bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipid biomarkers and Cancer risk - a population-based prospective cohort study in Taiwan
Authors: Chang Yu-Chen , Lin Chien-Ju , Yeh Tzu-Lin , Tsai Ming-Chieh , Hsu Le-Yin , Chien Kuo-Liong , Hsu Hsin-Yin
Published: October 2021

Background

Blood lipids are essential components for cellular growth. An inverse association between serum lipid levels and risk of cancer has led to a controversy among previous studies. The aim of this prospective cohort study was to investigate the association between blood lipids change and risk of cancer incidence.

Methods

A cohort of 4130 Taiwanese adults from the Taiwanese Survey on the Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia database underwent repeated examinations in 2002 and 2007. Six groups were established based on the combined baseline (lower/higher) and interval change (decreasing/stable/increasing) in plasma lipid levels. Multivariable Cox proportional hazard model was used to investigate the relationship between lipids change and all-cause cancer incidence.

Results

Two hundred and forty cancer events developed over a median follow-up of 13.4 years. Comparing these with individuals with decreasing lower-baseline lipid levels, cancer risk reduction was demonstrated in those with increasing lower-baseline total cholesterol (adjusted hazard ratio [aHR], 0.48; 95% confidence interval [CI], 0.27 to 0.85), low-density lipoprotein cholesterol (LDL-C; aHR, 0.56; 95% CI, 0.35 to 0.92), and non–high-density lipoprotein cholesterol (non-HDL-C) (aHR, 0.54; 95% CI, 0.31 to 0.92) levels. A decreased risk for cancer incidence also presented in participants with stable lower-baseline, decreasing and increasing higher-baseline LDL-C levels, and with decreasing and stable higher-baseline non-HDL-C levels.

Conclusions

The interval decline in lower-baseline total cholesterol, LDL-C, and non-HDL-C levels was linked to a higher risk for all-cause cancer incidence. More attention to a potential cancer risk may be warranted for an unexplained fall in serum lipids.
Simvastatin induced ferroptosis for triple-negative breast cancer therapy
Authors: Yao Xianxian , Xie Ruihong , Cao Yongbin , Tang Jing , Men Yongzhi , Peng Haibao , Yang Wuli
Published: October 2021

Triple-negative breast cancer (TNBC), a management of aggressive breast cancer, remains an unmet medical challenge. Although a wave of efforts had spurred to design novel therapeutic method of TNBC, unpredictable prognosis with lacking effective therapeutic targets along with the resistance to apoptosis seriously limited survival benefits. Ferroptosis is a non-apoptotic form of cell death that is induced by excessive lipid peroxidation, which provide an innovative way to combat cancer. Emerging evidence suggests that ferroptosis plays an important role in the treatment of TNBC cells. Herein, a novel ferroptosis nanomedicine was prepared by loading simvastatin (SIM), a ferroptosis drug, into zwitterionic polymer coated magnetic nanoparticles (Fe3O4@PCBMA) to improve the therapeutic effect of TNBC. The as-obtained Fe3O4@PCBMA-SIM nanoparticles demonstrated more cytotoxicity against MDA-MB-231 than MCF-7 due to the higher expression of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR), which demonstrated that statins could effectively kill TNBC. Further experiments showed that SIM could inhibit the expression of HMGCR to downregulate the mevalonate (MVA) pathway and glutathione peroxidase 4 (GPX4), thereby inducing cancer cell ferroptosis. What’s more, PCBMA endows Fe3O4@PCBMA longer blood circulation performance to enhance their accumulation at tumor sites. Given that Fe3O4 have proven for clinical applications by the U.S. Food and Drug Administration (FDA) and SIM could induce cancer cell ferroptosis, the developed Fe3O4@PCBMA-SIM nanosystem would have great potential in clinics for overcoming the drug resistance brought about by apoptotic drugs to cancer cells.
Comparison of content and psychometric properties for assessment tools used for brain tumor patients: a scoping review
Authors: Ģiga Lelde , Pētersone Anete , Čakstiņa Silva , Bērziņa Guna
Published: October 2021

Aims

To determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties.

Methods

A scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed.

Results

Nine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments.

Conclusion

Nine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.
Preimplantation genetic testing for BRCA gene mutation carriers: a cost effectiveness analysis
Authors: Michaan Nadav , Leshno Moshe , Cohen Yoni , Safra Tamar , Peleg-Hasson Shira , Laskov Ido , Grisaru Dan
Published: October 2021

Background

Gynecologic oncologists should be aware of the option of conception through IVF/PGT-M for families with high BRCA related morbidity or mortality. Our objective was to investigate the cost-effectiveness of preimplantation genetic testing for selection and transfer of BRCA negative embryo in BRCA mutation carriers compared to natural conception.

Methods

Cost-effectiveness of two strategies, conception through IVF/PGT-M and BRCA negative embryo transfer versus natural conception with a 50% chance of BRCA positive newborn for BRCA mutation carriers was compared using a Markovian process decision analysis model. Costs of the two strategies were compared using quality adjusted life years (QALYs’). All costs were discounted at 3%. Incremental cost effectiveness ratio (ICER) compared to willingness to pay threshold was used for cost-effectiveness analysis.

Results

IVF/ PGT-M is cost-effective with an ICER of 150,219 new Israeli Shekels, per QALY gained (equivalent to 44,480 USD), at a 3% discount rate.

Conclusions

IVF/ PGT-M and BRCA negative embryo transfer compared to natural conception among BRCA positive parents is cost effective and may be offered for selected couples with high BRCA mutation related morbidity or mortality. Our results could impact decisions regarding conception among BRCA positive couples and health care providers.
Impact of infertility duration on female sexual health
Authors: Dong Meng , Xu Xiaoyan , Li Yining , Wang Yixian , Jin Zhuo , Tan Jichun
Published: October 2021

Background

Infertility, an important source of stress, could affect sexual life. Extensive studies suggest that the incidence of sexual dysfunction is highly prevalent in infertile women. As the duration of infertility increases, the level of stress is also likely to increase even further, and this could aggravate psychological pain and cause sexual dysfunction. However, the effect of infertility duration on sexual health is unclear.

Methods

We conducted a case-control study in which 715 patients participated between September 1,2020 and December 25, 2020. We included patients diagnosed with infertility (aged between 20 to 45), who were divided into four groups according to their infertility durations: ≤ 2 years (Group I, n = 262), > 2 years but ≤ 5 years (Group II, n = 282), > 5 years but ≤ 8 years (Group III, n = 97), and > 8 years (Group IV, n = 74). A questionnaire survey on female sexual functions and psychological depression was administered to participants, and their female sexual functions and depression status were measured using the Female Sexual Function Index (FSFI) and Patient Health Questionnaire (PHQ-9), respectively.

Results

As the number of years of infertility increased, the PHQ-9 score as well as the incidence of psychological depression increased significantly (p < 0.05), but the total score of FSFI and those of its six domains/sub-scales were not significantly different among the four groups. An analysis of the relevant factors affecting sexual functions, using the multivariable logistic regression model, revealed that when the infertility duration was greater than 8 years, there was a significant increase in the incidence of sexual dysfunction [adjusted odds ratios (AOR) = 5.158, 95% confidence interval (CI): 1.935–13.746, P = 0.001], arousal disorder (AOR = 2.955, 95% CI: 1.194–7.314, P = 0.019), coital pain (AOR = 3.811, 95% CI: 1.045–13.897, P = 0.043), and lubrication disorder (AOR = 5.077, 95% CI: 1.340–19.244, P = 0.017).

Conclusions

An increasing infertility duration is a risk factor for the occurrence of sexual dysfunction. Hence, as the infertility duration increases, the incidence of female sexual dysfunction and psychological distress could also increase, especially when the infertility duration is more than 8 years.
Factors associated with the rural and remote practice of medical workforce in Maluku Islands of Indonesia: a cross-sectional study
Authors: Noya Farah , Carr Sandra , Thompson Sandra , Clifford Rhonda , Playford Denese
Published: October 2021

Background

Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province.

Methods

An online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression.

Results

A total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03–11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24–31.1), and have no additional practice (OR 2.78, CI 1.34–5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42–17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09–8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10–0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05–3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06–4.09), currently practising in RR Maluku (OR 8.23, CI 3.27–20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13–0.70).

Conclusion

This study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
Eliciting preferences of patients about the quality of hospital services in the west of Iran using discrete choice experiment analysis
Authors: Kazemi-Karyani Ali , Ramezani-Doroh Vajiheh , Khosravi Farid , Miankali Zhila Seyedi , Soltani Shahin , Soofi Moslem , Khoramrooz Maryam , Matin Behzad Karami
Published: October 2021

Objectives

Knowing about accurate customer expectations is the most important step in defining and delivering high-quality services. This study aimed to evaluate the preferences of patients referring to two hospitals in Kermanshah, Iran.

Method

Discrete choice experiment (DCE) method used to elicit preferences of 328 patients who were admitted in two hospitals of Kermanshah city in the west of Iran. Literature review and experts opinion were used to identify a candidate list of attributes related to the quality of cares in hospitals. The final study attributes were quality of physician care, quality of nursing care, waiting time for admission, cleaning of wards and toilets, and behavior of staff. Experimental design applied to extract choice sets of hospitals. The data was analyzed by a conditional logit regression.

Results

The regression results showed the most important predictors of hospital selection by respondents was the good quality of physician care (aOR: 3.18, 95% CI 2.61, 3.87), followed by friendly behavior of staffs (aOR: 2.03, 95% CI 1.81, 2.27), cleanness of wards and toilet (aOR: 1.61, 95% CI 1.40, 1.85), and finally quality of nursing cares (aOR: 1.13, 95% CI 0.89, 1.44). However, increasing waiting time made disutility in the study participants (aOR: 0.69, 95% CI 0.60, 0.80).

Conclusions

Our study finding emphasized some potential opportunity of quality augmentation in hospital sector by paying attention to different quality attributes including quality of physician, friendly behavior of staffs, cleanness of hospital environment and finally quality of nursing cares. Considering patients preferences in decision making process could lead to substantial satisfaction improvement.
Evaluation of an Alternative Learning System for youths at risk of involvement in urban violence in the Philippines
Authors: Mehra Nishant , Wang Shr-Jie Sharlenna , Reyes Juancho , Ambjørnsen Mette Møhl , Jarl Johan
Published: October 2021

Background

Globally, violence disproportionately affects young people, leading to injury, hospitalisation, death, social dysfunction, and poor mental wellbeing. Moreover, it has far-reaching economic consequences for whole nations, due to loss of productivity. Research suggests that attaining a higher level of education promotes factors that insulate youths from poverty and violence.

Purpose

In this study, we investigated the outcomes, the cost, and the cost-effectiveness of a non-formal education program with an additional psychosocial component. The short-term outcome measure was an increase in educational attainment, a crucial step for youth empowerment. The program analysed was the Alternative Learning System (ALS) offered by the Balay Rehabiliation Centre in Bagong Silang, an urban slum in Manila, which targeted out of school youth.

Methods

The cost-effectiveness analysis of ALS compared to a ‘do nothing approach’ was performed from the perspective of the service provider. The study sample comprised 239 learners who were enrolled in the ALS during 2015–2018. For the ‘do nothing’ comparator, a counterfactual scenario was hypothesised. The average cost of the intervention per enrolled learner, and the incremental cost effectiveness ratio (ICER) for passing the Accreditation and Evaluation (A&E) exam at elementary or secondary level, were calculated.

Results

The ALS intervention studied resulted in 41% (n = 97) of the learners passing the examination over a period of four years (from 2015–2018). The estimated total cost of the intervention was $371,110, corresponding to $1550 per enrolled learner. The incremental cost-effectiveness ratio for a pass in the exam was found to be $3830. Compared to other, international, alternative learning interventions, the ALS intervention as used in Bagong Silang was found to be more cost-effective.

Conclusion

From the service provider perspective, the ALS for out-of-school young people was found to be a valuable investment to benefit poor young people living in slums in Manila.
What alternative and innovative domestic methods of healthcare financing can be explored to fix the current claims reimbursement challenges by the National Health Insurance Scheme of Ghana? Perspectives of health managers
Authors: Laar Alexander Suuk , Asare Michael , Dalinjong Philip Ayizem
Published: October 2021

Background

Low-and-middle -income countries (LMICs), to achieve sustainable universal health coverage (UHC) governments are implementing local and sustainable methods of healthcare financing. However, in Ghana, there is limited evidence on these local methods for healthcare financing to inform policy. This study aimed at exploring health managers views on alternative domestic and sustainable methods of healthcare financing for UHC under the National Health Insurance Scheme (NHIS).

Methods

A qualitative study using in-depth interviews with 16 health facility managers were held. The health facilities and participants were selected using convenience and purposive sampling methods. A written consent was obtained from participants prior to participation in the interview. Data was transcribed verbatim and analyzed using thematic framework approach.

Results

Health managers across all the health facilities mentioned delayed and erratic claims reimbursement to health facilities as the main challenge. Participants attributed the main reason to lack of funds by the National Health Insurance Authority (NHIA). They said the delayed and irregular payments has been a challenge to efficient delivery of quality healthcare to clients. That in some instances they have been compelled to demand cash or out-of-pocket payment from insured clients or insurance card bearers to be able to render needed healthcare services to them. Participants think that to ensure regular reimbursement of claims to the health facilities by the NHIA, the managers think alternative local sources of funding need to be explored to fill the funding gap. To put in place this, they suggested the need to start levying special taxes on natural resources such as crude oil and gas, gold, bauxite, cocoa, mobile money transfers, airtime and increasing the proportion of levies on the existing Value Added Tax (VAT).

Conclusion

The study provides important insights into potential innovative alternative domestic sources for raising additional funds to finance healthcare services in Ghana. Despite the potential of these sources, it is important for governments and health policy makers in Ghana and other LMICs who are working towards implementing innovative local methods using special levies on mobile communication services and natural resources to finance their UHC, to implement those that best suit their economies to ensure equity for better health.
Gender-specific trends of educational inequality in diagnosed diabetes from 1999 to 2014 in Hong Kong: a serial cross-sectional study of 97,481 community-dwelling Chinese adults
Authors: Chung Gary Ka-Ki , Lai Francisco Tsz Tsun , Yeoh Eng-Kiong , Chung Roger Yat-Nork
Published: October 2021

Background

Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.

Methods

A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes.

Results

Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02–1.07, annual SII change = 0.36%; 95% CI = 0.16–0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83–3.24, SII = 9.21%; 95% CI = 6.47–11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality.

Conclusions

Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes.
Parent–adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis
Authors: Usonwu Ijeoma , Ahmad Raheelah , Curtis-Tyler Katherine
Published: October 2021

Background

Improving adolescent sexual and reproductive health continues to be a global public health need. Effective parent–adolescent communication on sexual health issues has been cited as a factor that could influence adolescents towards adopting safer sexual behaviour. The current review synthesises qualitative literature to understand the nature and relevance of parent–adolescent sexual and reproductive health communication and the barriers to effective communication in sub-Saharan Africa.

Methods

We systematically searched and synthesised qualitative literature published between 1st January 1990 to December 2019 and searched from CINAHL, PsycINFO, MEDLINE, Global Health, EMBASE, PubMed, and Google Scholar. We assessed the methodological quality of included studies using the Critical Appraisal Skills Programme (CASP) checklist. We thematically analysed qualitative data from the included primary studies.

Results

Fifteen studies were included. Social and physiological events act as triggers for initiating discussions. Fear of personal, social, and economic consequences of high-risk sexual behaviours act as drivers for communication but also carry a negative framing which hinders open discussion. Lack of parental self-efficacy and cultural and religious norms create an uncomfortable environment leaving peers, media, teachers, and siblings as important and sometimes preferred sources of sexual health information.

Conclusions

While mothers recognise their own role in adolescent sexual and reproductive health and school-based interventions can act as useful prompts for initiating discussion, fathers are mainly absent from home-based dialogue. Fear dominates the narrative, and the needs of adolescents remain unarticulated.
MR spectroscopy in HIV associated neurocognitive disorder in the era of cART: a review
Authors: Chaganti Joga , Brew Bruce James
Published: October 2021

Neuroimaging has been a critical tool for understanding the neuropathological underpinnings observed in HIV. The pathophysiology of HAND is chiefly driven by neuroinflammation. Despite adhering to cART, low levels of viraemia probably persist in the brain in some patients leading to chronic immune activation with resultant neuroinflammation and consequent neuronal injury. MR spectroscopy has been widely used as a biomarker for the presence and severity of HAND in several studies. By studying the MRS signatures, it is possible to characterise the presence of neuroinflammation and neural injury. Furthermore, metabolite concentrations measured by MRS could be used as a quantitative indicator of HIV cerebral involvement, thereby affording the opportunity to assess the efficacy of cART in HAND. However, currently there are three significant limitations in the MRS HIV research literature: the relative paucity of prospective studies, the small number of regions of interrogation due to current methodology (single voxel MRS), and the evolving understanding of the impact of co-morbidities (e.g. ageing, mood disorders, alcoholism etc.) on MRS measurements. This review critically addresses the current literature of MRS studies in people living with HIV (PWH) with HAND to determine its value, especially in the context of the current cART era. In addition, we discuss technical considerations related to the disease and the future direction in HAND using MRS.
Complex structural variations in non-human primate hepatitis B virus
Authors: Nagura Yoshihito , Fujiwara Kei , Matsuura Kentaro , Iio Etsuko , Tanaka Yasuhito , Kataoka Hiromi
Published: October 2021

Background

Recent genome sequence technology has revealed a novel type of genetic rearrangement referred to as complex structural variations (SVs). Previous studies have elucidated the complex SVs in human hepatitis B viruses (HBVs). In this study, we investigated the existence of complex SVs in HBVs from non-human primates (NHPs).

Methods

Searches for nucleotide sequences of NHP HBV were conducted using the PubMed, and genetic sequences were retrieved from databases. The candidate genetic sequences harboring complex SVs were analyzed using the CLUSTALW program and MAFFT. Additional bioinformatical analyses were performed to determine strains with complex SVs and to elucidate characteristics of NHP HBV strains.

Results

One hundred and fifty-four HBV strains from NHPs were identified from databases. SVs and complex SVs were observed in 11 (7.1%) strains. Three gibbon HBV (GiHBV) strains showed complex SVs consisting of an insertion and a deletion in the pre-S1 region. One GiHBV strain possessed a 6-nt insertion, which are normally specific to human HBV genotype A (HBV/A) in the Core region, and further analyses clarified that the 6-nt insertion was not caused by recombination, but rather by simple insertion. Another chimpanzee HBV strain showed complex SVs in the pre-S1 region, which were composed of human HBV/E, G-specific polymorphic SV, and an additional 6-nt insertion.

Conclusions

In this study, complex SVs were observed in HBV strains from NHPs, in addition to human HBV strains, as shown in previous studies. These data suggest that complex SVs could also be found in other members of hepadnaviruses, and may play a role in their genetic diversity.
A formulated poly (I:C)/CCL21 as an effective mucosal adjuvant for gamma-irradiated influenza vaccine
Authors: Sabbaghi Ailar , Malek Masoud , Abdolahi Sara , Miri Seyed Mohammad , Alizadeh Leila , Samadi Mehdi , Mohebbi Seyed Reza , Ghaemi Amir
Published: October 2021

Background

Several studies on gamma-irradiated influenza A virus (γ-Flu) have revealed its superior efficacy for inducing homologous and heterologous virus-specific immunity. However, many inactivated vaccines, notably in nasal delivery, require adjuvants to increase the quality and magnitude of vaccine responses.

Methods

To illustrate the impacts of co-administration of the gamma-irradiated H1N1 vaccine with poly (I:C) and recombinant murine CCL21, either alone or in combination with each other, as adjuvants on the vaccine potency, mice were inoculated intranasally 3 times at one-week interval with γ-Flu alone or with any of the three adjuvant combinations and then challenged with a high lethal dose (10 LD50) of A/PR/8/34 (H1N1) influenza virus. Virus-specific humoral, mucosal, and cell-mediated immunity, as well as cytokine profiles in the spleen (IFN-γ, IL-12, and IL-4), and in the lung homogenates (IL-6 and IL-10) were measured by ELISA. The proliferative response of restimulated splenocytes was also determined by MTT assay.

Results

The findings showed that the co-delivery of the γ-Flu vaccine and CCL21 or Poly (I:C) significantly increased the vaccine immunogenicity compared to the non-adjuvanted vaccine, associated with more potent protection following challenge infection. However, the mice given a combination of CCL21 with poly (I:C) had strong antibody- and cell-mediated immunity, which were considerably higher than responses of mice receiving the γ-Flu vaccine with each adjuvant separately. This combination also reduced inflammatory mediator levels (notably IL-10) in lung homogenate samples.

Conclusions

The results indicate that adjuvantation with the CCL21 and poly (I:C) can successfully induce vigorous vaccine-mediated protection, suggesting a robust propensity for CCL21 plus poly (I:C) as a potent mucosal adjuvant.
Visceral adiposity index is associated with arterial stiffness in hypertensive adults with normal-weight: the china H-type hypertension registry study
Authors: Li Junpei , Zhu Jian , Tan Ziheng , Yu Yun , Luo Linfei , Zhou Wei , Zhu Linjuan , Wang Tao , Cao Tianyu , Liu Lishun , Bao Huihui , Huang Xiao , Cheng Xiaoshu
Published: October 2021

Background

Limited information is available on arterial stiffness risk among hypertensive patients with metabolically abnormal but normal weight. Visceral adiposity index (VAI) is a novel indicator for visceral fat mass and metabolism, however, whether can be used to assessed arterial stiffness in a normal-weight population remains unclear. The goal of this study was to examine the independent association of VAI with arterial stiffness in normal-weight hypertensive patients.

Methods

3258 participants recruited from the China H-type Hypertension Registry Study. VAI value was calculated using sex-specific equations. High arterial stiffness was defined as baPWV ≥ 18 m/s. Multivariable regression analysis was used to identify the association of VAI with baPWV and high arterial stiffness.

Results

Of participants, 50.5% (1644) were males, the mean age was 65.5 (SD, 9.1) years. Mean VAI and baPWV were 2.0 (SD, 2.3) and 18.2 (SD, 3.9) m/s, respectively. For each unit increase of lg VAI in multivariable regression analysis, there was a 1.05 m/s increase in baPWV (95% CI 0.67, 1.43) and a 2.13-fold increase in the risk of high arterial stiffness (95% CI 1.59, 2.86). In all models, the VAI was consistently and significantly associated with baPWV after adjustment for different confounders. High VAI levels were stably associated with baPWV in all subgroups.

Conclusions

We found positive association of VAI with baPWV and high arterial stiffness in normal-weight adults with hypertension. The establishment of this association could help the arterial stiffness risk stratification in normal-weight hypertensive populations, who are frequently overlooked in preventing cardiovascular disease.
The Primate Cultural Significance Index: applications with Popoluca Indigenous people at Los Tuxtlas Biosphere Reserve
Authors: Pinto-Marroquin Marianna , Aristizabal John F. , García-Del Valle Yasminda , Ruan-Soto Felipe , Serio-Silva Juan Carlos
Published: October 2021

Background

The study of the cultural significance (CS) of biodiversity provides key information to develop conservation strategies consistent with traditions and perceptions of human communities. In Los Tuxtlas Biosphere Reserve (TBR) in Mexico, the mantled howler monkeys (Alouatta palliata mexicana) and the black-handed spider monkeys (Ateles geoffroyi vellerosus) have historically coexisted with Popoluca Indigenous Peoples. This study sought to determine how the presence of a natural protected area (TBR location) and a range of sociodemographic factors (gender, age, origin, language proficiency, education level, religion) relate to the CS held by the Popoluca Indigenous People in relation to these two endangered primate species.

Methods

The first Primate Cultural Significance Index (PCSI) was designed as a composed index of 11 cultural variables (sub-indices) and was applied randomly to a representative size sample of people over 15 years old in two Popolucas communities, one within the TBR (Piedra Labrada = 81 people) and another outside (Los Mangos = 91). U Mann–Whitney tests were used to compare the PCSI between communities and Generalized Linear Models (GLM) to evaluate the sociodemographic factors of participants that influenced the sub-indices in the PCSI.

Results

The cultural significance of spider monkeys held by the Popolucas was higher for the community within the TBR than for the community outside, while for howler monkeys it was higher outside. For both primate species across the two communities, the most relevant sub-indices were (1) interest in conservation and (2) touristic significance of primates. Sociodemographic factors of participants influenced nine sub-indices of cultural significance out of the possible 10 sub-indices applied for each primate species. The demographic factors that most influenced each sub-index for both species were location and gender.

Conclusions

The main differences found between communities may be linked to the conservation and sustainable development programs promoted by the reserve, as well as the greater persistence of Popolucan ancestral traditions within the boundaries of the reserve. We recommend that conservation efforts should focus on people less interested about primate conservation (women, non-natives and residents outside the reserve), and turn to the leadership of people more interested (native men who reside inside the reserve).
Breastfeeding experiences of Latina migrants living in Spain: a qualitative descriptive study
Authors: Iglesias-Rosado Blanca , Leon-Larios Fatima
Published: October 2021

Background

The migratory flows in Spain have changed due to the arrival of a diverse migrant population. Among the new migrants the Latino collective predominate with more than half being women of childbearing age. There are no previous studies exploring breastfeeding experiences of migrants in a country where their mother tongue is spoken. This study aimed to explore Latina migrants’ breastfeeding experiences in a Spanish-speaking country.

Methods

A descriptive qualitative study was carried out in the main province in southern Andalusia between November 2019 and June 2020. The study used intentional sampling. The study participants were contacted by video calls and data were collected through a semi-structured in-depth interview (n = 19). The interviews were transcribed and analysed by thematic analysis.

Results

The nineteen participants were aged between 22 and 43 years old and came from six different countries in Latin America. The two main categories that emerged were breastfeeding facilitators and barriers, divided into ten interrelated sub-categories: working conditions; precarious socioeconomic conditions; lack of support (health professionals, family and society); physiological changes, pain and fatigue; ignorance and wrong beliefs; support networks (partner, health professionals and family); host country versus home country; religious practices/worship; appropriate attitude, knowledge and experience; and breastfeeding support groups. Most of the study participants stated that their breastfeeding experiences were influenced by barriers such as work and by facilitators such as peer support.

Conclusions

More support from caregivers and more sensitivity to cultural diversity were demanded by the women and well-trained professionals are needed to enable breastfeeding for a longer time. This paper provides caregivers, such as nurses, more knowledge about the care demanded by migrant women to ensure a longer breastfeeding experience.
The intractable problems with brain death and possible solutions
Authors: Joffe Ari R. , Khaira Gurpreet , de Caen Allan R.
Published: October 2021

Brain death has been accepted worldwide medically and legally as the biological state of death of the organism. Nevertheless, the literature has described persistent problems with this acceptance ever since brain death was described. Many of these problems are not widely known or properly understood by much of the medical community. Here we aim to clarify these issues, based on the two intractable problems in the brain death debates. First, the metaphysical problem: there is no reason that withstands critical scrutiny to believe that BD is the state of biological death of the human organism. Second, the epistemic problem: there is no way currently to diagnose the state of BD, the irreversible loss of all brain functions, using clinical tests and ancillary tests, given potential confounders to testing. We discuss these problems and their main objections and conclude that these problems are intractable in that there has been no acceptable solution offered other than bare assertions of an ‘operational definition’ of death. We present possible ways to move forward that accept both the metaphysical problem - that BD is not biological death of the human organism - and the epistemic problem - that as currently diagnosed, BD is a devastating neurological state where recovery of sentience is very unlikely, but not a confirmed state of irreversible loss of all [critical] brain functions. We argue that the best solution is to abandon the dead donor rule, thus allowing vital organ donation from patients currently diagnosed as BD, assuming appropriate changes are made to the consent process and to laws about killing.
Radiographic optimization of the lateral position of the knee joint aided by CT images and the maximum intensity projection technique
Authors: Wang Shiming , Xiao Zhibo , Lu Yunfeng , Zhang Zhiwei , Lv Fajin
Published: October 2021

Background

Standard lateral knee-joint X-ray images are crucial for the accurate diagnosis and treatment of many knee-joint-related conditions. However, it is difficult to obtain standard lateral knee-joint X-ray images in the current knee-joint lateral radiography position.

Purpose

To optimize the lateral position of knee joint for radiography aided by computed tomography (CT) images and the maximum intensity projection technique.

Materials and methods

One hundred cases of anteroposterior and lateral radiographs of knee joints were included. Of these, 50 cases were for lateral radiography in conventional position, and the other 50 cases were for lateral radiography in optimized position. The optimized position was acquired by a retrospective analysis of one hundred cases of knee-joint CT images. The quality of the X-ray images in optimized group was compared with those in conventional group. The data were statistically analyzed using the Mann–Whitney U test.

Results

There were differences in the optimized position between males and females. The posterior condyles of the femoral epiphysis in optimized group were in perfect superimposition for most patients. However, the ones in conventional group were not. The average quality score of the lateral knee-joint X-ray images in optimized position was 3.76 ± 0.98, which is much higher than the 1.84 ± 1.15 score in conventional position. Moreover, the difference in the average quality score was statistically significant (P < 0.05).

Conclusion

Optimization of the lateral position of knee joint for radiography is possible with the aid of CT images and the maximum intensity projection technique.
Left atrial geometry in an ovine ischemic mitral regurgitation model: implications for transcatheter mitral valve replacement devices with a left atrial anchoring mechanism
Authors: Imai Akito , Khamooshian Arash , Okamoto Keitaro , Saito Yoshiaki , Wijdh-den Hamer Inez J. , Mariani Massimo A. , Gillespie Matthew J. , Gorman Robert C. , Gorman Joseph H. , Bouma Wobbe
Published: October 2021

Background

Transcatheter mitral valve replacement (TMVR) is a challenging, but promising minimally invasive treatment option for patients with mitral valve disease. Depending on the anchoring mechanism, complications such as mitral leaflet or chordal disruption, aortic valve disruption or left ventricular outflow tract obstruction may occur. Supra-annular devices only anchor at the left atrial (LA) level with a low risk of these complications. For development of transcatheter valves based on LA anchoring, animal feasibility studies are required. In this study we sought to describe LA systolic and diastolic geometry in an ovine ischemic mitral regurgitation (IMR) model using magnetic resonance imaging (MRI) and echocardiography in order to facilitate future research focusing on TMVR device development for (I)MR with LA anchoring mechanisms.

Methods

A group of 10 adult male Dorsett sheep underwent a left lateral thoracotomy. Posterolateral myocardial infarction was created by ligation of the left circumflex coronary artery, the obtuse marginal and diagonal branches. MRI and echocardiography were performed at baseline and 8 weeks after myocardial infarction (MI).

Results

Six animals survived to 8 weeks follow-up. All animals had grade 2 + or higher IMR 8 weeks post-MI. All LA geometric parameters did not change significantly 8 weeks post-MI compared to baseline. Diastolic and systolic interpapillary muscle distance increased significantly 8 weeks post-MI.

Conclusions

Systolic and diastolic LA geometry do not change significantly in the presence of grade 2 + or higher IMR 8 weeks post-MI. These findings help facilitate future tailored TMVR device development with LA anchoring mechanisms.
A rare cause of chronic dysphagia: pulmonary inflammatory myofibroblastic tumor with distal esophagus invasion
Authors: Gu Yi-Min , Chen Long-Qi
Published: October 2021

Background

Inflammatory myofibroblastic tumor (IMT) is rare intermediate tumor, which happens mostly in children and young adults.

Case presentation

Reported is the successful treatment of a 29-year-old man presented with progressively dysphagia and weight loss. No other abnormal symptoms were observed. The contrast enhanced computed tomography (CT) revealed a dumbbell-shaped lesion between lung and esophagus. Finally, it was pathologically diagnosed as pulmonary IMT invading to the distal esophagus after operation. The patient underwent partial esophagectomy and left lower lobectomy, and was discharged on 10th postoperative day.

Conclusions

IMT is a rare lesion that usually occurs in the lung, but pulmonary IMT with distal esophagus invasion has not been described previously. Discriminating untypical symptom, completed resection, pathological expertise and closed follow-up will reach the successful diagnosis and treatment.
Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study
Authors: Kim Jong Duk
Published: October 2021

Background

Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients.

Methods

For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management.

Results

The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential.

Conclusions

The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study.

Trial registration: Not applicable.
Diagnostic utility of next-generation sequencing-based panel testing in 543 patients with suspected skeletal dysplasia
Authors: Scocchia Alicia , Kangas-Kontio Tiia , Irving Melita , Hero Matti , Saarinen Inka , Pelttari Liisa , Gall Kimberly , Valo Satu , Huusko Johanna M. , Tallila Jonna , Sistonen Johanna , Koskenvuo Juha , Alastalo Tero-Pekka
Published: October 2021

Background

Skeletal dysplasia is typically diagnosed using a combination of radiographic imaging, clinical examinations, and molecular testing. Identifying a molecular diagnosis for an individual with a skeletal dysplasia can lead to improved clinical care, guide future medical management and treatment, and inform assessment of risk for familial recurrence. The molecular diagnostic utility of multi-gene panel testing using next-generation sequencing (NGS) has not yet been characterized for an unselected population of individuals with suspected skeletal dysplasia. In this study, we retrospectively reviewed patient reports to assess the diagnostic yield, reported variant characteristics, impact of copy number variation, and performance in prenatal diagnostics of panel tests for variants in genes associated with skeletal dysplasia and growth disorders.

Results

Clinical reports of consecutive patients with a clinical indication of suspected skeletal dysplasia who underwent panel testing were examined. The 543 patients included in the study submitted samples for diagnostic genetic testing with an indication of suspected skeletal dysplasia or growth disorder and received one of three nested panel tests. A molecular diagnosis was established in 42.0% of patients (n = 228/543). Diagnostic variants were identified in 71 genes, nearly half of which (n = 35, 49.3%) contributed uniquely to a molecular diagnosis for a single patient in this cohort. Diagnostic yield was significantly higher among fetal samples (59.0%, n = 52/88) than postnatal samples (38.7%, n = 176/455; z = 3.55, p < 0.001). Diagnostic variants in fetal cases were identified across 18 genes. Thirteen diagnostic CNVs were reported, representing 5.7% of diagnostic findings and ranging in size from 241-bp to whole chromosome aneuploidy. Additionally, 11.4% (36/315) of non-diagnostic patient reports had suspicious variants of unknown significance (VUS), in which additional family studies that provide segregation data and/or functional characterization may result in reclassification to likely pathogenic.

Conclusions

These findings demonstrate the utility of panel testing for individuals with a suspected skeletal dysplasia or growth disorder, with a particularly high diagnostic yield seen in prenatal cases. Pursuing comprehensive panel testing with high-resolution CNV analysis can provide a diagnostic benefit, given the considerable phenotype overlap amongst skeletal dysplasia conditions.