bluuebunny/crossref_metadata_2025 huggingface dataset:
Telerobotic interventions from a distance: an initial experience in 3D phantom mapping
Authors: Ailoaei S , Wright P , Griffiths S , Jansen M , Ernst S
Published: December 2021

Introduction

The current COVID-19 pandemic has fostered several accelerations in “remote” patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place.

Purpose

We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system.

Method

Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process.

Results

Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard.

Conclusion

Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted.

Funding Acknowledgement

Type of funding sources: None. Matched data for aorta
Specialised IP Judiciary: What Are the Key Elements to Consider when Establishing or Reforming an Effective IP Court?
Authors: Gurgula Olga , Padamczyk Maciej , Shemtov Noam
Published: December 2021

Intellectual property (‘IP’) is one of the key instruments for fostering innovation and promoting the growth of national economies. Given both the economic significance and the legal complexities associated with IP rights due to constant technological development, the benefits of having a specialised IP judiciary are being increasingly recognised across the globe. Many countries have either established or have been considering the introduction of various forms of such a specialised judiciary. This paper examines this trend and explores some key considerations in relation to the efficacy of an IP judiciary. It draws on some of the findings of a recently completed project funded by the UK government on the creation and functioning of a new IP court in Ukraine. While there is no ‘one-size-fits-all’ model when creating a specialised IP judiciary, the discussion in this article sheds light on a number of key factors that should be taken into account and carefully assessed when establishing or reforming such a judiciary. This includes specific considerations related to the structure of an IP judiciary, its location, the specialisation of IP judges, exclusive jurisdiction and other procedural issues. We believe that the guidance provided in this article will assist policymakers in their choices regarding the most suitable design of an IP judiciary for a particular jurisdiction, leading to the enhancement of its operation for the benefit of all the stakeholders in the IP enforcement system.
Social singing, culture and health: interdisciplinary insights from the CHIME project for perinatal mental health in The Gambia
Authors: Stewart Lauren , McConnell Bonnie B , Darboe Buba , Glover Vivette , Huma Hajara B , Sanfilippo Katie Rose M , Cross Ian , Ceesay Hassoum , Ramchandani Paul , Cornelius Victoria
Published: December 2021

Arts in Health initiatives and interventions to support health have emerged from and been applied to mainly WEIRD (Western, Educated, Industrialized, Rich and Democratic) contexts. This overlooks the rich cultural traditions that exist across the globe, where community groups often make prolific use of participatory song and dance as a part of ceremonies, ritual and gatherings in everyday life. Here, we argue that these practices can provide a valuable starting point for the co-development of health interventions, illustrated by the CHIME project for perinatal mental health in The Gambia, which worked with local Kanyeleng groups (female fertility societies) to design and evaluate a brief intervention to support maternal mental health through social singing. Here, we use the project as a lens through which to highlight the value of co-creation, cultural embeddedness and partnership building in global health research.
Measurement of soluble PD-1 and soluble PD-L1 as well as PD-L1 and PD-1 from perioperative patients with gastric carcinoma
Authors: Wei Hangzhi , Wu Fahong , Mao Yudong , Zhang Youcheng , Leng Guangxian , Wang Jia , Zhang Wei , Wang Tianwei
Published: December 2021

Background

Till now, no experiment has been performed to detect programmed death ligand 1 (PD-L1)/programmed death 1 (PD-1), soluble PD-L1/soluble PD-1 simultaneously in perioperative patients of gastric carcinoma. Our experiment aims at determining the clinical significance and possible mechanism of soluble PD-L1/soluble PD-1 in gastric carcinoma.

Methods

Thirty patients undergone gastrectomy were selected as the experimental group. Tissue’s programmed death ligand 1 and peripheral programmed death 1 were detected using immunofluorescence and flow cytometry. Soluble PD-L1 and soluble PD-1 were detected using enzyme-linked immunosorbent assay.

Results

First, preoperative programmed death 1 was higher than control group and decreased to normal post-operatively. Preoperatively ,elevated levels of programmed death 1 on cluster of differentiation (CD)4 T cells indicated less lymphatic metastasis (P < 0.01) and small tumor volume (P < 0.01); elevated programmed death 1 of CD8 T cells indicated big tumor volume (P < 0.01) and well histological differentiation (P < 0.01). Second, preoperative soluble PD-L1 and soluble PD-1 are lower than in control group. Post-operatively, the soluble PD-1 rose to normal, but the soluble PD-L1 showed no change. Third, programmed death ligand 1 can be observed in carcinoma tissue. Fourth, the area under the curve of soluble PD-1 (0.675) for diagnosis was worse than that of soluble PD-L1 (0.885). Kaplan-Meier analysis showed that soluble PD-1 < 245.26 pg/ml in post-operative serum predicted a poor prognosis (overall survival percentage: 60%) at 2 years (P < 0.05). Multivariate analysis revealed that carcinoembryonic antigen (>5 ng/l) and soluble PD-1 after gastrectomy (>245.26 pg/ml) were independent prognostic factors for overall survival (hazard ratio: 20.812, 95% confidence interval: 1.217–355.916, P = 0.036; hazard ratio: 0.028, 95% confidence interval: 0.001–0.786, P = 0.036, respectively).

Conclusions

We propose that soluble PD-1 combined with programmed death ligand 1 are effective not only in protecting T cells from the adhesion by programmed death ligand 1 but also in preventing the occurrence and the development of tumor as well. Through multivariate analysis, we found that soluble PD-1 was an independent protective factor for post-operative prognosis of gastric carcinoma patients, which indirectly verified the vital function of soluble PD-1. Soluble PD-1 might be promising predictive biomarkers for the diagnosis and prognosis of gastric carcinoma patients.
Effect of GLIM-defined malnutrition on postoperative clinical outcomes in patients with colorectal cancer
Authors: Song Hao-Nan , Wang Wen-Bin , Luo Xin , Huang Dong-Dong , Ruan Xiao-Jiao , Xing Chun-Gen , Chen Wei-Zhe , Dong Qian-Tong , Chen Xiao-Lei
Published: December 2021

Background

Malnutrition is common in colorectal cancer patients. Malnutrition is recognized as a risk factor for adverse postoperative outcomes, yet there are no consistent diagnostic criteria for it. Thus, the Global Leadership Initiative on Malnutrition published new universal criteria. We aimed to investigate the prevalence of malnutrition with the application of Global Leadership Initiative on Malnutrition criteria, and explore the correlations between Global Leadership Initiative on Malnutrition-defined malnutrition and postoperative clinical outcomes in colorectal cancer patients.

Methods

We included a cohort of 918 patients who underwent radical resection surgery for colorectal cancer from July 2014 to October 2019. Malnutrition was diagnosed based on the Global Leadership Initiative on Malnutrition criteria. The associations between nutritional status and postoperative clinical outcomes were analyzed by the Kaplan–Meier method, logistic and Cox regression analyses.

Results

Among the included patients, 23.6% were diagnosed as malnutrition based on Global Leadership Initiative on Malnutrition criteria. Global Leadership Initiative on Malnutrition-defined malnutrition was associated with total postoperative complications [odds ratio: 1.497 (1.042–2.152), P = 0.029]. Further, Global Leadership Initiative on Malnutrition-diagnosed malnutrition was an independent risk factor for overall survival [hazard ratio: 1.647 (1.048–2.587), P = 0.030] and disease-free survival [hazard ratio: 1.690 (1.169–2.441), P = 0.005].

Conclusions

The Global Leadership Initiative on Malnutrition criteria is effective to assess malnutrition. Preoperative malnutrition is associated with postoperative complications, overall survival and disease-free survival in colorectal cancer patients after radical resection surgery.
Pre-existing chromatin accessibility of switchable repressive compartment delineates cell plasticity
Authors: Ma Xiaolong , Cao Xuan , Zhu Linying , Li Ying , Wang Xuelong , Wu Baihua , Wei Gang , Hui Lijian
Published: December 2021

Cell plasticity endows differentiated cells with competence to be reprogrammed to other lineages. Although extrinsic factors driving cell-identity conversion have been extensively characterized, it remains elusive which intrinsic epigenetic attributes, including high-order chromatin organization, delineate cell plasticity. By analysing the transcription-factor-induced transdifferentiation from fibroblasts to hepatocytes, we uncovered contiguous compartment-switchable regions (CSRs) as a unique chromatin unit. Specifically, compartment B-to-A CSRs, enriched with hepatic genes, possessed a mosaic status of inactive chromatin and pre-existing and continuous accessibility in fibroblasts. Pre-existing accessibility enhanced the binding of inducible factor Foxa3, which triggered epigenetic activation and chromatin interaction as well as hepatic gene expression. Notably, these changes were restrained within B-to-A CSR boundaries that were defined by CTCF occupancy. Moreover, such chromatin organization and mosaic status were detectable in different cell types and involved in multiple reprogramming processes, suggesting an intrinsic chromatin attribute in understanding cell plasticity.
Prospective Nasal Screening for Methicillin-Resistant Staphylococcus aureus in Critically Ill Patients With Suspected Pneumonia
Authors: Raush Nicholas , Betthauser Kevin D , Shen Karen , Krekel Tamara , Kollef Marin H
Published: December 2021

We carried out a prospective de-escalation study based on methicillin-resistant Staphylococcus aureus (MRSA) nasal cultures in intensive care unit patients with suspected pneumonia. Days of anti-MRSA therapy was significantly reduced in the intervention group (2 [0–3] days vs 1 [0–2] day; P < .01). Time to MRSA de-escalation was also shortened in the intervention group.
Suboptimal Uptake, Retention, and Adherence of Daily Oral Prexposure Prophylaxis Among People With Opioid Use Disorder Receiving Hepatitis C Virus Treatment
Authors: Brokus Christopher , Kattakuzhy Sarah , Gayle Britt , Narayanan Shivakumar , Davis Ashley , Cover Amelia , Eyasu Rahwa , Ebah Emade , Ogbumbadiugha-Weekes Onyinyechi , Hoffmann Jennifer , Silk Rachel , Stevens Jasmine , Mount Julia , Gannon Catherine , Nussdorf Laura , Mathur Poonam , Bijole Phyllis , Jones Miriam , Kier Randy , Sternberg David , Greenblatt Aaron , Weintraub Eric , Masur Henry , Kottilil Shyamasundaran , Rosenthal Elana
Published: December 2021

Background

Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID.

Methods

The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis.

Results

One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred.

Conclusions

This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.
Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt
Authors: Ariff Shabina , Soofi Sajid Bashir , Suhag Zamir , Chanar Suhail , Bhura Maria , Dahar Zaib , Ahmed Imran , Turab Ali , Habib Atif , Nisar Yasir Bin , Aboubaker Samira , Wall Steve , Soomro Abdul Wahab , Qazi Shamim Ahmad , Bahl Rajiv , Bhutta Zulfiqar A
Published: December 2021

Background

The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible.

Methods

We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data.

Results

Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7–59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital.

Conclusion

It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.
Predicting survival and immune microenvironment in colorectal cancer: a STAT signaling-related signature
Authors: Zeng R , Wu H , Qiu X , Zhuo Z , Sha W , Chen H
Published: December 2021

Background

Despite research advances, studies on predictive models of colorectal cancer (CRC) remain scarce and none have evaluated signal transducer and activator of transcription (STAT) signaling.

Aim

To develop an effective prognostic signature for and evaluate its association with immune microenvironment.

Design

Comprehensive analysis based on The Cancer Genome Atlas and Gene Expression Omnibus databases with experimental validation.

Methods

Gene expression and clinical profiles of CRC patients were extracted from the databases. Differentially expressed genes with prognostic values were used to construct a signature. Immune cell infiltration and composition were further evaluated by TIMER, single-sample gene set enrichment and CIBERSORT analyses. The impact of the hub gene Caveolin-1 (CAV1) on cell proliferation, apoptosis, senescence and tumor angiogenesis was experimentally validated.

Results

The five-gene-based STAT signaling-related prognostic signature was significantly associated with CRC survival, and the nomogram was with improved prognostic efficacy than the conventional TNM stage. The STAT signaling-related signature was correlated with tumor immune microenvironment. CAV1 was further identified as the hub gene within the signature. CAV1 inhibits the proliferation and induces the apoptosis as well as senescence of CRC cells. In addition, the tumor angiogenesis of CRC can be suppressed by CAV1 overexpression.

Conclusions

The STAT signaling-related signature effectively predicts the prognosis and regulates tumor immune microenvironment in CRC. Our study underscores the role of STAT regulator, CAV1, as an important tumor suppressor in CRC carcinogenesis. Modulating STAT and its regulators could be a promising strategy for CRC in clinical practice.
What Moves Stock Prices? The Roles of News, Noise, and Information
Authors: Brogaard Jonathan , Nguyen Thanh Huong , Putnins Talis J , Wu Eliza
Published: December 2021

We develop a return variance decomposition model to distinguish the roles of different types of information and noise in stock price movements. We disentangle four components: noise, private firm-specific information revealed through trading, firm-specific information revealed through public sources and market-wide information. Overall, we find that 31$\%$ of the return variance is from noise, 24$\%$ from private firm-specific information, 37$\%$ from public firm-specific information and 8$\%$ from market-wide information. Since the mid-1990s, there has been a dramatic decline in noise and an increase in firm-specific information, consistent with increasing market efficiency.

The Internet Appendix that accompanies this paper can be obtained here: https://bit.ly/3FcV9UR
Reducing the Duration of Untreated Psychosis (DUP) in a US Community: A Quasi-Experimental Trial
Authors: Srihari Vinod H , Ferrara Maria , Li Fangyong , Kline Emily , Gülöksüz Sinan , Pollard Jessica M , Cahill John D , Mathis Walter S , Yoviene Sykes Laura , Walsh Barbara C , McDermott Glen , Seidman Larry J , Gueorguieva Ralitza , Woods Scott W , Tek Cenk , Keshavan Matcheri S
Published: December 2021

Objective

Duration of Untreated Psychosis (DUP) remains unacceptably long and limits effectiveness of care. To determine whether an early detection campaign (“Mindmap”) can reduce DUP in a US community setting.

Methods

In this nonrandomized controlled trial, Mindmap targeted the catchment of one specialty first-episode service or FES (STEP, Greater New Haven) from 2015 to 2019, while usual detection efforts continued at a control FES (PREP, Greater Boston). Mindmap targeted diverse sources of delay through mass & social media messaging, professional outreach & detailing, and rapid enrollment of referrals. Both FES recruited 16–35 years old with psychosis onset ≤3 years. Outcome measures included DUP-Total (onset of psychosis to FES enrollment), DUP-Demand (onset of psychosis to first antipsychotic medication), and DUP-Supply (first antipsychotic medication to FES enrollment).

Results

171 subjects were recruited at STEP and 75 at PREP. Mindmap was associated with an increase in the number of referrals and in efficiency of engagement at STEP. Pre-campaign DUP (2014–2015) was equivalent, while Mindmap was associated with DUP reductions at STEP but not PREP. DUP-Total fell significantly in both the first and the second quartile (11.5 and 58.5 days reduction per campaign year, respectively). DUP-Demand and DUP-Supply fell in the third quartiles only (46.3 and 70.3 days reduction per campaign year, respectively). No reductions were detectable across all quartiles at PREP, but between site comparisons were not significant.

Conclusions

This is the first controlled demonstration of community DUP reduction in the US, and can inform future early detection efforts across diverse settings.
Isolated Lomentospora prolificans Endophthalmitis
Authors: Dolgetta Alexandra , Bergman Zachary , Merbs Shannath L.
Published: December 2021

Lomentaspora prolificans is a rare fungal infection that has emerged as an opportunistic pathogen, particularly in immunosuppressed patients. Infection can caused disseminated infection, as well as localized infections in multiple organs in the body, including the eye. Endophthalmitis is a sight-threatening condition most commonly caused by bacterial pathogens and rarely associated with fungal infection. Endophthalmitis caused by L. prolificans is typically the result of ocular penetration, active keratitis, or endogenous seeding with positive blood cultures. Infection with L. prolificans is very difficult to treat because of the limited efficacy of currently available antifungal medications. Thus, the prognosis of endophthalmitis secondary to L. prolificans is guarded. We present a case of a 70-year-old woman who developed isolated endophthalmitis from L. prolificans infection with no identifiable source.
Factors associated with immunological and virological discordant responses to highly active antiretroviral therapy among adult HIV positive individuals in Ethiopia
Authors: Manaye Gizachew Ayele , Abateneh Dejene Derseh , Asmare Wondwossen Niguse , Abebe Milkias
Published: December 2021

In clinical practice, not all human immune deficiency virus (HIV) positive individuals who received highly active antiretroviral therapy (HAART) achieve the desired concordant response characterized by a sustained viral suppression or immune recovery. The expected success of HAART doesn’t occur in all treated patients and a discordant response between CD4 count and the viral load (VL) has been a major concern in the treatment of HIV patients. Thus, this study is designed to describe the factors associated with immunological and virological discordant responses to HAART among adult HIV positive individuals.

A hospital-based cross-sectional study with secondary data review was conducted on 423 HIV positive individuals on HAART from February 1 to April 30, 2017. Socio-demographic characteristics, clinical data and about 10 mL of blood specimen for HIV VL, and CD4 count measurement were collected. The data was entered into SPSS version 20 and descriptive, bivariate, and multivariate logistic regression analysis was employed.

The mean age of the patients at study time was 39 (±9.8). The average follow-up duration of patients on antiretroviral therapy (ART) was 7 (±3) years. The prevalence of immunological discordance and virological discordance to HAART were 13.2% and 47%, respectively. With multivariate logistic regression analysis duration of follow-up on ART ≤ 6 years (adjusted odds ratio [AOR] = 3.29 (1.80–6.03), P ≤ .001) and VL ≥20 copies/mm3 (AOR = 3.08 [1.70–5.61], P ≤ .001) were significant factors for immunological discordance conversely the patients who switched drug as a result of TB (AOR = 3.33 [1.10–10.08], P = .03) was significant factors for virological discordance.

The prevalence of immunological discordance and virological discordance to HAART among HIV patients is high. Patients with the duration of follow-up on ART ≤ 6 years, VL ≥ 20 copies/mm3 and patients who switched drugs as a result of TB were significant factors for discordance. Hence, intensive adherence support and counseling should be provided to achieve the UNAIDS 90 target. HIV positive individuals co-infected with TB, who have had VL ≥ 20 copies/mm3 and who are ≤6 years duration of follow-up on ART need to be carefully monitored. In addition, national based study of discordant groups is recommended.
The effectiveness of herbal acupoint application for functional diarrhea
Authors: Liu Baiyan , Yan Bing , Jiang Hailin , Zhao Xuewei , Wang Luyao , Li Tie , Wang Fuchun
Published: December 2021

Background:

Functional diarrhea (FDr), one of the most common functional gastrointestinal diseases, is a kind of functional bowel disease characterized by repeated paste feces or watery feces. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of herbal acupoint application (HAA) on FDr. There is also a lack of systematic evaluation and analysis of acupoints and herbs.

Methods:

We will search the following 8 databases from their inception to October 15, 2021, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database, and the China National Knowledge Infrastructure. The primary

outcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software (Available at: https://community.cochrane.org/help/tools-and-software/revman-5). Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence supporting the primary outcomes. We will also use SPASS software (Version 19.0 (Available at: https://www.ibm.com/analytics/spss-statistics-software)) for complex network analysis to explore the potential core prescription of acupoint herbal patching for FDr.

Results:

This study will analyze the clinical effective rate, bristol stool scale, number of daily bowel movements, clinical symptom scale of diarrhea, and effective prescriptions of HAA for patients with FDr.

Conclusion:

The conclusion of our findings will provide evidence for the effectiveness and potential treatment prescriptions of HAA for patients with FDr.
Physicians’ religious/spiritual characteristics and their behavior regarding religiosity and spirituality in clinical practice
Authors: Kørup Alex K. , Søndergaard Jens , Lucchetti Giancarlo , Ramakrishnan Parameshwaran , Baumann Klaus , Lee Eunmi , Frick Eckhard , Büssing Arndt , Alyousefi Nada A. , Karimah Azimatul , Schouten Esther , Wermuth Inga , Hefti René , de Diego-Cordero Rocío , Menegatti-Chequini Maria Cecilia , Hvidt Niels Christian
Published: December 2021

Background:

Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association.

Methods:

Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists.

Results:

We found 11 eligible surveys from 8 countries (n = 3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48–0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists.

Conclusions:

We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.

Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine.
Postpartum cerebral arterial dissections
Authors: Ruan Chun-Yun , Gao Bu-Lang , Pang Hong-Li , Zhang Kun , Zhang Yao-Hui , Wei Li-Ping , Li Tian-Xiao , Wang Zi-Liang
Published: December 2021

Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.

One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.

A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).

Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.
Follow-up care over 12 months of patients with prostate cancer in Spain
Authors: Bonfill Xavier , Martinez-Zapata María José , Vernooij Robin WM , Sánchez María José , Morales-Suárez-Varela María , Emparanza José Ignacio , Ferrer Montse , Pijoan José Ignacio , Palou Joan , Madrid Eva , Abraira Víctor , Zamora Javier
Published: December 2021

The therapeutic approach is crucial to prostate cancer prognosis. We describe treatments and outcomes for a Spanish cohort of patients with prostate cancer during the first 12 months after diagnosis and identify the factors that influenced the treatment they received.

This multicenter prospective cohort study included patients with prostate cancer followed up for 12 months after diagnosis. Treatment was stratified by factors such as hospital, age group (<70 and ≥70 years), and D’Amico cancer risk classification. The outcomes were Eastern Cooperative Oncology Group (ECOG) performance status, adverse events (AEs), and mortality. The patient characteristics associated with the different treatment modalities were analyzed using multivariate logistic regression.

We included 470 men from 7 Spanish tertiary hospitals (mean (standard deviation) age 67.8 (7.6) years), 373 (79.4%) of which received treatment (alone or in combination) as follows: surgery (n = 163; 34.7%); radiotherapy (RT) (n = 149; 31.7%); and hormone therapy (HT) (n = 142; 30.2%). The remaining patients (n = 97) were allocated to no treatment, that is, watchful waiting (14.0%) or active surveillance (5.7%). HT was the most frequently administered treatment during follow-up and RT plus HT was the most common therapeutic combination. Surgery was more frequent in patients aged <70, with lower histologic tumor grades, Gleason scores <7, and lower prostate-specific antigen levels; while RT was more frequent in patients aged ≥70 with histologic tumor grade 4, and higher ECOG scores. HT was more frequent in patients aged ≥70, with histologic tumor grades 3 to 4, Gleason score ≥8, ECOG ≥1, and higher prostate-specific antigen levels. The number of fully active patients (ECOG score 0) decreased significantly during follow-up, from 75.3% at diagnosis to 65.1% at 12 months (P < .001); 230 (48.9%) patients had at least 1 AE, and 12 (2.6%) patients died.

Surgery or RT were the main curative options. A fifth of the patients received no treatment. Palliative HT was more frequently administered to older patients with higher tumor grades and higher Gleason scores. Close to half of the patients experienced an AE related to their treatment.
CB-LPD, MGUS, T-LGLL, and PRCA
Authors: Xu Qinhong , Yu Jieni , Lin Xiaoyan , Li Youli , Zhang Kejie
Published: December 2021

Rationale:

Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic clonal plasma cell or lymphoplasmacytic proliferative disorder. Recently, some case reports have described the association of pure red cell aplasia (PRCA) with MGUS, even with a relatively low monoclonal immunoglobulin burden. T large granular lymphocyte leukemia (T-LGLL) is a chronic lymphoproliferative disorder characterized by clonal expansion of T large granular lymphocytes, which is rare in China. There are some reports about T-LGL leukemia in patients with B-cell lymphoma; however, it is very rare that T-LGLL coexists with MGUS and clonal B-cell lymphoproliferative disorders (CB-LPD).

Patient concerns:

A 77-year-old man was hospitalized because of anemia. He was diagnosed with MGUS, CB-LPD, and PRCA. During the development of the disease, a group of abnormal T lymphocytes was detected by flow cytometry of peripheral blood.

Diagnosis:

Combining clinical manifestations with the result of T cell receptor gene rearrangement and immunophenotype, it was consistent with the diagnosis of T large granular lymphocyte leukemia.

Interventions:

The patient was treat with bortezomib and dexamethasone regimen, Rituximab and sirolimus.

Outcomes:

The patient was transfusion independent after therapies.

Lessons:

We report a patient with 4 concomitant hematological disorders: T-LGLL, MGUS, CB-LPD, and PRCA, aiming to represent the clinical and flow cytometry characteristics of these concomitant diseases, analyze the mechanism between diseases, and provide a clinical reference.
The texture of collagen in the microenvironments of Merkel cell carcinoma
Authors: Laurito Tiago Luders , França Flávia Thomé , Vieira-Damiani Gislaine , Pelegati Vitor Bianchin , Baratti Mariana Ozello , de Carvalho Hernandez Faustino , Cesar Carlos Lenz , de Moraes Aparecida Machado , Cintra Maria Letícia , Teixeira Fernanda
Published: December 2021

Solid tumors typically contain high levels of fibrillar collagen. The increased stromal collagen deposition usually promotes cancer progression since biochemical and biophysical cues from tumor-associated collagen fibers stimulate neoplastic cells. Few studies have investigated the relationship between Merkel cell carcinoma (MCC) and the extracellular matrix (ECM), but there are no works evaluating collagen.

This is an observational, analytical, retrospective study including 11 patients with MCC. Primary tumor-stained sections were evaluated by second harmonic generation microscopy and texture analysis.

Peritumoral texture features (area fraction, mean gray value, entropy, and contrast) showed much lower values than normal skin (P < .0001) revealing extensively altered structure of peritumoral collagen fibers. These differences were not significant between tumors with unfavorable and favorable known prognostic factors.

Profound changes in collagen fibers present in the stroma accompanying primary MCC may contribute to the aggressive behavior of this tumor. Our results indicate that whatever MCC histological subtype, size or anatomical location, MCC promotes the same type of ECM for its development. As an outlook, therapies using ECM macromolecules or fibroblasts (the architects of ECM remodeling) as target could be useful in the treatment of MCC.
The effectiveness and safety of Naoxintong capsules in the treatment of vascular dementia
Authors: Li Yan-Lin , Cheng Fang , Chen Yan , Wang Jun , Xiao Zeng-Dong , Han Ying
Published: December 2021

Background:

Traditional Chinese medicine Naoxintong capsules have achieved good results in the treatment of vascular dementia, but there is no evidence-based medical evidence on the effectiveness and safety of the drug. Therefore, this study uses meta-analysis method to systematically evaluate the effectiveness and safety of Naoxintong capsules in the treatment of vascular dementia, with the aim of providing scientific guidance for clinical treatment and practice.

Methods:

This study retrieves a total of 7 network electronic databases, including 4 Chinese databases: China biomedical literature database, CNKI, Chongqing VIP database and WANFANG database, and three English databases: PubMed, Embase, The Cochrane Library. Using the combination of theme words and key words to retrieve the Chinese and English database, the literature is searched from January 1, 1990 to October 1, 2021. Two researchers independently sift through the literature, extract data and evaluate the bias risk included in the study, and in the event of a disagreement, the third researcher is invited to discuss the decision, followed by meta-analysis using software RveMan 5.3 and Stata 12.0.

Results:

All findings of this study will be published in a peer-reviewed, high-quality academic journal of medicine.

Conclusion:

The results of this study will provide evidence for clinicians to find effective and safe methods of treating vascular dementia in TCM.

OSF registration number:

DOI 10.17605/OSF.IO/YVF72, https://osf.io/yvf72.
Sacrum morphometry and spinopelvic parameters among the Indonesian population using computed tomography scans
Authors: Triwidodo Arsanto , Rahyussalim Ahmad Jabir , Yulisa Nyimas Diana , Pandelaki Jacub , Huraiby Lina Saleh , Hadi Ivana Ariella Nita , Liosha Faza Yuspa , Dilogo Ismail Hadisoebroto
Published: December 2021

This is a cross-sectional study. This study aims to describe the characteristics of sacrum vertebrae and spinopelvic parameters among the Indonesian population and compare them with studies from other populations. This study also intends to determine the sexual dimorphism of sacrum vertebrae and find the correlations between spinopelvic parameters.

Morphometry of the sacrum is necessary for designing sacral prosthesis and instrumentations. Knowledge of spinopelvic parameters further supports the prosthesis installation procedure to restore the physiological spinal alignment of the patients. However, previous studies showed varied results among different populations. This is the first study to be conducted among the Indonesian population.

Morphometric dimensions of sacrum vertebrae and the spinopelvic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis) were analyzed using thin-cut (1 mm) computed tomography images in 150 males and 150 females, aged 25 to 50 years without any spinal pathology.

Generally, the size of the sacrum vertebrae was greater in males (P < .05). The sacral index, curvature index, and corporo-basal index were statistically different between genders (P < .001). Lumbar lordosis was the only spinopelvic parameter found significantly greater in females (P < .001). Significant positive correlations between all spinopelvic parameters, except for lumbar lordosis and pelvic tilt, were found in the present study (P < .001).

The study serves as the first large series database of sacrum morphometric characteristics and spinopelvic parameters of the Indonesian population. There was significant gender-associated differences in various dimensions of sacrum vertebrae. The sacral index was found to be the most useful parameter for sex determination. There were strong significant positive correlations between various spinopelvic parameters. A comparison of populations revealed morphometric characteristic differences, which is proved to be critical in surgical implications.
Network pharmacology-based strategy to investigate the active ingredients and molecular mechanisms of Scutellaria Barbata D. Don against radiation pneumonitis
Authors: Sun Ping-Yi , Wang Ai-Shuai , Zhang Zhen-Fei , Zhang Yan-Li , Zheng Xin
Published: December 2021

Introduction:

Herbal medicines combined with radiotherapy significantly reduced the incidence of radiation pneumonitis (RP), and theScutellaria barbata D. Don (SBD)is a perennial herb that has been reported to protect against radiation-induced pneumonitis. However, the exact molecular mechanism is not known. The objective of this research was to investigate the against radiation pneumonitis ingredients and their functional mechanisms inSBD.

Methods:

Based on the network pharmacology approaches, we collected active ingredients and target genes inSBDagainst RP through Traditional Chinese Medicine System Pharmacology (TCMSP) Database, and the “Herb–Ingredients–Target Genes–Disease” Network was constructed by using of Cytoscape. STRING analysis was performed to reveal the protein-protein interactions, and then we applied enrichment analysis on these target proteins, gene function, and pathways.

Results:

A total of 18 ingredients inSBDregulate 65 RP related target proteins, which show that quercetin, luteolin, baicalein, wogonin may be the key active ingredients, while IL6, AKT1, VEGFA, MMP9, CCL2, prostaglandin-endoperoxide synthase 2 (PTGS2) (cyclooxygenase-2 [COX-2]), CXCL8, IL1B, mitogen-activated protein kinase (MAPK1), and IL10 were identified as critical targets. Besides, the results of Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis indicated that predicted targets ofSBDare mostly associated with the pathological process of oxidative stress and inflammation. AGE- Receptor of Advanced Glycation Endproducts (RAGE) signaling pathway in diabetic complications, IL-17 signaling pathway, hypoxia-inducible factor-1 (HIF-1) signaling pathway, NF-kappa B signaling pathway might serve as the principal pathways for RP treatment.

Conclusion:

In our study, the pharmacological and molecular mechanism ofSBDagainst RP was predicted from a holistic perspective, and the results provided theoretical guidance for researchers to explore the mechanism in further research.
A nomogram combining inflammatory markers and clinical factors predicts survival in patients with diffuse glioma
Authors: Yan Ping , Li Jian-Wen , Mo Li-Gen , Huang Qian-Rong
Published: December 2021

In this study, we aimed to investigate the prognostic value of neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) in diffuse glioma, and to establish a prognostic nomogram accordingly.

The hematologic and clinicopathological data of 162 patients with primary diffuse glioma who received surgical treatment from January 2012 to December 2018 were retrospectively analyzed. Receiver operator characteristic (ROC) curve was carried out to determine the optimal cut-off values for NLR, MLR, PLR, age, and Ki-67 index, respectively. Kaplan–Meier method was used to investigate the correlation between inflammatory indicators and prognosis of glioma patients. Univariate and multivariate Cox regression were performed to evaluate the independent prognostic value of each parameter in glioma. Then, a nomogram was developed to predict 1-, 3-, and 5-year postoperative survival in diffuse glioma patients based on independent prognostic factors. Subsequent time-dependent ROC curve, calibration curve, decision curve analysis (DCA), and concordance index (C-index) were performed to assess the predictive performance of the nomogram.

The Kaplan–Meier curve indicated that patients with high levels of NLR, MLR, and PLR had a poor prognosis. In addition, we found that NLR level was associated with World Health Organization (WHO) grade and IDH status of glioma. The multivariate Cox analysis indicated that resection extent, WHO grade, and NLR level were independent prognostic factors, and we established a nomogram that included these three parameters. The evaluation of the nomogram indicated that the nomogram had a good predictive performance, and the addition of NLR could improve the accuracy.

NLR, MLR, and PLR were prognostic factors of diffuse glioma. In addition, the nomogram including NLR was reliable for predicting survival of diffuse glioma patients.
A comparative study between open versus laparoscopic Hartmann reversal
Authors: Cho Hye Jung , Kim Woo Ram , Kim Jong Woo
Published: December 2021

As one of the most challenging procedures in colorectal surgery, Hartmann reversal (HR) carries a burden of morbidity and mortality. We report our experience and compare open and laparoscopic HR.

Between December 2012 and January 2020, 30 patients who underwent Hartmann reversal were reviewed. All patients either received laparoscopic or open reversal.

Of the 87 patients who underwent Hartmann operation (HO), 30 patients received HR (Laparoscopic Hartmann Reversal, [LHR], n = 20; Open Hartmann Reversal, Open Hartmann Reversal [OHR], n = 10). There were 15 males and 15 female patients. The mean operation time was 223.8 minutes (range 115–350 minutes) with mean blood loss of 252.5 mL (range 0–700 mL). There was no conversion from LHR to OHR, and there was no ileostomy formation. Mean time to flatus was 5.0 days (range 2–13 days). There were 15 early postoperative complications and 5 late postoperative complications, but only 1 case of grade 3A. No anastomosis leakage was reported.

HR is an operation that can be performed safely in well-selected patients. Minimally invasive techniques, such as LHR, is an attractive option resulting in shorter operation time, less blood loss, less pain, and shorter hospital stay.