bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelets upregulate tumor cell programmed death ligand 1 in an epidermal growth factor receptor-dependent manner in vitro
Authors: Guo Qiuchen , Malloy Michael W. , Roweth Harvey G. , McAllister Sandra S. , Italiano Joseph E. , Battinelli Elisabeth M.
Published: April 2022

Programmed death ligand 1 (PD-L1) is an immune checkpoint protein that suppresses cytotoxic T lymphocytes and is often overexpressed in cancers. Due to favorable clinical trial results, immune checkpoint inhibition (ICI) is part of Food and Drug Administration approved immuno-oncology therapies; however, not all patients benefit from ICI therapy. High blood platelet-to-lymphocyte ratio has been associated with failure of ICI treatment, but whether platelets have a role in hindering ICI response is unclear. Here, we report that coculturing platelets with cancer cell lines increased protein and gene expression of tumor cell PD-L1, which was reduced by antiplatelet agents, such as aspirin and ticagrelor. Platelet cytokine arrays revealed that the well-established cytokines, including interferon-γ, were not the main regulators of platelet-mediated PD-L1 upregulation. Instead, the high molecular weight epidermal growth factor (EGF) is abundant in platelets, which caused an upregulation of tumor cell PD-L1. Both an EGF-neutralizing antibody and cetuximab (EGF receptor [EGFR] monoclonal antibody) inhibited platelet-induced increases in tumor cell PD-L1, suggesting that platelets induce tumor cell PD-L1 in an EGFR-dependent manner. Our data reveal a novel mechanism for platelets in tumor immune escape and warrant further investigation to determine if targeting platelets improves ICI therapeutic responses.
Dexmedetomidine attenuates oxygen-glucose deprivation/ reperfusion-induced inflammation through the miR-17-5p/ TLR4/ NF-κB axis
Authors: Suo Liangyuan , Wang Mingyu
Published: April 2022

Background

Dexmedetomidine (DEX) is a selective agonist of α2-adrenergic receptors with anesthetic activity and neuroprotective benefits. However, its mechanism of action at the molecular level remains poorly defined. In this study, we investigated the protective effects of DEX on oxygen-glucose deprivation/ reperfusion (OGD/R)-induced neuronal apoptosis in PC12 cells, and evaluated its underlying mechanism(s) of neuroprotection and anti-inflammation.

Methods

An OGD/R model in PC12 cells was established. PC12 cells were cultured and divided into control, OGD/R, and OGD/R + DEX (1 μM, 10 μM, 50 μM) groups. Cell apoptosis was analyzed by flow cytometry and expression profiles were determined by qRT-PCR, western blot analysis, and enzyme linked immunosorbent assays (ELISA). The interaction between miRNA and its downstream targets was evaluated through luciferase reporter assays.

Results

DEX significantly decreased apoptosis rates and inhibited interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) release (P < 0.05). While expression of the pro-apoptotic proteins Bax and Caspase-3 was down-regulated, expression of Bcl-2 was upregulated in a dose-dependent manner (P < 0.05). Interestingly, miR-17-5p expression was down-regulated in the OGD/R group (compared to controls). Toll-like receptor 4 (TLR4), a key regulator of nuclear factor kappa-B (NF-κB) signaling, was identified as a novel target of miR-17-5p in PC12 cells. miR-17-5p expression was upregulated in the OGD/R + DEX group, suppressing TLR4 expression and reducing the secretion of proinflammatory cytokines.

Conclusion

DEX inhibits OGD/R-induced inflammation and apoptosis in PC12 cells by increasing miR-17-5p expression, downregulating TLR4, and inhibiting NF-κB signaling.
National trend in heart failure hospitalization and outcome under public health insurance system in Thailand 2008–2013
Authors: Janwanishstaporn Satit , Karaketklang Khemajira , Krittayaphong Rungroj
Published: April 2022

Background

There are limited data on the burden, characteristics, and outcomes of hospitalized heart failure (HF) patients in Thailand. The aim of this study was to investigate national trend in HF hospitalization rate, in-hospital and 1-year mortality rate, and rehospitalization rate in Thailand.

Methods

We analyzed the claims data of hospitalized patients obtained from the three major Thailand public health reimbursement systems between 2008 and 2013. Patients aged ≥ 18 years with a principal diagnosis of HF by the International Classification of Diseases, Tenth Revision, Thai modification were included. Comorbidities were identified by secondary diagnosis codes. The annual rate of HF hospitalization was calculated per 100,000 beneficiaries. Records of subsequent hospitalization of discharged patients were retrieved. For 1-year mortality rate, vital status of each patient was obtained from Thai Civil Registration of Death database. All outcomes were tested for linear trends across calendar years.

Results

Between 2008 and 2013, 434,933 HF hospitalizations were identified. The mean age was 65.3 years (SD 14.6), and 58.1% were female. The HF hospitalization rate increased from 138 in 2008 to 168 per 100,000 beneficiaries in 2013 (P for trend < 0.001). Nearly half (47.4%) had had a prior HF admission within 1 year. A small proportion of patients (7.4%) received echocardiography during hospitalization. The median length of hospital stay was 3 days. In-hospital mortality declined from 4.4 to 3.8% (P for trend < 0.001). The overall 30-day and 1-year rehospitalization rates were 34 and 73%, respectively, without significant trends over the study period. Most common cause of 30-day rehospitalization was HF (42%). One-year mortality decreased from 31.8% in 2008 to 28.5% in 2012 (P for trend < 0.001).

Conclusion

Between 2008 and 2013, HF hospitalization rate in Thailand increased. The in-hospital and 1-year mortality rates decreased slightly. However, the rehospitalization rate remained high mainly due to recurrent HF hospitalization.
Predictors of critical care, mechanical ventilation, and mortality among hospitalized patients with COVID-19 in an electronic health record database
Authors: Chomistek Andrea K. , Liang Caihua , Doherty Michael C. , Clifford C. Robin , Ogilvie Rachel P. , Gately Robert V. , Song Jennifer N. , Enger Cheryl , Lin Nancy D. , Wang Florence T. , Seeger John D.
Published: April 2022

Background

There are limited data on risk factors for serious outcomes and death from COVID-19 among patients representative of the U.S. population. The objective of this study was to determine risk factors for critical care, ventilation, and death among hospitalized patients with COVID-19.

Methods

This was a cohort study using data from Optum’s longitudinal COVID-19 electronic health record database derived from a network of healthcare provider organizations across the US. The study included patients with confirmed COVID-19 (presence of ICD-10-CM code U07.1 and/or positive SARS-CoV-2 test) between January 2020 and November 2020. Patient characteristics and clinical variables at start of hospitalization were evaluated for their association with subsequent serious outcomes (critical care, mechanical ventilation, and death) using odds ratios (OR) and 95% confidence intervals (CI) from logistic regression, adjusted for demographic variables.

Results

Among 56,996 hospitalized COVID-19 patients (49.5% male and 72.4% ≥ 50 years), 11,967 received critical care, 9136 received mechanical ventilation, and 8526 died. The median duration of hospitalization was 6 days (IQR: 4, 11), and this was longer among patients that experienced an outcome: 11 days (IQR: 6, 19) for critical care, 15 days (IQR: 8, 24) for mechanical ventilation, and 10 days (IQR: 5, 17) for death. Dyspnea and hypoxemia were the most prevalent symptoms and both were associated with serious outcomes in adjusted models. Additionally, temperature, C-reactive protein, ferritin, lactate dehydrogenase, D-dimer, and oxygen saturation measured during hospitalization were predictors of serious outcomes as were several in-hospital diagnoses. The strongest associations were observed for acute respiratory failure (critical care: OR, 6.30; 95% CI, 5.99–6.63; ventilation: OR, 8.55; 95% CI, 8.02–9.11; death: OR, 3.36; 95% CI, 3.17–3.55) and sepsis (critical care: OR, 4.59; 95% CI, 4.39–4.81; ventilation: OR, 5.26; 95% CI, 5.00–5.53; death: OR, 4.14; 95% CI, 3.92–4.38). Treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers during hospitalization were inversely associated with death (OR, 0.57; 95% CI, 0.54–0.61).

Conclusions

We identified several clinical characteristics associated with receipt of critical care, mechanical ventilation, and death among COVID-19 patients. Future studies into the mechanisms that lead to severe COVID-19 disease are warranted.
Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) cancer survivor health: program project protocols for remote lifestyle intervention and assessment in 3 inter-related randomized controlled trials among survivors of obesity-related cancers
Authors: Pekmezi Dori , Fontaine Kevin , Rogers Laura Q. , Pisu Maria , Martin Michelle Y. , Schoenberger-Godwin Yu-Mei , Oster Robert A. , Kenzik Kelly , Ivankova Nataliya V. , Demark-Wahnefried Wendy
Published: April 2022

Background

Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project.

Methods

Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis.

Discussion

Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors.

Trial registration

ClinicalTrials.gov, NCT04000880. Registered 27 June 2019.
Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial
Authors: Ghasemi Masoomeh , Hoseinialiabadi Poria , Yazdanpanah Fatemeh , Mahani Maryam Askaryzadeh , Malekyan Leila , Najafi Kazem , Arab Mohammadreza , Arab Mansour , Ranjbar Hadi
Published: April 2022

Background

Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia.

Methods

The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements.

Results

During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control.

Conclusions

Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation.

Trial registration

The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904.
Maternal stress, child behavior and the promotive role of older siblings
Authors: Amici Federica , Röder Stefan , Kiess Wieland , Borte Michael , Zenclussen Ana C. , Widdig Anja , Herberth Gunda
Published: April 2022

Background

In the first years of their lives, children develop the cognitive, social and emotional skills that will provide the foundations for their lifelong health and achievements. To increase their life prospects and reduce the long-term effects of early aversive conditions, it is therefore crucial to understand the risk factors that negatively affect child development and the factors that are instead beneficial. In this study, we tested (i) the effects of different social and environmental stressors on maternal stress levels, (ii) the dynamic relationship between maternal stress and child behavior problems during development, and (iii) the potential promotive (i.e. main) or protective (i.e. buffering) effect of siblings on child behavior problems during development.

Methods

We used longitudinal data from 373 mother–child pairs (188 daughters, 185 sons) from pregnancy until 10 years of age. We assessed maternal stress and child behavior problems (internalizing and externalizing) with validated questionnaires, and then used linear mixed models, generalized linear mixed models and longitudinal cross-lagged models to analyze the data.

Results

Our results showed that higher maternal stress levels were predicted by socio-environmental stressors (i.e. the lack of sufficient social areas in the neighborhood). Moreover, prenatal maternal stress reliably predicted the occurrence of behavior problems during childhood. Finally, the presence of older siblings had a promotive function, by reducing the likelihood that children developed externalizing problems.

Conclusions

Overall, our results confirm the negative effects that maternal stress during pregnancy may have on the offspring, and suggest an important main effect of older siblings in promoting a positive child development.
Impact of anxiety and depression on the prognosis of copd exacerbations
Authors: Martínez-Gestoso Sandra , García-Sanz María-Teresa , Carreira José-Martín , Salgado Francisco-Javier , Calvo-Álvarez Uxío , Doval-Oubiña Liliana , Camba-Matos Sandra , Peleteiro-Pedraza Lorena , González-Pérez Miguel-Angel , Penela-Penela Pedro , Vilas-Iglesias Andrés , González-Barcala Francisco-Javier
Published: April 2022

Background

Frequent and highly prevalent as comorbidities in Chronic Obstructive Pulmonary Disease (COPD) patients, both depression and anxiety seem to have an impact on COPD prognosis. However, they are underdiagnosed and rarely treated properly.

Aim

To establish the prevalence of depression and anxiety in patients admitted for Acute Exacerbation of COPD (AECOPD) and determine their influence on COPD prognosis.

Methods

Prospective observational study conducted from October 1, 2016 to October 1, 2018 at the following centers in Galicia, Spain: Salnés County Hospital, Arquitecto Marcide, and Clinic Hospital Complex of Santiago de Compostela. Patients admitted for AECOPD who agreed to participate and completed the anxiety and depression scale (HADS) were included in the study.

Results

288 patients (46.8%) were included, mean age was 73.7 years (SD 10.9), 84.7% were male. 67.7% patients were diagnosed with probable depression, and depression was established in 41.7%; anxiety was probable in 68.2% and established in 35.4%. 60.4% of all patients showed symptoms of both anxiety and depression. Multivariate analysis relates established depression with a higher risk of late readmission (OR 2.06, 95% CI 1.28; 3.31) and a lower risk of mortality at 18 months (OR 0.57, 95% CI 0.37; 0.90).

Conclusion

The prevalence of anxiety and depression in COPD patients is high. Depression seems to be an independent factor for AECOPD, so early detection and a multidisciplinary approach could improve the prognosis of both entities. The study was approved by the Ethical Committee of Galicia (code 2016/460).
“My life became more meaningful”: confronting one’s own end of life and its effects on well-being—a qualitative study
Authors: Kukla Helena , Herrler Angélique , Strupp Julia , Voltz Raymond
Published: April 2022

Background

The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress.

To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts.

Methods

Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach.

Results

While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted.

Conclusions

There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action.

Trial registration

www.germanctr.de, DRKS-ID: DRKS00020577.
Microcredentials training in pharmacy practice and education: an exploratory study of its viability and pharmacists’ professional needs
Authors: Lok Peggy , Beyene Kebede , Awaisu Ahmed , Woods David , Kheir Nadir
Published: April 2022

Background

Microcredentials (MCs) are short courses that certify/recognise an individual’s achievement of specific skills or knowledge. Schools of pharmacy could be well-placed to contribute to the continuing professional development (CPD) of pharmacists through the inclusion of MCs training in their programs. This study aimed to explore pharmacy professionals’ views on the need and viability of MC courses globally.

Methods

Eleven semi-structured telephone interviews were conducted with pharmacy practitioners, policymakers, and academics across seven countries. The participants were selected using purposive sampling to explore information from varying pharmacy disciplines. Interviews were audio-recorded, transcribed verbatim, and analysed using a general inductive approach.

Results

Participants regarded MCs in pharmacy as an innovative idea, well-suited to the increasingly technology-driven world. They believe MCs provide easily accessible means of skills and knowledge acquisition that fulfils the needs of the pharmacy profession. MCs were also perceived as an alternative pathway of meeting the requirements of traditional CPD programmes. Many participants believe universities are well-suited to provide MCs; however, numerous challenges such as recognition, time and resources have been identified as potential barriers to enrolment and implementation.

Conclusions

This study provides an insight into the views of pharmacy practitioners and academics on MCs, and their potential utility in pharmacy education and practice. The findings should help in the development of MCs that could be utilised by pharmacy practitioners around the world for CPD purposes. This study comes at a time when alternative models of teaching and learning are being explored as a direct result of the COVID-19 pandemic.
Improving medical term embeddings using UMLS Metathesaurus
Authors: Chanda Ashis Kumar , Bai Tian , Yang Ziyu , Vucetic Slobodan
Published: April 2022

Background

Health providers create Electronic Health Records (EHRs) to describe the conditions and procedures used to treat their patients. Medical notes entered by medical staff in the form of free text are a particularly insightful component of EHRs. There is a great interest in applying machine learning tools on medical notes in numerous medical informatics applications. Learning vector representations, or embeddings, of terms in the notes, is an important pre-processing step in such applications. However, learning good embeddings is challenging because medical notes are rich in specialized terminology, and the number of available EHRs in practical applications is often very small.

Methods

In this paper, we propose a novel algorithm to learn embeddings of medical terms from a limited set of medical notes. The algorithm, calleddefinition2vec, exploits external information in the form of medical term definitions. It is an extension of a skip-gram algorithm that incorporates textual definitions of medical terms provided by the Unified Medical Language System (UMLS) Metathesaurus.

Results

To evaluate the proposed approach, we used a publicly available Medical Information Mart for Intensive Care (MIMIC-III) EHR data set. We performed quantitative and qualitative experiments to measure the usefulness of the learned embeddings. The experimental results show thatdefinition2veckeeps the semantically similar medical terms together in the embedding vector space even when they are rare or unobserved in the corpus. We also demonstrate that learned vector embeddings are helpful in downstream medical informatics applications.

Conclusion

This paper shows that medical term definitions can be helpful when learning embeddings of rare or previously unseen medical terms from a small corpus of specialized documents such as medical notes.
A case of superficial spreading type of poorly differentiated adenocarcinoma of the stomach with invasion to the esophagus
Authors: Mase Junichi , Adachi Takahito , Kiriyama Shunya , Horaguchi Takeshi , Yawata Kazunori , Ikawa Aiko , Sano Bun , Imai Susumu , Okamoto Kiyohisa , Shiroko Takashi
Published: April 2022

Background

Invasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions.

Case presentation

A 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas (por, sig) were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence.

Conclusion

We encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal.
Evaluation of Apixaban safety and effectiveness in morbidly obese patients with atrial fibrillation: a retrospective cohort study
Authors: Al Sulaiman Khalid , Badreldin Hisham A. , Korayem Ghazwa B. , Alenazi Abeer A. , Alsuwayyid Faisal , Alrashidi Abdulrahman , Alhijris Mohammed , Almutairi Faisal , Alharthi Fahad , Vishwakarma Ramesh , Al Shaya Omar , Al Amri Abdulrahman , Tayyab Saqiba , Al Bekairy Abdulkareem M. , Aljuhani Ohoud
Published: May 2022

Background

The benefit of apixaban to reduce stroke risk in morbidly obese patients with nonvalvular atrial fibrillation (AF) is still undetermined. The International Society of Thrombosis and Hemostasis recommends avoiding the use of direct oral anticoagulants (DOAC)s in morbidly obese patients (body mass index > 40 or weight > 120 kg) because of limited clinical data. This exploratory study aims to evaluate the effectiveness and safety of using apixaban in morbidly obese (body mass index (BMI) ≥ 40) patients with AF.

Methods

An exploratory retrospective cohort study was conducted at a single-center, including adult patients with non-valvular AF using apixaban between 01/01/2016 and 31/12/2019. Patients were excluded if they were known to have liver cirrhosis Child-Pugh C, mechanical valve, serum creatinine > 1.5 mg/dL, follow up < 3 months, or using apixaban with a dose of ≤5 or > 10 mg/day. Included patients were categorized into two groups based on their BMI (BMI<40 Vs. BMI ≥ 40). The primary outcome was all thrombotic events, while the secondary outcomes were major and minor bleeding after apixaban initiation. Propensity score (PS) matching was used (1:1 ratio) based on the patient’s age, gender, and HAS-BLED score.

Results

A total of 722 patients were eligible; 254 patients were included after propensity score matching based on the selected criteria. The prevalence of all thrombotic events was similar between the two groups in the first year of apixaban initiation (OR (95%CI): 0.58 (0.13, 2.5), p-value = 0.46). In addition, the odds of developing major and minor bleeding were not statistically significant between the two groups (OR (95%CI): 0.39 (0.07, 2.03), p-value = 0.26 and OR (95%CI): 1.27 (0.56, 2.84), p-value = 0.40), respectively).

Conclusion

This exploratory study showed similar effectiveness and safety of apixaban use in both morbid and non-morbid obese patients with non-valvular AF. However, a larger randomized controlled trial with a longer follow-up period needs to confirm our findings.
I expected to be pain free: a qualitative study exploring athletes’ expectations and experiences of care received by sports chiropractors
Authors: Eindhoven Evan , Lee Alex , Stilwell Peter , Mior Silvano
Published: May 2022

Background

Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care.

Objective

To explore the athletes’ expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research.

Methods

A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories.

Results

We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants’ perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration.

Conclusions

In general, participants were very satisfied with care. Overall, participants’ expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed.
Genome-wide DNA Methylation Differences in Nonfunctioning Pituitary Adenomas With and Without Postsurgical Progression
Authors: Hallén Tobias , Johannsson Gudmundur , Dahlén Rahil , Glad Camilla A M , Örndal Charlotte , Engvall Angelica , Carén Helena , Skoglund Thomas , Olsson Daniel S
Published: April 2022

Context

Tumor progression in surgically treated patients with nonfunctioning pituitary adenomas (NFPAs) is associated with excess mortality. Reliable biomarkers allowing early identification of tumor progression are missing.

Objective

To explore DNA methylation patterns associated with tumor progression in NFPA patients.

Methods

This case-controlled exploratory trial at a university hospital studied patients who underwent surgery for NFPA that had immunohistochemical characteristics of a gonadotropinoma. Cases included patients requiring reintervention due to tumor progression (reintervention group, n = 26) and controls who had a postoperative residual tumor without tumor progression for at least 5 years (radiologically stable group, n = 17). Genome-wide methylation data from each tumor sample were analyzed using the Infinium MethylationEPIC BeadChip platform.

Results

The analysis showed that 605 CpG positions were significantly differently methylated (differently methylated positions, DMPs) between the patient groups (false discovery rate adjusted P value < 0.05, beta value > 0.2), mapping to 389 genes. The largest number of DMPs were detected in the genes NUP93 and LGALS1. The 3 hypomethylated DMPs and the 3 hypermethylated DMPs with the lowest P values were all significantly (P < 0.05) and individually associated with reintervention-free survival. One of the hypermethylated DMPs with the lowest P value was located in the gene GABRA1.

Conclusion

In this exploratory study, DNA methylation patterns in NFPA patients were associated with postoperative tumor progression requiring reintervention. The DMPs included genes that have been previously associated with tumor development. Our study is a step toward finding epigenetic signatures to predict tumor progression in patients with NFPA.
The Valuation of Local School Quality under School Choice
Authors: Zheng Angela
Published: April 2022

School choice programs break the link between residential location and school attendance, and should weaken the capitalization of school quality into house prices. For the first time, I quantify the effect of one such program—charter school expansions—across several states using a dataset covering charter entries and house prices. I embed an event study of charter entry into a boundary discontinuity design and find that, on average, school choice decreases the valuation of traditional schools by four percentage points. Suggestive evidence shows school choice can lead to neighborhood change through resorting as school boundaries become less important. (JEL H75, I21, I24, I28, R23, R31)
Contemporary transformations of myth
Authors: Μαζαράκης Ιωάννης
Published: April 2022

Η μελέτη του μύθου έχει ιστορία σχεδόν ανάλογη με αυτή του ίδιου του μύθου. Οι πρώτες καταγεγραμμένες μυθικές αναλύσεις εντοπίζονται στην Αρχαία Ελλάδα και στην κριτική που ασκεί ο Ξενοφάνης στα Ομηρικά έπη. Από τότε, πολλές διαφορετικές θεωρητικές προσεγγίσεις έχουν διαμορφωθεί ανά τους αιώνες, με διαφορετικά σημεία εστίασης και διαφορετικές ερευνητικές μεθοδολογίες. Βασικός στόχος της παρούσας έρευνας είναι η διερεύνηση των διαχρονικά επαναλαμβανόμενων μυθικών μοτίβων και των διαδοχικών τους μεταμορφώσεων, με την χρήση ενός νέου μεθοδολογικού εργαλείου που συνδυάζει έννοιες δανεισμένες από τον σημειωτικό στρουκτουραλισμό και το πεδίο της μελέτης των αφηγηματικών διασκευών (adaptation studies). Ο συνδυασμός του σημειωτικού στρουκτουραλισμού (ως ένα εργαλείο χαρτογράφησης των σχέσεων μεταξύ των στοιχείων του μύθου και των πολιτισμικών τους συνδηλώσεων) και της μελέτης των αφηγηματικών διασκευών (ως ένα εργαλείο έρευνας των σχέσεων μεταξύ των μύθων και των σημειωτικών τους συσχετισμών) θα οδηγήσει σε ένα συνεκτικό θεωρητικό εργαλείο, το οποίο θα χρησιμοποιηθεί στην ανάλυση συγκεκριμένων μύθων και των πιο πρόσφατων διασκευών τους. Η παρούσα διατριβή εστιάζει στους μύθους του Δράκουλα, του Εωσφόρου και της Κοκκινοσκουφίτσας, των οποίων οι πολλαπλές μεταμορφώσεις στην σύγχρονη εποχή φαίνεται να αναδεικνύουν μια λιγότερη δυϊστική και Μανιχαϊστική και περισσότερο σχετικιστή αντίληψη του μύθου και του κόσμου.
Using behavioural science to enhance use of core outcome sets in trials: protocol
Authors: Matvienko-Sikar Karen , Byrne Molly , Clarke Mike , Kirkham Jamie , Kottner Jan , Mellor Katie , Quirke Fiona , J. Saldanha Ian , Smith Valerie , Toomey Elaine , Williamson Paula
Published: April 2022

Background: Core outcome sets (COS) represent agreed-upon sets of outcomes, which are the minimum that should be measured and reported in all trials in specific health areas. Use of COS can reduce outcome heterogeneity, selective outcome reporting, and research waste, and can facilitate evidence syntheses. Despite benefits of using COS, current use of COS in trials is low. COS use can be understood as a behaviour, in that it is something trialists do, or not do, adequately. The aim of this study is to identify stakeholder-prioritised strategies, informed by behaviour change theory, to increase COS use in trials.

Methods: The project will be conducted in three stages, informed by the behaviour change wheel (BCW). The BCW is a theoretically based framework that can be used to classify, identify, and develop behaviour change strategies. In Stage 1, barriers and enablers to COS use will be extracted from published studies that examined trialist’s use of COS. Barriers and facilitators will be mapped to the components of COM-B model (capability, opportunity, and motivation), which forms part of the BCW framework. Stage 2 will build on Stage 1 findings to identify and select intervention functions and behaviour change techniques to enhance COS use in trials. Stage 3 will involve an online stakeholder consensus meeting including trialists, healthcare professionals, and patient/public representatives. The purpose of the meeting is to prioritise identified intervention approaches that will inform future research to increase COS use.

Discussion: The findings of this study will provide an understanding of the behavioural factors that influence COS use in trials, what strategies might be used to target these factors to increase COS use, and what strategies key stakeholders perceive as especially important in future research to enhance COS use in trials.
Bridging the gaps in the global governance of antimicrobial resistance: the UN sustainable development goals and global health security agenda
Authors: Esiovwa Regina , Connolly John , Hursthouse Andrew , Mukherji Soumyo , Mukherji Suparna , Parasnis Anjali , Sachwani Kavita , Henriquez Fiona
Published: April 2022

Background: This paper examines the suitability of extant governance frameworks at an international level for addressing antimicrobial resistance (AMR), which is a creeping crisis for global health security.

Methods: Our study begins by evaluating the place of antimicrobial resistance (AMR) within United Nations (UN) Sustainable Development Goals (SDG) targets and indicators. This is followed by a discussion of the global health security agenda (GHSA). We examine how AMR needs to be taken more seriously within global policy frameworks based on adopting a One Health approach.  The research is supported by a systematic analysis of the national action plans for addressing AMR published by the World Health Organisation (WHO).

Results: We determine that political leaders need to do more to promote the problem of AMR and that global health institutions need to invest more energy in thinking about how AMR is governed as part of an already busy global health security agenda. This includes building capacities within health systems, embedding evaluation processes, and enhancing public service leadership within this area. 

Conclusions: Our review of global policy frameworks and the national plans for AMR highlight the patchy coverage of AMR strategies globally and nationally. This article represents a springboard for future research including whether and to what extent a One Health approach to AMR in the environment has been implemented in practice within national health and environmental systems.
Comparative study of electrolyte exchange in patients with varying severity of urinary syndrome of chronic pyelonephritis
Authors: Gozhenko Anatoliy , Kushneruk Anatoliy , Zukow Walery , Popovych Igor
Published: April 2022

Background. The severity of urinary syndrome in chronic pyelonephritis varies widely. Concomitant changes in electrolyte exchange are also differently expressed. The aim of this study is to compare the rates of electrolyte metabolism in patients with minimal and moderate manifestations of urinary syndrome. Materials and Methods. The object of clinical-physiological observation were 68 men and 20 women aged 24-76 years, who underwent rehabilitation treatment in the Truskavets’ spa of chronic pyelonephritis in remission with of neuroendocrine-immune complex dysfunction. Urinary syndrome was assessed by quantitative and quantitative-qualitative levels of bacteriuria, leukocyturia and erythrocyturia. We determined in daily urine and blood plasma the concentration of sodium, potassium, chloride, calcium, magnesium and phosphates. Results. By transforming the actual values into normalized (Z-score) in patients with minimal expressed urinary syndrome (n=25) compared with moderately expressed (n=63) more pronounced decrease in phosphatemia (-1,26±0,17 vs -0,77±0,13), while a more significant increase in excretion of magnesium (+1,16±0,34 vs +0,27±0,24), sodium (+2,92±0,64 vs +1,41±0,31) and chloride (+2,44±0,76 vs +1,04±0,37). Conclusion. Probably, common causal factors for both sets of parameters are changes in neuro-endocrine regulation of electrolyte exchange and immunity, especially bactericidal mechanisms, which, in turn, cause a reduction in bacteriuria and leukocyturia, ie resolving chronic pyelonephritis. Evidence of this hypothesis we have obtained and will be presented in the next article.
Effect of Processing Treatments on the Nutritional, Anti-Nutritional, and Bioactive Composition of Blue Maize (Zea Mays L.)
Authors: Chauhan Divya , Kumar Krishan , Ahmed Naseer , Pal Singh Tajendra , Thakur Priyanka , Hyder Rizvi Qurat-Ul-Eain , Yadav Ajar Nath , Dhaliwal Harcharan Singh
Published: April 2022

Maize is considered as an important annual cereal crop cultivated widely throughout the world. Blue Maize (Zea mays L.) is a blue-colored variety of maize containing high content of anthocyanin and belongs to the family Poaceae. The current study aimed to evaluate the effect of soaking, germination, natural fermentation, and roasting on nutritional, anti-nutritional, and bioactive components of blue maize. The changes in chemical composition were studied after 12 and 24 h of soaking and 24, 48, and 72 h of germination treatment. The blue maize grains were subjected to natural fermentation for time intervals of 12, 24, and 36 h, and roasting treatment by heating at 180 °C on a hot plate for 10 s. The results revealed that the phenolic content increased significantly (p≤0.05) from 44.88 to 51.56 mg GAE/100g after 36 h fermentation and from 44.88 to 61.05 mg GAE/100g after 72 h of germination whereas it decreased from 44.88 to 35.73 mg GAE/100g during the roasting process. Further, there was a 44.02 and 20.22% increase in protein content during germination and fermentation processes, respectively, and a slight decrease of 2.16% after roasting treatment. The antioxidant activity increased significantly (p≤0.05) from 10.41 to 18.85% during germination and 10.41 to 14.50% during fermentation, respectively. But it was found to get decreased by 6.53% after the roasting process. The anti-nutrients such as phytic acid and tannins declined significantly (p≤0.05) during the processing treatments. Phytic acid decreased to the extent of 63.57, 55.99, and 27%, and tannin contents as 62.5, 50, and 41.66%, after germination, fermentation, and roasting processes, respectively. There was a significant (p≤0.05) increase in mineral contents after all processing treatments of blue maize.
Prevention of Higher Triglycerides, Malondialdehyde, And Fatty Liver Disease Using the Ethanolic Extract of Sea Lettuce (Ulva lactuca) in Male Wistar Rats (Rattus Norvegicus)
Authors: Widyasari Wijaya Putu Austin , Wihandani Desak Made , Sundari Luh Putu Ratna
Published: April 2022

Fatty liver disease is caused by high-calorie intake and the prevalence is currently increased due to lack of definite treatment. However, antioxidants are used as a preventive measure, and some exist as bioactive compounds in the Ulva lactuca extract used. These compounds include alpha-tocopherol, vitamin C, and polyphenols, which has an anti-hyperlipidemic and antioxidant effect. Therefore, this study aims to analyze the Ulva lactuca extract in preventing higher triglyceride, malondialdehyde (MDA), and fatty liver disease. This experiment was a randomized control with a post-test only group design using 36 male Wistar rats. The animals were given high fat and fructose diet, and divided randomly into 2 groups, those were: control group who were given a placebo; and treatment group were given ethanol extract of Ulva lactuca 200mg / kg-weight for 42 days. Data between groups were analyzed by Independent-t test. The results showed that Ulva lactuca extract can prevent higher triglyceride and MDA levels in treatment group significantly, which is p <0.001 and p=0.003 respectively (p < 0.05). Furthermore, histological examination showed the infiltration of fat vacuoles in control group. In conclusion, Ulva lactuca extract could be an alternative prevention for fatty liver disease due to its ability to prevent higher triglyceride and mda level in male wistar rats.
Initial Research of Renewable Energy Resources for Hybrid Microgrid Implementation, Using Solar and Wind; Transforming the Diesel Dependence. Case Study of Mamburit Island - Indonesia
Authors: Hughes Arrocha Eric Marcos
Published: April 2022

Electrical demands are growing rapidly in the world, especially in larger cities, and Indonesia is not an exception. Indonesia's average peak demand is projected to increase by 73% (reaching 43.7 GW) in 2020, by 142% (reaching 61.2 GW) in 2025, and by 205% (reaching 77.3 GW) in 2030, compared with 25.3 GW in 2010 [1]. However, the challenge of completing the growing demand in big cities reveals another huge problem, which are those small villages, communities and islands who doesn’t have access to electricity until now.Many countries apply and use the concept of Micro Grid [MG] as an effective solution, which can be defined as: the grid where each generator or load has to take part in the network management, joining in reactive power supply/voltage control, active power supply/frequency control, fault ride-through capability, and power quality control independently [5].Using an Indonesian remote Island as a real case, different renewable energy sources available will be evaluated to propose the best Micro Grid design integration system to supply electricity facility.This research will describe the principles, measurement process and general mathematical description for the application of the MG model integration.Planning to minimize the traditional electric sources of fossil dependence, the design for Mamburit Island in Sumenep-Indonesia will integrate different generation sources such as, Solar Panel System [PV/SHS] showing Daily Average Irradiation [DNI] of 5.78 kwh/ , vertical Axis Wind Turbine [VAWT] shows wind speed annual average of 8.82 m/s and energy Storage system [ESS] as a real, feasible and friendly options to complete the demand, integrated with Engine Diesel Generator [EDG] present as the actual main sources; minimizing the fossil dependence, through MG principle. Keywords— Smart Micro Grid, Micro Grid Integration, Renewable Energy.