bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractional Exhaled Nitric Oxide as a Marker of Mucosal Inflammation in Chronic Rhinosinusitis
Authors: Olonisakin Tolani F. , Moore John A. , Barel Stephanie , Uribe Bliss , Parker Dana M. , Bowers Eve M. R. , Nouraie Seyed M. , Wenzel Sally E. , Lee Stella E.
Published: March 2022

Background

Fractional exhaled nitric oxide (FeNO) is a cost-effective, noninvasive point-of-care test that has proven valuable in identifying patients with lower airway inflammation and predicting the likelihood of responsiveness to inhaled corticosteroid therapy in asthma. The utility of FeNO in upper airway disease, specifically in CRS, remains to be determined.

Objective

The goal of this study was to test whether FeNO could serve as a noninvasive marker of sinonasal mucosal inflammation in CRS patients.

Methods

FeNO was obtained using a nitric oxide analyzer (NIOX VERO) as well as nasal mucus, the 22-item Sinonasal Outcome Test (SNOT-22), University of Pennsylvania Smell Identification Test (UPSIT), and Lund-Kennedy endoscopic scores concurrently in 112 CRS patients. Nasal mucus was analyzed for cytokine expression using solid-phase sandwich ELISA. Linear regression with Spearman correlation coefficient was used to determine strength of relationship between variables.

Results

CRS patients showed elevated FeNO levels with asthma (47.12 ± 5.21 ppb) or without asthma (43.24 ± 9.810 ppb). Elevated FeNO levels correlated with sinonasal mucosal inflammation, as determined by increased levels of CCL26 and TNFα in nasal mucus obtained from CRS patients. Furthermore, elevated FeNO levels selectively correlated with worsened SNOT-22 nasal symptoms (P = 0.03) and Lund-Kennedy endoscopic scores (P = 0.007), but did not correlate with UPSIT scores.

Conclusions

FeNO levels correlated with increased sinonasal mucosal inflammation and symptom severity in CRS regardless of asthma status. FeNO measurements may serve as a quick and noninvasive marker in evaluating CRS patients.
Broadened Concepts of Harm Appear Less Serious
Authors: Dakin Brodie C. , McGrath Melanie J. , Rhee Joshua J. , Haslam Nick
Published: March 2022

Harm-related concepts have progressively broadened their meanings to include less severe phenomena, but the implications of this expansion are unclear. Across five studies involving 1,819 American participants recruited on MTurk or Prolific, we manipulated whether participants learned about marginal, prototypical (severe), or mixed examples of workplace bullying (Studies 1 and 3a), trauma (Studies 2 and 3b), or sexual harassment (Study 4). We hypothesized that exposure to marginal examples of a concept would lead participants to view the harm associated with it as less serious than those exposed to prototypical examples ( trivialization hypothesis). We also predicted that mixing marginal examples with prototypical examples would disproportionately reduce perceived seriousness ( threshold shift hypothesis). All studies supported the trivialization hypothesis, but threshold shift was not consistently supported. Our findings suggest that broadened concepts of harm may dilute the perceived severity and urgency of the harms they identify.
Learning whiplash: Chinese College EFL learners’ perceptions of sudden online learning
Authors: Barnhart Christopher R , Li Luna , Thompson Jerry
Published: March 2022

As coronavirus disease 2019 swept through mainland China, students were forced to quickly switch to learning online. This study aimed to capture college Chinese English as a Second/Foreign Language (ESL/EFL) learners’ perceptions of rapidly switching to online learning at two colleges in China’s southern Guangdong Province. A bilingual (Chinese/English) online survey was used to collect data. The participants ( n = 504) responded to a survey about their feelings and perceptions of sudden online learning, a term the authors call “learning whiplash.” We asked students about how much they liked online at the beginning of learning online, how long students have been taking online courses, and how many online courses the students were currently taking. We also asked about the students’ perceptions of the quality of online learning when compared to physical learning. Finally, we asked students about getting drowsy and/or falling asleep during their online classes. We found that students were taking on average five to seven online courses and that they did not like learning online early in the epidemic. Our study confirmed that students preferred a hybrid learning environment. Seventy-nine percent of students admitted to getting drowsy and/or falling asleep during their online classes. Specific suggestions are given for teachers to keep students active and engaged in online learning. Practical guidance and strategies for creating vibrant online learning environments are provided. This research informs both the communities on online and e-learning as well as ESL/EFL teaching.
Does digital advertising affect vote choice? Evidence from a randomized field experiment
Authors: Coppock Alexander , Green Donald P. , Porter Ethan
Published: March 2022

Despite the increasing sums devoted to online political advertising, our understanding of the persuasive effects of such advertising is limited. We report the results of a ZIP code level randomized field experiment conducted over Facebook and Instagram during the 2018 U.S. midterm elections in Florida. The ads, produced by a Democratic-leaning political action committee, were designed to spur Democratic vote share and were seen more than 1.1 million times with over 100,000 full views. This wide saturation notwithstanding, we find that these advertisements had very small estimated effects on Democratic vote share at the precinct level (−0.04 percentage points, SE: 0.85 points). Our results underline the challenges of political persuasion via digital advertisements, particularly in competitive electoral contexts.
A new path to address health disparities: How older Aboriginal & Torres Strait Islander women use social media to enhance community health (Protocol)
Authors: Henson Connie , Rambaldini Boe , Carlson Bronwyn , Wadolowski Monika , Vale Carol , Gwynne Kylie
Published: March 2022

Background

Digital health offers a fresh avenue to address health disparities experienced by Aboriginal and Torres Strait Islanders. Despite the scant evidence about how Aboriginal and Torres Strait Islanders access and use health technology, the Australian government has prioritised research that uses technology to enable people to manage their health and promote better health outcomes. Older Aboriginal and Torres Strait Islander women are cultural leaders in their communities, enabling them to provide valuable insights about the safety and efficacy of health care messaging. However, no research has engaged older Aboriginal and Torres Strait Islander, women as partners in digital health research.

Objective

This paper provides a protocol for co-designed translational research that privileges older Aboriginal & Torres Strait Islander women’s cultural expertise to design and test a framework for accessible, culturally safe and feasible digital health technologies.

Methods

This mixed-methods research project will use the collective impact approach, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology. A series of yarning circles with three different communities will elucidate enablers and barriers to access health information; co-create a framework clarifying what works and does not work for digital health promotion in their communities; and test the framework by co-creating three digital health information programs.

Conclusions

Privileging the cultural expertise of older Aboriginal and Torres Strait Islander women will provide a novel perspective and vital guidance that end users and developers can trust and rely upon to create and evaluate culturally safe and efficacious digital health promotion programs.
Centrifugal Pump Generates Superior Hemodynamic Performance Compared to a new Diagonal Blood Pump in Neonatal and Pediatric ECMO Circuits
Authors: Patel Krishna , Ündar Akif
Published: March 2022

Purpose

With newer generation diagonal and centrifugal blood pumps gaining popularity, the objective of this study was to compare the DP3-i-cor diagonal and RotaFlow centrifugal pumps in terms of hemodynamic performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits.

Description

The DP3-i-cor diagonal pump is a part of the newly FDA-approved NovaLung system. The experimental circuit consisted of either the DP3-i-cor diagonal or RotaFlow centrifugal pump, a polymethylpentene membrane oxygenator, neonatal and pediatric arterial/venous cannulae, and 1/4-inch ID tubing. Three circuits were tested using combinations of either the DP3-i-cor or RotaFlow pump and varying arterial/venous cannulae sizes. Real-time pressure and flow data were collected.

Evaluation

The new DP3-i-cor diagonal pump exhibited lower flow rate and pressure head when compared to the RotaFlow centrifugal pump at similar rotational speeds and identical experimental conditions. Large-caliber arterial cannulae expectedly generated higher flow rates and pressures.

Conclusions

The RotaFlow centrifugal pump demonstrated superior hemodynamic performance when compared to the DP3-i-cor diagonal pump in simulated neonatal and pediatric ECMO circuits. Translational research of all ECMO components is crucial.
Major Aortopulmonary Collateral Arteries Requiring Percutaneous Intervention Following the Arterial Switch Operation: A Case Series and Systematic Review
Authors: Doulamis Ilias P. , Marathe Supreet P. , Oh Nicholas A. , Saeed Mossab Y. , Muter Angelika , del Nido Pedro J. , Nathan Meena
Published: March 2022

Background: Dextro transposition of the great arteries (d-TGA) is the most common critical congenital cardiac defect surgically treated in the neonatal period by arterial switch operation (ASO). Major aortopulmonary collaterals (MAPCAs) can be present in this population and may complicate the early postoperative period. Our aim was to review our institutional data and systematically review the available literature to provide further insight on the clinical significance of MAPCAs during the early postoperative course after ASO. Methods: This is a retrospective study of patients with simple d-TGA who underwent ASO between March 1998 and September 2020 at Boston Children's Hospital. The MEDLINE, Embase, and Cochrane databases were searched from inception to June 2020. Results: Of the 671 d-TGA patients who underwent ASO at our center, 13 (1.9%) were diagnosed with MAPCAs. Five were diagnosed before ASO, while eight were diagnosed after ASO. Of these, two patients required catheterization for MAPCAs coiling during the same hospitalization on the 2nd and 11th postoperative days. The systematic review retrieved a total of 34 articles after duplicates were removed. Finally, nine studies reporting on 23 patients were deemed eligible for our analysis. The average time to MAPCAs coiling was 12 days, while the mean hospital stay was 36 days. Conclusions: MAPCAs should be included in the differential diagnosis of ASO complicated by cardiac or respiratory failure, or pulmonary hemorrhage acutely postoperatively. Once managed, recovery of these patients is predictable, and mortality is low. Further studies investigating the diagnostic value of echocardiography and the long-term outcomes of these MAPCAs are necessary.
Outcomes Following Aortic Valve Replacement in Children With Conotruncal Anomalies
Authors: Alsoufi Bahaaldin , Knight Jessica H. , St. Louis James , Raghuveer Geetha , Kochilas Lazaros
Published: March 2022

Objective

Conotruncal anomalies can develop aortopathy and/or aortic valve (AV) disease and AV replacement (AVR) is occasionally needed. We report long-term results and examine factors affecting survival following AVR in this group.

Methods

We queried the Pediatric Cardiac Care Consortium (PCCC, US database for interventions for congenital heart diseases) to identify patients with repaired conotruncal anomalies and AVR. Long-term outcomes were provided by the PCCC, the US National Death Index, and Organ Procurement and Transplantation Network. Competing risks analysis examined outcomes following AVR (death/transplantation, reoperation) and multivariable regression analysis assessed significant factors.

Results

One hundred six children with repaired conotruncal anomalies underwent AVR (1982-2003). Underlying anomaly was truncus (n = 40), d-transposition (n = 22), type-B interrupted arch (n = 16), double-outlet right ventricle (n = 12), pulmonary atresia with ventricular septal defect (n = 9), tetralogy of Fallot (n = 6), corrected transposition (n = 1). 18 (17%) had prior aortic valvuloplasty (surgical = 12, percutaneous = 6). Median age at AVR was 6.9 years (interquartile range = 2.5-12.4). AV pathophysiology was regurgitation (n = 83, 78%), stenosis (n = 9, 9%), and mixed (n = 14, 15%). AVR type was mechanical (n = 72, 68%), homograft (n = 21, 20%), and Ross (n = 13, 12%). Operative mortality was 13(12%). Infant age at AVR was risk factor (odds ratio = 55, 95% confidence interval [CI] = 6-539, P = .0006). On competing risks analysis, five years after AVR, 6% died or received transplantation, 20% had reoperation. Twenty-five years transplant-free survival was 53%. Factors associated with death after hospital discharge included mitral surgery (hazards ratio [HR] = 11, 95% CI = 3-39, P = .0002), underlying defect (HR = 2, 95% CI = 1-5, P = .446). Twenty years transplant-free survival in conotruncal anomalies group was inferior to matched children undergoing AVR for congenital non-conotruncal disease (61% vs 82%, P = .0012).

Conclusions

Long-term survival following AVR in children with conotruncal anomalies is inferior to that of isolated congenital AV disease and is linked to an underlying cardiac defect. Although valve type was not associated with survival, infant age was a risk factor for operative mortality. Continuous attrition and high reoperation warrant vigilant monitoring.
Stent Angioplasty for Post-Operative Coronary Artery Stenosis in Infants
Authors: Chaszczewski Kasey J. , Nicholson George T. , Shahanavaz Shabana , Dori Yoav , Gillespie Matthew J. , O’Byrne Michael L. , Rome Jonathan J. , Glatz Andrew C.
Published: March 2022

Introduction

While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA.

Methods

A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed.

Results

Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent.

Conclusion

CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.
Whole Health in the Veterans Health Administration
Authors: Kligler Benjamin
Published: March 2022

The Whole Health System being developed and implemented at the Veterans Health Administration is an approach to care which aims to shift the discussion from "What's the Matter With You?" to "What Matters to You?" This article describes some of the progress and future challenges in the implementation of this approach across the VHA.
The Impacts of Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dysplasia (APECED) on the Oral Health of Children and Young People: A Review and Case Report
Authors: Graham Anna , Javidi Hanieh , Stern Melanie , Rogers Helen J.
Published: March 2022

Aim:

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare, highly variable disease with significant oral health impacts. The aim of the study is to examine the existing evidence base surrounding the oral health impacts of APECED and consider the wider clinical significance of the condition relevant to the provision of pediatric dental care.

Materials and Methods:

The evidence surrounding APECED and the oral health impacts obtained from a review of multiple databases was qualitatively summarized in the form of a literature review. A case study was used to illustrate the relevance of literature in caring patients with APECED.

Results:

The literature describes a broad range of impacts from APECED, although it is characterized by chronic candidal infection, autoimmune hypoparathyroidism, and Addison’s disease. Oral manifestations of APECED appear frequently and can present early. Developmental defects of the teeth affect a large proportion of patients with APECED and together with candidiasis, characterize the key oral manifestations of the disease. An enhanced preventive and minimally invasive approach to oral health care is recommended for these patients in light of the complexities of their medical condition.

Conclusion:

Patients with APECED require careful multidisciplinary care to ensure that the optimal oral health outcomes are achieved.
Long-Term Correlates of Racially Diverse Schooling: Education, Wealth, and Social Engagement in Later Life
Authors: Reynolds John R. , Carr Dawn C.
Published: March 2022

Racially diverse educational settings yield various benefits according to past research. However, researchers have not fully considered how longlasting the benefits are and whether they exist for adults who attended school prior to the Civil Rights Act of 1964. We analyze a national sample of older adults born between 1931 and 1953 to test for an association between attending a race discordant school in early life and socioeconomic status and social engagement in later life. We use OLS regression and propensity adjusted regression to account for early life factors that select children into race discordant schools. Findings indicate that race discordant schooling is associated with long-term educational benefits for Hispanic adults and greater wealth for Black adults at age 65. Attending a race discordant school was not correlated with socioeconomic outcomes in later life for Whites. Additionally, Black and White older adults who attended discordant schools reported higher levels of social engagement at age 65. To the extent our models successfully account for selection, early exposure to race discordant schools yielded some later-life benefits to all racial/ethnic groups and reduced racial/ethnic inequalities among older adults, despite growing up in a time of entrenched institutional racism and significant White opposition to school integration.
The Evolution of Turkey’s ‘South Asia Policy’: Continuities and Ruptures in Outlook, Roles, Actors and Constraints
Authors: Aslan Ömer
Published: March 2022

Turkey’s South Asia policy remains an underexplored area of research in Turkish foreign policy literature despite a rich history of Turkish activism in the region. While bringing to surface Turkey’s perception of South Asia, this article utilises insights from foreign policy analysis literature to make sense of international and domestic drivers behind Turkey’s South Asia policies during and after the Cold War. Using primary resources drawn from Turkish, American, Indian and Australian archives, memoirs by retired Turkish generals and diplomats, and interviews the author conducted with retired Turkish diplomats serving previously as ambassadors to New Delhi and Islamabad, the article argues that Turkey has felt most motivated to be involved in the region when encouraged by and had the ability to coordinate its policies with its western partners. I highlight Turkey’s mediation missions in inter- and intra-state disputes in the region, attempts to shift its South Asia policy and discuss Turkey’s approach to various hot conflicts within and between states in the region. I finally provide the place of South Asia in Turkey’s recent ‘Asia Anew Initiative’ and seek to explain an actor-based evolution of Turkey’s South Asia policy under the AKP governments over the last two decades.
Lessons Learned from the Preimplementation Phase of an Oral Health Care Project
Authors: Murray J. , Hunter S.C. , Splawinski Z. , Conroy T.
Published: March 2022

Implementation research aims to improve uptake of evidence-based interventions into health care practice and policy, but conducting such research can be complex. This brief report discusses the intentions of the research team versus the reality faced when conducting the preimplementation phase of a project aiming to improve adherence to best-practice oral health care in a hospital geriatric unit. Using our project as an example, our aim is to provide researchers with an insight into potential hurdles they may also face and strategies that could be employed to overcome these. During the preimplementation stage, it is important to take sufficient time to ensure that the local site is ready and motivated for the proposed change and committed to the shared goal. Explicit delineation of roles of facilitators is needed. Contextual circumstances will always change, and additional support or resources might be required to navigate them. A flexible mind-set is required as goals and strategies may need to be renegotiated along the way. The success and effectiveness of implementation projects are often built from the time and relationship building invested in the preimplementation phase.

Knowledge Transfer Statement:

This commentary highlights that effective implementation of best-practice oral health care in acute geriatric units is built on the time and relationship building invested in the preimplementation phase.
Medical Student Portfolios: A Systematic Scoping Review
Authors: Tan Rei , Qi Ting Jacquelin Jia , Zhihao Hong Daniel , Sing Lim Annabelle Jia , Ong Yun Ting , Pisupati Anushka , Xin Chong Eleanor Jia , Chiam Min , Inn Lee Alexia Sze , Shuen Tan Laura Hui , Chew Chin Annelissa Mien , Wijaya Limin , Fong Warren , Radha Krishna Lalit Kumar
Published: March 2022

Phenomenon

Medical Student Portfolios (MSP)s allow medical students to reflect and better appreciate their clinical, research and academic experiences which promotes their individual personal and professional development. However, differences in adoption rate, content design and practice setting create significant variability in their employ. With MSPs increasingly used to evaluate professional competencies and the student's professional identity formation (PIF), this has become an area of concern.

Approach

We adopt Krishna’s Systematic Evidence-Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on MSPs. The structured search process of six databases, concurrent use of thematic and content analysis in the Split Approach and comparisons of the themes and categories with the tabulated summaries of included articles in the Jigsaw Perspective and Funnelling Process offers enhanced transparency and reproducibility to this review.

Findings

The research team retrieved 14501 abstracts, reviewed 779 full-text articles and included 96 articles. Similarities between the themes, categories and tabulated summaries allowed the identification of the following funnelled domains: Purpose of MSPs, Content and structure of MSPs, Strengths and limitations of MSPs, Methods to improve MSPs, and Use of E-portfolios.

Insights

Variability in the employ of MSPs arise as a result of a failure to recognise its different roles and uses. Here we propose additional roles of MSPs, in particular, building on a consistent set of content materials and assessments of milestones called micro-competencies. Whislt generalised micro-competencies assess achievement of general milestones expected of all medical students, personalised micro-competencies record attainment of particular skills, knowledge and attitudes balanced against the medical student’s abilities, context and needs. This combination of micro-competencies in a consistent framework promises a holistic, authentic and longitudinal perspective of the medical student’s development and maturing PIF.
Housing Condition, Livelihood Pattern and Socio-cultural Life of Oraon, Munda and Santal Tribes in Dooars, Jalpaiguri District, West Bengal: The Migrants from Chota Nagpur Plateau Region
Authors: Deb Pamela
Published: March 2022

The Oraon, Munda and Santal are the three major Scheduled Tribes of the Jalpaiguri district of West Bengal. During the colonial period (mainly between 1880 and 1930), their arrival from the Chota Nagpur region to the Dooars region (Jalpaiguri district) took place by the British. In the present article, an attempt has been made to assess housing condition, livelihood pattern and socio-cultural life of the concerned tribes. For this purpose, 650 household surveys were carried out with the help of semi-structured questionnaire, focus group discussion, informal interviews and field visits. The study finds that, after being displaced from their homeland (Chota Nagpur Plateau region) and settled for long in the Jalpaiguri district, they undergone many changes in their habitat, economic condition and society, but it did not bring any improvement in their quality of life. The deplorable residence, lack of housing amenities and necessities, inadequate income, illiteracy, loosening of social organization are the major features presently prevalent among them.
Metal-Free Fixation for Free Bone-Block Reconstruction of Chronic Anteroinferior Shoulder Instability
Authors: Scheibel M. , Lorenz C. J.
Published: March 2022

Background:

Anterior shoulder instability is common and may cause a considerable effect on quality of life. For cases with glenoid bone loss, there is still a controversial discussion regarding the optimal treatment. Most of the recent methods are using metal implants to attach the needed graft to the glenoid with reported disadvantages such as metal impingement, damage to the humeral head, cartilage destruction, and premature arthritis.

Indications:

(1) Erosion-type defects with significant bone loss (>15%-20%); (2) chronic fragment-type defects if the size of the fragment is not large enough for an anatomical reconstruction; and (3) non-reconstructible, multifragmented acute fragment type of lesions.

Technique Description:

After placing the patient in a lateral decubitus position and fixing the arm in a traction devise, 3 arthroscopic entries are established: a posterior portal, an anterosuperior portal, and an anteroinferior portal. A harvested tricortical iliac crest bone graft is provided with 2 drilling holes which match the drilling holes through the glenoid. The tapes are then placed from the posterior to the anterior side of the glenoid, and then the graft is passed from the anterior to the posterior side, thus compressing the cancellous side of the bone block onto the glenoid defect. A following interconnection of the sutures creates a continuous loop. The end of the tapes was loaded into a pretied racking hitch knot system, which creates sliding knots between the 2 pair of tapes, whereon the knots can be reduced to the glenoid in a symmetrical fashion. Finally, the reconstruction of the anterosuperior labrum can be done, to cover the bone block with enough soft tissue.

Results:

First short-term results show radiographic consolidation after 3 months and an increased median glenoid estimated surface area at 12 months. The functional scores showed good outcomes, and there were no serious complications reported.

Discussion/Conclusion:

The presented arthroscopic reconstruction of the glenoid using a tricortical bone graft and high-strength fiber tapes provides a metal-free technique which results in a high primary stability of the construct and should therefore be considered when treating anterior shoulder instability with significant bone loss.
The effects of the probiotic cocktail on modulation of the NF-kB and JAK/STAT signaling pathways involved in the inflammatory response in bowel disease model
Authors: Aghamohammad Shadi , Sepehr Amin , Miri Seyedeh Tina , Najafi Saeideh , Rohani Mahdi , Pourshafiea Mohammad R.
Published: March 2022

Background

Probiotics positively affect inflammatory responses, in part, through Janus kinase/signal transduction and activator of transcription (JAK/STAT) and inflammatory signaling pathways. To evaluate the precise effects of probiotics as protective treatment, we aimed to investigate the effectiveness of Lactobacillus spp., Bifidobacterium spp., and a mixture of these probiotics in modulating the JAK/STAT and inflammatory signaling pathways.

Methods

A quantitative real-time polymerase chain reaction (qPCR) assay was used to analyze the expression of JAK/STAT and inflammatory genes (TIRAP, IRAK4, NEMO, and RIP) following HT-29 cell line treatment with sonicated pathogens Lactobacillus spp., Bifidobacterium spp., and a mixed cocktail. A cytokine assay was also used to evaluate the IL-6 and IL-1β production following the probiotic treatment.

Results

The probiotic cocktail downregulated the JAK genes and TIRAP, IRAK4, NEMO, and RIP genes in the NF-kB pathway compared to sonicate pathogen treatment cells. The expression of STAT genes was variable following probiotic treatment. The IL-6 and IL-1β production decreased after probiotic treatment.

Conclusions

Our probiotic cocktail showed anti-inflammatory effects on HT-29 cells by modulating JAK/STAT and NF-kB pathways. Therefore, Lactobacillus spp. and Bifidobacterium spp. probiotics as nutritional supplements may reduce inflammation-associated diseases such as inflammatory bowel disease (IBD).
A competing risk analysis of colorectal cancer recurrence after curative surgery
Authors: Schellenberg Angela E. , Moravan Veronika , Christian Francis
Published: March 2022

Background

This study examines the effect of prognostic patient and disease characteristics on colorectal cancer (CRC) recurrence after curative resection. We used competing risk analysis with death as a competing risk. This method provides the clinician a perspective into a patient’s actual risk of experiencing a recurrence.

Methods

A retrospective cohort study of patients diagnosed with CRC who underwent curative resection for CRC from 2003–2007 at the Royal University Hospital in Saskatoon was completed. The outcome of interest was the first CRC recurrence, either local or distant metastasis. Demographic data, tumor characteristics, adjuvant treatment and follow-up data, date of local recurrence or metastasis were recorded from the medical record. Univariate analysis was completed to look at the relationship between each of the prognostic indicators and recurrence. Multivariable modelling (subdistribution regression modelling) was done to identify the main risk factors in determining recurrence.

Results

Of 148 patients, 38 (25.7%) experienced a recurrence, 16 (10.8%) died without evidence of recurrence, and 94 (63.5%) experienced neither outcome. The median follow-up was 30.5 months (interquartile range 10.6–50). In univariable subdistribution regression, T-stage, N-stage, vascular invasion and positive margins were all predictive of cancer recurrence, with p ≤ 0.001, with subdistribution hazard ratios for T4 stage at 11.93, T3 stage at 2.46, N2 stage at 10.58, and presence of vascular invasion at 4.27. N-stage remained as the sole predictor in multivariable regression. Cumulative incidence function (CIF) of recurrence at 48 months after surgery was 15%, 27% and 90% for N1/2, N3 and N4 respectively.

Conclusion

The highest CIF of recurrence was associated with T4 stage, N2 stage, and vascular invasion. Patient’s age, tumour location, type, or histological grade were not found to have a significant effect on the success of CRC surgery in precluding a recurrence.
Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography
Authors: Lin Meng-Ying , Lee Chun-Te , Hsieh Ming-Tsung , Ou Ming-Ching , Wang Yao-Shen , Lee Meng-Chieh , Chang Wei-Lun , Sheu Bor-Shyang
Published: March 2022

Background

The current guideline recommends patients who meet high probability criteria for choledocholithiasis to receive endoscopic retrograde cholangiopancreatography (ERCP). However, adverse events can occur during ERCP. Our goal is to determine whether endoscopic ultrasound (EUS) before ERCP can avoid unnecessary ERCP complications, especially in patients with a negative CT scan.

Methods

A total of 604 patients with high probability of choledocholithiasis were screened and 104 patients were prospectively enrolled. Patients with malignant biliary obstruction, altered GI anatomy, and choledocholithiasis on CT scan were excluded. Among them, 44 patients received EUS first, and ERCP if choledocholithiasis present (EUS-first group). The other 60 patients received ERCP directly (ERCP-first group). The baseline characteristics, presence of choledocholithiasis, and complications were compared between groups. All patients were followed for 3 months to determine the difference in recurrent biliary event rate. Cost-effectiveness was compared between the two strategies.

Results

There was no marked difference in age, sex, laboratory data, presenting with pancreatitis, and risk factors for choledocholithiasis. Overall, 51 patients (49.0%) had choledocholithiasis, which did not justify the risk of direct ERCP. In the EUS-first group, 27 (61.4%) ERCP procedures were prevented. The overall complication rate was significantly lower in the EUS-first group compared to the ERCP-fist group (6.8% vs. 21.7%, P = 0.04). The number-needed-to-treat to avoid one unnecessary adverse event was 6.71. After a 3-month follow-up, the cumulative recurrence biliary event rates were similar (13.6% vs. 15.0%, P = 0.803). EUS-first strategy was more cost-effective than the ERCP-first strategy (mean cost 2322.89$ vs. 3175.63$, P = 0.002).

Conclusions

In high-probability choledocholithiasis patients with a negative CT, the EUS-first strategy is cost-effective, which can prevent unnecessary ERCP procedures and their complications.
The mediation role of sleep quality in the relationship between cognitive decline and depression
Authors: Liu Xiaolei , Xia Xin , Hu Fengjuan , Hao Qiukui , Hou Lisha , Sun Xuelian , Zhang Gongchang , Yue Jirong , Dong Birong
Published: March 2022

Objectives

Associations between cognitive decline and depression have been inconclusive. We examined 1) whether sleep quality mediates these relationships and 2) which factor of sleep quality mediates these relationships.

Methods

This study utilized baseline data from the 2018 West China Health and Aging Trend study (WCHAT), a large cohort data-set that including participants aged over 50 years old. We defined depression using the 15-item Geriatric Depression Scale (GDS-15). Cognitive status was measured using the Short Portable Mental Status Questionnaire (SPMSQ) and sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Direct relationships between cognitive decline, sleep quality and depression were assessed using multiple linear regression. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of specific aspects of sleep (e.g., quality, duration) in the relationship between cognitive decline and depression.

Results

Of 6828 participants aged 50 years old or older, the proportion of depression was 17.4%. Regression analysis indicated a total association between cognitive scores (β = 0.251, 95% CI 0.211 to 0.290, p < 0.001) and depression status. After adjusted PSQI scores, the association between cognitive scores and depression status was still significant (β = 0.242, 95% CI 0.203 to 0.281, p < 0.001), indicating a partial mediation effect of sleep quality. Mediation analysis verified sleep quality partially mediate the associations between cognitive decline and depression (indirect effect estimate = 0.0308, bootstrap 95% CI 0.023 to 0.040; direct effect estimate = 0.3124, bootstrap 95% CI 0.269 to 0.350). And daytime dysfunction had a highest mediation effect with a proportion of mediation up to 14.6%.

Conclusions

Sleep quality partially mediated the relationship between cognitive decline and depression. Daytime dysfunction had a highest mediation effect. Further research is necessary to examine the effects of sleep quality on the relationship of cognitive decline and depression.
Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment – results from the randomised controlled study CGA-Swed
Authors: Wilhelmson Katarina , Andersson Hammar Isabelle , Westgård Theresa , Holmquist Henrikson Lena , Dahlin-Ivanoff Synneve
Published: March 2022

Background

Today’s acute hospital care is poorly adapted to the complex needs of frail older people. This exposes them to avoidable risks, such as loss of functional capacities, leading to unnecessary health and social care needs. Being frail and in need of acute hospital care often leads to higher dependence in Activities of Daily Living (ADL), especially if one’s needs are not acknowledged. Comprehensive Geriatric Assessment (CGA) is one way to meet frail older people’s complex needs. The study’s aim was to investigate the effects on frail older people’s ADL 12 months after receiving CGA.

Methods

This is a two-armed randomised controlled intervention study. Participants were frail older people (75+) who sought the emergency department and needed admission to a medical ward. The intervention was CGA performed at a geriatric management unit during the hospital stay. The CGA included comprehensive assessment of medical, functional, psychological, social, and environmental status as well as treatment, rehabilitation, discharge planning, and follow-up. Multidisciplinary teamwork and a person-centred approach were used. The control was care at an ordinary medical hospital ward. The primary outcome was change in dependence in ADL from 2 weeks before admission to the 12-month follow-up.

Results

At admission, 155 people participated (77 in the control, 78 in the intervention). At the 12-month follow-up, 78 participated (40 in the control, 38 in the intervention). Attrition was mainly due to mortality. Four participants in the control (5.2%) and twelve in the intervention group (15.4%) had improved in their ADL 1 year after discharge (OR = 3.32; 95% CI = 1.02–10.79).

Conclusions

In-hospital CGA performed at a geriatric management unit improves frail older people’s ADL. Being less dependent in ADL increases frail older people’s ability to remain in their own housing, which is important for both the individual and society.

Trial registration

ClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.
Visceral disseminated varicella zoster infection: a rare cause of acute abdomen in a patient with well-controlled diabetes mellitus—a case report
Authors: Mizu Daisuke , Nishida Haruka , Matsuoka Yoshinori , Ariyoshi Koichi
Published: March 2022

Background

Visceral disseminated varicella zoster virus (VZV) infections frequently affect immunocompromised patients. Diabetes mellitus has been associated with VZV infection, and most cases of disseminated infection involve patients with poorly controlled blood glucose levels. It initially presents as severe abdominal pain, which is evaluated as an acute abdomen, however, the cause is typically unidentified due to unremarkable computed tomography (CT) findings. We report a case of visceral disseminated VZV infection in a patient with well-controlled diabetes mellitus with fat stranding around the celiac and superior mesenteric artery on CT.

Case presentation

A 61-year-old Japanese woman with well-controlled diabetes mellitus presented to the emergency department with severe abdominal pain that gradually worsened. She had stable vital signs and skin rashes, suggestive of varicella. Abdominal CT showed fat stranding around the celiac and superior mesenteric arteries. The patient tested positive for the VZV antigen and was diagnosed with a visceral disseminated VZV infection. Acyclovir was administered, and the patient was discharged on the 14th day.

Conclusions

Visceral disseminated VZV infection may affect patients with well-controlled diabetes mellitus and causes acute abdomen. Periarterial fat stranding on CT is associated with abdominal pain due to visceral disseminated VZV infection.
Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia
Authors: Tadesse Tsion , Assefa Nega , Roba Hirbo Shore , Baye Yohannes
Published: March 2022

Background

Induction of labor is a process of artificially initiating labor to attain vaginal birth. Despite its vital role in the reduction of maternal mortality, the failure rate of induction and its contributing factors were not well studied in Ethiopia; particularly there was a limited study in the study area. This study aimed to assess the prevalence and factors associated with failed induction of labor among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia.

Methods

An institution-based retrospective cross-sectional study was conducted among 743 women undergoing induction at University of Gondar Specialized Hospital. A systematic random sampling method was used to draw a sample and the data were retrieved from the maternity registration books and medical records. Data were cleaned and entered into EpiData version 3.1 and SPSS version 20 used for analysis. Frequencies, proportions, and summary statistics were used to describe the study population and a multivariable logistic regression model was fitted to identify factors contributing to failed induction of labor. Odds ratio with 95% confidence interval computed and level of significance declared at P-value< 5%.

Results

The prevalence of failed induction of labor was 24.4% (95% CI: 21.4, 27.9). Age ≤ 30 years (AOR = 3.7, 95% CI: 2.2,6.2), rural residence (AOR = 3.7, 95% CI: 2.4,5.8), being nulliparous (AOR = 2.1, 95% CI: 1.2,3.7), 5 or less Bishop Score (AOR = 3.4, 95% CI: 2.2,5.4), premature rupture of membrane (AOR = 2.7, 95% CI: 1.5,4.6), having pregnancy-induced hypertension (AOR = 4.0, 95% CI: 2.3,7.1), and artificial rupture of membrane with oxytocin (AOR = 0.2, 95% CI: 0.1, 0.4) were associated with failed induction of labor.

Conclusions

One-fourth of women undergoing induction at University of Gondar Specialized Hospital had failed induction of labor. Age, residence, parity, bishop score, premature-rupture of the membrane, pregnancy-induced hypertension, and method of induction were independent predictors for failed induction of labor. The combination method of ARM with oxytocin, early detection and treatment of pregnancy-induced hypertension and premature rupture of the membrane are highly recommended for reducing failed induction of labor.
Prognostic mutational subtyping in de novo diffuse large B-cell lymphoma
Authors: Kim Eugene , Jiang Yanwen , Xu Tao , Bazeos Alexandra , Knapp Andrea , Bolen Christopher R. , Humphrey Kathryn , Nielsen Tina G. , Penuel Elicia , Paulson Joseph N.
Published: March 2022

Background

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease defined using a number of well-established molecular subsets. Application of non-negative matrix factorization (NMF) to whole exome sequence data has previously been used to identify six distinct molecular clusters in DLBCL with potential clinical relevance. In this study, we applied NMF-clustering to targeted sequencing data utilizing the FoundationOne Heme® panel from the Phase III GOYA (NCT01287741) and Phase Ib/II CAVALLI studies (NCT02055820) in de novo DLBCL. Biopsy samples, survival outcomes, RNA-Seq and targeted exome-sequencing data were available for 423 patients in GOYA (obinutuzumab [G]-cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP] vs rituximab [R]-CHOP) and 86 patients in CAVALLI (venetoclax+[G/R]-CHOP).

Results

When the NMF algorithm was applied to samples from the GOYA study analyzed using a comprehensive genomic profiling platform, four of the six groups previously reported were observed: MYD88/CD79B, BCL2/EZH2, NOTCH2/TNFAIP3, and no mutations. Mutation profiles, cell-of-origin subset distributions and clinical associations of MYD88/CD79B and BCL2/EZH2 groups were similar to those described in previous NMF studies. In contrast, application of NMF to the CAVALLI study yielded only three; MYD88/CD79B-, BCL2/EZH2-like clusters, and a no mutations group, and there was a trend towards improved outcomes for BCL2/EZH2 over MYD88/CD79B.

Conclusions

This analysis supports the utility of NMF used in conjunction with targeted sequencing platforms for identifying patients with different prognostic subsets. The observed trend for improved overall survival in the BCL2/EZH2 group is consistent with the mechanism of action of venetoclax, suggesting that targeting sequencing and NMF has potential for identifying patients who are more likely to gain benefit from venetoclax therapy.
Prognostic value and immune relevancy of a combined autophagy-, apoptosis- and necrosis-related gene signature in glioblastoma
Authors: Bi Ying , Wu Zeng-Hong , Cao Fei
Published: March 2022

Background

Glioblastoma (GBM) is considered the most malignant and devastating intracranial tumor without effective treatment. Autophagy, apoptosis, and necrosis, three classically known cell death pathways, can provide novel clinical and immunological insights, which may assist in designing personalized therapeutics. In this study, we developed and validated an effective signature based on autophagy-, apoptosis- and necrosis-related genes for prognostic implications in GBM patients.

Methods

Variations in the expression of genes involved in autophagy, apoptosis and necrosis were explored in 518 GBM patients from The Cancer Genome Atlas (TCGA) database. Univariate Cox analysis, least absolute shrinkage and selection operator (LASSO) analysis, and multivariate Cox analysis were performed to construct a combined prognostic signature. Kaplan–Meier survival, receiver-operating characteristic (ROC) curves and Cox regression analyses based on overall survival (OS) and progression-free survival (PFS) were conducted to estimate the independent prognostic performance of the gene signature. The Chinese Glioma Genome Atlas (CGGA) dataset was used for external validation. Finally, we investigated the differences in the immune microenvironment between different prognostic groups and predicted potential compounds targeting each group.

Results

A 16-gene cell death index (CDI) was established. Patients were clustered into either the high risk or the low risk groups according to the CDI score, and those in the low risk group presented significantly longer OS and PFS than the high CDI group. ROC curves demonstrated outstanding performance of the gene signature in both the training and validation groups. Furthermore, immune cell analysis identified higher infiltration of neutrophils, macrophages, Treg, T helper cells, and aDCs, and lower infiltration of B cells in the high CDI group. Interestingly, this group also showed lower expression levels of immune checkpoint molecules PDCD1 and CD200, and higher expression levels of PDCD1LG2, CD86, CD48 and IDO1.

Conclusion

Our study proposes that the CDI signature can be utilized as a prognostic predictor and may guide patients’ selection for preferential use of immunotherapy in GBM.