bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinico-radiological features of cerebral proliferative angiopathy: A large case series from India
Authors: Srivastava Trilochan , Gandhi Ashok , Kumar Rahul
Published: May 2022

Background

Based on angiographic features, a rare subgroup, different from classical brain AVMs, called cerebral proliferative angiopathy (CPA) was suggested by Lasjaunias et al. in 1989. There are only few reports of CPA described from Asia. Liu et al. has described 5 cases of CPA from China. The objective of study was to evaluate the clinico-radiological features of patients with CPA in our cohort and to find out the differences between our study and the study by Lasjaunias and Liu et al.

Methods

We retrospectively analysed cases of CPA from March 2012 to April 2020. All radiological images of the patients with AVMs were studied and findings suggestive of CPA were identified. We found 10 patients with CPA out of 272 cases of AVM (10/272) and described the various demographic and clinico-radiological features.

Results

The age of the patients with CPA in our series varied from 14 to 53 years and the mean age was 28.6 years. There was male preponderance (60%) with male to female ratio of 3:2. The most common presentation was seizure (70%). Intracranial haemorrhage was present in five patients. One patient had cerebral infarction.

Conclusions

There were substantial differences in clinico-radiological profile of patients with CPA in our cohort as compared to the study by Lasjaunias et al. and Liu et al. in form of male dominance, higher rate of ICH and seizure. In our knowledge, this is the second largest series of CPA worldwide and the first largest series in Asia.
Dupilumab and tezepelumab in severe refractory asthma: new opportunities
Authors: Ragnoli Beatrice , Morjaria Jaymin , Pignatti Patrizia , Montuschi Paolo , Barbieri Mariangela , Mondini Lucrezia , Ruggero Luca , Trotta Liliana , Malerba Mario
Published: May 2022

Bronchial asthma is a chronic inflammatory condition with increasing prevalence worldwide that may present as heterogeneous phenotypes defined by the T2-mediated pattern of airway inflammation T2-high and T2-low asthma. Severe refractory asthma includes a subset of asthmatic patients who fail to control their disease despite maximal therapy and represent a group of patients needing marked resource utilization and hence may be eligible to add-on biological therapies. Among the new biologics, we focused our attention on two monoclonal antibodies: dupilumab, exerting a dual blockade of cytokine (interleukin (IL)-4 and IL-13) signaling; and tezepelumab, acting at a higher level preventing the binding of thymic stromal lymphopoietin (TSLP) to its receptor, thus blocking TSLP, IL-25, and IL-33 signaling, hence modulating airway T2 immune responses. With their different mechanisms of action, these two biologics represent important options to provide an enhanced personalized treatment regimen. Several clinical trials have been conducted testing the efficacy and safety of dupilumab in severe refractory asthmatic patients showing improvements in lung function, asthma control, and reducing exacerbations. Similar results were reported with tezepelumab that, differently from dupilumab, acts irrespectively on eosinophilic or non-eosinophilic phenotype. In this review, we provide an overview of the most important highlights regarding dupilumab and tezepelumab characteristics and mechanism of action with a critical review of the principal results of clinical (Phase II and III) studies concluded and those still in progress.
Ammunition, not a ride: Humor, human geography, and the fragile absurdities of power
Authors: Gerlofs Ben A.
Published: May 2022

In this author's response, I close this forum on the spatiality and political utility of humor by responding to a superb set of critical commentaries – for which I am extremely grateful – in three parts, with the sobering contemporary reality of the comedian-president facing down a brutal invasion serving as a critical, conjunctural point of entry. First, humor can be, as the commentators highlight in different ways, extremely serious business. Second, context matters. And, third, there's a great deal more work to be done. In each of these areas, I respond to some of the many significant issues and questions raised by the commentators that remain for the study of humor, both within geography and as a matter of interdisciplinary inquiry.
Lumbar swelling and migrating edema in 3- and 4-year-old boys
Authors: Marcia Marta , Parodi Emilia
Published: May 2022

Henoch-Schönlein purpura is the most common systemic vasculitis in children, characterized by IgA deposits in small vessels. The etiology is unknown, but Henoch-Schönlein purpura typically follows an upper respiratory infection, or less frequently other infective or chemical triggers. The classic tetrad of symptoms includes palpable purpura (mandatory criterion), arthralgias, abdominal pain, and renal involvement. However, the cutaneous rash of Henoch-Schönlein purpura is not the presenting sign in approximately one-quarter of patients. Moreover, the other typical manifestations can present isolated or nuanced; for that reason, a prompt diagnosis may be challenging. Other clinical findings such as subcutaneous edema in hands, ankles, and feet, are quite common at pediatric Henoch-Schönlein purpura onset. Edema occurring in other locations (i.e facial and genital swelling), is uncommon, but can be a helpful additional clinical sign of Henoch-Schönlein purpura. To our knowledge, only two cases of lumbar swelling as Henoch-Schönlein purpura presentation signs have been described in literature so far.
Book review: Abdul Basit, Hostility: A Diplomat’s Diary on Pakistan-India Relations
Authors: Bhat Mukhtar Ahmad
Published: May 2022

Abdul Basit, Hostility: A Diplomat’s Diary on Pakistan-India Relations. HarperCollins, 2021, 331 pp (Hardback). ISBN: 978-93-5422-645-8.
Book review: Chan Young Bang, Transition Beyond Denuclearisation: A Bold Challenge for Kim Jong Un
Authors: Nguyen Hong Kong
Published: May 2022

Chan Young Bang, Transition Beyond Denuclearisation: A Bold Challenge for Kim Jong Un. Palgrave Macmillan, 2020, pp. xiii + 169. (ebook). ISBN: 978-981-15-4316-6.
Express improvement of acute stroke care accessibility in large regions using a centralized telestroke network
Authors: Barragán-Prieto Ana , Pérez-Sánchez Soledad , Moniche Francisco , Moyano Roberto Valverde , Delgado Fernando , Martínez-Sánchez Patricia , Moya Miguel , Oropesa Juan M , Mínguez-Castellanos Adolfo , Villegas Inmaculada , Álvarez Soria María José , Tamayo Toledo Jose Antonio , de la Cruz Cosme Carlos , Canto Neguillo Rafael , Herrerías Esteban Juan Manuel , Montero Cobos Daniel José , Moreno Muñoz Jose Antonio , González Alejandro , Montaner Joan
Published: May 2022

Introduction:

Acute ischemic stroke therapy has improved in recent decades, decreasing the rates of disability and death among stroke patients. Unfortunately, all health care systems have geographical disparities in infrastructure for stroke patients. A centralized telestroke network might be a low-cost strategy to reduce differences in terms of geographical barriers, equitable access, and quality monitoring across different hospitals.

Aims:

We aimed to quantify changes in stroke patients’ geographic access to specialized evaluation by neurologists and to intravenous acute stroke reperfusion treatments following the rapid implementation of a centralized telestroke network in the large region of Andalusia (8.5 million inhabitants).

Methods:

We conducted an observational study using spatial and analytical methods to examine how a centralized telestroke network influences the quality and accessibility of stroke care for a large region.

Results:

In the pre-implementation period, 5,005,477 (59.72% of the Andalusian population) had access to specialized stroke care in less than 30 min. After the 5-month process of implementing the telestroke network, 7,832,988 (93.5%) inhabitants had an access time of less than 30 min, bridging the gap in acute stroke care in rural hospitals.

Conclusions:

A centralized telestroke network may be an efficient tool to reduce the differences in stroke care access and quality monitoring across different hospitals, especially in large regions with low population density.
Molecular Classification of Gastric Cancer With Emphasis on PDL-1 Expression: The First Report From Iran
Authors: Amirmoezi Fatemeh , Geramizadeh Bita
Published: May 2022

Background:

Gastric cancer is one of the lethal cancers and there is no effective treatment for these patients and still, 5-year survival rate is about 25% to 30%. Finding reliable biomarkers for early-stage diagnosis, targeted therapy, and survival prediction is a priority in this cancer.

Objectives:

In this study we were trying to know about the molecular classification of gastric cancers in a group of patients from the South of Iran.

Patients and Methods:

In a cross sectional study, 50 specimens of gastric cancer were selected that have enough tissue to be stained by immunohistochemistry (IHC). IHC was performed for Her-2, mismatch repair genes (MLH-1, MSH-2, MSH-6, and PMS-2), and PDL-1. Frequency of positive makers was compared with survival and outcome.

Results and Conclusion:

In our study, deficient MMR (dMMR) was detected in 4 patients (8.0%). PD-L1 expression in tumor cells (TC) was observed in 1 of 4 cases (25%) with PMS2 loss. However, PD-L1 in TCs and TILs (tumor infiltrating lymphocytes) was negative in 1 case with MLH1 loss and in 3 of 4 cases with PMS2 loss, which was not statistically significant. All of our 50 cases were positive for MSH2 and MSH6, 24% of which showed TCs with PDL-1 expression and 32% of them in TIL. HER2 was positive in 2 (2/50, 4.0%) cases, among which all of the cases were positive for PD-L1 expression in TCs and TILs, respectively. However, in HER2-negative group, 26.2% (11/42) and 28.6% (12/42) of tumors were positive for PD-L1 in TCs and TILs, respectively. The expression rate of PD-L1 in HER2 negative TCs was significantly higher than that in HER2 positive TCs ( P = .033). Immunohistochemistry for Her-2 was equivocal in 6 cases (12.0%) none of which expressed PD-L1 in tumor cells. In our study minimum and maximum survival times from detection of gastric cancer were 1 and 87 months, respectively. The mean ± SD and median ± SD of overall survival time were 30.69 ± 4.88 and 18 ± 1.45 months, respectively. One and 3-year survival rates of 40% and 24%, respectively. PD-L1 expression was not associated with survival, but its expression was associated with intestinal type Lauren classification and negative HER-2. PD-L1 positivity in tumor cells or tumor infiltrating lymphocytes was not an independent prognostic factor in gastric cancer.
An emerging phenotype of pulmonary arterial hypertension patients carryingSOX17variants
Authors: Montani David , Lechartier Benoit , Girerd Barbara , Eyries Mélanie , Ghigna Maria-Rosa , Savale Laurent , Jaïs Xavier , Seferian Andrei , Jevnikar Mitja , Boucly Athénais , Riou Marianne , Traclet Julie , Chaouat Ari , Levy Maryline , Le Pavec Jerome , Fadel Elie , Perros Frédéric , Soubrier Florent , Remy-Jardin Martine , Sitbon Olivier , Bonnet Damien , Humbert Marc
Published: May 2022

Background

The phenotype of pulmonary arterial hypertension (PAH) patients carryingSOX17pathogenic variants remains mostly unknown.

Methods

We report the genetic analysis findings, characteristics and outcomes of patients with heritable PAH carryingSOX17variants from the French Pulmonary Hypertension Network.

Results

20 patients and eight unaffected relatives were identified. The median (range) age at diagnosis was 17 (2–53) years, with a female:male ratio of 1.5. At diagnosis, most of the patients (74%) were in New York Heart Association Functional Class III or IV with severe haemodynamic compromise, including a median pulmonary vascular resistance of 14.0 (4.2–31.5) WU. An associated congenital heart disease (CHD) was found in seven PAH patients (35%). Patients with CHD-associated PAH were significantly younger at diagnosis than PAH patients without CHD. Four patients (20%) suffered from recurrent haemoptysis requiring repeated arterial embolisations. 13 out of 16 patients (81%) for whom imaging was available displayed chest computed tomography abnormalities, including dilated, tortuous pulmonary vessels, ground-glass opacities as well as anomalies of the bronchial and nonbronchial arteries. After a median (range) follow-up of 47 (1–591) months, 10 patients underwent lung transplantation and one patient benefited from a heart–lung transplantation due to associated CHD. Histopathological analysis of lung explants showed a congested lung architecture with severe pulmonary arterial remodelling, subpleural vessel dilation and numerous haemorrhagic foci.

Conclusions

PAH due toSOX17pathogenic variants is a severe phenotype, frequently associated with CHD, haemoptysis and radiological abnormalities. Pathological assessment reveals severe pulmonary arterial remodelling and malformations affecting pulmonary vessels and thoracic systemic arteries.
The prevalence and physiological impacts of centrilobular and paraseptal emphysema on computed tomography in smokers with preserved ratio impaired spirometry
Authors: Shiraishi Yusuke , Shimada Takafumi , Tanabe Naoya , Terada Kunihiko , Sakamoto Ryo , Maetani Tomoki , Shima Hiroshi , Mochizuki Fumi , Oguma Tsuyoshi , Shimizu Kaoruko , Sato Susumu , Muro Shigeo , Hizawa Nobuyuki , Fukui Motonari , Iijima Hiroaki , Masuda Izuru , Hirai Toyohiro
Published: May 2022

Centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are observed in smokers with preserved ratio impaired spirometry (PRISm, defined as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ≥0.7 and FEV1<80%), but their prevalence and physiological impacts remain unestablished. This multicentre study aimed to investigate its prevalence and to test whether emphysema subtypes are differently associated with physiological impairments in smokers with PRISm.

Both never- and ever-smokers aged ≥40 years who underwent computed tomography (CT) for lung cancer screening and spirometry were retrospectively and consecutively enrolled at three hospitals and a clinic. Emphysema subtypes were visually classified according to the Fleischner system. Air-trapping was assessed as the ratio of FVC to total lung capacity on CT (TLCCT).

In 1046 never-smokers and 772 smokers with ≥10 pack-years, the prevalence of PRISm was 8.2% and 11.3%, respectively. The prevalence of PSE and CLE in smokers with PRISm was comparable to that in smokers with normal spirometry (PSE 43.7%versus36.2%, p=1.00; CLE 46.0%versus31.8%, p=0.21), but higher than that in never-smokers with PRISm (PSE 43.7%versus1.2%, p<0.01; CLE 46%versus4.7%, p<0.01) and lower than that in smokers with airflow limitation (PSE 43.7%versus71.0%, p<0.01; CLE 46%versus79.3%, p<0.01). The presence of CLE, but not PSE, was independently associated with reduced FVC/TLCCTin smokers with PRISm.

Both PSE and CLE were common, but only CLE was associated with air-trapping in smokers with PRISm, suggesting different physiological roles of these emphysema subtypes.
Porosity analysis of three types of balsa (Ochroma pyramidale) wood depending on density
Authors: Jang Eun-Suk , Kang Chun-Won
Published: May 2022

Balsa (Ochroma pyramidale), which is the lowest density wood, is a useful species in various industries. In general, balsa can be divided into three types (low density: LD, middle density: MD, high density: HD). In this study, we classified the porosities of the three balsa types into through-pore porosity, blind-pore porosity, and closed-pore porosity. As a result, the total porosity of balsa showed a high positive (+) correlation with closed-pore porosity, but total porosity of balsa showed negative (−) correlations with blind-pore porosity and through-pore porosity. Such information can be useful when using balsa as a natural porous material.
Single-molecule long-read sequencing analysis improves genome annotation and sheds new light on the transcripts and splice isoforms of Zoysia japonica
Authors: Guan Jin , Yin Shuxia , Yue Yuesen , Liu Lingyun , Guo Yidi , Zhang Hui , Fan Xifeng , Teng Ke
Published: May 2022

Background

Zoysia japonica is an important warm-season turfgrass used worldwide. Although the draft genome sequence and a vast amount of next-generation sequencing data have been published, the current genome annotation and complete mRNA structure remain incomplete. Therefore, to analyze the full-length transcriptome of Z. japonica, we used the PacBio single-molecule long-read sequencing method in this study.

Results

First, we generated 37,056 high-confidence non-redundant transcripts from 16,005 gene loci. Next, 32,948 novel transcripts, 913 novel gene loci, 8035 transcription factors, 89 long non-coding RNAs, and 254 fusion transcripts were identified. Furthermore, 15,675 alternative splicing events and 5325 alternative polyadenylation sites were detected. In addition, using bioinformatics analysis, the underlying transcriptional mechanism of senescence was explored based on the revised reference transcriptome.

Conclusion

This study provides a full-length reference transcriptome of Z. japonica using PacBio single-molecule long-read sequencing for the first time. These results contribute to our knowledge of the transcriptome and improve the knowledge of the reference genome of Z. japonica. This will also facilitate genetic engineering projects using Z. japonica.
Exploration of the impact of the COVID-19 pandemic on the mental health of home health care workers in Japan: a multicenter cross-sectional web-based survey
Authors: Hamano Jun , Tachikawa Hirokazu , Takahashi Sho , Ekoyama Saori , Nagaoka Hiroka , Ozone Sachiko , Masumoto Shoichi , Hosoi Takahiro , Arai Tetsuaki
Published: May 2022

Background

The COVID-19 pandemic has caused home health care workers (home-HCWs) to experience anxiety. The mental health of home-HCWs and related factors during the COVID-19 pandemic have not been clarified; therefore, we aimed to investigate the status and associated factors of fear of COVID-19 infection, anxiety, and depression among home-HCWs in Japan.

Methods

We conducted a multicenter cross-sectional web-based anonymous survey of home-HCWs in August 2021, during the fifth wave of the pandemic in Japan. We surveyed members of facilities that provided home visit services during the COVID-19 pandemic. We measured the Japanese version of the Fear of COVID-19 scale (FCV-19S-J) and the Hospital Anxiety and Depression scale (HADS) as objective variables, and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (J-AITCS-II) as an explanatory variable.

Results

A total of 328 members of 37 facilities responded to the survey, and we ultimately analyzed 311 participants. The most frequent occupation was nurse (32.8%), followed by doctor (24.8%) and medical office staff (18.0%). The mean score of the FCV-19S-J was 16.5 ± 5.0 (7.0 – 31.0), and the prevalences of definitive anxiety and depression were 7.4% and 15.7%, respectively. Multivariate regression analysis revealed that the J-AITCS-II teamwork subscale was significantly negatively associated with FCV-19S-J, HADS-anxiety, and HADS-depression (β = -0.171, p = 0.004; β = -0.151, p = 0.012; β = -0.225, p < 0.001, respectively). Medical office staff showed significant positive associations with FCV-19S-J and HADS-depression (β = 0.219, p = 0.005; β = 0.201, p = 0.009, respectively), and medical social workers with HADS-anxiety and HADS-depression (β = -0.166, p = 0.011; β = -0.214, p < 0.001, respectively) compared with doctors. The unmet support need for expert lectures on COVID-19 was significantly positively associated with FCV-19S-J (β = 0.131, p = 0.048), and the unmet support need for support systems for psychological stress and emotional exhaustion was significantly positively associated with HADS-anxiety (β = 0.141, p = 0.022).

Conclusions

Fear of COVID-19 infection and depression of nurses, medical office staff, and other occupations was significantly higher than those of doctors. These findings suggest that non-physicians were more likely to be fearful and depressed during the COVID-19 pandemic; thus, it is necessary to tailor mental health support based on occupation in the home care setting.
Increased prescriptions for irritable bowel syndrome after the 2018 Japan Floods: a longitudinal analysis based on the Japanese National Database of Health Insurance Claims and Specific Health Checkups
Authors: Okazaki Yuji , Yoshida Shuhei , Kashima Saori , Miyamori Daisuke , Matsumoto Masatoshi
Published: May 2022

Background

The frequency and intensity of natural disasters are increasing worldwide, which makes our understanding of disaster-related diseases more important than ever. Natural disasters cause mental stress and infectious diarrhea, but the causal relationship between disasters and a potential consequence of these conditions, irritable bowel syndrome (IBS), is unreported. The 2018 Japan Floods, which took place in July 2018 was one of the largest water disasters in Japan’s recorded history. We investigate the change of drug prescriptions for IBS between disaster-suffers and non-sufferers throughout the disaster period to examine the relationship.

Methods

This is a retrospective cohort study based on the Japanese National Database of Health Insurance Claims and Specific Health Checkups in flood-stricken areas between July 2017 and June 2019. We included subjects older than 15 years of age who had visited a medical institution or been hospitalized in the hardest-hit areas of the disaster. Ramosetron, polycarbophil calcium, and mepenzolate bromide (IBS drugs) approved solely for the treatment of IBS in Japan were analyzed. The monthly rate of prescriptions for IBS drugs was compared between municipality-certified disaster victims and non-victims using a controlled interrupted time series analysis. For those who were not prescribed IBS drugs before the disaster (non-users), the occurrence of an IBS drug prescription after the disaster was evaluated using a multivariable logistic regression analysis adjusted for gender and age.

Results

Of 5,287,888 people enrolled, 32,499 (0.61%) were certified victims. The prescription rate for IBS drugs among victims increased significantly by 128% immediately after the disaster, while it was stable among non-victims. The trend for the post-disaster prescription rate among victims moved upward significantly when compared to non-victims (0.01% per month; 95% confidence interval (CI) 0.004–0.015; P = 0.001). Among non-users, the occurrence of an IBS drug prescription for victims was 0.71% and was significantly higher than non-victims (0.35%, adjusted odds ratio 2.05; 95% CI 1.81–2.32).

Conclusions

The 2018 Japan Floods increased the rate of prescriptions for IBS drugs, suggesting that the disaster caused or worsened IBS among victims.
The experience of giving birth: a prospective cohort in a French perinatal network
Authors: Arthuis Chloé , LeGoff Juliette , Olivier Marion , Coutin Anne-Sophie , Banaskiewicz Nathalie , Gillard Philippe , Legendre Guillaume , Winer Norbert
Published: May 2022

Background

To assess women's positive and negative perceptions after giving birth. The secondary objectives were to identify the women who had a negative perception of their delivery, define the risk factors, and propose actions that maternity units can take to improve their management.

Methods/design

This study was a multicenter, prospective cohort, conducted in 23 French maternity units constituting one perinatal network, in 2019. All adult women who understood French and gave birth between February 1 and September 27, 2019, were eligible. The exclusion criterion was the woman's objection to participation. Validated self-administered questionnaire (QACE) was sent by email 6 weeks after the child's birth. The main outcome was the experience of childbirth, assessed on a scale of 0 to 10. A good experience was defined by a score ≥ 8/10, and a poor experience by a score < 5. A multinomial logistic regression model, expressed by cumulative proportional odds ratios, were used to determine the factors that might have affected women's experiences during childbirth.

Results

Two thousand one hundred and thirty-fifth women completed the questionnaire, for a participation rate of 49.6%. Overall, 70.7% (n = 1501/2121) of the women reported a good experience, including 38% (n = 807/2121) who graded their experience with the maximum score of 10. On the other hand, 7.3% (n = 156) of the women reported a poor experience. Vaginal delivery (aOR 3.93, 95%CI, 3.04–5.08) and satisfactory management (aOR 11.35 (7.69–16.75)) were the principal determining factors of a positive experience. Epidural analgesia increased the feeling of failure (aOR 5.64, 95%CI, 2.75–13.66). Receiving information and being asked for and agreeing to consent improved the global experience (P = 0.03).

Conclusion

The Identikit picture of the woman associated with a poor experience of childbirth shows a nullipara who had a complication during her pregnancy, gave birth after induction of labor, or by cesarean or operative vaginal delivery, with the newborn transferred for pediatric care, and medical management considered unsatisfactory.
Challenges and solutions for the promotion of medical sciences faculty members in Iran: a systematic review
Authors: Salajegheh Mahla , Hekmat Somayeh Noori , Macky Maryam
Published: May 2022

Introduction

The faculty promotion system is expected to benefit the faculty, institute, and profession and lead to the sustainable and comprehensive development. This present systematic review aims to investigate the challenges and solutions for the promotion of medical sciences faculty members in Iran.

Method

This study was a systematic review conducted by searching in PubMed, Scopus, Eric, Web of Science, Cochrane, SID, Magiran, andhttps://irandoc.ac.ir/linewith Persian and English terms in the period from 2015 to 2020. Study selection and data extraction were performed independently by reviewers.

Results

Thirteen articles were included. Challenges and solutions for the promotion of medical sciences faculty members were reviewed and grouped into five main categories: 1. The general regulations for the promotion of faculty members, 2. Cultural, disciplinary, and social activities, 3. Educational activities, 4. Research-technology activities, and 5. Scientific-executive activities.

Conclusion

Despite several modifications to regulations for the promotion of medical sciences faculty members in Iran, this process still encounters challenges because of its complex nature. This article provides tips to policymakers on regulations of promotion for educational activities.
Challenges facing clinical midwifery education in Iran
Authors: Hajiesmaello Maryam , Hajian Sepideh , Riazi Hedyeh , Majd Hamid Alavi , Yavarian Roya
Published: May 2022

Background

Delivering high-quality midwifery services requires a professional, educated and competent workforce. The challenges of clinical training and education for midwives in Iran have prevented midwifery students from fully gaining the clinical competency required of midwifery graduates.

Methods

This qualitative study was conducted to identify and explain the challenges of clinical training for midwives in Iran and to determine their underlying factors within the sociocultural and educational context of this country. Data were collected from a purposive sample in a western province of Iran, which included clinical midwives working in public and private maternity units, midwifery instructors working at educational institutes, and midwifery students. After receiving an ethics approval for the project and informed consent from the participants, data were collected through focus group interviews held with midwifery students (n = 9) and semi-structured interviews held with midwifery instructors (n = 6) and clinical midwives (n = 7). Data were then analyzed using the framework proposed by Graneheim and Lundman using MAXQDA-10.

Findings

The analysis of the data led to two themes: “Discriminatory approach in the health system” and “Professional nature of midwifery”. The noted discrimination was caused by the insecure position of midwives in the health system, inequalities related to education and training opportunities, and the demotivation of midwives. The professional nature of midwifery discussed the community in transition, functional paradoxes and high-risk labor.

Conclusion

The findings revealed numerous challenges facing clinical midwifery education and training in the study setting, which may in part be explained by the sociocultural context of maternity services in Iran. The learning opportunities provided to midwifery students should be improved by making significant revisions to the structure of clinical settings where students are placed. Tackling discrimination against a profession and its students is essential, and it is equally important to value the contributions of midwifery students and midwives to their practice and their efforts to ensure safe maternity care for women and newborns. The quality of the clinical learning environment must therefore be improved for this group, and the active participation of competent and autonomous midwifery instructors in this environment can have a facilitatory role.
The resilience of nursing staffs in nursing homes: concept development applying a hybrid model
Authors: Chang Sung Ok , Kim Eun Young
Published: May 2022

Background

The resilience of nursing home (NH) nursing staff is emphasized to improve the quality of care provided, but the concept has not been clearly defined. By composing such a definition through concept development, a basis for active research in the future can be established.

Aim

To identify the definition and conceptual characteristics of the concept of resilience of NH nursing staffs.

Method

In this study, the concept was developed using Schwartz-Barcott and Kim’s hybrid model, which included theoretical, fieldwork, and final analysis stages. In the theoretical stage, a literature review on the definition and measurement of concepts was performed. For the fieldwork stage, 22 interviews were conducted with 7 participants, and a content analysis was performed. During the final analysis stage, the results of the theoretical and field work stages were integrated.

Results

Three dimensions, eight attributes, and three types were identified. The three dimensions are internal resources, external support, and positive coping with situations as they arise; the eight attributes are optimism, patience, mindfulness, supportive relationships, available resources, work-life boundary setting, self-development, and growth; and the three types are those who want to adapt themselves to the situation, those who actively seek to cope with stressful situations, and those who hold positive expectations for the future.

Conclusion

Coping with difficult situations using internal resources and external support was a unique trait revealed in the resilience of NH nursing staff members. This study provided future research directions to improve the resilience of NH nursing staffs by revealing the characteristics of their resilience.
Factors associated with the workload of health professionals in hospital at home: a systematic review
Authors: Cordero-Guevara José A. , Parraza-Díez Naiara , Vrotsou Kalliopi , Machón Mónica , Orruño Estibalitz , Onaindia-Ecenarro Miren J. , Millet-Sampedro Manuel , Regalado de los Cobos José
Published: May 2022

Background

Understanding the factors related to workload, could help hospital at home (HaH) managers to make decisions on the most appropriate and efficient use of the HaH services. Published studies on this topic are scarce, so we have conducted a systematic review to identify such factors according to published evidence.

Methods

Due to the heterogeneity of HaH models, HaH was defined as a care that provides a set of medical and nursing care and attention of hospital rank to patients at home, when they no longer require hospital infrastructure but still need active monitoring and complex care. The electronic data base literature search was conducted in MEDLINE (Ovid), EMBASE (Ovid), and Cinahl (EBSCOhost) from inception to December 2021, including grey literature. Search terms related to `hospital at home´, `workload´ and `care time´ were used. There was no restriction on language, type of study or year of publication. Quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist and certainty in the body of evidence was assessed using the GRADE Pro Tool. Results were summarised in a tabulated format.

Results

Eighteen studies with 56,706 patients were included. Workload was measured as time, number of visits or both. The predictive factors of the workload included variables related to patient characteristics and other valid and reliable patient classification systems, as well as characteristics of the institutions where the studies were conducted. The factors associated with higher workloads were: being older, male, living in a rural environment, presenting a higher number of diagnoses, having worse functional status and being unable to assume self-care.

Conclusions

The identified predictors of workload are mostly associated with home nursing care. The results could be useful and applicable to different organisational models of HaH health systems. More studies that include physicians and proxy measures of workload are needed.
The impact of medication reviews by general practitioners on psychotropic drug use and behavioral and psychological symptoms in home-dwelling people with dementia: results from the multicomponent cluster randomized controlled LIVE@Home.Path trial
Authors: Gedde Marie H. , Husebo Bettina S. , Mannseth Janne , Naik Mala , Selbaek Geir , Vislapuu Maarja , Berge Line Iden
Published: May 2022

Background

There is limited knowledge regarding the process of deprescribing psychotropic drugs to people with dementia (PwD) conducted by general practitioners (GP). We investigated the impact of a multicomponent intervention, emphasizing medication reviews, on psychotropic drugs and behavioral and psychological symptoms (BPSD) in home-dwelling PwD and quantified change in patient-GP communication evaluated by their informal caregivers.

Methods

LIVE@Home.Path is a stepped-wedge closed-cohort cluster randomized controlled trial for people with mild to moderate dementia aged ≥65 and their informal caregivers (dyads) in Norway. Complementary to health care as usual (control condition), municipal coordinators implemented the multicomponent LIVE intervention: Learning, Innovation, Volunteer support, and Empowerment (including medication review by the PwD’s regular GPs). Block-randomization was used to allocate dyads in three groups receiving the intervention sequentially in periods of 6 months duration. Prepandemic data from the first period is reported, resulting in a 1:2 intervention-to-control ratio. Primary outcome was change in psychotropic drug use. Secondary outcomes were changes in BPSD by Neuropsychiatric Inventory and Cornell Scale of Depression in Dementia and patient-GP communication by an adaption of the Clinical Global Impression of Change.

Results

Four hundred thirty-eight dyads were screened, 280 included, and 237 participated at 6 months (intervention group n=67; control condition n=170). At baseline, 63% used psychotropic medication regularly: antidementia drugs (47%), antidepressants (13%), hypnotics/sedatives (13%), antipsychotics (5%), and anxiolytics (2%). At 6 months, medication reviews were more frequently conducted in the intervention group compared to control (66% vs 42%, P=0.001). We found no differences regarding a change in drug use and BPSD. Patient-GP communication enhanced in the intervention group (mean score 0.95 [standard deviation 1.68] vs 0.41 [1.34], P=0.022). In the intervention group, control group, and overall sample, the informal caregivers of those who had their medications reviewed reported improved patient-GP communication compared to those who did not.

Conclusions

Change in psychotropic drug use and BPSD did not differ, even though patient-GP communication improved with medication reviews. Restricted psychotropic drug use among PwD likely reflects more judicious prescribing practices in recent years. Nevertheless, medication reviews could be cultivated to optimize pharmacologic treatment for this complex population.

Trial registration

ClinicalTrials.gov: NCT04043364; registered 15/03/2019.
When the messenger is more important than the message: an experimental study of evidence use in francophone Africa
Authors: Fillol Amandine , McSween-Cadieux Esther , Ventelou Bruno , Larose Marie-Pier , Kanguem Ulrich Boris Nguemdjo , Kadio Kadidiatou , Dagenais Christian , Ridde Valéry
Published: May 2022

Background

Epistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context.

Methods

The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African.

Results

The initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university.

Conclusions

The results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.
Novel dual-targeting c-Myc inhibitor D347-2761 represses myeloma growth via blocking c-Myc/Max heterodimerization and disturbing its stability
Authors: Yao Ruosi , Zhang Menghui , Zhou Jian , Liu Linlin , Zhang Yan , Gao Jian , Xu Kailin
Published: May 2022

Background

Transcription factor c-Myc plays a critical role in various physiological and pathological events. c-Myc gene rearrangement is closely associated with multiple myeloma (MM) progression and drug resistance. Thereby, targeting c-Myc is expected to be a useful therapeutic strategy for hematological disease, especially in MM.

Methods

Molecular docking-based virtual screening and dual-luciferase reporter gene assay were used to identify novel c-Myc inhibitors. Cell viability and flow cytometry were performed for evaluating myeloma cytotoxicity. Western blot, immunofluorescence, immunoprecipitation, GST pull down and Electrophoretic Mobility Shift Assay were performed for protein expression and interaction between c-Myc and Max. c-Myc downstream targets were measured by Q-PCR and Chromatin immunoprecipitation methods. Animal experiments were used to detect myeloma xenograft and infiltration in vivo.

Results

We successfully identified a novel c-Myc inhibitor D347-2761, which hindered the formation of c-Myc/Max heterodimer and disturbed c-Myc protein stability simultaneously. Compound D347-2761 dose-and time-dependently inhibited myeloma cell proliferation and induced apoptosis. Dual knockout Bak/Bax partially restored D347-2761-mediated cell death. Additionally, compound D347-2761 could, in combination with bortezomib (BTZ), enhance MM cell DNA damage and overcome BTZ drug resistance. Our in vivo studies also showed that compound D347-2761 repressed myeloma growth and distal infiltration by downregulating c-Myc expression. Mechanistically, novel dual-targeting c-Myc inhibitor D347-2761 promoted c-Myc protein degradation via stimulating c-Myc Thr58 phosphorylation levels, which ultimately led to transcriptional repression of CDK4 promoter activity.

Conclusions

We identified a novel dual-targeting c-Myc small molecular inhibitor D347-2761. And this study may provide a solid foundation for developing a novel therapeutic agent targeting c-Myc.
The feasibility and safety of cocktail treatment of triple anti-inflammatory agents loaded with gelatin sponge promotes early recovery after posterior percutaneous endoscopic cervical discectomy
Authors: Zou Peng , Zhang Xiaoping , Zhang Rui , Yang Jun-Song , Chu Lei , Wang Xiang-Fu , Wei Jian-Min , Chai Xin , Zhao Yuan-Ting , Liao Bo
Published: May 2022

Purpose

To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD.

Methods

Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient’s treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up.

Results

The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p < 0.05). The cocktail group had a lower VAS than the control group 1 week postoperatively (p < 0.05); however, VAS not different between groups at the remaining time points. The NDI scores were significantly better postoperatively than preoperatively, and no significant differences were seen when comparing nodes at postoperative follow-up (p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery.

Conclusions

Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD.
Can fat infiltration in the multifidus muscle be a predictor of postoperative symptoms and complications in patients undergoing lumbar fusion for degenerative lumbar spinal stenosis? A case–control study
Authors: Han Gengyu , Zou Da , Li Xinhang , Zhang Shuquan , Li Zhenxu , Zhou Siyu , Li Wei , Sun Zhuoran , Li Weishi
Published: May 2022

Purpose

This study aimed to explore whether 25% as the cutoff value of fat infiltration (FI) in multifidus (MF) could be a predictor of clinical outcomes of lumbar spinal stenosis (LSS) patients.

Methods

A total of 461 patients undergoing posterior lumbar interbody fusion for LSS with 1-year follow-up were identified. After sex- and age-match, 160 pairs of patients were divided into a FI < 25% group and a FI ≥ 25% group according to FI of MF at L4 on preoperative magnetic resonance imaging. Patient-reported outcomes including the visual analog scale scores (VAS) for back pain and leg pain and the Oswestry disability index (ODI) scores were evaluated. Bone nonunion and screw loosening were evaluated by dynamic X-ray.

Results

After matching, there was no significant difference in age, sex, body mass index, fusion to S1, number of fusion levels, osteoporosis, spondylolisthesis, smoking and diabetes. FI ≥ 25% group had significantly higher VAS for back pain, VAS for leg pain and ODI than FI < 25% group at 1-year follow-up. However, there was no significant difference in the change of them from baseline to 1-year follow-up between the two groups. In light of complications, FI ≥ 25% group had a significantly higher rate of bone nonunion than FI < 25% group, whereas there was no significant difference of screw loosening rates between the two groups.

Conclusion

MF FI might be a pragmatic cutoff value to predict bone nonunion in LSS patients, but it has little predictive value on screw loosening and postoperative improvement of symptoms.
Histologic evidence of tracheal stenosis directly resulting from SARS-CoV-2 tissue infiltration, a case series
Authors: Draeger Tyler B. , Tedesco Sarah , Andaz Shahriyour K. , Gibson Vanessa R.
Published: May 2022

Background

There has been an anecdotal increase in the incidence of tracheal stenosis that has coincided with the SARS-CoV-2 pandemic.

Case presentation

This is a case series in which we report clinical and pathologic findings of two patients who subsequently developed subglottic tracheal stenosis after having been hospitalized with COVID-19 pneumonia. Histopathologic analysis of tissue from these patients shows features consistent with tissue infiltrated with SARS-CoV-2 virus, namely multinucleated syncytial cells with prominent nucleoli.

Conclusion

Our findings directly implicate SARS-CoV-2 in the pathogenesis of tracheal stenosis.
VATS surgical anatomical resection of bronchopulmonary sequestration presenting as chest sepsis
Authors: Patel Akshay J. , Mangel Tobin , Perris Rebecca , El-Gamal Islam , Shatila Mohamed , Farooq Muhammad Omar , Kalkat Maninder S.
Published: May 2022

Background

Bronchopulmonary sequestration (BPS) is a malformation of the lungs resulting in lung tissue lacking direct communication to the tracheobronchial tree. Most cases demonstrate systemic arterial blood supply from the descending thoracic aorta, the abdominal aorta, celiac axis or splenic artery and venous drainage via the pulmonary veins with occasional drainage into azygos vein. BPS is considered a childhood disease and accounts for 0.15–6.40% of congenital pulmonary malformations. BPS is divided into intralobar sequestrations (ILS) and extralobar sequestrations (ELS) with ILS accounting for 75% of all cases.

Methods

Here we present our 11-year experience of dealing with BPS; all cases presented with recurrent chest sepsis in young-late adulthood regardless of the type of pathological sequestration. The surgical technique employed was a minimally invasive video-assisted thoracoscopic anterior approach (VATS).

Results

Between May 2010 and September 2021, we have operated on nine adult patients with bronchopulmonary sequestration who presented late with symptoms of recurrent chest sepsis. Most patients in the cohort had lower lobe pathology, with a roughly even split between right and left sided pathology. Moreover, the majority were life-long never smokers and an equal preponderance in males and females. The majority were extralobar sequestrations (56%) with pathological features in keeping with extensive bronchopneumonia and bronchiectasis. There were no major intra-operative or indeed post-operative complications. Median length of stay was 3 days.

Conclusions

Dissection and division of the systemic feeding vessel was readily achievable through a successful anterior VATS approach, regardless of the type of sequestration and without the use of pre-operative coiling of embolization techniques. This approach gave excellent access to the hilar structures yet in this pathology, judicious and perhaps a lower threshold for open approach should be considered.