bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of fentanyl administration in mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis
Authors: Aoki Yoshitaka , Kato Hiromi , Fujimura Naoyuki , Suzuki Yuji , Sakuraya Masaaki , Doi Matsuyuki
Published: October 2022

Background

Fentanyl is selected to manage pain in critical care patients on mechanical ventilation in the intensive care unit (ICU). However, the usefulness of fentanyl compared with other opioids is unknown. This study examined the evidence for using fentanyl to improve the clinical outcomes of ICU patients, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Methods

We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases in June 2021. Two independent assessors reviewed studies to identify randomized, controlled trials (RCTs) that compared the intravenous administration of fentanyl and other opioids in mechanically ventilated patients in the ICU. The study quality was assessed using the GRADE system and Cochrane methodology. The primary outcome was mortality. The secondary outcomes were the duration of mechanical ventilation, duration of the ICU stay, incidence of severe adverse events, and incidence of delirium. We integrated outcome data using a random-effects model and showed absolute values and certainty of evidence in the GRADE evidence profile.

Results

Seven RCTs met the study inclusion criteria with 534 patients (251 were treated with fentanyl and 283 with other opioids, including 242 with remifentanil and 41 with morphine). Among 191 participants from 2 RCTs, fentanyl was not associated with mortality (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.24 to 2.60; low-quality evidence). Regarding the secondary outcomes, fentanyl did not shorten the duration of mechanical ventilation (mean difference, 0.49 h; 95% CI, − 0.90 to 1.88; moderate-quality evidence) or the duration of the ICU stay (mean difference, 7.04 h; 95% CI, − 3.27 to 17.35; moderate-quality evidence) compared with other opioids. Fentanyl did not increase the incidence of severe adverse events (RR, 0.98; 95% CI, 0.50 to 1.90; low-quality evidence) or delirium (RR, 1.27; 95% CI, 0.79 to 2.04; low-quality evidence).

Conclusions

Although fentanyl is a frequently administered opioid in the ICU, patients’ outcomes are not different between fentanyl use and use of other opioids. However, the GRADE evaluation provides little certainty to support the results of this systematic review. Therefore, further large RCTs are required to confirm our conclusions.

Trial registration

PROSPERO, CRD42019130648 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130648).
Predictors of nursing home admission in the older population in Belgium: a longitudinal follow-up of health interview survey participants
Authors: Berete Finaba , Demarest Stefaan , Charafeddine Rana , De Ridder Karin , Vanoverloop Johan , Van Oyen Herman , Bruyère Olivier , Van der Heyden Johan
Published: October 2022

Background

This study examines predictors of nursing home admission (NHA) in Belgium in order to contribute to a better planning of the future demand for nursing home (NH) services and health care resources.

Methods

Data derived from the Belgian 2013 health interview survey were linked at individual level with health insurance data (2012 tot 2018). Only community dwelling participants, aged ≥65 years at the time of the survey were included in this study (n = 1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis.

Results

Over the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4, 5.7 and 13.1% at respectively 1 year, 3 years and end of follow-up period. After multivariable adjustment, higher age, low educational attainment, living alone and use of home care services were significantly associated with a higher risk of NHA. A number of need factors (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer’s disease) were also significantly associated with a higher risk of NHA. On the contrary, being female, having multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Perceived health and limitations were both significant determinants of NHA, but perceived health was an effect modifier on limitations and vice versa.

Conclusions

Our findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. Practical implications include prevention of falls, management of urinary incontinence at home and appropriate and timely management of limitations, depression and Alzheimer’s disease. Focus should also be on people living alone to provide more timely contacts with health care providers. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA.
Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis
Authors: Yang Yong , Wang Guotuan , Zhang Shikun , Wang Huan , Zhou Wensheng , Ren Feifei , Liang Huimin , Wu Dongdong , Ji Xinying , Hashimoto Makoto , Wei Jianshe
Published: October 2022

Background

Exercises are an effective treatment in Parkinson’s disease (PD), but there is still controversy over which types should be used. We aimed to compare and rank the types of exercise that improve PD symptoms by quantifying information from randomised controlled trials.

Methods

We performed a systematic review and network meta-analysis and searched PubMed, MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and China National Knowledge Infrastructure (CNKI) from their inception date to June 30, 2022. We included randomized controlled trials of 24 types of exercise for the interventional treatment of adults (≥ 50 years old) with PD. Effect size measures were standardized mean differences (SMDs) with 95% credible intervals (CrIs). The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA).

Results

We identified 10 474 citations and included 250 studies involving 13 011 participants. Results of NMA showed that power training (PT) had the best benefits for motor symptoms compared with the control group (CON), with SMDs (95% CrI) (-1.46, [-2.18 to -0.74]). Body weight support treadmill training (BWS_TT) showed the best improvement in balance (1.55, [0.72 to 2.37]), gait velocity (1.15 [0.57 to 1.31]) and walking distance (1.96, [1.18 to 2.73]), and robotic assisted gait training (RA_GT) had the most benefits for freezing of gait (-1.09, [-1.80 to -0.38]). For non-motor symptoms, Dance showed the best benefits for depression (-1.71, [-2.79 to -0.73]). Only Yoga significantly reduced anxiety symptom compared with CON (-0.53, [0.96 to -0.11]). Only resistance training (RT) significantly enhanced sleep quality and cognition (-1.42, [-2.60 to -0.23]; 0.51, [0.09 to 0.94]). For muscle strength, PT showed the best advance (1.04, [0.64 to 1.44]). For concern of falling, five types of exercise were more effective than CON.

Conclusions

There is low quality evidence that PT, Yoga, BWS_TT, Dance, and RT are the most effective treatments, pending outcome of interest, for adults with PD.

Trial registration

PROSPERO (CRD42021220052).
Individualized combination therapies based on whole-exome sequencing displayed significant clinical benefits in a glioblastoma patient with secondary osteosarcoma: case report and genetic characterization
Authors: Yi Guo-zhong , Zhu Tai-chen , Que Tian-shi , Li Zhi-yong , Huang Guang-long
Published: October 2022

Background

The incidence of osteosarcoma as a secondary neoplasm in glioblastoma patient is extremely rare. The genetic characteristic still remains unclear until now.

Case description

We reported a 47-year-old female patient with multiple intracranial disseminations and infiltrations (splenium of the corpus callosum and lateral ventricular wall) of a rapid progressive glioblastoma underwent occipital craniotomy and total resection of all the enhancing lesions. Whole-exome sequencing and pathological examination revealed glioblastoma, IDH1 wild type, PTEN deficient, TERT mutated, NF1mutated, MGMT unmethylated. After surgery, the patient received combined therapeutic regimen of TTFields (tumor-treating fields) plus pembrolizumab plus temozolomide and TTFields plus everolimus, which displayed significant clinical benefits. During the combined therapeutic course, an extremely rare secondary malignant neoplasm occurred, femur MR and pathological detection of biopsy tissue demonstrated osteosarcoma. The result of whole-exome sequencing revealed 7 germline mutated genes (EPAS1, SETD2, MSH3, BMPR1A, ERCC4, CDH1, AR). Bioinformatic analysis showed the two germline mutations (MSH3 and ERCC4) induced deficiency in the DNA repair machinery, which resulting in the accumulation of mutations and may generate neoantigens contributing to the development of a secondary osteosarcoma in this case.

Conclusion

Individualized combination therapies based on whole-exome sequencing displayed significant clinical benefits in this case. Germline MSH3 and ERCC4 mutation may induce a secondary osteosarcoma in glioblastoma patients.
A randomized feasibility pilot-study of intravenous and subcutaneous administration of ketamine to prevent postpartum depression after planned cesarean delivery under neuraxial anesthesia
Authors: Monks David Thomas , Palanisamy Arvind , Jaffer Danish , Singh Preet Mohinder , Carter Ebony , Lenze Shannon
Published: October 2022

Background

Evidence suggests ketamine may prevent postpartum depression (PPD) after cesarean delivery (CD) although intolerability and inconvenience of administration are problematic. We assessed the feasibility of studying ketamine (0.5 mg/kg, via subcutaneous injection or 40-min intravenous infusion) to prevent PPD after CD.

Methods

Twenty-three women scheduled for cesarean delivery under neuraxial anesthesia were randomized to one of three groups: subcutaneous ketamine (SC Group, n = 8), intravenous ketamine (IV Group, n = 8) or placebo (n = 7). We measured depression (Edinburgh Postpartum Depression Scale [EPDS]) scores pre-operatively and at 1, 2, 21 and 42 days postoperatively. Anxiety, adverse effects, surgical site pain and analgesic consumption were also assessed. Feasibility was assessed based on acceptability, burden of disease, ability to collect study data and, tolerability of interventions.

Results

Baseline characteristics of groups were similar, however, more women in the placebo group had pre-existing anxiety disorder (p = 0.03). 20.7% (25/121) of those approached consented to participate and 34.8% (8/23), of those assessed, screened positive for depression in the postpartum (EPDS > 12). PPD screening data was complete in 78.3% (18/23). No differences were observed for any adverse effect outcomes except for fewer incidences of intraoperative shivering with ketamine (SC: 25%, IV: 0% and Placebo: 85.7%, p = 0.01). No statistically significant difference in positive screening for PPD was observed (SC: 14.3%, IV: 50% and Placebo: 42.9%, p = 0.58).

Conclusion

An RCT was judged to be feasible and there was no evidence of intolerability of either route of ketamine administration. Dispensing with the need for intravenous access makes the subcutaneous route a particularly attractive option for use in the postpartum population. Further examination of these interventions to prevent, and possibly treat, postpartum depression is warranted.

Trial registration

NCT04227704, January 14th, 2020.
Changes in retinal vascular bifurcation in eyes with myopia
Authors: Sun Caixia , Chen Tingli , Cong Jing , Wu Xinyuan , Wang Jing , Yuan Yuanzhi
Published: October 2022

Objective

To evaluate the effect of myopia on retinal vascular bifurcation.

Methods

A cross-sectional study that retrospectively analyzed the fundus photographs and clinical data of 493 people who participated in routine physical examinations in Huadong Sanatorium. One eye of each subject was included in the analysis. Retinal vascular bifurcation measurements were extracted by using a validated computer program. One-way ANOVA and analysis of covariance were performed to compare the measurements across high myopia, low to moderate myopia, and non-myopia groups.

Results

The mean age was 41.83 ± 10.43 years and 63.49% were women. The mean spherical equivalent refraction (SER) was − 4.59 ± 3.07 D. Ninety-nine (20.08%) eyes met the definition of high myopia (SER ≤ -6.0 D), along with 234 (47.46%) low to moderate myopia (-6.0 D < SER <-0.5 D), and 160 (32.45%) non-myopia (SER ≥ -0.5 D). The differences in the arteriolar branching angle, venular branching coefficient, venular asymmetry ratio, venular angular asymmetry, and venular junctional exponent among the three groups remained significant (p < 0.05) after multivariate adjustment. Pairwise comparisons showed arteriolar branching angle and venular angular asymmetry in high myopia were significantly lower than low to moderate myopia (p < 0.001, p = 0.014 respectively) and non-myopia (p = 0.007, p = 0.048 respectively). Venular asymmetry ratio and venular branching coefficient in high myopia were significantly higher than low to moderate myopia (p = 0.029, p = 0.001 respectively) and non-myopia (p = 0.041, p = 0.043 respectively). There was a significant difference in venular junctional exponent between high myopia and low to moderate myopia (p = 0.031).

Conclusion

The vascular bifurcation differs in dependence on the myopic refractive error and a significant increase in the difference can be observed in high myopic eyes.
Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study
Authors: Balgovind Preeti , Mohammadnezhad Masoud
Published: October 2022

Introduction

Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision–making process. This research aimed to explore the factors that influence healthcare workers’ experience and perceptions about delivering childhood immunization in Fiji.

Materials and methods

A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi–structured open–ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews.

Results

There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule.

Conclusion

Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.
Thematic analysis of the raters’ experiences administering scales to assess depression and suicide in Arab schizophrenia patients
Authors: Amro Iman , Ghuloum Suhaila , Hammoudeh Samer , Hani Yahya , Yehya Arij , Al-Amin Hassen
Published: October 2022

Background

This study aimed to enhance the cultural adaptation and training on administering the Arabic versions of the Calgary Depression Scale in Schizophrenia (CDSS) and The International Scale for Suicidal Thinking (ISST) to Arab schizophrenia patients in Doha, Qatar.

Methods

We applied the qualitative thematic analysis of the focus group discussions with clinical research coordinators (CRCs). Five CRCs met with the principal investigator for two sessions; we transcribed the conversations and analyzed the content.

Results

This study revealed one set of themes related to the scales themselves, like the role of the clinician-patient relationship during administration, the semantic variations in Arabic dialects, and the design of scales to assess suicide and differentiate between negative symptoms and depression. The other set of themes is relevant to the sociocultural domains of Muslim Arabs, covering religion, families’ roles, and stigma. It also covered the approaches to culturally sensitive issues like suicide, taboos in Islam, and the gender roles in Arab countries and their impact on the patients’ reports of their symptoms.

Conclusions

Our results highlight several cultural and religious aspects to tackle when approaching schizophrenia patients through in-depth discussions and training to improve the validity of the assessment tools and treatment services.
Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study
Authors: Starzec-Proserpio Małgorzata , Węgrzynowska Maria , Sys Dorota , Kajdy Anna , Rongies Witold , Baranowska Barbara
Published: October 2022

Background

Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland.

Methods

This was a prospective, observational study. In phase 1, 411 women were recruited 24–72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report.

Results

In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43–48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04–4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01–1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34–48.72).

Conclusion

Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.
Comparison of freehand technique and a novel laser guiding navigation in distal locking of femoral intramedullary nails: a randomized controlled trial
Authors: Gao Hua , Liu Zhenyu , Bai Xiaodong , Xu Guoqiang , Chen Wentao , Ma Ji , Wang Yijun , Wang Jiatian , Wang Gang , Wang Baojun
Published: October 2022

Background

Intramedullary nail (IMN) is one of the key essential minimally invasive “weapons” in orthopaedic trauma, while the distal locking is still challenging for surgeons. Although there are various inventions and technologies to improve the locking procedure, there are still problems such as inaccurate positioning, excessive radiation exposure, low first success rate and long learning curve. Therefore, a new laser guiding navigation device was designed and compared with the traditional freehand (FH) technique in the distal locking of femoral IMN.

Methods

This randomized controlled single-blind trial recruited patients with femoral diaphyseal fracture. The self-designed laser navigation device (laser group) and freehand technique (FH group) were used in the distal locking of the IMNs. The patients enrolled were randomized into FH group and laser group, all operations were performed by two surgeons of the same level. The differences between the two groups were compared in terms of radiation exposure time, operative time, first success rate, blood loss, visual analogue score (VAS), Harris score and healing time.

Results

32 patients ended the study period and 16 patients in each group. The results showed that the laser group was better than the FH group in terms of distal locking time (10(9/11) vs 19.5 (17.25/21) min, Z = 4.83, P < 0.001), distal locking radiation exposure time (46.5 (41.25/51.75) vs 105 (88.25/140) s, Z = 4.807, P < 0.001), first success rate (30/32 vs 20/32, χ2 = 9.143, P = 0.002) and blood loss (60 (50–100) vs 150 (105–192.5) mL, Z = 3.610, P = 0.0003). There was no difference in Harris score, VAS score, or fracture healing time between the two groups.

Conclusion

Compared with the FH technique, the novel laser guiding navigation device for distal locking of femoral IMN has the advantages of shorter operative time, less radiation exposure and higher first success rate.

Trial registration Chinese Clinical Trial Registry, ChiCTR2200060236. Registered 23 May 2022, https://www.chictr.org.cn/showprojen.aspx?proj=169130
Integrative analyses of immune-related biomarkers and associated mechanisms in coronary heart disease
Authors: Zhang Lianbo , Li Guibin , Liang Bo , Su Xiaoli , Xie Haolin , Sun Hongxia , Wu Ge
Published: October 2022

Various studies showed that the effect of immune activation is pro-atherogenic and coronary heart disease (CHD) should therefore be considered an autoimmune disease. This study aimed to identify potential immune-related biomarkers, pathways, and the potential regulatory networks underlying CHD. Differentially expressed genes (DEGs) between CHD and control samples were determined by analyzing GSE71226 and GSE9128. The overlapping differential expression immune-related genes (DE-IRGs) for CHD were identified by analyzing the ImmPort database and two GEO databases. A total of 384 DE-IRGs were identified. Subsequently, comprehensive enrichment analyses suggested that DE-IRGs were enriched in immune-related pathways, including autoimmune thyroid disease, the intestinal immune network for IGA production, and downstream signaling events of B cell receptors. The signature of DE-IRGs was validated using an external independent dataset GSE20681 (AUC = 0.875). Furthermore, we conducted protein–protein interaction network analysis and identified eight hub genes, which were most enriched in regulation of defense response, NF-κB signaling pathway, regulation of JNK cascade, and regulation of cytokine production. Moreover, networks of miRNAs-mRNAs and transcription factors (TFs)-mRNA underlying the integrated data were established, involving eight miRNAs and 76 TF-targeting hub genes. Ultimately, 17 SNPs in miRNA-mediated gene networks were identified. We screened potential immune-related genes in CHD and constructed miRNA-mRNA-TF and SNP-miRNA networks, which not only provide inspired insights into the occurrence and the molecular mechanisms of CHD but also lay a foundation for targeting potential biomarkers using immunotherapy and for understanding the molecular mechanisms of CHD.
Exosome-like nanovesicles derived from Phellinus linteus inhibit Mical2 expression through cross-kingdom regulation and inhibit ultraviolet-induced skin aging
Authors: Han Jingxia , Wu Ting , Jin Jing , Li Zhiyang , Cheng Wenjun , Dai Xintong , Yang Kai , Zhang Heng , Zhang Zhiyuan , Zhang Haohao , Fan Rong , Zheng Shaoting , Liu Haoyang , Li Yinan , Zhao Huan , Yao Cheng , Lin Tingting , Zhu Caibin , Liu Huijuan
Published: October 2022

Background

Phellinus linteus (PL), which is a typical medicinal fungus, has been shown to have antitumor and anti-inflammatory activities. However, studies on the effect of anti-photoaging are limited. Studies have shown that exosome-like nanovesicles are functional components of many medicinal plants, and miRNAs in exosome-like nanovesicles play a cross-kingdom regulatory role. At present, research on fungi exosome-like nanovesicles (FELNVs) is few.

Results

We systematically evaluated the anti-aging effects of PL. FELNVs of PL were isolated, and the functional molecular mechanisms were evaluated. The results of volunteer testing showed that PL had anti-aging activity. The results of component analysis showed that FELNVs were the important components of PL function. FELNVs are nanoparticles (100–260 nm) with a double shell structure. Molecular mechanism research results showed that miR-CM1 in FELNVs could inhibit Mical2 expression in HaCaT cells through cross-kingdom regulation, thereby promoting COL1A2 expression; inhibiting MMP1 expression in skin cells; decreasing the levels of ROS, MDA, and SA-β-Gal; and increasing SOD activity induced by ultraviolet (UV) rays. The above results indicated that miR-CM1 derived from PL inhibited the expression of Mical2 through cross-kingdom regulation and inhibited UV-induced skin aging.

Conclusion

miR-CM1 plays an anti-aging role by inhibiting the expression of Mical2 in human skin cells through cross-species regulation.

Graphical abstract
High co-expression of immune checkpoint receptors PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT on tumor-infiltrating lymphocytes in early-stage breast cancer
Authors: Mollavelioglu Baran , Cetin Aktas Esin , Cabioglu Neslihan , Abbasov Aykhan , Onder Semen , Emiroglu Selman , Tükenmez Mustafa , Muslumanoglu Mahmut , Igci Abdullah , Deniz Gunnur , Ozmen Vahit
Published: October 2022

High expression of immune checkpoint receptors (ICRs) in the tumor microenvironment regulates the anti-tumor response. In this study, the differential expressions of ICRs on tumor-infiltrating lymphocytes (TILs) in patients with early-stage breast cancer were investigated.

The study included 32 patients who underwent surgery with a diagnosis of early-stage breast cancer between September 2018 and March 2020. TIL isolation was performed using a MACS tumor separation device and tumor separation kit. PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT expression of cytotoxic T and natural killer (NK) cells on TILs and peripheral blood lymphocytes (PBLs) were determined by flow cytometry.

Patients with a high Ki-67 index, high TIL density, and HER-2 positivity were more likely to have increased CD16+CD56dim NK cells on TILs. Patients with T2 tumors were more likely to have increased expression of PD-1, LAG-3, and TIGIT on tumor-infiltrating CD8+ cytotoxic T cells than those with T1 tumors. PD-1, CTLA-4, TIGIT, LAG-3, and TIM-3 expression of CD8+ T and CD16-CD56bright NK cells in TILs showed significant positive correlations with each other. PD1+CD8+, TIGIT+CD16+, and CTLA-4+CD56+ cells in PBLs and TILs were found to be negatively correlated, whereas only TIM-3+ expression of CD8+ T and CD16+CD56dim cells in PBLs and TILs showed positive correlations.

Our results suggest that CD16+CD56dim NK cells on TILs may play a major role in the immune response against HER2-positive or highly proliferating breast tumors in patients with early-stage breast cancer. Furthermore, various ICRs were found to be highly co-expressed with each other on TILs, including PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT. These receptors may synergistically suppress the response to the tumor, which may trigger immune escape mechanisms in the early stage of carcinogenesis. However, ICR expressions other than TIM3 on PBLs were not found to accompany their counterparts on TILs.
Adherence to 24-hour movement guidelines among rural Brazalian preschool children: associations with parenting practices
Authors: Goncalves Widjane Sheila Ferreira , Byrne Rebecca , de Lira Pedro Israel Cabral , Viana Marcelo Tavares , Trost Stewart G.
Published: October 2022

Background:

Young children residing in rural areas of low-and-middle income countries (LMICs) such as Brazil are at greater risk of obesity and related chronic health conditions. Yet, the extent to which rural preschool children from Brazil aged 3- to 6-years meet the World Health Organisation (WHO) 24-hour movement guidelines is unknown. Parents play a central role in the development of children’s movement behaviors with logistic support, co-participation, modelling, and setting rules and limits recognized as influential parenting practices. However, the bulk of parenting research has been conducted in families from high income countries (HICs) and little is known about the relationship between parenting practices and children’s movement behaviors in LMIC communities. Therefore, the aims of this study were two-fold: (1) report the proportion of preschool children from low-income families in rural Brazil meeting the WHO 24-hour movement guidelines; and (2) determine associations with theory-based parenting practices related to physical activity, screen time, and sleep.

Methods:

A representative sample of 324 families from a rural district in north-eastern Brazil completed a validated, culturally adapted interviewer-administered survey assessing child physical activity, screen time and sleep, and associated parenting practices. The proportion of children meeting the physical activity, screen time, and sleep recommendations and all combinations of these recommendations was calculated. Forward selection logistic regression was used to determine which parenting practices were associated with meeting the individual recommendations and the 24-hour movement guidelines.

Results:

Less than half of the children (47.5%) met the physical activity recommendation, 22% met the screen time recommendation, 62% met the sleep recommendation, with just over 10% meeting all three recommendations in the 24-h movement guidelines. Having fewer rules and restrictions around indoor and outdoor play, limiting, or monitoring screen time, and maintaining a consistent bedtime routine were key parenting practices associated with children´s adherence to the 24-hour movement guidelines.

Conclusion:

Only 1 in 10 rural Brazilian preschool children meet the 24-hour movement guidelines. These findings underscore the need for family-based interventions targeting parenting practices to support healthful movement behaviors in young children from LMICs.
A shared fate: adapting and personalising medical care from the perspective of a refugee reception country
Authors: Śniadecki Marcin , Boyke Zuzanna
Published: October 2022

The article outlines socio-medical challenges faced by a country hosting refugees. Since the full-scale Russian invasion, more than 3.6 million Ukrainians have fled to Poland. Among these, a 9-year-old post-transplant patient, Tetiana. The story of the girl and her family reveals the refugees’, the authors’, and other doctors’ varied attitudes towards the war. Considering differences between the Polish and Ukrainian health care systems, and the need for well-coordinated and effective assistance, a professional, and realistically financed system needs to be established. The presence of Ukrainian doctors is potentially advantageous because of the shared language with Ukrainian refugees. Notwithstanding the medical community’s demonstrable solidarity, the months of effort and the awareness that many people may not be helped may result in burnout. Supporting others starts with us, so that neither poor management, nor cultural differences or simple fatigue, undermine the community cohesion that Poles and Ukrainians can build together.
No increased rate of cyclops lesions and extension deficits after remnant-preserving ACL reconstruction using the sparing technique
Authors: Bierke Sebastian , Häner Martin , Karpinski Katrin , Hees Tilman , Petersen Wolf
Published: October 2022

Background

Remnant-preserving anterior cruciate ligament reconstruction (ACLR) should have advantages for postoperative remodeling and proprioception. However, it has been suggested that the larger diameter of the graft tends to lead to impingement phenomena with a higher rate of cyclops lesions. The aim of this work was to find out whether the remnant-preserving ACLR actually leads to an increased rate of range of motion restraints compared to the remnant-sacrificing technique.

Methods

Patients, who fulfilled the inclusion criteria, were followed up for one year after surgery. The primary endpoint was arthrolysis due to extension deficit or cyclops syndrome.

Secondary outcome measures were pain (NRS), knee function (KOOS), patient satisfaction and return to sports rate.

Results

One hundred and sixty-four patients were included in the study, 60 of whom received the “remnant augmentation” procedure (group 1). In the remnant augmentation group, one cyclops resection was performed, whereas in the non-remnant augmentation group three cyclops lesion resections had to be performed (odds ratio 0.6). There was no difference between the groups in pain (NRS) and knee function (KOOS) and patient satisfaction. The return to sports rate after one year was higher in the remnant augmentation group.

Conclusions

Patients who have undergone the sparing “remnant augmentation” ACLR have no increased risk of cyclops lesion formation or extension deficit in the first year after surgery. An improvement of the proprioceptive abilities by remnant augmentation ACLR should be investigated in further studies.

Level of evidence

III (prospective cohort study).
Work productivity and activity in patients with SAPHO syndrome: a cross-sectional observational study
Authors: Li Chen , Xu Heng , Gong Liang , Wang Afang , Dong Xia , Yuan Kai , Huang Guangrui , Wei Shufeng , Sun Luying
Published: October 2022

Background

Our understanding of work productivity impairment among patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is limited. The purpose of this study was to provide an overview of work productivity loss in SAPHO syndrome patients through the use of the work productivity and activity impairment (WPAI) questionnaire, as well as to investigate the relationship between the WPAI and other disease-related indicators.

Methods

Patients for this cross-sectional study were recruited from Peking Union Medical College Hospital (Beijing, China). The questionnaires incorporating the WPAI were administered, along with the inclusion of demographic data, disease-specific measures, and general health variables. The construct validity of the WPAI was evaluated via the correlations between WPAI outcomes and other measures. Wilcoxon rank-sum tests and nonparametric Kruskal‒Wallis tests were used for the comparison of the WPAI outcomes between known groups.

Results

A total of 376 patients were included, and 201 patients (53.5%) were employed. The medians (interquartile range [IQR]) of absenteeism, presenteeism, work productivity loss, and activity impairment were 0% (0–13%), 20% (0–40%), 20% (0–52%), and 30% (0–50%), respectively. All of the WPAI outcomes showed moderate to strong correlations with other generic and disease-specific measures (|r| = 0.43–0.75), except for absenteeism. Increasing disease activity and worse health status were significantly associated with increased impairments of work productivity and activity.

Conclusion

This study highlights the negative effects of SAPHO syndrome on the work productivity and activity of patients, thus indicating good construct validity and discriminative ability of the WPAI. To reduce the economic burden, it is important to improve the work productivity and daily activity of patients by ameliorating clinical care.
PredictCBC-2.0: a contralateral breast cancer risk prediction model developed and validated in ~ 200,000 patients
Authors: Giardiello Daniele , Hooning Maartje J. , Hauptmann Michael , Keeman Renske , Heemskerk-Gerritsen B. A. M. , Becher Heiko , Blomqvist Carl , Bojesen Stig E. , Bolla Manjeet K. , Camp Nicola J. , Czene Kamila , Devilee Peter , Eccles Diana M. , Fasching Peter A. , Figueroa Jonine D. , Flyger Henrik , García-Closas Montserrat , Haiman Christopher A. , Hamann Ute , Hopper John L. , Jakubowska Anna , Leeuwen Floor E. , Lindblom Annika , Lubiński Jan , Margolin Sara , Martinez Maria Elena , Nevanlinna Heli , Nevelsteen Ines , Pelders Saskia , Pharoah Paul D. P. , Siesling Sabine , Southey Melissa C. , van der Hout Annemieke H. , van Hest Liselotte P. , Chang-Claude Jenny , Hall Per , Easton Douglas F. , Steyerberg Ewout W. , Schmidt Marjanka K.
Published: October 2022

Background

Prediction of contralateral breast cancer (CBC) risk is challenging due to moderate performances of the known risk factors. We aimed to improve our previous risk prediction model (PredictCBC) by updated follow-up and including additional risk factors.

Methods

We included data from 207,510 invasive breast cancer patients participating in 23 studies. In total, 8225 CBC events occurred over a median follow-up of 10.2 years. In addition to the previously included risk factors, PredictCBC-2.0 includedCHEK2c.1100delC, a 313 variant polygenic risk score (PRS-313), body mass index (BMI), and parity. Fine and Gray regression was used to fit the model. Calibration and a time-dependent area under the curve (AUC) at 5 and 10 years were assessed to determine the performance of the models. Decision curve analysis was performed to evaluate the net benefit of PredictCBC-2.0 and previous PredictCBC models.

Results

The discrimination of PredictCBC-2.0 at 10 years was higher than PredictCBC with an AUC of 0.65 (95% prediction intervals (PI) 0.56–0.74) versus 0.63 (95%PI 0.54–0.71). PredictCBC-2.0 was well calibrated with an observed/expected ratio at 10 years of 0.92 (95%PI 0.34–2.54). Decision curve analysis for contralateral preventive mastectomy (CPM) showed the potential clinical utility of PredictCBC-2.0 between thresholds of 4 and 12% 10-year CBC risk forBRCA1/2mutation carriers and non-carriers.

Conclusions

Additional genetic information beyondBRCA1/2germline mutations improved CBC risk prediction and might help tailor clinical decision-making toward CPM or alternative preventive strategies. Identifying patients who benefit from CPM, especially in the general breast cancer population, remains challenging.
Double inversion recovery MRI versus contrast-enhanced MRI for evaluation of knee synovitis in juvenile idiopathic arthritis
Authors: Verkuil Floris , Hemke Robert , van Gulik E. Charlotte , Barendregt Anouk M. , Nassar-Sheikh Rashid Amara , Schonenberg-Meinema Dieneke , Dolman Koert M. , Deurloo Eline E. , van Dijke Kees F. , Harder J. Michiel den , Kuijpers Taco W. , van den Berg J. Merlijn , Maas Mario
Published: October 2022

Background

Double inversion recovery (DIR) MRI has the potential to accentuate the synovium without using contrast agents, as it allows simultaneous signal suppression of fluid and fat. The purpose of this study was (1) to compare DIR MRI to conventional contrast-enhanced (CE) MRI for delineation of the synovium in the knee in children with juvenile idiopathic arthritis (JIA) and (2) to assess the agreement between DIR MRI and CE-MRI regarding maximal synovial thickness measurements.

Results

In this prospective study, 26 children with JIA who consecutively underwent 3.0-T knee MRI between January 2018 and January 2021 were included (presence of knee arthritis: 13 [50%]; median age: 14 years [interquartile range [IQR]: 11–17]; 14 girls). Median confidence to depict the synovium (0–100 mm visual analogue scale; scored by 2 readers [consensus based]) was 88 (IQR: 79–97) for DIR MRI versus 100 (IQR: 100–100) for CE-MRI (p value = < .001). Maximal synovial thickness per child (millimeters; scored by 4 individual readers) on DIR MRI was greater (p value = < .001) in the children with knee arthritis (2.4 mm [IQR: 2.1–3.1]) than in those without knee arthritis (1.4 mm [IQR: 1.0–1.6]). Good inter-technique agreement for maximal synovial thickness per child was observed (rs = 0.93 [p value = < .001]; inter-reader reliability: ICC DIR MRI = 0.87 [p value = < .001], ICC CE-MRI = 0.90 [p value = < .001]).

Conclusion

DIR MRI adequately delineated the synovium in the knee of children with JIA and enabled synovial thickness measurement similar to that of CE-MRI. Our results demonstrate that DIR MRI should be considered as a child-friendly alternative to CE-MRI for evaluation of synovitis in children with (suspected) JIA.
Evidence on the social, economic, and environmental impact of interventions that facilitate bamboo industry development for sustainable livelihoods: a systematic map protocol
Authors: Binfield Lucy , Britton Tamara L. , Dai Chunping , Innes John
Published: October 2022

Background

Bamboo has been identified as a potential instrument for socioeconomic development due to its fast growth, perceived environmental benefits, promising material properties, myriad applications, and relative underdevelopment as a global industrial product. Many projects and interventions have been carried out that aim to utilize bamboo’s social and environmental potential in development. However, critical evaluations that demonstrate this effect using real-world evidence and outcomes are rare, and existing case studies have not been collated and analyzed in a systematic way. The proposed systematic map aims to summarize and evaluate evidence on the social, economic, and environmental impact of bamboo industry development initiatives on beneficiary communities and ecosystems, and to identify priority areas for future funding and research.

Methods

In the proposed systematic map, we will collect and thematically categorize evidence on the social, environmental, and economic impact of bamboo development implementations, identifying themes, research gaps, and critical success factors. Literature discussing this type of intervention is published by researchers, organizations, and governments in academic journals, institutional reports, and program evaluations describing various socio-economic and environmental outcomes, impacts and metrics for success. Search sources for this systematic map therefore include bibliographic databases, institutional websites, web-based search engines, and expert consultation. Targeted search strings will be used to identify relevant texts in a two-step review process comprising an abstract and a full-text screening process. Sources describing interventions with a primary aim of bamboo industry development for social benefit that concluded between 1990 and 2021 will be sought. Metadata coded from these texts will be reviewed, categorized, and checked by two reviewers. Reviewers will be checked for consistency on batches of 30 articles using the Kappa interrater reliability test with a goal of a Kappa coefficient of 0.9. Metadata will be coded into different categories including outcomes and impacts using NVivo. Results of both quantitative and qualitative data analysis will be summarized in a searchable online database. Themes will be synthesized and explored in a narrative review and using simple logic models demonstrating theories of change for eligible case studies.
A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children
Authors: Wu Zhiping , Zou Yun , Fu Ronghua , Jin Pingliang , Yuan Hua
Published: October 2022

Purpose

In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response.

Methods

A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%, < 90%), and poor (< 50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson’s Chi-square or Fisher’s exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots.

Results

The mean number of treatment sessions was 3.1 (range, 1–6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥ 90%) and 68 patients (88.3%) had an acceptable response (≥ 50%, < 90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response.

Conclusions

An acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram based on the prognostic factors of sclerotherapy response for LMs in children was shown to possess an excellent performance to predict the probability of LMs sclerotherapy response.