bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune checkpoint inhibitors in Cancer patients with rheumatologic preexisting autoimmune diseases: a systematic review and meta-analysis
Authors: Liu Xin , Li Su , Ke Liyuan , Cui Hongxia
Published: April 2024

Background

Patients with rheumatologic preexisting autoimmune disease (PAD) have not been enrolled in clinical trials of immune checkpoint inhibitors (ICIs). Therefore, the risks and benefits of ICI therapy in such patients are unclear. Herein, we investigated the safety and efficacy of ICIs in rheumatologic PAD patients through a meta-analysis.

Methods

The PubMed, Cochrane Library, Embase and Web of Science databases were searched for additional studies. We analyzed the following data through Stata software: incidence of total irAEs (TirAEs), rate of flares, incidence of new on-set irAEs, rate of discontinuation, objective response rate (ORR) and disease control rate (DCR).

Results

We identified 23 articles including 643 patients with rheumatologic PAD. The pooled incidences of TirAEs, flares and new-onset irAEs were 64% (95% CI 55%-72%), 41% (95% CI 31%-50%), and 33% (95% CI 28%-38%), respectively. In terms of severity, the incidences were 7% (95% CI 2%-14%) for Grade 3–4 flares and 12% (95% CI 9%-15%) for Grade 3–4 new-onset irAEs. Patients with RA had a greater risk of flares than patients with other rheumatologic PADs did (RR = 1.35, 95% CI 1.03–1.77). The ORR and DCR were 30% and 44%, respectively. Baseline anti-rheumatic treatment was not significantly associated with the frequency of flares (RR = 1.05, 95% CI 0.63–1.77) or the ORR (RR = 0.45, 95% CI 0.12–1.69).

Conclusions

Patients with rheumatologic PAD, particularly those with RA, are susceptible to relapse of their rheumatologic disease following ICI therapy. ICIs are also effective for treating rheumatologic PAD patients.

Prospective register of systematic reviews (PROSPERO)

number CRD 42,023,439,702.
Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway
Authors: Solbakken Line Elisabeth , Bergvik Svein , Wynn Rolf
Published: April 2024

Background

Mental health problems are highly prevalent in prison populations. Incarcerated persons generally come from disadvantaged backgrounds and are living under extraordinary conditions while in prison. Their healthcare needs are complex compared to the general population. Studies have found that incarcerated individuals are reluctant to seek help and that they experience challenges in accessing mental healthcare services. To some extent, seeking treatment depends on the degree of fit between potential users and health services, and actual use might be a better indication of accessibility than the fact that services are available. This study aimed to explore individual and systemic facilitators and barriers to accessing mental healthcare in a prison context.

Methods

An analytical approach drawing on elements of constructivist Grounded theory was the methodological basis of this study. Fifteen male participants were recruited from three prisons in Northern Norway. Data was collected through in-depth interviews on topics such as help-seeking experiences, perceived access to services and availability of health information.

Results

We found that distrust in the system, challenges with the referral routines, worries about negative consequences, and perceived limited access to mental healthcare were barriers to help-seeking among incarcerated individuals. How prison officers, and healthcare personnel respond to incarcerated persons reporting mental distress could also be critical for their future willingness to seek help. Providing information about mental health and available services, initiating outreaching mental health services, and integrating mental health interventions into treatment programs are examples of efforts that might reduce barriers to accessing services.

Conclusions

Facilitating access to mental health services is crucial to accommodate the mental health needs of those incarcerated. This study provides insights into the complex interplay of individual, social and systemic factors that may contribute to the utilization of mental health care among incarcerated persons. We suggest that correctional and healthcare systems review their practices to facilitate access to healthcare for people in prison.
How much do adverse childhood experiences contribute to adolescent anxiety and depression symptoms? Evidence from the longitudinal study of Australian children
Authors: Sahle Berhe W. , Reavley Nicola J. , Morgan Amy J. , Yap Marie Bee Hui , Reupert Andrea , Jorm Anthony F.
Published: April 2024

This study aims to: (i) examine the association between adverse childhood experiences (ACEs) and elevated anxiety and depressive symptoms in adolescents; and (ii) estimate the burden of anxiety and depressive symptoms attributable to ACEs.

Data were analyzed from 3089 children followed between Waves 1 (age 4–5 years) and 7 (16–17 years) of the Longitudinal Study of Australian Children. Logistic regression was used to estimate the associations between ACEs and child-reported elevated anxiety and depressive symptoms at age 16–17. Anxiety and depressive symptoms were measured using the Children’s Anxiety Scale and Short Mood and Feelings Questionnaire, respectively. The punaf command available in STATA 14 was used to calculate the population attributable fraction (PAF).

Before the age of 18 years, 68.8% of the children had experienced two or more ACEs. In the analysis adjusted for confounding factors, including co-occurring ACEs, both history and current exposure to bullying victimisation and parental psychological distress were associated with a statistically significant increased likelihood of elevated anxiety and depressive symptoms at age 16–17. Overall, 47% of anxiety symptoms (95% CI for PAF: 35–56) and 21% of depressive symptoms (95% CI: 12–29) were attributable to a history of bullying victimisation. Similarly, 17% (95% CI: 11–25%) of anxiety and 15% (95% CI: 4–25%) of depressive symptoms at age 16–17 years were attributable to parental psychological distress experienced between the ages of 4–15 years.

The findings demonstrate that intervention to reduce ACEs, especially parental psychological distress and bullying victimisation, may reduce the substantial burden of mental disorders in the population.
Problematic usage of the internet among Hungarian elementary school children: a cross-sectional study
Authors: Szapary Adam , Feher Gergely , Radvanyi Ildiko , Fejes Eva , Nagy Gabor Daniel , Jancsak Csaba , Horvath Lilla , Banko Zoltan , Berke Gyula , Kapus Krisztian
Published: April 2024

Introduction

Problematic usage of the internet (PUI) is perhaps one of the most frequently studied phenomena of the 21st century receiving increasing attention in both scientific literature and the media. Despite intensive research there have been relatively few meaningful studies among elementary school students in Hungary and worldwide, who may be considered as a high-risk population with regard to problematic internet use. The aim of our study was to carry out a complex research focusing on the prevalence and risk factors of PUI among elementary school children aged 10–15 years (Grade 5–8).

Methods

Demographics included were gender, age, place of stay, type of residence, family type, parental education, start of internet use, used devices, daily internet use, purpose of internet use, internet accounts, ways of keeping in touch with friends and sporting activities. PUI was evaluated using the paper-based version of the Potentially Problematic Use of the Internet Questionnaire.

Results

Overall, 2000 paper-based questionnaires were successfully delivered and the final analysis included 1168 responses (overall response rate 58.4%). Mean age was 12.55 ± 1.24 years. Female gender (OR = 2.760, p = 0,006, CI 95% 0.065 to 0.384), younger age (11–12 years) (OR = 3.812, p < 0.001, 95% CI: 1.747–4.731), early exposure to the internet (OR = 3.466, p = 0.001, 95% CI 1.535–5.446), living in a small village (OR = 1.081, p = 0.002, 95% CI 1.041–1.186) urgency to answer online (OR = 4.677, p < 0.001, 95% CI: 2.714–6.639), decreased frequency of personal contact with friends (OR = 2.897, p = 0.004, 95% CI: 1.037–1.681), spending more than 6 h online (OR = 12.913, p < 0.001, 95% CI: 10.798–14.892), morning and nighttime internet use (OR = 3.846, p < 0.001, CI 95% 1.886–5.810) and never doing any sports (OR = 2.016, p = 0.044, 95% CI: 1.050–3.354) were independently associated with problematic internet use.

Conclusions

Based on the results of our questionnaire survey more than 10% seemed to be problematic users in our study population, which is a relatively high rate. Early exposure to the internet as well as younger age were strongly related to this phenomenon. Duration of being online as well as daily time interval of internet use are important predisposing factors. Scarcely studied social factors such as being online at the expense of personal relationships and the lack of physical activity should be payed more attention to prevent the development of PUI.
Muscle loss phenotype in COPD is associated with adverse outcomes in the UK Biobank
Authors: Attaway Amy H. , Lopez Rocio , Welch Nicole , Bellar Annette , Hatipoğlu Umur , Zein Joe , Engelen Marielle PKJ , Dasarathy Srinivasan
Published: April 2024

Background

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder with systemic consequences that can cause a muscle loss phenotype (MLP), which is characterized by the loss of muscle mass, muscle strength, or loss of both muscle and fat mass. There are limited data comparing the individual traits of MLP with clinical outcomes in a large unbiased cohort of COPD patients. Our aim was to determine the proportion of patients who met criteria for MLP in an unbiased sample of COPD patients at the population-level. We also determined if specific MLP features were associated with all-cause and COPD-related mortality.

Methods

A retrospective population-based cohort analysis of the UK Biobank was performed. COPD was defined by a FEV1/FVC ratio < 0.7, physician established diagnosis of COPD, or those with a COPD-related hospitalization before baseline assessment. MLP included one or more of the following: 1) Low fat-free mass index (FFMI) on bioelectric impedance analysis (BIA) or 2) Appendicular skeletal muscle index (ASMI) on BIA, 3) Low muscle strength defined by handgrip strength (HGS), or 4) Low muscle and fat mass based on body mass index (BMI). Cox regression was used to determine the association between MLP and all-cause or COPD-related mortality. All models were adjusted for sex, age at assessment, ethnicity, BMI, alcohol use, smoking status, prior cancer diagnosis and FEV1/FVC ratio.

Results

There were 55,782 subjects (56% male) with COPD followed for a median of 70.1 months with a mean(± SD) age at assessment of 59 ± 7.5 years, and FEV1% of 79.2 ± 18.5. Most subjects had mild (50.4%) or moderate (42.8%) COPD. Many patients had evidence of a MLP, which was present in 53.4% of COPD patients (34% by ASMI, 26% by HGS). Of the 5,608 deaths in patients diagnosed with COPD, 907 were COPD-related. After multivariate adjustment, COPD subjects with MLP had a 30% higher hazard-ratio for all-cause death and 70% higher hazard-ratio for COPD-related death.

Conclusions

Evidence of MLP is common in a large population-based cohort of COPD and is associated with higher risk for all-cause and COPD-related mortality.
Abnormal heart rate responses to exercise in non-severe COPD: relationship with pulmonary vascular volume and ventilatory efficiency
Authors: Shi Minghui , Qumu Shiwei , Wang Siyuan , Peng Yaodie , Yang Lulu , Huang Ke , He Ruoxi , Dong Feng , Niu Hongtao , Yang Ting , Wang Chen
Published: April 2024

Background

Despite being a prognostic predictor, cardiac autonomic dysfunction (AD) has not been well investigated in chronic obstructive pulmonary disease (COPD). We aimed to characterise computed tomography (CT), spirometry, and cardiopulmonary exercise test (CPET) features of COPD patients with cardiac AD and the association of AD with CT-derived vascular and CPET-derived ventilatory efficiency metrics.

Methods

This observational cohort study included stable, non-severe COPD patients. They underwent clinical evaluation, spirometry, CPET, and CT. Cardiac AD was determined based on abnormal heart rate responses to exercise, including chronotropic incompetence (CI) or delayed heart rate recovery (HRR) during CPET.

Results

We included 49 patients with FEV1 of 1.2–5.0 L (51.1–129.7%), 24 (49%) had CI, and 15 (31%) had delayed HRR. According to multivariate analyses, CI was independently related to reduced vascular volume (VV; VV ≤ median; OR [95% CI], 7.26 [1.56–33.91]) and low ventilatory efficiency (nadir VE/VCO2 ≥ median; OR [95% CI], 10.67 [2.23–51.05]). Similar results were observed for delayed HRR (VV ≤ median; OR [95% CI], 11.46 [2.03–64.89], nadir VE/VCO2 ≥ median; OR [95% CI], 6.36 [1.18–34.42]).

Conclusions

Cardiac AD is associated with impaired pulmonary vascular volume and ventilatory efficiency. This suggests that lung blood perfusion abnormalities may occur in these patients. Further confirmation is required in a large population-based cohort.
Additional suture augmentation to anterior cruciate ligament reconstruction with hamstring autografts bring no benefits to clinical results, graft maturation and graft-bone interface healing
Authors: Meng Qingyang , Dai Ruilan , Wang Cheng , Shi Weili , Jiang Yanfang , Liu Ningjing , Li Rui , Ao Yingfang , Gong Xi , Ma Yong
Published: April 2024

Background

From the perspective of graft protection and early rehabilitation during the maturation and remodeling phases of graft healing, suture augmentation (SA) for anterior cruciate ligament reconstruction (ACLR) has attracted more and more attention.

Study Design

Retrospective study.

Purpose

To determine whether the additional SA affects clinical results, graft maturation and graft-bone interface healing during two years follow-up after ACLR.

Methods

20 ACLRs with additional SA (ACLR-SA group) and 20 ACLRs without additional SA (ACLR group) were performed between January 2020 and December 2021 by the same surgeon and were retrospectively analyzed. Pre- and postoperative International Knee Documentation Committee (IKDC) scores, Lysholm scores, graft failure and reoperation were evaluated. The signal/noise quotient (SNQ) of autografts and the signal intensity of graft-bone interface were analyzed. All 40 patients in ACLR-SA group and ACLR group completed 2-years follow-up.

Results

There was no patient in the two cohorts experienced graft failure and reoperation. The postoperative IKDC and Lysholm scores have been significantly improved compared with preoperative scored in both ACLR-SA group and ACLR group, however, there was no significant difference between two groups. The SNQ of proximal graft of ACLR-SA group (14.78 ± 8.62 vs. 8.1 ± 5.5, p = 0.041) was significantly greater while the grades of graft-bone interface healing of posterior tibial was significantly lower than that of ACLR group at 1-year postoperatively (p = 0.03), respectively. There were no significant differences between the two groups of the SNQ of proximal, distal medial graft segments, and the graft-bone interface healing grades of anterior femoral, posterior femoral, anterior tibial and posterior tibial at other time points (p>0.05).

Conclusions

The additional SA in ACLR had no effect on IKDC scores, Lysholm scores, graft maturation and graft-bone interface healing at 2-year postoperatively. Our research does not support the routine use of SA in ACLR.
Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model
Authors: Mitrovic Mirjana , Pantic Nikola , Bukumiric Zoran , Sabljic Nikica , Virijevic Marijana , Pravdic Zlatko , Cvetkovic Mirjana , Ilic Nikola , Rajic Jovan , Todorovic-Balint Milena , Vidovic Ana , Suvajdzic-Vukovic Nada , Thachil Jecko , Antic Darko
Published: April 2024

Background

Patients with acute myeloid leukemia (AML) are at increased risk of venous thromboembolic events (VTE). However, thromboprophylaxis is largely underused.

Objectives

This study aimed to determine possible VTE development risk factors and to develop a novel predictive model.

Methods

We conducted a retrospective cohort study of adult patients with newly diagnosed AML. We used univariate and multivariable logistic regression to estimate binary outcomes and identify potential predictors. Based on our final model, a dynamic nomogram was constructed with the goal of facilitating VTE probability calculation.

Results

Out of 626 eligible patients with AML, 72 (11.5%) developed VTE during 6 months of follow-up. Six parameters were independent predictors: male sex (odds ratio [OR] 1.82, 95% confidence interval [CI]: 1.077–2.065), prior history of thrombotic events (OR 2.27, 95% CI: 1.4–4.96), international normalized ratio (OR 0.21, 95% CI: 0.05–0.95), Eastern Cooperative Oncology Group performance status (OR 0.71, 95% CI: 0.53–0.94), and intensive therapy (OR 2.05, 95% CI: 1.07–3.91). The C statistics for the model was 0.68. The model was adequately calibrated and internally validated. The decision-curve analysis suggested the use of thromboprophylaxis in patients with VTE risks between 8 and 20%.

Conclusion

We developed a novel and convenient tool that may assist clinicians in identifying patients whose VTE risk is high enough to warrant thromboprophylaxis.
Methods for health workforce projection model: systematic review and recommended good practice reporting guideline
Authors: Lee John Tayu , Crettenden Ian , Tran My , Miller Daniel , Cormack Mark , Cahill Megan , Li Jinhu , Sugiura Tomoko , Xiang Fan
Published: April 2024

Background

Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines.

Methods

We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858.

Results

Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand–supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements.

Conclusions

This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.
Integrated lipid metabolomics and proteomics analysis reveal the pathogenesis of polycystic ovary syndrome
Authors: Qian Yu , Tong Yun , Zeng Yaqiong , Huang Jingyu , Liu Kailu , Xie Ying , Chen Juan , Gao Mengya , Liu Li , Zhao Juan , Hong Yanli , Nie Xiaowei
Published: April 2024

Background

Polycystic ovary syndrome (PCOS) is an endocrinological and metabolic disorder that can lead to female infertility. Lipid metabolomics and proteomics are the new disciplines in systems biology aimed to discover metabolic pathway changes in diseases and diagnosis of biomarkers. This study aims to reveal the features of PCOS to explore its pathogenesis at the protein and metabolic level.

Methods

We collected follicular fluid samples and granulosa cells of women with PCOS and normal women who underwent in vitro fertilization(IVF) and embryo transfer were recruited. The samples were for the lipidomic study and the proteomic study based on the latest metabolomics and proteomics research platform.

Results

Lipid metabolomic analysis revealed abnormal metabolism of glycerides, glycerophospholipids, and sphingomyelin in the FF of PCOS. Differential lipids were strongly linked with the rate of high-quality embryos. In total, 144 differentially expressed proteins were screened in ovarian granulosa cells in women with PCOS compared to controls. Go functional enrichment analysis showed that differential proteins were associated with blood coagulation and lead to follicular development disorders.

Conclusion

The results showed that the differential lipid metabolites and proteins in PCOS were closely related to follicle quality,which can be potential biomarkers for oocyte maturation and ART outcomes.
Sexual health literacy level and its related factors among married medical sciences college students in an Iranian setting: a web‑based cross‑sectional study
Authors: Nematzadeh Samaneh , Shahhosseini Zohreh , Moosazadeh Mahmood , Hamzehgardeshi Zeinab
Published: April 2024

Background

Sexual health literacy (SHL) leads to the development of personal ability, understanding, evaluation and use of information related to sexual health. The purpose of this study was to assess the sexual health literacy level and its related factors among married college students at Mazandaran University of Medical Sciences (MAZUMS).

Methods

A web-based cross-sectional online study was conducted on married college students at Mazandaran University of Medical Sciences between January and November 2020. All students were included in the study by census, and the study method was explained by telephone. If they agreed to participate in the study, the online link to the questionnaire, including sociodemographic and clinical information and Sexual Health Literacy for Iranian Adults (SHELIA), was emailed. The Statistical Package for the Social Sciences (SPSS) software version 26 was used for data analysis. Univariate and multivariate logistic regression tests were used to assess factors related to sexual health literacy.

Results

The sample consisted of 277 male and 123 female students. Sexual Health Literacy Level and all subscales are at the sufficient level (66.1–88). Among the participants, 20.5% had limited sexual health literacy. Multivariate analysis found factors related to sexual health literacy among students: economic status (OR 0.03; 95% CI 0.0–0.55) and faculty (OR 0.07; 95% CI 0.01–0.52) is related to decrease and subscription to social media for sexual health (OR 3.27; 95% CI 1.53–7.01), information source of channels and cyberspace (OR 3.23; 95% CI 1.41–7.39), educational level (OR 16.39; 95% CI 2.16–32.70), Internet search information source (OR 1.91; 95% CI 1.00–3.64) is related to increase, were statistically significant factors.

Conclusion

In Iran, medical sciences college students, who constitute a significant portion of the country's population, are responsible for sexual health education. Government agencies, with the collaboration of all stakeholders, should develop policies and programs for implementing and evaluating integrated and comprehensive sexual health literacy promotion programs for them.
A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study
Authors: Ali Samir , Moors Xavier , van Schuppen Hans , Mommers Lars , Weelink Ellen , Meuwese Christiaan L. , Kant Merijn , van den Brule Judith , Kraemer Carlos Elzo , Vlaar Alexander P. J. , Akin Sakir , Lansink-Hartgring Annemiek Oude , Scholten Erik , Otterspoor Luuk , de Metz Jesse , Delnoij Thijs , van Lieshout Esther M. M. , Houmes Robert-Jan , Hartog Dennis den , Gommers Diederik , Dos Reis Miranda Dinis
Published: April 2024

Background

The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients.

Methods

The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months.

Discussion

The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment.

Trial registration

Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.
Outcomes of sentinel node biopsy according to MRI response in an association with the subtypes in cN1–3 breast cancer after neoadjuvant systemic therapy, multicenter cohort study
Authors: Bae Soong June , Chun Jung Whan , Lee Sae Byul , Ryu Jai Min , Nam Seok Jin , Jeong Joon , Park Hyung Seok , Ahn Sung Gwe
Published: April 2024

Background

This study investigated the feasibility of sentinel lymph node biopsy (SLNB) after neoadjuvant systemic therapy (NAST) in patients with initially high nodal burden.

Methods

In the multicenter retrospective cohort, 388 individuals with cN1–3 breast cancer who underwent NAST and had SLNB followed by completion axillary lymph node dissection were included. In an external validation cohort, 267 patients with HER2+ or triple-negative breast cancer (TNBC) meeting similar inclusion criteria were included. Primary outcome was the false-negative rates (FNRs) of SLNB according to the MRI response and subtypes. We defined complete MRI responders as patients who experienced disappearance of suspicious features in the breast and axilla after NAST.

Results

In the multicenter retrospective cohort, 130 (33.5%) of 388 patients were of cN2-3, and 55 (14.2%) of 388 patients showed complete MRI responses. In hormone receptor-positive HER2− (n = 207), complete and non-complete responders had a high FNRs (31.3% [95% CI 8.6–54.0] and 20.9% [95% CI 14.1–27.6], respectively). However, in HER2+ or TNBC (n = 181), the FNR of complete MRI responders was 0% (95% CI 0–0), whereas that of non-complete responders was 33.3% (95% CI 20.8–45.9). When we validated our findings in the external cohort with HER2+ or TNBC (n = 267), of which 34.2% were cN2-3, the FNRs of complete were 7.1% (95% CI 0–16.7).

Conclusions

Our findings suggest that SLNB can be a reliable option for nodal status evaluation in selected patients who have responded well to NAST, especially in HER2+ and TNBC patients who show a complete MRI response.
Inhibition of Foxp3 expression in the placenta of mice infected intraperitoneally by toxoplasma gondii tachyzoites: insights into the PPARγ/miR-7b-5p/Sp1 signaling pathway
Authors: Zhong Yue , Qin Cheng , Wang Qing , Ding Maoyuan , Qiu Chong , Xu Yunzhao , Chen Jinling
Published: April 2024

Background

Toxoplasma gondii, an obligate intracellular parasitic protozoa, infects approximately 30% of the global population. Contracting T. gondii at the primary infection of the mother can result in neonatal microcephaly, chorioretinitis, hydrocephalus, or mortality. Our previous study indicated that pregnant mice infected with T. gondii displayed a decrease in both the number and the suppressive ability of regulatory T cells, accompanied by the reduced Forkhead box P3 (Foxp3). Numerous studies have proved that microRNAs (miRNAs) are implicated in T. gondii infection, but there is meager evidence on the relationship between alterations of miRNAs and downregulation of Foxp3 induced by T. gondii.

Methods

Quantitative reverse transcription polymerase chain reaction was utilized to detect the transcriptions of miRNAs and Foxp3. Protein blotting and immunofluorescence were used to detect the expressions of Foxp3 and related transcription factors. The structure of mouse placenta was observed by hematoxylin and eosin (HE) staining.

To examine the activity of miR-7b promoter and whether miR-7b-5p targets Sp1 to suppress Foxp3 expression, we constructed recombinant plasmids containing the full-length/truncated/mutant miR-7b promoter sequence or wildtype/mutant of Sp1 3' untranslated region (3' UTR) to detect the fluorescence activity in EL4 cells.

Results

In T. gondii-infected mice, miR-7b transcription was significantly elevated, while Foxp3 expression was decreased in the placenta. In vitro, miR-7b mimics downregulated Foxp3 expression, whereas its inhibitors significantly upregulated Foxp3 expression. miR-7b promoter activity was elevated upon the stimulation of T. gondii antigens, which was mitigated by co-transfection of mutant miR-7b promoter lacking peroxisome proliferator-activated receptor γ (PPARγ) target sites. Additionally, miR-7b mimics diminished Sp1 expression, while miR-7b inhibitors elevated its expression. miR-7b mimics deceased the fluorescence activity of Sp1 3' untranslated region (3' UTR), but it failed to impact the fluorescence activity upon the co-transfection of mutant Sp1 3' UTR lacking miR-7b target site.

Conclusions

T. gondii infection and antigens promote miR-7b transcription but inhibit Foxp3 protein and gene levels. T. gondii antigens promote miR-7b promoter activity by a PPARγ-dependent mechanism. miR-7b directly binds to Sp1 3' UTR to repress Sp1 expression. Understanding the regulatory functions by which T. gondii-induced miR-7b suppresses Foxp3 expression can provide new perspectives for the possible therapeutic avenue of T. gondii-induced adverse pregnancy outcomes.

Graphical Abstract
Twenty-four hour physical activity, sedentary behaviour and sleep profiles in adults living with rheumatoid arthritis: a cross-sectional latent class analysis
Authors: Feehan Lynne , Xie Hui , Lu Na , Li Linda C.
Published: April 2024

Background

Rheumatoid Arthritis (RA), an autoimmune systemic inflammatory disease, affects more than 17 million people globally. People with RA have higher risk of premature mortality; often experience chronic fatigue, pain and disrupted sleep; and are less physically active and more sedentary than healthy counterparts. It remains unclear how people with RA may balance sleep and awake movement activities over 24-hours, or how differences in 24-hour behaviours may be associated with determinants of health, or alignment with published activity guidelines.

Methods

Cross-sectional exploration of objective measures of 24-hour sleep-wake activities in 203 people with RA. Latent Class Analysis (LCA) derived classes from time, by tertile, in six sleep-awake activities over 24 h. Comparisons of model fit statistics, class separation and interpretability defined best fit for number of classes. Variations in sleep-awake behaviour across classes and association of profile allocation with determinants of health, quality metrics for sleep, sitting and walking and alignment with published guidelines were explored. Multinomial logistic regression identified factors associated with likelihood of profile allocation.

Results

LCA identified 2 to 6 classes and a 4-class model was determined as best fit for 24-hour sleep-awake behaviour profiles. One profile (26%) presented with more balanced 24-hour sleep, sitting and walking behaviours. The other three profiles demonstrated progressively less balanced 24-hour behaviours including: having low (< 7 h), high (> 8 h), or recommended (7–8 h) sleep duration in respective combination with high sitting (> 10 h), limited walking (< 3 h) or both when awake. Age, existing sitting and walking habit strength and fatigue were associated with likelihood of belonging to different profiles. More balanced 24-hour behaviour was aligned with better quality metrics for sleep, sitting and walking and published guidelines.

Discussion

For people living with RA it is important to understand the ‘whole person’ and their ‘whole day’ to define who may benefit from support to modify 24-hour sleep-awake behaviours and which behaviours to modify. Supports should be informed by an understanding of personal or health-related factors that could act as barriers or facilitators for behavioural change, including exploring existing habitual sitting and walking behaviours.

Trial registrations

ClinicalTrials.gov ID: NCT02554474 (2015-09-16) and ClinicalTrials.gov ID: NCT03404245 (2018-01-11)
Point-of-Care 3-Dimensional–Printed Polyetheretherketone Customized Implants for Cranioplastic Surgery of Large Skull Defects
Authors: Pöppe Johannes P. , Spendel Mathias , Griessenauer Christoph J. , Gaggl Alexander , Wurm Werner , Enzinger Simon
Published: April 2024

BACKGROUND AND OBJECTIVES:

3-Dimensional (3D) printing has become a common tool to aid implant molding for cranioplastic surgery of large skull defects. Until now, 3D printing of cranial implants itself has not been used, mainly because of medicolegal concerns. With a 3D printer developed for printing medical applications and with implant-grade polyetheretherketone (PEEK) filament available, we established a workflow (in compliance with medical device regulations) to 3D print cranial implants for cranioplastic surgery directly at the point of care (POC). Here, we describe the implementation of 3D printing these PEEK implants for cranioplastic surgery at our academic hospital.

METHODS:

A thorough design and 3D printing process, in accordance with local medical device regulations, was developed. Implants are digitally designed based upon pre- and post-craniectomy cranial computed tomography scans by trained 3D printing experts from the department of medical engineering at our institution. Implants are then produced on a medical 3D printer with implant-grade PEEK filament using the fused filament fabrication process. After postprocessing and steam sterilization, implantation for reconstruction of the skull can be performed.

RESULTS:

Cranioplastic surgery with a 3D-printed PEEK implant was performed at our institution in a patient with a large frontotemporoparietal skull defect after traumatic brain injury with consecutive decompressive craniectomy. No intra- or post-operative complications occurred. Postoperative cranial computed tomography scans showed perfect reconstruction of precraniectomy skull shape. The aesthetic result was promising and satisfactory to the patient.

CONCLUSION:

This novel 3D printing workflow enables the production of patient-specific cranial implants from PEEK, to reconstruct large skull defects directly at the POC in accordance with the European Medical Device Regulation. This marks an unprecedented technological and legal advancement, enabling the hospital infrastructure not only to deliver the cranioplastic surgery itself, but also additive manufacturing of the implant directly at the POC.
COMUNICAÇÃO E COORDENAÇÃO EM EQUIPES VIRTUAIS DE DESENVOLVIMENTO DISTRIBUÍDO DE SOFTWARE
Authors: Severo Ricardo Augusto Niederauer Flores , Andrade Adrianne Paula Vieira de
Published: April 2024

O desenvolvimento de software é uma atividade desafiadora e em constante transformação. Atualmente, projetos de desenvolvimento de software contam com equipes distribuídas (Desenvolvimento Distribuído de Software - DDS). Tais projetos enfrentam desafios de comunicação e coordenação, os quais têm sido amplamente investigados na literatura. Todavia, ainda não houve uma compreensão clara dos desafios e das práticas específicos para diferentes tipos de arranjos de equipe em projetos de DDS. Portanto, realizou-se uma Revisão da Literatura do tipo Revisão de Escopo (ScR) embasada no PRISMA, com o objetivo de identificar os desafios, as práticas e os diferentes arranjos de equipes virtuais em DDS em 26 estudos. Foram identificados desafios e práticas em cinco dimensões (interações sociais; processos, eventos e mecanismos de colaboração; distâncias e diferenças; aspectos humanos; e aspectos organizacionais) que influenciam, de forma positiva ou negativa, a comunicação e a coordenação em projetos de DDS, além de quatro tipos de arranjos de equipes: colocalizada, distribuída, remota e hibrida. Conclui-se que a comunicação promove a coordenação em DDS, e que a adaptação de abordagens de gestão de projetos é necessária para o sucesso de tais projetos.
Intrinsic motivation between face-to-face and blended learning in surgical clinical education
Authors: Jawaid Masood , Masood Zubia , Imran Nazish
Published: April 2024

Objective: The variability and opportunistic nature of surgical clinical education is the main problem for effective teaching and training of medical students. Incorporating online mediums including discussion forums, interactive videos/scenarios, static pages, and quizzes is known as blended learning (BL). This study aimed to compare the intrinsic motivation of surgical students enrolled in blended learning to those enrolled in face-to-face teaching (f2f teaching).

Methods: A quasi-experimental, cross-over study was conducted in Surgical Unit-I and Surgical Unit-II of Dow University Hospital, Karachi, from March to August 2014. A total of 31 students participated and were exposed to two different teachings. For the first four weeks, Group A was posted in Surgical-I (f2f teaching) and Group B in Surgical-II (BL). Both groups were taught the same contents with the same schedule. The F2F group had clinical exposure to real patients, and small group discussions (SGDs) while The BL group students were exposed to an additional online learning component. Intrinsic Motivation Inventory (IMI) was administered at the end of four weeks and groups were swapped. Exchanged groups were again taught the same contents with the same schedule for another four weeks and IMI was administered.

Results: Fifty-eight students completed IMI; 28 in f2f and 30 in BL group. There was a significant difference in all four subscales of IMI between the two groups. In three subscales, students in BL were more motivated as compared to f2f (p<0.01). Students in f2f experienced more perceived tension than in BL (p<0.048).

Conclusion: This study concluded that blended surgical learning programs keep medical students more intrinsically motivated to learn. By utilizing online learning, superior educational opportunities for students can be cultivated. It can result in enhanced faculty effectiveness and efficiency as well.

doi: https://doi.org/10.12669/pjms.40.5.1048

How to cite this: Jawaid M, Masood Z, Imran N. Intrinsic motivation between face-to-face and blended learning in surgical clinical education. Pak J Med Sci. 2024;40(5):913-917. doi: https://doi.org/10.12669/pjms.40.5.1048

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.
Effect of Clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction: A retrospective single-center analysis
Authors: Huang Huiying , Zhang Shan , Du Hong , Guo Yonghua , Zheng Hui
Published: April 2024

Objective: To explore the effect of clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction (APCI).

Methods: We retrospectively analyzed the records of 190 patients with APCI admitted to Chengdu First People’s Hospital from September 2020 to April 2023. The records were divided into an aspirin group (76 cases), a clopidogrel group (72 cases), and a clopidogrel plus aspirin group (42 cases) according to the treatment records. We compared the efficacy of the three treatment outcomes by analyzing the National Institutes of Health Stroke Scale (NIHSS) scores, and the levels of serum inflammatory factors (IL-8, TNF-α, and IL-1β), cone like protein-1 (VILIP-1), and caveolin-1 (Cav-1).

Results: The total efficacy of the combination group (97.62%) was significantly higher than those of the aspirin group (73.68%) or the clopidogrel group (79.17%) (p<0.05). After treatment, the NIHSS scores, inflammatory factor levels, serum VILIP-1 and Cav-1 levels were significantly lower than those before treatment in the three groups, but all the levels were significantly lower in the combination group (all p<0.05).

Conclusions: Our results indicate that compared with aspirin alone or clopidogrel alone, the combination of aspirin and clopidogrel is more effective for the treatment of APCI. The combination regimen effectively lowers serum inflammatory factors (IL-8, TNF-α, and IL-1β), as well as the VILIP-1 and Cav-1 levels.

doi: https://doi.org/10.12669/pjms.40.5.9206

How to cite this: Huang H, Zhang S, Du H, Guo Y, Zheng H. Effect of Clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction: A retrospective single-center analysis. Pak J Med Sci. 2024;40(5):891-895. doi: https://doi.org/10.12669/pjms.40.5.9206

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.
Incidencia de los factores estratégicos, el empleo informal y el contexto macroeconómico en la supervivencia de firmas exportadoras industriales en economías emergentes
Authors: López González Cristina , López González Mauricio , Mesa Callejas Ramón Javier
Published: April 2024

Esta investigación usa un modelo de datos de panel para firmas exportadoras colombianas y peruanas de materias plásticas y manufacturas. Las estimaciones dan cuenta de mayores probabilidades de supervivencia en firmas que logran aumentar la gama de productos exportados, alcanzan niveles más altos de formalización laboral, venden en los mercados internacionales en forma continua y consiguen ampliar su participación global al aumentar los países a los cuales exportan. Adicionalmente, las firmas que operan en mercados altamente concentrados cuentan con probabilidades mayores de supervivencia, a diferencia de aquellas que pretenden ingresar en esas condiciones. El estudio permite observar la importancia de los factores estratégicos al momento de explicar la supervivencia exportadora y, al observarla como variable estadística, su forma de campana en relación con el poder o cuota de mercado.
Lectura crítica y filosofía: ¿mutua implicación?
Authors: Cárdenas Sánchez Ninfa Stella , Niño Castro Ángela Milena
Published: April 2024

Este capítulo asume como punto de partida que el problema al que se enfrenta la filosofía (en el contexto de la decisión del ICFES del año 2014) no radica en discutir si la filosofía o la lectura crítica son los temas centrales de la educación media. Esta disputa, afirman las autoras, antes que resolver el problema, termina distorsionándolo. En ese sentido, el trabajo señala que el verdadero problema que atraviesa toda la discusión es el de tratar de mostrar y hacer evidentes las múltiples implicaciones que existen entre la enseñanza de la filosofía y la lectura crítica, ya que, según las autoras, cuando se consideran como elementos aislados o independientes es cuando se cristalizan los mayores riesgos de las transformaciones educativas.
Can an artist be mature? Rorschach studies of prominent Polish actors
Authors: Mróz Barbara
Published: April 2024

Introduction: The peculiarities of being a prominent actor - the unity of the person and the work, recognition and significance - have made possible new and relevant from the point of view of personality and creativity psychology to analyze using the Rorschach method.
Objective: The purpose of the study was to assess the personality maturity, type of experiencing, social contacts of prominent Polish actors by means of a qualitative method.
Method: The Rorschach Test according to the American signing system of Z. Piotrowski. The study group consisted of 120 Polish actors: 40 outstanding Polish actors, also known in the world from international films or received awards (group A), 40 actors working in theaters in large cities (B), 40 actors employed in theaters in small cities(C). The groups were matched for age (M= 44.7 years, SD 9.31).
Results: Analysis of the level of differences in maturity proved statistically significant. The study showed indicators of rivalry, which can stimulate aggressive behavior, for example, but the overall profile indicates good adaptation and control of emotions. The psychogram was dominated by signatures indicating an ambidextrous, differentiated type of experiencing,signifying creative imagination, a tendency to reflect, which is at the same time balanced by external activity,good adaptation.
Discussion: The respondents' life activity is characterized by decisiveness, with a tinge of aggression. This attitude can be a cause conflicts with people who may be perceived as rivals, the results of other researchers also indicate.
Conclusions: The study of prominent actors using the Rorschach test was conducted for the first time on such a scale, providing many valuable findings.

Keywords: Rorschach Test, type of experiencing, emotional sphere, interpersonal relations
La sirena del Caribe
Authors: Ortega Jorge , Morelos-Martínez Mercedes , Gutiérrez Edgar G.
Published: April 2024

El manatí, reconocido por su carácter apacible, es un mamífero marino con hábitos herbívoros. Inicialmente, se le asoció con las sirenas debido a su aleta caudal distintiva. Hoy en día se enfrenta a desafíos y amenazas que subrayan la importancia de su conservación.