates
Authors: Reece Albert Stuart , Hulse Gary Kenneth
Published: February 2021

Background

Age-adjusted US total pediatric cancer incidence rates (TPCIR) rose 49% 1975–2015 for unknown reasons. Prenatal cannabis exposure has been linked with several pediatric cancers which together comprise the majority of pediatric cancer types. We investigated whether cannabis use was related spatiotemporally and causally to TPCIR.

Methods

State-based age-adjusted TPCIR data was taken from the CDC Surveillance, Epidemiology and End Results cancer database 2003–2017. Drug exposure was taken from the nationally-representative National Survey of Drug Use and Health, response rate 74.1%. Drugs included were: tobacco, alcohol, cannabis, opioid analgesics and cocaine. This was supplemented by cannabinoid concentration data from the Drug Enforcement Agency and ethnicity and median household income data from US Census.

Results

TPCIR rose while all drug use nationally fell, except for cannabis which rose. TPCIR in the highest cannabis use quintile was greater than in the lowest (β-estimate = 1.31 (95%C.I. 0.82, 1.80), P = 1.80 × 10− 7) and the time:highest two quintiles interaction was significant (β-estimate = 0.1395 (0.82, 1.80), P = 1.00 × 10− 14). In robust inverse probability weighted additive regression models cannabis was independently associated with TPCIR (β-estimate = 9.55 (3.95, 15.15), P = 0.0016). In interactive geospatiotemporal models including all drug, ethnic and income variables cannabis use was independently significant (β-estimate = 45.67 (18.77, 72.56), P = 0.0009). In geospatial models temporally lagged to 1,2,4 and 6 years interactive terms including cannabis were significant. Cannabis interactive terms at one and two degrees of spatial lagging were significant (from β-estimate = 3954.04 (1565.01, 6343.09), P = 0.0012). The interaction between the cannabinoids THC and cannabigerol was significant at zero, 2 and 6 years lag (from β-estimate = 46.22 (30.06, 62.38), P = 2.10 × 10− 8). Cannabis legalization was associated with higher TPCIR (β-estimate = 1.51 (0.68, 2.35), P = 0.0004) and cannabis-liberal regimes were associated with higher time:TPCIR interaction (β-estimate = 1.87 × 10− 4, (2.9 × 10− 5, 2.45 × 10− 4), P = 0.0208). 33/56 minimum e-Values were > 5 and 6 were infinite.

Conclusion

Data confirm a close relationship across space and lagged time between cannabis and TPCIR which was robust to adjustment, supported by inverse probability weighting procedures and accompanied by high e-Values making confounding unlikely and establishing the causal relationship. Cannabis-liberal jurisdictions were associated with higher rates of TPCIR and a faster rate of TPCIR increase. Data inform the broader general consideration of cannabinoid-induced genotoxicity.
Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017
Authors: Amini Maedeh , Zayeri Farid , Salehi Masoud
Published: February 2021

Background

Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.

Methods

The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.

Results

The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.

Conclusions

Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.
Having less and wanting more: an investigation of socioeconomic status and reinforcement pathology
Authors: Crandall Amanda K. , Ziegler Amanda M. , Mansouri Tegan , Matteson Jalen , Isenhart Emily , Carter Autum , Balantekin Katherine N. , Temple Jennifer L.
Published: February 2021

Background

In the United states obesity and socioeconomic status (SES), or one’s standing in society based on income, education, and/or occupation, are strongly associated. The mechanisms for this relationship may include having high levels of motivation to get food (reinforcing value of food; RRV) and low levels of inhibitory control (delay discounting; DD) which, when combined, is referred to as reinforcement pathology (RP). We sought to examine the relationships among multiple measures of household SES, RP, and age-adjusted body mass index (zBMI) among adolescents.

Methods

These data were collected as part of ongoing longitudinal study of risk factors for obesity in 244 adolescents. The adolescents and one parent/guardian had height and weight measured and completed surveys. The adolescents completed an adjusting amount DD task and a computer-based RRV task. Analyses consisted of correlations among measures of SES and RRV, DD, and BMI z-scores. In the case of significant associations, multiple regression models were created with theoretically informed covariates.

Results

Household income, parent/guardian education, parent/guardian occupation, and food insecurity status were all related to one another. Among the adolescents, a significant portion of the variance in RRV was accounted for by household income after controlling for covariates. For DD, it was parent/guardian education that was most associated after controlling for covariates.

Conclusion

When low income and low parent/guardian education occur together, there may be an increased risk of RP. Separately, food insecurity was predictive of higher parent/guardian BMI. Future research should continue to explore the effects of low income and parent/guardian education on RP among youth by examining them over time.
Plasma mitochondrial DNA levels are associated with acute lung injury and mortality in septic patients
Authors: Mao Jia-yu , Li Dong-kai , Zhang Hong-min , Wang Xiao-ting , Liu Da-wei
Published: February 2021

Background

Mitochondrial DNA (mtDNA) is a critical activator of inflammation. Circulating mtDNA released causes lung injury in experimental models. We hypothesized that elevated plasma mtDNA levels are associated with acute lung injury (ALI) in septic patients.

Methods

We enrolled 66 patients with sepsis admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital between January 2019 and October 2019. Respiratory, hemodynamic and bedside echocardiographic parameters were recorded. Plasma mtDNA, procalcitonin, interleukin 6, and interleukin 8 levels were examined.

Results

Plasma mtDNA levels within 24 h after admission were significantly increased in the group of septic patients with ALI [5.01 (3.38–6.64) vs 4.13 (3.20–5.07) log copies/µL, p 0.0172]. mtDNA levels were independently associated with mortality (hazard ratio, 3.2052; 95% CI 1.1608–8.8500; p 0.0253) and ALI risk (odds ratio 2.7506; 95% CI 1.1647–6.4959; p 0.0210). Patients with high mtDNA levels had worse outcomes, and post hoc tests showed significant differences in 28-day survival rates. Increased mtDNA levels were seen in patients with abdominal infection.

Conclusions

Increased plasma mtDNA levels within 24 h after admission were significantly associated with ALI incidence and mortality in septic patients.
A rare case of multiple endocrine neoplasia type 1 initially presenting as an asymptomatic, huge mediastinal mass: case report
Authors: Jun Ji Eun , Hwang You-Cheol , Ahn Kyu Jeong , Chung Ho Yeon , Jeong In-Kyung
Published: February 2021

Background

Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited syndrome that concurrently involves various endocrine glands. We report a rare case of MEN1 in a 43-year-old man whose first manifestation was an asymptomatic mediastinal mass.

Case presentation

A 13-cm-sized mediastinal mass was diagnosed as an atypical thymic carcinoid by computed tomography and percutaneous needle biopsy. In addition, hypercalcemia from a left inferior parathyroid hyperplasia, and a non-functioning gastric neuroendocrine tumor seen on esophagogastroduodenoscopy were found. Therefore, the patient was clinically diagnosed with MEN1 syndrome, and underwent surgical resection of thymic carcinoid tumor after pre-operative concurrent chemoradiation therapy to decrease tumor size and volume. Parathyroid lesion and gastric neuroendocrine tumor were also removed. Finally, a MEN1 gene mutation was observed in the patient and his 7-year-old son.

Conclusion

Despite its rare occurrence, thymic carcinoid tumor should be considered as a MEN1-associated tumor and necessitates screening of other endocrine glands. Thymic carcinoid tumor carries a poor prognosis in patients with MEN1, and thus it needs to be carefully monitored even after radical excision.
Oral health promotion practices of Australian community mental health professionals: a cross sectional web-based survey
Authors: McGrath Roisin , Marino Rodrigo , Satur Julie
Published: February 2021

Background

This study explored the oral health promotion practices of Australian community mental health professionals working with people living with severe mental illness (SMI).

Methods

An anonymous cross-sectional web-based survey was distributed to all Community Rehabilitation and Support Workers (CRSWs) working at Neami National (n = 471), an Australian community mental health service. The validated questionnaire assessed participants’ self-rated oral health knowledge and confidence (7 questions); their perceived barriers (9 questions) and attitudes (5 questions) to oral health promotion; and their oral health promotion practices (7 questions). Differences in responses between groups were analysed using Chi-square, Fisher’s exact and Mann–Whitney U tests. Logistic Regression Analysis served to explore the probability of providing oral health support to mental health consumers.

Results

A total of 141 CRSWs were included in this study, achieving a response rate of 30 percent. Roughly two-fifths (39.0%) of participants had oral health training in the previous 12-months. The majority of CRSWs (89.3%) believed (‘Agreed’ or ‘Strongly agreed’) that mental health support workers have a role to play in promoting oral health. However, less than half (44.0%) of CRSWs practiced oral health promotion activities when working with mental health consumers. When asked about barriers to promoting oral health, ‘lack of consumer interest’ was the most prevalent issue. CRSWs who had oral health training were over three-times (OR 3.5, 95% CI 1.25–9.83, p = 0.017) more likely to provide oral health support. Results showed the provision of oral health support was most strongly associated with self-rated knowledge and confidence (OR 4.089, 95% CI 1.629–10.263, p = 0.003) and attitudes to oral health promotion (OR 3.906, 95% CI 1.77–8.65, p = 0.001).

Conclusion

The results of this study suggest that mental health support workers who have more positive attitudes to oral health promotion and who have higher self-rated oral health knowledge and confidence are more likely to provide oral health support in their professional role. Training for community mental health professionals is essential to build confidence and skills to promote oral health for mental health consumers.
Human papillomavirus infection rate, distribution characteristics, and risk of age in pre- and postmenopausal women
Authors: Shen Yan , Xia Jing , Li Huihui , Xu Yang , Xu Sanping
Published: February 2021

Background

The incidence rate of cervical cancer is increasing yearly. The persistent infection of high-risk human papillomavirus (HPV) is the main factor leading to cervical cancer. HPV infection is double peak type. This study aimed at analyzing the HPV distribution characteristics, infection rate, and risk of age in pre- and postmenopausal women. So as to provide reference for the prevention of HPV infection and cervical cancer screening strategy.

Methods

A retrospective analysis of 4614 women who underwent cervical cytology, and HPV examination from January 2018 to October 2019 at the healthcare department of Wuhan Union Hospital was done. We explored the characteristics and distribution of HPV infections around the menopause, then comparing the infection rate of HPV in postmenopause and over 65 years old, in order to analyze the influence of different ages on HPV infection.

Results

Generally, the HPV infection rate was 13.10% (539/4115), whereby the high-risk subtype constituted 73.84% (398/539) of all positive cases. On the other hand, the HPV39 infection was more common in postmenopausal women; however, there was no significant difference in the distribution of the other types in the pre- and postmenopausal women. The first four types were 52/53/58/16. The results further showed that the rates of HPV infection before and after menopause were 12.34% (367/2975) and 15.09% (172/1140), respectively, which had no significant difference (P = 0.056), but more susceptible to high-risk HPV infection after the age of 65 (P = 0.041). Except for 40 years old to menopause, the infection rate of high-risk HPV in this age group was different from that in postmenopause (P = 0.023, 0.729 (0.555, 0.957)), other age groups had no significant effect on high-risk HPV infection.

Conclusions

It was concluded that whether menopause has nothing to do with HPV infection. Moreover, the risk of high-risk HPV infection in women aged 40 to premenopausal is relatively low, but the infection rate increases after 65. Hence the cutoff screening age should be appropriately prolonged.