bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypoxia increases RCC stem cell phenotype via altering the androgen receptor (AR)-lncTCFL5-2-YBX1-SOX2 signaling axis
Authors: Guo Changcheng , Sun Yin , Zhai Wei , Yao Xudong , Gong Dongkui , You Bosen , Huang Chi-Ping , Zheng Junhua , Chang Chawnshang
Published: November 2022

Background

Early studies indicated that the androgen receptor (AR) could promote renal cell carcinoma (RCC) development and metastasis, but its linkage to RCC progression under hypoxia, remains unclear.

Results

Here we found AR expression in RCC cells decreased in response to hypoxia, which might then lead to increase the cancer stem cells (CSC) phenotype through the lncTCFL5-2-modulated YBX1/SOX2 signals. The consequences of such hypoxia-modulated AR/lncTCFL5-2/YBX1/SOX2 signals ablity to alter the CSC phenotype might render RCC cells more resistant to targeted therapy with Sunitinib. Mechanism dissection revealed that AR might alter the lncTCFL5-2/YBX1/SOX2 signaling through transcriptional suppression of the lncTCFL5-2 expression via the AR-response-elements (AREs) on the lncTCFL5-2 promoter. The lncTCFL5-2 interacts with YBX1 to increase its stability, which in turn increases SOX2 expression at a transcriptional level via the YBX1-response-elements (YBX1Es) on the SOX2 promoter. The in vivo mouse model with orthotopic xenografts of RCC cells also validates the in vitro data, and a human RCC sample survey demonstrated the clinical significance of the AR/lncTCFL5-2/YBX1/SOX2 signaling axis for the RCC prognosis, likely as a result of regulating CSC phenotypes.

Conclusions

Together, these findings suggest that hypoxia may increase the RCC CSC phenotype via altering the AR/lncTCFL5-2/YBX1/SOX2 signaling axis and a potential therapy to target this newly identified signal perhaps may help improve the targeted therapy with Sunitinib to better suppress RCC progression.
Clinical outcome of wild-type AmpC-producing Enterobacterales infection in critically ill patients treated with β-lactams: a prospective multicenter study
Authors: Mounier Roman , Le Guen Ronan , Woerther Paul-Louis , Nacher Mathieu , Bonnefon Clément , Mongardon Nicolas , Langeron Olivier , Levesque Eric , Couffin Séverine , Houcke Stéphanie , Wolff Michel , Roujansky Ariane , Schimpf Caroline , Mekontso Dessap Armand , Cook Fabrice , Razazi Keyvan , Kallel Hatem
Published: November 2022

Background

β-lactams are the main antibiotics used against wild-type AmpC-producing Enterobacterales (wtAE). However, they may fail or select AmpC-overproducing mutants. Our aim was to assess factors associated with clinical failure of β-lactams in the treatment of wtAE infection.

Methods

From September 2017 to December 2020, we prospectively included all consecutive patients treated by definitive β-lactams therapy for wtAE infection in four university ICUs. Clinical failure was defined as inadequate response to antimicrobial therapy leading to death or to the switch for a broader-spectrum antibiotic.

Results

177 patients were included and 29.4% progressed to clinical failure. E. cloacae was the most prevalent species (42.4%) and ventilator-associated pneumonia (VAP) was the most frequent wtAE infection (69.5%). Cefepime and cefotaxime were used as definitive antibiotic treatment in 42.9% and 27.7% of patients, respectively. Occurrence of AmpC-overproduction was documented in 5.6% of patients and was associated with clinical failure (p = 0.004). In multivariate analysis, VAP (p < 0.001, OR 11.58 [95% CI 3.11–43.02] and K. aerogenes (p = 0.030, OR 3.76 [95% CI 1.13–12.46]) were independently associated with clinical failure. Conversely, cefotaxime as definitive treatment was found inversely associated with the risk of clinical failure (p = 0.022, OR 0.25 [95% CI 0.08–0.82]). After inverse probability weighting, cefotaxime showed a 20% risk reduction of clinical failure (95% CI  5–35%, p = 0.007) whatever the location of infection, the SOFA score on the day of wtAE infection, or the bacterial species.

Conclusions

Clinical failure in the treatment of wtAE infections is associated with the infection site and the causal microorganism. Additionally, cefotaxime use is probably protective against clinical failure in wtAE infection.
Experimental Investigation on Bond, Microstructure and Durability of Expired Hardened Cement Blended with Ground Granulated Blast Furnace Slag as Partial Replacement of Cement in High-Strength Concrete
Authors: Chofore Ashenafi Tofu , Mitikie Bahiru Bewket , Haile Abenezer Tariku
Published: November 2022

The current study aimed to investigate the influence of the expired hardened cement blended with ground granulated blast furnace slag on the bond, microstructure, and durability of high-strength concrete (HSC). Five concrete mixes are prepared; the first mix is taken as a control, and the remaining four mixes are used as experimental blends. HSC characteristics are evaluated by compressive, flexural, splitting tensile, bond, and durability tests. Furthermore, the ultrasonic pulse velocity and microstructural characteristics tests are carried out to check concrete quality. The synergistic action of blends (expired harden cement with GGBS) on the strength test results was found to increase with an increase in blends up to 20%. The durability result reveals that HSC was found to be impermeable under aggressive conditions. The microstructural characteristics achieved in the current investigation explain the above strength, bond, and durability performance of these mixes. The whole performance of blends in HSC is adequate for industrial use.
“In the office nine to five, five days a week… those days are gone”: qualitative exploration of diplomatic personnel’s experiences of remote working during the COVID-19 pandemic
Authors: Brooks Samantha K. , Hall Charlotte E. , Patel Dipti , Greenberg Neil
Published: November 2022

Background

Many employees had to work remotely during the COVID-19 pandemic. Literature suggests there are both challenges and benefits to remote working and that remote working can have detrimental effects on mental health. This study aimed to explore diplomatic personnel’s perceptions and experiences of working from home during the pandemic.

Methods

Twenty-five employees of the Foreign, Commonwealth and Development Office took part in semi-structured interviews. Thematic analysis was carried out to extract recurring themes from the data.

Results

Seven main themes emerged from the data: impact of the pandemic on work; relationships with colleagues; benefits of working from home; challenges of working from home; family; moving posts during the pandemic; and perceptions and predictions of post-pandemic work. Participants provided mixed views on how remote working had affected productivity and relationships with colleagues. Benefits of working from home included greater freedom and flexibility; new opportunities; and inclusivity of remote meetings. Challenges included being in different time zones to the countries they were working for; unsuitable home ergonomics; technological issues; and difficulties finding appropriate work-life balance. Those with young children reported difficulties juggling work and childcare. Adjusting to new posts at a time when staff were working remotely appeared particularly challenging. However, most did not want or expect to return to entirely office-based work. They predicted a hybrid model of working in the future, involving both office work and remote work; they stressed the importance of flexibility and suggested there would not be a one-size-fits-all approach to returning to face-to-face work.

Conclusions

Remote working during the COVID-19 pandemic has changed the ways in which employees work, showing them that they do not have to be in the office to successfully achieve their work goals and leaving many wanting flexibility to make their own decisions about working from home (or not). There are both benefits and challenges to remote working; managers can take steps to reduce some of the challenges by being available to support their employees, organising regular remote meetings and allowing employees autonomy in terms of when and where they work.
Cervical cancer heterogeneity: a constant battle against viruses and drugs
Authors: Sun Qian , Wang Liangliang , Zhang Cong , Hong Zhenya , Han Zhiqiang
Published: November 2022

Cervical cancer is the first identified human papillomavirus (HPV) associated cancer and the most promising malignancy to be eliminated. However, the ever-changing virus subtypes and acquired multiple drug resistance continue to induce failure of tumor prevention and treatment. The exploration of cervical cancer heterogeneity is the crucial way to achieve effective prevention and precise treatment. Tumor heterogeneity exists in various aspects including the immune clearance of viruses, tumorigenesis, neoplasm recurrence, metastasis and drug resistance. Tumor development and drug resistance are often driven by potential gene amplification and deletion, not only somatic genomic alterations, but also copy number amplifications, histone modification and DNA methylation. Genomic rearrangements may occur by selection effects from chemotherapy or radiotherapy which exhibits genetic intra-tumor heterogeneity in advanced cervical cancers. The combined application of cervical cancer therapeutic vaccine and immune checkpoint inhibitors has become an effective strategy to address the heterogeneity of treatment. In this review, we will integrate classic and recently updated epidemiological data on vaccination rates, screening rates, incidence and mortality of cervical cancer patients worldwide aiming to understand the current situation of disease prevention and control and identify the direction of urgent efforts. Additionally, we will focus on the tumor environment to summarize the conditions of immune clearance and gene integration after different HPV infections and to explore the genomic factors of tumor heterogeneity. Finally, we will make a thorough inquiry into completed and ongoing phase III clinical trials in cervical cancer and summarize molecular mechanisms of drug resistance among chemotherapy, radiotherapy, biotherapy, and immunotherapy.
Towards a single-assay approach: a combined DNA/RNA sequencing panel eliminates diagnostic redundancy and detects clinically-relevant fusions in neuropathology
Authors: Slocum Cheyanne C. , Park Hyeon Jin , Baek Inji , Catalano Jeff , Wells Martin T. , Liechty Benjamin , Mathew Susan , Song Wei , Solomon James P. , Pisapia David J.
Published: November 2022

Since the introduction of integrated histological and molecular diagnoses by the 2016 World Health Organization (WHO) Classification of Tumors of the Nervous System, an increasing number of molecular markers have been found to have prognostic significance in infiltrating gliomas, many of which have now become incorporated as diagnostic criteria in the 2021 WHO Classification. This has increased the applicability of targeted-next generation sequencing in the diagnostic work-up of neuropathology specimens and in addition, raises the question of whether targeted sequencing can, in practice, reliably replace older, more traditional diagnostic methods such as immunohistochemistry and fluorescence in-situ hybridization. Here, we demonstrate that the Oncomine Cancer Gene Mutation Panel v2 assay targeted-next generation sequencing panel for solid tumors is not only superior to IHC in detecting mutation in IDH1/2 and TP53 but can also predict 1p/19q co-deletion with high sensitivity and specificity relative to fluorescence in-situ hybridization by looking at average copy number of genes sequenced on 1p, 1q, 19p, and 19q. Along with detecting the same molecular data obtained from older methods, targeted-next generation sequencing with an RNA sequencing component provides additional information regarding the presence of RNA based alterations that have diagnostic significance and possible therapeutic implications. From this work, we advocate for expanded use of targeted-next generation sequencing over more traditional methods for the detection of important molecular alterations as a part of the standard diagnostic work up for CNS neoplasms.
Antibiotics use evaluation among hospitalized adult patients at Jimma Medical Center, southwestern Ethiopia: the way to pave for antimicrobial stewardship
Authors: Dechasa Mesay , Chelkeba Legese , Jorise Amente , Sefera Birbirsa , Melaku Tsegaye
Published: November 2022

Background

An irrational antibiotic use is a common problem in developing countries like Ethiopia, which makes empiric antibiotics use difficult. It is considered to be the greatest health problem in our time and future unless intervened. Therefore, this study aimed to assess the patterns of antibiotics use among hospitalized adult patients to pave the way for antimicrobial stewardship.

Methods

A hospital-based prospective observational study was conducted at Jimma Medical Center, southwestern Ethiopia, from 30 October 2020 to 29 January 2021 with 360 adult hospitalized patients participating. A semi-structured questionnaire and consecutive sampling technique was used for data collection. The data were collected through medical record reviews and patient interviews. The collected data were entered into Epi-data and exported to SPSS® version 23.0 for analysis. Days of therapy (DOT) and essential medicine lists “Access, Watch, and Reserve (AWaRe)” antibiotics classification were used to assess antibiotic use pattern among participants.

Results

The majority of study participants were females (55.3%), attended formal education (59.4%), and live in rural areas (61.4%) with mean age ± (SD) of 37.65 ± (16.75). The overall rate of antibiotics consumption during the study was 111 days of therapy per 100 bed-days and about two-thirds (66%) of the prescribed antibiotics were from the “Watch” group antibiotics. The indicator level of antibiotics use for “Access” group antibiotics was 34% in this study based on the World Health Organization Essential Medicine List. Cephalosporins were the most commonly used class of antibiotics (93.9%).

Conclusion

Higher antibiotics exposure and their consumption frequently observed among adult hospitalized patients in the study setting. There was a rapid increase in “Watch” group antibiotics use and about two-thirds of the prescribed antibiotics were from this group. The third-generation cephalosporin were the most commonly used class of antibiotics. Generally, higher consumption and inappropriate antibiotics use among hospitalized adult patients showed the need for urgent interventions by implementing Antimicrobial Stewardship Programs in hospitals.
Analytical dual quaternion algorithm of the weighted three-dimensional coordinate transformation
Authors: Zeng Huaien , Wang Junjie , Wang Zhihao , Li Siyang , He Haiqing , Chang Guobin , Yang Ronghua
Published: November 2022

Considering that a unit dual quaternion can describe elegantly the rigid transformation including rotation and translation, the point-wise weighted 3D coordinate transformation using a unit dual quaternion is formulated. The constructed transformation model by a unit dual quaternion does not need differential process to eliminate the three translation parameters, while traditional models do. Based on the Lagrangian extremum law, the analytical dual quaternion algorithm (ADQA) of the point-wise weighted 3D coordinate transformation is proved existed and derived in detail. Four numerical cases, including geodetic datum transformation, the registration of LIDAR point clouds, and two simulated cases, are studied. This study shows that ADQA is valid as well as the modified procrustes algorithm (MPA) and the orthonormal matrix algorithm (OMA). ADQA is suitable for the 3D coordinate transformation with point-wise weight and no matter rotation angles are small or big. In addition, the results also indicate that if the distribution of common points degrades from 3D or 2D space to 1D space, the solvable correct transformation parameters decrease. In other words, all common points should not be located on a line. From the perspective of improving the transformation accuracy, high accurate control points (with small errors in the coordinates) should be chosen, and it is preferred to decrease the rotation angles as much as possible.

Graphical Abstract
Expression, characterization, and application potentiality evaluation of recombinant human-like collagen in Pichia pastoris
Authors: Ma Lingling , Liang Xiaolin , Yu Shiqin , Zhou Jingwen
Published: November 2022

Collagen is a biofunctional protein that has been widely used in many fields, including but not limited to biomedical, cosmetics and skin care, food, and novel materials. Recombinant collagen has great potential as an alternative to collagen extracted from animals because it avoids the immune response, and the yield and properties are stable. However, challenges remain in the industrial application of recombinant collagen, including improving the expression yield, reducing the cost of purification for industry and expanding applications. In this study, a cloning and recombination method was used to heterologously express the recombinant human-like collagen (RHLC) in Pichia pastoris GS115 using the pPIC9k expression vector. The RHLC expression titre was 2.33 g/L via a 5-L fermenter, and the purification was completed within 48 h and was 98% pure. The characteristics of RHLC were investigated. Furthermore, potential applications for RHLC were explored, such as basal collagen sponge preparation, forming films with chitosan and production of collagen hydrolysed peptides. RHLC has various potential applications due to its triple helical structure, thermostability, good biocompatibility and film-forming ability.

Graphical Abstract
Short-term outcomes in patients with center-involving diabetic macular edema after a single dose of intravitreal bevacizumab
Authors: Turski Christopher A. , Jacobs Mitchell A. , Abou-Jaoude Michelle M. , Fowler Nicholas H. , Harpole Ryan , Altman Emily , Chadwell John B. , Kindl Gabriel , James Hayley R. , Reddy Shivani V. , Maldonado Ramiro S.
Published: November 2022

Background

A significant portion of diabetic macular edema (DME) is refractory to anti-vascular endothelial growth factor (anti-VEGF) agents. This study investigates morphological and functional outcomes to a single intravitreal bevacizumab (IVB) injection in patients with center-involving DME (ciDME) at 4–6 weeks and compares treatment responders and non-responders based on spectral domain optical coherence tomography (SD-OCT) features.

Methods

IRB approved observational, retrospective chart review of patients with ciDME, identified by ICD-10 code, who received IVB and underwent baseline and 4–6 weeks follow-up SD-OCT imaging between January 1, 2016 and January 19, 2021. Patients who had received previous treatment with anti-VEGF or intraocular steroids within 1 year were excluded. Variables included best-corrected visual acuity (BCVA), central subfield thickness (CST) and total macular volume (TMV). Eyes were classified as responders if CST reduction was greater than 10%. OCT scans were graded qualitatively by two masked graders using Imagivault software. Paired Student’s t-tests, Wilcoxon signed rank tests and Chi-Square tests were used for analysis.

Results

A total of 334 prospective subjects were identified, and after applying exclusion criteria 52 eyes from 46 patients (mean age 64.22 ± 8.12 years, 58.7% male) were included. Mean BCVA did not significantly change with treatment, 63.9 ETDRS letters (~ 20/50) at baseline and 65.9 ETDRS letters (~ 20/50) post-treatment (p = 0.07). Mean CST decreased from 466 ± 123 μm at baseline to 402 ± 86 μm post-treatment (p < 0.001). 22 (42.3%) of eyes were categorized as responders and 30 (57.7%) as non-responders. Average change in CST from baseline in responders was -164 μm (p < 0.001) and + 9 μm in non-responders (p = 0.47). Vitreomacular adhesion (VMA) was more prevalent in non-responders (28.7% vs. 4.8%, p = 0.03). In addition, cyst location in the inner nuclear layer (INL) was present more frequently in responders (95.5% vs. 73.3%, p = 0.037) as was subretinal fluid (45.5% vs. 13.3%, p = 0.01).

Conclusion

The short-term response to a single IVB was sub-optimal with structural but no functional improvements. Greater baseline CST, presence of INL cysts and subretinal fluid may represent factors indicative of a better treatment response.
Using patient-reported outcome measures to assess psychological well-being in a non-representative US general population during the COVID-19 pandemic
Authors: Kaur Manraj N. , Tsangaris Elena , Dey Tanujit , Deibert Shelby , Kueper Janina , Edelen Maria , Pusic Andrea L.
Published: November 2022

Purpose

The impact of the COVID-19 pandemic on psychological well-being will likely be long-lasting. Efforts directed towards monitoring the onset and progression of distress and mental health disorders are needed to identify and prioritize at-risk populations. This study assesses the psychological well-being of the United States (US) general population during the early phase of the COVID-19 COVID-19 pandemic using validated patient-reported outcome measures (PROMs).

Methods

A cross-sectional study design was used. Adults (18 years or older) who could read and write in English were recruited through Prolific in May 2020. Participants completed a REDCap survey including demographic and health-related questions and three PROMs measuring global health (PROMIS-10 Global Health), anxiety [Generalized Anxiety Disorder Scale-7 (GAD-7)], and depression [Patient Health Questionnaire-9 (PHQ-9)]. A multivariable linear regression was used to identify key factors associated with worse psychological well-being.

Results

Mean age of the 2023 participants was 31.92 ± 11.57 years (range, 18–82). Participants were mainly White (64.7%, n = 1309), female (52.2%, n = 1057), working full-time before the pandemic (43.5%, n = 879), and completed a college, trade, or university degree (40.7%, n = 823). Most participants reported mild to severe anxiety (57.3%, n = 1158) and depression (60%, n = 1276) on the GAD-7 and PHQ-9, respectively. Patient characteristics associated with worse psychological well-being included: age ≤ 39 years, non-White, female or gender diverse, BMI ≥ 30, uninsured, annual income ≤ $49,999 (USD), lower educational attainment, and belief that COVID-19 is deadlier than flu.

Conclusion

PROMs can be used to assess and monitor psychological well-being during the COVID-19 pandemic and to inform the planning and delivery of targeted public health interventions to support at-risk populations.
Transverse myelitis with positive dengue virus serology: a case report
Authors: Jafri Lubna , Hameed Sajid , Shakeel Erum , Shaikh Naeemuddin , Kanwar Dureshahwar
Published: November 2022

Background

Transverse myelitis is an inflammation of the spinal cord that spreads along the horizontal plane of a section of the spinal cord. Arboviruses, including dengue virus, are rare but known causative factors. However, this association and underlying pathophysiology is unclear. We report a case of transverse myelitis in a patient with a dengue viral infection.

Case presentation

A 38-year-old man presented with fever followed by acute paraplegia and urinary retention. His workup was positive for serum IgM antibodies against dengue virus and imaging of the spine showed inflammation in multiple sections of the spinal cord. A diagnosis of TM secondary to a dengue infection was made. He was managed with high dose of methylprednisolone for 5 days followed by oral tapering dose. The weakness subsequently improved with full recovery on follow-up visits.

Conclusions

TM secondary to acute dengue infection is a rarely reported consequence. Timely diagnosis and treatment can cause significant reduction in the otherwise resultant morbidity.
Experimental validation of a portable tidal volume indicator for bag valve mask ventilation
Authors: Maxey Benjamin S. , White Luke A. , Solitro Giovanni F. , Conrad Steven A. , Alexander J. Steven
Published: November 2022

Introduction

Short-term emergency ventilation is most typically accomplished through bag valve mask (BVM) techniques. BVMs like the AMBU® bag are cost-effective and highly portable but are also highly prone to user error, especially in high-stress emergent situations. Inaccurate and inappropriate ventilation has the potential to inflict great injury to patients through hyper- and hypoventilation. Here, we present the BVM Emergency Narration-Guided Instrument (BENGI) – a tidal volume feedback monitoring device that provides instantaneous visual and audio feedback on delivered tidal volumes, respiratory rates, and inspiratory/expiratory times. Providing feedback on the depth and regularity of respirations enables providers to deliver more consistent and accurate tidal volumes and rates. We describe the design, assembly, and validation of the BENGI as a practical tool to reduce manual ventilation-induced lung injury.

Methods

The prototype BENGI was assembled with custom 3D-printed housing and commercially available electronic components. A mass flow sensor in the central channel of the device measures air flow, which is used to calculate tidal volume. Tidal volumes are displayed via an LED ring affixed to the top of the BENGI. Additional feedback is provided through a speaker in the device. Central processing is accomplished through an Arduino microcontroller. Validation of the BENGI was accomplished using benchtop simulation with a clinical ventilator, BVM, and manikin test lung. Known respiratory quantities were delivered by the ventilator which were then compared to measurements from the BENGI to validate the accuracy of flow measurements, tidal volume calculations, and audio cue triggers.

Results

BENGI tidal volume measurements were found to lie within 4% of true delivered tidal volume values (95% CI of 0.53 to 3.7%) when breaths were delivered with 1-s inspiratory times, with similar performance for breaths delivered with 0.5-s inspiratory times (95% CI of 1.1 to 6.7%) and 2-s inspiratory times (95% CI of –1.1 to 2.3%). Audio cues “Bag faster” (1.84 to 2.03 s), “Bag slower” (0.35 to 0.41 s), and “Leak detected” (43 to 50%) were triggered close to target trigger values (2.00 s, 0.50 s, and 50%, respectively) across varying tidal volumes.

Conclusions

The BENGI achieved its proposed goals of accurately measuring and reporting tidal volumes delivered through BVM systems, providing immediate feedback on the quality of respiratory performance through audio and visual cues. The BENGI has the potential to reduce manual ventilation-induced lung injury and improve patient outcomes by providing accurate feedback on ventilatory parameters.
Toxic myocarditis presenting as an acute coronary syndrome
Authors: Kalekar Tushar , Kapoor Reetika , Soman Nikhith , Singh Tejvir , Mohanan Karthik
Published: November 2022

Background

Acute myocarditis is one of the causes of acute non-ischemic myocardial injury mimicking acute coronary syndrome (ACS) on presentation. It is usually underdiagnosed due to the non-specificity of presenting symptoms, elevated troponin levels, and abnormal ECG (electrocardiogram) findings. Delayed contrast-enhanced cardiac MRI (CMR) is known as the gold standard imaging modality for differentiating acute non-ischemic myocardial injury from infarcted myocardium. The most frequent cause of myocarditis is viral infections, but further infrequent causes include other infectious pathogens, toxins, hypersensitivity drug reactions, and autoimmune diseases. Cannabis is one of the most abused illicit and recreational drugs in the world among adolescents and adults. Also, many reports of marijuana-associated cardiovascular risks have been established previously, mainly presenting as arrhythmias, myocardial infarction, and myocarditis.

Case presentation

A 19-year-old female, complaining of radiating chest pain to the left arm and jaw, along with associated sweating for 1 day. Initial work-up showed elevated troponin levels with ST segment elevation on ECG. On further investigation, CMR showed findings of myocarditis and negative virology work-up led to a work-up of proper history, which revealed marijuana abuse, with a history of consumption 3 days before presentation. Hence, it was diagnosed as toxic myocarditis secondary to presumed cannabis abuse and treated for same.

Conclusions

Non-ischemic myocardial injury causes like myocarditis should be considered in young patients especially, who are presenting to emergency with ACS. CMR should be used as a first line diagnostic imaging modality (based on its availability) in cases mimicking an ACS or suspected myocarditis, especially in young patients. Though viral etiology is considered the most common cause of myocarditis, less common causes such as toxic myocarditis must be considered in cases of young individuals presenting with ACS in an emergency.
Theoretical model of recovery following a suicidal episode (COURAGE): scoping review and narrative synthesis
Authors: Sokol Yosef , Levin Chynna , Linzer Mairav , Rosensweig Chayim , Hubner Shifra , Gromatsky Molly , Walsh Samantha , Dixon Lisa , Goodman Marianne
Published: November 2022

Background

Despite a significant need, there are currently no rigorously developed empirically based models for what personal recovery from a suicidal episode looks like.

Aims

To develop a theoretical model of personal recovery after a suicidal episode, based on a comprehensive literature review and stakeholder feedback.

Method

A scoping review of all empirical studies on this topic was conducted, followed by a thematic analysis to create a preliminary framework. Consultation-based revisions were then made based on feedback from a stakeholder panel to develop the final theoretical model.

Results

The final model comprised seven themes: choosing life, optimising identity, understanding oneself, rediscovering meaning, acceptance, growing connectedness and empowerment (acronym ‘COURAGE’). Although there are some similarities between COURAGE and other models of personal recovery, there are components, such as ‘choosing life’ and ‘understanding oneself’, that are specific to recovery after an acute suicidal episode.

Conclusions

To our knowledge, this is the first study to use a comprehensive literature review with stakeholder feedback to develop a conceptual model of personal recovery after an acute suicidal episode. This model has important implications for both researchers and clinicians to consider. Looking ahead, COURAGE can inform the reconceptualisation of assessment, research and clinical care of individuals who have experienced a suicidal episode.
Oncology Informatics for Lynch Syndrome Research and Care: A Literature Review
Authors: Dehghani Soufi Mahsa , Rezaei Hachesu Peyman , Ferdousi Reza
Published: November 2022

PURPOSE

This study aims to review and evaluate available informatics platforms for research and management purposes of Lynch syndrome (LS) to identify gaps and needs for future development.

METHODS

LS informatics tools were identified through literature search in four publication databases (1 and Scopus). First, the LS and functional elements of every informatics tools for LS were introduced. Then, current existing LS informatics tools were reviewed and explained.

RESULTS

A detailed review of implemented studies shows that many types of informatics platforms are available for LS management (ie, prediction model, clinical decision support system, database website, and other tools for research and management purposes of LS). Moreover, several dimensions of existing LS informatics tools were discussed and features and positive findings were reported.

CONCLUSION

Reviewing the literature reveals that several LS informatics tools were focused on gene-specific estimate, cancer risk prediction, identifying/screening patients, supporting personalized care of individuals with LS, and storing mismatch repair mutations information. Nevertheless, these platforms do not fully cover the care and research purposes. For instance, future developments of LS tools require more attention to dynamic knowledgebase, extra-colonic lynch–related cancers on the basis of precision medicine, variants of unknown significance, and support from diagnosis to surveillance for patient follow-up. Insights and recommendations provided in this study could help researchers and developers to meet the existing challenges in future developments.
Lipophilic Nitrile N-Oxide for Catalyst-Free Surface Modification of Nanoemulsions as Light-Harvesting Nanoantennas
Authors: Kaneko Masuomi , Nakayama Taku , Seki Hitomi , Yamamoto Shinkuro , Uemura Takumi , Inoue Keiji , Hadano Shingo , Watanabe Shigeru , Niko Yosuke
Published: November 2022

The therapeutic and diagnostic applications of nanoemulsions (NEs) are restricted by a lack of suitable methods to modify their surfaces, specifically the surfactant-stabilized oil–water interface. Herein, we developed a modification technique using a lipophilic nitrile N-oxide compound (LipoCNO). LipoCNO-loaded NEs underwent efficient 1,3-dipolar cycloaddition with functional molecules bearing a terminal C=C or C≡C bond under mild, catalyst-free conditions at the oil–water interface, thus producing surface-functionalized NEs that could be used without purification. To exemplify the applicability of this technique, NEs encapsulating fluorescent molecules (Cy3.5LP) and LipoCNO were surface functionalized with pheophorbide a (PpA), a singlet-oxygen-generating photosensitizer. These NEs acted as light-harvesting nanoantennas, with the excitation energy gathered by Cy3.5LP in the NEs migrating to PpA on the NE surfaces via Förster resonance energy transfer. This system showed 7–18 times more efficient singlet oxygen generation than direct PpA excitation. Furthermore, PpA-functionalized dye-loaded NEs induced cancer cell death under photoillumination. These results highlight the utility of LipoCNO for functionalizing NE surfaces toward the realization of new biological applications.
Placenta Accreta Spectrum Disorders: A. Chohan Continuous Squeezing Suture (ACCSS) for Controlling Haemorrhage from the Lower Uterine Segment at Caesarean Section
Authors: Chohan Muhammad Arshad , Butt Prof Fauzia , Imran Dr Maria , Zahra Dr Sadaf , Chohan Dr Moiz
Published: November 2022

Objectives: To describe the simplicity, efficacy and safety of A. Chohan Continuous Squeezing Suture (ACCSS) for controlling haemorrhage from the lower uterine segment at caesarean section for placenta Praevia and accrete spectrum disorders.

Methods: This prospective study was conducted on 47 patients with placenta Praevia and accreta spectrum disorders from February 2019 to May 2022 in two teaching hospitals of Lahore and ACCSS was applied. The outcome measures were peripartum hysterectomy procedure time, estimated blood loss, number of blood transfusions, duration of stay in the hospital, bladder trauma, uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage and maternal mortality. Descriptive statistics were calculated by using SPSS version 21.

Results: Out of 47 patients, 7 (15%) had placenta creta, 29 (61.7%) increta, 11 (23.3%) percreta (grade 3a), and 36 (76.6%) central anterior dominant placenta. Peripartum hysterectomy was prevented in 97.8% of patients. ACCSS procedure time was 5-10 minutes (87.2%), with mean blood loss 2500±485 ml, mean blood transfusion 1.85±1.02 units and mean hospital stay of 3.3±0.84 days. One patient had bladder trauma. There was no case of uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage or maternal mortality.

Conclusion: ACSS appears to be a simple, effective and safe treatment option for placenta praevia and accreta spectrum disorders, as an alternative to hysterectomy.

Registration: ClinicalTrial.gov NCT04660578, NCT05070689.

doi: https://doi.org/10.12669/pjms.39.1.6990

How to cite this: Chohan MA, Butt F, Imran M, Zahra S, Chohan MA. Placenta Accreta Spectrum Disorders: A. Chohan Continuous Squeezing Suture (ACCSS) for Controlling Haemorrhage from the Lower Uterine Segment at Caesarean Section. Pak J Med Sci. 2023;39(1):---------.   doi: https://doi.org/10.12669/pjms.39.1.6990

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria
Authors: Oaiya Agbonkhese I. , Tinuoye Oluwabambi , Olatawura Layi , Balarabe Hadiza , Abubakar Hamza
Published: November 2022

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available.

Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study.

Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated.

Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.
The effects of beliefs, knowledge, and attitude on herbal medicine use during the COVID-19 pandemic: A cross-sectional survey in Indonesia
Authors: Kristianto Heri , Pramesona Bayu Anggileo , Rosyad Yafi Sabila , Andriani Lili , Putri Tri Antika Rizki Kusuma , Rias Yohanes Andy
Published: November 2022

Background: Herbal medicines are gaining a greater degree of popularity as complementary and alternative medicines during the COVID-19 pandemic. Nonetheless, there is a lack of data concerning the rationale for and factors influencing their use.

Methods: A cross-sectional community-based online study involving 1,621 participants was conducted to explore the effects of magical health beliefs, holistic health beliefs, knowledge, and pro- complementary alternative medicine (CAM) attitudes on herbal medicine use in the Indonesian population.

Results: Logistic regression findings showed that knowledge about herbal medicines was independently and positively associated with herbal medicine use to a greater extent than herbal medicine non-use (adjusted odds ratio; AOR = 1.20; 95% confidence interval; CI = 1.16 to 1.24). The participants who used herbal medicines had a greater magical health belief score than herbal medicine non-users, with AOR = 1.03 and 95% CI = 1.00 to 1.06. Moreover, holistic health beliefs and pro-CAM attitudes were also found to be independently associated with herbal medicine use.

Conclusion: Magical health beliefs, holistic health belief, knowledge, and attitudes are key factor in determining the herbal medicine use. Our findings offer crucial implications for health policymakers to encourage the use of herbal medicine during the COVID-19 pandemic.
A Review of Wound Healing Mechanisms of Natural Products in Keratinocyte Cells
Authors: Fristiohady Adryan , Asasutjarit Rathapon , Julian Purnama La Ode Muh , Haruna Lidya Agriningsih , Al-Ramadan Wirhamsah
Published: November 2022

Background: Wound-healing in the skin is one mechanism that maintains homeostasis. Ineffective skin wound healing is a significant health problem that ultimately causes morbidity and mortality. The process of wound healing using traditional medicine has a good effect with various mechanisms of action. This review aims to provide insights related to the wound-healing mechanisms of several plants in HaCat cells.

Methods: The literature study method was used from primary and secondary libraries. The library search was conducted using online-based library search instruments from 1988 to 2021, such as NCBI-PubMed, Google Scholar, and Elsevier.

Results: The wound-healing mechanism includes processes that restore skin integrity through four stages: hemostasis, inflammation, multiplication, and remodeling. Many plants have been studied to have activity in wound healing by various mechanisms.

Conclusions: Several compounds in plants have shown the activity in wound healing in keratinocyte cells  by various mechanisms.
SARS-CoV-2 and the role of close contact in transmission: a systematic review
Authors: Onakpoya Igho J. , Heneghan Carl J. , Spencer Elizabeth A. , Brassey Jon , Plüddemann Annette , Evans David H. , Conly John M. , Jefferson Tom
Published: November 2022

Background: SARS-CoV-2 transmission has been reported to be associated with close contact with infected individuals. However, the mechanistic pathway for transmission in close contact settings is unclear. Our objective was to identify, appraise and summarise the evidence from studies assessing the role of close contact in SARS-CoV-2 transmission. 

Methods: This review is part of an Open Evidence Review on Transmission Dynamics of SARS-CoV-2. We conduct ongoing searches using WHO Covid-19 Database, LitCovid, medRxiv, PubMed and Google Scholar; assess study quality based on the QUADAS-2 criteria and report important findings on an ongoing basis.

Results: We included 278 studies: 258 primary studies and 20 systematic reviews. The settings for primary studies were predominantly in home/quarantine facilities (39.5%) and acute care hospitals (12%). The overall reporting quality of the studies was low-to-moderate. There was significant heterogeneity in design and methodology. The frequency of attack rates (PCR testing) varied between 2.1-75%; attack rates were highest in prison and wedding venues, and in households. The frequency of secondary attack rates was 0.3-100% with rates highest in home/quarantine settings. Three studies showed no transmission if the index case was a recurrent infection. Viral culture was performed in four studies of which three found replication-competent virus; culture results were negative where index cases had recurrent infections. Eighteen studies performed genomic sequencing with phylogenetic analysis – the completeness of genomic similarity ranged from 77-100%. Findings from systematic reviews showed that children were significantly less likely to transmit SARS-CoV-2 and household contact was associated with a significantly increased risk of infection.

Conclusions: The evidence from published studies demonstrates that SARS-CoV-2 can be transmitted in close contact settings. The risk of transmission is greater in household contacts. There was a wide variation in methodology. Standardized guidelines for reporting transmission in close contact settings should be developed.
Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial
Authors: Fadil Azim Darlina H. , Mohd Ghazi Azmee , Ong Siew Hoon , Abdul Majid Hariyati S. , Morgan Karen , Hickey Anne
Published: November 2022

Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia.

Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures.

Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression.

Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).