bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence of an Increased Prevalence of Multiple Sclerosis: A Population-Based Study of Tehran Registry during 1999–2018
Authors: Almasi-Hashiani Amir , Sahraian Mohammad Ali , Eskandarieh Sharareh
Published: April 2020

Background: The epidemiological characteristics of multiple sclerosis (MS) have been investigated in various studies, which have revealed that the prevalence of MS varies across countries. The present study was conducted to investigate the longitudinal prevalence of MS in Tehran, Iran. Methods: The present population-based study was conducted in Tehran, the capital of Iran from 1999 to 2018 based on the annual report data provided by the Iranian MS Society (IMSS) registry system. The age-standardized and crude prevalence were estimated using population data presented by the Statistical Centre of Iran. Results: A total of 21,580 MS cases were registered and included in the analysis. Among the participant patients, 24.99% (5,393) and 75.01% (16,187) of cases were male and female, respectively. The mean age of MS onset was 28.8 years (S.D: 8.7). The age-standardized prevalence (ASP) of MS increased from 73.7 (95%CI: 72.1-75.2) per 100,000 people in 2006 to 137.6 (95% CI: 135.7-139.5) per 100,000 people in 2018. The ASP of MS in 2018 was estimated to be 67.9 (95%CI: 66.0-69.8) and 207.3 (95%CI: 204.0-210.7) per 100,000 people among males and females, respectively. The age-standardized female-to-male ratio of MS ranged from 3.7 (in 2010) to 2.06 (in 2017). Conclusion: The findings of this study suggested that the prevalence of MS in Tehran province is relatively high, and the occurrence of the disease is more common in the age groups under 40 years as compared with older-aged groups. In line with reports provided for various regions of the world, the prevalence of MS was higher among women. Similarly, the findings of this study revealed that the female-to-male ratio was 2.14 in 2018.
Immediate Effects of Urgent Reorganisation of Emergency Department-Based Treatment Pathway in Nonperforated Appendicitis: A Retrospective Study
Authors: Ojakäär Artur , Purdy Martin , Kechagias Aristotelis , Järvelin Ulla , Palomäki Ari
Published: April 2020

Background Acute appendicitis is a global disease and a very common indication for emergency surgery worldwide. The need for hospital resources is therefore constantly high. The administration in Kanta-Häme Central Hospital, Southern Finland, called for an urgent reorganisation due to shortage of hospital beds at the department of general surgery. According to it, postoperative treatment pathway of patients with nonperforated acute appendicitis was ordered to take place in the Emergency Department (ED). The aim of this study was to assess whether this reorganisation affected the length of in-hospital stay (LOS) and the 30-day complication rate.Methods This is a retrospective pre- and post-intervention analysis. After the reorganisation, most patients with nonperforated appendicitis were followed postoperatively at the 24-hour observation unit of the ED instead of surgical ward. Patients operated during the first three months after the reorganisation were compared to those operated during the three months before it. A case met inclusion criteria if there were no signs of appendiceal perforation during surgery. Exclusion criteria comprised age <18 years and perforated disease. Results During the study period, appendicectomy was performed on 112 patients, of whom 62 were adults with nonperforated appendicitis. Twenty-seven of the included patients were treated before the reorganisation, and 35 after it. Twenty of the latter were followed only at the ED. Postoperative LOS decreased significantly after the reorganisation. Median postoperative time till discharge was 15.7 hours for all patients after the reorganisation compared to 24.4 hours before the reorganisation (standard error 6.2 hours, 95% confidence interval 2.3–15.2 hours, p < 0.01). There were no more complications in the group treated postoperatively in the ED. Conclusions Early discharge of patients with nonperforated appendicitis after enforced urgent reorganisation of the treatment pathway in the ED observation unit is safe and feasible. Shifting the postoperative monitoring and the discharge policy of such patients to the ED – instead of the surgical ward – occurred in the majority of the cases after the reorganisation. This change may spare resources as in our series it resulted in a significantly shorter LOS without any increase in the 30-day complication rate.
Feasibility investigation of uniportal video-assisted thoracoscopic anatomical lung resection for pulmonary sequestration
Authors: Sun Yungang , Shao Feng , Zhang Qiang , Wang Zhao
Published: April 2020

Background Uniportal video-assisted thoracic surgery (UVATS) technique has been increasingly used for many thoracic diseases. Whether UVATS has equivalent or better perioperative outcomes for pulmonary sequestration (PS) patients remains controversial. Our study aimed to evaluate the feasibility of UVATS in anatomical lung resection for pulmonary sequestration. Methods A total of 24 patients with PS including fifteen males and nine females with the mean age of 40 (rang, 18-65) years old, who had received completely UVATS anatomical lung resection for PS in Nanjing Chest Hospital between January 2016 and December 2018 were retrospectively reviewed. Related clinical data were retrieved from hospital records and analyzed. Results All 24 patients had been treated with the UAVTS approach successfully without aberrant artery ruptured or massive hemorrhage, and no patients died during the perioperative period. Overall median surgery time was 102 mins (range, 55-150mins), the mean blood loss was 94 ml (range, 10-300ml), the mean days of chest tube maintained were 4 days (range,1-10days), and the mean postoperative hospitalization days was 6 days (range,2-11days). All patients were cured, without cough, fever, hemoptysis, and so on, associated with PS, occurring during the average follow-up of 17 months (range, 3-35months). Conclusions Our preliminary results revealed that anatomical lung resection by UVATS is a safe and feasible mini-invasive technique for PS patients, which might be associated with less postoperative pain, reduced paresthesia, better cosmetic results, and faster recovery.
Validation of the Psychometric Properties of the Malay Advance Care Planning Questionnaire
Authors: Lim Mun Kit , Lai Pauline Siew Mei , Wong Pei Se , Othman Sajaratulnisah , Mydin Fadzilah Hanum Mohd
Published: April 2020

Background There is a growing interest among the developing countries on advance care planning (ACP) due to the reported benefits of planning ahead in the developed countries. Validated instruments in various languages have been developed to facilitate study on the views of public prior to its implementation. However, instrument to explore the views on advance care planning (ACP) in Malay has not been developed and validated yet, even though Malay is spoken extensively by approximately 220 million people in the Malay Archipelago. There is also a need for instrument in Malay language to facilitate the assessment of knowledge, attitude and practice (KAP) of Malaysians regarding advance care planning (ACP). Therefore, the aim of this study was to validate the psychometric properties of the Malay Advance Care Planning Questionnaire (ACPQ-M) to assess the knowledge, attitude and practice of Malaysians regarding advance care planning Methods The ACPQ was translated according to international guidelines. This validation study was conducted from January to June 2018. Participants who were ≥21 years old, and able to understand Malay were recruited from an urban primary care clinic and a tertiary education institution in Malaysia. A researcher administered the ACPQ-M to participants via a face-to-face interview at baseline and two weeks later. Each interview took approximately 15-20 minutes. Results A total of 222/232 participants agreed to participate (response rate=96.0%). Exploratory factor analysis and confirmatory factor analysis found that the ACPQ-M was a 4-factor model. The Cronbach’s α values for the four domains ranged from 0.674-0.947. Only 157/222 participants completed the test-retest (response rate=71%). At test-retest, quadratic weighted kappa values for all domains ranged from 0.340-0.674, except for two domains which ranged from -0.200-0.467. Conclusions The ACPQ-M was found to be a 4-factor model, and a valid and reliable instrument to assess the KAP regarding ACP. This instrument can contribute to profound understanding of the KAP of Malaysians regarding ACP, and assist policy makers in determining the readiness for legislation of ACP in Malaysia.
Circular RNAs Serve as Prognostic, Diagnostic and Clinicopathological Markers in Lung Cancer: An Updated Systematic Review and Meta-Analysis
Authors: Liang Zhuozheng , Chen Cui , Guo Cheng , Meng Ping , Zou Manman , Zhang Liyi , Liu Hui , Zhang Tiantuo
Published: April 2020

Background: In recent years, the roles of circular RNAs (circRNAs) in the biogenesis and clinical application have gradually garnered much interest in the field of cancer research. However, high-quality studies evaluating the roles of circRNAs in clinicopathological features and clinical application of lung cancer are still unrevealed. Herein, we aimed to elucidate the functions of circRNAs in the association with clinicopathology, diagnosis and prognosis in lung cancer. Methods: Comprehensive and reasonable search strategies were used in four databases up to Nov. 24th, 2019. The odds ratio (OR) was used to analyze the risks of circRNAs in lung cancer. Sensitivity (Sen), specificity (Spe) and area under curve (AUC) were used to assess the diagnostic value. What’s more, the hazard ratio (HR) was used for the analysis of survival outcomes. A fixed-effect model was firstly used in data analysis. If I2 >50% in heterogeneity, the random-effect model was chosen. Results: A total of 50 studies with 3815 samples were incorporated into our meta-analysis, in which 40 focused on clinical characteristics, 10 related to diagnosis and 31 were aimed at prognosis. In terms of clinical characteristics, both OR and 95% confidence interval (95%CI) were shown that circRNAs were significantly associated with TNM, tumor differentiation, lymph node metastasis, distal metastasis and tumor size in lung cancer. For diagnosis, both upregulated and downregulated circRNAs distinguished patients with lung cancer from healthy people with pooled Sen, Spe and AUC, of which the values were 0.78, 0.76 and 0.81 respectively. In the section of prognosis, circRNAs can better predict the survival time of patients with lung cancer (overall survival, OS: HR=0.46, 95%Cl: 0.33–0.65 in downregulated circRNAs; HR=2.23, 95%CI: 1.97-2.53 in upregulated circRNAs). Conclusions: The results presented here suggested that circRNAs were the potential cancer biomarkers in clinicopathology, diagnosis and prognosis of lung cancer patients, which deserve further application in clinical practice.
Building Towards Common Psychosocial Measures in U.S. Cohort Studies: Principal Investigators’ Views Regarding the Role of Religiosity and Spirituality in Human Health
Authors: Shields Alexandra E. , Balboni Tracy
Published: April 2020

Background. The goal of this study was to understand prospective cohort Principal Investigators’ (PIs’) attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research. Methods. One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation. Results. The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of R/S. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates; (2) studies that posit a plausible biological mechanism; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research; and (5) NIH funding for R/S research. Conclusions. Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide a new leverage points for reducing health disparities.
Substances use and its association with sociodemographic, family and environment-related factors among technical and vocational education and training College students in Ataye, Ethiopia, 2019.
Authors: Wubetu Abate Dargie , Getachew Sintayehu , Negash Wassie
Published: April 2020

Background: Legal substances use is prevalent in Ethiopia. Substance use can have several health problems that are potentially harmful in educational performance, social issues, psychological and physical wellbeing. This study aimed to know prevalence of lifetime and last month substances use and its associated factors among technical and vocational education and training College students in Ataye town. Methods: an institution based cross-sectional study conducted from 1 March to last May 2019. Participants selected by using simple random sampling technique. Chi-square with its p-value used to identify correlates for each legal/illegal substance use. Bivariate and multivariate binary logistic regression analysis performed to identify associated factors. Backward logistic regression method used. Odds ratio with their 95% confidence interval, and p value less than 0.05 used to declare the statistical significance of associated factors. Results: Four hundred eighty three individuals participated in the study, which was a response rate of 94%. The prevalence of lifetime legal substances use was 32.5% (95% CI: 28.2, 36.5). The prevalence of last month's legal substances use was 21.9% (95% CI= 18.2, 25.5). Among lifetime legal substance users, the majority (25.5%) chewed khat. The others, (19.5%) drunk alcohol, and, 15.3% smoked cigarette. Cannabis and cocaine users were 2.5%, and 7.2% respectively. Among last month's legal substance users, (21.9%) chewed khat followed by alcohol drinking (16.6%), and cigarette smoking (15.3%). In the last month, 1.2% and 3.3% of students used cannabis and cocaine respectively. Multivariate logistic regression showed that, being male, having divorced family, living greater than twenty years in the town, having substance user family member, having intimate friend substance user, and easily availability of substances were independent predictors of lifetime legal substances use. Conclusions: The prevalence of last month and lifetime legal substance use at Ataye technical and vocational education and training (TVET) College students were analogous with most studies done in Ethiopia. Cannabis and cocaine are illegal drugs in Ethiopia. Nevertheless, the reported proportion of these illegal drug uses informs us there may not be under reporting of legal substances use. It is advisable if furthers emphasis is given for TVET students with the predictor variables.
The geno-spatio analysis of Mycobacterium tuberculosis complex in hot and cold spots of Guangxi, China
Authors: Lin Dingwen , Cui Zhezhe , Virasakdi Virasakdi , Palittapongarnpim Prasit , Chaiprasert Angkana , Ruangchai Wuthiwat , Ou Jing , Huang Liwen
Published: April 2020

Background At present, there are few studies on polymorphism of Mycobacterium tuberculosis (Mtb) gene and how it affects the TB epidemic. This study aimed to document the differences of polymorphisms between tuberculosis hot and cold spot areas of Guangxi Zhuang Autonomous Region, China. Methods The cold and hot spot areas, each with 3 counties, had been pre-identified by TB incidence for 5 years from the surveillance database. Whole genome sequencing analysis was performed on all sputum Mtb isolates from the detected cases during January and June 2018. Single nucleotide polymorphism (SNP) of each isolate compared to the H37Rv strain were called and used for lineage and sub-lineage identification. Pairwise SNP differences between every pair of isolates were computed. Analyses of Molecular Variance (AMOVA) across counties of the same hot or cold spot area and between the two areas were performed. Results As a whole, 59.8% (57.7% sub-lineage 2.2 and 2.1% sub-lineage 2.1) and 39.8% (17.8% sub-lineage 4.4, 6.5% sub-lineage 4.2 and 15.5% sub-lineage 4.5) of the Mtb strains were Lineage 2 and Lineage 4 respectively. The percentages of sub-lineage 2.2 (Beijing family strains) are significantly higher in hot spots. Through the MDS dimension reduction, the genomic population structure in the three hot spot counties is significantly different from those three cold spot counties (T-test p = 0.05). The median of SNPs distances among Mtb isolates in cold spots was greater than that in hot spots (897 vs 746, Rank-sum test p < 0.001). Three genomic clusters, each with genomic distance ≤ 12 SNPs, were identified with 2, 3 and 4 consanguineous strains. Two clusters were from hot spots and one was from cold spots. Conclusion Narrower genotype diversity in the hot area may indicate higher transmissibility of the Mtb strains in the area compared to those in the cold spot area.
Risk factors for esophagitis after hypofractionated palliative (chemo)radiotherapy for non-small cell lung cancer
Authors: Nieder Carsten , Imingen Kristian S. , Mannsåker Bård , Yobuta Rosalba , Haukland Ellinor
Published: April 2020

Introduction: Esophagitis influences quality of life and might cause treatment interruption and hospitalization. Previous studies of risk factors focused on curative treatment for non-small cell lung cancer (NSCLC), which often involves concomitant chemoradiation (CRT). Given the uncertainty around extrapolation of dose constraints, we analyzed risk factors in patients treated with hypofractionated palliative regimens. Patients and Methods: A retrospective review of 106 patients treated with palliative radiotherapy or CRT between 2009 and 2017 was performed. Inclusion criteria: prescribed total dose 30-54 Gy, dose per fraction 2.5-4 Gy, esophageal dose >1 Gy. Uni- and multivariate analyses were performed in 97 eligible patients to identify predictive factors for acute esophagitis grade ≥1 (CTCAE 5.0). Results: Forty percent of patients were treated with 15 fractions of 2.8 Gy (42 Gy) and 28% also received chemotherapy according to the CONRAD study regimen (induction and concomitant Carboplatin/Vinorelbine) published by the Norwegian Lung Cancer Group. Thirty-four percent were treated with 10 fractions of 3 Gy. Stage IV NSCLC was present in 47%. Esophagus Dmax was 39 Gy (population median) and Dmean 15 Gy. Overall 31% of patients developed esophagitis (26% grade 2-3, no grade 4-5). Several dosimetric parameters correlated with the risk of esophagitis (Dmax, Dmean, D5cc, V20, V30, V35, V40). Dmax outperformed other dosimetric variables in multivariate analysis. Furthermore, concomitant chemotherapy significantly increased the risk of esophagitis, while oral steroid medication reduced it. In patients with Dmax ≥40 Gy a reduced Dmean (≤20 Gy) was beneficial.Conclusion: In order to reduce esophagitis after hypofractionated palliative treatment lower doses than those recommended in curative NSCLC settings are preferable. Besides esophageal dose, CRT is the main risk factor for esophagitis. Additional work is needed to confirm that steroids are able to modify the risk (or to rule out confounding effects of baseline variables not included in our database).
Highly variable chloroplast genome from two endangered Papaveraceae lithophytes Corydalis saxicola and C. tomentella
Authors: Ren fengming , Wang Liqiang , Li Ying , Zhuo Wei , Xu Zhichao , Guo Haojie , Liu Yan , Gao Ranran , Song Jingyuan
Published: April 2020

Backgroud: Corydalis DC., the largest genus of Papaveraceae, is recognized as one of the most taxonomically challenging plant taxa. However, no complete chloroplast (cp) genome for this genus has been reported to date. Results: We sequenced four complete cp genomes of two affinities Corydalis saxicola and C. tomentellav of the genus Corydalis, compared these cp genomes with each other and others from Papaveraceae, and analyzed the phylogenetic relationships based on the sequences of common CDS. The cp genomes are 189,029 to 190,247 bp in length, possessing a quadripartite structure and with two highly expanded inverted repeat (IR) regions (length: 41,955 to 42,350 bp). Comparison between the cp genomes of C. tomentella, C. saxicola and Papaveraceae species revealed high variability in genome sizes, genome structures, gene content, and gene arrangements. Five NADH dehydrogenase-like genes with psaC, rpl32, ccsA and trnL-UAG normally located in the SSC region have migrated to IRs resulting in IR expansion and gene duplication. An up to 9 kb inversion involving five genes (rpl23, ycf2, ycf15, trnI-CAU and trnL-CAA) was found within IR regions. In addition, the accD gene was found to be absent. The ycf1 gene has shifted from the IR/SSC border to the SSC region as a single copy. Phylogenetic analysis showed that genus Corydalis is quite distantly related to the other genera of Papaveraceae, supporting for recent advocacy to establish a separate Fumariaceae family. Conclusions: Our results provide a useful resource for classification of this taxonomically complicated genus, and will be valuable for understanding Papaveraceae evolutionary relationships.
Racial Residential Segregation and Colorectal Cancer Mortality in the Mississippi Delta Region
Authors: Kruse-Diehr Aaron J , McDaniel Justin T , Lewis-Thames Marquita W , James Aimee , Yahaya Musa
Published: April 2020

Background
Few studies have examined the effects of segregation on colorectal cancer (CRC) outcomes, and none has determined if rurality moderates the effect of segregation on CRC mortality. We examined whether the effect of segregation on CRC mortality was moderated by rurality in the Mississippi Delta Region, an economically distressed and historically segregated region of the United States.
Methods
Using data from the US Census Bureau and the Surveillance, Epidemiology, and End Results (SEER) program, we estimated linear mixed-effects models with state-level random effects in which Black and White CRC mortality rates in Delta Region counties (N = 252) were regressed on county rurality, White-Black residential segregation indices, an interaction term for these two variables, and a vector of socioeconomic control variables. Missing data were replaced with values generated via random forest imputation.
Results
Segregation was a risk factor for Black CRC mortality in urban Delta counties but was associated with lower Black CRC mortality in rural counties (B = − 23.30 [95% CI = − 38.51, − 7.92]). For Whites, living in a rural area did not moderate the relationship between segregation and CRC mortality, though White CRC mortality was inversely associated with White population proportion (B = − 7.12 [95% CI = − 10.66, − 3.43]).
Conclusions
Health outcomes related to segregation vary by racial, contextual and community factors. We give possible explanations for our findings and provide implications for practice and recommendations for further research to better understand the CRC mortality burden in segregated communities.
The Development of Clinical Thinking in Physicians in Training: The Educator Perspective
Authors: LOCKE RACHEL , Mason Alice , Coles Colin , Lusznat Rosie M , Masding Mike G
Published: April 2020

Background An important element of effective clinical practice is the way physicians ‘think’ when they encounter a clinical situation, with a significant number of physicians in training challenged by translating their learning into professional practice in the clinical setting. This research explores the perceptions of educators about how physicians in training develop their clinical thinking in clinical settings. It considers what educators and their colleagues did to help, as well as the nature of the ‘context’ in which they worked. Method A qualitative approach was used in this study with in depth interviews carried out with educators as ‘key informants’. Rich data derived from fifteen interview transcripts were analysed thematically in a rigorous and iterative process. Results Three broad and overlapping themes were identified: working in an educationally minded culture; proximity of the educator to the physician in training; and trajectory of the physician in training. The departments in which these educators worked emphasised the importance on the education of physicians in training. All members of the team were responsible for education of the team, and all members, particularly senior nurses, were able to give feedback upon the physicians’ in training progress. Educators described working side by side with their physician in training and frequently being in close proximity to them, which means that the educator was both easily accessible and spent more time with their physicians in training. They described a trajectory of the physicians in training through the placement with close monitoring and informal assessment throughout. Conclusion Recommendations are made as to how physicians in training can be supported to develop their clinical thinking. Educators and managers can analysis their own and department’s practice and select the recommendations relevant to their local circumstances in order to make change. This study adds the educator perspective to a body of literature about the importance of context and supportive learning environments. As such the discussion is applicable to the education of other health professionals.
Transcultural Adaptation and Validation of the Fonseca Anamnestic Index in a Spanish Population with Temporomandibular Disorders.
Authors: Sánchez-Torrelo Carmen María , Zagalaz-Anula Noelia , Alonso-Royo Roger , Ibáñez-Vera Alfonso Javier , López-Collantes Jesús , Rodríguez-Almagro Daniel , Obrero-Gaitán Esteban , Lomas-Vega Rafael
Published: April 2020

Background. The Fonseca Anamnestic Index (FAI) offers a simple method to screen temporomandibular disorders (TMD). This study aimed to validate the standard version of the FAI in a Spanish population and to analyze the clinimetric properties of the Spanish version of the FAI in patients with TMD.Methods. The sample consisted of 179 subjects aged over 18 years, of which 119 were diagnosed with TMD and 60 were healthy controls. Construct validity (exploratory factor analysis), internal consistency, test-retest reliability, and concurrent validity were analyzed. To discriminate between patients with and without TMD, Receiver Operating Characteristic (ROC) curve analysis was performed.Results. The Spanish version of the FAI showed construct validity formed by three factors. Cronbach’s alpha was 0.820, indicating good internal consistency. The reliability of the items measured with the weighted kappa coefficient was between 0.588 and 0.899, varying between moderate to almost perfect. The intraclass correlation coefficient (ICC) of the total score was 0.938, indicating excellent reliability. The standard error of measurement (SEM) was 6.42, with a minimum detectable change (MDC) of 12.59 points. The concurrent validity showed a significant correlation with headache, neck pain, vertigo and the Mental Component Summary (SF-12 MCS) of the SF-12. However, the relationship with the Physical Component Summary (SF-12 PCS) was not significant. The ROC curve analysis showed a good accuracy of the FAI in differentiating between healthy and TMD patients with an area under the curve (AUC) = 0.869, corresponding to a cut-off point for the FAI of >35 points, with a sensitivity = 83.19% and a specificity = 78.33%.Conclusions. The Spanish version of the FAI is a valid and reliable instrument for diagnosing people with TMD, with appropriate general clinimetric properties. Discrimination between patients with and without TMD is excellent.
Clinical Educator-Facilitated Schwartz Centre Rounds in Second-Year Medical Students: “A Facilitated Whinge”?
Authors: Smith Joshua , Stewart Molly , Foggin Emily , Matthews Stuart , Harris Joanne , Thomas Peter , Cooney Andrew , Stocker Claire
Published: April 2020

Background Medical students are increasingly being exposed to the clinic at early stages in their education, with the benefits becoming widely realised. This early exposure to such a highly pressurized environment can result in increased levels of stress and emotional unrest. Schwartz Center Rounds, reflective forums primed to aid social and emotional issues healthcare professionals’ experience, are now a relatively common and effective means to combat these effects in hospitals in the UK and USA. Recent studies show that the Schwartz Center Round format may also provide positive benefits for medical students. It has been suggested that students may be able to develop good coping strategies from discussions with “real” professionals.Methods This study investigated whether the guidance of Schwartz Center Rounds in year 2 of an MBChB by junior doctors enriches students’ appreciation and benefits of the Schwartz Center Round.Results The results reinforce the concept that Schwartz Center Rounds are an effective way of fostering empathy and understanding towards both patients and colleagues. Moreover, the facilitation of the Round by Clinical Educators, who also act as an imperfect role model, provides a pertinence to the exercise. The results show that early-year undergraduate medical students generally engage positively with SRs and demonstrate an ability to empathise with each other and share feelings regarding early clinical exposure without inhibition. However, correlation analyses suggest that engagement with the Schwartz Center Round is fundamental to gaining an understanding of its purpose and concurrently gain the most awareness of the emotional needs of themselves, their colleagues and patients.Conclusion Schwartz Center Rounds are an effective way of fostering empathy and understanding towards patients and colleagues in the healthcare environment. There is some evidence that the inclusion of Clinical Educators made the Round feel more pertinent to the students with the junior doctors’ clinical experiences being described as a useful addition to the discussion. Moreover, the students that benefitted most from the Round were the ones who engaged with and understood the process best and therefore it is important to help students realise that Schwartz Rounds are not merely a “facilitated whinge”.
Inflammation induced-PINCH expression leads to actin depolymerization and mitochondrial mislocalization in neurons
Authors: Natarajaseenivasan Kalimuthusamy , Shanmughapriya Santhanam , Velusamy Prema , Sayre Matthew , Garcia Alvaro , Gomez Nestor Mas , Langford Dianne
Published: April 2020

Diseases and disorders with a chronic neuroinflammatory component are often linked with changes in brain metabolism. Among neurodegenerative disorders, people living with human immunodeficiency virus (HIV) and Alzheimer’s disease (AD) are particularly vulnerable to metabolic disturbances, but mechanistic connections of inflammation, neurodegeneration and bioenergetic deficits in the central nervous system (CNS) are poorly defined. The particularly interesting new cystine histidine-rich protein called PINCH is nearly undetectable in healthy mature neurons, but is robustly expressed in tauopathy-associated neurodegenerative diseases including HIV infection and AD. Although robust PINCH expression has been reported in neurons in the brains of patients with HIV and AD, the molecular mechanisms and cellular consequences of increased PINCH expression in CNS disease was not known. In this context, we have identified the transcription factor responsible for PINCH induction in neuroinflammatory conditions and the effects of increased PINCH expression in neurons. Given that AD and neuroHIV share pathological features including cognitive impairment with chronic neuroinflammation, TNFa plays an important role in neurodegenerative processes. The viral protein Tat, is produced in the brain and is one of the main drivers of neuroinflammation and strongly induces TNFa. Our data show that TNFα-mediated activation of MEF2A via increased cellular calcium induces PINCH. In turn, this leads to disruption of the PINCH-ILK-Parvin ternary complex, cofilin activation by Tesk1 inactivation, and actin depolymerization. Disruption of actin led to perinuclear mislocalization of mitochondria by destabilizing the kinesin-dependent mitochondrial transport machinery resulting in impaired neuronal metabolism. Blocking TNFα-induced PINCH preserves mitochondrial localization and maintains metabolic functioning. These data report for the first time mechanistic and biological consequences of PINCH expression in neurons in the CNS in diseases with a chronic neuroinflammatory component. These findings point to maintenance of PINCH at normal physiological levels as a new therapeutic target for neurodegenerative diseases with impaired metabolism.
Total and high-molecular weight plasma adiponectin associates with markers of inflammation and circulating chemokines in subjects with untreated newly diagnosed rheumatoid arthritis.
Authors: Vasileiadis Georgios K. , Lundell Anna-Carin , Zhang Yuan , Andersson Kerstin , Gjertsson Inger , Rudin Anna , Maglio Cristina
Published: April 2020

Background Adiponectin is an adipokine circulating in blood in three forms, whereof the high molecular weight (HMW) is supposed to mediate the metabolic effects of adiponectin. Subjects with rheumatoid arthritis (RA) have elevated levels of adiponectin in serum and synovial fluid but it is unclear if circulating adiponectin associates with disease activity markers in subjects with RA. Here we aimed to determine whether total and/or HMW adiponectin levels associate with markers of disease activity and plasma chemokines in a cohort of subjects with untreated newly diagnosed RA.Methods Inflammation and disease activity were assessed in a cohort of 70 subjects with untreated newly diagnosed RA using erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), number of tender or swollen joints, as well as disease activity scores (DAS28 and CDAI) Plasma levels of 15 chemokines were measured using flow cytometry bead-based immunoassay or ELISA. Total and HMW adiponectin plasma levels were determined with ELISA.Results Both total and HMW adiponectin were positively associated with CRP (both P = 0.001) and ESR (P = 0.001 and P < 0.001 respectively). Furthermore, a positive association was found between total adiponectin and CXCL10 (P = 0.021), CCL2 (P = 0.012) and CXCL9 (P = 0.044), whereas HMW adiponectin associated with CXCL9 only (P = 0.033).Conclusion Total and HMW adiponectin are associated with markers of inflammation as well as pro-inflammatory chemokines in a cohort of 70 subjects with untreated newly diagnosed RA. Our results support the hypothesis that adiponectin might be a pro-inflammatory factor involved in the pathogenesis of RA.
Foot Care Knowledge and Practices Among Japanese Nurses and Care Workers in Home Care and Adult Service Center: A Cross Sectional Study
Authors: Fujii Kashiko , Komoda Takuyuki , Maekawa Atsuko , Nishikawa Mariko
Published: April 2020

Background Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients.Methods This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in N City, A Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman’s rank correlation tests.Results Among the 305 surveyed, 232 (63 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.
Impact of hypertension on short- and long-term survival of Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection
Authors: Wang Zhigang , Wang Dongjin , Chen Tao , Ge Min , Chen Cheng , Zong Qiuyan , Lu Lichong
Published: April 2020

ObjectiveTo explore the clinical characteristics and prognosis of patients with hypertension underwent emergency surgery for type A acute aortic dissection (TA-AAD).MethodsThe present study enrolled 712 consecutive patients diagnosed with TA-AAD who were admitted to our hospital between January 2014 to December 2018. All patients accepted aortic repair surgery during hospitalization. The cohort was separated into two groups based on if they were diagnosed with hypertension upon administration. Before analyzing the short-term outcomes, baseline characteristics were matched for propensity scores. Patients’ clinical characteristics were compared and analyzed before and after propensity scoring. To identify predictors for long-term mortality rate, Kaplan-Meier survival estimation and Cox proportional hazard analysis were performed.ResultsThe 492 patients (69.1% of all patients in the cohort) included in the hypertensive group were generally older and heavier than patients in the non-hypertensive group. Between two groups, preoperative leukocyte count and serum creatinine level were found significant different (P < 0.05). After propensity scoring, 128 pairs (256 patients) were successfully matched. Our analysis showed that there was no significant difference of ventilation duration, 30-day mortality rate, intensive care unit (ICU) stay time and hospitalization time between these patients. However, our observation from surgeries suggested that hypertensive patients presented with less intraoperative aortic valve involvement.There was a significant difference in long-term survival rate (P=0.037) between two groups and Cox regression analysis demonstrated that hypertension was an independent risk factor (hazard ratio [HR], 2.290; 95% confidence interval [CI], 1.013-5.178; P=0.046).Conclusions Our data suggested that TA-AAD patients complicated with hypertension were generally older and heavier compared to non-hypertensive patients. The hypertension diagnosed upon hospital administration was an independent risk factors for long-term survival in TA-AAD patients but did not influence the 30-day mortality rate.
Prevalence of Risk Factors of Non-Communicable Diseases in the Sultanate of Oman: STEPS Survey 2017
Authors: Al-Mawali Adhra , Jayapal Sathish Kumar , Morsi Magdi , Al-Shekaili Waleed , Pinto Avinash Daniel , Al-Kharusi Hilal , Al-Harrasi Ayaman , Al-Balushi Zainab , Idikula John
Published: April 2020

Background Non-Communicable Diseases (NCD) represent a major public health issue and currently are the cause of 71% of deaths globally and 72% deaths in Oman. Hence, there is a need for comprehensive, up-to-date and internationally comparable data on NCD risk factors in order to evaluate the effectiveness of ongoing public health policies and to develop further NCD prevention and control interventions. The aim of the study was to provide evidence-based, up-to-date, extensive, and reliable baseline data on the behavioural and biological risk factors of NCDs in the Sultanate of Oman.Methods A cross-sectional community‐based survey designed to be nationally representative of the Sultanate of Oman was conducted based on the WHO STEPwise approach to Surveillance (STEPS). Multi-stage stratified random sampling according to geographical distribution selected a total of 9053 households (Omani nationals and non-Omani residents). Cluster sampling was used and symmetric equal number of blocks were chosen in each governorate with 823 households chosen from each governorate and one eligible adult selected from each household randomly. The survey used demographic and behavioural information questionnaires along with physical and biochemical measurements among adults aged 18 years and above.Results The prevalence of behavioural risk factors such as tobacco use was 9%, alcohol consumption was 2%, insufficient fruit or vegetable intake was 61%, and insufficient physical activity was 39%. The prevalence of biological risk factors such as overweight and obesity was 66%, raised blood pressure was 33%, raised blood glucose was 16%, and raised blood cholesterol was 36%. The prevalence of multiple risk factors was also determined and 95% of the population were found to have more than one risk factor. Three or more risk factors were found among 33% of population aged 18–69 years and 45% of the population aged 45 years.Conclusions These findings are important to support the formulation and implementation of NCD-related policies and action plans that improve health status and prevent mortality due to NCDs in the Sultanate of Oman.
Incidence and risk factors of Postdural Puncture Headache: Prospective cohort study design
Authors: Weji Bedilu Girma , Obsa Mohammed Suleiman , Melese Kidest Getu , Azeze Gedion Asnake
Published: April 2020

Background: Post-dural puncture headache is one of the complications following spinal anaesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture which includes needle size, needle design, direction of the bevel and number of LP attempts. This study aimed to assess the incidence and risk of postdural puncture headache.Methods: This prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow up were made. Data was entered in to Epi info version 7 software and transported to SPSS version 20 for analysis. Odd ratio and 95% confidence interval was computed. The findings of the study were reported using tables, figures and narration. Variables that were found to be candidate (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache.Results: One hundred fifty eligible study participants were included in our study of which 28.67% had developed postdural puncture headache. This study found that needle size, number of CSF drops and multiple attempts as independent predictors of postdural puncture headache at significant level (p < 0.05). In addition, twenty five needle was identified as strongest pre-operative independent predictor with PDPH (AOR = 4.150, CI = 1.433–12.021)Conclusions: Recent study revealed that small size pencil-point spinal needle was much better to large size cutting spinal needle regarding the frequency of postdural puncture headache. Besides, frequent attempts during lumbar puncture and increased CSF leakage were associated with the events. In view of this, we recommend the use of small size pencil-point spinal needle; avoid more leakage of cerebrospinal fluid and multiple in spinal anesthesia and lumbar puncture.
ZnO NPs delay the recovery of psoriasis-like skin lesions through promoting inflammation and keratinocyte apoptosis via nuclear translocation of phosphorylated NF-κB p65 and cysteine deficiency
Authors: Lai Xuan , Wang Menglei , Zhu Yixia , Feng Xiaoli , Liang Huimin , Nie Li , Li Li , Shao Longquan
Published: April 2020

Background

This study aimed to confirm the safety and risk of applying zinc oxide nanoparticles (ZnO NPs) to pathological skin, such as psoriasis-like skin. The majority of previous studies confirmed the safety of applying ZnO NPs to normal skin. However, we know very little about the risks of using sunscreen, cosmetics and topical drugs containing ZnO NPs for individuals with skin diseases. In addition, some studies claimed that ZnO NPs can penetrate normal or pathological skin, and ZnO NPs have frequently been reported to have proinflammatory and lethal effects in vitro. Therefore, it is necessary to evaluate the safety of applying ZnO NPs to pathological skin.
Results

ZnO NPs passed through gaps between keratinocytes and entered stratum basale of epidermis and dermis in imiquimod (IMQ)-induced psoriasis-like skin lesions. Application of a ZnO NP-containing suspension for 3 connective days delayed the healing of the epidermal barrier; increased the expression levels of inflammatory cytokines; promoted keratinocyte apoptosis and disturbed redox homeostasis. In vitro, ZnO NPs promoted TNF-α, IL-1β and IL-6 secretion and apoptosis of recombinant-human-TNF-α-stimulated HaCaT cells. NF-κB, ERK, p38 and JNK inhibitors blocked ZnO NP-induced inflammation. JSH-23, an inhibitor of the nuclear translocation of p-NF-κB p65, and NAC, an acetylated precursor of L-cysteine, not only inhibited the ZnO NP-induced inflammation but also inhibited apoptosis and cysteine deficiency. Neither erastin nor RSL3 induced p-NF-κB p65 nuclear translocation, but they did reduce cysteine biosynthesis. Additionally, ferropstatin-1, an inhibitor of lipid peroxidation, partially rescued ZnO NP-induced decreases in cell viability and cysteine content.
Conclusions

ZnO NPs delay the recovery of psoriasis-like skin lesions through promoting inflammation and keratinocyte apoptosis via the nuclear translocation of phosphorylated NF-κB p65 and cysteine deficiency. This work reminds the public that ZnO NPs are not safe for pathological skin, especially in inflammatory skin diseases such as psoriasis, and has revealed a partial mechanism by which ZnO NPs delay the recovery of pathological skin, promoting the appropriate use of ZnO NPs.