bluuebunny/crossref_metadata_2025 huggingface dataset:
All devices are not created equal: Simultaneous data collection of three triaxial accelerometers sampling at different frequencies
Authors: Gruber Allison H , Marotta Luca , McDonnell James , Reenalda Jasper
Published: December 2022

The surge of wearable device technology has enabled out-of-the-lab collection of running gait data for commercial, clinical, and coaching applications. However, low sampling frequencies interfere with measuring peak acceleration magnitudes accurately, and the ability to track relative changes during a prolonged run with lower sampling devices is unknown. The purposes of this study were to compare peak resultant acceleration measured simultaneously at different sampling frequencies and evaluate if different sampling frequencies could track similar relative changes in peak acceleration over a 20-min treadmill run. Seventeen participants ran on a treadmill at a self-selected, “easy” pace for 20-min (mean ± SD = 2.6 ± 0.4 m s−1). Three research-grade, triaxial accelerometers (“HiRes” = 1200 Hz, “MedRes” = 462 Hz, and “LoRes” = 100 Hz) were secured to each of three anatomical locations (tibia, low-back, forehead). Mean peak resultant accelerations from each device during minutes 3 to 18 were compared within each location (linear mixed model, α = 0.050). No significant device by timepoint interaction was observed ( p > 0.999). A significant main effect of sampling frequency at all three locations (HiRes > MedRes > LoRes; p < 0.001) confirmed the underestimation of low sampling frequencies on peak resultant acceleration. However, the significant main effect of time indicated that peak resultant acceleration changed similarly over time between sampling frequencies at the tibia ( p = 0.010) and head ( p = 0.002), but not the low-back ( p = 0.318). Downsampling HiRes to 400 and 100 Hz reduced the underestimation of the resultant peaks within the MedRes and LoRes signals by <7.7% across anatomical locations. This study confirms sampling frequency of wearable devices significantly affects peak resultant acceleration and demonstrates these effects are greater for signals captured at lower sampling frequencies and caudal locations. Despite these effects, this study cautiously supports the use of ≥100 Hz sampling frequencies for within-individual peak resultant acceleration tracking during “easy” prolonged runs for research, clinical, and coaching applications.
Diagnostic Value and Clinical Application of Nasal Fractional Exhaled Nitric Oxide in Subjects with Allergic Rhinitis
Authors: Abdullah Alwi Aishah Harizah , Zahedi Farah Dayana , Husain Salina , Wan Hamizan Aneeza Khairiyah , Abdullah Baharudin
Published: December 2022

Purpose

Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients.

Methods

The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment.

Results

One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control ( p < 0.001). Both the subjective (VAS and NOSE), both ( p  < 0.01) and objective (nasal FeNO, p < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve.

Conclusion

Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR.
Attitude-Behavior Relation and Language Use: Chinese-English Code-Switching and Code-Mixing Among Chinese Undergraduate Students
Authors: Moradi Hamzeh , Chen Jianbo
Published: December 2022

The socio-psychological variables that affect bilinguals’ choices of code-switching (CS) and code-mixing (CM) as a verbal strategy make prediction of their occurrence almost impossible. This research investigates the social motivations and socio-pragmatic aspects of Chinese-English CS/CM among Chinese undergraduate students. Using a questionnaire survey and interviews, the paper investigates attitude-behavior relations by considering patterns of language use and CS/CM patterns between Chinese and English in this group. The results demonstrate that the participants’ highly positive attitudes toward English and the CS/CM process play a major role in CS/CM use in their daily interactions. Chinese-English bilingual students draw on their proficiency and knowledge of the two language systems to precisely and effectively convey their thoughts, intentions, experiences, solidarity, emphasis, and other aspects that affect interaction outcomes.
Sociocultural Costs of the Long-term COVID-19 Outbreak in Bangladesh: A Systematic Review
Authors: Chanda Sanjoy Kumar , Kabir Md. Ripul , Roy Tuhin , Shohel Tunvir Ahamed , Howlader Md. Hasan , Razu Shaharior Rahman
Published: December 2022

Beyond the physical transmission of COVID-19, the pandemic has had far-reaching consequences in Bangladesh, including social and cultural implications. This review paper aimed at identifying and synthesizing the costs of COVID-19 on sociocultural issues in Bangladesh. For this purpose, we conducted a systematic search in MEDLINE, PubMed, ProQuest, Web of Science, Scopus and Google Scholar up to August 2021. Studies related to the costs of COVID-19 were identified, tabulated, analyzed, and synthesized by using a thematic approach. Our final synthesis of 19 studies resulted in five analytical themes: (i) disruption in education, (ii) loss of everyday social interaction, (iii) increase of “new poor” and suicide, (iv) rise of violence against women, and (v) worsening the life of refugees. Our findings showed that the costs of disruption in education, loss of everyday social interaction, and increase of “new poor” and suicide were more evident. Finally, we recommend the government and the community to adopt some integrated actions and policies to combat the problems in improving Bangladeshi sociocultural situations.
Analysis of Additional Degrees in Academic Plastic Surgery Faculty
Authors: Chawla Sahil , Faheem Sarim , Moreton Michael L. , Sekhon Amardeep , Amornteerasawas Orapin M. , Ding Jeffrey , Khosa Faisal
Published: December 2022

Background: As plastic surgery continues to evolve, an increasing number of surgeons are attaining additional degrees (ADs). Prior studies illustrate this trend of increased AD attainment among plastic surgery faculty within the United States. Yet, no such study has documented AD attainment variability and influence within Canadian plastic surgery faculty. Objectives: Our objective was to investigate the relationship between AD attainment and gender, alongside research productivity, and academic rank of Canadian plastic surgery faculty members. Methods: All Canadian academic plastic surgery faculty members were identified and information regarding gender, academic rank, research productivity, timing of AD attainment was recorded. AD was defined as any degree beyond a medical degree or equivalent. Results: A total of 299 faculty members were identified. Of these, 33% (N = 99) attained an AD. A higher percentage of females (40%) obtained ADs compared to males (30%) ( P = .0402). When controlling for number of years in practice, there was a significantly larger proportion of females than males with ADs as assistant and associate professor ( P = .033). Faculty with ADs were associated with higher research productivity and higher academic rank than those with MDs ( P < .05). ADs were commonly obtained post-residency (38%) and most common ADs were MSc (51%) and PhDs (21%). It was found that the Canadian plastic surgeons were less likely to pursue MBAs than US plastic surgeons ( P = .002). Conclusion: One-third of Canadian academic plastic surgeons had ADs. Those with ADs present with higher research productivity and academic rank. When segmented by gender, there were significant differences among AD holders. The results of this study will lend support to ongoing endeavors voicing the need for gender equity in academic plastic surgery.
A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges
Authors: St Clair B. , Jorgensen M. , Nguyen A. , Georgiou A.
Published: December 2022

Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies ( n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries ( n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country’s aged care system ( n = 26, 56%). Only five studies (11%) included residents’ voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.
Reproductive Regrets among a Population-Based Sample of U.S. Women
Authors: Greil Arthur L. , Lowry Michele H. , Burch Andrea R. , Slauson-Blevins Kathleen , Park Nicholas , McQuillan Julia
Published: December 2022

Women have many reproductive options, but little is known about their regrets regarding prior reproductive choices and outcomes. Guided by the life-course and stratified reproduction perspectives, this study draws on an open-ended question about reproductive regrets from wave I of the National Survey of Fertility Barriers, a representative telephone survey of reproductive aged U.S. women conducted from 2004 to 2006. The authors classified regrets into five broad categories: (1) none, (2) problematic fertility, (3) unfulfilled fertility desires, (4) family, and (5) pregnancy experiences. The authors conducted the analyses separately by motherhood status. Logistic regression analysis revealed that regardless of parental status, those who were older, had infertility, or were experiencing economic hardship were more likely to report reproductive regrets. The authors also investigated factors associated with the likelihood of expressing specific reproductive regrets. In general, the present findings confirm expectations based on the life-course and stratified reproduction perspectives.
MPFL Reconstruction With a Double-Loop Gracilis: The Concept of “Favorable Anisometry”
Authors: Deroche Etienne , Erasmus Pieter , Roberts Cecilia
Published: December 2022

Background:

Medial patellofemoral ligament (MPFL) reconstruction has shown very good results in patella dislocation and patient satisfaction. However, correct positioning and tensioning of the graft can be difficult to achieve and can lead to complications.

Indications:

Medial patellofemoral ligament reconstruction is always indicated for recurrent patellar instability with dislocation in extension, with or without other procedures that aim to correct predisposing factors of instability.

Technique Description:

An arthroscopic examination is first done to assess chondral lesions. The gracilis tendon is detached from the tibia and prepared to pass through 3-mm drill holes. The medial edge of the patella is exposed, and two 3-mm drill holes are made. Dissection is performed with a scissors between the second and third layers toward the medial epicondyle, where a small skin incision is made. A guidewire is placed just anterior and distal to the adductor tubercle. A suture is used to test the isometry of the femoral drill hole. If correct tension or “favorable anisometry” is achieved, a 5-mm bone anchor is placed. The graft is looped and pulled into the femoral hole with sliding sutures. The 2 free ends of the graft are pulled through the patellar drill holes and looped back onto themselves. The graft is tensioned with the knee in maximum extension while pulling the patella proximally with a bone hook as hard as possible in the direction of the femoral shaft. The principle is that with maximum quads contraction, the tension in the patella tendon should be more than in the reconstructed MPFL.

Results:

Immediate full range of motion, intensive isomeric quads contraction exercises, and full weight-bearing with crutches for 2 to 4 weeks are recommended. Sport can be resumed after 3 months, but it usually takes 6 months to play at the same level as before.

Discussion/Conclusion:

The technique of “favorable anisometry” of the MPFL has shown a very low rate of recurrence of patella dislocation. Complications are rare and extensor lag is very uncommon, thanks to the specificity of tensioning the graft. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Inferring regulatory element landscapes and gene regulatory networks from integrated analysis in eight hulless barley varieties under abiotic stress
Authors: Xu Qijun , Huang Shunmou , Guo Ganggang , Yang Chunbao , Wang Mu , Zeng Xingquan , Wang Yulin
Published: December 2022

Background

The cis-regulatory element became increasingly important for resistance breeding. There were many DNA variations identified by resequencing. To investigate the links between the DNA variations and cis-regulatory element was the fundamental work. DNA variations in cis-regulatory elements caused phenotype variations in general.

Results

We used WGBS, ChIP-seq and RNA-seq technology to decipher the regulatory element landscape from eight hulless barley varieties under four kinds of abiotic stresses. We discovered 231,440 lowly methylated regions (LMRs) from the methylome data of eight varieties. The LMRs mainly distributed in the intergenic regions. A total of 97,909 enhancer-gene pairs were identified from the correlation analysis between methylation degree and expression level. A lot of enriched motifs were recognized from the tolerant-specific LMRs. The key transcription factors were screened out and the transcription factor regulatory network was inferred from the enhancer-gene pairs data for drought stress. The NAC transcription factor was predicted to target to TCP, bHLH, bZIP transcription factor genes. We concluded that the H3K27me3 modification regions overlapped with the LMRs more than the H3K4me3. The variation of single nucleotide polymorphism was more abundant in LMRs than the remain regions of the genome.

Conclusions

Epigenetic regulation is an important mechanism for organisms to adapt to complex environments. Through the study of DNA methylation and histone modification, we found that many changes had taken place in enhancers and transcription factors in the abiotic stress of hulless barley. For example, transcription factors including NAC may play an important role. This enriched the molecular basis of highland barley stress response.
The primary care COVID-19 integrated pathway: a rapid response to health and social impacts of COVID-19
Authors: Aghajafari Fariba , Hansen Brian , McBrien Kerry , Leslie Myles , Chiew Alexandra , Ward Rick , Li Bing , Hu Jia
Published: December 2022

Background

The first wave of COVID-19 in Calgary, Alberta accelerated the integration of primary care with the province’s centrally managed health system. This integration aimed to deliver wraparound in-community patient care through two interventions that combined to create the COVID-19 Integrated Pathway (CIP). The CIP’s interventions were: 1) a data sharing platform that ensured COVID-19 test results were directly available to family physicians (FPs), and 2) a clinical algorithm that supported FPs in delivering in-community follow up to improve patient outcomes. We describe the CIP function and its capacity to facilitate FP follow-up with COVID-19 patients and evaluate its impact on Emergency Department (ED) visits and hospitalization.

Method

We generated descriptive statistics by analyzing data from a Calgary Zone hub clinic called the Calgary COVID-19 Care Clinic (C4), provincially maintained records of hospitalization, ED visits, and physician claims.

Results

Between Apr. 16 and Sep. 27, 2020, 7289 patients were referred by the Calgary Public Health team to the C4 clinic. Of those, 48.6% were female, the median age was 37.4 y. 97% of patients had at least one visit with a healthcare professional, where follow-up was conducted using the CIP’s algorithm. 5.1% of patients visited an ED and 1.9% were hospitalized within 30 days of diagnosis. 75% of patients had a median of 4 visits with their FP.

Discussion

Our data suggest that information exchange between Primary Care (PC) and central systems facilitates primary care-based management of patients with COVID-19 in the community and has potential to reduce acute care visits.
Health among workers retiring after the state pension age: a longitudinal and comparative study
Authors: Baumann Isabel , Froidevaux Ariane , Cabib Ignacio
Published: December 2022

Background

In recent decades, many countries have observed increasing labor force participation beyond the state pension age (SPA). However, there is a lack of research on employment beyond SPA and how it relates to older workers’ health. Moreover, there is a need to better understand how institutional factors affect the relationship between older workers’ employment and health. In this study, we examine simultaneous employment and health trajectories over 11 years in 12 countries from Europe and the Americas, and study how these trajectories differ by welfare state regime and level of old-age pension redistribution.

Methods

We used a harmonized pooled-country dataset of 3699 older workers based on four representative panel surveys: the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Survey (HRS), and the Chilean Social Protection Survey (EPS). We conducted multichannel sequence analysis to estimate the types of simultaneous employment–health trajectories, and multinomial regression analysis to examine the relationship between trajectory types and institutional factors.

Results

We found that late retirement was equally associated with poor and good health. There is also a higher prevalence of late retirement trajectories in combination with poor health in liberal welfare regimes and in countries with lower levels of old-age pension redistribution.

Conclusion

Our study indicates that nonliberal welfare regimes and redistributive old-age pension policies may be better suited to protect vulnerable workers while providing those in good health with the opportunity to work beyond the SPA.
Risk assessment of failure during transitioning from in-centre to home haemodialysis
Authors: Haroon Sabrina-Wong-Peixin , Lau Titus-Wai-Leong , Tan Gan Liang , Liu Eugene-Hern Choon , Hui Soh Heng , Lim Siao Luan , Santos Diana , Hodgson Robyn , Taylor Lindsay , Tan Jia Neng ,   FH HHD, Davenport Andrew
Published: December 2022

Background

Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD.

Methods

We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk.

Results

Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable.

Conclusions

We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.
Early clinical features of new-onset refractory status epilepticus (NORSE) in adults
Authors: Haanpää Anna , Laakso Sini M. , Kinnunen Antti , Kämppi Leena , Forss Nina
Published: December 2022

Background

The aim of this study was to identify early clinical features of patients with new-onset refractory status epilepticus (NORSE) that could direct the treatment in the first days of hospitalisation.

Methods

A retrospective cohort study of adult NORSE patients treated in the intensive care units of Helsinki University Hospital 2007-2018.

Results

We found 19 adult NORSE patients who divided into three subgroups on the basis of their clinical features: viral encephalitis (n = 5, 26%), febrile infection-related epilepsy syndrome (FIRES) (n = 6, 32%) and afebrile NORSE (n = 8, 42%). FIRES and afebrile NORSE patients remained without confirmed etiology, but retrospectively two paraneoplastic and two neurodegenerative causes were suspected in the afebrile NORSE group.

Viral encephalitis patients were median 64 years old (IQR 55-64), and four (80%) had prodromal fever and abnormal findings in the first brain imaging. FIRES patients were median 21 years old (IQR 19-24), all febrile and had normal brain imaging at onset. In the afebrile NORSE group, median age was 67 (IQR 59-71) and 50% had prodromal cognitive or psychiatric symptoms. FIRES patients differed from other NORSE patients by younger age (p = 0.001), respiratory prodromal symptoms (p = 0.004), normal brain MRI (p = 0.044) and lack of comorbidities (p = 0.011). They needed more antiseizure medications (p = 0.001) and anesthetics (p = 0.002), had a longer hospital stay (p = 0.017) and more complications (p < 0.001).

Conclusions

Among febrile NORSE patients, FIRES group was distinctive due to patients’ young age, prodromal respiratory symptoms and normal first brain imaging. These features should be confirmed by subsequent studies as basis for selecting patients for early intensive immunotherapy.
Effect of chlorhexidine mouthrinse on prevention of microbial contamination during EBUS-TBNA: a randomized controlled trial
Authors: Kim Na Young , Park Jae Hyeon , Park Jimyung , Kwak Nakwon , Choi Sun Mi , Park Young Sik , Lee Chang-Hoon , Cho Jaeyoung
Published: December 2022

Background

Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure, fatal infectious complications have been reported. However, adequate preventive strategies have not been determined. We aimed to investigate the effect of chlorhexidine mouthrinse on the prevention of microbial contamination during EBUS-TBNA.

Methods

In this single-center, assessor-blinded, parallel-group randomized controlled trial, we randomly assigned adult participants undergoing EBUS-TBNA using a convex probe to gargle for 1 minute with 100 mL of 0.12% chlorhexidine gluconate before EBUS-TBNA or to receive usual care (no chlorhexidine mouthrinse). Aspiration needle wash samples were collected immediately after completion of EBUS-TBNA by instilling sterile saline into the used needle. The primary outcome was colony forming unit (CFU) counts per mL of needle wash samples in aerobic cultures. Secondary outcomes were CFU counts per mL of needle wash samples in anaerobic cultures, fever within 24 hours after EBUS-TBNA, and infectious complications within 4 weeks after EBUS-TBNA.

Results

From January 2021 to June 2021, 106 patients received either chlorhexidine mouthrinse (n = 51) or usual care (n = 55). The median CFU counts of needle wash samples in aerobic cultures were not significantly different in the two groups (10 CFU/mL vs 20 CFU/mL; P = 0.70). There were no significant differences between the groups regarding secondary outcomes, including median CFU counts in anaerobic cultures (P = 0.41) and fever within 24 hours after EBUS-TBNA (11.8% vs 5.6%, P = 0.31). There were no infectious complications within 4 weeks in both groups.

Conclusions

Chlorhexidine mouthrinse did not reduce CFU counts in needle wash samples of EBUS-TBNA.

Trial registration

ClinicalTrials.gov, NCT04718922. Registered on 22/01/2021.
Setting and prioritizing evidence-informed policies to control childhood obesity in Iran: a mixed Delphi and policy dialogue approach
Authors: Toorang Fatemeh , Takian Amirhossein , Pouraram Hamed , Amiri Parisa , Abdullahi Zahra
Published: December 2022

Background

The prevalence of childhood obesity (CO) and related complications is high and alarmingly increasing in Iran. This study applied a mixed Delphi & Policy Dialogue approach to exploring and prioritizing policy options to control childhood obesity in Iran.

Methods

This study is organized in three Delphi phases followed by a policy dialogue session. This study applied the advocacy collation framework and evidence-informed policy-making approach to enhance the chance of a feasible and acceptable policy package. The first step consisted of interviews with 30 experts and primary stakeholders. Based on their answers and a comprehensive literature review, a list of presumed effective policy options to combat CO in Iran was made. Then, panelists were asked to score each policy option using a five-point Likert scale in seven constructs. To maximize the spread of opinions, panelists were chosen to represent three perspectives: policy-makers at different levels, presidents of various organizations who would implement potential policy options, and academics. Twenty-one stakeholders were invited to discuss the policy options in a policy dialogue section.

Results

We introduced 27 policy options and asked stakeholders to rank them using seven criteria on a five-level Likert scale. Totally, 41 experts participated in round 2 (66.2% response rate), and 33 experts took part in round 3 (72% response rate). Participants believed that healthy schools, creating healthy environments in kindergartens and other child care centers, subsidizing healthy foods, educating healthy lifestyles in mass media, and increasing access to physical activity facilities are the most effective and feasible policies in controlling CO. After the policy dialogue, the healthy school remained the most prioritized policy. a policy package to combat CO in Iran was designed with the participation of all stakeholders.

Conclusion

The advocacy collation framework and the evidence-informed policy-making approach were used to draft a policy package to combat CO, increasing the acceptability and feasibility of the developed policy package.

Graphical Abstract
ECMO support as a bridge to lung transplantation is an independent risk factor for bronchial anastomotic dehiscence
Authors: Atchade Enora , Ren Mélissa , Jean-Baptiste Sylvain , Tran Dinh Alexy , Tanaka Sébastien , Tashk Parvine , Lortat-Jacob Brice , Assadi Maksud , Weisenburger Gaelle , Mal Hervé , Sénémaud Jean Nicolas , Castier Yves , de Tymowski Christian , Montravers Philippe
Published: December 2022

Background

Airway complications are frequent after lung transplantation (LT), as they affect up to 23% of recipients. The implication of perioperative extracorporeal membrane oxygenation (ECMO) support and haemodynamic instability has never been specifically assessed. The first aim of this study was to explore the impact of perioperative ECMO support on bronchial anastomotic dehiscence (BAD) at Day 90 after LT.

Methods

This prospective observational monocentric study analysed BAD in all consecutive patients who underwent LT in the Bichat Claude Bernard Hospital, Paris, France, between January 2016 and May 2019. BAD visible on bronchial endoscopy and/or tomodensitometry was recorded. A univariate analysis was performed (Fisher’s exacts and Mann–Whitney tests), followed by a multivariate analysis to assess independent risk factors for BAD during the first 90 days after LT (p < 0.05 as significant). The Paris North Hospitals Institutional Review Board approved the study.

Results

A total of 156 patients were analysed. BAD was observed in the first 90 days in 42 (27%) patients and was the main cause of death in 22 (14%) patients. BAD occurred during the first month after surgery in 34/42 (81%) patients. ECMO support was used as a bridge to LT, during and after surgery in 9 (6%), 117 (75%) and 40 (27%) patients, respectively. On multivariate analysis, ECMO as a bridge to LT (p = 0.04) and septic shock (p = 0.01) were independent risk factors for BAD.

Conclusion

ECMO as a bridge to LT is an independent risk factor for BAD during the first 90 days after surgery. Close monitoring of bronchial conditions must be performed in these high-risk recipients.
Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM)
Authors: Yang Fan , Wangen Knut Reidar , Victor Mattias , Solbakken Ole André , Holman Per Arne
Published: December 2022

Background

Norway has prioritized health services according to the principle of “severity of conditions”, where waiting time reflects patients’ medical urgency. We aim to investigate if the “severity-of-condition” principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients’ diagnoses and symptom severity at the start of treatment and the corresponding waiting time.

Methods

The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), together with patients’ diagnoses to identify patients’ needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times.

Results

Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders.

Conclusion

Overall, patients waited in accordance with the “severity of condition” principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.
The impact of the COVID-19 pandemic on healthcare access and utilisation in South Sudan: a cross-sectional mixed methods study
Authors: Schots M. A. S. , Coleman H. L. S. , Lutwama G. W. , Straetemans M. , Jacobs E.
Published: December 2022

Background

Indirect effects of the COVID-19 pandemic on communities in fragile and conflict-affected settings may be severe due to reduced access and use of healthcare, as happened during the 2015 Ebola Virus Disease outbreak. Achieving a balance between short-term emergency response and addressing long-term health needs is particularly challenging in fragile and conflict-affected settings such as South Sudan, given the already significant barriers to accessing healthcare for the population. This study sought to characterise the effect of COVID-19 on healthcare access and South Sudan’s healthcare response. This can inform efforts to mitigate the potential impacts of COVID-19 or other epidemiological threats, and contribute to understanding how these may be balanced for greater health system resilience in fragile contexts.

Methods

We conducted a mixed methods study in three of South Sudan’s states, combining data from a cross-sectional quantitative household survey with qualitative interviews and Focus Group Discussions.

Results

Even though some fears related to COVID-19 were reported, we found these did not greatly dissuade people from seeking care and do not yield significant consequences for health system programming in South Sudan. The pillars of the response focused on risk communication and community engagement were effective in reaching communities through different channels. Respondents and participants reported behaviour changes that were in line with public health advice. We also found that the implementation of COVID-19 response activities sometimes created frictions between the national government and international health actors, and that COVID-19 caused a greater reliance on, and increased responsibility for, international donors for health planning.

Conclusions

Given the fact that global priorities on COVID-19 are greatly shifting, power dynamics between international health agencies and the national government may be useful to consider in further COVID-19 planning, particularly for the vaccine roll-out. South Sudan must now navigate a period of transition where COVID-19 vaccine roll-out continues and other domestic health burdens are re-prioritised.
Single-cell transcriptomics highlights immunological dysregulations of monocytes in the pathobiology of COPD
Authors: Huang Qiqing , Wang Yuanyuan , Zhang Lili , Qian Wei , Shen Shaoran , Wang Jingshen , Wu Shuangshuang , Xu Wei , Chen Bo , Lin Mingyan , Wu Jianqing
Published: December 2022

Background

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease, whose pathogenetic complexity was strongly associated with aging/smoking and poorly understood.

Methods

Here we performed single-cell RNA sequencing (scRNA-seq) analysis of 66,610 cells from COPD and age-stratified control lung tissues of donors with different smoking histories to prioritize cell types most perturbed in COPD lungs in aging/smoking dependent or independent manner. By performing an array of advanced bioinformatic analyses, such as gene set enrichment analysis, trajectory analysis, cell–cell interactions analysis, regulatory potential analysis, weighted correlation network analysis, functional interaction analysis, and gene set variation analysis, we integrated cell-type-level alterations into a system-level malfunction and provided a more clarified COPD pathological model containing specific mechanisms by which aging and smoking facilitate COPD development. Finally, we integrated the publicly available scRNA-seq data of 9 individuals, resulting in a total of 110,931 cells, and replicated the analyses to enhance the credibility of our findings.

Results

Our study pointed to enrichment of COPD molecular alteration in monocytes, which further induced a previously unrecognized pro-inflammatory effect on alveolar epithelial cells. In addition, aged monocytes and club cells facilitated COPD development via maintaining an autoimmune airway niche. Unexpectedly, macrophages, whose defect to resolve inflammation was long-recognized in COPD pathogenesis, primarily induced an imbalance of sphingolipids rheostat in a smoking-dependent way. These findings were validated in a meta-analysis including other public single-cell transcriptomic data.

Conclusions

In sum, our study provided a clarified view of COPD pathogenesis and demonstrated the potential of targeting monocytes in COPD diagnosis and treatment.
Risk of all-cause mortality or hospitalization for pneumonia associated with inhaled β2-agonists in patients with asthma, COPD or asthma-COPD overlap
Authors: Amegadzie Joseph Emil , Gamble John-Michael , Farrell Jamie , Gao Zhiwei
Published: December 2022

β2-agonists provide necessary bronchodilatory action, are recommended by existing clinical practice guidelines and are widely prescribed for patients with these conditions. We examined the risk of all-cause mortality and hospitalization for pneumonia associated with long-or short-acting β2-agonists (LABA or SABA) or ICS (inhaled corticosteroids)/LABA use. In a nested case–control of 185,407 patients, we found no association between β2-agonist use and the risk of pneumonia in patients with asthma, COPD, or asthma-COPD overlap. In contrast, new SABA [HR 1.82 (95% CI 1.04–3.20)] or LABA [HR 2.77 (95% CI 1.22–6.31)] use was associated with an increased risk of all-cause mortality compared to ICS use in COPD patients.
How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy
Authors: Salvatori Guglielmo , De Rose Domenico Umberto , Clemente Maria , Gentili Cristina , Verardi Giovanni Paride , Amadio Patrizia , Reposi Maria Paola , Bagolan Pietro , Dotta Andrea
Published: December 2022

Background

To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature.

Methods

This study was a cross-sectional study performed at “Bambino Gesù” Children’s Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB.

Results

During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was € 178,287.00 and the average cost was € 231.00 per liter. € 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference (€ 231.00 vs € 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was € 0.22 per unit).

Conclusion

The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.
Ultra-low-dose radiotherapy in the treatment of ocular adnexal lymphoma: a prospective study
Authors: Yang Xiaolu , Wang Ruonan , Yuan Xiaochun , Yao Shengyu , Wang Chungang , Cheng Jinwei
Published: December 2022

Purpose

This single-arm, prospective, exploratory study investigated the effectiveness of ultra-low-dose radiotherapy in the treatment of ocular adnexal lymphoma (OAL).

Patients and methods

Patients with pathologically confirmed ocular adnexal low-grade non-Hodgkin lymphoma (predominantly mucosa-associated lymphoid tissue, MALT or follicular lymphoma) were included and treated with ultra-low-dose radiotherapy consisting of 2 successive fractions of 2 Gy at our institution between 2019 and 2021. Disease response was assessed clinically and radiographically within 4 months and at 3 to 6-month intervals after treatment. Data collected included rates of overall response, complete response (CR), partial response (PR), lesion size, and acute/chronic ocular toxic effects.

Results

Sixteen patients with median age of 63 years (range 23–86 years) were included in the study. The histological subtypes included MALT (11 patients; 69%); follicular lymphoma (2 patients; 12%); Lymphoid hyperplasia (3 patient, 19%). At a median follow-up time of 15.5 months (range 5.0–30.0 months), the overall response rate was 88%, with a CR rate of 75% (n = 12) and a PR rate of 13% (n = 2). The average lesion area was reduced from 117.9 ± 60.4 mm2 before radiation therapy to 38.7 ± 46.0mm2 at initial evaluation post radiation therapy (P = 0.002, n = 16), and to 8.5 ± 21.2 mm2 (P < 0.001 compared with postoperative lesion area) in patients with response at one year (n = 11). Disease progression was noted in 2 patients (12%). The 1-year rates of local progression-free survivals (LPFS) and overall survival (OS) were 85% and 100%, respectively. No distant relapses were observed in any of the patients. No acute or late toxic effects were noted.

Conclusion

Ultra–low-dose radiotherapy in patients with OAL is associated with excellent local disease control and long-term survival with no significant acute or late toxicities.
Correlation of the severity of anemia in patients undergoing total joint arthroplasty with preoperative deep vein thrombosis: a retrospective cohort study
Authors: Xiong Xiaojuan , Xu Shenglian , Li Ting , Cheng Bo
Published: December 2022

Background

To explore the correlation of the severity of preoperative anemia with deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA).

Methods

A total of 2461 TJA patients were classified into anemia and non-anemia groups or DVT and non-DVT groups. A logistic regression model was established using propensity score matching (PSM) analysis with preoperative anemia of TJA patients as a dependent variable and DVT-related variables as covariates. The caliper value was set as 0.01, and the anemia and non-anemia groups were matched based on the ratio of 1:1 (835 pairs). Finally, data of all patients were analyzed by binary logistic regression.

Results

Preoperative anemia was observed in 872 cases (35.43%) and DVT in 170 cases (6.91%). Binary logistic regression after PSM revealed that the DVT risk of patients with preoperative, moderate and severe anemia increased by 1.82 [P = 0.00, 95% confidence interval (95% CI) (1.32–2.48)], 2.77 [P = 0.00, 95% CI (1.72–4.45)], and 8.26 [P = 0.00, 95% CI (3.22–21.16)] times, respectively. The risks of blood transfusion in the perioperative period in patients with anemia, mild anemia, moderate anemia, and severe anemia increased by 3.52 times [P = 0.00, 95% CI (2.78–4.47)], 2.13 [P = 0.00, 95% CI (1.63–2.79)], 7.22 [P = 0.00, 95% CI (5.30–9.83)], and 61.37 [P = 0.00, 95% CI (14.21–265.04)] times, respectively.

Conclusion

Preoperative anemia is an independent risk factor for preoperative DVT and blood transfusion in the perioperative period for TJA patients. The more severe the preoperative anemia, the greater the risk of preoperative DVT and perioperative blood transfusion in TJA patients. Therefore, patients with preoperative anemia, especially with moderate and severe anemia, should be screened for DVT formation before undergoing TJA.

Trial registration ChiCRT2100054844.
SMAD9-MYCN positive feedback loop represents a unique dependency for MYCN-amplified neuroblastoma
Authors: Tan Kezhe , Mo Jialin , Li Meng , Dong Yu , Han Yujie , Sun Xi , Ma Yingxuan , Zhu Kai , Wu Wei , Lu Li , Liu Jiangbin , Zhao Kewen , Zhang Lei , Tang Yujie , Lv Zhibao
Published: December 2022

Background

Neuroblastoma (NB) is the most common extracranial solid tumor occurring during childhood and high-risk NB patients have a poor prognosis. The amplified MYCN gene serves as an important determinant of a high risk of NB.

Methods

We performed an integrative screen using public NB tissue and cell line data, and identified that SMAD9 played an important role in high-risk NB. An investigation of the super-enhancers database (SEdb) and chromatin immunoprecipitation sequencing (ChIP-seq) dataset along with biological experiments of incorporating gene knockdown and CRISPR interference (CRISPRi) were performed to identify upstream regulatory mechanism of SMAD9. Gene knockdown and rescue, quantitative real-time PCR (Q-RT-PCR), cell titer Glo assays, colony formation assays, a subcutaneous xenograft model and immunohistochemistry were used to determine the functional role of SMAD9 in NB. An integrative analysis of ChIP-seq data with the validation of CRISPRi and dual-luciferase reporter assays and RNA sequencing (RNA-seq) data with Q-RT-PCR validation was conducted to analyze the downstream regulatory mechanism of SMAD9.

Results

High expression of SMAD9 was specifically induced by the transcription factors including MYCN, PHOX2B, GATA3 and HAND2 at the enhancer region. Genetic suppression of SMAD9 inhibited MYCN-amplified NB cell proliferation and tumorigenicity both in vitro and in vivo. Further studies revealed that SMAD9 bound to the MYCN promoter and transcriptionally regulate MYCN expression, with MYCN reciprocally binding to the SMAD9 enhancer and transactivating SMAD9, thus forming a positive feedback loop along with the MYCN-associated cancer cell cycle.

Conclusion

This study delineates that SMAD9 forms a positive transcriptional feedback loop with MYCN and represents a unique tumor-dependency for MYCN-amplified neuroblastoma.