bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological distress, oral health behaviour and related factors among adolescents: Finnish School Health Promotion Study
Authors: Pohjola Vesa , Nurkkala Meri , Virtanen Jorma I.
Published: January 2021

Background

Psychological distress may affect health behaviour. We examined how psychological distress, social phobia (SP) and anxiety associated with tooth brushing among Finnish adolescents with respect to gender, school grade, parents’ education, family structure, smoking and perceived general health.

Methods

This study is part of the Finnish national School Health Promotion Study (SHP). The study population comprised a representative sample of Finnish 15-year-olds (N = 45,877). Mini-Social Phobia Inventory (Mini-SPIN) and generalized anxiety disorder (GAD) served to assess SP and anxiety. A questionnaire enquired about the respondents’ oral health habits (tooth brushing, smoking), background factors (age, gender, family structure and parents’ education) and perceived general health. Chi-squared tests and logistic regression analyses served in the statistical analyses.

Results

About two-thirds of the girls (66.7%) and less than half of the boys (40.1%) followed the international recommendation of tooth brushing twice daily. Girls reported possible problems with SP and GAD more often than boys did. Those reporting possible problems with SP or moderate or severe anxiety brushed their teeth at least twice daily less often than did those reporting no possible problems with SP and those with no, slight or mild anxiety. Logistic regression analyses showed that male gender (OR = 3.2; 95% CI 3.1–3.4), parents’ basic education (OR = 1.5; 95% CI 1.4–1.5), and adolescents’ perception of their current state of health as moderate, fairly or very poor (OR = 1.8; 95% CI 1.5–2.0) associated with not brushing teeth twice daily. Gender-specific logistic regression analyses showed that boys who smoked (OR = 1.7; 95% CI 1.6–1.8) were less likely than non-smokers to brush their teeth twice daily.

Conclusion

Adolescents with psychological distress, such as possible SP or possible general anxiety, had less favourable oral health behaviour. Psychological distress indicates a greater risk for oral health problems already in adolescence.
Oral health status of children and young adults with maple syrup urine disease in Turkey
Authors: Ballikaya Elif , Yildiz Yılmaz , Koç Nagihan , Tokatli Ayşegül , Uzamis Tekcicek Meryem , Sivri Hatice Serap
Published: January 2021

Background

Maple syrup urine disease (MSUD) is an inherited disorder clinically characterized by ketoacidosis, seizures, coma, psychomotor delay, and intellectual disability. The treatment requires a life-long protein-restricted diet, rich in carbohydrates and fats, supplemented with a medical amino acid formula. Diet, oral health and general health influence each other in a vicious cycle. The aim of this study was to investigate the oral health status of children and young adults with MSUD in Turkey.

Methods

A descriptive study was conducted on patients with MSUD who applied for routine follow-up to the pediatric metabolic diseases clinic at Hacettepe University, Children's Hospital in Ankara, Turkey in a 12-month period. Patients with any other concomitant genetic diseases and acute infection were excluded. A total of twenty-five patients were enrolled and underwent oral examination including DMFT/S, dmft/s (decayed/missing/filled teeth/surfaces for deciduous and primary teeth, respectively), plaque and gingival indices. Panoramic radiographs were obtained in 12 cooperative patients.

Results

Mean age was 9.88 ± 5.68 s.d years. More than half of the parents had only primary school level education, and low income. Fourteen patients consumed medical formula during or right before sleep. Fourteen patients reported caries-associated pain. Gingival inflammation was present in all 15 patients who cooperated for evaluation. Seven out of twelve patients had at least one dental anomaly or alterations in mandibular morphology. Five patients had previously been treated for caries under general anesthesia. To our knowledge, this is the first study to document oral clinical and radiologic findings in patients with MSUD.

Conclusions

Impaired oral health was observed in this rare disease population. Regular dental referral by physicians, preventive measures and dental treatments should be included in multidisciplinary management of maple syrup urine disease to promote oral health.
Effects of qigong on systolic and diastolic blood pressure lowering: a systematic review with meta-analysis and trial sequential analysis
Authors: Ching Siew Mooi , Mokshashri Naidu Ragubathi , Kannan Maharajan Mari , Lee Kai Wei , Sallahuddin Nurin Amalina , Ng Jun Xun , Wong Jie Lin , Devaraj Navin Kumar , Hoo Fan Kee , Loo Yee Shen , Veettil Sajesh K.
Published: January 2021

Background

The benefits of qigong for systolic and diastolic blood pressure (BP) reduction have been noted in previously published systematic reviews; however, the data on its effectiveness has been at best scarce. We aimed to update the evidence of qigong on blood pressure reduction after taking into consideration the risks of random error and reliability of data in the cumulative meta-analysis using trial sequential analysis (TSA).

Methods

Included trials were assessed using Cochrane risk of bias instrument. We performed meta-analysis with random-effects model and random errors were evaluated with TSA. We performed the search for the eligible randomized controlled trial (RCT) through Medline, Cinahl, Cochrane Central Register of Controlled Trials and also PubMed.

Results

A total of 370 subjects sourced from seven eligible RCTs were entered into the analysis. The pooled results demonstrated the significant reduction with the use of qigong of the systolic blood pressure [weighted mean difference (WMD), − 10.66 mmHg (95% confidence interval (CI) = − 17.69,-3.62, p < 0.001] and diastolic BP [WMD, − 6.76 mmHg, 95% CI = − 12.22, − 1.30, p < 0.001] as compared to the control group.

Conclusions

Significant reductions in BP is seen with the use of qigong as compared with the control group, suggesting that qigong may be used as a complementary therapy in the somewhat complicated management of hypertension.
Curcumin protects radiation-induced liver damage in rats through the NF-κB signaling pathway
Authors: Li Wei , Jiang Liangjun , Lu Xianzhou , Liu Xianrong , Ling Mingjiong
Published: January 2021

Background

Curcumin has been demonstrated to exert anti-oxidant, anti-fibrotic, anti-inflammatory, and anti-cancer activities. This study was conducted to observe the effect and inner mechanism of curcumin in rats with radiation-induced liver damage (RILD).

Methods

Thirty SD rats were classified into Control, Radiation group and Curcumin (Cur) + Radiation group (n = 10 in each group). The changes in body weight of the rats were observed on the 3rd, 7th and 14th days after the treatment with curcumin. On the 14th day post treatment, the heart blood of the rats was drawn for measurement of liver function indices including total protein (TP), alanine aminotransfetase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) as well as aspartate aminotransfetase (AST). Subsequently, the rats were euthanized and liver tissues were taken to observe liver morphological changes using hematoxylin-eosin (HE), and to analyze apoptosis condition using transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assays. Meanwhile, the oxidative stress level in liver tissue homogenate was determined by biochemical analysis. The expression of nuclear factor kappa B (NF-κB) pathway-associated and apoptosis-associated proteins was detected using Western blot analysis, and the expression levels of inflammatory factors were measured by Enzyme-linked immunosorbent assay (ELISA).

Results

The reduced body weight was observed in rats of the Radiation group compared to the Control and Cur + Radiation groups on day 14. In the Radiation group, hepatic cell edema and inflammatory cell infiltration could be visible under the light microscope, and the hepatocytes presented with vacuolar degeneration. In the Cur + Radiation group, the hepatocytes swelled under the microscope, but the pathological changes were alleviated in comparison with the Radiation group. RILD rats with curcumin treatment presented with decreased ALT, AST, ALP, LDH, and maleicdialdehyde (MDA) levels, and elevated TP, superoxide dismutase (SOD), caspase activated DNase (CAD) and glutathione (GSH) levels. Apoptosis and inflammation in rats with RILD were up-regulated, and the NF-κB pathway was activated, but they were reversed after continuously intragastric administration of curcumin for 14 days.

Conclusion

Our study highlights that curcumin treatment reduces the liver damage caused by radiation through the inhibition of the NF-κB pathway.
Systematic development and refinement of a contextually relevant strategy for undergraduate medical ethics education: a qualitative study
Authors: Shamim Muhammad Shahid , Torda Adrienne , Baig Lubna A. , Zubairi Nadeem , Balasooriya Chinthaka
Published: January 2021

Background

Delivery of medical ethics education is complex due to various reasons, compounded by the context-dependent nature of the content. The scarcity of relevant resources in the contexts of some developing countries adds a further layer of difficulty to ethics education in these contexts. We used a consultative approach with students, teachers and external experts to develop a practical approach to medical ethics education. This study aimed to develop and refine a contextually relevant approach to ethics education in the region of Saudi Arabia.

Methods

The study utilised an explorative qualitative methodology to seek views of students and faculty of Rabigh Faculty of Medicine, Saudi Arabia, and international experts in the field of ethics and education to review and enhance a new ethics learning strategy which included a workbook-based tool. Three focus groups with 12 students, in-depth interviews with four faculty members and qualitative feedback from eleven external experts enabled the study participants to objectively critique the WBEL and provide feedback to enhance its quality. Thematic content analysis of the data was done to draw inferences which were used to refine the educational strategy.

Results

The analysis generated twenty-one sub-themes within four main themes: design features, content, teaching methods and assessment. These findings helped to design the educational strategy to improve its effectiveness in the given context.

Conclusion

The study drew on the views of students, faculty and external experts to systematically develop a novel approach to ethics education for countries like Saudi Arabia. It also demonstrated the use of the consultative approach for informing a culturally relevant educational strategy in the Middle East context.
Using medical reality television as a technology-enhanced learning strategy to provide authentic patient care experiences during clinical placements: a case study research investigation
Authors: Osborne Fiona , Harrison Miles , Fisher James , Bateman Belinda
Published: January 2021

Background

Over the last decade, the use of technology-enhanced learning (TEL) has rapidly expanded and diversified. Since the COVID-19 pandemic, there is a growing demand for distance and online learning strategies to support and even replace learning experiences previously afforded by clinical placements and clerkships. An intriguing but under-researched modality is the use of medical reality television to provide authentic experiences of patient care. This strategy does not feature in published medical educational literature, though promising research is emerging from other disciplines.

Methodology

A programme of learning using medical reality television clips to facilitate case-based learning was developed according to the principles of ‘anchored instruction’, a technology-based educational theory. Clips were taken from the UK television show ’24 hours in A&E’. Medical students’ learning experiences were investigated using a qualitative approach addressing the following research questions:

- What is the perceived emotional experience of medical students when watching reality television in an educational context?

- How do medical students relate their experience of watching reality television in a formal educational setting to their perceived learning needs in the clinical environment?

A case study research methodology was adopted within the interpretivist paradigm. Data were triangulated from semi-structured interviews with students and non-participant observation of the teaching session. Field notes and transcripts were analysed through an inductive thematic analysis.

Results

In response to the medical reality television, a diverse range of emotions were expressed including: excitement, amusement, concern, nervousness, sadness and joy. Students identified gaps in their clinical knowledge such as interpreting results, practical aspects of prescribing and end of life care. Key themes were increased student engagement and a promotion of holistic care practices.

Discussion

Students perceived reality television as a highly realistic and relatable medium and an enjoyable, memorable way to contextualise learning from the classroom to real life, a finding mirrored in previous studies in other fields. The high degree of emotion expressed may explain the improved subjective memorability of the cases.

Conclusion

Medical reality television offers a unique means of engaging students by providing authentic experiences of patient care and should be valued alongside other technology-enhanced learning strategies.
Work-life balance in medical students: self-care in a culture of self-sacrifice
Authors: Picton Aled
Published: January 2021

Background

Work-life balance is a key contributor to doctors’ wellbeing and consequently is a central factor in their career decisions. General Medical Council guidance outlines the importance of work-life balance as part of compassionate self-care. Learning self-care should begin as an undergraduate, when academic and clinical workload can contribute to stress, anxiety and burnout.

Methods

Sequential mixed methods study of medical students in Years 3–5 at the University of Birmingham, UK. Students (n = 145) defined work-life balance in free-text answers and self-assessed their current work-life balance via questionnaires. Following this, a sub-sample of students (n = 44) participated in exploratory individual mini-interviews.

Results

Work-life balance emerged as a broad and multifactorial concept. Questionnaire respondents most frequently referenced enjoyment, meeting work requirements and time management in their definitions. Interview participants highlighted additional influencing factors such as peer groups, study skills, family and professional culture. Students expect a significant shift towards work after graduating and expressed concerns about the stresses of delivering patient care. 42% (n = 60) of students felt they had received support with their work-life balance during their training, mostly from family and friends. Most students had not received support or advice on their work-life balance from University or hospital staff.

Conclusion

Self-care and work-life balance are essential for medical students and doctors to cope with lifelong learning and deliver effective care. Medical school staff should be pro-active in supporting students to develop these skills, particularly during critical transition periods. Early interventions targeting study skills and time management may be beneficial. Further research should include students in Years 1–2 and compare different institutions.
Consensual qualitative research on the internship experience and development of career identity of Korean doctors
Authors: Lee Hye-Jin , Ahn Moonsang
Published: January 2021

Background

Career identity is defined as the ability to substantialise career goals and results from the social learning process achieved through interactions with others.

This study aimed to understand how the internship experience in Korea affects career identity, which provides a foundation for developing professional values while promoting personal goals and aspirations.

Methods

We conducted eleven semi-structured interviews with interns at a university hospital in Korea who had completed internships and chosen a speciality. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised from three domains for the year-long internship experience: personal cognitive, social interaction, and system domains.

Results

Researchers derived seven categories and 20 subcategories from the transcripts: (1) self-reflection throughout internship training, (2) practical awareness of the internship programme’s operation, (3) perception of individual competence, (4) recognition of mentor importance, (5) situational awareness in the clinical department, (6) relationship experience, and (7) experience of institutional limitations. The internship experience, during which the individual is in charge and core values drive career decisions, is important for the formation of career identity and career orientation.

The internship programme provides information about the clinical department to applicants seeking residency and serves a mediating role, providing information about applicants to the clinical departments. Internship is an important period during which career identity is formed.

Conclusion

The internship programme provides information about clinical departments to applicants seeking residency; it is an important period during which career identity is formed. This study helps provide an in-depth understanding of interns and a base for developing institutional and policy support for students during an uncertain time when specialties should be selected.
Faculty retention in regional medical schools in Iran: a qualitative content analysis
Authors: Shaterjalali Maria , Gholampoor Yousef , Jeihooni Ali Khani , Mansoori Yaser , Homayounfar Reza , Ehrampoush Elham , Karimi Shahnaz
Published: January 2021

Background and purpose

Recruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members’ views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran.

Methods

In this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members who had applied for transfer, four with more than 10 years of experience and working in the type 3 universities with no intention to be transferred. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. The interview was developed for this study (Supplementary file). To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and conformability, as proposed by Lincoln and Guba.

Results

The findings were classified into three categories and 14 subcategories. The first category was “retention facilitators” including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was “retention threats” including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was “retention strategies” which included four subcategories of recruitment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs.

Conclusion

Several factors play a role in the faculty members’ retention in regional medical schools in Iran. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of faculty autonomy practically to develop a sense of belonging among them and reduce the intention to be transferred among their human resources.
Predicting cardiovascular health trajectories in time-series electronic health records with LSTM models
Authors: Guo Aixia , Beheshti Rahmatollah , Khan Yosef M. , Langabeer James R. , Foraker Randi E.
Published: January 2021

Background

Cardiovascular disease (CVD) is the leading cause of death in the United States (US). Better cardiovascular health (CVH) is associated with CVD prevention. Predicting future CVH levels may help providers better manage patients’ CVH. We hypothesized that CVH measures can be predicted based on previous measurements from longitudinal electronic health record (EHR) data.

Methods

The Guideline Advantage (TGA) dataset was used and contained EHR data from 70 outpatient clinics across the United States (US). We studied predictions of 5 CVH submetrics: smoking status (SMK), body mass index (BMI), blood pressure (BP), hemoglobin A1c (A1C), and low-density lipoprotein (LDL). We applied embedding techniques and long short-term memory (LSTM) networks – to predict future CVH category levels from all the previous CVH measurements of 216,445 unique patients for each CVH submetric.

Results

The LSTM model performance was evaluated by the area under the receiver operator curve (AUROC): the micro-average AUROC was 0.99 for SMK prediction; 0.97 for BMI; 0.84 for BP; 0.91 for A1C; and 0.93 for LDL prediction. Model performance was not improved by using all 5 submetric measures compared with using single submetric measures.

Conclusions

We suggest that future CVH levels can be predicted using previous CVH measurements for each submetric, which has implications for population cardiovascular health management. Predicting patients’ future CVH levels might directly increase patient CVH health and thus quality of life, while also indirectly decreasing the burden and cost for clinical health system caused by CVD and cancers.
Subgingival microbiota of dogs with healthy gingiva or early periodontal disease from different geographical locations
Authors: Wallis C. , Milella L. , Colyer A. , O’Flynn C. , Harris S. , Holcombe L. J.
Published: January 2021

Background

Periodontal disease is the most common oral disease of dogs worldwide and results from a complex interplay between plaque bacteria, the host and environmental factors. Recent studies have enhanced our understanding of the associations between the plaque microbiota and canine periodontal disease. These studies, however, were limited in their geographical reach. Thus associations between the canine oral microbiota and geographical location were investigated by determining the composition of subgingival plaque samples from 587 dogs residing in the United Kingdom (UK), United States of America (USA), China and Thailand using 454-pyrosequencing.

Results

After quality filtering 6,944,757 sequence reads were obtained and clustering of these at ≥98% sequence resulted in 280 operational taxonomic units (OTUs) following exclusion of rare OTUs (present at < 0.05% in all four countries). The subgingival plaque from dog populations located in the UK, USA, China and Thailand had a similar composition although the abundance of certain taxa varied significantly among geographical locations. Exploration of the effect of clinical status and age revealed a marked similarity among the bacteria associated with increased age and those associated with gingivitis: Young dogs and those with no gingivitis were dominated by taxa from the phyla Bacteroidetes and Proteobacteria whereas older dogs and those with moderate gingivitis were dominated by members of the Firmicutes. The plaque microbiota of small breed dogs was found to significantly differ to medium and large breeds and was dominated by species belonging to the Firmicutes.

Conclusions

The bacterial associations with health, gingivitis and periodontitis were conserved across dogs from the UK, USA, China and Thailand. These bacterial signatures of periodontal health and disease have potential as biomarkers for disease detection.
DNA methylation abnormalities of imprinted genes in congenital heart disease: a pilot study
Authors: Chang Shaoyan , Wang Yubo , Xin Yu , Wang Shuangxing , Luo Yi , Wang Li , Zhang Hui , Li Jia
Published: January 2021

Background

Congenital heart disease (CHD) is resulted from the interaction of genetic aberration and environmental factors. Imprinted genes, which are regulated by epigenetic modifications, are essential for the normal embryonic development. However, the role of imprinted genes in the etiology of CHD remains unclear.

Methods

After the samples were treated with bisulfate salt, imprinted genes methylation were measured by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. T test and One-way ANOVA were performed to evaluate the differences among groups. Odds ratios (ORs) were performed to evaluate the incidence risk of CHD in relation to methylation levels.

Results

We investigated the alterations of imprinted gene germline differential methylation regions (gDMRs) methylation in patients with CHD. Eighteen imprinted genes that are known to affect early embryonic development were selected and the methylation modification genes were detected by massarray in 27 CHD children and 28 healthy children. Altered gDMR methylation level of 8 imprinted genes was found, including 2 imprinted genes with hypermethylation of GRB10 and MEST and 6 genes with hypomethylation of PEG10, NAP1L5, INPP5F, PLAGL1, NESP and MEG3. Stratified analysis showed that the methylation degree of imprinted genes was different in different types of CHD. Risk analysis showed that 6 imprinted genes, except MEST and NAP1L5, within a specific methylation level range were the risk factors for CHD

Conclusion

Altered methylation of imprinted genes is associated with CHD and varies in different types of CHD. Further experiments are warranted to identify the methylation characteristics of imprinted genes in different types of CHD and clarify the etiologies of imprinted genes in CHD.
TERT rs2736100 and TERC rs16847897 genotypes moderate the association between internalizing mental disorders and accelerated telomere length attrition among HIV+ children and adolescents in Uganda
Authors: Kalungi Allan , Kinyanda Eugene , Womersley Jacqueline S. , Joloba Moses L. , Ssembajjwe Wilber , Nsubuga Rebecca N. , Kaleebu Pontiano , Levin Jonathan , Kidd Martin , Seedat Soraya , Hemmings Sian M. J.
Published: January 2021

Background

Internalizing mental disorders (IMDs) (depression, anxiety and post-traumatic stress disorder) have been associated with accelerated telomere length (TL) attrition; however, this association has not been investigated in the context of genetic variation that has been found to influence TL. We have previously reported an association between IMDs and accelerated TL attrition among Ugandan HIV+ children and adolescents. This study investigated the moderating effects of selected single nucleotide polymorphisms in the telomerase reverse transcriptase gene (TERT) (rs2736100, rs7726159, rs10069690 and rs2853669) and the telomerase RNA component gene (TERC) (rs12696304, rs16847897 and rs10936599) on the association between IMDs and TL, among Ugandan HIV+ children (aged 5–11 years) and adolescents (aged 12–17 years).

Results

We found no significant interaction between IMDs as a group and any of the selected SNPs on TL at baseline. We observed significant interactions of IMDs with TERT rs2736100 (p = 0.007) and TERC rs16847897 (p = 0.012), respectively, on TL at 12 months.

Conclusions

TERT rs2736100 and TERC rs16847897 moderate the association between IMDs and TL among Ugandan HIV+ children and adolescents at 12 months. Understanding the nature of this association may shed light on the pathophysiological mechanisms underlying advanced cellular aging in IMDs.
Novel mutation in the TGFBI gene in a Moroccan family with atypical corneal dystrophy: a case report
Authors: Benbouchta Yahya , Cherkaoui Jaouad Imane , Tazi Habiba , Elorch Hamza , Ouhenach Mouna , Zrhidri Abdelali , Sadki Khalid , Sefiani Abdelaziz , Lyahyai Jaber , Berraho Amina
Published: January 2021

Background

Corneal dystrophies (CDs) are a heterogeneous group of bilateral, genetically determined, noninflammatory bilateral corneal diseases that are usually limited to the cornea. CD is characterized by a large variability in the age of onset, evolution and visual impact and the accumulation of insoluble deposits at different depths in the cornea. Clinical symptoms revealed bilateral multiple superficial, epithelial, and stromal anterior granular opacities in different stages of severity among three patients of this family. A total of 99 genes are involved in CDs. The aim of this study was to identify pathogenic variants causing atypical corneal dystrophy in a large Moroccan family and to describe the clinical phenotype with severely different stages of evolution.

Case presentation

In this study, we report a large Moroccan family with CD. Whole-exome sequencing (WES) was performed in the three affected members who shared a phenotype of corneal dystrophy in different stages of severity. Variant validation and familial segregation were performed by Sanger sequencing in affected sisters and mothers and in two unaffected brothers. Whole-exome sequencing showed a novel heterozygous mutation (c.1772C > A; p.Ser591Tyr) in the TGFBI gene. Clinical examinations demonstrated bilaterally multiple superficial, epithelial and stromal anterior granular opacities in different stages of severity among three patients in this family.

Conclusions

This report describes a novel mutation in the TGFBI gene found in three family members affected by different phenotypic aspects. This mutation is associated with Thiel-Behnke corneal dystrophy; therefore, it could be considered a novel phenotype genotype correlation, which will help in genetic counselling for this family.
Visceral adiposity index is associated with lung function impairment: a population-based study
Authors: He Sunyue , Yang Jie , Li Xiaoyong , Gu Hongxia , Su Qing , Qin Li
Published: January 2021

Background

The effects of visceral adiposity on decreased lung function have drawn much attention. Recently, the visceral adiposity index (VAI) has been proposed as a visceral fat distribution and dysfunction marker. However, the relationship between the VAI and lung function has not been investigated. The objective of the study was to analyze the association between the VAI and lung function and evaluate the potential of VAI as a predictor of lung function.

Methods

We collected data from a population-based study of 1786 subjects aged 40 years or older. All subjects completed a questionnaire and underwent anthropometric measurements and laboratory tests. Linear and logistic regression models were developed to assess the association between the VAI and lung function.

Results

The VAI was inversely related to FVC%predicted in men and negatively associated with both FVC%predicted and FEV1%predicted in women. In the linear regression analysis, the decrease in FVC%predicted associated with each 10% increase in the VAI was 1.127% in men and 1.943% in women; the decrease in FEV1%predicted associated with each 10%increase in the VAI was 0.663% in men and 1.738% in women. Further regression analysis revealed that the VAI was positively correlated with FVC and FEV1 impairment in women.

Conclusions

We were the first to show a clear correlation between the VAI and lung function impairment in the Chinese population. The VAI could be a simple and reliable approach in daily practice, and individuals, especially women with a high VAI, should receive additional screening and preventive interventions for respiratory disease.
Happy hypoxemia, or blunted ventilation?
Authors: Ora Josuel , Rogliani Paola , Dauri Mario , O’Donnell Denis
Published: January 2021

Happy hypoxemia is an unspecified definition that is used in COVID-19 patients to define hypoxemia without dyspnoea. Dyspnoea is a very complex symptom, and although hypoxemia can cause breathlessness, dyspnoea is not related to hypoxemia, but is more closely related to inspiratory drive and mechanical alterations. The lack of dyspnoea in the early stages of the disease is likely related to the absence of increased inspiratory drive due to compensatory mechanisms of hypoxemia, while in the advanced stages there is no evidence of a lack of dyspnoea in COVID-19 patients.
Outcomes associated with comorbid diabetes among patients with COPD exacerbation: findings from the ACURE registry
Authors: Mao Xihua , Liang Chen , Niu Hongtao , Dong Fen , Huang Ke , Chen Yahong , Huang Kewu , Zhan Qingyuan , Zhang Yaowen , Huang Yin , Yang Ting , Wang Chen
Published: January 2021

Background

Diabetes is a common comorbidity among patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Diabetes has been reported to be associated with length of stay (LOS), death, and cost among AECOPD patients. However, most studies are retrospective or have small sample sizes. The association for cost has not been researched using diabetes as a main analytic factor. This study aimed to fill gaps mentioned above, to compare basic characteristics between the diabetic and non-diabetic group, and to detect associations between diabetes and clinical outcomes among patients hospitalized with AECOPD.

Methods

A total of 5334 AECOPD patients, classified into diabetic and non-diabetic group, were included from a prospective multicenter patient registry study. Generalized linear regression and logistic regression were separately used for the association between diabetes and direct hospitalization cost and the association between diabetes and LOS.

Results

Generally, diabetic patients had a more severe profile, including being older, more overweight or obese, having more former smokers, more emergency room visits in the past 12 months, and more comorbidities occurrence. Diabetic patients also had worse clinical outcomes, including higher cost and longer LOS. Additionally, the generalized linear regression indicated that the marginal mean cost difference between diabetic and non-diabetic patients was RMB (¥) 775.7.

Conclusions

AECOPD patients with comorbid diabetes had a more severe profile and higher direct hospitalization cost. Diabetes screening and integrated care programs might help reduce the heavy comorbidity and economic burden. Moreover, corticosteroids and metformin could be considered in the treatment of these patients.

Trial registration Clinicaltrials.gov with the identifier NCT0265752.
Circ_ZFR contributes to the paclitaxel resistance and progression of non-small cell lung cancer by upregulating KPNA4 through sponging miR-195-5p
Authors: Li Junmin , Fan Rongmei , Xiao Hui
Published: January 2021

Background

A growing body of evidence has demonstrated the vital roles of circular RNAs (circRNAs) in cancer progression and drug resistance. We intended to explore the roles and mechanisms of circ_ZFR in the paclitaxel (PTX) resistance and progression of non-small cell lung cancer (NSCLC).

Methods

Two NSCLC cell lines A549 and H460 were used in this study. Quantitative real-time polymerase chain reaction (qRT-PCR) assay was conducted to measure the levels of circ_ZFR, ZFR, miR-195-5p and karyopherin subunit alpha 4 (KPNA4) mRNA. RNase R assay was used to analyze the characteristic of circ_ZFR. MTT assay was carried out to assess PTX resistance and cell proliferation. Flow cytometry analysis was utilized to analyze cell cycle and apoptosis. Transwell assay was used to examine cell migration and invasion. Western blot assay was conducted to measure the protein levels of Ki67, Twist1, E-cadherin and KPNA4. Dual-luciferase reporter assay was adopted to verify the combination between miR-195-5p and circ_ZFR or KPNA4. Murine xenograft model assay was used to investigate the effect of circ_ZFR on PTX resistance of NSCLC in vivo.

Results

Circ_ZFR level was enhanced in PTX-resistant NSCLC tissues and cells. Knockdown of circ_ZFR suppressed PTX resistance, cell cycle process, proliferation, migration and invasion and induced apoptosis in PTX-resistant NSCLC cells. For mechanism analysis, circ_ZFR knockdown markedly downregulated the expression of KPNA4 by sponging miR-195-5p, thereby promoting PTX sensitivity and suppressing cell progression in PTX-resistant NSCLC cells. In addition, circ_ZFR silencing enhanced PTX sensitivity of NSCLC in vivo.

Conclusion

Circ_ZFR knockdown played a positive role in overcoming PTX resistance of NSCLC via regulating miR-195-5p/KPNA4 axis, which might provide a possible circRNA-targeted therapy for NSCLC.
Bacteria‐derived ferrichrome inhibits tumor progression in sporadic colorectal neoplasms and colitis‐associated cancer
Authors: Iwama Takuya , Fujiya Mikihiro , Konishi Hiroaki , Tanaka Hiroki , Murakami Yuki , Kunogi Takehito , Sasaki Takahiro , Takahashi Keitaro , Ando Katsuyoshi , Ueno Nobuhiro , Kashima Shin , Moriichi Kentaro , Tanabe Hiroki , Okumura Toshikatsu
Published: January 2021

Background

Colorectal cancers develop through several pathways, including the adenoma–carcinoma sequence and colitis-associated carcinogenesis. An altered intestinal microflora has been reported to be associated with the development and progression of colorectal cancer via these pathways. We identified Lactobacillus casei-derived ferrichrome as a mediator of the bacterial anti-tumor effect of colorectal cancer cells through the upregulation of DDIT3. In this study, we investigated the anti-tumor effects of ferrichrome on precancerous conditions and cancer cells associated with sporadic as well as colitis-associated colorectal cancer.

Methods

SRB and MTT assays were performed to assess growth inhibition in vitro. Eighteen organoids were prepared from biopsy specimens obtained by colonoscopy. An AOM-DSS carcinogenesis model and xenograft model of colorectal cancer cells were generated for the assessment of the tumor suppressive effect of ferrichrome in vivo.

Results

Ferrichrome inhibited the cell growth of colorectal cancer cells in vitro and in in vivo xenograft models. Ferrichrome exerted a strong tumor-suppressive effect that was superior to that of currently available anti-tumor agents, including 5-FU and cisplatin, both in vitro and in vivo. The tumor-suppressive effect of the combination of ferrichrome and 5-FU was superior to that of single treatment with either drug. The tumor suppressive effects of ferrichrome were confirmed through the upregulation of DDIT3 in patient-derived organoids of adenoma and carcinoma. Ferrichrome inhibited the tumor progression in the AOM-DSS model while exhibiting no anti-inflammatory effect in the DSS-colitis model, suggesting that ferrichrome inhibited cancer cells, but not a precancerous condition, via the colitis-associated pathway.

Conclusions

Ferrichrome exerts a tumor suppressive effect on precancerous conditions and cancer cells associated with sporadic as well as colitis-associated colorectal cancer. The anti-tumor effect of ferrichrome was mediated by the upregulation of DDIT3, and was superior to that of 5-FU or cisplatin. These results suggest that Lactobacillus brevis-derived ferrichrome may be a candidate anti-tumor drug for the treatment of colorectal neoplasms.
Dendritic cell responses to Plasmodium falciparum in a malaria-endemic setting
Authors: Turner Triniti C. , Arama Charles , Ongoiba Aissata , Doumbo Safiatou , Doumtabé Didier , Kayentao Kassoum , Skinner Jeff , Li Shanping , Traore Boubacar , Crompton Peter D. , Götz Anton
Published: January 2021

Background

Plasmodium falciparumcauses the majority of malaria cases worldwide and children in sub-Saharan Africa are the most vulnerable group affected. Non-sterile clinical immunity that protects from symptoms develops slowly and is relatively short-lived. Moreover, current malaria vaccine candidates fail to induce durable high-level protection in endemic settings, possibly due to the immunomodulatory effects of the malaria parasite itself. Because dendritic cells play a crucial role in initiating immune responses, the aim of this study was to better understand the impact of cumulative malaria exposure as well as concurrentP. falciparuminfection on dendritic cell phenotype and function.

Methods

In this cross-sectional study, the phenotype and function of dendritic cells freshly isolated from peripheral blood samples of Malian adults with a lifelong history of malaria exposure who were either uninfected (n = 27) or asymptomatically infected withP. falciparum(n = 8) was assessed. Additionally, plasma cytokine and chemokine levels were measured in these adults and in Malian children (n = 19) with acute symptomatic malaria.

Results

With the exception of lower plasmacytoid dendritic cell frequencies in asymptomatically infected Malian adults, peripheral blood dendritic cell subset frequencies and HLA-DR surface expression did not differ by infection status. Peripheral blood myeloid dendritic cells of uninfected Malian adults responded to in vitro stimulation withP. falciparumblood-stage parasites by up-regulating the costimulatory molecules HLA-DR, CD80, CD86 and CD40 and secreting IL-10, CXCL9 and CXCL10. In contrast, myeloid dendritic cells of asymptomatically infected Malian adults exhibited no significant responses above the uninfected red blood cell control. IL-10 and CXCL9 plasma levels were elevated in both asymptomatic adults and children with acute malaria.

Conclusions

The findings of this study indicate that myeloid dendritic cells of uninfected adults with a lifelong history of malaria exposure are able to up-regulate co-stimulatory molecules and produce cytokines. Whether mDCs of malaria-exposed individuals are efficient antigen-presenting cells capable of mounting an appropriate immune response remains to be determined. The data also highlights IL-10 and CXCL9 as important factors in both asymptomatic and acute malaria and add to the understanding of asymptomaticP. falciparuminfections in malaria-endemic areas.
The effects of family physician-contracted service on health-related quality of life and equity in health in China
Authors: Lai Sha , Lu Li , Zhou Zhongliang , Shen Chi , Yang Xiaowei , Zhao Yaxin , Zhang Xiaolong
Published: January 2021

Background

Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents’ health-related quality of life (HRQoL) and equity in health among the Chinese population.

Methods

The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health.

Results

Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <  0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p <  0.001).

Conclusions

This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.
Developing and validating measures of self-reported everyday and healthcare discrimination for Aboriginal and Torres Strait Islander adults
Authors: Thurber Katherine A. , Walker Jennie , Batterham Philip J. , Gee Gilbert C. , Chapman Jan , Priest Naomi , Cohen Rubijayne , Jones Roxanne , Richardson Alice , Calear Alison L. , Williams David R. , Lovett Raymond
Published: January 2021

Background

It is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination.

Methods

Instruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach’s alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity.

Results

An 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2–3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity.

Conclusion

These brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults’ experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.
Clinical characteristics and predictors of mortality in young adults with severe COVID-19: a retrospective observational study
Authors: Lu Yanjiao , Huang Zhenli , Wang Meijia , Tang Kun , Wang Shanshan , Gao Pengfei , Xie Jungang , Wang Tao , Zhao Jianping
Published: January 2021

Background and objective

Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19.

Methods

A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model.

Results

In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19.

Conclusion

Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.