bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Evidence-Based Design Strategies on Nurse Wellness
Authors: Raj Minakshi , Jimenez Francesqca E. , Rich Renae K. , Okland Kathy , Roy Lonnie , Opollo Jackline , Rogers Juliet , Brittin Jeri
Published: August 2022

Objectives:

The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness.

Background:

Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness.

Methods:

This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses’ tasks and documentation, (4) ability to care for patients, and (5) nurses’ overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness.

Results:

Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness.

Conclusions:

It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.
Associated factors of potential drug-drug interactions and drug–food interactions in patients with multiple sclerosis
Authors: Debus Jane Louisa , Bachmann Paula , Frahm Niklas , Mashhadiakbar Pegah , Langhorst Silvan Elias , Streckenbach Barbara , Baldt Julia , Heidler Felicita , Hecker Michael , Zettl Uwe Klaus
Published: August 2022

Background:

Multiple sclerosis (MS) is the most common immune-mediated demyelinating disease in younger adults. Patients with MS (PwMS) are vulnerable to the presence of potential drug–drug interactions (pDDIs) and potential drug–food interactions (pDFIs) as they take numerous medications to treat MS, associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can increase treatment success and reduce side effects.

Objective:

We aimed at determining the frequency and severity of pDDIs and pDFIs in PwMS, with regard to polypharmacy.

Methods:

In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged ⩾18 years. Data collection was performed through patient record reviews, clinical examinations and structured patient interviews. pDDIs and pDFIs were identified using two DDI databases: Drugs.com Interactions Checker and Stockley’s Interactions Checker.

Results:

We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%) had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334 patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a 15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001). The most frequently recorded severe pDDI was between citalopram and fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent severe pDFI.

Conclusion:

Pw/P were particularly at risk of severe pDDIs. Age and educational level were found to be factors associated with the occurrence of pDDIs, independent of the number of medications taken. Screening for pDDIs/pDFIs should be routinely done by the clinical physician to increase drug safety and reduce side effects.
Applying knowledge translation frameworks, approaches and principles to co-create a dissemination plan: Optimizing the spread of a pediatric concussion guideline
Authors: Provvidenza Christine , Kingsnorth Shauna , Dawson Jennifer , Ledoux Andree-Anne , Zemek Roger , Reed Nick
Published: August 2022

Background

Clinical practice guidelines are evidence-based statements that assist healthcare professionals with improving patient care. Achieving guideline aims depends on successful knowledge translation (KT) and includes dissemination and implementation efforts. Dissemination efforts are important precursors to implementation, help to maximize awareness and reach of best practices, and prepare for evidence adoption. This article shares the application of KT frameworks, approaches and principles in the creation of a dissemination plan and KT products for the Living Guideline for Pediatric Concussion Care. The target audience for dissemination are healthcare professionals delivering clinical care to patients between 5–18 years.

Methods

Guided by the Framework for Knowledge Transfer and an integrated KT (iKT) approach, 46 concussion experts participated in an iKT workshop and knowledge board activity to: 1) establish a Living Guideline dissemination plan; 2) identify products to share the Living Guideline; and, 3) prepare for Living Guideline implementation planning. Post-workshop, a snowball approach invited knowledge users including educators and youth/young adults with lived experience in concussion via interviews and focus groups, to expand upon the dissemination plan and recommended products.

Results

The dissemination plan yielded a reach of nearly 42,000 Living Guideline page views from September, 2019-January, 2022. Dissemination efforts included 13 multi-media interviews, over 40 activities (e.g. webinars), and 28 engagement emails to help raise awareness. Eight KT products were developed to foster sharing and use of the Living Guideline, with over 3000 downloads across all KT products.

Conclusions

Applying an iKT approach alongside appropriate frameworks and principles allowed for interaction and partnership building, resulting in the development of a robust dissemination plan and essential KT products. By showing the breadth and impact of the KT activities undertaken, it is hoped that the concussion community will explore how KT practices can bolster efforts to drive evidence into practice and optimize concussion care.
Reviving Hearts That Were Born to Advocate for the Cause of Children and Youth Without Parental Care: Wataneya Society’s Youth Forum
Authors: Nada Manar , Hagry Yasmine El
Published: August 2022

In Egypt, there are 12,000 children in residential care; however, this figure is underestimated due to the number of unregistered care homes. Like elsewhere in the world, children raised in residential care in Egypt usually receive inadequate quality of care. Nevertheless, when they reach 18–21 years old, they are abruptly required to leave care and manage all the details of their lives, while often unsupported, unprepared and unequipped to make the move. In addition, they carry the burden of a strong societal stigma, affecting them psychologically and standing in the way of their personal, social and professional well-being. To support youths’ transition to independence, Wataneya Society launched the ’Youth Forum’ in 2017. To date, the Youth Forum targets youth aged 18 and above with the following objectives: (a) providing a safe space for the youth to exchange their thoughts and experiences; (b) enabling youth to discuss the challenges they face and come up with possible solutions; and (c) empowering youth to communicate their voice to the concerned authorities and equipping them with the needed skills to become agents of change to their cause. Years of regular meetups imprinted the Youth Forum’s ripple effects on Wataneya Society’s different projects, such as Sanad Conference in 2019, which was the first regional conference on leaving care in the Arab World; the Care Leavers independence programme, which is a programme to develop the after-care system in Egypt; and Mobader (meaning ‘being proactive’) programme, which is led by the youth to enable them to practise community leadership skills. This article will highlight case studies of two of the Youth Forum’s participants to demonstrate: (a) the main challenges children and youth in residential care in Egypt face that affect their transition to independence; (b) how the Youth Forum tackles those challenges through its main objectives, activities and development processes; (c) the main outcomes of the Youth Forum and how it is connected to Wataneya Society’s different projects and the reform of the alternative care system in Egypt; and (d) key learned lessons from the process of implementation of the Youth Forum. The article will employ a framework adopted from the World Health Organization (2017).
Learning to Practice Compassionate Care: Medical Students Discuss Their Most Memorable Lessons
Authors: Schairer Cynthia E. , Tutjer Jenna , Cannavino Christopher , Mobley William C. , Eyler Lisa , Bloss Cinnamon S.
Published: August 2022

Compassion in interactions between physicians and patients can have a therapeutic effect independent of the technical medical treatment provided. However, training physicians to effectively communicate compassion is challenging. This study explores how medical students experienced training focused on interacting with patients by examining students’ reports of particularly memorable lessons. Six focus groups were conducted with medical students (total n = 48) in their fourth year of training. We report on responses from students to the question, “What was the most memorable lesson you have learned about interacting with patients?” Students discussed lessons aimed at patient-centered physical navigation, interpersonal navigation, and perspective taking. Concerns were raised that navigation techniques felt inauthentic and that perspective taking was too time consuming to be sustainable in actual practice. While perspective-taking exercises should motivate medical students to treat every patient with dignity by demonstrating the complexity of others’ lives, if students assume that full understanding is a prerequisite to delivery of compassionate care, they may dismiss explicit techniques of patient-centered care as inauthentic and perceive compassion and efficiency as mutually exclusive.
Analysis and interpretation of pharmacokinetic studies following DEET administration to rats, dogs, and humans
Authors: Nikiforov Andrey I , Osimitz Thomas G
Published: August 2022

Pharmacokinetic studies on the undiluted insect repellent active ingredient, DEET, were assessed for relevance to exposure assessment for humans. Five studies designed to define the DEET plasma concentration profiles of systemic exposure occurring at the respective NOAELs for two laboratory species using dermal and/or oral exposure scenarios and human volunteers at the 95th percentile of consumer use were undertaken to support EPA re-registration. The studies reported herein demonstrate that the DEET plasma concentration for Sprague-Dawley rats and Beagle dogs at the respective NOAELs following oral bolus dosing is much greater in terms of Cmax and AUC than that achieved following human dermal administration at the 95th percentile of consumer use. In addition, these plasma level data confirm that a high-dose rat subchronic dermal toxicity study with DEET is the most relevant model for human safety assessment of this topically applied insect repellent active ingredient. Therefore, utilization of pharmacokinetic plasma level data is important to exposure assessment of DEET and significantly reduces uncertainty in human health safety assessment.
Sensitisation to recombinantAspergillus fumigatusallergens and clinical outcomes in COPD
Authors: Tiew Pei Yee , Narayana Jayanth Kumar , Quek Marilynn Swee Li , Ang Yan Ying , Ko Fanny Wai San , Poh Mau Ern , Jaggi Tavleen Kaur , Xu Huiying , Thng Kai Xian , Koh Mariko Siyue , Tee Augustine , Hui David Shu Cheong , Abisheganaden John Arputhan , Tsaneva-Atanasova Krasimira , Chew Fook Tim , Chotirmall Sanjay H.
Published: August 2022

Background

Variable clinical outcomes are reported with fungal sensitisation in chronic obstructive pulmonary disease (COPD), and it remains unclear which fungi and what allergens associate with the poorest outcomes. The use of recombinant as opposed to crude allergens for such assessment is unknown.

Methods

A prospective multicentre assessment of stable COPD (n=614) was undertaken in five hospitals across three countries: Singapore, Malaysia and Hong Kong. Clinical and serological assessment was performed against a panel of 35 fungal allergens including crude and recombinantAspergillusand non-Aspergillusallergens. Unsupervised clustering and topological data analysis (TDA) approaches were employed using the measured sensitisation responses to elucidate if sensitisation subgroups exist and their related clinical outcomes.

Results

Aspergillus fumigatussensitisation was associated with increased exacerbations in COPD. Unsupervised cluster analyses revealed two “fungal sensitisation” groups. The first was characterised byAspergillussensitisation and increased exacerbations, poorer lung function and worse prognosis. Polysensitisation in this group conferred even poorer outcome. The second group, characterised byCladosporiumsensitisation, was more symptomatic. Significant numbers of individuals demonstrated sensitisation responses to only recombinant (as opposed to crude)A. fumigatusallergens f 1, 3, 5 and 6, and exhibited increased exacerbations, poorer lung function and an overall worse prognosis. TDA validated these findings and additionally identified a subgroup withinAspergillus-sensitised COPD of patients with frequent exacerbations.

Conclusion

Aspergillussensitisation is a treatable trait in COPD. Measuring sensitisation responses to recombinantAspergillusallergens identifies an important patient subgroup with poor COPD outcomes that remains overlooked by assessment of only crudeAspergillusallergens.
Airway pathogens detected in stable and exacerbated COPD in patients in Asia-Pacific
Authors: Taddei Laura , Malvisi Lucio , Hui David S. , Malvaux Ludovic , Samoro Ronnie Z. , Lee Sang Haak , Yeung Yiu Cheong , Liu Yu-Chih , Arora Ashwani Kumar
Published: August 2022

Background

The burden of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region is projected to increase. Data from other regions show bacterial and viral infections can trigger acute exacerbations of COPD (AECOPD).

Methods

This 1-year prospective epidemiological study (ClinicalTrials.gov identifier:NCT03151395) of patients with moderate to very severe COPD in Hong Kong, the Philippines, South Korea and Taiwan assessed the prevalence in sputum samples (by culture and PCR) of bacterial and viral pathogens during stable COPD and AECOPD. The odds of experiencing an exacerbation was evaluated for pathogen presence, acquisition and apparition. Health-related quality of life (HRQOL) was assessed.

Results

197 patients provided 983 sputum samples, with 226 provided during exacerbation episodes. The mean yearly AECOPD incidence rate was 1.27 per patient. The most prevalent bacteria by PCR at exacerbation wereHaemophilus influenzae(Hi) andMoraxella catarrhalis(Mcat); Mcat prevalence was higher at exacerbation than at stable state. Virus prevalence was low, other than for human rhinovirus (HRV) (8.1%, stable state; 16.6%, exacerbation). The odds ratio (95% CI) for an exacerbation (versusstable state) was statistically significant for the presence, acquisition and apparition of Hi (2.20, 1.26–3.89; 2.43, 1.11–5.35; 2.32, 1.20–4.46, respectively), Mcat (2.24, 1.30–3.88; 5.47, 2.16–13.86; 3.45, 1.71–6.98, respectively) and HRV (2.12, 1.15–3.91; 2.22, 1.09–4.54; 2.09, 1.11–3.91, respectively). HRQOL deteriorated according to the number of exacerbations experienced.

Conclusion

In patients with COPD in the Asia-Pacific region, the presence of Hi, Mcat or HRV in sputum samples significantly increased the odds of an exacerbation, providing further evidence of potential roles in triggering AECOPD.
All-cause admissions following a first ever exacerbation-related hospitalisation in COPD
Authors: Waeijen-Smit Kiki , Jacobsen Peter A. , Houben-Wilke Sarah , Simons Sami O. , Franssen Frits M.E. , Spruit Martijn A. , Pedersen Christian T. , Kragholm Kristian H. , Weinreich Ulla M.
Published: August 2022

Background

Hospital admissions are important contributors to the overall burden of chronic obstructive pulmonary disease (COPD). Understanding the patterns and causes of hospital admissions will help to identify targets for preventive interventions. This study aimed to determine the 5-year all-cause hospital admission trajectories of patients with COPD following their first ever exacerbation-related hospitalisation.

Methods

Patients with COPD were identified from the Danish national registries. Patients experiencing their first ever exacerbation-related hospitalisation, defined as the index event, between 2000 and 2014 were included. All-cause hospital admissions were examined during a subsequent 5-year follow-up period, and categorised using the International Classification of Diseases, 10th revision.

Results

In total, 82 964 patients with COPD were included. The mean±sdage was 72±10 years and 48% were male. Comorbidities were present in 58%, and 65% of the patients collected inhalation medication ≤6 months prior to the index event. In total, 337 066 all-cause hospital admissions were identified, resulting in a 5-year admission rate of 82%. Most admissions were due to nonrespiratory causes (59%), amongst which cardiac events were most common (19%).

Conclusion

Hospital admissions following a first exacerbation-related hospitalisation are common; nonrespiratory events constitute the majority of admissions. Besides the respiratory causes, treatment targeting the nonrespiratory causes of hospital admission should be considered to effectively decrease the burden of hospitalisation in COPD.
Size-Dependent Magnetic and Magneto-Optical Properties of Bi-Doped Yttrium Iron Garnet Nanopowders
Authors: Spivakov Aleksandr , Lin Chun-Rong , Tsai Chang-Yen , Chen Ying-Zhen
Published: August 2022

Bi-doped yttrium iron garnet nanopowders were successfully synthesized by a combustion method at different synthesis conditions, and the evolution of their structural, magnetic, and magneto-optical properties has been studied by various methods. X-ray diffraction analysis revealed that crystallite size increases with increase as in annealing time (tA) well as in annealing temperature (TA) and varied from 15.2 nm (TA = 650 °C, tA = 0.5 h) to 44.5 nm (TA = 800 °C, tA = 12 h). The magnetic hysteresis loops exhibit behavior characteristic of soft magnetic materials; herewith, the saturation magnetization demonstrates a growing trend with increasing crystallite size (D). The behavior of the coercivity indicates that, at room temperature, the transition between single-domain and multidomain states occurs at D = 35.3 nm. It was found that the size effect in the MCD spectra is clearly observed for the samples with crystallite sizes less than 42.2 nm for an intersublattice charge-transfer transition and a crystal-field tetrahedral transition. The influence of cation redistribution on the observed changes has been discussed.
Synthesis of Novel Triphenylamine-Based Organic Dyes with Dual Anchors for Efficient Dye-Sensitized Solar Cells
Authors: Mahmoud Samar E. , Fadda Ahmed A. , Abdel-Latif Ehab , Elmorsy Mohamed R.
Published: August 2022

A new series of metal-free organic dyes (SM1-5) with dual anchors are synthesized for application in dye-sensitized solar cells (DSSC). Here, a simple triphenylamine (TPA) moiety serves as the electron donor, while di-cyanoacrylamide and di-thiazolidine-5-one units serve as the electron acceptors and anchoring groups. To understand the effect of dye structure on the photovoltaic characteristics of DSSCs, the photophysical and electrochemical properties, as well as molecular geometries calculated from density functional theory (DFT), are used for dyes SM1-5. The extinction coefficients of the organic dyes SM1-5 are high (5.36–9.54 104 M−1 cm−1), indicating a high aptitude for light harvesting. The photovoltaic studies indicated that using dye SM4 as a sensitizer showed a power conversion efficiency (PCE) of 6.09% (JSC = 14.13 mA cm−2, VOC = 0.624 V, FF = 68.89%). Interestingly, SM4 showed the highest values of VOC among all dyes, including N-719, due to its maximum dye coverage on the TiO2 surface, enhancing charge recombination resistance in the sensitized cell. The good agreement between the theoretically and experimentally obtained data indicates that the energy functional and basis set employed in this study can be successfully utilized to predict new photosensitizers' absorption spectra with great precision before synthesis. Also, these results show that bi-anchoring molecules have a lot of potentials to improve the overall performance of dye-sensitized solar cells.
ImputAccur: fast and user-friendly calculation of genotype-imputation accuracy-measures
Authors: Thormann Kolja A. , Tozzi Viola , Starke Paula , Bickeböller Heike , Baum Marcus , Rosenberger Albert
Published: August 2022

Background

ImputAccur is a software tool to measure genotype-imputation accuracy. Imputation of untyped markers is a standard approach in genome-wide association studies to close the gap between directly genotyped and other known DNA variants. However, high accuracy for imputed genotypes is fundamental. Several accuracy measures have been proposed, but unfortunately, they are implemented on different platforms, which is impractical.

Results

With ImputAccur, the accuracy measures info, Iam-hiQ and r2-based indices can be derived from standard output files of imputation software. Sample/probe and marker filtering is possible. This allows e.g. accurate marker filtering ahead of data analysis.

Conclusions

The source code (Python version 3.9.4), a standalone executive file, and example data for ImputAccur are freely available at https://gitlab.gwdg.de/kolja.thormann1/imputationquality.git.
DCSE:Double-Channel-Siamese-Ensemble model for protein protein interaction prediction
Authors: Chen Wenqi , Wang Shuang , Song Tao , Li Xue , Han Peifu , Gao Changnan
Published: August 2022

Background

Protein-protein interaction (PPI) is very important for many biochemical processes. Therefore, accurate prediction of PPI can help us better understand the role of proteins in biochemical processes. Although there are many methods to predict PPI in biology, they are time-consuming and lack accuracy, so it is necessary to build an efficiently and accurately computational model in the field of PPI prediction.

Results

We present a novel sequence-based computational approach called DCSE (Double-Channel-Siamese-Ensemble) to predict potential PPI. In the encoding layer, we treat each amino acid as a word, and map it into an N-dimensional vector. In the feature extraction layer, we extract features from local and global perspectives by Multilayer Convolutional Neural Network (MCN) and Multilayer Bidirectional Gated Recurrent Unit with Convolutional Neural Networks (MBC). Finally, the output of the feature extraction layer is then fed into the prediction layer to output whether the input protein pair will interact each other. The MCN and MBC are siamese and ensemble based network, which can effectively improve the performance of the model. In order to demonstrate our model’s performance, we compare it with four machine learning based and three deep learning based models. The results show that our method outperforms other models in all evaluation criteria. The Accuracy, Precision, $$F_{1}$$

F
1

, Recall and MCC of our model are 0.9303, 0.9091, 0.9268, 0.9452, 0.8609. For the other seven models, the highest Accuracy, Precision, $$F_{1}$$

F
1

, Recall and MCC are 0.9288, 0.9243, 0.9246, 0.9250, 0.8572. We also test our model in the imbalanced dataset and transfer our model to another species. The results show our model is excellent.

Conclusion

Our model achieves the best performance by comparing it with seven other models. NLP-based coding method has a good effect on PPI prediction task. MCN and MBC extract protein sequence features from local and global perspectives and these two feature extraction layers are based on siamese and ensemble network structures. Siamese-based network structure can keep the features consistent and ensemble based network structure can effectively improve the accuracy of the model.
High-frequency repetitive transcranial magnetic stimulation (rTMS) protects against ischemic stroke by inhibiting M1 microglia polarization through let-7b-5p/HMGA2/NF-κB signaling pathway
Authors: Hong Ye , Lyu Jinfeng , Zhu Lin , Wang Xixi , Peng Mengna , Chen Xiangliang , Deng Qiwen , Gao Jie , Yuan Zhenhua , Wang Di , Xu Gelin , Xu Mengyi
Published: August 2022

Background

Microglia assume opposite phenotypes in response to ischemic brain injury, exerting neurotoxic and neuroprotective effects under different ischemic stages. Modulating M1/M2 polarization is a potential therapy for treating ischemic stroke. Repetitive transcranial magnetic stimulation (rTMS) held the capacity to regulate neuroinflammation and astrocytic polarization, but little is known about rTMS effects on microglia. Therefore, the present study aimed to examine the rTMS influence on microglia polarization and the underlying possible molecular mechanisms in ischemic stroke models.

Methods

Previously reported 10 Hz rTMS protocol that regulated astrocytic polarization was used to stimulate transient middle cerebral artery occlusion (MCAO) rats and oxygen and glucose deprivation/reoxygenation (OGD/R) injured BV2 cells. Specific expression levels of M1 marker iNOS and M2 marker CD206 were measured by western blotting and immunofluorescence. MicroRNA expression changes detected by high-throughput second-generation sequencing were validated by RT-PCR and fluorescence in situ hybridization (FISH) analysis. Dual-luciferase report assay and miRNA knock-down were applied to verify the possible mechanisms regulated by rTMS. Microglia culture medium (MCM) from different groups were collected to measure the TNF-α and IL-10 concentrations, and detect the influence on neuronal survival. Finally, TTC staining and modified Neurological Severity Score (mNSS) were used to determine the effects of MCM on ischemic stroke volume and neurological functions.

Results

The 10 Hz rTMS inhibited ischemia/reperfusion induced M1 microglia and significantly increased let-7b-5p level in microglia. HMGA2 was predicted and proved to be the target protein of let-7b-5p. HMGA2 and its downstream NF-κB signaling pathway were inhibited by rTMS. Microglia culture medium (MCM) collected from rTMS treated microglia contained lower TNF-α concentration but higher IL-10 concentration than no rTMS treated MCM, reducing ischemic volumes and neurological deficits of MCAO mice. However, knockdown of let-7b-5p by antagomir reversed rTMS effects on microglia phenotype and associated HMGA/NF-κB activation and neurological recovery.

Conclusion

High-frequency rTMS could alleviate ischemic stroke injury through inhibiting M1 microglia polarization via regulating let-7b-5p/HMGA2/NF-κB signaling pathway in MCAO models.
Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia
Authors: Chen Yu , Liu Ziyou , Fang Jun , Xie Yanhu , Zhang Min , Yang Jia
Published: August 2022

Background

Accurate assessment of volume responsiveness in elderly patients is important as it may reduce the risk of post-operative complications and enhance surgical recovery. This study evaluated the utility of two Doppler ultrasound-derived parameters, the carotid corrected flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak), to predict volume responsiveness in elderly patients under general anaesthesia.

Methods

A total of 97 elderly patients undergoing elective abdominal surgery under general anaesthesia were enrolled in this prospective observational study. After entering the operating room, all patients underwent radial artery puncture connected with a LiDCO device to measure stroke volume variation (SVV), and fluid therapy was performed after anaesthesia induction. Patients were classified as responders if SVV ≥ 13% before fluid challenge and nonresponders if SVV < 13%. The FTc, ΔVpeak, SVV and haemodynamic data were measured by ultrasound at baseline (T0) and before (T1) and after (T2) fluid challenge. The correlations between the Doppler ultrasound-derived parameters and SVV were analysed, and the receiver operating characteristic (ROC) curves was computed to characterize both FTc and ΔVpeak as measures of volume responsiveness in elderly patients.

Results

Forty-one (42.3%) patients were fluid responders. Carotid FTc before fluid challenge was negatively correlated with SVV before fluid challenge (r = -0.77; P < 0.01), and ΔVpeak was positively correlated with SVV (r = 0.72; P < 0.01). FTc and ΔVpeak predicted SVV ≥ 13% after general anaesthesia in elderly patients, with areas under the receiver operating characteristic curves (AUROCs) of 0.811 [95% confidence interval (CI), 0.721–0.900; P < 0.001] and 0.781 (95% CI, 0.686–0.875; P < 0.001), respectively. The optimal cut-off values of FTc and ΔVpeak to predict SVV ≥ 13% were 340.74 ms (sensitivity of 76.8%; specificity of 80.5%) and 11.69% (sensitivity of 78.0%; specificity of 67.9%), respectively.

Conclusions

There was a good correlation between carotid artery ultrasound parameters and SVV. FTc predicted fluid responsiveness better than ΔVpeak in elderly patients during general anaesthesia. Further study is needed before these parameters can be recommended for clinical application.

Trial registration

www.chictr.org.cn(ChiCTR2000031193); registered 23 March 2020.
Association of serum apoA-I with in-stent restenosis in coronary heart disease
Authors: Wang Xin , Zhang Min , Cheng Jie , Zhou Hua
Published: August 2022

Background

Despite use of drug-eluting stents (DES), in-stent restenosis (ISR) continues adversely affecting clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Apolipoprotein A-I (apoA-I) has athero-protective effects. However, there is a paucity of clinical data regarding the association between apoA-I and ISR. We sought to investigate whether serum apoA-I is related to ISR after DES-based PCI.

Methods

In this retrospective case control study, 604 consecutive patients who underwent DES implantation before were enrolled. Patients who underwent repeat angiography within 12 months were included in the early ISR study (n = 205), while those beyond 12 months were included in the late ISR study (n = 399). ISR was defined as the presence of > 50% diameter stenosis at the stent site or at its edges. Clinical characteristics were compared between ISR and non-ISR patients in the early and late ISR study, respectively, after adjusting for confounding factors by multivariate logistic regression, stratified analysis, and propensity score matching. The predictive value was assessed by univariate and multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and quartile analysis.

Results

In the early ISR study, 8.8% (18 of 205) patients developed ISR. Serum apoA-I in the ISR group was lower than that in the non-ISR group (1.1 ± 0.26 vs. 1.24 ± 0.23, P < 0.05). On multivariate logistic regression analysis, apoA-I was an independent risk factor for early ISR. Incidence of early ISR showed negative correlation with apoA-I and could be predicted by the combined use of apoA-I and glycosylated hemoglobin (HbA1c) level. In the late ISR study, 21.8% (87 of 399) patients developed ISR. On subgroup analysis, late ISR showed negative correlation with apoA-I irrespective of intensive lipid lowering; on multivariate logistic regression analysis, apoA-I was also an independent risk factor for late ISR. In patients with intensive lipid lowering, combined use of apoA-I, stenting time, and diabetes predicted the incidence of late ISR.

Conclusions

ApoA-I was an independent risk factor for ISR, and showed a negative correlation with ISR after DES-based PCI. Combined use of apoA-I and clinical indicators may better predict the incidence of ISR under certain circumstances.
Repetitive application of remote ischemic conditioning (RIC) in patients with peripheral arterial occlusive disease (PAOD) as a non-invasive treatment option: study protocol for a randomised controlled clinical trial
Authors: Hummitzsch Lars , Voelckers Luisa , Rusch Melanie , Cremer Jochen , Albrecht Martin , Rusch René , Berndt Rouven
Published: August 2022

Background

The best medical treatment (BMT) for most patients with early stage of peripheral arterial occlusive disease (PAOD) is often limited to gait training and pharmacological therapy besides endovascular surgery. The application of remote ischemic conditioning (RIC) has been described as a promising experimental strategy for the improvement of therapeutic outcome in cardiovascular disease but has not proven beneficial effects in clinical practice and treatment of PAOD yet.

Methods

Here we describe a prospective, randomized trial for the evaluation of possible effects of repeated application of RIC in patients with PAOD. This monocentric study will enrol 200 participants distributed to an intervention group receiving RIC + BMT and a control group only receiving BMT for four weeks. Patients are at least 18 years of age and have diagnosed PAOD Fontaine stage II b. Pain-free and total walking distance will be measured via treadmill test (primary endpoints). In addition, ankle-brachial index (ABI) and quality of life (QoL) will be assessed using the SF-36 and VascuQoL-6 questionnaire. Moreover, evaluation of markers for atherosclerosis, angiogenic profiling and mononuclear cell characterization will be performed using biochemical assays, proteome profiling arrays and flow cytometry (secondary endpoints).

Discussion

Our prospective, randomized monocentric trial is the first of its kind to analyse the effects of chronic and repetitive treatment with RIC in patients with PAOD and might provide important novel information on the molecular mechanisms associated with RIC in PAOD patients.

Trial registration: Prospectively registered in the German Clinical Trials Register (Deutsche Register Klinischer Studien) Registration number: DRKS00025735; Date of registration: 01.07.2021.
Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report
Authors: Di Weihua , Cui Jing , Yu Hui , Cui Xiao , Sa Huanlan , Fu Zhong , Fu Bingjin , Guan Guofeng , Du Rui , Shao Cuijie , Gao Yong
Published: August 2022

Background

Vibrio vulnificus infections develop rapidly and are associated with a high mortality rate. The rates of diagnosis and treatment are directly associated with mortality.

Case presentation

We describe an unusual case of a 61-year-old male patient with chronic liver disease and diabetes who presented with a chief complaint of pain in both lower legs due to V. vulnificus infection in winter. Within 12 h of arrival, typical skin lesions appeared, and the patient rapidly developed primary sepsis. Despite prompt appropriate antibiotic and surgical treatment, the patient died 16 days after admission.

Conclusion

Our case findings suggest that V. vulnificus infection should be suspected in patients with an unclear infection status experiencing pain of unknown origin in the lower legs, particularly in patients with liver disease or diabetes, immunocompromised status, and alcoholism.
Performances of birthweight charts to predict adverse perinatal outcomes related to SGA in a cohort of nulliparas
Authors: Galvão Rafael B. , Souza Renato T. , Vieira Matias C. , Pasupathy Dharmintra , Mayrink Jussara , Feitosa Francisco E. , Rocha Filho Edilberto A , Leite Débora F. , Vettorazzi Janete , Calderon Iracema M. , Sousa Maria H. , Cecatti Jose G. ,   for the Preterm SAMBA study group
Published: August 2022

Background

Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes.

Methods

This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40th-60th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart.

Results

A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0–11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55–0.64, p < .05). The charts had poor performance (AUC 0.492 – 0.522) for the detection of neonatal morbidity related to SGA born at term.

Conclusion

The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.
Impact of the COVID-19 pandemic on emergency hospital cancer admissions in a UK region
Authors: Mitchell Helen , Alford Ben S. , O’Hare Simon , O’Callaghan Eamon , Fox Colin , Gavin Anna T.
Published: August 2022

Background

The pandemic disrupted society and health services through lockdowns and resource reallocation to care for COVID-19 patients. Reductions in numbers of cancer patients having surgery, being diagnosed pathologically or via 2-week wait, and screening programs pauses have been described. The effect on emergency presentation, which represents an acute episode with poor outcomes, has not been investigated. This study explored the pandemic’s impact on emergency hospital admissions for cancer patients in a UK region.

Methods

Hospital discharge data for cancer patients in Northern Ireland, which included route to admission, were analysed for the pandemic era in 2020 compared to averages for March to December 2017–2019, focusing on volume and route of emergency admissions by demography and tumour site.

Findings

Compared with the pre-pandemic era, the number of cancer emergency admissions fell by 12·3% in 2020. Emergency admissions for cancer were significantly reduced when COVID-19 levels were highest (− 18·5% in April and − 16.8% in October). Females (− 15·8%), urban residents (− 13·2%), and age groups 0 to 49 and 65–74 years old (− 17%) experienced the largest decreases as did those with haematological (− 14·7%), brain and CNS (− 27·9%), and lung cancers(− 14·3%). Significant reductions in referrals from outpatient departments (− 51%) and primary care (− 43%) (p < 0·001) were counterbalanced by admissions from other routes including confirmed or suspected COVID-19 infection (increase 83·6%).

Interpretation

Reductions in emergency admissions, and pathologically diagnosed cancers, as reported by the Northern Ireland Cancer Registry (NICR), indicate undiagnosed patients in the community which has implications for future workloads and survival. Data suggest undiagnosed cases may be higher for haematological, brain and CNS, and lung cancers and among females. Efforts should be made to encourage people with symptoms to present for diagnosis or reassurance.

Funding

The NICR is funded by the Public Health Agency of Northern Ireland. This work was supported by Macmillan Cancer Support and uses data collected by health services as part of their care and support functions.
The pillars of health: influence of multiple lifestyle behaviors on body mass index and depressive symptoms in adult twins
Authors: Duncan Glen E. , Avery Ally R. , Tsang Siny , Watson Nathaniel F. , Williams Bethany D. , Turkheimer Eric
Published: August 2022

Background

Guidelines promoting healthy lifestyles are cornerstones of chronic disease prevention and treatment. The purpose of this study is to investigate independent and joint associations of five key health behaviors with health outcomes (body mass index (BMI kg/m2) and depressive symptoms) in adult twins.

Methods

We included 6,048 twin pairs from a community-based registry. Five key health behaviors were: (1) ≥ 8 h of sleep per night, (2) ≥ 5 servings of fruits and vegetables daily, (3) ≤ 2 h sedentary time per day, (4) ≥ 150 min of moderate-to-vigorous physical activity (MVPA) per week, and (5) no smoking. We analyzed phenotypic associations between behaviors and outcomes; whether phenotypic associations were confounded by additive genetic and shared environmental factors within twin pairs (“quasi-causal” associations); and which behaviors, considered simultaneously, had the largest associations with outcomes.

Results

We found negative phenotypic associations between number of behaviors achieved with BMI and depressive symptoms score (ps < 0.05). Associations remained significant, though attenuated, when controlling for genetic and shared environmental factors, and demographics, for depressive symptoms score but not BMI (p < 0.05). Quantitative variable importance measures derived from regression tree models showed sedentary time and MVPA were the most important variables in partitioning twins with different BMI, and smoking and sedentary time for partitioning twins with different depressive symptoms score.

Conclusions

Achievement of commonly endorsed health behaviors is associated with lower BMI (especially sedentary and MVPA targets) and depressive symptoms score (especially sedentary and smoking targets). This provides further support of health behavior promotion to improve health outcomes.
A structural equation model-based study on the status and influencing factors of acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease within 30 days
Authors: Lu Hong-Yan , Zhang Rui , Chang Yan , Zhang Xiao-Na , Zhao Jie , Li Xin-Dan , Feng Xiang-Kai
Published: August 2022

Objective

To investigate the circumstances that lead to acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease (COPD) within 30 days and to explore the influencing factors of readmission using a structural equation model to provide evidence for medical staff so that effective intervention measures can be taken.

Methods

The convenience sampling method was used to select 1120 elderly patients with COPD from the respiratory departments of thirteen general hospitals in the Ningxia region, China, from April 2019 to August 2020, who then completed a survey questionnaire. The survey questionnaire contained a general data questionnaire and the modified Medical Research Council, activities of daily living, geriatric depression scale and COPD assessment test scales.

Results

The readmission rate of patients with COPD presenting with acute exacerbation within 30 days was determined to be 21.52%. Therefore, the modified model measures data accurately. The results showed that seasonal factors, family rehabilitation, age factors and overall health status were direct factors in the acute exacerbation readmission of patients with COPD within 30 days of hospital discharge. Smoking is not only a direct factor for acute exacerbation readmission within 30 days but also an indirect factor through disease status; disease status and chronic disease are not only direct factors for acute exacerbation readmission within 30 days but also indirect factors through the patient’s overall health status.

Conclusions

The rate of patients with COPD presenting with acute exacerbation within 30 days is high; while taking measures to prevent readmission based on influencing factors that directly impact admission rates, attention should also be paid to the interaction between these factors.
Routine data-based quality indicators for the treatment of gonarthrosis and coxarthrosis patients in the ambulatory care sector – A study protocol for a cluster-randomised pilot trial to evaluate the MobilE-ARTH study
Authors: Bock Tobias , Flemming Ronja , Schüttig Wiebke , Schramm Anja , Weigl Martin B. , Sundmacher Leonie
Published: August 2022

Background

In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study’s aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care.

Methods

The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set’s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach.

Discussion

Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments.

Trial registration

German Clinical Trials Register, number DRKS00027516, Registered 25th January 2022 – Prospectively registered.