bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral pulmonary artery aneurysms in Behcet's disease
Authors: Almog Y , Polliack G , Dranitzki Elhalel M , Shalit M , Rosenmann E
Published: November 2022

A patient presented with fever, haemoptysis and large bilateral perihilar masses. Histology proved that these were pulmonary artery aneurysms due to pulmonary vasculitis, as a manifestation of Behcet's disease. It is suggested that a routine dynamic computed tomographic (CT) scan should be performed in the evaluation of such cases.
Early assessment of diaphragmatic dysfunction in children in the ITU: chest radiology and phrenic nerve stimulation
Authors: Russell RI , Helps BA , Dicks-Mireaux CM , Helms PJ
Published: November 2022

Diaphragmatic dysfunction is a common postoperative complication of cardiac surgery in children, with important effects on respiratory morbidity. Its early diagnosis, followed by prompt surgical intervention, has been shown to reduce morbidity. However, the commonest method of diagnosis, based on hemi-diaphragmatic elevation on the chest radiograph, may be less accurate than direct techniques for assessing phrenic nerve function. We have compared electrophysiological and radiological diagnoses of diaphragmatic abnormality in 100 children (aged 3 days to 17.5 yrs) undergoing cardiac surgery, looking at respiratory morbidity as assessed by the duration of ventilation, the time spent on the cardiac intensive care unit (CICU), and the requirement for reintubation. Despite showing good reproducibility, radiological diagnosis was neither sensitive nor specific in identifying patients with electrophysiological phrenic nerve damage. Analysis of the measures of outcome supported the electrophysiological technique. Patients with electrophysiological evidence of damage had a longer duration of ventilation, spent longer on the CICU, and had a greater incidence of reintubation than either radiologically abnormal or "normal" patients. Chest X-rays are not a good method for diagnosing phrenic nerve damage in the early postoperative period in children. If early diagnosis is needed, then direct assessment of phrenic nerve function, such as the measurement of phrenic latency, may be a better technique.
Tracheocele: a rare cause of difficult endotracheal intubation and subsequent pneumomediastinum
Authors: Moller GM , ten Berge EJ , Stassen CM
Published: November 2022

A case is described in which accidental perforation of a tracheocele caused by endotracheal intubation resulted in a postoperative pneumomediastinum. The tracheocele, an extremely rare finding in clinical anaesthesia, was confirmed radiologically and for the first time demonstrated by computed tomography.
iEnhancer-DCLA: using the original sequence to identify enhancers and their strength based on a deep learning framework
Authors: Liao Meng , Zhao Jian-ping , Tian Jing , Zheng Chun-Hou
Published: November 2022

Enhancers are small regions of DNA that bind to proteins, which enhance the transcription of genes. The enhancer may be located upstream or downstream of the gene. It is not necessarily close to the gene to be acted on, because the entanglement structure of chromatin allows the positions far apart in the sequence to have the opportunity to contact each other. Therefore, identifying enhancers and their strength is a complex and challenging task. In this article, a new prediction method based on deep learning is proposed to identify enhancers and enhancer strength, called iEnhancer-DCLA. Firstly, we use word2vec to convert k-mers into number vectors to construct an input matrix. Secondly, we use convolutional neural network and bidirectional long short-term memory network to extract sequence features, and finally use the attention mechanism to extract relatively important features. In the task of predicting enhancers and their strengths, this method has improved to a certain extent in most evaluation indexes. In summary, we believe that this method provides new ideas in the analysis of enhancers.
Explainable machine learning approach to predict extubation in critically ill ventilated patients: a retrospective study in central Taiwan
Authors: Pai Kai-Chih , Su Shao-An , Chan Ming-Cheng , Wu Chieh-Liang , Chao Wen-Cheng
Published: November 2022

Background

Weaning from mechanical ventilation (MV) is an essential issue in critically ill patients, and we used an explainable machine learning (ML) approach to establish an extubation prediction model.

Methods

We enrolled patients who were admitted to intensive care units during 2015–2019 at Taichung Veterans General Hospital, a referral hospital in central Taiwan. We used five ML models, including extreme gradient boosting (XGBoost), categorical boosting (CatBoost), light gradient boosting machine (LightGBM), random forest (RF) and logistic regression (LR), to establish the extubation prediction model, and the feature window as well as prediction window was 48 h and 24 h, respectively. We further employed feature importance, Shapley additive explanations (SHAP) plot, partial dependence plot (PDP) and local interpretable model-agnostic explanations (LIME) for interpretation of the model at the domain, feature, and individual levels.

Results

We enrolled 5,940 patients and found the accuracy was comparable among XGBoost, LightGBM, CatBoost and RF, with the area under the receiver operating characteristic curve using XGBoost to predict extubation was 0.921. The calibration and decision curve analysis showed well applicability of models. We also used the SHAP summary plot and PDP plot to demonstrate discriminative points of six key features in predicting extubation. Moreover, we employed LIME and SHAP force plots to show predicted probabilities of extubation and the rationale of the prediction at the individual level.

Conclusions

We developed an extubation prediction model with high accuracy and visualised explanations aligned with clinical workflow, and the model may serve as an autonomous screen tool for timely weaning.
A prediction model for massive hemorrhage in trauma: a retrospective observational study
Authors: Guo Chengyu , Gong Minghui , Ji Lei , Pan Fei , Han Hui , Li Chunping , Li Tanshi
Published: November 2022

Background

Massive hemorrhage is the main cause of preventable death after trauma. This study aimed to establish prediction models for early diagnosis of massive hemorrhage in trauma.

Methods

Using the trauma database of Chinese PLA General Hospital, two logistic regression (LR) models were fit to predict the risk of massive hemorrhage in trauma. Sixty-two potential predictive variables, including clinical symptoms, vital signs, laboratory tests, and imaging results, were included in this study. Variable selection was done using the least absolute shrinkage and selection operator (LASSO) method. The first model was constructed based on LASSO feature selection results. The second model was constructed based on the first vital sign recordings of trauma patients after admission. Finally, a web calculator was developed for clinical use.

Results

A total of 2353 patients were included in this study. There were 377 (16.02%) patients with massive hemorrhage. The selected predictive variables were heart rate (OR: 1.01; 95% CI: 1.01–1.02;P<0.001), pulse pressure (OR: 0.99; 95% CI: 0.98–0.99;P = 0.004), base excess (OR: 0.90; 95% CI: 0.87–0.93;P<0.001), hemoglobin (OR: 0.95; 95% CI: 0.95–0.96;P<0.001), displaced pelvic fracture (OR: 2.13; 95% CI: 1.48–3.06;P<0.001), and a positive computed tomography scan or positive focused assessment with sonography for trauma (OR: 1.62; 95% CI: 1.21–2.18;P = 0.001). Model 1, which was developed based on LASSO feature selection results and LR, displayed excellent discrimination (AUC: 0.894; 95% CI: 0.875–0.912), good calibration (P = 0.405), and clinical utility. In addition, the predictive power of model 1 was better than that of model 2 (AUC: 0.718; 95% CI: 0.679–0.757). Model 1 was deployed as a public web tool (http://82.156.217.249:8080/).

Conclusions

Our study developed and validated prediction models to assist medical staff in the early diagnosis of massive hemorrhage in trauma. An open web calculator was developed to facilitate the practical application of the research results.
Teachers as multipliers of knowledge about schistosomiasis: a possible approach for health education programmes
Authors: Murta Felipe Leão Gomes , Massara Cristiano Lara , Rodrigues Maria Gabriela , Beck Lilian Christina Nóbrega Holsbach , Favre Tereza Cristina
Published: November 2022

Background

In the past decade, Brazil has significantly reduced the prevalence of schistosomiasis through a combined effort of early treatment of infected people, expansion of basic sanitation infrastructure and educational measures. Despite these efforts, in some areas, prevalence of schistosomiasis exceeds 20% of the school population, who lack knowledge of the risks of the disease. Action can be taken in schools to empower this population about their health condition. This paper describes the role of the teacher as a multiplier of knowledge about schistosomiasis and proposes two different approaches to training these teachers.

Methods

This study used mixed methods to evaluate training of teachers and educational intervention with those teachers’ pupils. Two training courses, each with 40 h of face-to-face activity, were offered to 19 teachers, using two different but complementary approaches, based on theoretical references and specific educational strategies: Critical Pedagogical Approach (Training Course I, held in 2013) and Creative Play Approach (Training Course II, held in 2014).The courses included classroom activities, laboratory and field work. After the training, the teachers conducted activities on schistosomiasis with their pupils. These activities involved constructing educational materials and cultural productions. The pupils’ knowledge about the disease was evaluated before the activities and 12 months later. The teachers’ acceptance and perceptions were assessed through structured interviews and subsequent thematic analysis. The Shistosoma mansoni infection status of teachers and their students was also assessed using the Kato Katz stool test.

Results

The parasitological study showed 31.6% of the teachers and 21.4% of the pupils to be positive for S. mansoni. The teachers’ knowledge of important aspects of schistosomiasis transmission and prevention was fragmented and incorrect prior to the training. The teachers’ knowledge changed significantly after the training and they were strongly accepting of the pedagogical methods used during the training. The level of their pupils’ knowledge about the disease had increased significantly (p < 0.05). However, pupils responded that, even after the educational activities, they still had contact with the city’s contaminated waters (p > 0.05).

Conclusions

The results of this study underline the importance of schools and teachers as partners in controlling and eliminating schistosomiasis. Teacher training on the disease significantly increases their pupils’ knowledge, reflecting empowerment with regard to local health conditions.
Molecular characterization and genotyping of hepatitis C virus from Sudanese end-stage renal disease patients on haemodialysis
Authors: Zitha Trodia , Chen Chien-Yu , Mudawi Hatim , Hussein Waleed , Mukhtar Maowia , Shigidi Mazin , Yousif Mohamed Elamin Awad , Ali Mohammed Ahmed , Glebe Dieter , Kramvis Anna
Published: November 2022

Background

Hepatitis C virus (HCV) is a global public health problem, with ~ 11 million people in Africa infected. There is incomplete information on HCV in Sudan, particularly in haemodialysis patients, who have a higher prevalence compared to the general population. Thus, our objectives were to genotype and molecularly characterize HCV isolated from end-stage renal disease haemodialysis patients.

Methods

A total of 541 patients were recruited from eight haemodialysis centres in Khartoum and screened for anti-HCV. Viral loads were determined using in-house real-time PCR in seropositive patients. HCV was genotyped and subtyped using sequencing of amplicons of 5′ untranslated (UTR) and non-structural protein 5B (NS5B) regions, followed by phylogenetic analysis of corresponding sequences.

Results

The HCV seroprevalence in the study was 17% (93/541), with HCV RNA-positive viremic rate of 7% (40/541). A low HCV load, with a mean of 2.85 × 104 IU/ml and a range of 2.95 × 103 to 4.78 × 106 IU/ml, was detected. Phylogenetic analyses showed the presence of genotypes 1, 3, 4, and 5 with subtypes 1a, 1b, 1 g, 3a, 4a, 4 l, 4 m, 4 s, and 4t. Sequences of HCV from the same haemodialysis units, clustered in similar genotypes and subtypes intimating nosocomial infection.

Conclusion

HCV infection is highly prevalent in haemodialysis patients from Sudan, with phylogenetic analysis intimating nosocomial infection. HCV genotyping is useful to locate potential transmission chains and to enable individualized treatment using highly effective direct-acting antivirals (DAAs).
The impact of oocytes containing smooth endoplasmic reticulum aggregates on assisted reproductive outcomes: a cohort study
Authors: Fang Tingfeng , Yu Wenchang , Ou Songbang , Lu Jinyu , Li Ruiqi , Zhao Mingpeng , Chan Yiu Leung , Wang Wenjun
Published: November 2022

Background

The impact of smooth endoplasmic reticulum aggregates (SERa) on assisted reproductive technology (ART) outcomes was still controversial. Our objective is to investigate the impact of the presence of SERa on intracytoplasmic sperm injection (ICSI) outcomes.

Methods

This was a retrospective cohort study. A total of 1,090 fresh ICSI cycles from 944 patients between January 2016 and June 2020 were included. Outcomes from clinical, embryological and neonatal aspects were compared between SERa + and SERa- cycles as well as between SERa + and SERa- oocytes.

Results

The total gonadotropin (Gn) dose, number of oocytes retrieved, serum estradiol concentration and number of the available embryo were significantly higher in SERa + cycles than in SERa- cycles (P < 0.05). Comparable two pronuclei (2PN) fertilization rate and poly-pronucleus zygote rate were shown in SERa + and SERa- cycles (P > 0.05), but which were higher in SERa + oocytes than in SERa- oocytes (P < 0.05). No statistical difference in blastocyst formation rate was found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). Good-quality embryo rate was statistically higher in SERa- cycles than in SERa + cycles (P < 0.05), but the difference was comparable between SERa + and SERa- oocytes (P > 0.05). No statistical difference in clinical pregnancy rate, spontaneous abortion rate, live birth rate and premature delivery rate were found in SERa + and SERa- cycles as well as in SERa + and SERa- oocytes (P > 0.05). The implantation rate was comparable in SERa + and SERa- cycles (P > 0.05), but it is higher in the group of only SERa- embryo transfer when compared with the group of mixed SERa + and SERa- embryo transfer (P < 0.05). 159 newborns in SERa + cycles and 140 newborns in SERa- cycles were followed up. Comparable newborn malformation rate was observed between SERa + and SERa- cycles and oocytes (P > 0.05). Logistic regression analysis revealed number of oocytes and total dose of Gn were risk factors for SERa occurrence (aOR = 1.05 and 1.55, P < 0.001).

Conclusion

Oocyte's SERa is correlated with a number of oocytes retrieved and higher Gn dose, but it does not affect pregnancy outcomes and increase newborn malformation rate.
The link between intrauterine adhesions and impaired reproductive performance: a systematic review of the literature
Authors: Hooker Angelo B. , de Leeuw Robert A. , Emanuel Mark Hans , Mijatovic Velja , Brolmann Hans A. M. , Huirne Judith A.F.
Published: November 2022

Background

Intrauterine adhesions (IUAs) are one of the main reproductive system diseases in women worldwide. Fusion between the injured opposing walls leads to partial-to-complete obliteration of the cavity and/or cervical canal. The main clinical manifestations in case of IUAs are menstrual disturbances, cyclic pain and reproductive disorders. The reproductive outcomes of women with IUAs remain limited and inefficient compared to women without IUAs, even after adhesiolysis. An exact understanding of the underlying mechanisms and processes to explain the compromised reproductive performance and outcomes in case of IUAs are lacking.

Methods

A systematic literature review of MEDLINE-PubMed (1966 to January 2022) and EMBASE (1974 to January 2022) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported underlying causes, related mechanisms and processes to explain the association between IUAs and impaired reproductive performance, pregnancy and obstetric complications.

Results

After an extensive review of the literature, 58 articles were identified reporting underlying mechanisms to explain the association between IUAs and impaired fertility. Intrauterine scarring influences the process of fertilization, reproductive performance and ultimately reproductive outcome. IUAs can disturb the cervico-utero-tubal sperm transport and result in an avascular and unresponsive endometrium with decreased receptivity and thickness. Abnormal decidualization and abnormal trophoblastic infiltration leads to placental attachment disorders. Moreover, the risk for premature delivery, intrauterine fetal growth restriction and fetal anomalies is increased in case of IUAs.

Conclusion

The impact of IUAs on reproductive performance, even after adhesiolysis, is becoming more apparent. The postulated mechanisms to explain the association are related to sperm transport, embryo implantation and placentation. Prevention, by preserving the basal layer of the endometrium is essential. Effective and evidence-based strategies for the prevention of endometrial injury and formation of IUAs, are urgently needed.
Resilience and prenatal mental health in Pakistan: a qualitative inquiry
Authors: Bhamani Shireen Shehzad , Arthur David , Van Parys An-Sofie , Letourneau Nicole , Wagnild Gail , Premji Shahirose Sadrudin , Asad Nargis , Degomme Olivier
Published: November 2022

Background

Women in Pakistan suffer from a high rate of depression. The stress of low-income, illiteracy, exposure to violence and living in a patriarchal society are predisposing vulnerabilities for depression, particularly during and following pregnancy. The resilience of an individual plays a significant role in promoting prenatal mental health, but this has yet to be thoroughly researched. In this article, our objective is to identify the core characteristics of resilience among pregnant women, which will then help us in developing an intervention.

Methods

The exploratory-descriptive study was conducted over 6 months in five different antenatal hospitals in Sindh, Pakistan. A total of 17 semi-structured interviews were conducted with pregnant women, purposefully selected with heterogeneous characteristics to explore diverse perspectives, while symptoms of depression were quantified by the Edinburgh Postnatal Depression Scale before the interview. Verbatim transcriptions were coded openly and merged into categories and themes.

Result

A total of six themes emerged from in-depth thematic analysis: 1) purpose of life, 2) dealing with emotions, 3) believing in yourself, 4) optimistic approach, 5) strengthening support and relationship and 6) spirituality and humanity. Women agreed that these characteristics could help them improve their mental health.

Conclusion

In conclusion, these themes were the core components of pregnant women’s resilience which ultimately could help to promote prenatal mental health. These pave a pathway towards developing culturally and contextually resilience interventions aimed at enhancing mental health of pregnant women which then may improve neonatal and family mental wellbeing.
Association between niacin and mortality among patients with cancer in the NHANES retrospective cohort
Authors: Ying Hongan , Gao Lijie , Liao Nansheng , Xu Xijuan , Yu Wenfeng , Hong Weiwen
Published: November 2022

Background

The vitamin niacin is used as a lipid-regulating supplement, but it is unknown whether niacin has a positive influence on cancer prognosis. In this study, we examine the relationship between niacin intake and mortality among patients with cancer.

Methods

Our study utilized all available continuous data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Multivariable Cox regression models were applied in order to investigate dietary niacin intake’s association with mortality. We compared the survival probability between groups of low and high niacin intake by plotting Kaplan-Meier curves. An analysis of subgroups was used to investigate heterogeneity sources.

Results

A total of 3504 participants were included in the cohort, with 1054 deaths. One thousand eight hundred forty-seven participants (52.3%) were female, 2548 participants (73.4%) were white, and the mean age (SE) was 65.38 years (0.32). According to multivariate logistic regression analysis, niacin intake was negatively associated with mortality outcomes in patients with cancer, with P values below 0.05 in all models. In subgroup analyses based on sex, age, and BMI, the association persisted. The Kaplan-Meier curves indicate that high niacin intake groups have better survival rates than low intake groups. Niacin supplementation improved cancer mortality but not all-cause mortality.

Conclusion

According to our study, higher dietary niacin intake was associated with lower mortality in cancer patients. Niacin supplements improved cancer survival rates, but not all causes of mortality.
Multidimensional self-rating biological rhythm disorder and its association with depression and anxiety symptoms among adolescents aged 11–23 years: a school-based cross-sectional study from China
Authors: Zeng Xin , Chen Yiyang , Zhang Qian , Jin Yexin , Song Yalin , Xue Kunyu , Lou Hao , Li Ran , Lou Xiaomin , Wang Xian
Published: November 2022

Background

Depression and anxiety are topical concerns worldwide, especially among adolescents. Besides, biological rhythm disorder as a candidate mechanism for mood disorders is highly prevalent, but relevant research among adolescents in China is presently limited. We conducted the present study to investigate the distribution of multi-dimensional self-rating biological rhythm disorder and the association of self-rating biological rhythm disorders with depression and anxiety symptoms among Chinese adolescents in different academic stages.

Methods

In the cross-sectional study, 3693 students aged 11–23 from Zhengzhou City, Henan Province, China were included. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) were used to evaluate symptoms of depression and anxiety, respectively. Additionally, the Self-Rating of Biological Rhythm Disorder for Adolescents (SBRDA) was used to assess status of biological rhythm disorders. Multivariate logistic regression was developed to explore factors potentially associated with symptoms of depression and anxiety stratified by academic stages.

Results

Among all participants, 44.14 and 36.15% suffered from depression and anxiety symptoms, respectively. On average, participants scored 74.66 ± 19.37 on the measure of total biological rhythm disorder. Adjusted for demographic confounding factors, the logistic regression analysis showed higher scores of total biological rhythm disorder were associated with more severe depression (OR = 14.38, 95%CI: 11.38–18.16) and anxiety symptoms (OR = 11.63, 95%CI: 9.14–14.81). The similar results were also found in the stratified analysis by academic stages.

Conclusions

Self-rating biological rhythm disorders are significantly associated with depression and anxiety symptoms among adolescents. Discrepancy across academic stages should also be taken into account in establishing public health strategies.
The 14-item short health anxiety inventory (SHAI-14) used as a screening tool: appropriate interpretation and diagnostic accuracy of the Swedish version
Authors: Österman Susanna , Axelsson Erland , Lindefors Nils , Hedman-Lagerlöf Erik , Hedman-Lagerlöf Maria , Kern Dorian , Svanborg Cecilia , Ivanov Volen Z.
Published: November 2022

Background

The 14-item Short Health Anxiety Inventory (SHAI-14) is a common measure of health anxiety but its screening properties have not been studied. The aims of this study were to evaluate the SHAI-14 as a screening instrument, identify cut-offs for clinically significant health anxiety and investigate which scores correspond to different severity levels.

Method

The study included 1729 psychiatric patients and 85 healthy controls. Participants completed the SHAI-14 and underwent a diagnostic interview. Cut-off scores were evaluated in three scenarios to approximate screening 1) in a psychiatric clinic, 2) in a low prevalence setting and, 3) of healthy volunteers (cut-off for remission). Receiver operating characteristics were used. Classification of severity was based on the distribution of SHAI-14 scores reported by patients with clinically significant health anxiety.

Results

The area under the curve (AUC) values were high in all scenarios (above 0.95). The optimal cut-off scores on the SHAI-14 were 22 in the psychiatric context, 29 in a setting with low prevalence of psychiatric disorders and 18 versus healthy controls. SHAI-14 scores of 0–27 represented no or mild health anxiety, 28–32 moderate health anxiety and 33–42 substantial health anxiety.

Conclusion

Brief self-report measures used as screening instruments are a simple way of gathering information about the presence of specific symptoms and thus a way to detect the likelihood of a diagnosis. The SHAI-14 shows evidence of good diagnostic utility in both clinical and non-clinical settings. However, which cut-off score is to be used, depends on the intended purpose and the setting where the cut-off is used.
The association between academic stress, social support, and self-regulatory fatigue among nursing students: a cross-sectional study based on a structural equation modelling approach
Authors: Yuhuan Zhang , Pengyue Zheng , Dong Chen , Qichao Niu , Dong Pang , Anqi Song , Hongbo Jiang , Zhixin Di
Published: November 2022

Background

Emphasizes the state of academic stress, social support, and self-regulatory fatigue on the physical and mental development of Chinese nursing students, the purpose of this study was to investigate the relationship between these variables and the mediating role of social support in academic stress and self-regulatory fatigue among a group of undergraduate nursing students in Heilongjiang Province, China, in order to provide a theoretical basis for working to reduce nursing students’ self-regulatory fatigue.

Methods

In this cross-sectional study, 1703 nursing students from various academic years completed the scales of social support, academic stress, and self-regulatory fatigue. In the end, there were 797 valid questionnaires, for a recovery rate of 46.80%. For statistical analysis, the independent t-test, Kruskal Wallis test, and Pearson correlation coefficient were used. In addition, we undertake analyses using structural equation modeling.

Results

The bulk of nursing students, or 81.4%, are between the ages of 19 and 21. Eighty percent were females. The bulk (93.0%) was comprised of freshmen. Academic stress, social support, and self-regulatory fatigue had total scores of 111.28 ± 29.38, 37.87 ± 6.70, and 45.53 ± 5.55,respectively. Academic stress was correlated with social support and self-regulatory fatigue (all p < 0.001). Social support was an intermediate variable (p < 0.001), with an intermediate effect value of 0.122, representing 32.35% of the total effect.

Conclusion

Academic pressure is associated with an increase in self-regulatory fatigue, mediated by social support. Educational administrators should pay attention to the social support and resource supplement of nursing students, the adjustment and compensatory development of nursing students’ physical and mental resources, the advancement of nursing students’ internal resource adjustment, and the reduction of their self-regulatory fatigue.
Knowledge, attitude, and practice of evidence-based medicine among resident physicians in hospitals of Syria: a cross-sectional study
Authors: Alabdullah Muhammad Nour , Alabdullah Hadi , Kamel Sondos
Published: November 2022

Background

Evidence-based medicine (EBM) is to integrate the best research evidence with our clinical expertise, circumstances, and unique values of our patient. However, there are no studies about using EBM in clinical practice among resident doctors in Syria. In this study, we aimed to evaluate the self-reported knowledge, attitude and practice (KAP) of EBM by resident doctors throughout different teaching hospitals in Syria.

Methods

The study is a cross-sectional. A self-reported online questionnaire was used to collect data about KAP of EBM from 214 resident physicians working in secondary and tertiary teaching hospitals. The study was conducted between September 2021 and February 2022. All data were analyzed using SPSS, and non-parametric statistical tests were used to identify the correlation between different variables and make the necessary comparisons.

Results

Two hundred and fourteen physicians responded to the questionnaire with a response rate of 85.6%. The overall mean scores of KAP of EBM were 59.2, 74.3 and 53.9%, respectively. The participants displayed a low level of awareness of resources and statistical terms used in EBM. The most well-known resources for residents were Up To Date and PubMed. Among the participants, pediatric residents achieved the highest score in practicing EBM, while family medicine residents scored the lowest score.

Conclusion

The overall impression about the KAP of EBM among Syrian residents was as following: weak awareness, neutral attitude and poor practice of EBM. Training workshops should be set up to teach residents the skills needed to move from opinion-based practice to evidence-based practice.
Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment
Authors: Chauhan Akashdeep Singh , Guinness Lorna , Bahuguna Pankaj , Singh Maninder Pal , Aggarwal Vipul , Rajsekhar Kavitha , Tripathi Surbhi , Prinja Shankar
Published: November 2022

The 'Cost of Health Services in India (CHSI)' is the first large scale multi-site facility costing study to incorporate evidence from a national sample of both private and public sectors at different levels of the health system in India. This paper provides an overview of the extent of heterogeneity in costs caused by various supply-side factors.

A total of 38 public (11 tertiary care and 27 secondary care) and 16 private hospitals were sampled from 11 states of India. From the sampled facilities, a total of 327 specialties were included, with 48, 79 and 200 specialties covered in tertiary, private and district hospitals respectively. A mixed methodology consisting of both bottom-up and top-down costing was used for data collection. Unit costs per service output were calculated at the cost centre level (outpatient, inpatient, operating theatre, and ICU) and compared across provider type and geographical location.

The unadjusted cost per admission was highest for tertiary facilities (₹ 5690, 75 USD) followed by private facilities (₹ 4839, 64 USD) and district hospitals (₹ 3447, 45 USD). Differences in unit costs were found across types of providers, resulting from both variations in capacity utilisation, length of stay and the scale of activity. In addition, significant differences in costs were found associated with geographical location (city classification).

The reliance on cost information from single sites or small samples ignores the issue of heterogeneity driven by both demand and supply-side factors. The CHSI cost data set provides a unique insight into cost variability across different types of providers in India. The present analysis shows that both geographical location and the scale of activity are important determinants for deriving the cost of a health service and should be accounted for in healthcare decision making from budgeting to economic evaluation and price-setting.
Single melatonin injection enhances the testicular artery hemodynamic, reproductive hormones, and semen parameters in German shepherd dogs
Authors: Salama Ali , Abdelnaby Elshymaa A. , Emam Ibrahim A. , Fathi Mohamed
Published: November 2022

This study aimed to determine the effects of melatonin administration on testicular vascular perfusion in relation to steroid hormones and semen characteristics in dogs. The study included 12 normospermic German shepherd dogs (weighed 35 ± 0.5 kg and aged 4 ± 0.5 years). Males received a single melatonin administration (melatonin dimethyl sulfoxide + corn oil via subcutaneous route; MEL;n = 6), while the rest of the animals served as controls (dimethyl sulfoxide + corn oil; Control;n = 6). Males were subjected to routine examination on days -15, 0, 15, 30, 45, and 60. All examined dogs were subjected to Doppler screening, semen collection, and blood sampling. The MEL group showed a significant (P < 0.05) elevation in semen volume, concentration, percentage of sperm motility, and total sperm × 106/ ejaculate compared to other control males. Doppler indices as resistance (RI) and pulsatility (PI) indices declined (P < 0.05) from D 30 (1.02 ± 0.01) until day 60 (0.87 ± 0.02) of treatment. In MEL males, the peak systolic point of velocity (PSV; cm/sec) of the testicular artery elevated (P < 0.05) on day 60 (20.15 ± 0.99) compared to its value on day 0 (17.39 ± 1.84). On D 60, the levels of testosterone (T), estradiol 17-ß (E2), and nitric oxide (NO) elevated (P < 0.05). A negative correlation was detected between testicular volume, scrotal circumference (SC), T levels, Doppler indices, and velocities. In conclusion, single melatonin administration could improve testicular vascularization via increasing Doppler velocities and intratesticular colored areas. In addition, it could improve semen picture and steroids (T and E2) and nitric oxide.
The perceptions of Lithuanian hunters towards African swine fever using a participatory approach
Authors: Stončiūtė Evelina , Malakauskas Alvydas , Conraths Franz J. , Masiulis Marius , Sauter-Louis Carola , Schulz Katja
Published: November 2022

Background

African swine fever (ASF) has been present in Lithuania since 2014. The disease affects mainly the wild boar population. Thus, hunters play a key role in the performance of disease surveillance and control measures. We used participatory methods to gain insight into the knowledge of hunters and to include their perceptions in the design and the implementation of surveillance and control measures to increase their effectiveness.

Results

The willingness and the interest of hunters to participate was high, but only eight focus group meetings with 33 hunters could be held due to the COVID-19 pandemic. The overall knowledge of Lithuanian hunters regarding ASF, investigated by semi-structured interviews, was sufficient to understand their part in ASF control and surveillance. However, their knowledge did not necessarily lead to an increased acceptance of some ASF control measures, like the targeted hunting of female wild boar. Participating hunters showed a good understanding of the processes of the surveillance system. Their trust in the performance within this system was highest towards the hunters themselves, thus emphasizing the importance of acknowledging their role in the system. Hunters refused measures including the reduction of hunting activities. They feared a complete elimination of the wild boar population, which in turn demonstrates the necessity to increase professional information exchange.

Conclusions

The perceptions of Lithuanian hunters regarding ASF surveillance and control in wild boar resembled those obtained in neighboring countries. It is imperative to communicate the results with decision-makers, to consider the views of hunters, when designing or adapting measures to control ASF in wild boar and to communicate with hunters on these measures and their justification.
Does the LHPP gene share a common biological function in pancancer progression?
Authors: Guo Kai , Tian Wei , Wang Hongtao , Chang Dongmin , Dou Yawei , Yuan Jinyan , Chen Yaohua , Hou Bin
Published: November 2022

Although emerging evidence has revealed that LHPP, a histidine phosphatase protein, suppresses the progression of different cancers, a pan-cancer analysis still remains unavailable. Therefore, we first utilized different bioinformatics tools to explore the tumor inhibitory role of LHPP protein across 33 tumor types based on the TCGA project. Additionally, HGC-27 gastric cancer cells were used to evaluate the biological functions of LHPP after stable transfection with lentiviruses. Consequently, LHPP mRNA and protein expression were down-regulated in the most cancer tissues corresponding to normal tissues. The data showed that patients with higher LHPP performance had a better prognosis of overall survival (OS) and disease-free survival (DFS) in brain glioma and renal carcinoma. In addition, we found that enhancement of LHPP expression attenuated the proliferation, migration and invasion of gastric cancer cells. The expression levels of cell-cycle-related and EMT-related molecules, such as CDK4, CyclinD1, Vimentin and Snail, were clearly reduced. Moreover, a genetic alteration analysis showed that the most frequent mutation types in LHPP protein was amplification. The patients without LHPP mutation showed a better tendency of prognosis in UCEC, STAD and COAD. Cancer-associated fibroblast infiltration was also observed in head and neck squamous cell carcinoma, stomach adenocarcinoma and testicular germ cell tumors. In summary, our pancancer analysis among various tumor types could provide a comprehensive understanding of LHPP biological function in the progression of malignant diseases and promote the development of novel therapeutic targets.
The need for larval source management accompanying urban development projects in malaria endemic areas: a case study on Bioko Island
Authors: García Guillermo A. , Fuseini Godwin , Donfack Olivier Tresor , Wofford Rachel N. , Nlang Jose Antonio Mba , Efiri Prudencio Bibang , Maye Valeriano Oluy Nsue , Weppelmann Thomas A. , Galick David , Phiri Wonder Philip , DeBoer Kylie , Smith Jordan M. , Eyono Jeremias Nzamio Mba , Rivas Matilde Riloha , Guerra Carlos A. , von Fricken Michael E.
Published: November 2022

Background

In 2017, several new housing districts were constructed on Bioko Island, Equatorial Guinea. This case study assessed the impact construction projects had on mosquito larval habitats and the effectiveness of larval source management in reducing malaria vector density within the surrounding area.

Methods

Anopheline larval presence was assessed at 11 new construction sites by the proportion of larval habitats containing Anopheline pupae and late instar larval stages. Bacillus thuringiensis israelensis (Bti) larvicide was applied weekly to nine locations for 30 weeks, while two locations received no larvicide and acted as controls. Adult mosquito density was monitored via human landing collections in adjacent communities of six construction sites, including the two control sites.

Results

The sites that received Bti had significantly lower observation rates of both pupae (3.2% vs. 18.0%; p < 0.001) and late instar Anopheles spp. mosquitoes (14.1 vs. 43.6%; p < 0.001) compared to the two untreated sites. Anopheles spp. accounted for 67% of mosquitoes collected with human landing collections and were captured at significantly lower levels in communities adjacent to treated construction sites compared to untreated sites (p < 0.001), with an estimated 38% reduction in human biting rate (IRR: 0.62, 95% CI IRR: 0.55, 0.69). Seven months after the start of the study, untreated sites were treated due to ethical concerns given results from treatment sties, necessitating immediate Bti application. The following week, the number of habitats, the proportion of larval sites with Anopheles spp. pupae, late instars, and adult biting rates in adjacent communities to these sites all decreased to comparable levels across all sites.

Conclusion

Findings suggest larval source management represents an effective intervention to suppress mosquito populations during infrastructure development. Incorporating larval source management into ongoing and planned construction initiatives represents an opportunity to fine tune vector control in response to anthropogenetic changes. Ideally, this should become standard practice in malaria-endemic regions in order to reduce viable mosquito habitats that are common by-products of construction.
The history and current epidemiology of malaria in Kalimantan, Indonesia
Authors: Sugiarto Sri Riyati , Baird J. Kevin , Singh Balbir , Elyazar Iqbal , Davis Timothy M. E.
Published: November 2022

Kalimantan is a part of Indonesia, which occupies the southern three-quarters of the island of Borneo, sharing a border with the Malaysian states of Sabah and Sarawak. Although most areas of Kalimantan have low and stable transmission ofPlasmodium falciparumandPlasmodium vivax, there are relatively high case numbers in the province of East Kalimantan. Two aspects of malaria endemicity in Kalimantan differentiate it from the rest of Indonesia, namely recent deforestation and potential exposure to the zoonotic malaria caused byPlasmodium knowlesithat occurs in relatively large numbers in adjacent Malaysian Borneo. In the present review, the history of malaria and its current epidemiology in Kalimantan are examined, including control and eradication efforts over the past two centuries, mosquito vector prevalence, anti-malarial use and parasite resistance, and the available data from case reports of knowlesi malaria and the presence of conditions which would support transmission of this zoonotic infection.
YKL-39 is an independent prognostic factor in gastric adenocarcinoma and is associated with tumor-associated macrophage infiltration and angiogenesis
Authors: Xue Ling , Chu Wei , Wan Fangsheng , Wu Pingfan , Zhao Xiaowen , Ma Linna , She Yali , Li Changtian , Li Yaling
Published: November 2022

Background

Gastric cancer has a high incidence and mortality rate. Angiogenesis is necessary for tumor infiltration and metastasis and affects patient prognosis. YKL-39 has monocyte chemotactic activity and pro-angiogenic activity in some tumors. In this study, we investigated the relationship between YKL-39 and tumor-associated macrophages and microangiogenesis in gastric cancer to determine its potential as a prognostic biomarker.

Materials and methods

A total of 119 patients with gastric cancer who had undergone gastrectomy at the 940th Hospital of the Joint Security Force between 2014 and 2018 were included in this study. We assayed the protein expression of YKL-39, CD68, and CD34 by immunohistochemistry in tissues of 119 patients with gastric cancer, as well as the intracellular expression of YKL-39 and CD68 by immunofluorescence. Data were analyzed with SPSS Statistics 25.0 to explore the impact of expression of YKL-39, CD68, and CD34 in gastric cancer patients and the relationship among them.

Results

Our results show that YKL-39 was expressed in both the nucleus and cytoplasm of gastric cancer cells and tumor mesenchyme. YKL-39 protein expression was associated with the depth of tumor infiltration, lymph node metastasis, and TNM stage; CD68 protein expression was associated with lymph node metastasis and TNM stage; CD34 protein expression was not associated with clinicopathological characteristics. Expression of YKL-39 was positively correlated with CD68 and CD34 (p < 0.001), and high expression of YKL-39 was associated with poor prognosis (p < 0.05).

Conclusion

In gastric cancer, YKL-39 expression is positively correlated with the degree of tumor-associated macrophage infiltration and angiogenesis, and is a potential prognostic marker for gastric cancer.
PHLPP isoforms differentially regulate Akt isoforms and AS160 affecting neuronal insulin signaling and insulin resistance via Scribble
Authors: Sharma Medha , Dey Chinmoy Sankar
Published: November 2022

Background

The aim of the present study was to determine the role of individual PHLPP isoforms in insulin signaling and insulin resistance in neuronal cells.

Methods

PHLPP isoforms were either silenced or overexpressed individually, and the effects were observed on individual Akt isoforms, AS160 and on neuronal glucose uptake, under insulin sensitive and resistant conditions. To determine PHLPP regulation itself, we tested effect of scaffold protein, Scribble, on PHLPP isoforms and neuronal glucose uptake.

Results

We observed elevated expression of both PHLPP1 and PHLPP2 in insulin resistant neuronal cells (Neuro-2A, mouse neuroblastoma; SHSY-5Y, human neuroblastoma) as well as in the whole brain lysates of high-fat-diet mediated diabetic mice. In insulin sensitive condition, PHLPP isoforms differentially affected activation of all Akt isoforms, wherein PHLPP1 regulated serine phosphorylation of Akt2 and Akt3, while PHLPP2 regulated Akt1 and Akt3. This PHLPP mediated Akt isoform specific regulation activated AS160 affecting glucose uptake. Under insulin resistant condition, a similar trend of results were observed in Akt isoforms, AS160 and glucose uptake. Over-expressed PHLPP isoforms combined with elevated endogenous expression under insulin resistant condition drastically affected downstream signaling, reducing neuronal glucose uptake. No compensation was observed amongst PHLPP isoforms under all conditions tested, indicating independent roles and pointing towards possible scaffolding interactions behind isoform specificity. Silencing of Scribble, a scaffolding protein known to interact with PHLPP, affected cellular localization of both PHLPP1 and PHLPP2, and caused increase in glucose uptake.

Conclusions

PHLPP isoforms play independent roles via Scribble in regulating Akt isoforms differentially, affecting AS160 and neuronal glucose uptake.
Identification of MAP3K4 as a novel regulation factor of hepatic lipid metabolism in non-alcoholic fatty liver disease
Authors: He Zhiyong , Bin Yangyang , Chen Guangshun , Li Qiang , Fan Wenling , Ma Yongqiang , Yi Junfang , Luo Xiaohua , Tan Zhi , Li Jiequn
Published: November 2022

Background

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder with abnormal lipid metabolism. The present study was to identify regulatory genes related to lipid droplets (LDs) abnormal accumulation in NAFLD.

Methods

transcriptomic analysis and bioinformatics analysis (GEO database) were used to identify potential genes in abnormal lipid metabolism of NAFLD. A candidate gene MAP3K4 expression were detected by immunohistochemistry staining in NAFLD and controls. RNA interference and immunoblotting were used to verify the roles of MAP3K4 in the formation of hepatic LDs.

Results

A total of 134 candidate genes were screened, including 44 up-regulated genes and 90 down-regulated genes. 29 genes in the protein–protein interaction (PPI) were selected as hub genes, including MAP3K4. The expression levels of MAP3K4 were positively correlated with NAFLD activity score (r = 0.702, p = 0.002). Furthermore, we found a positive correlation of MAP3K4 expression with serum total cholesterol (r = 0.564, p = 0.023), uric acid levels (r = 0.520, p = 0.039), and body mass index (r = 0.574, p = 0.020). Downregulation of MAP3K4 decreased LDs accumulation in HepG2 cells and reduced the expression of CGI-58 and Plin-2 by imbibition of JNK and group IVA cytosolic phospholipase A2 (cPLA2) activation.

Conclusion

The study revealed a number of regulatory genes related to hepatic lipid metabolism of NAFLD, and demonstrated that MAP3K4 played a pivotal role in the hepatic lipogenesis of NAFLD.