bluuebunny/crossref_metadata_2025 huggingface dataset:
Pentafecta outcomes of robotic laparoscopically assisted radical prostatectomy during the initial experience in a university hospital
Authors: Cachoeira Eduardo Tosetto , de Oliveira Paludo Artur , Knijnik Pedro Glusman , Brum Pietro Waltrick , Burttet Lucas Medeiros , Berger Milton , Silva Neto Brasil
Published: February 2023

Background

Robotic laparoscopically assisted radical prostatectomy (RARP) is an option for the treatment of localized prostate cancer. The objective of the present study was to evaluate the pentafecta outcomes (biochemical recurrence, continence, potency, surgical complications and surgical margins) in patients undergoing RARP during the initial experience in a university hospital.

Methods

This is a retrospective study of patients who had RARP for localized prostate adenocarcinoma at a university hospital from August 2013 to October 2019 to evaluate pentafecta outcomes (biochemical recurrence, continence, potency, surgical complications and surgical margins). Data were collected and stored via Microsoft Office Excel program and analyzed using SPSS Software, version 20.0.

Results

One hundred and sixty-three RARP were performed, the mean age is 64.16 ± 6.54 years, PSA 6.20 (IQR = 4.91–8.95) ng/dl, BMI 27.14 (IQR = 24.22–29.26) kg/m2, D’Amico risk classification was 35 (22.3%) low risk, 81 (51.6%) intermediate risk and 41 (26.1%) high risk. One hundred and fifty-four patients entered the analysis of pentafecta with a rate of 38.3% reaching this outcome. Complications: Twenty-three (14.1%) patients had minor complications (Clavien I and II) and eight patients had major complications (Clavien IIIa, IIIb and IVa). Surgical margins were negative in 69.9% of patients. The biochemical recurrence-free rate was 89.5%. The overall continence rate was 93.5%, and the potency rate was 63.5%. Multivariate analysis showed that T2 patients are 2.7 times more likely to achieve pentafecta outcome than patients ≥ T3 (p < 0.05), while younger age and lower BMI data were found as a protective factor with RR of 0.95 and 0.94, respectively.

Conclusions

Preliminary pentafecta outcome of RARP in this university hospital is promising.
Low-dose pleiotropic radiosensitive nanoformulations for three-pronged radiochemotherapy of hypoxic brain glioblastoma under BOLD/DWI monitoring
Authors: Zhao Fangshi , Wang Xiaoyi , Zhu Wei , Zhao Dongju , Ye Caihua , Guo Yanyan , Dou Yan
Published: February 2023

Background

Hypoxia-mediated radioresistance is the main obstacle to the successful treatment of glioblastoma (GBM). Enhancing hypoxic radiosensitivity and alleviating tumor hypoxia are both effective means to improve therapeutic efficacy, and the combination of the two is highly desirable and meaningful.

Results

Herein, we construct a low-dose pleiotropic radiosensitive nanoformulation consisting of a high-Z atomic nanocrystal core and mesoporous silica shell, surface-modified with angiopep-2 (ANG) peptide and loaded with nitric oxide (NO) donor and hypoxia-activated prodrug (AQ4N). Benefiting from ANG-mediated transcytosis, this nanoformulation can efficiently cross the BBB and accumulate preferentially in the brain. Low-dose radiation triggers this nanoformulation to exert a three-pronged synergistic therapeutic effect through high-Z-atom-dependent dose deposition enhancement, NO-mediated hypoxia relief, and AQ4N-induced hypoxia-selective killing, thereby significantly inhibiting GBM in situ growth while prolonging survival and maintaining stable body weight in the glioma-bearing mice. Meanwhile, the proposed in vivo 9.4 T BOLD/DWI can realize real-time dynamic assessment of local oxygen supply and radiosensitivity to monitor the therapeutic response of GBM.

Conclusions

This work provides a promising alternative for hypoxia-specific GBM-targeted comprehensive therapy, noninvasive monitoring, and precise prognosis.

Graphical Abstract
Antibiotic resistance pattern, capsular types, and molecular characterization of invasive isolates of Streptococcus pneumoniae in the south of Tunisia from 2012 to 2018
Authors: Ktari Sonia , Ben Ayed Nourelhouda , Ben Rbeh Imen , Garbi Nourhène , Maalej Sonda , Mnif Basma , Rhimi Faouzia , Hammami Adnene
Published: February 2023

Background

Streptococcus pneumoniae remains a leading cause of morbidity and mortality worldwide. In this study, we sought to analyze serotype distributions, antibiotic resistance, and genetic relationships of 106 clinical invasive pneumococcal isolates recovered in Tunisia between 2012 and 2018, prior to the routine use of pneumococcal conjugate vaccines (PCV).

Methods

We used multiplex PCR, the disk diffusion method and/or E-test, and multi-locus sequence typing (MLST).

Results

The most frequent serotypes were 14 (17%), 19F (14.2%), and 3 (11.3%). Of the 106 S. pneumoniae isolates, 67.9% were penicillin non-susceptible (29.4% were resistant), 45.3% were amoxicillin non-susceptible (17% were resistant), and 16% were cefotaxime non-susceptible. For antibiotics other than β-lactams, resistance rates to erythromycin, tetracycline, cotrimoxazole, and chloramphenicol were 62.3, 33, 22.6, and 4.7%, respectively. Two isolates were non-susceptible to levofloxacin. Among 66 erythromycin-resistant pneumococci, 77.3% exhibited the cMLSB phenotype, and 87.9% carried ermB gene. All tetracycline-resistant strains harbored the tetM gene. The potential coverage by 7-, 10-, and 13-valent pneumococcal conjugate vaccines were 55.7, 57.5, and 81.1%, respectively. A multilocus sequence typing analysis revealed great diversity. Fifty different sequence types (STs) were identified. These STs were assigned to 10 clonal complexes and 32 singletons. The most common STs were 179, 2918, 386, and 3772 – related mainly to 19F, 14, 6B/C, and 19A serotypes, respectively.

Conclusions

This study demonstrated that the majority of the serotypes of invasive pneumococci in the Tunisian population were 14, 19F, and 3. Moreover, we noted a high degree of genetic diversity among invasive S. pneumoniae isolates. The highest proportions of antibiotic non-susceptible isolates were for penicillin, erythromycin, and tetracycline. Further molecular characteristics are required to monitor the genetic variations and to follow the emergence of resistant pneumococci for the post-vaccination era in Tunisia.
Primary and secondary data in emergency medicine health services research – a comparative analysis in a regional research network on multimorbid patients
Authors: Schneider Anna , Wagenknecht Andreas , Sydow Hanna , Riedlinger Dorothee , Holzinger Felix , Figura Andrea , Deutschbein Johannes , Reinhold Thomas , Pigorsch Mareen , Stasun Ulrike , Schenk Liane , Möckel Martin
Published: February 2023

Background

This analysis addresses the characteristics of two emergency department (ED) patient populations defined by three model diseases (hip fractures, respiratory, and cardiac symptoms) making use of survey (primary) and routine (secondary) data from hospital information systems (HIS). Our aims were to identify potential systematic inconsistencies between both data samples and implications of their use for future ED-based health services research.

Methods

The research network EMANET prospectively collected primary data (n=1442) from 2017-2019 and routine data from 2016 (n=9329) of eight EDs in a major German city. Patient populations were characterized using socio-structural (age, gender) and health- and care-related variables (triage, transport to ED, case and discharge type, multi-morbidity). Statistical comparisons between descriptive results of primary and secondary data samples for each variable were conducted using binomial test, chi-square goodness-of-fit test, or one-sample t-test according to scale level.

Results

Differences in distributions of patient characteristics were found in nearly all variables in all three disease populations, especially with regard to transport to ED, discharge type and prevalence of multi-morbidity. Recruitment conditions (e.g., patient non-response), project-specific inclusion criteria (e.g., age and case type restrictions) as well as documentation routines and practices of data production (e.g., coding of diagnoses) affected the composition of primary patient samples. Time restrictions of recruitment procedures did not generate meaningful differences regarding the distribution of characteristics in primary and secondary data samples.

Conclusions

Primary and secondary data types maintain their advantages and shortcomings in the context of emergency medicine health services research. However, differences in the distribution of selected variables are rather small. The identification and classification of these effects for data interpretation as well as the establishment of monitoring systems in the data collection process are pivotal.

Trial registration

DRKS00011930 (EMACROSS), DRKS00014273 (EMAAGE), NCT03188861 (EMASPOT)
Consultation frequency and general practitioners’ and practices’ characteristics
Authors: Baudier Laura , Senn Nicolas , Wild Pascal , Cohidon Christine
Published: February 2023

Background

High workloads generated by a few patients who consult very frequently can become huge burdens for general practitioners (GPs). Patient-related factors have been repeatedly associated with frequent consultations, but there is evidence that GPs can also influence that frequency. We investigated how patients, GPs and their practices’ organisational characteristics were associated with consultation frequency.

Methods

Data came from the SPAM Prev (Swiss Primary Health Care Active Monitoring, Prevention in primary care) national, cross-sectional survey conducted in 2015–16, including 167 GPs and 1105 patients. GPs completed an online questionnaire focused on practice organisation. Patients randomly recruited in general practices completed a questionnaire with fieldworkers. Factors predicting consultation frequency were investigated using multilevel Poisson regression models.

Results

Negative associations with consultation frequency were found for females (Incidence Rate Ratio (IRR) 0.94, 95%CI [0.88–1.01]), less compliant patients (IRR 0.91, 95%CI [0.84–0.98]), high self-perceived health status (IRR 0.8, 95%CI [0.75–0.84]) and physical exercise (IRR 0.87, 95%CI [0.81–0.94]). Consultation frequencies were higher among patients with sleeping problems (IRR 1.08, 95%CI [0.96–1.23]), psychological distress (IRR 1.66, 95%CI [1.49–1.86]), chronic diseases (IRR 1.27, 95%CI [1.18–1.37]) and treatment with medication (IRR 1.24, 95%CI [1.12–1.37]). Positive associations with consultation frequency were found among GPs working longer hours (IRR 1.21, 95%CI [1.01–1.46]). Using shared medical records (IRR 0.79, 95%CI [0.67–0.92]) were negatively associated with consultation frequency.

Conclusion

GPs’ practices’ characteristics, like patients’, are predictive of patients’ consultation frequency, but those associations’ underlying mechanisms require further qualitative investigation. These new findings could help optimise intervention strategies and reduce healthcare costs.
New balance capability index as a screening tool for mild cognitive impairment
Authors: Suzuki Yasuhiro , Tsubaki Takumi , Nakaya Kensuke , Kondo Genta , Takeuchi Yoshinori , Aita Yuichi , Murayama Yuki , Shikama Akito , Masuda Yukari , Suzuki Hiroaki , Kawakami Yasushi , Shimano Hitoshi , Arai Tetsuaki , Hada Yasushi , Yahagi Naoya
Published: February 2023

Background

Mild cognitive impairment (MCI) is not just a prodrome to dementia, but a very important intervention point to prevent dementia caused by Alzheimer's disease (AD). It has long been known that people with AD have a higher frequency of falls with some gait instability. Recent evidence suggests that vestibular impairment is disproportionately prevalent among individuals with MCI and dementia due to AD. Therefore, we hypothesized that the measurement of balance capability is helpful to identify individuals with MCI.

Methods

First, we developed a useful method to evaluate balance capability as well as vestibular function using Nintendo Wii balance board as a stabilometer and foam rubber on it. Then, 49 healthy volunteers aged from 56 to 75 with no clinically apparent cognitive impairment were recruited and the association between their balance capability and cognitive function was examined. Cognitive functions were assessed by MoCA, MMSE, CDR, and TMT-A and -B tests.

Results

The new balance capability indicator, termed visual dependency index of postural stability (VPS), was highly associated with cognitive impairment assessed by MoCA, and the area under the receiver operating characteristic (ROC) curve was more than 0.8, demonstrating high sensitivity and specificity (app. 80% and 60%, respectively).

Conclusions

Early evidence suggests that VPS measured using Nintendo Wii balance board as a stabilometer helps identify individuals with MCI at an early and preclinical stage with high sensitivity, establishing a useful method to screen MCI.
The role of trust and habit in the adoption of mHealth by older adults in Hong Kong: a healthcare technology service acceptance (HTSA) model
Authors: Liu Justina Yat Wa , Sorwar Golam , Rahman Mohammed Sajedur , Hoque Md Rakibul
Published: February 2023

Background

Evidence from the literature suggests that mobile health (mHealth) services can potentially improve healthcare outcomes among older adults. Hence, the government of Hong Kong has recently taken several community and information technology (IT) services initiatives to train older adults on how to enhance their abilities and interest in using mHealth technology. Although mHealth services have been widely implemented globally, their adoption and use by older adults are very low, including those in Hong Kong. This study aims to understand key factors influencing mHealth use intention among the older Chinese population in Hong Kong.

Methods

We extended the Unified Theory of Acceptance and Use of Technology (UTAUT2) as the basis of our conceptual framework. We applied Partial Least Squares path modeling method to conduct the Structural Equation Model (SEM) technique that allows measuring the theoretical validity of any conceptual framework. Convenience and snowball sampling methods were used to recruit participants aged 65 or above. In total, 201 valid responses were used for testing the theoretical validity of the proposed conceptual framework.

Results

The primary finding shows that the widely used UTAUT2 model falls short in explaining mHealth service acceptance behavior in the Chinese older population in Hong Kong. We further propose a simplified model, the Healthcare Technology Service Acceptance (HTSA) model, to understand the formation of mHealth service acceptance behavior. The findings show that trust is an important component of technology service acceptance intention behavior that was missing in the UTAUT2 model. The results also show that several antecedent factors (i.e., social influence, government policy, and service quality) are critical in forming technology trust beliefs.

Conclusions

The study shows that the HTSA model can better explain mHealth acceptance behavior than the UTAUT2 model. This study advances knowledge in the mHealth technology adoption domain by proposing a simplified new version of the UTAUT2 model for understanding healthcare technology service acceptance and use intention among older adults. The findings of the study provide valuable information to the Hong Kong government and healthcare organizations for wider adoption of mHealth services, especially in older adults.
Retraction Note: Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study
Authors: El Refaeey Abd Elaziz A. , Abdelfattah Hosam , Mosbah Alaa , Gamal Anas M. , Fayla Emad , Refaie Waleed , Zaied Abdelhady , Barakat Rafik I. , Seleem Amal K. , Maher Mohammed
Published: February 2023

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12884-017-1349-x.
Epidemiology and comorbidities in idiopathic pulmonary fibrosis: a nationwide cohort study
Authors: Lee Jang Ho , Park Hyung Jun , Kim Seonok , Kim Ye-Jee , Kim Ho Cheol
Published: February 2023

Background

Idiopathic pulmonary fibrosis (IPF) is frequently accompanied by comorbidities, with the management of these comorbidities crucial for clinical outcomes. This study investigated the prevalence, incidence, changes over time, and clinical impact of comorbidities in IPF patients, based on nationwide claims data in South Korea.

Methods

This retrospective cohort study utilised nationwide health claim data in South Korea between 2011 and 2019. Patients with IPF were defined as those with ICD-10 code J84.1 and Rare Intractable Disease code V236 who made at least one claim per year. Patients were classified by sex, age, pirfenidone use and burden of comorbidities, and differences among groups were determined.

Results

The yearly prevalence rate of IPF increased from 7.50 to 23.20 per 100,000 people, and the yearly incidence rate increased from 3.56 to 7.91 per 100,000 person-years over time. The most common respiratory comorbidity was chronic obstructive pulmonary disease (37.34%), followed by lung cancer (3.34%), whereas the most common non-respiratory comorbidities were gastro-oesophageal reflux disease (70.83%), dyslipidaemia (62.93%) and hypertension (59.04%). The proportion of some comorbidities differed by sex, age and use of pirfenidone. The proportion of lung cancer was higher in patients treated with pirfenidone, whereas the proportion of anxiety and depression were lower in patients not treated with pirfenidone. Charlson comorbidity index ≥ 4 was associated with increases in hospitalisations and total medical costs.

Conclusions

The yearly prevalence and incidence of IPF and comorbidities in Korea increased over time. These comorbidities affected the use of pirfenidone and medical resources.
MRONJ in breast cancer patients under bone modifying agents for cancer treatment-induced bone loss (CTIBL): a multi-hospital-based case series
Authors: Mauceri Rodolfo , Coppini Martina , Attanasio Massimo , Bedogni Alberto , Bettini Giordana , Fusco Vittorio , Giudice Amerigo , Graziani Filippo , Marcianò Antonia , Nisi Marco , Isola Gaetano , Leonardi Rosalia Maria , Oteri Giacomo , Toro Corrado , Campisi Giuseppina
Published: February 2023

Background

Cancer treatment-induced bone loss (CTIBL) is the most common adverse event experienced by patients affected by breast cancer (BC) patients, without bone metastases. Bone modifying agents (BMAs) therapy is prescribed for the prevention of CTIBL, but it exposes patients to the risk of MRONJ.

Methods

This multicentre hospital-based retrospective study included consecutive non-metastatic BC patients affected by MRONJ related to exposure to low-dose BMAs for CTIBL prevention. Patients’ data were retrospectively collected from the clinical charts of seven recruiting Italian centres.

Results

MRONJ lesions were found in fifteen females (mean age 67.5 years), mainly in the mandible (73.3%). The mean duration of BMAs therapy at MRONJ presentation was 34.9 months. The more frequent BMAs was denosumab (53.3%). Ten patients (66.7%) showed the following local risk factors associated to MRONJ development: periodontal disease (PD) in three cases (20%) and the remaining six (40%) have undergone PD-related tooth extractions. One patient presented an implant presence-triggered MRONJ (6.7%). In five patients (33.3%) no local risk factors were observed.

Conclusions

This is the first case series that investigated BC patients under BMAs for CTIBL prevention suffering from MRONJ. These patients seem to have similar probabilities of developing MRONJ as osteo-metabolic ones. Breast cancer patients under BMAs for CTIBL prevention need a regular prevention program for MRONJ, since they may develop bone metastases and be treated with higher doses of BMAs, potentially leading to a high-risk of MRONJ.
Teledentistry use during the COVID-19 pandemic: perceptions and practices of Ontario dentists
Authors: Cheuk Rocco , Adeniyi Abiola , Farmer Julie , Singhal Sonica , Jessani Abbas
Published: February 2023

Background

Teledentistry has demonstrated to expedite oral health consultations, diagnosis, and treatment planning while mitigating COVID-19 transmission risk in dental offices. However, the use of teledentistry by clinicians remains suboptimal. Therefore, this study aimed to determine the perceptions and practices of teledentistry among dentists during the COVID-19 pandemic in Ontario, Canada, and identify associated factors.

Methods

A cross-sectional study using an online 39 item survey was conducted among Ontario dentists in December 2021. The questionnaire inquired about socio-demographic attributes, as well as perceptions of teledentistry use during the pandemic, and its future application. Descriptive statistics including frequency distribution of categorical variables and univariate analysis of continuous variables were conducted. Chi-square test was used determine the associations between professionals’ attributes such as age, gender, years of practice, and location of practice, and respondents use of teledentistry. SPSS Version 28.0 was used for statistical analysis.

Results

Overall, 456 dentists completed the survey. The majority were general dentists (91%), worked in private practices (94%), were between 55 and 64 years old (33%), and had over 16 years of professional experience (72%). Approximately 49.3% reported using teledentistry; 13% started before the pandemic, and 36% during the pandemic. The most common reason for non-utilization was a lack of interest (54%). Respondents identified patient triage, consultation, and patient education as the three most important uses of teledentistry. Female dentists (p < 0.05), dentist working in private practice (p < 0.05), and those who worked in a single dental office (p < 0.05) adopted teledentistry more during the pandemic. Respondents who accessed more resources were more likely to report greater utilization of teledentistry, while those who reported being unconformable with teledentistry (p < 0.05) reported less utilization. Additionally, participants who reported feeling comfortable discussing teledentistry with others (p < 0.05), were more inclined to use it in the future.

Conclusions

Participants expressed mixed perceptions toward teledentistry with more than half indicating it is reliable for patient triaging and patient follow-ups. Despite the increased utilization during the COVID-19 pandemic, participants' lack of interest in teledentistry emerged as a barrier to its use. More education and knowledge dissemination about teledentistry's areas of application and technical aspects of use can increase interest in this tool, which may lead to a greater uptake by dental professionals.
The effects of Saline Infusion Sonography on the histological quality of endometrial sampling in women with postmenopausal bleeding
Authors: Vroom Albertine J. , Bongarts Simone , Bongers Marlies Y. , Kooreman Loes F. S. , Bosch Steven L. , Geomini Peggy M. A. J. , van Hanegem Nehalennia
Published: February 2023

Background

The aim of this study is to analyze the histopathological features of endometrial samples obtained by aspiration when performed before or after the saline contrast sonohysterography in women with postmenopausal bleeding and a thickened endometrium. Hypothetically, the saline infusion could disrupt the tissue and therefore affect the quality of the sample. Furthermore, we want to determine which histological features have impact on the quality of the endometrial sample.

Methods

We performed a randomized controlled trial (ESPRESSO trial) in which we analyzed the aspiration samples in two groups. Women were allocated either to saline contrast sonohysterography and subsequent endometrial sampling (SCSH-Sampling group) or to the opposite order (Sampling-SCSH group). Dedicated gyneco-pathologists retrospectively assessed the specimens and recorded the type (blood, mucus, epithelium, intact glands, stroma and tissue context) and quantity (on a scale of 0–3) of material that was found in the specimens.

Results

This analysis consisted of 197 samples, with 101 women in the SCSH-Sampling group and 96 women in the Sampling-SCSH group. No significant differences were found in the histological features between the two groups. All significant histological features differed significantly in the sufficient samples compared to the insufficient samples: higher amounts of blood, more endometrial epithelium, presence of intact endometrial glands, better stroma and tissue context. Oppositely, a significantly higher amount of mucus was found in the insufficient samples.

Conclusion

This study shows that the histological features of the endometrial sample were not affected by the saline contrast sonohysterography, when performed prior to the tissue sampling.

Trial registration ESPRESSO TRIAL, NTR5690, registered 16 February 2016,https://trialsearch.who.int/Trial2.aspx?TrialID=NTR5690.
Determination of the synergistic anti-influenza effect of Huangqin Su tablet and Oseltamivir and investigation of mechanism of the tablet based on gut microbiota and network pharmacology
Authors: Cui Xuran , Liu Xibao , Wang Feng , Lou Kun , Hong Junping , Bai Hequn , Chen Rongchu , Yang Yang , Liu Qingquan
Published: February 2023

Huangqin Su (HQS) tablet is mainly composed of baicalein which has been evaluated for its ability to inhibit influenza. The present study aimed to investigate the effect of HQS and oseltamivir phosphate (OS) (single or combination therapy) on influenza-induced acute pneumonia in male and female ICR mice. The regulatory effect of HQS on gut microbiota was also studied by using 16 s rDNA sequencing, and the targets and mechanisms of HQS against influenza were comprehensively analyzed by network pharmacology. Pharmacodynamic results, including lung index and pathological changes, showed that HQS exhibited significant anti-influenza efficacy and could improve the efficacy of low-dose OS (P < 0.05 and P < 0.01, respectively). The results of 16 s rDNA sequencing revealed that HQS modulated the gut microbiota and remarkably enriched the abundance of Lactobacillus. The findings of network pharmacology research suggested that the anti-influenza mechanism of HQS was related to TLRs, MAPK, and other signal transduction pathways. Taken together, this study identified the possibility of the combined use of HQS and OS and demonstrated the role of HQS in modulating the gut microbiota of mice against influenza. Network pharmacology studies also suggested that the anti-influenza effect of HQS was related to TLRs, MAPK, TNF, and other signaling pathways.
A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study
Authors: Shiao Yi-Chih , Lu Zxy-Yann Jane , Fu Chung-Pei , Lin Jing-Yi , Chang Yaw-Wen , Chen Wan-Ting , Wang Chih-Chia
Published: February 2023

Background

The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA–PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course.

Methods

A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year.

Results

In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors.

Conclusion

The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.
Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review
Authors: Bae Sung-Heui
Published: February 2023

Background

During the COVID-19 pandemic, the demand for nursing care increased, making the retention of nurses even more important. Among staff nurses, it is reported that the turnover rate of newly licensed registered nurses is higher. However, no systematic reviews have focused on the factors that influence newly licensed registered nurses’ turnover. Additionally, because newly licensed registered nurses are a major source of the supply of nurses, it is critical to retain them to meet patient needs. Therefore, this study aimed to systematically synthesize the factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals.

Methods

CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS, and Web of Science were searched for studies published between January 2000 and June 2021. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Ten articles from 9029 were included in this review. All studies used a longitudinal design. The annual turnover rates of newly licensed registered nurses ranged from 12 to 25%. Health status, including sleep and healthy lifestyles, were significant factors affecting turnover. Most studies focused on work environment factors, and emotional exhaustion, job satisfaction, peer support, and intent to leave, were significantly associated with newly licensed registered nurses’ turnover. Small hospitals located in nonmetropolitan areas were at risk of high turnover of newly licensed registered nurses.

Conclusions

Turnover is inevitable in the process of employment, but high turnover can be prevented. Through reviewing ten articles, significant contributing factors for newly licensed registered nurses’ turnover included personal factors of health status; work environment factors of physical exhaustion, emotional exhaustion, depersonalization, occupational injuries, income, intent to stay, job satisfaction, and peer support; and hospital factors of hospital size, location, and unionization. Most existing studies focus on work environment factors, which reflects the significance of fostering healthy work conditions to prevent high turnover. These findings can be used to develop strategies and policies for work environment to reduce high turnover of newly licensed registered nurses, and support high-risk groups, such as small hospitals located in nonmetropolitan areas with high levels of nurses’ turnover.
Factors associated with delaying medical care: cross-sectional study of Nebraska adults
Authors: Ratnapradipa Kendra L. , Jadhav Snehal , Kabayundo Josiane , Wang Hongmei , Smith Lisa C.
Published: February 2023

Background

Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

Methods

Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

Results

The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the past year (10.1% cost-related). Cost-related ever delay was associated with younger age [< 45 years aOR 6.17 (3.24–11.76); 45–64 years aOR 2.36 (1.29–4.32)], low- and middle-income [< $50,000 aOR 2.85 (1.32–6.11); $50,000-$74,999 aOR 3.06 (1.50–6.23)], and no health insurance [aOR 3.56 (1.21–10.49)]. Transportation delays were associated with being non-White [aOR 8.07 (1.54–42.20)], no bachelor’s degree [≤ high school aOR 3.06 (1.02–9.18); some college aOR 4.16 (1.32–13.12)], and income < $50,000 [aOR 8.44 (2.18–32.63)]. Those who did not have a primary care provider were 80% less likely to have transportation delays [aOR 0.20 (0.05–0.80)].

Conclusions

Delayed care affects more than one-third of Nebraskans, primarily due to financial concerns, and impacting low- and middle-income families. Transportation-related delays are associated with more indicators of low socio-economic status. Policies targeting minorities and those with low- and middle-income, such as Medicaid expansion, would contribute to addressing disparities resulting from delayed care.
Small-scale field evaluation of transfluthrin-treated eave ribbons and sandals for the control of malaria vectors in rural Tanzania
Authors: Mmbando Arnold S. , Mponzi Winifrida P. , Ngowo Halfan S. , Kifungo Khamis , Kasubiri Robert , Njalambaha Rukiyah M. , Gavana Tegemeo , Eiras Alvaro E. , Batista Elis P. A. , Finda Marceline F. , Sangoro Onyango P. , Okumu Fredros O.
Published: February 2023

Background

Early-evening and outdoor-biting mosquitoes may compromise the effectiveness of frontline malaria interventions, notably insecticide-treated nets (ITNs). This study aimed to evaluate the efficacy of low-cost insecticide-treated eave ribbons and sandals as supplementary interventions against indoor-biting and outdoor-biting mosquitoes in south-eastern Tanzania, where ITNs are already widely used.

Methods

This study was conducted in three villages, with 72 households participating (24 households per village). The households were divided into four study arms and assigned: transfluthrin-treated sandals (TS), transfluthrin-treated eave ribbons (TER), a combination of TER and TS, or experimental controls. Each arm had 18 households, and all households received new ITNs. Mosquitoes were collected using double net traps (to assess outdoor biting), CDC light traps (to assess indoor biting), and Prokopack aspirators (to assess indoor resting). Protection provided by the interventions was evaluated by comparing mosquito densities between the treatment and control arms. Additional tests were done in experimental huts to assess the mortality of wild mosquitoes exposed to the treatments or controls.

Results

TERs reduced indoor-biting, indoor-resting and outdoor-biting Anopheles arabiensis by 60%, 73% and 41%, respectively, while TS reduced the densities by 18%, 40% and 42%, respectively. When used together, TER & TS reduced indoor-biting, indoor-resting and outdoor-biting An. arabiensis by 53%, 67% and 57%, respectively. Protection against Anopheles funestus ranged from 42 to 69% with TER and from 57 to 74% with TER & TS combined. Mortality of field-collected mosquitoes exposed to TER, TS or both interventions was 56–78% for An. arabiensis and 47–74% for An. funestus.

Conclusion

Transfluthrin-treated eave ribbons and sandals or their combination can offer significant household-level protection against malaria vectors. Their efficacy is magnified by the transfluthrin-induced mortality, which was observed despite the prevailing pyrethroid resistance in the study area. These results suggest that TER and TS could be useful supplementary tools against residual malaria transmission in areas where ITN coverage is high but additional protection is needed against early-evening and outdoor-biting mosquitoes. Further research is needed to validate the performance of these tools in different settings, and assess their long-term effectiveness and feasibility for malaria control.
The significance of ophthalmological features in diagnosis of thyroid-associated ophthalmopathy
Authors: Huang Xiao , Tang Wei , Shen Ya , He Linfeng , Tong Fei , Liu Siyu , Li Jian , Li Pan , Zhang Yun , Ma Xiaoye , Wei Ruili , Yang Weihua
Published: February 2023

Background

Thyroid-associated ophthalmopathy (TAO) is an autoimmune disorder. It has discriminable appearance. This study was conducted to dig the clinical significance of demographic characteristics and ophthalmologic diagram features in TAO diagnosis and stage/severity evaluation.

Results

We included 320 males and 633 females, with an average age of 41.75 ± 13.75. A majority of TAO patients had hyperthyroidism, and most of them were in the inactive stage and at the moderate level. The thyroid function type, stage and severity were closely associated with hypopsia, eyelid congestion, conjunctival congestion, corneal ulcer, ocular motility disorder, best corrected visual acuity, and extraocular muscle thickening. Using these features, we established different logistic regression models to predict thyroid function subtypes, abnormal thyroid function, stage, and severity, in which the AUC of the ROC curve and accuracies were satisfactory.

Conclusion

Together, TAO subtype, stage and severity can be diagnosed by auxiliary references including demographic factors, symptoms from complains, and image features. These non-invasive indices can be applied in a timely manner in clinical estimating TAO status.
Regulatory cells and the effect of cancer immunotherapy
Authors: Iglesias-Escudero María , Arias-González Noelia , Martínez-Cáceres Eva
Published: February 2023

Several mechanisms and cell types are involved in the regulation of the immune response. These include mostly regulatory T cells (Tregs), regulatory macrophages (Mregs), myeloid suppressor cells (MDSCs) and other regulatory cell types such as tolerogenic dendritic cells (tolDCs), regulatory B cells (Bregs), and mesenchymal stem cells (MSCs). These regulatory cells, known for their ability to suppress immune responses, can also suppress the anti-tumor immune response. The infiltration of many regulatory cells into tumor tissues is therefore associated with a poor prognosis. There is growing evidence that elimination of Tregs enhances anti-tumor immune responses. However, the systemic depletion of Treg cells can simultaneously cause deleterious autoimmunity. Furthermore, since regulatory cells are characterized by their high level of expression of immune checkpoints, it is also expected that immune checkpoint inhibitors perform part of their function by blocking these molecules and enhancing the immune response. This indicates that immunotherapy does not only act by activating specific effector T cells but can also directly or indirectly attenuate the suppressive activity of regulatory cells in tumor tissues. This review aims to draw together our current knowledge about the effect of immunotherapy on the various types of regulatory cells, and how these effects may be beneficial in the response to immunotherapy.
Letter to the Editor: clinical utility of urine DNA for noninvasive detection and minimal residual disease monitoring in urothelial carcinoma
Authors: Yang Kaiwei , Hu Hailong , Wu Junlong , Wang Huina , Guo Zhaoxia , Yu Wei , Yao Lin , Ding Feng , Zhou Tao , Wang Wang , Wang Yunkai , Liu Lei , Guo Jing , Zhu Shuaipeng , Zhang Xinhao , Cao Shanbo , Lou Feng , Niu Yuanjie , Ye Dingwei , He Zhisong
Published: February 2023

Current methods for the early detection and minimal residual disease (MRD) monitoring of urothelial carcinoma (UC) are invasive and/or possess suboptimal sensitivity. We developed an efficient workflow named urine tumor DNA multidimensional bioinformatic predictor (utLIFE). Using UC-specific mutations and large copy number variations, the utLIFE-UC model was developed on a bladder cancer cohort (n = 150) and validated in The Cancer Genome Atlas (TCGA) bladder cancer cohort (n = 674) and an upper tract urothelial carcinoma (UTUC) cohort (n = 22). The utLIFE-UC model could discriminate 92.8% of UCs with 96.0% specificity and was robustly validated in the BLCA_TCGA and UTUC cohorts. Furthermore, compared to cytology, utLIFE-UC improved the sensitivity of bladder cancer detection (p < 0.01). In the MRD cohort, utLIFE-UC could distinguish 100% of patients with residual disease, showing superior sensitivity compared to cytology (p < 0.01) and fluorescence in situ hybridization (FISH, p < 0.05). This study shows that utLIFE-UC can be used to detect UC with high sensitivity and specificity in patients with early-stage cancer or MRD. The utLIFE-UC is a cost-effective, rapid, high-throughput, noninvasive, and promising approach that may reduce the burden of cystoscopy and blind surgery.
Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation
Authors: Frueh Lisa , Collins Alexandra B. , Newman Roxxanne , Barnett Nancy P. , Rich Josiah D. , Clark Melissa A. , Marshall Brandon D. L. , Macmadu Alexandria
Published: February 2023

Background

The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic’s influence on increased overdose risk behaviors.

Methods

From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors.

Results

Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels.

Conclusions

Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.
Prognostic value of the pretreatment systemic immune-inflammation index in patients with prostate cancer: a systematic review and meta-analysis
Authors: Meng Linghao , Yang Yujia , Hu Xu , Zhang Ruohan , Li Xiang
Published: February 2023

Background

The systemic immune-inflammation index (SII) is a novel biomarker to predict the prognosis of some malignant tumors based on neutrophil, platelet, and lymphocyte counts. Evidence is scarce about the prognostic value of SII for prostate cancer patients. This systematic review and meta-analysis was conducted to explore the prognostic value of the SII in prostate cancer.

Methods

The PubMed, Embase, Web of Science, and Cochrane Library (CENTRAL) databases were searched to determine eligible studies from inception to August 15, 2022. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to pool the results. Statistical analyses were conducted by using Stata 17.0 software.

Results

A total of 12 studies with 8083 patients were included. The quantitative synthesis showed that a high SII was related to poor overall survival (OS) (HR = 1.44, 95% CI 1.23–1.69, p < 0.001). Furthermore, a subgroup analysis showed that a high SII was associated with poor OS in the groups of any ethnicity, tumor type, and cutoff value. An increased SII was also associated with inferior progression-free survival (PFS) (HR = 1.80, 95% CI 1.27–2.56, p = 0.001). In the subgroup analysis, a high SII value was related to poor PFS in Asian patients (HR = 4.03, 95% CI 1.07–15.17, p = 0.04) and a cutoff value > 580 (HR = 1.19, 95% CI 1.04–1.36, p = 0.01).

Conclusion

Based on the current evidence, a high pretreatment SII may be associated with poor OS and PFS. The SII may serve as an important prognostic indicator in patients with prostate cancer. More rigorously designed studies are needed to explore the SII and the prognosis of prostate cancer.
Endothelial Toll-like receptor 4 is required for microglia activation in the murine retina after systemic lipopolysaccharide exposure
Authors: Tsioti Ioanna , Steiner Beatrice L. , Escher Pascal , Zinkernagel Martin S. , Benz Peter M. , Kokona Despina
Published: February 2023

Background

Clustering of microglia around the vasculature has been reported in the retina and the brain after systemic administration of lipopolysaccharides (LPS) in mice. LPS acts via activation of Toll-like receptor 4 (TRL4), which is expressed in several cell types including microglia, monocytes and vascular endothelial cells. The purpose of this study was to investigate the effect of systemic LPS in the pigmented mouse retina and the involvement of endothelial TLR4 in LPS-induced retinal microglia activation.

Methods

C57BL/6J, conditional knockout mice that lack Tlr4 expression selectively on endothelial cells (TekCre−posTlr4loxP/loxP) and TekCre−negTlr4loxP/loxP mice were used. The mice were injected with 1 mg/kg LPS via the tail vein once per day for a total of 4 days. Prior to initiation of LPS injections and approximately 5 h after the last injection, in vivo imaging using fluorescein angiography and spectral-domain optical coherence tomography was performed. Immunohistochemistry, flow cytometry, electroretinography and transmission electron microscopy were utilized to investigate the role of endothelial TLR4 in LPS-induced microglia activation and retinal function.

Results

Activation of microglia, infiltration of monocyte-derived macrophages, impaired ribbon synapse organization and retinal dysfunction were observed after the LPS exposure in C57BL/6J and TekCre−negTlr4loxP/loxP mice. None of these effects were observed in the retinas of conditional Tlr4 knockout mice after the LPS challenge.

Conclusions

The findings of the present study suggest that systemic LPS exposure can have detrimental effects in the healthy retina and that TLR4 expressed on endothelial cells is essential for retinal microglia activation and retinal dysfunction upon systemic LPS challenge. This important finding provides new insights into the role of microglia–endothelial cell interaction in inflammatory retinal disease.