bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of timing of surgical resection of primary hepatocellular carcinoma on survival outcomes in elderly patients and prediction of clinical models
Authors: He Yongfei , Liang Tianyi , Mo Shutian , Chen Zijun , Zhao Shuqi , Zhou Xin , Yan Liping , Wang Xiangkun , Su Hao , Zhu Guangzhi , Han Chuangye , Peng Tao
Published: May 2021

Background

The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients.

Methods

A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed.

Results

A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival.

Conclusions

We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.
An emm-type specific qPCR to track bacterial load during experimental human Streptococcus pyogenes pharyngitis
Authors: Fabri Loraine V. , Azzopardi Kristy I. , Osowicki Joshua , Frost Hannah R. , Smeesters Pierre R. , Steer Andrew C.
Published: May 2021

Background

Streptococcus pyogenescauses a profound global burden of morbidity and mortality across its diverse clinical spectrum. To support a new controlled human infection (‘challenge’) model seeking to accelerateS. pyogenesvaccine development, we aimed to develop an accurate and reliable molecular method for quantifying bacterial load from pharyngeal swabs collected during experimental human pharyngitis.

Methods

Combined sequential RNA + DNA extraction from throat swabs was compared to traditional separate RNA-only and DNA-only extractions. Anemm-type specific qPCR was developed to detect theemm75 challenge strain. Results from the qPCR were compared to culture, using throat swab samples collected in a human challenge study.

Results

The qPCR was 100% specific for theemm75 challenge strain when tested against a panel ofS. pyogenes emm-types and other respiratory pathogens. Combined RNA + DNA extraction had similar yield to traditional separate extractions. The combined extraction method andemm75 qPCR had 98.8% sensitivity compared to culture for throat swabs collected from challenge study participants.

Conclusions

We have developed a reliable molecular method for measuringS. pyogenesbacterial load from throat swabs collected in a controlled human infection model ofS. pyogenespharyngitis.

Trial registration

NCT03361163on 4th December 2017.
Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism
Authors: Lu Ruigang , Zhao Wei , Yin Li , Guo Ruijun , Wei Bojun , Jin Mulan , Zhou Xiang , Zhang Chun , Lv Xiuzhang
Published: May 2021

Background

Primary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas.

Methods

A total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated.

Results

In this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; χ2 = 26.224, 18.227 respectively, P < 0.001). The differences between US + Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (χ2 = 33.410, 21.587 respectively, P < 0.001), yet there were no significant differences in the sensitivity or accuracy between US + Tc-99m MIBI SPECT/CT and US-alone (χ2 = 0.866, 0.187 respectively, P = 0.352 and 0.665).

Conclusions

US shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.
Knowledge and practice to prevent COVID-19 and its associated factors among pregnant women in Debre Tabor Town Northwest Ethiopia, a community-based cross-sectional study
Authors: Ayele Alemu Degu , Mihretie Gedefaye Nibret , Belay Habtamu Gebrehana , Teffera Adanech Getie , Kassa Bekalu Getnet , Amsalu Bedemariam Tadesse
Published: May 2021

Background

Coronavirus disease is now a global concern with the non-availability of antiviral treatment and attacks all groups of the population. Hence, applying preventive measures is the most critical intervention to control the infection. Pregnant women are particularly susceptible to respiratory pathogens because of their immunosuppressive state and physiological adaptive change during pregnancy. Therefore, this study was aimed to assess knowledge and practice to prevent coronavirus disease and its associated factors among pregnant women in Debre Tabor Town.

Methods

Community-based cross-sectional study was conducted among 422 participants from May 25–June 15, 2020. A simple random sampling technique was employed. Data were collected by face-to-face interview using a structured and pre-tested questionnaire and analysis using SPSS version 23. Bivariable and multivariable logistic regression analysis was carried out and p-value < 0.05 at 95% CI were considered as statistically significant.

Results

Overall 46.8 and 47.6% of women were knowledgeable and had good practice to prevent coronavirus respectively. Women’s age (15–24 years) (AOR = 4.85, 95% CI: 1.34–5.42), educational status (AOR:3.70; 95% CI: 1.16–5.40) being civil servant (AOR:2.84; 95% CI: 1.55–5.21), wanted pregnancy (AOR:3.37; 95% CI: 1.20–9.45), antenatal care follow-up (AOR:2.07; 95% CI: 1.03–4.13) were significantly associated with COVID-19 knowledge, whereas educational status (AOR:3.78; 95% CI: 1.19–5.11), number of children (AOR:2.89; 95% CI: 1.29–6.45) and knowledge (AOR:8.42;95% CI: 4.50–15.85), were also found to be statistically significant with practice.

Conclusions

Most of the participants had poor knowledge and inappropriate practice. Increasing health education programs via different media, coordinated and combined efforts of authorities and all individuals will be needed to battles the spread of the infection.
The tumor immune microenvironment and immune-related signature predict the chemotherapy response in patients with osteosarcoma
Authors: He Lijiang , Yang Hainan , Huang Jingshan
Published: May 2021

Background

Genome-wide expression profiles have been shown to predict the response to chemotherapy. The purpose of this study was to develop a novel predictive signature for chemotherapy in patients with osteosarcoma.

Methods

We analysed the relevance of immune cell infiltration and gene expression profiles of the tumor samples of good responders with those of poor responders from the TARGET and GEO databases. Immune cell infiltration was evaluated using a single-sample gene set enrichment analysis (ssGSEA) and the CIBERSORT algorithm between good and poor chemotherapy responders. Differentially expressed genes were identified based on the chemotherapy response. LASSO regression and binary logistic regression analyses were applied to select the differentially expressed immune-related genes (IRGs) and developed a predictive signature in the training cohort. A receiver operating characteristic (ROC) curve analysis was employed to assess and validate the predictive accuracy of the predictive signature in the validation cohort.

Results

The analysis of immune infiltration showed a positive relationship between high-level immune infiltration and good responders, and T follicular helper cells and CD8 T cells were significantly more abundant in good responders with osteosarcoma. Two hundred eighteen differentially expressed genes were detected between good and poor responders, and a five IRGs panel comprising TNFRSF9, CD70, EGFR, PDGFD and S100A6 was determined to show predictive power for the chemotherapy response. A chemotherapy-associated predictive signature was developed based on these five IRGs. The accuracy of the predictive signature was 0.832 for the training cohort and 0.720 for the validation cohort according to ROC analysis.

Conclusions

The novel predictive signature constructed with five IRGs can be effectively utilized to predict chemotherapy responsiveness and help improve the efficacy of chemotherapy in patients with osteosarcoma.
Hsa_circ_0000301 facilitates the progression of cervical cancer by targeting miR-1228-3p/IRF4 Axis
Authors: Deng Zhi-Min , Dai Fang-Fang , Zhou Quan , Cheng Yan-Xiang
Published: May 2021

Background

With the broadened application of gene expression profiles analysis, the role of miRNA and circRNA are of increasing concern in recent years, especially during the pathogenesis of cancer. However, to date, the reported on this area in cervical cancer are limited.

Method

In this study, Weighted Gene Co-Expression Network Analysis (WGCNA) and differential gene expression analysis were utilized to screen out differentially expressed (DE) circular RNAs in cervical cancer, and then we predicted and screened the combined microRNAs (miRNA) and downstream mRNAs to construct circular (circ)RNA-miRNA-mRNA network.

Result

As a result, a regulatory circular (circ)RNA-miRNA-mRNA with 1 circRNA node, 4 miRNA nodes, 135 mRNA nodes were constructed in an attempt to provide novel biomarkers for the pathogenesis of cervical cancer. In addition, enrichment analysis including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed on mRNAs in the network. After further screening of mRNAs by two online databases of GEPIA2 and RNAyhrid, precise target genes were obtained. Next, we screened out four target genes (CXCL16, IRF4, OAS3 and PTGER3) by constructing the protein-protein interaction (PPI) network, and mapped them to the initial network to reconstruct the circRNA-miRNA-mRNA network. Notably, the low expression of IRF4 was demonstrated to be associated with a significantly poorer overall survival in the GEPIA2 database, which was also verified by the immunofluorescence of the sections in Human Protein Atlas (HPA). The upstream miRNA corresponding to IRF4 is hsa-miR-1228-3p.

Conclusion

From above concern, it can conclude that hsa_circ_0000301/hsa-miR-1228-3p/IRF4 may be involved in the occurrence and development of cervical cancer. However, the specific mechanism should be further studied and confirmed.
Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: study protocol of the FIVALIN project
Authors: Homs C. , Berruezo P. , Según G. , Estrada L. , de Bont J. , Riera-Romaní J. , Carrillo-Álvarez E. , Schröder H. , Milà R. , Gómez S. F.
Published: May 2021

Background

Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 5–19 years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal.

Methods

We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 8–12 years and 600 parents will be recruited during 3 consecutive editions (1st – 2019/2020; 2nd – 2020/2021; 3rd – 2021/2022) of 10 months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups.

Discussion

There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status.

Trial registration

ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered.

Protocol version: 30 April 2021, version 5.
Prognostic and functional impact of perioperative LAMA/LABA inhaled therapy in patients with lung cancer and chronic obstructive pulmonary disease
Authors: Azuma Yoko , Sano Atsushi , Sakai Takashi , Koezuka Satoshi , Otsuka Hajime , Tochigi Naobumi , Isobe Kazutoshi , Sakamoto Susumu , Takai Yujiro , Iyoda Akira
Published: May 2021

Background

Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.

Methods

Between January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records.

Results

Patients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV1) and percentage of predicted forced expiratory volume in 1 s (FEV1%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV1%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008).

Conclusions

We believe this treatment combination is optimal for patients with lung cancer and COPD.
Visualizing complex healthcare disparities: proof of concept for representing a cyclical continuum of care model for a retrospective cohort of patients with musculoskeletal infections
Authors: Carvour Martha L. , Chiu Allyssa , Page Kimberly
Published: May 2021

Background

Care continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions—musculoskeletal infections—and assessed for racial and ethnic disparities across the complex care process related to these infections.

Methods

Cyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care.

Results

Racial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48).

Conclusions

By identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.
Is unilateral transverse process-pedicle percutaneous kyphoplasty a better choice for osteoporotic thoracolumbar fractures in the old patients?
Authors: Tao Wu , Hu Qin , Nicolas Yap San Min , Nuo Xu , Daoyu Huang , Zhen Jin , Jinpeng Sun , Jun Liu
Published: May 2021

Background

A few reports have shown that unilateral transverse process-pedicle percutaneous kyphoplasty is a good choice for patients with osteoporotic vertebral compression fracture (OVCF). However, this issue remains controversial and the related comprehensive research was lacked.

Methods

A retrospective study was conducted on patients receiving PKP surgery for OVCF. Patients were divided into three groups according to surgical approach. Symptom and radiographical evaluation were performed preoperatively, 1-month postoperatively, 1-year postoperatively and follow-ups. And follow-ups were repeated every year. Visual Analogue Scale Score (VAS), Oswestry Disability Index (ODI) scores, anterior vertebral height, coronal Cobb angle and sagittal Cobb angle was determined and compared among three groups.

Results

Totally 447 patients were included with an average age of 76.6 ± 7.2 years old. UTP showed significantly shorter surgical duration (p < 0.001), lower cement volume (p < 0.001) but higher cement leakage proportion (p = 0.044). No significant statistical difference was found in terms of improvement rates among three groups. Besides, it was notable that the a significantly higher coronal Cobb angle was observed in UTP group, and a about 4°coronal correction was found after UTP PKP.

Conclusion

UTTP PKP could achieve similar symptoms relief and kyphosis correction as UTP and BTP PKP. However, it had shorter surgical time and less radio exposure than BTP PKP, lower risk of cement leakage and higher proportion of bilaterally cement distribution than UTP PKP. It seemed to be a better choice for patients with OVCF. In addition, we found that UTP PKP was especially fit for OVCF patients with asymmetrical vertebral compression.
Maternal adaptation of working mothers with infants or toddlers in South Korea: a systematic review
Authors: Ahn Jeong-Ah , Roh Eun Ha , Kim Tiffany , Lee Jin Hyang , Song Ju-Eun
Published: May 2021

Background

The fertility rate in South Korea has been decreasing dramatically, as working women postpone or avoid childbirth due to the challenges of maintaining a career while raising a family. Working mothers with infants or toddlers have unique maternal adaptation needs, which must be understood in order to support their needs during childbearing years. Supporting successful maternal adaptation of working mothers is not only essential for each individual new working mother, but also benefits her family, her workplace, and the country.

Methods

A systematic review was conducted to describe the current state of the science on maternal adaptation of working mothers with infants or toddlers in South Korea. Eligible studies, published between 2009 and 2018, were identified by searching electronic databases. Quantitative studies related to the maternal adaptation of Korean working mothers who had a child younger than age 3 years were included. 37 articles met the inclusion criteria for narrative analysis and synthesis.

Results

Studies were classified into 4 major groups by maternal adaptation categories as psychological, behavioral, relational, and cognitive adaptation. The majority of studies were focused on working mothers’ psychological adaptation (n = 36, 97.3%), followed by behavioral (n = 10, 27.0%), relational (n = 9, 24.3%), and cognitive (n = 3, 8.1%) adaptation. We found that maternal adaptation of working mothers was ultimately influenced by diverse variables within their communities, spousal and familial support, personal attributes, and job-related characteristics.

Conclusions

These findings demonstrate the importance of understanding variable aspects of maternal adaptation of working mothers with infants or toddlers. The complexity of working mothers’ needs at the individual, family, and community levels must be considered in order to develop effective intervention programs and public policy for supporting maternal adaptation in Korea.
Antifungal and anti-biofilm activity of a new Spanish extract of propolis against Candida glabrata
Authors: Fernández-Calderón María Coronada , Hernández-González Laura , Gómez-Navia Carolina , Blanco-Blanco María Teresa , Sánchez-Silos Rosa , Lucio Leopoldo , Pérez-Giraldo Ciro
Published: May 2021

Background

Resistance to traditional antifungal agents is a considerable health problem nowadays, aggravated by infectious processes related to biofilm formation, usually on implantable devices. Therefore, it is necessary to identify new antimicrobial molecules, such as natural products, to develop new therapeutic strategies to prevent and eradicate these infections. One promising product is propolis, a natural resin produced by honeybees with substances from various botanical sources, beeswax and salivary enzymes. The aim of this work was to study the effect of a new Spanish ethanolic extract of propolis (SEEP) on growth, cell surface hydrophobicity, adherence and biofilm formation of Candida glabrata, a yeast capable of achieving high levels of resistance to available anti-fungal agents.

Methods

The antifungal activity of SEEP was evaluated in the planktonic cells of 12 clinical isolates of C. glabrata. The minimum inhibitory concentration (MIC) of propolis was determined by quantifying visible growth inhibition by serial plate dilutions. The minimum fungicide concentration (MFC) was evaluated as the lowest concentration of propolis that produced a 95% decrease in cfu/mL, and is presented as MFC50 and MFC90, which corresponds to the minimum concentrations at which 50 and 90% of the C. glabrata isolates were inhibited, respectively. Influence on cell surface hydrophobicity (CSH) was determined by the method of microbial adhesion to hydrocarbons (MATH). The propolis effect on adhesion and biofilm formation was determined in microtiter plates by measurement of optical density (OD) and metabolic activity (XTT-assay) in the presence of sub-MIC concentrations of SEEP.

Results

SEEP had antifungal capacity against C. glabrata isolates, with a MIC50 of 0.2% (v/v) and an MFC50 of 0.4%, even in azole-resistant strains. SEEP did not have a clear effect on surface hydrophobicity and adhesion, but an inhibitory effect on biofilm formation was observed at subinhibitory concentrations (0.1 and 0.05%) with a significant decrease in biofilm metabolism.

Conclusions

The novel Spanish ethanolic extract of propolis shows antifungal activity against C. glabrata, and decreases biofilm formation. These results suggest its possible use in the control of fungal infections associated with biofilms.
Current wishes to die; characteristics of middle-aged and older Dutch adults who are ready to give up on life: a cross-sectional study
Authors: Kox Roosmarijne M. K. , Pasman H. Roeline W. , Huisman Martijn , Benneker Wim , Onwuteaka-Philipsen Bregje D.
Published: May 2021

Background

Literature shows that middle-aged and older adults sometimes experience a wish to die. Reasons for these wishes may be complex and involve multiple factors. One important question is to what extent people with a wish to die have medically classifiable conditions.

Aim

(1) Estimate the prevalence of a current wish to die among middle-aged and older adults in The Netherlands; (2) explore which factors within domains of vulnerability (physical, cognitive, social and psychological) are associated with a current wish to die; (3) assess how many middle-aged and older adults with a current wish to die do not have a medically classifiable condition and/or an accumulation of age-related health problems.

Methods

Data of 2015/16 from the Longitudinal Aging Study Amsterdam were used for this cross-sectional study (1563 Dutch middle-aged and older adults aged between 57 and 99 years), obtained through structured medical interviews and self-reported questionnaires. Three experienced physicians assessed whether the participants with a current wish to die could be classified as having a medically classifiable condition and/or an accumulation of age-related health problems.

Results

N = 62 participants (4.0%) had a current wish to die. Having a current wish to die was associated with multiple characteristics across four domains of vulnerability, among which: self-perceived health, problems with memory, self-perceived quality of life and meaningfulness of life. Fifty-four participants with a current wish to die were assessed with having a medically classifiable condition, of which one was also assessed with having an accumulation of age-related health problems. Six people were assessed to have neither, and for two people it was unclear.

Conclusion

A small minority of middle-aged and older adults in the Netherlands have a current wish to die. Most of them can be classified with a medical condition and one person with an accumulation of age-related health problems. Furthermore, the findings show that having a current wish to die is multi-faceted. There is still a need for more knowledge, such as insight in to what extent suffering stemming from the medical classifiable disease contributes to the development of the wish to die.
Minimizing the knowledge-to-action gap; identification of interventions to change nurses' behavior regarding fall prevention, a mixed method study
Authors: Hakvoort Lysette , Dikken Jeroen , van der Wel Maaike , Derks Christel , Schuurmans Marieke
Published: May 2021

Background

The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients.

Methods

This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n = 26). Geriatric experts (n = 11), managers (n = 13) and educators (n = 13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability.

Results

In Geriatric experts’ opinions interventions targeting behavior change of nurses regarding fall prevention should aim at ‘after-care’, ‘estimating fall risk’ and ‘providing information’. However, in nurses’ opinions it should target; ‘providing information’, ‘fall prevention’ and ‘multifactorial fall risk assessment’. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning.

Conclusions

The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice.
An epilepsy-causing mutation leads to co-translational misfolding of the Kv7.2 channel
Authors: Urrutia Janire , Aguado Alejandra , Gomis-Perez Carolina , Muguruza-Montero Arantza , Ballesteros Oscar R. , Zhang Jiaren , Nuñez Eider , Malo Covadonga , Chung Hee Jung , Leonardo Aritz , Bergara Aitor , Villarroel Alvaro
Published: May 2021

Background

The amino acid sequence of proteins generally carries all the necessary information for acquisition of native conformations, but the vectorial nature of translation can additionally determine the folding outcome. Such consideration is particularly relevant in human diseases associated to inherited mutations leading to structural instability, aggregation, and degradation. Mutations in the KCNQ2 gene associated with human epilepsy have been suggested to cause misfolding of the encoded Kv7.2 channel. Although the effect on folding of mutations in some domains has been studied, little is known of the way pathogenic variants located in the calcium responsive domain (CRD) affect folding. Here, we explore how a Kv7.2 mutation (W344R) located in helix A of the CRD and associated with hereditary epilepsy interferes with channel function.

Results

We report that the epilepsy W344R mutation within the IQ motif of CRD decreases channel function, but contrary to other mutations at this site, it does not impair the interaction with Calmodulin (CaM) in vitro, as monitored by multiple in vitro binding assays. We find negligible impact of the mutation on the structure of the complex by molecular dynamic computations. In silico studies revealed two orientations of the side chain, which are differentially populated by WT and W344R variants. Binding to CaM is impaired when the mutated protein is produced in cellulo but not in vitro, suggesting that this mutation impedes proper folding during translation within the cell by forcing the nascent chain to follow a folding route that leads to a non-native configuration, and thereby generating non-functional ion channels that fail to traffic to proper neuronal compartments.

Conclusions

Our data suggest that the key pathogenic mechanism of Kv7.2 W344R mutation involves the failure to adopt a configuration that can be recognized by CaM in vivo but not in vitro.
Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials
Authors: Sivapalan Pradeesh , Rutishauser Jonas , Ulrik Charlotte Suppli , Leuppi Jörg D. , Pedersen Lars , Mueller Beat , Eklöf Josefin , Biering-Sørensen Tor , Gottlieb Vibeke , Armbruster Karin , Janner Julie , Moberg Mia , Lapperre Therese S. , Nielsen Thyge L. , Browatzki Andrea , Mathioudakis Alexander , Vestbo Jørgen , Schüetz Philipp , Jensen Jens-Ulrik
Published: May 2021

Background

Systemic corticosteroid administration for severe acute exacerbations of COPD (AECOPD) reduces the duration of hospital stays. Corticosteroid-sparing regimens have showed non-inferiority to higher accumulated dose regimens regarding re-exacerbation risk in patients with AECOPD. However, it remains unclear whether 14-day or 2–5-day regimens would result in shorter admission durations and changes in mortality risk. We explored this by analysing the number of days alive and out of hospital based on two randomised controlled trials with different corticosteroid regimens.

Methods

We pooled individual patient data from the two available multicentre randomised trials on corticosteroid-sparing regimens for AECOPD: the REDUCE (n = 314) and CORTICO-COP (n = 318) trials. In the 14-day regimen group, patients were older, fewer patients received pre-treatment with antibiotics and more patients received pre-treatment with systemic corticosteroids. Patients randomly allocated to the 14-day and 2–5-day regimens were compared, with adjustment for baseline differences.

Results

The number of days alive and out of hospital within 14 days from recruitment was higher for the 2–5 day regimen group (mean 8.4 days; 95% confidence interval [CI] 8.0–8.8) than the 14-day regimen patient group (4.2 days; 95% CI3.4–4.9; p < 0.001). The 14-day AECOPD group had longer hospital stays (mean difference, 5.4 days [standard error ± 0.6]; p < 0.0001) and decreased likelihood of discharge within 30 days (hazard ratio [HR] 0.5; 95% CI 0.4–0.6; p < 0.0001). Comparing the 14-day regimen and the 2–5 day regimen group showed no differences in the composite endpoint ‘death or ICU admission’ (odds ratio [OR] 1.4; 95% CI 0.8–2.3; p = 0.15), new or aggravated hypertension (OR 1.5; 95% CI 0.9–2.7; p = 0.15), or mortality risk (HR 0.8; 95% CI 0.4–1.5; p = 0.45) during the 6-month follow-up period.

Conclusion

14-day corticosteroid regimens were associated with longer hospital stays and fewer days alive and out of hospital within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients. Our results favour 2–5 day regimens for treating COPD exacerbations. However, prospective studies are needed to validate these findings.
Use of capnography for prediction of obstruction severity in non-intubated COPD and asthma patients
Authors: Pertzov Barak , Ronen Michal , Rosengarten Dror , Shitenberg Dorit , Heching Moshe , Shostak Yael , Kramer Mordechai R.
Published: May 2021

Background

Capnography waveform contains essential information regarding physiological characteristics of the airway and thus indicative of the level of airway obstruction. Our aim was to develop a capnography-based, point-of-care tool that can estimate the level of obstruction in patients with asthma and COPD.

Methods

Two prospective observational studies conducted between September 2016 and May 2018 at Rabin Medical Center, Israel, included healthy, asthma and COPD patient groups. Each patient underwent spirometry test and continuous capnography, as part of, either methacholine challenge test for asthma diagnosis or bronchodilator reversibility test for asthma and COPD routine evaluation. Continuous capnography signal, divided into single breaths waveforms, were analyzed to identify waveform features, to create a predictive model for FEV1 using an artificial neural network. The gold standard for comparison was FEV1 measured with spirometry.

Measurements and main results

Overall 160 patients analyzed. Model prediction included 32/88 waveform features and three demographic features (age, gender and height). The model showed excellent correlation with FEV1 (R = 0.84), R2 achieved was 0.7 with mean square error of 0.13.

Conclusion

In this study we have developed a model to evaluate FEV1 in asthma and COPD patients. Using this model, as a point-of-care tool, we can evaluate the airway obstruction level without reliance on patient cooperation. Moreover, continuous FEV1 monitoring can identify disease fluctuations, response to treatment and guide therapy.

Trial registration

clinical trials.gov, NCT02805114. Registered 17 June 2016, https://clinicaltrials.gov/ct2/show/NCT02805114
Circ_0000745 strengthens the expression of CCND1 by functioning as miR-488 sponge and interacting with HuR binding protein to facilitate the development of oral squamous cell carcinoma
Authors: Li Kuangzheng , Fan Xiaosheng , Yan Ziyi , Zhan Jia , Cao Fangyun , Jiang Yixia
Published: May 2021

Background

The implication of circular RNAs (circRNAs) in human cancers has aroused much concern. In this study, we investigated the function of circ_0000745 and its potential functional mechanisms in oral squamous cell carcinoma (OSCC) to further understand OSCC pathogenesis.

Methods

The expression of circ_0000745, miR-488 and cyclin D1 (CCND1) mRNA was measured by quantitative real-time polymerase chain reaction (qPCR). Cell proliferation capacity was assessed by cell counting kit-8 (CCK-8) assay and colony formation assay. Cell cycle progression and cell apoptosis were determined by flow cytometry assay. The protein levels of CCND1, PCNA, Cleaved-caspase 3 and HuR were detected by western blot. Animal study was conducted to identify the role of circ_0000745 in vivo. The targeted relationship was verified by dual-luciferase reporter assay, pull-down assay or RNA immunoprecipitation (RIP) assay.

Results

The expression of circ_0000745 was increased in OSCC tissues and cells. Circ_0000745 downregulation inhibited OSCC cell proliferation and induced cell cycle arrest and apoptosis in vitro, as well as blocked tumor growth in vivo. MiR-488 was a target of circ_0000745, and circ_0000745 downregulation suppressed OSCC development by enriching miR-488. Besides, circ_0000745 regulated CCND1 expression by targeting miR-488. In addition, circ_0000745 regulated CCND1 expression by interacting with HuR protein. CCND1 knockdown also inhibited OSCC cell proliferation and induced cell cycle arrest and apoptosis in vitro, and CCND1 overexpression recovered the inhibitory effects on OSCC cell malignant behaviors caused by circ_0000745 downregulation.

Conclusions

Circ_0000745 regulated the expression of CCND1 partly by acting as miR-488 sponge and interacting with HuR protein, thus promoting the progression of OSCC.
Assessment of medical equipment maintenance management: proposed checklist using Iranian experience
Authors: Arab-Zozani Morteza , Imani Ali , Doshmangir Leila , Dalal Koustuv , Bahreini Rona
Published: May 2021

Background

Effective maintenance management of medical equipment is one of the major issues for quality of care, for providing cost-effective health services and for saving scarce resources. This study aimed to develop a comprehensive checklist for assessing the medical equipment maintenance management (MEMM) in the Iranian hospitals.

Methods

This is a multi-methods study. First, data related to factors which affect the assessment of MEMM were collected through a systematic review in PubMed, ProQuest, Scopus, Embase, and web of science without any time limitation until October 2015, updated in June 2017. Then, we investigated these factors affecting using document review and interviews with experts in the Iranian hospitals. In the end, the results of the first and second stages were combined using content analysis and the final checklist was developed in a two-round Delphi.

Results

Using a combination of factors extracted from the systematic and qualitative studies, the primary checklist was developed in the form of assessment checklists in seven dimensions. The final checklist includes 7 dimensions and 19 sub-categories: “resources = 3,” “quality control = 3,” “information bank = 4,” “education = 1,” “service = 3,” “inspection and preventive maintenance = 2” and “design and implementation = 3.”

Conclusions

Developing an assessment checklist for MEMM provide a comprehensive framework for the proper implementation of accurate assessment of medical equipment maintenance. This checklist can be used to improve the profitability of health facilities and the reliability of medical equipment. In addition, it is implicated in the decision-making in support of selection, purchase, repair and maintenance of medical equipment, especially for capital equipment managers and medical engineers in hospitals and also for the assessment of this process.
Socioeconomic inequalities in curative healthcare-seeking for children under five before and after the free healthcare initiative in Sierra Leone: analysis of population-based survey data
Authors: Bognini Joel D. , Samadoulougou Sekou , Ouedraogo Mady , Kangoye Tiga David , Van Malderen Carine , Tinto Halidou , Kirakoya-Samadoulougou Fati
Published: May 2021

Background

Socioeconomic inequalities between and within countries lead to disparities in the use of health services. These disparities could lead to child mortality in children under 5 years by depriving them of healthcare. Therefore, initiatives to remove healthcare fees such as the Free Healthcare Initiative (FHCI) adopted in Sierra Leone can contribute to reducing these inequities in healthcare-seeking for children. This study aimed to assess the socioeconomic inequalities in healthcare-seeking for children under 5 years of age before and after the implementation of the FHCI.

Methods

Data were included on 1207, 2815, 1633, and 1476 children under 5 years of age with fever from the 2008, 2013, 2016, and 2019 nationwide surveys, respectively. Concentration curves were drawn for the period before (2008) and after (2013–2019) the implementation of the FHCI to assess socioeconomic inequalities in healthcare-seeking. Finally, Erreyger’s corrected concentration indices were calculated to understand the magnitude of these inequalities.

Results

Before the implementation of the FHCI, there were inequalities in healthcare-seeking for children under five (Erreyger’s corrected concentration index (CI) = 0.168, standard error (SE) = 0.049; p < 0.001) in favor of the wealthy households. These inequalities decreased after the implementation of the FHCI (CI = 0.061, SE = 0.033; p = 0.06 in 2013, CI = 0.039, SE = 0.04; p = 0.32 in 2016, and CI = − 0.0005, SE = 0.362; p = 0.98 in 2019). Furthermore, before the implementation of the FHCI, a significant pro-rich inequality in the districts of Kenema (CI = 0.117, SE = 0.168, p = 0.021), Kono (CI = 0.175, SE = 0.078, p = 0.028) and Western Area Urban (CI = 0.070, SE = 0.032, p = 0.031) has been observed. After the implementation of the FHCI in 2019, these disparities were reduced, 11 of the 14 districts had a CI around the value of equality, and only in 2 districts the pro-rich inequality were significant (Western Area Urban (CI = 0.035, SE = 0.016, p = 0.039) and Western Area Rural (CI = 0.066, SE = 0.030, p = 0.027)).

Conclusion

The results of this study demonstrated that socio-economic inequalities in healthcare-seeking for children have been considerably reduced after the FHCI in Sierra Leone. To further reduce these inequalities, policy actions can focus on the increase of availability of health services in the districts where the healthcare-seeking remained pro-rich.
Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature
Authors: Blanchet Garneau Amélie , Bélisle Marilou , Lavoie Patrick , Laurent Sédillot Catherine
Published: May 2021

Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.