bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct oral anticoagulation in atrial fibrillation and heart valve surgery—a meta-analysis and systematic review
Authors: Gerfer Stephen , Djordjevic Ilija , Eghbalzadeh Kaveh , Mader Navid , Wahlers Thorsten , Kuhn Elmar
Published: April 2022

Aims:

Oral anticoagulation with direct oral anticoagulants (DOAC) could provide an alternative to vitamin K antagonists (VKA) for patients with atrial fibrillation (AF) undergoing bioprosthetic heart valve replacement or valve repair.

Methods and results:

The aim of this meta-analysis was to review the safety and efficacy of DOAC in patients with surgical implanted bioprosthetic heart valves or valve repairs and AF including data from six clinical trials with a total of 1,857 patients. The efficacy and safety data of DOAC and VKA were pooled to perform random-effects meta-analyses using the Mantel–Haenszel method with pooled risk ratios (RR) and 95% confidence interval (CI). A trial sequential analysis (TSA) was performed to assess statistical robustness. Death caused by cardiovascular cause or thromboembolic events were comparable (RR 0.67, 95% CI: 0.42–1.08; p = 0.10) as DOAC significantly reduced the risk for major bleeding (RR 0.55, 95% CI: 0.35–0.88; p = 0.01) and thromboembolic stroke or systemic embolism rates (RR 0.54, 95% CI: 0.32–0.90; p = 0.02). Rates for intracranial bleeding and hemorrhagic stroke (RR 0.27, 95% CI: 0.07–0.99; p = 0.05) show a trend toward fewer events in the DOAC group. Outcomes for major or minor bleeding events and all-cause mortality were comparable for DOAC and VKA.

Conclusion:

Cumulative data analysis reveals that DOAC may provide an effective and safe alternative to VKA in patients with AF after surgically implanted bioprosthetic heart valves or repair with AF. Within a relatively heterogeneous study population, this meta-analysis shows a risk reduction of major bleedings and thromboembolic stroke or systemic embolisms for DOAC.
A Difference-In-Difference Approach to Estimate the Price Effect of Market Entry in High-Speed Rail
Authors: Beria Paolo , Tolentino Samuel , Shtele Evgeniia , Lunkar Vardhman
Published: April 2022

The effect of competition on prices in the passenger transport sector can be difficult to estimate because of many influencing factors such as state regulation, demand, seasonality, and reactions of indirect competitors. A case of great interest in the rail sector is Italy, where on-track competition in the high-speed segment has been in place for nearly ten years. The paper aims at answering the question whether—and how much—incumbent’s prices are affected when competition starts on a route previously in monopoly. The case is the start of operations on the Turin–Milan–Venice route, where Italo entered in May 2018. Adopting a difference-in-difference approach, we check if Trenitalia changed the price strategy on the route before and after the entry, with respect to two control groups. The addition of placebo tests allows us to understand the ranges of significance of the results and to estimate the noise level of the estimates. Our findings suggest that the start of competition led to lower prices in the short-medium period. In the specific case, the Milano–Venezia route saw Trenitalia’s prices reduced by 21–26% (±2–5%) in a time span of 84–140 days after Italo’s entry and for advanced bookings from 2 to 10 days. Last-day prices remain unchanged, while early bookings are reduced by just 9%. This price reduction does not remain stable in the longer term, when other effects add up and blur the effect of the entry. Nevertheless, we keep observing a smaller, ∼15%, but still negative prices change.
Combined Network Pharmacology, Molecular Docking, and Experimental Verification Approach to Investigate the Potential Mechanisms of Polydatin Against COVID-19
Authors: Wang Meng , Qin Kaijian , Zhai Xiaofeng
Published: April 2022

Background: Coronavirus disease 2019 (COVID-19) has posed a serious threat to human health and there is an urgent need for drug development. In this study, we explored the potential mechanisms underlying the efficacy of polydatin against COVID-19. Methods: A combined approach of network pharmacology, molecular docking, and experimental verification were employed in this study. Potential targets of polydatin for treating COVID-19 were obtained from multiple drug and disease databases. Protein–protein interaction and enrichment analyses were performed to predict the potential mechanism of action of polydatin against COVID-19. The binding potential of polydatin and key targets was evaluated through molecular docking. Furthermore, experimental methods including flow cytometry and luciferase assay were used to validate the results of computational analyses. Results: The main diseases identified as polydatin targets included metabolic diseases, lung diseases, inflammation, infectious diseases, and tumors. Polydatin may be used to treat COVID-19 through interventions that alter the immune and inflammatory responses, including IL-17 signaling pathway, T-cell activation, cytokines and inflammatory response, lipopolysaccharide-mediated signaling pathway, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) innate immunity evasion and cell-specific immune response. Polydatin can potentially bind to the target proteins related to COVID-19, such as SARS-CoV-2 Mpro, RdRp, and human angiotensin-converting enzyme 2 (ACE2), while directly exerting its regulatory or therapeutic functions. The experimental results showed that polydatin decreased the infectivity of the SARS-CoV-2 spike pseudovirus in HEK293T-ACE2 cells. Accordingly, polydatin may retard the entry of SARS-CoV-2 into cells by competitively binding to human ACE2. Conclusion: The potential targets and signaling pathways of polydatin against COVID-19 were preliminarily identified. The findings may benefit the development and application of polydatin as a treatment for COVID-19.
Dural Arteriovenous Fistula as a Reversible Cause of Progressive Parkinsonism and Dementia: A Case Report
Authors: Prosperini Luca , Gentile Mara , Ricci Monica , Gerace Carmela , Fabiano Sebastiano , Stasolla Alessandro , Gasperini Claudio , Cotroneo Enrico
Published: April 2022

A dural arteriovenous fistula (DAVF) is an abnormal direct connection between an intracranial artery and the dural venous sinus. In rare cases, DAVF might show rapidly progressive dementia onset with extrapyramidal signs, often misdiagnosed as Parkinson disease or vascular parkinsonism and, therefore, pharmacological treatments are ineffective. Here, we report the case of 84-year-old man with rapidly progressive parkinsonism and dementia who was initially treated with levodopa without any improvement. Approximately 8 months following the symptom onset, a magnetic resonance (MR) imaging of the brain revealed bilateral and symmetrical hyperintensity of the white matter on both cerebral hemispheres on T2-weighted images. Three-dimensional and post-contrast T1-weighted images showed a subtentorial ovalar area with venous drainage alteration, and hypertrophic left occipital artery direct to venous sac. The angiography study confirmed a diagnosis of DAVF. Endovascular treatment by cook pressure technique successfully provided fistula obliteration. The patient rapidly recovered after the endovascular treatment, with restitutio ad integrum of cognitive functioning and resolution of extrapyramidal syndrome. Approximately 1 year after the endovascular treatment, a brain MR scan with angiogram-MR sequences showed almost complete disappearance of white matter alterations on both cerebral hemispheres, and normal visualization of venous system.
Home-based management practice of diarrhea in under 5 years old children and associated factors among caregivers in Ginchi town, Oromia region, west Ethiopia
Authors: Terefe Gemechu , Murugan Rajalakshim , Bedada Tadesse , Bacha Girma , Bekele Gadisa
Published: April 2022

Objective:

The study was aimed to assess the home-based management practice of diarrhea and associated factors among caregivers in children under 5 years old at Ginchi town, Oromia region, West Ethiopia.

Methods:

A community-based cross-sectional study was conducted among 335 caregivers in Ginchi town. Data were collected using face-to-face interviewing questionnaires by using a systematic sampling technique. Data were entered into Epi-data version 3.5.1 and exported to statically software package for social science version 23.0 for analysis. Descriptive analyses were carried out. Bivariable and multivariable logistic regressions were done to identify predictors of home-based management practice of diarrhea in children under 5 years old.

Result:

The study had a total of 326 participants, with a 97.3% response rate. Accordingly, 193 (59%) have a good home-based management practice of diarrhea in children under the age of 5 years. Attended elementary school (adjusted odds ratio (95% confidence interval), 0.17 (0.06, 0.47)), high school education (adjusted odds ratio (95% confidence interval), 0.04 (0.013, 0.126)), monthly income in second class (adjusted odds ratio (95% confidence interval), 0.19 (0.04, 0.94)), and being mother in child relationship (adjusted odds ratio (95% confidence interval), 1.27 (1.4, 4.20)) were the identified predictors of home-based management practice of diarrhea in children under 5 years old.

Conclusion:

More than half of the respondents have a good home-based management practice of diarrhea in children under 5 years old. Caregivers’ educational status, being mothers of the child, and monthly income were the identified predictors. As a result, health education and awareness programs for caregivers on diarrhea control, proper use of oral rehydration solution, home-based fluid preparation, and diarrhea prevention are critical.
Performance of an auto-adjusting prosthetic socket during walking with intermittent socket release
Authors: Weathersby Ethan J , Vamos Andrew C , Larsen Brian G , McLean Jake B , Carter Ryan V , Allyn Katheryn J , Ballesteros Daniel , Wang Horace , deGrasse Nicholas S , Friedly Janna L , Hafner Brian J , Garbini Joseph L , Ciol Marcia A , Sanders Joan E
Published: April 2022

Introduction

A challenge in the engineering of auto-adjusting prosthetic sockets is to maintain stable operation of the control system while users change their bodily position and activity. The purpose of this study was to test the stability of a socket that automatically adjusted socket size to maintain fit. Socket release during sitting was conducted between bouts of walking.

Methods

Adjustable sockets with sensors that monitored distance between the liner and socket were fabricated. Motor-driven panels and a microprocessor-based control system adjusted socket size during walking to maintain a target sensed distance. Limb fluid volume was recorded continuously. During eight sit/walk cycles, the socket panels were released upon sitting and then returned to position for walking, either the size at the end of the prior bout or a size 1.0% larger in volume.

Results

In six transtibial prosthesis users, the control system maintained stable operation and did not saturate (move to and remain at the end of the actuator’s range) during 98% of the walking bouts. Limb fluid volume changes generally matched the panel position changes executed by the control system.

Conclusions

Stable operation of the control system suggests that the auto-adjusting socket is ready for testing in users’ at-home settings.
The blame game in a child abuse incident in Vietnamese online news media: A framing analysis
Authors: Yến-Khanh Nguyễn
Published: April 2022

This study examined the Vietnamese online news media discourse of a child abuse incident at a private autism center. Using framing analysis, the study found the news media frame the child abuse dominantly as a professional misconduct. The study detailed how the media’s blame was directed to the abusive staff and the uninformed parents, not institutional governance and policy loopholes. The study argued that the Vietnamese media focused on constructing ideologies of parental responsibilization and autonomous citizenship rather than state authorities’ accountability.
Internationalizing Afghan security? Strategic narratives and transnational public sphere (dis)formation in Chinese, Russian, Afghani, and US media
Authors: Hinck Robert S , Ehrl Marco
Published: April 2022

For most of the past two decades, the United States pursued a policy leveraging its traditional NATO partners to secure Afghanistan’s future against the Taliban with little lasting success. However, in a dramatic reversal of U.S. policy in July 2018, President Trump ordered the start of direct talks between the United States and Taliban with the goal of internationalizing Afghan security. We argue that this move in 2018 by the United States can be understood as an attempt toward forming a transnational community around Afghan security by allowing non-allied nations greater voice and agency in Afghanistan’s political future. However, current theories of transnational public sphere are unable to account for such processes. Thus, the primary aim of this study is development of a theory of transnational foreign policy sphere formation. Drawing upon Wessler et al.’s (2008) four-step process of transnational public sphere development, we conceptualize this process as one of strategic narrative (dis)alignment across and within foreign nations’ media reporting on a common issue of concern. We then use media narratives reporting on Afghanistan’s political future as an empirical case study to demonstrate our theory, by examining over 2000 news articles from 17 different Chinese, Russian, U.S., and Afghani media outlets from February 2017 to January 2020. Theoretically, our study advances research into the transnational public sphere by examining their (dis)formation over time as well as the limits and opportunities of transnational public sphere emergence outside of European contexts and on foreign policy issues among publics with very different sociopolitical interests and cultures.
The Roles of Vehicle Currency and Real Effective Exchange Rates in the Trade of Every ASEAN Member With the EU-28
Authors: Bao Ho Hoang Gia , Le Hoang Phong
Published: April 2022

A common limitation of the studies on the exchange rate-trade balance linkage is ignoring the USD’s role as a vehicle currency. Some recent papers have recognized this gap and proposed a hypothesis that the neglection of the USD’s role as a vehicle currency can restrict the significance of findings. This study aims to test that hypothesis in the trade between each of the 10 countries in ASEAN (Association of Southeast Asian Nations) with the whole EU-28. Specifically, this paper is the first to examine how the vehicle currency USD’s exchange rates, along with the real effect exchange rates, asymmetrically impact the trade balance of each ASEAN country with the EU-28 by employing the NARDL method to investigate whether the ignorance of the USD leads to fewer significant coefficients of exchange rates. The results indicate that the vehicle currency model (VCER) outperforms the real effective exchange rate (REER) model, which supports the hypothesis. In addition, the results are robust when controlling for the role of exchange rate volatility.
Elevating Teachers’ Professional Capital: Effects of Teachers’ Engagement in Professional Learning and Job Satisfaction, Awi District, Ethiopia
Authors: Belay Sintayehu , Melese Solomon , Seifu Amera
Published: April 2022

This study examined the contribution of teachers’ engagement in collaborative professional learning, engagement in individualized professional learning, and job satisfaction to their professional capital development using structural equation modeling. The study tested three hypotheses: teachers’ level of engagement in collaborative professional learning and development activities has a significant contribution to their professional capital development, teachers’ level of engagement in individualized professional learning and development activities would have a significant contribution to their professional capital development and teachers’ job satisfaction has a significant effect on their professional capital development. The sample consisted of 379 teachers randomly selected from Awi district primary schools, Ethiopia. Data were collected using 25 items. Cronbach’s alpha (α) coefficients for internal consistency ranged from .806 to .919. Composite reliability, convergent validity, and discriminant validity of latent variables were established using CFA. The measurement model and structural model showed a good fit based on established criteria. Findings showed a significant effect of teachers’ engagement in collaborative learning, engagement in individualized learning, and job satisfaction on their professional capital development. These independent variables accounted for 68.3% variance in professional capital development, thereby indicating 31.7% unexplained variance. In conclusion, the study highlighted the importance of teacher-level factors to boost professional capital in the teaching profession.
Caught in the Middle: Internal and External Pressures on the Coverage of Organized Crime in Mexico
Authors: Díaz-Cerveró Elba , Barredo-Ibáñez Daniel , González Macías Rubén Arnoldo
Published: April 2022

With 33 journalists killed since the beginning of Andrés Manuel López Obrador’s presidential term in December 2018, Mexico heads the list of the most violent countries for journalists in Latin America—and that of countries not at war. While journalist organizations demand a meaningful protection apparatus to safeguard their physical safety, official corruption, and criminal impunity continue to escalate the pressures to which media staff are exposed, especially in Mexican states where cartels and criminal groups have the largest footprint. This study aims to precisely identify the pressures, both internal and external, facing journalists who report on organized crime in Mexico. To do this, we drew from the Hierarchy of Influences Model, and interviewed 22 Mexican journalists who work on the organized crime beat in the country’s capital and in the most violent states in the Republic. The results suggest that the most influential forces they face are associated with the organizational level (such as editorial line or institutional censorship), and the extramedia level (e.g., anti-press violence from cartels/authorities, and government advertising contracts).
Managing the Built Environment for Health Promotion and Disease Prevention With Maharishi Vastu Architecture: A Review
Authors: Lipman Jon , Fergusson Lee , Bonshek Anna , Schneider Robert H.
Published: April 2022

Background and objectives

The evolution of healthcare from 18th-century reductionism to 21st-century postgenomic holism has been described in terms of systems medicine, and the impact of the built environment on human health is the focus of investigation and development, leading to the new specialty of evidence-based, therapeutic architecture. The traditional system of Vāstu architecture—a design paradigm for buildings which is proposed to promote mental and physical health—has been applied and studied in the West in the last 20 years, and features elements absent from other approaches. This review critically evaluates the theory and research of a well-developed, standardized form of Vāstu—Maharishi Vastu® architecture (MVA). MVA’s principles include development of the architect’s consciousness, universal recommendations for building orientation, siting, and dimensions; placement of key functions; and occupants’ head direction when sleeping or performing tasks. The effects of isolated Vāstu elements included in MVA are presented. However, the full value of MVA, documented as a systematic, globally applicable practice, is in the effect of its complete package, and thus this review of MVA includes evaluating the experience of living and working in MVA buildings.

Methods

The published medical and health-related literature was systematically surveyed for research on factors related to isolated principles applied in MVA as well as on the complete system.

Results

Published research suggests that incorporating MVA principles into buildings correlates with significant improvements in occupants’ physical and mental health and quality of life: better sleep, greater happiness of children, and the experience of heightened sense of security and reduced stress. The frequency of burglaries, a social determinant of health, also correlates. Potential neurophysiological mechanisms are described.

Conclusions

Findings suggest that MVA offers an actionable approach for managing a key social determinant of health by using architectural design as preventive medicine and in public health.
Book review: Rory Medcalf. 2020. Contest for the Indo-Pacific: Why China Won’t Map the Future
Authors: Patil Uday
Published: April 2022

Rory Medcalf. 2020. Contest for the Indo-Pacific: Why China Won’t Map the Future. La Trobe University Press. 320 pp. (Paperback). ISBN: 9781760641573.
Deserving poor in public sanitation: Tracing the policymaking processes of who gets what, when, how, and why in Delhi
Authors: Bhan Tanushree
Published: April 2022

This study investigates why sanitation outcomes vary across urban poor communities in Delhi, India. Unequal access to quality sanitation has serious implications for the health, dignity, and economic well-being of the poor and public health in general due to risks of environmental contamination. For this multiple-case study, a sample of 7 communities is drawn from slums, public housing, and homeless shelters. The database comprises of direct observations of sanitation outcomes in these communities, interviews with 67 key policy informants, official documents of relevant government agencies, newspaper articles, and court filings. The qualitative dataset is analyzed using process-tracing to uncover policy decisions across communities. Findings show that inequitable sanitation outcomes are manufactured by biases that blame the poor for service deficits and make the provision of entitled benefits contingent on political mobilization of exhibiting “good citizenship.” This has serious implications for democratic accountability between the government and the very citizens that are most in need of public services to meet their sanitation needs.
Infracardiac Total Anomalous Pulmonary Venous Drainage: A Case Report
Authors: Pereira Sujith S. , Meinerikandathevan Sivathatishana
Published: April 2022

Anomalous pulmonary venous drainage is a rare cause of congenital heart disease with varied clinical presentation. Symptoms can differ depending on the degree of venous obstruction. An 8-day-old term baby presented with tachypnea and was subsequently found to have an unobstructed infracardiac total anomalous pulmonary venous drainage. She underwent an uneventful surgical repair. The diagnosis of total anomalous pulmonary venous drainage can be delayed or missed, and a high index of suspicion is necessary.
Identification of crucial circRNAs in skeletal muscle during chicken embryonic development
Authors: Wu Pengfei , Zhou Kaizhi , Zhang Jin , Ling Xuanze , Zhang Xinchao , Zhang Li , Li Peifeng , Wei Qingyu , Zhang Tao , Wang Xinglong , Zhang Genxi
Published: April 2022

Background

Chicken provides humans with a large amount of animal protein every year, in which skeletal muscle plays a leading role. The embryonic skeletal muscle development determines the number of muscle fibers and will affect the muscle production of chickens. CircRNAs are involved in a variety of important biological processes, including muscle development. However, studies on circRNAs in the chicken embryo muscle development are still lacking.

Results

In the study, we collected chicken leg muscles at 14 and 20-day embryo ages both in the fast- and slow-growing groups for RNA-seq. We identified 245 and 440 differentially expressed (DE) circRNAs in the comparison group F14vsF20 and S14vsS20 respectively. GO enrichment analysis for the host genes of DE circRNAs showed that biological process (BP) terms in the top 20 related to growth in F14vsF20 were found such as positive regulation of transcription involved in G1/S phase of mitotic cell cycle, multicellular organismal macromolecule metabolic process, and multicellular organismal metabolic process. In group S14vsS20, we also found some BP terms associated with growth in the top 20 including actomyosin structure organization, actin cytoskeleton organization and myofibril assembly. A total of 7 significantly enriched pathways were obtained, containing Adherens junction and Tight junction. Further analysis of those pathways found three crucial host genes MYH9, YBX3, IGF1R in both fast- and slow-growing groups, three important host genes CTNNA3, AFDN and CREBBP only in the fast-growing group, and six host genes FGFR2, ACTN2, COL1A2, CDC42, DOCK1 and MYL3 only in the slow-growing group. In addition, circRNA-miRNA network also revealed some key regulation pairs such as novel_circ_0007646-miR-1625-5p, novel_circ_0007646-miR-1680-5p, novel_circ_0008913-miR-148b-5p, novel_circ_0008906-miR-148b-5p and novel_circ_0001640-miR-1759-3p.

Conclusions

Comprehensive analysis of circRNAs and their targets would contribute to a better understanding of the molecular mechanisms in poultry skeletal muscle and it also plays an important guiding role in the next research.
Applications of Bayesian shrinkage prior models in clinical research with categorical responses
Authors: Bhattacharyya Arinjita , Pal Subhadip , Mitra Riten , Rai Shesh
Published: April 2022

Background

Prediction and classification algorithms are commonly used in clinical research for identifying patients susceptible to clinical conditions such as diabetes, colon cancer, and Alzheimer’s disease. Developing accurate prediction and classification methods benefits personalized medicine. Building an excellent predictive model involves selecting the features that are most significantly associated with the outcome. These features can include several biological and demographic characteristics, such as genomic biomarkers and health history. Such variable selection becomes challenging when the number of potential predictors is large. Bayesian shrinkage models have emerged as popular and flexible methods of variable selection in regression settings. This work discusses variable selection with three shrinkage priors and illustrates its application to clinical data such as Pima Indians Diabetes, Colon cancer, ADNI, and OASIS Alzheimer’s real-world data.

Methods

A unified Bayesian hierarchical framework that implements and compares shrinkage priors in binary and multinomial logistic regression models is presented. The key feature is the representation of the likelihood by a Polya-Gamma data augmentation, which admits a natural integration with a family of shrinkage priors, specifically focusing on Horseshoe, Dirichlet Laplace, and Double Pareto priors. Extensive simulation studies are conducted to assess the performances under different data dimensions and parameter settings. Measures of accuracy, AUC, brier score, L1 error, cross-entropy, and ROC surface plots are used as evaluation criteria comparing the priors with frequentist methods as Lasso, Elastic-Net, and Ridge regression.

Results

All three priors can be used for robust prediction on significant metrics, irrespective of their categorical response model choices. Simulation studies could achieve the mean prediction accuracy of 91.6% (95% CI: 88.5, 94.7) and 76.5% (95% CI: 69.3, 83.8) for logistic regression and multinomial logistic models, respectively. The model can identify significant variables for disease risk prediction and is computationally efficient.

Conclusions

The models are robust enough to conduct both variable selection and prediction because of their high shrinkage properties and applicability to a broad range of classification problems.
Association of personality traits with polypharmacy among community-dwelling older adults in Japan: a cross-sectional analysis of data from the SONIC study
Authors: Yoshida Yuko , Ishizaki Tatsuro , Masui Yukie , Arai Yasumichi , Inagaki Hiroki , Ogawa Madoka , Yasumoto Saori , Iwasa Hajime , Kamide Kei , Rakugi Hiromi , Ikebe Kazunori , Gondo Yasuyuki
Published: April 2022

Background

Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults.

Methods

This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI.

Results

The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy.

Conclusions

Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.
AQP9 and ZAP70 as immune-related prognostic biomarkers suppress proliferation, migration and invasion of laryngeal cancer cells
Authors: Ren Li , Li Ping , Li Zhouping , Chen Quan
Published: April 2022

Background

Laryngeal cancer represents a common malignancy that originates from the larynx, with unfavorable prognosis. Herein, this study systematically analyzed the immune signatures of laryngeal cancer and to evaluate their roles on tumor progression.

Methods

Differentially expressed immune-related genes (IRGs) were screened between laryngeal cancer and normal tissues from TCGA dataset. Then, two prognosis-related IRGs AQP9 and ZAP70 were analyzed by a series of survival analysis. Based on them, molecular subtypes were constructed by unsupervised cluster analysis. Differences in survival outcomes, HLA expression and immune cell infiltrations were assessed between subtypes. Expression of AQP9 and ZAP70 was validated in laryngeal cancer tissues and cells by RT-qPCR and immunohistochemistry. After silencing and overexpressing AQP9 and ZAP70, CCK-8, EdU, wound healing and transwell assays were performed in TU212 and LCC cells.

Results

Totally, 315 IRGs were abnormally expressed in laryngeal cancer. Among them, AQP9 and ZAP70 were distinctly correlated to patients’ prognosis. Two subtypes were developed with distinct survival outcomes, HLA expression and immune microenvironment. Low expression of AQP9 and ZAP70 was confirmed in laryngeal cancer. AQP9 and ZAP70 up-regulation distinctly suppressed proliferation, migration, and invasion of laryngeal cancer cells. The opposite results were investigated when their knockdown.

Conclusions

Our findings revealed the roles of AQP9 and ZAP70 in progression of laryngeal cancer, and suggested that AQP9 and ZAP70 could potentially act as candidate immunotherapeutic targets for laryngeal cancer.
Prognosis of resected non-small cell lung cancer with pleural plaques on intrathoracic findings
Authors: Kagimoto Atsushi , Mimura Takeshi , Kamigaichi Atsushi , Yamashita Yoshinori
Published: April 2022

Background

The prognosis of patients with lung cancer who demonstrate pleural plaques intraoperatively, which may be associated with exposure to asbestos, is unclear. Here, we compared the clinicopathological characteristics and prognosis of these patients to those of patients without pleural plaques.

Methods

We included patients who underwent curative-intent resection for non-small cell lung cancer. We retrospectively investigated the relationship of intrathoracic findings of pleural plaques with clinicopathological features and prognosis.

Results

Pleural plaques were found in 121/701 patients (17.3%) during surgery. The incidence of squamous cell carcinoma (P < 0.001) and the pathological stage (P = 0.021) were higher in patients with pleural plaques. Overall survival was significantly worse in patients with pleural plaques (5-year rate; 64.5% vs. 79.3%;P < 0.001), and the same finding was noted in clinical stage I patients (5-year rate; 64.8% vs. 83.4%;P < 0.001). In multivariable analysis, the presence of pleural plaques was a significant predictor of overall survival in patients with clinical stage I (hazard ratio, 1.643;P = 0.036). In the analysis among patients with emphysema more severe than Goddard score 5 points or interstitial pneumonia, overall survival was significantly worse in those with pleural plaques than in those without pleural plaques (5-year rate; 66.3% vs. 49.5%;P < 0.001).

Conclusions

Patients with non-small cell lung cancer who underwent resection and demonstrated pleural plaques intraoperatively had a significantly worse prognosis. It is important to recognize the presence of pleural plaques intraoperatively, and our findings will be useful in determining the treatment and follow-up strategy for such patients with lung cancer and pleural plaques on intrathoracic examination.
The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China
Authors: Liu Yan , Liu Zhaorui , Liang Richard , Luo Yanan
Published: April 2022

Background

There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.

Methods

Using data from the China Health and Retirement Longitudinal 2011–2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.

Results

Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.

Conclusions

This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.
Predictors of COVID-19 vaccine acceptability among health professions students in Vietnam
Authors: Le Cua Ngoc , Nguyen Uyen Thi To , Do Diem Thi Hoang
Published: April 2022

Background

The COVID-19 vaccine hesitancy or refusal has actually been a threat to global health. In the current situation, health professions students are at risk for SARS-CoV-2 infection during their internship at healthcare facilities. Furthermore, those future healthcare workers will advise people to accept the COVID-19 vaccination. Therefore, the attitude of students towards vaccine acceptance and the predicting factors needs to be elucidated. This study applied the Health Belief Model to determine predictors of COVID-19 vaccine acceptability among health professions students.

Methods

Nine hundred eleven students participated in a cross-sectional online survey in Vietnam. Data were collected from 1st April to 30th June 2021. Data analysis was performed using SPSS software version 20.0 with Chi-square and Kruskal-Wallis tests before executing multinomial logistic regression to identify predictors of the COVID-19 vaccine acceptability

Results

The overall vaccine acceptance, hesitancy, and refusal rates were 58% (95% CI: 54.7% - 61.3%), 40.4% (95% CI: 37.2% - 43.7%) and 1.5% (95% CI: 0.8% - 2.6%), respectively. Regarding vaccination hesitancy, a predictor such as "Receiving recent flu shots” had a negative correlation, whereas "Vaccines have little efficacy & serious adverse effects” (Perceived barriers), nationality, and majors were positive correlates. For refusal, "Unvaccinated students feasibly infected COVID-19 during hospital internship” (Perceived susceptibility) was a negative correlate. For predicting both hesitancy and refusal, "Mass media appreciating effectiveness and safety of vaccines" (Cues to action), and " Health professions students get serious complications of COVID-19 if not vaccinated" (Perceived severity) were negative predictors. In contrast, "Manufacturers do not disclose adverse effects of vaccines" (Cues to action), and "Adverse effect causes death" (Perceived barrier) were recognized as positive predictors. Strong Health Belief Model predictors of vaccine refusal were "Manufacturers do not disclose adverse effects of vaccines" (Cues to action) with OR= 5.299(95% CI: 1.687-16.641, p= 0.004), and "Adverse effect causes death" (Perceived barrier) with OR= 10.255 (95% CI = 3.528-29.814, p= 0.0005).

Conclusion

Health professions students' acceptability of COVID-19 vaccination might be based on the perceived susceptibility to and severity of COVID-19, concerns about vaccine efficacy and safety, and the influence levels of information from various sources. Health education and measures to prevent the harmful effects of COVID-19 vaccine misinformation could potentially improve the acceptance rate of the COVID-19 vaccine
Supervisory dyads’ communication and alignment regarding the use of workplace-based observations: a qualitative study in general practice residency
Authors: de Jonge Laury P. J. W. M. , Minkels Floor N. E. , Govaerts Marjan J. B. , Muris Jean W. M. , Kramer Anneke W. M. , van der Vleuten Cees P. M. , Timmerman Angelique A.
Published: April 2022

Background

In medical residency, performance observations are considered an important strategy to monitor competence development, provide feedback and warrant patient safety. The aim of this study was to gain insight into whether and how supervisor-resident dyads build a working repertoire regarding the use of observations, and how they discuss and align goals and approaches to observation in particular.

Methods

We used a qualitative, social constructivist approach to explore if and how supervisory dyads work towards alignment of goals and preferred approaches to performance observations. We conducted semi-structured interviews with supervisor-resident dyads, performing a template analysis of the data thus obtained.

Results

The supervisory dyads did not frequently communicate about the use of observations, except at the start of training and unless they were triggered by internal or external factors. Their working repertoire regarding the use of observations seemed to be primarily driven by patient safety goals and institutional assessment requirements rather than by providing developmental feedback. Although intended as formative, the institutional test was perceived as summative by supervisors and residents, and led to teaching to the test rather than educating for purposes of competence development.

Conclusions

To unlock the full educational potential of performance observations, and to foster the development of an educational alliance, it is essential that supervisory dyads and the training institute communicate clearly about these observations and the role of assessment practices of- and for learning, in order to align their goals and respective approaches.
Evaluating the utility of an international webinar as a platform to educate students and doctors on the UK core surgical training portfolio
Authors: Raj Siddarth , Bola Harroop , Rai Amar , Grover Sarika , Bandyopadhyay Anisha , Naruka Vinci
Published: April 2022

Background

Core Surgical Training (CST) is a competitive two-year postgraduate training program in the UK that is scored based on three equally weighted stations: management, clinical and portfolio. Preparing a surgical portfolio can start in medical school, however, there is limited guidance on what forms a competitive portfolio with the majority of advice coming from university resources and national societies which are variable throughout the country. Our aim was to assess the utility of a webinar to educate students and doctors on the CST portfolio to address this disparity.

Methods

Pre- and post-event questionnaires that included demographic data, 10-point Likert scales to self-report confidence on the understanding of the CST portfolio and its domains, and questions on utilising webinars were distributed to attendees. Pre- and post-event responses were paired, and scores were assessed for normality via the Shapiro–Wilk test; the Mann–Whitney U test was used to assess statistical significance. Cohen's d effect sizes were calculated to report standardised differences between pre-and post-event scores.

Results

A total of 177 participants from over 24 countries responded to both questionnaires. A statistically significant improvement in awareness of how to score maximum points was demonstrated across all nine CST domains (p < 0.0001). Regardless of whether they were UK-based or international, approximately half of the participants stated a preference for a webinar over an in-person format. Interestingly, most attendees did not feel that their university had provided them with adequate information on preparing for a surgical career with over half of the attendees stating that they had to attend events by external organisations to obtain such information.

Conclusions

This study has demonstrated that a webinar can be effectively utilised to educate students and doctors on the various domains of the CST portfolio and how to maximise points in each section. Such events could address the variability of university resources and national societies across the country and provide equal opportunities for students. Further studies that directly compare webinars with in-person events and investigate long-term outcomes, such as success in CST applications, are required.
Cost-effectiveness analysis of brolucizumab versus aflibercept for the treatment of neovascular age-related macular degeneration (nAMD) in Italy
Authors: Ferrante Nicola , Ritrovato Daniela , Bitonti Rossella , Furneri Gianluca
Published: April 2022

Background

Age-related macular degeneration (AMD) is a common and chronic eye condition characterized by the presence of progressive degenerative abnormalities in the central retina (macula). Notably, neovascular, or wet, AMD (nAMD) occurs when new, abnormal blood vessels grow under the macula causing scarring of the macula itself and resulting in a loss of central vision, visual distortion, and an impaired capacity of perceiving colour contrast and intensity. Brolucizumab, a new generation anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody, was approved by the European Medicines Agency for the treatment of nAMD. The aim of this analysis is to evaluate the cost-effectiveness profile of brolucizumab, compared to the main therapeutic alternative available (aflibercept), for the treatment of nAMD.

Methods

The simulation of costs and outcomes was carried out using a Markov model over a time horizon of 15 years. In base-case, treatment effectiveness inputs for brolucizumab and aflibercept were extracted from the HAWK and HARRIER studies and from a network meta-analysis. The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (treatment acquisition, administration, adverse events, disease monitoring) were analysed. In the alternative scenarios, the societal perspective and a prolonged time horizon were considered. Model robustness was tested through sensitivity analyses.

Results

In the base-case analysis, brolucizumab was dominant over aflibercept (+ 0.11 years QALY gained and -€15,679 costs). Both one-way deterministic and probabilistic sensitivity analyses confirmed the robustness and reliability of base-case results. The results of the probabilistic sensitivity analysis showed that when the willingness to pay is equal to €50,000 per QALY gained, brolucizumab would be dominant in 84% of simulations and in the remaining simulations brolucizumab would be cost-effective compared to aflibercept. Results of the alternative scenarios and sensitivity analyses confirmed the results of base-case.

Conclusion

The cost-utility analysis shows that brolucizumab is dominant over aflibercept. Treatment with brolucizumab reduces the economic impact of nAMD and determined a slight increase of quality-adjusted survival. This analysis gives a high level of confidence that the treatment with brolucizumab would reduce the burden of intravitreal injections, compared to aflibercept, a relevant therapeutic alternative in Italy.
Transcriptional inhibition of miR-486-3p by BCL6 upregulates Snail and induces epithelial–mesenchymal transition during radiation-induced pulmonary fibrosis
Authors: Yan Ziyan , Ao Xingkun , Liang Xinxin , Chen Zhongmin , Liu Yuhao , Wang Ping , Wang Duo , Liu Zheng , Liu Xiaochang , Zhu Jiaojiao , Zhou Shenghui , Zhou Pingkun , Gu Yongqing
Published: April 2022

Background

Ionizing radiation (IR) can induce pulmonary fibrosis by causing epithelial mesenchymal transition (EMT), but the exact mechanism has not been elucidated. To investigate the molecular mechanism of how radiation induces pulmonary fibrosis by altering miR-486-3p content and thus inducing EMT.

Methods

The changes of miR-486-3p in cells after irradiation were detected by RT-qPCR. Western blot was used to detect the changes of cellular epithelial marker protein E-cadherin, mesenchymal marker N-cadherin, Vimentin and other proteins. The target gene of miR-486-3p was predicted by bioinformatics method and the binding site was verified by dual luciferase reporter system. In vivo experiments, adeno-associated virus (AAV) was used to carry miR-486-3p mimic to lung. Radiation-induced pulmonary fibrosis (RIPF) model was constructed by 25Gy60Co γ-rays. The structural changes of mouse lung were observed by HE and Masson staining. The expression of relevant proteins in mice was detected by immunohistochemistry.

Results

IR could decrease the miR-486-3p levels in vitro and in vivo, and that effect was closely correlated to the occurrence of RIPF. The expression of Snail, which induces EMT, was shown to be restrained by miR-486-3p. Therefore, knockdown of Snail blocked the EMT process induced by radiation or knockdown of miR-486-3p. In addition, the molecular mechanism underlying the IR-induced miRNA level reduction was explored. The increased in BCL6 could inhibit the formation of pri-miR-486-3p, thereby reducing the levels of miR-486-3p in the alveolar epithelial cells, which would otherwise promote EMT and contribute to RIPF by targeting Snail.

Conclusion

IR can exacerbate RIPF in mice by activating the transcription factor BCL6, which inhibits the transcription of miR-486-3p and decreases its content, which in turn increases the content of the target gene slug and triggers EMT.