bluuebunny/crossref_metadata_2025 huggingface dataset:
The Fifth Metatarsal Shaft Fracture Is Well Treated With Benign Neglect
Authors: Gonzalez Leah J. , Johnson Joseph R. , Konda Sanjit R. , Egol Kenneth A.
Published: November 2021

Background. Spiral fifth metatarsal fractures have been studied previously in professional dancers. However, little has been reported about outcomes of these injuries in the general population. The objective of this study was to examine patient demographics of those who sustain this injury and their functional outcomes, as stratified by treatment type. Methods. A total of 186 “nonprofessional dancer” patients with a fifth metatarsal fracture who were treated by one orthopaedic surgeon at our academic medical center were identified through chart review. All patients were allowed to weight bearing as tolerated (WBAT). Time to healing, persistence of pain, range of motion, and complications were recorded. Independent samples t tests, 1-way analysis of variance, and Fisher exact tests were used for analysis. Results. Thirty-seven of the 186 patients with fifth metatarsal fractures reviewed were identified as having a spiral fifth metatarsal fracture with appropriate follow-up. The cohort was 78.4% female with a mean age of 50.3 years. Twenty-two were initially treated in a controlled ankle motion (CAM) boot, 14 in a postoperative shoe, and 1 continued in their own shoes. All patients were allowed to WBAT. All fractures healed by a mean of 3.1 months. By the end of the follow-up period, 67.6% of patients had full range of ankle motion, with 5.4% reporting feeling stiff, 27.0% reporting mild persistent pain, and 2.7% reporting significant persistent pain. Conclusion. Fifth metatarsal shaft (“Dancer’s”) fractures occur within the general population, not only among professional dancers. Without operative fixation and regardless of nonoperative treatment selected, these fractures heal reliably and do so without clinically relevant complication.

Level of Evidence: Level III: Retrospective comparative study
The Impact of COVID-19 on Patients With ADPKD
Authors: Kutky Meherzad , Cross Erin , Treleaven Darin J. , Alam Ahsan , Lanktree Matthew B.
Published: November 2021

Purpose of review:

Patients with autosomal dominant polycystic kidney disease (ADPKD) have kidney cysts and kidney enlargement decades before progressing to advanced chronic kidney disease (CKD), meaning patients live most of their adult life with a chronic medical condition. The coronavirus disease 2019 (COVID-19) pandemic has created common questions among patients with ADPKD. In this review, we discuss COVID-19 concerns centered around a patient with a common clinical vignette.

Sources of information:

We performed PubMed and Google scholar searches for English, peer-reviewed studies related to “COVID-19,” “ADPKD,” “CKD,” “tolvaptan,” “angiotensin-converting enzyme inhibitors” (ACEi), “angiotensin receptor blockers” (ARB), and “vaccination.” We also evaluated transplant data provided by the Ontario Trillium Gift of Life Network.

Methods:

Following an assessment of available literature, this narrative review addresses common questions of patients with ADPKD in the context of the COVID-19 pandemic.

Key findings:

Data regarding the risk of developing COVID-19 and the risk of adverse COVID-19 outcomes in patients with ADPKD remain limited, but patients with ADPKD with impaired estimated glomerular filtration rate (eGFR), kidney transplants, or on dialysis are likely at similar increased risk as those with generally defined CKD. We provide strategies to improve virtual care, which is likely to persist after the pandemic. Current evidence suggests ACEi, ARB, and tolvaptan treatment should be continued unless contraindicated due to severe illness. When available, and in the absence of a severe allergy, vaccination is recommended for all patients with ADPKD.

Limitations:

This narrative review is limited by a paucity of high-quality data on COVID-19 outcomes in patients specifically with ADPKD.

Implications:

Patients with ADPKD who have developed advanced CKD, require dialysis, or who have received a kidney transplant are at elevated risk of COVID-19 complications.
The Impact of Restaurant Recommendation Information and Recommendation Agent in the Tourism Website on the Satisfaction, Continuous Usage, and Destination Visit Intention
Authors: Shi Yan chao , Lee Un-Kon
Published: November 2021

Enjoying local food could be one of the motives for tourism, and local food and restaurant recommendation information would be important for tourists to decide their destination. Recommendation agents are the sorting and searching function to find the best local food and restaurant among the complexity of information, and they could also be helpful for the tourist to decide their destination. Online tourism websites (e.g., Ctrip.com ) started to provide restaurant recommendations containing food-related information and recommendation agents to attract tourists. However, few studies have investigated their impact on the destination visit intention of potential Chinese tourists. This study aims to empirically validate how restaurant recommendation information, including food-related information and recommendation agents, could impact online tourists’ reactions, such as satisfaction, continuous website usage, and destination visits. We developed our hypothesis based on the information system (IS) success model. We gathered 202 data points from potential tourists using quasi-experimental methods, and these data were analyzed by the PLS algorithm. The results indicate that restaurant recommendation information and recommendation agents significantly increase the perceived information quality and perceived system quality. Increased perceived information quality and system quality could significantly increase potential tourists’ satisfaction, website continuous usage intention, and destination visit intention. The results of this study could contribute to making tourism websites more attractive by using local food and restaurant information and recommendation agents.
A comparison between Chinese and American male and female college students’ critical thinking dispositions
Authors: Dennett Susan K , DeDonno Michael A
Published: November 2021

This quantitative research study compared the critical thinking dispositions of 91 college students studying in a public university in South East Florida. Forty-one students identified as Chinese and 50 students identified as American. The California Critical Thinking Disposition Inventory (CCTDI) measured these students’ critical thinking dispositions. There were differences between students on the scale of open-mindedness and gender. A dis-ordinal interaction occurred. American males scored lower than American females on the CCTDI scale of open-mindedness. However, the opposite occurred for the Chinese students. Chinese males received a higher score on the CCTDI scale of open-mindedness than Chinese females. These findings are significant for educators and organizations when designing curriculum and workplace training development for leaders. Being open-minded feeds into decision-making and problem-solving are skills which are necessary for leadership. It is helpful to understand which variables impact individual’s disposition to critical thinking so that leadership skills can be developed.
Human-Centered Leadership Development: A Communication-Based Approach for Promoting Authentic and Transformational Leadership
Authors: Anders Abram D.
Published: November 2021

Leadership development (LD) has been shown to deliver significant value in both professional and academic settings. However, scholars of leadership communication and LD have argued for a need to recognize LD as a highly social, co-creative, and communicative process in which followership and larger organizational and social contexts play a significant role. Recent research has also argued for self-directed and experiential learning approaches to promote learning mindsets and psychological resources for long-term growth. The present study addresses these challenges by developing a holistic theoretical model and an applied design for LD comprised of evidence-based communication interventions that address intrapersonal, interpersonal, and strategic communication contexts in order to promote both authentic leadership and transformational leadership capacities. The model employs human-centered design methods to complement established experiential learning models and facilitate co-creative engagement with situated organizational challenges.
Reducing unintended retained foreign objects in operating rooms: a proactive risk assessment framework to improve patient safety
Authors: Tabibzadeh Maryam , Patel Zarna
Published: November 2021

According to a study by Johns Hopkins, an average of 251,454 Americans die annually from medical errors. Medical error is the third leading cause of death in the U.S. after heart disease and cancer. Unintended retained foreign objects (URFOs) has been identified as the most common sentinel event by The Joint Commission. This paper proposes a proactive risk assessment framework to enhance patient safety in operating rooms by addressing the URFOs issue. This framework is developed by integrating the 10 traits of a positive safety culture, initially introduced by the nuclear industry and later adopted by other industries, with an accident investigation methodology called AcciMap, originally developed by Rasmussen.

The AcciMap is a hierarchical framework consisting of several layers: government and regulatory bodies, company (hospital), (surgery division) management, (operating room) staff, and work. Thirty main categories of socio-technical contributing causes of URFOs were captured across the AcciMap layers. Organizational factors were identified as the root cause of questionable decisions made by staff and management. Financial and budget constraints, inadequate training infrastructure, absence of a risk management infrastructure, and leadership failure are the most influential organizational factors contributed to URFOs.

Our mapping of the aforementioned positive safety culture traits on the AcciMap depicted that the four traits of Work Processes, Leadership Safety Values and Actions, Effective Communication, and Continuous Learning had the most influence on the URFOs issue. Associated recommendations to these findings are provided to contribute to reducing risks of URFOs instances.
Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient
Authors: Alfi David M. , Hassan Abdullahi , East Sebastian M. , Gianulis Elena C.
Published: November 2021

Reconstruction of large segmental mandibular defects presents a challenge for oral and maxillofacial surgeons, particularly in the skeletally immature pediatric patient. Autogenous bone graft is historically preferred; however, harvest of autograft requires a second surgical site, risking donor-site complications as well as the potential for long-term complications in the growing child. Here, we present the first known report of a pediatric patient who underwent immediate mandibular reconstruction of a 6.5-cm long segmental defect using a cellular bone allograft (VF-CBA) combined with custom-fabricated guides and plates following tumor resection. The use of VF-CBA, along with the custom guides and plates, eliminated the need for autograft harvest in a child, enabled an entirely intraoral approach, avoiding the creation of a cutaneous scar, and reduced the total operative time, resulting in a fast recovery and improved patient satisfaction. By 7 months postoperative, the patient’s mandible was fully healed with solid osseous consolidation. These results support VF-CBA combined with custom intraoral guides and plates as an effective treatment option for reconstruction of large segmental mandibular defects in a pediatric patient.
Facial Feminization Surgery Review: Diagnosis, Preoperative Planning, Surgical Techniques, and Outcomes
Authors: Choe Joshua , Parikh Sajni , Barnett Sarah L. , Sam Sabrina , Chen Kevin , Bradley James P.
Published: November 2021

Facial Feminization Surgery (FFS) broadly encompasses a series of surgical procedures offered by craniomaxillofacial surgeons designed to modify facial features and transform both skeletal and soft tissues to create a more feminine appearance. Techniques, initially pioneered by Dr. Douglas Ousterhout, have been modified to include preoperative virtual planning and evolving aesthetic preferences. Computed Tomography (CT) imaging assists with morphologic typing of the brow, supraorbital, chin, and lateral mandible regions. Advancements in instrumentation increase the efficiency and accuracy of FFS procedures. More recently, trends in transgender acceptance have led to improved insurance authorization for FFS procedures. Objective outcome studies have shown success in achieving goals of (1) minimizing mis-gendering in public (appropriately identifying trans-women as female) and (2) reduction in dysphoric feelings (improved patient satisfaction).
Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
Authors: Kawakami Naoki , Moriya Tomohiro , Kato Rina , Nakamura Kentaro , Saito Hiroaki , Wakai Yoko , Saito Kazuhito , Sakashita Mai
Published: November 2021

Background

Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported.

Case presentation

A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer.

Conclusions

Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.
Association of fibroblast growth factor 23 and α-klotho in hemodialysis patients during administration of ferric citrate hydrate: post hoc analysis of ASTRIO study
Authors: Ito Kyoko , Yokoyama Keitaro , Nakayama Masaaki , Fukagawa Masafumi , Hirakata Hideki
Published: November 2021

Background

Fibroblast growth factor-23 (FGF23) and α-klotho are associated with anemia in patients with chronic kidney disease. In this post hoc analysis of the ASTRIO study (UMIN000019176), we investigated the relationship between FGF23 and α-klotho during treatment with an iron-based phosphate binder, ferric citrate hydrate (FC), compared with non-iron-based phosphate binders in hemodialysis (HD) patients. We examined the effect of iron absorption by FC on the relationship between FGF23 and α-klotho. There have been few clinical studies evaluating these biomarkers simultaneously in HD patients.

Methods

The ASTRIO study was a 24-week, randomized, open-label, multicenter trial. HD patients taking non-iron-based phosphate binder(s) were randomized at a 1:1 ratio to continue other binder(s) (control group) or switch to FC (FC group). Serum phosphate (P) and hemoglobin (Hb) were maintained within 3.5–6.0 mg/dL and 10–12 g/dL, respectively. Plasma levels of intact FGF23 (i-FGF23), C-terminal FGF23 (c-FGF23), and α-klotho were measured, as were iron-related parameters. Association analyses of FGF23 and α-klotho were conducted.

Results

Patients were randomized to FC (n = 48) and control (n = 45) groups. Serum ferritin significantly increased from baseline to end-of-treatment (EOT) in the FC group, compared with the control group (adjusted mean difference [95% confidence interval]: 79.5 [44.7, 114.4] ng/mL; p <  0.001). The mean change from baseline to EOT in c-FGF23 was significantly different between the FC and control groups (mean ± standard deviation (SD): − 0.2 ± 0.8 loge pg/mL vs. 0.2 ± 0.8 loge pg/mL, respectively; p = 0.04). The mean change from baseline to EOT in i-FGF23 and α-klotho were not significantly different between the FC and control groups (mean ± SD: − 0.1 ± 0.8 loge pg/mL vs. 0.1 ± 0.9 loge pg/mL; p = 0.33, and 2.0 ± 91.5 pg/mL vs. − 8.9 ± 145.3; p = 0.58, respectively). However, both forms of FGF23 and α-klotho were not significantly associated with each other in both groups.

Conclusions

Iron absorbed via FC administration in HD patients did not influence the correlation relationship between plasma levels of FGF23 and α-klotho under the condition of serum P and Hb were maintained.

Trial registration

ASTRIO study (UMIN000019176, registered at UMIN Clinical Trials Registry on October 1, 2015).
Mapping connectivity fingerprints for presurgical evaluation of temporal lobe epilepsy
Authors: Sala-Padro Jacint , Miró Júlia , Rodriguez-Fornells Antoni , Rifa-Ros Xavier , Plans Gerard , Santurino Mila , Falip Mercè , Càmara Estela
Published: November 2021

Background

Surgery may render temporal lobe epilepsy (TLE) patients seizure-free. However, TLE is a heterogenous entity and surgical prognosis varies between patients. Network-based biomarkers have been shown to be altered in TLE patients and hold promise for classifying TLE subtypes and improving pre-surgical prognosis. The aim of the present study is to investigate a network-based biomarker, the weighted degree of connectivity (wDC), on an individual level, and its relation to TLE subtypes and surgical prognosis.

Methods

Thirty unilateral TLE patients undergoing the same surgical procedure (anterior temporal resection) and 18 healthy controls were included. All patients were followed-up in the same center for a mean time of 6.85 years and classified as seizure-free (SF) and non seizure-free (non-SF). Using pre-surgical resting state functional MRI, whole brain wDC values for patients and controls were calculated. Then, we divided both temporal lobes in three Regions-of-interest (ROIs) -mesial, pole and lateral- as these areas are known to behave differently in seizure onset and propagation, delimiting different TLE profiles. The wDC values for the defined ROIs of each individual patient were compared with the healthy group.

Results

After surgery, 14 TLE patients remained SF. As a group, patients had higher wDC than controls in both the temporal pole (p < 0.05) as well as in the mesial regions (p < 0.002) of the to-be-resected temporal lobe. When comparing between SF and non-SF patients, a step-wise binary logistic regression model including all the ROIs, showed that having an increased wDC of the temporal pole (p < 0.05) and the mesial area (p < 0.05) of the to-be-resected temporal lobe was associated with seizure freedom long-term after surgery.

Conclusions

This study provides a network-based presurgical biomarker that could pave the way towards personalized prediction. In patients with TLE undergoing anterior temporal resections, having an increased wDC at rest could be a signature of the epileptogenic area, and could help identifying those patients who would benefit most from surgery.
Concurrent central diabetes insipidus and cerebral salt wasting disease in a post-operative case of craniopharyngioma: a case report
Authors: Jameel Patel Zeeshan , Lohiya Sham , Vagha Keta , Ahmed Tauheed , Pujari Divya , Vagha Jayant , Varma Ashish
Published: November 2021

Background

Water and electrolyte disorders commonly encountered in children post-surgery involving hypothalamus and posterior pituitary, are central diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone and cerebral salt wasting disease. Delayed diagnosis and inadequate management of such cases may lead to worsened neurological outcomes with a high mortality rate.

Case presentation

Here we report the case of a 7-year-old girl who underwent surgical resection of a craniopharyngioma, following which she initially developed central diabetes insipidus. However, later on in the course of her illness she developed symptomatic hyponatremia with natriuresis which was diagnosed to be due to cerebral salt wasting disease. This combination of central diabetes insipidus and cerebral salt wasting syndrome is a rare occurrence and poses a diagnostic challenge. Diagnosis and management can be even more difficult when these conditions precede or coexist with each other.

Conclusion

In such cases development of hyponatremia should always prompt consideration of unusual causes like cerebral salt wasting disease in addition to the classically described syndrome of inappropriate secretion of anti-diuretic hormone. Hence, a thorough knowledge of these disorders along with intensive monitoring of fluid and sodium status is critical for timely diagnosis and management of these patients.
Reliability of the performance-based measure of executive functions in people with schizophrenia
Authors: Chiu En-Chi , Lee Ya-Chen , Lee Shu-Chun , Hsueh I-Ping
Published: November 2021

Background

The Performance-based measure of Executive Functions (PEF) with four domains is designed to assess executive functions in people with schizophrenia. The purpose of this study was to examine the test-retest reliability of the PEF administered by the same rater (intra-rater agreement) and by different raters (inter-rater agreement) in people with schizophrenia and to estimate the values of minimal detectable change (MDC) and MDC%.

Methods

Two convenience samples (each sample, n = 60) with schizophrenia were conducted two assessments (two weeks apart). The intraclass correlation coefficient (ICC) was analyzed to examine intra-rater and inter-rater agreements of the test-retest reliability of the PEF. The MDC was calculated through standard error of measurement.

Results

For the intra-rater agreement study, the ICC values of the four domains were 0.88–0.92. The MDC (MDC%) of the four domains (volition, planning, purposive action, and perfromance effective) were 13.0 (13.0%), 12.2 (16.4%), 16.2 (16.2%), and 16.3 (18.8%), respectively. For the inter-rater agreement study, the ICC values of the four domains were 0.82–0.89. The MDC (MDC%) were 15.8 (15.8%), 17.4 (20.0%), 20.9 (20.9%), and 18.6 (18.6%) for the volition, planning, purposive action, and performance effective domains, respectively.

Conclusions

The PEF has good test-retest reliability, including intra-rater and inter-rater agreements, for people with schizophrenia. Clinicians and researchers can use the MDC values to verify whether an individual with schizophrenia shows any real change (improvement or deterioration) between repeated PEF assessments by the same or different raters.
Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
Authors: Bravo Jorge , Rosado Hugo , Tomas-Carus Pablo , Carrasco Cristina , Batalha Nuno , Folgado Hugo , Pereira Catarina
Published: November 2021

Background

Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.

Methods

Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.

Results

The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001).

Conclusions

The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.
HPV vaccine: uptake and understanding among global Indigenous communities – a qualitative systematic review
Authors: Poirier Brianna , Sethi Sneha , Garvey Gail , Hedges Joanne , Canfell Karen , Smith Megan , Ju Xiangqun , Jamieson Lisa
Published: November 2021

Background

Indigenous populations have a high prevalence of Human Papillomavirus (HPV) infection and a high incidence of HPV associated cancers, such as cervical and oropharyngeal cancer. There is an effective HPV vaccination program in almost all developed countries to prevent the incidence of cervical cancer, but reports suggest that the uptake of these vaccinations by Indigenous populations is low. The objective of this qualitative systematic review was to explore the knowledge and beliefs of global Indigenous populations regarding HPV vaccines. This review was performed to identify the barriers faced by Indigenous peoples and to provide evidence for more effective and acceptable execution of vaccination policies for Indigenous peoples.

Methods

Two investigators independently searched MEDLINE, PubMed, SCOPUS, and Web of Science databases using a pre-specified search strategy to identify qualitative studies on narratives of Indigenous peoples regarding HPV vaccine awareness, knowledge and experiences across all geographic and income-level settings.

Results

After performing the literature search and quality appraisals 5 papers were included in the final review. Three core synthesised findings were identified: reasons for acceptance or hesitancy, and areas for improvement. Lack of correct knowledge and mistrust in the healthcare system were important categories observed in all papers included in the review. Other categories within the conceptual model included prioritising disease prevention, health professional guidance, family support and supportive community environment.

Conclusion

Qualitative systematic reviews are an excellent means of exploring the gaps in current healthcare practices. Indigenous healthcare research should be grounded in community experiences and feedback. This review provides insights into HPV vaccination understanding and acceptance amongst Indigenous populations, from which recommendations for increasing resonance of vaccination strategies with Indigenous communities can be formed.
Oral health plays second fiddle in palliative care: an interview study with registered nurses in home healthcare
Authors: Gustafsson Anna , Skogsberg Johanna , Rejnö Åsa
Published: November 2021

Background

Oral health is crucial to the experience of well-being, and symptoms from the mouth are common at the end of life. Palliative care aims to identify and treat symptoms early to avoid unnecessary suffering and is thus an important part of nursing in home healthcare. The aim of this study was to illustrate the professional reflections of registered nurses about oral health amongst patients in palliative care, who are being cared for in a home healthcare setting.

Results

The results showed oral health in end-of-life care, to be an area marked by responsibility and ethical considerations. This was seen in all four partly overlapping themes that emerged through the analysis:Oral health is easily overlooked in palliative care, Oral health is everybody’s but in reality nobody’s responsibility, Patient integrity can be an obstacle for oral health,andFocus on oral health is urgently needed. The mouth is often not included as part of the daily basic care routine, by the registered nurses and the home healthcare staff, until the patient is near end of life. Moreover, neither does the patient tell about symptoms from the mouth. The interpreted whole indicates that the registered nurses had a bad conscience about not doing what they are actually responsible for and ought to do.

Conclusion

The oral health of patients at the end of life risks being forgotten or falling between the cracks, due to the nurses’ scattered tasks and unclear delimitations between their, and other professionals’ responsibilities. The responsibilities of registered nurses are also ethically demanding, since their intent to respect the patient’s integrity could mean that in some cases the patients does not allow them to help with oral health. To reduce the risk that oral health is overlooked, clearer demarcation and guidelines on the division of responsibilities are required. Routines that clearly implement early and recurring oral health assessments in home healthcare as well as continuing education updates on oral health and oral care are also needed.
The use of Caralluma fimbriata as an appetite suppressant and weight loss supplement: a systematic review and meta-analysis of clinical trials
Authors: Jayawardena Ranil , Francis Tormalli V. , Abhayaratna Sachith , Ranasinghe Priyanga
Published: November 2021

Background

Obesity prevalence has increased during the past few decades, causing a pandemic with an influx in other co-morbidities. Many factors influence weight gain in an obesogenic environment therefore strategies for treating obesity may vary from conventional dietary and physical activity interventions to pharamacotherapy. A shift in unconventional strategies as herbal products for treating obesity have been investigated and one such plant extract is Caralluma fimbriata (C. fimbriata). Further, the studies included were systematically reviewed to gather evidence on potential effects of C. fimbriata as an appetite suppressant and weight loss supplement.

Methods

A systematic review of clinical trials reporting the effects of C. fimbriata as appetite suppression and anti-obesity supplement was reported according to PRISMA guidelines. Data were obtained by searching three databases: PubMed®, Web of Science® and SciVerse Scopus® for studies published until 30th April 2020.

Results

A total of 7 articles studying C. fimbriata satisfied the inclusion and exclusion criteria and were sourced from various countries including Australia (3), Cuba (1), India (2) and Spain (1). Almost all studies recruited adults who were overweight or obese with a BMI > 25 kg/m2 (n = 5), with the exception of two studies, one that recruited healthy adults with a BMI average of 26.5 kg/m2 and the second one utilised a population of children and adolescents with Prader-Willis Syndrome (PWS). Parameters assessing obesity, biochemical and appetite factors were analysed by carrying out a meta-analysis. Compared to placebo controlled group, C. fimbriata extract significantly reduced WC by 1.59 cm (95% CI, − 3.07 to − 0.10, p = 0.041) and WHR by 0.06 (95% CI, − 0.12 to − 0.01, p = 0.05) although no significant effects were seen on BW, BMI and HC. Biochemical and appetite parameters outcome on C. fimbriata consumption had no significant changes. Any side effects of individuals who ingested the extract were reported by few studies of which most common effects were constipation, diarrhoea, nausea and rashes.

Conclusion

Appetite parameters showed no significant changes and metabolic parameters did not improve with C.fimbriata supplementation therefore it is unlikely to recommend C. fimbriata as a weight loss supplement and an appetite suppressant.
Lactate induces aberration in the miR-30a–DBF4 axis to promote the development of gastric cancer and weakens the sensitivity to 5-Fu
Authors: Wang Tengkai , Ji Rui , Liu Guanqun , Ma Beilei , Wang Zehua , Wang Qian
Published: November 2021

Background

Gastric cancer (GC) is one of the most common malignancies, molecular mechanism of which is still not clear. Aberrant expression of tumor-associated genes is the major cause of tumorigenesis. DBF4 is an important factor in cancers, although there is yet no report on its function and molecular mechanism in GC.

Methods

The expression of DBF4 in tumor tissues or cells of GC was detected by qRT-PCR and western blotting. Gastric cancer cell line MGC-803 and AGS were transfected with DBF4 siRNA or overexpression vector to detect the function of DBF4 in proliferation, migration and the sensitivity to 5-Fu with CCK-8 assay, colony formation assay, transwell assay, and wound healing assay. miR-30a was found to be the regulator of DBF4 by online bioinformatics software and confirmed with qRT-PCR, western blot and dual-luciferase reporter assays.

Results

In our study, increased expression of DBF4 in GC tissues was first identified through The Cancer Genome Atlas (TCGA) and later confirmed using specimens from GC patients. Furthermore, functional experiments were applied to demonstrate that DBF4 promotes cell proliferation and migration in GC cell lines, moreover weakens the sensitivity of MGC803 and AGS cells to 5-Fu. We further demonstrated that miR-30a showed significantly lower expression in GC cells and inhibited the expression of DBF4 through 3ʹ-UTR suppression. Furthermore, rescue experiments revealed that the miR-30a-DBF4 axis regulated the GC cell proliferation, migration and the sensitivity to 5-Fu. The important composition in tumor microenvironment, lactate, may be the primary factor that suppressed miR-30a to strengthen the expression of DBF4.

Conclusions

Taken together, our study was the first to identify DBF4 as a regulator of cell proliferation and migration in GC. Furthermore, our study identified the lactate-miR-30a-DBF4 axis as a crucial regulator of tumor progression and the tumor sensitivity to 5-Fu, which maybe serve useful for the development of novel therapeutic targets.
Hexokinases 2 promoted cell motility and distant metastasis by elevating fibronectin through Akt1/p-Akt1 in cervical cancer cells
Authors: Chen Qian , Li Lu , Liu Xian , Feng Qian , Zhang Yanru , Zheng Pengsheng , Cui Nan
Published: November 2021

Background

Hexokinases 2 (HK2) is a member of the hexokinases, linking with malignant tumor growth and distant metastasis. However, evidence regarding the potential role of HK2 in regulating cell motility and tumor metastasis during the cervical cancer malignant progression remains limited.

Methods

In vitro migration and invasion assay, in vivo metastasis experiments were performed to detect the effective of HK2 on regulating cell motility and tumor metastasis in cervical cancer cells. RNA-Seq was performed to explore the potential molecules that participate in HK2-mediated cell motility and tumor metastasis in cervical cancer cells. The correlation between HK2 and Akt1, p-Akt1, FN1 expression in cervical cancer cells and human squamous cervical carcinoma (SCC) samples was verified in this study.

Results

In this study, cervical cancer cells with exogenous HK2 expression exhibited enhanced cell motility and distant metastasis. Transcriptome sequencing analysis revealed that fibronectin (FN1) was significantly increased in HK2-overexpressing HeLa cells, and the PI3K/Akt signaling pathway was identified by KEGG pathway enrichment analysis. Further studies demonstrated that this promotion of cell motility by HK2 was probably a result of it inducing FN1, MMP2 and MMP9 expression by activating Akt1 in cervical cancer cells. Additionally, HK2 expression was altered with the changing of Akt1/p-Akt1 expression, implying that HK2 expression is also modulated by Akt1/p-Akt1. Moreover, the positive correlation between HK2 and Akt1, p-Akt1, FN1 expression in human squamous cervical carcinoma (SCC) samples was verified by using Pearson correlation analysis.

Conclusions

This study demonstrated that HK2 could activate Akt1 in cervical cancer cells, subsequently enhancing cell motility and tumor metastasis by inducing FN1, MMP2 and MMP9 expression. There likely exists an interactive regulatory mechanism between HK2 and Akt1 during the malignant process of cervical cancer.
Absence of Plasmodium falciparum artemisinin resistance gene mutations eleven years after the adoption of artemisinin-based combination therapy in Nigeria
Authors: Ikegbunam Moses , Ojo Johnson A. , Kokou Kossiwa , Morikwe Ugonna , Nworu Chukwuemeka , Uba Chibuzo , Esimone Charles , Velavan Thirumalaisamy P. , Ojurongbe Olusola
Published: November 2021

Background

The occurrence of artemisinin resistance (ART)-associated polymorphism of Plasmodium falciparum K13-propeller (pfk13) gene before and after the introduction of artemisinin-based combination therapy (ACT) in two regions of Nigeria was investigated in this study. Regular surveillance is necessary to make a definite conclusion on the emergence and pattern of possible resistance to ART.

Methods

This cross-sectional study was carried out in the Southwestern and Southeastern geopolitical zones of Nigeria. A total of 150, 217, and 475 participants were enrolled for the study in the Southwest (2004_Group A), Southwest (2015_Group B), and southeast (2015_Group C), respectively. Blood samples were collected from the study participants for DNA extraction and a nested PCR for P. falciparum identification. Samples that were positive for P. falciparum were genotyped for the pfk13 gene using the Sanger sequencing method. The single nucleotide polymorphisms were analysed using the Bioedit software.

Results

A total of 116, 125, and 83 samples were positive for P. falciparum, respectively for the samples collected from the Southwest (2004 and 2015) and southeast (2015). Parasite DNA samples collected from febrile children in 2004 (Group A; n = 71) and 2015 (Group B; n = 73) in Osogbo Western Nigeria and 2015_Group C (n = 36) in southeast Nigeria were sequenced successfully. This study did not observe mutations associated with the in vitro resistance in southeast Asia, such as Y493H, R539T, I543T, and C580Y. Two new polymorphisms V520A and V581I were observed in two samples collected in Osogbo, Southwest Nigeria. These two mutations occurred in the year 2004 (Group A) before the introduction of ACT. Six mutations were identified in 17% of the samples collected in southeast Nigeria. One of these mutations (D547G) was non-synonymous, while the remaining (V510V, R515R, Q613Q, E688E, and N458N) were synonymous. Also, one (2%) heterozygote allele was identified at codon 458 in the 2015 (Group C) samples.

Conclusions

None of the mutations observed in this study were previously validated to be associated with ART resistance. These results, therefore, suggest that artemisinin is likely to remain highly effective in treating malaria in the study areas that are malarious zone.
The proteomics analysis of the effects of Zhishi Rhubarb soup on ischaemic stroke
Authors: Zhang Jing-Hua , Shao Yue-Jia , Hui Zhen , Wang Su-Lei , Huang Chi , Zhao Yang
Published: November 2021

Background

Stroke has always been a major threat worldwide but is most severe in China, with 2.5 million new stroke cases each year and 7.5 million stroke survivors, placing a heavy burden on the social and national health care systems. Zhishi Rhubarb Soup (ZRS) is a traditional Chinese medicine (TCM) that has been used clinically for many years in China. To explore the potential mechanism of ZRS in the treatment of stroke, liquid chromatography with mass spectrometry (LC–MS) was performed.

Methods

In this study, a quantitative proteomic method with LC–MS was used to analyse the proteomic differences between MACO samples treated with ZRS and those without ZRS treatment.

Results

Liquid chromatography with mass spectrometry (LC–MS) analysis led to the identification of 35,006 peptides, with 5160.0 proteins identified and 4094.0 quantified. Significantly differentially expressed proteins were identified through data analysis, and the difference was found to be more than 1.2 times (P < 0.05). The Gene Ontology (GO) analysis provided a summary of the dysregulated protein expression in the biological process (BP), cell component (CC), and molecular function (MF) categories. Proteins related to brain repair, including BDNF, IL-10, IL-6, and TGF-β, were found to change significantly, partially demonstrating the effectiveness of ZRS to attenuate tissue injury.

Conclusion

In this study, LC–MS/MS was performed to assess the effects of ZRS on differentially expressed proteins in rats with cerebral infarction. These promising results could help to improve the understanding of the effects of drugs on stroke.
Leaf reflectance can surrogate foliar economics better than physiological traits across macrophyte species
Authors: Villa Paolo , Bolpagni Rossano , Pinardi Monica , Tóth Viktor R.
Published: November 2021

Background

Macrophytes are key players in aquatic ecosystems diversity, but knowledge on variability of their functional traits, among and within species, is still limited. Remote sensing is a high-throughput, feasible option for characterizing plant traits at different scales, provided that reliable spectroscopy models are calibrated with congruous empirical data, but existing applications are biased towards terrestrial plants. We sampled leaves from six floating and emergent macrophyte species common in temperate areas, covering different phenological stages, seasons, and environmental conditions, and measured leaf reflectance (400–2500 nm) and leaf traits (dealing with photophysiology, pigments, and structure). We explored optimal spectral band combinations and established non-parametric reflectance-based models for selected traits, eventually showing how airborne hyperspectral data could capture spatial–temporal macrophyte variability.

Results

Our key finding is that structural—leaf dry matter content, leaf mass per area—and biochemical—chlorophyll-a content and chlorophylls to carotenoids ratio—traits can be surrogated by leaf reflectance with normalized error under 17% across macrophyte species. On the other hand, the performance of reflectance-based models for photophysiological traits substantively varies, depending on macrophyte species and target parameters.

Conclusions

Our main results show the link between leaf reflectance and leaf economics (structure and biochemistry) for aquatic plants, thus envisioning a crucial role for remote sensing in enhancing the level of detail of macrophyte functional diversity analysis to intra-site and intra-species scales. At the same time, we highlighted some difficulties in establishing a general link between reflectance and photosynthetic performance under high environmental heterogeneity, potentially opening further investigation directions.
VMAT2 availability in Parkinson’s disease with probable REM sleep behaviour disorder
Authors: Valli Mikaeel , Cho Sang Soo , Uribe Carme , Masellis Mario , Chen Robert , Mihaescu Alexander , Strafella Antonio P.
Published: November 2021

REM sleep behaviour disorder (RBD) can be an early non-motor symptom of Parkinson’s disease (PD) with pathology involving mainly the pontine nuclei. Beyond the brainstem, it is unclear if RBD patients comorbid with PD have more affected striatal dopamine denervation compared to PD patients unaffected by RBD (PD-RBD−). To elucidate this, we evaluated the availability of vesicular monoamine transporter 2 (VMAT2), an index of nigrostriatal dopamine innervation, in 15 PD patients with probable RBD (PD-RBD+), 15 PD-RBD−, and 15 age-matched healthy controls (HC) using [11C]DTBZ PET imaging. This technique measured VMAT2 availability within striatal regions of interest (ROI). A mixed effect model was used to compare the radioligand binding of VMAT2 between the three groups for each striatal ROI, while co-varying for sex, cognitive function and depression scores. Multiple regressions were also computed to predict clinical measures from group condition and VMAT2 binding within all ROIs explored. We observed a significant main effect of group condition on VMAT2 availability within the caudate, putamen, ventral striatum, globus pallidus, substantia nigra, and subthalamus. Specifically, our results revealed that PD-RBD+ had lower VMAT2 availability compared to HC in all these regions except for the subthalamus and substantia nigra, while PD-RBD− was significantly lower than HC in all these regions. PD-RBD− showed a negative relationship between motor severity and VMAT2 availability within the left caudate. Our findings reflect that both PD patient subgroups had similar denervation within the nigrostriatal pathway. There were no significant interactions detected between radioligand binding and clinical scores in PD-RBD+. Taken together, VMAT2 and striatal dopamine denervation in general may not be a significant contributor to the pathophysiology of RBD in PD patients. Future studies are encouraged to explore other underlying neural chemistry mechanisms contributing to RBD in PD patients.
Early intervention for young children with autism spectrum disorder: protocol for a scoping review of economic evaluations
Authors: Pye Katherine , Jackson Hannah , Iacono Teresa , Shiell Alan
Published: November 2021

Background

In many countries, children who are diagnosed with autism during the first 5 years of life are offered a range of early intervention options. These options vary considerably in the theoretical approaches and techniques applied, their intensity and duration, settings, the person/s delivering supports and the training they require. Early interventions are a significant contributor to total autism-related costs in Western countries, but only in the last 10–20 years has there been adequate outcome data to enable the comparison of different interventions’ cost-effectiveness. This protocol describes a scoping review to better understand what economic evaluations have been completed in this field, and the methods used to date.

Methods

We will systematically search the following databases from their inception to 2021 for eligible studies: MEDLINE, EMBASE, PsycINFO, Econlit, PEDE, NHS EED and HTA. Full economic evaluations of any types of early intervention for children with autism prior to school entry will be included. Two reviewers will screen the studies, extract the data and assess the study quality using established checklists. The risk of bias will be assessed using the extended CHEC-list for all studies and, additionally, the Philips checklist for modelled studies. Quality of reporting will be assessed using the CHEERS checklist. A narrative synthesis will be completed to collate the findings, describe the methods used and identify which interventions have been researched from an economic perspective.

Discussion

This review will provide researchers, policymakers and service providers with current information about the economic evidence for early interventions for young children with autism and point to priorities for further research. It will inform future economic evaluations by highlighting the gaps or inconsistencies in the methods used to date. Limitations of the review will be acknowledged and discussed.

Systematic review registration

Open Science Framework: https://osf.io/sj7kt