bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis
Authors: Wathanavasin Wannasit , Phannajit Jeerath , Poosoonthornsri Manorom , Lewsuwan Songkiat , Tanateerapong Patchara , Chongthanakorn Kamonrat , Takkavatakarn Kullaya , Katavetin Pisut , Tiranathanagul Khajohn , Eiam-ong Somchai , Susantitaphong Paweena
Published: September 2021

Background:

Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports.

Objective:

To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients.

Design:

A multicenter, randomized, open-label study

Setting:

In a developing country, Thailand

Patients:

Chronic HD patients with tunneled central venous catheter

Measurements:

Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infection

Methods:

The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI).

Results:

The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA).

Limitations:

Short follow-up period.

Conclusions:

In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis.

Trial registration:

The study was registered with the Thai Clinical Trials Registry TCTR 20200610003
Visualization of the renal artery in kidney transplant patients using time-resolved computed tomography angiography
Authors: Anders Svensson-Marcial , Helena Genberg , Katharina Brehmer , Raquel Themudo , Torkel Brismar B
Published: October 2021

Background

Transplant renal artery stenosis (TRAS) is a post-operative complication which most often occurs between 3 months and 2 years after transplantation. TRAS is associated with kidney failure and hypertension and, thereby, with an increased risk of cardiovascular events.

Purpose

The purpose of this retrospective study was to report our experience of perfusion computed tomography angiography (P-CTA) to identify a 50% lumen reduction (as compared to digital subtraction angiography, DSA), assess its subjective image quality and evaluate if contrast-induced acute kidney injury (CI-AKI) occurred.

Material and Methods

All 13 patients who had undergone P-CTA for suspected TRAS at our institution were retrospectively evaluated. At P-CTA, eight or 12 g of iodine were administered intravenously, and five to seven scan sequences were merged into time-resolved images after motion correction. Eight patients underwent subsequent DSA.

Results

The average patient weight was 76 kg (range 55–97 kg). Image quality was rated as good or excellent for all patients, and pathological changes were shown in 10 of 13 patients undergoing P-CTA. Two patients had a serum creatinine increase of >26 μmol/L during the first 3 days, but serum creatinine was significantly lower in all patients 1 month after P-CTA (165+/−69 μmol/L versus 232+/−66 μmol/L, P < .01). The diagnosis at P-CTA was verified in all eight patients who underwent DSA. However, in two cases with suspected stenosis, renal function was restored without angioplasty.

Conclusion

Anatomy and blood flow of the transplant renal artery can be visualized using less than a third of the standard contrast media dose by using P-CTA technique.
Acute Kidney Injury After Neonatal Aortic Arch Surgery: Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermia With Distal Aortic Perfusion
Authors: Böttcher Wolfgang , Weixler Viktoria , Redlin Mathias , Murin Peter , Dehmel Frank , Schmitt Katharina , Cho Mi-Young , Miera Oliver , Sinzobahamvya Nicodème , Photiadis Joachim
Published: October 2021

Background:

Acute kidney injury (AKI) is a common complication observed after neonatal aortic arch repair. We studied its incidence after procedures carried out using deep hypothermic circulatory arrest (DHCA) versus moderate hypothermia with distal aortic perfusion (MHDP), usually through the common femoral artery. In both groups, continuous regional cerebral perfusion (RCP) was used during the time required for aortic arch repair.

Methods:

A total of 125 neonates underwent aortic arch repair. Between 2007 and 2012, DHCA with RCP was used in 51 neonates. From 2013 to 2019, MHDP with RCP was performed on 74 newborns. Operative complexity was similar in both periods. Acute kidney injury was defined as a significant elevation of serum creatinine and was classified according to the neonatal modified n-KDIGO (neonatal Kidney Disease: Improving Global Outcomes) stages 1 to 3 (Kidney Disease Improving: Global Outcomes).

Results:

Acute kidney injury was observed in a total of 68 patients (68/125: 54.4%). In the majority (44/68: 64.7%), n-KDIGO stage 1 occurred. Stage 2 (n = 14) and stage 3 (n = 10) were observed more frequently after DHCA versus MHDP: 29.4% (15/51) versus 12.2% (9/74), P = .02. At cardiopulmonary bypass end, lactate levels were significantly higher ( P = .001) after DHCA: 3.4 (2.9-4.3) mmol/L compared to 2.7 (2.3-3.7) mmol/L after MHDP. Early mortality was 12% (15/125) in the entire cohort. It was 17.6% (9/51) after DHCA versus 8.1% (6/74) after MHDP, however not statistically significant ( P = .16).

Conclusion:

Mild (stage 1) AKI occurred frequently after neonatal aortic arch repair. The use of MHDP was associated with a significantly lower incidence of moderate (stage 2) and severe (stage 3) AKI forms.
Systemic Venous Reconstructions During Pediatric Heart Transplantation
Authors: Altin Firat , Alsoufi Bahaaldin , Kanter Kirk , Deshpande Shriprasad R.
Published: October 2021

Background:

Congenital heart disease continues to be an important indication for pediatric heart transplantation (HT) and is often complicated by systemic venous anomalies. The need for reconstruction, surgical technique used, as well as the outcomes of these have limited documentation.

Methods:

Descriptive, retrospective study of patients transplanted at Emory University between 2006 and 2017. We reviewed surgical data, follow-up, and interventions for patients necessitating venous reconstruction during transplantation.

Results:

A total of 179 transplants were performed during the time period of which 74 (41%) required systemic venous reconstruction. Mean age at transplant was 6.3 (±6.16) years, and 74.3% of these patients carried a diagnosis of single ventricle; 51 (68.9%) of 74 patients required pulmonary artery reconstruction at the time of HT. Forty patients required superior vena caval reconstruction, while 22 patients required inferior vena caval reconstruction due to prior palliation or anomaly. Venous anomalies along with other anatomic features necessitated biatrial transplantation in four patients. Posttransplant evaluation revealed systemic venous stenosis in 14 (18.9%) of 74 patients. Eight (10.8%) patients required 12 interventions for the systemic veins. Patients with bilateral Glenn anastomosis prior to transplant were at high risk for the development of stenosis and needing interventions. Systemic venous complications were uncommon in those with native systemic veins without Glenn or Fontan procedure.

Conclusion:

Systemic venous reconstruction needs are high in pediatric HT. Posttransplant stenosis and the need for interventions are relatively common. Current techniques for systemic venous reconstruction for complex congenital heart disease patients may deserve further review to optimize these outcomes.
Long-Term Outcome Following Pulmonary Valve Replacement in Repaired Tetralogy of Fallot
Authors: Al Mosa Alqasem Fuad H. , Madathil Sreenath , Bernier Pierre-Luc , Tchervenkov Christo
Published: October 2021

Background:

Late pulmonary valve replacement following repair of tetralogy of Fallot may become necessary in patients with chronic pulmonary insufficiency. There is limited information on the long-term outcome of these prostheses, which is the focus of this study.

Methods:

We conducted a retrospective study of patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement from 1990 to 2015 in our institution. We investigated imaging and clinical parameters including mortality and late adverse events (reintervention [surgical or transcatheter]), infective endocarditis, or arrhythmias requiring device implantation or ablation.

Results:

There were 69 patients divided into 3 groups: Carpentier-Edwards (n = 14), Contegra (n = 40), and pulmonary homograft (n = 15). The mean age at the time of pulmonary valve replacement was 21 ± 12 years. The mean follow-up was 8.5 ± 4.7 years. The mean preoperative and postoperative right ventricular end-diastolic volume index was 210 ± 42 and 120 ± 24 mL/m2, respectively. There were no mortalities. Late adverse events were observed in 23 (33%) patients: 15 (22%) reintervention (surgical or transcatheter), 11 (16%) endocarditis, and 11 (16%) arrhythmias. Overall, 1-, 5-, and 10-year freedom from surgical reintervention was 98.5%, 93.6%, and 79.3%, respectively. The Contegra group had significantly higher pulmonary valve gradients, a higher risk of developing late adverse events compared to Carpentier-Edwards ( P = .046) and pulmonary homograft ( P = .055) in multivariate analysis and increased risk for reintervention in the univariate analysis (hazard ratio: 3.4; 95% CI: 0.92-13; P value.066).

Conclusion:

Pulmonary valve replacement in patients with repaired tetralogy of Fallot has acceptable short- and intermediate-term outcomes. Contegra prosthesis had a higher risk of late adverse events with higher pulmonary valve gradients.
Impact of Transcatheter Pulmonary Artery Intervention Following Superior Cavopulmonary Connection on Pulmonary Artery Growth
Authors: Chaszczewski Kasey J. , Huang Jing , Fuller Stephanie , Smith Christopher L. , Dori Yoav , Glatz Andrew C. , Gillespie Matthew J. , Rome Jonathan J. , O’Byrne Michael L.
Published: October 2021

Introduction:

Balloon and stent angioplasty of the pulmonary arteries (PAs) are frequently performed following superior cavopulmonary connection (SCPC), not only to normalize the caliber of the affected PA but also in hopes of maximizing downstream growth over time. There are limited data on the impact on subsequent PA growth prior to total cavopulmonary connection (TCPC).

Methods:

A single-center, retrospective cohort study was performed on children who underwent transcatheter (TC) PA intervention following SCPC between January 1, 2010, and December 31, 2018. Growth of treated and contralateral PAs was measured at the lobar bifurcation (distal branch PA [DBPA]) and in the proximal lower lobe (lower lobe branch [LLB]) on serial angiograms. Growth rate was evaluated using a mixed-effect model clustered by individual patient with an interaction term for treated PA and time to evaluate for differential growth rates between treated and contralateral PAs.

Results:

Thirty-five patients underwent TC PA intervention following SCPC, at a median of 70 days (interquartile range: 19-297 days) postoperatively. Significant growth was seen at both DBPA and LLB for raw (0.8 mm/year, 95% CI: 0.6-1.0, P < .001 for both) and body surface area (BSA) adjusted measures (8.4mm/m2/year, 95% CI: 5.6-11.2, P < .001; 7.9 mm/m2/year, 95% CI: 5.5-10.2, P < .001). The growth rate of the treated vessel was not significantly different from that of the contralateral vessel at the DBPA or LLB positions for raw ( P = .71, .70) or BSA-adjusted measurements ( P = .86, .64).

Conclusion:

Transcatheter PA intervention was associated with normal distal PA growth rate relative to the untreated side.
Effect of Nonsurgical Versus Surgical Management on Geriatric Hip Fracture Mortality of Hispanic-American Male Veterans
Authors: De Virgilio-Salgado Lucas G. , Olivella Gerardo , Ruberté Henry , Abreu Ricardo J. , Otero-López Antonio , Reyes-Martínez Pedro , Ramírez Norman , Otero-López Francisco
Published: October 2021

Introduction

The effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied. Hence, we examined the mortality and life expectancy effect of nonsurgical vs surgical management after hip fracture in a geriatric Hispanic-American male veterans’ population.

Material and Methods

This was a retrospective cohort study of Hispanic-American male veterans who were 65 years of age or older and suffered a femoral neck or intertrochanteric fracture from January 2008 to December 2015. Analysis between a surgical cohort (cannulated screw fixation, hemiarthroplasty, total hip arthroplasty, or cephalomedullary nail) and a non-surgical cohort was performed. In-hospital, 30-day, one-year, and two-year mortality were compared between both groups.

Results

Out of 268 patients with hip fracture, 159 (59.2%) were treated surgically and 109 (40.8%) non-surgically. The overall in-hospital (9.2% vs 1.9%, P = .009), 30-day (17.4% vs 5.0%, P = .002), one-year (48.6% vs 23.3%, P < .001), and two-year (63.3% vs 36.5%, P < .001) mortality rate was found to be higher for the nonoperative group. The average life expectancy of the nonoperative cohort was significantly shorter than those who were managed surgically (216 days vs 260 days, P < .001).

Discussion and Conclusion

This study shows a higher mortality rate and lower life expectancy in geriatric male patients who were treated nonsurgically in a Veterans Health Affair hospital facility that mostly serves Hispanic-American veterans. Our results provide an expansion to the findings of other geriatric studies on hip fracture with focus in a Hispanic-American veteran male population.
Political Economy of Education: Assessing Institutional and Structural Constraints to Quality and Access to Education Opportunities in Tanzania
Authors: Ochieng Haggai Kennedy , Yeonsung Cho
Published: September 2021

In the year 2000, a global agenda to achieve quality education for all children by 2015 was birthed. However, even after the lapse of this period, quality of education remained low in developing countries. In light of this, the World Bank developed a framework for assessing education quality based on six facets, namely, assessment; autonomy; accountability; attention to teachers; attention to early childhood development; and attention to culture, together called 6As. Based on this framework, this paper examines education quality and attainment in Tanzania, and how Korea, which has partnered with Tanzania can help mitigate the challenges in the sector, which the two countries have set as their priority development partnership sector. The study is qualitative analysis based on secondary data. The study finds that Tanzania has made significant progress in line with education for all, exhibited by high enrollment rates, which is above the average of sub-Saharan Africa. Nonetheless, major failures exist in regard to quality of education, occasioned by policies that are inconsistent with the 6As. In situations where proper reforms have been instituted, laxity in enforcement have played a role to undermine quality. Moreover, Korea’s support to Tanzania does not involve significant cross-border financial flows. As a result, the impact of its assistance on local education system is limited. The paper recommends significant reforms in education management. Korea can leverage its partnership with Tanzania to initiate stakeholder dialog in areas of necessary reforms. It should also increase cross-border financial flows and provide technical assistance to Tanzania’s based on its success with education reforms.
Trend of Migration Studies in Sociocultural Anthropology: A Critical Analysis
Authors: Kaur Kiran Jyoti , Sinha A. K.
Published: October 2021

Migration studies have always found their unique place in anthropology since the birth of anthropology in India under colonial rule. From the formative phase, anthropology of migration has grown multifold. In the present time when the Indian diaspora is the largest in the whole world, the process of migration has affected the lives of all individuals and has become an important area of research. The present article examines the growth of this field in sociocultural anthropology in India and is based on secondary data. Work of renowned Indian anthropologists like M. N. Srinivas, Moni Nag, L. P. Vidyarthi, Amitav Ghosh and others like R. K. Jain, Ashish Bose, etc. on migration has been discussed in the present article. Migration studies in India have found and sustained a key place in the anthropology curriculum report since the first time of its release by the University Grants Commission, New Delhi. Migration studies have grown from studying mobility among the tribals to the movement of people from rural to urban areas and then to international migration. New areas like displacement and refugee movements, literature and art, diaspora studies, urbanism, labour migration and many more are emerging as important topics in the landscape of migration studies.
The knee function of the soccer players after ACLR is comparable with non-injured controls: A case-control study
Authors: Domzalski Marcin E , Pieta Filip , Przybylak Katarzyna
Published: September 2021

Purpose:

Many studies report a high primary success rate of ACL reconstruction (ACLR), with an increased risk of decline in knee performance correlating with the time passed since surgery. Only one study has compared male soccer players after ACLR to a matched control group of uninjured players in terms of their return to sport and performance. The purpose of this cross-sectional case-control study was to determine the knee performance between soccer players after ACLR and control group matched by age, sex, and professional experience.

Methods:

All the male professional soccer players aged 18–36 years at the time of injury, who sustained an ACL tear while playing league soccer in Poland between January 2008 and December 2011 were contacted and compared with age and experience-matched healthy control group selected from professional football players. KOOS, IKDC-2000, Lysholm and SF-36 scales were used for comparison.

Results:

The average follow-up was 7.9 years (range 6–9 years). The ACL-injured soccer players scored significantly lower in IKDC and Lysholm scores compared with the reference group but still were classified as normal knee function in both scales. In all five dimensions of the KOOS and subscales of SF-36 no apparent differences were noted. In all scales in the study group, no correlation was observed between the player’s age and follow-up time after ACLR.

Conclusion:

After ACL reconstruction and successful return to professional sport, knee function is as good as uninjured team members in the midterm follow-up.

Level of evidence:

III
A biomechanical study on the effect of lengthening magnitude on spine off-loading in magnetically controlled growing rod surgery: Implications on lengthening frequency
Authors: Wong Douglas C , Nafo Wanis , Lu William Weijia , Chee Cheung Kenneth Man
Published: October 2021

Purpose: To assess whether the magnitude of lengthening in magnetically controlled growing rod (MCGR) surgeries has an immediate or delayed effect on spinal off-loading. Methods: 9 whole porcine spines were instrumented using two standard MCGRs from T9 to L5. Static compression testing using a mechanical testing system (MTS) was performed at three MCGR lengthening stages (0 mm, 2 mm, and 6 mm) in each spine. At each stage, five cycles of compression at 175N with 25 min of relaxation was carried out. Off-loading was derived by comparing the load sustained by the spine with force applied by the MTS to the spine. Micro-CT imaging was subsequently performed. Results: The mean load sustained by the vertebral body before lengthening was 39.69N, and immediately after lengthening was 25.12N and 19.91N at 2 mm and 6 mm lengthening, respectively; decreasing to 10.07N, 8.31N, and 8.17N after 25 minutes of relaxation, at 0 mm, 2 mm, and 6 mm lengthening stages, respectively. There was no significant difference in off-loading between 2 mm and 6 mm lengthening stages, either instantaneously ( p = 0.395) or after viscoelastic relaxation ( p = 0.958). CT images showed fractures/separations at the level of pedicle screws in six spines and in the vertebral body’s growth zone in five spines after 6 mm MCGR lengthening. Conclusion: This study demonstrated MCGRs cause significant off-loading of the spine leading to stress shielding. 6 mm of lengthening caused tissue damage and microfractures in some spines. There was no significant difference in spine off-loading between 2 mm and 6 mm MCGR lengthening, either immediately after lengthening or after viscoelastic relaxation.
Mediating Role of Psychological Contract Fulfilment on the Relationship between Strength of HR Signal and Organisational Commitment: Evidence from the Indian Manufacturing Sector
Authors: Bandyopadhyay Chiradip , Srivastava Kailash B. L.
Published: October 2021

This study examined the relationship between human resource (HR) signals’ strength and affective organisational commitment (AOC) through the mediating role of psychological contract fulfilment (PCF). Survey data were collected from 460 manufacturing sector respondents. Structural equation modelling confirmed that HR signals’ strength and PCF positively influenced AOC. PCF also mediated the relationship between the HR signal and AOC’s strength. Results have theoretical implications, as well as practical implications for the management to consider fulfilling its obligations to meet employee needs and expectations through appropriate HR strategies for enhancing employees’ AOC.
Screening for Retinopathy of Prematurity Through Utilization a Pediatric Retinal Camera at Jim Pattison Children’s Hospital: A Vision for Improved Care
Authors: Karunatilake Malshi , Daspal Sibasis , Mugarab Samedi Veronica , Rubab Shehla , Erraguntla Vasudha
Published: September 2021

Retinopathy of Prematurity (ROP) is a vascular proliferative disorder of preterm infants, with increased disease severity and incidence occurring with lower gestational age and birth weight. An alternate approach to ROP screening with wide-field digital retinal imaging helps with the early detection of ROP, especially during the pandemic.
Is Vitamin A Supplementation Associated With Anemia in Children Under 5 Years of Age in Peru: Secondary Analysis of the “Demographic Health Survey” 2015-2018?
Authors: Ribaudo Isabella , Aramburú-Duclos Camila B. , Blitchtein Dora
Published: September 2021

Vitamin A deficiency (VAD) affects 12% of Peruvians under 5 years of age. Recent studies have shown an association with hematopoiesis and iron metabolism. In Peru, 3-quarters of a million children have anemia. We aimed to identify an association between Vitamin A supplementation (VAS) and anemia in children under 5 years of age. A cross-sectional secondary analytical study from the Peruvian Demographic Survey and Family Health (DHS) was conducted. The primary outcome, anemia, was measured through hemoglobin concentration and adjusted by altitude. The DHS interviewer ensured the participant’s VAS in the last 6 months through a structural healthcare card. The association was statistically significant using crude regression but disappeared when adjusted per socioeconomic level and gender. VAS was not significantly associated with a lower prevalence of anemia. Further studies are required to help identify the association between VAS and anemia.
Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study
Authors: Yamamoto Kanako , Yonekura Yuki , Hayama Junko , Matsubara Taketo , Misumi Hiroyasu , Nakayama Kazuhiro
Published: October 2021

Introduction

Patients in intensive care units (ICUs) may transition into an end-of-life phase during treatment. Advance care planning (ACP) for this population has not been studied comprehensively, and support for its implementation is insufficient.

Objective

This study aims to clarify the ACP support needs among critical perioperative patients.

Methods

In this qualitative descriptive study, semistructured interviews were conducted with patients previously admitted to the ICU. The survey was conducted from September to November 2019. Participants comprised 13 individuals, who were admitted to the ICU for a period of 3 months to 2 years after surgery.

Results

The average age of the participants was 63.8 years. The average mechanical ventilation duration following surgery was 24.5 h. The interviews focused on the ACP needs from the preoperative period to discharge. About 90% of the patients thought about the possibility of death before surgery and considered giving advance orders (e.g., “I don't want life-sustaining treatment”). The participants discussed inheritance, work-related matters, and household issues with their families but rarely spoke about treatment and care. Although they examined the content of the advance directives, the medical staff was not informed about them. Patients revealed that they wanted to understand the distinction between life-prolonging and life-saving treatments and discuss it with the medical staff, apart from being educated on ACP. Many patients previously admitted to the ICU are unclear about the difference between life-prolonging and life-saving treatments; this is also true for medical staff.

Conclusion

Patients who had been admitted to the ICU after high-risk surgery thought they needed help with ACP before surgery. Therefore, patients have the right to know about treatment risks; however, medical staff believes that this is difficult to communicate. Thus, medical staff should consider ways to communicate clearly with patients, including discussing the risks associated with surgery.
Spontaneous Spiral Dissection of Left Anterior Descending Coronary Artery in a Young Female
Authors: Das Debasish , Acharya Debasish , Das Tutan , Pramanik Subhas
Published: September 2021

The present case is unique and the first to describe the spiral nature of dissection in spontaneous coronary artery dissection in a young female which has not yet been described in the world literature.
Anti-inflammatory treatment in MPN: targeting TNFR1 and TNFR2 in JAK2-V617F–induced disease
Authors: Müller Peter , Baldauf Conny K. , Haage Tobias R. , Waldleben Ana M. , Richter Fabian , Pfizenmaier Klaus , Fischer Thomas
Published: October 2021

Chronic nonresolving inflammatory syndrome is a major disease feature in myeloproliferative neoplasms (MPNs). Systemic inflammation promotes the growth of the JAK2-V617F+ hematopoietic stem cell clone and is associated with constitutive symptoms (eg, fever, cachexia, and fatigue). Therefore, it is being discussed whether anti-inflammatory therapy, in addition to the well-established JAK inhibitor therapy, may be beneficial in the control of constitutive symptoms. Moreover, effective control of the inflammatory microenvironment may contribute to prevent transformation into secondary myelofibrosis and acute leukemia. Given the pivotal role of tumor necrosis factor α (TNF-α) in MPN and the distinct roles of TNF-α receptor 1 (TNFR1) and TNFR2 in inflammation, we investigated the therapeutic effects of αTNFR1 and αTNFR2 antibody treatment in MPN-like disease using the JAK2+/VF knock-in mouse model. Peripheral blood counts, bone marrow/spleen histopathology, and inflammatory cytokine levels in serum were investigated. αTNFR2 antibody treatment decreased white blood cells and modulated the serum levels of several cytokines [CXCL2, CXCL5, interleukin-12(p40)], as well as of macrophage colony-stimulating factor, but they lacked efficacy to ameliorate hematocrit and splenomegaly. αTNFR1 antibody treatment resulted in the mild suppression of elevated hematocrit of −10.7% and attenuated splenomegaly (22% reduction in spleen weight). In conclusion, our studies show that TNFR1 and TNFR2 play different roles in the biology of JAK2-V617F–induced disease that may be of relevance in future therapeutic settings.
ALCAM-EGFR interaction regulates myelomagenesis
Authors: Luo Hongmei , Zhang Dan , Wang Fangfang , Wang Qiang , Wu Yu , Gou Maling , Hu Yiguo , Zhang Wenyan , Huang Jingcao , Gong Yuping , Pan Ling , Li Tianshu , Zhao Pan , Zhang Danfeng , Qu Ying , Liu Zhigang , Jiang Tao , Dai Yang , Guo Tingting , Zhu Jiang , Ye Lingqun , Zhang Li , Liu Weiping , Yi Qing , Zheng Yuhuan
Published: October 2021

Multiple myeloma, a plasma cell malignancy in the bone marrow, remains largely incurable with currently available therapeutics. In this study, we discovered that the activated leukocyte cell adhesion molecule (ALCAM) interacted with epidermal growth factor receptor (EGFR), and regulated myelomagenesis. ALCAM was a negative regulator of myeloma clonogenicity. ALCAM expression was positively correlated with patients’ survival. ALCAM-knockdown myeloma cells displayed enhanced colony formation in the presence of bone marrow stromal cells (BMSCs). BMSCs supported myeloma colony formation by secreted epidermal growth factor (EGF), which bound with its receptor (EGFR) on myeloma cells and activated Mek/Erk cell signaling, PI3K/Akt cell signaling, and hedgehog pathway. ALCAM could also bind with EGFR, block EGF from binding to EGFR, and abolish EGFR-initiated cell signaling. Hence, our study identifies ALCAM as a novel negative regulator of myeloma pathogenesis.
Role of radiotherapy to bulky sites of advanced Hodgkin lymphoma treated with ABVD: final results of FIL HD0801 trial
Authors: Ricardi Umberto , Levis Mario , Evangelista Andrea , Gioia Daniela Maria , Sacchetti Gian Mauro , Gotti Manuel , Re Alessandro , Buglione Michela , Pavone Vincenzo , Nardella Antonio , Nassi Luca , Zanni Manuela , Franzone Paola , Frezza Giovanni Piero , Pulsoni Alessandro , Grapulin Lavinia , Santoro Armando , Rigacci Luigi , Simontacchi Gabriele , Tani Monica , Zaja Francesco , Abruzzese Elisabetta , Botto Barbara , Zilioli Vittorio Ruggero , Rota-Scalabrini Delia , Freilone Roberto , Ciccone Giovannino , Filippi Andrea Riccardo , Zinzani Pier Luigi
Published: October 2021

The role of consolidation radiotherapy (RT) for bulky lesions is controversial in patients with advanced-stage Hodgkin lymphoma who achieve complete metabolic response (CMR) after doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD)–based chemotherapy. We present the final results of the Fondazione Italiana Linfomi HD0801 trial, which investigated the potential benefit of RT in that setting. In this phase 3 randomized study, patients with a bulky lesion at baseline (a mass with largest diameter ≥5 cm) who have CMR after 2 and 6 ABVD cycles were randomly assigned 1:1 to RT vs observation (OBS) with a primary endpoint of event-free survival (EFS) at 2 years. The sample size was calculated estimating an EFS improvement for RT of 20% (from 60% to 80%). The secondary end point was progression-free survival (PFS). One hundred sixteen patients met the inclusion criteria and were randomly assigned to RT or OBS. Intention-to-treat (ITT) analysis showed a 2-year EFS of 87.8% vs 85.8% for RT vs OBS (hazard ratio [HR], 1.5; 95% confidence interval [CI], 0.6-3.5; P = .34). At 2 years, ITT-PFS was 91.3% vs 85.8% (HR, 1.2; 95% CI, 0.5-3; P = .7). Patients in CMR randomly assigned to OBS had a good outcome, and the primary end point of a 20% benefit in EFS for RT was not met. However, the sample size was underpowered to detect a benefit of 10% or less, keeping open the question of a potential, more limited role of RT in this setting. This trial was registered at www.clinicaltrials.gov as #NCT00784537.
Patient-centered practices for engaging transgender and gender diverse patients in clinical research studies
Authors: Asquith Andrew , Sava Lauren , Harris Alexander B. , Radix Asa E. , Pardee Dana J. , Reisner Sari L.
Published: October 2021

Background

The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.

Method

Between September–November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N = 28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.

Results

Participants were a mean age of 33.9 years (SD 12.3; Range 18–66). Participants varied in gender identity with 4 (14.3%) men, 3 (10.7%) women, 8 (28.6%) transgender men, 10 (35.7%) transgender women, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a ‘cisgender lens”, distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.

Conclusion

Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.
Longitudinal association between physical activity and health-related quality of life among community-dwelling older adults: a longitudinal study of Urban Health Centres Europe (UHCE)
Authors: Zhang Xuxi , Tan Siok Swan , Franse Carmen Betsy , Alhambra-Borrás Tamara , Verma Arpana , Williams Greg , van Grieken Amy , Raat Hein
Published: October 2021

Background

Physical activity (PA) may play a key role in healthy aging and thus in promoting health-related quality of life (HRQoL). However, longitudinal studies on the association between PA and HRQoL are still scarce and have shown inconsistent results. In this study, we aimed to examine the longitudinal association between frequency of moderate PA and physical and mental HRQoL. Secondly, to assess the association between a 12-month change in frequency of moderate PA and HRQoL.

Methods

A 12-month longitudinal study was conducted in Spain, Greece, Croatia, the Netherlands, and the United Kingdom with 1614 participants (61.0% female; mean age = 79.8; SD = 5.2) included in the analyses. Two categories of the self-reported frequency of moderate PA including 1) ‘regular frequency’ and 2) ‘low frequency’ were classified, and four categories of the change in frequency of moderate PA between baseline and follow-up including 1) ‘continued regular frequency’, 2) ‘decreased frequency’, 3) ‘continued low frequency’ and 4) ‘increased frequency’ were identified. Physical and mental HRQoL were assessed by the 12-Item Short-Form Health Survey (SF-12).

Results

The frequency of moderate PA at baseline was positively associated with HRQoL at follow-up. Participants with a continued regular frequency had the highest HRQoL at baseline and follow-up. Participants who increased the frequency of moderate PA from low to regular had better physical and mental HRQoL at follow-up than themselves at baseline. After controlling for baseline HRQoL and covariates, compared with participants who continued a regular frequency, participants who decreased their frequency had significantly lower physical (B = -4.42; P < .001) and mental (B = -3.95; P < .001) HRQoL at follow-up; participants who continued a low frequency also had significantly lower physical (B = -5.45; P < .001) and mental (B = -4.10; P < .001) HRQoL at follow-up. The follow-up HRQoL of participants who increased their frequency was similar to those who continued a regular frequency.

Conclusions

Maintaining or increasing to a regular frequency of PA are associated with maintaining or improving physical and mental HRQoL. Our findings support the development of health promotion and long-term care strategies to encourage older adults to maintain a regular frequency of PA to promote their HRQoL.
Tricyclic antidepressants for major depressive disorder: a comprehensive evaluation of current practice in the Netherlands
Authors: Vos Cornelis F. , Aarnoutse Rob E. , Op de Coul Marijke J. M. , Spijker Jan , Groothedde-Kuyvenhoven Mascha M. , Mihaescu Raluca , Wessels-Basten Sonja J. W. , Rovers Jordy J. E. , ter Hark Sophie E. , Schene Aart H. , Hulscher Marlies E. J. L. , Janzing Joost G. E.
Published: October 2021

Background

Traditionally tricyclic antidepressants (TCAs) have an important place in treatment of major depressive disorder (MDD). Today, often other antidepressant medications are considered as first step in the pharmacological treatment of MDD, mainly because they are associated with less adverse effects, whereby the position of TCAs appears unclear. In this study we aimed to examine the current practice of TCAs in treatment of unipolar MDD.

Methods

A mixed methods approach was applied. First, a selection of leading international and national guidelines was reviewed. Second, actual TCA prescription was examined by analyzing health records of 75 MDD patients treated with the TCAs nortriptyline, clomipramine or imipramine in different centers in the Netherlands. Third, promotors and barriers influencing the choice for TCAs and dosing strategies were explored using semi-structured interviews with 24 Dutch psychiatrists.

Results

Clinical practice guidelines were sometimes indirective and inconsistent with each other. Health records revealed that most patients (71%) attained therapeutic plasma concentrations within two months of TCA use. Patients who achieved therapeutic plasma concentrations reached them on average after 19.6 days (SD 10.9). Both health records and interviews indicated that therapeutic nortriptyline concentrations were attained faster compared to other TCAs. Various factors were identified influencing the choice for TCAs and dosing by psychiatrists.

Conclusions

Guideline recommendations and clinical practice regarding TCA prescription for MDD vary. To increase consistency in clinical practice we recommend development of an up-to-date guideline integrating selection and dosing of TCAs, including the roles of therapeutic drug monitoring and pharmacogenetics. Such a guideline is currently lacking and would contribute to optimal TCA treatment, whereby efficacy and tolerability may be increased.
Social norms, attitudes and access to modern contraception for adolescent girls in six districts in Uganda
Authors: Bukuluki Paul , Kisaakye Peter , Houinato Maxime , Ndieli Adekemi , Letiyo Evelyn , Bazira Dan
Published: October 2021

Background

Social norms continue to be entrenched in Uganda. Understanding social norms helps to uncover the underlying drivers that influence attitudes and behavior towards contraceptive access and use. This study therefore seeks to investigate the factors that influence the social norm – access to contraception by adolescent girls – in six districts in Uganda.

Data and methods:

Using data from a community cross-sectional survey in six districts (Amudat, Kaberamaido, Kasese, Moroto, Tororo and Pader) in Uganda, a binary logistic regression model was fitted to examine the variation in individual beliefs and socio-economic and demographic factors on ‘allowing adolescent girls to access contraception in a community’ – we refer to as a social norm.

Results

Results demonstrate that a higher proportion of respondents hold social norms that inhibit adolescent girls from accessing contraception in the community. After controlling for all variables, the likelihood for adolescent girls to be allowed access to contraception in the community was higher among respondents living in Kaberamaido (OR = 2.58; 95 %CI = 1.23–5.39), Kasese (OR = 2.62; 95 %CI = 1.25–5.47), Pader (OR = 4.35; 95 %CI = 2.15–8.79) and Tororo (OR = 9.44; 95 %CI = 4.59–19.37), those aged 30–34 years likely (OR = 1.73; 95 %CI = 1.03–2.91). However, the likelihood for respondents living in Moroto to agree that adolescent girls are allowed to access contraception was lower (OR = 0.27; 95 %CI = 0.11–0.68) compared to respondents living in Amudat. Respondents who were not formally employed (OR = 0.63; 95 %CI = 0.43–0.91), and those who agreed that withdrawal prevents pregnancy (OR = 0.45; 95 %CI = 0.35–0.57) were less likely to agree that adolescent girls are allowed to access contraception in the community. Respondents who agreed that a girl who is sexually active can use contraception to prevent unwanted pregnancy (OR = 1.84; 95 %CI = 1.33–2.53), unmarried women or girls should have access to contraception (OR = 2.15; 95 %CI = 1.61–2.88), married women or girls should have access to contraception (OR = 1.55; 95 %CI = 0.99–2.39) and women know where to obtain contraception for prevention against pregnancy (OR = 2.35; 95 %CI = 1.19–4.65) were more likely to agree that adolescent girls are allowed to access contraception.

Conclusions

The findings underscore the need for context specific ASRH programs that take into account the differences in attitudes and social norms that affect access and use of contraception by adolescents.
Measuring social capital of hospital management boards in European hospitals: A validation study on psychometric properties of a questionnaire for Chief Executive Officers
Authors: Hammer Antje , Arah Onyebuchi A. , Mannion Russell , Groene Oliver , Sunol Rosa , Pfaff Holger , Choi Kyung-Eun
Published: October 2021

Background

The commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly shared values and mutual trust. The purpose of this study is to investigate the reliability and validity of a survey scale designed to assess Social Capital within hospital management boards (SOCAPO-B) in European hospitals.

Methods

Data were collected as part of the EU funded mixed-method project “Deepening our understanding of quality improvement in Europe (DUQuE)” from 210 hospitals in 7 European countries (France, Poland, Czech Republic, Germany, Portugal, Spain, and Turkey). The Chief Executive Officers (CEOs) completed the SOCAPO-B scale (six-item survey, numeric scale, 1=‘strongly disagree’ to 4=‘strongly agree’) regarding their perceptions of social capital within the hospital management board. We investigated the factor structure of the social capital scale using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach’s alpha, while construct validity was assessed through Pearson’s correlation coefficients between the scale items.

Results

A total of 188 hospitals participated in the DUQuE-study. Of these, 177 CEOs completed the questionnaire(172 observations for social capital) Hospital CEOs perceive relatively high social capital among hospital management boards (average SOCAPO-B mean of 3.2, SD = 0.61). The exploratory factor analysis resulted in a 1-factor-model with Cronbach’s alpha of 0.91. Pearson’s correlation coefficients between the single scale items ranged from 0.48 to 0.68.

Conclusions

The SOCAPO-B−scale can be used to obtain reliable and valid measurements of social capital in European hospital management boards, at least from the CEO’s point of view. The brevity of the scale enables it to be a cost-effective and tool for measuring social capital in hospital management boards.

Trial registration

This validation study was not registered.
Fidelity and the impact of patient safety huddles on teamwork and safety culture: an evaluation of the Huddle Up for Safer Healthcare (HUSH) project
Authors: Lamming Laura , Montague Jane , Crosswaite Kate , Faisal Muhammad , McDonach Eileen , Mohammed Mohammed A. , Cracknell Alison , Lovatt Alison , Slater Beverley
Published: October 2021

Background

The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals – 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture.

Methods

A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality.

Results

Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward.

Conclusions

PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.