bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Sense of Troubled Livelihoods: Gendered Expectations and Poor Health Narratives in Rural South Africa
Authors: Ice Erin , Mojola Sanyu A. , Angotti Nicole , Gómez-Olivé F. Xavier , Houle Brian
Published: July 2022

When men and women cannot attain idealized gendered forms of economic provision and dependence, how do they make sense of this perceived failure? In this article, we posit that poor health narratives serve as a gendered tool to make sense of inadequate livelihoods, even when that inadequacy is attributable to structural conditions. We draw on survey and life-history interview data from middle-aged and older rural South Africans. The survey data show that even after adjusting for biometrically measured health differences, working-age (40–59 years) men report poorer health when they are unemployed, and women (age 40+) and pension-age men (age 60+) report poorer health when they live without household earners. Life-history interviews show parallel patterns: When their economic circumstance is not troubled, individuals regularly minimize health concerns; conversely, when they have a troubled livelihood, individuals draw on poor health to explain it. When women and men cannot perform idealized gendered practices in the family, poor health becomes a tool to reduce the resulting cognitive dissonance. Poor health narratives recast perceived gender failures to an individualized, biological explanation. Our study illustrates how the epidemiological context can be a resource that forestalls a redefinition of gender norms when the gender order is in crisis.
‘Dirty Hands’: Guilt and Regret in Moral Reasoning
Authors: Gingles Dallas J.
Published: July 2022

Nigel Biggar argues against ‘dirty hands’ reasoning for two reasons. The first is that dirty hands reasoning is paradoxical. The second is that ‘dirt’ in dirty hands is often—and wrongly—conceived as guilt. According to Biggar, the dirt should instead be understood as regret. In this article, I defend dirty hands reasoning against both criticisms. On the one hand, I argue that dirty hands reasoning is not necessarily paradoxical. On the other, I argue that, because guilt, more than regret, is meant to motivate the agent we should prefer a prima facie interpretation of the ‘dirt’ in dirty hands as guilt instead of regret.
3D MHD dusty nanofluid flow within cubic heterogeneous porous enclosures with hot and cold cylinders using non-homogeneous nanofluid model
Authors: Ahmed Sameh E. , Arafa Anas A.M.
Published: July 2022

The heterogeneity of the porous medium properties is an important topic due to the important wide practical applications in the reservoir rocks and the petroleum reservoirs. This study aims to examine both the heterogeneity of the permeability, thermal conductivity and the nanofluid model on the dusty nanofluid within a three-dimensional cubic container. The convective transport is due to the buoyancy–driven flow resulting from two inner hot/cold cylinders separated by variable distance [Formula: see text]. The nanofluids are simulated by a non-homogeneous two phase model and the impact of a constant magnetic field in Z -direction is considered. Two systems of the governing equations are introduced for the dusty and nanofluid phase and the boundary conditions for the nanoparticle function are passively controlled. The major findings revealed that the flow structures can be well-controlled using the distance between the inner cylinders. Also, the heterogeneity in [Formula: see text] plane gives a higher rate of the heat transfer. Furthermore, the maximizing of the dusty parameter is better for enhancing the dusty temperature and velocities.
The benefits of covariate adjustment for adaptive multi-arm designs
Authors: Lee Kim May , Robertson David S. , Jaki Thomas , Emsley Richard
Published: July 2022

Covariate adjustment via a regression approach is known to increase the precision of statistical inference when fixed trial designs are employed in randomized controlled studies. When an adaptive multi-arm design is employed with the ability to select treatments, it is unclear how covariate adjustment affects various aspects of the study. Consider the design framework that relies on pre-specified treatment selection rule(s) and a combination test approach for hypothesis testing. It is our primary goal to evaluate the impact of covariate adjustment on adaptive multi-arm designs with treatment selection. Our secondary goal is to show how the Uniformly Minimum Variance Conditionally Unbiased Estimator can be extended to account for covariate adjustment analytically. We find that adjustment with different sets of covariates can lead to different treatment selection outcomes and hence probabilities of rejecting hypotheses. Nevertheless, we do not see any negative impact on the control of the familywise error rate when covariates are included in the analysis model. When adjusting for covariates that are moderately or highly correlated with the outcome, we see various benefits to the analysis of the design. Conversely, there is negligible impact when including covariates that are uncorrelated with the outcome. Overall, pre-specification of covariate adjustment is recommended for the analysis of adaptive multi-arm design with treatment selection. Having the statistical analysis plan in place prior to the interim and final analyses is crucial, especially when a non-collapsible measure of treatment effect is considered in the trial.
Impact of Energy Enterprise Exports on Technological Innovation: PSM Analysis Based on Chinese Industrial Enterprise Database
Authors: Yi Su , Dan Li
Published: July 2022

Export is an important way to promote the innovation and growth of energy enterprises by learning new knowledge and technology. To explore the impact mechanism of energy enterprises’ export behaviour on technological innovation, this article uses the micro data of 8,548 energy enterprises in the Chinese Industrial Enterprise Database from 2004 to 2007 for propensity score matching analysis, from the two dimensions of technological innovation willingness and technological innovation capability. The empirical results show that (a) the export behaviour of energy enterprises has a significant promotion effect on the technological innovation willingness and capability of energy enterprises; export behaviour has a continuous promotion effect on the technological innovation willingness of energy enterprises, and this promotion effect has gradually increased. There is a time lag in the promotion effect of export behaviour on the technological innovation capability of energy enterprises, and this promotion effect is gradually increasing. (b) Compared with non-state-owned energy enterprises, export behaviours have a more immediate effect on the technological innovation willingness of state-owned energy enterprises; compared with small and medium-sized energy enterprises, export behaviours have a more positive impact on the technological innovation willingness and capabilities of large energy enterprises.
Analysis of factors affecting the time for implantation of a total hip arthroplasty in patients with symptomatic primary and secondary hip osteoarthritis
Authors: Becker Leon D , Floerkemeier Thilo , Derksen Alexander , Schwarze Michael , Budde Stefan , Windhagen Henning , Wirries Nils
Published: July 2022

Background:

Many studies have identified factors associated with an unfavourable clinical outcome or an early conversion to total hip arthroplasty (THA) after joint-preserving treatment. We analysed the effect and reliability of different factors on the age at which THA becomes necessary.

Methods:

Hip joint radiographs of 2485 cases were evaluated using the lateral centre-edge angle (LCEA) and acetabulum angle (ACA) as well as the alpha angle to describe the femoral head shapes. Regressions were performed using patient’s age at the time of THA and body mass index (BMI) as well as LCEA and ACA. Multiple linear regressions were used to create a formula comprising factors that significantly correlated with patient age at the time of joint replacement surgery.

Results:

The BMI, LCEA, and ACA showed significant correlations with the age of THA implantation ( p < 0.001). Multiple linear regressions produced the following formula: age (THA) = 72.40–0.40 × BMI + 0.20 × LCEA–0.18 × ACA. BMI showed a stronger impact on the age of end-stage osteoarthritis than the ACA. The formula explained 12.1% of the distributing data (r2). Surprisingly, the alpha angle did not show an impact on the age of THA surgery.

Conclusions:

BMI had the greatest impact on patient’s age at the time of THA, followed by the characteristic radiological angles for hip dysplasia. The resulting formula could emphasise and visualise the significant impact of these factors. However, despite the calculation being based on 2485 cases, the calculated validity of 12.1% was limited.
Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority
Authors: Liang Kun , Wang Bin , Zhao Linbo , Cao Yuezhou , Jiang Lei , Liu Qianghui , Liu Sheng , Shi Haibin , Jia Zhenyu
Published: July 2022

Purpose

To illustrate the characteristics of acute ostial vertebral artery (VA) and basilar artery (BA) tandem occlusions. The endovascular treatment strategy for ostial VA-BA tandem occlusion was reported.

Materials and Methods

We conducted a retrospective analysis of patients with ostial VA-BA tandem occlusion who underwent endovascular treatment in our center between November 2018 and February 2022. We preferred to recanalize the dominant vertebral artery with priority. The imaging characteristics, treatment strategy, clinical outcomes, and complications were analyzed.

Results

In total, 9 patients with ostial VA-BA tandem occlusion were enrolled in this study. All the VA-BA tandem occlusion was caused by acute occlusion of the dominant VA. Endovascular revascularization was performed through the occluded dominant VA in 8 patients and was performed through contralateral non-dominant VA in 1 patient. Successful recanalization (mTICI 2b/3 grade) was achieved in all 9 patients, and 5 patients (55.5%) achieved functional independence with a mRS score of 0–2 at 90 days.

Conclusions

In this case series, the occurrence of ostial VA-BA tandem occlusions was mainly caused by acute occlusion of the dominant VA. Endovascular revascularization of ostial VA-BA tandem occlusions through occluded dominant VA was feasible and recommended.
Pipeline embolization of complex, wide-necked middle cerebral artery bifurcation aneurysms: A single-center experience
Authors: Wang Jingjing , Deng Xin , Li Dong , Yang Zhen , Guo Xin-bin
Published: July 2022

Purpose

To evaluate the performance of Pipeline Embolization Device (PED) in complex, wide-necked middle cerebral artery (MCA) bifurcation aneurysms.

Methods

We performed a retrospective review of patients treated with PED for complex, wide-necked MCA bifurcation aneurysms between August 2016 and March 2021. In addition to demographic data, we collected aneurysmal neck width, dome-to-neck ratio, complications, and clinical and angiographic follow-up. The embolization degree of aneurysms was evaluated by O’Kelly-Marotta (OKM) grading scale, and the prognosis was assessed with the modified Rankin Scale (mRS).

Results

From August 2016 to March 2021, a total of 46 patients with 49 MCA bifurcation aneurysms in our center were enrolled, of whom all received PEDs successfully. The O’Kelly-Marotta (OKM) grading showed that post-procedure 15 patients (32.6%) were grade C, another 8 patients (17.4%) were grade D. Aneurysms with small remnant or complete occlusion were 50%, symptomatic ischemic events occurred in 3 (6.5%), and bleeding events in 1 (2.2%). 41 patients underwent a 6-month angiography follow-up, in which 7 patients (17.1%) remained OKM grade C and 30 patients (73.2%) achieved OKM grade D. Complete occlusion and small remnant aneurysms were up to 90.3%. 40 (97.6%) patients’ mRS scores were 0, and 1 (2.4%) patient was 2. No new bleeding and ischemic events occurred during the 6-month.

Conclusions

The Pipeline Embolization Device provides a safe and effective treatment alternative for complex, wide-necked MCA aneurysms. A larger number with longer-term follow-up data is needed for further verification.
Thermophoresis phenomenon in radiative flow about vertical movement of a rotating disk in porous region
Authors: Bashir Muhammad Nauman , Rauf Amar , Shehzad Sabir Ali , Ali Mohsin , Mushtaq Tahir
Published: July 2022

This study examines the time-dependent, three-dimensional, laminar, incompressible, and inclined hydromagnetic flow of viscous fluid above a rotating disk. The disk is saturated in a porous space and moves vertically along axial direction. Heat transfer process is analyzed by the thermal radiation and convective boundary condition. Thermophoresis process is illustrated in the flow stream by mass equation. The similarity functions are exerted to transform the system of partial differential equations into a one independent variable expressions. The finite differences scheme is applied to the resultant dimensionalized system and then solved in iterative manner using Successive over Relaxation (SOR) method. The physical quantities are illustrated graphically in terms of velocity, thermal and concentration fields. Two-dimensional contour phenomenon and three-dimensional flow visualizations for some parameters are also sketched. The skin-friction co-efficient, frictional torque, Nusselt number and Sherwood number against selected parameters are discussed in tabular format.
Conceptualisations of COPD self-management: A narrative review of the research literature
Authors: Delaney Sarah , Cronin Patricia , Huntley-Moore Sylvia
Published: July 2022

Aim

To examine how self-management is conceptualised in the research literature on chronic obstructive pulmonary disease (COPD).

Methods

A narrative review was undertaken to search the research literature on COPD self-management. Ten databases (2000–2021) were searched for published texts. Sixty-two articles met the inclusion criteria. A thematic analysis was conducted of the literature.

Results

Three conceptualisations of COPD self-management were identified: 1) a dominant medicocentric conceptualisation which represented self-management as medical in focus; 2) a less dominant experiential conceptualisation that viewed it as arising from the experiences of people living with COPD; and 3) a smaller body of literature that attempted to integrate medicocentric and experiential conceptualisations of self-management.

Discussion

The dominance of the medicocentric conceptualisation of self-management and the polarisation of medicocentric and experiential perspectives were striking. An integrated conceptualisation of self-management has the potential to unite these competing perspectives and promote collaborative relationships between individuals and professionals, so long as the underlying values informing it are made explicit. However, there is a dearth of literature on this approach and it would benefit from more attention. Methods such as Co-production and the Personal Outcomes Approach offer the potential to support an integrated perspective in clinical practice.
Analgesic efficacy and safety of paracervical block versus conscious sedation in the surgical evacuation of the uterus following first-trimester incomplete miscarriages: A randomised controlled trial
Authors: Nweke Nnenna A , Anikwe Chidebe Christian , Ewah Richard L , Umeononihu Osita S , Eze Justus N
Published: July 2022

Objective:

To compare the analgesic efficacy and safety of paracervical block and conscious sedation in the surgical evacuation of the uterus following a first-trimester miscarriage.

Methods:

This is an open-label, randomised control trial comparing pain relief by paracervical block versus conscious sedation during manual vacuum aspiration of first-trimester incomplete miscarriages. One-hundred and sixty-two women were equally randomised into two groups. Group A (paracervical group) received a paracervical block of 4 ml of lidocaine each at the 4 and 8 o’clock positions. Group B (conscious sedation group) received intravenous 30 mg pentazocine and 10 mg diazepam. Data obtained were presented using a frequency table, student t-test, chi-square and Mann–Whitney test and bar chart. A P-value of ⩽0.05 was taken to be statistically significant.

Results:

The mean pain score was lower in the paracervical block group compared to the conscious sedation group (P < 0.05); however, there was no significant difference in women’s satisfaction between the groups (P ⩾ 0.05). Conscious sedation had more negative side effects compared to paracervical block which was significant (P < 0.05).

Conclusion:

Paracervical block has better pain control compared with conscious sedation and has a good side effect profile.

Trial registration:

Pan African Clinical Trial Registry (registered trial no. PACTR202108841661192).

Synopsis

Paracervical block for manual vacuum aspiration (MVA) during first-trimester miscarriage is associated with less pain among women compared with conscious sedation.
Health and health inequalities impact assessment for non-clinical measures to control COVID-19 in the Basque Country and Navarre (Spain)
Authors: Urtaran-Laresgoiti M , González-Rábago Y , Martín U , Rivadeneyra-Sicilia A , Morteruel M
Published: July 2022

This article describes the results of a health and health inequalities impact assessment of the COVID-19 pandemic control measures in the regions of the Basque Country and Navarre in Spain. A literature review was conducted on Pubmed and Web of Science (WoS) databases, in addition to individual semi-structured interviews and focus groups with experts, key informants and different profiles of citizens. A wide variety of social determinants of health have been affected by the measures, which included individual health-related behaviors, service disruption in formal care, educational settings, and health care provision. These changes have particularly affected certain population groups including children and adolescents, older people, those with health conditions and disabilities together with caregivers, women, as well as people with low levels of education, income, and resources. In future scenarios it will be necessary to pay attention to the potential impacts of policy responses on health inequalities to avoid an increase in existing health gaps.
The Lateral Drawer Test: A New Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures
Authors: Zhao John Z. , Ingall Eitan M. , Sharma Siddhartha , Ashkani-Esfahani Soheil , Sakakibara Yuzuru , Yi Anthony , Miller Christopher P. , Kwon John Y.
Published: July 2022

Background:

Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. Although instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the isolated Weber B fibula fracture often requires further investigation. Prior authors have demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis, and swelling with instability. The goal of this study is to test the validity of a new clinical examination maneuver, the lateral drawer test, against the gravity stress view (GSV) in a cohort of patients with Weber B fibula fractures. Secondary goals included assessing pain tolerability of the lateral drawer test, as well as testing interobserver reliability.

Methods:

Sixty-two patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three nonweightbearing radiographic views of the ankle as well as a GSV were obtained. Radiographs were not visualized before conducting the lateral drawer test. Two foot and ankle fellowship–trained orthopaedic surgeons performed and graded the lateral drawer test. Radiographs were then examined and medial clear space (MCS) was measured. Visual analog scale (VAS) pain scores were obtained before and after testing. The results of the lateral drawer test were compared with radiographic measurements of MCS on GSV. A cadaveric experiment was devised to assess interobserver reliability of the lateral drawer test.

Results:

Thirty (48%) of 62 consecutively enrolled patients demonstrated radiographic instability with widening of the MCS ≥5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83%, specificity of 97%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 86%. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (Spearman correlation ρ = 0.82, P < .005). Patients tolerated the maneuver well with an average increase of 0.7 on the VAS pain scale. Testing of 2 observers utilizing the cadaveric model demonstrated a Cohen’s Kappa coefficient of 0.7 indicating moderate interobserver agreement.

Conclusion:

The lateral drawer test demonstrates high sensitivity, specificity, PPV, and NPV with moderate interobserver reliability compared with the MCS on GSV in patients presenting with Weber B fibula fractures. Although further external validation is required, the lateral drawer test may offer an adjunct tool via physical examination to help determine mortise stability.

Level of Evidence:

Level II, Prospective Cohort Study.
GAF domain is essential for nitrate-dependent AtNLP7 function
Authors: Wu Jie , Song Ying , Zhang Zi-Sheng , Wang Jing-Xian , Zhang Xuan , Zang Jian-Ye , Bai Ming-Yi , Yu Lin-Hui , Xiang Cheng-Bin
Published: July 2022

Nitrate is an essential nutrient and an important signaling molecule in plants. However, the molecular mechanisms by which plants perceive nitrate deficiency signaling are still not well understood. Here we report that AtNLP7 protein transport from the nucleus to the cytoplasm in response to nitrate deficiency is dependent on the N-terminal GAF domain. With the deletion of the GAF domain, AtNLP7ΔGAF always remains in the nucleus regardless of nitrate availability. AtNLP7 ΔGAF also shows reduced activation of nitrate-induced genes due to its impaired binding to the nitrate-responsive cis-element (NRE) as well as decreased growth like nlp7-1 mutant. In addition, AtNLP7ΔGAF is unable to mediate the reduction of reactive oxygen species (ROS) accumulation upon nitrate treatment. Our investigation shows that the GAF domain of AtNLP7 plays a critical role in the sensing of nitrate deficiency signal and in the nitrate-triggered ROS signaling process.
Is there a relationship between two different anesthetic methods and postoperative length of stay during radical resection of malignant esophageal tumors in China?: a retrospective cohort study
Authors: Yang Jieping , Guo Xukeng , Zheng Zonggui , Ke Weiqi
Published: July 2022

Background

Data providing a relationship between the anesthetic method and postoperative length of stay (PLOS) is limited. We aimed to investigate whether general anesthesia alone or combined with epidural anesthesia might affect perioperative risk factors and PLOS for patients undergoing radical resection of malignant esophageal tumors.

Methods

The study retrospectively analyzed the clinical data of 680 patients who underwent a radical esophageal malignant tumor resection in a Chinese hospital from January 01, 2010, to December 31, 2020. The primary outcome measure was PLOS, and the secondary outcome was perioperative risk-related parameters that affect PLOS. The independent variable was the type of anesthesia: general anesthesia (GA) or combined epidural-general anesthesia (E-GA). The dependent variable was PLOS. We conducted univariate and multivariate logistic regression and propensity score matching to compare the relationships of GA and E-GA with PLOS and identify the perioperative risk factors for PLOS. In this cohort study, the confounders included sociodemographic data, preoperative chemotherapy, coexisting diseases, laboratory parameters, intraoperative variables, and postoperative complications.

Results

In all patients, the average PLOS was 19.85 ± 12.60 days. There was no significant difference in PLOS between the GA group and the E-GA group either before or after propensity score matching (20.01 days ± 14.90 days vs. 19.79 days ± 11.57 days,P = 0.094, 18.09 ± 9.71 days vs. 19.39 ± 10.75 days,P = 0.145). The significant risk factors for increased PLOS were lung infection (β = 3.35, 95% confidence interval (CI): 1.54–5.52), anastomotic leakage (β = 25.73, 95% CI: 22.11–29.34), and surgical site infection (β = 9.39, 95% CI: 4.10-14.68) by multivariate regression analysis. Subgroup analysis revealed a stronger association between PLOS and vasoactive drug use, blood transfusions, and open esophagectomy. The results remained essentially the same (stable and reliable) after subgroup analysis.

Conclusions

Although there is no significant association between the type of anesthesia(GA or E-GA) and PLOS for patients undergoing radical esophageal malignant tumor resection, an association between PLOS and lung infection, anastomotic leakage, and surgical site infection was determined by multivariate regression analysis. A larger sample future study design may verify our results.
Distributed lag interrupted time series model for unclear intervention timing: effect of a statement of emergency during COVID-19 pandemic
Authors: Yoneoka Daisuke , Kawashima Takayuki , Tanoue Yuta , Nomura Shuhei , Eguchi Akifumi
Published: July 2022

Background

Interrupted time series (ITS) analysis has become a popular design to evaluate the effects of health interventions. However, the most common formulation for ITS, the linear segmented regression, is not always adequate, especially when the timing of the intervention is unclear. In this study, we propose a new model to overcome this limitation.

Methods

We propose a new ITS model, ARIMAITS-DL, that combines (1) the Autoregressive Integrated Moving Average (ARIMA) model and (2) distributed lag functional terms. The ARIMA technique allows us to model autocorrelation, which is frequently observed in time series data, and the decaying cumulative effect of the intervention. By contrast, the distributed lag functional terms represent the idea that the intervention effect does not start at a fixed time point but is distributed over a certain interval (thus, the intervention timing seems unclear). We discuss how to select the distribution of the effect, the model construction process, diagnosing the model fitting, and interpreting the results. Further, our model is implemented as an example of a statement of emergency (SoE) during the coronavirus disease 2019 pandemic in Japan.

Results

We illustrate the ARIMAITS-DL model with some practical distributed lag terms to examine the effect of the SoE on human mobility in Japan. We confirm that the SoE was successful in reducing the movement of people (15.0–16.0% reduction in Tokyo), at least between February 20 and May 19, 2020. We also provide the R code for other researchers to easily replicate our method.

Conclusions

Our model, ARIMAITS-DL, is a useful tool as it can account for the unclear intervention timing and distributed lag effect with autocorrelation and allows for flexible modeling of different types of impacts such as uniformly or normally distributed impact over time.
Association between dentition and frailty and cognitive function in community-dwelling older adults
Authors: Tan Li Feng , Chan Yiong Huak , Merchant Reshma A.
Published: July 2022

Objectives

To evaluate dentition status amongst community-dwelling older adults and its association with frailty and cognitive impairment.

Methodology

One thousand forty-seven community-dwelling older adults aged ≥65 years were surveyed in an epidemiologic population-based cohort study in Singapore between April 2015 and August 2016. Data on demographics, dentition status, chronic diseases, activities and instrumental activities on daily-living, cognition (age- and education-specific MMSE cut-offs), frailty (FRAIL scale), perceived health and functional status were collected. Multiple logistic regression was performed to examine the association between dentition, frailty and cognition.

Results

Mean age of participants was 71.2 ± 5.5 years. The prevalence of denture use was 70.7% and edentulism 7.9%. Compared to edentulousness, having teeth was associated with lower odds of cognitive impairment and higher odds of being robust or pre-frail. Denture-wearers compared with edentulous persons were less likely to be male, had higher education level and more likely be robust or pre-frail.

Conclusion and implications

There were significant associations between dentition status, frailty and cognition in our study where those with remining teeth and / or dentures had better overall outcomes. As oral health, frailty and cognitive impairments are all modifiable risk factors for healthy ageing, countries should consider population level screening for oral health, frailty and cognitive impairment.
Impact of renin-angiotensin system inhibitors on the survival of patients with rectal cancer
Authors: Zeman Marcin , Skałba Władysław , Wilk Agata Małgorzata , Cortez Alexander Jorge , Maciejewski Adam , Czarniecka Agnieszka
Published: July 2022

Background

Renin-angiotensin system inhibitors (RASIs) are widely used in the treatment of hypertension. However, their impact on the outcome of the combined treatment of rectal cancer is poorly understood. The aim of this study was to assess the effect of RASIs on the survival of rectal cancer patients with associated hypertension after neoadjuvant treatment and radical resection.

Methods

Between 2008 and 2016, 242 radical (R0) rectal resections for cancer were performed after neoadjuvant treatment in patients with associated hypertension. At the time of treatment, 158 patients were on RASIs, including 35 angiotensin-receptor antagonists (ARB) users and 123 angiotensin-converting enzyme inhibitors (ACEI) users. Eighty-four patients were on drugs other than RASIs (non-RASI users). The survival analysis was performed using the Kaplan–Meier estimator with the log-rank test and the Cox proportional hazards model.

Results

The log-rank test showed a significantly worse overall survival (OS) in the group of ACEI users compared to ARB users (p = 0.009) and non-RASI users (p = 0.013). Disease-free survival (DFS) was better in the group of ARB users compared to ACEI users. However, the difference was not statistically significant (p = 0.064). The Multivariate Cox analysis showed a significant beneficial effect of ARBs on OS (HR: 0.326, 95% CI: 0.147–0.724, p = 0.006) and ARBs on DFS (HR: 0.339, 95% CI: 0.135–0.850, p = 0.021) compared to ACEIs. Other factors affecting OS included age (HR: 1.044, 95% CI: 1.016–1.073, p = 0.002), regional lymph node metastasis (ypN +) (HR: 2.157, 95% CI: 1.395–3.334, p = 0.001) and perineural invasion (PNI) (HR: 3.864, 95% CI: 1.799–8.301, p = 0.001). Additional factors affecting DFS included ypN + (HR: 2.310, 95% CI: 1.374–3.883, p = 0.002) and PNI (HR: 4.351, 95% CI: 1.584–11.954, p = 0.004).

Conclusions

The use of ARBs instead of ACEIs may improve the outcome of the combined therapy for rectal cancer patients with associated hypertension.
Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study
Authors: Simms Victoria , McHugh Grace , Dauya Ethel , Bandason Tsitsi , Mujuru Hilda , Nathoo Kusum , Munyati Shungu , Weiss Helen A. , Ferrand Rashida A.
Published: July 2022

Background

Children who initiate antiretroviral therapy (ART) before age 5 years can recover height and weight compared to uninfected peers, but growth outcomes are unknown for children initiating ART at older ages. We investigated factors associated with growth failure at ART initiation and modelled growth by age on ART.

Methods

We conducted secondary analysis of cohort of children aged 6–15 years late-diagnosed with HIV in Harare, Zimbabwe, with entry at ART initiation in 2013–2015.

Factors associated with height-for-age (HAZ), weight-for-age (WAZ) and BMI-for-age (BAZ) z-scores <− 2 (stunting, underweight and wasting respectively) at ART initiation were assessed using multivariable logistic regression. These outcomes were compared at ART initiation and 12 month follow-up using paired t-tests. HAZ and BAZ were modelled using restricted cubic splines.

Results

Participants (N = 302; 51.6% female; median age 11 years) were followed for a median of 16.6 months (IQR 11.0–19.8). At ART initiation 34.8% were stunted, 34.5% underweight and 15.1% wasted. Stunting was associated with age ≥ 12 years, CD4 count < 200 cells/μl, tuberculosis (TB) history and history of hospitalisation. Underweight was associated with older age, male sex and TB history, and wasting was associated with older age, TB history and hospitalisation. One year post-initiation, t-tests showed increased WAZ (p = 0.007) and BAZ (p = 0.004), but no evidence of changed HAZ (p = 0.85). Modelling showed that HAZ and BAZ decreased in early adolescence for boys on ART, but not girls.

Conclusion

Stunting and underweight were prevalent at ART initiation among late-diagnosed children, and HAZ did not improve after 1 year. Adolescent boys with perinatally acquired HIV and late diagnosis are particularly at risk of growth failure in puberty.
The Malay version of the attitudes and beliefs about cardiovascular disease (ABCD-M) risk questionnaire: a translation, reliability and validation study
Authors: Mat Said Zarudin , Tengku Ismail Tengku Alina , Abdul Hamid Anees , Sahathevan Ramesh , Abdul Aziz Zariah , Musa Kamarul Imran
Published: July 2022

Background

Cardiovascular disease (CVD) and stroke are global public health problems and cause high mortality, especially in low- and middle-income countries. Knowledge and awareness are critical points in managing the risk in the general population. The Attitudes and Beliefs about Cardiovascular Disease (ABCD) risk questionnaire was developed to evaluate the awareness of stroke and CVD risk. Thus, the government can set up a practical risk assessment and management programme. The initiative will encourage people to seek healthcare timely and reduce the possibilities of developing complications.

Objective

This study aimed to translate and validate the ABCD risk questionnaire into the Malay language and evaluate the psychometric properties of the Malay version in the general population in Malaysia.

Methods

The questionnaire was translated using a standard forward–backwards translation method. The validation was perfomed by both expert panels and a potential user group. Next, the exploratory factor analysis was conducted to examine factorial validity. The respondents were selected from the government health clinics and according to the study criteria irrespective of the CVD risk. We used Cronbach’s alpha and Raykov’s rho to explore the internal consistency and composite reliability of the 18 items from three domains. Finally, the confirmatory factor analysis (CFA) was conducted using a robust maximum likelihood estimator.

Results

The content and face validity indices were determined to be 0.94 and 0.99 respectively. Data were obtained from 179 respondents (mean age, 36.8 years; female, 68.2%; secondary level education, 51.1%). The internal consistency and composite reliability of the domains showed good results ranging from 0.643 to 0.885. The factor loadings of each item were acceptable (> 0.3), and the fit indices from the CFA resulted in a good model fit [χ2 (p-value = 0.16), SRMR = 0.054, RMSEA = 0.029, CFI = 0.99, TLI = 0.99)].

Conclusions

The Malay version of the ABCD risk questionnaire is a valid and reliable tool to assess the awareness of stroke and CVD risk in the general population in Malaysia.
The effect of preserving pregnancy in cervical cancer diagnosed during pregnancy: a retrospective study
Authors: He Zuoxi , Xie Chuan , Qi Xiaorong , Hu Zhengjun , He Yuedong
Published: July 2022

Objective

Cervical cancer diagnosed during pregnancy is a rare event, and data regarding efficacy of cancer treatment during pregnancy is limited. This study aimed to assess the safety of continuation of the pregnancy for mother and fetus when concomitantly diagnosed with cervical cancer.

Methods

This study retrospectively analyzed all cervical cancer patients diagnosed while pregnant or immediately postpartum, inclusive from Jan 2010 to June 2019 at our institute. Patient clinical details and follow-up were obtained from hospital records.

Results

The study comprised 40 patients with clinical cancer stages of IA1 (1/40, 2.5%); IB1 (15/40, 37.5%); IB2 (10/40, 25%); IIA (12/40, 30%); and IIB (2/40, 5%). There were 38 patients diagnosed during pregnancy, and 2 diagnosed in the postpartum period. Of the 38 patients, 17 were diagnosed in the first trimester, 13 in the second trimester, and 8 in the third trimester. 10 of 38 patients (26.3%) continued their pregnancy after learning of their diagnosis; 7 (70%) in the third trimester and 3 (30%) in the second trimester. The mean time from diagnosis to surgery in the patients who continued their pregnancy was 52.7 days, which was statistically significantly greater than the termination of pregnancy group (52.7 vs. 16.3 days, P < 0.01). Notably, there was no survival difference between the 2 groups (100% vs. 90.91%, P = 0.54), and none of the pregnant women who ultimately died had delayed treatment due to pregnancy. Similarly, the surgical estimated blood loss and operative duration comparison in the 2 groups were not significantly different.

Conclusions

In the present study, the gestational age of pregnancy at the time of initial diagnosis of cervical cancer was an important determinant in the disease management. Continuation of the pregnancy when diagnosed with cervical cancer may not affect the oncologic outcome of the mother nor increase either surgical or obstetric complications. Additionally, the use of neoadjuvant chemotherapy did not threaten the health of the fetus. These results may be useful in counseling patients facing the diagnosis of cervical cancer during pregnancy.
The relationship between dietary phytochemical index and resting metabolic rate mediated by inflammatory factors in overweight and obese women: a cross-sectional study
Authors: Mirzababaei Atieh , Taheri Akram , Rasaei Niloufar , Mehranfar Sanaz , Jamili Shahin , Clark Cain C. T. , Mirzaei Khadijeh
Published: July 2022

Background

Unhealthy dietary patterns are the most important modifiable risk factors for obesity and overweight. This study aimed to examine the relationship between Dietary Phytochemical Index (DPI) and resting metabolic rate (RMR), mediated by inflammatory factors, in overweight and obese women.

Methods

A total of 404 women, aged 18–48 years, were included in the cross-sectional study. DPI was calculated using the 147-item food frequency questionnaire (FFQ). Anthropometric measurements, RMR, and blood biomarkers were assessed using standard protocols.

Results

There was marginally significant association between adherence to DPI and RMR status in the crude model (OR = 1.41, 95% CI 0.94–2.11, P = 0.09). After adjusting for potential confounders, a significant association was seen between the DPI and increase RMR.per.kg (OR = 2.77, 95% CI 0.98–7.82, P = 0.05). Our results indicated that plasminogen activator inhibitor-1 (PAI-1), transforming growth factor (TGF-β), and monocyte chemoattractant protein-1 (MCP-1) had a mediatory effect on the association between RMR and DPI (P > 0.05). Indeed, it was shown that, PAI-1, TGF-β, and MCP-1 destroyed the significance of this association and could be considered as mediating markers. However, no mediating effect was observed for high-sensitivity C reactive protein (hs-CRP).

Conclusions

Adherence to DPI can improve the RMR by reducing levels of inflammatory markers, and may be considered as a treatment for obesity. However, more long-term studies are recommended.
Where the public health principles meet the individual: a framework for the ethics of compulsory outpatient treatment in psychiatry
Authors: Martinho Sérgio M. , Santa-Rosa Bárbara , Silvestre Margarida
Published: July 2022

Background

Compulsory treatments represent a legal means of imposing treatment on an individual, usually with a mental illness, who refuses therapeutic intervention and poses a risk of self-harm or harm to others. Compulsory outpatient treatment (COT) in psychiatry, also known as community treatment order, is a modality of involuntary treatment that broadens the therapeutic imposition beyond hospitalization and into the community. Despite its existence in over 75 jurisdictions worldwide, COT is currently one of the most controversial topics in psychiatry, and it presents significant ethical challenges. Nonetheless, the ethical debate regarding compulsory treatment almost always stops at a preclinical level, with the different ethical positions arguing for or against its use, and there is little guidance to support for the individual clinicians to act ethically when making the decision to implement COT.

Main body

The current body of evidence is not clear about the efficacy of COT. Therefore, despite its application in several countries, evidence favouring the use of COT is controversial and mixed at best. In these unclear circumstances, ethical guidance becomes paramount. This paper provides an ethical analysis of use of COT, considering the principlist framework established by Ross Upshur in 2002 to justify public health interventions during the 2002–2004 severe acute respiratory syndrome outbreak. This paper thoroughly examines the pertinence of using the principles of harm, proportionality, reciprocity, and transparency when considering the initiation of COT.

Conclusion

Ross Upshur’s principlist model provides a useful reflection tool for justifying the application of COT. This framework may help to inform sounder ethical decisions in clinical psychiatric practice.
Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection
Authors: Yaghoobi Notash Anaram , Yaghoobi Notash Aidin , Omidi Zahra , Haghighat Shahpar
Published: July 2022

Background

Breast cancer-related lymphedema is one of the most important complications that adversely affect patients' quality of life. Lymphedema can be managed if its risk factors are known and can be modified. This study aimed to select an appropriate model to predict the risk of lymphedema and determine the factors affecting lymphedema.

Method

This study was conducted on data of 970 breast cancer patients with lymphedema referred to a lymphedema clinic. This study was designed in two phases: developing an appropriate model to predict the risk of lymphedema and identifying the risk factors. The first phase included data preprocessing, optimizing feature selection for each base learner by the Genetic algorithm, optimizing the combined ensemble learning method, and estimating fitness function for evaluating an appropriate model. In the second phase, the influential variables were assessed and introduced based on the average number of variables in the output of the proposed algorithm.

Result

Once the sensitivity and accuracy of the algorithms were evaluated and compared, the Support Vector Machine algorithm showed the highest sensitivity and was found to be the superior model for predicting lymphedema. Meanwhile, the combined method had an accuracy coefficient of 91%. The extracted significant features in the proposed model were the number of lymph nodes to the number of removed lymph nodes ratio (68%), feeling of heaviness (67%), limited range of motion in the affected limb (65%), the number of the removed lymph nodes ( 64%), receiving radiotherapy (63%), misalignment of the dominant and the involved limb (62%), presence of fibrotic tissue (62%), type of surgery (62%), tingling sensation (62%), the number of the involved lymph nodes (61%), body mass index (61%), the number of chemotherapy sessions (60%), age (58%), limb injury (53%), chemotherapy regimen (53%), and occupation (50%).

Conclusion

Applying a combination of ensemble learning approach with the selected classification algorithms, feature selection, and optimization by Genetic algorithm, Lymphedema can be predicted with appropriate accuracy. Developing applications by effective variables to determine the risk of lymphedema can help lymphedema clinics choose the proper preventive and therapeutic method.
The fatty acid composition in follicles is related to the developmental potential of oocytes up to the blastocyst stage: a single-centre cohort study
Authors: Liu Yujie , Tilleman Kelly , Vlaeminck Bruno , Gervais Rachel , Chouinard P Yvan , De Sutter Petra , Fievez Veerle
Published: July 2022

Background

Advanced maternal age and obesity are associated with impaired female fertility. Moreover, fatty acids (FA) in follicular fluid (FF) play important roles in oocyte maturation and embryo development. However, the effects of body mass index (BMI), age, and FF FA composition on embryo development between days 3 and 5 and blastocyst stage on day 5 are still unclear.

Methods

This study included 138 patients undergoing assisted reproductive technology (ART), which were divided into three BMI groups (18.5–24.9 kg/m2 vs. 25.0–29.9 kg/m2 vs. ≥ 30.0 kg/m2) and three age-related groups (20–30 years vs. 31–34 years vs. ≥ 35 years) which were compared for ART outcomes. Further, observations were divided into quartiles based on either of three parameters related to embryo outcome, i.e. (i) embryos developing between days 3 and 5 (ED3-5) and (ii) expanded blastocysts on day 5 (EB5), both expressed proportionally to the number of oocytes with two pronuclei (2PN), as well as (iii) the embryo utilization rate (EUR). Proportions of FF FA were then compared between Q1 and Q4, representing the quartile with the worst vs. the best embryo outcome, respectively. Finally, regression models were created to assess the relationships between BMI, age, FF total FA (TFA) concentration, relative proportions of specific FA and embryo outcome.

Results

Patients of Q1 had higher proportions of FF C20:5n-3, C22:6n-3 and total n-3 PUFA than Q4 patients. Furthermore, Q4 patients tended to be younger than Q1 patients. Within the whole cohort, the proportion of C20:5n-3 negatively correlated with ED3-5/2PN and EUR, while EB5/2PN tended to be negatively correlated with age. Regression models within the overweight and obese group confirmed the negative relation between C20:5n-3 and ED3-5/2PN, but also indicated additional associations: C18:1n-9 and C20:4n-6 were positively associated with ED3-5/2PN and EUR, respectively while the proportion of C18:0 was negatively associated with EUR.

Conclusion

The proportions of n-3 PUFA, particularly C20:5n-3 and C22:6n-3 were reduced in the patients’ quartile with the best embryo outcome. This group of patients was also younger. However, the embryo quality parameters of overweight/obese patients were not associated with age but were positively associated with FF C18:1n-9 and negatively with the proportions of C18:0 or C20:5n-3.

Trial registration

This study’ registration number was B670201627735.