bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat
Authors: Di Paolo Stefano , Agostinone Piero , Grassi Alberto , Lucidi Gian Andrea , Pinelli Erika , Bontempi Marco , Marchiori Gregorio , Bragonzoni Laura , Zaffagnini Stefano
Published: July 2021

Background:

Lateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion in daily life.

Purpose/Hypothesis:

The primary aim of the present study was to identify kinematic differences during the execution of an activity under weightbearing conditions between knees having undergone ACLR using anatomic single-bundle (SB) versus single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was to compare the postoperative kinematic data with those from the same knees before ACLR and from the healthy contralateral knees in order to investigate if ACLR was able to restore physiologic knee biomechanics during squat execution. The hypotheses were that (1) the SBLP technique would allow a better restoration of internal-external (IE) knee rotation than would SB and (2) regardless of the technique, ACLR would not fully restore physiologic knee biomechanics.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

In total, 32 patients (42 knees) were included in the study. Patients were asked to perform a single-leg squat before surgery (ACL-injured group, n = 32; healthy contralateral group, n = 10) and at minimum 18-month follow-up after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined using a validated model-based tracking process that matched patient-specific magnetic resonance imaging bone models to dynamic biplane radiographic images under the principles of roentgen stereophotogrammetric analysis. Data processing was performed using specific software. The authors compared IE and varus-valgus rotations and anterior-posterior and medial-lateral translations among the groups.

Results:

The mean follow-up period was 21.7 ± 4.5 months. No kinematic differences were found between the SB and SBLP groups ( P > .05). A more medial tibial position ( P < .05) of the ACL-injured group was reported during the entire motor task and persisted after ACLR in both the SB and the SBLP groups. Differences in IE and varus-valgus rotations were found between the ACL-injured and healthy groups.

Conclusion:

There were no relevant kinematic differences between SBLP and anatomic SB ACLR during the execution of a single-leg squat. Regardless of the surgical technique, ACLR failed in restoring knee biomechanics.

Registration:

NCT02323386 ( ClinicalTrials.gov identifier).
Listening Effort Is Not the Same as Speech Intelligibility Score
Authors: Winn Matthew B. , Teece Katherine H.
Published: July 2021

Listening effort is a valuable and important notion to measure because it is among the primary complaints of people with hearing loss. It is tempting and intuitive to accept speech intelligibility scores as a proxy for listening effort, but this link is likely oversimplified and lacks actionable explanatory power. This study was conducted to explain the mechanisms of listening effort that are not captured by intelligibility scores, using sentence-repetition tasks where specific kinds of mistakes were prospectively planned or analyzed retrospectively. Effort measured as changes in pupil size among 20 listeners with normal hearing and 19 listeners with cochlear implants. Experiment 1 demonstrates that mental correction of misperceived words increases effort even when responses are correct. Experiment 2 shows that for incorrect responses, listening effort is not a function of the proportion of words correct but is rather driven by the types of errors, position of errors within a sentence, and the need to resolve ambiguity, reflecting how easily the listener can make sense of a perception. A simple taxonomy of error types is provided that is both intuitive and consistent with data from these two experiments. The diversity of errors in these experiments implies that speech perception tasks can be designed prospectively to elicit the mistakes that are more closely linked with effort. Although mental corrective action and number of mistakes can scale together in many experiments, it is possible to dissociate them to advance toward a more explanatory (rather than correlational) account of listening effort.
Reparative accumulation? Financial risk and investment across socio-environmental crises
Authors: Cohen Dan , Nelson Sara , Rosenman Emily
Published: July 2021

With the growing global recognition that environmental and social crises are pushing systems of social and ecological reproduction to their breaking points, governments, philanthropists, and the private sector are proposing a variety of strategies that aim to shift the social and environmental role of finance capital from an extractive process to a reparative one. A frequent refrain is that only finance capital promises the scale of investment necessary to address Earth’s complex social and environmental problems, and that trillions of private investment dollars wait in the wings ready to mobilize for the right kinds of projects. A hallmark of these approaches is their promise of “triple bottom line” outcomes, with social, environmental, and financial benefits—what the industry refers to as “responsible investing.” This symposium interrogates the political dynamics and financial mechanisms underlying ongoing experiments in so-called responsible finance, including various forms of impact investing and financial “solutionism” to social and environmental problems. We develop the term “reparative accumulation” to conceptualize the divergent forms and continuities in how these new financial devices function across sectors, what types of futures the industry is attempting to create, the effects on socionatures, and what resistance might look like both within and outside these systems.
Changes in community clinicians’ attitudes and competence following a transdiagnostic Cognitive Behavioral Therapy training
Authors: Creed Torrey A , Crane Margaret E , Calloway Amber , Olino Thomas M , Kendall Philip C , Wiltsey Stirman Shannon
Published: July 2021

Background:

Although the literature suggests that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training.

Methods:

Community clinicians ( N = 891) received intensive training in cognitive behavioral therapy skills followed by 6 months of consultation. Clinician attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase).

Results:

Latent change models identified significant improvement in attitudes ( Mslatent change ⩾ 1.07, SEs ⩽ 0.19, zs ⩾ 6.85, ps < .001) and competence ( Mslatent change ⩾ 13.13, SEs ⩽ 3.53, zs ⩾ 2.30, ps < .001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop phase and across the full training ( bs ⩾ 1.58, SEs ⩽ 1.13, z ⩾ 1.89, p < .048, β ⩾ .09); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in the consultation phase ( b = 1.40, SE = 1.07, z = 1.31, p = .19, β = .08). Change in attitudes and change in competence in the training period, the workshop phase, and the consultation phase were not significantly correlated.

Conclusions:

Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in initial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence throughout consultation.

Plain Language Summary

Although previous research has suggested that a learner’s knowledge of evidence-based practices (EBPs) and their attitudes toward EBPs may be related, little is known about the association between a learner’s attitudes and their competence in delivering EBPs. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following training in an EBP. This study suggests that community clinicians’ initial attitudes about evidence-based mental health practices are related to how well they ultimately learn to deliver those practices. This finding suggests that future implementation efforts may benefit from directly targeting clinician attitudes prior to training, rather than relying on more broad-based training strategies.
Belumosudil for chronic graft-versus-host disease after 2 or more prior lines of therapy: the ROCKstar Study
Authors: Cutler Corey , Lee Stephanie J. , Arai Sally , Rotta Marcello , Zoghi Behyar , Lazaryan Aleksandr , Ramakrishnan Aravind , DeFilipp Zachariah , Salhotra Amandeep , Chai-Ho Wanxing , Mehta Rohtesh , Wang Trent , Arora Mukta , Pusic Iskra , Saad Ayman , Shah Nirav N. , Abhyankar Sunil , Bachier Carlos , Galvin John , Im Annie , Langston Amelia , Liesveld Jane , Juckett Mark , Logan Aaron , Schachter Levanto , Alavi Asif , Howard Dianna , Waksal Harlan W. , Ryan John , Eiznhamer David , Aggarwal Sanjay K. , Ieyoub Jonathan , Schueller Olivier , Green Laurie , Yang Zhongming , Krenz Heidi , Jagasia Madan , Blazar Bruce R. , Pavletic Steven
Published: July 2021

Belumosudil, an investigational oral selective inhibitor of Rho-associated coiled-coil–containing protein kinase 2 (ROCK2), reduces type 17 and follicular T helper cells via downregulation of STAT3 and enhances regulatory T cells via upregulation of STAT5. Belumosudil may effectively treat patients with chronic graft-versus-host disease (cGVHD), a major cause of morbidity and late nonrelapse mortality after an allogeneic hematopoietic cell transplant. This phase 2 randomized multicenter registration study evaluated belumosudil 200 mg daily (n = 66) and 200 mg twice daily (n = 66) in subjects with cGVHD who had received 2 to 5 prior lines of therapy. The primary end point was best overall response rate (ORR). Duration of response (DOR), changes in Lee Symptom Scale score, failure-free survival, corticosteroid dose reductions, and overall survival were also evaluated. Overall median follow-up was 14 months. The best ORR for belumosudil 200 mg daily and 200 mg twice daily was 74% (95% confidence interval [CI], 62-84) and 77% (95% CI, 65-87), respectively, with high response rates observed in all subgroups. All affected organs demonstrated complete responses. The median DOR was 54 weeks; 44% of subjects have remained on therapy for ≥1 year. Symptom reduction with belumosudil 200 mg daily and 200 mg twice daily was reported in 59% and 62% of subjects, respectively. Adverse events (AEs) were consistent with those expected in patients with cGVHD receiving corticosteroids and other immunosuppressants. Sixteen subjects (12%) discontinued belumosudil because of possible drug-related AEs. Belumosudil, a promising therapy for cGVHD, was well tolerated with clinically meaningful responses. This trial was registered at www.clinicaltrials.gov as #NCT03640481.
MitoTox: a comprehensive mitochondrial toxicity database
Authors: Lin Yu-Te , Lin Ko-Hong , Huang Chi-Jung , Wei An-Chi
Published: July 2021

Background

Mitochondria play essential roles in regulating cellular functions. Some drug treatments and molecular interventions have been reported to have off-target effects damaging mitochondria and causing severe side effects. The development of a database for the management of mitochondrial toxicity-related molecules and their targets is important for further analyses.

Results

To correlate chemical, biological and mechanistic information on clinically relevant mitochondria-related toxicity, a comprehensive mitochondrial toxicity database (MitoTox) was developed. MitoTox is an electronic repository that integrates comprehensive information about mitochondria-related toxins and their targets. Information and data related to mitochondrial toxicity originate from various sources, including scientific journals and other electronic databases. These resources were manually verified and extracted into MitoTox. The database currently contains over 1400 small-molecule compounds, 870 mitochondrial targets, and more than 4100  mitochondrial toxin-target associations. Each MitoTox data record contains over 30 fields, including biochemical properties, therapeutic classification, target proteins, toxicological data, mechanistic information, clinical side effects, and references.

Conclusions

MitoTox provides a fully searchable database with links to references and other databases. Potential applications of MitoTox include toxicity classification, prediction, reference and education. MitoTox is available online at http://www.mitotox.org.
Three-stage segmentation of lung region from CT images using deep neural networks
Authors: Osadebey Michael , Andersen Hilde K. , Waaler Dag , Fossaa Kristian , Martinsen Anne C. T. , Pedersen Marius
Published: July 2021

Background

Lung region segmentation is an important stage of automated image-based approaches for the diagnosis of respiratory diseases. Manual methods executed by experts are considered the gold standard, but it is time consuming and the accuracy is dependent on radiologists’ experience. Automated methods are relatively fast and reproducible with potential to facilitate physician interpretation of images. However, these benefits are possible only after overcoming several challenges. The traditional methods that are formulated as a three-stage segmentation demonstrate promising results on normal CT data but perform poorly in the presence of pathological features and variations in image quality attributes. The implementation of deep learning methods that can demonstrate superior performance over traditional methods is dependent on the quantity, quality, cost and the time it takes to generate training data. Thus, efficient and clinically relevant automated segmentation method is desired for the diagnosis of respiratory diseases.

Methods

We implement each of the three stages of traditional methods using deep learning methods trained on five different configurations of training data with ground truths obtained from the 3D Image Reconstruction for Comparison of Algorithm Database (3DIRCAD) and the Interstitial Lung Diseases (ILD) database. The data was augmented with the Lung Image Database Consortium (LIDC-IDRI) image collection and a realistic phantom. A convolutional neural network (CNN) at the preprocessing stage classifies the input into lung and none lung regions. The processing stage was implemented using a CNN-based U-net while the postprocessing stage utilize another U-net and CNN for contour refinement and filtering out false positives, respectively.

Results

The performance of the proposed method was evaluated on 1230 and 1100 CT slices from the 3DIRCAD and ILD databases. We investigate the performance of the proposed method on five configurations of training data and three configurations of the segmentation system; three-stage segmentation and three-stage segmentation without a CNN classifier and contrast enhancement, respectively. The Dice-score recorded by the proposed method range from 0.76 to 0.95.

Conclusion

The clinical relevance and segmentation accuracy of deep learning models can improve though deep learning-based three-stage segmentation, image quality evaluation and enhancement as well as augmenting the training data with large volume of cheap and quality training data. We propose a new and novel deep learning-based method of contour refinement.
The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China
Authors: Tang Di , Gao Xiangdong , Coyte Peter C.
Published: July 2021

Background

China has one of the world’s largest internal migrant populations. The Chinese Hukou system is a unique household registration system that limits internal migrants in their access to basic urban public services, such as public health insurance and social assistance of their host city. In the case of female internal migrants, this may lead to high-risk pregnancies. The objective of this study is to assess the relationship between internal migrant status (Hukou) and the likelihood of high-risk pregnancies that occur in one large municipal-level obstetrics hospital in Shanghai, China.

Methods

Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to May 31, 2018, were used to analyze 133,358 live births for Shanghai natives (n = 83,872) and internal migrant women (n = 49,486). A propensity score matching approach was used in conjunction with logistic regression analysis to identify the role of internal migrant status (Hukou) on the likelihood of high-risk pregnancies.

Results

A greater likelihood of high-risk pregnancies were found among internal migrant women who moved from other parts of China to Shanghai. This effect was more obvious for women who gave birth for the first time and internal migrant women who were employed.

Conclusion

The results show the effects of internal migrant status (Hukou) and the elevated likelihood of high-risk pregnancies among internal migrant women relative to their urban counterparts in Shanghai even after accounting for self-selection by employing the propensity score matching method. China’s unique Hukou household registration system limits access to public services for internal migrant women and accordingly may account for the elevated likelihood of high-risk pregnancies.
Predictive potential of Nomogram based on GMWG for patients with hepatocellular carcinoma after radical resection
Authors: Ren Liying , Chen Dongbo , Xu Wentao , Xu Tingfeng , Wei Rongyu , Suo Liya , Huang Yingze , Chen Hongsong , Liao Weijia
Published: July 2021

Background

Since it’s a challenging task to precisely predict the prognosis of patients with hepatocellular carcinoma (HCC). We developed a nomogram based on a novel indicator GMWG [(Geometric Mean of gamma-glutamyltranspeptidase (GGT) and white blood cell (WBC)] and explored its potential in the prognosis for HCC patients.

Methods

The patients enrolled in this study were randomly assigned to training and validation cohorts. And we performed the Least Absolute Shrinkage and Selection Operator proportional hazards model (LASSO Cox) model with clinical characteristics, serum indexes, and novel GMWG. Multivariate analysis was performed to build a nomogram. The performance of the nomogram was evaluated by C-index, the area under the receiver operating characteristic curve (AUC), and the calibration curve. Kaplan-Meier curves showed discrimination of the nomogram. Clinical utility was assessed by decision curve analysis (DCA). The discrimination ability of the nomogram was determined by the net reclassification index (NRI).

Results

The geometric mean of GGT and white WBC count (GMWG), neutrophil to lymphocyte ratio (NLR), and tumor size were significantly associated with the overall survival (OS). The variables above were used to develop the nomogram. The indexes of nomogram were 0.70 and 071 in the training or validation cohort, respectively. AUC of 1-, 3- and 5-year OS showed satisfactory accuracy as well. The calibration curve showed agreement between the ideal and predicted values. Kaplan-Meier curves based on the overall survival (OS) and disease-free survival (DFS) showed significant differences between nomogram predictive low and high groups. DCA showed clinical utilities while NRI showed discrimination ability in both training or validation cohort.

Conclusions

GMWG might be a potential prognostic indicator for patients with HCC. The nomogram containing GMWG also showed satisfaction prediction capacity.
Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients “case report”
Authors: Weiss David , Kertzscher Lisa , Degering Magdalena , Wozniak David , Kluge Michael
Published: July 2021

Background

Anti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications.

Case presentation

We report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange.

Conclusions

Continuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.
Female partner experiences of prostate cancer patients’ engagement with a community-based football intervention: a qualitative study
Authors: Midtgaard Julie , Tjørnhøj-Thomsen Tine , Rørth Mette , Kronborg Malene , Bjerre Eik D. , Oliffe John L.
Published: July 2021

Background

Prostate cancer is often labelled a couple’s disease wherein the partner plays an important role in the man’s illness management and related health promotion activities. The aim of this study was to explore partner experiences of prostate cancer patients’ engagement with a community-based football program.

Methods

Eight audio-visual recorded semi-structured focus group interviews were conducted with a total of 39 female partners of men with prostate cancer who participated in a community-based football program as part of the nationwide FC Prostate Community Trial (NCT02430792). Data was managed with the software program Nvivo 11 and analysed inductively to derive thematic findings.

Results

The four thematic findings were: 1) ‘Hope of a new beginning’ which included stories of hope that football would mitigate the negative effects of men’s prostate cancer treatment [s]; 2) ‘My new partner’ was characterized by attributing connections between physical activity and elevated mood as a by-product of men’s involvement in the program; 3) ‘Football first’ included assertions of the couples mutual commitment to the football program; and 4) ‘Invisible needs’ contrasted insecurity, and unforeseen challenges for partners feeling somewhat neglected. Overall, the results confirm the need for cohesion and flexibility amongst couple-dyads to ensure partners and men with prostate cancer benefit from their involvement in football programs.

Conclusions

This study indicates that partners of prostate cancer survivors’ engaging with community-based football align to idealized gender relations, roles and identities. In many instances, these gendered dimensions aided positive dyadic coping and long-term exercise adherence.
Comparison of digital subtraction angiography combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia
Authors: Ge Hongwei , Song Bin , Wang Xin , Zhu Yunfeng , Huang Yiming , Huang Weibin , Zhu Yongbin
Published: July 2021

Background

This study aimed to compare the clinical efficacy of digital subtraction angiography (DSA) combined arterial thrombectomy versus simple arterial thrombectomy in the treatment of acute lower limb ischemia (ALI).

Methods

This retrospective cohort study collected the clinical data from 124 patients (128 affected lower limbs) with ALI who underwent emergency surgery from March 2010 to November 2019. Patients were consecutively divided into Group A and Group B. Patients in Group A underwent simple arterial thrombectomy via the Fogarty catheterization. Patients in Group B underwent arterial thrombectomy, and the DSA was performed during the surgery. The differences in the success rate of primary surgery, the second intervention rate, and the amputation/mortality rate within 30-days after surgery were compared.

Results

In Group A, 4 of 70 limbs (5.7%) were amputated, 54 of 70 limbs (77.1%) had improved blood flow, 14 of 70 limbs (20.0%) received a second intervention, and 3 of 68 patients (4.4%) died within 30 days. In Group B, 1 of 58 limbs (1.7%) was amputated, 56 of 58 limbs (96.6%) had improved blood flow, 3 of 58 limbs (5.2%) received a second intervention, and 2 of 56 patients (3.5%) died within 30-days. The success rate of primary surgery, the second intervention rate, and the amputation rate of Group B were significantly lower than Group A (P < 0.05).

Conclusion

Arterial thrombectomy combined with DSA may effectively improve the clinical efficacy of patients with ALI.
Comparison of bacterial microleakage of three bioactive endodontic sealers in simulated underwater diving and aviation conditions
Authors: Dastorani Mehdi , Malekpour Behnam , AminSobhani Mohsen , Alemrajabi Mohammadsadegh , Mahdian Arezoo , Malekpour Behrooz
Published: July 2021

Background

Bacterial microleakage is an important cause of apical periodontitis and endodontic treatment failure. This study aimed to assess the bacterial microleakage of nano-mineral trioxide aggregate (nano-MTA) as a sealer, Endoseal MTA, and GuttaFlow Bioseal sealers in atmospheric pressure, and simulated underwater diving and aviation conditions.

Methods

In this in vitro, experimental study, 180 extracted single-rooted teeth were cleaned and shaped, and were then randomly divided into three groups for single-cone obturation using Endoseal MTA, GuttaFlow Bioseal, or nano-MTA as a sealer. Each group was then randomly divided into three subgroups, and subjected to ambient atmospheric pressure, 2 atm pressure (to simulate underwater diving), and 0.5 atm pressure (to simulate aviation) using a custom-made pressure chamber. The teeth then underwent microbial leakage test using Streptococcus mutans (S. mutans), and the percentage of samples showing microleakage was recorded for up to 1 month, and analyzed using the Chi-square test.

Results

The three sealer groups were significantly different regarding bacterial microleakage (P < 0.05). The nano-MTA group showed significantly higher microleakage after 15 days than the other two groups (P = 0.006). The effect of pressure on bacterial microleakage was not significant in any sealer group (P > 0.05).

Conclusion

Within the limitations of this in vitro study, it may be concluded that single-cone obturation technique using nano-MTA as a sealer results in lower resistance to bacterial microleakage compared with the use of GuttaFlow Bioseal, and Endoseal MTA. Pressure changes in simulated underwater diving and aviation conditions had no significant effect on bacterial microleakage.

Trial Registration NumberThis is not a human subject research.
Evaluation and comparison of oral function after resection of cancer of the upper gingiva in patients who underwent reconstruction surgery versus those treated with a prosthesis
Authors: Ohashi Yu , Shiga Kiyoto , Katagiri Katsunori , Saito Daisuke , Oikawa Shin-ichi , Tsuchida Kodai , Ikeda Aya , Miyaguchi Jun , Kusaka Takahiro , Yamada Hiroyuki
Published: July 2021

Background

We retrospectively analyzed the articulation, mastication, and swallowing function of patients who underwent reconstruction or used a prosthesis after resection of the upper gingiva.

Methods

This study included patients who underwent resection of cancer of the upper gingiva from January 2014 to December 2018. Articulatory function was evaluated with Hirose’s conversational function evaluation criteria. Mastication function was evaluated with the Yamamoto’s occlusion table. Swallowing function was assessed with the MTF (Method of intake, Time, Food) score.

Results

The mean articulatory function score was 8 points in the Reconstruction Surgery Group (RSG) and 8.8 points in the Prosthesis Group (PG). The mean mastication function score was 2.8 points in the RSG and 3.3 points in the PG. The mean swallowing function score was M3T4F4 in the RSG and M4T4F4.3 in the PG.

Conclusions

The prosthesis depends on the remaining occlusal support area. Our study suggest that prosthesis is better indication when there is more than one occlusal support area.
Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong
Authors: Wong Charlene Hoi Lam , Tse Jeffrey Van Ho , Nilsen Per , Ho Leonard , Wu Irene Xin Yin , Chung Vincent Chi Ho
Published: July 2021

Background

In response to the World Health Organization’s recommendation, policy makers have been adopting evidence-based healthcare approach to promote the development of traditional, complementary and integrative medicine (TCIM) into Hong Kong’s health system. Disseminating synopses of clinical evidence from systematic reviews or randomized trials is regarded as a potentially effective strategy to promote evidence uptake. The study aimed to identify barriers and facilitators to implementing this strategy among Hong Kong Chinese medicine practitioners (CMPs).

Methods

Twenty-five CMPs aged under 45 years and trained in Hong Kong after reunification with China in 1997 were interviewed individually. Four clinical evidence synopses of randomized trials and systematic reviews on Chinese medicine interventions were presented, and CMPs were asked to comment on their applicability in routine practice. The Consolidated Framework for Implementation Research (CFIR) was applied to guide interview and analysis.

Results

The barriers included: i) CMPs’ perceived difficulties in applying complex evidence in decision-making and ii) inadequate training and limited consultation time. The facilitators were i) availability of publicly accessible and user-friendly synopses, ii) formation of community of evidence-based practice among CMPs with input from key opinion leaders, iii) opportunity for interprofessional collaborations with conventional healthcare providers, and iv) patients’ demand for evidence-based clinical advice. Besides, i) CMPs’ knowledge and beliefs in evidence-based healthcare approach, ii) presentations of evidence-based information in the synopses, and iii) clinical decision making as influenced by quality of evidence reported acted as both barriers and facilitators.

Conclusions

This CFIR-based qualitative study investigated how the World Health Organization recommendation of promoting evidence use in routine practice was perceived by CMPs trained in Hong Kong after reunification with China in 1997. Key barriers and facilitators to applying evidence were identified. Such results will inform tailoring of implementation strategies for promoting evidence uptake, in the context of a well-developed health system dominated by conventional medicine.
The impact of global health opportunities on residency selection
Authors: Kaeppler Caitlin , Holmberg Peter , Tam Reena P. , Porada Kelsey , Stryker Shanna D. , Conway Kate , Schubert Charles ,   On behalf of the Medical Student Global Health Study Group, Chamberlain Stacey , Cobb Carmen , Conway James H. , Groothuis Elizabeth , Hjertstedt Ebba , Lam Suet Kam , McHenry Megan , Nguyen Theresa
Published: July 2021

Background

An increasing number of medical trainees across specialties desire and expect Global Health (GH) experiences during training. It is useful for residency programs to know the impact that offering GH opportunities has on resident recruitment. The study objectives were to explore the importance of GH opportunities in residency selection among fourth-year medical students, examine the relationship between interest in GH and career plans, and describe students’ perspectives on prior GH experiences.

Methods

The authors administered an electronic survey to all fourth-year medical students attending 12 different US institutions in February 2020. Data from the ten schools who were able to comply with the survey distribution methodology and with response rates above 25% were analyzed using descriptive statistics and Pearson’s correlation.

Results

A total of 707 fourth-year medical students from the included schools completed the survey out of 1554 possible students (46% response rate). One third of respondents ranked the presence of GH experiences in residency as moderately or very important and 26% felt that the presence of a formal GH curriculum was at least moderately important, with variation noted among specialties. After training, 65% of students envision practicing internationally in some capacity. A desire to care for underserved patients in their careers was significantly correlated with an interest in GH experiences during residency.

Conclusions

The opportunity to be involved in GH experiences during training can be an important factor for many medical students when considering residency choice, and the availability of these opportunities may be a valuable recruitment tool. Students valuing GH opportunities during residency are more interested in working with underserved populations in their future careers.
A qualitative study of National Health Service (NHS) complaint-responses
Authors: McCreaddie May , Benwell Bethan , Gritti Alice
Published: July 2021

Background

Healthcare complaints are grievances that may be indicative of some system failures, individual failings, or a combination of both. Moreover, the experience of making a complaint, including its outcome, often falls short of patient expectations, particularly in relation to the interpersonal conduct of National Health Service (NHS) staff. Over half of unresolved (local) complaints are subsequently upheld by the ombudsman with others potentially resulting in costly litigation.

Method

A nuanced discourse analytical approach to analysing the language choices within complaint-responses could potentially provide greater insight into why many local complaints continue to remain unresolved. Over a period of 1 month we collated a data corpus of written complaints and their responses (n = 60) from an NHS healthcare area in Scotland, United Kingdom (UK) following anonymisation by NHS complaint handling staff. We took a qualitative approach to analysing the data drawing upon Discourse Analysis with this paper reporting on the complaint-responses only (n = 59). We had undertaken a similar review of the initial written complaints and this is reported elsewhere. In this paper we examine how, and to what extent, the complaint-responses fully addressed the complainants’ perceived grievances.

Results

The complaint-responses rarely acknowledged the amount of detail or ‘work’ involved in making the complaint. Complaint-responses constructed complainants’ accounts as subjective by using specific discourse strategies. Further, complaint responses used unintentionality or exceptionality to mitigate sub-standard experiences of care. We also observed the ‘fauxpology’ - a non-apology or false apology (e.g. I am sorry you feel) which imputes the cause of distress to the subjective (and possibly misguided) impressions of the complainant. The complaint-responses thereby evade blame or responsibility for the complainable action by implying that the complainants’ feelings do not align with the facts.

Conclusions

Complainants and complaint-responders work to different frames of reference. Complaint responders need to engage and align with complainants from the outset to ensure more appropriate complaint- responses. Complaint resolution as opposed to complaint handling could be enhanced by the approach of linguistic analysis and reference to the consumer literature’s justice-based approach to post-complaint behaviour.
Identification and validation of an immune-related prognostic signature and key gene in papillary thyroid carcinoma
Authors: Qin Rujia , Li Chunyan , Wang Xuemin , Zhong Zhaoming , Sun Chuanzheng
Published: July 2021

Background

Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer. The effect of traditional anti-tumor therapy is not ideal for the patients with recurrence, metastasis and radioiodine resistance. The abnormal expression of immune-related genes (IRGs) has critical roles in the etiology of PTC. However, the effect of IRGs on PTC prognosis remains unclear.

Methods

Based on The Cancer Genome Atlas (TCGA) and ImmPort databases, we integrated IRG expression profiles and progression-free intervals (PFIs) of PTC patients. First, we identified the differentially expressed IRGs and transcription factors (TFs) in PTC. Subsequently, an IRG model that can predict the PFI was constructed by using univariate Cox regression, least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analyses of the differentially expressed IRGs in the TCGA. Additionally, a protein–protein interaction (PPI) network showed the interactions between the differentially expressed genes (DEGs), and the top 30 genes with the highest degree were extracted from the network. Then, the key IRG was identified by the intersection analysis of the PPI network and univariate Cox regression, which was verified the differential expression of by western blotting and immunohistochemistry (IHC). ssGSEA was performed to understand the correlation between the key IRG expression level and immune activity.

Results

A total of 355 differentially expressed IRGs and 43 differentially expressed TFs were identified in PTC patients. Then, eight IRGs were finally utilized to construct an IRG model. The respective areas under the curve (AUCs) of the IRG model reached 0.948, 0.820, and 0.831 at 1, 3 and 5 years in the training set. In addition, lactotransferrin (LTF) was determined as the key IRG related to prognosis. The expression level of LTF in tumor tissues was significantly lower than that in normal tissues. And the results of ssGSEA showed the expression level of LTF is closely related to immune activity.

Conclusions

These findings show that the prognostic model and key IRG may become promising molecular markers for the prognosis of PTC patients.
Validation of improved 24-hour dietary recall using a portable camera among the Japanese population
Authors: Matsushita Yumi , Takahashi Tosei , Asahi Kumiko , Harashima Emiko , Takahashi Hiroko , Tanaka Hiroyuki , Tsumuraya Yoshiko , Sarukura Nobuko , Furuta Masashi , Tanaka Heizo , Yokoyama Tetsuji
Published: July 2021

Background

The collection of weighed food records (WFR) is a gold standard for dietary assessment. We propose using the 24-h recall method combined with a portable camera and a food atlas (24hR-camera). This combination overcomes the disadvantages of the 24-h dietary recall method. Our study examined the validity of the 24hR-camera method against WFR by comparing the results.

Methods

Study subjects were 30 Japanese males, aged 31–58 years, who rarely cook and reside in the Tokyo metropolitan area. For validation, we compared the estimated food intake (24hR-camera method) and weighed food intake (WFR method). The 24hR-camera method uses digital photographs of all food consumed during a day, taken by the subjects, and a 24-h recall questionnaire conducted by a registered dietitian, who estimates food intake by comparing the participant’s photographs with food atlas photographs. The WFR method involves a registered dietitian weighing each food item prepared for the subject to consume and any leftovers. Food intake was calculated for each food group and nutrient using the 24hR-camera vs. weighed methods.

Results

Correlation coefficients between the estimated vs. weighed food intake were 0.7 or higher in most food groups but were low in food groups, such as oils, fats, condiments, and spices. The estimated intake of vegetables was significantly lower for the 24hR-camera method compared to the WFR method. For other food groups, the percentages of the mean difference between estimated vs. weighed food intake were -22.1% to 5.5%, with no significant differences between the methods (except for algae, which had a very low estimated intake). The correlation coefficients between the two methods were 0.774 for energy, and 0.855, 0.769, and 0.763 for the macronutrients, proteins, lipids, and carbohydrates, respectively, demonstrating high correlation coefficients: greater than 0.75. The correlation coefficients between the estimated vs. weighed for salt equivalents and potassium intake were 0.583 and 0.560, respectively, but no significant differences in intake were observed.

Conclusions

The 24hR-camera method satisfactorily estimated the intake of energy and macronutrients (except salt equivalents and potassium) in Japanese males and was confirmed as a useful method for dietary assessment.
Prediction of plant-level tomato biomass and yield using machine learning with unmanned aerial vehicle imagery
Authors: Tatsumi Kenichi , Igarashi Noa , Mengxue Xiao
Published: July 2021

Background

The objective of this study is twofold. First, ascertain the important variables that predict tomato yields from plant height (PH) and vegetation index (VI) maps. The maps were derived from images taken by unmanned aerial vehicles (UAVs). Second, examine the accuracy of predictions of tomato fresh shoot masses (SM), fruit weights (FW), and the number of fruits (FN) from multiple machine learning algorithms using selected variable sets. To realize our objective, ultra-high-resolution RGB and multispectral images were collected by a UAV on ten days in 2020’s tomato growing season. From these images, 756 total variables, including first- (e.g., average, standard deviation, skewness, range, and maximum) and second-order (e.g., gray-level co-occurrence matrix features and growth rates of PH and VIs) statistics for each plant, were extracted. Several selection algorithms (i.e., Boruta, DALEX, genetic algorithm, least absolute shrinkage and selection operator, and recursive feature elimination) were used to select the variable sets useful for predicting SM, FW, and FN. Random forests, ridge regressions, and support vector machines were used to predict the yield using the top five selected variable sets.

Results

First-order statistics of PH and VIs collected during the early to mid-fruit formation periods, about one month prior to harvest, were important variables for predicting SM. Similar to the case for SM, variables collected approximately one month prior to harvest were important for predicting FW and FN. Furthermore, variables related to PH were unimportant for prediction. Compared with predictions obtained using only first-order statistics, those obtained using the second-order statistics of VIs were more accurate for FW and FN. The prediction accuracy of SM, FW, and FN by models constructed from all variables (rRMSE = 8.8–28.1%) was better than that from first-order statistics (rRMSE = 10.0–50.1%).

Conclusions

In addition to basic statistics (e.g., average and standard deviation), we derived second-order statistics of PH and VIs at the plant level using the ultra-high resolution UAV images. Our findings indicated that our variable selection method reduced the number variables needed for tomato yield prediction, improving the efficiency of phenotypic data collection and assisting with the selection of high-yield lines within breeding programs.
Downregulation of FeSOD-A expression in Leishmania infantum alters trivalent antimony and miltefosine susceptibility
Authors: Santi Ana Maria Murta , Silva Paula Alves , Santos Isabella Fernandes Martins , Murta Silvane Maria Fonseca
Published: July 2021

Background

Superoxide dismutase (SOD), a central component of the antioxidant defence system of most organisms, removes excess superoxide anions by converting them to oxygen and hydrogen peroxide. As iron (Fe) SOD is absent in the human host, this enzyme is a promising molecular target for drug development against trypanosomatids.

Results

We obtained Leishmania infantum mutant clones with lower FeSOD-A expression and investigated their phenotypes. Our attempts to delete this enzyme-coding gene using three different methodologies (conventional allelic replacement or two different CRISPR/methods) failed, as FeSOD-A gene copies were probably retained by aneuploidy or gene amplification. Promastigote forms of WT and mutant parasites were used in quantitative reverse-transcription polymerase chain reaction (RT-qPCR) and western blot analyses, and these parasite forms were also used to assess drug susceptibility. RT-qPCR and western blot analyses revealed that FeSOD-A transcript and protein levels were lower in FeSOD-A−/−/+L. infantum mutant clones than in the wild-type (WT) parasite. The decrease in FeSOD-A expression in L. infantum did not interfere with the parasite growth or susceptibility to amphotericin B. Surprisingly, FeSOD-A−/−/+L. infantum mutant clones were 1.5- to 2.0-fold more resistant to trivalent antimony and 2.4- to 2.7-fold more resistant to miltefosine. To investigate whether the decrease in FeSOD-A expression was compensated by other enzymes, the transcript levels of five FeSODs and six enzymes from the antioxidant defence system were assessed by RT-qPCR. The transcript level of the enzyme ascorbate peroxidase increased in both the FeSOD-A−/−/+ mutants tested. The FeSOD-A−/−/+ mutant parasites were 1.4- to 1.75-fold less tolerant to oxidative stress generated by menadione. Infection analysis using THP-1 macrophages showed that 72 h post-infection, the number of infected macrophages and their intracellular multiplication rate were lower in the FeSOD-A−/−/+ mutant clones than in the WT parasite.

Conclusions

The unsuccessful attempts to delete FeSOD-A suggest that this gene is essential in L. infantum. This enzyme plays an important role in the defence against oxidative stress and infectivity in THP-1 macrophages. FeSOD-A-deficient L. infantum parasites deregulate their metabolic pathways related to antimony and miltefosine resistance.

Graphic Abstract