bluuebunny/crossref_metadata_2025 huggingface dataset:
GLP-1 vasodilatation in humans with coronary artery disease is not adenosine mediated
Authors: Aetesam-ur-Rahman Muhammad , Giblett Joel P. , Khialani Bharat , Kyranis Stephen , Clarke Sophie J. , Zhao Tian X. , Braganza Denise M. , Clarke Sarah C. , West Nick E. J. , Bennett Martin R. , Hoole Stephen P.
Published: May 2021

Background

Incretin therapies appear to provide cardioprotection and improve cardiovascular outcomes in patients with diabetes, but the mechanism of this effect remains elusive. We have previously shown that glucagon-like peptide (GLP)-1 is a coronary vasodilator and we sought to investigate if this is an adenosine-mediated effect.

Methods

We recruited 41 patients having percutaneous coronary intervention (PCI) for stable angina and allocated them into four groups administering a specific study-related infusion following successful PCI: GLP-1 infusion (Group G) (n = 10); Placebo, normal saline infusion (Group P) (n = 11); GLP-1 + Theophylline infusion (Group GT) (n = 10); and Theophylline infusion (Group T) (n = 10). A pressure wire assessment of coronary distal pressure and flow velocity (thermodilution transit time—Tmn) at rest and hyperaemia was performed after PCI and repeated following the study infusion to derive basal and index of microvascular resistance (BMR and IMR).

Results

There were no significant differences in the demographics of patients recruited to our study. Most of the patients were not diabetic. GLP-1 caused significant reduction of resting Tmn that was not attenuated by theophylline: mean delta Tmn (SD) group G − 0.23 s (0.27) versus group GT − 0.18 s (0.37), p = 0.65. Theophylline alone (group T) did not significantly alter resting flow velocity compared to group GT: delta Tmn in group T 0.04 s (0.15), p = 0.30. The resulting decrease in BMR observed in group G persisted in group GT: − 20.83 mmHg s (24.54 vs. − 21.20 mmHg s (30.41), p = 0.97. GLP-1 did not increase circulating adenosine levels in group GT more than group T: delta median adenosine − 2.0 ng/ml (− 117.1, 14.8) versus − 0.5 ng/ml (− 19.6, 9.4); p = 0.60.

Conclusion

The vasodilatory effect of GLP-1 is not abolished by theophylline and GLP-1 does not increase adenosine levels, indicating an adenosine-independent mechanism of GLP-1 coronary vasodilatation.

Trial registration: The local research ethics committee approved the study (National Research Ethics Service-NRES Committee, East of England): REC reference 14/EE/0018. The study was performed according to institutional guidelines, was registered on http://www.clinicaltrials.gov (unique identifier: NCT03502083) and the study conformed to the principles outlined in the Declaration of Helsinki.
A case report of left atrial myxoma presenting with amnesia
Authors: Shabab Sadegh , Erfanzadeh Majid , Ahmadian Shamsa , Mahmoudabady Maryam , Mazloum Naser
Published: May 2021

Background

Primary cardiac tumors are rare, and approximately 90% of them are benign. Myxoma is the most common type of these tumors occurring in the left atrium in 75–85% of cases. The tumor can cause the left atrio-ventricular valve obstruction and embolization phenomenon.

Case presentation

We reported a case of 54-year-old man with complaints of dyspenea and amnesia. In our patient, transthoracic echocardiography revealed a mass of 28*63 mm attached to the upper intra-atrial septum, which was prolapsing through the mitral valve into the left ventricle during diastole, being indicative of the left atrial myxoma. On examination, he was alert and conversant, and no pathological abnormality was observed in the examination of cardiovascular, gastrointestinal, respiratory, hepatic, renal and nervous systems. After myxoma diagnosis, the tumor was removed under cardiac surgery and discharged under good conditions. In the telephone follow-up after discharge, the patient recovered and did not report the disease and surgery complications.

Conclusions

Patients with cardiac myxoma are usually asymptomatic, but they may have manifestations related to the embolism phenomenon or intracardiac obstruction. Therefore, myxoma may represent an emergency. Surgery should be performed as soon as possible. If surgery is delayed, the patient may suffer from serious and irreversible complications, such as stroke and cardiac arrest.
Consequences of the emergency response to COVID-19: a whole health care system review in a single city in the United Kingdom
Authors: Tankel Jeremy W. , Ratcliffe David , Smith Martin , Mullarkey Andrew , Pover Jennifer , Marsden Zoe , Bennett Paula , Green Darren
Published: May 2021

Background

The response to the COVID-19 pandemic in the United Kingdom included large scale changes to healthcare delivery, without fully understanding the potential for unexpected effects caused by these changes.

The aim was “to ascertain the characteristics of patients, uncertainty over diagnosis, or features of the emergency response to the pandemic that could be modified to mitigate against future excess deaths”.

Methods

Review of the entire pathway of care of patients whose death was registered in Salford during the 8 week period of the first wave (primary care, secondary care, 111 and 999 calls) in order to create a single record of healthcare prior to death. An expert panel judged avoidability of death against the National Mortality Case Record Review Programme scale. The panel identified themes using a structured judgement review format.

Results

There were 522 deaths including 197 in hospital, and 190 in care homes. 51% of patients were female, 81% Caucasian, age 79 ± 9 years. Dementia was present in 35%, COVID-19 was cause of death in 44%.

Healthcare contact prior to death was most frequently with primary care (81% of patients). Forty-six patients (9%) had healthcare appointments cancelled (median 1 cancellation, range 1–9). Fewer than half of NHS 111 calls were answered during this period.

18% of deaths contained themes consistent with some degree of avoidability. In people aged ≥75 years who lived at home this was 53%, in care home residents 29% and in patients with learning disability 44% (n = 9). Common themes were; delays in patients presenting to care providers (10%), delays in testing (17%), avoidable exposure to COVID-19 (26%), delays in provider response (5%), and sub-optimal care (11%). For avoidability scores of 2 or 3 (indicating more than 50% chance of avoidability), 44% of cases had > 2 themes.

Conclusions

The initial emergency response had unforeseen consequences resulting in late presentation, sub-optimal assessments, and delays in receiving care. Death in more vulnerable groups was more likely to display avoidability themes.
Spinach consumption and nonalcoholic fatty liver disease among adults: a case–control study
Authors: Mokhtari Ebrahim , Farhadnejad Hossein , Salehi-Sahlabadi Ammar , Najibi Narjes , Azadi Mina , Teymoori Farshad , Mirmiran Parvin
Published: May 2021

Background

Spinach has high antioxidants and polyphenols and showed protective effects against liver diseases in experimental studies. We aimed to assess the association between dietary intake of spinach and odds of nonalcoholic fatty liver disease (NAFLD) in a case–control study among Iranian adults.

Methods

Totally 225 newly diagnosed NAFLD patients and 450 controls, aged 20–60 years, were recruited in this study. Participants’ dietary intakes were collected using a valid and reliable 168-item semi-quantitative food frequency questionnaire (FFQ). The logistic regression test was used for assessing the association between total, raw, and boiled dietary spinach with the odds of NAFLD.

Results

The mean (SD) age and BMI of participants (53% male) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final adjusted model for potential confounders, the odds (95% CI) of NAFLD in individuals in the highest tertile of daily total and raw spinach intake was [0.36 (0.19–0.71), P_trend = 0.001] and [0.47 (0.24–0.89), P_trend = 0.008], respectively compared with those in the lowest tertile. Furthermore, in the adjusted analyses, an inverse association was observed between the highest yearly intake versus no raw spinach consumption and odds of NAFLD [(OR 0.41; 95% CI 0.18–0.96), P for trend = 0.013]. However, there was no significant association between higher boiled spinach intake and odds of NAFLD.

Conclusions

The present study found an inverse association between total and raw spinach intake with the odds of NAFLD.
Good performance in the management of acute heart failure in cardiogeriatric departments: the ICREX-94 experience
Authors: Berthelot Emmanuelle , Broussier Amaury , Damy Thibaud , Donadio Cristiano , Cosson Stephane , Rovani Xavier , Salengro Emmanuel , Billebeau Gilles , Megbemado Richard , Rekik Noomen , Godreuil Christian , Richard Kevin , Shourick Jason , Assayag Patrick , Belmin Joel , David Jean Philippe , Hittinger Luc ,   for the FINC-94 network
Published: May 2021

Context

A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area.

Methods

Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne.

Results

A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection.

Conclusion

AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.
Infant rhesus macaques as a non-human primate model of Bordetella pertussis infection
Authors: Jiang Wenwen , Wei Chen , Mou Dachao , Zuo Weilun , Liang Jiangli , Ma Xiao , Wang Lichan , Gao Na , Gu Qin , Luo Peng , Ma Yan , Li Jingyan , Liu Shuyuan , Shi Li , Sun Mingbo
Published: May 2021

Background

The prevalent resurgence of pertussis has recently become a critical public health problem worldwide. To understand pertussis pathogenesis and the host response to both the pathogen and vaccines, a suitable pertussis animal model, particularly a non-human primate model, is necessary. Recently, a non-human primate pertussis model was successfully established with baboons. Rhesus macaques have been shown to be ideal animal models for several infectious diseases, but a model of infectious pertussis has not been established in these organisms. Studies on rhesus macaque models of pertussis were performed in the 1920s–1930s, but limited experimental details are available. Recent monkey pertussis models have not been successful because the typical clinical symptoms and transmission have not been achieved.

Methods

In the present study, infant rhesus macaques were challenged with Bordetella pertussis (B.p) using an aerosol method to evaluate the feasibility of this system as an animal model of pertussis.

Results

Upon aerosol infection, monkeys infected with the recently clinically isolated B.p strain 2016-CY-41 developed the typical whooping cough, leukocytosis, bacteria-positive nasopharyngeal wash (NPW), and interanimal transmission of pertussis. Both systemic and mucosal humoral responses were induced by B.p.

Conclusion

These results demonstrate that a model of pertussis was successfully established in infant rhesus macaques. This model provides a valuable platform for research on pertussis pathogenesis and evaluation of vaccine candidates.
Headache from clinically confirmed hemicrania continua arising from the sternocleidomastoid muscle: a case report
Authors: Wende Osnat , Markowitz Shira
Published: May 2021

Background

A patient with a history of cluster headaches, now in remission, presented with confirmed hemicrania continua that resolved with a local anaesthetic injection into the Sternocleidomastoid (SCM) muscle. To the best of our knowledge, this is the first reported case of a trigeminal autonomic cephalalgia arising from a soft tissue source in the neck.

Case presentation

A 66-year-old man with a history of cluster headaches presented with a six-month history of a new constant right-sided headache. The new headaches were associated with tearing and redness of the right eye and responded to indomethacin, thus meeting the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for hemicrania continua. The history and physical examination suggested a cervical source of the headache arising from the ipsilateral SCM muscle. Injection of the muscle with 1% lidocaine resulted in the elimination of the pain for 1 month without indomethacin.

Conclusions

Due to the convergence of trigeminal, cervical and autonomic nerve fibres, various combinations of headache syndromes can result. This case report demonstrates how a meticulous examination is a crucial component of headache evaluation. Treatment directed to this muscle spared this patient further daily indomethacin and associated side effects.
The effect of yoga on the delivery and neonatal outcomes in nulliparous pregnant women in Iran: a clinical trial study
Authors: Yekefallah Leili , Namdar Peyman , Dehghankar Leila , Golestaneh Fereshteh , Taheri Soghra , Mohammadkhaniha Frahnaz
Published: May 2021

Background

Yoga can reduce the risk of preterm delivery, cesarean section (CS), and fetal death. The aim of the present study was to investigate the effects of Yoga on pregnancy, delivery, and neonatal outcomes.

Methods

This was a clinical trial study and using the random sampling without replacement 70 pregnant women entered Hatha Yoga and control groups according to the color of the ball they took from a bag containing two balls (blue or red). The data collection tool was a questionnaire pregnancy, delivery, and neonatal outcomes. The intervention in this study included pregnancy Hatha Yoga exercises that first session of pregnancy Yoga started from the 26th week and samples attended the last session in the 37th week. They exercised Yoga twice a week (each session lasting 75 min) in a Yoga specialized sports club. The control group received the routine prenatal care that all pregnant women receive.

Results

The results showed that yoga reduced the induction of labor, the episiotomy rupture, duration of labor, also had a significant effect on normal birth weight and delivery at the appropriate gestational age. There were significant differences between the first and second Apgar scores of the infants.

Conclusion

The results of the present study showed that Yoga can improve the outcomes of pregnancy and childbirth. They can be used as part of the care protocol along with childbirth preparation classes to reduce the complications of pregnancy and childbirth.

Trial registration

IRCT20180623040197N2 (2019-02-11).
Fixed versus flexible antagonist protocol in women with predicted high ovarian response except PCOS: a randomized controlled trial
Authors: Luo Xiu , Pei Li , Li Fujie , Li Chunli , Huang Guoning , Ye Hong
Published: May 2021

Background

No previous study directly compares the fixed day-5 initiation versus the flexible initiation of GnRH antagonist administration in IVF/ICSI for those patients who are predicted as high ovarian responders without PCOS. To evaluate whether the number of oocytes retrieved is different by using the two GnRH antagonist protocols in Chinese women with predicted high ovarian response except PCOS.

Methods

A randomized controlled trial of 201 infertile women with predicted high ovarian response except PCOS undergoing in vitro fertilization. Ovary stimulation was performed using recombinant FSH and GnRH antagonists. GnRH antagonist ganirelix (0.25 mg/d) was started either on day 5 of stimulation (fixed group) or when LH was > 10 IU/L, and/or a follicle with mean diameter > 12 mm was present, and/or serum E2 was > 600 pg/ml. Patient monitoring was initiated on day 3 of stimulation in flexible group.

Result(s)

No significant difference was observed between the fixed and flexible groups regarding the number of oocytes retrieved (16.72 ± 7.25 vs. 17.47 ± 5.88, P = 0.421), the Gonadotropin treatment duration (9.53 ± 1.07 vs. 9.67 ± 1.03, P = 0.346) and total Gonadotropin dose (1427.75 ± 210.6 vs. 1455.94 ± 243.44, P = 0.381). GnRH antagonist treatment duration in fixed protocol was statistically longer than the flexible protocol (6.57 ± 1.17 vs 6.04 ± 1.03, P = 0.001). There was no premature LH surge in either protocol.

Conclusion(s)

Fixed GnRH antagonist administration on day 5 of stimulation appear to achieve a comparable oocyte retrieved compared with flexible antagonist administration.

Trial registration

NCT02635607 posted on December 16, 2015 in clinicaltrials.gov.
COXIBs and 2,5-dimethylcelecoxib counteract the hyperactivated Wnt/β-catenin pathway and COX-2/PGE2/EP4 signaling in glioblastoma cells
Authors: Majchrzak-Celińska Aleksandra , Misiorek Julia O. , Kruhlenia Nastassia , Przybyl Lukasz , Kleszcz Robert , Rolle Katarzyna , Krajka-Kuźniak Violetta
Published: May 2021

Background

Glioblastoma (GBM) is the deadliest and the most common primary brain tumor in adults. The invasiveness and proliferation of GBM cells can be decreased through the inhibition of Wnt/β-catenin pathway. In this regard, celecoxib is a promising agent, but other COXIBs and 2,5-dimethylcelecoxib (2,5-DMC) await elucidation. Thus, the aim of this study was to analyze the impact of celecoxib, 2,5-DMC, etori-, rofe-, and valdecoxib on GBM cell viability and the activity of Wnt/β-catenin pathway. In addition, the combination of the compounds with temozolomide (TMZ) was also evaluated. Cell cycle distribution and apoptosis, MGMT methylation level, COX-2 and PGE2 EP4 protein levels were also determined in order to better understand the molecular mechanisms exerted by these compounds and to find out which of them can serve best in GBM therapy.

Methods

Celecoxib, 2,5-DMC, etori-, rofe- and valdecoxib were evaluated using three commercially available and two patient-derived GBM cell lines. Cell viability was analyzed using MTT assay, whereas alterations in MGMT methylation level were determined using MS-HRM method. The impact of COXIBs, in the presence and absence of TMZ, on Wnt pathway was measured on the basis of the expression of β-catenin target genes. Cell cycle distribution and apoptosis analysis were performed using flow cytometry. COX-2 and PGE2 EP4 receptor expression were evaluated using Western blot analysis.

Results

Wnt/β-catenin pathway was attenuated by COXIBs and 2,5-DMC irrespective of the COX-2 expression profile of the treated cells, their MGMT methylation status, or radio/chemoresistance. Celecoxib and 2,5-DMC were the most cytotoxic. Cell cycle distribution was altered, and apoptosis was induced after the treatment with celecoxib, 2,5-DMC, etori- and valdecoxib in T98G cell line. COXIBs and 2,5-DMC did not influence MGMT methylation status, but inhibited COX-2/PGE2/EP4 pathway.

Conclusions

Not only celecoxib, but also 2,5-DMC, etori-, rofe- and valdecoxib should be further investigated as potential good anti-GBM therapeutics.
Sociodemographic characteristics are associated with prevalence of high-risk waist circumference and high-risk waist-to-height ratio in U.S. adolescents
Authors: Setiono Felicia J. , Guerra Laura A. , Leung Cindy , Leak Tashara M.
Published: May 2021

Background

Adiposity status in adolescence is associated with various health outcomes in adulthood. Waist circumference [WC] and waist-to-height ratio [WHtR] are measures of abdominal obesity and have shown to be valid predictors of future chronic diseases. However, the relationship between sociodemographic characteristics and WC, as well as WHtR in U.S. adolescents remain unclear. Thus, the study aims to examine associations between sociodemographic characteristics and abdominal obesity among a nationally representative sample of U.S. adolescents.

Methods

The sample included 4712 adolescents (12–19 years) in the 2007–2016 National Health and Nutrition Examination Survey. Associations between sociodemographic characteristics and abdominal obesity (WC and WHtR) were examined using multiple logistic regression models, adjusted for age, physical activity level, and sedentary activity.

Results

Around 18% of adolescents had high-risk WC (≥90th percentile) and 34% had high-risk WHtR (≥0.5). Females had higher odds of high-risk WHtR compared to males (OR = 1.46, 95%CI = 1.23–1.72). Mexican American adolescents had higher odds of high-risk WHtR compared to non-Hispanic White (OR = 1.66, 95%CI = 1.24–2.20), non-Hispanic Black (OR = 1.73, 95%CI = 1.26–2.36), and other race/multi-racial adolescents (OR = 1.84, 95%CI = 1.21–2.80). When their parent were college graduates, adolescents had lower odds for high-risk WC compared to when the parent had some college education (OR = 0.68, 95%CI = 0.49–0.93) or a high school degree or less (OR = 0.70, 95%CI = 0.51–0.97). Similar associations were seen between parental education level and high-risk WHtR, as well as between household income and high-risk WHtR.

Conclusions

Measures of abdominal obesity should be considered to assess burden of adiposity, especially among female adolescents, adolescents from racial/ethnic minority and low socioeconomic status backgrounds. Additionally, future health interventions should consider including changes in WC and WHtR to measure the impact of these interventions.
“It was just for us”: qualitative evaluation of an exercise intervention for African-American couples
Authors: Hornbuckle Lyndsey M. , Barroso Cristina S. , Rauer Amy , Jones Chloe S. , Winters-Stone Kerri M.
Published: May 2021

Background

Promoting long-term exercise adherence should be a key focus for health and fitness professionals working to reduce obesity and cardiometabolic health disparities, and all-cause mortality in inactive African-American (AA) adults. Data have suggested that romantic partners can improve long-term exercise adherence and that this dyadic approach should be examined in exercise interventions. Therefore, the purpose of this study was to conduct a qualitative evaluation of a pilot exercise intervention conducted in older AA couples.

Methods

Two semi-structured focus groups were utilized to compare participants’ perceptions of and experiences during the pilot intervention across two randomly assigned treatment conditions (exercising together with partner [ET; n = 8] versus exercising separately [ES: n = 6]). Participants (mean age: 64.7 ± 6.8 years) of a previous 12-week pilot exercise intervention (walking ≥3 days/week, 30 min/day plus supervised resistance training 2 days/week) were interviewed. Verbatim transcripts were coded using an open coding approach.

Results

Three key themes (intervention value/benefits, intervention difficulties, and suggested improvements) emerged. Although all couples identified health and relationship benefits of the intervention, some differences surfaced within themes across the two intervention groups.

Conclusions

Overall, these qualitative data suggest that couples had a positive experience while participating in the pilot study. In addition, key learning points to improve the intervention were identified including a more gradual transition to independent exercise, more flexibility training, and the incorporation of tangential education. These data will help investigators continue to develop the intervention, which is ultimately designed to promote long-term exercise adherence to reduce cardiometabolic health disparities in the AA community.
How are academic achievement and inhibitory control associated with physical fitness, soil-transmitted helminth infections, food insecurity and stunting among South African primary schoolchildren?
Authors: Gerber Markus , Lang Christin , Beckmann Johanna , du Randt Rosa , Gall Stefanie , Seelig Harald , Long Kurt Z. , Ludyga Sebastian , Müller Ivan , Nienaber Madeleine , Nqweniso Siphesihle , Pühse Uwe , Steinmann Peter , Utzinger Jürg , Walter Cheryl
Published: May 2021

Background

Cardiovascular fitness has been associated with both executive function and academic achievement in multiple cohort studies including children and adolescents. However, research is scarce among children from low- and middle-income countries. Hence, this paper focuses on South African primary schoolchildren living in marginalized areas and examines if academic achievement and inhibitory control can be explained by children’s age, socioeconomic status, soil-transmitted helminth infections, food insecurity, stunting, grip strength, and cardiorespiratory fitness.

Methods

The sample of this cross-sectional study consisted of 1277 children (48% girls, mean age: 8.3 years). Data were assessed via questionnaires, stool samples, anthropometric measurements, 20 m shuttle run test, grip strength test, Flanker task, and school grades. Data were analysed with mixed linear regression models with random intercepts for school classes, separately for boys and girls.

Results

Higher socioeconomic status was most closely associated with academic achievement among boys (p < 0.05), whereas higher levels of cardiorespiratory fitness and not being stunted explained most variance in academic achievement in girls (p < 0.05). Higher age turned out to be associated with better performance in the Flanker task (p < 0.01). Additionally, in boys, higher grip strength was associated with better information processing and inhibitory control of attention (p < 0.01), whereas in girls, higher cardiorespiratory fitness levels were positively associated with these cognitive abilities (p < 0.05).

Conclusions

Academic performance has been shown to be compromised in schoolchildren living in marginalised areas, compared to schoolchildren in less disadvantaged parts of South Africa. The present study suggests that cardiorespiratory fitness and grip strength are two potentially modifiable factors that are associated with children’s academic achievement and cognitive performance, and that should be targeted in future school-based interventions.
An ecological study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat
Authors: Hansson Erik , Mansourian Ali , Farnaghi Mahdi , Petzold Max , Jakobsson Kristina
Published: May 2021

Background

Mesoamerica is severely affected by an epidemic of Chronic Kidney Disease of non-traditional origin (CKDnt), an epidemic with a marked variation within countries. We sought to describe the spatial distribution of CKDnt in Mesoamerica and examine area-level crop and climate risk factors.

Methods

CKD mortality or hospital admissions data was available for five countries: Mexico, Guatemala, El Salvador, Nicaragua and Costa Rica and linked to demographic, crop and climate data. Maps were developed using Bayesian spatial regression models. Regression models were used to analyze the association between area-level CKD burden and heat and cultivation of four crops: sugarcane, banana, rice and coffee.

Results

There are regions within each of the five countries with elevated CKD burden. Municipalities in hot areas and much sugarcane cultivation had higher CKD burden, both compared to equally hot municipalities with lower intensity of sugarcane cultivation and to less hot areas with equally intense sugarcane cultivation, but associations with other crops at different intensity and heat levels were not consistent across countries.

Conclusion

Mapping routinely collected, already available data could be a first step to identify areas with high CKD burden. The finding of higher CKD burden in hot regions with intense sugarcane cultivation which was repeated in all five countries agree with individual-level studies identifying heavy physical labor in heat as a key CKDnt risk factor. In contrast, no associations between CKD burden and other crops were observed.
Health behaviors and metabolic risk factors are associated with dyslipidemia in ethnic Miao Chinese adults: the China multi-ethnic cohort study
Authors: Nie Fang , Wang Ziyun , Zeng Qibing , Guan Han , Yang Jingyuan , Luo Peng , Du Lunwei , Wang Junhua , Hong Feng
Published: May 2021

Background

Cardiovascular risk factors in Chinese ethnic minority groups are rarely reported.

Objective

To quantify the cardiovascular risk factors in Miao Chinese adults and to examine the association of health behaviors and metabolic risk factors with dyslipidemia.

Methods

A cross-sectional analysis was conducted using baseline data from the China Multi-Ethnic Cohort (CMEC) study. A representative sample of 5559 Miao participants aged 30 to 79 years were surveyed and given physical and laboratory exams. The proportion of behavioral and metabolic risk factors were described in ethnic Miao adults. Logistic regression was utilized to evaluate the odds ratio (OR) and 95% confidence interval (CI) of the association between health behaviors and metabolic risk factors with dyslipidemia.

Results

In Miao Chinese adults, the prevalence of dyslipidemia was 32.8%. After multivariate adjustment, subjects with poor waist-to-hip ratio (WHR), body mass index (BMI), fasting blood glucose (FBG) and blood pressure (BP) were more likely to have higher risk of triglycerides (TG) abnormality, regardless of gender and age. Furthermore, the strongly association was detected between poor WHR and low density lipoprotein cholesterol (LDL-C) abnormality (adjusted OR = 5.24, 95%CI: 2.42–11.34) in the older subgroup (≥ 60 years). Males who current smoking were an independent risk factor only for high density lipoprotein cholesterol (HDL-C) abnormality (adjusted OR = 1.44, 95%CI: 1.05–1.99). However, in the subgroup age, current smoker were at greater risk of high TG and low HDL-C. Males with regular drinking were less likely to be high LDL-C (adjusted OR = 0.51, 95%CI: 0.32–0.81).

Conclusions

The present findings indicated that Miao adults with metabolic risk factors were at greater risk of dyslipidemia.
Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial
Authors: Gharisia Omar , Lohman Everett , Daher Noha , Eldridge Alan , Shallan Amjad , Jaber Hatem
Published: May 2021

Background

The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD).

Methods

Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention.

Results

There was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46).

Conclusion

Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients.

Trial registration

Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236.
Conditions associated with worse acceptance of a simplified accelerated recovery after surgery protocol in laparoscopic colorectal surgery
Authors: de Queiroz Fábio Lopes , Lacerda-Filho Antonio , Alves Adriana Cherem , de Oliveira Fábio Henrique , Neto Paulo Rocha França , de Almeida Paiva Rodrigo
Published: May 2021

Background

Enhanced Recovery Surgical Programs were initially applied to colorectal procedures and used as multimodal approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the poor tolerance of these patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery.

Methods

161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n = 51) and those who did not (n = 33), in order to analyze factors contributing to protocol nontolerance.

Results

The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). Complications rates and readmissions to emergency room were similar between groups. Multivariate analysis revealed that prolonged operating time, stoma creation and rates of surgical complications were independently associated with poor adherence to SARP (p < 0.0001).

Conclusions

The use of our SARP resulted in improved recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with poor program adhesion.

Trial registration Trial Registry: RBR2b4fyr—Date of registration: 03 October 2017.
Does cervical facet degeneration impact surgical outcomes and sagittal balance in patients with radiculopathy?
Authors: Wang Zheng , Liu Zhen , Wang Zhi-Wei , Ding Wen-Yuan , Yang Da-Long
Published: May 2021

Purpose

In our present study, we aimed to investigate (1) whether cervical facet degeneration (FD) affects the clinical functional scores of patients with cervical radiculopathy after single-segment anterior cervical discectomy fusion (ACDF) and (2) whether FD affects the sagittal parameters of the cervical spine.

Methods

A total of 120 enrolled patients who underwent single-segment ACDF for radiculopathy with more than 2 years of follow-up were classified into two groups based on whether the preoperative mean FD was greater than or less than the mean FD grading score: mild FD group (mean score ≤ 2, n = 102) or severe FD group (mean score > 2, n = 48). Sagittal alignment changes and clinical functional scores were compared between the 2 groups. The relevant factors for FD were identified using multivariate logistic regression.

Results

Age, duration of symptoms, disc height and interfacet distance were independently associated with preoperative FD (age: P < 0.001; duration of symptoms: P = 0.020; disc height: P < 0.001; interfacet distance: P = 0.045). Compared with the mild FD group, the preoperative VAS (neck pain) score and NDI of the severe FD group were also higher, and the improvement of neck symptoms was better during the follow-up period. However, all clinical scores and radiographic parameters showed no significant differences during the 2-year follow-up. Additionally, no significant differences in the sagittal parameter changes were presented.

Conclusion

Patients with severe FD tended to experience more severe neck pain before surgery and greater improvement of neck symptoms at the follow-up visit. However, 2-year clinical efficacy and sagittal alignment after ACDF may not be markedly affected by preoperative FD severity. ACDF is considered to be a good choice for patients with radiculopathy, especially for patients with severe FD.
Using real-world data to estimate the changing trends in the prevalence and incidence of type 2 diabetes mellitus in Xiamen of China from 2014 to 2019
Authors: He Weiwei , Xu Qiushi , Han Lili , Wu Ting , Shi Xiulin , Ye Lishan , Yao Guanhua , Li Xuejun
Published: May 2021

Background

The prevalence of diabetes is increasing worldwide. Our study aimed to estimate the changing trends in the prevalence and incidence of diagnosed type 2 diabetes mellitus (T2DM) among Xiamen residents and the floating population using real-world data.

Method

We used real-world data from the System of Xiamen Citizens Health Information from 2014 to 2019 to estimate the changing trends in the prevalence and incidence of diagnosed T2DM. The System included the diagnosis of diabetes and the prescription of hypoglycemic drugs. Prevalent cases of T2DM were individuals who were diagnosed with T2DM and/or using hypoglycemic drugs. Incident cases were individuals with diagnosed T2DM and/or using hypoglycemic drugs in 2014 or 2019 who had not been diagnosed and/or did not use hypoglycemic drugs in the past.

Results

In 2014 and 2019, the prevalence of T2DM in Xiamen was 4.04 and 4.84%, respectively. In 2014 and 2019, the incidence rate of T2DM in Xiamen was 14.1 per 1000 person-year and 15.0 per 1000 person-year, respectively. There was a significant increase in both the prevalence (Prevalence difference: 0.80, 95%CI 0.76–0.83%, P < 0.001) and the incidence of T2DM (Incidence difference: 0.9, 95%CI 0.7–1.1, P < 0.001). in Xiamen. The prevalence and incidence of T2DM in people aged 18–39 increased significantly (P < 0.001), while the prevalence and incidence of T2DM in people aged 40–69 reduced significantly (P < 0.001).

Conclusions

There was a significant increase in the prevalence and incidence of T2DM in Xiamen from 2014 to 2019 especially among those with younger age.
A four-hypoxia-genes-based prognostic signature for oral squamous cell carcinoma
Authors: Zhao Chenguang , Zhou Yingrui , Ma Hongwei , Wang Jinhui , Guo Haoliang , Liu Hao
Published: May 2021

Background

Oral squamous cell carcinoma (OSCC) is one of the most common maligancies of the head and neck. The prognosis was is significantly different among OSCC patients. This study aims to identify new biomarkers to establish a prognostic model to predict the survival of OSCC patients.

Methods

The mRNA expression and corresponding clinical information of OSCC patients were downloaded from The Cancer Genome Atlas and Gene Expression Omnibus. Additionally, a total of 26 hypoxia-related genes were also obtained from a previous study. Univariate Cox regression analysis and LASSO Cox regression analysis were performed to screen the optimal hypoxia-related genes which were associated with the prognosis of OSCC. to establish the predictive model (Risk Score) was established for estimating the patient's overall survival (OS). Multivariate Cox regression analysis was used to determine whether the Risk Score was an independent prognostic factor. Based on all the independent prognostic factors, nomogram was established to predict the OS probability of OSCC patients. The relative proportion of 22 immune cell types in each patient was evaluated by CIBERSORT software.

Results

We determined that a total of four hypoxia-related genes including ALDOA, P4HA1, PGK1 and VEGFA were significantly associated with the prognosis of OSCC patients. The nomogram established based on all the independent factors could reliably predict the long-term OS of OSCC patients. In addition, our resluts indicated that the inferior prognosis of OSCC patients with high Risk Score might be related to the immunosuppressive microenvironments.

Conclusion

This study shows that high expression of hypoxia-related genes including ALDOA, P4HA1, PGK1 and VEGFA is associated with poor prognosis in OSCC patients, and they can be used as potential markers for predicting prognosis in OSCC patients.
Hospital contextual factors affecting the implementation of health technologies: a systematic review
Authors: Grossi Adriano , Hoxhaj Ilda , Gabutti Irene , Specchia Maria Lucia , Cicchetti Americo , Boccia Stefania , de Waure Chiara
Published: May 2021

Background

To keep a high quality of assistance it is important for hospitals to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though guidance exists on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs.

Methods

We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs. PubMed, Scopus, Web of Science, Econlit and Ovid Medline electronic databases were searched to retrieve articles published in English and Italian from January 2000 to January 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Programme checklist for qualitative studies, Newcastle-Ottawa Scale for the cross-sectional studies and the Mixed Methods Appraisal Tool for mixed method studies.

Results

We included 33 articles, which were of moderate to high methodological quality. The included articles mostly addressed the contextual factors that impact the implementation of information and communication technologies (ICTs). Overall, for all HTs, the hospital contextual factors were part of four categories: hospital infrastructure, human resource management, financial resources and leadership styles.

Conclusion

Our systematic review reported that the contextual factors influencing the HTs utilization at hospital level are mainly explored for ICTs. Several factors should be considered when planning the implementation of a new HTs at hospital level. A potential publication bias might be present in our work, since we included articles published only in English and Italian Language, from January 2000 to January 2019. There remains a gap in the literature on the facilitators and barriers influencing the implementation and concrete utilization of medical and surgical HTs, suggesting the need for further studies for a better understanding.
Application of verbal autopsy in routine civil registration in Lusaka District of Zambia
Authors: Mapoma C. Chabila , Munkombwe Brian , Mwango Chomba , Bwalya Bupe Bwalya , Kalindi Audrey , Gona N. Philimon
Published: May 2021

Background

Ascertaining the causes for deaths occurring outside health facilities is a significant problem in many developing countries where civil registration systems are not well developed or non-functional. Standardized and rigorous verbal autopsy methods is a potential solution to determine the cause of death. We conducted a demonstration project in Lusaka District of Zambia where verbal autopsy (VA) method was implemented in routine civil registration system.

Methods

About 3400 VA interviews were conducted for bodies “brought-in-dead” at Lusaka’s two major teaching hospital mortuaries using a SmartVA questionnaire between October 2017 and September 2018. Probable underlying causes of deaths using VA and cause-specific mortality fractions were determined.. Demographic characteristics were analyzed for each VA-ascertained cause of death.

Results

Opportunistic infections (OIs) associated with HIV/AIDS such as pneumonia and tuberculosis, and malaria were among leading causes of deaths among bodies “brought-in-dead”. Over 21.6 and 26.9% of deaths were attributable to external causes and non-communicable diseases (NCDs), respectively. The VA-ascertained causes of death varied by age-group and sex. External causes were more prevalent among males in middle ages (put an age range like 30–54 years old) and NCDs highly prevalent among those aged 55 years and older.

Conclusions

VA application in civil registration system can provide the much-needed cause of death information for non-facility deaths in countries with under-developed or non-functional civil registration systems.
Physical rehabilitation financing in Iran: a policy analysis using Kingdon’s multiple streams
Authors: Shahabi Saeed , Mojgani Parviz , Shabaninejad Hosein , Teymourlouy Ahmad Ahmadi , Behzadifar Masoud , Lankarani Kamran Bagheri
Published: May 2021

Background

Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran.

Methods

An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon’s multiple streams.

Results

The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources’ earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream.

Conclusion

The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The recently enacted laws indicate that the PRF policies have already been on the national health political agenda. The study reflected the multifaceted nature of barriers to optimal PRF in Iran.