bluuebunny/crossref_metadata_2025 huggingface dataset:
Interaction between Physical Activity and Problematic Mobile Phone Use on Suicidality in Chinese College Students
Authors: Xie Yang , Zhu Ming , Wu Xiaoyan , Tao Shuman , Yang Yajuan , Li Tingting , Zou Liwei , Xu Honglv , Tao fangbiao
Published: October 2020

Background: Previous researches have found a relationship between problematic mobile phone use (PMPU) and suicidality. However, few studies have examined the interaction effects between low physical activity (PA) and PMPU on suicidality among college students. This study aimed to examine the interactions of PA and PMPU and their impacts on suicidality in a school-based sample among Chinese college students. Methods: Analysis was based on data from two universities in China, which recruited 4,787 participants. Binary logistic regression models were used to explore the associations of PA, PMPU with suicidal ideation and suicide attempt, as well as the interactions of PA and PMPU on suicidality. Results: The prevalence of suicide attempt and suicidal ideation were 3.5% and 7.2%, respectively. Low PA was significantly associated with suicide attempt (OR=3.48, 95%CI: 2.52-4.81) and suicidal ideation (OR=1.90, 95%CI: 1.46-2.46). PMPU was significantly associated with suicide attempt (OR=3.65, 95%CI: 2.66-5.01) and suicidal ideation (OR=2.83, 95%CI: 2.25-3.54). Interaction analysis indicated that low PA and PMPU were interactively associated with suicide attempt (OR=9.51, 95%CI: 6.15-14.73), RERI=4.85(1.20-8.50), AP=0.51(0.29-0.73), SI=2.32(1.34-4.04). There were no additive interaction effects between PA and PMPU on suicidal ideation.Conclusions: The findings reveal that PA levels and PMPU should be considered in the intervention programs of suicide attempt among college students.
Integrated 3D printing solution to mitigate shortages of airway consumables and personal protective equipment during the COVID-19 pandemic
Authors: Fillat-Gomà Ferran , Coderch-Navarro Sergi , Martínez-Carreres Laia , Monill-Raya Núria , Nadal-Mir Toni , Lalmolda Cristina , Luján Manel , de Haro Candelaria , Blanch Lluís
Published: October 2020

Background: To cope with shortages of equipment during the COVID-19 pandemic, we established a nonprofit end-to-end system to identify, validate, regulate, manufacture, and distribute 3D-printed medical equipment. Here we describe the local and global impact of this system. Methods: Together with critical care experts, we identified potentially lacking medical equipment and proposed solutions based on 3D printing. Validation was based on the ISO 13485 quality standard for the manufacturing of customized medical devices. We posted the design files for each device on our website together with their technical and printing specifications and created a supply chain so that hospitals from our region could request them. We analyzed the number/type of items, petitioners, manufacturers, and catalogue views.Results: Among 33 devices analyzed, 26 (78·8%) were validated. Of these, 23 (88·5%) were airway consumables and 3 (11·5%) were personal protective equipment. Orders came from 19 (76%) hospitals and 6 (24%) other healthcare institutions. Peak production was reached 10 days after the catalogue was published. A total of 22,135 items were manufactured by 59 companies in 18 sectors; 19,212 items were distributed to requesting sites during the busiest days of the pandemic. Our online catalogue was also viewed by 27,861 individuals from 113 countries.Conclusions: 3D printing helped mitigate shortages of medical devices due to problems in the global supply chain.
A novel age-structured mosquito model for assessing the mechanisms behind vector control success
Authors: Davis Emma L , Hollingsworth T Déirdre , Keeling Matt J
Published: October 2020

Background: Vector control is a vital tool utilised by malaria control and elimination programmes worldwide, and as such it is important that we can accurately quantify the expected public health impact of a range of vector control methods. There are very few previous models that consider vector control induced changes in the age-structure of the vector population and the resulting impact this will have on transmission.Methods: The steady-state solution of a novel age-structured deterministic compartmental model describing the mosquito gonotrophic cycle is analytically derived, with the age of each mosquito measured in the number of gonotrophic cycles (or successful blood meals) completed. From this model we derive analytical expressions for key transmission measures, such as the effective reproductive ratio under control, Rc, and investigate the impact of combinations of commonly used vector control methods on the age-structure of the vector population.Results: Our model output is an explicit solution that can be used to directly quantify key transmission statistics and investigate the age-structured impact of vector control. Application of this model confirms current knowledge thatadult-acting interventions, such as IRS or LLINs, can be highly effective at reducing transmission, due to the dual effects of repelling and killing mosquitoes. However, we demonstrate how larval measures can be implemented in addition to adult-acting measures to reduce Rc and mitigate the impact of waning insecticidal efficacy. We also find that mid-ranges of LLIN coverage see the largest effect of reduced net integrity on transmission.Conclusions: Whilst well-maintain adult-acting vector control measures are substantially more effective than larval-based interventions, incorporating larval control in existing LLIN or IRS programmes could substantially reduce transmission. This would most benefit areas with low coverage or poor maintenance of interventions.
Validation of three-item Fatigue Severity Scale for patients with substance use disorder: a cohort study from Norway for the period 2016-2020
Authors: Vold Jørn Henrik , Gjestad Rolf , Aas Christer , Meland Eivind , Johansson Kjell Arne , Fadnes Lars Thore
Published: October 2020

Background Little attention has been paid to customising fatigue questionnaires for patients with Substance Use Disorders (SUDs). The present study aims to validate and shorten the nine-item Fatigue Severity Scale (FSS-9) and Visual Analogue Fatigue Scale (VAFS) for use with this population.MethodsWe used data from a nested cohort with annual health assessments with responses on the FSS-9 and VAFS. During the period 2016–2020, 917 health assessments were collected from 655 patients with SUD in Bergen and Stavanger, Norway. A total of 225 patients answered the health assessment at least twice. We defined baseline as the first annual health assessment when the health assessments were sorted chronologically per patient. We checked for internal consistency, and we used longitudinal confirmatory factor analysis and linear mixed model analysis to validate and shorten the FSS-9 and VAFS. ResultsThe internal consistency of the FSS-9 was excellent with a Cronbach’s α of 0.94 at baseline and 0.93 at the second annual health assessment. When shortening the FSS-9 to a three-item FSS (FSS-3, items 5–7), the Cronbach’s α was 0.87 at baseline and 0.84 at the second health assessment. The internal consistency was not affected when the VAFS was added to the FSS-9 and the FSS-3. The longitudinal confirmatory factor analysis model between baseline and the second health assessment showed a well-fitting model for the FSS-3 (χ2 = 13.33, degree of freedom = 8, P = 0.101) with a correlation of r = 0.52 and P < 0.001 between the annual health assessments. The linear mixed model analysis showed equal linear changes at the individual level for the FSS-3 (slope: 0.00, P > 0.05) and FSS-9 (slope: 0.01, P > 0.05) between the health assessments.ConclusionThe ten items (FSS-9 plus VAFS) could be shortened to a three-item FSS with excellent validity and reliability for patients with SUDs. Shortened and validated fatigue scales may be a way to ensure reliable results in this population.
“We can’t handle things we don’t know about”: Perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors
Authors: Boubour Alexandra , Mboma Sebastian , Võ Tracy , Birbeck Gretchen L. , Seydel Karl B. , Mallewa Macpherson , Chinguo Dorothy , Gladstone Melissa , Mohamed Suraya , Thakur Kiran T.
Published: October 2020

Background: We sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.Methods: An exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs).Results: FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.Conclusions: There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.
Altered Metabolism of Mothers of Young Children with Autism Spectrum Disorder: A Case Control Study
Authors: Hollowood-Jones Kathryn , Adams James B. , Coleman Devon M. , Ramamoorthy Sivapriya , Melnyk Stephan , James S. Jill , Woodruff Bryan K. , Pollard Elena L. , Snozek Christine L. , Kruger Uwe , Chuah Joshua , Hahn Juergen
Published: October 2020

Background: Previous research studies have demonstrated abnormalities in the metabolism of mothers of young children with autism.Method: Metabolic analysis was performed on blood samples from 30 mothers of young children with Autism Spectrum Disorder (ASD-M) and from 29 mothers of young typically-developing children (TD-M). Targeted metabolic analysis focusing on the folate one-carbon metabolism (FOCM) and the transsulfuration pathway (TS) as well as broad metabolic analysis were performed. Statistical analysis of the data involved both univariate and multivariate statistical methods.Results: Univariate analysis revealed significant differences in 5 metabolites from the folate one-carbon metabolism and the transsulfuration pathway and differences in an additional 48 metabolites identified by broad metabolic analysis, including lower levels of many carnitine-conjugated molecules. Multivariate analysis with leave-one-out cross-validation allowed classification of samples as belonging to one of the two groups of mothers with 93% sensitivity and 97% specificity with five metabolites. Furthermore, each of these five metabolites correlated with 8-15 other metabolites indicating that there are five clusters of correlated metabolites. In fact, all but 5 of the 50 metabolites with the highest area under the receiver operating characteristic curve were associated with the five identified groups. Many of the abnormalities appear linked to low levels of folate, vitamin B12, and carnitine-conjugated molecules.Conclusions: Mothers of children with ASD have many significantly different metabolite levels compared to mothers of typically developing children at 2-5 years after birth.
Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data
Authors: Fisher Kathryn Ann , Griffith Lauren , Gruneir Andrea , Upshur Ross , Perez Richard , Favotto Lindsay , Nguyen Francis , Markle-Reid Maureen , Ploeg Jenny
Published: October 2020

Background: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada.Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship.Results: Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions.Conclusions: Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service in those with multimorbidity. The study’s results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.
Construction and description of a constitutive plipastatin mono-producing Bacillus subtilis
Authors: Vahidinasab Maliheh , Lilge Lars , Reinfurt Aline , Pfannstiel Jens , Henkel Marius , Heravi Kambiz Morabbi , Hausmann Rudolf
Published: October 2020

Background: Plipastatin is a potent Bacillus antimicrobial lipopeptide with the prospect to replace conventional antifungal chemicals for controlling plant pathogens. However, the application of this lipopeptide has so far been investigated in a few cases, principally because of the yield in low concentration and unknown regulation of biosynthesis pathways. B. subtilis synthesizes plipastatin by a non-ribosomal peptide synthetase encoded by the ppsABCDE operon. In this study, B. subtilis 3NA (a non-sporulation strain) was engineered to gain more insights about plipastatin mono-production.Results: The 4-phosphopantetheinyl transferase Sfp posttranslationally converts non-ribosomal peptide synthetases from inactive apoforms into their active holoforms. In case of 3NA strain, sfp gene is inactive. Accordingly, the first step was an integration of a repaired sfp version in 3NA to construct strain BMV9. Subsequently, plipastatin production was doubled after integration of a fully expressed degQ version from B. subtilis DSM10T strain ensuring stimulation of DegU-P regulon (strain BMV10). Moreover, markerless substitution of the comparably weak native plipastatin promoter (Ppps) against the strong constitutive promoter Pveg led to approximately fivefold enhancement of plipastatin production in BMV11 compared to BMV9. Intriguingly, combination of both repaired degQ expression and promoter exchange (Ppps::Pveg) did not increase the plipastatin yield. Afterwards, deletion of surfactin (srfAA-AD) operon by the retaining the regulatory comS which is located within srfAB and is involved in natural competence development, resulted in the loss of plipastatin production in BMV9 and significantly decreased the plipastatin production of BMV11. We also observed that supplementation of ornithine as a precursor for plipastatin formation caused higher production of plipastatin in mono-producer strains, albeit with a modified pattern of plipastatin composition.Conclusions: This study provides evidence that degQ stimulates the native plipastatin production. Moreover, it seems that surfactin synthetase or one of its subunits positively regulates plipastatin production by an unknown mechanism. Furthermore, as another conclusion of this study, results point towards ornithine provision being an indispensable constituent for a plipastatin mono-producer B. subtilis strain. Therefore, targeting the ornithine metabolic flux might be a promising strategy to further investigate and enhance plipastatin production by B. subtilis plipastatin mono-producer strains.
DASSI: Differential Architecture Search for Splice Identification from DNA Sequences
Authors: Moosa Shabir , Amira Abbes , Boughorbel Sabri
Published: October 2020

Background: The data explosion caused by unprecedented advancements in the field of genomics is constantly challenging the conventional methods used in the interpretation of the human genome. The demand for robust algorithms over the recent years has brought huge success in the field of Deep Learning (DL) in solving many difficult tasks in image, speech and natural language processing by automating the manual process of architecture design. This has been fueled through the development of new DL architectures. Yet genomics possesses unique challenges as we expect DL to provide a super human intelligence that easily interprets a human genome.Methods: We proposed a new model, DASSI, by adapting a differential architecture search method and applying it to the Splice Site (SS) recognition task on DNA sequences to discover new high-performance convolutional architectures in an automated manner. We evaluated the discovered model against state-of-the-art tools to classify true and false SS in Homo sapiens (Human), Arabidopsis thaliana (Plant), Caenorhabditis elegans (Worm) and Drosophila melanogaster (Fly).Results: Our experimental evaluation demonstrated that the discovered architecture outperformed baseline models and fixed architectures and showed competitive results against state-of-the-art models used in classification of splice sites. The proposed model - DASSI has a compact architecture and showed very good results on a transfer learning task. The benchmarking experiments of execution time and precision on architecture search and evaluation process showed better performance on recently available GPUs making it feasible to adopt such architecture search based methods for large datasets.Conclusions: We applied differential architecture search mechanism to perform SS classification on raw DNA sequences, and discovered new convolutional models with low number of tunable parameters and competitive performance compared with manually engineered architectures. The results have shown a potential of using this automated architecture search mechanism for solving various problems in the field of genomics.
Translation, Cultural Adaptation and Psychometric Properties of the Ghanaian language (Akan; Asante Twi) version of the Health Literacy Questionnaire
Authors: Boateng Millicent Addai , Agyei-Baffour Peter , Angel Sanne , Enemark Ulrika
Published: October 2020

BackgroundPatients’ competencies to manage their own health, which is termed health literacy, is a necessity for better health outcomes. Thus, it is relevant to have a comprehensive health literacy measurement tool suitable for populations of interest. The Health Literacy Questionnaire (HLQ) is a tool useful for health literacy assessment covering nine dimensions/scales of health literacy. The HLQ has been translated and validated in diverse contexts but has so far not been assessed in any country in sub-Saharan Africa. We sought to translate this tool into the most common language used in Ghana and assess its validity.Methods:We carried out a cross-sectional study using the HLQ concurrently with an assessment of a malaria programme for caregivers with children under five years. The HLQ was translated using a systematic translation procedure. We analysed the psychometric properties of the HLQ based on data collected by face-to-face interview of 1234 caregivers. The analysis covered tests on difficulty level of scales, composite reliability, Cronbach’s alpha and confirmatory factor analysis (CFA).Results:Cognitive testing showed that some words were ambiguous, which led to minor rewording of the questionnaire. A nine-factor CFA model was fitted to the 44 question items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ2 DWLS (866 df) = 17177.58, p < 0.000, CFI = 0.971, TLI = 0.969, RMSEA = 0.126 and SRMR = 0.107. Composite reliability and Cronbach’s alpha were >0.65 for all scales except Cronbach’s alpha for scale 9, ‘Understanding health information well enough to know what to do’ (0.57). The mean differences between most demographic groups among health literacy scales were statistically significant.Conclusion:The Akan-Twi version of HLQ proved relevant in our description of the health literacy levels among the caregivers in our study. This validated tool will be useful to conduct health literacy needs assessments to guide policies addressing such needs. Further work is needed to validate this tool for use in Ghana and similar contexts.
Diabetic Retinopathy Predicts Cardiovascular Mortality in Diabetes: A Meta-analysis
Authors: Xu Xiao-Hong , Sun Bo , Zhong Shan , Wei Dong-Dong , Hong Ze , Dong Aiqiang
Published: October 2020

Background: The prognostic significance of diabetic retinopathy (DR) for cardiovascular diseases (CVD) remained unclear. Therefore, we performed this meta-analysis to assess whether DR predicted CVD mortality in diabetic patients.Methods: We searched PubMed, Embase, Web of Science and Cochrane Library for cohort studies reporting the association of DR and CVD mortality. Then we pooled the data for analysis.Results: After screening the literature, 10 eligible studies with 11,239 diabetic subjects were finally included in quantitative synthesis. The pooled risk ratio (RR) of DR, mild DR, and severe DR for CVD mortality was 1.83 (95% confidence interval (CI): 1.42, 2.36; P < 0.001), 1.13 (95% CI: 0.81, 1.59; P = 0.46), and 2.26 (1.31, 3.91; P = 0.003), respectively, compared to those without DR. In type 2 DM, the patients with DR had a significantly higher CVD mortality (RR: 1.69; 95% CI: 1.27, 2.24; P < 0.001). Subgroup analysis also showed a significantly higher CVD mortality in DR according to various regions, study design, data source, and follow-up period (all RR > 1; all P values < 0.05). Data from 2 studies showed no significant correlation of DR and CVD mortality in diabetic patients receiving cardiovascular surgery (RR: 2.40; 95% CI: 0.63, 9.18; P = 0.200). Conclusions: DR is a risk marker of cardiovascular death, and severe DR predicts a doubled mortality of CVD in diabetes. These findings indicate the importance of early identification and management of diabetic patients with DR to reduce the risk of death.
Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic disease in New South Wales, Australia: a historical cohort study
Authors: Jayakody Amanda Anne , Oldmeadow Christopher , Carey Mariko , Bryant Jamie , Evans Tiffany , Ella Stephen , Attia John , Towle Simon , Sanson-Fisher Robert
Published: October 2020

Background: Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic diseases, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. Methods: A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years.Results: Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR=1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR=1.90; 95% CI=1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p=0.859; 0.860 respectively). Conclusion: Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.
Attenuated Self-serving Bias in People with Internet Gaming Disorder is Related to Altered Neural Activity in Subcortical-Cortical Midline Structures
Authors: Wang Yifan , Zheng Li , Wang Chenggong , Guo Xiuyan
Published: October 2020

Background: To protect and maintain the positivity of self-concept, normal people usually show a self-serving bias (internal attribution of positive events and external attribution of negative events) by the motives of self-enhancement and self-protection. Additionally, self-serving assessments predominantly activate the subcortical-cortical midline structures (CMS) in healthy individuals. However, little is known about self-serving bias and its underlying neural correlates among individuals with Internet gaming disorder (IGD). Methods: Twenty-four participants with IGD and 25 recreational Internet gaming users (RGUs) were scanned while attributing the causes of positive/negative self- and other-related events that could occur in both the game-world and real-world contexts. Region-of-interest (within CMS regions) and parametric analysis were performed to investigate the neural correlates of self-serving bias in IGD. Results: Behaviorally, the IGD participants attributed more negative and fewer positive events to themselves than RGU participants in both contexts. Neurally, during the attributions of negative events, the IGD participants exhibited increased ventromedial prefrontal cortex (vmPFC) activation in both contexts compared with RGU participants. Higher vmPFC activation was associated with weaker self-protective motivation in the IGD group. Meanwhile, during the attributions of positive events, the IGD participants exhibited decreased precuneus/posterior cingulate cortex activation in the real world compared with RGU participants. Parametric analysis showed a reduced positive correlation between precuneus activation and self-attribution ratings of positive events in the real world in the IGD group relative to the RGU group. Conclusion: These results suggest that individuals with IGD show an attenuated self-serving bias and altered brain activity within CMS regions involved in self-attribution, providing evidence for the negative self-concept and weakened abilities in both self-enhancement and self-protection in IGD.
Feasibility of a quality improvement project with an interrupted time series design to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Authors: Germini Federico , Hu Yang , Afzal Sarah , Al-haimus Fayad , Puttagunta Srikanth A. , Niaz Saghar , Chan Teresa , Clayton Natasha , Mondoux Shawn , Thabane Lehana , de Wit Kerstin
Published: October 2020

Background: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol.Methods: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018 to February 28, 2020. Components of the intervention were: clinical leadership endorsement; a new pathway for PE testing; physician education; personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites; capturing data on ≥ 80% of all CTPAs ordered in the EDs; timely access to electronic data; rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time; time required for manual data extraction and feedback preparation ≤ 2 day per week in total.Results: The intervention was successfully implemented in two out of three sites. 5,094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 hours).Conclusions: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED.Registration: The study was not registered.Funding: CanVECTOR Network, McMaster Division of Hematology & Thromboembolism.
Circ0120816 acts as an oncogene of esophageal squamous cell carcinoma via inhibiting miR-1305 and releasing TXNRD1
Authors: Li Xiaoyong , Song Laichun , Wang Bo , Tao Chao , Shi Lei , Xu Ming
Published: October 2020

Background: Circular RNAs (circRNAs) have been discovered to participate in the carcinogenesis of multiple cancers. However, the role of circRNAs in esophageal squamous cell carcinoma (ESCC) progression is yet to be properly understood. This research aimed to investigate and understand the mechanism used by circRNAs to regulate ESCC progression.Methods: Bioinformatics analysis was first performed to screen dysregulated circRNAs and differentially expressed genes in ESCC. The ESCC tissue samples and adjacent normal tissue samples utilized in this study were obtained from 36 ESCC patients. All the samples were subjected to qRT-PCR analysis to identify the expression of TXNRD1, circRNAs, and miR-1305. Luciferase reporter assay, RNA immunoprecipitation assay and RNA pull-down assay were later conducted to verify the existing relationship among circ0120816, miR-1305 and TXNRD1. CCK-8, BrdU, cell adhesion, cell cycle, western blot and caspase 3 activity assays were also employed to evaluate the regulation of these three biological molecules in ESCC carcinogenesis. To evaluate the effect of circ0120816 on ESCC tumor growth and metastasis, the xenograft mice model was constructed. Results: Experimental investigations revealed that circ0120816 was the highest upregulated circRNA in ESCC tissues and that this non-coding RNA acted as a miR-1305 sponge in enhancing cell viability, cell proliferation, and cell adhesion as well as repressing cell apoptosis in ESCC cell lines. Moreover, miR-1305 was observed to exert a tumor-suppressive effect in ESCC cells by directly targeting and repressing TXNRD1. It was also noticed that TXNRD1 could regulate cyclin, cell adhesion molecule, and apoptosis-related proteins. Furthermore, silencing circ0120816 was found to repress ESCC tumor growth and metastasis in vivo.Conclusions: This research confirmed that circ0120816 played an active role in promoting ESCC development by targeting miR-1305 and upregulating oncogene TXNRD1.
Improving Diagnostic Ability and Confidence in Otoscopy Through a Supplementary Web Based Learning Platform: A Prospective Interventional Study
Authors: Azman Mawaddah , Rajasingam Devyadarsshni , Mokhtar Rahmi Hidayati Mohammad Mursal , Hamzah Amir Thaqiff , Iskandarrani Izzatul Ismah , Roslan Ainur Atikah , Besar Mohd Nasri Awang
Published: October 2020

Background Otoscopy is an important clinical skill to master in the undergraduate medical curriculum. This study investigated the effect of a supplementary web-based learning platform in improving diagnostic ability and confidence in otoscopy among final year medical undergraduates in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).Methods A supplementary otoscopy training using a web-based learning platform was introduced to final year medical undergraduates who have completed a three-week posting in otorhinolaryngology. A total of 45 subjects who participated in the learning platform were included in this prospective interventional study. All of them answered questionnaires on level of confidence (LC) and completed online questions on diagnostic ability (DA) at three different timelines during the study: prior to intervention (T1), after intervention (T2) and 4 months following the intervention (T3).Results LC scores were significantly higher across the timelines measured: T1 vs T2 vs T3 respectively (p<0.05). DA scores were significantly higher across the timelines measured: T1 vs T2 vs T3 respectively (p<0.05). Both LC and DA scores showed sustained improvements at 4 months post intervention across both external auditory canal and tympanic membrane anatomical subsites. Conclusion Subjects’ level of confidence in performing otoscopy and diagnostic ability showed sustained improvements at 4 months with this intervention. We conclude that supplementary otoscopy training using a web based learning platform complements the teaching and learning of otoscopy among final year medical undergraduates.
“I have SMA, SMA doesn’t have me”- A Qualitative Snapshot into the Challenges, Successes, and Quality of Life of Adolescents and Young Adults with SMA
Authors: Mazzella Allison Joy , Curry Mary , Belter Lisa , Cruz Rosangel , Jarecki Jill
Published: October 2020

Background: With the approval of three treatments for spinal muscular atrophy (SMA) and several promising therapies on the horizon, the SMA adolescent and young adult populations are expected to evolve in the coming years. It is imperative to understand this cohort as it exists today to provide optimal care and resources, as well as to assess possible treatment effects over time. In 2018, Cure SMA launched two initiatives geared towards understanding adolescents and young adults with SMA, ages 12-25. First, Cure SMA launched a Quality of Life (QoL) survey to capture quantitative and qualitative information on this specific age demographic. Concurrently, Cure SMA invited SMA-affected individuals, ages 12-25, to create a three-minute video on their everyday experiences living with SMA. An inductive thematic analysis of the free-text survey questions along with the video contest findings are reported here. Results: Eighty-five individuals — 6 type Is, 58 type IIs, and 21 type IIIs — completed the Quality of Life free-response, while six individuals participated in the SMA awareness video contest. In both settings, individuals detailed a wide variety of challenges, including but not limited to forming or maintaining close relationships, feelings of isolation, challenges with accessibility, independence, and dealing with the stigma of being perceived as mentally disabled. Individuals also discussed their successes, including but not limited to higher education enrollment and attendance, development of quality friendships, and perseverance through obstacles. Additionally, in the survey, a substantial number of respondents (39%) requested the creation of an SMA peer support group in efforts to connect with each other as well as collectively navigate the aforementioned challenges they face. Conclusion: Together, these findings provide a rare glimpse into the unique mindsets, challenges and motivations of SMA adolescents and young adults, via patient-reported measures instead of caregiver proxy. The adolescent and young adult age demographics assessed represent a critical transition period in life and in SMA care. No one understands the needs of an adolescent or young adult with SMA better than the individuals themselves, and it is critical to encapsulate their insights to affect change.
Plasmatic and cell-based enhancement of in vitro induced coagulopathy by microparticles originated from platelets and endothelial cells
Authors: Boehm Julia , Schäfer Nadine , Maegele Marc , Stümpges Birgit , Bauerfeind Ursula , Caspers Michael
Published: October 2020

Background: Aggressive trauma management and other external factors lead to hypothermia, acidosis and hemodilution (defined as Lethal Triad, LT) contributing to coagulopathy after trauma (Trauma-induced coagulopathy, TIC) that worsens patients’ outcomes. Procoagulative microparticles (MP) are crucial players at the interface of cellular and plasmatic coagulation. However, their functions remain largely unexplored. This study aimed to characterize effects of MP subtypes and concentrations on functional coagulation under in vitro simulated conditions. Methods: Blood from eleven volunteers were collected to simulate in vitro conditions of haemodilution (HD) and LT, respectively. HD was induced by replacing a blood volume of 33% by crystalloids and for LT, samples were further processed by reducing the temperature to 32 °C and lowering the pH to 6.8. MP were obtained either from platelet concentrates (platelet-derived MP, PDMP) or from cell culture (ECV304 cells for endothelial-derived MP, EDMP) by targeted stimulation. After introducing MP to in vitro conditions, their concentration-dependent effects (1.000, 10.000 and 15.000 MP/µl blood) on coagulation compared to whole blood (WB) were characterized by flow cytometric platelet activation and by quantification of fibrin clot propagation and spontaneous clotting using Thrombodynamics® technology.Results: MP originated from platelets and endothelial cells affected blood coagulation in a concentration-dependent manner. Particularly, high PDMP quantities significantly induced platelet activation and fibrin clot growth and size in HD conditions. In LT conditions, the highest PDMP concentration enhanced platelet activation, clot growth and size. In contrast, EDMP supplementation did not affect platelet activation, but resulted in enhanced formation of spontaneous clots, irrespective of simulated condition. With increasing EDMP concentration, the time until the onset of spontaneous clotting decreased in both HD and LT conditions.Discussion: The study demonstrates an essential role of MP within the coagulation process under simulated coagulopathic conditions. While PDMP affected platelets promoting clot formation likely by providing a surface enlargement, EDMP presumably affected clotting factors of the plasmatic coagulation resulting in an increased formation of spontaneous fibrin clots.Conclusion: The diverse effects of in vitro generated MP from different cellular origin indicate a divergent mechanism of action exhibiting distinct functions within the coagulation process.
Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: A case report
Authors: Imanishi Jungo , Tanabe Masayuki , Kurihara Taisei , Torigoe Tomoaki , Kikkawa Jun , Ota Atsuhiko , Watanabe Atsuko , Tanaka Ryuhei , Saita Kazuo , Kadono Yuho , Yazawa Yasuo
Published: October 2020

Background: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection.Case Presentation: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate, and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.Conclusions: This case report provides an example of limb salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.
Resistin-like Molecule β Acts as a Mitogenic Factor in Hypoxic Pulmonary Hypertension via the Ca2+-dependent PI3K/Akt/mTOR and PKC/MAPK Signaling Pathways
Authors: Tian Heshen , Liu Lei , Wu Ying , Wang Ruiwen , Jiang Yongliang , Hu Ruicheng , Zhu Liming , Li Linwei , Fang Yanyan , Yang Chunlan , Ji Lianzhi , Liu Guoyu , Dai Aiguo
Published: October 2020

BACKGROUND: Pulmonary arterial smooth muscle cell (PASMC) proliferation plays a crucial role in hypoxia-induced pulmonary hypertension (HPH). Previous studies have found that resistin-like molecule β (RELM-β) is upregulated de novo in response to hypoxia in cultured human PASMCs (hPASMCs). RELM-β has been reported to promote hPASMC proliferation and is involved in pulmonary vascular remodeling in patients with PAH. However, the expression pattern, effects, and mechanisms of action of RELM-β in HPH remain unclear.METHODS: We assessed the expression pattern, mitogenetic effect, and mechanism of action of RELM-β in a rat HPH model and in hPASMCs.RESULTS: Overexpression of RELM-β caused hemodynamic changes in a rat model of HPH similar to those induced by chronic hypoxia, including increased mean right ventricular systolic pressure (mRVSP), right ventricular hypertrophy index (RVHI) and thickening of small pulmonary arterioles. Knockdown of RELM-β partially blocked the increases in mRVSP, RVHI, and vascular remodeling induced by hypoxia. The phosphorylation levels of the PI3K, Akt, mTOR, PKC, and MAPK proteins were significantly up- or downregulated by RELM-β gene overexpression or silencing, respectively. Recombinant RELM-β protein increased the intracellular Ca2+ concentration in primary cultured hPASMCs and promoted hPASMC proliferation. The mitogenic effects of RELM-β on hPASMCs and the phosphorylation of PI3K, Akt, mTOR, PKC, and MAPK were suppressed by a Ca2+ inhibitor.CONCLUSIONS: Our findings suggest that RELM-β acts as a cytokine-like growth factor in the development of HPH and that the effects of RELM-β are likely to be mediated by the Ca2+-dependent PI3K/Akt/mTOR and PKC/MAPK pathways.
Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: A randomized controlled trial
Authors: Malakian Arash , Aramesh Mohammad Reza , Agahin Mina , dehdashtian masoud
Published: October 2020

BackgroundThe most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications.Methods148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to N-DUOPAP group and 74 neonates to NCPAP group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 hours after birth and secondary outcomes included treatment complications.Resultsthere was not significant difference between DUOPAP (4.1%) and NCPAP (8.1%) in treatment failure at the first 72 hours of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Needing to repeat doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. the duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002).ConclusionIn the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 hours of birth compared to CPAP, but the duration of non-invasive ventilation and of oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group.Trial registration: IRCT20180821040847N1, Approved on 2018-09-10.