bluuebunny/crossref_metadata_2025 huggingface dataset:
Acceptability of a cessation intervention for pregnant smokers: a qualitative study guided by Normalization Process Theory
Authors: Jones Susan E. , Hamilton Sharon , Bell Ruth , Araújo-Soares Vera , White Martin
Published: October 2020

Background

Smoking during pregnancy has serious consequences for maternal and child health. An intervention package to embed National Institute for Health and Care Excellence guidance (babyClear©) was delivered across maternity and stop smoking services (SSS) within an English region, to support pregnant women to stop smoking. We aimed to ascertain acceptability among pregnant smokers receiving the intervention.

Methods

Pregnant smokers who received the intervention and participated in the study were interviewed, first at around 16 weeks of pregnancy (n = 17) and again several weeks later (n = 8) or postpartum (n = 3). Interview schedules were informed by Normalization Process Theory (NPT) and Theoretical Domains Framework; interviews were audio-recorded, transcribed and analysed thematically, using the Framework method and NPT. Findings are grouped according to the four NPT concepts.

Results

Coherence: Carbon monoxide monitoring appeared to make sense; women were motivated to quit by being monitored. Cognitive participation: When linked to a professional discourse of caring and concern, some women were prompted to engage with the SS message. Women were more guarded in their reaction to initial contact from the SSS; reporting attending appointments successfully, or in some cases, experiencing problems that decreased engagement and made quitting harder. Collective action: Where women continued to smoke or failed to attend SSS appointments, an extra intervention was delivered, the Risk Perception Tool (RPT), which often prompted pregnant women to act. Reflexive monitoring: Most women accepted the need for a hard-hitting approach (RPT) and, while it distressed them at the time, they claimed they were subsequently grateful for it. SSS intervention post-RPT was seen as supportive, partly because it often involved home visits. Aspects of family inclusion in babyClear© were reported as beneficial. In Trusts where women experienced services as less focused on prioritising the stop smoking message, less well integrated or reported maternity staff as less adept at delivering the RPT, women found babyClear© less acceptable overall.

Conclusions

The babyClear© package was acceptable to pregnant smokers interviewed during and shortly after pregnancy and, in some cases, to promote quitting. However, some contexts were more optimal than others, leading to variation in acceptability overall.
Why crowding matters in the time of COVID-19 pandemic? - a lesson from the carnival effect on the 2017/2018 influenza epidemic in the Netherlands
Authors:   LUMC-COVID-19 Research Group, Chen Qingui , Toorop Myrthe M. A. , de Boer Mark G. J. , Rosendaal Frits R. , Lijfering Willem M.
Published: October 2020

Background

To evaluate the association between crowding and transmission of viral respiratory infectious diseases, we investigated the change in transmission patterns of influenza and COVID-19 before and after a mass gathering event (i.e., carnival) in the Netherlands.

Methods

Information on individual hospitalizations related to the 2017/2018 influenza epidemic were accessed from Statistics Netherlands. The influenza cases were stratified between non-carnival and carnival regions. Distributions of influenza cases were plotted with time and compared between regions. A similar investigation in the early outbreak of COVID-19 was also conducted using open data from the Dutch National Institute for Public Health and the Environment.

Results

Baseline characteristics between non-carnival and carnival regions were broadly similar. There were 13,836 influenza-related hospitalizations in the 2017/2018 influenza epidemic, and carnival fell about 1 week before the peak of these hospitalizations. The distributions of new influenza-related hospitalizations per 100,000 inhabitants with time between regions followed the same pattern with a surge of new cases in the carnival region about 1 week after carnival, which did not occur in the non-carnival region. The increase of new cases for COVID-19 in the carnival region exceeded that in the non-carnival region about 1 week after the first case was reported, but these results warrant caution as for COVID-19 there were no cases reported before the carnival and social measures were introduced shortly after carnival.

Conclusion

In this study, a mass gathering event (carnival) was associated with aggravating the spread of viral respiratory infectious diseases.
Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study
Authors: Ayuk Adaeze , Ndukwu Chizalu , Uwaezuoke Samuel , Ekop Eno
Published: October 2020

Background

Global standards require that spirometry should be performed by trained and experienced personnel, who would be able to assess the correct performance of tests by patients and assure good quality of the result. The complete achievement of this requires a two-step assessment where competency in both knowledge and skills are tested. This study aims to assess the impact of a one-day hands-on spirometry training (Phase1), on the knowledge and application of spirometry among health workers.

Methods

This was a descriptive cross-sectional study, which describes a one-day (seven hours) spirometry training and skills impartation done at two conference city locations in Enugu and Calabar in the southern part of Nigeria. All the verbally consenting attendees who completed the training assessment tests constituted the study population. The assessment of the spirometry knowledge base before and after the theory and practical sessions, on the various aspects of spirometry, according to international best practices, quality assurance and the interpretation of results, was done and the outcome was analyzed. Factors that could affect the outcome were also assessed.

Results

There were 64 consenting participants of whom 54.7% (35/64) were females. Theparticipants demonstrated much improved post-intervention knowledge and could satisfactorily perform spirometry, calibration, interpretation of test results and quality control as evidenced by the post test scores after practical sessions were conducted. Pre-test mean scores improved by a mean difference of 12% (p < 001) and were affected by the year of academic graduation and availability of spirometers at the place of work, an effect that was no longer seen at post-test following the hands-on spirometry training.

Conclusion

The present study has shown that a one-day spirometry workshop significantly improved the knowledge of spirometry practice. There is need to set up more frequent locally-organized spirometry workshops since a one-day seven-hour effective knowledge and practical training would most likely have significant impact on participants’ spirometry practice with its expected positive outcome on respiratory health in Nigeria.
Peri-acetabular bone remodelling after uncemented total hip arthroplasty with monoblock press-fit cups: an observational study
Authors: Anderl Conrad , Mattiassich Georg , Ortmaier Reinhold , Steinmair Martin , Hochreiter Josef
Published: October 2020

Background

Bone stock preservation in total hip replacement is essential to allow for later revisions in an increasingly younger and fitter index patient population. While contemporary modular press-fit acetabular cups lead to rigid fixation with equatorial stress and central osteolysis, more elastic fixation may cause different peri-acetabular bone remodelling. The purpose of this study was to investigate changes in peri-acetabular bone mineral density (BMD) in uncemented elastic fixation with monoblock press-fit cups.

Methods

This prospective observational study included 45 patients with monoblock cups. We evaluated peri-acetabular BMD using dual-energy X-ray absorptiometry and reported functional outcomes and complications.

Results

At a mean follow-up of 24.2 ± 2.2 months, we found that BMD stabilised in DeLee and Charnley zones I and III and recovered to baseline value in zone II. The mean Harris Hip Scores improved significantly from 56.9 ± 20.0 to 97.2 ± 4.0 (p <  0001). Other than one peri-operative dislocation, we saw no post-operative complications.

Conclusions

We found favourable adaptive bone changes with BMD stabilisation in the equatorial zones and recovery to pre-operative values in the central zone. Additionally, excellent clinical outcomes and few prosthesis-related complications strengthened the favourable results of monoblock acetabular cups.

Trial registration

Registration number DRKS00017076.
Does the IOFix implant improve union rates?
Authors: Segal David , Ohana Nissim , Nyska Meir , Palmanovich Ezequiel
Published: October 2020

Background

First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant.

Methods

We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies.

Results

Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.

Conclusions

This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.

Level of evidence

4
Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology
Authors: Kamran Rakhshan , Dal Cin Arianna
Published: October 2020

Background

Eliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care.

Methods

Design-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature.

Results

Issues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this.

Conclusions

Our “Mission Statement” mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.
Prevalence and determinants of unmet need for contraception in North Gonja District, Ghana
Authors: Wemakor Anthony , Garti Humphrey , Saeed Nawaf , Asumadu Obed , Anyoka Bede
Published: October 2020

Background

Unmet need for contraception contributes to the burden of unwanted pregnancies, which are correlated with a host of adverse maternal and child outcomes. The aim of this study was to determine the prevalence and identify the determinants of unmet need for contraception in North Gonja District, Ghana.

Methods

A cross-sectional survey involving 386 randomly selected women of childbearing age was conducted in North Gonja district, Ghana, with the use of a questionnaire in household interviews. Women were classified as having unmet need for contraception if they were fecund, sexually active and wished to postpone the next birth or halt childbearing completely but were not using any form of contraception. Chi-square/Fisher’s exact test and logistic regression analysis were used to identify the determinants of unmet need.

Results

The mean age of the study population was 26.1 (±8.4) years and awareness on contraception was almost universal in the district (95.9%). The overall prevalence of unmet need for contraception was 38.9%, with 27.5% having unmet need for limiting and 12.2% unmet need for spacing. In multivariate analysis, compared to women aged 25–29 years, those aged 20–24 years [Adjusted Odds Ratio (AOR) 0.26; 95% Confidence Interval (CI) 0.11–0.58] and 30 years and above (AOR 0.25; 95% CI 0.09–0.73) were less likely to have unmet need for contraception. However, uneducated women (AOR 5.06; 95% CI 1.07–24.01) compared with those educated to tertiary level; those unaware of family planning (AOR 3.93; 95% CI 1.12–13.80) compared to those aware; and those who had not previously practised contraception (AOR 1.81; 95% CI 1.09–3.00) compared to those who did were more likely to have unmet need.

Conclusions

The present study found high prevalence of both awareness on and unmet need for contraception among the study population. Unmet need for contraception is associated with age, educational status, awareness on family planning and previous contraception practice. Educational campaigns to promote contraception should prioritize women of middle age and low educational status. Further studies are needed to understand the low correlation between awareness on and unmet need for contraception.
Defining and tracking medical student self-monitoring using multiple-choice question item certainty
Authors: Tweed Mike , Purdie Gordon , Wilkinson Tim
Published: October 2020

Background

Self-monitoring is an important component of clinical practice. It is underpinned by the framework of self-efficacy which is concerned with judgments of how well one believes one can achieve or perform a task. This research aimed to develop criteria for adequate self-monitoring, then to measure patterns of self-monitoring, and to explore how these patterns relate to a student’s year in a medical course and to patterns of knowledge.

Methods

Analysis of individuals’ levels of correctness in answering assessment items and their certainty in correctness may be used to inform assessments of ability to self-monitor. Two criteria were proposed and applied to define adequate self-monitoring. Firstly, increasing proportions correct with increasing levels of certainty. Secondly, having a proportion correct for high certainty responses that was not lower than cohort levels. Student responses in progress tests comprising multiple-choice questions (MCQs) and associated certainty were analysed. Criteria for the presence of adequate self-monitoring and for adequate knowledge were applied to the results of each of four tests conducted over 2 years, and used to categorise patterns of self-monitoring and knowledge.

Results

Data from 3 year group cohorts totalling 737 students were analysed. The majority (58%) of students demonstrated adequate knowledge and met both criteria for adequate self-monitoring across all four tests. The most advanced year group cohort had the highest rates of adequate knowledge and the highest rates of meeting both self-monitoring criteria. The patterns of self-monitoring were the same as the patterns of knowledge across the four tests for 454 students, but for the remaining 283 the patterns of self-monitoring and knowledge differed.

Conclusion

Analysis of responses to item level certainty has informed development of a definition of adequate self-monitoring that may be applied to individual student’s responses from a single test, and to track the adequacy of a student’s self-monitoring over time. Patterns of self-monitoring tend to match patterns of knowledge, but not in all cases, suggesting the self-monitoring measure could provide additional information about student ability.
Knowledge of undergraduate dental students toward orthodontic skeletal temporary anchorage devices at Kuwait University
Authors: Abu Al-Melh Manal M. , Al-Anzi Abrar N.
Published: October 2020

Background

The introduction of skeletal Temporary Anchorage Devices (TADs) into orthodontics has provided orthodontists with reliable techniques of correcting anchorage problems. The objective of this study was to evaluate the knowledge of undergraduate dental students during their clinical years (fifth, sixth and seventh-year) at Kuwait University Faculty of Dentistry regarding the use of TADs.

Methods

A printed structured questionnaire consisting of 21 questions was given to the undergraduate dental students of Kuwait University in the fifth (n = 22), sixth (n = 28) and seventh (n = 22)-years. It evaluated the level and source of information regarding orthodontic TADs.

Results

The seventh-year dental students displayed the best degree of knowledge regarding the use of TADs and the clinical case management, compared with the sixth and fifth-year dental students. The significance of introducing the orthodontic TADs topic earlier in the orthodontic curriculum has been agreed upon by 42% of respondents. The total knowledge score showed a significant difference (χ2 = 40.3, p = 0.000), where the seventh year dental students had the best level of knowledge regarding the topic of TADs. Two-thirds (63.6%) preferred to introduce that topic during the sixth year.

Conclusions

The senior (7th year) dental students had the best knowledge about the topic of TADs. Introducing the topic of TADs earlier in the undergraduate dental program will enhance the students’ case-based learning setup. Hence, the early exposure to use of TADs will improve the students’ clinical problem-solving and decision making skills during their undergraduate clinical years.
Anticipated nursing care: findings from a qualitative study
Authors: Bottega Michela , Palese Alvisa
Published: October 2020

Background

Contrary to Missed Nursing Care, some anecdotal data and sparse evidence has documented the tendency of nurses to anticipate some nursing interventions. However, no study has been conducted to date with the purpose of understanding this phenomenon and its underlying mechanisms and consequences. The aim of this study was to describe the phenomenon of delivering anticipated nursing care, its antecedents and consequences as perceived by nurses.

Method

A descriptive qualitative study. The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. A purposeful sample of 17 clinical nurses and nurse managers working in three Italian hospitals were interviewed in depth in 2019. The audio-recorded interviews were verbatim transcribed and thematically analysed.

Results

‘Anticipated Nursing Care’ is delivered significantly earlier than when expected by nurses in their care plan, by patients, by caregivers and by other members of the team. Medication administration, mobilisation of patients, hygiene care, changes of dressing, vital parameter monitoring, blood sampling and administrative activities were reported as interventions delivered before rather than when expected. Clinically stable patients have been reported to be at risk of receiving anticipated nursing care. Individual values and attitudes, group attitudes of being always ready for the “unexpected”, implicit group norms to “leave the patients and the unit in order”, high workloads, intertwined activities and work processes inside the units, have been reported as reasons for Anticipated Nursing Care. Effects of this phenomenon have been reported at the patients’ and at the nurses’ level.

Conclusion

Anticipated Nursing Care occurs when nurses perform interventions earlier than expected according to an implicit or explicit decision and not as a consequence of a request. The phenomenon requires future studies to detect its diffusion and to accumulate evidence. Its presence in daily practice, if confirmed, suggests that Missed Nursing Care studies should also consider the combined effect of these two phenomena as, on one hand, there may be the tendency to postpone and, on the other hand, the tendency to anticipate interventions.
Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study
Authors: Askew Deborah A. , Togni Samantha J. , Egert Sonya , Rogers Lynne , Potter Nichola , Hayman Noel E. , Cass Alan , Brown Alex D. H. , Schluter Philip J.
Published: October 2020

Background

Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants’ health and wellbeing at 12 months.

Methods

HOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months thereafter. Variables included self-rated health status, depression, utilisation of health services, and key clinical outcomes. Participants’ baseline characteristics were described using frequencies and percentages. Generalized estimating equation (GEE) models were employed to evaluate participant attrition and changes in outcome measures over time.

Results

60 participants were enrolled into the study and 37 (62%) completed the 12-month assessment. After receiving outreach case management for 12 months, 73% of participants had good, very good or excellent self-rated health status compared with 33% at baseline (p < 0.001) and 19% of participants had depression compared with 44% at baseline (p = 0.03). Significant increases in appointments with allied health professionals (p < 0.001) and medical specialists other than general practitioners (p = 0.001) were observed at 12-months compared with baseline rates. Mean systolic blood pressure decreased over time (p = 0.02), but there were no significant changes in mean HbA1c, body mass index, or diastolic blood pressure.

Conclusions

The HOME Study model of care was predicated on a holistic conception of health and aimed to address participants’ health and social care needs. The positive changes in self-rated health and rates of depression evinced that this aim was met, and that participants received the necessary care to support and improve their health and wellbeing.
Insulin-like growth factor binding protein-2: a new circulating indicator of pulmonary arterial hypertension severity and survival
Authors: Yang Jun , Griffiths Megan , Nies Melanie K. , Brandal Stephanie , Damico Rachel , Vaidya Dhananjay , Tao Xueting , Simpson Catherine E. , Kolb Todd M. , Mathai Stephen C. , Pauciulo Michael W. , Nichols William C. , Ivy David D. , Austin Eric D. , Hassoun Paul M. , Everett Allen D.
Published: October 2020

Background

Pulmonary arterial hypertension (PAH) is a fatal disease that results from cardio-pulmonary dysfunction with the pathology largely unknown. Insulin-like growth factor binding protein 2 (IGFBP2) is an important member of the insulin-like growth factor family, with evidence suggesting elevation in PAH patients. We investigated the diagnostic and prognostic value of serum IGFBP2 in PAH to determine if it could discriminate PAH from healthy controls and if it was associated with disease severity and survival.

Methods

Serum IGFBP2 levels, as well as IGF1/2 levels, were measured in two independent PAH cohorts, the Johns Hopkins Pulmonary Hypertension program (JHPH, N = 127), NHLBI PAHBiobank (PAHB, N = 203), and a healthy control cohort (N = 128). The protein levels in lung tissues were determined by western blot. The IGFBP2 mRNA expression levels in pulmonary artery smooth muscle cells (PASMC) and endothelial cells (PAEC) were assessed by RNA-seq, secreted protein levels by ELISA. Association of biomarkers with clinical variables was evaluated using adjusted linear or logistic regression and Kaplan-Meier analysis.

Results

In both PAH cohorts, serum IGFBP2 levels were significantly elevated (p < 0.0001) compared to controls and discriminated PAH from controls with an AUC of 0.76 (p < 0.0001). A higher IGFBP2 level was associated with a shorter 6-min walk distance (6MWD) in both cohorts after adjustment for age and sex (coefficient − 50.235 and − 57.336 respectively). Cox multivariable analysis demonstrated that higher serum IGFBP2 was a significant independent predictor of mortality in PAHB cohort only (HR, 3.92; 95% CI, 1.37–11.21). IGF1 levels were significantly increased only in the PAHB cohort; however, neither IGF1 nor IGF2 had equivalent levels of associations with clinical variables compared with IGFBP2. Western blotting shown that IGFBP2 protein was significantly increased in the PAH vs control lung tissues. Finally, IGFBP2 mRNA expression and secreted protein levels were significantly higher in PASMC than in PAEC.

Conclusions

IGFBP2 protein expression was increased in the PAH lung, and secreted by PASMC. Elevated circulating IGFBP2 was associated with PAH severity and mortality and is a potentially valuable prognostic marker in PAH.
A novel phenotype of 13q12.3 microdeletion characterized by epilepsy in an Asian child: a case report
Authors: Wang Mina , Li Bin , Liao Zehuan , Jia Yu , Fu Yuanbo
Published: October 2020

Background

The microdeletion of chromosome 13 has been rarely reported. Here, we report a 14-year old Asian female with a de novo microdeletion on 13q12.3.

Case presentation

The child suffered mainly from two types of epileptic seizures: partial onset seizures and myoclonic seizures, accompanied with intellectual disability, developmental delay and minor dysmorphic features. The electroencephalogram disclosed slow waves in bilateral temporal, together with generalized spike-and-slow waves, multiple-spike-and-slow waves and slow waves in bilateral occipitotemporal regions. The exome sequencing showed no pathogenic genetic variation in the patient’s DNA sample. While the single nucleotide polymorphism (SNP) array analysis revealed a de novo microdeletion spanning 2.324 Mb, within the cytogenetic band 13q12.3.

Conclusions

The epilepsy may be associated with the mutation of KATNAL1 gene or the deletion unmasking a recessive mutation on the other allele, and our findings could provide a phenotypic expansion.
Association of circulating PCSK9 concentration with cardiovascular metabolic markers and outcomes in stable coronary artery disease patients with or without diabetes: a prospective, observational cohort study
Authors: Peng Jia , Liu Ming-Ming , Jin Jing-Lu , Cao Ye-Xuan , Guo Yuan-Lin , Wu Na-Qiong , Zhu Cheng-Gang , Dong Qian , Sun Jing , Xu Rui-Xia , Li Jian-Jun
Published: October 2020

Background

Whether plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) levels is a predictor for cardiovascular outcomes has currently been controversial. No data is currently available regarding the relation of PCSK9 to cardiovascular metabolic markers (CVMMs) and major adverse cardiovascular events (MACEs) in stable coronary artery disease (CAD) patients with diabetes or without diabetes.

Methods

A total 1225 untreated patients with stable CAD were consecutively enrolled and their baseline plasma PCSK9 levels were determined by ELISA. Patients were divided into high and low PCSK9 groups according to PCSK9 median. All patients followed up for the occurrence of MACEs and received standard therapy after admission. The associations of PCSK9 with CVMMs and MACEs were evaluated.

Results

PCSK9 levels were positively correlated with multiple CVMMs including total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and hemoglobin A1cat baseline (allp < 0.05). During a median follow-up of 3.3 years, 103 (8.4%) events occurred. PCSK9 levels were higher in patients with events compared to those without (p < 0.05). The Kaplan–Meier analysis displayed that patients in high PCSK9 group had lower event-free survival than that in low group (p < 0.05). Multivariable Cox regression analysis revealed that PCSK9 levels were independently associated with MACEs in diabetic patients (adjusted hazard ratio [HR]: 1.361, 95% confidence interval [CI]: 1.037–1.785,p < 0.05). When added the combination of PCSK9 levels and diabetic status to stratifying factors, patients in high PCSK9 group appeared to have extremely high risk of subsequent MACEs with diabetes (adjusted HR: 5.233, 95% CI: 2.546–10.757,p < 0.01).

Conclusions

The present study firstly showed that elevated PCSK9 levels were related to multiple CVMMs and MACEs in stable CAD with diabetes, suggesting that plasma PCSK9 measurement could help to identify diabetic patients with CAD at higher cardiovascular risk. More studies may be needed to confirm our findings.
Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: a nationwide study
Authors: Simchoni Maya , Hamiel Uri , Pinhas-Hamiel Orit , Zucker Inbar , Cukierman-Yaffe Tali , Lutski Miri , Derazne Estela , Beer Zivan , Behar Doron , Keinan-Boker Lital , Mosenzon Ofri , Tzur Dorit , Afek Arnon , Tirosh Amir , Raz Itamar , Twig Gilad
Published: October 2020

Background

We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin.

Methods

Normoglycemic adolescents (range 16–20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied.

Results

226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3–5.1) and 15.8 (8.3–30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7–11.4) and 29.1 (12.9–70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI.

Conclusions

Ethiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.
Construction of a new T7 promoter compatible Escherichia coli Nissle 1917 strain for recombinant production of heme-dependent proteins
Authors: Fiege Kerstin , Frankenberg-Dinkel Nicole
Published: October 2020

Background

Heme proteins and heme-derived molecules are essential in numerous cellular processes. Research into their in vitro functionality requires the production of large amounts of protein. Unfortunately, high yield expression is hampered by the lack of E. coli strains naturally capable of taking up heme from the medium. We recently reported the use of the probiotic E. coli strain Nissle 1917 (EcN) to sufficiently produce heme containing proteins, as it encodes the outer membrane heme receptor, ChuA, which allows for natural uptake of heme. The EcN strain however lacks the gene for T7 RNA polymerase, which is necessary for the expression of genes under the control of the T7-promotor, widely used in expression vectors like the pET or pDuet series.

Results

A new T7-promoter compatible EcN strain was constructed by integrating the gene for T7-RNA polymerase under the control of a lacUV5 promoter into the malEFG operon of EcN. Test expressions of genes via T7 promoter-based vectors in the new EcN(T7) strain were successful. Expression in EcN(T7) resulted in the efficient production of recombinant heme proteins in which the heme cofactor was incorporated during protein production. In addition, the new EcN(T7) strain can be used to co-express genes for the production of heme-derived molecules like biliverdin or other linear tetrapyrroles. We demonstrate the successful recombinant production of the phytochromes BphP, from Pseudomonas aeruginosa, and Cph1, from Synechocystis sp. PCC6803, loaded with their linear tetrapyrrole cofactors, biliverdin and phycocyanobilin, respectively.

Conclusion

We present a new E. coli strain for efficient production of heme proteins and heme-derived molecules using T7-promoter based expression vectors. The new EcN(T7) strain enables the use of a broader spectrum of expression vectors, as well as the co-expression of genes using the pDuet expression vectors, for expressing heme containing proteins. By utilizing E. coli strains EcN and EcN(T7), capable of being fed heme, the rate limiting step of heme biosynthesis in E. coli is eliminated, thereby permitting higher heme saturation of heme proteins and also higher yields of heme-derived molecules.
Circ_0000285 regulates proliferation, migration, invasion and apoptosis of osteosarcoma by miR-409-3p/IGFBP3 axis
Authors: Long Zhisheng , Gong Feipeng , Li Yuxu , Fan Zhiqiang , Li Jingtang
Published: October 2020

Background

Circular RNAs (circRNAs) are important regulators in the pathogenesis of diseases and affects the occurrence and development of diseases. However, the role of circRNAs in osteosarcoma (OS) has not been fully elucidated.

Methods

The expression of circ_0000285, miR-409-3p and insulin-like growth factor binding protein 3 (IGFBP3) was detected using quantitative real-time PCR (qRT-PCR). The protein level of IGFBP3 was measured using western blot. CCK-8 and colony formation assays were used to determine cell proliferation. Flow cytometry was applied to measure cell cycle and cell apoptosis. Transwell assay was used to assess cell invasion and migration. Dual-luciferase reporter assay and RNA Binding Protein Immunoprecipitation (RIP) assay were performed to determine the relationship among circ_0000285, miR-409-3p and IGFBP3. The animal experiments were performed to determine the function of circ_0000285 in vivo.

Results

In this study, we found that the expression of circ_0000285 was significantly increased in OS tissues and cells and was enriched in the cytoplasm. Knockdown of circ_0000285 inhibited OS growth in vitro and in vivo. Moreover, miR-409-3p was a target miRNA of circ_0000285 and miR-409-3p targets to IGFBP3 in OS. Besides, circ_0000285 could promote proliferation, migration, invasion and inhibit apoptosis of osteosarcoma by miR-409-3p/IGFBP3 axis.

Conclusion

In this study, circ_0000285 regulated proliferation, migration, invasion and apoptosis of OS cells by miR-409-3p/IGFBP3 axis, implying that circ_0000285 was a potential target for OS therapy.
Correction to: Assessing the impact of the addition of pyriproxyfen on the durability of permethrin-treated bed nets in Burkina Faso: a compound-randomized controlled trial
Authors: Toé Kobié H. , Mechan Frank , Tangena Julie-Anne A. , Morris Marion , Solino Joanna , Tchicaya Emile F. S. , Traoré Alphonse , Ismail Hanafy , Maas James , Lissenden Natalie , Pinder Margaret , Lindsay Steve W. , Tiono Alfred B. , Ranson Hilary , Sagnon N’Falé
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime?
Authors: Rossi Carlo Maria , Beretta Flavio Niccolò , Traverso Grazia , Mancarella Sandro , Zenoni Davide
Published: October 2020

Background

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is the most Serious Cutaneous Adverse Reaction (SCAR) often with a fatal outcome. Coronavirus Disease (COVID-19) is caused by Severe Acute Respiratory Syndrome–Coronavirus—2 (SARS-COV2) and is an emergent pandemic for which no cure exist at the moment. Several drugs have been tried often with scant clinical evidence and safety.

Case presentation

Here we report the case of 78-years-old woman with cardiometabolic syndrome and COVID-19. A multidrug regimen including others hydroxychloroquine, antibiotics, dexamethasone and paracetamol, low-molecular-weight-heparin and potassium canrenoate was started. After almost 3 weeks, the patient started to display a violaceous rash initially involving the flexural folds atypical targetoid lesions and showing a very fast extension, blister formation and skin detachments of approximately 70% of the total body surface area and mucous membranes involvement consistent with toxic epidermal necrolysis (TEN). The ALDEN algorithm was calculated inserting all drugs given to the patient in the 28 days preceding the onset of the skin manifestations. The highest score retrieved was for hydroxychloroquine. Other less suspicious drugs were piperacillin/tazobactam, ceftriaxone and levofloxacin.

Conclusions

To our knowledge, this is the first case of TEN in a patient suffering from COVID-19 probably associated with hydroxychloroquine. Given the activation of the immune system syndrome induced by the virus and the widespread off-label use of this drug, we suggest a careful monitoring of skin and mucous membranes in all COVID-19 positive patients treated with hydroxychloroquine in order to early detect early signs of toxicities.
Reported patterns of vaping to support long-term abstinence from smoking: a cross-sectional survey of a convenience sample of vapers
Authors: Gentry Sarah Victoria , Ward Emma , Dawkins Lynne , Holland Richard , Notley Caitlin
Published: October 2020

Background

E-cigarettes are the most popular aid to smoking cessation attempts in England and the USA. This research examined associations between e-cigarette device characteristics and patterns of use, tobacco-smoking relapse, and smoking abstinence.

Methods

A convenience sample of 371 participants with experience of vaping, and tobacco-smoking abstinence and/or relapse completed an online cross-sectional survey about e-cigarettes. Factors associated with smoking relapse were examined using multiple linear and logistic regression models.

Results

Most participants were self-reported long-term abstinent smokers (86.3%) intending to continue vaping. Most initiated e-cigarette use with a vape pen (45.8%) or cig-a-like (38.7%) before moving onto a tank device (89%). Due to missing data, managed through pairwise deletion, only around 70 participants were included in some of the main analyses. Those using a tank or vape pen appeared less likely to relapse than those using a cig-a-like (tank vs. cig-a-like OR = 0.06, 95% CI 0.01–0.64, p = 0.019). There was an inverse association between starting self-reported e-cigarette liquid nicotine concentration and relapse, interacting with device type (OR = 0.79, 95% CI 0.63–0.99, p = 0.047), suggesting that risk of relapse may have been greater if starting with a low e-cigarette liquid nicotine concentration and/or cig-a-like device. Participants reported moving from tobacco-flavored cig-a-likes to fruit/sweet/food flavors with tank devices.

Conclusions

Knowledge of how people have successfully maintained tobacco-smoking abstinence using vaping could help other tobacco smokers wishing to quit tobacco smoking through vaping.
LncRNA NEAT1 mediates progression of oral squamous cell carcinoma via VEGF-A and Notch signaling pathway
Authors: He Ke , Zhu Zhi-Bin , Shu Rui , Hong Ai
Published: October 2020

Background

lncRNAs and VEGF have been shown to have close connections with oral squamous cell carcinoma (OSCC). We explored the interaction between lncRNA NEAT1 and VEGF-A in OSCC.

Methods

RT-qPCR was implemented to measure levels of lncRNA NEAT1 and VEGF-A in OSCC cell lines and normal cell lines. Cell functions then were checked after regulating the expressions of lncRNA NEAT1 and VEGF-A separately. Cell viabilities were examined with CCK-8 and apoptosis rate was checked with flow cytometry. Meanwhile, EMT-related genes E-cadherin, N-cadherin, Vimentin, and Snail and Notch signaling genes Notch1, Notch2, and Jagged were evaluated by RT-qPCR. IMR-1 was applied for impeding Notch signaling pathway. Later, cell viabilities, apoptosis, and EMT were assessed.

Results

Expressions of lncRNA NEAT1 and VEGF-A were both increased significantly in OSCC cell lines especially in TSCC1 cell line. Suppression of lncNRA NEAT1 was associated with lower cell viabilities and EMT and higher apoptosis rate in the TSCC1 cell line. Meanwhile, knockdown of VEGF-A significantly repressed cell viabilities and EMT in the TSCC1 cell line. Magnifying functions of inhibited lncRNA NEAT1 Notch signaling pathway was obviously activated with overexpressions of lncRNA NEAT1 and VEGF-A. Adding IMR-1 significantly downregulated cell viabilities and EMT and sharply increased apoptosis in the context of lncRNA NEAT1 and VEGF-A overexpression.

Conclusion

LncRNA NEAT1 may upregulate proliferation and EMT and repress apoptosis through activating VEGF-A and Notch signaling pathway in vitro, suggesting an underlying regulatory factor in OSCC. Nevertheless, further research is necessary to gain a greater understanding of lncRNA NEAT1 and connections with VEGF-A in vivo and in clinical study.
Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study
Authors: Zaman Rashid U. , Khaled Adiba , Sabur Muhammod Abdus , Islam Shahidul , Ahmed Shehlina , Varghese Joe , Sherratt Della , Witter Sophie
Published: October 2020

Background

Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills.

Methods

We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities.

Results

Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high.

Conclusion

While the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme.
Novel single-domain antibodies against the EGFR domain III epitope exhibit the anti-tumor effect
Authors: Chen Tao , Liu Xue , Hong Haifeng , Wei Henry
Published: October 2020

Background

Monoclonal antibodies (mAbs) have been used for cancer therapy. They are large and have some disadvantages limiting their use. Smaller antibody fragments are needed as their alternatives. A fully human single-domain antibody (sdAb) has a small size of only 15 kDa and consists of only the variable domain of the human antibody heavy chain (VH). It has no immunogenicity. It can easily penetrate into tumor tissues, target an epitope inaccessible to mAb and be manufactured in bacteria for a low cost. Epidermal growth factor receptor (EGFR) is over-expressed in many cancer cells and is a good target for cancer therapy.

Methods

The EGFR protein fragment located on the EGFR extracellular domain III was chosen to screen a human sdAb library. Five human anti-EGFR sdAbs were identified. Their specific binding to EGFR was confirmed by ELISA, Western blotting and flow cytometry. Their anti-tumor effects were tested.

Results

Five novel fully human anti-EGFR sdAbs were isolated. They specifically bound to EGFR, not to the seven unrelated proteins as negative controls. They also bound to the three different human cancer cell lines, but not to the two cell lines as negative controls. They inhibited cell proliferation, migration and invasion and increased apoptosis of these three cancer cell lines. Two of them were tested for their anti-tumor effect in vivo and showed the anti-tumor activity in a mouse xenograft model for human lung cancer. Immunohistochemical staining of xenograft tumors also showed that their anti-tumor effects were associated with the inhibition of cancer cell proliferation and the promotion of cancer cell apoptosis.

Conclusions

This study clearly demonstrated that the anti-EGFR sdAbs could inhibit cancer cell growth in vitro and tumor growth in vivo. They could be potential therapeutics for the treatment of different human cancers.