bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent, non-traumatic, non-exertional rhabdomyolysis after immunologic stimuli in a healthy adolescent female: a case report
Authors: Katz Jason , Labilloy Anatalia , Lee Andrew
Published: August 2022

Background

Dysferlinopathy refers to a heterogenous group of autosomal recessive disorders that affect a skeletal muscle protein called dysferlin. These mutations are associated with limb-girdle muscular dystrophy type 2B, Miyoshi myopathy, asymptomatic hyperCKemia, and distal myopathy with anterior tibial onset.

Case presentation

A 16 year old female presented with myalgia, weakness and dark urine one week after her second BNT162b2 mRNA (Pfizer) vaccine. Initial serum creatine kinase (CK) was measured at 153,000 IU/L, eventually up-trending to over 200,000 IU/L. However, stable renal function precluded hemodialysis allowing discharge after 10 days of intravenous (IV) hydration and alkaline diuresis.

Just two years prior to the current presentation, the patient was hospitalized following Group A Streptococcal pharyngitis infection complicated by rhabdomyolysis. She presented with fatigue, lower extremity weakness, and dark oliguria with CK measuring 984,800 IU/L. IV hydration was attempted however hemodialysis was ultimately required throughout her 24-day hospital stay. Her episode was presumed to be idiopathic and no further work-up was performed at that time.

During the patient’s current hospitalization, she reported similar symptomology (myalgias and weakness) following her first quadrivalent Gardasil vaccine at age 11. No hospitalization was required at that time. A comprehensive workup was now initiated while the patient was being treated for her suspected second or third non-exertional, non-traumatic rhabdomyolysis. Rheumatologic, metabolic, infectious, and endocrinologic workup were all unremarkable. Patient eventually had whole exome sequencing performed which revealed a heterozygous pathogenic variant in the DYSF gene (DYSF c.2643 + 1G > A) encoding dysferlin. No clinically significant sequelae occurred thus far.

Conclusions

While there have been reports of symptomatic heterozygote carriers of dysferlinopathies, to our knowledge none have been associated with recurrent rhabdomyolysis after immunogenic stimuli. This unique case presentation highlights the importance of a multi-disciplinary care team, the utility of modern whole-exome gene sequencing, and the future challenges of balancing vaccine risk vs benefit.
Application for simulating public health problems during floods around the Loei River in Thailand: the implementation of a geographic information system and structural equation model
Authors: Boonnuk Tanunchai , Poomphakwaen Kirati , Kumyoung Natchareeya
Published: August 2022

Background

Floods cause not only damage but also public health issues. Developing an application to simulate public health problems during floods around the Loei River by implementing geographic information system (GIS) and structural equation model (SEM) techniques could help improve preparedness and aid plans in response to such problems in general and at the subdistrict level. As a result, the effects of public health problems would be physically and mentally less severe.

Methods

This research and development study examines cross-sectional survey data. Data on demographics, flood severity, preparedness, help, and public health problems during floods were collected using a five-part questionnaire. Calculated from the population proportion living within 300 m of the Loei River, the sample size was 560 people. The participants in each subdistrict were recruited proportionally in line with the course of the Loei River. Compared to the empirical data, the data analysis examined the causal model of public health problems during floods, flood severity, preparedness, and help. The standardized factor loadings obtained from the SEM analysis were substituted as the loadings in the equations for simulating public health problems during floods.

Results

The results revealed that the causal model of public health problems during floods, flood severity, preparation, and help agreed with the empirical data. Flood severity, preparedness, and aid (χ2 = 479.757, df = 160, p value <.05, CFI = 0.985, RMSEA = 0.060, χ2/df = 2.998) could explain 7.7% of public health problems. The computed values were applied in a GIS environment to simulate public health problem situations at the province, district, and subdistrict levels.

Conclusions

Flood severity and public health problems during floods were positively correlated; in contrast, preparedness and help showed an inverse relationship with public health problems. A total of 7.7% of the variance in public health problems during floods could be predicted. The analysed data were assigned in the GIS environment in the developed application to simulate public health problem situations during floods.
Comparison of Ma-Griffith combined with a minimally invasive small incision to a modified suture technique for the treatment of acute achilles tendon ruptures
Authors: Jun Li , Hao Yu , Junfeng Zhan , Jisen Zhang , Xinzhong Xu , Yunfeng Yao , Dasheng Tian , Jia Xie
Published: August 2022

Background

The Achilles tendon is the strongest tendon in the human body, although it is also prone to injury and rupture. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. The aim of this study was to compare the efficacy of the Ma-Griffith method combined with a minimally invasive small incision (M-G/MISI) with the modified suture technique (MST).

Methods

We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analyzed to compare the treatment efficacy of the two operative methods.

Results

A total of 67 patients were enrolled in the study, 34 of whom underwent M-G/MISI treatment, and 33 of whom underwent MST treatment. The intraoperative blood loss in the M-G/MISI group (16.47 ± 13.23 ml) was significantly lower than that in the MST group (34.55 ± 13.01 ml), and the difference was statistically significant (P ˂0.001). The incision in the M-G/MISI group (3.79 ± 1.81 cm) was significantly shorter than that in the MST group (5.79 ± 1.00 cm), and the difference was statistically significant (P˂0.001). The Achilles tendon rupture score and the American Orthopedic Foot and Ankle Society (AOFAS) score were higher than those of the MST group at the sixth month after the operation (P˂0.001). Postoperatively, there was 1 case of traumatic Achilles tendon rupture in the M-G/MISI group and 1 case each of infection and deep vein thrombosis in the modified suture group.

Conclusions

Compared with the MST group, the M-G/MISI group had better Achilles tendon and ankle function scores at 6 months postoperatively, and less bleeding and shorter incisions. M-G/MISI is less invasive than MST.
Risk factors predicting residual lesion in subsequent hysterectomy following cold knife conization (CKC) for high-grade squamous intraepithelial lesion (HSIL)
Authors: Zeng Yong , Jiang Tao , Zheng Yahong , Yang Jing , Wei Hua , Yi Cunjian , Liu Yan , Chen Keming
Published: August 2022

Objective

To determine risk factors predicting residual lesion in a subsequent hysterectomy follow a cold knife conization (CKC) for high-grade squamous intraepithelial lesion (HSIL).

Method

Between January 2010 and December 2021, a total of 740 patients who underwent a hysterectomy within 3 months after CKC for HSIL were included in this study. We analyzed their demographic features and pathological parameters. A logistic regression model was used to analyze the relationship between parameters and residual lesion in subsequent hysterectomy specimens.

Results

104 (14.1%) had residual lesion in the hysterectomy specimen, 3 patients with microinvasive carcinoma. The rate of residual lesion in patients with positive endocervical margin was 31.3%, with positive ectocervical margin was 15.3%, with positive combine margin was 38.6%. In multivariate analysis, positive margin (OR 4.015; 95% CI 2.526–6.381; P < 0.001), glandular involvement (OR 3.484; 95% CI 1.457–8.330; P = 0.005), HPV16/18 infection (OR 2.804; 95% CI 1.705–4.611; P < 0.001) and multiple HR-HPV infection (OR 1.813; 95% CI 1.130–2.909; P < 0.014) were independent risk factors for residual lesion. The AUC calculated by logistic regression model was 0.78.

Conclusion

Positive margin, positive glandular involvement, HPV16/18 and multiple HR-HPV infection were independent high risk factors of residual lesion in a subsequent hysterectomy following CKC for HSIL.
Understanding medical students’ transformative experiences of early preclinical international rural placement over a 20-year period
Authors: Malau-Aduli Bunmi S. , Jones Karina , Smith Amy M. , Sen Gupta Tarun , Hays Richard B.
Published: August 2022

Introduction

Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program.

Methods

Sixty-five students received a bursary for an international rural placement between 2001–2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis.

Results

Participants reported that the bursary provided a “once in a lifetime opportunity” to “experience eye-opening and culturally rich difference”. Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that “being open-minded” allowed them “enjoy good company”. They were also able to assume “outsider view which allowed reassessment of their own country” and the “isolation experiences gingered desire to right health wrongs”. The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of “inspirational new horizons” based on an appreciation of the “value of rural practice” and “role-modelling for life-long learning.” These findings are consistent with Transformational Learning Theory.

Conclusion

Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice.
Livoneca redmanii Leach, 1818 (Cymothoidae) a parasitic isopod infesting the gills of the European seabass, Dicentrarchus labrax (Linnaeus, 1758): morphological and molecular characterization study
Authors: Abdallah Ebtsam Sayed Hassan , Hamouda Awatef Hamed
Published: August 2022

Background

Prevalence, morphology, and molecular characteristics of isopodiosis in the European seabass, Dicentrarchus labrax, in Egypt were assessed using light and electron microscopy and polymerase chain reaction targeting the mitochondrial COI (cytochrome oxidase c) gene.

Results

Adult parasites were found mainly in the branchial cavity between gill arches and to a lesser extent in the buccal cavity. They were morphologically identified as the Cymothoidae Livoneca redmanii Leach, 1818 (Crustacea: Isopoda). Obviously, a 23% prevalence rate of isopods was reported in D. labrax from Egyptian Mediterranean waters. Destructive and degenerative necrotic alterations with complete sloughing of gill lamellae of the infested fish were observed. DNA sequencing of the mitochondrial COI gene confirmed the identification of the parasite which was deposited in the GenBank under accession numbers MW600099, MZ208984, and MZ208985. Furthermore, the phylogenetic analysis demonstrated that parasites emerged from a monophyletic clade closely affiliated with L. redmanii and were clearly distinguished from other isopod genospecies.

Conclusion

The present investigation addresses L. redmanii infestation in D. labrax in Egypt and affirmed morphological properties via the scanning electron microscopy (SEM) and molecular characteristics of this isopod species. The drastic effects of this parasite on the infected fish were proven both clinically and histopathologically.
Genetic diversity of porcine reproductive and respiratory syndrome virus and evaluation of three one-step real-time RT-PCR assays in Korea
Authors: Shin Go-Eun , Park Ji-Young , Lee Kyoung-Ki , Ko Mi-Kyeong , Ku Bok-Kyung , Park Choi-Kyu , Jeoung Hye-Young
Published: August 2022

Background

Porcine reproductive and respiratory syndrome virus (PRRSV) has caused huge economic losses in the global swine industry. Frequent genetic variations in this virus cause difficulties in controlling and accurately diagnosing PRRSV.

Methods

In this study, we investigated the genetic characteristics of PRRSV-1 and PRRSV-2 circulating in Korea from January 2018 to September 2021 and evaluated three one-step real-time reverse transcription polymerase chain reaction (RT-PCR) assays.

Results

A total of 129 lung samples were collected, consisting of 47 samples for PRRSV-1, 62 samples for PRRSV-2, and 20 PRRSV-negative samples. Nucleotide sequence analysis of open reading frames (ORFs) 5, ORF6, and ORF7 genes from PRRSV samples showed that PRRSV-1 belonged to subgroup A (43/47, 91.49%) and subgroup C (4/47, 8.51%), whereas PRRSV-2 was classified as lineage 1 (25/62, 40.32%), Korean lineage (Kor) C (13/62, 20.97%), Kor B (10/62, 16.13%), lineage 5 (9/62, 14.52%), and Kor A (5/62, 8.06%). Amino acid sequence analysis showed that the neutralizing epitope and T cell epitope of PRRSV-1, and the decoy epitope region and hypervariable regions of PRRSV-2 had evolved under positive selection pressure. In particular, the key amino acid substitutions were found at positions 102 and 104 of glycoprotein 5 (GP5) in some PRRSV-2, and at positions 10 and 70 of membrane protein (M) in most PRRSV-2. In addition, one-step real-time RT-PCR assays, comprising two commercial tests and one test recommended by the World Organization for Animal Health (OIE), were evaluated.

Conclusion

The results revealed that two of the real-time RT-PCR assays had high sensitivities and specificities, whereas the real-time RT-PCR assay of the OIE had low sensitivity due to mismatches between nucleotides of Korean PRRSVs and forward primers. In this study, we genetically characterized recent PRRSV occurrences and evaluated three one-step real-time RT-PCR assays used in Korea.
Do Health Technology Assessment organisations consider manufacturers’ costs in relation to drug price? A study of reimbursement reports
Authors: Enzing Joost J. , Knies Saskia , Engel Jop , IJzerman Maarten J. , Sander Beate , Vreman Rick , Boer Bert , Brouwer Werner B. F.
Published: August 2022

Introduction

Drug reimbursement decisions are often made based on a price set by the manufacturer. In some cases, this price leads to public and scientific debates about whether its level can be justified in relation to its costs, including those related to research and development (R&D) and manufacturing. Such considerations could enter the decision process in collectively financed health care systems. This paper investigates whether manufacturers’ costs in relation to drug prices, or profit margins, are explicitly mentioned and considered by health technology assessment (HTA) organisations.

Method

An analysis of reimbursement reports for cancer drugs was performed. All relevant Dutch HTA-reports, published between 2017 and 2019, were selected and matched with HTA-reports from three other jurisdictions (England, Canada, Australia). Information was extracted. Additionally, reimbursement reports for three cases of expensive non-oncolytic orphan drugs prominent in pricing debates in the Netherlands were investigated in depth to examine consideration of profit margins.

Results

A total of 66 HTA-reports concerning 15 cancer drugs were included. None of these reports contained information on manufacturer’s costs or profit margins. Some reports contained general considerations of the HTA organisation which related prices to manufacturers’ costs: six contained a statement on the lack of price setting transparency, one mentioned recouping R&D costs as a potential argument to justify a high price. For the case studies, 21 HTA-reports were selected. One contained a cost-based price justification provided by the manufacturer. None of the other reports contained information on manufacturer’s costs or profit margins. Six reports contained a discussion about lack of transparency. Reports from two jurisdictions contained invitations to justify high prices by demonstrating high costs.

Conclusion

Despite the attention given to manufacturers’ costs in relation to price in public debates and in the literature, this issue does not seem to get explicit systematic consideration in the reimbursement reports of expensive drugs.
Chronic allergic lung inflammation negatively influences neurobehavioral outcomes in mice
Authors: Kanaya Akihiro , Yang Mu , Emala Charles , Mikami Maya
Published: August 2022

Background

Asthma is a major public health problem worldwide. Emerging data from epidemiological studies show that allergies and allergic diseases may be linked to anxiety, depression and cognitive decline. However, little is known about the effect of asthma, an allergic lung inflammation, on cognitive decline/behavioral changes. Therefore, we investigated the hypothesis that allergic lung inflammation causes inflammation in the brain and leads to neurobehavioral changes in mice.

Methods

Wild-type C57BL/6J female mice were sensitized with nasal house dust mite (HDM) antigen or control PBS for 6 weeks to induce chronic allergic lung inflammation. A series of neurocognitive tests for anxiety and/or depression were performed before and after the intranasal HDM administration. After the behavior tests, tissues were harvested to measure inflammation in the lungs and the brains.

Results

HDM-treated mice exhibited significantly increased immobility times during tail suspension tests and significantly decreased sucrose preference compared with PBS controls, suggesting a more depressed and anhedonia phenotype. Spatial memory impairment was also observed in HDM-treated mice when assessed by the Y-maze novel arm tests. Development of lung inflammation after 6 weeks of HDM administration was confirmed by histology, bronchoalveolar lavage (BAL) cell count and lung cytokine measurements. Serum pro-inflammatory cytokines and Th2-related cytokines levels were elevated in HDM-sensitized mice. In the brain, the chemokine fractalkine was increased in the HDM group. The c-Fos protein, a marker for neuronal activity, Glial Fibrillary Acidic Protein (GFAP) and chymase, a serine protease from mast cells, were increased in the brains from mice in HDM group. Chymase expression in the brain was negatively correlated with the results of sucrose preference rate in individual mice.

Conclusions

6 weeks of intranasal HDM administration in mice to mimic the chronic status of lung inflammation in asthma, caused significant inflammatory histological changes in the lungs, and several behavioral changes consistent with depression and altered spatial memory. Chymase and c-Fos proteins were increased in the brain from HDM-treated mice, suggesting links between lung inflammation and brain mast cell activation, which could be responsible for depression-like behavior.
Mathematical modelling of the CSF system: effects of microstructures and posture on optic nerve subarachnoid space dynamics
Authors: Holmlund Petter , Støverud Karen-Helene , Eklund Anders
Published: August 2022

Background

The pressure difference between the eye and brain in upright postures may be affected by compartmentalization of the optic nerve subarachnoid space (ONSAS). Both pressure and deformation will depend on the microstructures of the ONSAS, and most likely also on ocular glymphatic clearance. Studying these factors could yield important knowledge regarding the translaminar pressure difference, which is suspected to play a role in normal-tension glaucoma.

Methods

A compartment model coupling the ONSAS with the craniospinal CSF system was used to investigate the effects of microstructures on the pressure transfer through the ONSAS during a posture change from supine to upright body postures. ONSAS distensibility was based on MRI measurements. We also included ocular glymphatic flow to investigate how local pressure gradients alter this flow with changes in posture.

Results

A compartmentalization of the ONSAS occurred in the upright posture, with ONSAS porosity (degree of microstructural content) affecting the ONSAS pressure (varying the supine/baseline porosity from 1.0 to 0.75 yielded pressures between − 5.3 and − 2 mmHg). Restricting the minimum computed porosity (occurring in upright postures) to 0.3 prevented compartmentalization, and the ONSAS pressure could equilibrate with subarachnoid space pressure (− 6.5 mmHg) in $$\le$$
≤
1 h. The ocular glymphatics analysis predicted that substantial intraocular-CSF flows could occur without substantial changes in the ONSAS pressure. The flow entering the ONSAS in supine position (both from the intraocular system and from the cranial subarachnoid space) exited the ONSAS through the optic nerve sheath, while in upright postures the flow through the ONSAS was redirected towards the cranial subarachnoid space.

Conclusions

Microstructures affect pressure transmission along the ONSAS, potentially contributing to ONSAS compartmentalization in upright postures. Different pathways for ocular glymphatic flow were predicted for different postures.
Effectiveness of a practice change intervention in reducing alcohol consumption in pregnant women attending public maternity services
Authors: Tsang Tracey W. , Kingsland Melanie , Doherty Emma , Wiggers John , Attia John , Wolfenden Luke , Dunlop Adrian , Tully Belinda , Symonds Ian , Rissel Chris , Lecathelinais Christophe , Elliott Elizabeth J.
Published: August 2022

Background

The aim of this study was to examine the effect of a practice change intervention to support the implementation of guideline-recommended care for addressing alcohol use in pregnancy on self-reported alcohol use during pregnancy.

Methods

A randomized, stepped-wedge controlled trial in three clusters (sectors) within the Hunter New England Local Health District (NSW, Australia). We evaluated a practice change intervention that supported the introduction of a new model of care for reducing alcohol use in pregnancy, consistent with local and international guidelines, and implemented in random order across the sectors. Each week throughout the study period, pregnant women who attended any public antenatal services within the previous week, for a 27–28 or 35–36 week gestation visit, were randomly sampled and invited to participate in the survey. The intended intervention for all women was Brief advice (to abstain from alcohol and information about potential risks). Women identified as medium-risk alcohol consumers using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) were to be offered referral to a phone coaching service, and women identified as high-risk were to be offered referral to a Drug and Alcohol Service. Rates of self-reported alcohol use (AUDIT-C risk level and special occasion drinking) were summarized and compared in groups of women pre-intervention and post-intervention using multivariable logistic regression.

Results

Surveys were completed by 1309 women at pre-intervention and 2540 at post-intervention. The majority of women did not drink during pregnancy (pre-intervention: 89.68%; post-intervention: 90.74%). There was no change in the proportion of women classified as No risk from drinking (AUDIT-C score = 0) or Some risk from drinking (AUDIT-C score ≥ 1) pre- or post-intervention (p = 0.08). However, a significant reduction in special occasion drinking was observed (pre-intervention: 11.59%; post-intervention: 8.43%; p < 0.001).

Conclusions

Special occasion drinking was reduced following implementation of guideline-recommended care. Failure to change other patterns of alcohol use in pregnancy may reflect barriers to implementing the model of care in antenatal care settings and the need to address other social determinants of alcohol use.

Trial registration

Australian and New Zealand Clinical Trials Registry (registration number: ACTRN12617000882325; date: 16 June 2017).
Three-dimensional CT angiography facilitates uniportal thoracoscopic anatomic lung resection for pulmonary sequestration: a retrospective cohort study
Authors: Zheng Wenlong , Zhang Miao , Wu Wenbin , Zhang Hui , Zhang Xinhui
Published: August 2022

Background

Pulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered as the best treatment for PS. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the role of preoperative 3D-CTA and resection simulation in uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung surgery for PS.

Methods

The data of 20 consecutive PS patents undergoing anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. These patients were divided into the 3D-CTA group (10 patients) and the control group (10 patients) according to the initial surgical planning with or without 3D-CTA. The perioperative parameters regarding safety and fluency such as the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed.

Results

This cohort included 12 female and 8 male patients, with a mean age of 45 years old (range 24–60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic on admission. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed, whereas 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%), and the inferior phrenic artery in 1 patient (5.0%). There was no major bleeding or 30 days mortality. The initial surgical planning included 9 uniportal and 1 two-port VATS in the 3D-CTA group, as compared with 10 two-port VATS in the control group. Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. However, no conversion was needed in the 3D-CTA group; whereas 6 (60.0%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the control group, indicating a significant difference (P = 0.003). In addition, the operation time in the 3D-CTA group was significantly shorter than those in the control group [(108.5 ± 24.9) min vs. (154.5 ± 39.4) min,P = 0.006]. The other surgery-related outcomes were similar between the two groups.

Conclusion

Preoperative 3D-CTA facilitates the safe and fluent performance of uniportal VATS anatomical lung resection for PS with shortened operation time and lessened surgical conversions.
The protective role of mindful parenting against child maltreatment and aggressive behavior: an exploratory study among Chinese parent-adolescent dyads
Authors: Yue Lei , Cui Naixue , Golfenshtein Nadya , Cui Naisong , Hao Yinjun , Lyu Pingping
Published: August 2022

Background

It is well-established that child maltreatment practiced by parents is associated with adolescent aggression. Emerging evidence has suggested that higher levels of mindful parenting are associated with fewer negative parenting practices. However, the relationships among mindful parenting, child maltreatment, and adolescent aggression remain unclear.

Aim

To examine the association between mindful parenting, child maltreatment, and adolescent aggressive behavior among Chinese parent-adolescent dyads.

Methods

Survey data from 554 Chinese parent-adolescent dyads were used for the analysis. Parents reported mindful parenting, and adolescents reported three forms of child maltreatment (i.e., physical abuse, psychological aggression, and neglect) by their parents and aggressive behavior. Path models were used to analyze whether higher levels of mindful parenting were associated with decreased likelihood of parent-to-adolescent maltreatment that were further related to lower levels of adolescent aggression.

Results

Mindful parenting and its two factors (i.e., interaction with full attention and compassion and acceptance) were associated with lower likelihood of physical abuse and psychological aggression, which were related to decreased levels of adolescent aggressive behavior. Stratified analyses by parent gender showed that the path from interaction with full attention to adolescent aggression through psychological aggression was also significant or marginally significant in both mother-adolescent and father-adolescent dyads. Stratified analyses by adolescent gender demonstrated that the paths from interaction with full attention to physical abuse and psychological aggression were significant, which were also significantly correlated with adolescent aggression among male adolescents, whereas the mindful parenting-child maltreatment-adolescent aggression paths were not significant among female adolescents.

Conclusions

The findings contributed to the existing literature by assessing mindful parenting as a multifaceted construct and exploring the gender differences in the relationships. Gender-tailored interventions to improve mindful parenting, specifically focusing on the parents’ ability of interacting with adolescents providing full attention, compassion, and acceptance may work towards preventing child maltreatment and promoting adolescent behavioral health.
Effectiveness of the internet-based Unified Protocol transdiagnostic intervention for the treatment of depression, anxiety and related disorders in a primary care setting: a randomized controlled trial
Authors: Timulak Ladislav , Richards Derek , Bhandal-Griffin Louise , Healy Patrick , Azevedo Juliana , Connon Graham , Martin Elaine , Kearney Aoife , O’Kelly Conor , Enrique Angel , Eilert Nora , O’Brien Sorcha , Harty Siobhan , González-Robles Alberto , Eustis Elizabeth H. , Barlow David H. , Farchione Todd J.
Published: August 2022

Background

Research has shown that internet-based cognitive behavioural therapy (iCBT) can be a very promising solution to increase access to and the dissemination of evidence-based treatments to all of the population in need. However, iCBT is still underutilized in clinical contexts, such as primary care. In order to achieve the effective implementation of these protocols, more studies in ecological settings are needed. The Unified Protocol (UP) is a transdiagnostic CBT protocol for the treatment of emotional disorders, which includes depression, anxiety and related disorders, that has shown its efficacy across different contexts and populations. An internet-based UP (iUP) programme has recently been developed as an emerging internet-based treatment for emotional disorders. However, the internet-delivered version of the UP (iUP) has not yet been examined empirically. The current project seeks to analyse the effectiveness of the iUP as a treatment for depression, anxiety and related emotional disorders in a primary care public health setting.

Methods

The current study will employ a parallel-group, randomized controlled trial design. Participants will be randomly assigned to (a) the internet-based Unified Protocol (iUP), or (b) enhanced waiting list control (eWLC). Randomization will follow a 2:1 allocation ratio, with sample size calculations suggesting a required sample of 120 (iUP=80; eWLC=40). The Mini-International Neuropsychiatric Interview (M.I.N.I.) will be used for assessing potential participants. The Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) as well as other standardized questionnaires will be used for assessments at baseline, 4 weeks, 8 weeks and 12 weeks from baseline and for the iUP condition during the follow-up.

Discussion

Combining the advantages of a transdiagnostic treatment with an online delivery format may have the potential to significantly lower the burden of emotional disorders in public health primary care setting. Anxiety and depression, often comorbid, are the most prevalent psychological disorders in primary care. Because the iUP allows for the treatment of different disorders and comorbidity, this treatment could represent an adequate choice for patients that demand mental health care in a primary care setting.

Trial registration

ISRCTN18056450 https://doi.org/10.1186/ISRCTN18056450.
Impact of propofol versus sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery: study protocol of a randomized controlled trial
Authors: Wang Ji-hua , Lv Meng , Zhang Hai-xia , Gao Yang , Chen Ting-ting , Wan Tian-tian , Wang Yue-lan
Published: August 2022

Background

Postoperative delirium in elderly patients is a common and costly complication after surgery. Propofol and sevoflurane are commonly used anesthetics during general anesthesia, and the sedative and anti-inflammatory mechanisms of the two medications are different. The aim of this trial is to compare the impact of propofol with sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery.

Methods

A single-center randomized controlled trial will be performed at First Affiliated Hospital of Shandong First Medical University, China. A total of 298 participants will be enrolled in the study and randomized to propofol infusion or sevoflurane inhalation groups. The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include the day of postoperative delirium onset, duration (time from first to last delirium-positive day), and total delirium-positive days among patients who developed delirium; tracheal intubation time in PACU; the length of stay in PACU; the rate of postoperative shivering; the rate of postoperative nausea and vomiting; the rate of emergence agitation; pain severity; QoR40 at the first day after surgery; the length of stay in hospital after surgery; and the incidence of non-delirium complications within 30 days after surgery.

Discussion

The primary objective of this study is to compare the impact of propofol and sevoflurane on the incidence of postoperative delirium for elderly patients undergoing spine surgery. The results may help inform strategies to the optimal selection of maintenance drugs for general anesthesia in elderly patients undergoing spine surgery.

Trial registration

ClinicalTrials.govNCT05158998. Registered on 14 December 2021
A genetic model for central chondrosarcoma evolution correlates with patient outcome
Authors: Cross William , Lyskjær Iben , Lesluyes Tom , Hargreaves Steven , Strobl Anna-Christina , Davies Christopher , Waise Sara , Hames-Fathi Shadi , Oukrif Dahmane , Ye Hongtao , Amary Fernanda , Tirabosco Roberto , Gerrand Craig , Baker Toby , Barnes David , Steele Christopher , Alexandrov Ludmil , Bond Gareth ,   Genomics England Research Consortium, Cool Paul , Pillay Nischalan , Van Loo Peter , Flanagan Adrienne M.
Published: August 2022

Background

Central conventional chondrosarcoma (CS) is the most common subtype of primary malignant bone tumour in adults. Treatment options are usually limited to surgery, and prognosis is challenging. These tumours are characterised by the presence and absence of IDH1 and IDH2 mutations, and recently, TERT promoter alterations have been reported in around 20% of cases. The effect of these mutations on clinical outcome remains unclear. The purpose of this study was to determine if prognostic accuracy can be improved by the addition of genomic data, and specifically by examination of IDH1, IDH2, and TERT mutations.

Methods

In this study, we combined both archival samples and data sourced from the Genomics England 100,000 Genomes Project (n = 356). Mutations in IDH1, IDH2, and TERT were profiled using digital droplet PCR (n = 346), whole genome sequencing (n=68), or both (n = 64). Complex events and other genetic features were also examined, along with methylation array data (n = 84). We correlated clinical features and patient outcomes with our genetic findings.

Results

IDH2-mutant tumours occur in older patients and commonly present with high-grade or dedifferentiated disease. Notably, TERT mutations occur most frequently in IDH2-mutant tumours, although have no effect on survival in this group. In contrast, TERT mutations are rarer in IDH1-mutant tumours, yet they are associated with a less favourable outcome in this group. We also found that methylation profiles distinguish IDH1- from IDH2-mutant tumours. IDH wild-type tumours rarely exhibit TERT mutations and tend to be diagnosed in a younger population than those with tumours harbouring IDH1 and IDH2 mutations. A major genetic feature of this group is haploidisation and subsequent genome doubling. These tumours evolve less frequently to dedifferentiated disease and therefore constitute a lower risk group.

Conclusions

Tumours with IDH1 or IDH2 mutations or those that are IDHwt have significantly different genetic pathways and outcomes in relation to TERT mutation. Diagnostic testing for IDH1, IDH2, and TERT mutations could therefore help to guide clinical monitoring and prognostication.
Hurdles to developing and scaling remote patients’ health management tools and systems: a scoping review
Authors: Ruyobeza Barimwotubiri , Grobbelaar Sara S. , Botha Adele
Published: August 2022

Background

Despite all the excitement and hype generated regarding the expected transformative impact of digital technology on the healthcare industry, traditional healthcare systems around the world have largely remained unchanged and resultant improvements in developed countries are slower than anticipated. One area which was expected to significantly improve the quality of and access to primary healthcare services in particular is remote patient monitoring and management. Based on a combination of rapid advances in body sensors and information and communication technologies (ICT), it was hoped that remote patient management tools and systems (RPMTSs) would significantly reduce the care burden on traditional healthcare systems as well as health-related costs. However, the uptake or adoption of above systems has been extremely slow and their roll out has not yet properly taken off especially in developing countries where they ought to have made the greatest positive impact.

Aim

The aim of the study was to assess whether or not recent, relevant literature would support the development of in-community, design, deployment and implementation framework based on three factors thought to be important drivers and levers of RPMTS’s adoption and scalability.

Methods

A rapid, scoping review conducted on relevant articles obtained from PubMed, MEDLINE, PMC and Cochrane databases and grey literature on Google and published between 2012 and May 2020, by combining a number of relevant search terms and phrases.

Results

Most RPMTSs are targeted at and focused on a single disease, do not extensively involve patients and clinicians in their early planning and design phases, are not designed to best serve a specific catchment area and are mainly directed at post-hospital, disease management settings. This may be leading to a situation where patients, potential patients and clinicians simply do not make use of these tools, leading to low adoption and scalability thereof.

Conclusion

The development of a user-centred, context-dependent, customizable design and deployment framework could potentially increase the adoption and scalability of RPMTSs, if such framework addressed a combination of diseases, prevalent in a given specific catchment area, especially in developing countries with limited financial resources.
Multiplicity of solutions for the Dirichlet boundary value problem to a fractional quasilinear differential model with impulses
Authors: Shen Xiaohui , Shen Tengfei
Published: August 2022

This paper aims to consider the multiplicity of solutions for a kind of boundary value problem to a fractional quasilinear differential model with impulsive effects. By establishing a new variational structure and overcoming the difficulties brought by the influence of impulsive effects, some new results are acquired via the symmetry mountain-pass theorem, which extend and enrich some previous results.
Users’ perceptions of how an unmoderated eating disorder community may benefit or harm their recovery
Authors: Jones Maegan E. , Salafia Elizabeth H. Blodgett , Leonard Kerrie C.
Published: August 2022

Background

While the negative and positive outcomes of pro-eating disorder groups have been well-documented, more research is needed on the effects of pro-recovery communities. In particular, a gap in knowledge remains surrounding users’ feelings about their experiences in such communities. Using open-ended questions, we surveyed those involved in the recovery community on the social media site Tumblr, to determine how the community helped/did not help with recovery, and how it made them feel about recovery.

Methods

Participants (n = 29) answered a series of Likert and open-ended questions. The open-ended questions were examined using thematic analysis to learn about users’ lived experiences.

Results

Themes identified included connection/acceptance, motivation/encouragement, content, and competition/comparisons. Participants overall felt that the community helped them feel connected to others and accepted for their struggles and their successes, though a minority did note that such acceptance could sometimes reinforce negative behaviors, and connection could lead to pressure to help others. Participants found both direct advice and indirect support (e.g., encouraging posts) to be motivating for their recovery. Feelings of competition and comparison were mixed; some felt that comparing to others made them feel less than, while others used such comparisons as reminders to stay strong in recovery. Participants indicated that the content within the community varies; sometimes there is a large presence of pro eating disorder posts, while at other times, posts are more positive, motivational, and encouraging.

Conclusions

Participants overall indicated that the community had many helpful aspects and made them feel better about recovery. However, the presence of triggering content and competition in particular were notable drawbacks of the community. Overall, recovery communities on unmoderated sites or social media applications may be useful tools during the recovery process, despite some important limitations.
Married men’s sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study
Authors: Azmi Raia , Mahmud Ilias , Islam Kuhel Faizul , Hasan Md Tanvir , Rashid Sabina Faiz
Published: August 2022

Background

In Bangladesh, men’s sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men’s SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh.

Methods

Using a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment.

Results

The research findings reveal that- men’s various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain.

Conclusion

There is a need of appropriate interventions to address men’s anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek  formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.
On the evolution of the gender gap in life expectancy at normal retirement age for OECD countries
Authors: Coppola Mariarosaria , Russolillo Maria , Simone Rosaria
Published: August 2022

Population aging is evolving at different rates across countries and over time, and it represents a long-term challenge for both the sustainability of pension schemes and for the realization of public intergenerational transfers. In this context, this work focuses on gender differences in survival at older ages. Specifically, we implement a comparative analysis of OECD countries to assess the adequacy of the corresponding gender-specific normal retirement age when faced with growing life expectancy. The analysis hinges on several graphical representations and is motivated by recent findings on Italian longevity to determine optimal retirement age shifts necessary to match growing life expectancy at older ages while accounting for model risk for mortality projections. Our analysis determines—at the country level—the extent to which adjustments to the normal retirement age are advisable for the sustainability of the intergenerational paradigm for pensions. The study considers males and females separately because most of these countries are characterized by aging societies where men and women have different crucial characteristics, including life expectancy. It is therefore important that policymakers have information on the future evolution of the longevity gender gap so they will be able to apply policies that preserve the principles of equality and solidarity and reduce the pension gender gap. We find groups of countries where gender gap in life expectancy follows the same dynamics.