bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist?
Authors: Gaffar Balgis , Farooqi Faraz Ahmed , Nazir Muhammad Ashraf , Bakhurji Eman , Al-Khalifa Khalifa S. , Alhareky Muhanad , Virtanen Jorma I.
Published: March 2022

Background

There is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia.

Methods

A cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP.

Results

A total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients’ questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients’ oral health question as well as have more referral practices.

Conclusion

The results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.
An e-learning pediatric cardiology curriculum for Pediatric Postgraduate trainees in Rwanda: implementation and evaluation
Authors: Rusingiza Emmanuel , Alizadeh Faraz , Wolbrink Traci , Mutamba Barbra , Vinci Samuel , Profita Elizabeth L. , Rulisa Steven , DelSignore Lisa , Solis Jessica , Geggel Robert , Wilson Kim
Published: March 2022

Background

Access to pediatric sub-specialty training is a critical unmet need in many resource-limited settings. In Rwanda, only two pediatric cardiologists are responsible for the country’s clinical care of a population of 12 million, along with the medical education of all pediatric trainees. To strengthen physician training opportunities, we developed an e-learning curriculum in pediatric cardiology. This curriculum aimed to “flip the classroom”, allowing residents to learn key pediatric cardiology concepts digitally before an in-person session with the specialist, thus efficiently utilizing the specialist for additional case based and bedside teaching.

Methods

We surveyed Rwandan and US faculty and residents using a modified Delphi approach to identify key topics in pediatric cardiology. Lead authors from Rwanda and the USA collaborated with OPENPediatrics™, a free digital knowledge-sharing platform, to produce ten core topics presented in structured videos spanning 4.5 h. A mixed methods evaluation was completed with Rwandan pediatric residents, including surveys assessing knowledge, utilization, and satisfaction. Qualitative analysis of structured interviews was conducted using NVivo.

Results

Among the 43 residents who participated in the OPENPediatrics™ cardiology curriculum, 33 (77%) completed the curriculum assessment. Residents reported using the curriculum for a median of 8 h. Thirty-eight (88%) reported viewing the curriculum on their personal or hospital computer via pre-downloaded materials on a USB flash drive, with another seven (16%) reporting viewing it online. Twenty-seven residents viewed the course during core lecture time (63%). Commonly reported barriers to utilization included lack of time (70%), access to internet (40%) and language (24%). Scores on knowledge assessment improved from 66.2% to 76.7% upon completion of the curriculum (p < 0.001) across all levels of training, with most significant improvement in scores for PGY-1 and PGY-2 residents. Residents reported high satisfaction with the visuals, engaging presentation, and organization of the curriculum. Residents opined the need for expanded training material in cardiac electrocardiogram and echocardiogram and requested for slower narration by foreign presenters.

Conclusion

Video-based e-learning via OPENPediatrics™ in a resource-limited setting was effective in improving resident’s knowledge in pediatric cardiology with high levels of utilization and satisfaction. Expanding access to digital curriculums for other pediatric sub-specialties may be both an effective and efficient strategy for improving training in settings with limited access to subspecialist faculty.
Asthma and the risk of gastrointestinal disorders: a Mendelian randomization study
Authors: Freuer Dennis , Linseisen Jakob , Meisinger Christa
Published: March 2022

Background

The question of whether asthma is causally related to gastrointestinal disorders remained unanswered so far. Thus, this study investigated whether there is such a relation and whether the time of onset of asthma plays a role in the occurrence of the following gastrointestinal disorders: peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) including the distinction between Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

Using summary data of genome-wide association studies (GWASs), we ran Mendelian randomization analyses based on up to 456,327 European participants. Outlier assessment, a series of sensitivity analyses and validation of IBD results in a second GWAS were performed to confirm the results.

Results

Presented ORs represent the average change in the outcome per 2.72-fold increase in the prevalence of the exposure. Genetically predicted childhood-onset asthma was positively associated with PUD, GORD, and IBS with similar odds ratios near 1.003 and adjustedP-values from 0.007 (GORD) to 0.047 (PUD). Furthermore, it was inversely related to IBD (OR = 0.992, 95% CI: 0.986, 0.998, adjustedP = 0.023) and suggestively associated with its UC subtype (OR = 0.990, 95% CI: 0.982, 0.998, adjustedP = 0.059). There were no associations between genetically predicted adult-onset asthma and the mentioned gastrointestinal disorders.

Conclusions

This study provides evidence that the presence of asthma onset in childhood increases the risk for GORD, PUD, and IBS but decreases the risk for IBD in adults. The lower risk for IBD may be attributed to a lower risk primarily for UC.
A mini-whole lung lavage to treat autoimmune pulmonary alveolar proteinosis (PAP)
Authors: Mariani Francesca , Salvaterra Elena , Lettieri Sara , De Silvestri Annalisa , Corino Alessandra , Bosio Matteo , Fraolini Elia , Piloni Davide , Rodi Giuseppe , Corsico Angelo Guido , Campo Ilaria
Published: March 2022

Background

PAP is an ultra-rare respiratory syndrome characterized by the accumulation of surfactant within the alveoli. Whole lung lavage (WLL) is the current standard of care of PAP, however it is not a standardized procedure and the total amount of fluid used to wash each lung is still debated. Considering ICU hospitalization associated risks, a “mini-WLL” with anticipated manual clapping and reduced total infusion volume and has been proposed in our center.

The aim of the study is to retrospectively analyze the efficacy of mini-WLL compared to standard WLL at the Pavia center.

Methods

13 autoimmune PAP patients eligible for WLL were included: 7 patients were admitted to mini-WLL (9 L total infusion volume for each lung) and 6 patients underwent standard WLL (14 L of infusion volume). Functional data (VC%, FVC%, TLC%, DLCO%) and alveolar-arterial gradient values (A-aO2) were collected at the baseline and 1, 3, 6, 12, 18 months after the procedure.

Results

A statistically significant improvement of VC% (p = 0.013, 95%CI 3.49–30.19), FVC% (p = 0.016, 95%CI 3.37–32.09), TLC% (p = 0.001, 95%CI 7.38–30.34) was observed in the mini-WLL group in comparison with the standard WLL group, while no significant difference in DLCO% and A-aO2 mean values were reported.

Conclusion

Mini-WLL has demonstrated higher efficacy in ameliorating lung volumes, suggesting that a lower infusion volume is sufficient to remove the surfactant accumulation and possibly allows a reduced mechanical insult of the bronchi walls and the alveoli. However, no statistically significant differences were found in terms of DLCO% and Aa-O2.
Tumor-associated macrophage derived IL-6 enriches cancer stem cell population and promotes breast tumor progression via Stat-3 pathway
Authors: Radharani N. N. V. , Yadav Amit S. , Nimma Ramakrishna , Kumar T. V. Santosh , Bulbule Anuradha , Chanukuppa Venkatesh , Kumar Dhiraj , Patnaik Srinivas , Rapole Srikanth , Kundu Gopal C.
Published: March 2022

Background

Cancer stem cells (CSCs) play crucial role in tumor progression, drug resistance and relapse in various cancers. CSC niche is comprised of various stromal cell types including Tumor-associated macrophages (TAMs). Extrinsic ques derived from these cells help in maintenance of CSC phenotype. TAMs have versatile roles in tumor progression however their function in enrichment of CSC is poorly explored.

Methods

Mouse macrophages (RAW264.7) cells were activated by interaction with conditioned media (CM) of murine breast cancer cells (4T1) into TAMs and the effect of activated macrophage (TAM) derived factors was examined on enrichment of cancer stem cells (CSCs) and tumor growth using in vitro and in vivo models.

Results

In this study, we report that macrophages upon interaction with breast cancer cells activate tumor promoting function and exhibit differential expression of various proteins as shown by secretome analysis using proteomics studies. Based on secretome data, we found that Interleukin-6 (IL-6) is one of the up-regulated genes expressed in activated macrophages. Further, we confirm that TAMs produce high levels of IL-6 and breast cancer cell derived factors induce IL-6 production in activated macrophages via p38-MAPK pathway. Furthermore, we demonstrate that tumor activated macrophages induce enrichment of CSCs and expression of CSC specific transcription factors such as Sox-2, Oct-3/4 and Nanog in breast cancer cells. We further prove that TAM derived IL-6 plays a key role in TAM mediated CSC enrichment through activation of Signal transducer and activator of transcription 3 (STAT-3) signaling. TAM derived IL-6 influences breast cancer cell migration and angiogenesis. Moreover, our in vivo findings indicated that TAM derived IL-6 induces CSC population and resulting tumor growth in breast cancer.

Conclusion

These finding provide evidence that TAM derived IL-6 plays a major role in CSC enrichment and tumor progression in breast cancer and IL-6 and its regulated signalling network may act as potential therapeutic target for management of breast cancer.
Sub-national tailoring of malaria interventions in Mainland Tanzania: simulation of the impact of strata-specific intervention combinations using modelling
Authors: Runge Manuela , Thawer Sumaiyya G. , Molteni Fabrizio , Chacky Frank , Mkude Sigsbert , Mandike Renata , Snow Robert W. , Lengeler Christian , Mohamed Ally , Pothin Emilie
Published: March 2022

Background

To accelerate progress against malaria in high burden countries, a strategic reorientation of resources at the sub-national level is needed. This paper describes how mathematical modelling was used in mainland Tanzania to support the strategic revision that followed the mid-term review of the 2015–2020 national malaria strategic plan (NMSP) and the epidemiological risk stratification at the council level in 2018.

Methods

Intervention mixes, selected by the National Malaria Control Programme, were simulated for each malaria risk strata per council. Intervention mixes included combinations of insecticide-treated bed nets (ITN), indoor residual spraying, larval source management, and intermittent preventive therapies for school children (IPTsc). Effective case management was either based on estimates from the malaria indicator survey in 2016 or set to a hypothetical target of 85%. A previously calibrated mathematical model in OpenMalaria was used to compare intervention impact predictions for prevalence and incidence between 2016 and 2020, or 2022.

Results

For each malaria risk stratum four to ten intervention mixes were explored. In the low-risk and urban strata, the scenario without a ITN mass campaign in 2019, predicted high increase in prevalence by 2020 and 2022, while in the very-low strata the target prevalence of less than 1% was maintained at low pre-intervention transmission intensity and high case management. In the moderate and high strata, IPTsc in addition to existing vector control was predicted to reduce the incidence by an additional 15% and prevalence by 22%. In the high-risk strata, all interventions together reached a maximum reduction of 76%, with around 70% of that reduction attributable to high case management and ITNs. Overall, the simulated revised NMSP was predicted to achieve a slightly lower prevalence in 2020 compared to the 2015–2020 NMSP (5.3% vs 6.3%).

Conclusion

Modelling supported the choice of intervention per malaria risk strata by providing impact comparisons of various alternative intervention mixes to address specific questions relevant to the country. The use of a council-calibrated model, that reproduces local malaria trends, represents a useful tool for compiling available evidence into a single analytical platform, that complement other evidence, to aid national programmes with decision-making processes.
Past mercury exposure and current symptoms of nervous system dysfunction in adults of a First Nation community (Canada)
Authors: Philibert Aline , Fillion Myriam , Da Silva Judy , Lena Tanya Suvendrini , Mergler Donna
Published: March 2022

Background

The watershed in Asubpeeschoseewagong Netum Anishinabek (Grassy Narrows First Nation) territory has been contaminated by mercury (Hg) since 1962, resulting in very high Hg concentrations in fish, central to the community’s culture, traditions, economy and diet. Biomarkers of Hg exposure (umbilical cord blood and hair/blood samples), monitored between 1970 and 1997, decreased over time. A recent Grassy Narrows Community Health Assessment (GN-CHA) survey included current symptoms of nervous system dysfunction. The present study aimed to cluster self-reported symptoms and examine their associations with past Hg exposure.

Methods

The GN-CHA included 391 adults. Symptom clustering used a two-step segmentation approach. Umbilical cord Hg and/or yearly measurements of equivalent hair Hg were available for 242 participants. Structural Equation Models (SEM) displayed the associations between Hg exposure and clusters, with Hg exposure modelled as a latent variable or in separate variables (prenatal, childhood and having had hair Hg ≥ 5 μg/g at least once over the sampling period). Longitudinal Mixed Effects Models (LMEM) served to examine past hair Hg with respect to clusters.

Results

A total of 37 symptoms bonded into 6 clusters, representing Extrapyramidal impairment, Sensory impairment, Cranial nerve disturbances, Gross motor impairment, Neuro-cognitive deficits and Affect/Mood disorders. Median Hg concentrations were 5 μg/L (1–78.5) and 1.1 μg/g (0.2–16) for umbilical cord and childhood hair, respectively. More than one-third (36.6%) had hair Hg ≥ 5 μg/g at least once. In SEM, latent Hg was directly associated with Extrapyramidal and Sensory impairment, Cranial nerve disturbances and Affect/Mood disorders. Direct associations were observed for prenatal exposure with Affect/Mood disorders, for childhood exposure with Extrapyramidal impairment and Cranial nerve disturbances, and for hair Hg ≥ 5 μg/g with Extrapyramidal and Sensory impairment. For all clusters, a further association between past Hg exposure and symptom clusters was mediated by diagnosed nervous system disorders. LMEM showed higher past hair Hg among those with higher scores for all clusters, except Affect/Mood disorders.

Conclusion

Our findings provide evidence that in this First Nation community, past Hg exposure from fish consumption was associated with later-life clusters of coexisting symptoms of nervous system dysfunction.
Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients, and healthy individuals
Authors: Gerardin Eloïse , Bontemps Damien , Babuin Nicolas-Thomas , Herman Benoît , Denis Adrien , Bihin Benoît , Regnier Maxime , Leeuwerck Maria , Deltombe Thierry , Riga Audrey , Vandermeeren Yves
Published: March 2022

Background

Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs).

Methods

Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions.

Results

Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28–55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale.

Conclusions

Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke.

Trial registration: ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019.https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1
Surface functionalization and size modulate the formation of reactive oxygen species and genotoxic effects of cellulose nanofibrils
Authors: Aimonen Kukka , Imani Monireh , Hartikainen Mira , Suhonen Satu , Vanhala Esa , Moreno Carlos , Rojas Orlando J. , Norppa Hannu , Catalán Julia
Published: March 2022

Background

Cellulose nanofibrils (CNFs) have emerged as a sustainable and environmentally friendly option for a broad range of applications. The fibrous nature and high biopersistence of CNFs call for a thorough toxicity assessment, but it is presently unclear which physico-chemical properties could play a role in determining the potential toxic response to CNF. Here, we assessed whether surface composition and size could modulate the genotoxicity of CNFs in human bronchial epithelial BEAS-2B cells. We examined three size fractions (fine, medium and coarse) of four CNFs with different surface chemistry: unmodified (U-CNF) and functionalized with 2,2,6,6-tetramethyl-piperidin-1-oxyl (TEMPO) (T-CNF), carboxymethyl (C-CNF) and epoxypropyltrimethylammonium chloride (EPTMAC) (E-CNF). In addition, the source fibre was also evaluated as a non-nanosized material.

Results

The presence of the surface charged groups in the functionalized CNF samples resulted in higher amounts of individual nanofibrils and less aggregation compared with the U-CNF. T-CNF was the most homogenous, in agreement with its high surface group density. However, the colloidal stability of all the CNF samples dropped when dispersed in cell culture medium, especially in the case of T-CNF. CNF was internalized by a minority of BEAS-2B cells. No remarkable cytotoxic effects were induced by any of the cellulosic materials. All cellulosic materials, except the medium fraction of U-CNF, induced a dose-dependent intracellular formation of reactive oxygen species (ROS). The fine fraction of E-CNF, which induced DNA damage (measured by the comet assay) and chromosome damage (measured by the micronucleus assay), and the coarse fraction of C-CNF, which produced chromosome damage, also showed the most effective induction of ROS in their respective size fractions.

Conclusions

Surface chemistry and size modulate the in vitro intracellular ROS formation and the induction of genotoxic effects by fibrillated celluloses. One cationic (fine E-CNF) and one anionic (coarse C-CNF) CNF showed primary genotoxic effects, possibly partly through ROS generation. However, the conclusions cannot be generalized to all types of CNFs, as the synthesis process and the dispersion method used for testing affect their physico-chemical properties and, hence, their toxic effects.
Radical resection and reconstruction in patients with adenoid cystic carcinoma in the minor salivary glands of the palate
Authors: Chen Wei-liang , Wang Yan , Zhou Bin , Liao Juan-kun , Chen Rui
Published: March 2022

Background

This study evaluated the clinical outcomes of the patients with adenoid cystic carcinoma (ACC) of the minor salivary glands of the palate.

Methods

Forty-four patients with stage I–II disease and 14 patients with stage III–IV disease underwent radical excision and reconstruction with a facial-submental artery island flap (FSAIF) and titanium mesh plus a free anterolateral thigh flap (ALTF) and radiotherapy respectively. Patients with stage III–IV disease subsequently received cobalt Co 60 adjuvant radiotherapy. Ki-67 expression was determined semiquantitatively in 52 patients with ACC by based on the cytoplasm staining intensity and percentage of positively stained tumor cells.

Results

The median (range) follow-up was 32.9 (14–58) months. Forty-one (71.7%) patients survived without disease recurrence. Nine patients (15.5%) survived with recurrent tumors (four with local recurrence, three with regional recurrence requiring salvage surgery, and two with distant metastasis); among these patients, five had overlapping recurrence. Eight patients (13.8%) died of regional, distant, or multiorgan metastasis (range: 22–42 months). The overall median (95% CI) survival time was 32.5 (25.0–39.5) months, and the median (95% CI) progression-free survival time was 32.9 (28.5–36.9) months. Rates of survival and recurrence differed significantly between patients with low- and high-grade tumors, patients with clinical stage I–II disease and those with stage III–IV disease, patients with and without lymph node metastasis, patients who underwent radical excision with versus without radiotherapy, and patients with low and high Ki-67 expression.

Conclusion

Radical resection and reconstruction with FSAIF is suitable methods for the the treatment of stage I–II ACC of the minor salivary glands of the palate. Stage III–IV tumors require radical resection, reconstruction with titanium mesh and free ALTF, and radiotherapy.
Ribozyme-mediated CRISPR/Cas9 gene editing in pyrethrum (Tanacetum cinerariifolium) hairy roots using a RNA polymerase II-dependent promoter
Authors: Li Jia-Wen , Zeng Tuo , Xu Zhi-Zhuo , Li Jin-Jin , Hu Hao , Yu Qin , Zhou Li , Zheng Ri-Ru , Luo Jing , Wang Cai-Yun
Published: March 2022

Background

Traditional CRISPR/Cas9 systems that rely on U6 or U3 snRNA promoters (RNA polymerase III-dependent promoters) can only achieve constitutive gene editing in plants, hampering the functional analysis of specifically expressed genes. Ribozyme-mediated CRISPR/Cas9 systems increase the types of promoters which can be used to transcribe sgRNA. Therefore, such systems allow specific gene editing; for example, transcription of the artificial gene Ribozyme-sgRNA-Ribozyme (RGR) is initiated by an RNA polymerase II-dependent promoter. Genetic transformation is indispensable for editing plant genes. In certain plant species, including pyrethrum, genetic transformation remains challenging to do, limiting the functional verification of novel CRISPR/Cas9 systems. Thus, this study’s aim was to develop a simple Agrobacterium rhizogenes-mediated hairy root transformation system to analyze the function of a ribozyme-mediated CRISPR/Cas9 system in pyrethrum.

Results

A hairy root transformation system for pyrethrum is described, with a mean transformation frequency of 7%. Transgenic hairy roots transformed with the pBI121 vector exhibited significantly increased beta-glucuronidase staining as a visual marker of transgene expression. Further, a ribozyme-based CRISPR/Cas9 vector was constructed to edit the TcEbFS gene, which catalyzes synthesis of the defense-related compound (E)-β-farnesene in pyrethrum. The vector was transferred into the hairy roots of pyrethrum and two stably transformed hairy root transgenic lines obtained. Editing of the TcEbFS gene in the hairy roots was evaluated by gene sequencing, demonstrating that both hairy root transgenic lines had DNA base loss at the editing target site. Gas chromatography–mass spectrometry showed that the (E)-β-farnesene content was significantly decreased in both hairy root transgenic lines compared with the empty vector control group. Altogether, these results show that RGR can be driven by the CaMV35S promoter to realize TcEbFS gene editing in pyrethrum hairy roots.

Conclusion

An A. rhizogenes-mediated hairy root transformation and ribozyme-mediated CRISPR/Cas9 gene editing system in pyrethrum was established, thereby facilitating gene editing in specific organs or at a particular developmental stage in future pyrethrum research.
It’s time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy: a systematic review
Authors: O’Connor Niall , Sugrue Michael , Melly Conor , McGeehan Gearoid , Bucholc Magda , Crawford Aileen , O’Connor Paul , Abu-Zidan Fikri , Wani Imtiaz , Balogh Zsolt J. , Shelat Vishal G. , Tebala Giovanni D. , De Simone Belinda , Eid Hani O. , Chirica Mircea , Fraga Gustavo P. , Di Saverio Salomone , Picetti Edoardo , Bonavina Luigi , Ceresoli Marco , Fette Andreas , Sakakushe Boris , Pikoulis Emmanouil , Coimbra Raul , ten Broek Richard , Hecker Andreas , Leppäniemi Ari , Litvin Andrey , Stahel Philip , Tan Edward , Koike Kaoru , Catena Fausto , Pisano Michele , Coccolini Federico , Johnston Alison
Published: March 2022

Background

Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future.

Methods

A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of ≥ 16 for comparative and ≥ 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one “ideal” laparoscopic operative report template following international input from the World Society of Emergency Surgery board.

Results

A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic.

Conclusion

This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals’ medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.
Perioperative incidence of ECMO and IABP on 5901 mitral valve surgery procedures
Authors: Condello Ignazio , Lorusso Roberto , Santarpino Giuseppe , Di Bari Nicola , Fiore Flavio , Moscarelli Marco , Calafiore Antonio Maria , Speziale Giuseppe , Nasso Giuseppe
Published: March 2022

Background

Report the incidence and results of peri-operative extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP) of patients undergoing mitral valve surgery (MVS) through right mini-thoracotomy (RT) and conventional full sternotomy (FS) for a period of 6 years from eleven tertiary Cardiac Surgery Institutes of GVM Care & Research Italia.

Methods

From January 2016 to November 2021, a total of 5901 consecutive patients underwent MVS through RT and FS. The primary outcome of the study was the mortality and incidence of low cardiac output syndrome (LCOS) treated with intra-aortic balloon pump (IABP) with or without inotropic support and the incidence of Postcardiotomy Cardiogenic Shock (PCS) treated with Veno-arterial (VA) Extracorporeal Membrane Oxygenation (ECMO) on patients undergoing mitral valve surgery (MVS) through right mini-thoracotomy (RT) versus conventional full sternotomy (FS).

Results

The mean age was 66 ± 15 years, 3389 patients underwent in RT approach 2512 in FS, 3081 (52%) patients were male and 2.3% had previous cardiac operations. Cardiopulmonary bypass time was 93 min for RT and 81 min for FS and cross clamp time 75 min for RT and 63 min for FS for mitral valve repair. Incidence of perioperative IABP for the treatment of low cardiac output was reported on 99 patients (1.6%), 51 for RT (1.5%), 35% used inotropic support (adrenaline and milrinone) and 48 in FS (1.9), 28% use inotropic support, 21 patients died after IABP (3 RT and 18 FS). Incidence of perioperative VA-ECMO for the PCS treatment was 13 and 4 with IABP, 9 RT (0.2%) and 4 FS approach (0.15%), 12 patients died after VA-ECMO.

Conclusion

Minimally invasive mitral valve surgery is a safe and reproducible approach associated with low mortality and morbidity. ECMO and IABP incidence for the treatment of PCS was 0.2% and for Low cardiac output syndrome (LCOS) was 1.6% in elective mitral valve surgery is very low. The patients that use the perioperative IABP in minimally invasive mitral valve surgery (MIMVS) trough RT reported a reduced mortality compared to FS in relation to the operative risk and surgical technique. Low incidence of VA-ECMO was found in RT and FS approach, only one patient survived after VA-ECMO after minimally invasive mitral valve surgery.
BDNF and TrKB expression levels in patients with endometriosis and their associations with dysmenorrhoea
Authors: Wang Sha , Duan Hua , Li Bohan , Hong Wei , Li Xiao , Wang Yiyi , Guo Zheng Chen
Published: March 2022

Background

Brain-derived neurotrophic factor (BDNF) is a known regulator of the development and maintenance of chronic pain in various chronic disorders. Together with its high-affinity tyrosine kinase type B (TrKB) receptor, BDNF is extensively expressed in the mammalian female reproductive system. However, BDNF and TrKB expression in different stages of endometriosis and the relationship between the expression of each in ectopic lesions and endometriosis pain remain unclear.

Methods

Sixty-two women who underwent laparoscopic surgery were enrolled in this study: forty-six diagnosed with ovarian endometrioma (study group) and sixteen diagnosed with ovarian benign tumours (control group). Samples from eutopic endometrium and ovarian endometriotic lesions were obtained at laparoscopic surgery. BDNF and TrKB messenger RNA (mRNA) and proteins levels in the eutopic and ectopic endometrium of both groups were measured by real-time PCR and immunohistochemical staining, respectively. Before the surgery the visual analogue scale (VAS) was used to measure dysmenorrhoea.

Results

BDNF and TrKB expression levels were higher in ovarian endometriotic lesions than in eutopic endometrium and normal endometrium (P < 0.05), and there was no cyclical change. Furthermore, their expression levels were higher in eutopic endometrium than in normal endometrium (P < 0.05), and BDNF and TrKB levels were higher in stage IV ovarian endometriotic lesions than in stage II and III lesions (P < 0.05), with their expression being non-significantly higher in stage III than in stage II (P > 0.05). Additionally, correlation coefficients for the association analysis between the mRNA expression of BDNF or TrKB in eutopic endometrium and the dysmenorrhoea VAS score were r = 0.52 and r = 0.56 for BDNF and TrKB, respectively (P < 0.05). The correlation coefficients for the associations between BDNF and TrKB in both the eutopic and ectopic endometrium were r = 0.82 and r = 0.66, respectively (P < 0.05).

Conclusions

BDNF and TrKB are closely related to dysmenorrhoea caused by endometriosis and may be important in the pathobiology or pathophysiology of endometriosis.
CUT&Tag2for1: a modified method for simultaneous profiling of the accessible and silenced regulome in single cells
Authors: Janssens Derek H. , Otto Dominik J. , Meers Michael P. , Setty Manu , Ahmad Kami , Henikoff Steven
Published: March 2022

Cleavage Under Targets and Tagmentation (CUT&Tag) is an antibody-directed transposase tethering strategy for in situ chromatin profiling in small samples and single cells. We describe a modified CUT&Tag protocol using a mixture of an antibody to the initiation form of RNA polymerase II (Pol2 Serine-5 phosphate) and an antibody to repressive Polycomb domains (H3K27me3) followed by computational signal deconvolution to produce high-resolution maps of both the active and repressive regulomes in single cells. The ability to seamlessly map active promoters, enhancers, and repressive regulatory elements using a single workflow provides a complete regulome profiling strategy suitable for high-throughput single-cell platforms.
Erucin inhibits osteoclast formation via suppressing cell–cell fusion molecule DC-STAMP without influencing mineralization by osteoblasts
Authors: Takagi Tomohiro , Inoue Hirofumi , Fujii Shungo , Takahashi Nobuyuki , Uehara Mariko
Published: March 2022

Objective

Erucin (ERN), an isothiocyanate, is derived from the vegetable arugula. Although ERN has antitumor and antioxidant activity, the effect of ERN on osteoclast and osteoblast differentiation is not well documented. In this study, we evaluated the effects of ERN on osteoclast and osteoblast differentiation in vitro.

Results

ERN significantly reduced the formation of 1α,25(OH)2D3-induced tartrate-resistant acid phosphatase (TRAP)-positive cells at non-cytotoxic concentrations. Furthermore, ERN downregulated the mRNA expression of osteoclast-associated genes, such as nuclear factor of activated T cells cytoplasmic-1, TRAP, and cathepsin K. In addition, ERN suppressed mRNA expression of dendritic cell specific transmembrane protein (DC-STAMP), which encodes cell–cell fusion. However, ERN did not affect mineralization by osteoblasts. Thus, our data suggest that ERN may attenuate osteoclastic bone resorption by inhibiting multinucleation of mononuclear pre-osteoclasts and by suppressing mRNA expression of DC-STAMP in bone marrow cells without influencing mineralization by osteoblasts.
Comparison of circulating fibrocytes from non-asthmatic patients with seasonal allergic rhinitis between in and out of pollen season samples
Authors: Côté Marie-Ève , Boulay Marie-Ève , Plante Sophie , Côté Andréanne , Chakir Jamila , Boulet Louis-Philippe
Published: March 2022

Background

Allergic rhinitis is a risk factor for asthma development. In asthma, fibroblast progenitors, fibrocytes, are increased in the blood and bronchial mucosa following allergen exposure. These cells may play a role in lower airways remodeling as observed in non-asthmatic subjects with allergic rhinitis.

Objective

To determine the influence of seasonal allergen exposure on blood circulating fibrocytes in allergic rhinitic subjects without asthma.

Methods

Non-asthmatic subjects with seasonal allergic rhinitis had blood sampling at baseline and at the peak of rhinitis symptoms. Cells were stained for fibrocyte markers (CD34, CD45, CXCR4, collagen I) and analyzed by flow cytometry.

Results

Data from 26 subjects (11M:15F) aged 29 ± 8 years were analysed. Compared to baseline, there was a significant decrease in blood fibrocytes during the pollen season in subjects sensitized to trees [median (25–75 percentile), 9.3 (6.4–20.7)% vs 7.0 (4.2–10.1)%, P = 0.007] and a significant increase in subjects sensitized to grass [12.7 (9.9–23.1)% vs 64.0 (57.6–73.6)%, P < 0.001] and ragweed [8.0 (7.4–10.8)% vs 48.2 (43.5–52.6)%, P < 0.001]. A significant decrease in CXCR4 mean fluorescence was also observed between the two visits [1814 (1261–2235) vs 1352 (814–1796) (arbitrary units), P = 0.02].

Conclusions and clinical relevance

These results contribute to document dynamic variations in blood fibrocytes’ activation and migration into the airways following natural exposure to allergens. These findings may help identify one of the potential factors involved in the development of asthma in allergic rhinitic subjects.
Atypical presentation of an atypical pneumonia: a case report
Authors: Payus Alvin Oliver , Clarence Clarita , Nee Tiong , Yahya Wan Nur Nafisah Wan
Published: March 2022

Background

Neurologic impediments occur in only 0.1% of Mycoplasma pneumoniae infections. Although direct intracerebral infection can occur in these patients, autoimmune-mediated reactions secondary to molecular mimicry are the most common pathophysiology of such neurological complications. These complications include immune-mediated encephalitis, peripheral neuritis such as Guillain–Barré syndrome, and many others. Miller Fisher syndrome is a one of the variants of Guillain–Barré syndrome that has been rarely linked to Mycoplasma pneumoniae infection. It is a condition classically characterized by the triad of ophthalmoplegia, areflexia, and ataxia. Most patients with Miller Fisher syndrome will have positive anti-ganglioside GQ1b antibodies found in their serum, making this autoantibody a very useful serological confirmation parameter. We report a case of a Miller Fisher syndrome in a woman with Mycoplasma pneumoniae infection. To the best of the authors’ knowledge, such cases have been only rarely described in literature.

Case presentation

A 35-year-old Chinese woman presented with sudden onset of double vision and ataxia 5 days after fever and mild flu symptoms. Her Mycoplasma pneumoniae antigen was positive with 1 over 2560 titer of total mycoplasma antibody and presence of immunoglobulin M antibody, suggesting acute infection, and her nerve conduction study revealed mild sensory axonal polyneuropathy with segmental demyelination. the Miller Fischer syndrome variant of Guillain-Barré syndrome secondary to Mycoplasma pneumonia was suspected and later confirmed by presence of serum anti-GQ1b autoantibody. She was treated with intravenous immunoglobulin 0.4 g/kg once daily for 5 days.

Conclusions

The objective of this report is to share a case of an uncommon neurological complication of Mycoplasma pneumoniae infection, to increase the level of suspicion among clinicians that Miller Fischer syndrome can occur as an atypical presentation of an atypical pneumonia.
Half-linear differential equations of fourth order: oscillation criteria of solutions
Authors: Bazighifan Omar , Al-Ghafri Khalil S. , Al-Kandari Maryam , Ghanim F. , Mofarreh Fatemah
Published: March 2022

In this paper, we are concerned with the oscillation of solutions to a class of fourth-order delay differential equations withp-Laplacian like operators$( r ( t ) \vert x^{\prime \prime \prime } ( t ) \vert ^{p_{1}-2}x^{\prime \prime \prime } ( t ) ) ^{\prime }+q ( t ) \vert x ( \tau ( t ) ) \vert ^{p_{2}-2}x ( \tau ( t ) ) =0$(r(t)|x‴(t)|p1−2x‴(t))′+q(t)|x(τ(t))|p2−2x(τ(t))=0and$( r ( t ) \vert x^{\prime \prime \prime } ( t ) \vert ^{p_{1}-2}x^{\prime \prime \prime } ( t ) ) ^{\prime }+\sigma ( t ) \vert x^{\prime \prime \prime } ( t ) \vert ^{p_{1}-2}x^{ \prime \prime \prime } ( t ) +q ( t ) \vert x ( \tau ( t ) ) \vert ^{p_{2}-2}x ( \tau ( t ) ) =0$(r(t)|x‴(t)|p1−2x‴(t))′+σ(t)|x‴(t)|p1−2x‴(t)+q(t)|x(τ(t))|p2−2x(τ(t))=0. New oscillation criteria are presented by the comparison technique and employing the Riccati transformation. Moreover, our results are an extension and complement to previous results in the literature. Two examples are shown to illustrate the conclusions.
Environmental surveillance of ESBL and carbapenemase-producing gram-negative bacteria in a Ghanaian Tertiary Hospital
Authors: Acolatse Joseph Elikem Efui , Portal Edward A. R. , Boostrom Ian , Akafity George , Dakroah Mavis Puopelle , Chalker Victoria J. , Sands Kirsty , Spiller Owen B.
Published: March 2022

Background

The burden of antibiotic resistant infection is mainly felt in low-to-middle income countries, where the rate of antimicrobial resistance is largely under-surveyed and under huge pressure from unregulated, disparate and often self-guided access to antimicrobials. Nosocomial infections from hospital environments have been shown to be a particularly prevalent source of multi-drug resistant strains, yet surveillance of hospital environmental contamination is often not investigated.

Methods

The study was prospective, observational and cross-sectional, sampling 231 high and low touch surfaces from 15th March to 13th April 2021, from five wards in the Cape Coast Teaching Hospital, Ghana. Microbial growth in the presence of vancomycin and either meropenem or cefotaxime was examined and bacterial species were identified by MALDI-TOF. The presence of common extended-spectrum β-lactamases (ESBL) and carbapenemase antimicrobial resistance genes (ARG) were identified through PCR screening, which were confirmed by phenotypic antimicrobial susceptibility determination. Isolates positive for carbapenem resistance genes were sequenced using a multi-platform approach.

Results

We recovered microbial growth from 99% of swabs (n = 229/231) plated on agar in the absence of antimicrobials. Multiple sites were found to be colonised with resistant bacteria throughout the hospital setting. Bacteria with multi-drug resistance and ARG of concern were isolated from high and low touch points with evidence of strain dissemination throughout the environment. A total of 21 differing species of bacteria carrying ARG were isolated. The high prevalence of Acinetobacter baumannii carrying blaNDM-1 observed was further characterised by whole genome sequencing and phylogenetic analysis to determine the relationship between resistant strains found in different wards.

Conclusion

Evidence of multiple clonal incursions of MDR bacteria of high sepsis risk were found in two separate wards for a regional hospital in Ghana. The prevalence of multiple blaNDM carrying species in combination with combinations of ESBLs was particularly concerning and unexpected in Africa. We also identify strains carrying tet(X3), blaVIM-5 or blaDIM-1 showing a high diversity of carbapenamases present as a reservoir in a hospital setting. Findings of multi-drug resistant bacteria from multiple environmental sites throughout the hospital will inform future IPC practices and aid research prioritisation for AMR in Ghana.
Implementation of an e-Learning course in physical activity and sedentary behavior for pre- and in-service early childhood educators: Evaluation of the TEACH pilot study
Authors: Bruijns Brianne A. , Vanderloo Leigh M. , Johnson Andrew M. , Adamo Kristi B. , Burke Shauna M. , Carson Valerie , Heydon Rachel , Irwin Jennifer D. , Naylor Patti-Jean , Timmons Brian W. , Tucker Patricia
Published: March 2022

Background

Childcare-based physical activity (PA) and sedentary behavior (SB) interventions have traditionally used in-person training to supplement early childhood educators’ (ECEs) knowledge and confidence to facilitate physically active programming for the children in their care. However, this method of delivery is resource-intensive and unable to reach a high number of ECEs. The purpose of the Training pre-service EArly CHildhood educators in PA (TEACH) pilot study was to test the implementation (e.g., fidelity, feasibility, acceptability) of an e-Learning course targeting PA and SB among a sample of pre-service (i.e., post-secondary students) and in-service (i.e., practicing) ECEs in Canada.

Methods

A pre-/post-study design was adopted for this pilot study, and implementation outcomes were assessed cross-sectionally at post-intervention. Pre-service ECEs were purposefully recruited from three Canadian colleges and in-service ECEs were recruited via social media. Upon completing the e-Learning course, process evaluation surveys (n = 32 pre-service and 121 in-service ECEs) and interviews (n = 3 pre-service and 8 in-service ECEs) were completed to gather ECEs’ perspectives on the e-Learning course. Fidelity was measured via e-Learning course metrics retrieved from the web platform. Descriptive statistics were calculated for quantitative data, and thematic analysis was conducted to analyze qualitative data.

Results

Moderate-to-high fidelity to the TEACH study e-Learning course was exhibited by pre-service (68%) and in-service (63%) ECEs. Participants reported that the course was highly acceptable, compatible, effective, feasible, and appropriate in complexity; however, some ECEs experienced technical difficulties with the e-Learning platform and noted a longer than anticipated course duration. The most enjoyed content for pre- and in-service ECEs focused on outdoor play (87.5% and 91.7%, respectively) and risky play (84.4% and 88.4%, respectively).

Conclusions

These findings demonstrate the value of e-Learning for professional development interventions for ECEs. Participant feedback will be used to make improvements to the TEACH e-Learning course to improve scalability of this training.