bluuebunny/crossref_metadata_2025 huggingface dataset:
Phytochemical, Antioxidant, Toxicological, and Pharmaceutical Evaluation of Polyherbal Formulation: Irochel
Authors: Ghayas Syma , Hannan Abdul , Rizwani Ghazala H.
Published: February 2022

Background and Purpose: Irochel is a polyherbal formulation, comprises ethanolic extracts of Emblica officinalis, Cucurbita pepo L, Triticum aestivum, Fagonia cretica, Momordica charantia, and Tribulus terristris. It is prepared for the management of iron overload in transfusion-dependent thalassemia patients in which non-transfusion binds iron-produced reactive oxygen species ROS that causes severe damages to the organs leads to death. Research Study: In this study, phytochemical, antioxidant-DPPH assay, cytotoxicity, acute, and subacute toxicity in Wistar rats according to OECD guidelines 423 and 407, respectively, was carried out. The pharmaceutical analysis was conducted following standard protocols. Results: The results exhibited that each herb has a rich amount of phytochemical constituents. The DPPH assay showed IC50 values for Irochel and Gallic Acid 106.6 ± 4.28 [uM] and 21.8 ± 1.03 [uM], respectively. The LC50 124.327 μg/ml was obtained in cytotoxicity. In acute toxicity (14 days) and subacute toxicity (28 days) studies, the results revealed no treatment-related toxic manifestations, or mortality. Therefore, LD50 was found > 5000 mg/kg. However, there was some hematological and biochemical variations observed at 3 different doses of 2000, 300, and 50 mg/kg bw. Conclusion: Thus, Irochel has significant antioxidant activity and it is a safe drug for human use.
Worldview literacy as intercultural citizenship education: A framework for critical, reflexive engagement in plural democracy
Authors: Shaw Martha
Published: February 2022

Within plural democracies, the concept of ‘religious literacy’ is commonly understood as denoting the knowledge, skills and understanding vis- à -vis religious diversity required of the citizen. In schools across Europe such learning is traditionally housed within Religious Education (RE), the aims of which are increasingly framed in terms of citizenship education, yet the two school subjects are often unhelpfully siloed, and both criticised for lack of criticality and an over-focus on knowledge acquisition. This article introduces the concept of ‘worldview literacy’ as a reworking of ‘religious literacy’ that addresses concerns around inclusivity and criticality. Rather than a product of good RE or citizenship education, worldview literacy is envisaged as a transformational process of educational praxis through encounter in plurality, that forges a pathway between the two school subjects and contributes to the broader educational endeavour of engagement in social life.
The National (Hippo)Drama: Empire and the Nineteenth-Century Scottish Touring Circus
Authors: Potter Beth
Published: February 2022

This article demonstrates how nineteenth-century Scottish touring circus sits at the intersection of the National Drama and the imperial spectacle of the circus. It offers a timely analysis of how Scottish (inter)nationalism and nation formation were interwoven with imperialist discourse in popular public imaginaries. By analysing the deployment of and investment in Unionist-nationalist Scottish imagery in playbills, newspapers, and life-writing accounts, and in archives this article newly brings to light, I argue two things: firstly, that the continuities between rural touring and metropolitan permanent circuses helped bridge the historic cultural and ethnic divide between Highland and Lowland communities; and secondly, that this creation of a unified Scottish identity engendered and reflected an (inter)nationalist and imperial sentiment in diverse Scottish audiences. This article, therefore, complicates current conceptions and historiographies of Scottish nationalism which overlook how commitment to Unionism and the empire was often a prerequisite for nationalist feeling.
Monitoring the safety of COVID-19 vaccination in pregnancy in the UK: A national study using the UK Obstetric Surveillance System (UKOSS), UK Teratology Information Service (UKTIS) and Vaccination in Pregnancy (VIP) safety monitoring systems
Authors: Richardson Jonathan L , Stephens Sally , Chappell Lucy C , Campbell Helen , Amirthalingam Gayatri , O’Boyle Shennae , Bukasa Antoaneta , Knight Marian , Hodson Kenneth K
Published: February 2022

Background

COVID-19 vaccines are protective against disease. Pregnant women benefit from vaccination as they are at higher risk of poor maternal and neonatal outcomes following infection.

Methods

Following regulatory approval of two COVID-19 vaccines in the United Kingdom, a rapid national study of vaccination in pregnancy was instituted using three existing safety surveillance platforms: UKOSS, UKTIS and VIP. This preliminary report describes the data collected up to the 15th June 2021.

Results

There were 971 reports of COVID-19 vaccination in the UKOSS/UKTIS ( n = 493) and VIP ( n = 478) monitoring systems describing 908 individual pregnancies. Pfizer-BioNTech mRNA vaccination was most common ( n = 501, 55.2%), most women were vaccinated in their second or third trimester ( n = 566, 62.3%), and were mainly vaccinated due to occupational infection risk ( n = 577, 63.5%).

Conclusion

Obstetric outcome data will be obtained by December 2021. However, women should not delay vaccination whilst awaiting further safety data to emerge.
Listening, Engaging, Advocating and Partnering (L.E.A.P): A Model for Responsible Community Engagement for Educational Leaders
Authors: Stanley Darrius A. , Gilzene Alounso
Published: February 2022

Given the current, contested political climate, growing school-community inequities, and a renewed commitment to equity and justice in the National Education Leadership Preparation standards, aspiring educational leaders need practical approaches to leading school communities toward equitable outcomes. This conceptual article offers a comprehensive and practical approach for responsible community engagement for educational leaders. The authors outline a model that provides key examples of how contemporary educational leaders might begin: listening, engaging, advocating, and partnering with community-based assets to improve the outcomes of historically disenfranchised students. This scholarship concludes with implications for leadership preparation programs and aspiring educational leaders.
Prehabilitation and Rehabilitation Program for Patients Undergoing Arthroscopic Acetabular Labral Repair: A Comprehensive 5-Phase Patient-Guided Program
Authors: Naessig Sara , Kucharik Michael , Meek Wendy , Eberlin Christopher , Martin Scott
Published: February 2022

Background:

Many of the current rehabilitation programs for patients undergoing hip arthroscopy fail to consider the progression of soft tissue healing and inflammation that can be heightened due to aggressive therapy to the operative hip in the immediate postoperative period.

Hypothesis:

It was hypothesized that introducing conservative physical therapy (PT) preoperatively along with a slow progression to return to activity using a structured, patient-guided postoperative program would improve patient outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

The authors conducted a retrospective review of patients who received a hip arthroscopy, were at least 18 years old, and who had completed the following patient-reported outcomes (PROs) at 1-year follow-up: modified Harris Hip Score (mHHS), Hip Outcome Score, Nonarthritic Hip Score, International Hip Outcome Tool-33, and Lower Extremity Functional Scale. Patients who underwent previous surgery on the ipsilateral hip and those with cartilage erosion down to exposed subchondral bone (Outerbridge grade 4) were excluded. Paired-samples t tests were used to compare the change in PRO scores at 3-month, 6-month, and 1-year follow-up, and the percentage of patients who achieved minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds on the mHHS were stratified according to their Outerbridge grade (0-3).

Results:

Overall, 202 patients (53% female, 47% male) were included in the analysis. Significant improvement was seen from 3 to 6 months on all PRO measures and from 6 months to 1 year on all but the mHHS ( P < .05 for all except the mHHS). A significantly smaller percentage of patients with Outerbridge grade 3 cartilage damage achieved the MCID and SCB on the mHHS compared with those with grade 0, both at 6 months (grade 3 vs 0: 20% vs 63.2% [MCID]; 18.0% vs 52.6% [SCB]; both P = .03) and 1 year (grade 3 vs 0: 22.0% vs 57.9% [MCID]; 14.0% vs 52.6% [SCB]; both P < .05).

Conclusion:

A structured, patient-guided PT protocol after arthroscopic acetabular labral repair can significantly improve postoperative outcomes.
Patients’ Perceptions of Quality of Care: A Teamwork Intervention Study in a Surgical Ward
Authors: Hall-Lord Marie Louise , Ballangrud Randi
Published: February 2022

Introduction

Improving teamwork competencies among health care professionals is important for patient safety. Few previous studies have investigated whether a teamwork intervention has an impact on patients’ perceptions of quality of care.

Objective

To investigate patients’ perceptions of quality of care before and after the implementation of a team training program in a surgical ward.

Methods

A quasi-experimental pre- and posttest design was used. The TeamSTEPPS® team training program was implemented in a surgical ward. Three groups of consecutively sampled patients responded to the Quality from the Patient's Perspective (QPP) questionnaire including four dimensions with 25 items. In addition to the QPP, six items were developed for this study. In total, 223 patients responded to the questionnaire. The mean age was 59.6 years, and there were 128 males and 94 females.

Results

The physical-technical condition dimension and four items showed significantly higher scores after six months of intervention. The majority of the patients scored quality of care in the four dimensions as very high at all three time points. Younger patients reported the lowest care quality.

Conclusion

The results in this study indicate that the teamwork intervention had a minimal impact on the patients’ perceptions of quality of care, with only significant differences between baseline and six months of intervention in one dimension and three items. At each data collection time point, the numbers of patients who perceived quality of care as modest decreased slightly. Younger patients were more likely to perceive care quality as modest.
Gut bacterial metabolite Urolithin A inhibits myocardial fibrosis through activation of Nrf2 pathway in vitro and in vivo
Authors: Chen Pengfei , Pei Junyu , Wang Xiaopu , Tai Shi , Tang Liang , Hu Xinqun
Published: February 2022

Background

Myocardial fibrosis after myocardial infarction (MI) is one of the leading causes of cardiovascular diseases. Cardiac fibroblasts (CFs) are activated and promoted by MI to undergo myofibroblast transformation (CMT). Urolithin A (UA) is an active and effective gut metabolite derived from polyphenolics of berries and pomegranate fruits, which has been reported to have anti-inflammatory and anti-oxidant functions. However, whether UA affects the CMT process during myocardial fibrosis remains unclear.

Methods

TGF-β1-treated primary rat cardiac fibroblasts were used for in vitro study. Cell proliferation ability was evaluated by MTT assay. Cell migration and invasion abilities were tested by wound healing and Transwell assays. The expression of CMT process-related markers were measured by qRT-PCR and western blot. The rat MI model was established by left anterior descending coronary artery (LAD) ligation and evaluated by H&E and Masson staining.

Results

Our data demonstrated that UA treatment could inhibit the CMT process in TGF-β1-induced CFs, including cell proliferation, migration and invasion abilities. Knocking down of Nrf2, which was activated by UA treatment, could mitigate the effects of UA treatment on CMT process. Moreover, in vivo administration of UA in rat MI model successfully up-regulated Nrf2 expression and improved the myocardial damage and fibrosis.

Conclusions

The study discovered the function and mechanism of UA on myocardial fibrosis and demonstrated the protective effects of UA administration through activation of Nrf2 pathway.
Primary case inference in viral outbreaks through analysis of intra-host variant population
Authors: Gussler J. Walker , Campo David S. , Dimitrova Zoya , Skums Pavel , Khudyakov Yury
Published: February 2022

Background

Investigation of outbreaks to identify the primary case is crucial for the interruption and prevention of transmission of infectious diseases. These individuals may have a higher risk of participating in near future transmission events when compared to the other patients in the outbreak, so directing more transmission prevention resources towards these individuals is a priority. Although the genetic characterization of intra-host viral populations can aid the identification of transmission clusters, it is not trivial to determine the directionality of transmissions during outbreaks, owing to complexity of viral evolution. Here, we present a new computational framework, PYCIVO: primary case inference in viral outbreaks. This framework expands upon our earlier work in development of QUENTIN, which builds a probabilistic disease transmission tree based on simulation of evolution of intra-host hepatitis C virus (HCV) variants between cases involved in direct transmission during an outbreak. PYCIVO improves upon QUENTIN by also adding a custom heterogeneity index and identifying the scenario when the primary case may have not been sampled.

Results

These approaches were validated using a set of 105 sequence samples from 11 distinct HCV transmission clusters identified during outbreak investigations, in which the primary case was epidemiologically verified. Both models can detect the correct primary case in 9 out of 11 transmission clusters (81.8%). However, while QUENTIN issues erroneous predictions on the remaining 2 transmission clusters, PYCIVO issues a null output for these clusters, giving it an effective prediction accuracy of 100%. To further evaluate accuracy of the inference, we created 10 modified transmission clusters in which the primary case had been removed. In this scenario, PYCIVO was able to correctly identify that there was no primary case in 8/10 (80%) of these modified clusters. This model was validated with HCV; however, this approach may be applicable to other microbial pathogens.

Conclusions

PYCIVO improves upon QUENTIN by also implementing a custom heterogeneity index which empowers PYCIVO to make the important ‘No primary case’ prediction. One or more samples, possibly including the primary case, may have not been sampled, and this designation is meant to account for these scenarios.
A survey of Methylobacterium species and strains reveals widespread production and varying profiles of cytokinin phytohormones
Authors: Palberg Daniel , Kisiała Anna , Jorge Gabriel Lemes , Emery R. J. Neil
Published: February 2022

Background

Symbiotic Methylobacterium strains comprise a significant part of plant microbiomes. Their presence enhances plant productivity and stress resistance, prompting classification of these strains as plant growth-promoting bacteria (PGPB). Methylobacteria can synthesize unusually high levels of plant hormones, called cytokinins (CKs), including the most active form, trans-Zeatin (tZ).

Results

This study provides a comprehensive inventory of 46 representatives of Methylobacterium genus with respect to phytohormone production in vitro, including 16 CK forms, abscisic acid (ABA) and indole-3-acetic acid (IAA). High performance-liquid chromatography—tandem mass spectrometry (HPLC–MS/MS) analyses revealed varying abilities of Methylobacterium strains to secrete phytohormones that ranged from 5.09 to 191.47 pmol mL−1 for total CKs, and 0.46 to 82.16 pmol mL−1 for tZ. Results indicate that reduced methanol availability, the sole carbon source for bacteria in the medium, stimulates CK secretion by Methylobacterium. Additionally, select strains were able to transform L-tryptophan into IAA while no ABA production was detected.

Conclusions

To better understand features of CKs in plants, this study uncovers CK profiles of Methylobacterium that are instrumental in microbe selection for effective biofertilizer formulations.
A novel algorithm-driven hybrid simulation learning method to improve acquisition of endotracheal intubation skills: a randomized controlled study
Authors: Mankute Aida , Juozapaviciene Laima , Stucinskas Justinas , Dambrauskas Zilvinas , Dobozinskas Paulius , Sinz Elizabeth , Rodgers David L. , Giedraitis Mantas , Vaitkaitis Dinas
Published: February 2022

Background

Simulation-based training is a clinical skill learning method that can replicate real-life situations in an interactive manner. In our study, we compared a novel hybrid learning method with conventional simulation learning in the teaching of endotracheal intubation.

Methods

One hundred medical students and residents were randomly divided into two groups and were taught endotracheal intubation. The first group of subjects (control group) studied in the conventional way via lectures and classic simulation-based training sessions. The second group (experimental group) used the hybrid learning method where the teaching process consisted of distance learning and small group peer-to-peer simulation training sessions with remote supervision by the instructors. After the teaching process, endotracheal intubation (ETI) procedures were performed on real patients under the supervision of an anesthesiologist in an operating theater. Each step of the procedure was evaluated by a standardized assessment form (checklist) for both groups.

Results

Thirty-four subjects constituted the control group and 43 were in the experimental group. The hybrid group (88%) showed significantly better ETI performance in the operating theater compared with the control group (52%). Further, all hybrid group subjects (100%) followed the correct sequence of actions, while in the control group only 32% followed proper sequencing.

Conclusions

We conclude that our novel algorithm-driven hybrid simulation learning method improves acquisition of endotracheal intubation with a high degree of acceptability and satisfaction by the learners’ as compared with classic simulation-based training.
Factors affecting the evolution of Chinese elderly depression: a cross-sectional study
Authors: Cui Longyan , Ding Ding , Chen Junfeng , Wang Minghui , He Fanrong , Yu Shiyang
Published: February 2022

Background

In the past decades, China’s rapid economic growth has been accompanied by rapid changes in lifestyle and an increasing prevalence of mental disorders. This study explored the changes and factors associated with depression among the elderly population of China from 2011 to 2018.

Method

Data were obtained from the China Health and Retirement Longitudinal Study. The total sample size consists of 21,484 individuals aged ≥60 years, and the sample sizes in 2011, 2013, 2015 and 2018 were 5081, 4853, 5207, 6343, respectively. Depressive symptoms were measured by the 10-item Short-Form developed by the Center for Epidemiological Studies Depression.

Result

We found that the tendency in depression rate of the Chinese elderly from 2011 (36.8%) to 2018 (44.5%). The results showed poor health (OR = 3.553), ADL damage (OR = 2.010), multiple chronic diseases (OR = 1.287), and western (OR = 1.777) are risk factors for depression.

Conclusion

The rate of depression of the elderly people in China has risen dramatically. Therefore, additional steps to prevent, treat and care for the affected population are needed, Mental health prevention and treatment strategies should be incorporated into China’s public health policies in a timely manner to mitigate the serious economic burden caused by the increase of depression.
Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis
Authors: Astawesegn Feleke Hailemichael , Stulz Virginia , Conroy Elizabeth , Mannan Haider
Published: February 2022

Background

Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019.

Methods

Country-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model.

Results

ART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = − 0.18, 95% CI − 0.19–− 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18–8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate.

Conclusions

ART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.
Magnetic resonance imaging evaluation of the correlation between calcific tendinitis and rotator cuff injury
Authors: Yu Xiao-Kun , Li Jian , Zhang Le , Li Lei , Li Jin-Xing , Guo Wen-Bin
Published: February 2022

Background

This study aims to evaluate the incidence of calcific tendinitis (CaT) in rotator cuff tears (RCTs) and to assess the correlation between CaT and RCTs with magnetic resonance imaging (MRI).

Methods

The MRI of 108 patients with rotator cuff CaT admitted to our hospital from January 2019 to January 2021 were retrospectively analyzed. Another retrospective analysis was made of 108 patients with similar age, gender, occupation, and shoulder injury side to those in the first group. The incidence of RCTs and their correlation with CaT were assessed based on an MRI of shoulder joints.

Results

There was a statistical difference (p < 0.05) in the incidence of RCTs between the CaT group (23.4%) and the control group (37.2%). No significant difference was observed in the size of the RCTs between the two groups (P = 0.422). In the CaT group, 17.4% of patients had complete tears, compared with 26.3% in the control group. There was no significant correlation between the calcification site and RCTs in the CaT group, and only 3.7% of patients suffered calcification and a tear in the exact location of the same tendon (P > 0.05, r = 0.03).

Conclusions

Compared with patients with shoulder pain without CaT, patients with rotator cuff CaT suffered no increased risk of RCTs on MRI, so CaT and RCTs may have different pathological causes, and there is no significant correlation between the two.
Potassium responses to sodium zirconium cyclosilicate in hyperkalemic hemodialysis patients: post-hoc analysis of DIALIZE
Authors: Fishbane Steven , Ford Martin , Fukagawa Masafumi , McCafferty Kieran , Rastogi Anjay , Spinowitz Bruce , Staroselskiy Konstantin , Vishnevskiy Konstantin , Lisovskaja Vera , Al-Shurbaji Ayman , Guzman Nicolas , Bhandari Sunil
Published: February 2022

Background

Sodium zirconium cyclosilicate (SZC) is an effective and well-tolerated treatment for hyperkalemia in maintenance hemodialysis patients. In post-hoc analyses of the phase 3b DIALIZE study, we examined the spectrum of potassium responses to SZC.

Methods

Post-hoc analyses with SZC and placebo included: the number of long interdialytic interval (LIDI) visits during the 4-week evaluation period where patients attained pre-dialysis serum potassium (sK+) concentrations of 4.0–5.0 and 4.0–5.5 mmol/L; potassium gradient (the difference between pre-dialysis sK+ and dialysate potassium) at days 36, 43, 50, and 57, and change from baseline to the end of treatment (EOT) using categories of potassium gradient (1 to < 2, 2 to < 3, 3 to < 4, and ≥ 4 mmol/L).

Results

A greater proportion of patients achieved the ranges of pre-dialysis sK+ concentration with SZC versus placebo for ≥1, ≥ 2, ≥ 3, and 4 LIDI visits over 4 weeks; 23.7 and 48.5% of patients in the SZC group achieved pre-dialysis sK+ concentrations of 4.0–5.0 and 4.0–5.5 mmol/L, respectively, at all 4 LIDI visits. Baseline mean potassium gradient was similar with SZC and placebo. At day 57, mean (standard deviation) potassium gradient was 2.78 (0.08) mmol/L with SZC and 3.52 (0.08) mmol/L with placebo; mean difference (95% confidence interval) was − 0.74 mmol/L (− 0.97 to − 0.52). A greater reduction in potassium gradient category from baseline towards lower-risk categories at EOT was observed with SZC versus placebo.

Conclusions

These analyses expand our knowledge of the spectrum of potassium responses with SZC in hyperkalemic hemodialysis patients.

Trial registration

NCT03303521.
Correction to: Gambling-related suicide in East African Community countries: evidence from press media reports
Authors: Kaggwa Mark Mohan , Mamun Mohammed A. , Najjuka Sarah Maria , Muwanguzi Moses , Kule Moses , Nkola Rahel , Favina Alain , Kihumuro Raymond Bernard , Munaru Gideon , Arinaitwe Innocent , Rukundo Godfrey Zari , Griffiths Mark D.
Published: February 2022

An amendment to this paper has been published and can be accessed via the original article.
Clinical features and long-term prognosis of acute fibrinous and organizing pneumonia histologically confirmed by surgical lung biopsy
Authors: Kim Min Chul , Kim Yeon Wook , Kwon Byoung-Soo , Kim Junghoon , Lee Yeon Joo , Cho Young-Jae , Yoon Ho Il , Chung Jin-Haeng , Lee Jae Ho , Lee Choon-Taek , Park Jong Sun
Published: February 2022

Background

Acute fibrinous and organizing pneumonia (AFOP) is a rare interstitial pneumonia characterized by intra-alveolar fibrin deposition and organizing pneumonia. The clinical manifestations and long-term prognosis of AFOP are unclear. Our objective was to investigate the clinical features and prognosis of AFOP.

Methods

We identified patients diagnosed with AFOP by surgical lung biopsy between January 2011 and May 2018 at Seoul National University Bundang Hospital. We retrospectively reviewed clinical and radiologic findings, treatment, and outcomes of AFOP.

Results

Fifteen patients with histologically confirmed lung biopsies were included. The median follow-up duration was 2.4 (range, 0.1–82) months. The median age was 55 (range, 33–75) years, and four patients were immunocompromised. Fever was the most common clinical presentation (86.7%). Patchy ground-glass opacities and/or consolidations were the most predominant findings on chest computed tomography images. Nine patients (60%) received mechanical ventilator care, and eight patients (53.3%) died. The non-survivors tended to have slightly higher body mass index (BMI) and a long interval between symptom onset and diagnosis than the survivors, but these findings were not statistically significant. Among seven survivors, five patients were discharged without dyspnea and oxygen supplement.

Conclusions

The clinical course of AFOP was variable. Although AFOP was fatal, most of the patients who recovered from AFOP maintained normal life without supplemental oxygen therapy and respiratory symptoms.
A comparative study of 21,194 UKAs and 49,270 HTOs for the risk of unanticipated events in mid-age patients from the national claims data in South Korea
Authors: Lee Sun-Ho , Kim Hae-Rim , Seo Hyoung-Yeon , Seon Jong-Keun
Published: February 2022

Background

Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients.

Methods

We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI).

Results

Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO.

Conclusions

It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.
Prevalence of early childhood caries in South Africa: a systematic review
Authors: Kimmie-Dhansay Faheema , Barrie Robert , Naidoo Sudeshni , Roberts Tina
Published: February 2022

Background

The prevalence of Early Childhood Caries (ECC) in South Africa was last determined in 2002 in a national survey. Since then only few scattered studies were conducted across pocketed communities in the country. There appears to be an increasing trend in dental caries prevalence in South Africa. Since South Africa has one of the highest burden of HIV in the world, less focus was spent on Non-Communicable Diseases (NCDs), it was only when HIV patients developed NCD’s did the government start evaluating NCDs. However, oral health is still not given enough attention within the health sphere. It is the hope of this systematic review to showcase the extent of dental caries amongst the future leaders of our country.

Objectives

The systematic review presents the prevalence and severity of early childhood caries between age groups and provinces in South Africa from 1975 to 2014.

Design

A systematic review of prevalence was performed. Settings and participants: All studies performed on children under the age of six who lived in South Africa were eligible to be included.

Primary and Secondary outcome measures

The prevalence of ECC and the dmft scores were the primary and secondary outcome measures.

Results

Twenty-one studies were included in the present review. The overall prevalence was 44.94% (95% confidence interval (C.I.) 39.73–50.15%) and the overall dmft score was 2.422 (95% C.I. 2.148–2.696).

Conclusions

The dmft score was the lowest in the Limpopo Province and highest in the Eastern Cape. ECC prevalence increased post-apartheid possibly on account of lifestyle changes due to the exodus from rural to urban and peri-urban areas.

Registration The protocol of this systematic review was registered with PROSPERO, CRD42018112161, in November 2018.
Drivers of iPad use by undergraduate medical students: the Technology Acceptance Model perspective
Authors: Do Doan Hoa , Lakhal Sawsen , Bernier Mikaël , Bisson Jasmine , Bergeron Linda , St-Onge Christina
Published: February 2022

Background

Medical students need to acquire a continuously growing body of knowledge during their training and throughout their practice. Medical training programs should aim to provide students with the skills to manage this knowledge. Mobile technology, for example, could be a strategy used through training and practice. The objective of this study was to identify drivers of using mobile technology (an iPad) in a UGME preclinical settings and to study the evolution of those drivers over time.

Methods

We solicited all students from two cohorts of a preclinical component of a Canadian UGME program. They were asked to answer two online surveys: one on their first year of study and another on the second year. Surveys were built based on the Technology Acceptance Model (TAM) to which other factors were also added. Data from the two cohorts were combined and analysed with partial least squares structural equation modelling (PLS-SEM) to test two measurement models, one for each year.

Results

We tested fifteen hypotheses on both data sets (first year and second year). Factors that explained the use of an iPad the first year were knowledge, preferences, perceived usefulness and anticipation. In the second year, perceived usefulness, knowledge and satisfaction explained the use of an iPad. Other factors have also significantly, but indirectly influenced the use of the iPad.

Conclusions

We identified factors that influenced the use of an iPad in a preclinical medical program. These factors differed from the first year to the second year in the program. Our results suggest that interventions should be tailored for different point in time to foster the use of an iPad. Further study should investigate how interventions based on these factors may influence implementation of mobile technology to help students acquire ability to navigate efficiently through medical knowledge.
Identifying service quality gaps between patients and providers in a Native American outpatient clinic
Authors: Dorsey Robert , Claudio David , Velázquez María A. , Petersen Polly
Published: February 2022

Background

Native American communities in Montana reservations have reported low-level satisfaction in health services. This research explored if the services provided at a Blackfeet Indian Reservation outpatient clinic were designed to meet patient expectations.

Methods

Staff and patient interviews and surveys allowed service expectations to be assessed according to the clinic’s ability to meet those expectations. A total of 48 patients and ten staff members (83% of the staff at this clinic) participated in the study voluntarily.

Results

We found a disconnect between what patients anticipate for care and what staff think they are anticipating. We also found a discontent between what staff believes patients need versus what the patients feel is needed.

Conclusions

These gaps combine to increase the breach between patient expectations and perceptions of their healthcare services. With better insight that captures what patients are looking for from a service, the potential to meet those needs increases, and patients feel that their voice is respected and valued.
Estimates of inpatient admission rates and associated costs for infants before and after China’s universal two-child policy
Authors: Shen Menghan , Liang Xiaoxia , Wu Yushan , Fang Shixin
Published: February 2022

Background

China implemented a universal two-child policy in 2015. It is important to understand infants’ medical utilization in the context of this policy to inform health policies and resource allocation.

Methods

This study utilized a 20% random sample of administrative data from China’s Urban and Rural Basic Medical Insurance (URBMI) in one of the largest southern Chinese cities from January 2015 to June 2018. Ordinary least squares models were used to estimate changes in inpatient admission rates and costs for infants between 0 and 6 months old after the implementation of China’s universal two-child policy.

Results

The overall inpatient admission rate was 27.2% in 2015 and 31.3% in 2017. Compared with 2015, there was an increase in inpatient admission rates for infants 1 month old or younger (coef = 0.038, 95% CI = 0.029 to 0.047, p < .001) and infants 6 months old or younger (coef = 0.041, 95% CI = 0.030 to 0.052, p < .001) in 2017. The increase was larger for male infants than for female ones. The average inpatient admission cost was 8412.3 RMB ($1320.61) (SD = 15,088.2). There was no increase in inpatient admission costs overall. The average length of hospital stay was 7.3 days, the probability of going to a tertiary hospital was 76.2%, and the share of out-of-pocket costs was 53.0% for all diseases.

Conclusion

After the implementation of the universal two-child policy in China, there was a significant increase in inpatient admission rates, especially for male infants. The overall associated costs did not change, but the increase in admission rates caused additional economic burdens for families and for social health insurance. Understanding the healthcare utilization of infants in the universal two-child period can provide insight for healthcare resource allocation in a time of dramatic changes in population policy.
DHA alleviates diet-induced skeletal muscle fiber remodeling via FTO/m6A/DDIT4/PGC1α signaling
Authors: Chen Wei , Chen Yushi , Wu Ruifan , Guo Guanqun , Liu Youhua , Zeng Botao , Liao Xing , Wang Yizhen , Wang Xinxia
Published: February 2022

Background

Obesity leads to a decline in the exercise capacity of skeletal muscle, thereby reducing mobility and promoting obesity-associated health risks. Dietary intervention has been shown to be an important measure to regulate skeletal muscle function, and previous studies have demonstrated the beneficial effects of docosahexaenoic acid (DHA; 22:6 ω-3) on skeletal muscle function. At the molecular level, DHA and its metabolites were shown to be extensively involved in regulating epigenetic modifications, including DNA methylation, histone modifications, and small non-coding microRNAs. However, whether and how epigenetic modification of mRNA such as N6-methyladenosine (m6A) mediates DHA regulation of skeletal muscle function remains unknown. Here, we analyze the regulatory effect of DHA on skeletal muscle function and explore the involvement of m6A mRNA modifications in mediating such regulation.

Results

DHA supplement prevented HFD-induced decline in exercise capacity and conversion of muscle fiber types from slow to fast in mice. DHA-treated myoblasts display increased mitochondrial biogenesis, while slow muscle fiber formation was promoted through DHA-induced expression of PGC1α. Further analysis of the associated molecular mechanism revealed that DHA enhanced expression of the fat mass and obesity-associated gene (FTO), leading to reduced m6A levels of DNA damage-induced transcript 4 (Ddit4). Ddit4 mRNA with lower m6A marks could not be recognized and bound by the cytoplasmic m6A reader YTH domain family 2 (YTHDF2), thereby blocking the decay of Ddit4 mRNA. Accumulated Ddit4 mRNA levels accelerated its protein translation, and the consequential increased DDIT4 protein abundance promoted the expression of PGC1α, which finally elevated mitochondria biogenesis and slow muscle fiber formation.

Conclusions

DHA promotes mitochondrial biogenesis and skeletal muscle fiber remodeling via FTO/m6A/DDIT4/PGC1α signaling, protecting against obesity-induced decline in skeletal muscle function.
Effect of ACE, ACE2 and CYP11B2 gene polymorphisms and noise on essential hypertension among steelworkers in China: a case–control study
Authors: Zhang Xiaohong , Wang Ying , Zheng Yao , Yuan Juxiang , Tong Junwang , Xu Jingya , Li Qinglin , Li Peishuai , Jiang Shoufang , Wang Zhaoyang , Chai Feng , Li Xiangwen
Published: February 2022

Background

Previous studies on the relationship between ACE I/D, ACE2 G8790A and CYP11B2-344T/C gene polymorphisms and essential hypertension (EH) were inconsistent. Moreover, few studies have reported the combined effect of these gene polymorphisms and noise exposure on EH. The purpose of this study was to explore the combined and separate effects of ACE I/D, ACE2 G8790A and CYP11B2-344T/C gene polymorphisms and noise on EH among steelworkers.

Methods

A case–control study was conducted on 725 male workers between March 2014 and July 2014 in the Tangsteel Company, China. The noise exposure of the workers were measured. Logistic regression and crossover analysis were used to analyse the effects of the interactions on the EH among steelworkers. GMDR was used to determine the best combination model of gene–noise interactions.

Results

Multivariate logistic regression showed that noise exposure increased the odds of EH, and the OR is 1.52 (95% CI 1.04–2.22). The risk of having EH for ACE I/D DD genotype carriers was 1.99 times that for II genotype carriers (95% CI 1.14–3.51). There was a negative additive interaction between ACE2 G8790A and CYP11B2-344T/C on EH (U3 =  − 2.221, P = 0.026, and S = 0.128) and a positive multiplicative interaction between ACE I/D and CYP11B2-344T/C on essential hypertension (P = 0.041). In addition, there was no significant gene–noise interaction model through the GMDR method after adjusting the confounders.

Conclusions

The ACE DD genotype may make men susceptible to EH. Simultaneously carrying the DD genotype of ACE I/D and the TC genotype of CYP11B2-344T/C increased the risk of EH.
Equity, justice, and social values in priority setting: a qualitative study of resource allocation criteria for global donor organizations working in low-income countries
Authors: Kapiriri Lydia , Razavi S. Donya
Published: February 2022

Background

There is increasing acceptance of the importance of social values such as equity and fairness in health care priority setting (PS). However, equity is difficult to define: the term means different things to different people, and the ways it is understood in theory often may not align with how it is operationalized. There is limited literature on how development assistance partner organizations (DAP) conceptualize and operationalize equity in their health care prioritization decisions that affect low-income countries (LIC). This paper explores whether and how equity is a consideration in DAP priority setting processes.

Methods

This was a qualitative study involving 38 in-depth interviews with DAPs involved in health-system PS for LICs and a review of their respective webpages.

Results

While several PS criteria were identified, direct articulation of equity as an explicit criterion was lacking. However, the criterion was implied in some of the responses in terms of prioritizing vulnerable populations. Where mentioned, respondents discussed the difficulties of operationalizing equity as a PS criterion since vulnerability is associated with several varying and competing factors including gender, age, geography, and income. Some respondents also suggested that equity could be operationalized in terms of an organization not supporting the pre-existing inequities.

Although several organizations’ webpages identify addressing inequities as a guiding principle, there were variations in how they spoke about its operationalization. While intersectionalities in vulnerabilities complicate its operationalization, if organizations explicitly articulate their equity focus the other organizations who also have equity as a guiding principle may, instead of focusing on the same aspect, concentrate on other dimensions of vulnerability. That way, all organizations will contribute to achieving equity in all the relevant dimensions.

Conclusions

Since most development organizations support some form of equity, this paper highlights a need for an internationally recognized framework that recognizes the intersectionalities of vulnerability, for mainstreaming and operationalizing equity in DAP priority setting and resource allocation. Such a framework will support consistency in the conceptualization of and operationalization of equity in global health programs. There is a need for studies which to assess the degree to which equity is actually integrated in these programs.
A simple immunoassay for extracellular vesicle liquid biopsy in microliters of non-processed plasma
Authors: Campos-Silva Carmen , Cáceres-Martell Yaiza , Sánchez-Herrero Estela , Sandúa Amaia , Beneitez-Martínez Alexandra , González Álvaro , Provencio Mariano , Romero Atocha , Jara-Acevedo Ricardo , Yáñez-Mó María , Valés‐Gómez Mar
Published: February 2022

Background

Extracellular vesicles (EVs), released by most cell types, provide an excellent source of biomarkers in biological fluids. However, in order to perform validation studies and screenings of patient samples, it is still necessary to develop general techniques permitting rapid handling of small amounts of biological samples from large numbers of donors.

Results

Here we describe a method that, using just a few microliters of patient’s plasma, identifies tumour markers exposed on EVs. Studying physico-chemical properties of EVs in solution, we demonstrate that they behave as stable colloidal suspensions and therefore, in immunocapture assays, many of them are unable to interact with a stationary functionalised surface. Using flocculation methods, like those used to destabilize colloids, we demonstrate that cationic polymers increase EV ζ-potential, diameter, and sedimentation coefficient and thus, allow a more efficient capture on antibody-coated surfaces by both ELISA and bead-assisted flow cytometry. These findings led to optimization of a protocol in microtiter plates allowing effective immunocapture of EVs, directly in plasma without previous ultracentrifugation or other EV enrichment. The method, easily adaptable to any laboratory, has been validated using plasma from lung cancer patients in which the epithelial cell marker EpCAM has been detected on EVs.

Conclusions

This optimized high throughput, easy to automate, technology allows screening of large numbers of patients to phenotype tumour markers in circulating EVs, breaking barriers for the validation of proposed EV biomarkers and the discovery of new ones.

Graphical Abstract
Transmembrane p24 trafficking protein 2 regulates inflammation through the TLR4/NF-κB signaling pathway in lung adenocarcinoma
Authors: Feng Longhua , Cheng Pengjiang , Feng Zhengyun , Zhang Xiaoyu
Published: February 2022

Background

To investigate the role of transmembrane p24 trafficking protein 2 (TMED2) in lung adenocarcinoma (LUAD) and determine whether TMED2 knockdown could inhibit LUAD in vitro and in vivo.

Methods

TIMER2.0, Kaplan-Meier plotter, gene set enrichment analysis (GSEA), Target Gene, and pan-cancer systems were used to predict the potential function of TMED2. Western blotting and immunohistochemistry were performed to analyze TMED2 expression in different tissues or cell lines. The proliferation, development, and apoptosis of LUAD were observed using a lentivirus-mediated TMED2 knockdown. Bioinformatics and western blot analysis of TMED2 against inflammation via the TLR4/NF-κB signaling pathway were conducted.

Results

TMED2 expression in LUAD tumor tissues was higher than that in normal tissues and positively correlated with poor survival in lung cancer and negatively correlated with apoptosis in LUAD. The expression of TMED2 was higher in tumors or HCC827 cells. TMED2 knockdown inhibited LUAD development in vitro and in vivo and increased the levels of inflammatory factors via the TLR4/NF-κB signaling pathway. TMED2 was correlated with TME, immune score, TME-associated immune cells, their target markers, and some mechanisms and pathways, as determined using the TIMER2.0, GO, and KEGG assays.

Conclusions

TMED2 may regulate inflammation in LUAD through the TLR4/NF-κB signaling pathway and enhance the proliferation, development, and prognosis of LUAD by regulating inflammation, which provide a new strategy for treating LUAD by regulating inflammation.