bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of HMGB1 expression for assessing gastric cancer severity: a systematic meta-analysis
Authors: Zhou Chunxiang , Yang Qun
Published: March 2021

Objective

To evaluate the clinical value of high mobility group box-1 (HMGB1) expression levels in patients with gastric cancer.

Methods

Articles published from January 2000 to August 2022 were searched using PubMed, Google Scholar and Science Direct, Springer, Wiley and NIH to evaluate the clinicopathological significance of HMGB1 expression in gastric cancer.

Results

A total of 156 publications were selected, of which six studies, comprising 846 patients, met the criteria for inclusion in this study. Forest plots of clinicopathological characteristics indicated that HMGB1 expression was not associated with age (odds ratio (OR) = 1.07, 95% confidence interval (CI): 0.89–1.28), sex (OR = 0.90, 95% CI: 0.81–1.00), TNM (OR = 1.39, 95% CI: 0.82–2.37), N stage (OR = 1.42, 95% CI: 0.97–2.07), or tumor differentiation (OR = 0.96, 95% CI: 0.71–1.29), but was highly correlated with pT stage (OR = 1.56, 95% CI: 1.17–2.07). Funnel plots showed no significant publication bias in the included studies in terms of age, sex, TNM, pT stage, N stage, or tumor differentiation.

Conclusion

HMGB1 expression was significantly correlated with tumor pT stage, but not with age, sex, TNM stage, tumor N stage, tumor differentiation, or lymphatic metastasis in patients with GC.
Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study
Authors: Chen Xiaolan , Li Lu , Bai Ming , Sun Shiren , Chen Xiangmei
Published: March 2021

Objective:

Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia.

Methods:

We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality.

Result:

A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( p < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( n = 18) and 84% ( n = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000–1.019; p = 0.043) was an independent risk factor of 30-day mortality.

Conclusions:

BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.
Early intervention with probiotics and metformin alleviates liver injury in NAFLD rats via targeting gut microbiota dysbiosis and p-AKT/mTOR/LC-3II pathways
Authors: Seif el-Din Sayed H , Salem MB , El-Lakkany NM , Hammam OA , Nasr SM , Okasha H , Ahmed LA , Saleh S , Botros SS
Published: March 2021

Non-alcoholic fatty liver disease (NAFLD) constitutes a major health problem worldwide and intimately links with obesity and diabetes. This study aimed to explore the therapeutic impact of early treatment with metformin (MTF) alone or in combination with Lactobacillus reuteri DSM 17938 ( L. reuteri) + metronidazole (MTZ) in male Sprague Dawley rats with high-fat diet (HFD)-induced NAFLD. Hepatic steatosis was induced by feeding rats HFD for 6 weeks. MTF (150 mg/kg/day) or L. reuteri (2 × 109 colony forming unit/day) were given orally for 4 weeks; meanwhile, MTZ (15 mg/kg/day, p.o.) was administered for 1 week. Administration of L. reuteri + MTZ in combination with MTF produced a superior effect concerning insulin resistance (IR), lipid profile, liver function, oxidative stress, inflammatory and autophagic markers than using each treatment alone. Besides, this combination resulted in disappearance of steatosis, inflammation and vacuolation within hepatic architecture. Moreover, it normalized short chain fatty acids (SCFAs) as well as Firmicutes and Bacteroidetes faecal contents. In conclusion, early treatment with L. reuteri + MTZ in combination with MTF could prevent NAFLD progression and liver injury through targeting gut dysbiosis, inflammation and autophagic pathways.
American Dreams: Smart sleep, high-tech beds, and the National Football League
Authors: Barnes Sarah
Published: March 2021

Sleep Number became an official health and wellness sponsor of the National Football League (NFL) in 2018, making each active player eligible for a free internet-enabled smart bed. This article investigates the social and digital divides that arise as the NFL and Sleep Number imagine sleep as something “smart” and anchored in technological progress in marketing campaigns. This article argues that while the NFL and Sleep Number package smart beds as empowering and emancipatory, corporate storytelling creates new rest-related obligations and re-constitutes collective understandings of sleep and sleep difficulties along racial, gender, and economic lines. Smarter sleep promotes individualized, market-driven solutions which are at odds with emerging scientific findings that highlight the role of racism and other structural issues in sleep and sleep disparities.
Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty
Authors: Fuller Colin , Brown Kesley , Speed Olivia , Gardner James , Thomason Ashlen , Dornhoffer John , Johnson Adam B , Hartzell Larry
Published: March 2021

Objective:

Velopharyngeal insufficiency (VPI) is a common speech disorder in patients with a history of cleft palate (CP) or 22q11.2 deletion syndrome. Pharyngeal flap (PF) and sphincter pharyngoplasty (SP) are 2 common surgeries to treat this disorder by decreasing unwanted nasal air emission and hypernasal resonance. Because Eustachian tube dysfunction (ETD) in patients with CP may be more frequent after surgery for VPI, we examined whether ETD was associated with either type of surgery.

Design:

Retrospective cohort study.

Setting:

Children’s hospital-based tertiary referral center.

Patients:

A total of 225 children with VPI who underwent primary PF (201) or SP (24) between 2006 and 2017.

Outcome measures:

We examined differences in risk of ETD according to both surgical groups and proxies for postoperative nasal obstruction. These proxies included postoperative resonance measures and development of obstructive sleep apnea (OSA).

Results:

Both surgical groups had similar preoperative measures, except the PF group had higher hypernasality by PSA. Postoperatively, the PF group demonstrated lower hypernasal resonance by nasometry and PSA. There were no differences between PF and SP groups with regard to ETD. Proxies for postoperative nasal obstruction also were not predictive of postoperative ETD. Degree of CP and younger age were found to be risk factors for ETD.

Conclusion:

There was no significant difference in the effects of PF and SP on ETD in this study. Neither lower hypernasality nor incidence of OSA had any impact on ETD. Degree of CP and younger age were the only significant risk factors for ETD that this study identified.
Examining Mothers’ Childhood Maltreatment History, Parental Reflective Functioning, and the Long-Term Effects of the Minding the Baby® Home Visiting Intervention
Authors: Condon Eileen M. , Tobon Amalia Londono , Holland Margaret L. , Slade Arietta , Mayes Linda , Sadler Lois S.
Published: March 2021

Research is needed to better understand how childhood maltreatment history affects parental reflective capacities, and whether early childhood interventions help mitigate these effects. We examined associations between childhood maltreatment and current parenting (parental reflective functioning, parenting behaviors) among mothers who participated in a follow-up study ( N = 97) of the Minding the Baby® (MTB) randomized control trial. MTB is a home visiting program that aims to help mothers understand their child’s mental states (feelings, intentions, needs) by promoting parental reflective functioning. Mothers retrospectively reported childhood maltreatment using the Childhood Trauma Questionnaire. Endorsing a higher number of childhood maltreatment subtypes was associated with less supportive/engaged parenting and higher pre-mentalizing modes, or difficulty with appropriately reflecting on the child’s mental states. These relationships were not moderated by participation in the MTB intervention. However, exploratory analyses of individual maltreatment subtypes revealed that participation in MTB may mitigate the harmful effects of childhood emotional abuse on pre-mentalizing modes, specifically. Further research is needed to understand the mechanisms through which early childhood interventions may prevent intergenerational cycles of maltreatment.
Trafficking in human beings in Spain: What do the data on detected victims tell us?
Authors: Villacampa Carolina , Gómez Mª Jesús , Torres Clàudia
Published: March 2021

Although trafficking in human beings was criminalized in Spain in 2010, data on this phenomenon are scarce and incomplete, consisting only of cases formally identified by police as having a very clear bias to trafficking for sexual exploitation. In an effort to increase empirical understanding, in 2019 we undertook quantitative research by gathering information on cases detected during 2017 and 2018. A questionnaire was distributed online to 757 stakeholders who could potentially have come across victims of trafficking. The 150 responses obtained provide valuable information about the number of victims, their profile, the dynamics of trafficking and the types of exploitation they suffered. The number of victims detected during the research period ( n = 7448) is far higher than those officially identified ( n = 458), which indicates that official cases may represent only the tip of the iceberg and point to the necessity of adopting measures to improve the identification system. Findings also show differences in victims’ profiles, victimization dynamics and forms of exploitation depending on the type of trafficking that could be taken into account when designing intervention and prevention programmes in this matter.
Benin: Governance, lifelong learning and development
Authors: Biao Idowu
Published: March 2021

This article analyses and identifies the extent to which the different pre- and post-independence typologies of governance in Benin have facilitated the promotion of lifelong learning as instrument for development. Relying on the thematic content analysis method, the article identifies three themes and three main typologies of governance spanning the independence preparation period and post-independence era. Of the three styles of governance, only the Marxist–Leninist government succeeded in promoting lifelong learning by default. Lifelong learning being one type of learning that promotes the re-engineering of society through the constant dissemination of knowledge, information and know-how and through the constant retooling of the citizenry for purpose of investment of their talents in ever renewable ways, Benin is called upon to prioritise the promotion of lifelong learning soon. Specifically, Benin has been advised to restructure her national educational sector by bringing the whole sector under one Minister of Education with a view to enabling a seamless interaction across all sections of the national education. This restructuring as described in Figure 1 within the article, would facilitate timeous access to knowledge, information and skills that would enable individuals to participate in different sectors of the economy and thereby advance rapid national socio-economic development.
Proximal Interphalangeal Joint Arthrodesis Techniques: A Systematic Review
Authors: Faulkner Harrison , An Vincent , Lawson Richard D. , Graham David J. , Sivakumar Brahman S.
Published: March 2021

Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including screws, Kirschner wires, tension band wiring, intramedullary devices, and plate fixation. There remains no consensus as to the optimum method, and no recent summary of the literature exists. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases. English-language articles reporting PIPJ arthrodesis outcomes were included and presented in a systematic review. Pearson χ2 and 2-sample proportion tests were used to compare fusion time, nonunion rate, and complication rate between arthrodesis techniques. The mean fusion time ranged from 5.1 to 12.9 weeks. There were no statistically significant differences in fusion time between arthrodesis techniques. Nonunion rates ranged from 0.0% to 33.3%. Screw arthrodesis demonstrated a lower nonunion rate than wire fusion (3.0% and 8.5% respectively; P = .01). Complication rates ranged from 0.0% to 22.1%. Aside from nonunions, there were no statistically significant differences in complication rates between arthrodesis techniques. The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. The existing data have significant limitations, and further research would be beneficial to elucidate any differences between techniques.
The impact of video assistant referee (VAR) on match performance variables at men’s FIFA World Cup tournaments
Authors: Kubayi Alliance , Larkin Paul , Toriola Abel
Published: March 2021

This study explored how the video assistant referee (VAR) has inﬂuenced match performance variables at Fédération Internationale de Football Association (FIFA) World Cup tournaments. Comparative analysis was undertaken of matches played during the FIFA 2018 World Cup ( n = 64) tournament, where VAR was employed, and those played during the 2014 World Cup ( n = 64) tournament, where VAR was not employed. The following performance variables were recorded and analysed for each of the matches played: goals, penalties, corner kicks, yellow cards, red cards, offsides, playing time during the first half, playing time during the second half and total playing time. After the introduction of VAR, there were significant ( p < 0.05) increases in the number of penalties, as well as playing time during the first half, second half and total playing time. In contrast, a signiﬁcant ( p < 0.05) decline was observed in the number of offsides after VAR was implemented. The current findings have practical implications for improvement of VAR implementation guidelines at FIFA World Cup competitions.
Neurocognitive effects associated with proprotein convertase subtilisin-kexin type 9 inhibitor use: a narrative review
Authors: Yuet Wei C. , Ebert Didi , Jann Michael
Published: March 2021

Neurocognitive adverse events have been observed with the widespread use of 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors or “statins,” which reduce low-density lipoprotein cholesterol (LDL-C) levels and subsequently cardiovascular risk. The United States Food and Drug Association directed manufacturers of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors to monitor for neurocognitive adverse events due to their potent effects on LDL-C reduction, which is a proposed mechanism for neuronal cell dysfunction. Other proposed mechanisms for PCSK9 inhibitor-associated neurocognitive adverse events include N-methyl-d-aspartate receptor modulation, dysregulation of lipid and glucose metabolism, and patient-specific risk factors for cognitive impairment. The purpose of this narrative review article is to describe the proposed mechanisms, incidence of neurocognitive adverse events from phase II and III trials for PCSK9 inhibitors, neurocognitive assessments utilized in clinical trials, and clinical implications. Given the increasing prevalence of PCSK9 inhibitor use and the neurocognitive adverse events observed with prior lipid-lowering therapies, clinicians should be aware of the risks associated with PCSK9 inhibitors, especially when therapy is indicated for patients at high risk for cardiovascular events. Overall, the incidence of PCSK9 inhibitor-associated neurocognitive appears to be uncommon. However, additional prospective studies evaluating cognitive impairment may be beneficial to determine the long-term safety of these agents.
Experimental study on seismic performance of strengthening masonry wall using hybrid fiber-reinforced reactive powder concrete
Authors: Wang Xin , Xie Qun , Wu Zhenli , Bu Fanyang , Wang Fei
Published: March 2021

An experimental study was conducted to investigate the seismic performance of masonry walls strengthened using hybrid fiber-reinforced reactive powder concrete (HyFRRPC) as a coating. The proposed reinforcement technique was employed to improve the overall strength and structural integrity of the confined masonry wall. In order to guarantee the composite action between the masonry substrate and the coating material, material tests were conducted to achieve an optimal mixture for the HyFRRPC. Then, six full-scaled confined masonry specimens strengthened by HyFRRPCs with varied strengthening configurations were tested under in-plane quasi-static horizontal loading. The test and analysis results indicated that the proposed HyFRRPC-strengthening technique can effectively improve the lateral carrying capacity, displacement ductility, and energy dissipation capacity of masonry walls, and provide an optimal reinforcement. Finally, a simplified analytical model was also proposed for practical application.
Malaria parasite detection in thick blood smear microscopic images using modified YOLOV3 and YOLOV4 models
Authors: Abdurahman Fetulhak , Fante Kinde Anlay , Aliy Mohammed
Published: March 2021

Background

Manual microscopic examination of Leishman/Giemsa stained thin and thick blood smear is still the “gold standard” for malaria diagnosis. One of the drawbacks of this method is that its accuracy, consistency, and diagnosis speed depend on microscopists’ diagnostic and technical skills. It is difficult to get highly skilled microscopists in remote areas of developing countries. To alleviate this problem, in this paper, we propose to investigate state-of-the-art one-stage and two-stage object detection algorithms for automated malaria parasite screening from microscopic image of thick blood slides.

Results

YOLOV3 and YOLOV4 models, which are state-of-the-art object detectors in accuracy and speed, are not optimized for detecting small objects such as malaria parasites in microscopic images. We modify these models by increasing feature scale and adding more detection layers to enhance their capability of detecting small objects without notably decreasing detection speed. We propose one modified YOLOV4 model, called YOLOV4-MOD and two modified models of YOLOV3, which are called YOLOV3-MOD1 and YOLOV3-MOD2. Besides, new anchor box sizes are generated using K-means clustering algorithm to exploit the potential of these models in small object detection. The performance of the modified YOLOV3 and YOLOV4 models were evaluated on a publicly available malaria dataset. These models have achieved state-of-the-art accuracy by exceeding performance of their original versions, Faster R-CNN, and SSD in terms of mean average precision (mAP), recall, precision, F1 score, and average IOU. YOLOV4-MOD has achieved the best detection accuracy among all the other models with a mAP of 96.32%. YOLOV3-MOD2 and YOLOV3-MOD1 have achieved mAP of 96.14% and 95.46%, respectively.

Conclusions

The experimental results of this study demonstrate that performance of modified YOLOV3 and YOLOV4 models are highly promising for detecting malaria parasites from images captured by a smartphone camera over the microscope eyepiece. The proposed system is suitable for deployment in low-resource setting areas.
An intriguing characteristic of enhancer-promoter interactions
Authors: Talukder Amlan , Hu Haiyan , Li Xiaoman
Published: March 2021

Background

It is still challenging to predict interacting enhancer-promoter pairs (IEPs), partially because of our limited understanding of their characteristics. To understand IEPs better, here we studied the IEPs in nine cell lines and nine primary cell types.

Results

By measuring the bipartite clustering coefficient of the graphs constructed from these experimentally supported IEPs, we observed that one enhancer is likely to interact with either none or all of the target genes of another enhancer. This observation implies that enhancers form clusters, and every enhancer in the same cluster synchronously interact with almost every member of a set of genes and only this set of genes. We perceived that an enhancer can be up to two megabase pairs away from other enhancers in the same cluster. We also noticed that although a fraction of these clusters of enhancers do overlap with super-enhancers, the majority of the enhancer clusters are different from the known super-enhancers.

Conclusions

Our study showed a new characteristic of IEPs, which may shed new light on distal gene regulation and the identification of IEPs.
Effectiveness of securing central venous catheters with topical tissue adhesive in patients undergoing cardiac surgery: a randomized controlled pilot study
Authors: Prachanpanich Naruemol , Morakul Sunthiti , Kiatmongkolkul Napanont
Published: March 2021

Background

Central venous catheters (CVCs) play an important role during cardiac surgery. Topical tissue adhesives form a thin film of coating that becomes bound to keratin in the epidermis. The advantage of this “super glue” lies in its antimicrobial activity. This study aimed to evaluate fixation of CVCs with topical tissue adhesive in patients (prone to bleed) undergoing cardiac surgery regarding its ability to reduce the incidence of pericatheter leakage.

Methods

This randomized controlled trial included 150 patients > 15 years of age who were (1) scheduled to undergo elective cardiac surgery, (2) required CVC insertion at the internal jugular vein, and (3) scheduled for transfer postoperatively to the cardiac intensive care unit. We randomly assigned patients to a topical tissue adhesive group (TA) or a standard control group (SC). The primary outcome was a change in dressing immediately postoperatively due to pericatheter blood oozing. Secondary outcomes were the number of dressings, total dressings per catheter day, and composite outcome of catheter failure within 3 days. Both intention-to-treat and per-protocol analyses were performed. Seven patients violated the protocol (three TA patients and four SC patients).

Results

Regarding the primary outcome, the SC group exhibited a significantly increased incidence of dressing change immediately postoperatively due to pericatheter leakage compared with the TA group in both the intention-to-treat analysis (5.33% vs 18.67%, RR 0.25 [95% CI 0.08 to 0.79], P = 0.012) and the per-protocol analysis (5.56% vs 16.90%, RR 0.289 [95% CI 0.09 to 0.95], P = 0.031). No significant differences were noted in the number of dressings, total dressings per catheter day, or composite outcome of catheter failure within 3 days between the two groups. Multiple logistic regression analysis was performed to adjust baseline characteristics that were different in the per-protocol analysis. The results showed that the risk ratio of immediate postoperative dressing change in TA patients was 0.25 compared to the SC group ([95% CI 0.07 to 0.87], P = 0.029) in the per-protocol analysis.

Conclusion

The use of a topical tissue adhesive can reduce the incidence of immediate postoperative pericatheter blood oozing.

Trial registration

TCTR20180608004, retrospectively registered on June 06, 2018.
Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods
Authors: Kuo Ming-Jeng , Mo Lein-Ray , Chen Chi-Ling
Published: March 2021

Background

We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment.

Methods

Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression.

Results

One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE.

Conclusion

Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.
The impact of poly-traumatization on treatment outcomes in young people with substance use disorders
Authors: Karsberg Sidsel , Hesse Morten , Pedersen Michael Mulbjerg , Charak Ruby , Pedersen Mads Uffe
Published: March 2021

Background

It is believed that clients with psychological trauma experiences have a poor prognosis with regard to treatment participation and outcomes for substance use disorders. However, knowledge on the effect of the number of trauma experiences is scarce.

Methods

Using data from drug use disorder (DUD) treatment in Denmark, we assessed the impact of having experienced multiple potentially traumatic experiences on DUD treatment efficacy. Baseline and follow-up data from 775 young participants (mean age = 20.2 years, standard deviation = 2.6) recruited at nine treatment centers were included in analyses.

Results

Analyses showed that participants who were exposed multiple trauma experiences also reported a significantly higher intake of cannabis at treatment entry, and a lower well-being score than participants who reported less types or no types of victimization experiences. During treatment, patients with multiple types of trauma experiences showed a slower rate of reduction of cannabis than patients with few or no trauma experiences. The number of trauma types was not associated with number of sessions attended or the development of well-being in treatment.

Conclusion

Overall, the results show that although traumatized youth in DUD treatment show up for treatment, helping them to reduce substance use during treatment is uniquely challenging.

Trial registration

ISRCTN88025085, date of registration: 29.08.2016, retrospectively registered.
Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery
Authors: Qian Jingyu , Qian Miaofang , Ren Yanyan , Ye Linyan , Qian Fangfang , Jin Linlin , Chen Lili , Xu Haixia
Published: March 2021

Background

To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors.

Methods

A cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected.

Results

According to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05).

Conclusion

The level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.
Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm
Authors: Humm Gemma , Harries Rhiannon L. , Stoyanov Danail , Lovat Laurence B.
Published: March 2021

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care.
Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems
Authors: Wehkamp Kai , Kuhn Eva , Petzina Rainer , Buyx Alena , Rogge Annette
Published: March 2021

Background

Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS.

Methods

A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts’ experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics.

Results

Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance.

Conclusion

The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations’ presence and effectiveness. The proposed enhancement could contribute to hospitals’ ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction.
Dissecting the mechanism of temozolomide resistance and its association with the regulatory roles of intracellular reactive oxygen species in glioblastoma
Authors: Chien Chia-Hung , Hsueh Wei-Ting , Chuang Jian-Ying , Chang Kwang-Yu
Published: March 2021

Glioblastoma is the most common primary malignant brain tumor that is usually considered fatal even with treatment. This is often a result for tumor to develop resistance. Regarding the standard chemotherapy, the alkylating agent temozolomide is effective in disease control but the recurrence will still occur eventually. The mechanism of the resistance is various, and differs in terms of innate or acquired. To date, aberrations in O6-methylguanine-DNA methyltransferase are the clear factor that determines drug susceptibility. Alterations of the other DNA damage repair genes such as DNA mismatch repair genes are also known to affect the drug effect. Together these genes have roles in the innate resistance, but are not sufficient for explaining the mechanism leading to acquired resistance. Recent identification of specific cellular subsets with features of stem-like cells may have role in this process. The glioma stem-like cells are known for its superior ability in withstanding the drug-induced cytotoxicity, and giving the chance to repopulate the tumor. The mechanism is complicated to administrate cellular protection, such as the enhancing ability against reactive oxygen species and altering energy metabolism, the important steps to survive. In this review, we discuss the possible mechanism for these specific cellular subsets to evade cancer treatment, and the possible impact to the following treatment courses. In addition, we also discuss the possibility that can overcome this obstacle.
Mesenchymal stem cells and cancer therapy: insights into targeting the tumour vasculature
Authors: Aravindhan Surendar , Ejam Sura Salman , Lafta Methaq Hadi , Markov Alexander , Yumashev Alexei Valerievich , Ahmadi Majid
Published: March 2021

A crosstalk established between tumor microenvironment and tumor cells leads to contribution or inhibition of tumor progression. Mesenchymal stem cells (MSCs) are critical cells that fundamentally participate in modulation of the tumor microenvironment, and have been reported to be able to regulate and determine the final destination of tumor cell. Conflicting functions have been attributed to the activity of MSCs in the tumor microenvironment; they can confer a tumorigenic or anti-tumor potential to the tumor cells. Nonetheless, MSCs have been associated with a potential to modulate the tumor microenvironment in favouring the suppression of cancer cells, and promising results have been reported from the preclinical as well as clinical studies. Among the favourable behaviours of MSCs, are releasing mediators (like exosomes) and their natural migrative potential to tumor sites, allowing efficient drug delivering and, thereby, efficient targeting of migrating tumor cells. Additionally, angiogenesis of tumor tissue has been characterized as a key feature of tumors for growth and metastasis. Upon introduction of first anti-angiogenic therapy by a monoclonal antibody, attentions have been drawn toward manipulation of angiogenesis as an attractive strategy for cancer therapy. After that, a wide effort has been put on improving the approaches for cancer therapy through interfering with tumor angiogenesis. In this article, we attempted to have an overview on recent findings with respect to promising potential of MSCs in cancer therapy and had emphasis on the implementing MSCs to improve them against the suppression of angiogenesis in tumor tissue, hence, impeding the tumor progression.
Anxiety and depression are risk factors for recurrent pregnancy loss: a nested case–control study
Authors: Wang Yanxia , Meng Zhaoyan , Pei Jianyin , Qian Liu , Mao Baohong , Li Yamei , Li Jing , Dai Zhirong , Cao Jianing , Zhang Chunhua , Chen Lina , Jin Yuxia , Yi Bin
Published: March 2021

Background

To evaluate the interaction of depression and anxiety with the development of recurrent pregnancy loss (RPL).

Methods

A nested case–control study involving 2558 participants was conducted with data from the prospective Miscarriage Woman Cohort study between 2017 and 2019 in the province of Gansu, China. The questionnaire data, self-rating anxiety scale and self-rating depression scale were collected after each participant’s first miscarriage. Information on RPL outcomes was obtained from the medical records within the subsequent 2 years. All patients diagosed RPL were recruited as cases whilst a randomly selected group of women with only one miscarriage in the past were recruited as controls. The logistic regression and the interaction effects between anxiety and depression and RPL were analysed.

Results

The prevalence of anxiety (n = 325, 28.7% vs. n = 278, 19.5%) and depression symptoms (n = 550, 48.6% vs. n = 589, 41.3%) for the 1132 RPL cases were higher than 1426 non-RPL controls (P < 0.001). After adjusting for possible confounding variables, the odds ratio (OR) value, reflecting the multiplicative interaction, was 1.91 (95% CI 1.50–2.44,P < 0.001) for cases with both anxiety and depression symptoms compared with the non-RPL group. The relative excess risk of interaction value, reflecting the additive interaction between anxiety and depression to RPL was 1.15 (95% CI 0.32–4.21). Moreover, the adjusted OR for RPL cases with mild anxiety and severe depression was 2.77 (95% CI 1.07–44.14,P < 0.001), for RPL cases with severe anxiety and mild depression was 4.23 (95% CI 1.01–22.21,P < 0.001), for RPL cases with severe anxiety and moderate depression was 4.34 (95% CI 1.03–21.28,P < 0.001) and for RPL cases with severe anxiety and severe depression was 5.95 (95% CI 1.09–45.09,P < 0.05).

Conclusions

Either depression or anxiety alone could increase the risk of subsequent RPL. Anxiety and depression had a synergistic effect after the first miscarriage which increased the development of subsequent RPL disease.
Identification and validation of three core genes in p53 signaling pathway in hepatitis B virus-related hepatocellular carcinoma
Authors: Yu Mingxue , Xu Wenli , Jie Yusheng , Pang Jiahui , Huang Siqi , Cao Jing , Gong Jiao , Li Xinhua , Chong Yutian
Published: March 2021

Background

Hepatocellular carcinoma (HCC) is a common cancer and the leading cause is persistent hepatitis B virus (HBV) infection. We aimed to identify some core genes and pathways for HBV-related HCC.

Methods

Gene expression profiles of GSE62232, GSE121248, and GSE94660 were available from Gene Expression Omnibus (GEO). The GSE62232 and GSE121248 profiles were the analysis datasets and GSE94660 was the validation dataset. The GEO2R online tool and Venn diagram software were applied to analyze commonly differentially expressed genes between HBV-related HCC tissues and normal tissues. Then, functional enrichment analysis using Gene Ontology (GO) and the Kyoto Encyclopedia of Gene and Genome (KEGG) as well as the protein-protein interaction (PPI) network was conducted. The overall survival rates and the expression levels were detected by Kaplan-Meier plotter and Gene Expression Profiling Interactive Analysis (GEPIA). Next, gene set enrichment analysis (GSEA) was performed to verify the KEGG pathway analysis. Furthermore, quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was performed to validate the levels of these three core genes in tumor tissues and adjacent non-tumor liver tissues from 12 HBV related HCC patients, HBV-associated liver cancer cell lines and normal liver cell lines, and HepG2 with p53 knockdown or deletion, respectively.

Results

Fifteen highly expressed genes associated with significantly worse prognoses were selected and CCNB1, CDK1, and RRM2 in the p53 signaling pathway were identified as core genes. GSEA results showed that samples highly expressing three core genes were all enriched in the p53 signaling pathway in a validation dataset (P < 0.0001). The expression of these three core genes in tumor tissue samples was higher than that in relevant adjacent non-tumor liver tissues (P < 0.0001). Furthermore, we also found that the above genes were highly expressed in liver cancer cell lines compared with normal liver cells. In addition, we found that the expression of these three core genes in p53 knockdown or knockout HCC cell lines was lower than that in negative control HCC cell lines (P < 0.05).

Conclusions

CCNB1, CDK1, and RRM2 were enriched in the p53 signaling pathway and could be potential biomarkers and therapeutic targets for HBV-related HCC.
Implementation and effectiveness of continuous kangaroo mother care: a participatory action research protocol
Authors: Mohammadi Marzieh , Bergh Anne-Marie , Heidarzadeh Mohammad , Hosseini Mahammadbagher , Sattarzadeh Jahdi Niloufar , Valizadeh Leila , Sarvaran Behzad , Hakimi Sevil
Published: March 2021

Background

The efficacy of continuous kangaroo mother care (C-KMC) in reducing neonatal mortality and morbidity among low birthweight and premature infants has been confirmed. Despite the recommendations of the World Health Organization, UNICEF, and the Ministry of Health of Iran to use C-KMC for eligible hospitalized neonates, this type of care is not performed due to implementation problems. This protocol aims to describe the design, implementation, and assessment of C-KMC in one tertiary hospital by means of participatory action research.

Methods

The objective of this study is to design and implement a C-KMC program for neonates that will be performed in two phases using a stages-of-change model. The first phase will be conducted in three consecutive activities of designing, implementing, and assessing the introduction of C-KMC. The second phase of the study has a before-and-after design to assess the effectiveness of C-KMC by comparing the length of preterm neonates’ stay in hospital and exclusive breastfeeding at discharge before and after implementing C-KMC.

Discussion

KMC is an important component of neonatal developmental care as part of family-centered care. Applying this type of care requires creating appropriate strategies, budget allocation, and clear and coordinated planning at different levels of the health system. The stages-of-change model is one of the appropriate approaches to the implementation of C-KMC.
Cholesterol alters mitophagy by impairing optineurin recruitment and lysosomal clearance in Alzheimer’s disease
Authors: Roca-Agujetas Vicente , Barbero-Camps Elisabet , de Dios Cristina , Podlesniy Petar , Abadin Xenia , Morales Albert , Marí Montserrat , Trullàs Ramon , Colell Anna
Published: March 2021

Background

Emerging evidence indicates that impaired mitophagy-mediated clearance of defective mitochondria is a critical event in Alzheimer’s disease (AD) pathogenesis. Amyloid-beta (Aβ) metabolism and the microtubule-associated protein tau have been reported to regulate key components of the mitophagy machinery. However, the mechanisms that lead to mitophagy dysfunction in AD are not fully deciphered. We have previously shown that intraneuronal cholesterol accumulation can disrupt the autophagy flux, resulting in low Aβ clearance. In this study, we examine the impact of neuronal cholesterol changes on mitochondrial removal by autophagy.

Methods

Regulation of PINK1-parkin-mediated mitophagy was investigated in conditions of acute (in vitro) and chronic (in vivo) high cholesterol loading using cholesterol-enriched SH-SY5Y cells, cultured primary neurons from transgenic mice overexpressing active SREBF2 (sterol regulatory element binding factor 2), and mice of increasing age that express the amyloid precursor protein with the familial Alzheimer Swedish mutation (Mo/HuAPP695swe) and mutant presenilin 1 (PS1-dE9) together with active SREBF2.

Results

In cholesterol-enriched SH-SY5Y cells and cultured primary neurons, high intracellular cholesterol levels stimulated mitochondrial PINK1 accumulation and mitophagosomes formation triggered by Aβ while impairing lysosomal-mediated clearance. Antioxidant recovery of cholesterol-induced mitochondrial glutathione (GSH) depletion prevented mitophagosomes formation indicating mitochondrial ROS involvement. Interestingly, when brain cholesterol accumulated chronically in aged APP-PSEN1-SREBF2 mice the mitophagy flux was affected at the early steps of the pathway, with defective recruitment of the key autophagy receptor optineurin (OPTN). Sustained cholesterol-induced alterations in APP-PSEN1-SREBF2 mice promoted an age-dependent accumulation of OPTN into HDAC6-positive aggresomes, which disappeared after in vivo treatment with GSH ethyl ester (GSHee). The analyses in post-mortem brain tissues from individuals with AD confirmed these findings, showing OPTN in aggresome-like structures that correlated with high mitochondrial cholesterol levels in late AD stages.

Conclusions

Our data demonstrate that accumulation of intracellular cholesterol reduces the clearance of defective mitochondria and suggest recovery of the cholesterol homeostasis and the mitochondrial scavenging of ROS as potential therapeutic targets for AD.
Philadelphia chromosome positive chronic myeloid leukemia with 5q deletion at diagnosis
Authors: Haidary Ahmed Maseh , Ahmed Zeeshan Ansar , Abdul-Ghafar Jamshid , Rahmani Soma , Noor Sarah , Erfani Farahnaz , Ahmad Maryam , Lakanwall Naeem , Malakzai Haider Ali , Ibrahimkhil Abdul Sami , Esmat Esmatullah , Haidari Mujtaba , Yousufzai Nimattullah , Sharif Samuel , Saqib Abdul Hadi
Published: March 2021

Background

Although, molecular genetic analyses became more and more important to guide therapy decisions in leukemia, banding cytogenetic analysis has retained its vital role in diagnosis and monitoring of chronic myeloid leukemia (CML), by quick and easy enabling identification of pathognomonic Philadelphia chromosome (Ph).

Case presentation

A 45 year old female presented with characteristic hematological features of CML in chronic phase; cytogenetic studies revealed the presence of the typical Ph and a deletion of almost entire long arm of a chromosome 5.

Conclusion

5q deletions have rarely been reported in CML. Those seen yet were either associated with tyrosine kinase inhibitor therapy or detected post allogeneic stem cell transplantation. To our knowledge, this is the first case of Ph positive CML accompanied by a 5q deletion.