bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of risk factors and prognosis in differentiated thyroid cancer with focus on minimal extrathyroidal extension
Authors: Weber Manuel , Binse Ina , Oebbecke Karin , Brandenburg Tim , Herrmann Ken , Theurer Sarah , Weber Frank , Ehrlich Ann-Kathrin , Schmid Kurt Werner , Führer-Sakel Dagmar , Vardarli Irfan , Fendler Wolfgang P. , Gilman Elena , Görges Rainer
Published: August 2021

Aims

In contrast to all prior AJCC/TNM classifications for differentiated thyroid cancer (DTC) the 8th edition does not take minimal extrathyroidal extension (M-ETE) into consideration for local tumor staging. We therefore aimed to retrospectively assess the specific impact of M-ETE on the outcome of M-ETE patients treated in our clinic.

Methods

DTC patients with M-ETE and a follow-up time of ≥ 5 years were included and matched with an identical number of patients without M-ETE, but with equal histopathological tumor subtype and size. The frequency of initially metastatic disease among groups was compared using Fisher’s exact test, the recurrence rate by virtue of log-rank test. Fisher’s exact test and multivariate analysis were used to account for the presence of confounding risk factors.

Results

One hundred sixty patients (80 matching pairs) were eligible. With other confounding risk factors being equal, the prevalence of N1-/M1-disease at initial diagnosis was comparable among groups (M-ETE: 42.5 %; no M-ETE: 32.5 %; p = 0.25). No differences with regard to the recurrence rate were shown. However, M-ETE patients were treated with external beam radiation therapy more often (16.3 % vs. 1.3 %; p = 0.004) and received higher median cumulative activities of 131I (10.0 vs. 8.0 GBq; p < 0.001).

Discussion

Although having played a pivotal role for local tumor staging of DTC for decades M-ETE did not increase the risk for metastases at initial diagnosis and the recurrence rate in our cohort. Patients with M-ETE had undergone intensified treatment, which entails a possible confounding factor that warrants further investigation in randomized controlled trials.
Clinical efficacy of mineralized collagen (MC) versus anorganic bovine bone (Bio-Oss) for immediate implant placement in esthetic area: a single-center retrospective study
Authors: Dai Yan , Xu Jin , Han Xiao-Hui , Cui Fu-Zhai , Zhang Dong-Sheng , Huang Sheng-Yun
Published: August 2021

Background

The purpose of this retrospective study was to evaluate the clinical efficacy of mineralized collagen (MC) versus anorganic bovine bone (Bio-Oss) for immediate implant placement in esthetic area.

Methods

Medical records of Department of Oral and Maxillofacial Surgery of Shandong Provincial Hospital were screened for patients who had been treated with immediate implant implantation in the esthetic area using either MC (Allgens®, Beijing Allgens Medical Science and Technology Co., Ltd., China) or Bio-Oss (Bio-Oss®, Geistlich Biomaterials, Wolhusen, Switzerland), between January 2018 and December 2019. All patients fulfilling the in-/exclusion criteria and following followed for a minimum period of 1 year after surgery were enrolled into the presented study. Implant survival rate, radiographic, esthetic and patient satisfactory evaluations were performed.

Results

Altogether, 70 patients were included in the study; a total of 80 implants were inserted. All implants had good initial stability. The survival rate of implants was 100% at 1-year follow-up. The differences in horizontal and vertical bone loss between the MC group (0.72 ± 0.26 mm, 1.62 ± 0.84 mm) and the Bio-Oss group (0.70 ± 0.52 mm, 1.57 ± 0.88 mm) were no significant difference statistically no significant 6 months after permanent restoration. Similar results occurred at 12 months after permanent restoration functional loaded. Clinical acceptability defined by pink esthetic score (PES) ≥ 6 (6.07 ± 1.62 vs. 6.13 ± 1.41) was not significantly different between groups. Patient satisfaction estimated by visual analog scale (VAS) was similar (8.56 ± 1.12 vs. 8.27 ± 1.44), and the difference was no significant difference between the two groups.

Conclusions

The biomimetic MC showed a similar behaviour as Bio-Oss not only in its dimensional tissues changes but also in clinical acceptability and patient satisfaction. Within the limitations of this study, these cases show that MC could be considered as an alternative bone graft in IIP
Are medical students in Palestine adequately trained to care for individuals with autism spectrum disorders? A multicenter cross-sectional study of their familiarity, knowledge, confidence, and willingness to learn
Authors: Shawahna Ramzi , Jaber Mohammad , Yahya Nourhan , Jawadeh Firdaous , Rawajbeh Shahd
Published: August 2021

Background

Medical students are the future workforce of physicians in primary, secondary, tertiary, and highly specialized care centers. The present study was undertaken to assess familiarity, knowledge, confidence, of medical students with regard to autism spectrum disorders (ASDs).

Methods

This multicenter study was conducted in a cross-sectional design among medical students in the 3 main universities in Palestine. In addition to the sociodemographic and academic details, the questionnaire measured familiarity (8-items), knowledge (12-items), confidence and willingness to learn (5-items) with regard to ASDs.

Results

The questionnaire was completed by309 medical students (response rate = 77.3 %). The median familiarity, knowledge, and confidence scores were 50 % (42.5 %, 57.5 %), 50 % (41.7 %, 66.7 %), and 60.0 % (54.0 %, 68.0 %), respectively. There was a positive moderate correlation between familiarity and knowledge scores (Spearman’s rho = 0.29, p-value < 0.001) and familiarity and confidence scores (Spearman’s rho = 0.34, p-value < 0.001). Medical students who have received a course on autism were 3.08-fold (95 % C.I. of 1.78–5.31) more likely to score ≥ 50 % on the familiarity items compared to those who did not receive a course. The medical students who were in their clinical academic stage, who received a course on ASDs, and those who interacted with individuals with ASDs were 2.36-fold (95 % C.I. of 1.34–4.18), 2.66-fold (95 % C.I. of 1.52–4.65), and 2.59-fold (95 % C.I. of 1.44–4.63) more likely to score ≥ 50 % on the knowledge items. Medical students who reported high satisfaction with their social life were 2.84-fold (95 % C.I. of 1.15-7.00) more likely to score ≥ 50 % on the confidence items.

Conclusions

The present study identified considerable awareness and knowledge gaps among medical students with regard to ASDs. Medical students in this study reported low confidence in their ability to provide healthcare services to individuals with ASDs. Appropriately designed educational interventions might improve familiarity, knowledge, and confidence of medical students. More studies are still needed to investigate if such interventions can improve healthcare services for individuals with ASDs.
A critical ethnographic study of discriminatory social practice during clinical practice in emergency medical care
Authors: Maake Tshepo Nelson , Millar Bernadette Theresa , Christopher Lloyd Denzil , Naidoo Navindhra
Published: August 2021

Background

Post-apartheid, South Africa adopted an inclusive education system that was intended to be free of unfair discrimination. This qualitative study examines the experiences and perceptions of racial discrimination between Emergency Medical Care (EMC) students, clinical mentors, and patients within an Emergency Medical Service (EMS) during clinical practice. Understanding the nature of such discrimination is critical for redress.

Methods

Within the conceptual framework of Critical Race Theory, critical ethnographic methodology explored how discriminatory social practice manifests during clinical practice. Semi-structured interviews enabled thematic analysis. We purposively sampled 13 undergraduate EMC students and 5 Emergency Care (EC) providers.

Results

EMC student participants reported experiences of racial and gender discrimination during work-integrated learning (WIL) as they were treated differently on the basis of race and gender. Language was used as an intentional barrier to isolate students from the patients during WIL because EC providers would intentionally speak in a language not understood by the student and failed to translate vital medical information about the case. This conduct prevented some students from engaging in clinical decision-making.

Conclusions

Unfair discrimination within the pre-hospital setting have an impact on the learning opportunities of EMC students. Such practice violates basic human rights and has the potential to negatively affect the clinical management of patients, thus it has the potential to violate patient’s rights. This study confirms the existence of discriminatory practices during WIL which is usually unreported. The lack of a structured approach to redress the discrimination causes a lack of inclusivity and unequal access to clinical education in a public clinical platform.
Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study
Authors: Zakeri Rosita , Morgan Ann D. , Sundaram Varun , Bloom Chloe , Cleland John G. F. , Quint Jennifer K.
Published: August 2021

Background

Patients with atrial fibrillation (AF) complicated by heart failure (HF) have a poor prognosis. We investigated whether long term loop-diuretic therapy in patients with AF and no known diagnosis of HF, as a potential surrogate marker of undiagnosed HF, is also associated with worse outcomes.

Methods

Adults with incident AF were identified from UK primary and secondary care records between 2004 and 2016. Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as ‘isolated’ loop diuretic use.

Results

Amongst 124,256 people with incident AF (median 76 years, 47% women), 22,001 (17.7%) had a diagnosis of HF, and 22,325 (18.0%) had isolated loop diuretic use. During 2.9 (LQ-UQ 1–6) years’ follow-up, 12,182 patients were diagnosed with HF (incidence rate 3.2 [95% CI 3.1–3.3]/100 person-years). Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 31% of patients diagnosed with HF following an emergency hospitalisation. The median time from AF to HF diagnosis was 3.6 (1.2–7.7) years in men versus 5.1 (1.8–9.9) years in women (p = 0.0001). In adjusted models, patients with isolated loop diuretic use had higher mortality (HR 1.42 [95% CI 1.37–1.47], p < 0.0005) and risk of HF hospitalisation (HR 1.60 [95% CI 1.42–1.80], p < 0.0005) than patients with no HF or loop diuretic use, and comparably poor survival to patients with diagnosed HF.

Conclusions

Loop diuretics are commonly prescribed to patients with AF and may indicate increased cardiovascular risk. Targeted evaluation of these patients may allow earlier HF diagnosis, timely intervention, and better outcomes, particularly amongst women with AF, in whom HF appears to be under-recognised and diagnosed later than in men.
Long-term prognostic outcomes in patients with haemoptysis
Authors: Mondoni Michele , Carlucci Paolo , Cipolla Giuseppe , Pagani Matteo , Tursi Francesco , Fois Alessandro , Pirina Pietro , Canu Sara , Gasparini Stefano , Bonifazi Martina , Marani Silvia , Comel Andrea , Saderi Laura , De Pascalis Sabrina , Alfano Fausta , Centanni Stefano , Sotgiu Giovanni
Published: August 2021

Background

Haemoptysis is a challenging symptom that can be associated with potentially life-threatening medical conditions. Follow-up is key in these patients to promptly detect new or misdiagnosed pathologic findings. Few prospective studies have evaluated long-term prognostic outcomes in patients with haemoptysis. Furthermore, the role played by antiplatelet and anticoagulant drugs on mortality and recurrence rates is unclear. The aim of this study was to assess mortality after 18 months of follow-up. Furthermore, the incidence of recurrence and the risk factors for recurrence and death were evaluated (including the role played by anticoagulant and antiplatelet drugs).

Methods

Observational, prospective, multicentre, Italian study.

Results

451/606 (74.4%) recruited patients with haemoptysis completed the 18 months follow-up. 22/604 (3.6%) diagnoses changed from baseline to the end of the follow-up. 83/604 (13.7%) patients died. In 52/83 (62.7%) patients, death was the outcome of the disease which caused haemoptysis at baseline. Only the diagnosis of lung neoplasm was associated with death (OR (95%CI): 38.2 (4.2–347.5); p-value: 0.0001). 166 recurrences were recorded in 103/604 (17%) patients. The diagnosis of bronchiectasis was significantly associated with the occurrence of a recurrence (OR (95% CI): 2.6 (1.5–4.3)); p-value < 0.0001). Anticoagulant, antiaggregant, and anticoagulant plus antiaggregant drugs were not associated with an increased risk of death and recurrence.

Conclusions

Our study showed a low mortality rate in patients with haemoptysis followed-up for 18 months. Pulmonary malignancy was the main aetiology and the main predictor of death, whereas bronchiectasis was the most frequent diagnosis associated with recurrence. Antiplatelet and/or anticoagulant therapy did not change the risk of death or recurrence. Follow-up is recommended in patients initially diagnosed with lower airways infections and idiopathic bleeding.

Trial registration: NCT02045394
Triple-negative breast cancer: understanding Wnt signaling in drug resistance
Authors: Merikhian Parnaz , Eisavand Mohammad Reza , Farahmand Leila
Published: August 2021

Triple-negative breast cancer (TNBC) is not as prevalent as hormone receptor or HER2-positive breast cancers and all receptor tests come back negative. More importantly, the heterogeneity and complexity of the TNBC on the molecular and clinical levels have limited the successful development of novel therapeutic strategies and led to intrinsic or developed resistance to chemotherapies and new therapeutic agents. Studies have demonstrated deregulation of Wnt/β-catenin signaling in tumorigenesis which plays decisive roles at the low survival rate of patients and facilitates resistance to currently existing therapies. This review summarizes mechanisms of Wnt/β-catenin signaling for resistance development in TNBC, the complex interaction between Wnt/β-catenin signaling, and the transactivated receptor tyrosine kinase (RTK) signaling pathways, lymphocytic infiltration, epithelial-mesenchymal transition (EMT), and induction of metastasis. Such associations and how these pathways interact in the development and progression of cancer have led to the careful analysis and development of new and effective combination therapies without generating significant toxicity and resistance.
Recent advances of m6A methylation modification in esophageal squamous cell carcinoma
Authors: Zhang Xiaoqing , Lu Ning , Wang Li , Wang Yixuan , Li Minna , Zhou Ying , Cui Manli , Zhang Mingxin , Zhang Lingmin
Published: August 2021

In recent years, with the development of RNA sequencing technology and bioinformatics methods, the epigenetic modification of RNA based on N6-methyladenosine (m6A) has gradually become a research hotspot in the field of bioscience. m6A is the most abundant internal modification in eukaryotic messenger RNAs (mRNAs). m6A methylation modification can dynamically and reversibly regulate RNA transport, localization, translation and degradation through the interaction of methyltransferase, demethylase and reading protein. m6A methylation can regulate the expression of proto-oncogenes and tumor suppressor genes at the epigenetic modification level to affect tumor occurrence and metastasis. The morbidity and mortality of esophageal cancer (EC) are still high worldwide. Esophageal squamous cell carcinoma (ESCC) is the most common tissue subtype of EC. This article reviews the related concepts, biological functions and recent advances of m6A methylation in ESCC, and looks forward to the prospect of m6A methylation as a new diagnostic biomarker and potential therapeutic target for ESCC.
Revisiting the association of sedentary behavior and physical activity with all-cause mortality using a compositional approach: the Women's Health Study
Authors: Migueles Jairo H. , Lee I-Min , Sanchez Cristina Cadenas , Ortega Francisco B. , Buring Julie E. , Shiroma Eric J.
Published: August 2021

Background

While physical activity has consistently been associated with decreased mortality rates, it remains unknown if there is a single “ideal” combination of time in physical activities of different intensities and sedentary behavior (SB) associated with the lowest rate. This study examined the associations of combinations of time in moderate-to-vigorous intensity (MVPA), higher-light intensity (HLPA), lower-light intensity activities (LLPA), and SB with mortality rates in older women.

Methods

This prospective cohort study included 16,676 older women from throughout the United States enrolled in the Women’s Health Study. Women wore accelerometers on their hip from 2011 to 2015 and were followed through 2017 (mean (SD) of 4.3 (1.1) years). Deaths were confirmed with medical records, death certificates, or the National Death Index. Compositional Cox regression models were used.

Results

The mean (SD) age was 72 (5.7) years at accelerometer wear; 503 women died. Compared to the least active women (mean, 3 min/day MVPA, 27 min/day HLPA, 162 min/day LLPA, and 701 min/day SB): compositional models showed an inverse L-shaped dose-response association of MVPA replacing other behaviors with mortality rates mortality rates (P = .02); SB relative to LLPA, HLPA, and MVPA was directly associated with mortality rates in a curvilinear dose-response manner (P < .001); replacing 10 min of SB for MVPA (HR (95% CI) = .86 (.73–.98)) or for HLPA (HR (95% CI.94 (.88–1.00)) associated with 14 and 6% lower mortality rates, respectively; a 47% risk reduction (HR [95% CI] = .53 [.42–.64]) was observed among women meeting physical activity guidelines (mean, 36 min/day MVPA, 79 min/day HLPA, 227 min/day LLPA and 549 min/day SB); and similar mortality rate reductions of 43% (HR (95% CI) = .57 (.41–.73)) were observed with increases in HLPA and LLPA without increasing MVPA, e.g., reallocating SB to 90 min/day of HLPA plus 120 min/day of LLPA.

Conclusions

There was no “ideal” combination of physical activities of different intensities and SB associated with the lowest mortality rates. Of particular relevance to older women, replacing SB with light intensity activity was associated with lower mortality rates, and “mixing and matching” times in different intensities yielded equivalent mortality risk reductions.
Heparin-binding growth factor (HDGF) drives radioresistance in breast cancer by activating the STAT3 signaling pathway
Authors: Qiu Lingyun , Ma Yan , Chen Xiaohua , Zhou Liheng , Zhang Haibo , Zhong Guansheng , Zhang Lei , Tang Jianming
Published: August 2021

Although reports implicate radioresistance as an important obstacle for the management of breast cancer, its molecular mechanism is elusive. Herein, we found that high HDGF levels are expressed significantly in breast cancer and exhibit a positive association with poor survival prognosis. Heparin-binding growth factor (HDGF) was upregulated in radioresistant breast cancer cells, however, its knockdown could reduce breast cancer radioresistant both in vitro and in vivo. Additionally, the binding of RXRα to HDGF promoter blocked HDGF transcriptional activity, consequently inhibiting breast cancer radioresistance. The enhanced radioresistant activity of HDGF is induced by TKT and STAT3, impacting the STAT3-Tyr705 and STAT3-Ser727 phosphorylation and STAT3 transcriptional activity. Notably, HDGF depletion renders radioresistant hypersensitive to the drug that targets STAT3 phosphorylation. This article demonstrates the novel function of HDGF as a promising molecular target for predicting radioresistance in breast cancer.
Inflammatory pseudotumor of Castleman disease and IgG4-related disease masquerading as kidney malignancy
Authors: Liu Bolong , Huang Yong , Tang Luying , Guan Jiexia , Zhou Xiangfu , Zhan Hailun
Published: August 2021

Background

With widespread clinical application of imaging techniques, renal space-occupying lesions have been identified at an increasing frequency. Here, we report two rare cases, Castleman disease (CD) and IgG4-related disease (IgG4-RD), presenting primarily with the symptoms and imaging findings of kidney malignancy.

Case presentation

In case 1, an occupying lesion located in the right renal pelvis was detected using magnetic resonance imaging in a 32-year-old female who presented with hematuria and lumbago. First misdiagnosed as carcinoma of the renal pelvis, the patient underwent right radical nephroureterectomy. However, postoperative pathological and immunohistochemistry studies finally confirmed the diagnosis of CD. In case 2, a 45-year-old male presented with the chief complaint of anuria. Nephrostomy and renal biopsy indicated lymphoma, following which, antegrade urography and computed tomography urography were performed, which revealed bilateral hydronephrosis and mass lesions around the renal pelvis. Partial resection of the masses and frozen section examination indicated the diagnosis of CD. However, the results of postoperative histopathology and immunohistochemistry combined with serum IgG4 were consistent with IgG4-RD. Both the patients recovered well after drug treatment without recurrence of the diseases.

Conclusions

Inflammatory pseudotumor of CD and IgG4-RD with kidney involvement are primarily diagnosed by postoperative histopathology and can pose a preoperative diagnostic challenge because these lesions can masquerade as kidney malignancy. Therefore, we recommend core biopsy as a nonnegligible procedure to evaluate renal masses and potentially prevent unnecessary surgical treatment.
Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison
Authors: Pojar Marek , Karalko Mikita , Dergel Martin , Vojacek Jan
Published: August 2021

Objectives

Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain.

Methods

A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups.

Results

Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79).

Conclusions

In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.
Systems pharmacology and transcriptomics reveal the mechanisms of Sanhuang decoction enema in the treatment of ulcerative colitis with additional Candida albicans infection
Authors: Han Zhijun , Tan Xiaofen , Sun Juan , Wang Tianming , Yan Guiming , Wang Changzhong , Ma Kelong
Published: August 2021

Background

Ulcerative colitis (UC) is an important inflammatory phenotype in bowel disease (IBD), which is caused by multiple potential factors, including fungal dysbiosis.Candida albicans(C. albicans) was confirmed to be an important factor promoting the occurrence and development of UC. Sanhuang decoction (SHD) has been used for UC therapy in China for thousand of years, although its core active constituents and pharmacological mechanism remain undefined.

Methods

In this work, a murine model of UC withC. albicanscolonization was established with dextran sodium sulfate (DSS) andC. albicansintragastric administration. The major bioactive constituents and potential mechanism of SHD against UC with fungal dysbiosis were comprehensively examined by combining systems pharmacology and in vivo transcriptomics.

Results

SHD attenuatedC. albicans burden, reduced DAI, increased mucosal integrity and relived systemic inflammation in UC mice. Systems pharmacology analysis identified 9 core bioactive ingredients and 45 hub targets of SHD against UC. Transcriptomics analysis confirmed 370 differentially expressed genes (DEGs) after SHD treatment, which were mainly enriched in inflammatory and immune response related signaling pathways. Toll-like receptor and PI3K-Akt signaling pathway were screened out as the candidate targets involved in the action of SHD on fungal dysbiosis-associated UC, which were consistent with the findings in systems pharmacology. The expression of TLR4, IL-1β, NF-κB, PI3K and Akt proteins were stimulated byC. albicans, and partially reversed by SHD in UC mice.

Conclusion

These findings suggested SHD could be a candidate for the treatment of fungal dysbiosis-associated UC via TLR4-NF-κB and PI3K-Akt signaling pathways.
Herbal formula Huangqi Guizhi Wuwu decoction attenuates paclitaxel-related neurotoxicity via inhibition of inflammation and oxidative stress
Authors: Lv Zhangming , Shen Jiayun , Gao Xuejiao , Ruan Yonglan , Ling Jinying , Sun Rongwei , Dai Jingya , Fan Haizhen , Cheng Xiaolan , Cao Peng
Published: August 2021

Background

Paclitaxel-induced peripheral neuropathy (PIPN) is a challenging clinical problem during chemotherapy. Our previous work found that herbal formula Huangqi Guizhi Wuwu decoction (HGWD) could reduce oxaliplatin-induced neurotoxicity. However, its effect on PIPN remains unknown. In this study, we aim to investigate the therapeutic effect and the underlying mechanisms of HGWD against PIPN with pharmacological experiment and network pharmacology.

Methods

Male Wistar rats were used to establish an animal model of PIPN and treated with different doses of HGWD for 3 weeks. Mechanical allodynia, thermal hyperalgesia and body weight were measured to evaluate the therapeutic effect of HGWD on PIPN rats. On the day of the sacrifice, blood, DRGs, sciatic nerve, and hind-paw intra-plantar skins were collected to assess neuroprotective effect of HGWD on PIPN. Next, network pharmacology was performed to decipher the potential active components and molecular mechanisms of HGWD, as were further verified by western blotting analyses in PIPN rats. Finally, the effect of HGWD on the chemotherapeutic activity of paclitaxel was evaluated in vitro and in vivo.

Results

In rats with PIPN, HGWD reversed mechanical allodynia, thermal hyperalgesia, and ameliorated neuronal damage. Moreover, HGWD significantly increased the level of nerve growth factor, dramatically reduced IL-1β, IL-6, TNF-α levels and oxidative stress. Network pharmacology analysis revealed 30 active ingredients in HGWD and 158 candidate targets. Integrated pathway analysis identified PI3K/Akt and toll-like receptor as two main pathways responsible for the neuroprotective effect of HGWD. Further experimental validation demonstrated that HGWD expectedly inhibited the protein expression of TLR4, MyD88, IKKα, and p-NF-κB, and promoted PI3K, p-Akt, Nrf2, and HO-1 level in dorsal root ganglia. Last but not least, HGWD did not interfere with the antitumor activity of paclitaxel both in in vitro and in vivo models.

Conclusion

These combined data showed that HGWD could inhibit paclitaxel-evoked inflammatory and oxidative responses in peripheral nervous system viaTLR4/NF-κB and PI3K/Akt-Nrf2 pathways involvement. The neuroprotective property of HGWD on PIPN provides fundamental support to the potential application of HGWD for counteracting the side effects of paclitaxel during chemotherapy.
Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach)
Authors: Tinsel Iris , Metzner Gloria , Schlett Christian , Sehlbrede Matthias , Bischoff Martina , Anger Robin , Brame Judith , König Daniel , Wurst Ramona , Fuchs Reinhard , Lindinger Peter , Bredenkamp Rainer , Farin-Glattacker Erik
Published: August 2021

Background

A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation.

Methods

The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program).

The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants’ data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs.

According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15–20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction.

The online RCTs’ inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT.

Discussion

We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal’s intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020.

Trial registration

German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273. Registered on 11 December 2019
Differential expression of calcium-dependent protein kinase 4, tubulin tyrosine ligase, and methyltransferase by xanthurenic acid-induced Babesia bovis sexual stages
Authors: Hussein Hala E. , Johnson Wendell C. , Taus Naomi S. , Capelli-Peixoto Janaina , Suarez Carlos E. , Mousel Michelle R. , Ueti Massaro W.
Published: August 2021

Background

Babesia bovis is one of the most significant tick-transmitted pathogens of cattle worldwide. Babesia bovis parasites have a complex lifecycle, including development within the mammalian host and tick vector. Each life stage has developmental forms that differ in morphology and metabolism. Differentiation between these forms is highly regulated in response to changes in the parasite’s environment. Understanding the mechanisms by which Babesia parasites respond to environmental changes and the transmission cycle through the biological vector is critically important for developing bovine babesiosis control strategies.

Results

In this study, we induced B. bovis sexual stages in vitro using xanthurenic acid and documented changes in morphology and gene expression. In vitro induced B. bovis sexual stages displayed distinctive protrusive structures and surface ruffles. We also demonstrated the upregulation of B. bovis calcium-dependent protein kinase 4 (cdpk4), tubulin-tyrosine ligase (ttl), and methyltransferase (mt) genes by in vitro induced sexual stages and during parasite development within tick midguts.

Conclusions

Similar to other apicomplexan parasites, it is likely that B. bovis upregulated genes play a vital role in sexual reproduction and parasite transmission. Herein, we document the upregulation of cdpk4, ttl, and mt genes by both B. bovis in vitro induced sexual stages and parasites developing in the tick vector. Understanding the parasite's biology and identifying target genes essential for sexual reproduction will enable the production of non-transmissible live vaccines to control bovine babesiosis.

Graphical abstract
Cystic pancreatic lesions: MR imaging findings and management
Authors: Morana Giovanni , Ciet Pierluigi , Venturini Silvia
Published: August 2021

Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.
Physicochemical and microbiological evaluation of antioxidant-rich traditional black carrot beverage: Kanji
Authors: Sharma Chetna , Sahota Param Pal , Kaur Sarabjit
Published: August 2021

Background

Daucus carotasubsp.sativus(Black carrots) are underutilized in context to their nutritional properties. In this study, Kanji, a naturally fermented probiotic beverage, was prepared usingDaucus carotasubsp.sativus(var.Punjab Black Beauty). Analysis of the physicochemical and microbiological profile of the naturally fermented Kanji was investigated to boost its utilization for commercial purpose.

Results

The physicochemical parameters observed in the fermented Kanji beverage were pH 3.47, total soluble solids 3°B, lactic acid 0.99%, total sugars 36.32 mg/mL, total reducing sugars 27.16 mg/mL, flavonoids 38.14 mg/mL, phenols 40.8 mg/mL, antioxidant activity 79.96% and ascorbic acid 110 mg/100 mL. The microbiological analysis revealed an exponential increase in lactic acid bacterial count from 3.96 to 8.33 log CFU/mL. Out of 11 bacterial strains isolated from Kanji, the bacterial strain with high growth potential was genotypically characterized asPediococcus acidilacticiwith accession number MK028218.

Conclusion

The lactic acid bacterial Kanji beverage was characterized as a potential plant-based probiotic with high antioxidant activity. This functional autochthonous starter from the Kanji can be used for selective fermentation of black carrots for Kanji ascertaining its microbiological safety, unique flavor and aroma, and consumption as a commercial non-dairy-based probiotic beverage.
Effect of Clinical Trial Participation on Costs to Payers in Metastatic Non–Small-Cell Lung Cancer
Authors: Merkhofer Cristina , Chennupati Shasank , Sun Qin , Eaton Keith D. , Martins Renato G. , Ramsey Scott D. , Goulart Bernardo H. L.
Published: August 2021

PURPOSE:

The costs associated with clinical trial enrollment remain uncertain. We hypothesized that trial participation is associated with decreased total direct medical costs to health care payers in metastatic non–small-cell lung cancer.

METHODS:

In this retrospective cohort study, we linked clinical data from electronic medical records to sociodemographic data from a cancer registry and claims data from Medicare and two private insurance plans. We used a difference-in-difference analysis to estimate mean per patient per month total direct medical costs for patients enrolled on a second-line (2L) trial versus patients receiving standard-of-care 2L systemic therapy.

RESULTS:

Among 70 eligible patients, the difference-in-difference of mean per patient per month total direct medical costs between 2L trial participants and nonparticipants was –$6,663 ( P = .01), for a mean savings of $45,308 per patient for the duration of 2L trial therapy. In a secondary analysis by primary insurance payer, this difference-in-difference was –$5,526 ( P = .26) for patients with commercial insurance and –$7,432 ( P = .01) for patients with Medicare.

CONCLUSION:

Participation in a 2L trial was associated with a $6,663 per month cost savings to health care payers for the duration of trial participation. Further studies are necessary to elucidate differences in cost savings from trial participation for Medicare and commercial payers. If confirmed, these results support health care payer investment in programs to improve clinical trial access and enrollment.
Análise do perfil e da frequência de erros de dispensação de medicamentos em um hospital de médio porte nos anos de 2009 a 2019
Authors: Martins Jordânia Ferreira , Melo Lays Cássia Santos Duarte , Soares Lorena Aguiar , Morais Jéssica Octávia de , Sanches Cristina , Pereira Mariana Linhares , Baldoni André Oliveira
Published: August 2021

Objetivo: avaliar o perfil e a frequência de erros de dispensação de medicamentos entre os anos de 2009 e 2019 em um hospital de médio porte. Métodos: neste trabalho descritivo documental de abordagem quantitativa, os medicamentos envolvidos em erros de dispensação foram classificados de acordo com Anatomical Therapeutic Chemical (ATC) e medicamentos potencialmente perigosos. E os erros foram categorizados segundo guia da Política Nacional de Segurança do Paciente (PNSP). Resultados: os resultados demonstraram que os erros aumentaram no decorrer dos anos, apresentando 28 erros/mês no primeiro ano e 58,6 erros/mês no último, e que os tipos de erros mais frequentes são de omissão do envio (n=1532; 39,0%) e dispensação com dose ou quantidade errada (n=827; 21,0%). A classe de medicamento prescrita mais envolvida em erros foi a de agentes anti-infecciosos de uso sistêmico (n=806; 20,5%). Entre os medicamentos potencialmente perigosos, os de ação no sistema nervoso (n=271; 32,8%) foram os mais dispensados de forma errada, tendo, também, como principal tipo de erro, a omissão, e seu principal representante foi o diazepam (n=84; 31,0%). Conclusões: a quantidade de erros de dispensação (mais de um por dia, em média) evidencia a importância do profissional farmacêutico como potencializador para transformar esse cenário, tanto no âmbito gerencial ao propor barreiras de segurança, quanto clínico, ao acompanhar o processo de uso dos medicamentos.
Impact of an emergency department resident strike during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, South Korea: a retrospective cross-sectional study
Authors: Cho Yo Han , Cho Jae Wan , Ryoo Hyun Wook , Moon Sungbae , Kim Jung Ho , Lee Sang-Hun , Jang Tae Chang , Lee Dong Eun
Published: August 2021

Background: To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, Korea. Methods: We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21–September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21–September 8, 2019) and control period 2 was set as July 1–19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis. Results: During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between study periods; however, the results showed statistically significant differences in the length of ED stay. Conclusion: The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.
TRADISI KEPUNGAN TUMPENG TAWON DESA MANGUNWENI KECAMATAN AYAH KABUPATEN KEBUMEN: KAJIAN FOLKLOR
Authors: Sulastri Yosi , Apriyani Tristanti
Published: August 2021

This research is motivated by the existence of oral literature on the tradition of the tumpeng wasp siege that has not been documented in Mangunweni Village, Ayah District, Kebumen Regency. Oral literature has information that can be utilized by the public. Through documentation, this information can be opened and used so that the objectives of describing oral literature, deciphering the value of oral literature, and identifying the function of oral literature can be achieved. The theory used in this research is the theory of the function of folklore by William R. Bascom and the theory of folklore proposed by Ruth Finnegan that oral literature has value in the phenomenon of human culture.The formal object of this research is the form, function, and value of oral literature. The material object in this study is oral literature in the tradition of the tumpeng wasp siege of the people of Mangunweni Village, Ayah District, Kebumen Regency. The analysis technique used is qualitative data analysis conducted by induction.The results obtained from this study are: 1) the oral literature of the tumpeng tawonsiege tradition is a type of oral tradition in the form of myths and folk beliefs; 2) the values contained in the tumpeng wasp siege tradition consist of divine values, harmony between humans, equality between humans, diversity, sincerity, unyielding, usefulness to others, and concern in achieving goals; 3) the tumpeng wasp siege tradition has a function as a projection system, as a tool for ratifying cultural institutions and institutions, as an educational tool (pedagogical device), and as a coercive and supervisory tool so that community norms will always be obeyed by members.
the brownies’ book: du bois e a construção de uma referência literária para identidade negra infanto-juvenil
Authors: Silvério Valter Roberto
Published: August 2021

In the period from January 1920 to December 1921 a cooperation between Jessie Fauset, Augustus Dill and W.E.B. Du Bois resulted in the publication of a periodical called “The Brownies’ Book” (TBB) the first publication for North American black, and not white (colored people) children and young people. The creation of “The Brownies' Book” (TBB) was a pioneering event in African American literature in general and, more specifically, in the field of African American children's literature, as it was the first periodical composed and published by African Americans for black children who, until then, searched in vain for material that included a perspective on their experience and history. This article argues that the TBBs were one of the harbingers of the movement called the Harlem Renaissance, constituting a children's literary materialization of the path towards the emergence of what the philosopher Alain Locke called the New Negro. What was being formulated was both the deconstruction of stereotypes associated with blacks and the active projection/creation of a positive identification with their local and ancestral community. This paper seeks to identify the post-WWI discursive strategies and practices of de-racialization proposed for “the children of the sun”, as W.E.B. Du Bois called them, in order to stop seeing themselves “through the eyes of others” (Du Bois, 1903).
Needle decompression in tension pneumothorax: anterior or lateral approach?
Authors: Kilgour Ian , Baxter John
Published: August 2021

Background:

For tension pneumothorax, the UK recommendation is to use a 14 g, 5 cm cannula to decompress the chest. Advice around site selection differs between using the second intercostal space (ICS) mid-clavicular line or the fifth ICS near the mid-axillary line. The aim of this literature review is to determine the best approach for needle decompression using a standard 14 g, 5 cm cannula.

Methods:

A systematic search of multiple databases was conducted, using inclusion and exclusion criteria. Outcomes were tabulated to identify any trends between various criteria including success with a 5 cm cannula.

Results:

Thirty-one studies were found, of which four were included. Mean chest wall thickness was 35.8 mm at the anterior site and 39.7 mm at the lateral site. Overall success rates with a 5 cm catheter were on average 79.7% at the anterior and 80% at the lateral position.

Conclusion:

There is no significant difference in success between using the anterior or the lateral approach for needle decompression.
Training to improve responder attitudes and knowledge of opioid overdose
Authors: Thomas Matthew , Brady Laura , Wozniak Monika , Terranova Elizabeth , Moore Cheryll , Kahn Linda S
Published: August 2021

Background:

Opioid use is a major public health issue and opioid overdose requires rapid response with naloxone.

Aims:

This study assesses the impact of a training session on the knowledge and attitudes of first responders and members of the community regarding opioid overdose recognition and naloxone use.

Methods:

A training session was delivered to 2327 participants between July 2019 and March 2020. The study used a paired, pre-/post-analysis to quantify changes.

Findings:

Nearly all (99.7%) participants completed a survey before and after training. Statistically significant improvements were observed in nearly all attitude and knowledge items.

Conclusion:

An education session delivered to an educationally and professionally diverse group can improve trainees' knowledge and attitudes. There were some significant differences between sub-groups, particularly regarding their professional and educational background, and whether the location was urban or rural. Further study is needed to examine whether trainees would benefit from a course tailored toward their education and professional experience.