bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying postnatal anxiety: comparison of self-identified and self-reported anxiety using the Edinburgh Postnatal Depression Scale
Authors: Fellmeth Gracia , Harrison Siân , McNeill Jenny , Lynn Fiona , Redshaw Maggie , Alderdice Fiona
Published: March 2022

Background

Identifying women with perinatal anxiety is important in order to provide timely support and prevent adverse outcomes. Self-report instruments are commonly used in maternity settings. An alternative is to ask women directly whether they self-identify as having anxiety. We examine the agreement between self-reported and self-identified anxiety at 3 months postpartum and compare the characteristics of women with self-reported and self-identified anxiety.

Methods

A secondary analysis of national maternity surveys conducted in 2014 in England and Northern Ireland was conducted. Self-reported anxiety was assessed using the Edinburgh Postnatal Depression Scale anxiety subscale (EPDS-3A). Agreement between self-reported and self-identified anxiety was measured using Cohen’s kappa. Logistic regression was used to identify characteristics of women in each group.

Results

In our sample of 6752 women, 14.2% had self-reported anxiety, 5.9% had self-identified anxiety and 3.5% were positive on both measures. Among those with self-identified anxiety, 58.1% also had self-reported anxiety. Of those with self-reported anxiety, 24.4% also had self-identified anxiety. Statistical agreement between the two measures was minimal with Cohen’s kappa 0.283 at an EPDS-3A threshold of ≥6. Among both self-identified and self-reported anxiety groups, psychological factors were the strongest associated factors. Women with self-reported anxiety had higher odds of being from Northern Ireland (OR 1.81); having a mixed or unhappy reaction to the pregnancy (OR 1.65); living without a partner (aOR 1.37); and antenatal depression (aOR 1.32). Women with self-identified anxiety had higher odds of physical problems (OR 1.84); and being of Black or minority ethnicity (OR 0.39).

Conclusions

Asking postnatal women directly whether they self-identify as having anxiety identifies a different group of women from those who score highly on self-report measures. Women with self-identified anxiety may benefit from further follow-up and support.
Planned vaginal and planned cesarean delivery outcomes in pregnancies complicated with pregestational type 1 diabetes – A three-year academic tertiary hospital cohort study
Authors: Kruit Heidi , Mertsalmi Saara , Rahkonen Leena
Published: March 2022

Background

Finland has the world’s highest incidence of 62.5/100000 of diabetes mellitus type 1 (DM1) with approximately 400 (1%) DM1 pregnancies annually. Pregnancies complicated by DM1 are accompanied with increased risk for perinatal morbidity and mortality. Timing and mode of delivery are based on the risk of complications, yet the data on labor induction is limited. The aim of this study was to compare delivery outcomes in planned vaginal (VD) and planned cesarean deliveries (CD) in late preterm and term DM1 pregnancies, and to evaluate the feasibility of labor induction.

Materials and Methods

Pregnant women with DM1, live singleton fetus in cephalic presentation ≥34 gestational weeks delivering in Helsinki University Hospital between January 1st 2017 and December 31st 2019 were included. The primary outcome were the rates of adverse maternal and perinatal outcome. The study population was classified according to the 1980-revised White’s classification. Statistical analyses were performed by IBM SPSS Statistics for Windows.

Results

Two hundred four women were included, 59.8% (n = 122) had planned VD. The rate of adverse maternal outcome was 27.5% (n = 56), similar between the planned modes of delivery and White classes. The rate of perinatal adverse outcome was 38.7% (n = 79), higher in planned CD (52.4% vs. 29.5%;p = 0.001). The most common adverse perinatal event was respiratory distress (48.8% vs. 23.0%;p <  0.001). The rate of adverse perinatal outcome was higher in White class D + Vascular compared to B + C (45.0% vs. 25.0%, OR after adjustment by gestational age 2.34 [95% CI 1.20–4.50];p = 0.01). The total rate of CD was 63.7% (n = 130), and 39.3% (n = 48) in planned VD. Women with White class D + Vascular more often had emergency CD compared to White Class B + C (48.6% vs. 25.0%;p = 0.009). The rate of labor induction was 51%, being 85.2% in planned VD. The rate of VD in induced labor was 58.7% (n = 61) and the rate of failed induction was 14.1% (n = 15).

Conclusion

Planned VD was associated with lower rate of adverse perinatal outcome compared to planned CS, with no difference in the rates of adverse maternal outcome. Induction of labor may be feasible option but should be carefully considered in this high-risk population.
Primary central nervous system lymphoma high incidence and poor survival in Finnish population-based analysis
Authors: Puhakka Inka , Kuitunen Hanne , Jäkälä Pekka , Sonkajärvi Eila , Turpeenniemi-Hujanen Taina , Rönkä Aino , Selander Tuomas , Korhonen Miika , Kuittinen Outi
Published: March 2022

Background

We report here the first population-based incidence rates and prognosis of primary central nervous system lymphoma (PCNSL) in Finland.

Methods

Finnish Cancer Registry data by histological diagnosis and tumor location (2007–2017) for cases with diffuse large B-cell lymphoma.

Results

During 2007–2017, 392 new cases of PCNSL were reported (195 males, 197 females). The average age-adjusted incidence was 0.68/100,000 person-years. Incidence for males was 0.74/100,000 and for females 0.63/100,000, respectively. The incidence was highest, 2.93/100,000, among people aged 75–79 years. Concerning all cases in 2007–2017 the 2-year age-adjusted relative survival rate was 33% and the corresponding 5-year survival rate was 26%. Among patients under the age of 70, the age-adjusted 5-year relative survival rate increased from 36% in 2007–2012 to 43% for 2013–2017. Among patients aged 70+ the corresponding survival rates were poor, 7 and 9%.

Conclusions

PCNSL incidence in Finland is among the highest reported in the world. The annual increase in incidence was 2.4%. The prognosis is still dismal, especially in elderly patients.
Magnitude of common mental disorders and factors associated among people living in Addis Ababa Ethiopia 2018: community based cross-sectional study
Authors: Habtamu Yodit , Admasu Kalkidan , Tullu Mikiyas , Kebede Alem
Published: March 2022

Background

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms, affecting individuals in different age groups, causes suffering to the individuals, families and community.

Objective

This study assessed the magnitude of Common mental disorder and associated factors among people living in Addis Ababa, Ethiopia.

Methods

Community based cross sectional study design was conducted from November 1 to 30, 2018 among people living in Addis Ababa, Ethiopia. Multistage sampling technique was used to get a total of 755 samples. Common Mental Disorder was assessed through interview using Self-Reported questionnaire (SRQ-20). The collected data were coded, entered into EPI-Info 7 and analysed by using SPPS version 20. Descriptive, analytical statistical procedure; bivariate and multivariate binary logistic regressions with odds ratios and 95% confidence interval was employed. The statistical significance was accepted atpvalue < 0.05.

Result

In this study a total of 723 study subjects were participated, with response rate of 95.7%.The prevalence of common mental disorders was 24.7% with [95%CI; 21.6 – 27.7]. Females (AOR=2.1; 95% CI; 1.39- 3.23), Divorced/widowed (AOR=2.55; 95% CI; 1.16- 5.59), daily labourers (AOR=2.52; 95% CI; 1.3- 4.88, chronic medical illness (AOR=4.5; 95% CI; 2.46- 8.24). are independent predictors of CMD and educational status (primary, secondary and diploma) was positively associated with CMD. in this study. Regarding education (primary, secondary and diploma) (AOR=0.34; 95% CI; 0.17-0.66) and (AOR=0.35; 95% CI; 0.19-0.67) has positively associated with common mental disorders.

Conclusion

The prevalence of common mental disorders was found high. Female sex, marital status like Divorced/Widowed, daily labour workers and chronic medical illness were found to be independent predictors of CMD and educational status (primary, secondary school and diploma holders) was were found to be protective factors.
Blood biomarkers of post-stroke depression after minor stroke at three months in males and females
Authors: Qiu Xiuli , Wang He , Lan Yan , Miao Jinfeng , Pan Chensheng , Sun Wenzhe , Li Guo , Wang Yanyan , Zhao Xin , Zhu Zhou , Zhu Suiqiang
Published: March 2022

Background

Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke. Studies on the underlying mechanisms and biological markers of sex differences in PSD are of great significance, but there are still few such studies. Therefore, the main objective of this study was to investigate the association of biomarkers with PSD at 3 months after minor stroke in men and women.

Methods

This was a prospective multicenter cohort study that enrolled 530 patients with minor stroke (males, 415; females, 115). Demographic information and blood samples of patients were collected within 24 h of admission, and followed up at 3 months after stroke onset. PSD was defined as a depressive disorder due to another medical condition with depressive features, major depressive-like episode, or mixed-mood features according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Univariate analysis was performed using the chi-square test, Mann–Whitney U test, or t-test. Partial least-squares discriminant analysis (PLS-DA) was used to distinguish between patients with and without PSD. Factors with variable importance for projection (VIP) > 1.0 were classified as the most important factors in the model segregation.

Results

The PLS-DA model mainly included component 1 and component 2 for males and females. For males, the model could explain 13% and 16.9% of the variables, respectively, and 29.9% of the variables in total; the most meaningful predictors were exercise habit and fibrinogen level. For females, the model could explain 15.7% and 10.5% of the variables, respectively, and 26.2% of the variables in total; the most meaningful predictors in the model were brain-derived neurotrophic factor (BDNF), magnesium and free T3. Fibrinogen was positively correlated with the Hamilton Depression Scale-17 items (HAMD-17) score. BDNF, magnesium, and free T3 levels were negatively correlated with the HAMD-17 score.

Conclusions

This was a prospective cohort study. The most important markers found to be affecting PSD at 3 months were fibrinogen in males, and free T3, magnesium, and BDNF in females.

Trial registration

ChiCTR-ROC-17013993.
Official social media and its impact on public behavior during the first wave of COVID-19 in China
Authors: Liu Huan
Published: March 2022

Background

During the COVID-19 pandemic, official social media became a critical channel for the public to obtain pandemic information. No matter the positive function or negative effect of information dissemination, it involves the public’s risk perception and behavior. This study was designed to contribute to the existing research on how official social media information quality (IQ) and risk perception (RP) affect preventive behavior (PB) and continued use behavior (CB) of official social media during the first wave of COVID-19.

Methods

The required data were extracted from a national online survey of the Chinese Mainland during March 24–30 2020, a random sample was asked to participate in the survey (n = 666). Data analysis was performed using regression analysis, structural equation modeling, mediating effect analysis, and one-way ANOVA analysis.

Results

The results show that IQ (10.010 ± 3.568) has direct and indirect positive impact on PB (9.475 ± 3.571), and has a low significant positive indirect impact on CB (3.739 ± 1.566). The IQ has a significant positive impact on RP (β = 0.548), which show that there is no “risk perception paradox” in COVID-19. Furth more, this study also provides new evidence indicating that RP mediates the relationship between IQ and PB. According to the region, gender, age and annual income, and there are significant differences in PB and CB.

Conclusion

The study findings have remarkable implications for improving the information quality and public behaviors. Too high or too low level of risk perception is not conducive to pandemic prevention and control. Official social media should indirectly affect information flow through the reasonable supply of pandemic information and constantly improve the quality of pandemic information to avoid public’s undue panic and excessive health concerns during this ongoing outbreak and subsequent national public emergency events.
Rehabilitative interventions for ischaemic digital ulcers, pain, and hand functioning in systemic sclerosis: a prospective before-after study
Authors: Scaturro Dalila , Guggino Giuliana , Terrana Pietro , Vitagliani Fabio , Falco Vincenzo , Cuntrera Daniele , Benedetti Maria Grazia , Moretti Antimo , Iolascon Giovanni , Letizia Mauro Giulia
Published: March 2022

Background

Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vasculopathy, cellular inflammation, fibrosis of the skin associated with multiple internal organs involvement. Ischaemic digital ulcers (IDU) of the hands commonly occur in patients with SSc adversely affecting functional independence.

Purpose

Aim of the study is to investigate the effectiveness of a rehabilitation protocol based on the combined use of ultrasound (US) therapy and therapeutic exercise in terms of ulcers healing, pain relief, and hand functioning in patients affected by SSc with IDUs. Moreover, we also investigated the safety of the proposed intervention.

Study design

Prospective before-after study.

Methods

We included 20 patients with IDUs secondary to SSc. All patients were treated with US combined with manual therapy, including McMennel joint manipulation, pompage mobilization technique and connective tissue massage, for 10 sessions. We evaluated softness, dyschromia, pain, and hand mobility using the Pressure Sore Status Tool (PSST), the Numerical Rating Scale (NRS), and the Duruoz Hand Index (DHI) at T0 and at the end of the treatment (T1).

Results

Treatment with US combined with manual therapy significantly reduced ulcers depth, improved ulcers margins, and reduced periwound skin damage (median PSST score 16 at T1, p<0.0001). Moreover, significant benefits were reported in terms of pain relief (NRS 3 at T1; p<0.0005), and hand function (DHI score 19 at T1; p<0.0005). Finally, this approach seems to be safe, without side effects reported at the end of treatment, along with an optimal compliance.

Conclusion

Therapeutic US combined with manual therapy should be used as additional intervention to manage IDUs in SSc patients.
Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patellar fracture
Authors: Yang Weijie , Wang Haicheng , Wei Qun , Ding Kai , Jia Yuxuan , Li Chao , Zhu Yanbin , Chen Wei
Published: March 2022

Purpose

This study aimed to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures.

Methods

Patients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patients in both groups did not perform preoperative off-bed weight-bearing exercises. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Variables were evaluated between the two groups using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis.

Results

During the study period, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. In DVT patients, 85.4%(41/48) were injured, 8.3%(4/48) were not injured, and 6.3%(3/48) were lower limbs. Multivariate analysis showed that male (male vs. female, odds ratio, OR = 2.25), delayed from injury to DUS (in each day, OR = 1.29), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT.

Conclusions

Despite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, and encourage the early targeted use of anti-thromboembolic agents to reduce DVT occurrence.
Does ultrasound evaluation of the axilla increase the rate of axillary lymph node dissection in early stage clinically node negative breast cancer patients?
Authors: Vasigh Mahtab , Meshkati Yazd Seyed Mostafa , Karoobi Mohammadreza , Hajebi Reza , Yazdankhah Kenari Adel
Published: March 2022

Background

Management and axillary staging of breast cancer has become less invasive and more conservative, over the decades. Considering Z011, axillary lymph node dissection (ALND) can be avoided in T1-2 N0-1 breast cancers with one or two positive sentinel lymph nodes (SLNs), if they are candidates for breast conserving surgery and radiotherapy. The aim of this study was to recognize if pre-operative axillary US evaluation in early-stage breast cancer could lead to more ALND in post Z011 era.

Method

463 breast cancer patients were evaluated. 368 early-stage breast cancer patients (T1-2 N0) were included. We did not perform axillary US in early stage clinically node negative patients; however, 97 patients had axillary US prior to our visit. If axillary US could detect more than two suspicious LNs, US guided biopsy was performed. The remaining clinically node negative patients underwent upfront SLNB. ALND was performed if more than two SLNs were metastatic, or US-guided ALN biopsy proved metastatic involvement.

Results

97 patients had axillary US evaluation before the surgery. 67 patients (69.2%) did not have any suspicious US detected axillary LNs, 17 patients (17.5%) had one, 7 patients (7.2%) had two, and 6 patients (6.2%) had more than two suspicious LNs according to their axillary US evaluation. Those with more than two suspicious LNs underwent ALN US-guided biopsy. Metastatic involvement of the LNs was proved in all of them and they underwent upfront ALND. ALND revealed more than 2 metastatic LNs in 2/6 patients (33.3%). 91 patients who were evaluated by axillary US, had less than two US detected suspicious LNs and underwent SLNB. Amongst 24 patients with one or two US detected suspicious LNs, 1/24 patient had more than two positive SLNs and underwent ALND. In this group 15.6% underwent ALND and 5.2% of them were unnecessary according to the recent guidelines. Axillary US had a false positive rate of 36.6%. The sensitivity of axillary US in distinguishing patients with more than two suspicious LNs in clinically node negative patients was 25%. In the second group (without pre-operative axillary US evaluation), SLNB was performed. 204/272 patients (75%) did not have LN metastasis. 54/272 patients (19.9%) had one or two metastatic SLNs and according to Z011, ALND was omitted. 5.1% had more than two metastatic SLNs and underwent ALND.

Conclusion

US evaluation of the axilla in early stage, clinically node negative breast cancer patients, is not sensitive enough to recognize more than two metastatic ALNs. It leads to more unnecessary ALND. Despite the small number of patients in this study, these results question the rationale of axillary US guided biopsy in low burden (less than two) suspicious LNs. looking for an imaging modality with a higher sensitivity in detecting the Burdon of axillary metastatic involvement is mandatory.
Using noninvasive anthropometric indices to develop and validate a predictive model for metabolic syndrome in Chinese adults: a nationwide study
Authors: Xu Qian , Wang Li , Ming Jie , Cao Hongwei , Liu Tao , Yu Xinwen , Bai Yuanyuan , Liang Shengru , Hu Ruofan , Wang Li , Chen Changsheng , Zhou Jie , Ji Qiuhe
Published: March 2022

Purpose

Metabolic syndrome (Mets) is a pathological condition that includes many abnormal metabolic components and requires a simple detection method for rapid use in a large population. The aim of the study was to develop a diagnostic model for Mets in a Chinese population with noninvasive anthropometric and demographic predictors.

Patients and methods

Least absolute shrinkage and selection operator (LASSO) regression was used to screen predictors. A large sample from the China National Diabetes and Metabolic Disorders Survey (CNDMDS) was used to develop the model with logistic regression, and internal, internal-external and external validation were conducted to evaluate the model performance. A score calculator was developed to display the final model.

Results

We evaluated the discrimination and calibration of the model by receiver operator characteristic (ROC) curves and calibration curve analysis. The area under the ROC curves (AUCs) and the Brier score of the original model were 0.88 and 0.122, respectively. The mean AUCs and the mean Brier score of 10-fold cross validation were 0.879 and 0.122, respectively. The mean AUCs and the mean Brier score of internal–external validation were 0.878 and 0.121, respectively. The AUCs and Brier score of external validation were 0.862 and 0.133, respectively.

Conclusions

The model developed in this study has good discrimination and calibration performance. Its stability was proved by internal validation, external validation and internal-external validation. Then, this model has been displayed by a calculator which can exhibit the specific predictive probability for easy use in Chinese population.
Oral adverse events due to zinc deficiency after pancreaticoduodenectomy requiring continuous intravenous zinc supplementation: a case report and literature review
Authors: Hata Hironobu , Ota Yojiro , Uesaka Katsuhiko , Yamazaki Yutaka , Murata Tsubasa , Murai Chika , Yoshikawa Kazuhito , Imamachi Kenji , Yurikusa Takashi , Kitagawa Yoshimasa
Published: March 2022

Background

Zinc is mainly absorbed in the duodenum and proximal jejunum, which are removed during pancreaticoduodenectomy (PD). Little is known about the adverse oral events and skin disorders caused by zinc deficiency after PD. Herein, we reviewed studies on the development of zinc deficiency after PD and reported about a patient with zinc deficiency after PD who required home intravenous zinc replacement.

Case presentation

A 73-year-old woman with glossitis, taste disorder, and acrodermatitis enteropathica-like eruption on her fingers presented to the Division of Dentistry and Oral Surgery 69 days after PD. Her serum zinc level markedly decreased to 30 μg/dL. Oral zinc administration was inadequate to treat hypozincemia after PD; therefore, multi-trace elements were injected intravenously during readmission. Her serum zinc levels recovered, and her lesions gradually improved. Furthermore, a central venous port was implanted to maintain normal serum zinc levels, and she continued self-injecting zinc at home.

Conclusions

Zinc deficiency after PD rarely occurs. The clinical oncologist community, including dentists responsible for the oral care of cancer patients, should be aware of the oral adverse events, such as dysgeusia, glossitis, and oral pain, associated with zinc deficiency after cancer surgery and that induced by chemotherapy or head and neck radiation therapy.
Measuring impostor phenomenon in healthcare simulation educators: a validation of the Clance Impostor Phenomenon Scale and Leary Impostorism Scale
Authors: Freeman Kirsty J. , Houghton Stephen , Carr Sandra E. , Nestel Debra
Published: March 2022

Background

Impostor phenomenon is a term used to describe feelings of intellectual and professional fraudulence. The Clance Impostor Phenomenon Scale and the Leary Impostorism Scale are two self-report measures used to determine whether an individual experiences impostor phenomenon. This study examined the psychometric properties of both measures in healthcare simulation educators.

Methods

The study sample comprised 148 educators, 114 (77%) females, 34 (23%) males, who completed an online version of each instrument. Exploratory factor analysis was used to examine the factor structure of the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale.

Results

Exploratory factor analysis revealed that for both instruments a one-factor solution best fit the data, suggesting all items in both measures fit onto a single theoretical construct.

Both instruments demonstrated high internal reliability, with the Cronbach’s alpha for the Clance Impostor Phenomenon Scale being α = .96 and the Leary Impostorism Scale α = .95.

Conclusions

This study suggests that impostor phenomenon as measured by the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale is a unidimensional construct among healthcare simulation educators. With a growing interest in impostor phenomenon, the present findings will assist researchers to evaluate the phenomenon in healthcare settings.
Survival prediction in acute myeloid leukemia using gene expression profiling
Authors: Lai Binbin , Lai Yanli , Zhang Yanli , Zhou Miao , OuYang Guifang
Published: March 2022

Background

Acute myeloid leukemia (AML) is a genetically heterogeneous blood disorder. AML patients are associated with a relatively poor overall survival. The objective of this study was to establish a machine learning model to accurately perform the prognosis prediction in AML patients.

Methods

We first screened for prognosis-related genes using Kaplan–Meier survival analysis in The Cancer Genome Atlas dataset and validated the results in the Oregon Health & Science University dataset. With a random forest model, we built a prognostic risk score using patient’s age, TP53 mutation, ELN classification and normalized 197 gene expression as predictor variable. Gene set enrichment analysis was implemented to determine the dysregulated gene sets between the high-risk and low-risk groups. Similarity Network Fusion (SNF)-based integrative clustering was performed to identify subgroups of AML patients with different clinical features.

Results

The random forest model was deemed the best model (area under curve value, 0.75). The random forest-derived risk score exhibited significant association with shorter overall survival in AML patients. The gene sets of pantothenate and coa biosynthesis, glycerolipid metabolism, biosynthesis of unsaturated fatty acids were significantly enriched in phenotype high risk score. SNF-based integrative clustering indicated three distinct subsets of AML patients in the TCGA cohort. The cluster3 AML patients were characterized by older age, higher risk score, more frequent TP53 mutations, higher cytogenetics risk, shorter overall survival.

Conclusions

The random forest-based risk score offers an effective method to perform prognosis prediction for AML patients.
Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study
Authors: Nyande Felix Kwasi , Ricks Esmeralda , Williams Margaret , Jardien-Baboo Sihaam
Published: March 2022

Background

Over half of global deaths among children under five years of age occur in sub-Saharan Africa. Prompt and consistent access to and utilisation of child healthcare services improves child health outcomes. However, socio-cultural barriers impede the utilisation of child healthcare services among rural dwellers in Ghana. There is a paucity of studies that explore the experiences of nurses and caregivers regarding the socio-cultural barriers to the delivery and utilisation of child healthcare services in rural areas in Ghana such as the Nkwanta South Municipality.

Purpose

The purpose of this study was to explore the experiences of nurses and caregivers regarding the socio-cultural barriers that impede the delivery and utilisation of child healthcare services by caregivers for their children in the Nkwanta South Municipality, Ghana.

Methods

Data were collected through semi-structured interviews conducted with a purposive sample of ten nurses and nine caregivers of children under five years of age who utilised the available child healthcare services in a rural setting. The consent of all participants was sought and given before interviews were conducted. Data analysis entailed coding and the generation of themes the codes.

Results

The exploration of experiences of nurses and caregivers of children under-five years of age revealed that certain socio-cultural beliefs and practices, language barriers and reliance of caregivers on self-medication were the main socio-cultural barriers that impeded the delivery and utilisation of child healthcare services in the Nkwanta South Municipality.

Conclusion

Nurses and caregivers experienced several socio-cultural barriers which either delayed care seeking by caregivers for their sick children or interfered with the smooth and prompt delivery of needed child healthcare services by nurses. Some of the barriers negatively affected the interaction between nurses and caregivers with the tendency to affect subsequent child healthcare service utilisation. It is recommended that healthcare managers and nurses should foster close collaboration with caregivers and community leaders to address these socio-cultural barriers and facilitate prompt and consistent utilisation of child healthcare service in rural areas.
Expanding the phenotype associated with SMARCC2 variants: a fetus with tetralogy of Fallot
Authors: Sun Hairui , Zhang Siyao , Wang Jingyi , Zhou Xiaoxue , Zhang Hongjia , Yang Huixia , He Yihua
Published: March 2022

Background

Coffin-Siris syndrome-8 (CSS8) is a rare autosomal dominant disorder caused by variants in SMARCC2, a core subunit of the chromatin-remodeling complex BRG1-associated factor (BAF). The clinical characteristics of this disorder have not been entirely determined because of the rarity of clinical reports. The BAF complex plays a crucial role in embryogenesis and cardiac development, and pathogenic variants in genes encoding the components of the BAF complex have been associated with congenital heart disease (CHD). However, variants in SMARCC2 have not been reported in patients with CHD.

Case presentation

A 28-year-old primigravida was referred at 24 weeks gestation for prenatal echocardiography. The echocardiographic findings were consistent with a prenatal ultrasound diagnosis of tetralogy of Fallot (TOF). After detailed counseling, the couple decided to terminate the pregnancy and undergo genetic testing. A trio (fetus and the parents) whole-exome sequencing (WES) and copy number variation sequencing (CNV-seq) were performed. CNV-seq identified no chromosomal abnormalities. WES analysis revealed a pathogenic, de novo heterozygous frameshift variant in SMARCC2 (NM_003075.5: c.3561del, p.Leu1188fs). The genetic diagnosis of CSS8 was considered given the identification of the SMARCC2 pathogenic variant.

Conclusions

We report the first prenatal case with the SMARCC2 variant. The presence of CHD further broadens the phenotypic spectrum of SMARCC2-related disease.
A microenvironment-responsive FePt probes for imaging-guided Fenton-enhanced radiotherapy of hepatocellular carcinoma
Authors: Zhao Xingyang , Sun Xiang , Huang Wenchao , Chen Ronghe , Chen Kang , Nie Liming , Fang Chihua
Published: March 2022

Hepatocellular carcinoma (HCC) continues to be one of the most fatal malignancies with increasing morbidity, and potent therapeutics are urgently required given its insensitivity to traditional treatments. Here, we have developed a microenvironment-responsive FePt probes for the highly efficient Fenton-enhanced radiotherapy (FERT) of HCC. The selective release of Fe2+ in the acidic tumor microenvironment, but not in normal tissue, together with enhanced levels of hydrogen peroxide produced through the Pt radiosensitization effect, facilitates the generation of an enormous amount of hydroxyl radicals through the Fenton reaction, thereby extending the radiotherapeutic cascade and realizing a powerful therapeutic efficacy for HCC. Moreover, the “burst” release of Fe2+ contributes to the T2-to-T1 magnetic resonance imaging (MRI) switching effect, which informs the release of Fe2+, making imaging-guided cancer therapy feasible. This work not only breaks the bottleneck of traditional radiotherapy for HCC while minimally affecting normal tissues, but also provides a new strategy for FERT imaging guidance.

Graphical Abstract
Integrated analysis of ceRNA network reveals potential prognostic Hint1-related lncRNAs involved in hepatocellular carcinoma progression
Authors: Zhang Cheng , Bao Tianhao , Ke Yang , Liu Xin , Wang Xinghong , Liao Weiran , He Yutao , Wang Lin
Published: March 2022

Background

Hint1 is a novel tumor suppressor gene, and inactivation of its expression is closely associated with the carcinogenesis of a variety of malignancies. The effects of Hint1 deficiency on the competing endogenous RNA (ceRNA) regulatory network in the context of HCC remains to be fully characterized. This study aims to explore Hint1-related hub lncRNAs in HCC and to establish a reliable prognostic model for HCC patients based on these hub lncRNAs.

Methods

lncRNA + mRNA microarray was used to identify differentially expressed (DE) lncRNAs and mRNAs in Huh7 cells before and after Hint1 knockdown. A Hint1-related ceRNA network was mapped by bioinformation technology. The DEmRNAs in the network were analyzed via GO and KEGG enrichment analyses. Hub DElncRNAs associated with HCC patient prognosis were then detected through univariate and multivariate Cox regression analyses and were incorporated into a prognostic model. The prognostic value of this model was then assessed through the use of Kaplan-Meier curves, time-related ROC analyses, and nomograms. We also utilized Kaplan-Meier curves to validate the relationship between hub lncRNAs and the overall survival (OS) of HCC patients. Finally, A Hint1-related core ceRNA network based on the hub DElncRNAs and DEmRNAs was mapped.

Results

We identified 417 differentially expressed DElncRNAs and 2096 DEmRNAs in Huh7 cells before and after Hint1 knockdown. Three hub DElncRNAs (LINC00324, SNHG3, and DIO3OS) in the Hint1-associated ceRNA network were screened out using univariate and multivariate Cox regression analyses. A hepatocellular carcinoma (HCC) prognostic risk-scoring model and nomogram were constructed using these three hub lncRNAs, and it was confirmed that the risk score of the model could be used as an independent predictor of HCC prognosis. A Hint1-related core ceRNA network based on the hub DElncRNAs and DEmRNAs was also mapped.

Conclusion

We constructed a reliable prognostic model for HCC patients based on three Hint1-related hub lncRNAs, and we believe these three hub lncRNAs may play critical roles in hepatocarcinogenesis, and progression.
Global analysis of miRNA-mRNA regulation pair in bladder cancer
Authors: Fan Xingchen , Zou Xuan , Liu Cheng , Peng Shuang , Zhang Shiyu , Zhou Xin , Wang Tongshan , Zhu Wei
Published: March 2022

Purpose

MicroRNA (miRNA) is a class of short non-coding RNA molecules that functions in RNA silencing and post-transcriptional regulation of gene expression. This study aims to identify critical miRNA-mRNA regulation pairs contributing to bladder cancer (BLCA) pathogenesis.

Patients and methods

MiRNA and mRNA microarray and RNA-sequencing datasets were downloaded from gene expression omnibus (GEO) and the cancer genome atlas (TCGA) databases. The tool of GEO2R and R packages were used to screen differential miRNAs (DE-miRNAs) and mRNAs (DE-mRNAs) and DAVID, DIANA, and Hiplot tools were used to perform gene enrichment analysis. The miRNA-mRNA regulation pair were screened from the experimentally validated miRNA-target interactions databases (miRTarbase and TarBase). Twenty-eight pairs of BLCA tissues were used to further verify the screened DE-miRNAs and DE-mRNAs by quantitative reverse transcription and polymerase chain reaction (qRT-PCR). The diagnostic value of the miRNA-mRNA regulation pairs was evaluated by receiver operating characteristic curve (ROC) and decision curve analysis (DCA). The correlation analysis between the selected miRNA-mRNAs regulation pair and clinical, survival and tumor-related phenotypes was performed in this study.

Results

After miRTarBase, the analysis of 2 miRNA datasets, 6 mRNA datasets, and TCGA-BLCA dataset, a total of 13 miRNAs (5 downregulated and 8 upregulated in BLCA tissues) and 181 mRNAs (72 upregulated and 109 downregulated in BLCA tissues) were screened out. The pairs of miR-17-5p (upregulated in BLCA tissues) and TGFBR2 (downregulated in BLCA tissues) were verified in the external validation cohort (28 BLCA vs. 28 NC) using qRT-PCR. Areas under the ROC curve of the miRNA-mRNA regulation pair panel were 0.929 (95% CI: 0.885–0.972, p < 0.0001) in TCGA-BLCA and 0.767 (95% CI: 0.643–0.891, p = 0.001) in the external validation. The DCA also showed that the miRNA-mRNA regulation pairs had an excellent diagnostic performance distinguishing BLCA from normal controls. Correlation analysis showed that miR-17-5p and TGFBR2 correlated with tumor immunity.

Conclusions

The research identified potential miRNA-mRNA regulation pairs, providing a new idea for exploring the genesis and development of BLCA.
Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial
Authors: Rodríguez Carmen , Jara-Palomares Luis , Tabernero Eva , Tenes Andrés , González Sara , Briceño Winnifer , Lobo José Luis , Morillo Raquel , Bikdeli Behnood , Jiménez David
Published: March 2022

Background

For patients with suspected pulmonary embolism (PE), age- or clinically-adjusted D-dimer threshold level can be used to define a negative test that safely excludes PE and reduces the use of imaging. However, the utility of this approach in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation is undefined.

Methods

We ran an analysis of the patients hospitalized for COPD exacerbation and randomized to the intervention in the SLICE trial. Using the conventional strategy as the reference, we compared the proportion of patients with a negative D-dimer result, and the negative predictive value and sensitivity of three D-dimer threshold strategies for initial PE or subsequent diagnosis of venous thromboembolism (VTE): the age-adjusted strategy, the Wells-adjusted strategy, and the YEARS-adjusted strategy.

Results

We included 368 patients. Using a conventional threshold, 182 (49.5%) patients had negative D-dimer values, of whom 1 (0.6%) had PE (sensitivity, 94.1%). The use of an age-adjusted threshold increased the number of patients in whom PE could be excluded from 182 to 233 patients (63.3%), and the proportion of false-negative findings increased from 0.5% to 1.7% (sensitivity, 76.5%). With the use of the Wells or YEARS strategies, 64.4% and 71.5% had negative values, and the proportion of false-negative findings was 2.5% (sensitivity, 64.7%) and 2.7% (sensitivity, 58.8%), respectively.

Conclusions

In patients hospitalized for COPD exacerbation, compared with the conventional strategy, age- or clinically-adjusted strategies of D-dimer interpretation were associated with a larger proportion of patients in whom PE was ruled out with a higher failure rate.

Trial Registration

ClinicalTrials.gov number: NCT02238639.
Sec23a inhibits the self-renewal of melanoma cancer stem cells via inactivation of ER-phagy
Authors: Sun Zhiwei , Liu Doudou , Zeng Bin , Zhao Qiting , Li Xiaoshuang , Chen Hao , Wang Jianyu , Rosie Xing H.
Published: March 2022

Background

The genesis and developments of solid tumors, analogous to the renewal of healthy tissues, are driven by a subpopulation of dedicated stem cells, known as cancer stem cells (CSCs), that exhibit long-term clonal repopulation and self-renewal capacity. CSCs may regulate tumor initiation, growth, dormancy, metastasis, recurrence and chemoresistance. While autophagy has been proposed as a regulator of the stemness of CSCs, the underlying mechanisms requires further elucidation.

Methods

The CSC component in human melanoma cell lines M14 and A375 was isolated and purified by repetitive enrichments for cells that consistently display anchorage-independent spheroid growth. The stemness properties of the CSCs were confirmed in vitro by the expressions of stemness marker genes, the single-cell cloning assay and the serial spheroid formation assay. Subcutaneous tumor transplantation assay in BALB/c nude mice was performed to test the stemness properties of the CSCs in vivo. The autophagic activity was confirmed by the protein level of LC3 and P62, mRFP-LC3B punta and cytoplasmic accumulation of autolysosomes. The morphology of ER was detected with transmission electron microscopy.

Results

In the present study, by employing stable CSC cell lines derived from human melanoma cell lines M14 and A375, we show for the first time that Sec23a inhibits the self-renewal of melanoma CSCs via inactivation of ER-phagy. Mechanistically, inhibition of Sec23a reduces ER stress and consequently FAM134B-induced ER-phagy. Furthermore, TCGA data mining and analysis show that Sec23a is a favorable diagnostic and prognostic marker for human skin cutaneous melanoma.

Conclusion

This study has elucidated a new mechanism underlying the regulation of autophagy on stemness, i.e. CSCs can exploit the SEC23A/ER-stress/FAM134B/ER-phagy axis for the self-renewal. These observations provide new ideas for exploration of the regulatory network of CSC self-renewal to develop CSCs-based therapy strategies for malignant tumors.
Association between dietary saturated fat with cardiovascular disease risk markers and body composition in healthy adults: findings from the cross-sectional BODYCON study
Authors: Ozen Ezgi , Mihaylova Rada , Weech Michelle , Kinsella Sam , Lovegrove Julie A. , Jackson Kim G.
Published: March 2022

Background

Diets high in saturated fatty acids (SFAs) and greater abdominal obesity are both associated with raised low-density lipoprotein cholesterol (LDL-C) concentrations, an independent cardiovascular disease (CVD) risk marker. Although reducing SFA intake is a public health strategy for CVD prevention, the role of body fat distribution on the relationship between SFA and LDL-C is unclear. Therefore, our objective was to investigate whether the association between dietary SFAs and LDL-C concentrations is related to body composition.

Methods

In the BODYCON (impact of physiological and lifestyle factors on body composition) study, 409 adults [mean age 42 ± 16 years and median BMI of 23.5 (21.5–25.9) kg/m2] underwent a measure of body composition by dual energy x-ray absorptiometry, assessment of habitual dietary intake using a 4-day weighed food diary and physical activity level using a tri-axial accelerometer. Blood pressure was measured, and a fasting blood sample was collected to determine cardiometabolic disease risk markers. Correlations between body composition, circulating risk markers and dietary macronutrients were assessed prior to multivariate regression analysis. The effect of increasing intakes of dietary SFA on outcome measures was assessed using ANCOVA after adjusting for covariates.

Results

Abdominal visceral adipose tissue (VAT) mass was moderately positively correlated with total cholesterol (TC), LDL-C, systolic blood pressure (SBP), diastolic blood pressure and HOMA-IR (rs = 0.25–0.44, p < 0.01). In multiple regression analysis, 18.3% of the variability in LDL-C was explained by SFA intake [% total energy (TE)], abdominal VAT mass, carbohydrate%TE and fat%TE intakes. When data were stratified according to increasing SFA%TE intakes, fasting TC, LDL-C and non-high-density lipoprotein-cholesterol were higher in Q4 compared with Q2 (p ≤ 0.03). SBP was higher in Q4 versus Q3 (p = 0.01). Android lean mass was also higher in Q3 versus Q1 (p = 0.02). Other anthropometric and CVD risk markers were not different across quartile groups.

Conclusions

Although dietary SFA was found to explain 9% of the variability in LDL-C, stratification of data according to quartiles of SFA intake did not reveal a dose-dependent relationship with LDL-C concentration. Furthermore, this association appeared to be independent of abdominal obesity in this cohort.

Clinical Trail registration: Trial registration: clinicaltrials.gov as NCT02658539. Registered 20 January 2016, https://clinicaltrials.gov/ct2/show/NCT02658539.
COVID 19—impact on substance use treatment utilization and provision in South Africa
Authors: Harker Nadine , Johnson Kim , Erasmus Jodilee , Myers Bronwyn
Published: March 2022

Background

The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide. The aim of this study was to explore, changes in the number of SUD treatment episodes provided during the height of the pandemic and, SUD treatment providers’ perceptions of the impact of COVID-19-related restrictions on people with SUDs and the delivery of SUD treatment services in South Africa.

Methods

We used administrative data collected as part of the South African Community Epidemiology Network on Drug Use (SACENDU) project to assess whether the number of treatment episodes changed during the height of COVID-19 restrictions. We used data from an online survey of SUD treatment providers to assess providers’ perceptions of the impact of COVID-19 on SUD treatment delivery. Eight seven SUD facilities were recruited to participate in the online survey.

Results

Sixty-three organisations (out of a total of 86) participated in the survey, yielding a 73.2% response rate. About half (n = 30; 47.6%) of the sample thought the need for SUD treatment had remained the same or had increased during the COVID-19 lockdown. Half the sample (n = 32; 50.7%) reported decreased availability of SUD services during COVID-19 lockdowns. Participants believed that the lack of services during COVID-19 lockdown impacted negatively on patients that were enrolled in their programmes and on individuals who wished to access the service. Furthermore, changes in service provision seemed to increase patients’ anxiety, exacerbate pre-existing mental health problems and in some cases were thought to precipitate relapse. In addition, patient disengagement and attrition from treatment were thought to have increased during this period. Whilst 47.6% (n = 30) of providers agreed with the value of the alcohol ban, 23.8% (n = 15) of providers thought it had unintended negative consequences.

Conclusion

Based on the findings it is evident that SUD treatment services in South Africa have been significantly affected during the COVID-19 pandemic and more severely during the onset of the pandemic. Together with service providers, more effective ways should be sought on how to feasibly expand access to SUD treatment for all South Africans and enhance the country’s preparedness for future health emergencies.