bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcriptomic, proteomic, and physiological comparative analyses of flooding mitigation of the damage induced by low-temperature stress in direct seeded early indica rice at the seedling stage
Authors: Wang Wenxia , Du Jie , Chen Liming , Zeng Yongjun , Tan Xueming , Shi Qinghua , Pan Xiaohua , Wu Ziming , Zeng Yanhua
Published: March 2021

Background

Low temperature (LT) often occurs at the seedling stage in the early rice-growing season, especially for direct seeded early-season indica rice, and using flooding irrigation can mitigate LT damage in rice seedlings. The molecular mechanism by which flooding mitigates the damage induced by LT stress has not been fully elucidated. Thus, LT stress at 8 °C, LT accompanied by flooding (LTF) and CK (control) treatments were established for 3 days to determine the transcriptomic, proteomic and physiological response in direct seeded rice seedlings at the seedling stage.

Results

LT damaged chloroplasts, and thylakoid lamellae, and increased osmiophilic bodies and starch grains compared to CK, but LTF alleviated the damage to chloroplast structure caused by LT. The physiological characteristics of treated plants showed that compared with LT, LTF significantly increased the contents of rubisco, chlorophyll, PEPCK, ATP and GA3 but significantly decreased soluble protein, MDA and ABA contents. 4D-label-free quantitative proteomic profiling showed that photosynthesis-responsive proteins, such as phytochrome, as well as chlorophyll and the tricarboxylic acid cycle were significantly downregulated in LT/CK and LTF/CK comparison groups. However, compared with LT, phytochrome, chlorophyllide oxygenase activity and the glucan branching enzyme in LTF were significantly upregulated in rice leaves. Transcriptomic and proteomic studies identified 72,818 transcripts and 5639 proteins, and 4983 genes that were identified at both the transcriptome and proteome levels. Differentially expressed genes (DEGs) and differentially expressed proteins (DEPs) were significantly enriched in glycine, serine and threonine metabolism, biosynthesis of secondary metabolites, glycolysis/gluconeogenesis and metabolic pathways.

Conclusion

Through transcriptomic, proteomic and physiological analyses, we determined that a variety of metabolic pathway changes were induced by LT and LTF. GO and KEGG enrichment analyses demonstrated that DEGs and DEPs were associated with photosynthesis pathways, antioxidant enzymes and energy metabolism pathway-related proteins. Our study provided new insights for efforts to reduce the damage to direct seeded rice caused by low-temperature stress and provided a breeding target for low temperature flooding-resistant cultivars. Further analysis of translational regulation and metabolites may help to elucidate the molecular mechanisms by which flooding mitigates low-temperature stress in direct seeded early indica rice at the seedling stage.
Consistent ultra-long DNA sequencing with automated slow pipetting
Authors: Prall Trent M. , Neumann Emma K. , Karl Julie A. , Shortreed Cecilia G. , Baker David A. , Bussan Hailey E. , Wiseman Roger W. , O’Connor David H.
Published: March 2021

Background

Oxford Nanopore Technologies’ instruments can sequence reads of great length. Long reads improve sequence assemblies by unambiguously spanning repetitive elements of the genome. Sequencing reads of significant length requires the preservation of long DNA template molecules through library preparation by pipetting reagents as slowly as possible to minimize shearing. This process is time-consuming and inconsistent at preserving read length as even small changes in volumetric flow rate can result in template shearing.

Results

We have designed SNAILS (Slow Nucleic Acid Instrument for Long Sequences), a 3D-printable instrument that automates slow pipetting of reagents used in long read library preparation for Oxford Nanopore sequencing. Across six sequencing libraries, SNAILS preserved more reads exceeding 100 kilobases in length and increased its libraries’ average read length over manual slow pipetting.

Conclusions

SNAILS is a low-cost, easily deployable solution for improving sequencing projects that require reads of significant length. By automating the slow pipetting of library preparation reagents, SNAILS increases the consistency and throughput of long read Nanopore sequencing.
Screening for proteins related to the biosynthesis of hispidin and its derivatives in Phellinus igniarius using iTRAQ proteomic analysis
Authors: Guo Jinjing , Liu Xiaoxi , Li Yuanjie , Ji Hongyan , Liu Cheng , Zhou Li , Huang Yu , Bai Changcai , Jiang Zhibo , Wu Xiuli
Published: March 2021

Background

Hispidin (HIP) and its derivatives, a class of natural fungal metabolites, possess complex chemical structures with extensive pharmacological activities. Phellinus igniarius, the most common source of HIP, can be used as both medicine and food. However, the biosynthetic pathway of HIP in P. igniarius remains unclear and we have a limited understanding of the regulatory mechanisms related to HIP. In this work, we sought to illustrate a biosynthesis system for hispidin and its derivatives at the protein level.

Results

We found that tricetolatone (TL) is a key biosynthetic precursor in the biosynthetic pathway of hispidin and that its addition led to increased production of hispidin and various hispidin derivatives. Based on the changes in the concentrations of precursors and intermediates, key timepoints in the biosynthetic process were identified. We used isobaric tags for relative and absolute quantification (iTRAQ) to study dynamic changes of related proteins in vitro. The 270 differentially expressed proteins were determined by GO enrichment analysis to be primarily related to energy metabolism, oxidative phosphorylation, and environmental stress responses after TL supplementation. The differentially expressed proteins were related to ATP synthase, NAD binding protein, oxidoreductase, and other elements associated with electron transfer and dehydrogenation reactions during the biosynthesis of hispidin and its derivatives. Multiple reaction monitoring (MRM) technology was used to selectively verify the iTRAQ results, leading us to screen 11 proteins that were predicted to be related to the biosynthesis pathways.

Conclution

These findings help to clarify the molecular mechanism of biosynthesis of hispidin and its derivatives and may serve as a foundation for future strategies to identify new hispidin derivatives.
Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report
Authors: Navas-Blanco Jose R. , Lifgren Sofia A. , Dudaryk Roman , Scott Jeffrey , Loebe Matthias , Ghodsizad Ali
Published: March 2021

Background

The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas.

Case presentation

We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock.

Conclusions

Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.
Epirubicin-induced Kounis syndrome
Authors: Liang Hui-zhu , Zhao Hong , Gao Jian , Cao Cheng-fu , Wang Wei-min
Published: March 2021

Background

Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging.

Case presentation

A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made.

Conclusions

Kounis syndrome is common, but a prompt diagnosis is often not possible. ﻿This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.
Personalized hypertension management based on serial assessment and telemedicine (PHMA): a cluster randomize controlled trial protocol in Anhui, China
Authors: Shen Xingrong , Xiao Siyi , Liu Rong , Tong Guixian , Liu Tongzhu , Wang Debin
Published: March 2021

Background

Despite tremendous investment worldwide, hypertension treatment and control rates remain low. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.

Methods/design

PHMA strives to reduce hypertension harms by eight “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.

Discussion

PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.

Trial registration ISRCTN10999269. July 17, 2020; https://doi.org/10.1186/ISRCTN10999269.
Syncope due to non-sustained episodes of Torsade de Pointes associated to androgen-deprivation therapy use: a case presentation
Authors: Morales Ximena , Garnica Diego , Isaza Daniel , Isaza Nicolas , Durán-Torres Felipe
Published: March 2021

Background

Abiraterone is a medication frequently used for metastatic castrate-resistant prostate cancer. We report a case of non-sustained episodes of TdP associated with severe hypokalemia due to androgen-deprivation therapy. Few case presentations describe this association; the novelty lies in the potentially lethal cardiovascular events among cancer patients receiving hormonal therapy.

Case presentation

A 70-year-old male presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of TdP, and severe hypomagnesemia and hypokalemia. During potassium and magnesium infusion for repletion, the patient underwent temporary transvenous atrial pacing. As part of the work-up, coronary angiography revealed a mild coronary artery disease, and transthoracic echocardiogram showed a moderately depressed ejection fraction. After electrolyte disturbances were corrected, the QT interval normalized, and transvenous pacing was no longer necessary. Abiraterone was discontinued during the admission, and the patient returned to baseline.

Conclusions

Cancer treatment is complex and requires a multidisciplinary approach. We presented a case of non-sustained TdP associated with androgen-deprivation therapy in an elderly patient with mild coronary artery disease and moderately reduced ejection fraction. Close follow-up and increased awareness are required in patients with hormonal treatment, especially in the setting of other cardiovascular risk factors.
Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications
Authors: Fan Ting , Sun Qi , Cao Shouli , Fan Xiangshan , Huang Qin , Zhang Shu , Lv Ying , Zhang Xiaoqi , Ling Tingsheng , Wang Lei , Zou Xiaoping , Xu Guifang
Published: March 2021

Background

Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.

Methods

From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.

Results

The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group.

Conclusion

The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.
Body mass index, performance on activities of daily living and cognition: analysis in two different populations
Authors: Borda Miguel Germán , Venegas-Sanabria Luis Carlos , Garcia-Cifuentes Elkin , Gomez Ronald Camilo , Cano-Gutierrez Carlos Alberto , Tovar-Rios Diego Alejandro , Aarsland Vera , Khalifa Khadija , Jaramillo-Jimenez Alberto , Aarsland Dag , Soennesyn Hogne
Published: March 2021

Background

With this study, we aim to determine the associations of the different categories of the body mass index (BMI) with activities of daily living (ADL) and cognitive performance in two different populations living in the community; Colombian and South Korean older adults.

Methods

We performed a cross-sectional analysis of two surveys separately; The Survey on Health, Well-Being, and Aging in Colombia (SABE) (n = 23,343) and the Korean Longitudinal Study of aging (KLoSA) (n = 4556). Participants older than 50 years were selected from rural and urban areas achieving a representative sample. Here we investigated the association between BMI categories with function using zero-inflated negative binomial regressions, and with cognition using logistic regression models.

Results

After adjustment, in Colombia, underweight was associated with an impaired score on the Mini-mental State Examination (MMSE) and worse performance in the instrumental activities of daily living (IADL). Also, being overweight was associated with a better score on the MMSE and the IADL. For both outcomes education level significantly influenced the predictions. In South Korea, there were no significant associations for cognition, IADL, or basic activities of daily living (BADL).

Conclusions

In the Colombian population, underweight, was associated with reduced cognitive performance and daily functioning. Additionally, being overweight but not obese was associated with better cognition and daily functioning. In South Korea, there were no significant associations between BMI and cognition, IADL, or BADL.
Fever, pancytopenia, and elevated D-dimer in a 95‐year‐old woman with ehrlichiosis: a case report
Authors: Radcliffe Christopher , Tsay Cynthia , Glerum Kimberly , Liao Jane , Goshua George , Kerins Gerard
Published: March 2021

Background

Pancytopenia, fever, and elevated D-dimer are significant clinical findings. The differential diagnosis includes hematological malignancies, severe coronavirus disease 2019 (COVID-19), tick-borne illnesses, and other etiologies.

Case presentation

We report the case of a 95-year-old woman who presented with high fever (103.6 °F), pancytopenia, and markedly elevated D-dimer (32.21 mg/L; reference range ≤ 0.95 mg/L) in late-autumn during the COVID-19 pandemic at a large academic institution. After remaining persistently febrile, a peripheral blood smear was ordered and revealed parasites consistent with Ehrlichia spp. Doxycycline monotherapy led to symptomatic improvement and resolution of her pancytopenia. During her hospital stay, a computed tomography angiogram of the chest revealed pulmonary emboli, and esophagogastroduodenoscopy uncovered arteriovenous malformations. After appropriate treatment, she was discharged on hospital day 7 and has since done well.

Conclusions

Overall, our case offers a dramatic, unexpected presentation of ehrlichiosis in a nonagenarian. To our knowledge, this is the first report of concurrent ehrlichiosis and pulmonary embolus.
Perceived stress and depressive symptoms not neuropsychiatric symptoms predict caregiver burden in Alzheimer’s disease: a cross-sectional study
Authors: Pinyopornpanish Manee , Pinyopornpanish Kanokporn , Soontornpun Atiwat , Tanprawate Surat , Nadsasarn Angkana , Wongpakaran Nahathai , Wongpakaran Tinakon
Published: March 2021

Background

Caregiver burden affects the caregiver’s health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer’s Disease (AD) and to investigate the predictors for caregiving burden.

Methods

A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations.

Results

A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001).

Conclusion

Caregiver burden is associated with patients’ neuropsychiatric symptoms indirectly through the caregiver’s depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.
A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting
Authors: van Niekerk J. M. , Stein A. , Doting M. H. E. , Lokate M. , Braakman-Jansen L. M. A. , van Gemert-Pijnen J. E. W. C.
Published: March 2021

Background

Hand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.

Methods

Spatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors’ contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes.

Results

Nurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm).

Conclusion

Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies.
Phenotypic and genotypic drug sensitivity profiles of Mycobacterium tuberculosis infection and associated factors in northeastern Ethiopia
Authors: Gashaw Fikru , Erko Berhanu , Mekonnen Yalemtsehay , Yenew Bazezew , Amare Misikir , Gumi Balako , Ameni Gobena
Published: March 2021

Background

Tuberculosis is a devastating and a deadly disease despite the novel advances in its diagnostic tools and drug therapy. Drug resistant Mycobacterium contributes a great share to tuberculosis mortality. Status of drug resistance and patients’ awareness toward the disease is unknown in northeastern Ethiopia. Thus, the aim of this study was to determine the phenotypic and genotypic drug sensitivity patterns and associated factors in Oromia Special Zone and Dessie Town, northeastern Ethiopia.

Methods

In a cross-sectional study, 384 smear positive tuberculosis cases were recruited and Löwenstein-Jensen culture was done. The performance of GenoTypic MTBDRplus assay using the conventional BACTEC MGIT 960 as a “gold standard” was determined. Drug resistant strains were identified using spoligotyping. Pearson Chi-square test was used to determine the association of drug sensitivity test and tuberculosis type, lineages, dominant strains and clustering of the isolates.

Results

The 384 smear positive Mycobacterium samples were cultured on LJ media of which 29.2% (112/384) as culture positive. A fair agreement was found between MTBDRplus assay and the conventional MGIT test in detecting the Mycobacterium tuberculosis with sensitivity, specificity, positive and negative predictive value of 94.2, 30.2, 68.4 and 76.5%, respectively. Among LJ culture positive samples 95 of them gave valid result for MTBDRplus assay and 16.8% (16/95) as drug resistant. Similarly, MGIT subculture was made for the 112 isolates and 69 of them gave positive result with 15.9% (11/69) as drug resistant. Cohen’s kappa value showed almost a perfect agreement between the two testing methods in detecting rifampicin (sensitivity 100% and specificity 98.3%) and multi-drug resistance (sensitivity 83.3% and specificity 100%). Spoligotyping identified 76.5% (13/17) of the drug resistant isolates as Euro-American and family 33 as the predominant family. Significant association was observed between drug resistant isolates and the dominant strains (χ2: 34.861; p = 0.040) of the Mycobacterium.

Conclusion

Higher magnitude of drug resistance was found in the study area. The GenoTypic MDRTBplus assay had an acceptable drug sensitivity testing performance.
Pre-clinical study of IRDye800CW-nimotuzumab formulation, stability, pharmacokinetics, and safety
Authors: Bernhard Wendy , Barreto Kris , El-Sayed Ayman , Gonzalez Carolina , Viswas Raja Solomon , Toledo Darien , Casaco Angel , DeCoteau John , Fonge Humphrey , Geyer Clarence Ronald
Published: March 2021

Background

Epidermal growth factor receptor (EGFR) is a target for cancer therapy as it is overexpressed in a wide variety of cancers. Therapeutic antibodies that bind EGFR are being evaluated in clinical trials as imaging agents for positron emission tomography and image-guided surgery. However, some of these antibodies have safety concerns such as infusion reactions, limiting their use in imaging applications. Nimotuzumab is a therapeutic monoclonal antibody that is specific for EGFR and has been used as a therapy in a number of countries.

Methods

Formulation of IRDye800CW-nimotuzumab for a clinical trial application was prepared. The physical, chemical, and pharmaceutical properties were tested to develop the specifications to determine stability of the product. The acute and delayed toxicities were tested and IRDye800CW-nimotuzumab was determined to be non-toxic. Non-compartmental pharmacokinetics analysis was used to determine the half-life of IRDye800CW-nimotuzumab.

Results

IRDye800CW-nimotuzumab was determined to be non-toxic from the acute and delayed toxicity study. The half-life of IRDye800CW-nimotuzumab was determined to be 38 ± 1.5 h. A bi-exponential analysis was also used which gave a t1/2 alpha of 1.5 h and t1/2 beta of 40.8 h.

Conclusions

Here, we show preclinical studies demonstrating that nimotuzumab conjugated to IRDye800CW is safe and does not exhibit toxicities commonly associated with EGFR targeting antibodies.
Routine mortality surveillance to identify the cause of death pattern for out-of-hospital adult (aged 12+ years) deaths in Bangladesh: introduction of automated verbal autopsy
Authors: Shawon Md. Toufiq Hassan , Ashrafi Shah Ali Akbar , Azad Abul Kalam , Firth Sonja M. , Chowdhury Hafizur , Mswia Robert G. , Adair Tim , Riley Ian , Abouzahr Carla , Lopez Alan D.
Published: March 2021

Background

In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh.

Methods

Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool.

Results

Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates.

Conclusions

Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems.
Crazy‐paving patterns as rare radiological manifestations of pulmonary cryptococcosis: a case report
Authors: Yu He , Wang Kaige , Huang Dong , Wen Lu , Zhang Ying , Wang Ye , Tang Yongjiang , Dong Jiajia , Liang Zongan
Published: March 2021

Background

Crazy-paving patterns are rarely reported as radiological manifestations of pulmonary cryptococcosis.

Case presentation

Herein, we presented a very rare case of a crazy-paving pattern as a radiological manifestation of pulmonary cryptococcosis in a patient with primary ciliary dyskinesia. The diagnosis of pulmonary cryptococcosis and primary ciliary dyskinesia was ultimately confirmed by bronchoscopic biopsy, fungus culture, whole exome sequencing of blood, etc. The patient received flucytosine (PO, 5 g per day) and amphotericin B (IV, 70 mg per day) during hospitalization and sequential therapy with voriconazole (PO, 200 mg twice a day) after discharge. He recovered during follow-up.

Conclusions

We concluded that pulmonary cryptococcosis should be considered a possible cause of crazy-paving patterns in chest CT scans.
Non‐operative management of bilateral contained thoracic esophageal perforation: a case report
Authors: Amirian Armin , Shahriarirad Reza , Mardani Parviz , Salimi Maryam
Published: March 2021

Background

Despite profound advances in conservative management of esophageal perforation, patients’ selection for this type of treatment requires expert clinical judgment. Surgical intervention has been historically introduced as the optimal management in multifocal ruptures.

Case presentation

Here, we presented a 30-year-old man whose barium esophagogram confirmed bilateral perforations in the lower third of the esophagus contained in the mediastinum, and contrast drained back into the esophageal lumen. Concerning available contrast imaging studies and thoracic surgeons, conservative non-operative management was considered despite pneumomediastinum, a mild right-sided pleural effusion, and minimal leukocytosis. The patient was followed up for two months without any complications.

Conclusions

Bilateral and multifocal esophageal perforations can be managed conservatively provided that the leaks are confined to the mediastinum and drain back to the esophageal lumen, and other criteria for conservative management are met.
Validating potent anti-inflammatory and anti-rheumatoid properties of Drynaria quercifolia rhizome methanolic extract through in vitro, in vivo, in silico and GC-MS-based profiling
Authors: Modak Debabrata , Paul Subhashis , Sarkar Sourav , Thakur Subarna , Bhattacharjee Soumen
Published: March 2021

Background

The fronds of Drynaria quercifolia have traditionally been used in rheumatic pain management. The goal of the present study was to validate the potent anti-inflammatory and anti-rheumatoid properties of the methanolic-extract of its rhizome using in vitro, in vivo and in silico strategies.

Methods

The plant was collected and the methanolic extract was prepared from its rhizome. Protein denaturation test, hypotonicity and heat-induced haemolysis assays were performed in vitro. The in vivo anti-rheumatoid potential was assessed in Freund’s complete adjuvant (FCA)-induced Wistar rat model through inflammatory paw-edema, haematological, biochemical, radiological and histopathological measurements. Moreover, metabolites of methanolic extract were screened by gas chromatography-mass spectrometry (GC-MS) and 3D molecular structures of active components were utilized for in silico docking study using AutoDock.

Results

In vitro results evinced a significant (p < 0.05) anti-inflammatory activity of the rhizome methanolic extract in a dose-linear response. Further, Drynaria quercifolia rhizome methanolic extract (DME) significantly ameliorated rheumatoid arthritis as indicated by the inhibition of arthritic paw-edema (in millimeter) in the rat rheumatoid arthritis models in both the low (57.71 ± 0.99, p < 0.01) and high dose groups (54.45 ± 1.30, p < 0.001) when compared to arthritic control. Treatment with DME also normalized the haematological (RBC, WBC, platelet counts and hemoglobin contents) and biochemical parameters (total protein, albumin, creatinine and ceruloplasmin) significantly (p < 0.05), which were further supported by histopathological and radiological analyses. Furthermore, GC-MS analysis of DME demonstrated the presence of 47 phytochemical compounds. Compounds like Squalene, Gamma Tocopherol, n-Hexadecanoic acid showed potent inhibition of cyclooxygenase-2 (COX-2), tumor necrosis factor (TNF-α), and interleukin (IL-6) in the docking analysis.

Conclusion

Results from in vivo and in vitro studies indicated that DME possesses a potent anti-inflammatory and anti-arthritic activity. In silico studies delineated the emergent potent inhibitory effects of several bio-active components on the target inflammatory markers (COX-2, TNF-α and IL-6).
Cultural competence of Australian dental students
Authors: Mariño Rodrigo , Satur Julie , Tuncer Eren , Tran Megan , Milford Elizabeth , Tran Vivien Minh Thien Huong , Tran Phuong Qui , Tsai Richard Pei-Hua
Published: March 2021

Background

Australia possesses a highly multicultural demographic, and thus dental practitioners are likely to regularly encounter culturally and linguistically diverse individuals. It is important for dental practitioners to be culturally competent, however, cultural competency education is highly variable in the curricula of dentistry and oral health courses in Australia, and research is largely limited to dentistry students. This study aims to investigate and compare perceived attitudes, beliefs and practices of cultural competence amongst first and final year Doctor of Dental Surgery (DDS) and Bachelor of Oral Health (BOH) students at the University of Melbourne Dental School.

Methods

Following ethics approval, anonymous questionnaires were completed by 213 participants. The questionnaire was adapted from Schwarz’s Healthcare Provider Cultural Competence Instrument and consisted of five scales. Data was analysed using SPSS V 24.0 software.

Results

A total of 213 students participated in this study (response rate = 88%) The majority of participants were female (n = 114, 53.5%) and the mean age of 23.5 years (range 18–40). The majority of participants were Australian born (n = 110) with 74.6% (n = 159) first generation Australians. Participants who identified as Australian represented 35.7% (n = 76) with 66.1% (n = 141) identified as partly Australian. Multivariate analysis indicated that, after controlling for other independent variables in the model, those who had the highest cultural competence score were female, who self-identify as “Australian”, who were in the final year. Furthermore, those who were in the final BOH year scored significatively higher than final year DDS students.

Conclusion

The findings of this study suggest that there is a significant difference in students self-reported cultural competence at different stages of their education. This may be attributed to differences in cultural competence education, scope of practice and the type of patient encounters and role modelling that students may experience. Future research should involve follow up to create longitudinal data, as well as research at other dental schools in Australia and overseas.
Effectivity of near-peer teaching in training of basic surgical skills – a randomized controlled trial
Authors: Pintér Zsolt , Kardos Dániel , Varga Péter , Kopjár Eszter , Kovács Anna , Than Péter , Rendeki Szilárd , Czopf László , Füzesi Zsuzsanna , Schlégl Ádám Tibor
Published: March 2021

Background

Near-peer teaching (NPT) is a special way of teaching where the tutor is one or more academic years ahead of the person being tutored. The literature agrees on the benefits of the method, but there are only a few publications examining its effectiveness using objective methods. The aim of our study was to examine the effectiveness of NPT in the training of basic surgical skills.

Methods

We included 60 volunteer students who participated in a 20 × 45 min long surgical skills course. Based on the results of a pre-course test, we randomly divided the students into six equal groups. All groups completed the same curriculum, with three groups being assisted by a NPT tutor. After the course, they completed the same test as at the beginning. The exams were recorded on anonymized videos and were blindly evaluated. The students’ satisfaction was monitored using a self-administered online anonymous questionnaire. Statistical analysis was performed using the Mann-Whitney and Wilcoxon tests.

Results

Overall, student performance improved with completion of the course (from 119.86 to 153.55 points, p <  0.01). In groups where a NPT tutor assisted, students achieved a significantly better score (37.20 vs. 30.18 points improvement, p = 0.036). The difference was prominent in surgical knotting tasks (14.73 vs. 9.30 points improvement, p <  0.01). In cases of suturing (15.90 vs. 15.46 points) and laparoscopy (7.00 vs. 4.98 points), the presence of the NPT tutor did not significantly affect development. Based on student feedback, although students positively assessed the presence of NPT, it did not significantly improve students’ overall satisfaction since it was already 4,82 on a scale of 5 in the control group.

Conclusions

Overall, involving a NPT tutor had a positive impact on student development. An outstanding difference was observed in connection with knotting techniques.
Family presence during resuscitation: adaptation and validation into Spanish of the Family Presence Risk-Benefit scale and the Self-Confidence scale instrument
Authors: de Mingo-Fernández Eva , Belzunegui-Eraso Ángel , Jiménez-Herrera María
Published: March 2021

Background

Family Presence during Cardiopulmonary Resuscitation has been studied both to identify the opinions of health professionals, patients, and family members, and to identify benefits and barriers, as well as to design protocols for its implementation. R. Twibell and her team designed an instrument that measured nurses’ perceptions of Risks-Benefits and Self-Confidence regarding Family Presence during Resuscitation. There are few studies in Spain on this practice.

Methods

The aim is to adapt and validate into Spanish the Family Presence Risk-Benefit scale and Family Presence Self-Confidence scale instrument. For this purpose, this instrument was translated cross-culturally, and administered in paper and online version. Statistical tests were carried out for the validity of the questionnaire. Five hundred forty-one healthcare professionals were invited to respond. The results were analyzed by the same statistical procedures as in the original scale. Ethical approvals and research permissions were obtained according to national standards.

Results

Two hundred thirty-seven healthcare professionals (43.8%) answered the survey (69% women), of whom 167 were nurses. Validation of instruments: Cronbach’s α in Family Presence Risk-Benefit scale was 0.94. Cronbach’s α in Family Presence Self-Confidence scale was 0.96. Factor Analysis Kaiser, Meyer and Olkin (KMO) was greater than 0.9. The correlation between the two measured scales, is significant and has a moderate intensity of the relationship (r = 0.65 and α < 0.001).

A lower predisposition to Family Presence during Cardiopulmonary Resuscitation is observed, but the pure detractors are only 12%. Doctors are more reluctant than nurses.

Conclusions

The psychometric properties of the questionnaire in Spanish indicate high validity and reliability. Risk-Benefit perception and Self-Confidence are related to the healthcare professionals who consider the Family Presence to be beneficial. More studies in different contexts are necessary to confirm the psychometric results and validity of this instrument in Spanish.
Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients’ perspectives
Authors: Aekplakorn Wichai , Suriyawongpaisal Paibul , Srithamrongsawadi Samrit , Kaewkamjonchai Phanuwich
Published: March 2021

Background

To improve care for patients with chronic diseases, a recent policy initiative in Thailand focused on strengthening primary care based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients about the health care services after the implementation.

Methods

We conducted a cross-sectional survey of 4071 patients with hypertension and/or diabetes registered with 27 primary care units and 11 hospital non-communicable diseases (NCDs) clinics in 11 provinces.

The patients were interviewed using a validated questionnaire of the Patient Assessment of Chronic Illness Care. Upgraded primary care units (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect logistic models were employed to examine the association of subscales (high vs low score) of patient perception of the care quality with type of PCUs.

Results

Compared to hospital NCD clinics, ordinary PCUs were the best in the odds of receiving high score for every CCM subscale (ORs: 1.46–1.85; p < 0.05), whereas the trained upgraded PCUs were better in terms of follow-up (ORs:1.37; p < 0.05), and the upgraded PCU did not differ in all domains. According to the 5 A model subscales, patient assessment also revealed better performance of ordinary PCUs in all domains compared to hospital NCD clinics whereas upgraded PCUs and trained upgraded PCUs did so in some domains. Seeing the same doctor on repeated visits (ORs: 1.82–2.17; p < 0.05) or having phone contacts with the providers (ORs:1.53–1.99; p < 0.05) were found beneficial using CCM subscales and the 5A model subscales. However, patient assessment by both subscales did not demonstrate a statistically significant association across health insurance status.

Conclusions

The policy implementation might not satisfy the patients’ perception on quality of chronic care according to the CCM and the 5A model subscale. However, the arrangement of chronic care with patients seeing the same doctors or patients having telephone contact with healthcare providers may satisfy the patients’ perceived needs.
Concerns, quality of life, access to care and productivity of the general population during the first 8 weeks of the coronavirus lockdown in Belgium and the Netherlands
Authors: van Ballegooijen Hanne , Goossens Lucas , Bruin Ralph H. , Michels Renée , Krol Marieke
Published: March 2021

Background

The COVID-19 pandemic has a disruptive impact on our society. We therefore conducted a population survey to describe: 1) stress, concerns and quality of life 2) access to healthcare and cancelled/delayed healthcare and 3) productivity during the first 8 weeks of the coronavirus lockdown in the general population.

Methods

An online cross-sectional survey was conducted in a representative sample after 8 weeks of the coronavirus lockdown in Belgium and the Netherlands. The survey included a series of three validated questionnaires about quality of life delayed/cancelled medical care and productivity loss using validated questionnaires.

Results

In total, 2099 Belgian and 2058 Dutch respondents completed the survey with a mean age of 46.4 and 42.0 years, respectively. Half of the respondents were female in both countries. A small proportion tested positive for COVID-19, 1.4% vs 4.7%, respectively. The majority of respondents with a medical condition was worried about their current health state due to the pandemic (53%) vs (63%), respectively. Respondents experienced postponed/cancelled care (26%) and were concerned about the availability of medication (32%) for both countries. Productivity losses due to the COVID-19 restrictions were calculated in absenteeism (36%) and presenteeism (30%) for Belgium, and (19%) and (35%) for the Netherlands. Most concerns and productivity losses were reported by respondents with children < 12 years, respondents aged 18–35 and respondents with an (expected) COVID-19 infection.

Conclusions

This study describes stress, quality of life, medical resource loss and productivity losses in Belgium and the Netherlands after 8 weeks of coronavirus lockdown. The results underline the burden on society.
Determinants of the behavioral intention to use a mobile nursing application by nurses in China
Authors: Pan Minghao , Gao Wei
Published: March 2021

Background

Although a mobile nursing application has began to adopt in nursing, few studies have focused on nurses’ behavioral intention of it. The objective of this study is to gain insight into the behavioral intention of nurses, i.e. chinese nurses of the future, to use a mobile nursing application. This study adopted an extension of the Unified Theory of Acceptance and Use of Technology to examine Chinese nurses’ acceptance of a mobile nursing application.

Methods

A total of 1207 nurses participated in the cross-sectional survey. The majority of nurses were female (96.2%). The mean age of the participants was 34.18 (SD 7.39). The hypothesized relationships were tested using AMOS structural equation model.

Results

All constructs exhibited an acceptable level of reliability and validity with Cα and CR > 0.7 and AVE > 0.5. An extension of the Unified Theory of Acceptance and Use of Technology Model had good explanatory power for nurses’ behavioral intention of a mobile nursing application. Although effort expectancy and perceived risks had a surprisingly insignificant effect on nurses’ behavioral intention to use a mobile nursing application, performance expectancy, social influence, facilitating conditions, self-efficacy, and perceived incentives demonstrated significant influence with β = .259, p < .001, β = .296, p < .001, β = .063, p = .037, β = .344, p < .001, β = .091, p = .001, respectively.

Conclusion

With 70.2% of the variance in behavioral intention to use a mobile nursing app explained by this model, it could be helpful for potential adopters, and further investigation should test the actual usage behavior for a mobile nursing app and investigate the related factors.