bluuebunny/crossref_metadata_2025 huggingface dataset:
The concurrence of the current postanalytical phase management with the national recommendations
Authors: Jokic Anja , Rimac Vladimira , Vlasic Tanaskovic Jelena , Podolar Sonja , Honovic Lorena , Lenicek Krleza Jasna
Published: October 2021

The detection and prevention of errors in the postanalytical phase can be done through the harmonization and standardization of constituent parts of this phase of laboratory work. The aim was to investigate how well the ongoing management of the postanalytical phase corresponds to the document “Post-analytical laboratory work: national recommendations” in Croatian medical biochemistry laboratories (MBLs).
All 195 MBLs participating in the national external quality assessment scheme, were invited to undertake a part in a survey. Through 23 questions the participants were asked about management of the reference intervals (RI), delta check, reflex/reflective testing, postanalytical quality indicators and other parts of the postanalytical phase recommended in the national recommendations. The results are presented in numbers and percentages.
Out of 195 MBLs, 119 participated in the survey, giving a response rate of 61%. Not all of the respondents provided answers to all the questions. Delta check has not been used in 59% (70/118) of the laboratories. Only 22/113 (20%) laboratories use reflex and/or reflective testing. In 53% of the laboratories, critical results were reported within 30 minutes of the confirmation of the results. In 34% (40/118) of the laboratories, turnaround time and reporting of critical results are two most often monitored postanalytical quality indicators.
The results showed the critical results reporting and monitoring of postanalytical quality indicators are in the line with the recommendations. However, the management of RI verification, the use of delta check and reflex/reflective testing still must be harmonized among Croatian MBLs.
On the microphthalmous Lathrobium Gravenhorst species of Turkey II. Two new species, a new synonymy, and an updated key to Turkish species (Coleoptera: Staphylinidae: Paederinae)
Authors: ANLAŞ SİNAN
Published: October 2021

In the study, microphthalmous species of the genus Lathrobium Gravenhorst from northern Anatolia are examined. Two new species are described, illustrated, and distinguished from congeners: Lathrobium kacari sp. n. (Çorum province) and L. celiki sp. n. (Amasya province). A new synonym is proposed: Lathrobium bodemeyeri Bernhauer, 1903 = L. paphlagonicum Assing, 2001 syn. n. An updated key to the microphthalmous Lathrobium species of Turkey is presented. Distributions of microphthalmous Lathrobium species in Anatolia are mapped. A total of eight microphthalmous species is now known from Turkey.
Checklist and key for identification of larvae of Hydropsyche species (Hydropsychidae, Trichoptera) of the Maghreb
Authors: BEMMOUSSAT-DEKKAK SOUMYA , ABDELLAOUI-HASSAINE KARIMA , ZAMORA-MUÑOZ CARMEN
Published: October 2021

Twelve species of the genus Hydropsyche (Trichoptera) are reported from the Maghreb; six in Tunisia, eight in Morocco, and eleven in Algeria. These three North African countries are inhabited by common species, except that H. siltalai has been reported only from Algeria and H. pandiel only from Morocco. A list of Hydropsyche species known from the Maghreb is presented and a key for identification of described larvae of Maghreb Hydropsyche species is provided.
Taxonomic notes concerning the genus Catharsius Hope, 1837 (Scarabaeidae: Scarabaeinae)
Authors: TAKANO HITOSHI
Published: October 2021

Catharsius harpagus Harold, 1877 and Catharsius parafastidiosus Ferreira, 1971, both previously considered to belong to the Afrotropical fauna, are herein synonymised with the Asian Catharsius birmanensis Lansberge, 1874 in what are the first cases of transcontinental mislabelling within this genus. This leaves the C. harpagus sensu Ferreira, 1960 (nec Harold) without a name, and Catharsius haroldi sp. nov. is thus described herein. Catharsius convexiusculus (Shipp, 1897) is transferred to the genus Metacatharsius Paulian, 1939, and Metacatharsius omoensis (Müller, 1941) is restored to its original combination in the genus Catharsius.
Discounting under Severe Weather Threat
Authors: Cox David J. , Losee Joy E. , Webster Gregory D.
Published: October 2021

The human and economic costs of severe weather damage can be mitigated by appropriate preparation. Despite the benefits, researchers have only begun to examine if known decision-making frameworks apply to severe weather–related decisions. Using experiments, we found that a hyperbolic discounting function accurately described participant decisions to prepare for, and respond to, severe weather, although only delays of 1 month or longer significantly changed decisions to evacuate, suggesting that severe weather that is not imminent does not affect evacuation decisions. In contrast, the probability that a storm would impact the participant influenced evacuation and resource allocation decisions. To influence people’s evacuation decisions, weather forecasters and community planners should focus on disseminating probabilistic information when focusing on short-term weather threats (e.g., hurricanes); delay information appears to affect people’s evacuation decision only for longer-term threats, which may hold promise for climate change warnings.
A Closer Look at “Taller‐Than‐Wide” Thyroid Nodules: Examining Dimension Ratio to Predict Malignancy
Authors: Mattingly Aviva S. , Noel Julia E. , Orloff Lisa A.
Published: October 2021

Objective

To evaluate nodule height‐to‐width ratio as a continuous variable predicting likelihood of thyroid malignancy.

Study Design

Retrospective cohort study.

Setting

All study information was collected from a single academic tertiary care hospital.

Methods

Subjects included adult patients with thyroid nodules who underwent thyroid surgery between 2010 and 2020. The following variables were collected: patient demographics, nodule dimensions via ultrasound, fine‐needle aspiration biopsy results, and surgical pathology results. Statistical analysis included logistic regression modeling malignancy with variables of interest. We used a receiver operating characteristic curve to assess the discriminatory value of variables.

Results

Height‐to‐width ratio, as a continuous variable, was associated with malignancy (with each 0.1 increase in ratio; odds ratio [OR], 1.25; 95% CI, 1.14‐1.37). The same relationship was true for height‐to‐length ratio (OR, 1.36; 95% CI, 1.24‐1.56). The area under the receiver operating characteristic curve for height‐to‐width ratio was 63.7%. In line with current emphasis on the transverse ultrasound view, we determined 4 different height‐to‐width ratio intervals: <0.8, 0.8 to <1.0, 1.0 to <1.5, and ≥1.5. Likelihood ratios of malignancy for each interval were 0.6, 1.0, 2.3, and 4.9, respectively.

Conclusion

Our results support the association between greater height‐to‐width ratio and malignancy but suggest that a multilevel rather than binary variable improves prediction. The likelihood ratios at different intervals give a more nuanced view of how height‐to‐width ratio predicts malignancy. With continuing review of guidelines for thyroid nodule biopsy, it is important to consider these data for any point total attributed to shape.
Machine learning for lung texture analysis on thin-section CT: Capability for assessments of disease severity and therapeutic effect for connective tissue disease patients in comparison with expert panel evaluations
Authors: Ohno Yoshiharu , Aoyagi Kota , Takenaka Daisuke , Yoshikawa Takeshi , Fujisawa Yasuko , Sugihara Naoki , Hamabuchi Nayu , Hanamatsu Satomu , Obama Yuki , Ueda Takahiro , Hattori Hidekazu , Murayama Kazuhiro , Toyama Hiroshi
Published: October 2021

Background

The need for quantitative assessment of interstitial lung involvement on thin-section computed tomography (CT) has arisen in interstitial lung diseases including connective tissue disease (CTD).

Purpose

To evaluate the capability of machine learning (ML)-based CT texture analysis for disease severity and treatment response assessments in comparison with qualitatively assessed thin-section CT for patients with CTD.

Material and Methods

A total of 149 patients with CTD-related ILD (CTD-ILD) underwent initial and follow-up CT scans (total 364 paired serial CT examinations), pulmonary function tests, and serum KL-6 level tests. Based on all follow-up examination results, all paired serial CT examinations were assessed as “Stable” (n = 188), “Worse” (n = 98) and “Improved” (n = 78). Next, quantitative index changes were determined by software, and qualitative disease severity scores were assessed by consensus of two radiologists. To evaluate differences in each quantitative index as well as in disease severity score between paired serial CT examinations, Tukey's honestly significant difference (HSD) test was performed among the three statuses. Stepwise regression analyses were performed to determine changes in each pulmonary functional parameter and all quantitative indexes between paired serial CT scans.

Results

Δ% normal lung, Δ% consolidation, Δ% ground glass opacity, Δ% reticulation, and Δdisease severity score showed significant differences among the three statuses ( P < 0.05). All differences in pulmonary functional parameters were significantly affected by Δ% normal lung, Δ% reticulation, and Δ% honeycomb (0.16 ≤r2 ≤0.42; P < 0.05).

Conclusion

ML-based CT texture analysis has better potential than qualitatively assessed thin-section CT for disease severity assessment and treatment response evaluation for CTD-ILD.
Application of Machine Learning Techniques to Predict the Occurrence of Distraction-affected Crashes with Phone-Use Data
Authors: Ma Chaolun , Peng Yongxin , Wu Lingtao , Guo Xiaoyu , Wang Xiubin , Kong Xiaoqiang
Published: October 2021

Distraction occurs when a driver’s attention is diverted from driving to a secondary task. The number of distraction-affected crashes has been increasing in recent years. Accurately predicting distraction-affected crashes is critical for roadway agencies to reduce distracted driving behaviors and distraction-affected crashes. Recently, more and more emerging phone-use data and machine learning techniques are available to safety researchers, and can potentially improve the prediction of distraction-affected crashes. Therefore, this study first examines if phone-use events provide essential information for distraction-affected crashes. The authors apply the machine learning technique (i.e., XGBoost) under two scenarios, with and without phone-use events, and compare their performances with two conventional statistical models: logistic regression model and mixed-effects logistic regression model. The comparison demonstrates the superiority of XGBoost over logistic regression with a high-dimensional unbalanced dataset. Further, this study implements SHAP (SHapley Additive exPlanation) to interpret the results and analyze the importance of individual features related to distraction-affected crashes and tests its ability to improve prediction accuracy. The trained XGBoost model achieves a sensitivity of 91.59%, a specificity of 85.92%, and 88.72% accuracy. The XGBoost and SHAP results suggest that: (1) phone-use information is an important factor associated with the occurrences of distraction-affected crashes; (2) distraction-affected crashes are more likely to occur on roadway segments with higher exposure (i.e., length and traffic volume), unevenness of traffic flow condition, or with medium truck volume.
US aid and substitution of human rights violations
Authors: Kiyani Ghashia
Published: October 2021

This paper examines the relationship between US aid and human rights violations in autocracies. It argues that autocratic leaders do not want to lose aid owing to their poor human rights records, and yet at the same time, cannot completely stop their rights violations because they often come into power through force. In this situation, the leader acts strategically by substituting the visible rights violations for invisible ones. However, substitution depends on the strategic relationship between the US and the recipient. If the recipient is strategically unimportant, then we can expect substitution; otherwise, it will not be necessary.
The COVIDPregDK Study: A national survey on pregnancy during the early COVID-19 pandemic in Denmark
Authors: Stokholm Lonny , Schrøder Katja , Nøhr Ellen A. , Rubin Katrine H. , Jørgensen Jan S. , Petersen Lone K. , Bliddal Mette
Published: October 2021

Aim:

We aimed to describe the aim, data collection and content from a survey completed among pregnant women during the first peak of the COVID-19 pandemic in Denmark.

Methods:

The declaration of the COVID-19 pandemic in early 2020 challenged pregnant women’s mental well-being due to a concern for their unborn child and their need for healthcare services through pregnancy and birth. To explore how the COVID-19 pandemic and the intensified measures such as the lockdown of Denmark impacted pregnant women’s well-being and mental health, we conducted a questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its first peak, and the consequences for pregnant women and the unborn child were very uncertain. All women residing in Denmark and registered with an ongoing pregnancy on 24 April 2020 were invited to participate. The questionnaire included background information, variables on COVID-19 symptoms and validated batteries of questions on loneliness, anxiety, stress, quality of life, meditation and prayers. Additional questions were included to examine concerns related to pregnancy and childbirth during the pandemic.

Cohort characteristics:

Almost 18,000 women answered the questionnaire, which represents 60% of all invited women who experienced a national lockdown for the first time. Their median age was 30 years, and they were more likely to be multiparous.

Conclusions:

Data from the COVIDPregDK Study will enable us to gain valuable knowledge on how the pandemic, the intensified measures from the health authorities and the national lockdown affected pregnant women’s mental health and their concerns during the COVID-19 pandemic.
Design analysis and fabrication of side-drive electrostatic micromotor by UV-SLIGA
Authors: Shukla Rahul , Beera Gowtham , Dubey Ankit , Sharma Varun P. , Sankar P. Ram , Dhawan Rajnish , Tiwari Pragya , Sinha A. K.
Published: October 2021

In the present work, a micro-electro-mechanical system (MEMS)-based electrostatic micromotor is designed and fabricated. Finite element analysis is done and various parameters affecting the torque are studied. Maximum torque is achieved at 120° phase angle. The effect of change in voltage, micromotor height and frequency is analysed and discussed. UV-SLIGA, a microfabrication technique, is used for the fabrication of electrostatic micromotor of height 30µm and higher. UV lithography is conducted by both positive AZ P4620 and negative (SU-8 10 and SU-8 2150) photoresists. Copper (Cu) is used as a sacrificial layer to release the rotor (the movable part) of the electrostatic micromotor. Electroformed nickel (Ni) is used for making stator, rotor and axle, whereas chromium (Cr) is used as a seed layer. The micromotor is fabricated with a stator-rotor pole having configuration ratio of 3:2. The gap between the rotor and axle is 20 µm. Wet chemical etching is used to etch the deposited metal layers (Cr, Ni and Cu). Challenges such as the adhesion between the photoresist mould and substrate, cracks, seepage and misalignment are faced during the microfabrication. These challenges are overcome by optimizing the various parameters. The fabrication of electrostatic micromotor is done successfully and the results are discussed in the article.
Genome-wide scans for signatures of selection in Mangalarga Marchador horses using high-throughput SNP genotyping
Authors: Santos Wellington B. , Schettini Gustavo P. , Maiorano Amanda M. , Bussiman Fernando O. , Balieiro Júlio C. C. , Ferraz Guilherme C. , Pereira Guilherme L. , Baldassini Welder Angelo , Neto Otávio R. M. , Oliveira Henrique N. , Curi Rogério A.
Published: October 2021

Background

The detection of signatures of selection in genomic regions provides insights into the evolutionary process, enabling discoveries regarding complex phenotypic traits. In this research, we focused on identifying genomic regions affected by different selection pressures, mainly highlighting the recent positive selection, as well as understanding the candidate genes and functional pathways associated with the signatures of selection in the Mangalarga Marchador genome. Besides, we seek to direct the discussion about genes and traits of importance in this breed, especially traits related to the type and quality of gait, temperament, conformation, and locomotor system.

Results

Three different methods were used to search for signals of selection: Tajima’s D (TD), the integrated haplotype score (iHS), and runs of homozygosity (ROH). The samples were composed of males (n = 62) and females (n = 130) that were initially chosen considering well-defined phenotypes for gait: picada (n = 86) and batida (n = 106). All horses were genotyped using a 670 k Axiom® Equine Genotyping Array​ (Axiom MNEC670). In total, 27, 104 (chosen), and 38 candidate genes were observed within the signatures of selection identified in TD, iHS, and ROH analyses, respectively. The genes are acting in essential biological processes. The enrichment analysis highlighted the following functions: anterior/posterior pattern for the set of genes (GLI3, HOXC9, HOXC6, HOXC5, HOXC4, HOXC13, HOXC11, and HOXC10); limb morphogenesis, skeletal system, proximal/distal pattern formation, JUN kinase activity (CCL19 and MAP3K6); and muscle stretch response (MAPK14). Other candidate genes were associated with energy metabolism, bronchodilator response, NADH regeneration, reproduction, keratinization, and the immunological system.

Conclusions

Our findings revealed evidence of signatures of selection in the MM breed that encompass genes acting on athletic performance, limb development, and energy to muscle activity, with the particular involvement of the HOX family genes. The genome of MM is marked by recent positive selection. However, Tajima’s D and iHS results point also to the presence of balancing selection in specific regions of the genome.
Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study)
Authors: Lakhal Karim , Bigot-Corbel Edith , Sacchetto Emilie , Chabrun Floris , Senage Thomas , Figueres Lucile , Leroy Maxime , Legrand Arnaud , Rozec Bertrand
Published: October 2021

Background

For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI.

Methods

Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6).

Results

In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCrpostCPB-H6): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUCROC) of 0.84 [95%CI:0.73–0.92] vs. ≤0.67 [95%CI:0.54–0.78], p ≤ 0.03. The AUCROC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59–0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCrpostCPB-H6 was of no evident added value over considering ∆pCrpostCPB-H6 alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCrpostCPB-H6 (AUCROC = 0.69 [95%CI:0.48–0.85]).

Conclusions

In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required.
Prognostic factors associated with quality of life in heart failure patients considering the use of the generic EQ-5D-5L™ in primary care: new follow-up results of the observational RECODE-HF study
Authors: Boczor Sigrid , Eisele Marion , Rakebrandt Anja , Menzel Agata , Blozik Eva , Träder Jens-Martin , Störk Stefan , Herrmann-Lingen Christoph , Scherer Martin ,   for the RECODE-HF study group, Adam Winfried , Behrens Cassandra , Blozik Eva , Boczor Sigrid , Eisele Marion , Harder Malte , Herrmann-Lingen Christoph , Menzel Agata , Lühmann Dagmar , Rakebrandt Anja , Roeper Koosje , Scherer Martin , Störk Stefan , Träder Jens-Martin
Published: October 2021

Background

The implementation of care concepts fitting the needs of patients with chronic heart failure (HF) remains challenging. In this context, psycho-emotional well-being is not routinely assessed, and under-researched despite indications that it is of great relevance for, e.g., acceptance, adherence, and prognosis. The aim of this study was to observe clinical characteristics for their prognostic utility in HF patients, and to compare the patients’ health-related quality of life (QoL) with German population norm values.

Methods

The current post-hoc analysis was performed on data collected amongst participants of the RECODE-HF study who had fully answered the EQ-5D-5L™ items at both baseline and 12 months (n = 2354). The status in the patients’ self-assessment items, EQ-5D visual analog scale (VAS) and EQ-5D index was categorized into worse/unchanged/improved. General linear mixed models (GLMM) with logit link were applied. Subgroups included 630 patients (26.8%) screened positive and 1724 patients (73.2%) screened negative for psychosocial distress (PSD).

Results

The 12-months change in EQ-5D index, generally resulting from change in individual EQ-5D items, additionally associated not only with high NYHA class but sociodemographics (employment/living alone/GP practice years) (96.2% correctly classified in GLMM). The 12- months change in individual QoL aspects showed associations with age*NYHA, gender, body-mass index, and comorbidities dyslipidemia, myocardial infarction, asthma/chronic pulmonary disease. Important social roles were reflected in particular when HF patients lived alone or the doctor mentioned to the patient that the patient had HF. Patients with/without PSD differed in some sociodemographic and clinical parameters. However, no influence of PSD could be demonstrated in the 12-month follow-up of the EQ-5D-5L™. Nonetheless, comparison of the 12-months QoL with general German population norm values by age groups < 75 years and 75+ showed markedly health restrictions in HF patients in all EQ-5D-5L™ aspects.

Conclusion

Our analysis revealed different prognostic factors primarily associated with change of burden in different QoL aspects in HF patients. In GP practice it is important to consider in addition to the overall day-related VAS all the individual health-related QoL aspects to take a holistic view of the patient, as well as to pay particular attention to the interrelation of individual characteristics.
A combined prediction model for biliary tract cancer using the prognostic nutritional index and pathological findings: a single-center retrospective study
Authors: Utsumi Masashi , Kitada Koji , Tokunaga Naoyuki , Kato Takamitsu , Narusaka Toru , Hamano Ryosuke , Miyasou Hideaki , Tsunemitsu Yousuke , Otsuka Shinya , Inagaki Masaru
Published: October 2021

Background

The prognostic nutritional index, a marker of nutritional status and systemic inflammation, is a known biomarker for various cancers. However, few studies have evaluated the predictive value of the prognostic nutritional index in patients with biliary tract cancer. Therefore, we investigated the prognostic significance of the prognostic nutritional index, and developed a risk-stratification system to identify prognostic factors in patients with biliary tract cancer.

Methods

Between July 2010 and March 2021, 117 patients with biliary tract cancer were recruited to this single-center, retrospective study. The relationship between clinicopathological variables, including the prognostic nutritional index, and overall survival was analyzed using univariate and multivariate analyses. AP < 0.05 was considered statistically significant.

Results

The median age was 75 (range 38–92) years. Thirty patients had intrahepatic cholangiocarcinoma; 29, gallbladder carcinoma; 27, distal cholangiocarcinoma; 17, ampullary carcinoma; and 13, perihilar cholangiocarcinoma. Curative (R0) resection was achieved in 99 patients. In univariate analysis, the prognostic nutritional index (< 42), lymph node metastasis, carbohydrate antigen 19-9 level (> 20 U/mL), preoperative cholangitis, tumor differentiation, operation time (≥ 360 min), and R1–2 resection were significant risk factors for overall survival. The prognostic nutritional index (P = 0.027), lymph node metastasis (P = 0.040), and tumor differentiation (P = 0.006) were independent prognostic factors in multivariate analysis. A combined score of the prognostic nutritional index and pathological findings outperformed each marker alone, in terms of discriminatory power.

Conclusions

The prognostic nutritional index, lymph node metastasis, and tumor differentiation were independent prognostic factors after surgical resection in patients with biliary tract cancer. A combined prediction model using the prognostic nutritional index and pathological findings accurately predicted prognosis, and can be used as a novel prognostic factor in patients with biliary tract cancer.
Multiple cerebral infarctions associated with lung cancer-induced hypereosinophilia: a case report
Authors: Ozaki Maki , Mano Tomoo , Eura Nobuyuki , Horimoto Kazuhide , Takano Masato , Ohbayashi Chiho , Sugie Kazuma
Published: October 2021

Background

Hypereosinophilia (HE) is caused by various conditions, including solid and hematologic tumors. Nonetheless, there exist no reports on cerebral infarctions caused by HE associated with lung cancer metastasis to the bone marrow.

Case presentation

We report a case of a 67-year-old man with multiple cerebral infarctions associated with HE. His white blood cell and eosinophil counts were 38,900/μL and 13,600/μL, respectively, at 4 weeks before admission. During treatment for HE, he presented with dysarthria and walking difficulties. Magnetic resonance imaging of the brain showed multiple small infarcts in regions such as the bilateral cortex, watershed area, and cerebellum. Chest computed tomography showed small nodes in the lung and enlargement of the left hilar lymph nodes. Bronchoscopic biopsy did not reveal a tumor; however, bone marrow biopsy showed infiltration of tumor cells. We considered a diagnosis of lung cancer metastasizing to the bone marrow, which induced HE and later caused cerebral infarctions.

Conclusions

This case report demonstrates that metastatic cancer in the bone marrow can induce HE, which can consequently cause multiple cerebral infarctions. Clinicians should consider HE as a cause of multiple cerebral infarctions in patients with cancer.
The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study
Authors: Wang Yan , Luo Biru , Xiang Jie
Published: October 2021

Background

The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes.

Methods

Pregnant women between 13 and 24 weeks of gestation were recruited at a women’s and children’s hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments.

Results

A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section.

Conclusion

Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM.

Trial registration

Registration number: ChiCTR1900023721. Date of registration: June 9, 2019.
Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic
Authors: Liu Zhuang , Liu Rongxun , Zhang Yue , Zhang Ran , Liang Lijuan , Wang Yang , Wei Yange , Zhu Rongxin , Wang Fei
Published: October 2021

Objective

The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China.

Methods

A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors.

Results

In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19.

Conclusions

Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.
Stressful life events among individuals with a history of eating disorders: a case-control comparison
Authors: Lie Selma Ø. , Bulik Cynthia M. , Andreassen Ole A. , Rø Øyvind , Bang Lasse
Published: October 2021

Background

Experiencing stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other non-sexual SLEs and EDs.

Method

A case-control study of individuals with (n = 495, age mean ± SD = 29.1 ± 9.8 years) and without (n = 395, age = 30.2 ± 11.7) self-reported lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported history of sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events using an adaptation of the Stressful Life Events Screening Questionnaire. Individuals with EDs were divided into ED subtypes along the restricting – binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted for each SLE and ED subtype to obtain odds ratios (ORs). We report p-values corrected for multiple comparisons.

Results

Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p < .001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common among individuals with a history of binge-eating/purging ED subtypes (ORs = 2.15–3.58, p’s < .01) compared with controls. Furthermore, history of life-threatening disease and loss of a close relative/partner/friend were associated with some ED subtypes. The association between SLEs and EDs was stronger for individuals who had experienced multiple SLEs.

Conclusion

By investigating a range of different SLEs, we showed that both sexual and non-sexual SLEs were more common in individuals with a history of EDs (binge-eating/purging subtypes) than controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs.
Investigation on returning to work in liver cancer survivors in Taiwan: a 5-year follow-up study
Authors: Yang Shih-Wei , Chen Wei-Liang , Wu Wei-Te , Wang Chung-Ching
Published: October 2021

Background

Primary liver cancer is the fifth most common malignancy and limits patients’ quality of life and working ability. Return to work after cancer treatment is an important step in social recovery. In addition, return to work represents the recovery of financial ability and improvements in self-confidence. The purpose of this article is to discuss the relationship between return to work and various covariables in workers with liver cancer.

Methods

The national registry cohort study collected adult workers newly diagnosed with liver cancer from 2004 to 2010 in Taiwan. There were 2451 workers included in our study. Primary liver cancer was diagnosed by using the International Classification of Diseases for Oncology code. Return to work after liver cancer survival was determined as returning to the same work or reemployment within five years after cancer diagnosis. The associations between independent variables and return to work were analyzed by Cox proportional hazard models.

Results

Workers who underwent surgery were more likely to return to work not only in the 2nd year but also in the 5th year. A lower survival rate was noted in the non-return-to-work group (p < 0.001) among all patients with liver cancer. The completely adjusted model identified that the rate of return to work was related to all-cause mortality with a hazard ratio of 0.244 (95% Confidence Intervals: 0.235–0.253).

Conclusions

Our study indicated the impacts of treatment on the return to work of liver cancer survivors. In addition, in patient with liver cancer, return to work had positive effect on the survival rate.
Elbow valgus stability of the transverse bundle of the ulnar collateral ligament
Authors: Edama Mutsuaki , Matsuzawa Kanta , Yokota Hirotake , Hirabayashi Ryo , Sekine Chie , Maruyama Sae , Sato Noboru
Published: October 2021

Background

The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability.

Methods

Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load.

Results

No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N.

Conclusion

The findings from this study suggested that the TB may be involved in elbow valgus stability.
Temporary spanning plate across the elbow for complex fractures of the distal humerus
Authors: Moharram Ashraf N. , Mahmoud Mostafa , Lymona Ahmed , Afifi Ahmed , Ezzat Mostafa , Abdel-Wahed Mohamed
Published: October 2021

Background

Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union.

Methods

Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected.

Results

Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27.

Conclusion

Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss.

Level of evidence

Level IV, Therapeutic study
Discovery and validation of methylation signatures in circulating cell-free DNA for early detection of esophageal cancer: a case-control study
Authors: Qiao Guibin , Zhuang Weitao , Dong Bo , Li Chengcheng , Xu Jiayue , Wang Guoqiang , Xie Liang , Zhou Zihao , Tian Dan , Chen Gang , Tang Jiming , Zhou Haiyu , Zhang Dongkun , Shi Ruiqing , Chen Rixin , Nian Weiqi , Zhang Yuzi , Zhao Jing , Wen Xiaofang , Xu Yu , Li Bingsi , Zhang Zhihong , Cai Shangli , Ben Xiaosong , Qi Yu
Published: October 2021

Background

Plasma cell-free DNA (cfDNA) methylation has shown promising results in the early detection of multiple cancers recently. Here, we conducted a study to investigate the performance of cfDNA methylation in the early detection of esophageal cancer (ESCA).

Methods

Specific methylation markers for ESCA were identified and optimized based on esophageal tumor and paired adjacent tissues (n = 24). Age-matched participants with ESCA (n = 85), benign esophageal diseases (n = 10), and healthy controls (n = 125) were randomized into the training and test sets to develop a classifier to differentiate ESCA from healthy controls and benign esophageal disease. The classifier was further validated in an independent plasma cohort of ESCA patients (n = 83) and healthy controls (n = 98).

Results

In total, 921 differentially methylated regions (DMRs) between tumor and adjacent tissues were identified. The early detection classifier based on those DMRs was first developed and tested in plasma samples, discriminating ESCA patients from benign and healthy controls with a sensitivity of 76.2% (60.5–87.9%) and a specificity of 94.1% (85.7–98.4%) in the test set. The performance of the classifier was consistent irrespective of sex, age, and pathological diagnosis (P > 0.05). In the independent plasma validation cohort, similar performance was observed with a sensitivity of 74.7% (64.0–83.6%) and a specificity of 95.9% (89.9–98.9%). Sensitivity for stage 0–II was 58.8% (44.2–72.4%).

Conclusion

We demonstrated that the cfDNA methylation patterns could distinguish ESCAs from healthy individuals and benign esophageal diseases with promising sensitivity and specificity. Further prospective evaluation of the classifier in the early detection of ESCAs in high-risk individuals is warranted.
The workforce for rehabilitation in primary health care in Brazil
Authors: da Silva Debora Bernardo , dos Santos Sixel Taciana Rocha , de Almeida Medeiros Arthur , dos Santos Mota Paulo Henrique , Bousquat Aylene , Schmitt Ana Carolina Basso
Published: October 2021

Background

Studies on the workforce in rehabilitation in primary health care services are still unusual in health systems analysis. Data on the health worker density at the subnational level in rehabilitation in primary health care are not commonly observed in most health systems. Nevertheless, these data are core for the system's planning and essential for finding the balance between the composition, distribution, and number of workers for rehabilitation actions.

Objective

This study aims to analyze the temporal space distribution of health professionals with higher education who performed rehabilitation actions in primary health care in Brazil from 2007 to 2020.

Method

This is an ecological, time-series study on the supply of physiotherapists, audiologists, psychologists, and occupational therapists in primary health care, vis-a-vis the implementation of the Brazilian health policy denominated the Integrated Health Service Network for People with Disabilities. The data were obtained from the National Registry of Health Facilities. The period of analysis was from 2007 to 2020. The health worker density coefficient was calculated per 10,000 inhabitants annually, considering the five geographic regions of Brazil. The time trends of the coefficient of health professionals per year in Brazil and geographic regions were analyzed. For this purpose, joinpoint regression analysis was carried out. The average annual percentage variation was estimated, considering the respective confidence interval of 95%.

Results

In 2007, there were 0.12 physiotherapists/10,000 inhabitants (2326), 0.05 audiologists/10,000 inhabitants (1024), and 0.205 psychologists/10,000 inhabitants (3762). In 2020, there was an increase in the coefficient of professionals/10,000 inhabitants in all professional categories to 0.47 psychologists (> 268.1%), 0.46 physiotherapists (> 424.8%), 0.14 audiologists (> 297.1%), and 0.04 occupational therapists (> 504.5%). There was a significant increase in the supply of physiotherapists (AAPC: 10.8), audiologists (AAPC: 7.6), psychologists (AAPC: 6.8), and occupational therapists (AAPC: 28.3), with little regional variation.

Conclusion

Public health policies for rehabilitation have contributed to an increase in the workforce caring for people with disabilities in primary health care services. An increase in the workforce of physiotherapists, audiologists, psychologists, and occupational therapists was observed throughout the period studied in all regions.
A retrospective study of survival and risk factors for mortality among people living with HIV who received antiretroviral treatment in a resource-limited setting
Authors: Manosuthi Weerawat , Charoenpong Lantharita , Santiwarangkana Chalor
Published: October 2021

Background

The availability and accessibility of effective antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved in the past two decades in resource-limited settings. Therefore, evaluation of survival is needed in the current setting.

Method

We retrospectively analyzed secondary data of the national AIDS program database from national health security region number 4 among PLWH who were ART-naive between January 2014 and December 2018. All PLWH were followed until December 2019 to evaluate their survival status and possible risk factors related to death.

Results

A total of 42,229 PLWH were identified, of which 14,053 were ART-naive and thus enrolled in the study. Sixty-seven percent were male, the mean ± SD age was 35 ± 12 years, and the median (IQR) baseline CD4 count was 162 (44–353) cells/mm3. Regarding medical care benefits, 46% had a universal health coverage scheme, 34% had a national social security scheme, and 2% had a civil servants medical benefit scheme. A total of 2142 (15%) mortalities occurred during the total follow-up period of 28,254 patient-years. The mortality rate was 7.5 (95% CI 7.2–7.9) per 100 person-years. Survival rates at 1, 2, 3, 4 and 5 years after HIV registration were 88.2% (95% CI 87.6–88.7%), 85.3% (95% CI 84.6–85.9%), 82.9% (95% CI 81.9–83.4%), 81.3% (95% CI 80.5–82.0%) and 75.1% (95% CI 73.5–76.8%), respectively. The Cox proportional hazards model showed that all-cause mortality was associated with a history of ART switching (HR = 7.06, 95% CI 4.53–11.00), major opportunistic infections during ART (HR = 1.93, 95% CI 1.35–2.77), baseline CD4 count ≤ 200 vs. > 500 cells/mm3 (HR = 4.00, 95% CI 1.45–11.11), age ≥ 50 vs. < 30 years (HR = 1.77, 95% CI 1.12–2.78), and receiving nevirapine-based regimens(HR = 1.43, 95% CI 1.04–1.97).

Conclusions

This study demonstrated the substantial mortality rate over the consecutive 5 years of the follow-up period among PLWH who received ART in a resource-limited setting. Early case finding and prompt initiation of ART as well as continuous HIV care are a cornerstone to improve survival.