bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Job Satisfaction, Job Burnout and Turnover Intention of Surgical Nurses: A Cross-sectional Study in China
Authors: Zhong Yueping , Zhang Xiaomei , Wang Ya , Wei Rong , Cao Ling , Chen Xiaoyan , Hu Hanmei , Zhang Lei , Zhang Qun
Published: January 2021

Aim: To determine the correlation between job satisfaction, job burnout and turnover intention of surgical nurses.Background: Quite a number of studies have shown that there is a certain correlation between job satisfaction and job burnout of nurses, but researches on job satisfaction, job burnout and turnover intention of surgical nurses are relatively rare.Design: A descriptive correlational design was used in this study. Study participants were recruited from surgical nurses from Affiliated Hospital of Nantong University in Nantong, China. The main research method is questionnaire survey. The relationship between job satisfaction and job burnout and turnover intention of surgical nurses was analyzed by single factor analysis and correlation analysis.Results: A total of 506 participants was recruited from April to August 2020. The results show that there were significant differences in age and annual income of surgical nurses (P < 0.05). The job satisfaction level of surgical nurses was negatively correlated with emotional exhaustion of job burnout scale (r = -0.292, P < 0.05), negatively correlated with depersonalization (r = -0.424, P < 0.05), and negatively correlated with turnover intention (r = -0.375, P < 0.05).Conclusion: The findings indicate that the job satisfaction level of surgical nurses needs to be improved. Nursing managers should pay attention to the construction of hospital organization and culture, actively create supportive nursing work environment, strengthen the vocational training of junior nurses, further optimize the distribution of nursing human resources and welfare, reduce the job burnout and turnover rate of surgical nurses, and improve the job satisfaction of external nurses, so as to ultimately improve the quality of nursing.
TCF1 controls Treg functions that regulate inflammation, CD8 T-cell cytotoxicity, and severity of colon cancer
Authors: Khazaie Khashayarsha , Osman Abu , Yan Bingyu , Li Ying , Pavelko Kevin , Quandt Jasmin , Saadalla Abdulrahman , Rathore Mahendra , Kazemian Majid , Gounari Fotini
Published: January 2021

TCF1 is essential for the development and function of T regulatory cells (Tregs). However, how TCF1 regulates Treg function in homeostasis or under pathogenic conditions is poorly understood. Here, we ablated TCF1 in Tregs to elucidate its role in Treg specification in healthy mice and mice with colon cancer. RNAseq revealed that TCF1-deficient Tregs maintain their core transcriptional signature, but promote T-cell receptor, Tgfβ receptor, TH17, and Wnt/β-catenin signaling pathways. Single-cell RNAseq identified central-memory-Tregs with low Klf2 or high Mif expression, which upon downregulation of TCF1 gained TH17 characteristics and matured into Maf expressing effector Tregs. Tcf1-deficient Tregs exhibited enhanced suppression of T-cell proliferation and cytotoxicity but were compromised in controlling CD4+ T-cell polarization and inflammation. In mice with polyposis, Tcf1-deficient Tregs promoted inflammation and tumor growth. Thus, TCF1 differentially regulates Treg control of TH17 inflammation and T-cell cytotoxicity, and its action in Tregs determines colorectal cancer outcome.
The effects of naloxone, diazepam, and quercetin on seizure and sedation in acute on chronic tramadol administration: An experimental study
Authors: Nakhaee Samaneh , Farrokhfall Khadijeh , Miri-Moghaddam Ebrahim , Foadoddini Mohsen , Askari Masoumeh , Amirabadizadeh Alireza , Brent Jeffrey , Megarbane Bruno , Mehrpour omid
Published: January 2021

Background: Tramadol is a widely used synthetic opioid. Substantial research has previously focused on the neurological effects of this drug, while the efficacy of various treatments to reduce the associated side effects has not been well studied. This study aimed to evaluate the protective effects of naloxone, diazepam, and quercetin on tramadol induced seizure and sedation level in male rats. Methods: The project was performed with 72 male Wistar rats with an average weight of 200-250 g. The rats were randomly assigned to 8 groups. Tramadol was administered intraperitoneally at an initial dose of 25 mg/kg/day. On the 14th day, tramadol was injected at 75 mg/kg, either alone or together with naloxone, diazepam, and quercetin (acute and chronic) in different combinations. The rats were monitored for 6 hours on the last day, and the number, the duration, and the severity of seizures (using the criteria of Racine) were measured at different times. The sedation level was also assessed based on a 4-point criterion, ranging from 0 to 3, at different times after injection. Data were analyzed in SPSS software using Kruskal-Wallis, Chi-square, multivariate regression, and generalized estimating equation (GEE) tests. The significance level was set at P <0.05.Results: The naloxone-diazepam combination reduced the number of seizures, severity, and duration of seizures compared to the tramadol use alone and reduced the number of higher-intensity seizures to a greater extent than other treatments. Naloxone alone reduced the number and duration of seizures, as well as the duration of mild seizures. Diazepam decreased the severity and duration of seizures. However, it increased the number of mild seizures. In comparison with the tramadol alone group, the acute quercetin group had a lower duration of mild and severe seizures, and higher numbers of mild and moderate seizures. Chronic quercetin administration decreased the duration of seizures and significantly increased the number of mild seizures. Naloxone-Quercetin also reduced the duration of mild and severe seizures significantly. In the GEE model, all groups had higher sedation levels than the saline only group (P <0.001). None of the protocols had a significant effect on sedation levels compared to the other groups.Conclusion: The combined administration of naloxone and diazepam in acute on chronic tramadol poisoning can effectively reduce most seizure variables, compared to the tramadol use alone. However, none of the treatments can improve sedation levels.
Effectiveness of Paranasal Air Suction on Acute Migraine Using Portable Air Sucker – A Randomized, Double Blind Study
Authors: bandara SMR , samita S , kiridana AM , herath HMMTB
Published: January 2021

Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker.Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were used for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 seconds. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction was the key concern but effect of side of headache, type of headache, and gender were also studied with respect to number of response variables. The key response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-hour period.Results There was a significant reduction in the severity of headache and other migraine symptoms in the treatment group compared to the control group two minutes after the suction. These symptoms did not recur within 24-hour period and there were no significant side effects recorded during the 24-hour observation period.Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 seconds using the sucker can provide an immediate relief which can last for more than 24-hour period without any side effects.Trail registration Clinical Trial Government Identification Number – 1548/2016.
Application of The Robotic Seal PARO, A Neurological Biofeedback Medical Device, to Elderly Persons with Dementia at Home: An Analysis From Seven Cases
Authors: Inoue Kaoru , Yatsu Chiyomi , Yao Daryl Patrick , Sasaki Chihiro , Wada Kazuyoshi , Shibata Takanori
Published: January 2021

Background: In Japanese society today, many elderly persons with dementia (EPWD) are living at home. This research focused on the family members of EPWD who provide informal care and support. The purpose of this research was (1) to analyse the potential and effectiveness of care provided by the family with the use of the robotic seal PARO, a neurological biofeedback medical device, and (2) to identify and prioritise problems when utilising PARO in the home context. Methods: This study employed a mixed-methods approach involving observational data and interviews. Family members of seven households caring for EPWD were asked to use the seal robot “PARO” as a means to provide care. The family caregivers used PARO at home for more than three times per week, over one to three months. At the initial visit, an individualised purpose of PARO was established. Family members were taught how to operate PARO and how to facilitate PARO use. Research data were collected at initial and subsequent monthly visits, in the form of families’ observational feedback, interviews, and direct assessment of the subjects. Collected data were analysed quantitatively and qualitatively. Results: Five out of the seven elderly persons reacted positively to PARO and achieved their intervention goals. Acceptance of PARO use depended on the positive interaction observed at the initial encounter, which led to continued interest later on. On the other hand, for the subjects where “encouragement was required to trigger interaction” at the initial encounter, their subsequent interest may either increase or decrease. Furthermore, observed activities with PARO use for all families were conversations and physical touch to PARO. Some families facilitated reminiscence and intellectual activities. Conclusions: The study indicated that the effect of PARO application at home is possibly influenced by the participants' initial level of interest towards PARO. It is still crucial to perform careful observation and assessment of the benefit of PARO before adapting the treatment strategy. The families need specific advice from relevant healthcare professionals, such as occupational therapists, to maximise the use of PARO. This implies that effective robotic care at home requires professional support.
Mapping soil pollution risk from riparian land-cover changes in the headwater area of an inter-basin water diversion project
Authors: Wang Quanfang , Zhang Mengru , Zhang Yu , Yang Yuqi , Wang Xinsheng , Yang Lanfang , Chen Longyue , Xiao Ying
Published: January 2021

A novel scheme was proposed for mapping precise land-cover change in riparian zones and the resulted soil pollution risk of non-point source (NPS) from an inter-basin water diversion project on its headwater area. The scheme held three key points: 1) digital visualization of the riparian land-cover’s cyclical features was done using remote sensing data fusion of NDWI at high water level and NDVI and MNDWI at lower water level; 2) riparian zones were identified through color clustering on optimized RGB-fusion image that was picked out by applying Modified Vector-Angular Distance (MVAD) formula to measure difference between riparian and non-riparian zones in RGB space; 3) combining Export Coefficient Model (ECM) and the derived data on riparian land-cover change around Danjiangkou Reservoir in China, time-series loads of the soil NPS pollutants were estimated before and after the Middle Route of South-to-North Water Diversion Project (SNWDP) started running in 2014. The results indicated that risk of the potential soil pollution from land-cover change in the new riparian zones enlarged. Growth rates (GR) of total nitrogen (TN) and total phosphorus (TP) not only had significant spatial variation, but also were higher during initial running period of the SNWDP’s Middle Route.
The first record of exceptionally-preserved spiral coprolites from the Tsagan-Tsab Formation (Lower Cretaceous), Tatal, western Mongolia
Authors: Rummy Paul , Halaclar Kazim , Chen He
Published: January 2021

Seven coprolites from the Lower Cretaceous of Tsagan-Tsab formation have been described, thus making this paper a significant contribution to the study of the firstly recorded coprolites from the Mesozoic deposits in Mongolia. The collected coprolites comprised a total of five morphotypes, whereby six of them are considered to be spiral amphipolar and one as rod shape. CT scans have also revealed that all specimens showed various amounts of bony inclusions and fish scales of unknown affinity, hence deducing that the producers may have had a low acid digestive track and were unable to dissolve bone matters. Moreover, SEM-EDS analysis concluded its carnivorous nature. In addition, all coprolites exhibited bony elements of identical morphological structures, which indicated that the producers might have preyed on the same type of organism. Specimen IVPP V 27545 is the only non-spiral coprolite and the smallest compared to the rest and contain plant pollens, an infraorbital bone and clusters of bones of the prey; bioerosional scars are observed on the surface. We suggest that the spiral coprolites were produced by Asipenceriformes with ichthyophagous diet, while the non-spiral rod like coprolite might possibly belong to smaller vertebrate organisms that can’t be identified by us in this study.
Impact of the SARS-COV-2 Outbreak on Epidemiology and Management of Major Trauma in France: Registry-Based Study. The COVITRAUMA Study
Authors: Moyer Jean-Denis , James Arthur , Gakuba Clément , Boutonnet Mathieu , Angles Emeline , Rozenberg Emmanuel , Bardon Jean , Clavier Thomas , Legros Vincent , Werner Marie , Mathais Quentin , Ramonda Veronique , Berthelot Yann , Colas Clelia , Minh Pierre Le , Pottecher Julien , Gauss Tobias
Published: January 2021

BackgroundEvidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. MethodsThis retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. ResultsOver a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p<0.005). Mortality during the pandemic period and the difference between predicted and observed mortality was not different compared to the non-pandemic years. ConclusionsDuring this first wave of COVID-19 in France, management of trauma patients admitted to regional Traumacenters was not significantly altered, despite medical resources being reallocated and reorganized. Mortality as well as prehospital and in hospital care remained stable throughout the period of the first pandemic wave despite a massive increase in demand for acute care beds.
Anticancer Effects of Disulfiram: A Systematic Review of in Vitro, Animal, and Human Studies
Authors: wang ling , yu yang , zhou cong , wan run , Li Yumin
Published: January 2021

Background and objectives: Cancer morbidity and mortality rates remain high, and thus, at present, considerable efforts are focused on finding drugs with higher sensitivity against tumor cells and fewer side effects. Several preclinical and clinical studies have examined the potential of repurposing disulfiram (DSF) as an anticancer treatment. This systematic review aimed to assess evidence regarding the antineoplastic activity of DSF in in vitro and in vivo models, as well as in humans.Methods: Two authors independently conducted this systematic review of English and Chinese articles from the PubMed, Embase, and the Cochrane Library databases up to July 2019. Eligible in vitro studies needed to include assessments of the apoptosis rate by flow cytometry using annexin V/propidium iodide, and studies in animal models and clinical trials needed to examine tumor inhibition rates, and progression-free survival (PFS) and overall survival (OS), respectively. Data were analyzed using descriptive statistics.Results: Overall, 35 studies, i.e., 21 performed in vitro, 11 based on animal models, and three clinical trials, were finally included. In vitro and animal studies indicated that DSF was associated with enhanced apoptosis and tumor inhibition rates. Human studies showed that DSF prolongs PFS and OS. The greatest anti-tumor activity was observed when DSF was used as combination therapy or as a nanoparticle-encapsulated molecule.Conclusions: This systematic review provides evidence regarding the anti-tumor activity of DSF in vitro, in animals, and in humans and indicates the optimal forms of treatment to be evaluated in future research.
Kernel Weighted Least Square Approach for Imputing Missing Values of Metabolomics Data
Authors: Kumar Nishith , Hoque Md. , Sugimoto Masahiro
Published: January 2021

Mass spectrometry is a modern and sophisticated high-throughput analytical technique that enables large-scale metabolomics analyses. It yields a high dimensional large scale matrix (samples × metabolites) of quantified data that often contain missing cell in the data matrix as well as outliers which originate from several reasons, including technical and biological sources. Although, in the literature, several missing data imputation techniques can be found, however all the conventional existing techniques can only solve the missing value problems but not relieve the problems of outliers. Therefore, outliers in the dataset, deteriorate the accuracy of imputation. To overcome both the missing data imputation and outlier’s problem, here, we developed a new kernel weight function based missing data imputation technique (proposed) that resolves both the missing values and outliers. We evaluated the performance of the proposed method and other nine conventional missing imputation techniques using both artificially generated data and experimentally measured data analysis in both absence and presence of different rates of outliers. Performance based on both artificial data and real metabolomics data indicates that our proposed kernel weight based missing data imputation technique is a better performer than some existing alternatives. For user convenience, an R package of the proposed kernel weight based missing value imputation technique has been developed which is available at https://github.com/NishithPaul/tWLSA .
Allergen protease-induced Gsdmd p40 controls IL-33 secretion
Authors: Sun Bing , Wu Bin , Wu Dong , Shao Feng , Zhang Yaguang , Chen Wen , Yan Chenghua , Zhang Ronghua , Chen Shuangfeng , Chen Min , Zhong Shufen , Zhu Songling , Li Xuezhen , Lu Xiao , Zhang Danyan , Ling Zhiyang , Ma Liyan , Zhu Jinfang , Fan Weiguo
Published: January 2021

Interleukin (IL)-33, an epithelial cell-derived cytokine that responds rapidly to environmental insult, has a critical role in initiating airway inflammation, such as that in asthma. However, the molecular mechanism underlying IL-33 secretion following allergen exposure is not clear. Here, we demonstrated that Gasdermin D (Gsdmd) functions as a conduit for IL-33 secretion following allergen protease exposure. Gsdmd was rapidly cleaved into a functional neo-form, the N-terminal p40 fragment (p40 NT-Gsdmd), in the murine airway epithelium when cells were exposed to allergen proteases from fungi, house dust mites (HDMs), or bacteria. This cleavage event that produces the p40 Gsdmd fragment was independent of inflammatory caspases-1/11, as it could not be inhibited by caspase-1 and caspase-11 deficiency in murine cells. The functional p40 NT-Gsdmd fragment directly contributed to the secretion of both the nuclear full-length form and cytosolic mature form of IL-33. Both Gsdmd deficiency and blockade of the generation of p40 by amino acid mutation or deletion of residues 308–313 (ELRQQ) in the Gsdmd sequence could efficiently prevent IL-33 release in airway epithelial cells. In mice, Gsdmd deficiency prevented IL-33 release and hindered the activation of group 2 innate lymphoid cells (ILC2s), thus alleviating airway inflammation and lung tissue damage after stimulation with HDMs or papain. Our findings uncovered a mechanism of Gsdmd-mediated IL-33 release under allergen exposure and offer insight into Gsdmd cleavage prevention as a potential approach to reduce allergic airway inflammation.
An Insight into Patients’ Perspectives on their Participation in Medical Decision Making in Diabetes Mellitus Care in Malawi.
Authors: Makwero Martha , Muula Adamson , Anyanwu Felix , Igumbor Jude
Published: January 2021

Background: Patient participation in their own care has potential to improve experiences and responsiveness in chronic disease situations. Patient participation is a basic tenet for a patient centred care experience. However, the documented experiences show that patient participation in care decisions making is wanting. As Malawi strives to imbibe and institutionalise the concept of patient centred care, it is important to examine the experiences of patients regarding participation in their care as this may provide evidence to support policy implementation strategies on the same. Aim: The study therefore sought to describe DM patients’ experiences of participation in shared decision making in Malawi.Methods: This qualitative exploratory study involved patients attending DM clinics in four public health facilities in Southern Malawi. Using SHARE framework, we analysed data from 15 in-depth interviews and two focus group discussions. Results: From the perspective of DM patients, this study elucidated that participation in care was largely lacking in clinical encounters. Some of the prominent gaps identified in the interactional process of care included: i) unfavourable ambience for participation, ii) insufficient bidirectional informational exchange and iii) inconsideration for patients’ preferences and values, iv) paternalistic power tendencies and, v) lack of evaluation of decisions made. Conclusion: The study highlights gaps in the practice of patients’ participation in medical decisions. Patients’ reproof of paternalistic models of care confirms that transforming medical education through curriculum review for providers may be a good starting point. The review should focus on the content and effective delivery of competencies relating to provider roles and practices on patient participation.
Women’s Perception of Continuity of Team Midwifery Care in Iran: A Qualitative Study
Authors: shahinfar sholeh , abedi parvin , najafian mahin , abbaspoor zahra , Mohammadi Eesa , Alianmoghaddam narges
Published: January 2021

Background: Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran. Methods: This research is a qualitative study conducted in Iran to explore women's perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. 15 semi-structured interviews were conducted with women individually through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim and analyzed using conventional content analysis. Results: From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.Conclusion: Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.
Early Plain Film After Volar Plate Fixation for Distal Radius Fractures: Is Reallly Useful?
Authors: Cheng Wenjing - , DING GUOZHENG -
Published: January 2021

Background: The value of early postoperative radiographs is generally questioned after volar plate fixation(VLP) for distal radius fractures(DRFs). The purpose of this study was to evaluate the utility of early routine radiographs following volar plate fixation.Methods:A restropective study was developed on distal radius fractures treated with volar plate fixation between 1 January 2016 and 1 January 2020 in our hospital. We obtain relevant information from patient electronic records including basic patient information and treatment information.Reoperation or further checking after early postoperative radiographs was defined as management change，which illustrates early postoperative radiographs influence postoperative treatment.Results: A total of 213 patients treated with VLP were included. There are 179 patients having early postoperative radiographs in included patients. Two out of 179 patients were altered management,which underwent further imaging with computed tomography(CT) due to pain and swelling.This two patients were in line with Type C(AO/OTA classification). No patient has surgery again.Conclunsion: Early postoperative radiographs can not bring about an adjustment in postoperative management with VLP after DRF.But intra-articular fractures may still benefit from early postoperative radiographs compared with extra-articular fractures.
Cross-Cultural Translation and Validation of the Spanish Version of the Patellofemoral Pain and Osteoarthritis Subscale of the KOOS (KOOS-PF)
Authors: Martinez-Cano Juan Pablo , Vernaza-Obando Daniel , Chica Julián , Castro Andrés Mauricio
Published: January 2021

Background: Patellofemoral pain is a very common complaint in orthopedic sports medicine clinics. Disease-specific patient-reported outcome measures (PROMs) are useful for research and clinical practice; thus, it is important to have validated translations available for new PROMs. This study aims to translate and validate the Spanish version of the patellofemoral pain and osteoarthritis subscale of the knee injury and osteoarthritis outcome score (KOOS-PF).Methods: The KOOS-PF was translated and culturally adapted to Spanish following current guidelines, which included translation, back-translation, conciliation and pilot studies. Patients with a diagnosis of patellofemoral pain and/or osteoarthritis from one medical center were invited to participate and complete the questionnaire. The evaluation of the score included internal consistency (Cronbach´s alpha), floor and ceiling effects, measurement error, minimal detectable change and minimal important change. For test-retest reliability, the intraclass correlation coefficient (ICC) was used, and for responsiveness, the global rating of change (GROC) scale was measured one month later.Results: Sixty patients with patellofemoral pain and/or osteoarthritis were included in the study. The Spanish version showed very good internal consistency (Cronbach’s alpha: 0.93) and test-retest reliability (intraclass correlation coefficient: 0.82). Responsiveness was confirmed, with the KOOS-PF demonstrating a strong correlation with the GROC score (r 0.64). The minimal detectable change was 11.1 points, the minimal important change was 17.2 points, and there were no floor or ceiling effects for the score.Conclusions: The Spanish version of the KOOS-PF demonstrated very good measurement properties, including internal consistency, reliability and responsiveness. The KOOS-PF can be used in Spanish-speaking patients for clinical and research purposes in patellofemoral pain and osteoarthritis.Trial registration: Fundación Valle del Lili, Biomedical Research Ethical Committee: No. 01438.
A modified chief complaint-based cardiac triage strategy for reducing delays in the management of patients with ST-elevation myocardial infarction
Authors: Su Hung-Yuan , Tsai Jen-Long , Hsu Yin-Chou , Lee Kuo-Hsin , Chang Chao-Sheng , Sun Cheuk-Kwan , Wang Yu-Han , Hsu Chih-Wei
Published: January 2021

Timely performing electrocardiography (ECG) is crucial for early detection of ST-elevation myocardial infarction (STEMI). For shortening door-to-ECG time, a chief complaint-based “cardiac triage” protocol comprising (1) raising alert among medical staff with bedside triage tags, and (2) immediate bedside ECG after focused history-taking was implemented at the emergency department (ED) in a single tertiary referral center. All patients diagnosed with STEMI visiting the ED between November 2017 and January 2020 were retrospectively reviewed to investigate the effectiveness of strategy before and after implantation. Analysis of a total of 117 ED patients with STEMI (pre-intervention group, n = 57; post-intervention group, n = 60) showed significant overall improvements in median door-to-ECG time from 5 to 4 minutes (p = 0.02), achievement rate of door-to-ECG time < 10 minutes from 45–57% (p = 0.01), median door-to-balloon time from 81 to 70 minutes (p < 0.01). Significant trends of increase in achievement rates for door-to-ECG and door-to-balloon times (p = 0.01 and p = 0.006, respectively) was noticed after strategy implementation. The incidence of door-to-ECG time > 10 minutes for those with initially underestimated disease severity was also reduced from 90–10% (p < 0.01). In conclusion, a chief complaint-based “cardiac triage” strategy successfully improved the quality of emergency care for STEMI patients through reducing delays in diagnosis and treatment.
The F2-Isoprostane:Thromboxane-prostanoid receptor signaling axis drives persistent fibroblast activation in pulmonary fibrosis
Authors: Suzuki Toshio , Kropski Jonathan , Chen Jingyuan , Carrier Erica , Chen Xinping , Sherrill Taylor , Polosukhin Vasily , Han Wei , Rathinasabapathy Anandharajan , Gutor Sergey , Gulleman Peter , Banovich Nicholas , Tanjore Harikrishna , Freeman Michael , Tada Yuji , Young Lisa , Gokey Jason , Blackwell Timothy , West James
Published: January 2021

While transient fibroblast activation is a normal and adaptive aspect of injury-repair in many contexts, persistent fibroblast activation is a hallmark of idiopathic pulmonary fibrosis (IPF) and other chronic fibrotic lung diseases. The mechanisms regulating persistent fibroblast activation in IPF have not been fully elucidated. In the lungs of IPF patients and in mice with experimental lung fibrosis, we observed that expression of the thromboxane-prostanoid receptor (TBXA2R) was increased in fibroblasts. Genetic deletion of TBXA2R, but not inhibition of thromboxane synthase, protected mice from bleomycin-induced lung fibrosis, suggesting an alternative ligand activates profibrotic TBXA2R signaling. We found that F2-isoprostanes (F2-IsoPs), nonezymatic products of arachidonic acid metabolism generated in the setting of reactive oxygen species (ROS), are persistently elevated in experimental lung fibrosis and act as an alternative TBXA2R ligand. Further studies demonstrated that F2-isoprostanes signal through TBXA2R to activate Smad signaling, revealing TBXA2R as a previously unrecognized regulator of the transforming growth factor beta (TGF-β) pathway. Further, treatment with the small-molecule TBXA2R antagonist ifetroban protected mice from lung fibrosis in three pre-clinical models: bleomycin treatment, Hermansky-Pudlak Syndrome, and radiation-induced fibrosis. Importantly, treatment with ifetroban during the fibrotic phase of bleomycin injury markedly enhanced fibrotic resolution. Together, these studies implicate TBXA2R signaling as a crucial mediator linking oxidative stress to fibroblast activation and indicate that TBXA2R antagonists could be efficacious for treatment of IPF and other chronic fibrotic disorders.
Physician Associate/Assistant Impacts on Cancer Diagnosis in Primary Care: A Systematic Review
Authors: Sheringham Jessica , Kassianos Angelos , Plackett Ruth , Khan Anwar , King Angela , Cornes Michelle
Published: January 2021

Background: Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 15 healthcare systems across the world, with numbers increasing to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from international observational studies on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. Method: A rapid systematic review of international peer-reviewed literature was performed (PROSPERO reference: CRD42019154114). Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. Results: From 876 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n=6) and referrals to specialists (n=4). Fewer papers reported on consultation processes, such as examinations or history taking (n=3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. Conclusion: This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.
Three-Dimensional Electronic Microfliers With Designs Inspired by Wind-Dispersed Seeds
Authors: Rogers John , Kim Bong Hoon , Li Kan , Kim Jin-Tae , Park Yoonseok , Jang Hokyung , Wang Xueju , Xie Zhaoqian , Won Sang , Jang Woo Jin , Lee Kun Hyuk , Chung Ted , Jung Yei Hwan , Heo Seung Yun , Lee Yechan , Kim Juyun , Cai Tengfei , Kim Yeonha , Prasopsukh Poom , Yu YongJoon , Yu Xinge , Luan Haiwen , Song Honglie , Zhu Feng , Zhao Ying , Chen Lin , Han Seung Ho , Kim Jiwoong , Oh Soong Ju , Lee Heon , Lee Chi Hwan , Huang Yonggang , Chamorro Leonardo , Zhang Yihui
Published: January 2021

Large, distributed collections of miniaturized, wireless electronic devices may form the basis of future systems for environmental monitoring, population surveillance, disease management and other applications that demand coverage over expansive spatial scales. In this paper, we show that wind-dispersed seeds can serve as the bio-inspiration for unusual aerial schemes to distribute components for such networks via controlled, unpowered flight across natural environments or city settings. Techniques in mechanically guided assembly of three-dimensional (3D) mesostructures provide access to miniature, 3D fliers optimized for such purposes, in processes that align with the most sophisticated production techniques for electronic, optoelectronic, microfluidic and microelectromechanical technologies. We demonstrate a range of 3D macro-, meso- and microscale fliers produced in this manner, including those that incorporate active electronic payloads. Analytical, computational and experimental studies of the aerodynamics of high-performance structures of this type establish a set of fundamental considerations in bio-inspired design, with a focus on 3D fliers that exhibit controlled rotational kinematics and low terminal velocities. Battery-free, wireless devices for atmospheric measurements provide simple examples of a wide spectrum of applications of these unusual concepts.
Cancer Statistics in Kurdistan Region of Iraq: A Tale of Two Cities
Authors: M-Amen Karwan , Abdullah Omiad , Amin Ahmed , Hasan Bestoon , Mohamed Zeki , Sulaiman Luqman , Shekha Mudhir , Najmuldeen Hastyar , Barzingi Basak , Salih Ahmed , Mahmood Dler , Othman Hemin , Rahman Fryad , Mohammad Dara , Salih Fahmi , Ali Suad Khudhur , Housein Zjwan , Mohamad Trefa , Mahmood Kazhan , Othman Galawezh , Aali Mukhlis , Qader Govand , Hussen Bashdar , Awla Farhang , Qadir Fikry , Taher Dilan , Salihi Abbas
Published: January 2021

There is limited published data on recent cancer incidence trends in Iraqi Kurdistan. Therefore, this study assesses epidemiological estimates of cancer incidence as well as the projection of future cancer trends in the upcoming decade by analysing the population-based cancer registry from 2013 to 2019 in both Erbil and Duhok governorates. A retrospective study was conducted on data retrieved from the Medical Statistics Department at the Ministry of Health, KRG. The total number of female cancer patients was higher in both governorates, and the total number of patients more than doubled from 2013 to 2019 in Erbil and Duhok, from 73 to 174 patients/100,000 population for women, and 36 to 85 patients/100,000 population for men. Data analysis indicates that the percentage of cancer patients is projected to increase in the decade from 2020-2030 from 107.4% to 234.3% in 2030 in Erbil governorate; and from 106% to 163% in Duhok governorate. Female breast cancer and lung cancer are the most prominent types of cancers since 2013 in Erbil and Duhok governorates. The striking pattern of trends for both present and future cancer incidence rates require the urgent solutions and comprehensive efforts to control risk factors that promote the continuity of cancer diseases in these two KRG governorates.
Impact of Chemotherapy and Radiotherapy on the Survival of Elderly Esophagus Cancer Patients after Surgery: A SEER Database Analysis
Authors: Li Xinrong , Zhang Jin , Zhu Junquan , Guo Kaibo , Guo Yong
Published: January 2021

BackgroundEsophagus cancer (EC) is a common and lethal carcinoma, however, the effectiveness and feasibility of the conventional treatments for the elderly patients with surgery have not been discussed fully. The purpose of the current study is to discuss the potential effect of chemotherapy and radiotherapy on the prognosis.ResultsBy PSM, chemotherapy (sHR: 0.588, 95%CI: 0.453-0.763, P<0.001) and radiotherapy (sHR: 0.652, 95%CI: 0.513-0.83, P<0.001) were showed a negative correlation to the probability of cancer specific death (CSD). Based on the nomogram, patients with poor differentiation, large tumor size, advanced T-staging, lymphatic metastasis and distant metastasis tended to benefit from chemotherapy (HR: 0.441, 95%CI: 0.364-0.533, P < 0.001) or radiotherapy (HR: 0.539, 95%CI: 0.448-0.649, P < 0.001) to decrease the probabilities of CSD, while no benefit or even harm was showed among the low-risk ones. ConclusionAggressive treatment such as chemotherapy or radiotherapy was considered effective for the selective elder patients with EC.
Refractive Outcomes of Femtosecond Laser-assisted Cataract Surgery with Arcuate Keratotomy and Standard Phacoemulsification with Toric Intraocular Lens Implantation
Authors: Lin Meng-Yin , Shen Yun-Dun , Tan Hsin-Yuan , Wang I-Jong , Lin I-Chan
Published: January 2021

Background: Both femtosecond laser-assisted arcuate keratotomy (FS-AK) and toric intraocular lens (IOL) implantation were effective in correction for eyes with corneal astigmatism. The objective of this study was to evaluate the postoperative refractive outcomes of patients receiving femtosecond laser-assisted cataract surgery (FLACS) with FS-AK and patients receiving standard phacoemulsification with toric intraocular lens implantation Methods: This retrospective study reviewed the postoperative outcome of patients undergoing FLACS with FS-AK (FS-AK group) and patients undergoing standard phacoemulsification with toric IOL implantation (toric IOL group). The main outcome measures were bare and corrected visual acuities, keratometric and refractive astigmatism, and vector analysis.Results: The FL-AK group included 41 eyes with preoperative keratometric astigmatism of −1.64 diopters (D) ± 0.42 (standard deviation), and the toric IOL group included 53 eyes with preoperative keratometric astigmatism of −2.29 ± 0.91 D (P < 0.001). Postoperative refractive astigmatism was comparable between the two groups. Postoperative bare vision was significantly better (P = 0.005) and corrected visual acuity was marginally better in the toric IOL group than in the FS-AK group (P = 0.051). The absolute angles of error were 9.95 ± 9.57 degrees and 5.08 ± 4.94 degrees (P = 0.02) in the FS-AK and toric IOL groups, respectively.Conclusion: Both FLACS with FS-AK and standard phacoemulsification with toric IOL implantation represent safe and effective methods for astigmatism correction at the time of cataract surgery. Standard phacoemulsification with toric IOL implantation achieves better visual outcome than combined FLACS and FS-AK at 6-month follow up.
Identification of Co-Expression Network Correlated With Different Periods of Adipogenic and Osteogenic Differentiation of BMSCs by Weighted Gene Co-Expression Network Analysis (WGCNA)
Authors: Liu Yu , Tingart Markus , Lecouturier Sophie , Li Jianzhang , Eschweiler Jörg
Published: January 2021

Background: The differentiation of bone marrow mesenchymal stem cells (BMSCs) is a complex and dynamic process. The gene expression pattern and mechanism of different periods of adipogenic and osteogenic differentiation remain unclear. Additionally the inaction between these two lineages determination requires further exploration. Results: Five modules that are most significantly associated with osteogenic or adipogenic differentiation of BMSCs were selected for further investigation. Biological terms, such as ribosome biogenesis, TNF-α signaling pathway, glucose import, fatty acid metabolism along with hub transcript factors, such as PPARG, YY1, and hub miRNAs, such as hsa-mir-26b-5p were enriched in different modules. The expression pattern of 6 hub genes, ADIPOQ, FABP4, SLC7A5, SELPLG, BIRC3, and KLHL30 were validated by RT-qPCR. In the end, cell staining experiments extended the findings of bioinformatics analysis.Conclusion: This study identified the key genes, biological functions, and regulators of each time point of adipogenic and osteogenic differentiation of BMSCs and provided novel evidence and ideas for further research on the differentiation of BMSCs.
Do Acute Inflammatory Cytokines Affect 3- and 12-Month Postoperative Functional Outcomes–A Prospective Cohort Study of 12 Patients With Proximal Tibia Fractures
Authors: Iversen Imran , Pham That Minh , Schmal Hagen
Published: January 2021

BackgroundPatients with intra-articular fractures tend to develop post-traumatic osteoarthritis (PTOA). The initial inflammatory response with elevation of inflammatory cytokines following joint trauma might be responsible for triggering cartilage catabolism and degradation. We aimed to identify and quantify cytokine levels in fractured and healthy knee joints and the correlation of these cytokines with clinical outcomes.Methods In this prospective cohort study, synovial fluid and plasma were collected from 12 patients with proximal intra-articular tibia fractures before surgery. The concentration of sixteen inflammatory cytokines, two cartilage degradation products and four metabolic mediators where measured, comparing the acute injured knee with the healthy contralateral knee. Patients were evaluated 3- and 12-months after surgery with clinical parameters and radiographical scanning. Non-parametrical Wilcoxon rank-sum and Spearman tests were used for statistical analysis, and a P-value below 0.05 was considered significant.ResultsWe found an elevation of the pro-inflammatory cytokines IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF-α, IFN-y, MMP-1, MMP-3, and MMP-9 and a simultaneous elevation of the anti-inflammatory cytokines IL-1RA, IL-4, IL-10, and IL-13 in the injured knee. Several pro- and anti-inflammatory cytokines and metabolic mediators were correlated with clinical outcomes 12 months after surgery, especially with pain perception. ConclusionsOur results support that an inflammatory process occurs after intra-articular knee fractures, which is characterized by the elevation of both pro- and anti-inflammatory cytokines. There was no sign of cartilage damage within the timeframe from injury to operation. We found a correlation between the initial inflammatory reaction with clinical outcomes 12 months after surgery.
Long-Term Clinical Outcomes of Patients Receiving Proton Beam Therapy for Caudate Lobe Hepatocellular Carcinoma
Authors: Iizumi Takashi , Okumura Toshiyuki , Sekino Yuta , Takahashi Hiroaki , Tsai Yu-Lun , Takizawa Daichi , Ishida Toshiki , Hiroshima Yuichi , Nakamura Masatoshi , Shimizu Shosei , Saito Takashi , Numajiri Haruko , Mizumoto Masashi , Nakai Kei , Sakurai Hideyuki
Published: January 2021

BackgroundHepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than do those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scare. Therefore, the present study aimed to investigate the outcomes of this group of patients.MethodsThirty patients with caudate HCC who underwent definitive PBT between February 2001 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose.ResultsThe median follow-up period was 37.5 (range, 3.0–152.0) months. The overall survival rates at 1, 3, and 5 years were 86.6%, 62.8%, and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02), and a low serum alpha-fetoprotein level (P < 0.01) were significant factors predicting longer survival. The local control rates at 1, 3, and 5 years were 100.0%, 85.9%, and 85.9%, respectively, while the corresponding progression-free survival rates were 65.0%, 27.5%, and 22.0%, respectively. No grade 3 or worse adverse events were observed.ConclusionsPBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.