bluuebunny/crossref_metadata_2025 huggingface dataset:
Nomogram for predicting cancer-specific survival in undifferentiated pleomorphic sarcoma: A Surveillance, Epidemiology, and End Results -based study
Authors: Xu Fengshuo , Zhao Fanfan , Feng Xiaojie , Li Chengzhuo , Han Didi , Zheng Shuai , Liu Yue , Lyu Jun
Published: August 2021

Introduction

The purpose of this study was to construct and validate a nomogram for predicting cancer-specific survival (CSS) in undifferentiated pleomorphic sarcoma (UPS) patients at 3, 5, and 8 years after the diagnosis.

Methods

Data for UPS patients were extracted from the SEER (Surveillance, Epidemiology, and End Results) database. The patients were randomly divided into a training cohort (70%) and a validation cohort (30%). The backward stepwise Cox regression model was used to select independent prognostic factors. All of the factors were integrated into the nomogram to predict the CSS rates in UPS patients at 3, 5, and 8 years after the diagnosis. The nomogram’ s performance was then validated using multiple indicators, including the area under the time-dependent receiver operating characteristic curve (AUC), consistency index (C-index), calibration curve, decision-curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Results

This study included 2,009 UPS patients. Ten prognostic factors were identified after analysis of the Cox regression model in the training cohort, which were year of diagnosis, age, race, primary site, histological grade, T, N, M stage, surgery status, and insurance status. The nomogram was then constructed and validated internally and externally. The relatively high C-indexes and AUC values indicated that the nomogram has good discrimination ability. The calibration curves revealed that the nomogram was well calibrated. NRI and IDI values were both improved, indicating that our nomogram was superior to the AJCC (American Joint Committee on Cancer) system. DCA curves demonstrated that the nomogram was clinically useful.

Conclusions

The first nomogram for predicting the prognosis of UPS patients has been constructed and validated. Its usability and performance showed that the nomogram can be applied to clinical practice. However, further external validation is still needed.
A 10-year-old immunocompetent girl with endogenous fungal endophthalmitis: Report of a case and review of the literature
Authors: Guerriero Silvana , Dammacco Rosanna , Albano Valeria , Rizzo Tiziana , Cassano Flavio , Boscia Francesco , Alessio Giovanni
Published: August 2021

Endogenous Endophthalmitis (EE) is a rare cause of blindness in the pediatric age group and this may account for the paucity of management guidelines in the literature. In this report, we describe our experience with a 10-year-old immunocompetent female who developed EE and became blind because of rapidly progressive and destructive inflammatory changes in her eye in spite of seemingly timely treatment.
Characteristics of defect states in periodic railway track structure
Authors: Yi Qiang , Zhao Caiyou , Wang Ping
Published: August 2021

To overcome the ill-conditioned matrix problem of the traditional transfer matrix method, the Floquet transform method and supercell technology are used to study the defect states of the periodic track structure. By solving the equations of the supercell directly, the propagation characteristics of elastic waves in the track structure with defects are analyzed. The existence of defects destroys the periodicity of track structure, thus resulting in the formation of defect states within the band gaps. Moreover, the elastic wave is localized near the defect position at the frequency of the defect state. The formation mechanism of the defect state in track structure can be explained by the local resonance at the defect. With the expansion of the defect range, the number of local resonance modes that can be formed near the defect increases, thus generating multiple defect states. Furthermore, the defect state enhances the vibration of the structure adjacent to the defect. Therefore, the vibration transmission coefficient in a finite-length range can be used to detect the defect characteristics in the track structure, and the defect degree can be evaluated by the peak frequency of the vibration transmission coefficient within the band gap.
A probabilistic method for structural integrity assurance based on damage detection structural health monitoring data
Authors: Hey Leung Michael Siu , Corcoran Joseph
Published: August 2021

The value of using permanently installed monitoring systems for managing the life of an engineering asset is determined by the confidence in its damage detection capabilities. A framework is proposed that integrates detection data from permanently installed monitoring systems with probabilistic structural integrity assessments. Probability of detection (POD) curves are used in combination with particle filtering methods to recursively update a distribution of postulated defect size given a series of negative results (i.e. no defects detected). The negative monitoring results continuously filter out possible cases of severe damage, which in turn updates the estimated probability of failure. An implementation of the particle filtering method that takes into account the effect of systematic uncertainty in the detection capabilities of a monitoring system is also proposed, addressing the problem of whether negative measurements are simply a consequence of defects occurring outside the sensors field of view. A simulated example of fatigue crack growth is used to demonstrate the proposed framework. The results demonstrate that permanently installed sensors with low susceptibility to systematic effects may be used to maintain confidence in fitness-for-service while relying on fewer inspections. The framework provides a method for using permanently installed sensors to achieve continuous assessments of fitness-for-service for improved integrity management.
Maladaptive Beliefs of Young Adults in Interpersonal Relationships: A Systematic Literature Review
Authors: Araújo Eduardo , Cruz Olga Souza , Moreira Diana
Published: August 2021

Beliefs that are too rigid and misadjusted may legitimize interpersonal relationships marked by verbal, physical, or sexual violence. A systematic literature review was performed to identify the existence of maladaptive beliefs (MBs) in interpersonal relationships of young adults and their association with problematic behaviors. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, studies were obtained through a search in multiple databases: EBSCOhost, PubMed, and Web of Science. Of the 1,280 articles retrieved, 42 were retained for further analysis and 15 were considered eligible for inclusion. In addition, seven studies were added through manual search, leading to a final sample of 15 articles, published between 1964 and 2021. Only empirical studies with quantitative methodologies were included. Objectives, sample (age in years), sample type, country of origin of studies, instruments, control group, and results and main conclusions were extracted from each study. Results suggest the existence of MBs that may legitimize antisocial behavior and violence, whether physical, sexual, gender, domestic, or in intimate relationships. Some intervention programs were also identified, with different approaches with a reasonable degree of efficacy in changing these beliefs or in reducing the rates of recidivism by the aggressors.
How institutional doxa shapes access to higher education through framings of ‘potential’
Authors: Rainford Jon
Published: August 2021

Access to higher education is a global concern due to its dual role in transforming individual lives and value for global economic systems. However, pre-entry interventions to improve access often make comparatively little impact on who attends certain types of universities. Drawing upon a study that examined policy and practice relating to access to higher education conducted in 2016–2017 in England, this article furthers a theoretical discussion relating to the role institutional norms play in maintaining this status quo and why inequities endure especially in elite universities. In doing so, it highlights how institutional doxa can illuminate how taken-for-granted ideals shape policy and practice. This article theorises that institutional doxa shapes notions of who is seen as having ‘potential’, examines why doxic positions in relation to ‘potential’ endure and are rarely impacted by practices. This theorisation offers an important contribution to research on access to higher education as by foregrounding the central role played by these assumptions within marketised higher education systems this enables them to be challenged and deconstructed in order to effect meaningful progress on issues of access to higher education.
Professional Coping Strategies in a Temporal Perspective: A Pilot Study on How Swedish General Practitioners Deal With Challenges Inherent in Pain Management
Authors: Lundberg Tove , Melander Stina
Published: August 2021

The aim of this study was to explore how general practitioners cope with the challenges they face when trying to provide effective interventions to pain patients within the organizational context of a health center. Based on interviews with 15 Swedish providers, the study suggests that the challenges that general practitioners experience in the consultations with patients must be understood in a temporal perspective related to the process of care (from initial consultations to “post-treatment”) and the help-seeking process (close to the onset of problems or later). The coping strategies used to handle these challenges can be summarized into four major domains. First, participants adopted a biopsychosocial model to provide proper care. Second, they employed strategies to enhance communication. Third, they coped with the organizational environment, and fourth, they used strategies to cope emotionally. The study contributes to a holistic perspective on providers’ coping strategies by addressing temporal and organizational aspects.
Impacts of three glyphosate formulations on gonadal development of Xenopus laevis
Authors: Babalola Oluwaseun O , Truter J Christoff , van Wyk Johannes H
Published: August 2021

The emergence of widespread morphological malformations in the reproductive system of wildlife is generating increasing concerns. This concern is because the observed malformities may be linked to pollution by pesticides and other chemicals. The amphibian declines, for example, have been linked to pesticide pollution among other factors. Using an extended Xenopus Metamorphosis Assay protocol, until the tadpoles metamorphosized, the exposure impacts of three glyphosate formulations, namely, Roundup, Kilo Max and Enviro Glyphosate, were assessed on the reproductive system of Xenopus laevis, vis-a-vis the body mass, sex ratios and morphological malformations as endpoints. The exposure concentrations ranged between 0.2–0.6 mg/L, 0.9–28 mg/L and 90–280 mg/L for Roundup, Enviro Glyphosate, and Kilo Max, respectively. Both Kilo Max and Enviro Glyphosate formulations significantly reduced the body mass of the metamorphs compared to the control. In sex ratios, only Kilo Max altered the percentage sex ratio of the treated frogs at a ratio of 68:32 (F:M) compared to 50:50 ratio in the control. In reproductive malformations, the three formulations showed abnormality index range of 22.3–49%, 17.5–37.5% and 20–30% for the Kilo Max, Enviro Glyphosate and Roundup formulations, respectively, compared to 7.5% in the control. Observed reproductive malformations include mixed sex, translucence, aplasia, segmented hypertrophy and segmented aplasia and translucence. This result indicates that some of the glyphosate formulations have the capacity to cause widespread reproductive malformations in a way that could reduce the reproductive fitness of the amphibian. Care must therefore be taken to reduce the application rate of these formulations, particularly in aquatic environments.
Cryptogenic organising pneumonia: current understanding of an enigmatic lung disease
Authors: Raghu Ganesh , Meyer Keith C.
Published: August 2021

Organising pneumonia (OP) is currently recognised as a nonspecific lung injury response that is associated with a variety of imaging patterns obtained with high-resolution computed tomography (HRCT) of the chest and is characterised histopathologically by the presence of inflammatory cells and a connective tissue matrix within distal airspaces of the lungs. OP is associated with many conditions that include connective tissue disorders, various infections, drug reactions, hypersensitivity pneumonitis and aspiration. When OP cannot be linked to an associated condition and appears to be idiopathic, it is termed cryptogenic organising pneumonia.
rAAV9‐mediated supplementation of miR-29b improve angiotensin-II induced renal fibrosis in mice
Authors: Zhang Ju-hong , Li Jing , Ye Yang , Yu Wang-qi
Published: August 2021

Background

Renin–angiotensin–aldosterone system activation is the critical factor in renal remodeling and dysfunction. Our previous study suggested that miR-29b may attenuate AngII-induced renal intestinal fibrosis in vitro. In the present study, we aimed to determine whether recombinant rAAV9-mediated miR-29b delivery protects against AngII-induced renal fibrosis and dysfunction.

Method

Mice were treated with AngII via osmotic mini-pumps, or phosphate-buffered saline. rAAV9 vectors were produced using the rBac-based system in SF9 cells. rAAV9-miR-29b or rAAV9-control-miR was injected into the kidneys of mice subjected to the model of AngII infusion. The role of miR-29b in renal fibrosis was assessed using quantitative polymerase chain reaction, western blot, and histology.

Results

In AngII-induced fibrotic kidney tissue, miR-29b expression was downregulated. rAAV9-miR-29b delivery significantly reversed renal injury as indicated by decreased serum creatinine and injury related gene expression in AngII-infused mice. Regarding organ remodeling, tubulointerstitial fibrosis and deposition of extracellular matrix components such as collagen type I and type III were significantly decreased in renal tissue from mice delivered rAAV9-miR-29b.

Conclusion

Our results demonstrate great potential for use of rAAV9 as an applicable vector for delivery of miR-29b as an antifibrogenic factor for treatment of tubulointerstitial fibrosis-induced renal injury.
Effects of long-term nonylphenol exposure on myocardial fibrosis and cardiac function in rats
Authors: Liu Chao , Ni Chengyu , Liu Weichu , Yang Xiaolian , Zhang Renyi , Zhang Jianling , Luo Man , Xu Jie , Yu Jie
Published: August 2021

Background

Myocardial fibrosis is a critical pathological basis for the poor prognosis of cardiovascular diseases. Studies have found that myocardial fibrosis is closely associated with exposure to environmental estrogens such as nonylphenol (NP), as a representative of environmental estrogens. The aim of this study was to examine the effects of NP chronic exposure on myocardial fibrosis as well as cardiac structure and function. Forty Sprague–Dawley rats were randomly divided into four groups (n = 10): control group (C), low NP dose (0.4 mg/kg, L), medium NP dose (4 mg/kg, M), and high NP dose (40 mg/kg, H) groups. The NP dose groups were gavaged with NP for 180 days.

Results

The NP level in the heart of the NP groups was significantly higher than those in the control group (F = 43.658, P < 0.001). Serum aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isozyme (CK-MB), lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) significantly increased in the NP groups compared with the control group (P < 0.05). Histopathological examination of the heart biopsy illustrates that in the medium and high NP groups, the fibrous connective tissue had a disordered and loose gridding shape, muscle fibers had fractured, and muscle fibers were loose with a widened gap. Extensive inflammatory cell infiltration and fibroblast proliferation in the myocardial interstitium were also found. With increasing NP dose, the degree of muscle fiber loosing and disorder became more significant in the NP-treatment groups, and the collagen volume fraction (CVF) was higher than that in the control group (P < 0.01). Compared with the control group, the expression of collagen I and collagen III increased significantly in the medium and high NP groups (P < 0.05). The values of the systolic thickness of the left ventricular anterior wall (LVAWs), the diastolic thickness of the left ventricular posterior wall (LVPWd), the systolic thickness of the left ventricular posterior wall (LVPWs), and the left ventricular anterior wall (LVAWd) in the NP groups are were slightly lower than those in of the control group. The values of left ventricular end systolic dimensions (LVIDs) in the NP groups increased compared with the control group.

Conclusions

Long-term NP exposure could lead to fibrosis in the rat myocardium, which is characterized by increased expressions of myocardial collagen I and collagen III, as well as elevated cardiac enzymes. In addition, the cardiac structure was affected and changes were observed in the thinner ventricular wall and as an enlarged ventricular cavity.
Cost of septic and aseptic revision total knee arthroplasty: a systematic review
Authors: Okafor Charles , Hodgkinson Brent , Nghiem Son , Vertullo Christopher , Byrnes Joshua
Published: August 2021

Background

The increasing incidence of primary total knee arthroplasty (TKA) has led to an increase in both the incidence and the cost burden of revision TKA procedures. This study aimed to review the literature on the cost of revision TKA for septic and aseptic causes and to identify the major cost components contributing to the cost burden.

Methods

We searched MEDLINE (OvidSp), Embase, Web of Science, Cochrane Library, EconLit, and Google Scholar to identify relevant studies. Selection, data extraction and assessment of the risk of bias and cost transparency within the studies were conducted by two independent reviewers, after which the cost data were analysed narratively for 1- or 2-stage septic revision without re-revision; 2-stage septic revision with re-revision; and aseptic revision with and without re-revision, respectively. The major cost components identified in the respective studies were also reported.

Results

The direct medical cost from the healthcare provider perspective for high-income countries for 2-stage septic revision with re-revision ranged from US$66,629 to US$81,938, which can be about 2.5 times the cost of 1- or 2-stage septic revision without re-revision, (range: US$24,027 – US$38,109), which can be about double the cost of aseptic revision without re-revision (range: US$13,910 – US$29,213). The major cost components were the perioperative cost (33%), prosthesis cost (28%), and hospital ward stay cost (22%).

Conclusions

Septic TKA revision with re-revision for periprosthetic joint infection (PJI) increases the cost burden of revision TKA by 4 times when compared to aseptic single-stage revision and by 2.5 times when compared to septic TKA revision that does not undergo re-revision. Cost reductions can be achieved by reducing the number of primary TKA that develop PJI, avoidance of re-revisions for PJI, and reduction in the length of stay after revision.

Trial registration

PROSPERO;CRD42020171988.
Effects of mechanical strain on periodontal ligament fibroblasts in presence of Aggregatibacter actinomycetemcomitans lysate
Authors: Schröder Agnes , Stumpf Julia , Paddenberg Eva , Neubert Patrick , Schatz Valentin , Köstler Josef , Jantsch Jonathan , Deschner James , Proff Peter , Kirschneck Christian
Published: August 2021

Purpose

Many adult orthodontic patients suffer from periodontitis, which is caused by oral pathogens such as the gram-negative Aggregatibacter actinomycetemcomitans (Agac). Like orthodontic tooth movement, periodontitis is associated with inflammation and alveolar bone remodelling thereby affecting orthodontic treatment. Interactions of both processes, however, are not sufficiently explored, particularly with regard to oxidative stress.

Methods

After preincubation with Agac lysate for 24 h periodontal ligament fibroblasts (PDLF) were either stretched or compressed for further 48 h simulating orthodontic forces in vitro. We analysed the expression of genes and proteins involved in the formation of reactive oxygen species (NOX-4, ROS) and nitric oxide (NOS-2), inflammation (TNF, IL-6, PTGS-2) and bone remodelling (OPG, RANKL).

Results

Agac lysate elevated the expression of NOX-4, NOS-2, inflammatory IL-6 and PTGS-2 and the bone-remodelling RANKL/OPG ratio during compressive, but not tensile mechanical strain. Agac lysate stimulated pressure-induced inflammatory signalling, whereas surprisingly ROS formation was reduced. Pressure-induced downregulation of OPG expression was inhibited by Agac lysate.

Conclusions

Agac lysate impact on the expression of genes and proteins involved in inflammation and bone remodelling as well as ROS formation, when PDLF were subjected to mechanical forces occurring during orthodontic tooth movement.
The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study
Authors: Holmström Inger K. , Kaminsky Elenor , Lindberg Ylva , Spangler Douglas , Winblad Ulrika
Published: August 2021

Background

Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure – and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses’ views about managing difficult calls to emergency medical dispatch centres.

Methods

A descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted.

Results

Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected.

Conclusion

The registered nurses’ descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.
Treatment outcomes of passive scattering proton beam therapy for stage I non-small cell lung cancer
Authors: Bayasgalan Unurjargal , Moon Sung Ho , Jeong Jong Hwi , Kim Tae Hyun , Cho Kwan Ho , Suh Yang-Gun
Published: August 2021

Introduction

To investigate the treatment outcomes of passive scattering proton beam therapy using stereotactic ablative radiotherapy (SABR) or hypofractionated radiation therapy (RT) for inoperable patients or those who refused surgery for stage I non-small cell lung cancer (NSCLC).

Methods

From January 2016 to December 2019, we retrospectively analyzed 42 patients with stage I NSCLC treated with proton beam therapy. The initially intended dose regimen was 60 cobalt Gray equivalents (CGE) in 4 fractions; however, sequentially modified dose regimens were used when the dose-volume constraints could not be met. The median total dose was 50 CGE (range 50–70 CGE), while the corresponding median biologically effective dose using $$\alpha{/}\beta$$

α
/
β

= 10 (BED10) was 112.5 CGE (range 96–150 CGE).

Results

The median follow-up time was 40 months (interquartile range 32–48 months). Among the 42 treated patients, 33 had pathologically proven cancers of which most were adenocarcinoma (n = 21, 64%). The 3-year overall survival rate was 71.8%. The estimated rates of local control and progression free survival at 3 years were 91.5% and 66.9%, respectively. Thirteen patients experienced disease progression consisting of three local, six regional, and nine distant failures. No grade 4 or 5 toxicities were observed.

Conclusion

Passive scattering proton beam therapy for stage I NSCLC using SABR or hypofractionated RT was safe and showed high LC rates.
SIRT1 regulates the phosphorylation and degradation of P27 by deacetylating CDK2 to promote T-cell acute lymphoblastic leukemia progression
Authors: Wang Fangce , Li Zheng , Zhou Jie , Wang Guangming , Zhang Wenjun , Xu Jun , Liang Aibin
Published: August 2021

Background

Despite marked advances in the clinical therapies, clinical outcome of most T-cell acute lymphoblastic leukemia (T-ALL) patients remains poor, due to the high risk of relapse, even after complete remission. Previous studies suggest that the NAD-dependent deacetylase sirtuin 1 (SIRT1) has a dual role in hematologic malignancies, acting as a tumor suppressor or tumor promoter depending on the tumor type. However, little is known about the expression and functions of SIRT1 in T-ALL leukemogenesis.

Methods

Public RNA-seq data, a Notch1 driven T-ALL mouse model and γ-secretase inhibitor were used to identify SIRT1 expression in T-ALL. We knocked down SIRT1 expression with ShRNAs and assessed the impacts of SIRT1 deficiency on cell proliferation, colony formation, the cell cycle and apoptosis. Transgenic SIRT1 knockout mice were used to determine the function of SIRT1 in vivo. RT-PCR, western blot, co-immunoprecipitation and ubiquitination analyses were used to detect SIRT1, p27 and CDK2 expression and their interactions.

Results

SIRT1 protein expression was positively correlated with the activation of Notch1. Downregulation of SIRT1 expression suppressed the proliferation and colony formation of T-ALL cell lines, which was reversed by SIRT1 overexpression. SIRT1 silencing prolonged the lifespan of T-ALL model mice. We demonstrated that p27 was involved in the downstream mechanism of cell cycle arrest induced by silencing SIRT1. SIRT1 increased the phosphorylation of p27 on Thr187 by deacetylating CDK2 and enhanced the interaction between p27 and SKP2 leading to the degradation of p27.

Conclusion

Our findings suggest that SIRT1 is a promising target in T-ALL and offer a mechanistic link between the upregulation of SIRT1 and downregulation of p27.
An evaluation of the process of informed consent: views from research participants and staff
Authors: O’ Sullivan Lydia , Feeney Laura , Crowley Rachel K. , Sukumar Prasanth , McAuliffe Eilish , Doran Peter
Published: August 2021

Background

The process of informed consent for enrolment to a clinical research study can be complex for both participants and research staff. Challenges include respecting the potential participant’s autonomy and information needs while simultaneously providing adequate information to enable an informed decision. Qualitative research with small sample sizes has added to our understanding of these challenges. However, there is value in garnering the perspectives of research participants and staff across larger samples to explore the impact of contextual factors (time spent, the timing of the discussion and the setting), on the informed consent process.

Methods

Research staff and research participants from Ireland and the UK were invited to complete an anonymous survey by post or online (research participants) and online (research staff). The surveys aimed to quantify the perceptions of research participants and staff regarding some contextual factors about the process of informed consent. The survey, which contained 14 and 16 multiple choice questions for research participants and staff respectively, was analysed using descriptive statistics. Both surveys included one optional, open-ended question, which were analysed thematically.

Results

Research participants (169) and research staff (115) completed the survey. Research participants were predominantly positive about the informed consent process but highlighted the importance of having sufficient time and the value of providing follow-up once the study concludes, e.g. providing results to participants. Most staff (74.4%) staff reported that they felt very confident or confident facilitating informed consent discussions, but 63% felt information leaflets were too long and/or complicated, 56% were concerned about whether participants had understood complex information and 40% felt that time constraints were a barrier. A dominant theme from the open-ended responses to the staff survey was the importance of adequate time and resources.

Conclusions

Research participants in this study were overwhelmingly positive about their experience of the informed consent process. However, research staff expressed concern about how much participants have understood and studies of patient comprehension of research study information would seem to confirm these fears. This study highlights the importance of allocating adequate time to informed consent discussions, and research staff could consider using Teach Back techniques.

Trial Registration

Not applicable
Humeral metastasis as the only recurrence of a 5-year resected gastrointestinal stromal tumor: a case report
Authors: Braunstein C. , Sirveaux F. , Kalbacher E. , Aubry S. , Delroeux D. , Hubert P. , Marie B. , Meynard G. , Mihai I. , Chaigneau L.
Published: August 2021

Introduction

Gastrointestinal stromal tumors represent the most frequently encountered primary mesenchymal tumors. Whereas the liver and the peritoneum are known to be the preferential metastasis sites, no therapeutic standard has yet been established for the management of bone metastases because of their very low incidence. We report a unique example of a single humerus metastasis of a jejunal gastrointestinal stromal tumor.

Case presentation

We report the case of a 72-year-old European woman whose jejunal gastrointestinal stromal tumor was resected in 2013 and treated during the following 3 years with imatinib (400 mg daily). In 2018, she developed a single humeral bone lesion that was identified as a gastrointestinal stromal tumor metastasis. After 7 months of imatinib intake, reconstructive surgery was performed. Pathologists confirmed the satisfactory histological regression and assessed the complete tumor resection. The patient is still on imatinib maintenance therapy, with no recurrence reported so far. She fully recovered the upper limb function after following an appropriate rehabilitation program.

Discussion

Current literature and published case reports indicate that bones are one of the rarest locations of gastrointestinal stromal tumor metastasis (about 1%), with occurrence mainly in the spine. Patients initially diagnosed with gastrointestinal stromal tumor of the small intestine and stomach are more likely to suffer from bone metastasis, compared with other gastrointestinal stromal tumor locations. The median overall survival rate is higher for patients with isolated bone metastasis compared with those having liver metastasis. Metastasis occurs on average 4 years after the primary, but it may take up to 20 years, emphasizing the need for long-term clinical and radiological monitoring. Although specific guidelines for such cases have not yet been established, we suggest that a multimodal concerted approach involving surgery or radiotherapy associated with tyrosine kinase inhibitor intake should be considered.

Conclusion

Bones are one of the rarest locations of gastrointestinal stromal tumor metastasis. A multidisciplinary collaboration was set up to allow conservative surgery of our patient after several months of imatinib treatment. A year and a half later, the patient is still in complete remission. This specific case supports the concept of an intermediate stage between local and oligometastatic disease that should be managed with a curative aim, as much as possible.
Syntax-based transfer learning for the task of biomedical relation extraction
Authors: Legrand Joël , Toussaint Yannick , Raïssi Chedy , Coulet Adrien
Published: August 2021

Background

Transfer learning aims at enhancing machine learning performance on a problem by reusing labeled data originally designed for a related, but distinct problem. In particular, domain adaptation consists for a specific task, in reusing training data developedfor the same task but a distinct domain. This is particularly relevant to the applications of deep learning in Natural Language Processing, because they usually require large annotated corpora that may not exist for the targeted domain, but exist for side domains.

Results

In this paper, we experiment with transfer learning for the task of relation extraction from biomedical texts, using the TreeLSTM model. We empirically show the impact of TreeLSTM alone and with domain adaptation by obtaining better performances than the state of the art on two biomedical relation extraction tasks and equal performances for two others, for which little annotated data are available. Furthermore, we propose an analysis of the role that syntactic features may play in transfer learning for relation extraction.

Conclusion

Given the difficulty to manually annotate corpora in the biomedical domain, the proposed transfer learning method offers a promising alternative to achieve good relation extraction performances for domains associated with scarce resources. Also, our analysis illustrates the importance that syntax plays in transfer learning, underlying the importance in this domain to privilege approaches that embed syntactic features.
The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial
Authors: Yang Yang , Li Yuling , Zhang Haibin , Xu Yong , Wang Binquan
Published: August 2021

Background

Functional endoscopic sinus surgery (FESS) is required to minimize bleeding to maintain a clear operative field during surgery, so it is important to preoperative anti-anxiety and stable hemodynamics. Initial evidence suggests cognitive behavioral therapy (CBT) is effective to minimize surgery-related stress and to speed up recovery. The study aimed to evaluate the efficacy of a newly developed computer-assisted CBT (cCBT) program on surgery-related psychobiological responses in patients undergoing FESS.

Methods

Participants were allocated to a CCBT group (cCBT; n = 50) or a UC group (usual care; n = 50) by random number table. The State Anxiety Inventory (SAI), Patients Health Questionnaire-9 (PHQ-9), Athens Insomnia Scale (AIS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were assessed before intervention (T1), at 1 h before operation (T2), at postoperative 48 h (T3), and 96 h (T4: after intervention completed) respectively. The stress hormone was assayed at T1 and T2. The duration of surgery, anesthesia, and post-anesthesia care unit (PACU) were recorded. A satisfaction survey about nursing services was completed by participants before discharge.

Results

Compared to the UC group, the SAI scores at T2 and the AIS scores at T3 were lower in the CCBT group (p < 0.01 and p = 0.002). The positive rate of participants who were moderate and severe anxiety (SAI score > 37) at T2 were lower (72% vs. 88%, p = 0.04); the cortisol levels, SBP, DBP, and HR at T2 in the CCBT group were lower (p = 0.019 and all p < 0.01); the duration of anesthesia and PACU was shorter (p = 0.001 and p < 0.01); the CCBT group showed higher satisfaction scores.

Conclusion

The newly developed cCBT program was an effective non-pharmacological adjunctive treatment for improving the surgery-related psychosomatic responses and perioperative outcomes.

Trial registration

The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025994) on 17 September 2019.
Mental health groups in high school students and later school dropout: a latent class and register-based follow-up analysis of the Danish National Youth Study
Authors: Andersen Susan , Davidsen Michael , Nielsen Line , Tolstrup Janne S.
Published: August 2021

Background

Mental health represents an important public health issue, and mental health problems have been linked to school dropout. This study aimed to identify mental health groups of high school students using both positive and negative aspects of mental health and to examine whether these mental health groups longitudinally predict school dropout.

Methods

We conducted latent class analysis using the Danish National Youth Study 2014 (n = 60,526; mean 17.9 years) to identify clustering of mental health (11 items covering positive and negative aspects of emotional wellbeing and functioning in daily life), separately by sex. The relationship with subsequent school dropout was examined using logistic regression models, adjusted for age, ethnicity and socioeconomic status. Information on dropout status was obtained through educational registers.

Results

School dropout rates was highest among first-year students. Four mental health groups were identified: Flourishing (females: 38%, males: 55%), moderate mental health (females: 15%, males: 20%), emotionally challenged (females: 28%, males: 15%) and languishing (females: 19%, males: 10%). Compared to the flourishing group, adjusted odds ratio (AOR) for dropout were 3.43 (95% CI: 2.98, 3.95), 1.73 (95% CI: 1.45, 2.06) and 1.76 (95% CI: 1.52, 2.04) in the languishing, moderate mentally healthy and emotional challenged females. Results in males were comparable.

Conclusions

Mental health in high school students cluster together in four categories among both males and females. Students who are languishing, emotionally challenged or moderate mentally healthy have about 1.5-fold to threefold higher risk of dropping out of high school compared with flourishing students. Universal mental health interventions may be a promising strategy, particularly in the first year of high school where most students drop out of school.
Co-infection with Legionella and SARS-CoV-2: a case report
Authors: Shimizu Masaru , Chihara Yusuke , Satake Sakiko , Yone Astuko , Makio Mari , Kitou Hideki , Takeda Tomohiro
Published: August 2021

Introduction

We report a case of COVID-19 with Legionella co-infection that was treated successfully.

Case report

A 73-year-old man presented to the hospital with symptoms of fatigue that continued for the next 5 days. The patient was receiving docetaxel and prednisolone chemotherapy for prostate cancer. Laboratory findings on admission showed positive urine Legionella antigen test and SARS-CoV-2 test. He was administered antiviral and antibacterial agents, and a corticosteroid. Pneumonia exacerbated on day 2 of hospitalization. The patient underwent tracheal intubation and began receiving multidisciplinary care. On day 8 of hospitalization, his oxygenation improved, and the patient was extubated. He discharged on day 27 of hospitalization.

Conclusions

The patient had a favorable outcome with early diagnosis and early treatment of both diseases. Patients with severe COVID-19 disease need to be evaluated for co-infection. Further, early diagnosis and early treatment of the microbial bacteria causing the co-infection are important.
Calcineurin-nuclear factor for activated T cells (NFAT) signaling in pathophysiology of wound healing
Authors: Manabe Takahiro , Park Heamin , Minami Takashi
Published: August 2021

Wound healing occurred with serial coordinated processes via coagulation-fibrinolysis, inflammation following to immune-activation, angiogenesis, granulation, and the final re-epithelization. Since the dermis forms critical physical and biological barriers, the repair system should be rapidly and accurately functioned to keep homeostasis in our body. The wound healing is impaired or dysregulated via an inappropriate microenvironment, which is easy to lead to several diseases, including fibrosis in multiple organs and psoriasis. Such a disease led to the dysregulation of several types of cells: immune cells, fibroblasts, mural cells, and endothelial cells. Moreover, recent progress in medical studies uncovers the significant concept. The calcium signaling, typically the following calcineurin-NFAT signaling, essentially regulates not only immune cell activations, but also various healing steps via coagulation, inflammation, and angiogenesis. In this review, we summarize the role of the NFAT activation pathway in wound healing and discuss its overall impact on future therapeutic ways.
Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial
Authors: Teupen Sonja , Holle Daniela , Roes Martina
Published: August 2021

Background

Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result.

Methods

This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis.

Results

The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention.

Conclusion

The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations.
The current state of mental healthcare in Bangladesh: part 1 – an updated country profile
Authors: Hasan M. Tasdik , Anwar Tasnim , Christopher Enryka , Hossain Sahadat , Hossain Md Mahbub , Koly Kamrun Nahar , Saif-Ur-Rahman K. M. , Ahmed Helal Uddin , Arman Nazish , Hossain Saima Wazed
Published: August 2021

Mental health is a significant factor for a sound and productive life; nevertheless, mental disorders do not often receive adequate research attention and are not addressed as a serious public health issue in countries such as Bangladesh. Part 1 of this two-part profile describes the current situation of mental health in Bangladesh in its wider sociocultural context, outlining existing policies and highlighting mental illness as a neglected healthcare problem in the country using a narrative synthesis method. The prevalence of mental disorders is very high and augmented in nature among different population groups in Bangladesh. A lack of public mental health facilities, scarcity of skilled mental health professionals, insufficient financial resource distribution, inadequately stewarded mental health policies and stigma contribute to making current mental healthcare significantly inadequate in Bangladesh. The country has few community care facilities for psychiatric patients. Furthermore, the current mental health expenditure by the Bangladeshi government is only 0.44% of the total health budget. Less than 0.11% of the population has access to free essential psychotropic medications.
Physical Activity Patterns and Relationships With Cognitive Function in Patients With Breast Cancer Before, During, and After Chemotherapy in a Prospective, Nationwide Study
Authors: Salerno Elizabeth A. , Culakova Eva , Kleckner Amber S. , Heckler Charles E. , Lin Po-Ju , Matthews Charles E. , Conlin Alison , Weiselberg Lora , Mitchell Jerry , Mustian Karen M. , Janelsins Michelle C.
Published: August 2021

PURPOSE

Physical activity (PA) is a promising intervention for cancer-related cognitive decline, yet research assessing its use during chemotherapy is limited. This study evaluated patterns of PA before, during, and after chemotherapy in patients with breast cancer and the association between PA and cognitive function.

METHODS

In a nationwide, prospective cohort study, we assessed PA (Aerobics Center Longitudinal Study PA measure) and perceived and objectively measured cognitive functioning (Functional Assessment of Cancer Therapy–Cognitive, Delayed Match to Sample, and Rapid Visual Processing measures) at prechemotherapy (T1), postchemotherapy (T2), and 6 months postchemotherapy (T3) in patients with breast cancer and cancer-free, age-matched controls at equivalent time points. Longitudinal linear mixed-effects models (LMMs) characterized PA changes over time between patients and controls, adjusting for demographic and clinical factors. LMMs further estimated the role of prechemotherapy PA and changes in PA during chemotherapy on cognitive changes over time.

RESULTS

Patients with stage I-IIIC breast cancer (n = 580; age M [standard deviation] = 53.4 [10.6] years) and controls (n = 363; age M [standard deviation] = 52.6 [10.3] years) were included. One third of patients met national PA guidelines at T1, dropping to 21% at T2 before rising to 37% at T3. LMMs revealed declines in PA from T1 to T2 in patients compared with controls (all P < .001). Patients meeting guidelines at T1 demonstrated better cognitive scores over time on the Functional Assessment of Cancer Therapy–Cognitive and Rapid Visual Processing (all P < .05), with similar patterns of objectively-measured cognitive function as controls. In patients, greater moderate-to-vigorous PA at the previous time point was significantly associated with better cognitive trajectories (all P < .05), and adherence to PA guidelines throughout chemotherapy was associated with better self-reported cognition ( P < .01).

CONCLUSION

This nationwide study demonstrates that PA maintenance before and during chemotherapy is associated with better cognitive function immediately and 6 months after chemotherapy completion.