bluuebunny/crossref_metadata_2025 huggingface dataset:
Older Patient and Surrogate Attitudes Toward Deprescribing During the Transition From Acute to Post-Acute Care
Authors: Hollingsworth Emily Kay , Shah Avantika Saraf , Shotwell Matthew Stephen , Simmons Sandra Faye , Vasilevskis Eduard Eric
Published: February 2022

Attitudes toward deprescribing among hospitalized older patients transitioning to post-acute care in the United States are less known. This study describes older patients’ and their surrogate’s attitudes using all items of the Patient Attitudes Toward Deprescribing (PATD) questionnaire and compares perceived pill burden to the actual count of total daily pills and potentially inappropriate medications (PIMs). Overall, 93% of participants were willing to deprescribe if their physician agreed. Compared to patients, surrogates had 64% reduced odds (95% CI: 0.18–0.74) of believing that all of the care recipient’s medications were necessary and 61% reduced odds (95% CI: 0.17–0.88) of attributing cost as a factor in deprescribing. Perceptions of medication burden were associated with patients’ total daily pills (median 16) and PIMS (median 7), yet 61% agreed that all their medicines were necessary. Patients and surrogates typically express a willingness to deprescribe but have differing perceptions of medication appropriateness.
Ice from ‘nature's factory’
Authors: Bagle Eyvind
Published: February 2022

Norway's natural-ice export trade was a complex phenomenon that was shaped by demographic and consumption patterns, and by developments in the food and refrigeration industries. At the same time, it was a maritime business, comprising distinctive logistical modes and networks. Time, season and weather conditions were crucial variables. This article surveys the ways in which such contingencies were approached and mastered from the supply side on the Norwegian coast by a composite group of farmers, merchants, shipowners and independent agents. For most, ice harvesting and exporting were elements in a mix of activities. The strategies and outlooks of the Norwegian ice entrepreneurs have not been subject to systematic research. In this article, findings from three case studies are summarized and discussed. With particular attention afforded to knowledge and information dissemination, the contrasts between the three businesses provide insight into the constitution and dynamics of the trade in natural ice.
Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey
Authors: Velloza Jennifer , Davies Luke D. , Ensminger Alison L. , Theofelus Frieda Mboshono , Andjamba Helena , Kamuingona Rahimisa , Masseti Greta , Coomer Rachel , Forster Norbert , O’Malley Gabrielle
Published: February 2022

Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18–24 year old adolescent girls and young women ( N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64–5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07–3.05), sexual (aOR: 3.79; 95% CI: 2.54–5.67), or emotional (aOR: 2.39; 95% CI: 1.18–4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.
Crash recognition algorithm of automatic crash notification system with adaptive discrimination threshold
Authors: Lu Ying , Liu Yufa , Shu Yu , Ma Longfei
Published: February 2022

Efficiency and notification accuracy are two critical criteria for evaluating the performance of automatic crash notification (ACN) systems. The discrimination threshold (DT) is used to assess whether a collision accident occurs. Typically, the DT value is determined based on the maximal acceleration peak from multiple road tests. Because an overlarge DT value is unnecessary in most driving scenes and simultaneously adversely affects notification accuracy, a crash recognition (CR) algorithm with adaptive DT is proposed. First, a road–vehicle simulation model is constructed using the CarSim software. Next, the vehicle acceleration data at different driving speeds are obtained based on this road–vehicle model. Subsequently, a correlation model comprising a discrimination threshold value, an international roughness index, and the vehicle speed is developed. Finally, a CR algorithm is designed, in which discrimination threshold values that match the road roughness and vehicle speed are specified. Road and collision tests show that the proposed algorithm can identify collisions and calculate the speed change value more accurately compared with the conventional CR algorithm which has a fixed discrimination threshold.
Disruptive Therapy Using a Nonsurgical Orthodontic Airway Plate for the Management of Neonatal Robin Sequence: 1-Year Follow-up
Authors: Choo HyeRan , Galera Rhona I. , Balakrishnan Karthik , Lin Hung-Fu C. , Ahn HyoWon , Lorenz Peter , Khosla Rohit K. , Profit Jochen , Poets Christian F. , Lee Janice S.
Published: February 2022

We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.
Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings
Authors: Melhem Antonio M. , Ramly Elie P. , Al Abyad Omar S. , Chahine Elsa M. , Teng Sarena , Vyas Raj M. , Hamdan Usama S.
Published: February 2022

Introduction

Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge.

Methods

A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning.

Results

Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge.

Conclusion

The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.
Case Studies of Urban Metabolism: What Should be Addressed Next?
Authors: Wang Hsi-Chuan
Published: February 2022

This paper analyzes case studies of Urban Metabolism (UM), an interdisciplinary field that studies the flow of materials and energy in cities. It focuses on global cases to help researchers identify research gaps. I have categorized the studies based on location, scale, and urban system. Two findings need to be specified: first, the geographic distribution of UM case studies is uneven. Only limited studies have been developed for emerging African cities despite expected large future populations. Second, neighborhood-scale cases do not use an appropriate local scale, primarily due to the lack of reliable data sources. Upon noticing concerns over (1) the evaluation of optimized metabolisms, (2) the effectiveness of knowledge transfer, and (3) the awareness of timeframe in delivering practical policy, researchers may now focus on developing more applicable planning and design guidelines while paying attention to the early communication of UM assessment results between scientists and practitioners.
Post-COVID simultaneous onset of Graves’ disease and ocular myasthenia gravis in a patient with a complex ocular motility impairment
Authors: De Giglio Laura , Sadun Federico , Roberti Cinzia , Polidori Luigi , Gilardi Marta , Altavista Maria Concetta , Pennisi Elena Maria
Published: February 2022

A 74-years-old man experienced severe diplopia one month after recovery from an uncomplicated SARS-CoV-2 infection. Neurological examination was normal whereas ophthalmological examination showed bilateral exophthalmos with a complex ocular motility disorder characterized by a pseudo-internuclear ophthalmoplegia after fatigue associated to impairment of elevation and infraduction. Antibodies against TSH and acetylcholine receptors were positive; subsequent hormonal tests, ultrasonography of thyroid gland, single fiber electromyography and orbit MRI confirmed the diagnosis of concomitant Graves Disease (GD) and Myasthenia Gravis (MG). The coexistence between MG and GD is not rare but simultaneous onset after viral infection is very unsual. The complex ocular disorder simulated a deficit of the oculomotor nerve nuclei, and on clinical examination it posed some problems in the diagnosis. We suggest that recent SARS-COV-2 infection may have triggered a complex autoimmune response.
Minimal clinically important differences in daily physical activity outcomes following supervised and home-based exercise in peripheral artery disease
Authors: Gardner Andrew W , Montgomery Polly S , Wang Ming , Shen Biyi
Published: February 2022

Introduction: We estimated minimal clinically important differences (MCID) for small, moderate, and large changes in daily step counts and time spent in moderate-to-vigorous physical activity (MVPA) following both supervised and home-based exercise programs in symptomatic patients with peripheral artery disease (PAD). Methods: Patients were randomized to either 12 weeks of a supervised exercise program ( n = 60), a home-based exercise program ( n = 60), or an attention-control group ( n = 60). Results: Using the anchor-based method to determine MCID, the MCID value for a large change in health-related quality of life (HRQoL) was an increase of 1211 total daily steps and an increase in 11 minutes in the time spent in MVPA following 12 weeks of exercise intervention. Using the distribution-based method, the MCID values for small, moderate, and large changes in total daily steps in the home-based exercise group were 558, 1396, and 2233 steps/d, respectively, and the corresponding changes in the time spent in MVPA were 6, 15, and 23 minutes. Similar distribution-based MCID scores were noted for the supervised exercise group. Conclusion: Following 3 months of home-based and supervised exercise programs for patients with PAD and claudication, increases of 11 minutes in time spent in MVPA and 1211 total daily steps were associated with large anchor-based MCID increases in HRQoL. The clinical implication is that patients with PAD and claudication should be encouraged to increase daily steps, particularly by walking an additional 11 minutes each day in MVPA, which is associated with a large meaningful increase in HRQoL.
Using sport media exposure to promote gender equality: Counter-stereotypical gender perceptions and the 2019 FIFA Women’s World Cup
Authors: Vezzali Loris , Visintin Emilio Paolo , Bisagno Elisa , Bröker Laura , Cadamuro Alessia , Crapolicchio Eleonora , De Amicis Leyla , Di Bernardo Gian Antonio , Huang Fei , Lou Xi , Stathi Sofia , Valor-Segura Inmaculada , Harwood Jake
Published: February 2022

By relying on literature on counter-stereotypes and media contact, we investigated whether media exposure is associated with counter-stereotypical gender perceptions. Focusing on the 2019 FIFA Women’s World Cup, we recruited samples ( N = 2,228) from eight competing countries (China, France, Germany, Italy, Scotland, Spain, England, US) across three continents. We hypothesized that exposure to media coverage of the competition’s counter-stereotypical female exemplars would be associated with increased counter-stereotypical perceptions of women. Results revealed that media exposure was associated with greater communion and agency attributed to women. In turn, communion and agency were associated (negatively and positively, respectively) with attribution of stereotypically male abilities (abilities to engage in stereotypically male academic disciplines and jobs) to women compared to men. No effects emerged for perceptions of stereotypically female characteristics. Gender moderated these effects, with associations being stronger among male than among female respondents. Theoretical and practical implications of findings are discussed.
A study on the cabin indoor localization algorithm based on adaptive K-values
Authors: Gao Junbo , Fan Tao , Qin Zhenxiao , Sun Wei
Published: February 2022

In ocean voyages, cabin indoor localization plays a considerably important role in ship safety management. Due to the special structure of ships and the influence of internal and external environment, the mainstream indoor positioning technology nowadays is not ideal for positioning inside the cabin. In order to improve the positioning accuracy, this article proposes an adaptive K-value-based cabin indoor positioning algorithm. The algorithm constructs a fingerprint library by collecting Received Signal Strength Indication data and carries out filtering; matches fingerprint information by adaptive K-values during the localization process, while using double K-nearest neighbor to reduce the influence of outlier points on the final localization; and finally uses the multi-point mass center method to determine the final localization results. The experimental results in the automated cabin laboratory show that the average positioning error of the algorithm is 1.74 m, which can well meet the cabin indoor positioning requirements.
Can the use of long-acting injectable antipsychotic preparations be increased in routine clinical practice and the benefits realised?
Authors: Paton Carol , Okocha Chike I. , Patel Maxine X.
Published: February 2022

Background:

The use of continuing antipsychotic medication is an established evidence-based strategy for preventing relapse in people with schizophrenia, but medication adherence is known to be suboptimal. Covert non-adherence can be eliminated by the use of long-acting injectable (LAI) formulations. We sought to (1) raise awareness among clinicians of the potential benefits of LAI antipsychotic formulations, (2) increase use of these formulations for the treatment of schizophrenia in routine clinical practice and thereby (3) reduce the number of relapses requiring hospitalisation in patients with schizophrenia under our care.

Method:

Educational initiatives, promotion of reflective practice and patient-specific reminders were used to prompt increased use of LAI antipsychotic medication for patients with schizophrenia. Data relating to the use of these medications and the number of acute admissions for schizophrenia spectrum disorders (F20-29, ICD-10) over time were extracted from existing clinical information systems.

Results:

Over the 3-year time frame of our local initiative, the use of LAI antipsychotic preparations increased by 11%, the number of acute admissions for schizophrenia/schizoaffective disorder (F20 and F25) decreased by 26% and the number of acute bed days occupied by patients with these diagnoses decreased by 8%. The number of admissions for other psychosis diagnoses (F21-24 and F28-29) did not show the same pattern of improvement.

Conclusion:

In our health care organisation, raising clinicians’ awareness of the evidence base relating to the potentially favourable benefit–risk balance for LAI antipsychotic medication compared with oral formulations resulted in more use of the former. There were accompanying reductions in acute admissions and occupied bed days for patients with schizophrenia.
Living With My Baby With Congenital Anomaly: A Qualitative Case Report
Authors: Özer Özlü Nazife Gamze , Vural Fatma , Dökümcü Zafer
Published: February 2022

This case report was made to understand the emotions, thoughts, and experiences of the mother, who was lying in the long-term neonatal intensive care unit. An individual in-depth interview was conducted once with the mother of the infant with the diaphragm hernia. The interview recorded and lasted approximately 30 min. The data were analyzed by inductive method and themes and codes were created. The mother of the infant with a diaphragmatic hernia was 31 years old, married with 2 children, and employed full-time. The infant was diagnosed antenatally at 37 weeks old, weighed 3.000 g, and was male. As a result of the interview, 3 main themes were identified: “Facing the disease,” “Experiences in intensive care,” and “Change in family life.” The results show that having an infant with congenital anomaly affects the life of all family members and shows the problems experienced strikingly.
Remote Follow-up of Shoulder Arthroplasty Patients During COVID-19 Pandemic - Is This the way Forward?
Authors: Mansukhani Sameer A , Gopinath Praveen , Chaturvedi Amit , Konstantopoulos Georgios , Leivadiotou Dimitra
Published: February 2022

Background

The COVID-19 Pandemic has affected the way health care systems function across the globe. Apart from eliminating the risk of being in a vulnerable environment during the pandemic such as a hospital setting, virtual arthroplasty follow-up reduces the demand on funding and resources on the National Health Services (NHS).

Methods

We retrospectively reviewed our shoulder arthroplasty patients (55) operated between October 2018 to November 2020 at both our hospital sites. For remote follow-up, patients were contacted on a scheduled appointment date via telephone by an orthopaedic surgeon to enquire about their wound, pain and function. Patients were questioned as per questionnaire from the Oxford Shoulder Score (OSS) and American Shoulder and Elbow Surgeons (ASES) Standardised Assessment form.

Results

50 patients were included in the final data set after excluding those who had died (5 patients). All patients had had final x-rays with full Covid-19 precautions at the time of final follow-up. No patient had wound problems except one who had concerns of wound appearance. There were no cases of notching, impingement, deep infection, dislocation or nerve injury. Of the 50 patients, 40 (80%) patients were satisfied to have a remote follow-up. 36 (72%) patients said they wouldn't mind a remote follow-up appointment.

Conclusion

Remote follow-up via audio consultation may be an effective alternative to in person visits after shoulder arthroplasty. Patients in this series demonstrated a high level of satisfaction with virtual visits and post-operative complications were effectively identified.
Best Friends Forever: Relationship Schemas, Organizational Forms, and Institutional Change
Authors: Polletta Francesca
Published: February 2022

Scholars have drawn on cultural concepts to demonstrate the capacity of organizational actors to transform existing institutional scripts and invent new ones. When it comes to accounting for the limits on such change, however, scholars have tended to fall back on structural dynamics. I argue that paying attention to the symbolic analogies and oppositions in terms of which institutional schemas have meaning can shed light on the role of cultural constraints alongside creativity in institutional change. In this article, I investigate schemas of personal relationships. By transposing the obligations and expectations of a familiar relationship from one kind of interaction to another—by treating employees like members of a sports team or a research collaborative, for example—organizational actors can bring about new habits of interaction and create new organizational forms. But people’s emotional investment in the integrity of a relationship script may make them unwilling to modify the script when it proves impractical. Shared relationship schemas are thus a source of creativity and constraint. I show that understanding this dialectic accounts for several puzzling features of the diffusion of participatory democratic organizational forms among progressive movements in the late 1960s: notably, that even in the absence of a legitimated model of participatory democracy, activists adopted a similar form of organization, and that, for all their creativity, activists were unable to modify that form to cope with the inequalities it produced.
Genetics of inherited thrombocytopenias
Authors: Warren Julia T. , Di Paola Jorge
Published: February 2022

The inherited thrombocytopenia syndromes are a group of disorders characterized primarily by quantitative defects in platelet number, though with a variety demonstrating qualitative defects and/or extrahematopoietic findings. Through collaborative international efforts applying next-generation sequencing approaches, the list of genetic syndromes that cause thrombocytopenia has expanded significantly in recent years, now with over 40 genes implicated. In this review, we focus on what is known about the genetic etiology of inherited thrombocytopenia syndromes and how the field has worked to validate new genetic discoveries. We highlight the important role for the clinician in identifying a germline genetic diagnosis and strategies for identifying novel causes through research-based endeavors.
A novel 4 immune-related genes as diagnostic markers and correlated with immune infiltrates in major depressive disorder
Authors: Ning Linna , Yang Zhou , Chen Jie , Hu Zhaopeng , Jiang Wenrui , Guo Lixia , Xu Yan , Li Huiming , Xu Fanghua , Deng Dandong
Published: February 2022

Background

Immune response is prevalently related with major depressive disorder (MDD) pathophysiology. However, the study on the relationship between immune-related genes (IRGs) and immune infiltrates of MDD remains scarce.

Methods

We extracted expression data of 148 MDD patients from 2 cohorts, and systematically characterized differentially expressed IRGs by using limma package in R software. Then, the LASSO and multivariate logistic regression analysis was used to identify the most powerful IRGs. Next, we analyzed the relationship between IRGs and immune infiltrates of MDD. Finally, GSE76826 was used to to verificate of IRGs as a diagnostic markers in MDD.

Results

203 different IRGs s in MDD has been identified (P < 0.05). GSEA revealed that the different IRGs was more likely to be enriched in immune-specific pathways. Then, a 9 IRGs was successfully established to predict MDD based on LASSO. Next, 4 IRGs was obtained by multivariate logistic regression analysis, and AUC for CD1C, SPP1, CD3D, CAMKK2, and IRGs model was 0.733, 0.767, 0.816, 0.800, and 0.861, suggesting that they have a good diagnostic performance. Furthermore, the proportion of T cells CD8, T cells γδ, macrophages M0, and NK cells resting in MDD group was lower than that in the healthy controls, suggesting that the immune system in MDD group is impaired. Simultaneously, CD3D was validated a reliable marker in MDD, and was positively correlated with T cells CD8. GSEA revealed high expression CD3D was more likely to be enriched in immune-specific pathways, and low expression CD3D was more likely to be enriched in glucose metabolism metabolism-specific pathways.

Conclusions

We applied bioinformatics approaches to suggest that a 4 IRGs could serve as diagnostic markers to provide a novel direction to explore the pathogenesis of MDD.
Hyperlipidemia and hypertension have synergistic interaction on ischemic stroke: insights from a general population survey in China
Authors: Wang Chang , Du Zhi , Ye Ning , Shi Chuning , Liu Songyue , Geng Danxi , Sun Yingxian
Published: February 2022

Background

Hyperlipidemia (HLP) and hypertension (HTN) are both independent risk factors for ischemic stroke. This study aimed to assess whether HTN and HLP have a synergistic effect on the risk of ischemic stroke.

Methods

Between January and August 2013, 11,695 subjects in rural areas of northeastern China were enrolled. The additive and multiplicative scales were used to evaluate the interaction.

Results

The prevalence of ischemic stroke was 5.7%. Using the healthy group (without HTN or HLP) as the reference group, subjects with both HTN and HLP had a higher risk of ischemic stroke (odds ratio [OR]: 3.369, 95% confidence interval [CI]: 2.579–4.402), and this OR was greater than that of subjects with only HTN (OR: 1.995, 95% CI 1.526–2.610) or HLP (OR: 1.321, 95% CI 0.937–1.862) (adjusting for age, sex, race, education level, family income, current smoking and drinking status, physical activity, body mass index, diabetes, family history of stroke, and atrial fibrillation). Regarding the additive scale, the relative excess risk due to interaction (OR: 1.053, 95% CI 0.458–1.648) was positive after adjusting for confounders. Moreover, the attributable proportion was 31.3%, which means that 31.3% of the total risk of ischemic stroke was due to the synergistic interaction between HTN and HLP. Furthermore, the synergistic index (S) of ischemic stroke was 1.8 (95% CI 1.157–2.801), which also indicates a synergistic interaction between HTN and HLP. Regarding the multiplicative scale, the interaction effect was also significant after adjusting for confounders (OR: 2.163, 95% CI 1.817–2.575).

Conclusion

The results suggest that the synergistic effect of HTN and HLP on ischemic stroke is significantly higher than the sum of their independent effects. The quantification of the combined effect should help to promote healthy blood pressure and blood lipid levels among the general population.
Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis
Authors: Zhang Qun , Han Yu , Sun Shukun , Zhang Chuanxin , Liu Han , Wang Bailu , Wei Shujian
Published: February 2022

Objective

Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages.

Methods

A systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment.

Results

We included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency.

Conclusions

IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS.
Nilotinib related acute myocardial infarction with nonobstructive coronary arteries: a case report and literature review
Authors: Chen Weiwei , Du Beibei , Liu Kun , Yu Zhixi , Wang Xingtong , Yang Ping
Published: February 2022

Background

Myocardial Ischemia with No Obstructive Coronary Artery Disease (MINOCA) is a common cause of type 2 acute myocardial infarction (AMI) which requires careful differential diagnosis. Coronary artery spasm (CAS) syndrome is one etiology that can lead to MINOCA. Nilotinib, a targeted treatment for chronic myeloid leukemia (CML), has been reported to be related with increased risk of adverse vascular events.

Case presentation

A 67-year-old male patient was admitted to hospital with acute chest pain. He had a past medical history of CML and a history of treatment with nilotinib for 12 months. Coronary angiography (CAG) showed no significant stenosis. Since the onset of angina was generally in the early morning, and ECG and echocardiography suggested right coronary artery (RCA) disease, an ergonovine provocation test was performed to confirm the diagnosis of CAS. After intracoronary administration of ergonovine, middle and distal RCA showed over 90% vasoconstriction. Nilotinib related MINOCA, CAS and CML were diagnosed. Lifestyle changes (cessation of smoking), anti-spasmodics, statin treatment and adjustment of the nilotinib dose (from 200 mg bid, to 150 mg bid) were recommended for this patient. Six-month’s follow-up showed good recovery with no onsets of angina.

Conclusions

Physicians should be vigilant to adverse vascular events when treating patients who have been prescribed nilotinib. It is suggested that in patients with MINOCA who have a history of treatment with nilotinib, CAS-induced MINOCA should be included in the differential diagnosis. Further studies are needed to clarify the mechanism and to find better management.
Locked out during COVID-19 lockdown—an online survey of relatives of people with psychotic and bipolar disorders in Norway
Authors: Aminoff Sofie R. , Mork Erlend , Barrett Elizabeth Ann , Simonsen Carmen , ten Velden Hegelstad Wenche , Lagerberg Trine Vik , Melle Ingrid , Romm Kristin Lie
Published: February 2022

Background

Many relatives of people with psychotic and bipolar disorders experience a high caregiver burden normally. During the first COVID-19 lockdown, mental health services partly shut down in many countries. The impact on relatives is unknown.

Aims

Explore how relatives of people with psychotic and bipolar disorders experienced changes in treatment and service availability for their family member during the first COVID-19 pandemic lockdown in the spring of 2020, and to what extent they perceived information and support to be satisfactory. To help guide future contingency plans, we were also interested in what relatives would prioritize in the event of a future crisis.

Study setting

We distributed an anonymous Norwegian online survey inviting relatives of individuals with psychotic and bipolar disorders. We distributed the survey using social media, through snowball sampling, collecting both quantitative and qualitative data. The survey was available between May and June 2020. We used systematic text condensation to analyse qualitative data.

Results

Two hundred and seventy-nine respondents replied, mostly mothers and partners. A majority experienced a reduction in health care for their family member. Most respondents did not receive any support during the lockdown. However, most found the information they received from the mental health services regarding their family members’ treatment as sufficient. The qualitative data analysis revealed that relatives experienced three major challenges: reductions in treatment for the family member; reduced organised daily activity for the family member; and an increased caretaker load. In the case of a future lockdown, they would prefer increased access to care compared with a normal situation; increased support for relatives; and enhanced information.

Conclusions

Mental health services in Norway did not manage to meet the needs of patients with severe mental illness and their relatives during the first COVID-19 lockdown. To be better prepared, Norwegian mental health services should consider prioritising infrastructure to ensure access to care and support for both patients and relatives. Digital tools and telephone calls are generally well accepted as substitutes for face-to-face contact.
Evaluation of the efficacy of OLIF combined posterior internal fixation for single-segment lumbar tuberculosis: a single-center retrospective cohort study
Authors: Du Xing , Ou Yunsheng , Luo Wei , Jiang Guanyin , Qin Wanyuan , Zhu Yong
Published: February 2022

Objective

To evaluate the clinical efficacy of oblique lateral interbody fusion (OLIF) combined posterior fixation for single-segment lumbar tuberculosis (TB).

Methods

The medical records of spinal TB patients who were admitted to our department from January 2016 to December 2018 were retrospectively reviewed, and those meeting the inclusion criteria were finally included for analysis. The operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle of surgical segment, bone graft fusion rate, erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), neurological function (ASIA grade) and complications of the included patients were all recorded and analyzed.

Results

Thirty-nine patients with lumbar TB were finally included. The mean operative time, operative blood loss, and hospital stay were 135.8 ± 19.2 min, 239.4 ± 84.7 ml, and 9.5 ± 2.7 days, respectively. The mean follow-up time was 26.3 ± 7.5 months. During the follow-up, both VAS score and ODI were significantly improved at 1 month, 3 months, 6 months, 1 year postoperative, and the last follow-up, compared with preoperative (P < 0.001). Cobb angle was significantly corrected at 1 month postoperatively (P < 0.001), however, from 3 months postoperative to the last follow-up, Cobb angle was getting lost (P < 0.01). Bone graft fusion rate at 3 months, 6 months, 1 year postoperative, and last follow-up were 66.67%, 87.18%, 94.88%, and 100%, respectively. Compared with preoperative, ESR and CRP were both showed significant decrease at 1 and 6 months postoperative, and the last follow-up (P < 0.001). At the last follow-up, all patients had improvement in ASIA grade compared with preoperative (P < 0.001). Six patients were found with postoperative complications, and all were cured after active treatment.

Conclusions

OLIF combined posterior internal fixation is safe and effective in the treatment of single-segment lumbar TB, with satisfactory pain relief, improvement of lumbar and neurological function, and deformity correction.
Hepatobiliary-pancreatic surgery for patients with a prepancreatic postduodenal portal vein: a case report and literature review
Authors: Higashihara Taku , Morita Yasuhiro , Hayashi Tatsuya , Takahashi Makoto , Yogi Norikazu , Sasaki Shu , Zhou Daren
Published: February 2022

Background

Prepancreatic portal vein (PPV) is a congenital anatomical variant of the portal vein (PV). PPVs are extremely rare and generally classified into two categories, prepancreatic preduodenal portal vein and prepancreatic postduodenal portal vein (PPPV). Prepancreatic preduodenal portal veins are rare, with approximately 100 reported cases globally; PPPVs are even more atypical, with less than 20 documented cases globally. Despite the extremely low occurrence, PPPV knowledge and recognition are important, especially for hepatobiliary-pancreatic (HBP) surgeries, such as pancreaticoduodenectomy (PD) for patients of a PPPV. Here, we report a case of PPPV and a literature review.

Case presentation

A 73-year-old-male with ampullary carcinoma underwent PD at our hospital. Preoperative enhanced CT revealed an abnormal L-shaped PV, identified as a PPPV. Both the PPPV and the postpancreatic “normal” superior mesenteric vein (SMV) divaricated from the SMV at the caudal side of the pancreas. A splenic vein and inferior mesenchymal vein flowed into the postpancreatic “normal” PV, which encircled the common bile duct and potentially flowed into the liver, forming a cavernous transformation at the hilar plate. During surgery, we attempted to isolate the PV from the pancreas and common bile duct. However, it was difficult to isolate from the pancreas. The PPPV was so fragile that bleeding from the PPPV became uncontrollable. To remove the tumor, we resected the PPPV and reconstructed a “normal” PV as an autogenous graft. To maintain intraoperative hepatic blood flow and avoid small bowel congestion, an antithrombogenic bypass catheter was placed between the SMV and umbilical vein during reconstruction. After surgery, several complications occurred, such as PV thrombosis and hyperammonemia. The patient was discharged on postoperative day 45.

Conclusions

PPPV is a rare vascular variant but is easily diagnosed preoperatively due to its distinct shape on CT imaging. However, isolating the PPPV from the pancreas and bile duct is incredibly difficult and potentially associated with increased operative risks and postoperative complications. PV resection rather than isolation is a potential solution to reduce the risk of hemorrhage, even in the absence of invasion.
An efficient and specific CRISPR-Cas9 genome editing system targeting soybean phytoene desaturase genes
Authors: Lu Qing Shi Mimmie , Tian Lining
Published: February 2022

Background

Genome editing by CRISPR/Cas9 has become a popular approach to induce targeted mutations for crop trait improvement. Soybean (Glycine max L. Merr.) is an economically important crop worldwide. Although gene editing has been demonstrated in soybean, its utilization in stably transformed plants through whole plant regeneration is still not widespread, largely due to difficulties with transformation or low mutation efficiencies.

Results

We sought to establish a simple, efficient, and specific CRISPR/Cas9 system to induce heritable mutations in soybean through stable transformation. We targeted phytoene desaturase (PDS) genes due to the distinctive dwarf and albino phenotypes of the loss of function mutant. To evaluate gene editing efficiency and specificity, three constructs targeting each of the two homologous soybean PDS genes specifically, as well as two constructs targeting both simultaneously with one guide RNA were created. Instead of using cotyledonary nodes from germinated seedlings, we used ‘half-seed’ explants derived from imbibed seeds for Agrobacterium-mediated transformation of cultivar Williams 82. Transformed plants for all five constructs were recovered. Dwarf and albino phenotypes were observed in transgenic plants harboring the constructs targeting both PDS genes. Gene editing at the desired loci was detected in the majority of T0 transgenic plants, with 75–100% mutation efficiencies. Indel frequencies varied widely among plants (3–100%), with those exhibiting visible mutant phenotypes showing higher frequencies (27–100%). Deletion was the predominant mutation type, although 1-nucleotide insertion was also observed. Constructs designed to target only one PDS gene did not induce mutation in the other homologous counterpart; and no mutation at several potential off-target loci was detected, indicating high editing specificity. Modifications in both PDS genes were transmitted to T1 progenies, including plants that were negative for transgene detection. Strong mutant phenotypes were also observed in T1 plants.

Conclusions

Using simple constructs containing one guide RNA, we demonstrated efficient and specific CRISPR/Cas9-mediated mutagenesis in stably transformed soybean plants, and showed that the mutations could be inherited in progenies, even in plants that lost transgenes through segregation. The established system can be employed to edit other genes for soybean trait improvement.
Effectiveness of technology-enhanced teaching methods of undergraduate dental skills for local anaesthesia administration during COVID-19 era: students’ perception
Authors: Mladenovic Rasa , AlQahtani Sakher , Mladenovic Kristina , Bukumiric Zoran , Zafar Sobia
Published: February 2022

Background

Traditional face-to-face clinical learning became problematic for final year dental students during the COVID-19 pandemic. Distance-learning may help mitigate the immediate impact of dental school closures. Integrating e-learning technologies into the learning process helps bridge the gap between pre-clinical and clinical training. Simulation allows students to repeat procedures until they demonstrate acceptable levels of skill. This study aimed to determine the effectiveness of a serious game as an additional teaching tool during the COVID-19 era to improve dental students’ local anaesthesia administration technique and confidence.

Methods

This study applied a simulation-based serious game as an additional learning tool for training and educating dental students in local anaesthesia. Students used a mobile simulator in Serbian for 10 days from their homes. To evaluate the learning process, the students completed a post-training questionnaire.

Results

All respondents felt comfortable using the simulator. Over 90% of respondents believed that the application facilitated the learning process and had advantages in terms of accessibility and ease of use. Also, students found augmented reality (AR) technology particularly interesting to use. The use of a mobile simulator designed as a 3D and AR environment allows for simpler localisation and identification of anatomical structures and reference points, which is a good base for clinical practice.

Conclusion

Serious games of local anaesthesia procedures as an additional e-learning tool during the COVID-19 era could improve students’ knowledge and skills.
How important is income in explaining individuals having forgone healthcare due to cost-sharing payments? Results from a mixed methods sequential explanatory study
Authors: Salampessy Benjamin H. , Portrait France R. M. , Donker Marianne , Ismail Ismail , van der Hijden Eric J. E.
Published: February 2022

Background

Patients having forgone healthcare because of the costs involved has become more prevalent in recent years. Certain patient characteristics, such as income, are known to be associated with a stronger demand-response to cost-sharing. In this study, we first assess the relative importance of patient characteristics with regard to having forgone healthcare due to cost-sharing payments, and then employ qualitative methods in order to understand these findings better.

Methods

Survey data was collected from a Dutch panel of regular users of healthcare. Logistic regression models and dominance analyses were performed to assess the relative importance of patient characteristics, i.e., personal characteristics, health, educational level, sense of mastery and financial situation. Semi-structured interviews (n = 5) were conducted with those who had forgone healthcare. The verbatim transcribed interviews were thematically analyzed.

Results

Of the 7,339 respondents who completed the questionnaire, 1,048 respondents (14.3%) had forgone healthcare because of the deductible requirement. The regression model indicated that having a higher income reduced the odds of having forgone recommended healthcare due to the deductible (odds ratios of higher income categories relative to the lowest income category (reference): 0.29–0.49). However, dominance analyses revealed that financial leeway was more important than income: financial leeway contributed the most (34.8%) to the model’s overall McFadden’s pseudo-R2 (i.e., 0.123), followed by income (25.6%). Similar results were observed in stratified models and in population weighted models. Qualitative analyses distinguished four main themes that affected the patient’s decision whether to use healthcare: financial barriers, structural barriers related to the complex design of cost-sharing programs, individual considerations of the patient, and the perceived lack of control regarding treatment choices within a given treatment trajectory. Furthermore, “having forgone healthcare” seemed to have a negative connotation.

Conclusion

Our findings show that financial leeway is more important than income with respect to having forgone recommended healthcare due to cost-sharing payments, and that other factors such as the perceived necessity of healthcare also matter. Our findings imply that solely adapting cost-sharing programs to income levels will only get one so far. Our study underlines the need for a broader perspective in the design of cost-sharing programs.
Tidal volume significantly affects oxygenation in healthy pigs during high-frequency oscillatory ventilation compared to conventional ventilation
Authors: Roubík Karel , Ráfl Jakub , Rožánek Martin , Kudrna Petr , Mlček Mikuláš
Published: February 2022

Background

The role of high-frequency oscillatory ventilation (HFOV) has long been debated. Numerous studies documented its benefits, whereas several more recent studies did not prove superiority of HFOV over protective conventional mechanical ventilation (CV). One of the accepted explanations is that CV and HFOV act differently, including gas exchange.

Methods

To investigate a different level of coupling or decoupling between oxygenation and carbon dioxide elimination during CV and HFOV, we conducted a prospective crossover animal study in 11 healthy pigs. In each animal, we found a normocapnic tidal volume (VT) after the lung recruitment maneuver. Then, VT was repeatedly changed over a wide range while keeping constant the levels of PEEP during CV and mean airway pressure during HFOV. Arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were recorded. The same procedure was repeated for CV and HFOV in random order.

Results

Changes in PaCO2 intentionally induced by adjustment of VT affected oxygenation more significantly during HFOV than during CV. Increasing VT above its normocapnic value during HFOV caused a significant improvement in oxygenation, whereas improvement in oxygenation during CV hyperventilation was limited. Any decrease in VT during HFOV caused a rapid worsening of oxygenation compared to CV.

Conclusion

A change in PaCO2 induced by the manipulation of tidal volume inevitably brings with it a change in oxygenation, while this effect on oxygenation is significantly greater in HFOV compared to CV.