bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research
Authors: Watson Alastair , Wilkinson Tom M.A.
Published: March 2022

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.
Noticable Findings in Cranial MRI of the Patients with Idiopathic Intracranial Hypertension
Authors: Çankaya Imran , Bayar Muluk Nuray , Burulday Veysel , Karadeniz Bilgili M. Yasemin , Özdemir Adnan
Published: March 2022

Objectives

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. We investigated the optic nerve, Meckel’s cavity, internal carotid artery (ICA) and pituitary findings of IIH by Cranial Magnetic Resonance Imaging (MRI).

Methods

Cranial MRI images of 35 adult patients with IIH and 35 adult subjects with normal cranial MRI results (control) were evaluated. Optic nerve diameter (OND), optic nerve sheat diameter (ONSD), OND/ONSD ratio, ON tortuosity, ON protrusion, posterior scleral flattening, ICA transverse diameter, CSF distance in Meckel’s cavity and ICA transverse diameter/CSF distance in Meckel’s cavity ratio, and pituitary gland measurements (height and transverse dimension; and Optic chiasm- pituitary gland distance) were measured.

Results

OND and ONSD of the IIH group were significantly higher than those of the control groups at anterior and posterior measurements (p < 0.05). OND/ONSD ratio of the IIH group was lower at anterior measurement; and higher at the posterior measurement than the control group (p < 0.05). Right ICA transverse diameter and bilateral CSF distance in Meckel’s cavity of the IIH group were higher than those of the control. Optic chiasm- pituitary gland distance of the IIH group was significantly higher than that of the control group (p < 0.05).

Conclusion

OND/ONSD ratio is different in anterior and posterior measurements. So we recommend measuring OND and ONSD separately in IIH patients to use in the clinical practice. Similarly, optic chiasm-pituitary gland distance is also another point to note for IIH patients on MRI. Our paper adds new approach to IIH in terms of OND/ONSD ratio.
Nursing students’ learning about person-centred dementia care in a nursing home: A qualitative study
Authors: Kulla Gunilla , Slettebø Åshild
Published: March 2022

It is unclear to what extent nursing students are able to apply person-centred care in practice, despite a mixture of educational support approaches. The aim of this study was to explore nursing students’ experiences of learning about person-centred dementia care after they participated in an adopted education programme in a nursing home. The education programme presented the main concepts of person-centred care. A qualitative explorative design was chosen where 32 bachelor-level nursing students participated in seven focus groups. The study is reported according to the COREQ checklist. Qualitative thematic content analysis revealed two main themes: care culture in the nursing home as joyful and inclusive, and the nursing student role as ambivalent and challenging. The nursing home management, staff members and patients, together with the programme, seemed to enhance students’ learning about person-centred dementia care.
Varieties of Gendered Capitalism: Status Beliefs and the Gender Gap in Entrepreneurship
Authors: Auguste Daniel
Published: March 2022

Gender status research demonstrates that the power of gender status beliefs in shaping gender inequalities is rooted in the fact that these beliefs are institutionalized and operate at the societal level to shape social relations of inequality at the individual level. However, recent empirical analyses linking gender status beliefs to gender inequality in entrepreneurship have only examined the effect of individual gender, not that of societal-level gender status beliefs, on gender inequality in entrepreneurship. This study fills this gap in this literature by examining the potential effect of societal-level gender status beliefs on gender inequality in entrepreneurship, using data from 51 countries. The results show that gender inequality in entrepreneurship is greater in societies where gender status beliefs are stronger. For instance, gender inequality in entrepreneurship is greater in societies where status beliefs about gender differences in leadership competency and the right to employment are stronger. However, the results also show that these beliefs are more strongly associated with gender inequality among nascent entrepreneurs than established business owners. These findings support feminist scholars’ claim that gender status advantage is pervasive in modern institutions and suggest that gender status advantage may manifest differently across stages of the entrepreneurship process.
Effect of laser peripheral iridotomy on contrast sensitivity using Spaeth/Richman Contrast Sensitivity test
Authors: Ichhpujani Parul , Thakur Sahil , Singh Tanu , Singh Rohan Bir , Kumar Suresh
Published: March 2022

Background:

Laser peripheral iridotomy (LPI) is the current standard of care for primary angle-closure glaucoma. The existing literature lacks evidence regarding the effects of LPI on contrast sensitivity (CS) after the procedure.

Objective:

This study evaluates central and peripheral CS in patients undergoing LPI using the computer-based, Spaeth/Richman Contrast Sensitivity (SPARCS) test.

Methods:

We performed a pilot, prospective, interventional cohort study including 30 patients of primary angle-closure suspect (PACS) or primary angle closure (PAC) in both eyes. LPI was performed after a detailed history and clinical examination using standard procedure in all eyes. Intraocular pressure (IOP) and CS testing using SPARCS was performed before, 2 weeks and 3 months after LPI.

Results:

Data analyses revealed female predominance (66.67%, 20/30); the mean age of enrolled patients was 49.93 ± 10.43 years, and presenting acuity was 0.02 ± 0.06 (Log of Minimum Angle of Resolution [LogMAR]). The mean vertical cup-to-disc ratio (VCDR), mean deviation (MD in dB) and pattern standard deviation (PSD in dB) were 0.34 ± 0.09, –2.36 ± 1.72 and 2.34 ± 0.81, respectively. There was a statistically significant decrease between the pre- (15.17 ± 3.83 mmHg) and 2 weeks post-LPI (11.70 ± 1.53 mmHg) IOP ( p < 0.001). However, CS in the pre- (73.47 ± 9.88) and 3 months post-LPI (75.20 ± 11.98) SPARCS scores did not reveal any statistical difference. The group-wise analysis showed a similar trend between PAC and PACS patients.

Conclusion:

LPI does not affect central as well as peripheral CS assessment in patients with the primary angle-closure disease.
Utility of PET/CT in assessing early treatment response in patients with newly diagnosed multiple myeloma
Authors: Charalampous Charalampos , Goel Utkarsh , Broski Stephen M. , Dingli David , Kapoor Prashant , Gertz Morie A. , Lacy Martha Q. , Dispenzieri Angela , Hayman Suzanne R. , Buadi Francis , Hwa Lisa , Leung Nelson , Lin Yi , Gonsalves Wilson I. , Kourelis Taxiarchis V. , Warsame Rahma , Fonder Amie , Hobbs Miriam , Binder Moritz , Kyle Robert A. , Rajkumar S. Vincent , Kumar Shaji K.
Published: March 2022

Multiple myeloma (MM) is a plasma cell malignancy that is characterized by diverse clinical presentations. Although biochemical assessment of disease activity is commonly used to monitor treatment response, findings on magnetic resonance imaging and positron emission tomography (PET)/computed tomography (CT), among other imaging modalities, have proven to harbor prognostic value. We sought to corroborate these findings by examining the prognostic significance of fluorodeoxyglucose PET/CT scanning in the setting of newly diagnosed MM. We retrospectively analyzed 195 patients with a PET/CT available at diagnosis and at 6 months posttreatment to examine their value as an adjuvant metric to conventional hematologic responses in terms of time to next treatment (TTNT) and overall survival (OS). The median TTNT and OS for the entire cohort were 24.6 months (95% confidence interval [CI], 20.4-29.1) and 79 months (95% CI, 63.1-119.1), respectively. When comparing PET/CT negative (−) with PET/CT positive (+) patients, we found significantly prolonged median TTNT (55.2 vs 17.8 months, P < .0001) and OS (unreached vs 60.8 months, P < .0001) in the former group. We then examined the additive value of PET/CT on the hematologic response achieved at 6 months and found that PET/CT (−) is associated with significantly increased median TTNT and OS for the very good partial response (VGPR) group and the less than VGPR group. Importantly, PET/CT retained prognostic significance after adjusting for multiple other predictive variables. We conclude that a PET/CT (−) at 6 months confers a significant prognostic advantage for patients with newly diagnosed MM and adds significant value to the hematologic response assessment.
Programme costs of longer and shorter tuberculosis drug regimens and drug import: a modelling study for Karakalpakstan, Uzbekistan
Authors: Kohler Stefan , Sitali Norman , Achar Jay , Paul Nicolas
Published: March 2022

Background

The introduction of new and often shorter tuberculosis (TB) drug regimens affects the cost of TB programmes.

Methods

We modelled drug purchase and import costs for 20-month, 9-month and 4- to 6-month TB drug regimens based on 2016–2020 treatment numbers from a TB programme in Karakalpakstan, Uzbekistan, and 2021 Global Drug Facility prices.

Results

On average, 2225±374 (±sd) people per year started TB treatment, 30±2.1% of whom were diagnosed with drug-resistant forms of TB. Transitioning from a 6-month to a 4-month drug-susceptible (DS)-TB drug regimen increased the TB programme's annual DS-TB drug cost from USD 65±10 K to USD 357±56 K (p<0.001) and its drug import cost from USD 6.4±1.0 K to USD 9.3±1.4 K (p=0.008). Transitioning from a 20-month all-oral multidrug-resistant (MDR)-TB drug regimen to a 9-month MDR-TB drug regimen with an injectable antibiotic decreased the TB programme's annual MDR-TB drug cost from USD 1336±265 K to USD 266±53 K (p<0.001) and had no significant effect on the drug import cost (USD 28±5.5 KversusUSD 27±5.4 K; p=0.88). Purchasing (USD 577±114 K) and importing (USD 3.0±0.59 K) the 6-month all-oral MDR-TB drug regimen cost more than procuring the 9-month MDR-TB drug regimen but less than the 20-month all-oral MDR-TB drug regimen (both p<0.01).

Conclusion

Introducing new and shorter TB drug regimens could increase the cost of TB programmes with low drug resistance rates and decrease the cost of TB programmes with high drug resistance rates.
Secondary infection in COVID-19 critically ill patients: a retrospective single-center evaluation
Authors: De Bruyn Astrid , Verellen Stijn , Bruckers Liesbeth , Geebelen Laurien , Callebaut Ina , De Pauw Ilse , Stessel Björn , Dubois Jasperina
Published: March 2022

Background

Patients infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2) can develop severe illness necessitating intensive care admission. Critically ill patients are susceptible for the development of secondary bacterial infections. Due to a combination of virus- and drug-induced immunosuppression, critically ill patients with corona virus disease 2019 (COVID-19) may even have a higher risk of developing a secondary infection. These secondary infections can aggravate the severity of illness and increase the risk of death. Further research on secondary infections in COVID-19 patients is essential. Therefore, the objective of this study was to investigate the incidence and associated risk factors of secondary bacterial infections and to identify the most common groups of pathogens in critically ill COVID-19 patients.

Methods

This mono-center, retrospective observational cohort study was performed at the intensive care unit (ICU) of the Jessa Hospital, Hasselt, Belgium. All adult COVID-19 patients admitted to the ICU from 13th March 2020 until 17th October 2020, were eligible for inclusion in the study. Data from the resulting 116 patients were prospectively entered into a customized database. The resulting database was retrospectively reviewed to investigate three types of secondary bacterial infections (secondary pneumonia, bloodstream infections of unknown origin, catheter-related sepsis).

Results

Of 94 included patients, 68% acquired at least one of the studied secondary bacterial infections during their ICU stay. Almost two thirds of patients (65.96%, n = 62) acquired a secondary pneumonia, whereas 29.79% (n = 28) acquired a bacteremia of unknown origin and a smaller proportion of patients (14.89%, n = 14) acquired a catheter-related sepsis. Male gender (P = 0.05), diabetes mellitus (P = 0.03) and the cumulative dose of corticosteroids (P = 0.004) were associated with increased risk of secondary bacterial infection. The most common pathogens detected in the cultures of patients with secondary pneumonia were Gram-negative bacilli. Bacteremia of unknown origin and catheter-related sepsis were mostly caused by Gram-positive cocci.

Conclusion

This study confirms that the incidence of secondary bacterial infections is very high in critically ill COVID-19 patients. These patients are at highest risk of developing secondary pneumonia. Male gender, a history of diabetes mellitus and the administration of corticosteroids were associated with increased risk of secondary bacterial infection.
The effects of gestational diabetes mellitus with maternal age between 35 and 40 years on the metabolite profiles of plasma and urine
Authors: He Xiao-ling , Hu Xiao-jing , Luo Bai-yu , Xia Yin-Yin , Zhang Ting , Saffery Richard , De Seymour Jamie , Zou Zhen , Xu Ge , Zhao Xue , Qi Hong-bo , Han Ting-Li , Zhang Hua , Baker Philip N.
Published: March 2022

Background

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance in pregnancy and without a history of diabetes mellitus. While there are limited metabolomic studies involving advanced maternal age in China, we aim to investigate the metabolomic profiling of plasma and urine in pregnancies complicated with GDM aged at 35–40 years at early and late gestation.

Methods

Twenty normal and 20 GDM pregnant participants (≥ 35 years old) were enlisted from the Complex Lipids in Mothers and Babies (CLIMB) study. Maternal plasma and urine collected at the first and third trimester were detected using gas chromatography-mass spectrometry (GC-MS).

Results

One hundred sixty-five metabolites and 192 metabolites were found in plasma and urine respectively. Urine metabolomic profiles were incapable to distinguish GDM from controls, in comparison, there were 14 and 39 significantly different plasma metabolites between the two groups in first and third trimester respectively. Especially, by integrating seven metabolites including cysteine, malonic acid, alanine, 11,14-eicosadienoic acid, stearic acid, arachidic acid, and 2-methyloctadecanoic acid using multivariant receiver operating characteristic models, we were capable of discriminating GDM from normal pregnancies with an area under curve of 0.928 at first trimester.

Conclusion

This study explores metabolomic profiles between GDM and normal pregnancies at the age of 35–40 years longitudinally. Several compounds have the potential to be biomarkers to predict GDM with advanced maternal age. Moreover, the discordant metabolome profiles between the two groups could be useful to understand the etiology of GDM with advanced maternal age.
Exposure–response analyses of cabozantinib in patients with metastatic renal cell cancer
Authors: Krens Stefanie D. , van Erp Nielka P. , Groenland Stefanie L. , Moes Dirk Jan A. R. , Mulder Sasja F. , Desar Ingrid M. E. , van der Hulle Tom , Steeghs Neeltje , van Herpen Carla M. L.
Published: March 2022

Aim

In the registration trial, cabozantinib exposure ≥ 750 ng/mL correlated to improved tumor size reduction, response rate and progression free survival (PFS) in patients with metastatic renal cell cancer (mRCC). Because patients in routine care often differ from patients in clinical trials, we explored the cabozantinib exposure–response relationship in patients with mRCC treated in routine care.

Methods

Cabozantinib trough concentrations (Cmin) were collected and average exposure was calculated per individual. Exposure–response analyses were performed using the earlier identified target of Cmin > 750 ng/mL and median Cmin. In addition, the effect of dose reductions on response was explored. PFS was used as measure of response.

Results

In total, 59 patients were included:10% were classified as favourable, 61% as intermediate and 29% as poor IMDC risk group, respectively. Median number of prior treatment lines was 2 (0–5). Starting dose was 60 mg in 46%, 40 mg in 42% and 20 mg in 12% of patients. Dose reductions were needed in 58% of patients. Median Cminwas 572 ng/mL (IQR: 496–701). Only 17% of patients had an average Cmin ≥ 750 ng/mL. Median PFS was 52 weeks (95% CI: 40–64). No improved PFS was observed for patients with Cmin ≥ 750 ng/mL or ≥ 572 ng/ml. A longer PFS was observed for patients with a dose reduction vs. those without (65 vs. 31 weeks,p = .001). After incorporating known covariates (IMDC risk group and prior treatment lines (< 2 vs. ≥ 2)) in the multivariable analysis, the need for dose reduction remained significantly associated with improved PFS (HR 0.32, 95% CI:0.14–0.70,p = .004).

Conclusion

In these explorative analyses, no clear relationship between increased cabozantinib exposure and improved PFS was observed. Average cabozantinib exposure was below the previously proposed target in 83% of patients. Future studies should focus on validating the cabozantinib exposure required for long term efficacy.
In young women, a link between childhood abuse and subliminal processing of aversive cues is moderated by impulsivity
Authors: Regier P. S. , Sinko L. , Jagannathan K. , Aryal S. , Teitelman A. M. , Childress A. R.
Published: March 2022

Background

Childhood maltreatment is a serious public health concern. The association between child maltreatment, adverse behaviors, mental health outcomes, and alterations to brain function and structure have begun to be characterized. Less is known about the specific associations of maltreatment subtypes with cue-response to evocative cues and the moderating effects of confounding mental health/behavioral variables.

Methods

Fifty-four emerging adult women (aged 18–24) completed assessments for behaviors, mental health, and childhood maltreatment. They participated in a fMRI task featuring passive viewing of evocative (33 ms) cues presented by “backward masking” to prevent conscious processing. Correlations of abuse/neglect scores, behavioral/mental health factors, and brain function were assessed. Follow-up analyses investigated the moderating effects of behavioral/mental health factors on maltreatment and brain relationships.

Results

Greater frequency of childhood abuse and neglect were correlated with higher scores of impulsivity, depressive symptoms, and anxious attachment. Childhood abuse was positively associated with increased medial orbitofrontal cortical (mOFC) response to aversive (vs. neutral) cues. Among the behavioral/mental health variables, only impulsivity appeared to have a moderating effect on the relationship between childhood abuse and brain response to aversive cues.

Conclusions

The link between childhood abuse and a heightened mOFC response to “unseen” aversive stimuli, moderated by impulsivity, adds to the growing literature on the impact of prior adversity on brain function. These findings offer further understanding for the way in which childhood maltreatment affects the brain processing of negative stimuli, helping to explain the well-documented link between childhood maltreatment and a variety of adverse outcomes in adulthood.
Assessing the depression risk in the U.S. adults using nomogram
Authors: Zhang Yafeng , Tian Wei , Han Xinhao , Yan Guangcan , Ma Yuanshuo , Huo Shan , Shi Yu , Dai Shanshan , Ni Xin , Li Zhe , Fan Lihua , Zhang Qiuju
Published: March 2022

Background

Depression has received a lot of attention as a common and serious illness. However, people are rarely aware of their current depression risk probabilities. We aimed to develop and validate a predictive model applicable to the risk of depression in US adults.

Methods

This study was conducted using the database of the National Health and Nutrition Examination Survey (NHANES, 2017–2012). In particular, NHANES (2007–2010) was used as the training cohort (n = 6015) for prediction model construction and NHANES (2011–2012) was used as the validation cohort (n = 2812) to test the model. Depression was assessed (defined as a binary variable) by the Patient Health Questionnaire (PHQ-9). Socio-demographic characteristics, sleep time, illicit drug use and anxious days were assessed using a self-report questionnaire. Logistic regression analysis was used to evaluate independent risk factors for depression. The nomogram has the advantage of being able to visualize complex statistical prediction models as risk estimates of individualized disease probabilities. Then, we developed two depression risk nomograms based on the results of logistic regression. Finally, several validation methods were used to evaluate the prediction performance of nomograms.

Results

The predictors of model 1 included gender, age, income, education, marital status, sleep time and illicit drug use, and model 2, furthermore, included anxious days. Both model 1 and model 2 showed good discrimination ability, with a bootstrap-corrected C index of 0.71 (95% CI, 0.69–0.73) and 0.85 (95% CI, 0.83–0.86), and an externally validated C index of 0.71 (95% CI, 0.68–0.74) and 0.83 (95% CI, 0.81–0.86), respectively, and had well-fitted calibration curves. The area under the receiver operating characteristic curve (AUC) values of the models with 1000 different weighted random sampling and depression scores of 10–17 threshold range were higher than 0.7 and 0.8, respectively. Calculated net reclassification improvement (NRI) and integrated discrimination improvement (IDI) showed the discrimination or accuracy of the prediction models. Decision curve analysis (DCA) demonstrated that the depression models were practically useful. The network calculators work for participants to make personalized predictions.

Conclusions

This study presents two prediction models of depression, which can effectively and accurately predict the probability of depression as well as helping the U.S. civilian non-institutionalized population to make optimal treatment decisions.
Association of socioeconomic status with hypertension prevalence and control in Nanjing: a cross-sectional study
Authors: Qin Zhenzhen , Li Chao , Qi Shengxiang , Zhou Hairong , Wu Jie , Wang Weiwei , Ye Qing , Yang Huafeng , Wang Chenchen , Hong Xin
Published: March 2022

Background

The role of socioeconomic status (SES) on hypertension prevalence and hypertension control has gotten much attention but with conflicting results. This paper aimed to quantify the association of SES with both hypertension prevalence and hypertension control rate in Nanjing, China.

Methods

A community-based cross-sectional study was conducted using multistage random sampling on 60,283 adults aged more than 18 years between March 2017 and June 2018. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or self-reported diagnosis of hypertension or respondent's report of taking antihypertensive medications. The controlled hypertension was defined by systolic BP < 140 mmHg and diastolic BP of < 90 mmHg among the subjects that self-reported exhibiting hypertensive and taking antihypertensive medications. The associations between SES with hypertension prevalence and hypertension control were quantified using generalized mixed model regression analysis and reported as odds ratios (ORs) and 95% confidence interval (CI).

Results

There was a high prevalence of subjects with primary educational level (49.6%) or unemployed and retired (49.5%) or lower annual household income level (44.9%) in each SES group, respectively. After adjustments for potential confounding factors, there were higher odds of hypertension among those with primary educational level (OR = 1.56), but lower odds for controlled BP (OR = 0.51). Higher odds of hypertension could be found among unemployed and retired, and higher odds of controlled BP was observed in the mental laborers or students (OR = 1.30), compared with the other categories, respectively. The lower-income group was more likely to be hypertensive (OR = 1.35) and less likely to have controlled hypertension (OR = 0.73).

Conclusion

Socioeconomic status played an important role in hypertension prevalence and hypertension control among adults in Nanjing, China. Strategies for hypertension prevention and control should especially focus on people in the vulnerable lower SES groups.
Does the thoracolumbar kyphosis secondary to ankylosing spondylitis affect the iliac trajectory of S2AI screw?
Authors: Zhong Xiao-lin , Qian Bang-ping , Huang Ji-chen , Wang Bin , Qiu Yong
Published: March 2022

Background

The study aimed to evaluate the influence of thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) on parameters of S2AI trajectory and to compare the ideal S2AI trajectory with those of the non-deformity patients with AS, sagittal deformity patients without AS, and the normal population reported in literatures.

Methods

Sagittal parameters including global kyphosis (GK), pelvic tilt (PT) and sacral slope (SS) were measured. Besides, according to the simulated ideal S2AI trajectory on the CT images, trajectory parameters were measured including Sag angle, Tsv angle, Max-length, Sacral distance and Iliac width. Starting-point parameters were also measured including PSIS distance, Skin distance, Iliac wing and S2 midline.

Results

Ninety-four AS-related thoracolumbar kyphosis patients were included. After adjusting the age and gender, twenty non-deformity patients with AS and 20 sagittal deformity patients without AS were selected to compare with patients with AS-related thoracolumbar kyphosis, respectively. Sag angle in deformity patients with AS was smaller than other two groups (P < 0.001). No difference was found in Tsv angle and Sacral distance between AS patients with and without deformity. However, these two parameters were shown significant differences between deformity patients with AS and without AS. In deformity patients with AS, no significant differences were found in all parameters between genders Furthermore, there were strong correlations between PT and the bilateral Sag angle (P < 0.001).

Conclusions

The thoracolumbar kyphosis secondary to AS affects the Sag angle of the ideal S2AI trajectory which was approximately 20° smaller than that in non-deformity patients with AS, sagittal deformity patients without AS, and the normal population. Additionally, the Tsv angle and the Sacral distance in AS patients with thoracolumbar kyphosis were about 10° and 10 mm larger than those in sagittal deformity patients without AS, and the normal population reported in literatures.
Identification of risk factors for postoperative stage 3 acute kidney injury in patients who received surgical repair for acute type A aortic dissection
Authors: Wang Zhigang , Ge Min , Wang Zheyun , Chen Cheng , Lu Lichong , Zhang Lifang , Wang Dongjin
Published: March 2022

Background

Acute kidney injury (AKI) is a serious complication that often occurred after acute type A aortic dissection (ATAAD) surgery. Previous studies proved that the Kidney Disease Improving Global Outcomes (KDIGO) defined stage 3 AKI was associated with lower long-term survival rate. However, the risk factors for developing stage 3 AKI had not been identified. The aim of the study was to explore the risk factors for developing KDIGO stage 3 after ATAAD operation.

Methods

This study included 993 patients who received ATAAD operation from 2014 to 2019 at the Nanjing Drum Tower Hospital. Postoperative AKI was diagnosed according to the KDIGO criteria. Multivariate logistic regression analyses were applied to identify risk factors for stage 3 AKI. Kaplan–Meier survival analyses and Cox proportional hazards regression model were conducted to explore the association between different AKI stages and postoperative survival rate.

Results

The mean age of all enrolled patients was 53.0 ± 13.1 years. A total of 236 (23.8%) patients suffered postoperative stage 3 AKI including 165 patients who required renal replacement therapy. Advanced age (odds ratio [OR] 1.031; 95% confidence interval [CI] 1.005–1.057; P = 0.018), prolonged cardiopulmonary bypass (CPB) duration (OR 1.010; 95% CI 1.002–1.018; P = 0.013), and higher drainage volume 24 h after surgery (OR 1.000; 95% CI 1.000–1.001; P = 0.033) were identified as independent risk factors for developing stage 3 AKI. In addition, our result showed that the mortality rate was correlated significantly with the severity of AKI defined by KDIGO criteria and the Cox regression analysis showed that only stage 3 AKI, but not stage 1 and 2, was an independent risk factor for mortality (Hazard ratio 10.365, 95% CI 4.208 to 25.528; P < 0.001) after adjusting for important confounding factors.

Conclusions

Our study suggested that stage 3 postoperative AKI was significantly associated with decreased postoperative survival rate after ATAAD surgery. Advanced age, increased CPB duration and drainage volume 24 h after surgery were identified as risk factors for developing stage 3 AKI.
An advanced network pharmacology study to explore the novel molecular mechanism of Compound Kushen Injection for treating hepatocellular carcinoma by bioinformatics and experimental verification
Authors: Lu Shan , Meng Ziqi , Tan Yingying , Wu Chao , Huang Zhihong , Huang Jiaqi , Fu Changgeng , Stalin Antony , Guo Siyu , Liu Xinkui , You Leiming , Li Xiaojiaoyang , Zhang Jingyuan , Zhou Wei , Zhang Xiaomeng , Wang Miaomiao , Wu Jiarui
Published: March 2022

Background

Compound Kushen Injection (CKI) is a Chinese patent drug that exerts curative effects in the clinical treatment of hepatocellular carcinoma (HCC). This study aimed to explore the targets and potential pharmacological mechanisms of CKI in the treatment of HCC.

Methods

In this study, network pharmacology was used in combination with molecular biology experiments to predict and verify the molecular mechanism of CKI in the treatment of HCC. The constituents of CKI were identified by UHPLC-MS/MS and literature search. The targets corresponding to these compounds and the targets related to HCC were collected based on public databases. To screen out the potential hub targets of CKI in the treatment of HCC, a compound-HCC target network was constructed. The underlying pharmacological mechanism was explored through the subsequent enrichment analysis. Interactive Gene Expression Profiling Analysis and Kaplan-Meier plotter were used to examine the expression and prognostic value of hub genes. Furthermore, the effects of CKI on HCC were verified through molecular docking simulations and cell experiments in vitro.

Results

Network analysis revealed that BCHE, SRD5A2, EPHX2, ADH1C, ADH1A and CDK1 were the key targets of CKI in the treatment of HCC. Among them, only CDK1 was highly expressed in HCC tissues, while the other 5 targets were lowly expressed. Furthermore, the six hub genes were all closely related to the prognosis of HCC patients in survival analysis. Molecular docking revealed that there was an efficient binding potential between the constituents of CKI and BCHE. Experiments in vitro proved that CKI inhibited the proliferation of HepG2 cells and up-regulated SRD5A2 and ADH1A, while down-regulated CDK1 and EPHX2.

Conclusions

This study revealed and verified the targets of CKI on HCC based on network pharmacology and experiments and provided a scientific reference for further mechanism research.
A treatment recommender clinical decision support system for personalized medicine: method development and proof-of-concept for drug resistant tuberculosis
Authors: Verboven Lennert , Calders Toon , Callens Steven , Black John , Maartens Gary , Dooley Kelly E. , Potgieter Samantha , Warren Robin M. , Laukens Kris , Van Rie Annelies
Published: March 2022

Background

Personalized medicine tailors care based on the patient’s or pathogen’s genotypic and phenotypic characteristics. An automated Clinical Decision Support System (CDSS) could help translate the genotypic and phenotypic characteristics into optimal treatment and thus facilitate implementation of individualized treatment by less experienced physicians.

Methods

We developed a hybrid knowledge- and data-driven treatment recommender CDSS. Stakeholders and experts first define the knowledge base by identifying and quantifying drug and regimen features for the prototype model input. In an iterative manner, feedback from experts is harvested to generate model training datasets, machine learning methods are applied to identify complex relations and patterns in the data, and model performance is assessed by estimating the precision at one, mean reciprocal rank and mean average precision. Once the model performance no longer iteratively increases, a validation dataset is used to assess model overfitting.

Results

We applied the novel methodology to develop a treatment recommender CDSS for individualized treatment of drug resistant tuberculosis as a proof of concept. Using input from stakeholders and three rounds of expert feedback on a dataset of 355 patients with 129 unique drug resistance profiles, the model had a 95% precision at 1 indicating that the highest ranked treatment regimen was considered appropriate by the experts in 95% of cases. Use of a validation data set however suggested substantial model overfitting, with a reduction in precision at 1 to 78%.

Conclusion

Our novel and flexible hybrid knowledge- and data-driven treatment recommender CDSS is a first step towards the automation of individualized treatment for personalized medicine. Further research should assess its value in fields other than drug resistant tuberculosis, develop solid statistical approaches to assess model performance, and evaluate their accuracy in real-life clinical settings.
Increased BMSC exosomal miR-140-3p alleviates bone degradation and promotes bone restoration by targeting Plxnb1 in diabetic rats
Authors: Wang Ning , Liu Xuanchen , Tang Zhen , Wei Xinghui , Dong Hui , Liu Yichao , Wu Hao , Wu Zhigang , Li Xiaokang , Ma Xue , Guo Zheng
Published: March 2022

Background

Diabetes mellitus (DM) is considered to be an important factor for bone degeneration disorders such as bone defect nonunion, which is characterized by physical disability and tremendous economy cost to families and society. Exosomal miRNAs of BMSCs have been reported to participate in osteoblastogenesis and modulating bone formation. However, their impacts on the development of bone degeneration in DM are not yet known. The role of miRNAs in BMSCs exosomes on regulating hyperglycemia bone degeneration was investigated in the present study.

Results

The osteogenic potential in bone defect repair of exosomes derived from diabetes mellitus BMSCs derived exosomes (DM-Exos) were revealed to be lower than that in normal BMSCs derived exosomes (N-Exos) in vitro and in vivo. Here, we demonstrate that miR-140-3p level was significantly altered in exosomes derived from BMSCs, ADSCs and serum from DM rats. In in vitro experiments, upregulated miR-140-3p exosomes promoted DM BMSCs differentiation into osteoblasts. The effects were exerted by miR-140-3p targeting plxnb1, plexin B1 is the receptor of semaphoring 4D(Sema4D) that inhibited osteocytes differentiation, thereby promoting bone formation. In DM rats with bone defect, miR-140-3p upregulated exosomes were transplanted into injured bone and accelerated bone regeneration. Besides, miR-140-3p in the exosomes was transferred into BMSCs and osteoblasts and promoted bone regeneration by targeting the plexin B1/RohA/ROCK signaling pathway.

Conclusions

Normal-Exos and miR-140-3p overexpressed-Exos accelerated diabetic wound healing by promoting the osteoblastogenesis function of BMSCs through inhibition plexin B1 expression which is the receptor of Sema4D and the plexin B1/RhoA/ROCK pathway compared with diabetes mellitus-Exos. This offers a new insight and a new therapy for treating diabetic bone unhealing.

Graphical Abstract
The Faith, Activity, and Nutrition (FAN) dissemination and implementation study: changes in and maintenance of organizational practices over 24 months in a statewide initiative
Authors: Wilcox Sara , Day Kelsey R , Saunders Ruth P , Jake-Schoffman Danielle E , Kaczynski Andrew T , Stucker Jessica , Dunn Caroline G , Bernhart John A
Published: March 2022

Background

Few studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change.

Methods

Using a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component.

Results

PA and HE organizational practices increased over time (p < .0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies.

Conclusions

This study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time.

Trial registration

This study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016.
Women's strategies for managing domestic violence during pregnancy: a qualitative study in Iran
Authors: Amel Barez Malikeh , Babazadeh Raheleh , Latifnejad Roudsari Robab , Mousavi Bazaz Mojtaba , Mirzaii Najmabadi Khadigeh
Published: March 2022

Background

Domestic violence during pregnancy is a severe public health problem. Abused pregnant women are confronted with the threats posed by domestic violence. Pregnancy and protection of the unborn child could affect maternal strategies for managing violence. The purpose of this study was to explore Iranian women's strategies for managing domestic violence during pregnancy.

Methods

This qualitative study was conducted in October 2019 to June 2021 in Mashhad, Iran. Data were collected through individual semi structured interviews with 13 women who experienced perinatal domestic violence, two relatives and 24 related specialists as well as two focus group discussions with attendance of 20 abused mothers until the data saturation was achieved. Data were analyzed by the conventional content analysis approach of Graneheim and Lundman.

Results

The main themes "escape strategies" and "situation improvement strategies" were emerged as the result of data analysis. Escape strategies was comprised of three categories including concealment, passive dysfunctional behaviors and neutral behaviors to control maternal emotional distress. Situation improvement strategies was comprised of three categories including active self-regulation, protecting family privacy and help seeking to control violence.

Conclusion

Understanding the experience of managing domestic violence among pregnant women is essential to design evidence based violence prevention programs, which enable supportive healthcare and social systems to encourage abused mothers to use more effective strategies and seeking help to overcome domestic violence.
SSEA-4 positive dental pulp stem cells from deciduous teeth and their induction to neural precursor cells
Authors: Lopez-Lozano Ada Pricila , Arevalo-Niño Katiushka , Gutierrez-Puente Yolanda , Montiel-Hernandez Jose Luis , Urrutia-Baca Victor Hugo , Del Angel-Mosqueda Casiano , De la Garza-Ramos Myriam Angelica
Published: March 2022

Background

Stage-specific embryonic antigen-4 (SSEA-4) is a marker for the identification of multipotent embryonic cells. It is also positive in neuroepithelial cells, precursor neural cells (NPC), and human dental pulp cells. The aim of this study was to evaluate the potential morphodifferentiation and histodifferentiation to NPC of SSEA-4 positive stem cells from human exfoliated deciduous teeth (SHED).

Methods

A SHED population in culture, positive to SSEA-4, was obtained by magnetic cell separation. The cells were characterized by immunohistochemistry and flow cytometry. Subsequently, a neurosphere assay was performed in a medium supplemented with basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF); afterward, cells were neurodifferenciated with a neurobasal medium. Finally, indirect immunohistochemistry was performed to identify neuronal markers.

Results

The morphological and histological changes in the SSEA-4 positive SHEDs were observed after induction with epidermal and fibroblast growth factors in neurobasal culture medium. At the end of induction, the markers Nestin, TuJ-1, and GFAP were identified.

Conclusions

The findings show that SSEA-4 positive SHEDs have a behavior similar to neuronal precursor cells. Our findings indicate that the dental pulp of deciduous teeth is a promising source for regeneration therapies associated with neurodegenerative diseases or peripheral nerve alterations.
Exposure to marketing of breastmilk substitutes in Mexican women: Sources and scope
Authors: Hernández-Cordero Sonia , Vilar-Compte Mireya , Castañeda-Márquez Ana Cristina , Rollins Nigel , Kingston Gillian , Pérez-Escamilla Rafael
Published: March 2022

Background

Aggressive and unregulated marketing of breastmilk substitutes (BMS) results in increased child morbidity and mortality. Unregulated BMS marketing is a major public health concern because it encourages formula consumption at the expense of breastfeeding. This study aimed to identify the sources and characterize the nature of exposure to marketing of BMS among Mexican mothers of children under 18 months of age. As a secondary objective we explored potential association between exposure to BMS marketing and infant feeding practices.

Methods

Cross-sectional study, comprising a pre-piloted survey, was conducted between February 2020 to February 2021 with Mexican mothers of children under 18 months of age (n = 754), in two major cities in Mexico. Mothers were selected according to their current infant feeding practices (Breastfeeding only vs. Mixed feeding). We characterized the different BMS marketing sources and scope, and related them with infant feeding practices. In addition, we used logistic regression models to estimate the odds ratio for infant feeding practices by BMS marketing exposure or recommendation.

Results

Mothers reported different sources of exposure to BMS promotion, including BMS advertisements in diverse media channels (41.6%), recommendation by a healthcare professional and/or relative (76.2%), and receiving a BMS sample at a hospital (18.6%). By contrast, only 36.5% recalled hearing or seeing breastfeeding information the previous year. The odds of mixed feeding were substantially higher, compared to breastfeeding, when mothers were recommended to use a BMS by doctors/pediatricians (OR: 3.96, 95% CI: 2.00, 7.83). Having seen or heard breastfeeding information in the previous year was associated with a lower risk of mixed feeding compared to breastfeeding only (OR: 0.59, 95% CI: 0.35, 0.99).

Conclusions

Mexican mothers of young children in the metropolitan areas studied were highly exposed to BMS marketing and through different mass media channels and inter-personal sources. Health care professionals, particularly doctors/pediatricians, are a source of BMS promotion that are likely to have a strong influence on maternal decisions about infant feeding practices. There is an urgent need to protect mothers and their families against unregulated BMS promotion through mass media channels and directly by influential individuals, including health care providers.