bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproducibility of isokinetic measures of the knee and ankle muscle strength in community-dwelling older adults without and with Alzheimer’s disease
Authors: de Oliveira Marcos Paulo Braz , Calixtre Letícia Bojikian , da Silva Serrão Paula Regina Mendes , de Oliveira Sato Tatiana , de Medeiros Takahashi Anielle Cristhine , de Andrade Larissa Pires
Published: December 2022

Background

To interpret changes of muscle strength in older adults with Alzheimer’s disease (AD), determining the reliability of outcome measures is necessary. Therefore, the purpose of the present study was to investigate the relative and absolute intra-rater reliability of concentric isokinetic measures of the knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages.

Methods

A methodological study was conducted. The participants were submitted to two isokinetic evaluations with an interval of three to seven days. The evaluations consisted of knee extension and flexion at 60°/s (five repetitions) and 180°/s (15 repetitions) and plantar flexion and dorsiflexion of the ankle at 30°/s (five repetitions). The measures of interest were peak torque, average peak torque and total work. The intraclass correlation coefficient two-way mixed model of a single-measure (ICC3,1), standard error of measurement (SEM) and minimal detectable change at the 95% confidence interval (MDC95) were calculated. The ICC3,1 was interpreted based on Munro’s classification. Standard error of measurement and MDC95 were analyzed in absolute and relative values (percentage of error [SEM%] and change [MDC95%]).

Results

A total of 62 older adults were included and allocated to the three groups: mild-AD (n = 22, 79.9 years, 15 female and seven male), moderate-AD (n = 20, 81.6 years, 15 female and five male) and without-AD (n = 20, 74.3 years, 10 female and seven male). The ICCs3,1 of the measures of knee were high/very high in the three groups (0.71–0.98). The ICCs3,1 of the measures of ankle were high/very high in the mild-AD group (0.78–0.92), moderate/high/very high in the moderate-AD group (0.63–0.93) and high/very high in the group without-AD (0.84–0.97). The measurements of knee extensors at 60°/s, knee extensors (peak torque and total work), with the exception of peak torque in the mild-AD group, and flexors (average peak torque) at 180°/s, and ankle dorsiflexors at 30°/s had the lowest of SEM% and MDC95% in the three groups.

Conclusion

Concentric isokinetic measures are reliable for the assessment of knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages.
Postoperative spinal cord infarction on a gravid woman with suspected IV drug use: a case report
Authors: Baldino Janine N. , Recknagel Johnathon , Beckham A. Jenna
Published: December 2022

Background

Back pain is common in the gravid population and spinal cord infarction (SCI) or chronic osteomyelitis are exceptionally rare underlying causes of back pain in this population. No case report to date has described this unexpected adverse event in a gravid woman with suspected history of IV drug use (IVDU). This diagnosis could potentially become more common with increasing rates of IVDU, and increased education could result in sooner recognition.

Case

A 38 year old G9P0171 at 24 weeks gestation with a complex past medical history, and a suspected history of IVDU, presented repeatedly with back pain. Following cesarean delivery at 36w2d, she developed signs and symptoms of an anterior spinal artery syndrome (ASAS) and had evidence of chronic osteomyelitis at T9-T10 on imaging. This required emergent decompressive laminectomy and ultimately resulted in paraplegia.

Conclusion

This case highlights the difficulties in recognizing all SCI risk factors pre-operatively and the importance of investigating back pain in pregnant patients with a suspected history of IVDU. We believe this patient’s chronic infection put her at an increased risk for SCI that was possibly compounded by the anatomical changes from its chronicity, possibly occurring in combination with several other precipitating causes of hypoperfusion. We hope this case report highlights the modern necessity to include a history, or suspected history, of IVDU as a red flag to initiate imaging in pregnant patients with acute, persistent, or unresolved back pain.
ATBF1 is a potential diagnostic marker of histological grade and functions via WNT5A in breast cancer
Authors: Li Mei , Zheng Yanan , Li Xujun , Shen Xiaohan , Zhang Tingxia , Weng Bowen , Mao Haijiao , Zhao Jiyuan
Published: December 2022

Background

Histological grade has been demonstrated to be an important factor of breast cancer outcome and is associated with cell differentiation and is currently being evaluated via H&E-stained sections. Molecular biomarkers are essential to improve the accuracy of histological grading. ATBF1, a large transcription factor, has been considered a tumor suppressor gene with frequent mutations or deletions in multiple cancers. In breast cancer, ATBF1 was reported to function in cell differentiation and mammary development. However, its role in the clinic has rarely been reported.

Methods

Breast cancer tissues (BCTs) and adjacent noncancerous tissues (ANCTs) were collected to analyze the expression of ATBF1 at the mRNA and protein levels. Three anti-ATBF1 antibodies recognizing independent peptides of ATBF1 (N-terminal end, middle region and C-terminal end) were applied for IHC staining. Small interfering RNA (siRNA) was used to silence ATBF1 expression and to investigate the roles of ATBF1 in MCF7 cells. Microarrays were introduced to analyze the differentially expressed genes, enriched GO terms and KEGG terms regulated by ATBF1 and its potential downstream genes, which were further confirmed in vitro and in clinical samples.

Results

The expression of ATBF1 was reduced in BCTs at both the mRNA and protein levels compared with that in ANCTs. ATBF1 protein was predominantly localized in the nucleus of ANCTs but in the cytoplasm of BCTs. Both the mRNA and protein levels of ATBF1 were significantly correlated with histological grade. Consistently, knockdown of ATBF1 increased stemness marker expression and reduced differentiation markers in vitro. Further analysis identified WNT5A as an essential downstream gene of ATBF1 in breast cancer cells. Treatment of WNT5A disrupted cell proliferation induced by ATBF1 silencing. In BCTs, a significant correlation was observed between the expression of WNT5A and ATBF1.

Conclusion

The results indicated that ATBF1 expression might be a useful diagnostic marker associated with histological grade and breast cancer malignancy. WNT5A and its signaling pathway are novel mechanisms by which ATBF1 contributes to breast cancer tumorigenesis.
Perfluorocarbon liquid-assisted vitreo-dissection in eyes with firmly adherent posterior hyaloid
Authors: Aziz Ihab Abdel , Hussein Moaaz M. , Fouad Yousef A.
Published: December 2022

Background

Induction of posterior vitreous detachment (PVD) is a critical step during pars plana vitrectomy. Multiple techniques and utilities have been proposed for assistance with this step with no consensus on the safest and most effective means, especially in eyes with firmly adherent posterior hyaloid. Viscodissection or the utilization of perfluorocarbon liquid (PFCL) can be used to dissect the posterior hyaloid and widely adherent epiretinal membranes.

Methods

A technique of PFCL dissection of the posterior hyaloid in eyes with abnormal adhesion of the posterior hyaloid. After core vitrectomy, breaking into the posterior hyaloid face is made via active aspiration and cutting or a sharp dissection. This is followed by active and slow injection of PFCL into the potential space between the posterior cortical vitreous and the neurosensory retina. A wave of PFCL propagates anteriorly causing “vitreo-dissection” of the peripheral cortical vitreous.

Results

The technique was effective and safe in 8 successive cases, 4 cases with vitreoretinal traction syndrome and 4 with diabetic tractional membranes.

Conclusion

The technique can be considered in cases with abnormal firmly adherent posterior hyaloid when induction of PVD proves difficult.
miR-125b-5p upregulation by TRIM28 induces cisplatin resistance in non-small cell lung cancer through CREB1 inhibition
Authors: Tan Qiuyu , Ma Jinzhu , Zhang Hao , Wu Xu , Li Qiang , Zuo Xiaoxuan , Jiang Yuxin , Liu Haijun , Yan Liang
Published: December 2022

Objective

miR-125b-5p plays an important role in the development of cancer and drug resistance. However, in cisplatin resistance of non-small cell lung cancer (NSCLC), the function and potential mechanism of miR-125b-5p is still unclear. The aim of this study was to investigate the role and molecular mechanism of miR-125b-5p in cisplatin resistance of NSCLC.

Methods

A GEO dataset (GSE168707) was analyzed to find high miR-125b-5p levels were associated with DDP resistance. miR-125b-5p expression levels were detected in A549 and A549/DDP cells via real-time quantitative RT-PCR (qRT-PCR). Luciferase reporter assays, western blots and mouse model xenografted were performed to identify CREB1 as a direct target gene of miR-125b-5p. Cell proliferation and apoptosis were also performed to identify whether miR-125b-5p upregulation by TRIM28 induces DDP resistance in NSCLC through CREB1 inhibition.

Results

In A549/DDP cells, miR-125b-5p expression was upregulated compared to A549 cells. Then miR-125b-5p was found to increase DDP resistance in NSCLC in vivo and in vitro by increasing cell proliferation and suppressing cell apoptosis. Bioinformatic analyses were used to search for gene which miR-125b-5p can target. We identified miR-125b-5p can regulate CREB1 via luciferase reporter assays, qRT-PCR and western blots. Cell proliferation and apoptosis were also performed to confirm miR-125b-5p could impact on CREB1 and induce the DDP resistance in NSCLC. Additionally, we used bioinformatic analyses to find tripartite motif-containing 28 (TRIM28) as a transcriptional enhance factor of miR-125b-5p. The expression of TRIM28 was upregulated in A549/DDP cells compared with that in A549 cells by qRT-PCR. Finally, we found TRIM28 could mediate DDP resistance through miR-125b-5p/CREB1 axis via cell proliferation, western blot and apoptosis assay.

Conclusions

Overall, our findings demonstrated novel functions and mechanisms underlying DDP resistance in NSCLC through the TRIM28/miR-125b-5p/CREB1 axis. These may serve as novel therapeutic targets to improve the treatment efficacy using DDP for NSCLC in the future.
Regulation of Adropin by Sitagliptin monotherapy in participants with newly diagnosed type 2 Diabetes
Authors: Wang Qiu , An Yu , Zhang Lin , Zhang Yuanying , Wang Guang , Liu Jia
Published: December 2022

Background

Adropin is a potent metabolic regulator of insulin sensitivity and glycolipid metabolism. The present study investigated the effects of sitagliptin on adropin and metabolic parameters in participants with newly diagnosed type 2 diabetes (T2D).

Methods

Thirty-five participants newly-diagnosed with T2D were prescribed sitagliptin 100 mg once daily for 17 weeks. Twenty-eight age-, sex-, and BMI-matched healthy subjects were included as the control group. Adropin and clinical parameters were assessed at baseline and after treatment.

Results

At baseline, serum adropin levels were lower in T2D participants than in the healthy individuals (3.12 ± 0.73 vs. 5.90 ± 1.22 ng/ml, P <  0.01). Serum adropin levels were significantly higher in T2D patients after sitagliptin treatment (4.97 ± 1.01 vs. 3.12 ± 0.73 ng/ml, P <  0.01). The changes in serum adropin levels after sitagliptin treatment were associated with the improvements of fasting blood glucose (FBG) (β = − 0.71, P <  0.01), glycosylated hemoglobin (HbA1c) (β = − 0.44, P <  0.01) and homeostatic model assessment of β-cell function (HOMA-β) (β = 9.02, P <  0.01).

Conclusions

Sitagliptin treatment could significantly increase serum adropin levels in participants with newly diagnosed T2D. The increase in serum adropin levels could be associated with the amelioration of glucose metabolism, which might be involved in beneficial glucose-lowering mechanisms of sitagliptin.

Trial registration

Clinicaltrials.gov, NCT04495881. Retrospectively registered on 03/08/2020.
Implementation of a palliative care intervention for patients with COPD – a mixed methods process evaluation of the COMPASSION study
Authors: Broese Johanna M. C. , van der Kleij Rianne M. J. J. , Verschuur Els M. L. , Kerstjens Huib A. M. , Engels Yvonne , Chavannes Niels H.
Published: December 2022

Objectives

Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators.

Methods

A mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants.

Results

The training sessions with roleplay were positively evaluated and increased professionals’ self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient’s readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader.

Conclusions

Providing integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration.

Trial registration

The COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.
Synchronous online lecturing or blended flipped classroom with jigsaw: an educational intervention during the Covid-19 pandemic
Authors: Mohebbi Zinat , Mortezaei-Haftador Alireza , Mehrabi Manoosh
Published: December 2022

Background

The Covid-19 pandemic has changed the education system throughout the world. This study aimed to compare synchronous online lecturing with blended flipped classroom plus jigsaw in terms of their effects on the students’ learning, communication skills and critical thinking disposition.

Methods

This is an educational intervention conducted at the Nursing and Midwifery School of Shiraz University of Medical Sciences. Two incoming students of nursing and midwifery were selected by complete enumeration. Then synchronous online lecturing was given to one group (n = 40) and blended flipped classroom and jigsaw to the other (n = 44). After that, given the prevailing conditions, both methods were performed fully online. Then Participants completed an online questionnaire. A researcher-made learning questionnaire, the Interpersonal Communication Skills Questionnaire developed by Fetro, and Ricketts’ Critical Thinking Disposition Inventory were used to assess the study variables.

Results

The mean learning scores in the blended group were slightly higher but this difference was not significant (P = 0.767). In the blended group, the mean scores of communication skills were significantly higher after the intervention in all the dimensions, except for empathy & intimacy and listening skills. In the online lecture group, there was no significant difference between before and after the intervention. Communication skills (P < 0.001) scored significantly higher in the blended group after the intervention than that in the synchronous online lecturing group in all the dimensions except for empathy & intimacy. In the online lecture group, there was no significant difference in critical thinking disposition between before and after the intervention. In the blended group, the overall score of critical thinking disposition and its dimensions was significantly higher after the intervention (P < 0.001), except for the perfection dimension. There was no significant difference between the two groups in terms of the mean total score of critical thinking disposition and its dimensions before and after the intervention.

Conclusion

Given the global circumstances, the blended method was more effective in promoting learning outcomes and communication skills than synchronous online lectures. Furthermore, it seems that this new approach could improve critical thinking.
Validating the representation of distance between infarct diseases using word embedding
Authors: Yokokawa Daiki , Noda Kazutaka , Yanagita Yasutaka , Uehara Takanori , Ohira Yoshiyuki , Shikino Kiyoshi , Tsukamoto Tomoko , Ikusaka Masatomi
Published: December 2022

Background

The pivot and cluster strategy (PCS) is a diagnostic reasoning strategy that automatically elicits disease clusters similar to a differential diagnosis in a batch. Although physicians know empirically which disease clusters are similar, there has been no quantitative evaluation. This study aimed to determine whether inter-disease distances between word embedding vectors using the PCS are a valid quantitative representation of similar disease groups in a limited domain.

Methods

Abstracts were extracted from the Ichushi Web database and subjected to morphological analysis and training using Word2Vec, FastText, and GloVe. Consequently, word embedding vectors were obtained. For words including “infarction,” we calculated the cophenetic correlation coefficient (CCC) as an internal validity measure and the adjusted rand index (ARI), normalized mutual information (NMI), and adjusted mutual information (AMI) with ICD-10 codes as the external validity measures. This was performed for each combination of metric and hierarchical clustering method.

Results

Seventy-one words included “infarction,” of which 38 diseases matched the ICD-10 standard with the appearance of 21 unique ICD-10 codes. When using Word2Vec, the CCC was most significant at 0.8690 (metric and method: euclidean and centroid), whereas the AMI was maximal at 0.4109 (metric and method: cosine and correlation, and average and weighted). The NMI and ARI were maximal at 0.8463 and 0.3593, respectively (metric and method: cosine and complete). FastText and GloVe generally resulted in the same trend as Word2Vec, and the metric and method that maximized CCC differed from the ones that maximized the external validity measures.

Conclusions

The metric and method that maximized the internal validity measure differed from those that maximized the external validity measures; both produced different results. The cosine distance should be used when considering ICD-10, and the Euclidean distance when considering the frequency of word occurrence. The distributed representation, when trained by Word2Vec on the “infarction” domain from a Japanese academic corpus, provides an objective inter-disease distance used in PCS.
Investigating the pathways between swift trust and team creativity among nursing student teams in Taiwan: A moderated mediation model
Authors: Liu Hsing-Yuan
Published: December 2022

Background

Considerable theoretical and empirical work indicates that a multitude of factors are associated with team creativity in an organizational context. The complex relationships between the contributors, however, are not well understood in nursing education. This study was to take a process view investigating the pathways from swift trust to creativity via collaborative interactions and to explore whether task conflict would further change the strength of the indirect effect.

Methods

This study utilized a cross-sectional, quantitative, descriptive design. Taiwanese nursing students (finaln = 629), who enrolled in capstone courses of small interdisciplinary groups collaborating with industrial design students on designing healthcare products, participated in the study. Data were collected from students during 2018 and 2020. Questionnaires assessed their perceptions about teams' swift trust (including cognition- and affect-based), collaborative interactions (including constructive controversy, helping behavior, and spontaneous communication), task conflict, and creativity. SPSS PROCESS macro was used to test the proposed moderated mediation model.

Results

Bivariate correlation analysis showed that greater team creativity was associated with increased cognition-based team swift trust and collaborative interactions. Results revealed that collaborative interactions serving as the underlying mechanisms mediating the effect of cognition- and affect-based swift trust on team creativity. Moreover, the indirect effect of collaborative interactions, specifically, spontaneous communication, on linking swift trust to team creativity varied as a function of task conflict. As task conflict decreased, the effect became stronger.

Conclusion

Findings suggest that nursing student teams’ spontaneous communication serves as the underlying mechanism in linking the relationship between swift trust and team creativity and that lower task conflict plays a crucial role in enhancing the indirect effect. The proposed pathway could provide guidance for nursing educators to promote creativity outcomes by promoting swift trust and collaborative interactions as well as preventing task conflict for interdisciplinary nursing student teams.
Comparison of depression care provided in general practice in Norway and the Netherlands: registry-based cohort study (The Norwegian GP-DEP study)
Authors: Hansen Anneli Borge , Baste Valborg , Hetlevik Øystein , Smith-Sivertsen Tone , Haukenes Inger , de Beurs Derek , Nielen Mark , Ruths Sabine
Published: December 2022

Background

Depression is highly prevalent in general practice, and organisation of primary health care probably affects the provision of depression care. General practitioners (GPs) in Norway and the Netherlands fulfil comparable roles. However, primary care teams with a mental health nurse (MHN) supplementing the GP have been established in the Netherlands, but not yet in Norway. In order to explore how the organisation of primary mental care affects care delivery, we aimed to examine the provision of GP depression care across the two countries.

Methods

Registry-based cohort study comprising new depression episodes in patients aged ≥ 18 years, 2011–2015. The Norwegian sample was drawn from the entire population (national health registries); 297,409 episodes. A representative Dutch sample (Nivel Primary Care Database) was included; 27,362 episodes. Outcomes were follow-up consultation(s) with GP, with GP and/or MHN, and antidepressant prescriptions during 12 months from the start of the depression episode. Differences between countries were estimated using negative binomial and Cox regression models, adjusted for patient gender, age and comorbidity.

Results

Patients in the Netherlands compared to Norway were less likely to receive GP follow-up consultations, IRR (incidence rate ratio) = 0.73 (95% confidence interval (CI) 0.71–0.74). Differences were greatest among patients aged 18–39 years (adj IRR = 0.64, 0.63–0.66) and 40–59 years (adj IRR = 0.71, 0.69–0.73). When comparing follow-up consultations in GP practices, including MHN consultations in the Netherlands, no cross-national differences were found (IRR = 1.00, 0.98–1.01). But in age-stratified analyses, Dutch patients 60 years and older were more likely to be followed up than their Norwegian counterparts (adj IRR = 1.21, 1.16–1.26). Patients in the Netherlands compared to Norway were more likely to receive antidepressant drugs, adj HR (hazard ratio) = 1.32 (1.30–1.34).

Conclusions

The observed differences indicate that the organisation of primary mental health care affects the provision of follow-up consultations in Norway and the Netherlands. Clinical studies are needed to explore the impact of team-based care and GP-based care on the quality of depression care and patient outcomes.
A qualitative exploration of continuity of TB care in clinics after discharge from hospitals in Cape Town, South Africa
Authors: Kallon Idriss Ibrahim , Colvin Christopher J
Published: December 2022

Background

Continuity of care remains a challenge for TB patients who are discharged from hospital and referred to primary health care clinics in South Africa. The aim of this study was to explore the experiences and perceptions of patients, health care workers and family members regarding continuity of TB care in a Cape Town health district.

Methods

We conducted one-on-one interviews, using semi-structured interview guides, with TB patients and their families and health care workers. We also conducted focus group interviews with other health care workers who performed similar duties. Field notes were kept and patients’ home circumstances were also physically observed. Data saturation was achieved after 31 interviews. We used Miles and Huberman’s qualitative data analysis framework to interpret the data.

Results

Themes identified in the interviews were grouped into two categories: (1)  patients’ socio-economic circumstances including complex family relationships, good or lack of family support, inadequate income, and agency; and (2) health system challenges, including inadequate referral links between the clinic and the hospital and negative emotions as a result of poor service delivery experienced by patients.

Conclusion

Some TB Patients experienced poor continuity of care on discharge from hospitals to primary health clinics and perceived that this resulted from socio-economic conditions and health system-related problems that triggered negative emotions. Proper communication between the hospital and clinic regarding patients’ care, adequate counselling, and patient-centred treatment are required to address poor continuity of care among patients with TB down-referred to clinics.
Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial
Authors: Lohne Fredrik Klæboe , Fimland Marius Steiro , Holtermann Andreas , Mathiassen Svend Erik , Fischer Heike , Gellein Trine Minde , Redzovic Skender
Published: December 2022

Background

Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a “just right” weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care.

Methods

The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a “just right” distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant’s characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews.

Discussion

Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective.

Trial registration

This clinical trial was registered on 08/05/2022 under NCT05487027.
Inhibition of bone erosion, determined by high-resolution peripheral quantitative computed tomography (HR-pQCT), in rheumatoid arthritis patients receiving a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) plus denosumab vs csDMARD therapy alone: an open-label, randomized, parallel-group study
Authors: Iwamoto Naoki , Chiba Ko , Sato Shuntaro , Shiraishi Kazuteru , Watanabe Kounosuke , Oki Nozomi , Okada Akitomo , Koga Tomohiro , Kawashiri Shin-ya , Tamai Mami , Hosogaya Naoki , Furuyama Masako , Kobayashi Makiko , Saito Kengo , Okubo Naoki , Uetani Masataka , Osaki Makoto , Kawakami Atsushi
Published: December 2022

Background

This exploratory study compared the inhibition of bone erosion progression in rheumatoid arthritis (RA) patients treated with a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) plus denosumab versus csDMARD therapy alone and investigated the effects of denosumab on bone micro-architecture and other bone-related parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT).

Methods

In this open-label, randomized, parallel-group study, patients with RA undergoing treatment with a csDMARD were randomly assigned (1:1) to continue csDMARD therapy alone or to continue csDMARDs with denosumab (60-mg subcutaneous injection once every 6 months) for 12 months. The primary endpoint was the change from baseline in the depth of bone erosion, measured by HR-pQCT, in the second and third metacarpal heads at 6 months after starting treatment. Exploratory endpoints were also evaluated, and adverse events (AEs) were monitored for safety.

Results

In total, 46 patients were enrolled, and 43 were included in the full analysis set (csDMARDs plus denosumab, N = 21; csDMARD therapy alone, N = 22). Most patients were female (88.4%), and the mean age was 65.3 years. The adjusted mean (95% confidence interval) change from baseline in the depth of bone erosion, measured by HR-pQCT, in the 2–3 metacarpal heads at 6 months was − 0.57 mm (− 1.52, 0.39 mm) in the csDMARDs plus denosumab group vs − 0.22 mm (− 0.97, 0.53 mm) in the csDMARD therapy alone group (between-group difference: − 0.35 mm [− 1.00, 0.31]; P = 0.2716). Similar results were shown for the adjusted mean between-group difference in the width and volume of bone erosion of the 2–3 metacarpal heads. Significant improvements in bone micro-architecture parameters were shown. The incidence of AEs and serious AEs was similar between the csDMARDs plus denosumab and the csDMARD therapy alone groups (AEs: 52.2% vs 56.5%; serious AEs: 4.3% vs 8.7%).

Conclusions

Although the addition of denosumab to csDMARDs did not find statistically significant improvements in bone erosion after 6 months of treatment, numerical improvements in these parameters suggest that the addition of denosumab to csDMARDs may be effective in inhibiting the progression of bone erosion and improving bone micro-architecture.

Trial registration

University Hospital Medical Information Network Clinical Trials Registry, UMIN000030575. Japan Registry for Clinical Trials, jRCTs071180018
Expression of CFTR, a hallmark gene of ionocytes, is downregulated in salivary glands of Sjögren’s syndrome patients
Authors: Zhang Qi , Lv Xiuying , Wang Ying , Wang Bin , He Yan , Chen Chubing , Shi Guixiu , Li Yan
Published: December 2022

Introduction

The autoimmune exocrinopathy, Sjögren’s syndrome (SjS), is associated with secretory defects in salivary glands. The cystic fibrosis transmembrane conductance regulator (CFTR) of the chloride channel is a master regulator of fluid secretion, but its role in SjS has not been investigated. Our research found a link between CFTR and SjS at the genetic and protein levels, as well as through clinical data.

Methods

We used single-cell RNA sequencing to identify the presence of CFTR in glandular epithelial cells of the human salivary gland (scRNA-seq) and confirmed the difference using immunofluorescence tests in labial glands and clinical data statistics from 44 non-SjS and 36 SjS patients.

Results

The changes of CFTR expression in salivary glands of SjS patients was assessed at both mRNA and protein levels. According to the scRNA-seq analyses, CFTR was the hallmark gene of ionocytes. We firstly identified that SjS had a lower level of CFTR expression in the labial glands than non-SjS at mRNA level.

Using immunofluorescence assays, we also found that CFTR expression was decreased in SjS patients compared to non-SjS. The results of the clinical statistics revealed that CFTR expression was adversely correlated with feelings of dry mouth, lymphocyte infiltration in the labial glands, and certain autoantibodies in serum (antinuclear antibody, anti-Ro/SSA, and anti-La/SSB antibodies).

Conclusion

Those findings above proved an obviously downregulated expression of CFTR in salivary glands of SjS patients and its clinical significance. Dysfunction in CFTR or ionocytes may contribute to SjS pathogenesis and represents a promising therapeutic target.
Understanding the risk of developing weight-related complications associated with different body mass index categories: a systematic review
Authors: Taieb Adam Ben , Roberts Erika , Luckevich Maria , Larsen Sara , le Roux Carel W. , de Freitas Paulo Gomes , Wolfert Dingeman
Published: December 2022

Background

Obesity and overweight are major risk factors for several chronic diseases. There is limited systematic evaluation of risk equations that predict the likelihood of developing an obesity or overweight associated complication. Predicting future risk is essential for health economic modelling. Availability of future treatments rests upon a model’s ability to inform clinical and decision-making bodies. 

This systematic literature review aimed to identify studies reporting (1) equations that calculate the risk for individuals with obesity, or overweight with a weight-related complication (OWRC), of developing additional complications, namely T2D, cardiovascular (CV) disease (CVD), acute coronary syndrome, stroke, musculoskeletal disorders, knee replacement/arthroplasty, or obstructive sleep apnea; (2) absolute or proportional risk for individuals with severe obesity, obesity or OWRC developing T2D, a CV event or mortality from knee surgery, stroke, or an acute CV event.

Methods

Databases (MEDLINE and Embase) were searched for English language reports of population-based cohort analyses or large-scale studies in Australia, Canada, Europe, the UK, and the USA between January 1, 2011, and March 29, 2021. Included reports were quality assessed using an adapted version of the Newcastle Ottawa Scale.

Results

Of the 60 included studies, the majority used European cohorts. Twenty-nine reported a risk prediction equation for developing an additional complication. The most common risk prediction equations were logistic regression models that did not differentiate between body mass index (BMI) groups (particularly above 40 kg/m2) and lacked external validation. The remaining included studies (31 studies) reported the absolute or proportional risk of mortality (29 studies), or the risk of developing T2D in a population with obesity and with prediabetes or normal glucose tolerance (NGT) (three studies), or a CV event in populations with severe obesity with NGT or T2D (three studies). Most reported proportional risk, predominantly a hazard ratio.

Conclusion

More work is needed to develop and validate these risk equations, specifically in non-European cohorts and that distinguish between BMI class II and III obesity. New data or adjustment of the current risk equations by calibration would allow for more accurate decision making at an individual and population level.
How limb dominance influences limb symmetry in ACL patients: effects on functional performance
Authors: Zumstein F. , Centner C. , Ritzmann R.
Published: December 2022

Background

Timing for return to sport (RTS) after anterior cruciate ligament (ACL) injury is paramount for the avoidance of a secondary injury. A common criterion in RTS decision-making is the limb symmetry index (LSI) which quantifies (a)symmetries between the affected and unaffected limb. Limb dominance is one of many factors that may contribute to the recovery of the LSI after ACL reconstruction. The purpose of this study was to examine how limb dominance affects the LSI of functional performance tasks nine months following ACL reconstruction (time of RTS).

Methods

At time of return to sport, n = 100 patients (n = 48 injured the dominant limb, n = 52 injured the non-dominant limb, n = 34 female, n = 66 male) with ACL reconstruction surgery performed isokinetic strength measurements of the knee extensors and flexors, and drop jumps (DJ), single leg hop for distance (SHD) and 6 m timed hop (6MTH) testings.

Results

The findings indicated that injury of the dominant leg led to significantly higher LSI values in maximal isokinetic knee extensor strength (p = 0.030). No significant differences were observed for maximal isokinetic knee flexor strength, DJ, SHD or 6MTH performance. Stratifying for sex revealed no significant differences. Simple regression analyses demonstrated that LSI in maximal knee extensor strength significantly predicted LSIs in DJ and SHD while explaining 14% and 18% of the respective variance.

Conclusions

Given that limb dominance affects the LSI of muscle strength suggests that a differentiated interpretation of the LSI with respect to limb dominance should be considered for a safe return to sport. Monoarticular knee extensor strength and multiarticular hop test performance are interrelated and thus can show asymmetries which are not maladaptive but established during years of habituation or training.
Peer researchers’ experiences of a co-produced research project on supported decision-making
Authors: Webb Paul , Falls David , Keenan Fionnuala , Norris Barbara , Owens Aine , Davidson Gavin , Edge Rosalie , Kelly Berni , McLaughlin Aisling , Montgomery Lorna , Mulvenna Christine , Irvine Rebecca Shea
Published: December 2022

Background

Making decisions about your own life is a key aspect of independence, freedom, human rights and social justice. There are disabled people who, without support, would be assessed as incapable of making certain decisions but with the appropriate support are capable of making those decisions and so to not provide that support infringes their rights, undermines their autonomy and reinforces their exclusion from society. However, there is limited research evidence available about disabled people’s experiences of the range of approaches provided to support decision-making. This article will explore the experiences of four peer researchers who co-produced a research project on how people have, or have not been, supported to make their own decisions. Two of the peer researchers have experience of mental health problems and two are people with an intellectual disability. The article refers to peer research because its subject matter is the relevant lived experience of people. Peer research is therefore an approach within the broader areas of participatory research and co-production.

Methods

The peer researchers interviewed 21 people with mental health problems and 20 people with an intellectual disability to gain an in-depth understanding of their experiences and preferences for how decision-making should be supported. Peer researcher experiences at each stage of the study from design to analysis were explored using data collected from the peer researchers via blogs written at early stages of the study, discussions at team meetings as the fieldwork progressed and at a final workshop at the end of the study which gave the peer researchers the opportunity to focus on their overall reflections of being a peer researcher. The article also discusses motivations to undertake the peer research role, the process of co-production and the challenges negotiated during the study.

Results

The peer researchers reported a number of positive effects of being involved in the research project which included improvements in skills and self-confidence.

Conclusion

The peer researchers’ involvement challenged assumptions about the inability of people with an intellectual disability and/or mental health problems to participate proactively in a research project whilst also highlighting the importance of training for all team members.
Curvature attributes with the 3D seismic Kalman filter for fault opening description — An application to a shale oil reservoir in the Jimsar sag, Junggar Basin, Xinjiang
Authors: Chen Gang , Qi Hongyan , Song Yong , Li Wei , Xian Chenggang , Liu Yuzhang , Tang Tingming , Lu Minghui , Wang Zhenlin , Zhao Yang
Published: December 2022

The large-scale shale-oil production in the Jimsar sag of the Junggar Basin is being aggressively developed. To improve unconventional production and make precise suggestions for horizontal well developments, fault interpretations using seismic data play an important role. The target reservoir in the Jimsar sag of the Junggar Basin has a comprehensive network of faults, according to the drilled wells and fault identification from the broadband azimuth and high-density 3D seismic data. Several reasons such as the integration between source and reservoir, the substantial abundance of organic matter, and the major reservoir plasticity result in different fault types, which then create different impacts on horizontal wells. We have developed a fault-type identification tool using the curvature attributes via the 3D seismic Kalman filter to provide a more accurate description of fault types. In contrast with previous studies, we derive the Kalman-curvature formulation in terms of space and time, by using a dynamically iterative optimization model. Our strategy reveals that various fault types (open faults, semiopen faults, and sealed faults) represent their characteristics associated with the 3D Kalman-curvature attributes. The resultant fault divisions are valid by combining the drilled information of lost circulation and fracturing crosstalk of the horizontal wells. High-quality field results validate the robustness of our algorithms.
Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline
Authors: McCall Anthony L , Lieb David C , Gianchandani Roma , MacMaster Heidemarie , Maynard Gregory A , Murad M Hassan , Seaquist Elizabeth , Wolfsdorf Joseph I , Wright Robin Fein , Wiercioch Wojtek
Published: December 2022

Context

Hypoglycemia in people with diabetes is common, especially in those taking medications such as insulin and sulfonylureas (SU) that place them at higher risk. Hypoglycemia is associated with distress in those with diabetes and their families, medication nonadherence, and disruption of life and work, and it leads to costly emergency department visits and hospitalizations, morbidity, and mortality.

Objective

To review and update the diabetes-specific parts of the 2009 Evaluation and Management of Adult Hypoglycemic Disorders: Endocrine Society Clinical Practice Guideline and to address developing issues surrounding hypoglycemia in both adults and children living with diabetes. The overriding objectives are to reduce and prevent hypoglycemia.

Methods

A multidisciplinary panel of clinician experts, together with a patient representative, and methodologists with expertise in evidence synthesis and guideline development, identified and prioritized 10 clinical questions related to hypoglycemia in people living with diabetes. Systematic reviews were conducted to address all the questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.

Results

The panel agreed on 10 questions specific to hypoglycemia risk and prevention in people with diabetes for which 10 recommendations were made. The guideline includes conditional recommendations for use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps in people with type 1 diabetes (T1D), use of CGM for outpatients with type 2 diabetes at high risk for hypoglycemia, use of long-acting and rapid-acting insulin analogs, and initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia. Strong recommendations were made for structured diabetes education programs for those at high risk for hypoglycemia, use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children, use of real-time CGM for individuals with T1D receiving multiple daily injections, and the use of inpatient glycemic management programs leveraging electronic health record data to reduce the risk of hypoglycemia.

Conclusion

The recommendations are based on the consideration of critical outcomes as well as implementation factors such as feasibility and values and preferences of people with diabetes. These recommendations can be used to inform clinical practice and health care system improvement for this important complication for people living with diabetes.