bluuebunny/crossref_metadata_2025 huggingface dataset:
Entre Egito e Azania: Conexões Afro-Asiáticas a partir do Périplo do Mar Eritreu
Authors: Pinto Otávio Luiz Vieira
Published: February 2023

Este artigo tem por objetivo analisar os processos de contato e integração entre o nordeste africano e diferentes regiões da África e da Ásia, a partir, especificamente, de um texto anônimo do século I d.C. conhecido como Périplo do Mar Eritreu. Este documento, geralmente lido a partir de uma perspectiva romanocêntrica, será interpretado com base nos modelos analíticos da História Global. Com isso, espera-se mostrar que os portos egípcios do Mar Vermelho faziam parte de um ancestral sistema conectivo afro-asiático – do qual o Império Romano não foi o criador, mas sim um participante tardio.
La diaspora tras la campaña de salvamento de la Unesco: Su impacto en las poblaciones nubias desplazadas
Authors: Fernández-Toribio Salomé Zurinaga
Published: February 2023

Este artículo pivota entre el análisis de la acción de la Unesco durante la Campaña de Salvamento en Nubia, la gestión del patrimonio cultural (arqueológico, monumental, inmaterial), y el impacto que produjo la construcción de la presa de Asuán y la evacuación forzosa de las poblaciones nubias asentadas en la región. La historia de los desalojados a causa de la construcción de la presa, no ocupó tantas páginas de la literatura como lo hizo el rescate del patrimonio cultural sudanés y egipcio (arqueológico, histórico, epigráfico, artístico, etnográfico, etc.). La población contemporánea que ocupaba el territorio anegado, y que era heredera directa de los pueblos que habían habitado la región desde tiempos prehistóricos, pronto fue olvidada. Ocuparnos de ellos es lo que pretendemos con esta breve contribución. Ofreciendo algunas reflexiones sobre el pasado colonial, las interpretaciones con tintes de superioridad sobre el pasado de Nubia, las teorías arqueológicas postcoloniales, las nuevas prácticas arqueológicas: indígena, colaborativa, más la antropología de rescate.
Smooth Muscle Mineralocorticoid Receptor Promotes Hypertension After Preeclampsia
Authors: Biwer Lauren A. , Lu Qing , Ibarrola Jaime , Stepanian Alec , Man Joshua J. , Carvajal Brigett V. , Camarda Nicholas D. , Zsengeller Zsuzsanna , Skurnik Geraldine , Seely Ellen W. , Karumanchi S. Ananth , Jaffe Iris Z.
Published: February 2023

Background:

Preeclampsia is a syndrome of high blood pressure (BP) with end organ damage in late pregnancy that is associated with high circulating soluble VEGF receptor (sFlt1 [soluble Fms-like tyrosine kinase 1]). Women exposed to preeclampsia have a substantially increased risk of hypertension after pregnancy, but the mechanism remains unknown, leaving a missed interventional opportunity. After preeclampsia, women have enhanced sensitivity to hypertensive stress. Since smooth muscle cell mineralocorticoid receptors (SMC-MR) are activated by hypertensive stimuli, we hypothesized that high sFlt1 exposure in pregnancy induces a postpartum state of enhanced SMC-MR responsiveness.

Methods:

Postpartum BP response to high salt intake was studied in women with prior preeclampsia. MR transcriptional activity was assessed in vitro in sFlt1-treated SMC by reporter assays and PCR. Preeclampsia was modeled by transient sFlt1 expression in pregnant mice. Two months post-partum, mice were exposed to high salt and then to AngII (angiotensin II) and BP and vasoconstriction were measured.

Results:

Women exposed to preeclampsia had significantly enhanced salt sensitivity of BP verses those with a normotensive pregnancy. sFlt1 overexpression during pregnancy in mice induced elevated BP and glomerular endotheliosis, which resolved post-partum. The sFlt1 exposed post-partum mice had significantly increased BP response to 4% salt diet and to AngII infusion. In vitro, SMC-MR transcriptional activity in response to aldosterone or AngII was significantly increased after transient exposure to sFlt1 as was aldosterone-induced expression of AngII type 1 receptor. Post-partum, SMC-MR-KO mice were protected from the enhanced response to hypertensive stimuli after preeclampsia. Mechanistically, preeclampsia mice exposed to postpartum hypertensive stimuli develop enhanced aortic stiffness, microvascular myogenic tone, AngII constriction, and AngII type 1 receptor expression, all of which were prevented in SMC-MR-KO littermates.

Conclusions:

These data support that sFlt1-induced vascular injury during preeclampsia produces a persistent state of enhanced sensitivity of SMC-MR to activation. This contributes to postpartum hypertension in response to common stresses and supports testing of MR antagonism to mitigate the increased cardiovascular risk in women after PE.
ITDetect: a method to detect internal tandem duplication of FMS-like tyrosine kinase (FLT3) from next-generation sequencing data with high sensitivity and clinical application
Authors: Lee Sungyoung , Sun Choong-Hyun , Jang Heejun , Kim Daeyoon , Yoon Sung-Soo , Koh Youngil , Na Seung Chan , Cho Sung Im , Kim Man Jin , Seong Moon-Woo , Byun Ja Min , Yun Hongseok
Published: February 2023

Internal tandem duplication (ITD) of the FMS-like tyrosine kinase (FLT3) gene is associated with poor clinical outcomes in patients with acute myeloid leukemia. Although recent methods for detecting FLT3-ITD from next-generation sequencing (NGS) data have replaced traditional ITD detection approaches such as conventional PCR or fragment analysis, their use in the clinical field is still limited and requires further information. Here, we introduce ITDetect, an efficient FLT3-ITD detection approach that uses NGS data. Our proposed method allows for more precise detection and provides more detailed information than existing in silico methods. Further, it enables FLT3-ITD detection from exome sequencing or targeted panel sequencing data, thereby improving its clinical application. We validated the performance of ITDetect using NGS-based and experimental ITD detection methods and successfully demonstrated that ITDetect provides the highest concordance with the experimental methods. The program and data underlying this study are available in a public repository.
ARL9 is upregulated and serves as a biomarker for a poor prognosis in colon adenocarcinoma
Authors: Yang Hai-deng , Jin Xiu-xiu , Gu Bin-bin , Yu-Zhang  , Li Dan , Yan Ling-ling
Published: February 2023

Background

ARL9 is a newly identified member of the ARF family, and the clinical significance of ARL9 in colon adenocarcinoma is unknown. In this study, we aimed to explore the expression of ARL9 mRNA in colon adenocarcinoma, and its effect on the prognosis of patients with colon adenocarcinoma.

Methods

We investigated the differential expression of ARL9 between colon adenocarcinoma tissue and adjacent tissues through a bioinformatics analysis using The Cancer Genome Atlas (TCGA) database. The correlation between clinical characteristics and the mRNA expression level of ARL9 were analyzed. A survival analysis and a Cox regression analysis were used to determine the prognostic significance of ARL9. Finally, we conducted a gene set enrichment analysis (GSEA) to explore the ARL9 signaling pathways involved in the development of colon adenocarcinoma. The effect of the expression of ARL9 on the proliferation and migration of colon adenocarcinoma was analyzed by the CCK8 method and a cell scratch test, respectively.

Results

The mRNA expression of ARL9 in colon adenocarcinoma tissues was higher in comparison to the level in normal adjacent tissues (P < 0.05). The mRNA expression of ARL9 was not related to sex, tumor stage, T stage, N stage, M stage, but to age. The 5-year survival rate of colon adenocarcinoma patients with high ARL9 mRNA expression levels was significantly lower than that of patients with low ARL9 mRNA expression levels (P < 0.05). Age and the high mRNA expression of ARL9 were independent risk factors for a poor prognosis in patients with colon adenocarcinoma. The GSEA suggested that ARL9 may be able to upregulate cell adhesion, extracellular matrix receptor interactions, tumor-associated pathways, and downregulate the citrate cycle and tricarboxylic acid cycle pathway, which are involved in the development of colon adenocarcinoma. After knocking down ARL9, the proliferation and migration abilities of colon adenocarcinoma cells were decreased (P < 0.01).

Conclusion

The mRNA expression of ARL9 is upregulated in colon adenocarcinoma, and higher mRNA expression levels are associated with a poor prognosis. Knocking down ARL9 can reduce the proliferation and migration of colon adenocarcinoma cells. ARL9 mRNA can be used as a prognostic biomarker in patients with colon adenocarcinoma.
Relationship between social network and individual performance of core members from aged care services social organizations: cross-sectional study
Authors: Wang Zhengsheng , Chen Xuefei , Ji Kai , Sang Lingzhi , Bai Zhongliang , Chen Ren
Published: February 2023

Background

The social network of core members can affect the performance of the organization, while there is a lack of research on the relationship between the social network of core members of social organizations and individual performance in the field of aged care services. This study aimed to explore the relationship between social network and individual performance of core members from social organizations engaged in aged care services and explore measures to promote the development of aged care services.

Methods

We used a multi-stage stratified sampling method to conduct a cross-sectional study and collected the required data in six cities in Anhui Province, China. Univariate analysis and binary logistic regression were used to estimate the relationship between social network and individual performance.

Results

Our results indicated that core members with higher social network scores were more likely to yield better individual performance, including receiving awards or recognitions related to aged care services (AOR=2.534; 95% CI: 1.397-4.596). Moreover, teams led by the core members were more likely to receive awards or recognitions related to aged care services (AOR=2.930; 95% CI: 1.740-4.933). The core members or the teams led by them were more likely to be reported by the media (AOR=1.748; 95% CI: 1.030-2.966) and participate in the drafting or discussion of local aged care service standards or service specifications (AOR=2.088; 95% CI: 1.093-3.911). In addition, demographic variables such as gender, marital status, and education of core members were significantly related to their performance (P<0.05).

Conclusions

The social network of core members of aged care service social organizations has an impact on their individual performance. To improve the performance of the core members of senior citizens services and organizations, relevant measures should be taken from the government, social organizations and core members to strengthen the social network construction of core members.
Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence
Authors: Botwright Siobhan , Sutawong Jiratorn , Kingkaew Pritaporn , Anothaisintawee Thunyarat , Dabak Saudamini Vishwanath , Suwanpanich Chotika , Promchit Nattiwat , Kampang Roongnapa , Isaranuwatchai Wanrudee
Published: February 2023

Background

This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries.

Methods and findings

We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low.

Conclusions

For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation.

Funded by the Thai Health Promotion Foundation, grant number 61–00-1812.
The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines
Authors: Stevens Gabrielle , Johnson Lisa C. , Saunders Catherine H. , Schmidt Peter , Sierpe Ailyn , Thomeer Rachael P. , Little N. Ruth , Cantrell Matthew , Yen Renata W. , Pogue Jacqueline A. , Holahan Timothy , Schubbe Danielle C. , Forcino Rachel C. , Fillbrook Branden , Sheppard Rowena , Wooten Celeste , Goldmann Don , O’Malley A. James , Dubé Eve , Durand Marie-Anne , Elwyn Glyn
Published: February 2023

Background

Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs’ characteristics and other factors mediate and moderate the interventions’ effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions.

Methods

We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase.

Discussion

Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs.

Trial registration

NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.
Nurses’ reflections on caring for sexual and gender minorities pre-post stigma reduction training in Uganda
Authors: Muwanguzi Patience A. , Nabunya Racheal , Karis Victoria M. S. , Nabisere Allen , Nangendo Joan , Mujugira Andrew
Published: February 2023

Background

Men who have sex with men (MSM) and transgender women (TGW) have a significant HIV burden worldwide. Data from eight countries across sub-Saharan Africa found a pooled HIV prevalence of 14% among MSM and 25% among TGW. Stigma and discrimination among healthcare providers are barriers to healthcare access by these populations. We sought to explore nurses’ attitudes before and after sensitivity training to reduce stigma in HIV prevention and care provision to MSM and transgender persons in Uganda.

Methods

An explorative qualitative study comprising in-depth interviews. Nineteen nurses who underwent sensitivity training in caring for the vulnerable, priority and key populations in Uganda participated. We interviewed each participant before and after the stigma reduction training and analyzed the data with NVivo.

Results

Eight (8) themes emerged from the reflections before the training, namely, ‘the definition of MSM and transgender persons’, ‘legal concerns’, ‘mental illness’, ‘attitude in health care provision’, ‘personal perceptions’, ‘self-efficacy’, ‘insufficient training preparation’, and ‘reasons for gender or sexual orientation preference’. The post-training reflections suggested a change in knowledge and attitude. Five themes emerged for MSM: ‘stigma reduction’, ‘sexual practices and sexuality’, ‘the need for tailored health approaches’, ‘MSM and the law’ and ‘corrected misconceptions’. For transmen, ‘reproductive health needs’, ‘social needs’, ‘safety needs’, ‘Gender identity recognition’ and ‘reduced stigma, discrimination, and barriers to care’. Finally, the reflections on their attitudes towards transwomen were on five topics; Gender affirming care’, ‘Healthcare provision for transwomen’, ‘Need for further training’, ‘New knowledge acquired’, and ‘Sexual violence’.

Conclusion

Nurses’ attitudes and empathy for vulnerable and key populations improved following the training. Nursing training programs should consider incorporating sexual and gender minority (SGM) specific health training into their curricula to decrease negative attitudes. There is a need to identify best practices and conduct implementation research to provide culturally sensitive and affirming healthcare delivery in sub-Saharan Africa. Future studies should evaluate the effect of provider sensitivity training on sexual health and HIV outcomes for SGM. Furthermore, interventions targeting higher-level stigma, such as structural and policy levels, are critical because they influence interpersonal stigma reduction efforts and initiatives.
Post-traumatic growth in caregivers of children hospitalized in the PICU due to traffic accident: a qualitative study
Authors: Ni Zhi Hong , Lv Hai Tao , Wu Jin Hua , Wang Fang
Published: February 2023

Background

Globally, tens of millions of children are hospitalized every year for non-fatal traffic accident injuries, being confronted with an injured child can be extremely stressful for parents. Understandably, a significant level of psychological distress may ensue. Traumatic losses may lead parents to find new insights in life and develop a greater sense of spirituality and strength.

Method

Semi-structured interviews were conducted with caregivers of children who were hospitalized in the pediatric intensive care unit (PICU) with traffic accident injuries at children’s hospitals in China between January and June 2022. Caregivers were selected using a purposive sampling method until no new data were generated (n = 24).

Results

We identified eleven sub-themes and four higher-order themes based on these sub-themes: (1) changes in their life philosophy, (2) personal strength enhancement, (3) relationship improvements, and (4) effective responses. The findings of our research contribute to a better understanding of the psychological status of the caregivers of children injured by traffic accidents.

Conclusion

Professionals should guide caregivers from a positive perspective, stimulate their strengths and potential, increase personnel support and communication, promote positive coping, formulate targeted management countermeasures to improve the PTG level of caregivers, and develop strategies to maintain stable mental health and well-being.
A novel prognostic model based on pyroptosis-related genes for multiple myeloma
Authors: Zhang Cuiling , Wu Sungui , Chen Bing
Published: February 2023

Background

Multiple myeloma (MM) is an incurable and relapse-prone disease with apparently prognostic heterogeneity. At present, the risk stratification of myeloma is still incomplete. Pyroptosis, a type of programmed cell death, has been shown to regulate tumor growth and may have potential prognostic value. However, the role of pyroptosis-related genes (PRGs) in MM remains undetermined. The aims of this study were to identify potential prognostic biomarkers and to construct a predictive model related to PRGs.

Methods

Sequencing and clinical data were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Non-negative matrix factorization (NMF) was performed to identify molecular subtype screening. LASSO regression was used to screen for prognostic markers, and then a risk score model was constructed. The Maxstat package was utilized to calculate the optimal cutoff value, according to which patients were divided into a high-risk group and a low-risk group, and the survival curves were plotted using the Kaplan-Meier (K-M) method. Nomograms and calibration curves were established using the rms package.

Results

A total of 33 PRGs were extracted from the TCGA database underlying which 4 MM molecular subtypes were defined. Patients in cluster 1 had poorer survival than those in cluster 2 (p = 0.035). A total of 9 PRGs were screened out as prognostic markers, and the predictive ability of the 9-gene risk score for 3-year survival was best (AUC = 0.658). Patients in the high-risk group had worse survival than those in the low-risk group (p< 0.001), which was consistent with the results verified by the GSE2658 dataset. The nomogram constructed by gender, age, International Staging System (ISS) stage, and risk score had the best prognostic predictive performance with a c-index of 0.721.

Conclusion

Our model could enhance the predictive ability of ISS staging and give a reference for clinical decision-making. The new, prognostic, and pyroptosis-related markers screened out by us may facilitate the development of novel risk stratification for MM.

Clinical trial registration

Not applicable.
Weigh change across adulthood is related to the presence of NAFLD: results from NHANES III
Authors: Wang Lili , Yi Jiayi , Guo Jiajun , Ren Xiangpeng
Published: February 2023

Background

Obesity is a widely recognized driving factor of Non-alcoholic fatty liver disease (NAFLD), it remains unclear whether historical weight status was associated with the presence of NAFLD. The study aimed to explore the relationship between weight change across adulthood and the presence of NAFLD.

Methods

Data from the National Health and Nutrition Examination Survey III included 6586 participants. Weight change was assessed according to body mass index (BMI) at baseline, at 25 years old, and 10 years before baseline. Obesity was defined as BMI ≥ 30 kg/m2. NAFLD was assessed by hepatic ultrasonography.

Results

The prevalence of NAFLD was highest among stable obese participants (48.1%), and the lowest among stable non-obese participants (18.9%). Among non-obese participants, those who get obese in early adulthood had a higher risk for the presence of NAFLD than those who were never obese (odds ratio [OR], 1.82; 95% confidence interval [CI] 1.17–2.92). Among obese participants, those who become obese in middle-late adulthood had a lower risk of NAFLD (OR, 0.79; 95% CI 0.65–0.96) than those with stable obesity. A weight gain of more than 12 kg and 4 kg since early and middle-late adulthood respectively were associated with increased risks of NAFLD.

Conclusion

Among current nonobese individuals, those with a history of obesity in their early adulthood had a higher risk of NAFLD than those never obese. Among the currently obese population, those who became obese after mid-adulthood have a significantly lower risk of NAFLD compared with those who were stable obese.
Dynamics in the expression of programmed death ligand 1 and cluster of differentiation 163 in the tumor microenvironment of uterine cervical cancer: a single-center retrospective study
Authors: Miyata Yusaku , Ogo Etsuyo , Abe Toshi , Hirata Hideki , Tsuda Naotake , Ushijima Kimio , Kawahara Akihiko , Akiba Jun , Obara Hitoshi , Kakuma Tatsuyuki
Published: February 2023

Background

Radiotherapy (RT) destroys cancer cells and activates the immune system while suppressing the immunity of tumor-associated tissues, including the tumor microenvironment (TME). However, to date, no anti-tumor therapeutic strategy that uses these immune mechanisms has been established. This study investigated changes in the immunity of the TME during standard radical RT for cervical cancer combined with external beam RT and brachytherapy and determined whether these changes affect prognosis.

Methods

Twenty-six patients who had completed radical RT for cervical cancer were categorized into the following two groups according to whether the cancer recurred and/or metastasized within 2 years after the start of treatment: treatment failure (n = 14) and treatment success (n = 12). We assessed the expression of programmed death 1, programmed death ligand 1 (PD-L1), cluster of differentiation (CD) 8, CD68, CD163, Forkhead box protein P3, and hypoxia-inducible factor-1α in the TME of cervical tissues collected periodically during treatment and evaluated the difference in expression rates of each marker between the success and failure groups and assessed its effect on prognosis.

Results

The expression levels of PD-L1 and CD163 in the TME in the treatment success group were lower than those in the treatment failure group at the midpoint during brachytherapy (p < 0.01 and p = 0.08, respectively), and the 2-year progression-free-survival (PFS) rate depended on the expression levels of PD-L1 and CD163 (p = 0.04 and p = 0.02, respectively).

Conclusions

The expression rates of CD163 and PD-L1 in the TME during brachytherapy were related to treatment response and the 2-year PFS. This study may increase our understanding of tumor-associated immunity in the TME and aid in the development of therapies targeting PD-L1 or M2 macrophages in the TME in conjunction with RT, especially brachytherapy, for cervical cancer patients.
Detailed observation of anatomical location and pattern in Hangman’s fracture based on computed tomography three-dimensional reconstruction
Authors: Li Guangzhou , Wang Qing
Published: February 2023

Objective

To observe the precise anatomical location and pattern of the fracture lines in Hangman’s fracture.

Methods

Three-dimensional computed CT images of 210 patients with Hangman’s fracture were collected. According to the involvement of anatomical structures, the injuries were classified into facet joint injury and pure bony injury. The C2 ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns were observed.

Result

Total 520 anatomical structures injuries were involved in 210 patients Hangman’s fractures, including 298 facet joints injuries (57.3%) and 222 bony injuries (42.7%). The most common facet joints injury was superior articular facet injury of C2, and the most common pure bony injury was pediculoisthmic component fracture. The injuries of anterior element (60.6%) were more common than that of middle (20.4%) or posterior (19.0%) element. One injury in anterior element on one side and another injury located in the anterior, middle or posterior element other side was the most common fracture pattern. Injury of middle element on one side with another injury located in the middle or posterior element could be also observed.

Conclusion

In Hangman’s fractures, fracture lines could occur in any part of C2 ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were also more common than that of middle or posterior element. The high prevalence of facet joints injuries means that most of Hangman’s fractures may be involved with intra-articular injuries.
The impact of gingivitis reduction on lung function: a randomized trial under intensified oral hygiene
Authors: Kühnisch Jan , Zhao Tianyu , Bertelsen Randi J. , Jörres Rudolf A. , Nowak Dennis , Heinrich Joachim
Published: February 2023

Background

Periodontal disease and lung function impairment were found to be associated with low-grade systemic or local inflammation, and it might be that gingival/periodontal inflammation triggers lung function due to systemic inflammation or the transfer of oral bacteria or its components to the lung. A recent observational study in non-smoking subjects showed that lung volumes and flow rates were significantly reduced by 71–185 ml for severe gingivitis regardless of the adjustment for potential confounders. The result did not show any confounding by smoking, and the association between gingivitis and lower lung function was not modified by systemic inflammation. The designed interventional trial primarily aims to test the hypothesis that gingivitis reduction by optimized daily oral hygiene, professional tooth cleaning and antibacterial chlorhexidine (CHX)-containing mouth rinse improves lung function in terms of forced vital capacity (FVC) by at least 2%. The secondary objective will test the hypothesis that gingivitis reduction improves forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25–75% of the pulmonary volume (FEF25-75) by at least 2%. Furthermore, the influence of the oral microbiome will be taken into account.

Methods

The study has to include 120 non-smoking subjects aged between 18 and 30 years with biofilm-induced gingivitis. The chosen “waiting control group design” will compare the immediate intervention group with the delayed intervention group, which serves as a control group. Dental and gingival status, lung function and oral microbiome will be recorded. The intensified preventive intervention—professional tooth cleaning, one-stage full-mouth disinfection with CHX and safeguarding an optimal daily oral hygiene by each subject—cannot be blinded, but the outcome measurement in terms of lung function tests is blind.

Discussion

This proposed multidisciplinary study has several strengths. Only one previous intervention study with patients with severe periodontitis (mostly smokers) has been performed. It is novel to include non-smoking subjects with mild and potentially reversible oral inflammation. Furthermore, this research is innovative, because it includes evidence-based interventions for gingivitis reduction, standardized measures of the outcome on lung function and oral microbiome and combines expertise from dentistry, lung physiology, oral microbiology and epidemiology/statistical modelling.

Trial registration

German Clinical Trial Register DRKS00028176. Registered on February 2022.
A randomised open-label trial to assess outpatient induction of labour (HOMEIND) and compare efficacy of Propess vs Dilapan-S® for induction of labour at 39 weeks’ gestation in normal risk nulliparous women: study protocol for a randomised controlled trial
Authors: Nicholson Sarah M. , Smith Orla , Hatt Susan , Molphy Zara , Dicker Patrick , Flood Karen , Malone Fergal
Published: February 2023

Background

Induction of labour (IOL) at 39 weeks has been shown to decrease maternal and neonatal adverse outcomes. Given the growing demand for 39-week IOL, it is imperative that effective methods be assessed for induction in the outpatient setting.

The aim of this study is to answer the clinical question as to whether Dilapan-S® vs Propess® as a method of cervical ripening is non-inferior in the outpatient setting at 39 weeks and to ascertain whether Dilapan-S® 12 h is non-inferior to Dilapan-S® 24 h.

Methods

This study is an open-label parallel group single-centre randomised trial.

Participants are normal risk nulliparous women who have no pregnancy-related or medical contraindication to IOL. Women will be randomised to one of three induction groups—Dilapan-S® (12-h insertion or 24-h insertion) or Propess. Induction will be initiated between 39+0 and 39+4 weeks’ gestation and participants will return home for either 12 or 24 h. They will be readmitted 12/24 h later in order to continue with induction of labour.

Patient recruitment will take place over 30 months within a single centre. The study will recruit a maximum 109 women for each study arm. Total duration of participants’ involvement in the trial will be 8 weeks to allow for postpartum follow-up.

Discussion

This study will definitively answer whether Dilapan-S is non-inferior to Propess® as a method of induction of labour in the outpatient setting and whether cervical ripening with Dilapan-S over a 12-h timeframe is non-inferior to cervical ripening with Dilapan-S over a 24-h timeframe.

Trial registration

EudraCT Number 2019-004697-25 Registered 14 September 2020
Effect of stroke direction on plantar pressure in each foot during the forehand and backhand stroke among healthy adult tennis players of different performance levels
Authors: Lambrich Johanna , Muehlbauer Thomas
Published: February 2023

Background

In tennis, previous studies have shown differences in plantar pressure depending on tennis-specific movements (i.e., baseline play, serve & volley play, change of direction), playing surface (e.g., hard, grass, or clay), and serve type (e.g., slice, topspin or flat). However, the influence of stroke direction on plantar pressure in tennis players with diverging skill level is unknown. Thus, the purpose of this study was to determine the effect of stroke direction on plantar pressure in each foot during the forehand and backhand stroke among players of different performance levels.

Methods

Thirty-nine female and male healthy adult tennis players (mean ± SD age: 23.5 ± 6.4 years) representing athletes from three performance levels (recreational, intermediate, advanced) participated in this study. The players performed longline/cross forehand and backhand groundstrokes (topspin) on a clay court while plantar pressure distribution was measured in each foot using flexible instrumented insoles.

Results

The three-way ANOVA (performance level × stroke direction × foot dominance) showed (a) no significant differences in plantar pressure data between cross and longline strokes in almost all cases, (b) in part, significantly larger pressure values in advanced compared to intermediate and recreational players, and (c) significantly larger pressure data for the dominant compared to the non-dominant foot in nearly all comparisons.

Conclusion

Regarding an appropriate plantar pressure distribution, our results suggest that during training of especially recreational and intermediate players attention should be paid to the feet rather than to stroke direction.
First report of Staphylococcus pseudintermedius ST71-SCCmec III and ST45-ΨSCCmec57395 from canine pyoderma in Argentina
Authors: Srednik Mariela E. , Perea Claudia A. , Giacoboni Gabriela I. , Hicks Jessica A. , Schlater Linda K.
Published: February 2023

Staphylococcus pseudintermediusis an opportunistic pathogen commonly associated with skin infections in dogs. Twenty-three methicillin-resistantS. pseudintermedius(MRSP) isolated in Argentina from dogs with pyoderma were analyzed using whole genome sequencing (WGS) and classified into sequence types (ST) by multilocus sequence typing (MLST) and staphylococcal chromosome cassettemec(SCCmec) types.

Based on the WGS analysis, MLST, and SCCmectype results, we report for the first time in Argentina two MRSP strains, one each, belonging to ST71-SCCmecIII and ST45-ΨSCCmec57395from dogs with pyoderma. We also identified seven isolates with ST339, which had been previously reported in only two isolates in Argentina. Additionally, we identified ten MRSP isolates harboring variants of the SCCmecV found inS. aureus, seven SCCmecV (5C2&5) with twoccrC1 recombinases, and three SCCmecV (5C2) with oneccrC1 recombinase.

Our findings provide important insights into the evolution and geographic spread of these hypervirulent dominant clones that threaten the health of our companion animals and represent a significant risk for zoonotic infections.
Survival, prognostic factors, hospitalization time and clinical performance status after first cerebral relapse or progression in 54 patients with primary CNS lymphoma not eligible for high dose chemotherapy: a retrospective analysis
Authors: Seidel Sabine , Kowalski Thomas , Nilius-Eliliwi Verena , Schroers Roland , Schlegel Uwe
Published: February 2023

Background

Treatment of relapsed or refractory primary CNS lymphoma (r/r PCNSL) is difficult, particularly in patients not eligible for high dose chemotherapy with autologous stem cell transplantation (HDC-ASCT). No standard treatment has been defined for these patients yet.

Methods

We retrospectively analyzed survival, prognostic factors, hospitalization time and Karnofsky performance score (KPS) before and after treatment in 54 r/r PCNSL patients with isolated cerebral relapse or progression (n = 23 refractory, n = 31 relapsed) not eligible for HDC-ASCT, who received heterogenous salvage treatments.

Results

Treatments were temozolomide (+ rituximab) (n = 21), high dose methotrexate (HD-MTX)-based therapy (n = 11), whole brain radiotherapy (WBRT)/focal radiotherapy (n = 11), other systemic treatments (n = 2) and best supportive care (BSC, n = 9). Median progression free survival (PFS) and overall survival (OS) were 2.6 months (95% CI 1.0–4.2 months) and 4.8 months (95% CI 3.3–6.3 months), respectively. Eight patients survived for ≥ 3 years (13.1%, n = 3 received temozolomide, n = 3 WBRT, n = 2 HD-MTX-based treatment). Application of any salvage treatment (vs. BSC), younger age at relapse and asymptomatic (vs. symptomatic) relapse were positive prognostic factors. No significant differences in OS were found for the different salvage treatments. Median hospitalization time for treatment was 15/13 days for temozolomide (+ rituximab)/radiotherapy compared to 55 days for HD-MTX-based therapy. Median KPS in assessable patients (n = 41) was 60 (range 30–100) before treatment and 50 (range 20–90) after treatment. In patients with response to treatment (n = 16) KPS improved from 60 (range 40–90) before treatment to 70 (range 50–90) after treatment, while patients with PD (n = 25) deteriorated from 60 (range 30–100) to 40 (range 20–70).

Conclusion

Survival for this cohort of r/r PCNSL patients with isolated cerebral relapse or progression was poor. Considering long hospital stays associated with HD-MTX-based chemotherapy and neurotoxicity associated with WBRT, temozolomide might be worth considering with a chance of prolonged survival and avoidance of long hospitalization. Novel therapeutic agents are urgently needed to improve survival in r/r PCNSL patients.
Reproductive health of women with endometriosis: an improving educational intervention based on the planned behavior theory
Authors: Zandi Niusha , Behboodi Moghadam Zahra , Hossein Rashidi Batool , Namazi Masoumeh , Haghani Shima
Published: February 2023

Background

Endometriosis is a chronic deliberating disease with devastating effects on reproductive health. The present study aimed to investigate the impact of education based on the theory of planned behavior (TPB) on the reproductive health of women with endometriosis. This research was a randomized controlled trial performed on 71 women with endometriosis (35 intervention and 36 control groups) referred to the infertility clinic of Imam Khomeini Hospital in Tehran, Iran. The educational intervention based on the structures of the TPB was performed in the intervention group in 4 sessions, weekly for 90–120 min. The demographic questionnaire, model constructs questionnaire, and endometriosis reproductive health questionnaire (ERHQ) in both groups were completed in 3 stages (before intervention, 4, and 8 weeks after the intervention). Data were analyzed using SPSS software version 24.

Results

After the educational intervention, TPB values and overall reproductive health of women with endometriosis improved significantly in the intervention group (p< 0.05), while changes were not significant in the control group.

Conclusion

The study results showed that education based on the TPB had positive effects on the reproductive health of patients.

Trial registration

IRCT20120414009463N64. Registered 21 Jun 2021 - Retrospectively registered, http://www.irct.ir/trial/53341.
The psychological impact of the COVID-19 pandemic on the Sudanese healthcare workers in quarantine centers: a cross-sectional study 2020–2021
Authors: Idrees Malaz Hassan Dafaalla , Bashir Moez Mohammed Ibrahim
Published: February 2023

Background

After its emergence in Wuhan in December 2019, the COVID-19 virus disseminated around the globe creating an incredible panic and outweighing the healthcare system’s capacities. As a result of this hazardous situation, healthcare workers were placed at an unprecedented challenge making them vulnerable to a wide spectrum of mental health issues including anxiety and depression. This was a cross-sectional health facility-based study aiming to explore the psychological impact of the COVID-19 pandemic on Sudanese healthcare workers in COVID-19 treatment centers. Convenience sampling was applied. And two-part self-administered online questionnaire was used: the first part consisted of the demographic data and concerns related to COVID-19, and the second part consisted of the Hospital Anxiety and Depression Scale (HADS) standardized questionnaire. Ethical clearance was obtained from the Ministry of Health.

Results

One-hundred thirty-three healthcare workers of different job titles were enrolled in this study. A total of 54% were females, and 46% were males. Most of the participants had borderline depression (44%) or anxiety scores (47%). Females had significantly a higher mean anxiety score than males. There was no significant difference between participants with and without chronic disease on both anxiety and depression scores.

Conclusions

Healthcare workers at the forefront of the fight against COVID-19 pandemic are facing critical mental health challenges. An immediate intervention from the decision-makers is needed to mitigate this deleterious impact and to strengthen the healthcare system’s capacity in the face of healthcare emergencies in general.
Phase I study of Minnelide and paclitaxel combination chemotherapy in refractory gastric cancer (GC).
Authors: Lee Jeeyun , Kim Seung Tae , Kang Won Ki , Saluja Ashok
Published: February 2023

414

Background: Minnelide is a prodrug that rapidly releases the active compound triptolide when exposed to phosphatases in the bloodstream. Triptolide is a diterpene that has been shown to inhibit tumor cell proliferation and induce apoptosis in various cancer types. The anti-tumor effect of triptolide is the result of inhibition of heat shock protein (HSP) 70 expression. In GC Minnelide inhibits Sp1 to decrease HSP70 and induce cell death in preclinical data. Methods: This phase 1 trial was designed to determine the maximum tolerated dose (MTD) of Minnelide monotherapy and the MTD of Minnelide in combination with paclitaxel in refractory GC patients. There were 6 cohorts tested in this trial: cohort A: Minnelide 1 mg qd D1-21, q 28 days; cohort B: Minnelide 1.25 mg qd D1-21, q 28 days; cohort C: 1.5 mg qd D1-21, q 28 days; cohort D: Minnelide 0.25 mg D1-21 + weekly paclitaxel 60 mg/m2 on D1, D8, D15; cohort E: Minnelide 0.5 mg qd D1-21+ weekly paclitaxel 80 mg/m2 on D1, D8, D15; cohort F: Minnelide 0.75 mg qd D1-21+ weekly paclitaxel 80 mg/m2 D1, D8, D15. Results: From Feb 2021 to Sep 2022, 23 GC patients were enrolled (cohort A – C, N=10; cohort D-F, N=12). All patients had metastatic disease at the time of study enrollment. 20 of 23 patients received the study treatment as >= 3rd-line (range, 2 – 6th line). In all, 3 patients had HER2 positive GC and 10 patients had PDL1 + tumor. In the monotherapy cohorts, there were no DLTs observed, and the regimen was tolerated well. One patient achieved confirmed PR which lasted for 6 months. For the combination arm (cohort D-F), there were no DLTs observed. Of the 11 patients who were evaluable for treatment response, there were 1 PR, 5 SDs and 5 PDs. Two of five patients who achieved stable disease had durable stable disease for > 6 months on study treatment. In the combination cohorts, the most common adverse events of any grade were neutropenia; however, there was no neutropenic fever or treatment related mortality. Conclusions: Minnelide in combination with weekly paclitaxel demonstrated promising anti-tumor activity with durable responses in refractory AGC. Clinical trial information: Underreview .
Optimal perioperative therapy for incidental gallbladder cancer (OPT-IN): A randomized phase II/III trial—ECOG-ACRIN EA2197.
Authors: Maithel Shishir K. , Hong Sung Chul , Ethun Cecilia Grace , Ferrone Cristina R. , Rocha Flavio G. , Staley Charles A. , O'Dwyer Peter J.
Published: February 2023

TPS620

Background: Gallbladder carcinoma (GBC) is a rare disease with a poor prognosis, with an overall estimated 5-year survival rate of 5-13%. Approximately 70% of gallbladder cancers in the US are found incidentally on pathologic analysis after elective cholecystectomy for presumed benign disease. Current management guidelines for incidental gallbladder cancer (IGBC) recommend re-resection for T1b, T2, and T3 lesions, which entails a partial hepatectomy and lymph node dissection. Up to 75% of patients have residual locoregional disease and 20% have disseminated disease at the time of re-resection, both factors strongly associated with poor prognosis and inoperability, respectively. For those who undergo re-resection, the recurrence rate at one year can be as high as 40%. Therefore we designed a Phase II/III trial to assess the benefit of a perioperative chemotherapy approach around the re-resection procedure compared to standard of care adjuvant therapy alone. Methods: We have enrolled 18 of 186 planned patients (Phase III design) on study NCT 04559139/EA2197. Current eligibility criteria include: Incidentally diagnosed T2 / T3 gallbladder cancer with no evidence of metastatic disease or inoperable locoregional disease. At randomization, patients must be within 12 weeks of their index cholecystectomy. Patients are randomized 2:1 to receive perioperative chemotherapy with gemcitabine and cisplatin vs adjuvant therapy alone. The primary endpoint is overall survival. Secondary endpoints include resectability, presence of residual disease, and progression-free survival. Clinical trial information: 04559139 .