bluuebunny/crossref_metadata_2025 huggingface dataset:
An enhanced participant information leaflet and multimedia intervention to improve the quality of informed consent to a randomised clinical trial enrolling people living with HIV and obesity: a protocol for a Study Within A Trial (SWAT)
Authors: O’Sullivan Lydia , Savinelli Stefano , O’Hare Stephen , Holden Sinéad , McHugh Ciara , Mallon Patrick , Doran Peter
Published: January 2022

Background

It is the investigator’s responsibility to communicate the relevant information about a clinical trial to participants before they provide informed consent to take part. Systematic reviews indicate that participants often have a poor understanding of the concepts which are key to ensuring valid informed consent, such as randomisation and risks/discomforts. Paper-based participant information leaflets and informed consent forms (PIL/ICFs) are becoming longer and are often too complex for many participants. Multimedia interventions and enhanced PIL/ICFs have been trialled in an attempt to improve participants’ understanding of various aspects of research studies. However, there is insufficient empirical evidence to determine how effective such interventions are. This protocol describes a study to evaluate whether an enhanced PIL/ICF and website help research participants to understand important information about a human immunodeficiency virus (HIV) randomised clinical trial.

Methods

This Study Within A Trial (SWAT) is a prospective, multi-centre, randomised, controlled, parallel-group study embedded in a host clinical trial. The host trial (the SWIFT trial; EudraCT: 2019-002314-39) is a prospective, multi-centre, randomised, open-label, controlled trial investigating if semaglutide along with dietary advice assists individuals with HIV and obesity to lose weight, compared to dietary advice alone. For the SWAT, participants will be randomised in a 1:1 ratio to either the control (standard PIL/ICF) or the intervention (an enhanced PIL/ICF and a website which includes animations). The enhanced PIL/ICF and website were developed in line with the guidance from organisations which promote plain English and accessible public-facing materials in conjunction with HIV Ireland, a HIV advocacy organisation, and our previous work on consent documents. The primary outcome of the SWAT is the quality of informed consent, assessed by a validated comprehension test—the modified Deaconess Informed Consent Comprehension Test (DICCT). The DICCT will be administered within 48 h of consent to the host trial. The secondary is recall, measured by the modified DICCT questionnaire scores 2 weeks post-consent to the host trial.

Discussion

The results of this SWAT will add to the methodological evidence base on the use of multimedia to improve the quality of informed consent to randomised clinical trials.

Trial registration

ClinicalTrials.govNCT04174755. EudraCT 2019-002314-39. SWAT 160, Northern Ireland Hub for Trials Methodology Research SWAT repository (Clarke M, et al., Trials. 16:P209, 2015).
Fibrotic alterations in human annulus fibrosus correlate with progression of intervertebral disc herniation
Authors: Castro A. L. , Ribeiro-Machado C. , Oliveira C. M. , Teixeira G. Q. , Neidlinger-Wilke C. , Pereira P. , Vaz R. , Barbosa M. A. , Gonçalves R. M.
Published: January 2022

Background

Intervertebral disc (IVD) herniation is characterized by annulus fibrosus failure (AF) in containing the nucleus pulposus (NP). IVD herniation involves cellular and extracellular matrix (ECM) alterations that have been associated with tissue fibrosis, although still poorly investigated.

Methods

Here, fibrotic alterations in human AF were evaluated, by characterizing the herniated ECM. Human AF samples (herniated lumbar IVD (n = 39, age 24–83) and scoliosis controls (n = 6, age 15–21)) were processed for transmission electron microscopy and histological/immunohistochemical analysis of fibrotic markers. Correlations between the fibrotic markers in AF ECM and the degree of NP containment (protused, contained and uncontained) and patients’ age were conducted.

Results

Our results demonstrate that with herniation progression, i.e. loss of NP containment, human AF presents less stained area of sulphated glycosaminoglycans and collagen I, being collagen I fibres thinner and disorganized. On the other hand, fibronectin stained area and percentage of α-smooth muscle actin+ cells increase in human AF, while matrix metalloproteinase-12 (MMP12) production and percentage of macrophages (CD68+ cells) remain constant. These structural and biochemical fibrotic alterations observed in human AF with herniation progression occur independently of the age.

Conclusions

The characterization of human AF here conducted evidence the presence of fibrosis in degenerated IVD, while highlighting the importance of considering the herniation progression stage, despite the patients’ age, for a better understanding of the mechanisms behind AF failure and IVD herniation.
A role for neutrophils in early enthesitis in spondyloarthritis
Authors: Stavre Zheni , Bridgewood Charles , Zhou Qiao , Maeda Yukiko , Huang Ting-ting , Karman Jozsef , Khan Almas , Giryes Sami , Sharif Kassem , McGonagle Dennis , Gravallese Ellen M.
Published: January 2022

Background

Neutrophils are present in the early phases of spondyloarthritis-related uveitis, skin and intestinal disease, but their role in enthesitis, a cardinal musculoskeletal lesion in spondyloarthritis, remains unknown. We considered the role of neutrophils in the experimental SKG mouse model of SpA and in human axial entheses.

Methods

Early inflammatory infiltrates in the axial and peripheral entheseal sites in SKG mice were evaluated using immunohistochemistry and laser capture microdissection of entheseal tissue. Whole transcriptome analysis was carried out using Affymetrix gene array MTA 1.0, and data was analyzed via IPA. We further isolated neutrophils from human peri-entheseal bone and fibroblasts from entheseal soft tissue obtained from the axial skeleton of healthy patients and determined the response of these cells to fungal adjuvant.

Results

Following fungal adjuvant administration, early axial and peripheral inflammation in SKG mice was characterized by prominent neutrophilic entheseal inflammation. Expression of transcripts arising from neutrophils include abundant mRNA for the alarmins S100A8 and S100A9. In normal human axial entheses, neutrophils were present in the peri-entheseal bone. Upon fungal stimulation in vitro, human neutrophils produced IL-23 protein, while isolated human entheseal fibroblasts produced chemokines, including IL-8, important in the recruitment of neutrophils.

Conclusion

Neutrophils with inducible IL-23 production are present in uninflamed human entheseal sites, and neutrophils are prominent in early murine spondyloarthritis-related enthesitis. We propose a role for neutrophils in the early development of enthesitis.
Locally advanced gallbladder cancer treated with effective chemotherapy and subsequent curative resection: a case report
Authors: Inoue Masashi , Hakoda Keishi , Sawada Hiroyuki , Hotta Ryuichi , Ohmori Ichiro , Miyamoto Kazuaki , Toyota Kazuhiro , Sadamoto Seiji , Takahashi Tadateru
Published: January 2022

Background

Surgical resection of gallbladder cancer with negative margins is the only potentially curative therapy. Most patients with gallbladder cancer are diagnosed in an advanced stage and, despite the availability of several chemotherapies, the prognosis remains dismal. We report a case of locally advanced gallbladder cancer that was successfully treated with effective cisplatin plus gemcitabine, followed by curative resection.

Case presentation

A 55-year-old Japanese female was hospitalized with right hypochondrial pain. Enhanced computed tomography revealed a 49 × 47 mm mass at the neck of the gallbladder, with suspected invasion of the liver and right hepatic artery. Endoscopic retrograde cholangiopancreatography demonstrated displacement of the upper bile duct. Intraductal ultrasonography showed irregular wall thickening and disappearance of the wall structure in bile ducts from the B4 branch to distal B2 and B3. Percutaneous transhepatic biliary biopsy revealed a poorly differentiated carcinoma. The patient was diagnosed with unresectable gallbladder cancer (T4N0M0 stage IVA). Cisplatin plus gemcitabine chemotherapy was initiated. After six courses of chemotherapy, enhanced computed tomography showed that the mass in the neck of the gallbladder had shrunk to 30 mm, Endoscopic retrograde cholangiopancreatography showed improvement of the hilar duct stenosis. A biopsy of the bile duct mucosa showed no malignant cells in the branch of the left and right hepatic ducts, the left hepatic duct, or the intrapancreatic ducts. The patient underwent conversion surgery with right and segment 4a liver resection, extrahepatic duct resection, and cholangiojejunostomy. The histopathologic diagnosis showed that the tumor cells had shrunk to 2 × 1 mm, and that R0 resection of the T2aN0M0 stage IIA tumor was successful.

Conclusion

Although conversion surgery for gallbladder cancer is rarely possible, curative resection may offer a better prognosis, and it is important to regularly pursue possibilities for surgical resection even during chemotherapy.
Development and validation of a headspace GC-MS method to evaluate the interconversion of impurities and the product quality of liquid hand sanitizers
Authors: Abrigo Nicolas , Ruzicka Connie , Faustino Patrick , Stiber Neil , NguyenPho Agnes , O’Connor Thomas , Shakleya Diaa
Published: January 2022

The COVID-19 pandemic has led to increased usage of hand sanitizer products by the public to prevent the spread of COVID-19 and decrease the likelihood of acquiring the disease. The increase in demand has also led to an increase in the number of manufacturers. This work describes the FDA’s Center for Drug Evaluation and Research (CDER) laboratories efforts to develop tests to assess the quality of hand sanitizer products containing ethanol or isopropanol as the primary active ingredient. The products were evaluated for the active ingredient content and determination of the 12 impurities listed in the FDA Hand Sanitizer Temporary Guidance, followed by a spike recovery assay performed to verify the test results. Extensive method development was conducted including an investigation into the stability of ethanol, isopropanol, and the 12 impurities. Stability and kinetic studies confirmed the instability of acetal in acidic liquid hand sanitizer products during spike recovery assay testing. The headspace GC-MS method was validated according to ICH Q2 (R1) guidelines and the spike recovery assay was validated using three concentrations of standards for the drug product. During method application, six liquid hand sanitizer products were tested and all were determined to have ethanol or isopropanol above 70% v/v. Two liquid hand sanitizer products were determined to contain acetaldehyde as an impurity above the FDA recommended safety levels.
3D printing of nanocomposite pills through desktop vat photopolymerization (stereolithography) for drug delivery reasons
Authors: Sharma Peeyush Kumar , Choudhury Dinesh , Yadav Vivek , Murty U. S. N. , Banerjee Subham
Published: January 2022

Background

The desktop vat polymerization process or stereolithography printing is an ideal approach to develop multifunctional nanocomposites wherein a conventional solid dosage form is used as a reservoir for compliant administration of drug-loaded nanocarriers.

Methods

In this study, a nanocomposite drug delivery system, that is, hydrogel nanoparticles of an approved nutraceutical, berberine entrapped within vat photopolymerized monoliths, was developed for drug delivery applications. For the fabrication of the nanocomposite drug delivery systems/pills, a biocompatible vat photopolymerized resin was selected as an optimum matrix capable of efficiently delivering berberine from stereolithography mediated 3D printed nanocomposite pill.

Results

The obtained data reflected the efficient formation of berberine-loaded hydrogel nanoparticles with a mean particle diameter of 95.05 ± 4.50 nm but low loading. Stereolithography-assisted fabrication of monoliths was achieved with high fidelity (in agreement with computer-aided design), and photo-crosslinking was ascertained through Fourier-transform infrared spectroscopy. The hydrogel nanoparticles were entrapped within the pills during the stereolithography process, as evidenced by electron microscopy. The nanocomposite pills showed a higher swelling in an acidic environment and consequently faster berberine release of 50.39 ± 3.44% after 4 h. The overall results suggested maximal release within the gastrointestinal transit duration and excretion of the exhausted pills.

Conclusions

We intended to demonstrate the feasibility of making 3D printed nanocomposite pills achieved through the desktop vat polymerization process for drug delivery applications.
Judging the credibility of websites: an effectiveness trial of the spacing effect in the elementary classroom
Authors: Foot-Seymour Vanessa , Wiseheart Melody
Published: January 2022

Spaced learning—the spacing effect—is a cognitive phenomenon whereby memory for to-be-learned material is better when a fixed amount of study time is spread across multiple learning sessions instead of crammed into a more condensed time period. The spacing effect has been shown to be effective across a wide range of ages and learning materials, but few studies have been conducted that look at whether spacing can be effective in real-world classrooms, using real curriculum content, with real teachers leading the intervention. In the current study, lesson plans for teaching website credibility were distributed to homeroom elementary teachers with specific instructions on how to manipulate the timing of the lessons for either a one-per-day or one-per-week delivery. One month after the final lesson, students were asked to apply their knowledge on a final test, where they evaluated two new websites. Results were mixed, suggesting that classroom noise might lessen or impede researchers’ ability to find spacing effects in naturalistic settings.
Efficient SVV stabilized triangular spectral element methods for incompressible flows of high Reynolds numbers
Authors: Chen Lizhen , Tang Tao , Xu Chuanju
Published: January 2022

In this paper, we propose a spectral vanishing viscosity method for the triangular spectral element computation of high Reynolds number incompressible flows. This can be regarded as an extension of a similar stabilization technique for the standard spectral element method. The difficulty of this extension lies in the fact that a suitable definition of spectral vanishing viscosity operator in non-structured elements does not exist, and it is not clear that if a suitably defined spectral vanishing viscosity provides desirable dissipation for the artificially accumulated energy. The main contribution of the paper includes: 1) a well-defined spectral vanishing viscosity operator is proposed for non-standard spectral element methods for the Navier-Stokes equations based on triangular or tetrahedron partitions; 2) an evaluation technique is introduced to efficiently implement the stabilization term without extra computational cost; 3) the accuracy and efficiency of the proposed method is carefully examined through several numerical examples. Our numerical results show that the proposed method not only preserves the exponential convergence, but also produces improved accuracy when applied to the unsteady Navier-Stokes equations having smooth solutions. Especially, the stabilized triangular spectral element method efficiently stabilizes the simulation of high Reynolds incompressible flows.
MTHFR C677T (rs1801133) genetic polymorphism is associated with development risk of essential hypertension in the Turkish population
Authors: Er Zafer Cengiz , Muderrisoglu Ahmet , Ekim Meral , Ekim Hasan
Published: January 2022

Background

Hypertension is a serious condition that is spread worldwide and may lead to severe complications such as heart attack, stroke, hypertensive retinopathy, and renal failure. Although some genetic and environmental risk factors are known to play a role in the etiology of hypertension, like most of the other multi-factorial diseases, its etiology is yet to be fully elucidated. Our study aimed to investigate the effects of methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133) and A1298C (rs1801131), factor V Leiden (FVL) G1691A (rs6025), and prothrombin (PT) G20210A (rs1799963) genetic polymorphisms on the development risk of essential hypertension and level of blood pressure in hypertensive patients.

Results

The frequency of the homozygous polymorphic TT genotype for theMTHFRC677T polymorphism was significantly higher in male hypertensive patients than in the male control group (27% vs 6.3%,p = 0.028). The rate of the variant T allele for theMTHFRC677T polymorphism was also significantly higher in male hypertensive patients compared to male healthy controls (51.4% vs 21.9%,p = 0.0004). There was no difference among hypertensive patients and healthy controls regarding the frequencies ofMTHFRA1298C,FVLG1691A andPTG20210A polymorphisms. In addition, we found no difference between genotype groups regarding systolic and diastolic blood pressure levels in hypertensive patients.

Conclusions

Homozygous polymorphic TT genotype and variant T allele for theMTHFRC677T polymorphism may be considered as a risk factor for the development of essential hypertension in the Turkish male population.
Genes linked with early menopause and the pathogenesis of its associated diseases: a systematic review
Authors: Thasneem Kamila , Kalarani Iyshwarya Bhaskar , Jayaprasad Prema , Mohammed Vajagathali , Veerabathiran Ramakrishnan
Published: January 2022

Background

Menopause is a biological process when a woman’s reproductive capability is no longer functional. A naturally or artificially caused premenopausal is known as early menopause occurs between the ages 40–45, which substantially impacts fertility and disease influenced by genetic plus environmental factors and their interactions. Women in early menopause are at greater risk of cardiovascular disease, general mortality, neurological disorders, osteoporosis, mental illness, and other problems.

Main body

A PubMed search of the electronic literature database yielded articles on early menopause and disease etiology. Several unique genes were identified, such as ESR1, ESR2, CYP1B1, BRSK1, HK3, andTMEM150B are associated with early menopause, and research focused on case-control, cohort, and cross-sectional studies are finding novel predisposition loci for early menopause.

Conclusion

The current study’s focus is to understand better the genetic aspects of early menopause. This knowledge will help researchers enhance EM etiology and identify biomarkers that may detect early development of the disease, allowing women at risk to begin family planning earlier.
Study of the effect of vascular endothelial growth factor (VEGF) C(+405)G (rs2010963) single nucleotide polymorphism on the development of esophageal and gastric varices and risk of variceal bleeding in cirrhotic hepatitis C virus (HCV) patients (VEGF) C(+405)G IN esophageal and gastric varices
Authors: Aboismail Ashraf , El-Shazly Mohamed , Abdallah Nasser , Elsayed Eman , Abo-Yossef Rania
Published: January 2022

Background

HCV infection is a major worldwide cause of chronic liver diseases. Esophageal and gastric varices are common in cirrhotic patients due to concomitant portal hypertension. Variceal hemorrhage is a major decompensating event with high morbidity and mortality. Endothelial dysfunction, occurring in cirrhosis, facilitates the development of liver cirrhosis, portal hypertension and contributes to increased intrahepatic vascular resistance..VEGF family members are major regulators of blood vessel development and function.

Results

The study was conducted on 90 subjects admitted to Tropical Medicine Department, Alexandria Main University Hospital: 30 cirrhotic patients with endoscopically proven varices (group A), 30 cirrhotic patients without varices (group B), and 30 healthy controls (group C). All patients was subjected to detailed history taking and thorough clinical examination, laboratory investigations, ultrasound abdomen, upper gastrointestinal endoscopy, and genotyping forVEGFC(+405)G (rs2010963) by 5′ nuclease assay. TheVEGFC(+405)G (rs2010963) GG genotype was associated with higher prevalence of esophageal and gastric varices and higher bleeding risk.

Conclusion

VEGFC(+405)G (rs2010963) is an important genetic determinant of esophageal varices, gastric varices, and correlates with variceal bleeding risk. Genetic testing of this SNP would be useful in prediction of esophageal and gastric varices and bleeding risk.
Effectiveness, acceptability and potential harms of peer support for self-harm in non-clinical settings: systematic review
Authors: Abou Seif Nada , John-Baptiste Bastien Rayanne , Wang Belinda , Davies Jessica , Isaken Mette , Ball Ellie , Pitman Alexandra , Rowe Sarah
Published: January 2022

Background

Many people who have self-harmed prefer informal sources of support or support from those with lived experience. However, little is known about whether peer support improves outcomes for people who have self-harmed or about the risks of peer support interventions in non-clinical settings.

Aims

The aims of this review were to examine the effectiveness, acceptability and potential risks of peer support for self-harm, and how these risks might be mitigated.

Method

We searched bibliographic databases and grey literature for papers published since 2000. We included peer support for self-harm that occurred in voluntary-sector organisations providing one-to-one or group support, or via moderated online peer support forums.

Results

Eight of the ten papers included focused on peer support that was delivered through online media. No study compared peer support with other treatments or a control group, so limited conclusions could be made about its effectiveness. Peer support for self-harm was found to be acceptable and was viewed as having a range of benefits including a sense of community, empowerment, and access to information and support. The most commonly perceived risk associated with peer support was the potential for triggering self-harm.

Conclusions

Our findings highlighted a range of benefits of being part of a group with very specific shared experiences. Mitigations for potential risks include organisations using professional facilitators for groups, trigger warnings for online forums, and providing regular supervision and training so that peers are prepared and feel confident to support vulnerable people while maintaining their own emotional health.
Effects of Different Doses of Exercise on Inflammation Markers Among Adolescents With Overweight/Obesity: HEPAFIT Study
Authors: Ramírez-Vélez Robinson , García-Hermoso Antonio , Correa-Rodríguez María , Fernández-Irigoyen Joaquín , Palomino-Echeverría Sara , Santamaría Enrique , Correa-Bautista Jorge Enrique , González-Ruíz Katherine , Izquierdo Mikel
Published: January 2022

Propose

Obesity-related metabolic risk factors in adolescents who are overweight/obese may be associated with systemic low-grade inflammation; therefore, we investigated whether 6 months of exercise training altered markers of inflammation.

Methods

Secondary analyses of a randomized controlled exercise-based intervention trial (September 2017-December 2018). Adolescents aged 11 to 17 years (Tanner stage II-V), 70% girls, with a body mass index z-score at or above the 85th percentile, and/or with excess of adiposity (body fat ≥ 30%). The participants were randomly assigned to the following 4 groups for 6 months: (1) standard physical education lessons, as a control (CTRL); (2) high-intensity physical education class (HIPE); (3) low-to-moderate intensity physical education class (LIPE); (4) a combined group (PLUS). Inflammatory markers and immune molecules including chemokines, cytokines, and growth factors (n = 65 biomarkers) were determined by cytokine antibody array.

Results

Of the 120 randomly assigned participants, 95 were included in the analysis. Considering these 22 proteins, the LIPE group shows statistical significance in 9 proteins with log-fold change (logFC) and P < 0.05 (in BLC, eotaxin, fibroblast growth factor-6 [FGF-6], GCP-2, I-309, IGFBP-4, MCP-4, NAP-2, and PARC), followed by the PLUS group in 9 proteins (BLC, pro-epidermal growth factor, eotaxin, FGF-6, MCP-4, NAP-2, osteopontin, PARC, and RANTES), the HIPE group in 7 proteins (FGF-4, FGF-7, GCP-2, IGF-1, IGFBP-1, IGFBP-4, and MIP-1 delta), and the CTRL group in 6 proteins (FGF-4, IP-10, Leptin, MCP-1, MIG, and MIP-1 delta). However, subanalysis performed to detect differentially expressed proteins at baseline and after intervention, with significance at an adjusted P value ≤ 0.05 and absolute log fold-change (logFC) ≥ 1.0, showed 3 downregulated proteins in the LIPE group (BLC(logFC) = 1.27, eotaxin(logFC) = 1.18, and MCP-4(logFC) = 1.14), and 4 proteins in the HIPE group (BLC(logFC) = 1.45, FGF-6(logFC) = 1.20, MCP-4(logFC) = 1.50, and PARC(logFC) = 1.33), supporting that the changes we observed in the exercise groups were not time-related changes but occurred in response to exercise.

Conclusions

Implementing a 6-month physical exercise program in overweight/obese adolescents, based on LIPE and PLUS groups, significantly change several circulating inflammatory levels. Interventions involving supervised physical exercise may reduce the associated effects of systemic low-grade inflammation, thus preventing the development of obesity-related metabolic diseases in adolescents with overweight/obesity.
brinker levels regulated by a promoter proximal element support germ cell homeostasis
Authors: Dunipace Leslie , Newcomb Susan , Stathopoulos Angelike
Published: January 2022

A limited BMP signaling range in the stem cell niche of the ovary protects against germ cell tumors and promotes germ cell homeostasis. The canonical repressor of BMP signaling in both the Drosophila embryo and wing disc is the transcription factor Brinker (Brk), yet the expression and potential role of Brk in the germarium has not previously been described. Here, we find that brk expression requires a promoter-proximal element (PPE) to support long-distance enhancer action as well as to drive expression in the germarium. Furthermore, PPE subdomains have different activities; in particular, the proximal portion acts as a damper to regulate brk levels precisely. Using PPE mutants as well as tissue-specific RNA interference and overexpression, we show that altering brk expression within either the soma or the germline affects germ cell homeostasis. Remarkably, we find that Decapentaplegic (Dpp), the main BMP ligand and canonical antagonist of Brk, is upregulated by Brk in the escort cells of the germarium, demonstrating that Brk can positively regulate this pathway.
Impact of the COVID-19 pandemic on medical students of clinical clerkship in South Korea: A qualitative study exploring medical students’ experiences
Authors: Park Kwi Hwa , Yune So Jung , Jung Min Kyu , Kim Yura , Lee Geon Ho , Kim Seong Yong
Published: January 2022

Background and Objective: In 2020, during the coronavirus disease (COVID-19) pandemic, medical students were placed in a learning environment that exposed them to unsafe clinical settings. In this study, using a phenomenological approach, we analyze the experiences of fourth-year students in the Daegu area of South Korea, a region that experienced a high concentration of COVID-19 infections.

Methods: The essays of 80 students from four medical schools who agreed to participate in the study were utilized in the final data analysis. The data were analyzed using the proposed phenomenological analysis.

Results: Forty-seven condensed meaning units, twelve subthemes, and three essential themes were identified. The main theme includes the following: 1) confusion and stress due to sudden changes in the learning situation 2) learned the medical professionalism of physicians 3) reflection and internal change regarding what it means to be a physician.

Conclusions: The COVID-19 pandemic had a significant impact on students who participated in clinical clerkships. This study can provide baseline data for planning educational strategies and establishing a support system for students in response to the changes that they may experience in the event of the reoccurrence of a novel infectious disease in the future.

doi: https://doi.org/10.12669/pjms.38.3.5031

How to cite this:Park KH, Yune SJ, Jung MK, Kim Y, Lee GH, Kim SY. Impact of the COVID-19 pandemic on medical students of clinical clerkship in South Korea: A qualitative study exploring medical students’ experiences. Pak J Med Sci. 2022;38(3):---------.  doi: https://doi.org/10.12669/pjms.38.3.5031

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Μελέτη οφθαλμολογικών επιπλοκών μετά από καρδιοχειρουργικές επεμβάσεις με εξωσωματική κυκλοφορία
Authors: Τράντου Βασιλική
Published: January 2022

Σκοπός αυτής της μελέτης είναι να εξετάσουμε εάν οι ασθενείς πουυποβάλλονται σε καρδιοχειρουργική επέμβαση με μηχανή εξωσωματικήςκυκλοφορίας Extracorporeal Circulation (ECC)On-pump, διατρέχουν υψηλό κίνδυνο ανάπτυξης διαταραχών της όρασηςμε βάση την ανάλυση τυπικών οπτικών παραμέτρων.Συνολικά 88 ασθενείς, οι οποίοι υποβλήθηκαν σε επέμβαση αορτο-στεφανιαίας παράκαμψης Coronary Artery Bypass Grafting (CABG, n=56) ή αντικατάσταση αορτικής βαλβίδας Aortic Valve Replacement (AVR,n= 32) εντάχθηκαν στη μελέτη μας, προκειμένου να αξιολογηθεί η οπτικήλειτουργία τους, πριν την καρδιοχειρουργική επέμβαση και ένα μήνα μετάτην επέμβαση.Πραγματοποιήθηκαν οι ακόλουθες εξετάσεις:Μέτρηση Οπτικής Οξύτητας, Visual Acuity (VA),Μέτρηση Ενδοφθάλμιας Πίεσης, Intraocular Pressure (IOP),Βιομικροσκόπηση -Βυθοσκόπηση,Φλουοροαγγειογραφία, Fundus Fluorescein Angiography (FFA),Οπτική Τομογραφία Συνοχής, Optical Coherence Tomography (OCT)(Ωχράς -Οπτικού νεύρου - Retina Nerve Fibre Layer RNFL).Τα δεδομένα που συλλέχθηκαν αναλύθηκαν στατιστικά με τηνεκτέλεση του Mann Witney U Test σε SPSS (CI= 95%).Τα αποτελέσματα της μελέτης δύνανται να συνοψιστούν στακάτωθι:Ένας από τους 88 ασθενείς (1,13%),ο οποίος εμφάνισε απώλειαόρασης μετά από χειρουργική επέμβαση αορτικής βαλβίδας, εξαιρέθηκεαπό τη μελέτη. Από τους υπόλοιπους ασθενείς, οι 60 ασθενείς (69%)παρουσίασαν μείωση του μετ-εγχειρητικού χρόνου της FFA, ενώ σε 27ασθενείς (31%) o χρόνος της FFA αυξήθηκε.Οι χρόνοι της FFA μειώθηκαν - βελτιώθηκαν σε περισσότερουςασθενείς με AVR (74%) από ότι σε εκείνες με CABG (66%) (p< 0.05).Ασθενείς με χρόνο εξωσωματικής κυκλοφορίας (ECC) <90 minπαρουσίασαν βελτίωση των χρόνων της FFA, ενώ ασθενείς με χρόνοεξωσωματικής κυκλοφορίας (ECC) >101 min είχαν χειρότερους μετ-εγχειρητικά vs προ-εγχειρητικά χρόνους της FFA (38% έναντι 56%,αντίστοιχα).Δεν παρατηρήθηκαν σημαντικές διαφορές στα ευρήματα VA, IOP,OCT μεταξύ των επεμβάσεων CABG και AVR μετ-εγχειρητικά vs προ-εγχειρητικά.Συμπερασματικά η συντριπτική πλειοψηφία των ασθενών δεν είχανεπιπλοκές της όρασης μετά από καρδιοχειρουργική επέμβαση.Η πλειονότητα αυτών έδειξαν συντόμευση-άρα βελτίωση των χρόνων τηςFFA μετεγχειρητικά vs προ-εγχειρητικά, εμφανίζοντας κατ’ επέκτασηαναμενόμενη βελτιωμένη ροή στην οφθαλμική μικροκυκλοφορία.Η διάρκεια των χρόνων της FFA εξαρτάται, τουλάχιστον εν μέρει,από το χρόνο της ECC, και ενδεχομένως από το είδος της χειρουργικήςεπέμβασης
Effects of Antigravity Treadmill Training on Gait and Balance in Patients with Diabetic Polyneuropathy: A Randomized Controlled Trial
Authors: Abdelaal Ashraf , El-Shamy Shamekh
Published: January 2022

Background: Diabetic polyneuropathy (DPN) is the most prevalent consequence of diabetes mellitus, and it has a significant impact on the patient's health. This study aims to evaluate effects of antigravity treadmill training on gait and balance in patients with DPN. Methods: The study included 45 males with type 2 diabetes who were randomly assigned to one of two groups: the experimental group (n=23) or the control group (n=22). For a period of 12 weeks, the experimental group received antigravity treadmill training (75% weight bearing, 30 min per session, three times per week) combined with traditional physical therapy. During the same time period, the control group received only traditional physical therapy. The Biodex Balance System was used to assess postural stability indices, while the GAITRite Walkway System was used to assess spatiotemporal gait parameters. All measurements were obtained before and at the end of the study after 12 weeks of treatment. Results: The mean values of all measured variables improved significantly in both groups (P<0.05), with the experimental group showing significantly greater improvements than the control group. The post-treatment gait parameters (i.e., step length, step time, double support time, velocity, and cadence) were 61.3 cm, 0.49 sec, 0.25 sec, 83.09 cm/sec, and 99.78 steps/min as well as 56.14 cm, 0.55 sec, 0.29 sec, 75.73 cm/sec, and 88.14 steps/min for the experimental and control group, respectively. The post-treatment overall stability index was 0.32 and 0.70 for the experimental and control group, respectively. Conclusions: Antigravity treadmill training in combination with traditional physical therapy appears to be superior to traditional physical therapy alone in terms of gait and balance training. As a result, the antigravity treadmill has been found to be an effective device for the rehabilitation of DPN patients.
Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains
Authors: Volf Kevin , Kelly Liam , García Bengoechea Enrique , Casey Bláthín , Gobis Anna , Lakerveld Jeroen , Zukowska Joanna , Gelius Peter , Messing Sven , Forberger Sarah , Woods Catherine ,   Policy Evaluation Network (PEN) Consortium
Published: January 2022

Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown.  The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap.

Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria.

Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA.

Registration:  PROSPERO CRD42020156630 (10/07/2020).
Relationships between geomagnetic Ар-indeх and EEG parameters in patients with dysfunction of the neuroendocrine-immune complex
Authors: Tserkovniuk R. , Gozhenko A. , Korolyshyn T. , Lomeyko S. , Fil V. , Anchev A. , Zukow W. , Yanchij R. , Popovych I.
Published: January 2022

Background. Recently, on the example of two cohort of patients, we found that disturbances of the geomagnetic field cause a significant immediate modulating effect on the level of immune parameters in the blood. The data available in the literature give grounds for assumptions about the direct effect of disturbances of the geomagnetic field on immunocytes, and indirectly, through immunotropic neurotransmitters and hormones. Our hypothesis is as follows. Disturbances of the geomagnetic field are perceived by acupuncture points (APs). The information obtained is transmitted to neurons and endocrinocytes, the mediators of which, in turn, affect immunocytes. The purpose of this study is to test this hypothesis.

Methods. The object of observation were 21 men (24-63 y) and 20 women (30-72 y) with neuroendocrine-immune complex dysfunction. Each patient was tested twice with an interval of 4 days. We recorded the ongoing electroencephalogram (EEG). Retrospectively we recorded the geomagnetic Ap-Index on the day of testing and during the previous 7 days, using resource https://www.spaceweatherlive.com/.

Results. The canonical correlation between Ap-indices for 7 days before and on the day of testing, and EEG parameters is 0,886; immunity parameters is 0,921. In turn, the immune parameters are closely related to the EEG parameters (R=0,944).

Conclusion. Disturbances of the geomagnetic field (Ap-index) causes a significant immediate modulating effect on the parameters of immunity as well as EEG, apparently through acupuncture points as polymodal receptors of the ecoceptive sensitivity system.
Role of organic carbon and nitrogen of mineral waters in their immunomodulating effects at female rats
Authors: Popovych Igor , Mysula Igor , Popovych Andriy , Mysula Yuriy , Sydliaruk Nataliya , Bilas Volodymyra , Zukow Walery
Published: January 2022

Background. Drinking mineral water is one of the ethnopharmacologic factors. Organic substances, despite their presence in all drinking mineral waters, are still considered to be active only in the water of Naftussya type (which, due to mineralization less than 1 g/L, are not formally mineral), whereas the physiological activity of true mineral waters (which mineralization is greater than 1-2 g/L) are associated with electrolytes and trace elements. Previously, we identified the role of organic carbon and nitrogen of mineral waters in their effects on certain metabolic and neuro-endocrine parameters. The purpose of this study is to clarify the role of organic substances of same mineral waters in their effects on immunity parameters. Material and methods. Experiment was performed on 48 healthy female Wistar rats 240-290 g divided into 5 groups. Animals of the first group for 6 days administered a single tap water through the tube at a dose of 1,5 mL/100 g of body mass. In the second group we administered the water Naftussya from the Truskavets’ layer (Galychyna, Ukraine), in the third group the water Sophiya of the Truskavets’ field. The rats of the fourth group received the native water from the Hertsa (Bucovyna, Ukraine) field, and the last group received its artificial salt analogue. The day after the completion of the drinking course in all rats immunne parameters were registered. Results. On the basis of the correlation analysis with step-by-step exclusion, 9 immune parameters (Endotheliocytes of Thymus, Spleen Mass Index, Entropy of Splenocytogram, Natural Killers, B- and 0-Lymphocytes, Rod-shaped Neutrophils, Phagocytic Index and Microbian Count of Monocytes of Blood) are included in the regressive model for organic nitrogen (R=0,818) and 6 parameters (Endotheliocytes of Thymus, Fibroblastes and Reticulocytes of Spleen, Pan-Lymphocytes, Microbian Count of Neutrophils and Phagocytic Index of Monocytes of Blood) for organic carbon (R=0,690). Together, the organic components of the chemical composition of loading fluids determine their effect on the immune parameters by 77%. Conclusion. Organic substances of mineral waters play an essential role in their effects on the immune parameters of female rats.
Relationships between geomagnetic Ар-indeх and HRV and endocrine parameters in patients with dysfunction of the neuroendocrine-immune complex
Authors: Tserkovniuk Ruslan , Gozhenko Anatoliy , Korolyshyn Tetyana , Ruzhylo Sofiya , Kikhtan Volodymyr , Fil Vitalij , Anchev Anatoliy , Zukow Walery , Yanchij Roman , Popovych Igor
Published: January 2022

Background. Recently, on the example of two cohort of patients, we found that disturbances of the geomagnetic field cause a significant immediate modulating effect on the level of immune parameters in the blood. The data available in the literature give grounds for assumptions about the direct effect of disturbances of the geomagnetic field on immunocytes, and indirectly, through immunotropic neurotransmitters and hormones. Our hypothesis is as follows. Disturbances of the geomagnetic field are perceived by acupuncture points. The information obtained is transmitted to neurons and endocrinocytes, the mediators of which, in turn, affect immunocytes. The purpose of this study is to test this hypothesis. Material and methods. The object of observation were 21 men (24-63 y) and 20 women (30-72 y) with neuroendocrine-immune complex dysfunction. Each patient was tested twice with an interval of 4 days. Retrospectively we recorded the geomagnetic Ap-Index on the day of testing and during the previous 7 days, using resource https://www.spaceweatherlive.com/. Recorded the heart rate variability (HRV) parameters, determined the plasma level of cortisol, triiodothyronine and testosterone. Results. During the week, the average level of Ap-index ranged from 7 to 13 nT. Maximum coefficients of multiple correlation with HRV&Hormonal parameters were detected for Ap-index on 2 (R=0,506) and 7 (R=0,403) days before testing. The canonical correlation between Ap-indices for 7 days before and on the day of testing, and the HRV&Hormonal parameters is 0,766. In turn, the immune parameters are closely related to the HRV&Hormonal parameters (R=0,714). Conclusion. Disturbances of the geomagnetic field (Ap-index) causes a significant immediate modulating effect on the immune, HRV and endocrine parameters, apparently through acupuncture points as polymodal receptors of the ecoceptive sensitivity system.
Can Deep Reinforcement Learning Improve Inventory Management? Performance on Lost Sales, Dual-Sourcing, and Multi-Echelon Problems
Authors: Gijsbrechts Joren , Boute Robert N. , Van Mieghem Jan A. , Zhang Dennis J.
Published: January 2022

Problem definition: Is deep reinforcement learning (DRL) effective at solving inventory problems? Academic/practical relevance: Given that DRL has successfully been applied in computer games and robotics, supply chain researchers and companies are interested in its potential in inventory management. We provide a rigorous performance evaluation of DRL in three classic and intractable inventory problems: lost sales, dual sourcing, and multi-echelon inventory management. Methodology: We model each inventory problem as a Markov decision process and apply and tune the Asynchronous Advantage Actor-Critic (A3C) DRL algorithm for a variety of parameter settings. Results: We demonstrate that the A3C algorithm can match the performance of the state-of-the-art heuristics and other approximate dynamic programming methods. Although the initial tuning was computationally demanding and time demanding, only small changes to the tuning parameters were needed for the other studied problems. Managerial implications: Our study provides evidence that DRL can effectively solve stationary inventory problems. This is especially promising when problem-dependent heuristics are lacking. Yet, generating structural policy insight or designing specialized policies that are (ideally provably) near optimal remains desirable.
Revisión Sistemática sobre salud digital en la gestión del absentismo y el retorno al trabajo
Authors: Arevalo Alonso Gema
Published: January 2022

Objetivo: El uso de tecnologías digitales se ha convertido en una estrategia para incrementar la efectividad de los servicios de salud. El objetivo de este estudio es analizar el impacto del uso de las herramientas de salud digital sobre la gestión del absentismo laboral y el retorno al trabajo.

Métodos: Se realizó una revisión sistemática siguiendo el formato PRISMA en las bases de datos electrónicas Pubmed, Cochrane, Web of Science, CINAHL y ScienceDirect. La calidad metodológica fue analizada a partir de las herramientas de evaluación crítica del Joanna Briggs Institute (JBI).

Resultados: Un total de 24 estudios fueron incluidos en esta revisión, de los cuales se extrajeron resultados muy heterogéneos debido a la variabilidad de métodos de medición. El uso de herramientas digitales contribuía, mayoritariamente, en la mejora de las cifras de absentismo y de retorno a la actividad laboral, no evidenciándose en ninguno que ocasionara un perjuicio. Adicionalmente, en 10 de los estudios se obtuvieron datos sobre presentismo y otros factores influyentes en el absentismo y el retorno a la actividad laboral, como fueron la resiliencia, el compromiso laboral y el desapego psicológico al trabajo.

Conclusiones: El uso de herramientas de salud digital contribuye positivamente en la recuperación de los trabajadores que se encuentran en situación de incapacidad temporal, facilitando la gestión del retorno al trabajo y, por consiguiente, favoreciendo la reducción del absentismo laboral.
The business of recovery: embedding health in economies after COVID-19
Authors: McIntosh Bryan , Sheppy Bruce , Moscone Francesco , Areal Andreia
Published: January 2022

As the UK rebuilds and recovers after the COVID-19 pandemic, tackling socioeconomic inequalities will become increasingly pertinent. The link between health and wealth has been long established, with those at the highest risk of illness also being less likely to access healthcare. The pandemic has highlighted these disparities, with higher morbidity and mortality rates seen in deprived areas, as well as among ethnic minority communities. Leaders and clinicians across the NHS and social care have called for a ‘reset’ in the way healthcare is planned, commissioned and delivered in the UK. There is a growing need for a holistic approach to disease prevention, and it is crucial that government agencies take a strong role in addressing the wider determinants of health.
Suicide prevention: How nurses can make all the difference
Authors: Greener Mark
Published: January 2022

Recognising the signs of a suicide can turn a patient's life around, writes Mark Greener