bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of symptom distress on health-related quality of life in liver cancer patients receiving arterial chemoembolization: the mediating role of hope
Authors: Chen Nan-Yan , Chen Kang-Hua , Wang Yi-Wen , Tsai Hsiu-Hsin , Lee Wei-Chen , Weng Li-Chueh
Published: November 2022

Background

Trans-hepatic arterial chemoembolization (TACE) is a treatment option for liver cancer patients. It can prolong patients’ survival but can also cause symptom distress. Symptom distress (SDs) can directly impact quality of life (QOL) and may indirectly influence QOL by lessening hope. In this study, we wanted to explore the mediating effect of hope on the relationship between SDs and QOL among patients with liver cancer receiving TACE.

Methods

A cross-sectional study was conducted from December 20, 2017, to August 6, 2018, at a gastroenterology ward of a medical center. The participants were 92 liver cancer patients (69.6% male, mean age 67.8) who were admitted for TACE treatment. Information on SDs, hope, and QOL was collected by questionnaire on discharge day. Hayes’ PROCESS model was used to test the mediating effect of hope on the relationship between SDs and QOL.

Results

The mean score and standard deviation (SD) of SDs, hope, and QOL were 32.08 (SD = 6.22), 27.09 (SD = 3.51), and 55.16 (SD = 17.33), respectively. SDs negatively impacts quality of life. The total effect of SDs on QOL was − 1.41 (95% confidence interval [CI]: − 1.96, − 0.86). The indirect effect via the mediation of hope was − 0.95 (95% CI: − 1.7, − 0.45). Hope partially mediated the effect of SDs on QOL.

Conclusion

SDs after TACE is vital; it directly reduces a patient’s overall QOL and can indirectly hinder it by reducing the patient’s hope. In addition to symptom management, interventions that help patients maintain their hope are key to improving QOL among patients receiving TACE.
Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study
Authors: Yip Olivia , Dhaini Suzanne , Esser Jan , Siqeca Flaka , Mendieta Maria Jose , Huber Evelyn , Zeller Andreas , De Geest Sabina , Deschodt Mieke , Zúñiga Franziska , Zullig Leah L. , King Heather A. ,   the INSPIRE consortium, Urfer Pia , Vounatsou Penelope , Obas Katrina , Briel Matthias , Schwenkglenks Matthias , Quinto Carlos , Blozik Eva
Published: November 2022

Background

Home-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support.

Methods

Using an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table.

Results

Of the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care.

Conclusions

Given the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.
Diagnostic accuracy of linked administrative data for dementia diagnosis in community-dwelling older men in Australia
Authors: Chow Eric P. F. , Hsu Benjumin , Waite Louise M. , Blyth Fiona M. , Handelsman David J. , Le Couteur David G. , Naganathan Vasi , Stanaway Fiona F.
Published: November 2022

Background

Routinely collected health administrative data can be used to estimate the prevalence or incidence of dementia at a population level but can be inaccurate. This study aimed to examine the accuracy of hospital and death data for diagnosing dementia compared with a clinical diagnosis in community dwelling older men in Australia.

Methods

We performed a retrospective analysis of the Concord Health and Ageing in Men Project (CHAMP) in Sydney, Australia. Of the 1705 men aged ≥70 years in the CHAMP study, 1400 had available linked administrative data records from 1 year prior to 1 year post the date of clinical dementia diagnosis. The primary outcome was the accuracy of dementia diagnosis using linked administrative data records compared to clinical dementia diagnosis. The linked data diagnosis was based on hospital and death records for the 1 year pre and post the clinical diagnosis. Clinical dementia diagnosis was a two-stage process with initial screening, followed by clinical assessment for those meeting a validated cut-off. A final clinical diagnosis of dementia based on the Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria was reached by a consensus panel.

Results

Administrative data identified 28 participants as having dementia, compared to 88 identified through clinical assessment. Administrative data had a sensitivity of 20% (95% CI: 13–30%, 18/88), specificity of 99% (95% CI: 99–100%, 1301/1312), positive predictive value (PPV) of 62% (95% CI: 44–77%), negative predictive value of 95% (95% CI: 94–95%), positive likelihood ratio of 24.4 (95% CI: 11.9–50.0) and negative likelihood ratio of 0.80 (0.72–0.89).

Conclusions

Administrative hospital and death data has limited accuracy for dementia diagnosis with poor sensitivity and PPV. The prevalence of dementia is likely underestimated using hospital and deaths data.
The values of elastic quantitative and semi-quantitative indexes measured from different frequencies in the establishment of prediction models for breast tumor diagnosis
Authors: Xie Xiao , Ma Yibo , Xing Xiaoxiao , Zhou Haixia , Liu Shuiqing , Zhang Yanyan , Xu Min
Published: November 2022

Objective

To obtain the elastic quantitative and semi-quantitative indexes of solid breast masses using ultrasound linear array probes with two different frequencies, and to construct prediction models and evaluate their diagnostic values.

Methods

A total of 92 patients who were scheduled for surgical treatment on solid breast masses were enrolled in this study. Linear array probes with two frequencies, 9-3 MHz (L9 group) and 14-5 MHz (L14 group), were used for sound touch elastography and strain elastography before surgery, and the maximum elasticity value (Emax), average elasticity value (Emean), minimum elasticity value (Emin), standard deviation (SD)(in kPa), elasticity ratio (E), and strain ratio to fat (SRf) were recorded and calculated for the breast mass (A) and surrounding tissues (Shell). The elastic characteristic indexes of the L9 group and L14 group were compared, and the prediction models of these two groups were constructed using Logistic regression method.

Results

The diagnostic performance of the prediction model based on L9 group was better than the model based on L14 group (AUC: 0.904 vs. 0.810, P = 0.0343, z = 2.116) and the best single index EMax-shell-L9 (P = 0.0398, z = 2.056). The sensitivity of L9 based model was 85.19% and the specificity was 84.21%.

Conclusion

The prediction model based on quantitative and semi-quantitative elastic ultrasound indexes from L9-3 probe exhibited better performance, which could improve the diagnostic accuracy for malignant breast tumors.
Validation of the generalized anxiety disorder screener (GAD-7) in Cypriot pregnant and postpartum women
Authors: Vogazianos Paris , Motrico Emma , Domínguez-Salas Sara , Christoforou Andri , Hadjigeorgiou Eleni
Published: November 2022

Background

Anxiety is increasingly acknowledged as a common mental health issue during the perinatal period. Its prevalence as well as the associated adverse effects constitute screening imperative. This study evaluates the psychometric properties and underlying factor structures of a Greek version of GAD-7 among pregnant and postpartum women (up to 6 months) in Cyprus.

Methods

This study was conducted from June to December 2020. A total of 457 Cypriot women in the perinatal period (222 pregnant and 235 postpartum) were surveyed. The assessment included anxiety (GAD-7) and depression (EPDS), and psychosocial factors related with anxiety. The internal consistency and factor structure of GAD-7 were evaluated using reliability coefficients, Cronbach’s Alpha and McDonald's Omega, and factor analysis, both Exploratory as well as Confirmatory.

Results

GAD-7 demonstrated good internal consistency (α = 0.907; Ω = 0.909). Horn's parallel analysis indicated a single factor as the most appropriate. CFA using the standard ML method indicated a good model fit, χ2 = 21.207, p = 0.096; CFI = 0.999; SRMR = 0.027. More studies are needed to determinate the cut-off point and the maximisation of the scale’s sensitivity and specificity in pregnant and postpartum Greek Cypriot women.

Conclusions

GAD-7 is a valid and reliable measure and healthcare professionals should utilize GAD-7 as a standard instrument for the screening of anxiety symptoms in pregnant and postpartum Greek Cypriot women.
Nomogram-based development and evaluation for predictions of 30-day and 1-year survival in patients with spontaneously ruptured hepatocellular carcinoma
Authors: Wang Peng , Yang Shuping , Li Chao , Han Xiangjun , Hong Duo , Shao Haibo
Published: November 2022

Background

Accurately predicting the prognosis of patients with spontaneously ruptured hepatocellular carcinoma (HCC) is crucial for effective clinical management. The aim of the present study was to establish and evaluate prediction models for 30-day and 1-year survival in patients with spontaneously ruptured HCC.

Methods

A total of 118 patients with spontaneous rupture HCC were enrolled. Univariate and multivariate analyses were performed using logistic-regression model and Cox proportional-hazard model. The identified indicators were used to establish prediction models, the performance of which we compared with those of commonly used liver disease scoring models. The survival possibilities of different risk categories were calculated using the newly developed models.

Results

Largest tumor size (LTS), serum albumin (ALB), total bilirubin (TBil), and serum creatinine were identified as independent predictors, which were used to establish a 30-day survival prediction model. LTS, BCLC staging, ALB, TBil, hepatectomy at rupture, and TACE during follow-up were identified as independent predictors of 1-year survival model. The 30-day survival model had sensitivity of 79.3%, specificity of 87.1%, and an AUC of 0.879, exhibiting better predictive performance than scores for Chronic Liver Failure Consortium Acute Decompensation score (CLIF-C ADs) and Model for End-stage Liver Disease (MELD). The 1-year survival model had sensitivity of 66.7%, specificity of 94.6%, and an AUC of 0.835, showing better predictive performance than Albumin–Bilirubin (ALBI), Child–Pugh, CLIF-C ADs, and MELD. After stratification, survival possibilities were 90.9 and 21.1% in low- and high-risk groups within 30 days, respectively, and 43.90, 4.35%, and 0 in low-, intermediate-, and high-risk groups at 1 year, respectively.

Conclusions

The established models exhibited good performance in predicting both 30-day and 1-year survival in patients with spontaneously ruptured HCC.
Healthy physical education curriculum model and students’ extracurricular sports participation ——test based on the trans-contextual model of motivation
Authors: Hao Xiaoliang , Yang Yunyun
Published: November 2022

Background

In recent years, the mental health level and physical activity level of Chinese teenagers are not ideal, and all sectors of society are actively reversing this bad situation. The purpose of this study is to test the influence of healthy physical education curriculum model on middle school students’ extracurricular sports participation based on the trans-contextual model of motivation (TCM).

Methods

The trial adopts quasi-experimental design comparing equivalent groups. The experimental group adopted the healthy physical education curriculum model in physical education (PE), and the control group adopted the technical-traditional teaching. During the 12 weeks intervention, 327 junior school freshmen completed the test of TCM variables four times as the pre-test, test 2, test 3 and post-test of this experimental study.

Results

After the intervention, students’ perceived need support in PE, autonomous motivation in PE, autonomous motivation in leisure time (LT)and the amount of extracurricular sports activities in the experimental group have increased significantly. The perceived need support of experimental group students can predict autonomous motivation in PE positively (β = 0.385, P<.001); Autonomous motivation in PE can predict autonomous motivation in LT positively (β = 0.462, P<.001); Autonomous motivation in LT can predict the intention of extracurricular sports participation positively, and the direct effect was significant (β = 0.172, P<.01), the total indirect effect was significant (β = 0.382, P<.001), the indirect effect of subjective norms was not significant (P>.05); Extracurricular sports participation intention can predict the amount of extracurricular sports activities positively (β = 0.327, P<.001).

Conclusions

The structural characteristics of healthy physical education curriculum model provide need support for students’ learning, improve students’ autonomous motivation in and out of PE, and finally promote students’ participation in extracurricular sports.
Parental migration and left-behind children in Georgia – school teachers’ experience and perception: a qualitative study
Authors: Antia Khatia , Rodoreda Astrid Berner , Winkler Volker
Published: November 2022

Introduction

Georgia, like other Eastern European countries, showed a dramatic increase of international labour emigration after becoming independent in 1991. The collapse of the Soviet Union caused economic instability, unemployment and poverty resulting in labour migration. Since then, thousands of children have been left behind in the care of extended family members while their parents work abroad. The aim of this study is to explore schoolteachers’ perceptions on parental migration and left-behind children (LBC) in Georgia as schoolteachers are the main contact persons for LBC and their caregivers. 

Methods

We conducted six focus-group discussions with public school teachers, namely class-tutors and six in-depth interviews with school principals from two migrant sending regions. We applied reflexive thematic analysis to systematically analyse the data and identify main and sub-themes. The contextual model of family stress underpins this study.

Results

We identified the following themes expressed by both, teachers, and school principals: social and economic impact of migrant labour and relationships between schools and migrant families. School teachers and principals acknowledged some positive aspects of migrant labour, but primarily perceived parental migration as a negative experience for children leading to problems in mental health, well-being, and academic performance. Structural factors, lack of support and lack of community involvement were expressed to further worsen the situation. Teachers saw themselves as one of the main supporters for LBC while they described the role of caregivers ranging from caring to unhelpful or even destructive. School principals stated mitigating the situation by regular meetings with class tutors, extra-tutoring for LBC, psychological counselling, and developing/enacting internal guidelines.

Conclusions

Our findings suggest that LBCs and transnational families could benefit from the provision of psychological services at schools.
Stress in surgical educational environments: a systematic review
Authors: Tjønnås Maria Suong , Guzmán-García Carmen , Sánchez-González Patricia , Gómez Enrique Javier , Oropesa Ignacio , Våpenstad Cecilie
Published: November 2022

Background

The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance.

Methods

A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682).

Results

Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance.

Conclusions

The impact of stress responses presents an important factor in surgical environments, affecting residents’ training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons’ stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
Status and related factors of burnout among palliative nurses in China: a cross-sectional study
Authors: Zhang Yalin , Jiang Jianjun , Zhu Chuanmei , Liu Chunhua , Guan Chang , Hu Xiaolin
Published: November 2022

Background

Burnout occurs frequently in nurses and seems more common in nurses providing palliative care. However, to our knowledge, there is a lack of understanding regarding the factors influencing burnout among palliative nurses in China.

Methods

A cross-sectional design was conducted. A total of 331 palliative nurses from 25 hospitals participated in this study. Anonymous data were collected through a self-designed social-demographic questionnaire, the Nursing Burnout Scale, the Perceived Social Support Scale, the General Self-Efficacy Scale, the Connor-Davidson Resilience Scale, and the Simplified Coping Style Questionnaire. Independent sample t tests, one-way ANOVA, Pearson correlations, and multiple linear regressions were performed to identify the related factors of the three dimensions of burnout.

Results

In the results of multiple linear regression, resilience, health condition, coping style, and pessimistic personality were common related factors; in addition, end-of-life care training, social support, and income satisfaction were statistically significantly associated with burnout. These factors could explain 38.6%, 27.8%, and 34.5% of the total variance in emotional exhaustion, depersonalization, and reduced personal accomplishment, respectively.

Conclusions

The findings of this study help policy makers and nurse managers better understand burnout among palliative nurses in China. The results highlighted the importance of implementing culture-oriented training programs, providing perceived organizational support, and building a reasonable salary system to decrease burnout among palliative nurses, increase the quality of nursing and promote the development of Chinese palliative care.
Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study
Authors: Alkubati Sameer A. , Al-Sayaghi Khaled M. , Alrubaiee Gamil G. , Hamid Mokhtar Abdu , Saleh Khalil A , Al-Qalah Talal , Al-Sadi Ahmad K.
Published: November 2022

Background

Endotracheal suctioning (ETS) is one of the most common invasive procedures performed by critical care nurses (CCNs) to remove accumulated pulmonary secretions, ensure airway patency for adequate ventilation and oxygenation as well as prevent atelectasis in intubated patients.

Objectives

To assess the practice of CCNs in intensive care units (ICUs) before, during, and after performing the ETS procedure and identify factors affecting their practice.

Methods

A cross-sectional and non-participant observational design was conducted in the ICUs of four hospitals in Hodeida city, Yemen. The data were collected using a 25-item observational checklist in the period from May to August 2019.

Results

More than half (55%) of CCNs scored undesirable (< 50%) regarding their adherence to ETS practice guidelines while the rest scored moderate (50–75%), with none of showing desirable adherence (> 70%) to the guidelines. There was no significant association between gender, age, education level, or length of experience of CCNs in the ICUs and their practice during performance ETS procedures. However, training (p = 0.010) and receiving information about ETS (p = 0.028) significantly improved the CCNs’ practice.

Conclusion

Most CCNs at the ICUs of Hodeida hospitals do not adhere to evidence-based practice guidelines when performing ETS procedures, possibly resulting in numerous adverse effects and complications for patients. CCNs receiving information and training show better ETS practice than do their counterparts. Therefore, it is necessary to provide the nursing staff with clear guidelines, continuous education and monitoring to improve their practices.
Association between gut microbiota and preeclampsia-eclampsia: a two-sample Mendelian randomization study
Authors: Li Pengsheng , Wang Haiyan , Guo Lan , Gou Xiaoyan , Chen Gengdong , Lin Dongxin , Fan Dazhi , Guo Xiaoling , Liu Zhengping
Published: November 2022

Background

Several recent observational studies have reported that gut microbiota composition is associated with preeclampsia. However, the causal effect of gut microbiota on preeclampsia-eclampsia is unknown.

Methods

A two-sample Mendelian randomization study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study meta-analysis (n=13,266) conducted by the MiBioGen consortium. The summary statistics of preeclampsia-eclampsia were obtained from the FinnGen consortium R7 release data (5731 cases and 160,670 controls). Inverse variance weighted, maximum likelihood, MR-Egger, weighted median, weighted model, MR-PRESSO, and cML-MA were used to examine the causal association between gut microbiota and preeclampsia-eclampsia. Reverse Mendelian randomization analysis was performed on the bacteria that were found to be causally associated with preeclampsia-eclampsia in forward Mendelian randomization analysis. Cochran’s Q statistics were used to quantify the heterogeneity of instrumental variables.

Results

Inverse variance weighted estimates suggested that Bifidobacterium had a protective effect on preeclampsia-eclampsia (odds ratio = 0.76, 95% confidence interval: 0.64–0.89, P = 8.03 × 10−4). In addition, Collinsella (odds ratio = 0.77, 95% confidence interval: 0.60–0.98, P = 0.03), Enterorhabdus (odds ratio = 0.76, 95% confidence interval: 0.62–0.93, P = 8.76 × 10−3), Eubacterium (ventriosum group) (odds ratio = 0.76, 95% confidence interval: 0.63–0.91, P = 2.43 × 10−3), Lachnospiraceae (NK4A136 group) (odds ratio = 0.77, 95% confidence interval: 0.65–0.92, P = 3.77 × 10−3), and Tyzzerella 3 (odds ratio = 0.85, 95% confidence interval: 0.74–0.97, P = 0.01) presented a suggestive association with preeclampsia-eclampsia. According to the results of reverse MR analysis, no significant causal effect of preeclampsia-eclampsia was found on gut microbiota. No significant heterogeneity of instrumental variables or horizontal pleiotropy was found.

Conclusions

This two-sample Mendelian randomization study found that Bifidobacterium was causally associated with preeclampsia-eclampsia. Further randomized controlled trials are needed to clarify the protective effect of probiotics on preeclampsia-eclampsia and their specific protective mechanisms.
Comparison of the effects of triglyceride variability and exposure estimate on clinical prognosis in diabetic patients
Authors: Koh Sung Min , Chung Se Hwa , Yum Yun Jin , Park Se Jun , Joo Hyung Joon , Kim Yong-Hyun , Kim Eung Ju
Published: November 2022

Background

Hypertriglyceridemia is an important feature of dyslipidemia in type 1 and type 2 diabetic patients and associated with the development of atherosclerotic cardiovascular disease. Recently, variability of lipid profile has been suggested as a residual risk factor for cardiovascular disease. This study compared the clinical impact of serum triglyceride variability, and their cumulative exposure estimates on cardiovascular prognosis in diabetic patients.

Methods

A total of 25,933 diabetic patients who had serum triglyceride levels measured at least 3 times and did not have underlying malignancy, myocardial infarction (MI), and stroke during the initial 3 years (modeling phase) were selected from three tertiary hospitals. They were divided into a high/low group depending on their coefficient of variation (CV) and cumulative exposure estimate (CEE). Incidence of major adverse event (MAE), a composite of all-cause death, MI, and stroke during the following 5 years were compared between groups by multivariable analysis after propensity score matching.

Results

Although there was a slight difference, both the high CV group and the high CEE group had a higher cardiovascular risk profile including male-dominance, smoking, alcohol, dyslipidemia, and chronic kidney disease compared to the low groups. After the propensity score matching, the high CV group showed higher MAE incidence compared to the low CV group (9.1% vs 7.7%, p = 0.01). In contrast, there was no significant difference of MAE incidence between the high CEE group and the low CEE group (8.6% vs 9.1%, p = 0.44). After the multivariable analysis with further adjustment for potential residual confounding factors, the high CV was suggested as an independent risk predictor for MAE (HR 1.19 [95% CI 1.03–1.37]).

Conclusion

Visit-to-visit variability of triglyceride rather than their cumulative exposure is more strongly related to the incidence of MAE in diabetic patients.
Modelling malaria in southernmost provinces of Thailand: a two-step process for analysis of highly right-skewed data with a large proportion of zeros
Authors: Ammatawiyanon Lumpoo , Tongkumchum Phattrawan , Lim Apiradee , McNeil Don
Published: November 2022

Background

Malaria remains a serious health problem in the southern border provinces of Thailand. The issue areas can be identified using an appropriate statistical model. This study aimed to investigate malaria for its spatial occurrence and incidence rate in the southernmost provinces of Thailand.

Methods

The Thai Office of Disease Prevention and Control, Ministry of Public Health, provided total hospital admissions of malaria cases from 2008 to 2020, which were classified by age, gender, and sub-district of residence. Sixty-two sub-districts were excluded since they had no malaria cases. A logistic model was used to identify spatial occurrence patterns of malaria, and a log-linear regression model was employed to model the incidence rate after eliminating records with zero cases.

Results

The overall occurrence rate was 9.8% and the overall median incidence rate was 4.3 cases per 1,000 population. Malaria occurence peaked at young adults aged 20–29, and subsequently fell with age for both sexes, whereas incidence rate increased with age for both sexes. Malaria occurrence and incidence rates fluctuated; they appeared to be on the decline. The area with the highest malaria occurrence and incidence rate was remarkably similar to the area with the highest number of malaria cases, which were mostly in Yala province's sub-districts bordering Malaysia.

Conclusions

Malaria is a serious problem in forest-covered border areas. The correct policies and strategies should be concentrated in these areas, in order to address this condition.
Challenges with adherence to the ‘test, treat, and track’ malaria case management guideline among prescribers in Ghana
Authors: Kolekang Augusta Soninour , Afrane Yaw , Apanga Stephen , Zurovac Dejan , Kwarteng Anthony , Afari-Asiedu Samuel , Asante Kwaku Poku , Danso-Appiah Anthony
Published: November 2022

Background

Despite several efforts at addressing the barriers to adherence to the WHO-supported test, treat and track (T3) malaria case management guideline in Ghana, adherence remains a challenge. This study explored the challenges of prescribers regarding adherence to the T3 guideline.

Methods

This was an explorative study using key informant interviews amongst prescribers comprising medical doctors, physician assistants, nurses and a health extension worker from 16 health facilities in six districts in Ghana. The data was analysed using Nvivo 10 and organized into thematic areas.

Results

Prescribers lauded the guideline on testing and treatment as it ensures the quality of malaria case management, but irregular supply of malaria rapid diagnostic test kits (RDT), mistrust of laboratory tests, and the reluctance of prescribers to change from presumptive treatment were key barriers to testing. Patients with malaria test negative results if not treated, revisiting the facility with severe malaria, the experience of prescribers, lack of regular training and supervision for old and new staff and the inability of prescribers to investigate non-malaria fever hindered adherence to results-based treatment.

Conclusion

As malaria remains a significant cause of morbidity and mortality in Ghana, this study provides insights on gaps in adherence to the testing and treatment of malaria. While the diagnostic capacity for malaria case management is a challenge, the lack of training resulting in the inability of some prescribers to investigate non-malaria fever hinders adherence to the malaria case management guideline. Therefore, there is a need to train new prescribers, laboratory personnel, and other staff involved in malaria diagnosis and treatment on the malaria case management guideline before they assume duty. Equipping laboratory personnel and prescribers with the knowledge to investigate non-malaria fevers could improve adherence to the guideline for improved patient care.
Transanal down-to-up dissection of the distal rectum as a viable approach to achieve total mesorectal excision in laparoscopic sphincter-preserving surgery for rectal cancer near the anus: a study of short- and long-term outcomes of 123 consecutive patients from a single Japanese institution
Authors: Kagami Satoru , Funahashi Kimihiko , Koda Takamaru , Ushigome Toshimitsu , Kaneko Tomoaki , Suzuki Takayuki , Miura Yasuyuki , Nagashima Yasuo , Yoshida Kimihiko , Kurihara Akiharu
Published: November 2022

Background

In rectal cancer (RC) surgery, the complexity of total mesorectal excision (TME) in laparoscopic sphincter-preserving surgery (lap-SPS) for RC near the anus has been a critical issue. Recently, technical assistance via the anus for complete TME has been receiving attention. This study aimed at clarifying the transanal down-to-up dissection viability for achieving TME in lap-SPS for RC near the anus.

Methods

We evaluated surgical and oncological outcomes of a total of 123 consecutive patients undergoing either a transanal rectal dissection (TARD) under direct vision mobilizing the most difficult portion of TME via the anus or the transanal TME by using an endoscopic system (TaTME) for achieving TME in lap-SPS for RC near the anus between January 2006 and February 2021.

Results

A total of 123 consecutive patients (83 men) with a median age of 66 years (range 33–86 years) were included. TARD and TaTME were performed for 50 (40.7%) and for 73 (59.3%) patients, respectively. Preoperative treatment was performed for 40 (32.5%) patients, resulting in a complete pathological response in 5 (12.5%) patients. Intersphincteric resection was performed significantly more in the TARD group (p<0.001). Although the TaTME group needed a longer operative time at the transanal portion (p<0.001), the median blood loss was lower (p<0.001). Postoperative complications with the Clavien–Dindo classification grade ≧2 developed in 52 (42.3%) patients. Urinary dysfunction and stoma-related complications were found most frequently. More patients needing medication for urinary dysfunction were found in the TARD group, but a significant difference was not observed (10.0% vs. 6.8%, p=0.526). The quality of TME was good for almost all patients. Recurrence developed in 18 (14.6%) patients. The 5-year overall survival (OS) and relapse-free survival (RFS) rates in 123 patients were 95.8% and 88.8%, respectively. The 5-year OS and RFS between the two groups were comparable.

Conclusions

Our data suggested that a transanal down-to-up dissection of the distal rectum might be a viable approach in lap-SPS for RC near the anus. Further studies are needed to examine the differences between TARD and TaTME.
Synthesis and bioactivities evaluation of quinazolin-4(3H)-one derivatives as α-glucosidase inhibitors
Authors: Moheb Mahshid , Iraji Aida , Dastyafteh Navid , Khalili Ghomi Minoo , Noori Milad , Mojtabavi Somayeh , Faramarzi Mohammad Ali , Rasekh Fatemeh , Larijani Bagher , Zomorodian Kamiar , Sadat-Ebrahimi Seyed Esmaeil , Mahdavi Mohammad
Published: November 2022

The development of new antidiabetes agents is necessary to obtain optimal glycemic control and overcome its complications. Different quinazolin-4(3H)-one bearing phenoxy-acetamide derivatives (7a–r) were designed and synthesized to develop α-glucosidase inhibitors. All the synthesized derivatives were evaluated against α-glucosidase in vitro and among them, compound 7b showed the highest α-glucosidase inhibition with an IC50 of 14.4 µM, which was ∼53 times stronger than that of acarbose. The inhibition kinetic studies showed that the inhibitory mechanism of compound 7b was a competitive type towards α-glucosidase. Also, molecular docking studies analyzed the interaction between the most potent derivative and α-glucosidase. Current findings indicate the new potential of quinazolin-4(3H)-ones that could be used for the development of novel agents against diabetes mellitus.
Immunogenicity and antigenicity of a conserved fragment of the rhoptry-associated membrane antigen of Plasmodium vivax
Authors: Ge Jieyun , Wang Qiubo , Chen Gangcheng , Kassegne Kokouvi , Zhang Hangye , Yu Jiali , Tang Jianxia , Wang Bo , Lu Feng , Cao Jun , Han Eun-Taek , Cheng Yang
Published: November 2022

Background

Plasmodium vivax rhoptry-associated membrane antigen (RAMA) is a glycophosphatidylinositol-anchored membrane protein currently under consideration as a malaria vaccine candidate. Immunoglobulin G (IgG) antibodies induced by P. vivax RAMA (PvRAMA) have been proved to persist over 12 months in the sera of people infected with P. vivax. It has also been shown that through stimulation of peripheral blood mononuclear cells with PvRAMA in vitro, the antigen can induce CD4+ T cells to produce interleukin-10. However, the genetic diversity of the RAMA gene in isolates of P. vivax (pvrama) and the immunogenicity of PvRAMA in animals remain unclear.

Methods

Genomic DNA was extracted from blood samples (n = 25) of patients in Jiangsu Province, China with imported infections of P. vivax from endemic countries in South and Southeast Asia. The extract genomic DNA was used as templates to amplify the P. vivax rama gene (pvrama) by PCR, and the PCR products were then sequenced and analyzed by the DnaSP, MEGA, and GeneDoc software packages. Recombinant PvRAMA (rPvRAMA) protein was expressed and purified, and then used to immunize mice. Levels of total IgG and different IgG subclasses of rPvRAMA-immunized mice were evaluated by enzyme-linked immunosorbent assay. Also, spleen cells of rPvRAMA-immunized mice were stimulated with rPvRAMA in vitro and levels of T cells were measured by flow cytometry.

Results

The average pairwise nucleotide diversity (π) of the pvrama gene was 0.00190, and the haplotype diversity (Hd) was 0.982. The C-terminal of PvRAMA showed lower haplotype diversity compared to the N-terminal and was completely conserved at amino acid sites related to erythrocyte binding. To further characterize immunogenicity of the C-terminal of PvRAMA, mice were immunized with rPvRAMA antigen. The rPvRAMA protein induced antibody responses, with the end-point titer ranging from 1:10,000 to 1:5,120,000. IgG1 was the predominant IgG subclass in rPvRAMA-immunized mice, followed by IgG2b. In addition, levels of CD4+ and CD8+ T cells in the rPvRAMA-stimulated group were significantly higher than those in the phosphate-buffered saline-stimulated group (normal control group).

Conclusions

The high conservation at specific amino acid sites and the high immunogenicity of the C-terminal of PvRAMA indicate the presence of conserved epitopes able to generate broadly reactive humoral and cellular immune responses. These findings support the potential of PvRAMA to serve as a vaccine candidate against P. vivax infection.

Graphical Abstract
Genomic and transcriptomic analysis of a diffuse pleural mesothelioma patient-derived xenograft library
Authors: Offin Michael , Sauter Jennifer L. , Tischfield Sam E. , Egger Jacklynn V. , Chavan Shweta , Shah Nisargbhai S. , Manoj Parvathy , Ventura Katia , Allaj Viola , de Stanchina Elisa , Travis William , Ladanyi Marc , Rimner Andreas , Rusch Valerie W. , Adusumilli Prasad S. , Poirier John T. , Zauderer Marjorie G. , Rudin Charles M. , Sen Triparna
Published: November 2022

Background

Diffuse pleural mesothelioma (DPM) is an aggressive malignancy that, despite recent treatment advances, has unacceptably poor outcomes. Therapeutic research in DPM is inhibited by a paucity of preclinical models that faithfully recapitulate the human disease.

Methods

We established 22 patient-derived xenografts (PDX) from 22 patients with DPM and performed multi-omic analyses to deconvolute the mutational landscapes, global expression profiles, and molecular subtypes of these PDX models and compared features to those of the matched primary patient tumors. Targeted next-generation sequencing (NGS; MSK-IMPACT), immunohistochemistry, and histologic subtyping were performed on all available samples. RNA sequencing was performed on all available PDX samples. Clinical outcomes and treatment history were annotated for all patients. Platinum-doublet progression-free survival (PFS) was determined from the start of chemotherapy until radiographic/clinical progression and grouped into < or ≥ 6 months.

Results

PDX models were established from both treatment naïve and previously treated samples and were noted to closely resemble the histology, genomic landscape, and proteomic profiles of the parent tumor. After establishing the validity of the models, transcriptomic analyses demonstrated overexpression in WNT/β-catenin, hedgehog, and TGF-β signaling and a consistent suppression of immune-related signaling in PDXs derived from patients with worse clinical outcomes.

Conclusions

These data demonstrate that DPM PDX models closely resemble the genotype and phenotype of parental tumors, and identify pathways altered in DPM for future exploration in preclinical studies.
Clinical characterizations of three adults with genetically confirmed spinal muscular atrophy: a case series
Authors: Setyaningrum Cempaka Thursina Srie , Harahap Indra Sari Kusuma , Nurputra Dian Kesumapramudya , Ar Rochmah Mawaddah , Sadewa Ahmad Hamim , Alkarani Giga Hasabi , Harahap Nur Imma Fatimah
Published: November 2022

Background

Spinal muscular atrophy is a recessively inherited autosomal neuromuscular disorder, with characteristic progressive muscle weakness. Most spinal muscular atrophy cases clinically manifest during infancy or childhood, although it may first manifest in adulthood. Although spinal muscular atrophy has come to the era of newborn screening and promising treatments, genetically confirmed spinal muscular atrophy patients are still rare in third world countries, including Indonesia.

Case presentations

We presented three Indonesian patients with spinal muscular atrophy genetically confirmed during adulthood. The first case was a 40-year-old male who presented with weakness in his lower limbs that started when he was 9 years old. At the age of 16 years, he could no longer walk and started using a wheelchair. He first came to our clinic at the age of 38 years, and was diagnosed with spinal muscular atrophy 2 years later. The second patient was a 58-year-old male who presented with lower limb weakness since he was 12 years old. Owing to the geographical distance and financial problems, he was referred to our clinic at the age of 56 years, when he already used a walker to walk. Lastly, the third patient was a 28-year-old woman, who was in the first semester of her second pregnancy, and who presented with slowly progressing lower limb weakness. Her limb weakness began at the age of 8 years, and slowly progressed until she became dependent on her wheelchair 8 years later until now. She had successfully given birth to a healthy daughter 3 years before her first visit to our clinic. All three patients were diagnosed with neuromuscular disorder diseases, with the differential diagnoses of Duchenne muscular dystrophy, spinal muscular atrophy, and Becker muscular dystrophy. These patients were finally confirmed to have spinal muscular atrophy due to SMN1 deletion by polymerase chain reaction and restriction fragment length polymorphism.

Conclusions

Many genetic diseases are often neglected in developing countries owing to the difficulty in diagnosis and unavailable treatment. Our case series focused on the disease courses, diagnosis difficulties, and clinical presentations of three patients that finally lead to diagnoses of spinal muscular atrophy.
Gut microbiota is associated with the effect of photoperiod on seasonal breeding in male Brandt’s voles (Lasiopodomys brandtii)
Authors: Zhu Hanyi , Li Guoliang , Liu Jing , Xu Xiaoming , Zhang Zhibin
Published: November 2022

Background

Seasonal breeding in mammals has been widely recognized to be regulated by photoperiod, but the association of gut microbiota with photoperiodic regulation of seasonal breeding has never been investigated.

Results

In this study, we investigated the association of gut microbiota with photoperiod-induced reproduction in male Brandt’s voles (Lasiopodomys brandtii) through a long-day and short-day photoperiod manipulation experiment and fecal microbiota transplantation (FMT) experiment. We found photoperiod significantly altered reproductive hormone and gene expression levels, and gut microbiota of voles. Specific gut microbes were significantly associated with the reproductive hormones and genes of voles during photoperiod acclimation. Transplantation of gut microbes into recipient voles induced similar changes in three hormones (melatonin, follicle-stimulating hormone, and luteinizing hormone) and three genes (hypothalamic Kiss-1, testicular Dio3, and Dio2/Dio3 ratio) to those in long-day and short-day photoperiod donor voles and altered circadian rhythm peaks of recipient voles.

Conclusions

Our study firstly revealed the association of gut microbiota with photoperiodic regulation of seasonal breeding through the HPG axis, melatonin, and Kisspeptin/GPR54 system. Our results may have significant implications for pest control, livestock animal breeding, and human health management.
How Universal Health Coverage can curb the escalating antimicrobial resistance in Pakistan: a call to action for the country's healthcare system
Authors: Imran Laiba , Rehan Syeda Tayyaba , Lee Ka Yiu
Published: November 2022

Antimicrobial resistance (AMR) has emerged as a major threat to the global healthcare economy during Coronavirus disease 2019 (COVID-19), especially in developing countries like Pakistan where the healthcare facilities are already substandard. To combat AMR, the World Health Organization (WHO) has taken several initiatives including the establishment of a sustainable Universal Health Coverage (UHC) system. The implementation of UHC could eliminate various factors that contribute to a high AMR rate including self-medication. Our commentary explores in depth the current UHC system in Pakistan and how UHC could be the answer to Pakistan’s AMR crisis.
Analysis of GPS P(Y) signal power enhancement based on the observations with a semi-codeless receiver
Authors: Tang Xiaomei , Yuan Muzi , Wang Feixue
Published: November 2022

The Global Position System (GPS) satellites of Block IIR-M and later versions can turn on the signal power enhancement if needed. In recent years, this power enhancement has been triggered several times when the U.S force was involved in local conflicts, which was observed by the monitoring receivers at International GNSS Service (IGS)/international GNSS Monitoring and Assessment System (iGMAS) stations or the high-gain antennas at monitoring ground stations. The specific power enhancement magnitudes with these two observation methods are different. The observations of L1/L2 P(Y) power with a high-gain antenna are accurate, while the observations at IGS/iGMAS stations contain biases. This paper analyses the reasons for the observation biases with monitoring receivers at IGS/iGMAS stations and proposes a method verifying the accurate relation between the observed carrier-to-noise ratio (C/N0) data and the real power enhancement magnitudes. When the power enhancement event happens, the observed L1/L2 P(Y) C/N0 data at IGS/iGMAS stations can be corrected using the model proposed in this paper. In the analysis, this paper concludes that the power of L1P(Y) increases by about 4.3–5.3 dB and the power of L2P(Y) by about 4.6–5.2 dB in power enhancement events, which matches the designed capability of GPS satellites as well. The results are also verified by the data of high-gain antennas.