bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Affecting the Surgical Outcomes of Patients Treated With “de-tension” Surgical Strategy for Multilevel Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine: A Minimum 2-year Follow-Up Study of 83 Patients in a Single Center
Authors: Chen Guanghui , Fan Tianqi , Chen Zhongqiang , Li Weishi , Qi Qiang , Guo Zhaoqing , Zhong Woquan , Jiang Yu , Song Chunli , Sun Chuiguo
Published: May 2023

Study Design

Retrospective cohort study

Objectives

To describe the clinical characteristics and surgical outcomes of patients with multilevel-ossification of the posterior longitudinal ligament (mT-OPLL), and to identify risk factors for unfavorable outcomes.

Methods

Patients who were diagnosed with mT-OPLL and underwent one-stage thoracic posterior laminectomy combined with selective OPLL resection, spinal cord de-tension, and fusion surgery between August 2012 and October 2020 were recruited. Patients’ demographic-, surgical- and radiological-related parameters were collected and analyzed. Neurological status was evaluated with mJOA score, and recovery rate (RR) was calculated using the Hirabayashi formula. According to RR, patients were divided into a favorable outcome group (FOG, RR ≥50%) and an unfavorable outcome group (UOG, RR <50%). Univariate and multivariate analyses were used to compare the difference between the 2 groups and to identify risk factors for unfavorable outcomes.

Results

A total of 83 patients were included, with an average age of 50.6 ± 8.3 years. Cerebrospinal fluid leakage (60.2%) and transient neurological deterioration (9.6%) were the most common complications. The average mJOA score improved from preoperative 4.3 ± 2.2 to 9.0 ± 2.4 at the last follow-up, and the mean RR was 74.9 ± 26.3%. Disease duration, preoperative nonambulatory status, and the number of decompressed levels were identified as potential risk factors by Univariate analysis (all P < .05). Multivariate analysis showed that the preoperative disease duration and nonambulatory status were independent risk factors for unfavorable outcomes.

Conclusions

Long disease duration and nonambulatory status before surgery were independent risk factors for unfavorable outcomes.
The impact of knowledge brokering in health sector and the challenges: A review of literature
Authors: Yamanie N , Amanda NF , Felistia Y
Published: May 2023

Knowledge brokering is a type of knowledge translation that bridge the researchers and end users. Knowledge brokering assist the interactions between all agents to understand each other’s perspectives and goals to improve health system performance. The failure to deliver how important the research implementation in society may cause significant outcome. A person or organization who perform knowledge brokering is called knowledge broker (KB). Literature review is conducted for the clinical question of how knowledge brokering impact the health sector and the visible challenges. A literature search is performed by systematic search using three major online databases; Cochrane, PubMed, and EBSCO. Hand-searching also yielded one result that fit the objective of this study. The database result search was being screened from the title and abstract which resulted in 14 relevant articles. After reading the full-text articles, four literatures were ruled-in. The study assessed knowledge brokering process using various methods like single framework or model as well as the combination. The challenges include the lack of communication between internal team and end users, leadership skill, engaging end users, knowledge transfer activity, different timeline, and diverse vision. Evaluating and applying knowledge brokering strategies were needed as the practice itself bringing positive outcomes. Knowledge brokering approaches consist of many methods which tailored to the study objective. Challenges that stand out were communication and personal skill, engaging end users, and perspectives difference. The impact of knowledge brokering is challenging to assess. Further studies that evaluate the impacts of knowledge brokering are still needed.
Assessing Nutritional Status and Functionality in Geriatric Population of Bangladesh: The Hidden Epidemic of Geriatric Malnutrition
Authors: Reza Sompa , Alam Mohammad Rahanur , Chowdhury Akibul Islam , Mamun Md. Abdullah Al , Akhter Marufa , Habib Mohammad Asadul
Published: May 2023

The average life expectancy of the Bangladeshi population has risen over the last decade due to economic growth and improved medical care. Although the increased number of older adults and their health is a significant concern, there is scarce of data regarding that. A community-based cross-sectional study was conducted to analyze the association between nutritional status and functional ability among selected Bangladeshi geriatric populations living in their homes. Of 400 participants, the prevalence of malnutrition, and people at risk of malnutrition was 25.4% and 58.8%, respectively. Furthermore, almost 80% of participants are dependent in terms of activities of daily living. High risk of falling ( OR = 10.82; 95% CI: 5.85–20.37; p ≤ .001), limited activities of daily living (IADL) ( OR = 6.21; 95% CI: 4.02–9.58; p ≤ .001), along with dependency in performing IADL ( OR = 4.48; 95% CI: 2.83–7.06; p ≤ .001) are significantly associated with malnutrition. Geriatric malnutrition can accelerate disability conditions, leading to early functional aging.
The Effect of Education and Telephone Follow-up on the Burden of Family Caregivers of Patients With Cancer
Authors: Abdigaravand Mahin , Goudarzi Fateme , Hasanvand Shirin , Birjandi Mehdi , Galehdar Nasrin , Hojati Zohreh
Published: May 2023

Introduction

Family caregivers of patients with cancer face a care burden due to the responsibilities and problems of providing care to the patients. Applying appropriate strategies to reduce the burden is essential.

Objective

The study aimed to determine the effect of education and telephone follow-up on family caregivers’ burden on patients with cancer.

Methods

In this quasi-experimental study, 69 family caregivers of patients with cancer referred to only one chemotherapy center of a hospital in Lorestan province in Iran were recruited by convenience sampling method. They were randomly assigned to intervention ( n  =  33) and control ( n  =  36) groups. For the intervention group, two face-to-face training sessions and six telephone counseling sessions were held related to the care of the patients and self-care. The control group received only routine care. The family caregiver burden was measured by Novak and Gast Caregiver Burden Inventory (1989) completed before, immediately, and 6 weeks after the study. Data were analyzed by SPSS21 using independent t-tests, paired t-tests, and repeated measures.

Results

Both groups were homogeneous regarding demographic characteristics and the baseline care burden. The caregiver burden decreased significantly in the intervention group, so its score was 77.33  ±  8.49, 58.93  ±  8.03, and 52.78  ±  6.86 before the study, immediately after and 6 weeks later, respectively ( p < .001). In the control group, there were no significant changes.

Conclusion

Education and telephone counseling reduced the burden on family caregivers. Therefore, this type of support is beneficial for providing holistic care and preserving the health of family caregivers.
Randomized Trial to Test a Chemo-Mechanical Antiplaque Regimen as Adjunct to Periodontal Therapy
Authors: Li L. , Hayashi-Okada Y. , Falkner K.L. , Cervi S. , Andrusz S. , Shimizu Y. , Zambon J.J. , Kirkwood K.L. , Schifferle R.E. , Diaz P.I.
Published: May 2023

Background:

The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP).

Objectives:

This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics.

Methods:

This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969.

Results:

In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75).

Conclusion:

Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy.

Knowledge Transfer Statement:

This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes.
Large Medial Orbital Wall Fracture in the Setting of Prior Functional Endoscopic Sinus Surgery
Authors: Andrew Ovadia Steven , Harshbarger Raymond
Published: May 2023

Functional endoscopic sinus surgery (FESS) is performed as a treatment for refractory sinusitis. Ethmoidectomy is a component of FESS. In performing ethmoidectomy, the septa that are believed to buttress the medial orbital wall are removed. The impact of endoscopic sinus surgery upon orbital biomechanics have been studied in a cadaver model. These studies have demonstrated increased likelihood of medial orbital wall fracture in a cadaver model. In this report, the authors present the case of a patient who sustained facial trauma with a history of prior FESS. She developed a large medial orbital wall fracture and nondisplaced floor fracture. Reconstruction was successfully performed with an alloplastic implant. Despite increasing numbers of FESS operations performed, there is limited evidence in the literature regarding orbital fracture in patients with a history of FESS. This case provides support for the findings of the recent cadaver studies.
A review of passenger-oriented railway rescheduling approaches
Authors: Sharma Bishal , Pellegrini Paola , Rodriguez Joaquin , Chaudhary Neeraj
Published: May 2023

Railway operations are highly susceptible to delays and disruptions caused by various factors, such as technical issues, operational inefficiencies, and unforeseen events. To counter these delays and ensure efficient railway operations during real-time management, several rescheduling approaches can be implemented. Among these approaches, passenger-oriented rescheduling considers train rescheduling while taking passenger data into account, as opposed to operation-oriented rescheduling. This paper provides an overview of the former group of approaches. Particular focus is put on different ways passenger data is exploited to optimize rescheduling and on the measures, the approaches can decide on. The rescheduling measures typically considered vary from decisions on maintaining transfers, canceling trains, adding emergency trains, changing routes and orders of trains, skipping or adding stops at stations, short-turning trains, applying speed control, and modifying rolling stock compositions. In this regard, the paper presents a comprehensive analysis of real-time rescheduling approaches adopted in both the conventional railway and urban rail transit and points out possible directions for further research in the field.
Comparative analysis of dioecious Amaranthus plastomes and phylogenomic implications within Amaranthaceae s.s.
Authors: Raiyemo Damilola A. , Tranel Patrick J.
Published: May 2023

Background

The genusAmaranthusL. consists of 70–80 species distributed across temperate and tropical regions of the world. Nine species are dioecious and native to North America; two of which are agronomically important weeds of row crops. The genus has been described as taxonomically challenging and relationships among species including the dioecious ones are poorly understood. In this study, we investigated the phylogenetic relationships among the dioecious amaranths and sought to gain insights into plastid tree incongruence. A total of 19Amaranthusspecies’ complete plastomes were analyzed. Among these, seven dioeciousAmaranthusplastomes were newly sequenced and assembled, an additional two were assembled from previously published short reads sequences and 10 other plastomes were obtained from a public repository (GenBank).

Results

Comparative analysis of the dioeciousAmaranthusspecies’ plastomes revealed sizes ranged from 150,011 to 150,735 bp and consisted of 112 unique genes (78 protein-coding genes, 30 transfer RNAs and 4 ribosomal RNAs). Maximum likelihood trees, Bayesian inference trees and splits graphs support the monophyly of subgeneraAcnida(7 dioecious species) andAmaranthus; however, the relationship ofA. australisandA. cannabinusto the other dioecious species inAcnidacould not be established, as it appears a chloroplast capture occurred from the lineage leading to theAcnida + Amaranthusclades. Our results also revealed intraplastome conflict at some tree branches that were in some cases alleviated with the use of whole chloroplast genome alignment, indicating non-coding regions contribute valuable phylogenetic signals toward shallow relationship resolution. Furthermore, we report a very low evolutionary distance betweenA. palmeriandA. watsonii, indicating that these two species are more genetically related than previously reported.

Conclusions

Our study provides valuable plastome resources as well as a framework for further evolutionary analyses of the entireAmaranthusgenus as more species are sequenced.
Genome-wide identification and expression profile analysis of metal tolerance protein gene family in Eucalyptus grandis under metal stresses
Authors: Shirazi Zahra , Khakdan Fatemeh , Rafiei Fariba , Balalami Mahdi Yahyazadeh , Ranjbar Mojtaba
Published: May 2023

Metal tolerance proteins (MTPs) as Me2+/H+(K+) antiporters participate in the transport of divalent cations, leading to heavy metal stress resistance and mineral utilization in plants. In the present study, to obtain better knowledge of the biological functions of the MTPs family, 20 potential EgMTPs genes were identified in Eucalyptus grandis and classified into seven groups belonging to three cation diffusion facilitator groups (Mn-CDFs, Zn/Fe-CDFs, and Zn-CDFs) and seven groups. EgMTP-encoded amino acids ranged from 315 to 884, and most of them contained 4–6 recognized transmembrane domains and were clearly prognosticated to localize into the cell vacuole. Almost all EgMTP genes experienced gene duplication events, in which some might be uniformly distributed in the genome. The numbers of cation efflux and the zinc transporter dimerization domain were highest in EgMTP proteins. The promoter regions of EgMTP genes have different cis-regulatory elements, indicating that the transcription rate of EgMTP genes can be a controlled response to different stimuli in multiple pathways. Our findings provide accurate perception on the role of the predicted miRNAs and the presence of SSR marker in the Eucalyptus genome and clarify their functions in metal tolerance regulation and marker-assisted selection, respectively. Gene expression profiling based on previous RNA-seq data indicates a probable function for EgMTP genes during development and responses to biotic stress. Additionally, the upregulation of EgMTP6, EgMTP5, and EgMTP11.1 to excess Cd2+ and Cu2+ exposure might be responsible for metal translocation from roots to leaves.
Deficiency of neuropeptide Y attenuates neointima formation after vascular injury in mice
Authors: Peng Song , Wu Wei-qiang , Li Lin-yu , Shi Yan-chuan , Lin Shu , Song Zhi-yuan
Published: May 2023

Background

Restenosis after percutaneous coronary intervention (PCI) limits therapeutic revascularization. Neuropeptide Y (NPY), co-stored and co-released with the sympathetic nervous system, is involved in this process, but its exact role and underlying mechanisms remain to be fully understood. This study aimed to investigate the role of NPY in neointima formation after vascular injury.

Methods

Using the left carotid arteries of wild-type (WT, NPY-intact) and NPY-deficient (NPY−/−) mice, ferric chloride-mediated carotid artery injury induced neointima formation. Three weeks after injury, the left injured carotid artery and contralateral uninjured carotid artery were collected for histological analysis and immunohistochemical staining. RT-qPCR was used to detect the mRNA expression of several key inflammatory markers and cell adhesion molecules in vascular samples. Raw264.7 cells were treated with NPY, lipopolysaccharide (LPS), and lipopolysaccharide-free, respectively, and RT-qPCR was used to detect the expression of these inflammatory mediators.

Results

Compared with WT mice, NPY−/− mice had significantly reduced neointimal formation three weeks after injury. Mechanistically, immunohistochemical analysis showed there were fewer macrophages and more vascular smooth muscle cells in the neointima of NPY−/− mice. Moreover, the mRNA expression of key inflammatory markers such as interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1), and intercellular adhesion molecule-1 (ICAM-1) was significantly lower in the injured carotid arteries of NPY−/− mice, compared to that in the injured carotid arteries of WT mice. In RAW264.7 macrophages, NPY significantly promoted TGF-β1 mRNA expression under unactivated but not LPS-stimulated condition.

Conclusions

Deletion of NPY attenuated neointima formation after artery injury, at least partly, through reducing the local inflammatory response, suggesting that NPY pathway may provide new insights into the mechanism of restenosis.
Patient-centredness in primary care walk-in clinics for refugees in Hamburg
Authors: Hill Josephine Nana , Krüger Katarina , Boczor Sigrid , Kloppe Thomas , von dem Knesebeck Olaf , Scherer Martin
Published: May 2023

Background

The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg.

Methods

Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations.

Results

Patient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores.

Conclusions

The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness.

Practice implications

We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.
A novel gene, TARDBP, and the protein it encodes can predict glioma patient prognosis and establish a prediction model
Authors: Fang Xu , Wu Fan , Jiang Chen
Published: May 2023

Background

TDP-43 (43-kD transactive response DNA-binding protein) is a DNA-/RNA-binding protein that plays an important role in several nervous system diseases, such as amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Whether it plays an important role in glioma patients is unknown.

Methods

Datasets were downloaded from the Chinese Glioma Genome Atlas (CGGA) website (http://www.cgga.org.cn/). Cox survival analysis was performed to determine the relationship between TARDBP gene expression and the overall survival of glioma patients. GO analyses were performed to determine the biological functions of the TARDBP gene. Finally, we used PRS type, age, grade, IDH mutation status, 1p/19q codeletion status, and expression value of the TARDBP gene to construct a prediction model. With this model, we can predict patients’ 1-, 2-, 3-, 5-, and 10-year survival rates.

Results

The TARDBP gene plays an important role in glioma patients. The expression of the TARDBP gene has a significant correlation with glioma patient survival. We also constructed an ideal prediction model.

Conclusion

Our findings suggest that the TARDBP gene and the protein it encodes play important roles in glioma patients. The expression of the TARDBP gene has a significant correlation with the overall survival of glioma patients.
Nomogram for predicting the risk of preterm birth in women undergoing in vitro fertilization cycles
Authors: Wang Mohan , Hao Mengzhe , Liu Ning , Yang Xiao , Lu Yubin , Liu Ruizhi , Zhang Hongguo
Published: May 2023

Background

The aim of this study was to develop a nomogram for predicting the risk of preterm birth in women undergoing in vitro fertilization (IVF) cycles.

Methods

A retrospective study of 4266 live birth cycles collected from January 2016 to October 2021 at the Center for Reproductive Medicine, First Hospital of Jilin University was performed. The sample size was sufficient based on the minimal ten events per variable (EPV) rule. The primary outcome of this study was preterm birth. The cycles were divided into the preterm birth group (n = 827) and the full-term delivery group (n = 3439). A nomogram was established based on the multivariate logistic regression analysis results. The area under the curve (AUC) was calculated to assess the prediction accuracy of the nomogram model. The calibration curve was used to measure the calibration of the nomogram.

Results

Multivariate logistic regression analyses showed that female obesity or overweight (OR = 1.366, 95% CI: 1.111–1.679; OR = 1.537, 95% CI: 1.030–2.292), antral follicle count (AFC) of more than 24 (OR = 1.378, 95% CI: 1.035–1.836), multiple pregnancies (OR = 6.748, 95% CI: 5.559–8.190), gestational hypertension (OR = 9.662, 95% CI: 6.632–14.078) and gestational diabetes (OR = 4.650, 95% CI: 2.289–9.445) were the independent risk factors for preterm birth in IVF patients. The area under curve (AUC) under the receiver operating characteristic (ROC) curve in the prediction model was 0.781(95%CI: 0.763–0.799). The calibration curve of the nomogram showed that the prediction model had a good calibration.

Conclusions

We used five risk factors to conduct a nomogram to predict preterm birth rates for patients undergoing IVF cycles. This nomogram can provide a visual assessment of the risk of preterm birth for clinical consultation.
Effective screening methods to prevent surgical site infections in orthopedic surgery: an observational study
Authors: Kobayashi Tatsuki , Ishikawa Tetsuhiro , Katsuragi Joe , Ota Mitsutoshi , Omae Takanori , Sasaki Yasuhito , Tsurumi Yousuke , Nomoto Takashi , Ohtori Seiji
Published: May 2023

Background

The bacterial source of surgical-site infections (SSIs) can have either endogenous and/or exogenous origins, and some studies have revealed that endogenous transmission is an important pathway for SSIs in orthopedic surgery. However, since the frequency of SSIs is low (0.5–4.7%), screening all surgery patients is labor-intensive and cost-prohibitive. The goal of this study was to better understand how to improve the efficacy of nasal culture screening in preventing SSIs.

Methods

Nasal cultures for 1616 operative patients over a 3-year period were evaluated for the presence of nasal bacterial microbiota and the species identity. We also investigated the medical factors that influence colonization and evaluated the ratio of agreement between nasal cultures and SSI-causing bacteria.

Results

In a survey of 1616 surgical cases, 1395 (86%) were normal microbiota (NM), 190 (12%) were MSSA carriers, and 31 (2%) were MRSA carriers. The risk factors for MRSA carriers were significantly higher than the NM group in patients with a history of hospitalization (13 [41.9%], p = 0.015), patients who had been admitted to a nursing facility (4 [12.9%], p = 0.005), and patients who were > 75 years of age (19 [61.3%], p = 0.021). The incidence of SSIs was significantly higher in the MSSA group (17/190 [8.4%]) than the NM group (10/1395 [0.7%], p = 0.00). The incidence of SSIs in the MRSA group (1/31 [3.2%]) tended to be higher than that in the NM group, but there was no statistically significant difference (p = 0.114). The concordance rate between causative bacteria of SSI and species present in nasal cultures was 53% (13/25 cases).

Conclusions

The results of our study suggest screening patients with a history of past hospitalization, a history of admission in a long-term care facility, and older than 75 to reduce SSIs.

Trial registration

This study was approved by the institutional review board of the authors’ affiliated institutions (the ethics committee of Sanmu Medical Center, 2016-02).
Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies
Authors: Zhu Nanxi , Yang Liu , Wang Xianlin , Tuo Jinmei , Chen Liuliu , Deng Renli , Kwan Rick Yiu Cho
Published: May 2023

Background

Life-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients’ future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high.

Aim

To explore the facilitators of and barriers to healthcare professionals’ provision of advance care planning to life-limited patients to better implement it for this population.

Methods

We followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies.

Results

A total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration.

Conclusion

Healthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures.
Clinical and metabolic characteristics of endometrial lesions in polycystic ovary syndrome at reproductive age
Authors: Zhong⋅ Xiaozhu , Li⋅ Yang , Liang Weiying , Hu Qiyue , Zeng Anqi , Ding Miao , Chen Dongmei , Xie Meiqing
Published: May 2023

Background

We aimed to explore the clinical and metabolic characteristics in polycystic ovary syndrome (PCOS) patients with different endometrial lesions.

Methods

234 PCOS patients who underwent hysteroscopy and endometrial biopsy were categorized into four groups: (1) normal endometrium (control group, n = 98), (2) endometrial polyp (EP group, n = 92), (3) endometrial hyperplasia (EH group, n = 33), (4) endometrial cancer (EC group, n = 11). Serum sex hormone levels, 75 g oral glucose tolerance test, insulin release test, fasting plasma lipid, complete blood count and coagulation parameters were measured and analyzed.

Results

Body mass index and triglyceride level of the EH group were higher while average menstrual cycle length was longer in comparison with the control and EP group. Sex hormone-binding globulin (SHBG) and high density lipoprotein were lower in the EH group than that in the control group. 36% of the patients in the EH group suggested obesity, higher than the other three groups. Using multivariant regression analysis, patients with free androgen index > 5 had higher risk of EH (OR 5.70; 95% CI 1.05–31.01), while metformin appeared to be a protective factor for EH (OR 0.12; 95% CI 0.02–0.80). Metformin and hormones (oral contraceptives or progestogen) were shown to be protective factors for EP (OR 0.09; 95% CI 0.02–0.42; OR 0.10; 95% CI 0.02–0.56). Hormones therapy appeared to be a protective factor for EC (OR 0.05; 95% CI 0.01–0.39).

Conclusion

Obesity, prolonged menstrual cycle, decreased SHBG, and dyslipidemia are risk factors for EH in patients with PCOS. Oral contraceptives, progestogen and metformin are recommended for prevention and treatment of endometrial lesions in PCOS patients.
Proportion and associated factors of maternal complications of cesarean sections among mothers who deliver at Bahir Dar City Public Specialized Hospitals, Bahir Dar, Ethiopia
Authors: Alemu Hiwotemariam , Yigzaw Zeamanuel Anteneh , Asrade Lakachew , Nega Bantayehu , Belachew Amare
Published: May 2023

Introduction

Cesarean delivery carries both short term and long-term maternal complications. Eventhough it’s being a public burden, the proportion of complications and underlying risk factors are not studied well in our setup. This study aimed to assess the proportion and associated factors of complications of cesarean sections among mothers who delivered at Bahir Dar city public specialized hospitals, Bahir Dar, Ethiopia 2021.

Methods

A cross-sectional study was conducted at two specialized Hospitals in Bahir Dar city, Ethiopia. The sample size was 495 mothers who had cesarean section in the time period from January 1, 2020 to December 30, 2020. Checklist was used to retrieve information from the patient medical document. Study population was selected from the operation registration book. Systematic sampling was used after arranging the study frame based on date of operation. Both bivariable and multivariable logistic regression was done. In multivariable logistic regression variables with p value < 0.05 at 95% confidence interval were significantly associated with outcome variable.

Result

Overall maternal complication rate was 44.04% (95% CI: 39.6–48.5). Living in rural setting (AOR = 4.247,95%CI: 2.765–6.522), having one or more obstetric complication (AOR = 1.913,95% CI: 1.214–3.015), cesarean section done at Second stage of labor (AOR = 4.358,95%CI: 1.841–10.317), having previous cesarean section (AOR = 3.540,95%CI: 2.121–5.910), emergency operation (AOR = 2.967,95%CI: 1.492–5.901), duration of surgery taking more than 60 min (AOR = 3.476,95%CI: 1.521–7.947) were found to be significantly associated with maternal complications.

Conclusion

The magnitude of maternal complication of cesarean section was higher than most studies. Living in rural setting, having obstetric complications, previous cesarean scar, emergency surgeries, operation done in second stage of labor and prolonged duration of surgery are important predictors of maternal complication. Therefore, we recommend timely and adequate progress of labor evaluation, timely decision for cesarean delivery and vigilant care in post-operative period shall be conducted.
Factors associated with academic burnout and its prevalence among university students: a cross-sectional study
Authors: Liu Zheng , Xie Yujin , Sun Zhuhong , Liu Di , Yin Hang , Shi Lei
Published: May 2023

Background

This study aimed to evaluate the current state of academic burnout among Chinese college students and its influencing factors.

Methods

A cross-sectional study of 22,983 students was conducted using structured questionnaires and the Maslach Burnout Inventory General Survey on sociodemographic characteristics, educational process, and personal aspects. Multiple variables were statistically evaluated using logistic regression analysis.

Results

The total score of the students’ academic burnout was 40.73 (± 10.12) points. The scores for the reduced personal accomplishment, emotional exhaustion, and cynicism were 23.63 (± 6.55), 11.20 (± 6.05), and 5.91 (± 5.31), respectively. Students with academic burnout accounted for 59.9% (13,753/22,983). Male students had higher burnout scores than female students, upper-grade students had higher burnout scores than lower-grade students, and students who smoked had higher burnout than non-smokers during the school day.

Conclusions

More than half of students experienced academic burnout. Gender, grade, monthly living expenses, smoking, parents’ education level, study and life pressures, and the current degree of professional knowledge interest significantly impacted academic burnout. An effective wellness program and an annual long-term burnout assessment may sufficiently reduce student burnout.
The long-term effect of generic price competition on the Hungarian statin market
Authors: Répásy Balázs , Gazsó Tibor , Elmer Diána , Pónusz-Kovács Dalma , Kajos Fanni Luca , Csákvári Tímea , Kovács Bettina , Boncz Imre
Published: May 2023

Background

Generic competition is a vital health policy tool used in regulating the pharmaceutical market. Drug group HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase) inhibitors, widely known as “statins,” was the first drug group in Hungary in which generic prescriptions became mandatory. Our aim is to analyze the changes in the retail and wholesale margins through the generic competition regarding “statins”.

Methods

Data was derived from the nationwide pharmaceutical database of the Hungarian National Health Insurance Fund Administration, the only health care financing agency in Hungary. We observed the turnover data regarding the HMG-CoA-reductase inhibitor “statins” from 2010 through 2019. As the drugs under review have a fixed price point in Hungary, we effectively calculated the margins.

Results

In 2010, the consumer expenditure of statins was 30.7 billion HUF ($148 million), which decreased by 59%, to 12.5 billion HUF ($42.9 million) in 2019. In 2010, the annual health insurance reimbursement of statins was 23.7 billion HUF ($114 million), which underwent a 63% decrease to 8.6 billion HUF ($29.7 million) in 2019. In 2010, the DOT turnover was 287 million days, and it increased to above 346 million days for 2019, which reflects a 20% increase over the past nine years. The monthly retail margins decreased from 334 million HUF ($1.6 million), (January, 2010) to 176 million HUF ($0.61 million), (December, 2019). The monthly wholesale margins decreased from 96.3 million HUF ($0.46 million), (January, 2010) to 41.4 million HUF ($0.14 million), (December, 2019). The most significant downturn in margins was due to the introduction of the first two blind bids. The combined DOT turnover in reference to the examined 43 products consistently increased.

Conclusions

The decline in retail and wholesale margin and in health insurance expenditures was largely due to a reduction in the consumer price of generic medicines. DOT turnover of statins also increased significantly.
Health workforce governance and professions: a re-analysis of New Zealand’s primary care workforce policy actors
Authors: Rees Gareth H.
Published: May 2023

Background

This article contributes to the health workforce planning literature by exploring the dynamics of health professions in New Zealand’s Primary Care sector and deriving broad lessons for an international audience. Professions tend influence health policy and governance decisions and practices to retain their place, status and influence. Therefore, understanding their power dynamics and the positions that they have on workforce policies and issues assists workforce governance or health system reform plans.

Methods

Using the infrequently reported health workforce policy tool, actor analysis, a reanalysis of previously collected data is undertaken using an actor-based framework for the study of professionalism. Two models were developed, (1) the framework’s original four-actor model and (2) a five-actor model for the comparison of the Medical and Nurse professions. Existing workforce actor data were reclassified, formatted, and entered into actor analysis software to reveal the professions’ relative power, inter-relationships and strategic workforce issue positions.

Results

In the four-actor model, the Organised user actor is found to be most influential, while the others are found to be dependent. In the five-actor model, the Medical and Nurse professions are individually more influential than their combined position in the four-actor model. Practicing professionals and Organised user actors have strong converging inter-relationships over workforce issues in both models, though in the five-actor model, the Nurse profession has weaker coherency than the Medical profession. The Medical and Nurse professions are found to be in opposition over the workforce issues labelled divisive.

Conclusions

These results reflect the professions’ potential to influence New Zealand’s Primary Care sector, indicating their power and influence over a range of policy and reform measures. As such, the four lessons that are derived from the case indicate to policy makers that they should be aware of situational contexts and actor power, take care when encountering divisive issues and try to achieve broad-based support for proposed policies.
Preparation of a Klebsiella pneumoniae conjugate nanovaccine using glycol-engineered Escherichia coli
Authors: Liu Yan , Pan Chao , Wang Kangfeng , Guo Yan , Sun YanGe , Li Xiang , Sun Peng , Wu Jun , Wang Hengliang , Zhu Li
Published: May 2023

Background

Engineered strains of Escherichia coli have been used to produce bioconjugate vaccines using Protein Glycan Coupling Technology (PGCT). Nanovaccines have also entered the vaccine development arena with advances in nanotechnology and have been significantly developed, but chassis cells for conjugate nanovaccines have not been reported.

Results

To facilitate nanovaccine preparation, a generic recombinant protein (SpyCather4573) was used as the acceptor protein for O-linked glycosyltransferase PglL, and a glycol-engineered Escherichia coli strain with these two key components (SC4573 and PglL) integrated in its genome was developed in this study. The targeted glycoproteins with antigenic polysaccharides produced by our bacterial chassis can be spontaneously bound to proteinous nanocarriers with surface exposed SpyTag in vitro to form conjugate nanovaccines. To improve the yields of the targeted glycoprotein, a series of gene cluster deletion experiments was carried out, and the results showed that the deletion of the yfdGHI gene cluster increased the expression of glycoproteins. Using the updated system, to the best of our knowledge, we report for the first time the successful preparation of an effective Klebsiella pneumoniae O1 conjugate nanovaccine (KPO1-VLP), with antibody titers between 4 and 5 (Log10) after triple immunization and up to 100% protection against virulent strain challenge.

Conclusions

Our results define a convenient and reliable framework for bacterial glycoprotein vaccine preparation that is flexible and versatile, and the genomic stability of the engineered chassis cells promises a wide range of applications for biosynthetic glycobiology research.
Peak left atrial longitudinal strain is associated with all-cause mortality in patients with ventricular functional mitral regurgitation
Authors: Gomes Daniel A. , Lopes Pedro M. , Freitas Pedro , Albuquerque Francisco , Reis Carla , Guerreiro Sara , Abecasis João , Trabulo Marisa , Ferreira António M. , Ferreira Jorge , Ribeiras Regina , Mendes Miguel , Andrade Maria J.
Published: May 2023

Purpose

Chronic mitral regurgitation promotes left atrial (LA) remodeling. However, the significance of LA dysfunction in the setting of ventricular functional mitral regurgitation (FMR) has not been fully investigated. Our aim was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in patients with FMR and reduced left ventricular ejection fraction (LVEF).

Methods

Patients with at least mild ventricular FMR and LVEF < 50% under optimized medical therapy who underwent transthoracic echocardiography at a single center were retrospectively identified in the laboratory database. PALS was assessed by 2D speckle tracking in the apical 4-chamber view and the study population was divided in two groups according to the best cut-off value of PALS, using receiver operating characteristics (ROC) curve analysis. The primary endpoint-point was all-cause mortality.

Results

A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median effective regurgitant orifice area (EROA) was 15mm2 (IQR: 9 – 22mm2). According to current European guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS. On multivariable analysis, PALS remained independently associated with all-cause mortality (adjusted hazard ratio 1.052 per % decrease; 95% CI: 1.010 – 1.095; P = 0.016), even after adjustment for several (n = 14) clinical and echocardiographic confounders.

Conclusion

PALS is independently associated with all-cause mortality in patients with reduced LVEF and ventricular FMR.

Graphical Abstract
Recent development of surface-enhanced Raman scattering for biosensing
Authors: Lin Chenglong , Li Yanyan , Peng Yusi , Zhao Shuai , Xu Meimei , Zhang Lingxia , Huang Zhengren , Shi Jianlin , Yang Yong
Published: May 2023

Surface-Enhanced Raman Scattering (SERS) technology, as a powerful tool to identify molecular species by collecting molecular spectral signals at the single-molecule level, has achieved substantial progresses in the fields of environmental science, medical diagnosis, food safety, and biological analysis. As deepening research is delved into SERS sensing, more and more high-performance or multifunctional SERS substrate materials emerge, which are expected to push Raman sensing into more application fields. Especially in the field of biological analysis, intrinsic and extrinsic SERS sensing schemes have been widely used and explored due to their fast, sensitive and reliable advantages. Herein, recent developments of SERS substrates and their applications in biomolecular detection (SARS-CoV-2 virus, tumor etc.), biological imaging and pesticide detection are summarized. The SERS concepts (including its basic theory and sensing mechanism) and the important strategies (extending from nanomaterials with tunable shapes and nanostructures to surface bio-functionalization by modifying affinity groups or specific biomolecules) for improving SERS biosensing performance are comprehensively discussed. For data analysis and identification, the applications of machine learning methods and software acquisition sources in SERS biosensing and diagnosing are discussed in detail. In conclusion, the challenges and perspectives of SERS biosensing in the future are presented.
Clinicopathological analysis and prognostic treatment study of angiosarcoma of the breast: a SEER population-based analysis
Authors: Teng Lizhi , Yan Shuai , Du Juntong , Yang Ru , Xu Peng , Tao Weiyang
Published: May 2023

Introduction

Breast angiosarcoma is a rare malignancy of endovascular origin, accounting for less than 1% of all mammary cancers. Our aim was to explore clinicopathological features and the factors associated with prognosis.

Methods

We extracted information from the Surveillance, Epidemiology, and End Results Program (SEER) for all patients with breast angiosarcoma between 2004 and 2015. Chi-square analysis was used to compare the clinicopathological features in all patients. Overall survival (OS) was assessed using the Kaplan and Meier method. Univariate and multivariate analyses were performed to evaluate the factors associated with prognosis.

Results

A total of 247 patients were included in the analyses. The median OS of patients with primary breast angiosarcoma (PBSA) and secondary breast angiosarcoma (SBAB) was 38 months and 42 months, respectively. The 1-, 3- and 5-year OS with PBSA was 80%, 39%, and 25%, respectively, and the 1-, 3- and 5-year OS with SBAB was 80%, 42%, and 34%, respectively. Multivariate analysis revealed that tumor size (p = 0.001), tumor grade (p < 0.001), tumor extension (p = 0.015), and tumor spread (p < 0.001) were statistically significant factors for OS. Partial mastectomy with radiation (HR = 0.160, 95% CI, 0.036–0.719, p = 0.016), partial mastectomy with chemotherapy (HR = 0.105, 95% CI, 0.011–1.015, p = 0.052), and partial mastectomy (HR = 0.125, 95% CI, 0.028–0.583, p = 0.007) were related to significantly better OS outcomes in primary angiosarcoma.

Conclusion

Primary breast angiosarcoma has a better clinical phenotype than secondary breast angiosarcoma. Although overall survival was not statistically significant, primary breast angiosarcoma was better than secondary breast angiosarcoma with systemic therapy. Depending on the outcome of survival, partial mastectomy is effective in treating primary breast angiosarcoma.
Infantile hemangioma models: is the needle in a haystack?
Authors: Kong Meng , Li Yanan , Wang Kai , Zhang Shisong , Ji Yi
Published: May 2023

Infantile hemangioma (IH) is the most prevalent benign vascular tumor in infants, with distinct disease stages and durations. Despite the fact that the majority of IHs can regress spontaneously, a small percentage can cause disfigurement or even be fatal. The mechanisms underlying the development of IH have not been fully elucidated. Establishing stable and reliable IH models provides a standardized experimental platform for elucidating its pathogenesis, thereby facilitating the development of new drugs and the identification of effective treatments. Common IH models include the cell suspension implantation model, the viral gene transfer model, the tissue block transplantation model, and the most recent three-dimensional (3D) microtumor model. This article summarizes the research progress and clinical utility of various IH models, as well as the benefits and drawbacks of each. Researchers should select distinct IH models based on their individual research objectives to achieve their anticipated experimental objectives, thereby increasing the clinical relevance of their findings.