bluuebunny/crossref_metadata_2025 huggingface dataset:
Microsatellite Instability–High Endometrial Cancers with MLH1 Promoter Hypermethylation Have Distinct Molecular and Clinical Profiles
Authors: Manning-Geist Beryl L. , Liu Ying L. , Devereaux Kelly A. , Paula Arnaud Da Cruz , Zhou Qin C. , Ma Weining , Selenica Pier , Ceyhan-Birsoy Ozge , Moukarzel Lea A. , Hoang Timothy , Gordhandas Sushmita , Rubinstein Maria M. , Friedman Claire F. , Aghajanian Carol , Abu-Rustum Nadeem R. , Stadler Zsofia K. , Reis-Filho Jorge S. , Iasonos Alexia , Zamarin Dmitriy , Ellenson Lora H. , Lakhman Yulia , Mandelker Diana L. , Weigelt Britta
Published: July 2022

Purpose:

Microsatellite instability–high (MSI-H) endometrial carcinomas are underpinned by distinct mechanisms of DNA mismatch repair deficiency (MMR-D). We sought to characterize the clinical and genetic features of MSI-H endometrial cancers harboring germline or somatic mutations in MMR genes or MLH1 promoter hypermethylation (MLH1ph).

Experimental Design:

Of > 1,100 patients with endometrial cancer that underwent clinical tumor-normal sequencing, 184 had MSI-H endometrial cancers due to somatic MMR mutations or MLH1ph, or harbored pathogenic germline MMR mutations. Clinicopathologic features, mutational landscape, and tumor-infiltrating lymphocyte (TIL) scores were compared among MMR-D groups using nonparametric tests. Log-rank tests were used for categorical associations; Kaplan–Meier method and Wald test based on Cox proportional hazards models were employed for continuous variables and survival analyses.

Results:

Compared with patients with germline (n = 25) and somatic (n = 39) mutations, patients with MLH1ph endometrial cancers (n = 120) were older (P < 0.001), more obese (P = 0.001) and had more advanced disease at diagnosis (P = 0.025). MLH1ph endometrial cancers were enriched for JAK1 somatic mutations as opposed to germline MMR-D endometrial cancers which showed enrichment for pathogenic ERBB2 mutations. MLH1ph endometrial cancers exhibited lower tumor mutational burden and TIL scores compared with endometrial cancers harboring germline or somatic MMR mutations (P < 0.01). MLH1ph endometrial cancer patients had shorter progression-free survival (PFS) on univariate analysis, but in multivariable models, stage at diagnosis remained the only predictor of survival. For stage I/II endometrial cancer, two-year PFS was inferior for patients with MLH1ph endometrial cancers compared with germline and somatic MMR groups (70% vs. 100%, respectively).

Conclusions:

MLH1ph endometrial cancers likely constitute a distinct clinicopathologic entity compared with germline and somatic MMR-D ECs with potential treatment implications.
Combined Performance of Fecal Immunochemical Tests and a Genetic Risk Score for Advanced Neoplasia Detection
Authors: Niedermaier Tobias , Guo Feng , Weigl Korbinian , Hoffmeister Michael , Brenner Hermann
Published: July 2022

Fecal immunochemical tests (FITs) are increasingly used as noninvasive screening tests in colorectal cancer–screening programs. Polygenic risk scores (PRS) are increasingly propagated for risk stratification in colorectal cancer screening. We aimed to assess the potential of combining FIT results and PRS to enhance diagnostic accuracy of detecting advanced neoplasia (AN) compared with using FIT results alone. Of 10,362 participants of screening colonoscopy in Southern Germany who conducted either one of two quantitative FITs, genotyping was done in all participants with AN (colorectal cancer or advanced adenoma) and a random subset of controls. Among 5,306 individuals, a PRS was calculated on the basis of the number of risk alleles in 140 SNPs. Partial areas under the receiver operating characteristics (ROC) curves (pAUCs) were computed for FIT and PRS alone and combined, focusing on a specificity range of 100%–80%. Both FITs showed similar performance characteristics with pAUCs of 0.661 (95% confidence interval (CI), 0.625–0.698; Ridascreen Hemoglobin) and 0.682 (95% CI, 0.661–0.701; FOB Gold) for AN detection. PRS alone reached a pAUC of 0.524 (95% CI, 0.499–0.550) and 0.530 (95% CI, 0.516–0.545), respectively, and its addition to FIT did not improve pAUCs (0.659; 95% CI, 0.622–0.697) and 0.667 (95% CI, 0.650–0.687), respectively. This finding was confirmed by investigating sensitivities at fixed specificities at 85%, 90%, and 95%. Partial AUCs also did not improve when adding the weighted PRS to FIT instead of the unweighted PRS. In summary, the combination with PRS did not improve diagnostic accuracy of FIT-based screening in a large asymptomatic colorectal cancer screening population from South-Western Germany.

Prevention Relevance:

In our study, combining polygenic risk score with fecal immunochemical test (FIT) did not improve diagnostic accuracy for advanced colorectal neoplasia detection compared with FIT alone. So far, such a combination cannot be recommended because it would come at extra costs and effort despite no relevant gain in neoplasia detection.
Humoral Response and SARS-CoV-2 Infection Risk following the Third and Fourth Doses of the BNT162b2 Vaccine in Dialysis Patients
Authors: Einbinder Yael , Perl Jeffrey , Nacasch Naomi , Bnaya Alon , Shavit Linda , Erez Daniel , Shashar Moshe , Halperin Tamar , Grupper Ayelet , Benchetrit Sydney , Wand Ori , Cohen-Hagai Keren
Published: July 2022

The optimal SARS-CoV-2 vaccination schedule in dialysis patients and the potential need for a fourth vaccine dose are debatable. We prospectively assessed the humoral responses to three and four doses of BNT162b2 among dialysis patients. The study included 106 dialysis patients; 60 (56.6%) and 46 (43.4%) received 3 and 4 vaccine doses, respectively. Anti-spike (anti-S) antibody titers significantly increased after the third vaccine dose, followed by a decline, yet still remained higher than all previous measurements. The fourth vaccine dose led to another profound rise in anti-S titers. The absolute increase following the fourth dose correlated with response to the third dose. Infection risk however was similar between patients vaccinated with three or four doses.
Detection and Gene Mutation Analysis of Three Variations in Two Unrelated Chinese Hereditary Coagulation Factor XI Deficiency Families
Authors: Yang Ting , Zhu Jin , Chen Xiuhua , Wang Fengping , Zheng Xiaoyan , Cheng Xiaoli
Published: July 2022

Introduction: Three variations including a novel F11 gene variation were detected in two unrelated Chinese families with coagulation factor XI deficiency, and their possible pathogenesis was elucidated. Methods: The genomic DNA of the probands’ pedigrees was extracted, and all exons and flanking sequences of F11 gene were subjected to PCR amplification and Sanger sequencing. ClustalX-2.1-win, Mutation Taster, and Swiss-Pdb Viewer software were used to analyze the conservation and impact of the variations on protein function and structure. Results: DNA sequencing showed that the proband one had p.Gly350Glu and p.Trp501stop complex heterozygous variations, while the proband two took p.Pro338Leu and p.Trp501stop compound heterozygous variations. Conservation, structural, and functional analysis of variant amino acids indicated that these three variations were harmful and probably affected the structure and function of the variable protein. Conclusions: Three variations including p.Pro338Leu, p.Gly350Glu, and p.Trp501stop responsible for the reduction of the FXI activities were herein detected. Notably, the p.Pro338Leu variation was discovered for the first time in the world. Furthermore, the p.Gly350Glu was first reported in China.
Estatuto morfológico das sequências -alhão e -arrão
Authors: Rio-Torto Graça
Published: July 2022

O presente estudo procura caracterizar o estatuto morfológico de -alh- e de -arr- nas sequências -alhão e -arrão, as mais prototípicas de construções similares que envolvem, por exemplo, -alhaço, -alhote, -alhaz, -arraz. Os afixos -alh- e -arr-, pouco representados na língua portuguesa hodierna, têm sido considerados infixos, sufixos ou segmentos de sufixos compósitos -alhão e -arrão. Os dados do português europeu ‘popular’ de grande parte do século XX contribuem para clarificar o percurso destes sufixos na língua portuguesa (variedades europeia e brasileira). A hipótese que se coloca é a de que se trata de formativos que, de sufixos pouco produtivos, terão sido reanalisados como constituintes de sufixos compósitos, nos quais os formativos mantiveram, cristalizando-os, os valores matriciais herdados. O quadro teórico que espalda esta reflexão é multidimensional, envolvendo nomes de referência dos estudos morfológicos e lexicais como Aronoff e Fudeman (2005), Basílio (1999, 2004), Bechara (2004), Booij (2007, 2010), Cunha e Cintra (1984), Nunes (1989), Rio-Torto (1993, 2020), Vasconcelos (1914). Dados de diferentes sincronias e de diferentes universos sociodialectais podem contribuir para clarificar as representações conceptuais que poderão estar na base de mudanças de estatuto de certos afixos, por via de processos de reanálise que os afetam.
Africanos livres: aspectos históricos e discursivos da constituição do português brasileiro em manuscrito do século XIX
Authors: Bomfim Leticia Marinha , Moraes Milena Borges de
Published: July 2022

Este artigo tem como objetivo compreender aspectos históricos, linguísticos e discursivos da participação dos africanos livres na constituição do português brasileiro, no século XIX, na Sociedade de Mineração do Mato Grosso, por meio da análise da edição de Façanha (2019) do Livro de registro da correspondencia e mais acontecimentos relativos aos africanos livres entregues pelo Governo Imperial à Sociedade de Mineração da Província, códice no qual foram registradas informações sobre a vida cotidiana dos africanos livres. Com relação aos aspectos históricos, investigamos a formação da classe jurídica africanos livres e quais línguas africanas foram trazidas para o Mato Grosso, no século XIX; com relação aos aspectos linguísticos empreendemos uma análise léxico-discursiva do códice, para compreendermos os efeitos de sentidos provocados pelas unidades lexicais utilizadas para se referirem aos africanos livres. Como resultado, verificamos, que a classe jurídica africanos livres é apenas uma distinção jurídica com relação aos africanos escravizados, e que estes provinham da região denominada Área Austral, na qual há a predominância de línguas do subgrupo banto; em nossa análise léxico-discursiva, verificamos que as unidades lexicais utilizadas para se referirem ao africano livre vão de encontro àquilo que se entendia por liberdade no século XIX.
Cultura educativa na França e no Brasil: uma análise de discursos comparativa de exames nacionais
Authors: Sardá Daniela Nienkötter
Published: July 2022

Neste artigo, faz-se uma análise de discursos comparativa com o objetivo de explicitar quais culturas educativas estão presentes na prova de dissertação de francês no exame do baccalauréat (BAC), na França, e na prova de redação do Exame Nacional do Ensino Médio (ENEM), no Brasil. O corpus selecionado para esta pesquisa é composto das cartilhas dos Ministérios da Educação francês e brasileiro, as quais orientam sobre a prova escrita de dissertação do BAC de francês e sobre a redação do ENEM. As categorias nocionais mobilizadas na análise são as noções de cultura educativa, gênero do discurso e destinatário presumido. Os resultados apontam para uma cultura educativa embasada na aprendizagem da escrita do gênero dissertação, na França, e na cristalização da própria prova de redação do ENEM como gênero discursivo, no Brasil.
Factores relacionados con costos por atención médica de siniestros de tránsito en Bucaramanga, Colombia
Authors: Rivera-Carvajal Raquel , Páez-Esteban Astrid Nathalia , Torres-Contreras Claudia Consuelo , Esquiaqui-Felipe Rafael Enrique , González Nixon Ricardo , Mejía-Muñoz Claudia Celmira
Published: July 2022

OBJETIVO Determinar los factores relacionados con los costos generales durante la atención en salud de siniestros de tránsito en Bucaramanga, Colombia. MÉTODOS Estudio descriptivo, transversal, con análisis de registros de siniestros de tránsito durante 2019 en Bucaramanga, Colombia. Se realizó una comparación entre cuartiles de los costos en dólares con pruebas estadísticas de Chi-cuadrado de Pearson y exacta de Fisher. También, se calcularon odds ratio en regresión logística. RESULTADOS En 2019 se registraron 3.150 siniestros, con 7.038 personas involucradas, de los cuales 812 tenían información de costos generados por atención en instituciones de salud. La mediana de costos fue US$ 56,59 (RI = 29,35–140,15), promedio de US$ 290,11 ± 731,22 (IC95% 239,74–340,48). Se observó mayor posibilidad para estar en cuartil 4 de los costos si la persona tenía menos de 18 años (OR = 4,88; IC95% 1,30–18,32) o entre los 46–60 años de edad (OR = 3,66; IC95% 1,01–13,30), cuando el tipo de vehículo es la motocicleta (OR = 2,79; IC95% 1,25–6,24) y la bicicleta (OR = 7,66; IC95% 2,70–21,68), si la lesión ocurre en la cabeza (OR = 4,50; IC95% 2,61–7,76) y si la hipótesis está relacionada con embriaguez (OR = 12,44; IC95% 2,01–76,87). CONCLUSIÓN Los factores relevantes en los costos fueron la motocicleta, bicicleta, lesión en la cabeza, ser menor de 18 años o tener entre los 46 años y los 60 años y embriaguez como hipótesis. Es relevante implementar medidas de prevención según los factores identificados para disminuir la accidentalidad y, por ende, sus costos socioeconómicos.
Case Report – Successful Thrombectomy After Critical Resuscitation Following a Cardiac Arrest
Authors: Mathur Rohan , Agbe‐Davies Olanrewaju , Urrutia Victor , Caplan Justin M. , Carhuapoma Juan Ricardo
Published: July 2022

Sparse evidence exists to support a delayed attempt at thrombectomy after a periprocedural cardiac arrest or acute medical decompensation. This case highlights the presentation of a 23‐year‐old woman with dilated cardiomyopathy, who initially presented with a left middle cerebral artery stroke syndrome, but who had a cardiac arrest in the angiogram suite prior to the procedure starting. After aggressive resuscitation in the critical care unit, repeat imaging showed a persistent perfusion deficit in the left middle cerebral artery territory and she successfully underwent a thrombectomy. The case highlights that critical care efforts, even after a severe initial presentation, and significant resuscitative efforts in the intensive care unit setting, can still lead to a successful thrombectomy, and that eligibility for thrombectomy can be reassessed as the patient stabilizes.
Risk of device-related thrombosis following short-term oral anticoagulation with low-dose dabigatran versus warfarin after Watchman left atrial appendage occlusion
Authors: Ge Heng , Zhang Chi , Qiao Zhi-Qing , Hao Zi-Yong , Li Zheng , Gu Zhi-Chun , Jiang Li-Sheng , He Ben , Pu Jun
Published: July 2022

Background:

Percutaneous left atrial appendage occlusion (LAAO) provides an alternative for poor candidates for long-term oral anticoagulation (OAC). To prevent device-related thrombosis (DRT), OAC should be continued for the first 45 days to allow complete endothelialization post-LAAO implantation. Whereas, evidence is limited on the feasibility and safety of direct oral anticoagulants (DOACs) used after LAAO.

Methods:

This was a retrospective observational single-center study of AF patients undergoing LAAO with a Watchman device and receiving either low-dose dabigatran (110mg twice daily) or warfarin in the peri- and post-procedural period for 45 days. Transesophageal echocardiography was scheduled to perform at 6 weeks, 6 months, and 12 months after the procedure to assess the stability of the device and to detect DRT. Incidence of thromboembolic and bleeding events were also evaluated during the follow-up period.

Results:

There were a total of 84 patients who successfully underwent Watchman implantation, with 38 patients (45.2%) receiving low-dose dabigatran and 46 patients (54.8%) using warfarin post-LAAO. Peri-procedural complications occurred in 10 patients, with 3 patients in the dabigatran group and 7 patients in the warfarin group (7.9% vs. 15.2%, p = 0.30). During the 12-month follow-up, 1 patient experienced major bleeding and 16 patients suffered minor bleeding in the warfarin group, while 5 patients treated with dabigatran had minor bleeding (34.8% vs. 13.2%, p = 0.02). Besides, 6 DRT (15.8%) were detected in dabigatran groups, and the incidence was higher than in the warfarin group (15.8% vs. 2.2%, p = 0.03). No DRT-related ischemic events were found.

Conclusions:

This study suggested that short-term low-dose dabigatran (110 mg twice daily) could significantly decrease the risk of bleeding compared with warfarin at the expense of increased risk of DRT post-LAAO. Therefore, low-dose dabigatran should be used with caution for post-implant anticoagulation of LAAO. Further studies are urgently needed on the feasibility and safety of DOACs post-LAAO.
Management for lower limb malperfusion in acute type a aortic dissection patients
Authors: Qin Wei , Wang Jiankai , Huang Fuhua , Chen Xin
Published: July 2022

Objective

Acute type A aortic dissection (ATAAD) accompanied with lower limb malperfusion (LLM) is considered to be a catastrophic event, and remains a great challenge for cardiac surgeons. Here we introduce our experience in treating ATAAD patients accompanied with LLM.

Methods

61 patients diagnosed with ATAAD accompanied by LLM enrolled in this study. All patients received aortic repair (Total-arch replacement or Hemi-arch replacement) as soon as possible on admission. Patients who still suffered LLM were performed extra-anatomic bypass using artificial vessels. All the discharged patients underwent the standard follow-up protocol.

Results

38 patients (38/61, 62.3%) got satisfied reperfusion of the lower limbs after aortic repair while the others did not. Five patients had femorofemoral bypass, 16 received aortofemoral bypass, and two underwent aortofemoral bypass plus femorofemoral bypass. The ICU stay time was 5.4 ± 3.6 days. Fifty-five patients were discharged home successfully, while six patients died postoperatively with hospital mortality of 9.8%. Major postoperative complications included acute kidney injury requiring hemodialysis in seven patients, delayed wake-up (>3 days) in 5, prolonged ventilation (>4 days) in 8, and lower limb ischaemia in 1. Follow-up was successfully conducted in 50 patients with a mean follow-up time 4.9 ± 2.6 years. Five patients died during the follow-up. The estimated 5-year survival rate was 87.5 ± 6.1%. CTA images showed 100% patency of the extra-anatomic bypass.

Conclusion

Aortic repair plus concomitant extra-anatomic bypass grafting in one operative setting could be a simple, safe and effective treatment on ATAAD patients with LLM.
Association of Smoking Media Literacy with Vietnamese and South Korean Adolescents’ Susceptibility to Smoking
Authors: Shim Sun Young , Lee Hyeonkyeong , Kim Sookyung , Huong Nguyen Thi Thanh , Lee Young-Me , Thị Phương Lê , Loan Bui Thi Thanh
Published: July 2022

Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15–18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.
Improving the floating efficiency for the pads in fluid pivot journal bearing
Authors: Nguyen Tuyen Vu , Li Weiguang , Phan Van Tuan
Published: July 2022

Previous studies have shown that during the operation of a fluid pivot journal bearing (FPJB), almost only the bottom pad floats. The other two pads are not able to float, resulting in no squeeze film damper (SFD) formed in their places. Therefore, the bearing has not yet reached its full advantage. From this situation, the work focuses on studying how to improve the floating efficiency of the pads in FPJB. Based on a thorough study of the hydrodynamic pressure distribution on the pads and related issues, the orifices are placed in the appropriate position to increase the pressure in the recess. According to this proposed method, all three pads reach the floating state during the stable working of the bearing. The numerical model of FPJB in previous studies is applied to evaluate the effectiveness of the proposed solution. The effect of orifice positions on the buoyancy of the pads was then also thoroughly investigated, and results are then provided and discussed. In the case that orifices are in the middle of the pads, only the bottom pad satisfies floating conditions and the other two pads are almost not able to float. The floating effect of the pad increases when the orifice is moved closer to the top of the hydrodynamic pressure. After the orifice's position is adjusted, the recess pressure increases significantly so that the hydrostatic torque increases while the hydrodynamic torque remains unchanged. As a result, all three pads satisfy the floating conditions. The SFD is not only formed, but also reaches a large value, and therefore, the damping will be greatly increased. Then the calculation results are verified based on a comparison with the data in the previous studies.
Causes of death in low-grade B-cell lymphomas in the rituximab era: a prospective cohort study
Authors: Tun Aung M. , Khurana Arushi , Mwangi Raphael , Link Brian K. , Wang Yucai , Feldman Andrew L. , Thompson Carrie A. , Novak Anne J. , Villasboas Jose C. , Thanarajasingam Gita , Farooq Umar , Syrbu Sergei , Nowakowski Grzegorz S. , Witzig Thomas E. , Ansell Stephen M. , Rimsza Lisa M. , Cerhan James R. , Habermann Thomas M. , Maurer Matthew J.
Published: July 2022

Low-grade B-cell lymphomas other than follicular and small lymphocytic lymphoma (LGBCL) account for 10% of all B-cell non-Hodgkin lymphomas. Despite improvements in survival outcomes for these patients, little is known about cause of death (COD) in the rituximab era. For a better understanding, we studied 822 newly diagnosed patients with marginal zone, lymphoplasmacytic, and unclassifiable low-grade B-cell lymphoma prospectively enrolled in the University of Iowa/Mayo Clinic Specialized Program of Research Excellence Molecular Epidemiology Resource from 2002 to 2015. COD was assigned based on medical record review using a standard protocol. At a median follow-up of 107 months, 219 (27%) patients had died. The incidence of lymphoma-related deaths when pooling across subtypes was lower than non–lymphoma-related deaths (10-year incidence, 8.0%; 95% confidence interval [CI]: 6.2-10.4 vs 13.6%; 95% CI: 11.2-16.6). The incidence of lymphoma-related deaths varied by subtype, ranging from 3.7% at 10 years in extranodal marginal zone lymphoma to 19.3% in lymphoplasmacytic lymphoma/Waldenström macroglobulinemia. Patients with early progression or retreatment events, defined using event-free survival at 24 months from diagnosis, had significantly higher likelihood of lymphoma-related death compared with patients without early events (10-year estimate: 19.1% vs 5.1%, respectively; P < .001), whereas the rates for non–lymphoma-related death were comparable in patients with or without early events (10-year estimates: 11.0% vs 15.3%, respectively). In conclusion, the most common COD in LGBCLs in the first decade after diagnosis was for causes other than lymphoma. Progression or retreatment within the first 2 years of diagnosis was a strong predictor for risk of lymphoma-related death.
Skin/muscle incision and retraction regulates the persistent postoperative pain in rats by the Epac1/PKC-βII pathway
Authors: Qian Jiashu , Lin Xuezheng , Zhou Zhili
Published: July 2022

Persistent postoperative pain causes influence the life quality of many patients. The Epac/PKC pathway has been indicated to regulate mechanical hyperalgesia. The present study used skin/muscle incision and retraction (SMIR) to induce postoperative pain in rats and evaluated the Epac/PKC pathway in postoperative pain. Mechanical allodynia was assessed by paw withdrawal threshold before and after incision. The levels of Epac, PKC, proinflammatory cytokines, and blood-nerve barrier-related proteins were assessed using Western blotting. We found that SMIR induced the activation of the Epac/PKC pathway, mechanical allodynia, and upregulation of Glut1, VEGF, and PGP9.5 proteins in dorsal root ganglia. Under the influence of agonists of Epac/PKC, normal rats showed mechanical allodynia and increased Glut1, VEGF, and PGP9.5 proteins. After inhibition of Epac1 in rats with SMIR, mechanical allodynia was alleviated, and proinflammatory cytokines and Glut1, VEGF, and PGP9.5 proteins were decreased. Moreover, dorsal root ganglia neurons showed abnormal proliferation under the activation of the Epac/PKC pathway. Using Captopril to protect vascular endothelial cells after SMIR had a positive effect on postoperative pain. In conclusion, SMIR regulates the persistent postoperative pain in rats by the Epac/PKC pathway.
Capillary refill time for the management of acute circulatory failure: a survey among pediatric and adult intensivists
Authors: Jacquet-Lagrèze Matthias , Wiart Cléo , Schweizer Rémi , Didier Léa , Ruste Martin , Coutrot Maxime , Legrand Matthieu , Baudin Florent , Javouhey Etienne , Dépret François , Fellahi Jean-Luc
Published: July 2022

Introduction

Recent studies have shown the prognostic value of capillary refill time (CRT) and suggested that resuscitation management guided by CRT may reduce morbidity and mortality in patients with septic shock. However, little is known about the current use of CRT in routine clinical practice. This study aimed to assess the modalities of CRT use among French adult and pediatric intensivists.

Methods

A cross-sectional survey exploring CRT practices in acute circulatory failure was performed. The targeted population was French adult and pediatric intensivists (SFAR and GFRUP networks). An individual invitation letter including a survey of 32 questions was emailed twice. Descriptive and analytical statistics were performed.

Results

Among the 6071 physicians who received the letter, 418 (7%) completed the survey. Among all respondents, 82% reported using CRT in routine clinical practice, mainly to diagnose acute circulatory failure, but 45% did not think CRT had any prognostic value. Perfusion goal-directed therapy based on CRT was viewed as likely to improve patient outcome by 37% of respondents. The measurement of CRT was not standardized as the use of a chronometer was rare (3%) and the average of multiple measurements rarely performed (46%). Compared to adult intensivists, pediatric intensivists used CRT more frequently (99% versus 76%) and were more confident in its diagnostic value and its ability to guide treatment.

Conclusion

CRT measurement is widely used by intensivists in patients with acute circulatory failure but most often in a non-standardized way. This may lead to a misunderstanding of CRT reliability and clinical usefulness.
Patient-reported continuity of care and the association with patient experience of cardiovascular prevention: an observational study in Germany
Authors: Arnold Christine , Hennrich Patrick , Wensing Michel
Published: July 2022

Background

Cardiovascular diseases are often accompanied by comorbidities, which require good coordination of care. Especially in fragmented healthcare systems, it is important to apply strategies such as case management to achieve high continuity of care. The aim of this study was to document continuity of care from the patients’ perspective in ambulatory cardiovascular care in Germany and to explore the associations with patient-reported experience of cardiovascular prevention.

Methods

This cross-sectional observational study was performed in primary care practices in Germany. The study included patients with three recorded chronic diseases, including coronary heart disease. Continuity of care was measured with the Nijmegen Continuity Questionnaire, which addresses personal/relational and team/cross-boundary continuity. From aspects of medical care and health-related lifestyle counselling a patient-reported experience of cardiovascular prevention index was formed with a range of 0–7. The association between continuity of care within the family practice and patient-reported experience of cardiovascular prevention was examined, using a linear multilevel regression model that adjusted for sociodemographics, structured care programme and numbers of contacts with the family practice.

Results

Four hundred thirty-five patients from 26 family practices participated. In a comparison between general practitioners (GPs) and cardiologists, higher values for relational continuity of care were given for GPs. Team/cross-boundary continuity for ‘within the family practice’ had a mean of 4.0 (standard deviation 0.7) and continuity between GPs and cardiologists a mean of 3.8 (standard deviation 0.7). Higher personal continuity of care for GPs was positively associated with patient-reported experience (b = 0.75, 95% CI 0.45–1.05, P < 0.001).

Conclusions

Overall, there was high patient-reported continuity, which positively influenced the experience of cardiovascular prevention. Nevertheless, there is potential for improvement of personal continuity of the cardiologists and team/cross-boundary continuity between GPs and cardiologists. Structured care programs may be able to support this.

Trial registration

We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS) under ID no. DRKS00019219.
Including formal and informal caregivers in the development of Play Intervention for Dementia: a qualitative study
Authors: Li Bingyu , Ho Rainbow Tin Hung , Leung Wing Yeung Vivian , Tsang Ka Tat
Published: July 2022

Background

Play Intervention for Dementia is a practice initiative using play to help people living with dementia (PWD) experience engagements, autonomy, and cognitive stimulation. This program was developed under a participatory paradigm, with extensive contribution from formal and informal caregivers. This article describes how caregivers contributed to the practice principles, materials, and assessment during the development phase of Play Intervention for Dementia through community-based participatory research (CBPR).

Methods

Three service supervisors, 16 formal caregivers and 14 informal caregivers from the community participated in this study. Based on CBPR, the study progressed in a reflexive, iterative and collaborative way. Data were collected from diverse sources, including practice journals, observation notes and reflexive focus group interviews. Two trained qualitative researchers conducted thematic analysis on the data collected, with focus on practical skills, outcomes, and caregivers’ general experience during the intervention.

Results

The therapeutic and liberating power of play was thoroughly discussed by the caregivers. They considered play as an innovative way to understand, engage, and connect with the PWD. Also, improvement in energy level, motivation and communicative capacity was observed among the PWD. The researcher and caregivers collaboratively refined and designed the protocol of Play Intervention for Dementia, adding localized principles and games to the original design.

Conclusion

Caregivers found play to be a meaningful way to engage with PWD, as it provided an equal platform for them. The intervention also enabled them to reflect upon ageing and disease at a deeper level. Caregivers have contributed significantly to the refinement and contextualisation of the intervention. The efficiency of the refined program should be further tested on a larger scale.
Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi
Authors: Chirwa Gowokani Chijere
Published: July 2022

Background

Cervical cancer is a prevalent public health concern and is among the leading causes of death among women globally. Malawi has the second highest cervical cancer prevalence and burden in the world. Due to the cervical cancer burden, the Malawi government scaled up national cancer screening services in 2011, which are free for all women. This paper is the first study to examine the socioeconomic inequality in cervical cancer screening uptake using concentration indices, in Malawi. Furthermore, it decomposes the concentration index to examine how each factor contributes to the level of inequality in the uptake of cervical cancer screening.

Methods

The data used in this paper were obtained from the nationally representative Malawi Population HIV Impact Assessment (MPHIA) household survey, which was conducted in 2015. Concentration curves were constructed to explore whether there was any socioeconomic inequality in cervical cancer screening and, if so, its extent. This was complemented by concentration indices that were computed to quantify the magnitude of socioeconomic inequality. A decomposition analysis was then conducted to examine the factors that explained/were associated with greater socioeconomic inequality in cervical cancer screening. The methodology in this paper followed that of previous studies found in the literature and used the wealth index to measure socioeconomic status.

Results

The results showed that the concentration curves lay above the line of equality, implying a pro-rich inequality in cervical cancer screening services. Confirming the results from the concentration curves, the overall concentration index was positive and significant (0.142; %95 CI = 0.127, 0.156; p < 0.01). The magnitude was lower in rural areas (0.075; %95CI = 0.059, 0.090; p < 0.01) than in urban areas (0.195; %95CI = 0.162, 0.228 p < 0.001). After undertaking a decomposition of the concentration index, we found that age, education, rural or urban location, and wealth status account for more than 95% of the socioeconomic inequality in cervical cancer uptake.

Conclusion

Despite the national scale-up of free cancer care at the point of use, cervical cancer screening uptake in Malawi remains pro rich. There is a need to implement parallel demand-side approaches to encourage uptake among poorer groups. These may include self-testing and mobile screening centres, among others.
Implementation of a patient-teaching workshop to improve pharmacy students’ competencies in patient-centered communication: a case report
Authors: Hache Caroline , Honoré Stéphane , Hache Guillaume
Published: July 2022

Background

The pharmacist-patient relationship has evolved over recent decades and the development of clinical pharmacy requires pharmacists to take patient-centered responsibilities. This requires a specific set of skills, such as patient-centered communication. Evaluation of students’ competencies in patient-centered communication is challenging in academic settings and complementary assessment methods may be designed in order to overcome the limits of traditional preceptors’ ratings or objective structured clinical examination (OSCE). There is increasing interest in a more active patient role in healthcare professional education and there are very few reports about patient-led education in pharmacies. Thus, the objective of this work was to implement a patient-teaching workshop and to assess its impact on pharmacy students’ competencies in patient-centered communication.

Methods

The workshop was developed in collaboration between four patients, a senior clinical pharmacist and a lecturer in education sciences and implemented in the hospital pharmacy residency program. The main course objective was acquiring the three competencies of the Calgary-Cambridge guide to the medical interview: (i) building a relationship, (ii) conducting structured interview and (iii) gathering information. The learning process integrated: working on participants’ perception of pharmacists-patient communication, a first simulated interview, didactic learning and a second simulated interview. After simulated interviews, patients and peer residents assessed learner’s performance with a competency chart and provided individual feedback. Assessment methods included comparisons between the first and second interview scores and an anonymous post-course survey.

Results

Forty-seven residents and 19 patient teachers attended the session. Competency scores were higher after the second interview in all three competencies as rated by both patients (+ 25%) and peer residents (+ 29%).

Residents expressed a high satisfaction and reported learning about conducting interviews and soft skills contributing to the development of a relationship with patients. “The involvement of patients” was expressed as most appreciated in the majority of the evaluation charts (87%) and the residents valued the importance of collaborative and interprofessional learning during the workshop. Three themes emerged: (1) patients’ expertise, (2) reliability and (3) relationship, which underlined that the students estimated the patients were credible sources of information in this pedagogical context.

Conclusion

This patient-teaching approach improved patient-centered competencies of pharmacy residents and promoted partnership between patients and pharmacy students.
Protective effect of melatonin on alleviating early oxidative stress induced by DOX in mice spermatogenesis and sperm quality maintaining
Authors: Zi Teng , Liu YaNan , Zhang YuSheng , Wang ZeLin , Wang ZhiXin , Zhan Song , Peng Zhu , Li Ning , Liu XueXia , Liu FuJun
Published: July 2022

Doxorubicin (DOX) is an effective chemotherapy drug, but its clinical use has adverse effects on male reproduction. However, there are few studies about the specific biological processes related to male reproduction or strategies for improving fertility protection. In this paper, we examined the effects of DOX on spermatogenesis and sperm function, and tested the possible protective role of melatonin (MLT) against DOX’s reproductive toxicity. DOX-treated mice showed signs of significantly impaired spermatogenesis, including vacuolated epithelial cells, decreased testis weights, and lowered sperm counts and motility. DOX also reduced germ cell proliferation (PCNA) and meiosis-related proteins (SYCP3), but this effect could be partially improved with MLT administration. HSPA2 expression was maintained, which indicated that although MLT did not improve sperm motility, it did have a significant protective effect on elongated sperm. IVF results showed that MLT could partially promote two-cell and blastocyte development that was restricted by DOX. MLT reversed DOX-driven changes in the testes, including the antioxidant indices of SOD1, CAT and PRDX6, and the apoptotic indices of BAX and Caspase3. These results suggest that MLT effectively prevents DOX-induced early reproductive toxicity, and increase our understanding of the molecular mechanisms underlying DOX’s effects on male reproduction and the protective mechanism of MLT.
Expressed emotion of caregivers among schizophrenic patients visiting Jimma University Medical Center Psychiatry Outpatient Unit, Southwest Ethiopia
Authors: Yimam Bethlehem , Soboka Matiwos , Getachew Yemiamrew , Alemu Bezaye , Ahmed Gutema , Tesfaye Elias , Necho Mogesie
Published: July 2022

Background

Expressed emotion (EE) measures the emotion among caregivers of schizophrenic patients and is predictive of symptom levels in a range of medical and psychiatric conditions. It is worth assessing expressed emotion and associated factors among caregivers of patients with schizophrenia in Ethiopia since there is limited data on this issue in this part of the world.

Objective

To assess the status of expressed emotions and selected patients’ clinical factors among caregivers of patients with schizophrenia attending Psychiatry Outpatient Unit of Jimma University Medical Center, Southwest Ethiopia, 2019.

Method

A cross-sectional study was conducted on 422 caregivers of schizophrenic patients using a consecutive sampling technique. Data were collected using a structured interviewer administrated questionnaires (Family Questionnairre) which assessed the level of expressed emotion. Data were entered into Epidata 4.4 and analyzed by Statistical package for social science (SPSS) version 25. Descriptive statistics was which used to summarize data, bivariate logistic regression was done to identify candidate variables for multivariable logistic regressions and the association between expressed emotion and predictor variables was identified by using multiple logistic regression models.

Results

High expressed emotion was observed in 43.6% of respondents while caring for schizophrenic patients for about 6–8 years, having 3–4 episodes of the illness which was significantly associated with high expressed emotion.

Conclusions

This study revealed that there is a high level of expressed emotion among caregivers. It also showed that increment in the episode of the illnesses had a significant association with high caregivers’ expressed emotion. Hence, health care systems which provide interventions for patients with schizophrenia need to design proper strategies to address caregivers’ needs as well.
GHG Monitoring Project for the Global Stocktake 2023: implications of the COP26 Japan Pavilion seminar
Authors: Oda Tomohiro
Published: July 2022

During the 2021 Glasgow Climate Change Conference (COP26), a hybrid seminar event “Greenhouse gas (GHG) Monitoring Project for the Global Stocktake 2023” was held at the COP26 Japan Pavilion on 2nd of November 2011. The participants presented and discussed science-based GHG monitoring approaches in support of the Global Stocktake. This report summarizes the five research talks given at the event.
Possible role of autophagy induced by COVID-19 in cancer progression, chemo-resistance, and tumor recurrence
Authors: Zalpoor Hamidreza , Akbari Abdullatif , Nayerain Jazi Negar , Liaghat Mahsa , Bakhtiyari Maryam
Published: July 2022

COVID-19 infection is a serious threat to patients with primary diseases, especially multiple cancers. Studies suggest that cancer patients are one of the most susceptible populations to experience severe COVID-19 and death. In addition, a number of studies suggest various mechanisms for SARS-CoV-2 in cancer progression. In this study, we discussed the role of SARS-CoV-2 in the induction of autophagy and we hypothesized that autophagy induced by COVID-19 not only can contribute to viral replication but also potentially can lead to cancer progression, chemo-resistance, and tumor recurrence in multiple cancer patients. Therefore, targeting autophagy-related signaling pathways and cellular and molecular processes could be a potentially promising therapeutic approach for cancer patients with COVID-19. Hence, this study can shed light on a new window on the management of such patients. However, more investigations in the future are required to understand other pathological effects of COVID-19 infection on cancer patients to provide new therapeutic strategies to combat these complications in these patients.
Tidal volume challenge to predict preload responsiveness in patients with acute respiratory distress syndrome under prone position
Authors: Shi Rui , Ayed Soufia , Moretto Francesca , Azzolina Danila , De Vita Nello , Gavelli Francesco , Carelli Simone , Pavot Arthur , Lai Christopher , Monnet Xavier , Teboul Jean-Louis
Published: July 2022

Background

Prone position is frequently used in patients with acute respiratory distress syndrome (ARDS), especially during the Coronavirus disease 2019 pandemic. Our study investigated the ability of pulse pressure variation (PPV) and its changes during a tidal volume challenge (TVC) to assess preload responsiveness in ARDS patients under prone position.

Methods

This was a prospective study conducted in a 25-bed intensive care unit at a university hospital. We included patients with ARDS under prone position, ventilated with 6 mL/kg tidal volume and monitored by a transpulmonary thermodilution device. We measured PPV and its changes during a TVC (ΔPPV TVC6–8) after increasing the tidal volume from 6 to 8 mL/kg for one minute. Changes in cardiac index (CI) during a Trendelenburg maneuver (ΔCITREND) and during end-expiratory occlusion (EEO) at 8 mL/kg tidal volume (ΔCI EEO8) were recorded. Preload responsiveness was defined by both ΔCITREND ≥ 8% and ΔCI EEO8 ≥ 5%. Preload unresponsiveness was defined by both ΔCITREND < 8% and ΔCI EEO8 < 5%.

Results

Eighty-four sets of measurements were analyzed in 58 patients. Before prone positioning, the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen was 104 ± 27 mmHg. At the inclusion time, patients were under prone position for 11 (2–14) hours. Norepinephrine was administered in 83% of cases with a dose of 0.25 (0.15–0.42) µg/kg/min. The positive end-expiratory pressure was 14 (11–16) cmH2O. The driving pressure was 12 (10–17) cmH2O, and the respiratory system compliance was 32 (22–40) mL/cmH2O. Preload responsiveness was detected in 42 cases. An absolute change in PPV ≥ 3.5% during a TVC assessed preload responsiveness with an area under the receiver operating characteristics (AUROC) curve of 0.94 ± 0.03 (sensitivity: 98%, specificity: 86%) better than that of baseline PPV (0.85 ± 0.05;p = 0.047). In the 56 cases where baseline PPV was inconclusive (≥ 4% and < 11%), ΔPPV TVC6–8 ≥ 3.5% still enabled to reliably assess preload responsiveness (AUROC: 0.91 ± 0.05, sensitivity: 97%, specificity: 81%;p < 0.01vs.baseline PPV).

Conclusion

In patients with ARDS under low tidal volume ventilation during prone position, the changes in PPV during a TVC can reliably assess preload responsiveness without the need for cardiac output measurements.

Trial registration:ClinicalTrials.gov (NCT04457739). Registered 30 June 2020 —Retrospectively registered,https://clinicaltrials.gov/ct2/show/record/NCT04457739