bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the Effectiveness of the 2012 Canadian Graphic Warning Label Policy Change by Sex, Income, and Education
Authors: Usidame Bukola , Meng Gang , Thrasher James F , Thompson Mary , Fong Geoffrey T , Fleischer Nancy L
Published: October 2022

Introduction

We examined the differential impact of the 2012 Canadian GWL policy changes on key indicators of warning label impact and quit intentions using national cohorts of Canadian and U.S. adults who smoke.

Aims and Methods

We used data from all waves of the International Tobacco Control surveys (2002–2020) in Canada and the United States. Our key measures were quit intentions and an index of warning label effectiveness (salience, cognitive and behavioral reactions). We estimated overall policy impact by comparing Canada (treatment group) with the United States (control group) using controlled interrupted time series (CITS) regression models, with interactions to examine whether policy impact varied by sex, education, and income.

Results

The CITS model showed a statistically significant increase in the warning label effectiveness in Canada post-policy, compared to the United States (β = 0.84, 95% CI 0.35,1.33). Similarly, the odds of quit intentions were relatively higher among adults who smoked in Canada compared to the United States (OR = 1.89, 95% CI 1.51,2.36) post-policy. The three-way interaction model showed that these associations were greater among adults from low socioeconomic status (SES) groups than in high SES groups.

Conclusions

The 2012 change in the Canadian GWL policy was associated with stronger cognitive and behavioral responses to GWLs and higher odds of quit intentions among adults who smoked in Canada when compared to the United States, specifically among individuals from low SES groups, suggesting a positive equity impact. Our findings affirm the need for countries to implement or enhance GWLs, in line with the WHO Framework Convention on Tobacco Control (FCTC).

Implications

The evidence on the potential health equity benefit of GWL policies is mixed. To further understand the influence of GWL policies on tobacco use disparities, more systematic research using pre/post-policy designs with control groups is needed. Using a CITS model, we aimed to strengthen the available evidence on the causal influence of this tobacco control approach. Our findings show that the 2012 GWL policy change had a greater impact on adults who smoked from low SES groups than it did on adults who smoked from high SES groups, indicating a potentially positive equity impact and confirming the need for countries to implement or maximize the size of GWLs, as recommended by the WHO FCTC.
DWARF AND ROBUST PLANT regulates plant height via modulating gibberellin biosynthesis in chrysanthemum
Authors: Zhang Xue , Ding Lian , Song Aiping , Li Song , Liu Jiayou , Zhao Wenqian , Jia Diwen , Guan Yunxiao , Zhao Kunkun , Chen Sumei , Jiang Jiafu , Chen Fadi
Published: October 2022

YABBY (YAB) genes are specifically expressed in abaxial cells of lateral organs and determine abaxial cell fate. However, most studies have focused on few model plants, and the molecular mechanisms of YAB genes are not well understood. Here, we identified a YAB transcription factor in chrysanthemum (Chrysanthemum morifolium), Dwarf and Robust Plant (CmDRP), that belongs to a distinct FILAMENTOUS FLOWER (FlL)/YAB3 sub-clade lost in Brassicaceae. CmDRP was expressed in various tissues but did not show any polar distribution in chrysanthemum. Overexpression of CmDRP resulted in a semi-dwarf phenotype with a significantly decreased active GA3 content, while reduced expression generated the opposite phenotype. Furthermore, plant height of transgenic plants was partially rescued through the exogenous application of GA3 and Paclobutrazol, and expression of the GA biosynthesis gene CmGA3ox1 was significantly altered in transgenic plants. Yeast one-hybrid, luciferase, and chromatin immunoprecipitation-qPCR analyses showed that CmDRP could directly bind to the CmGA3ox1 promoter and suppress its expression. Our research reveals a nonpolar expression pattern of a YAB family gene in dicots and demonstrates it regulates plant height through the GA pathway, which will deepen the understanding of the genetic and molecular mechanisms of YAB genes.
Technology-Enhanced Delivery Models to Facilitate the Implementation of Psychologically Informed Practice for Chronic Musculoskeletal Pain
Authors: Doorley James D , Lentz Trevor A , Yeh Gloria Y , Wayne Peter M , Archer Kristin R , Vranceanu Ana-Maria
Published: October 2022

Chronic musculoskeletal pain is prevalent, challenging to treat, and often disabling. Evidence supports the role of psychological factors in pain-related outcomes, and it is now accepted that rehabilitation should combine physical and psychological approaches (ie, psychologically informed practice). This Perspective articulates a vision for technology-enhanced psychologically informed practice for chronic musculoskeletal pain, highlights relevant research evidence, discusses how technology can circumvent implementation barriers, and proposes directions for future research.
The Role of Exercise Self-Efficacy in Exercise Participation Among Women With Persistent Fatigue After Breast Cancer: A Mixed-Methods Study
Authors: Wechsler Stephen , Fu Mei R , Lyons Kathleen , Wood Kelley C , Wood Magee Lisa J
Published: October 2022

Objective

Survivors of breast cancer with persistent cancer-related fatigue (CRF) report less exercise participation compared with survivors of breast cancer without CRF. Although CRF predicts other domains of self-efficacy among survivors, the effect of CRF on exercise self-efficacy (ESE)—an important predictor of exercise participation—has not been quantified. This study examined the relationship between CRF, ESE, and exercise participation and explored the lived experience of engaging in exercise among survivors of breast cancer with persistent CRF.

Methods

Fifty-eight survivors of breast cancer (3.7 [SD = 2.4] years after primary treatment) self-reported CRF, ESE, and exercise participation (hours of moderate-intensity exercise per week). Regression and mediation analyses were conducted. Survivors who reported clinically significant CRF and weekly exercise were purposively sampled for 1-on-1 interviews (N = 11). Thematic analysis was performed across participants and within higher versus lower ESE subsets.

Results

Greater CRF predicted lower ESE (β = −0.32) and less exercise participation (β = −0.08). ESE mediated the relationship between CRF and exercise participation (β = −0.05, 95% CI = −0.09 to −0.02). Qualitative data showed that survivors of breast cancer with higher ESE perceived exercise as a strategy to manage fatigue, described self-motivation and commitment to exercise, and had multiple sources of support. In contrast, survivors with lower ESE described less initiative to manage fatigue through exercise, greater difficulty staying committed to exercise, and less support.

Conclusions

Survivors of breast cancer with persistent CRF may experience decreased ESE, which negatively influences exercise participation. Clinicians should screen for or discuss confidence as it relates to exercise and consider tailoring standardized exercise recommendations for this population to optimize ESE. This may facilitate more sustainable exercise participation and improve outcomes.

Impact

This study highlights the behavioral underpinnings of CRF as a barrier to exercise. Individualized exercise tailored to optimize ESE may facilitate sustainable exercise participation among survivors of breast cancer with CRF. Strategies for clinicians to address ESE are described and future research is suggested.

Lay Summary

Women with fatigue after breast cancer treatment may have lower confidence about their ability to engage in exercise. Individually tailoring exercise to build confidence as it relates to exercise may result in more consistent exercise and better health-related outcomes.
002 Paediatric rheumatology training: a naive subject to medical trainees in Tanzania
Authors: Meleki Elton , Furia Francis F
Published: October 2022

Background

Pediatric rheumatic disorders are common and result in significant impairment in the quality of life, morbidity and mortality. Tanzania with a population of over 60 million out which children and youth (0–17 years) comprise of > 50% has only one paediatric rheumatologist. Given the low number of trained experts in this sub specialty, it is expected training of medical students and residents will provide adequate training in paediatric rheumatology. This survey was aimed at determining paediatric rheumatology training among medical students and residents in Tanzania.

Methods

This was a survey conducted among senior medical undergraduate students who had completed paediatric rotations and final year residents from medical schools in Tanzania. Survey questionnaire was administered through interview to final year medical students and final year paediatric resident’s medical schools, the questions asked included duration of rotation in paediatric for undergraduate students and duration of paediatric residency programs.

Results

There are 11 universities in Tanzania that offer undergraduate (UG) medical degree, and 5 of them offer residency programs for pediatrics and child health. The duration for undergraduate rotation in pediatrics varied among universities with the longest being 12 weeks and the shortest being 7 weeks. The duration for paediatric residency programs is 3 years in all the universities with an exception of one university which the program for 4 years. There were only two universities that reported to train pediatric rheumatology to undergraduate students in the country, and the topics taught to both of the universities were juvenile idiopathic arthritis. Five universities that provide undergraduate training were excluded due to absence of final year UG students. Final year residents in three out of five universities which offer paediatric residency programs reported to have trained in pediatric rheumatology. One university did not have any class session on pediatric rheumatology, and the other was excluded since there were no final year residents. Common paediatric rheumatology topics covered for residents in the three universities were juvenile idiopathic arthritis and systemic lupus erythematosus. Only one of the three universities had an extra class on dermatomyositis.

Conclusion and Recommendations

Pediatric rheumatology is not adequately taught to university trainees at both undergraduates and paediatric residency levels. There is a need to put emphasis on exposing all trainees in pediatric to catall common pediatric rheumatology conditions because of the severe shortage of rheumatology trained practitioners in Tanzania.
42 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of juvenile dermatomyositis. An initiative by the Egyptian College of Pediatric Rheumatology
Authors: El Miedany Y , Lotfy H , Salah S , Yehia M , Mosa D. M , Kaber A , Mortada M , Tabra S. A , El Gaafary M , Abdulhady H , Hassan W. A , Osman N. S , Eissa M , Medhat B. M , Mohamed S. S , Farag Y , Amer Y , Maher S. Esam , Radwan A , El-Shanawany Amira T , El Mikkawy D , El Deriny G , Fouad N. A , Nasef S. I , Elkaraly N. E , Abu-Zaid M. H ,   Egyptian College of Pediatric Rheumatology
Published: October 2022

Background

Juvenile dermatomyositis (JDM) is the most common type of juvenile idiopathic inflammatory myopathy mainly affecting the skin and proximal muscles. To date, there are no Egyptian nationally agreed, evidence-based guidelines concerning the diagnosis and management of JDM in children and treatment is often based on clinical expertise. These facts prompted us to develop clinical practice guidance for JDM suitable for patients in Egypt. This work was an initiative by the Egyptian College of Pediatric Rheumatology aiming at optimizing the management approaches for children and young adults with JDM.

Objective

To provide evidence-based consensus recommendations for diagnosis and management of JDM.

Methods

This study was carried out to achieve an Egyptian expert consensus on a management strategy for JDM using Delphi technique. A multistep process strategy was adopted, which started by developing 16 key clinical questions by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Time (PICOT) approach. The core leadership team identified clinicians and researchers with expertise in pediatric rheumatology all over Egypt. An evidence-based, systematic, literature review was conducted to compile evidence for the JDM management. Delphi process was implemented (3-rounds) to reach a consensus.

Results

Twenty-five expert panel participated in the 3 rounds with response rate 100%. A total of 22 recommendations, categorized into 15 domains (Targeted population, diagnostic criteria, high risk patients, diagnostic criteria, definition of disease activity status, differences between JDM and DM in adults, lab tests, treatment targets, treatment, monitoring, resisted cases, drug tapering, comorbidities, prognosis, vaccination and transition program. The Agreement with the recommendations (rank 7–9) ranged from 85.2–95.2%. The Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithm for management has also been developed.

Conclusion

This work provided an updated management approach for JDM patients. This evidence-based informed consensus process is expected to support uniform, high quality standards of care for children with JDM in Egypt

The implication to policy, practice, research and advocacy

to provide updated recommendations for better management of JDM.
43 Egyptian evidence-based consensus recommendations for diagnosis and targeted management of childhood-onset systemic lupus erythematosus. An initiative by the Egyptian College of Pediatric Rheumatology
Authors: Lotfy H , El Miedany Y , Salah S , Tabra S. A , Salaby R. A , Amer Y , Adel Y , Osman N. S , Medhat B. M , El Gaafary M , Abdulhady H , Hassan W. A , Farag Y , Eissa M , Maher S. Esam , Radwan A , El-Shanawany Amira T , El Mikkawy D , Mosa D. M , El Deriny G , Mortada M , Fouad N. A , Nasef S. I , Elkaraly N. E , Mohamed S. S , Abu-Zaid M. H ,   Egyptian College of Pediatric Rheumatology
Published: October 2022

Background

Childhood-onset systemic lupus erythematosus (cSLE) is a rare prototype of a multi-systemic, inflammatory, heterogeneous and potentially life-threatening autoimmune condition with quite significant linked morbidity. To date, there are no Egyptian nationally agreed, evidence-based guidelines concerning the diagnosis and management of kDa in children and treatment is often based on clinical expertise. Consequently, treatment regimens vary broadly. This work was an initiative by the Egyptian College of Paediatric Rheumatology aiming at optimising the management approaches for children and young adults with cSLE.

Objective

To provide evidence-based consensus recommendations for diagnosis and management of cSLE

Methods

This study was carried out to achieve an Egyptian expert consensus on a management strategy for cSLE using Delphi technique. A multistep process strategy was adopted, which started by developing 18 key clinical questions by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Time (PICOT) approach. The core leadership team identified clinicians and researchers with expertise in pediatric rheumatology all over Egypt. An evidence-based, systematic, literature review was conducted to compile evidence for the cSLE management. Delphi process was implemented (3-rounds) to reach a consensus.

Results

Twenty-five expert panel participated in the 3 rounds with response rate 100%. A total of 24 recommendations, categorized into 14 domains (Targeted population, criteria for classification, definition of disease activity status, definition of flare up, lab tests, treatment targets, monitoring, treatment, recommendations for specific organ system, prognostic markers, refractory condition, vaccination and transition program. The Agreement with the recommendations (rank 7–9) ranged from 84.8–94.8%. The Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithm for management has also been developed.

Conclusion

This work provided an updated management approach for cSLE patients. This evidence-based informed consensus process is expected to support uniform, high quality standards of care for children with cSLE in Egypt

The implication to policy, practice, research and advocacy: to provide updated recommendations for better management of cSLE.
Ultrastructural characteristics of erythroid cells in congenital dyserythropoietic anemia type II, with a focus on peripheral cisternae and double membranes
Authors: Ru Yong-Xin , Dong Shu-Xu , Liu Jing , Eyden Brian
Published: October 2022

Peripheral cisternae and double membranes (PCDMs) in erythroid cells are a landmark of type II congenital dyserythropoietic anemia (CDA). To gain further insights into the mechanism of dyserythropoiesis, erythroblasts and erythrocytes in bone marrow were studied in 22 Chinese patients with CDA Ⅱ by transmission electron microscopy. The study demonstrated an increase in all patients in erythroblasts with PCDMs with development from pro-erythroblast to red blood cells. PCDMs often connected with cisternae of endoplasmic reticulum (ER) and the perinuclear space, and were accompanied by karyopyknosis, karyolysis and disruption in polychromatic and orthochromatic erythroblasts. The results suggest that PCDMs are transformed from ER during erythropoiesis and participate in the dissolution and deletion of late erythroid cells in patients with CDA II.
Application of long non-coding RNA RBAT1 in improving diagnosis and prognosis of ovarian carcinoma
Authors: Luo Jie , Zhang Yuqing , Zheng Ting , Jing Yongping , Cao Rongyu , Wu Minmin , Fan Die , Tao Ying , Zhao Mandan
Published: October 2022

Tumorigenesis of bladder cancer and retinoblastoma is correlated with long non-coding RNA (lncRNA) RBAT1. However, the role of RBAT1 in ovarian carcinoma (OC) is unclear. Thus, the study explored the role of RBAT1 in OC. This research enrolled patients with OC (n = 68), irritable bowel disease (IBD, n = 68, females), digestive tract inflammation (DTI, n = 68, females), urinary tract infection (UTI, n = 68, females), endometriosis (EM, n = 68, females), and healthy controls (HCs, n = 68) to collect plasma sampled. OC and paired non-tumor tissues were collected from patients with OC. RBAT1 accumulation in all samples was analyzed using RT-qPCR. The role of plasma RBAT1 in OC diagnosis was examined using the ROC curves with OC patients as the true positive cases and other patients and HCs as the true negative cases. The role of RBAT1 in predicting the survival of OC patients was analyzed using the survival curve study. RBAT1 was overexpressed in both OC plasma and tissues. Plasma RBAT1 levels were correlated with RBAT1 levels in OC tissues but not in non-tumor tissues. Plasma RBAT1 could distinguish OC patients from other patients and HCs. Patients with high plasma RBAT1 levels had a shorter survival. RBAT1 is overexpressed in OC and might be applied to improve the diagnosis and prognosis of OC.
Exosomal circPRRX1 functions as a ceRNA for miR-596 to promote the proliferation, migration, invasion, and reduce radiation sensitivity of gastric cancer cells via the upregulation of NF-κB activating protein
Authors: He Yuxin , Zheng Liangjian , Yuan Mengzhen , Fan Jia , Rong Liwen , Zhan Tingting , Zhang Jun
Published: October 2022

Exosomes, which are small extracellular vesicles, have been unveiled to carry circular RNAs (circRNAs). CircRNA paired-related homeobox 1 (circPRRX1) can be transferred by exosomes derived from gastric cancer cells. Here, we investigated the activity and mechanism of exosomal circPRRX1 in gastric tumorigenesis and radiation sensitivity. CircPRRX1, microRNA (miR)-596, and NF-κB activating protein (NKAP) were quantified by quantitative real-time PCR and immunoblotting. Cell proliferation, motility, and invasion were detected by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide and transwell assays, respectively. Cell colony formation and survival were assessed by colony formation assays. Dual-luciferase reporter assays were performed to verify the direct relationship between miR-596 and circPRRX1 or NKAP. In-vivo xenograft studies were used to evaluate the role of exosomal circPRRX1 in tumor growth. Our data showed that circPRRX1 expression was elevated in human gastric cancer, and circPRRX1 could be transferred by exosomes from gastric cancer cells. Exosomal circPRRX1 affected cell proliferation, motility, invasion, and radiation sensitivity in vitro and tumor growth in vivo. Mechanistically, circPRRX1 directly regulated miR-596 expression, and exosomal circPRRX1 affected cell biological functions at least in part through miR-596. NKAP was identified as a direct target and functionally downstream effector of miR-596. Exosomal circPRRX1 modulated NKAP expression by acting as a competing endogenous RNA (ceRNA) for miR-596. Our findings suggest a new mechanism, the exosomal circPRRX1/miR-596/NKAP ceRNA crosstalk, in regulating gastric tumorigenesis and radiation sensitivity.
MiR-30a-5p/CHD1 axis enhances cisplatin sensitivity of ovarian cancer cells via inactivating the Wnt/β-catenin pathway
Authors: Wang Xiaoyan , Zhao Hong , Wang Pei , Zhang Jinbin , Li Na , Liu Yangyang , Zhang Feng , Yu Yanling
Published: October 2022

Oovarian cancer is a common lethal gynecological malignancy with a high occurrence and dismal prognosis on account of its drug resistance. MicroRNAs (miRNAs) are widely involved in the chemotherapy resistance of tumors, including miR-30a-5p. Herein, we probed the functional role and molecular mechanism of miR-30a-5p in the chemoresistance of ovarian cancer. We enrolled 48 ovarian cancer patients in this study. Statistical analysis and a series of experiments including quantitative reverse transcription polymerase chain reaction, western blot, methyl thiazolyl tetrazolium assay, colony formation assay, flow cytometry analysis, Transwell assay, luciferase reporter assay, RNA pull-down assay and TOP/FOP flash assay were explored in the study. Animal experiments were performed to verify the role of miR-30a-5p in vivo. In our study, miR-30a-5p showed a prominently low level in ovarian cancer tissues and cells. Importantly, its expression in cisplatin-resistant cell lines was more downregulated than in cisplatin-sensitive ones. Additionally, miR-30a-5p overexpression inhibited proliferative, migratory and invasive abilities of ovarian cancer cells while enhancing cell apoptosis and improving cell sensitivity to cisplatin in ovarian cancer. Further, miR-30a-5p targeted to chromodomain helicase DNA binding protein 1 (CHD1) and inhibited the expression of CHD1 in ovarian cancer. Moreover, rescue experiments manifested that miR-30a-5p weakened cisplatin resistance and the cellular process of ovarian cancer by mediating CHD1. Besides, miR-30a-5p regulated CHD1 expression to suppress Wnt/β-catenin signaling in ovarian cancer. The findings were verified by in vivo experiments. This article elucidated that miR-30a-5p/CHD1 axis inhibited the cellular process and enhanced cisplatin sensitivity of ovarian cancer cells through the Wnt/β-catenin pathway, which may provide a useful direction for the targeted chemotherapy of ovarian cancer.
A Scoping Review of Health Care Faculty Mentorship Programs in Academia: Implications for Program Design, Implementation, and Outcome Evaluation
Authors: Crites Gerald E. , Ward Wendy L. , Archuleta Penny , Fornari Alice , Hill Sarah E. M. , Westervelt Lauren M. , Raymond Nancy
Published: October 2022

Introduction:

Formal mentoring programs have direct benefits for academic health care institutions, but it is unclear whether program designs use recommended components and whether outcomes are being captured and evaluated appropriately. The goal of this scoping review is to address these questions.

Methods:

We completed a literature review using a comprehensive search in SCOPUS and PubMed (1998–2019), a direct solicitation for unpublished programs, and hand-searched key references, while targeting mentor programs in the United States, Puerto Rico, and Canada. After three rounds of screening, team members independently reviewed and extracted assigned articles for 40 design data items into a comprehensive database.

Results:

Fifty-eight distinct mentoring programs were represented in the data set. The team members clarified specific mentor roles to assist the analysis. The analysis identified mentoring program characteristics that were properly implemented, including identifying program goals, specifying the target learners, and performing a needs assessment. The analysis also identified areas for improvement, including consistent use of models/frameworks for program design, implementation of mentor preparation, consistent reporting of objective outcomes and career satisfaction outcomes, engagement of program evaluation methods, increasing frequency of reports as programs as they mature, addressing the needs of specific faculty groups (eg, women and minority faculty), and providing analyses of program cost-effectiveness in relation to resource allocation (return on investment).

Conclusion:

The review found that several mentor program design, implementation, outcome, and evaluation components are poorly aligned with recommendations, and content for URM and women faculty members is underrepresented. The review should provide academic leadership information to improve these discrepancies.
When Illness and Loss Hit Close to Home—Do Health Care Providers Learn How to Cope?
Authors: Lee Alex , Niu Bonnie , Balaa Fady , Gawad Nada
Published: October 2022

Introduction:

Up to 85% of newly qualified physicians report loss or illness in themselves or a loved one. These experiences can intensify feelings of grief in the professional setting, but the range of formal training that addresses personal illness or loss is unknown. This study aimed to explore interventions that teach health care providers and trainees about personal illness experience.

Methods:

A scoping review was conducted by searching three bibliographic databases using the terms “illness,” “personal,” “education,” and synonyms. Article screening was performed in duplicate to identify studies that described an intervention that included teaching or learning on personal experiences with illness or loss for health care providers and trainees.

Results:

The search yielded 4168 studies, of which 13 were included. Education most often targeted medical students (54%), resident or attending physicians (31%), and nurses (31%). Other participants included social workers and psychologists. Personal illness was most frequently taught for reflection in the context of palliative care curricula (54%). Only two studies' primary purpose was to teach about coping with grief related to personal experiences. No studies within the scope of our defined methodology described training on how to support colleagues or trainees facing personal illness or loss. Reported outcomes included improved coping skills, decreased stress, and better ability to support bereaving patients.

Discussion:

Specific training on personal illness experience is limited, with gaps in continuity of learning, particularly for continuing medical education. Future curricula can equip providers with coping strategies while enabling improved resilience and patient care.
Associations of maternal and foetoplacental factors with prehypertension/hypertension in early childhood
Authors: Michael Navin , Sadananthan Suresh Anand , Yuan Wen Lun , Ong Yi Ying , Loy See Ling , Huang Jonathan Y. , Tint Mya-Thway , Padmapriya Natarajan , Choo Jonathan , Ling Lieng Hsi , Kramer Michael S. , Godfrey Keith M. , Gluckman Peter D. , Tan Kok Hian , Eriksson Johan G. , Chong Yap-Seng , Lee Yung Seng , Karnani Neerja , Yap Fabian , Shek Lynette Pei-Chi , Fortier Marielle V. , Moritz Karen M. , Chan Shiao-Yng , Velan S. Sendhil , Wlodek Mary E.
Published: October 2022

Objective:

To evaluate whether characterization of maternal and foetoplacental factors beyond birthweight can enable early identification of children at risk of developing prehypertension/hypertension.

Methods:

We recruited 693 mother–offspring dyads from the GUSTO prospective mother–offspring cohort. Prehypertension/hypertension at age 6 years was identified using the simplified paediatric threshold of 110/70 mmHg. We evaluated the associations of pregnancy complications (gestational diabetes, excessive/inadequate gestational weight gain, hypertensive disorders of pregnancy), foetal growth deceleration (decline in foetal abdominal circumference at least 0.67 standard deviations between second and third trimesters), high foetoplacental vascular resistance (third trimester umbilical artery systolic-to-diastolic ratio ≥90th centile), preterm birth, small-for-gestational age and neonatal kidney volumes with risk of prehypertension/hypertension at age 6 years, after adjusting for sex, ethnicity, maternal education and prepregnancy BMI.

Results:

Pregnancy complications, small-for-gestational age, preterm birth, and low neonatal kidney volume were not associated with an increased risk of prehypertension/hypertension at age 6 years. In contrast, foetal growth deceleration was associated with a 72% higher risk [risk ratio (RR) = 1.72, 95% confidence interval (CI) 1.18–2.52]. High foetoplacental vascular resistance was associated with a 58% higher risk (RR = 1.58, 95% CI 0.96–2.62). Having both these characteristics, relative to having neither, was associated with over two-fold higher risk (RR = 2.55, 95% CI 1.26–5.16). Over 85% of the foetuses with either of these characteristics were born appropriate or large for gestational age.

Conclusion:

Foetal growth deceleration and high foetoplacental vascular resistance may be helpful in prioritizing high-risk children for regular blood pressure monitoring and preventive interventions, across the birthweight spectrum.
Prediction of long-term outcomes by arterial stiffness and pressure wave reflections in patients with acute stroke: the Athens Stroke Registry
Authors: Samara Stamatia , Vemmou Anastasia , Kyrkou Aikaterini , Papamichael Christos , Korompoki Eleni , Ntaios George , Manios Efstathios , Stamatelopoulos Kimon , Protogerou Athanase D. , Vemmos Konstantinos
Published: October 2022

Background and purpose:

Stroke patients’ management might be improved by addressing the role of aortic stiffness (carotid-femoral pulse wave velocity: cfPWV) and pressure wave reflections (PWRs, augmentation index: AIx) in their pathogenesis and outcome. We tested the hypothesis that cfPWV and AIx, separately and combined, predict long-term outcomes [all-cause mortality, incidence of cardiovascular events, stroke recurrence and disability defined by modified Ranking Scale (mRS) ≥3] in patients with acute stroke, using data from the ‘Athens Stroke Registry’.

Methods:

Data from 552 patients (70% men, age: 66.1 ± 10.4 years, 13.4% deaths from any cause, 21.2% cardiovascular events, 14.1% stroke recurrences and 20.1% poor mRS, mean follow-up 68.4 ± 41.4 months) were analyzed.

Results:

The main findings were that: high aortic stiffness (cfPWV > 13 m/s) alone is an independent predictor of all-cause mortality and cardiovascular (CV) events, but not of stroke recurrence and poor functional outcome; evaluated separately from aortic stiffness, neither low nor high PWRs have any prognostic value; even after multiple adjustments, patients with both high aortic stiffness (cfPWV > 13 m/s) and low PWRs (Aix < 22%) have almost two-fold higher hazard ratio, not only for all-cause mortality and CV events but also for stroke recurrence and poor functional outcome.

Conclusions:

The present study provides evidence about the role of aortic stiffness, PWRs and their combined incremental value in the long-term survival, morbidity, and functional disability after acute stroke.
Two Novel FECH Mutations in a Patient with Erythropoietic Protoporphyria
Authors: Tan Qi , Yang Hui-Fang , Lan Li-Fang , Xie Ling , Lin Ru-Bing , Wan Chun-Lei , Li Long-Nian
Published: October 2022

Introduction:

Erythropoietic protoporphyria (EPP) is a rare photodermatosis mainly caused by deficiency of the enzyme ferrochelatase (FECH). We herein report a case of EPP associated with two novel mutations in FECH.

Case presentation:

A 15-year-old boy experienced pain and pruritus after sunlight exposure. He had occasional claret-red urine, hepatomegaly with increased alanine aminotransferase and aspartate aminotransferase levels, and an elevated free erythrocyte protoporphyrin level. He was treated with oral β-carotene and cholestyramine and avoidance of sunlight as much as possible.

Discussion:

Genome sequencing revealed two novel FECH mutations that had been inherited from his healthy parents. Pathogenicity analysis involving prediction using PolyPhen-2, SIFT, and Mutation Taster revealed that the two novel mutations were likely pathogenic. Although the patient’s parents were healthy, they each had one of these two mutations. This finding is consistent with previous reports stating that individuals carrying low-expression alleles can be asymptomatic. The pathogenesis of the disease caused by these two mutations requires verification by larger and more detailed studies.

Conclusion:

Although the precise role of these mutations in EPP is not clear, the findings in the present case expand the genotypic spectrum of the disease.
Clinical application of 3D reconstruction in pancreatic surgery: a narrative review
Authors: Zhang Yiming , Yang Yuanyuan , Chen Shu , Ji Jianbing , Ge Huiting , Huang Heguang
Published: October 2022

Progress in medicine requires not only innovation and development in the medical field but also the integration of the technology of other fields into the medical field. As an important technological advancement, three-dimensional (3D) reconstruction transforms traditional two-dimensional images into 3D images that are more consistent with the physiological habits of human eyes. It has been applied to the bones, heart, liver, and maxillofacial area, promoting the progress of medical technology and surgeons. This article introduces the progress of 3D reconstruction technology in the clinical application of pancreatic surgery, from the preoperative, intraoperative, and postoperative perspectives, as well as the education of young surgeons. It also puts forward new ideas for the further development of pancreatic surgery.
Using Wet Bulb Globe Temperature and Physiological Equivalent Temperature as Predicative Models of Medical Stress in a Marathon: Analysis of 30 Years of Data From the Twin Cities Marathon
Authors: Schroeder Allison N. , Suriano Zachary J. , Kliethermes Stephanie A. , Asplund Chad A. , Roberts William O.
Published: October 2022

Objectives

: Assess the relationships between wet bulb globe temperature (WBGT) and physiologic equivalent temperature (PET) at the start of a northern latitude marathon and their associations with medical stress and transfers to the emergency room (ER) when the race environment is unexpectedly warm, and participants are not acclimatized.

Design

: Retrospective review.

Setting

: Twin Cities Marathon from 1990 to 2019.

Participants

: Runners competing in the Twin Cities Marathon.

Independent variables

: Start WBGT (prospectively collected) and PET (retrospectively calculated).

Main Outcome Measures

: Marathon race starters and finishers and race day medical data (eg, medical stress, number of medical encounters, and number of ER visits).

Results

: The mean WBGT was 7.4°C (range −1.7°C to 22.2°C), and the meant PET was 5.2°C (range −16.7°C to 25.9°C). PET was not determined to be a significant predictor of medical stress (P = 0.71); however, a significant quadratic association between WBGT and medical stress was found (P = 0.006). WBGT (P = 0.002), but not PET (P = 0.07), was a significant predictor of the number of ER visits.

Conclusions:

Start WBGT was a better predictor of medical stress and ER visits than PET at the Twin Cities Marathon over a 30-year period. The start WBGT may be a better tool to predict race day environment medical safety.
Communicating with health providers and romantic partners: The impact of negative emotions on quality of life for individuals with hidradenitis suppurativa
Authors: Ingraham Natalie , Hann Lena R. , Williamson J. Austin , Drew Caleb
Published: October 2022

Background:

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease.

Objective:

This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life.

Methods:

Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners.

Results:

Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life.

Limitations:

Limited generalizability due to convenience sampling.

Conclusion:

Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.
Matched Cohort Study of Radiographic Superior Semicircular Canal Dehiscence and Tegmen Dehiscence and Obstructive Sleep Apnea
Authors: Kaufman Adam C. , Cooperman Shayna , Ali Noor-E-Seher , Alyono Jennifer C.
Published: October 2022

Objective

To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA).

Study Design

Retrospective matched cohort study.

Setting

Tertiary care center.

Patients

Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded.

Main Outcome Measures

Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers.

Results

The average body mass index of the OSA patients was 29.2 kg/m2 with an average apnea–hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m2. Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group (p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group (p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence.

Conclusion

The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from age- and sex-matched controls. This is in contrast to a previous case–control study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.
Chronic pain in adults with osteogenesis imperfecta and its relationship to appraisal, coping, and quality of life: A cross-sectional study
Authors: Muñoz Cortés Rubén , Soriano Pastor José Francisco , Monsalve Dolz Vicente
Published: October 2022

Chronic pain is a common experience in osteogenesis imperfecta (OI). However, there are few studies on this topic, and none of them emerge from psychology as a discipline. The purpose of this work is to describe the frequency of chronic pain and its characteristics in a large sample of adults with OI, as well as its relationship with clinical, sociodemographic, psychological, and quality of life variables.

A cross-sectional study was carried out in a sample of 418 adults with OI who answered a battery of online questionnaires. Sociodemographic and clinical variables, pain parameters, participants’ appraisal of pain, coping strategies, interference in daily activities, and health-related quality of life were evaluated. A descriptive and correlational analysis was performed.

Up to 83% of the sample reported experiencing pain frequently. Both the frequency and intensity of pain were related to the accumulation of fractures over the years (P < .05), but were independent of other variables like the severity of the pathology or the use of bisphosphonates. Higher threat appraisal of pain was associated with an increase in perceived pain intensity and its interference with daily activities, as well as a decrease in physical and mental health (P < .001).

Chronic pain frequent condition in adults with OI, regardless of the severity of the pathology. It interferes with their usual activities and has an impact on their quality of life. The way in which participants appraise their pain also have an influence on its intensity and its consequences. Interventions aimed at training strategies for managing appraisals about pain could potentially improve adaptation to chronic pain.
Long-acting reversible contraceptives utilization and its determinants among married Yemeni women of childbearing age who no longer want children
Authors: Boah Michael , Issah Abdul-Nasir , Demuyakor Isaac , Hyzam Dalia
Published: October 2022

Some contraceptive methods, such as long-acting and permanent methods, are more effective than others in preventing conception and are key predictors of fertility in a community. This study aimed to determine which factors were linked to married women of childbearing age who no longer desired children using long-acting reversible contraceptives (LARCs) in Yemen. We used a population-based secondary dataset from Yemen’s National Health and Demographic Survey (YNHDS), conducted in 2013. The study analyzed a weighted sample of 5149 currently married women aged 15 to 49 years who had no plans to have children. Logistic regression analyses were used to investigate the parameters linked to the present use of LARCs. The final model’s specifications were evaluated using a goodness-of-fit test. An alpha threshold of 5% was used to determine statistical significance. Of the total sample, 45.3% (95% CI: 43.3–47.4) were using contraception. LARCs were used by 21.8% (95% CI: 19.6–24.1) of current contraceptive users, with the majority (63.8%) opting for short-acting reversible contraceptives (SARCs). In the adjusted analysis, maternal education, husbands’ fertility intention, place of residence, governorate, and wealth groups were all linked to the usage of LARCs. According to the findings, women whose spouses sought more children, for example, were more likely to use LARCs than those who shared their partners’ fertility intentions (AOR = 1.44; 95% CI: 1.07–1.94; P = .015). In this study, married women of reproductive age who had no intention of having children infrequently used contraception and long-acting methods. Improving women’s education and socioeconomic status could contribute to increasing their use of LARCs.
Primary bronchial schwannoma: A case report
Authors: Aoyama Yosuke , Miyamoto Atsushi , Fujii Takeshi , Fujimori Sakashi , Tamaoka Meiyo , Takai Daiya
Published: October 2022

Rationale:

Bronchial schwannomas are extremely rare among the benign tracheobronchial tumors and little are known about its epidemiology and optimal clinical management. Here, we report a case of bronchial schwannoma in a young Japanese man and clinical implications about epidemiology, symptom, diagnosis, and treatment of bronchial schwannoma.

Patients concern:

A 37-year-old man visited our department with a nodule incidentally found on his chest radiograph during a routine medical checkup.

Diagnosis:

The tumor was diagnosed as a bronchial schwannoma after pathological evaluation. Microscopically, the tumor consisted of spindle cell proliferation characterized by an alternating highly ordered cellular Antoni A component with occasional nuclear palisading and a loose myxoid Antoni B component. Tumor cells were immunoreactive for S100 but not for smooth muscle actin or KIT.

Interventions:

A video-assisted right middle and lower bilobectomy was performed.

Outcome:

He remains under observation without recurrence.

Lessons:

In our review, many reports have come from Asian countries. Bronchial schwannoma can occur within a wide range of age groups and in both men and women. No difference in incidence was observed between right and left bronchial tree. Bronchial schwannoma is sometimes difficult to differentiate from malignant diseases. We should include bronchial schwannoma as one of the differential diagnoses of primary bronchial tumors.
Long-term traditional Chinese medicine–induced liver cirrhosis
Authors: Chao Hung-Hsiang , Chen Pei-Yu , Hsu Wei-Fan
Published: October 2022

Rationale:

Traditional Chinese medicine (TCM), based on ancient medical practices in Chinese societies, is a popular alternative to Western medicine. However, serious harm may occur if TCM is used without caution. TCM-related drug-induced liver injury is not rare in East Asia; however, TCM-induced decompensated liver cirrhosis, confirmed by paired histologic examinations, is.

Patient concerns:

A 60-year-old man with psoriasis for more than 30 years had received TCM for 15 years. The patient presented to the gastrointestinal clinic with hepatitis.

Diagnosis:

The patient underwent detailed history taking and liver biopsy. The patient developed a mixed-type drug-induced liver injury, and other etiologies were excluded.

Interventions:

The patient’s liver injury improved after discontinuation TCM for 5 months. Unfortunately, the patient again sought TCM 1 month later because of recurrent and progressive psoriasis.

Outcomes:

Decompensated cirrhotic symptoms developed 3 months after resuming TCM. The patient underwent living-donor liver transplantation 16 months after initial presentation because of decompensated liver cirrhosis. The patient died 28 days after liver transplantation due to rejection of the transplanted liver.

Lessons:

Discontinuation of the offending agent was the mainstay of treatment. TCM-related drug-induced liver injury is common in East Asia, including Taiwan. Physicians must be cautious about possible medications causing drug-induced liver injury, and patients must obey the order to permanently discontinue any use of the offending medications.