bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensory Reconstruction of a Posterior Heel Defect Using a Proximally Based Sensate Medial Plantar Flap with Retrograde Nerve Cleavage Technique
Authors: Jung Sung Yoon , Kim Min Bom , Lee Young Ho
Published: November 2021

Reconstruction of posterior heel defects is important because it requires thick and durable skin that can withstand pressure and shear from shoe and bed contact. Therefore, the sensate flap could be a better option for the defect. This paper reports on the safety of a medial plantar sensory flap for these defects as well as an objective measurement of the sensation of the medial plantar flap and the plantar surface distal to the donor site. Twelve patients had soft-tissue defects in the posterior heel and underwent reconstructive surgery using a proximally based sensate medial plantar sensory flap. Cases of plantar defects involving not posterior heel were excluded. For wider flap coverage, special neurovascular dissection was required. We evaluated levels of sensation quantitatively using Semmes–Weinstein (SW) monofilaments and a two-point discriminator at the final follow-up. All flaps survived without major complications. Postoperative follow-up was 12 to 64 months (mean 26 months). All 12 flaps healed without postoperative complications. There was no significant difference in minimal two-point discrimination and SW evaluator size between the transferred medial plantar flap area and the contralateral heel area or between the plantar area distal to the donor site and the contralateral side. Patients could walk normally and sleep without protective shoes or brace. A proximally based sensate medial plantar flap is a good option for the reconstruction of posterior heel defects. It can restore the characteristics of the posterior heel for shoe wearing and sleeping.
Age of Early Specialization, Competitive Volume, Injury, and Sleep Habits in Youth Sport: A Preliminary Study of US Youth Basketball
Authors: Meisel Peter L. , DiFiori John P. , Côté Jean , Nguyen Joseph T. , Brenner Joel S. , Malina Robert M. , Ryan Ed , Güllich Arne
Published: November 2021

Background:

Concerns for youth sports in the United States often focus on early sport specialization, overemphasis on competition, injuries, and burnout. Little research has addressed relationships among the preceding and other concerns, including time away from organized sport, sleep, and perceptions of physical and psychological well-being.

Hypothesis:

There is an association between reported competitive gameplay volume and specialization, injury, and fatigue among elite youth basketball players.

Study Design:

Cross-sectional study; convenience sample.

Level of Evidence:

Level 4.

Methods:

An anonymous questionnaire was administered to a convenience sample of youth basketball players between 13 and 18 years of age from across the United States. Participants were queried about multiple factors, including the extent of their participation in organized basketball and other sports, time away from organized basketball, injury, sleep, and feelings of exhaustion related to basketball participation.

Results:

A total of 772 participants (145 girls, 627 boys) completed a survey. All participants played for a select or elite club basketball team and/or a high school basketball team. Overall, 49% played more than 50 games within the past year. A total of 73% were specialized in basketball, 58% prior to age 14 years, and 35% prior to age 11 years. In all, 70% reported less than 1 month away from organized basketball within the past year, and 28% reported no time away. A total of 54% reported sleeping less than the recommended 8 hours each night during the school year. Within the prior year, 55% reported feeling physically exhausted and 45% reported feeling mentally exhausted from basketball. Regression analysis did not find any significant relationships between early specialization prior to age 14 years and basketball-related injury or feelings of mental or physical exhaustion.

Conclusion:

In this select group of youth basketball players, the majority specialized in basketball prior to age 14 years and reported a large number of competitive events with little time away from organized basketball.

Clinical Relevance:

The results from a sample of highly competitive youth basketball players indicate issues that warrant further attention and research regarding the potential impact of specialization, frequent competitions, lack of time away from organized sport, and perceptions of well-being in young athletes.
Marxist geography: A personal journey
Authors: Ahmed Waquar
Published: November 2021

I am fascinated by Marx’s openness to learning and engagement with diverse intellectual traditions—political economic, German and Greek philosophy, utopian socialist tradition, and English literature to name a few. Marxism for me, hence, is engagement and conversations with eclectic ideas, with fidelity to the communist manifesto, and in turn, its commitment to equality and justice. In this paper, while highlighting my own journey as a student of Marx’s scholarship, I examine the key role hegemony plays in our society. Formal education, I argue, is hegemonic to the extent that it is geared at producing docile individuals, particularly from oppressed sections of the society, that internalize theories and concepts favorable to elites: it should not surprise us when the oppressed act or vote against their own interest. Yet some centers of learning are also epicenters of counter-hegemonic praxis—one such place is Jawaharlal Nehru University where I unlearn and re-learned my Marxism and began my journey as a Marxist geographer. Additionally, I examine the role of “vulgar Marxism” (unwillingness to engage with contemporary geographically specific challenges) that is often passed off as Marxist orthodoxy and argue that this has been a real threat to the spirit of the Communist Manifesto. I examine the decline of the Communist Party in Bengal in India to highlight how vulgar Marxism can subvert social justice and make the “Communist Party” unpopular.
Alpha-fetoprotein–producing recurrent nasopharyngeal carcinoma: A case report
Authors: Yang Zhen-Chong , Luo Mei-Juan , Liu Li-Li , Cai Mu-Yan , Liang Yu-Jing , Chen Qiu-Yan , Tang Lin-Quan , Mai Hai-Qiang
Published: November 2021

Alpha-fetoprotein hardly increased due to nasopharyngeal cancer. In this article, we reported a 57-year-old male nasopharyngeal carcinoma patient who had posttreatment subscapular metastasis with high serum alpha-fetoprotein but negative plasma Epstein–Barr virus DNA. Pathology results indicated that the scapular mass was undifferentiated non-keratinizing carcinoma originated in the nasopharynx. Moreover, no liver lesion was detected by imaging examination. In view of the positive alpha-fetoprotein and alpha-fetoprotein messenger RNA staining result in the right scapular mass fine needle aspiration biopsy sample, we considered the diagnosis of alpha-fetoprotein-producing nasopharyngeal carcinoma that had never been reported before.
Total cerebral small vessel disease score and all-cause mortality in older adults of Amerindian ancestry: The Atahualpa Project
Authors: Del Brutto Victor J , Mera Robertino , Recalde Bettsy Y , Rumbea Denisse A , Costa Aldo F , Del Brutto Oscar H
Published: November 2021

Introduction

Cerebral small vessel disease (SVD) predicts all-cause mortality in Eastern Asian and Caucasian populations. However, little is known about SVD impact in individuals of different races/ethnic groups. In this study, we sought to estimate the mortality risk according to the total SVD (tSVD) score in older adults of Amerindian ancestry.

Methods

Participants aged ≥60 years from the prospective population-based Atahualpa Project cohort underwent brain MRI between June 2012 and June 2017. The tSVD score was calculated based on the presence of moderate-to-severe white matter hyperintensities, enlarged perivascular spaces, one or more lacune, and one or more cerebral microbleed. We ascertained all-cause mortality during post-MRI follow-up. Poisson regression and Cox-proportional hazards models adjusted for demographics and cardiovascular risk were obtained to estimate mortality risk according to the tSVD score.

Results

Analysis included 375 participants with available brain MRI and clinical data (mean age 69.0 ± 8.3 years, 56.3% women). The tSVD score was 0 point in 216 individuals (57.6%), 1 point in 71 (18.9%), 2 points in 53 (14.1%), and 3–4 points in 35 (9.3%). Increasing tSVD score was associated with advancing age, hypertension, low level of education, and physical inactivity. Using tSVD score of 0 as reference, a multivariate Poisson regression model showed an increased mortality for individuals with a tSVD score 3–4 points (IRR: 2.27; 95% CI: 1.20–4.28). Likewise, in the Cox-proportional model adjusted for demographics and cardiovascular risk, participants with a tSVD score 3–4 maintained a greater than two-fold mortality risk when compared to those with tSVD score of 0 points (HR: 2.32; 95% CI: 1.23–4.39).

Conclusions

High-burden SVD as determined by the tSVD score predicts mortality in community-dwelling older adults of Amerindian ancestry. Incidental diagnosis of covert SVD should prompt aggressive control of cardiovascular health.
Paraneoplastic tubulointerstitial nephritis exacerbated by immune checkpoint inhibitor
Authors: Scherer Thomas Paul , Saba Karim Alexander , Strebel Raeto Thomas , Gaspert Ariana , Cathomas Richard , Fehr Thomas
Published: November 2021

Background:

With the expanding indications and thus broader use of immune checkpoint inhibitors, clinicians are faced with a new kind of immune-related adverse events. Because of their immune modulating effects, immune checkpoint inhibitors have the potential to worsen autoimmunity in general. Paraneoplastic syndromes can be caused by tumor-induced autoimmune mechanisms. The use of immune-activating substances such as checkpoint inhibitors might lead to exacerbation of paraneoplastic syndromes causing premature discontinuation of the immunotherapy.

Case presentation:

We report on a 64-year-old patient with metastasized renal cell carcinoma who developed acute kidney failure after cytoreductive nephrectomy. Work-up revealed a paraneoplastic syndrome that caused tubulointerstitial nephritis (TIN). Glucocorticoid therapy successfully reversed the acute kidney injury. However, adjuvant therapy with Nivolumab provoked a flare-up of the paraneoplastic syndrome on two occasions, eventually leading to a treatment discontinuation.

Conclusions:

Many cases of Nivolumab-induced TIN have been described lately. However, our case demonstrates therapy failure due to a flare-up of a pre-existing paraneoplastic syndrome of the renal cancer. Against this background, it can only be speculated that some of the TIN cases discussed in prior literature might also have been flare-ups of subclinical autoimmunity.
Optimization Transmission Efficiency with Driver Intention for Automotive Continuously Variable Transmission under Slip Mode
Authors: Han Ling , Zhang Hui , Fang Ruoyu , Liu Hongxiang
Published: November 2021

This study proposes and experimentally validates an optimal integrated system to control the automotive continuously variable transmission (CVT) by Model Predictive Control (MPC) to achieve its expected transmission efficiency range. The control system framework consists of top and bottom layers. In the top layer, a driving intention recognition system is designed on the basis of fuzzy control strategy to determine the relationship between the driver intention and CVT target ratio at the corresponding time. In the bottom layer, a new slip state dynamic equation is obtained considering slip characteristics and its related constraints, and a clamping force bench is established. Innovatively, a joint controller based on model predictive control (MPC) is designed taking internal combustion engine torque and slip between the metal belt and pulley as optimization dual targets. A cycle is attained by solving the optimization target to achieve optimum engine torque and the input slip in real-time. Moreover, the new controller provides good robustness. Finally, performance is tested by actual CVT vehicles. Results show that compared with traditional control, the proposed control improves vehicle transmission efficiency by approximately 9.12%–9.35% with high accuracy.
Difficulty of internal bond prediction of particleboard using the density profile
Authors: Korai Hideaki
Published: November 2021

The relationship between density profile and internal bond (IB) of commercial particleboards was investigated. Minimum density was theoretically related to the IB, but the correlation coefficient between them was low at 0.435. The correlation coefficients between core layer densities and IB were also low. These correlation coefficients were approximately 0.460. The IB is influenced not only by density, but also by other factors such as the manufacturing conditions. In addition, commercial particleboards have a narrow density range. This narrow density range results in overfitting, showing a low correlation coefficient. Thus, predicting the IB using density profile was difficult.
The low-complexity domains of the KMT2D protein regulate histone monomethylation transcription to facilitate pancreatic cancer progression
Authors: Li Weihan , Wu Lei , Jia Hui , Lin Zenghua , Zhong Renhao , Li Yukun , Jiang Chenwei , Liu Shifan , Zhou Xiaorong , Zhang Erhao
Published: November 2021

Background

Liquid–liquid phase separation (LLPS) within the nucleus is directly linked to driving gene expression through transcriptional complexes. Histone lysine methyltransferase 2D (KMT2D) is widely present in many cancers. It is known to epigenetically stimulate the expression of genes associated with tumorigenesis and metastasis. Our analyses show that KMT2D possesses two distinct low-complexity domains (LCDs) capable of driving the assembly of membrane-less condensates. The dependence of the mechanisms underlying monomethylation of H3K4 on the LLPS microenvironment derived from KMT2D LCDs is unclear in tumor.

Methods

KMT2D LCD-depletion cells were used to investigate tumor cell proliferation, apoptosis, and migration. We identified some core proteins, including WDR5, RBBP5, and ASH2L, which are involved in the KMT2D-associated catalytic complex in KMT2D LCD-deficient cells to further elucidate the mechanism that decreases monomethylation of H3K4. We also evaluated the viability of KMT2D LCD-deficient cells in vivo. Finally, using 1,6-hexanediol (HD), an inhibitor of LLPS, we determined cell activities associated with KMT2D function in wild-type PANC-1 cells.

Results

Without the LLPS microenvironment in KMT2D LCD-deficient cells or wild-type PANC-1 cells treated with HD, the WDR5 protein was significantly less stable and the protein–protein interactions between the components of the KMT2D–enzyme complex were attenuated, impairing the formation of the complex. Moreover, with the decrease in H3K4me1 level at enhancers, transcription factors such as LIFR and KLF4 were markedly downregulated, effectively inhibiting tumor progression. In xenograft tumor models, PANC-1 cells lacking the KMT2D LCDs showed effectively suppressed tumor growth compared to normal cells.

Conclusions

Our data indicate that the two low-complexity domains of the KMT2D protein could form a stable LLPS microenvironment, promoting the KMT2D catalysis of H3K4 monomethylation through stabilization of the WDR5 protein and KMT2D–enzyme complex. Therefore, finding ways to regulate the LLPS microenvironment will be benefitial for new cancer treatment strategies.
Synergistic Photocatalytic-Adsorption Removal of Basic Magenta Effect of AgZnO/Polyoxometalates Nanocomposites
Authors: Tian Heyun , Luo Jie , Zhang Ke , Ma Chenguang , Qi Yiyi , Zhan Shixia , Liu Xiao , Li Mingxue , Liu Hongling
Published: November 2021

The bifunctional photocatalytic-adsorbent AgZnO/polyoxometalates (AgZnO/POMs) nanocomposites were synthesized by combining AgZnO hybrid nanoparticles and polyoxometalates [Cu(L)2(H2O)]H2[Cu(L)2(P2Mo5O23)]⋅4H2O (HL = C6H6N2O) into nanostructures via a sonochemical method. Transmission electron microscopy (TEM) indicated that AgZnO/POMs nanocomposites were uniform with narrow particle size distribution and without agglomeration. X-ray powder diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) analysis confirmed the nanostructure and composition of AgZnO/POMs nanocomposites. The ultraviolet–visible spectra (UV–Vis) and photoluminescence spectra (PL) confirmed excellent optical properties of the AgZnO/POMs nanocomposites. 94.13% ± 0.61 of basic magenta (BM) in aqueous solution could be removed using the AgZnO/POMs nanocomposites through adsorption and photocatalysis. The kinetic analysis showed that both the adsorption and photocatalysis process conform to pseudo-second-order kinetics. In addition, the removal rate of AgZnO/POMs nanocomposites was found to be almost unchanged after 5 cycles of use. The bifunctional photocatalytic-adsorbent AgZnO/POMs nanocomposites with high stability and cycling performance have broad application prospects in the treatment of refractory organic dye wastewater containing triphenylmethane.
Prevalence of hepatopancreatic injury and clinical outcomes in patients with COVID-19 in USA
Authors: Rastogi Vaibhav , Banwait Ranjit , Singh Devina , Toklu Hale , Finer Lexie , Parajuli Dipendra , Ganti Latha
Published: November 2021

Background

(1) To determine the prevalence of hepatopancreatic injury in coronavirus disease 2019 (COVID-19) patients. (2) To correlate hepatopancreatic injury in COVID-19 with mortality, disease severity, and length of stay in this cohort.

Results

Forty-five thousand three hundred sixty patients were included in the analysis, 62.82% of which had either hepatic or pancreatic injury. There was a significant upward trend in transaminases, alkaline phosphatase, prothrombin time, bilirubin, lactate dehydrogenase, and lipase and a downward trend in albumin with an increase in disease severity. COVID-19-positive patients with hepato-pancreatic injury have a significantly higher mortality (OR 3.39, 95%CI 3.15–3.65) after controlling for the differences in age, sex, race/ethnicity, liver cirrhosis, and medication exposures. They also have increased disease severity (OR 2.7, 95%CI 2.5–2.9 critical vs mild/moderate; OR 1.4, 95% CI 1.3–1.5 severe vs mild/moderate) and longer hospital length of stay (2 days).

Conclusion

COVID-19 can cause liver injury. Mortality, disease severity, and hospital length of stay are increased in COVID-19 patients with hepatopancreatic injury.

Graphical Abstract
Genetic mapping and candidate gene identification of BoGL5, a gene essential for cuticular wax biosynthesis in broccoli
Authors: Han Fengqing , Huang Jingjing , Xie Qi , Liu Yumei , Fang Zhiyuan , Yang Limei , Zhuang Mu , Zhang Yangyong , Lv Honghao , Wang Yong , Ji Jialei , Li Zhansheng
Published: November 2021

Background

The aerial organs of most terrestrial plants are covered by cuticular waxes, which impart plants a glaucous appearance and play important roles in protecting against various biotic and abiotic stresses. Despite many glossy green (wax-defective) mutants being well characterized in model plants, little is known about the genetic basis of glossy green mutant in broccoli.

Results

B156 is a spontaneous broccoli mutant showing a glossy green phenotype. Detection by scanning electron microscopy (SEM) and chromatography-mass spectrometry (GC-MS) revealed that B156 is a cuticular wax-defective mutant, lacking waxes mostly longer than C28. Inheritance analysis revealed that this trait was controlled by a single recessive gene, BoGL5. Whole-genome InDel markers were developed, and a segregating F2 population was constructed to map BoGL5. Ultimately, BoGL5 was mapped to a 94.1 kb interval on C01. The BoCER2 gene, which is homologous to the Arabidopsis CER2 gene, was identified as a candidate of BoGL5 from the target interval. Sequence analyses revealed that Bocer2 in B156 harbored a G-to-T SNP mutation at the 485th nucleotide of the CDS, resulting in a W-to-L transition at the 162nd amino acid, a conserved site adjacent to an HXXXD motif of the deduced protein sequence. Expression analysis revealed that BoCER2 was significantly down-regulated in the leaves, stems, and siliques of B156 mutant than that of B3. Last, ectopic expression of BoCER2 in A. thaliana could, whereas Bocer2 could not, rescue the phenotype of cer2 mutant.

Conclusions

Overall, this study mapped the locus determining glossy phenotype of B156 and proved BoCER2 is functional gene involved in cuticular wax biosynthesis which would promotes the utilization of BoCER2 to enhance plant resistance to biotic and abiotic stresses, and breeding of B. oleracea cultivars with glossy traits.
Diagnostic yield of esophagogastroduodenoscopy, colonoscopy, and small bowel endoscopy in Thai adults with chronic diarrhea
Authors: Limsrivilai Julajak , Sakjirapapong Choompunuj , Sattayalertyanyong Onuma , Geeratragool Tanawat , Sathirawich Phalat , Pongpaibul Ananya , Apisarnthanarak Piyaporn , Phaophu Phutthaphorn , Subdee Nichcha , Charatcharoenwitthaya Phunchai , Pausawasdi Nonthalee
Published: November 2021

Background

Gastrointestinal endoscopy is frequently recommended for chronic diarrhea assessment in Western countries, but its benefit in the Southeast Asia region is not well established.

Methods

Medical records of consecutive patients undergoing esophagogastroduodenoscopy (EGD), colonoscopy, and small bowel endoscopy for chronic diarrhea from 2008 to 2018 were reviewed. Small bowel endoscopy included push enteroscopy, balloon-assisted enteroscopy (BAE), and video capsule endoscopy (VCE). The diagnostic yield of each endoscopic modality and predictors for positive small bowel endoscopy were analyzed.

Results

A total of 550 patients were included. The mean age was 54 years, and 266 (46.3%) patients were male. The mean hemoglobin and albumin levels were 11.6 g/dL and 3.6 g/dL, respectively. EGD and colonoscopy were performed in 302 and 547 patients, respectively, and the diagnostic yield was 24/302 (7.9%) for EGD and 219/547 (40.0%) for colonoscopy. EGD did not reveal positive findings in any patients with normal colonoscopy. Fifty-one patients with normal EGD and colonoscopy underwent small bowel endoscopy. Push enteroscopy, BAE, and VCE were performed in 28, 21, and 19 patients with a diagnostic yield of 5/28 (17.9%), 14/21 (66.7%), and 8/19 (42.1%), respectively. Significant weight loss, edema, and hypoalbuminemia were independent predictors for the positive yield of small bowel endoscopy.

Conclusion

Colonoscopy was an essential diagnostic tool in identifying the cause of chronic diarrhea in Thai patients, whereas EGD provided some benefits. Small bowel endoscopy should be performed when colonoscopy and EGD were negative, particularly in patients with significant weight loss, edema, and hypoalbuminemia.
Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study
Authors: Kasede Agnes Napyo , Tylleskär Thorkild , Mukunya David , Tumuhamye Josephine , Ndeezi Grace , Arach Anna Agnes Ojok , Waako Paul , Tumwine James K.
Published: November 2021

Background

Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda.

Methods

This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker).

Results

The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home.

Conclusion

Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.
POstmastectomy radioThErapy in Node-posiTive breast cancer with or without Internal mAmmary nodaL irradiation (POTENTIAL): a study protocol for a multicenter prospective phase III randomized controlled trial
Authors: Zhao Xu-Ran , Fang Hui , Tang Yu , Hu Zhi-Hui , Jing Hao , Liang Lin , Yan Xue-Na , Song Yong-Wen , Jin Jing , Liu Yue-Ping , Chen Bo , Tang Yuan , Qi Shu-Nan , Li Ning , Lu Ning-Ning , Men Kuo , Hu Chen , Zhang Yu-Hui , Li Ye-Xiong , Wang Shu-Lian
Published: November 2021

Background

Various randomized trials have demonstrated that postmastectomy radiotherapy (RT) to the chest wall and comprehensive regional nodal areas improves survival in patients with axillary node-positive breast cancer. Controversy exists as to whether the internal mammary node (IMN) region is an essential component of regional nodal irradiation. Available data on the survival benefit of IMN irradiation (IMNI) are conflicting. The patient populations enrolled in previous studies were heterogeneous and most studies were conducted before modern systemic treatment and three-dimensional (3D) radiotherapy (RT) techniques were introduced. This study aims to assess the efficacy and safety of IMNI in the context of modern systemic treatment and computed tomography (CT)-based RT planning techniques.

Methods

POTENTIAL is a prospective, multicenter, open-label, parallel, phase III, randomized controlled trial investigating whether IMNI improves disease-free survival (DFS) in high-risk breast cancer with positive axillary nodes (pN+) after mastectomy. A total of 1800 patients will be randomly assigned in a 1:1 ratio to receive IMNI or not. All patients are required to receive ≥ six cycles of anthracycline and/or taxane-based chemotherapy. Randomization will be stratified by institution, tumor location (medial/central vs. other quadrants), the number of positive axillary nodes (1–3 vs. 4–9 vs. ≥10), and neoadjuvant chemotherapy (yes vs. no). Treatment will be delivered with CT-based 3D RT techniques, including 3D conformal RT, intensity-modulated RT, or volumetric modulated arc therapy. The prescribed dose is 50 Gy in 25 fractions or 43.5 Gy in 15 fractions. Tiered RT quality assurance is required. After RT, patients will be followed up at regular intervals. Oncological and toxilogical outcomes, especially cardiac toxicities, will be assessed.

Discussion

This trial design is intended to overcome the limitations of previous prospective studies by recruiting patients with pN+ breast cancer, using DFS as the primary endpoint, and prospectively assessing cardiac toxicities and requiring RT quality assurance. The results of this study will provide high-level evidence for elective IMNI in patients with breast cancer after mastectomy.

Trial registration

ClinicalTrails.gov, NCT04320979. Registered 25 Match 2020, https://clinicaltrials.gov/ct2/show/NCT04320979
The association between depression and esophageal cancer in China: a multicentre population-based study
Authors: Zhu Juan , Ma Shanrui , Zhou Yueyue , Chen Ru , Xie Shuanghua , Liu Zhengkui , Li Xinqing , Wei Wenqiang
Published: November 2021

Background

Esophageal cancer (EC) is one of the leading contributors to the global burden of cancer, and the underlying mechanism is still unknown. Recently, there has been a growing interest in understanding modifiable psychosocial risk factors, particularly depression, to prevent EC and reduce morbidity and mortality. However, related research is sparse and has been ignored. The study was designed to assess the association between depression and EC in China.

Methods

From 2017 to 2019, a population-based multicenter study was conducted in high-risk regions of EC. Participants underwent a free endoscopy screening. If the endoscopic results were suspicious, a pathological biopsy was applied to confirm. Depression was measured with Patient Health Questionnaire-9 (PHQ-9). In addition, information on demographic characteristics and risk factors was collected from participants by trained interviewers using uniform questionnaires.

Results

After Endoscopy and pathologic diagnosis, 15,936 participants in high-risk regions of EC (ECHRRs) were enrolled, 10,907 (68.44%) of which were diagnosed health, 4048 (25.40%) with esophagitis, 769 (4.83%) with low-grade intraepithelial neoplasia (LGIN), 157 (0.99%) with high-grade intraepithelial neoplasia (HGIN), and 55 (0.35%) with EC, respectively. The overall prevalence of depression symptoms of participants was 4.16% (health: 4.63%, esophagitis: 2.99%, LGIN: 2.99%, HGIN: 5.73%, and EC: 9.09%). Multiple logistic regression analyses revealed that the unadjusted OR (95% CI) between depression and each esophageal pathology grades were esophagitis 0.93 (0.92-0.95), LGIN 0.97 (0.94-0.99), HGIN 1.05 (1.00-1.10), and EC 1.04 (0.97-1.14), respectively. However, after adjustment for potential confounders (age, gender, region, alcohol consumption, BMI), no statistically significant associations between depression and EC (adjusted OR = 1.10, 0.99-1.21) and esophageal lesions (esophagitis: adjusted OR = 1.02, 0.99-1.04; LGIN: adjusted OR = 0.98, 0.95-1.01; HGIN: adjusted OR = 1.04, 0.98-1.11) were observed in this study.

Conclusions

No significant association was observed between depression and EC in the study. Future prospective cohort studies are needed to verify this preliminary finding.
Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff
Authors: Srivastava Kanchan , Yadav Ranjana , Pelly Lorine , Hamilton Elisabeth , Kapoor Gaurav , Mishra Aman Mohan , Anis Parwez , Crockett Maryanne
Published: November 2021

Background

Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children.

Methods

This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death.

Results

There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff.

Conclusion

The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.
Bending rod is unnecessary in single-level posterior internal fixation and fusion in treatment of lumbar degenerative diseases
Authors: Han Xiao , Chen Xin , Li Kuan , Li Zheng , Li Shugang
Published: November 2021

Background

Bending rod is a routine in lumbar fusion and fixation surgery, but there is no study investigating whether bending rod in one level is necessary.

Methods

Patients receiving 1 level lumbar fixation and fusion between May 2018 and September 2020 were included with a minimum 6-month follow-up. The routine of bending rod was omitted during fixation. Preoperative and postoperative radiological parameters were compared.

Results

There were 67 patients included in the study. Segment lordosis angle increased obviously from 10° (1–39°) to 14° (2–30°) immediately after operation (p = 0.000). T5-T12 increased from 22.97 ± 12.31° to 25.52 ± 11.83° by the 3rd months after surgery (p = 0.011). SS decreased from 35.45 ± 10.47 to 32.19 ± 11.37 in 6-month follow-up (p = 0.038), and PI dropped from 56.97 ± 14.24 to 53.19 ± 12.84 (p = 0.016). ROM of SLA decreased from 4.13 ± 3.14° to 1.93 ± 1.87° at that time point (p = 0.028). Those changes were not seen at 12-month follow-up. No evidence of adjacent vertebral disc degeneration was observed at any time point.

Conclusions

No sagittal imbalance, dynamic instability or adjacent vertebral degeneration was observed by the 12th month after single-segment posterior lumbar fusion with the use of unbent rods. Bending rod could be omitted in 1-level lumbar fusion to simplify the procedure and reduce operating time.
Iranian nurses’ views on barriers to moral courage in practice: A qualitative descriptive study
Authors: Rakhshan Mahnaz , Mousazadeh Noushin , Hakimi Hamideh , Hosseini Fahimeh Alsadat
Published: November 2021

Background

Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses.

Methods

This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran.

Results

According to data analysis, six categories and three themes were extracted. Themes are “organizational failure”, “deterrent personal identity” and “defeated professional identity”.

Conclusions

The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses’ competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses’ moral courage.
Alpha-Synuclein, cyclooxygenase-2 and prostaglandins-EP2 receptors as neuroinflammatory biomarkers of autism spectrum disorders: Use of combined ROC curves to increase their diagnostic values
Authors: El-Ansary Afaf , Alhakbany Manan , Aldbass Abeer , Qasem Hanan , Al-Mazidi Sarah , Bhat Ramesa Shafi , Al-Ayadhi Laila
Published: November 2021

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social interaction and restricted and repetitive behaviors. Neuroinflammation and abnormal lipid mediators have been identified in multiple investigations as an acknowledged etiological mechanism of ASD that can be targeted for therapeutic intervention.

Methods

In this study, multiple regression and combined receiver operating characteristic (ROC) curve analyses were used to determine the relationship between the neuroinflammatory marker α-synuclein and lipid mediator markers related to inflammation induction, such as cyclooxygenase-2 and prostaglandin-EP2 receptors, in the etiology of ASD. Additionally, the study aimed to determine the linear combination that maximizes the partial area under ROC curves for a set of markers. Forty children with ASD and 40 age- and sex-matched controls were enrolled in the study. Using ELISA, the levels of α-synuclein, cyclo-oxygenase-2, and prostaglandin-EP2 receptors were measured in the plasma of both groups. Statistical analyses using ROC curves and multiple and logistic regression models were performed.

Results

A remarkable increase in the area under the curve was observed using combined ROC curve analyses. Moreover, higher specificity and sensitivity of the combined markers were reported.

Conclusions

The present study indicates that measurement of the predictive value of selected biomarkers related to neuroinflammation and lipid metabolism in children with ASD using a ROC curve analysis should lead to a better understanding of the etiological mechanism of ASD and its link with metabolism. This information may facilitate early diagnosis and intervention.
COVID-19 vaccine uptake among health care workers in Ghana: a case for targeted vaccine deployment campaigns in the global south
Authors: Alhassan Robert Kaba , Owusu-Agyei Seth , Ansah Evelyn Korkor , Gyapong Margaret
Published: November 2021

Background

Health care workers (HCWs) are among the high-risk groups in contracting and dying from COVID-19. World Health Organization estimates that over 10,000 HCWs in Africa have been infected with COVID-19 making it a significant occupational health hazard to HCWs. In Ghana, over 100 HCWs have already been infected and dozen others died from the virus. Acceptability and uptake of the COVID-19 vaccine is therefore critical to promote health and safety of HCWs as the country battles out of a third wave of the pandemic.

Objective

The study sought to ascertain the correlates of HCWs likelihood of participating in a COVID-19 vaccine trial and accepting the vaccine when given the opportunity.

Methods

The study was a web-based cross-sectional survey among HCWs (n = 1605) in all sixteen (16) administrative regions in Ghana. Data were analyzed with STATA statistical analysis software (version 14). Chi-square (X2) and Fisher’s exact tests were used to test for differences in categorical variables; bivariate probit regression analysis with Average Marginal Effect (AME) was employed to ascertain the determinants of HCWs’ likelihood of participating in a COVID-19 vaccine trial and taking the vaccine.

Results

It was found that 48% of HCWs will participate in a COVID-19 vaccine trial when given the opportunity; 70% will accept the COVID-19 vaccine; younger HCWs (AME = 0.28, SE = 0.16, p < 0.1), non-Christians (AME = 21, SE = 0.09, p < 0.05) and those who worked in faith-based health facilities (AME = 18, SE = 0.07, p < 0.05) were more likely to participate in a COVID-19 vaccine trial. Female HCWs (AME = − 11, SE = 0.04, p < 0.05) and those with lower educational qualification were less likely to accept a COVID-19 vaccine (AME = − 0.16, SE = 0.08, p < 0.1). Reasons cited for unwillingness to participate in a COVID-19 vaccine trial or uptake the vaccine were mainly fear, safety concerns, mistrust, uncertainty, spiritual and religious beliefs.

Conclusions

Acceptance of the COVID-19 vaccine appear to be high among HCWs; conversely, willingness to volunteer for the vaccine trial was low. Continuous targeted and integrated public health education for HCWs will enhance vaccine acceptability to promote safety and population health in the global south as Ghana intensifies efforts to produce COVID-19 vaccines locally.
Periodontal effects of maxillary expansion in adults using non-surgical expanders with skeletal anchorage vs. surgically assisted maxillary expansion: a systematic review
Authors: Vidalón José Antonio , Loú-Gómez Ismael , Quiñe Aldo , Diaz Karla T. , Liñan Duran Carlos , Lagravère Manuel O.
Published: November 2021

Objectives

Describe and compare harmful periodontal effects as a consequence of maxillary expansion in adult patients with different types of anchorage devices in non-surgical expanders with skeletal anchorage and surgically assisted maxillary expansion.

Materials and methods

An exhaustive search was carried out on the electronic databases PubMed (MEDLINE), Embase, Cochrane and LILACS. Additionally, journal references and grey literature were searched without any restrictions. After the selection and extraction process; risk of bias was assessed by the ROB-1 Cochrane tool and Newcastle-Ottawa Scale (NOS) for randomized trials and cohort studies, respectively.

Results

Of 621 studies retrieved from the searches, six were finally included in this review. One of them presented a low risk bias, while five were excellent respective to selection, comparability and outcomes. Results showed that maxillary expansion in adults using non-surgical expanders (bone-borne or tooth-bone-borne with bicortical skeletal anchorage) produce less harmful periodontal effects, such as: alveolar bending with an average range from 0.92° to 2.32°, compared to surgically assisted maxillary expansion (tooth-borne) of 6.4°; dental inclination with an average range from 0.07° to 2.4°, compared to surgically assisted maxillary expansion (tooth-borne) with a range from 2.01° to 5.56°.

Conclusions

Although limited, the current evidence seems to show that the bone-borne or tooth-bone-borne with bicortical skeletal anchorage produces fewer undesirable periodontal effects.
The role of philosophy and ethics at the edges of medicine
Authors: Hofmann Bjørn
Published: November 2021

Background

The edge metaphor is ubiquitous in describing the present situation in the world, and nowhere is this as clearly visible as in medicine. “The edge of medicine” has become the title of books, scholarly articles, media headlines, and lecture series and seems to be imbued with hype, hope, and aversion. In order better to understand what is at stake at “the edge of medicine” this article addresses three questions: What does “the edge of medicine” mean in contemporary debates on modern medicine? What are the challenges “on the edge of medicine” (in these various meanings of “on the edge”)? How can philosophy and ethics contribute with addressing these challenges?

Methods

Literature searches in PubMed and Google Scholar are used to identify uses of the phrase “the edge of medicine” while conventional content analysis is used to analyze meanings of and challenges with “the edge of medicine.” These results are then investigated with respect to how philosophy and ethics can address the identified challenges.

Results

The literature reveals that “the edge of medicine” has many meanings, such as: Border; Margin (of life); Frontier; Forefront; Fringes; Plunge (abyss); Brink (verge); Conflict; and Balancing. In general, the various meanings address four basic challenges: setting limits, keeping control, make meaning, and handling conflicts or aporias. The analysis of each of the meanings of “the edge of medicine” identifies a wide range of important and urgent tasks for the humanities in general, and for philosophy and ethics in particular: 1) clarifying concepts; 2) clarifying assumptions and premises of arguments, methods, advice, and decisions; 3) elaborate new concepts and new theories; 4) conceptualize and handle uncertainty, moral regret, and residue; 5) reveal “the emperor’s new clothes;” 6) identify trends and reflect on their implications; 7) demarcation; and 8) reflecting on goodness in medicine.

Conclusion

The phrase “the edge of medicine” expresses a wide range of challenges for modern health care. Together with other disciplines philosophy and ethics can and should make crucial contributions at “the edge of medicine,” which is where the future of human beings and societies is created and formed.
Association of the type of counselor with suicidal ideation and suicide attempts: a survey of South Korean adolescents
Authors: Kim Yunkyung , Jeong Wonjeong , Yang Jieun , Lee Sang Ah , Park Eun-Cheol
Published: November 2021

Background

Counseling for adolescents who consider or attempt suicide may help reduce suicide rates. However, the impact of the type of counselor (e.g., father, mother, sibling, friend, teacher, other) on suicidal ideation/suicide attempts remains unclear. Therefore, we examined this association in Korean adolescents.

Methods

Using data from the 2015 Korea Youth Risk Behavior Web-based Survey of 65,485 adolescents, we examined risk factors for suicidal ideation/suicide attempts according to sex using a multiple logistic regression analysis. In a subgroup analysis, we investigated the associations between counselor type and suicidal ideation/suicide attempts stratified by the cause of stress for both sexes.

Results

Male participants were less likely to consider suicide when counseled by their mother (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.70–0.90) or friend (OR 0.89; 95% CI 0.80–0.99) and to attempt suicide when counseled by a friend (OR 0.74; 95% CI 0.60–0.92) than were those who did not receive any counseling. Female participants were less likely to attempt suicide when counseled by their mother (OR 0.66; 95% CI 0.53–0.82) or friends (OR 0.70; 95% CI 0.58–0.83) than when not counseled. Furthermore, adolescents with achievement/career choice-related and family problems were at a lower risk of suicide ideation/suicide attempts when counseled by their mother or friend than when they received no counseling.

Conclusions

Suicidal ideation/suicide attempts showed different associations for both sexes in accordance with the type of counselor. Even if counseling by specialists for issues such as achievement/career choice-related or family matters is needed, the risk of suicide could be reduced through counseling by the people around them. Therefore, adolescents should form mutually supportive relationships through active communication with surrounding people.