bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Manipulation of Tumor-associated Macrophages: Facts and Hopes from a Clinical and Translational Perspective
Authors: Allavena Paola , Anfray Clément , Ummarino Aldo , Andón Fernando Torres
Published: February 2021

The stroma of most solid tumors is populated by myeloid cells, which mostly represent macrophages. Tumor-associated macrophages (TAMs), strongly influenced by cancer cell–derived factors, are key drivers of immunosuppression and support tumor growth and spread to distant sites. Their accurate quantification and characterization in the tumor microenvironment are gaining prognostic value: increasing evidence demonstrates their ability to hamper cancer patients' response to chemotherapy, as well as to immunotherapies based on checkpoint inhibition. Therefore, strategies to counteract their negative effects are nowadays gaining momentum at preclinical, translational, and clinical levels. Our knowledge of the biology of TAMs has greatly advanced in the last years; several strategies to target and reprogram their functions to become antitumor effectors have proven successful in experimental preclinical tumor models; on the other hand, few approaches have so far been effectively translated into clinic practice. A growing interest in the therapeutic manipulation of TAMs is evidenced by numerous early-phase clinical trials, which are continuously fueled by new discoveries from basic research. This gives us hope that the targeting and sustained reprogramming of TAMs will be more specific to synergize with current therapies and maximize antitumor responses in patients.
Lower Airway Dysbiosis Exacerbates Lung Cancer
Authors: Zitvogel Laurence , Kroemer Guido
Published: February 2021

Accumulating evidence supports the impact of the gut microbiota on the clinical efficacy of cancer immunotherapies against extraintestinal tumors, but it has not yet been addressed whether local commensals could also dictate the prognosis of patients with cancer. In this issue of Cancer Discovery, Tsay and colleagues demonstrate that the lower airway microbiota may harbor oral commensals that turn on IL17-mediated inflammatory pathways and reprogram host transcription to exacerbate lung cancer progression.

See related article by Tsay et al., p. 293.
Impactos da morfologia da cidade nas condições microclimáticas de áreas urbanas consolidadas em dias quentes
Authors: Novaes Gabriel Bonansea de Alencar , Monteiro Leonardo Marques
Published: February 2021

O objetivo deste trabalho é a investigação dos potenciais impactos que diferentes composições morfológicas urbanas de assentamentos de áreas urbanas consolidadas podem ocasionar sobre as condições microclimáticas locais ao longo de dias quentes percebidas na escala do pedestre. A avaliação se baseia no levantamento de dados empíricos, com base em simulações computacionais das condições térmicas de ambientes urbanos abertos de exemplos de distritos de São Paulo, por meio do software ENVI-met, calibrado a partir de medições empíricas de variáveis microclimáticas em ambientes existentes da cidade. Os resultados das avaliações permitem a verificação comparativa de variáveis microclimáticas encontradas em cada local frente às características da ocupação urbana dos diferentes modelos, o que possibilita compreender de que forma as diferentes morfologias urbanas respondem às mesmas condições climáticas. Verifica-se, portanto, os principais impactos que as distribuições, as formas, as geometrias e as relações dos edifícios podem ocasionar no microclima de nossas cidades ao longo de dias quentes, tomando como exemplo bairros representativos de São Paulo.
Arquitetura da lata: Matosinhos e a história atlântica da arquitetura das sardinhas
Authors: Souza Diego Beja Inglez de , Tavares André
Published: February 2021

O estudo das relações entre a pesca e a arquitetura pode revelar novas perspectivas para a compreensão das dinâmicas entre a costa e o mar, além de contribuir para a formulação de estratégias para a organização dos territórios litorâneos, afetados diretamente pelas mudanças climáticas e pela crise ambiental. Este artigo procura compreender a história urbana recente de Matosinhos a partir da pesca, vetor fundamental da urbanização desta cidade portuária do Norte de Portugal, sobretudo através da produção de conservas da sardinha. A produção intensiva deste alimento industrializado revela aspectos culturais que deram origem à mitos e tradições, econômica e politicamente explorados, além de apontar para uma geografia Atlântica para dar conta dos fluxos e circulações característicos da produção e do consumo das conservas de peixe. Ao analisar as transformações desta atividade de maneira integrada entre diversos campos do conhecimento, procuramos estabelecer relações entre os aspectos ecológicos característicos da exploração de um recurso natural específico e seus impactos no ambiente construído.
The R1-weighted connectome: complementing brain networks with a myelin-sensitive measure
Authors: Boshkovski Tommy , Kocarev Ljupco , Cohen-Adad Julien , Mišić Bratislav , Lehéricy Stéphane , Stikov Nikola , Mancini Matteo
Published: February 2021

Myelin plays a crucial role in how well information travels between brain regions. Complementing the structural connectome, obtained with diffusion MRI tractography, with a myelin-sensitive measure could result in a more complete model of structural brain connectivity and give better insight into white-matter myeloarchitecture. In this work we weight the connectome by the longitudinal relaxation rate (R1), a measure sensitive to myelin, and then we assess its added value by comparing it with connectomes weighted by the number of streamlines (NOS). Our analysis reveals differences between the two connectomes both in the distribution of their weights and the modular organization. Additionally, the rank-based analysis shows that R1 can be used to separate transmodal regions (responsible for higher-order functions) from unimodal regions (responsible for low-order functions). Overall, the R1-weighted connectome provides a different perspective on structural connectivity taking into account white matter myeloarchitecture.
Les Missionnaires Belges en Afrique Centrale, Fin 19e-20e Siecle
Authors: Blondeel William
Published: February 2021

Belgian Missionaries in Central Africa, At the End of the 19th and in the 20th Century. Evangelization: Not a World Apart.

This contribution is an attempt to define in rather general terms the field in which Belgian catholic missionaries were active in Central Africa at the end of the 19th and in the 20th century. It is not an acceptable synthesis, but rather a “tour d’horizon”. The image of the missionary is examined as a consistent whole as well as in its different aspects, such as teacher, medical agent, social worker and researcher. The relation between the mission on the one hand and the whole community life on the other appears as a central issue.
Boerenhuishoudens Tegenover Markt en Staat in Tanzania
Authors: Coudere Hugo
Published: February 2021

The economic reality of the peasant households in Tanzania is situated at the convergence of three spheres:

1. the economy of affection, based on the peasant mode of production;

2. the market, which is dominated by parallel circuits;

3. the Tanzanian state, which is expanding continuously. Each of these spheres has its own logic with its own beneficiaries. The economy of affection redistributes income, often at the expense of market laws and official economic policies. The parallel circuits in the market system only benefit the black marketeers and the well-off. The state has expanded, sometimes in favour of peasant-farmers and workers, but most of the time for its own sake.
Traditional Beers Processing in Tanzania: Development Needs
Authors: Tiisekwa Bendantunguka
Published: February 2021

A general account of the status of the traditional alcoholic beverages in Tanzania is presented with special focus on sorghum beers. The traditional procedure used to prepare Mtama (sorghum) beer, a popular alcoholic beverage of Tanzania is described. Based on the personal experience of the author himself and on reports in the literature the problem areas requiring technological improvement on this beer are outlined. The case for immediate research needs, aimed at developing a commercially viable Mtama beer, is argued.
Bruikbaarheid van Alternatieve Energiesystemen ter Vervanging van Hout en Kolen in Afrika.
Authors: Baert Daniel , Bangurambona Bonaventure , Kuyken Hugo
Published: February 2021

Alternative Energy-Sources to Replace Wood and Coal in Africa

In the article, the possibility of the use of alternative energy sources (a.e.) in Africa is discussed. The authors give some criteria which have to be fulfilled before a.e. sources can succesfully be applicated.
Hospitaalbouw in Zimbabwe
Authors: Schuerman Wim
Published: February 2021

Designing a hospital means making a study of all the influencing parameters of the form and functional organisation. The thoroughness of this process will determine the quality of the design itself. This article containes a distilation of such a process. By making such a study I hoped to come to a valid conclusion design different from the health – factories that are normally implanted in developing countries. This, by taking in account not only the health care facility on itself -with which we are quite familiar – but also the specific human values of the indegenious population.
Geometric Constraints on Glacial Fjord–Shelf Exchange
Authors: Zhao Ken X. , Stewart Andrew L. , McWilliams James C.
Published: February 2021

The oceanic connections between tidewater glaciers and continental shelf waters are modulated and controlled by geometrically complex fjords. These fjords exhibit both overturning circulations and horizontal recirculations, driven by a combination of water mass transformation at the head of the fjord, variability on the continental shelf, and atmospheric forcing. However, it remains unclear which geometric and forcing parameters are the most important in exerting control on the overturning and horizontal recirculation. To address this, idealized numerical simulations are conducted using an isopycnal model of a fjord connected to a continental shelf, which is representative of regions in Greenland and the West Antarctic Peninsula. A range of sensitivity experiments demonstrate that sill height, wind direction/strength, subglacial discharge strength, and depth of offshore warm water are of first-order importance to the overturning circulation, while fjord width is also of leading importance to the horizontal recirculation. Dynamical predictions are developed and tested for the overturning circulation of the entire shelf-to-glacier-face domain, subdivided into three regions: the continental shelf extending from the open ocean to the fjord mouth, the sill overflow at the fjord mouth, and the plume-driven water mass transformation at the fjord head. A vorticity budget is also developed to predict the strength of the horizontal recirculation, which provides a scaling in terms of the overturning and bottom friction. Based on these theories, we may predict glacial melt rates that take into account overturning and recirculation, which may be used to refine estimates of ocean-driven melting of the Greenland and Antarctic ice sheets.
A review of the recent trends on core structures and impact response of sandwich panels
Authors: Ma Quanjin , Rejab MRM , Siregar JP , Guan Zhongwei
Published: February 2021

It is a challenging task to advance the excellent strength and structural performance of sandwich structures, while continuing to reduce the weight and cost parameters. Thousands of researchers have studied and developed the core structural innovation with periodical achievements. This review paper concentrates on the core structural trends and impact response of sandwich panels, which highlights the novel design concepts and impact failure modes. Three kinds of core structures have been classified, which are foam-core, two- and three-dimensional periodic cores. It is shown that the core structure of sandwich panels plays a vital role in structural performance and applications. Three common types of loading conditions have been considered, i.e. compression, projectile impact and three-point bending. Examples of novel core structures are further studied and summarised under corresponding impact loadings. Recent applications of sandwich structures are briefly concentrated on aerospace, automotive, marine and civil engineering areas. Furthermore, future research and development prospect of sandwich structures are suggested and predicted.
Loss of the exocyst complex component EXOC3 promotes hemostasis and accelerates arterial thrombosis
Authors: Walsh Tony G. , Li Yong , Williams Christopher M. , Aitken Elizabeth W. , Andrews Robert K. , Poole Alastair W.
Published: February 2021

The exocyst is an octameric complex comprising 8 distinct protein subunits, exocyst complex components (EXOC) 1 to 8. It has an established role in tethering secretory vesicles to the plasma membrane, but its relevance to platelet granule secretion and function remains to be determined. Here, EXOC3 conditional knockout (KO) mice in the megakaryocyte/platelet lineage were generated to assess exocyst function in platelets. Significant defects in platelet aggregation, integrin activation, α-granule (P-selectin and platelet factor 4), dense granule, and lysosomal granule secretion were detected in EXOC3 KO platelets after treatment with a glycoprotein VI (GPVI)-selective agonist, collagen-related peptide (CRP). Except for P-selectin exposure, these defects were completely recovered by maximal CRP concentrations. GPVI surface levels were also significantly decreased by 14.5% in KO platelets, whereas defects in proximal GPVI signaling responses, Syk and LAT phosphorylation, and calcium mobilization were also detected, implying an indirect mechanism for these recoverable defects due to decreased surface GPVI. Paradoxically, dense granule secretion, integrin activation, and changes in surface expression of integrin αIIb (CD41) were significantly increased in KO platelets after protease-activated receptor 4 activation, but calcium responses were unaltered. Elevated integrin activation responses were completely suppressed with a P2Y12 receptor antagonist, suggesting enhanced dense granule secretion of adenosine 5′-diphosphate as a critical mediator of these responses. Finally, arterial thrombosis was significantly accelerated in KO mice, which also displayed improved hemostasis determined by reduced tail bleeding times. These findings reveal a regulatory role for the exocyst in controlling critical aspects of platelet function pertinent to thrombosis and hemostasis.
Socioeconomic and lifestyle determinants of the prevalence of hypertension among elderly individuals in rural southwest China: a structural equation modelling approach
Authors: Xiao Li , Le Cai , Wang Gui-Yi , Fan Lu-Ming , Cui Wen-Long , Liu Ying-Nan , Shen Jing-Rong , Golden Allison Rabkin
Published: February 2021

Background

This study examines the association between socioeconomic and lifestyle factors and the prevalence of hypertension among elderly individuals in rural Southwest China.

Methods

A cross-sectional survey of 4833 consenting adults aged ≥ 60 years in rural regions of Yunnan Province, China, was conducted in 2017. Data on individual socioeconomic status, sleep quality, physical activity level, and family history of hypertension were collected with a standardized questionnaire. Blood pressure, fasting blood glucose, height, weight, and waist circumference were also measured. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Structural equation modelling (SEM) was applied to analyse the association between socioeconomic and lifestyle factors and the prevalence of hypertension.

Results

The overall prevalence of hypertension was 50.6% in the study population. Body fat distribution, including measures of obesity and central obesity, had the greatest total effect on hypertension (0.21), followed by family history of hypertension (0.14), biological sex (0.08), sleep quality (− 0.07), SEP (− 0.06), physical inactivity (0.06), and diabetes (0.06). Body fat distribution, SEP, and family history of hypertension had both direct and indirect effects on hypertension, whereas physical inactivity, diabetes, and sleep quality were directly associated with the prevalence of hypertension. Biological sex was indirectly associated with the prevalence of hypertension.

Conclusions

SEP, body fat distribution, physical inactivity, diabetes, and sleep quality critically influence the prevalence of hypertension. Future interventions to prevent and control hypertension should give increased attention to individuals with low SEP and should focus on controlling diabetes and obesity, increasing physical activity levels, and improving quality of sleep among older adults aged ≥ 60 years in rural Southwest China.
Association of human platelet alloantigens encoding gene polymorphisms with the risk of Coronary artery disease in Iranian patients
Authors: Malakootikhah Farideh , Naghavi Hossein , Firouzabadi Negar , Maadani Mohsen , Shafiei Massoumeh , Tajik Nader
Published: February 2021

Background

Coronary artery disease (CAD) is characterized by narrowing/ blockade of coronary arteries that is mainly caused by atherosclerotic plaques. Considering the involvement of platelet abnormalities, such as defective aggregation and adhesion, in the cardiovascular-related disorders, genetic variations in human platelet alloantigens (HPA) have been implicated in the CAD susceptibility. Herein, we intended to determine the association of HPA-1 to -6, -9, and -15 biallelic polymorphisms with CAD in an Iranian population.

Methods

In this retrospective case–control study, 200 CAD subjects and 100 matched healthy individuals were enrolled. DNA samples were isolated from peripheral blood samples and genotyping of HPA polymorphisms was accomplished using polymerase chain reaction-sequence-specific primers.

Results

The alleles and genotypes of studied HPA polymorphisms were equally distributed among cases and controls and therefore no statistically significant differences were detected. Univariate analysis identified no association of combined haplotypes with CAD risk. However, multivariate analysis showed a positive association of the‌ HPA1b/2a/3b haplotype with CAD after adjustment for some covariates (including BMI, TG, LDL, FBS and blood pressure) that conferred a CAD susceptibility haplotype (P = 0.015; OR = 2.792; 95% CI 1.45–8.59).

Conclusions

Although alleles, genotypes, and haplotypes of HPA polymorphisms were not associated with CAD risk, HPA1b/2a/3b haplotype was found to be a dependent disease risk haplotype in Iranian population after correcting for confounding factors.
Increased multiple sclerosis disease activity in patients transitioned from fingolimod to dimethyl fumarate: a case series
Authors: Delgado Silvia , Hernandez Jeffrey , Tornes Leticia , Rammohan Kottil
Published: February 2021

Background

Fingolimod is a S1P1 receptor modulator that prevents activated lymphocyte egress from lymphoid tissues causing lymphopenia, mainly affecting CD4+ T lymphocytes. Withdrawal from fingolimod can be followed by severe disease reactivation, and this coincides with return of autoreactive lymphocytes into circulation. The CD8+ T cytotoxic population returns prior to the regulatory CD4+ T lymphocytes leading to a state of dysregulation, which may contribute to the rebound and severity of clinical relapses. On the other hand, dimethyl fumarate (DMF) preferentially reduces CD8+ T lymphocytes, has the same efficacy as fingolimod, and therefore, was expected to be a suitable oral alternative to reduce the rebound associated with fingolimod withdrawal.

Case presentation

We present six patients with relapsing-remitting MS who developed an unexpected increase in disease activity after transitioning from fingolimod to DMF. All patients were clinically and radiologically stable on fingolimod for at least 1 year. The switch in therapy was due to significantly low CD4+ T lymphocyte count ≤65 cells/ul (normal range 490–1740 cells/ul), after discussing the results with the patients and the potential risk for opportunistic infections including cryptococcal infections. DMF was introduced following a washout period of 5 to 11 weeks to allow reconstitution of the immune system and for the absolute lymphocyte count to reach ≥500 cells/ul. Every patient who experienced a relapse had several enhancing lesions in the brain and/or spinal cord between 12 to 23 weeks after cessation of fingolimod and 1 to 18 weeks after starting DMF. All relapses were treated with intravenous methylprednisolone with good clinical responses.

Conclusion

The anticipated beneficial response of DMF treatment to mitigate rebound after fingolimod therapy cessation was not observed. Our patients experienced rebound disease despite being on treatment with DMF. Additional studies are necessary to understand which treatments are most effective to transition to after discontinuing fingolimod.
Knowledge and understanding of obstetric danger signs among pregnant women attending the antenatal clinic at the National Referral Hospital in Thimphu, Bhutan: a cross-sectional study
Authors: Tamang Saran Tenzin , Dorji Thinley , Yoezer Sonam , Phuntsho Thinley , Dorji Phurb
Published: February 2021

Background

The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies.

Methods

This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as ‘good’ (≥80%), ‘satisfactory’ (60–79%) and ‘poor’ (< 60%). Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson’s correlation coefficient. Association between knowledge score and participant characteristics was tested using t-tests (and Kruskal-Wallis test) for numeric variables. Socio-demographic and clinical characteristics associated with the level of knowledge ('good’ versus ‘satisfactory’ and ‘poor’ combined) were assessed with odds ratios using a log-binomial regression model. All results with p < 0.05 were considered significant.

Results

Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had ‘good’ knowledge, 245 (58.1%) had ‘satisfactory’ knowledge and 157 (37.2%) had ‘poor’ knowledge. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 women (20.3%) could not recall any danger signs. Most women were knowledgeable about pre-labour rupture of membranes (96.0%) while very few women were knowledgeable about spotting during pregnancy (19.9%). Both knowledge score and number of danger signs recalled had significant correlation with the period of gestation. Women with previous surgery on the reproductive tract had higher odds of having ‘good’ level of knowledge.

Conclusions

Most pregnant women had ‘satisfactory’ knowledge score with poor explicit recall of danger signs. However, women recognized obstetric emergencies and identified the appropriate action warranted.
Late ANC initiation and factors associated with sub-optimal uptake of sulphadoxine-pyrimethamine in pregnancy: a preliminary study in Cape Coast Metropolis, Ghana
Authors: Amoako Benjamin Kwasi , Anto Francis
Published: February 2021

Background

Malaria infection during pregnancy is of public health importance as it poses risk to the pregnant woman, her foetus and the newborn child. Intermittent preventive treatment during pregnancy using sulphadoxine-pyrimethamine is one way of reducing the effect of the disease on pregnancy outcomes. The study determined factors associated with uptake of sulphadoxine-pyrimethamine during pregnancy in the Cape Coast Metropolis of Ghana.

Methods

A health facility-based cross-sectional study involving pregnant women of ≥36 weeks gestation visiting antenatal clinics in three selected health facilities in the Cape Coast Metropolis was conducted. Participants were consecutively recruited using a structured questionnaire over a 6-week period from May to June, 2018. Descriptive statistics was used to summarize the data whilst Pearson’s chi-square/Fisher exact test was performed to determine associations and logistic regression done to determine the strength of the associations.

Results

A total of 212 pregnant women participated in the study. Formal education, initiating ANC early, taking first dose of SP during second trimester, not experiencing side effects of SP, having knowledge about schedule for taking SP and making ≥4 ANC visits were factors associated with uptake of ≥3 doses of IPTp-SP. Logistic regression analysis revealed that, mothers who made ≥4 ANC visits were 53.77 times more likely to take ≥3 doses of SP compared with those who made < 4 ANC visits (p <  0.001). Those who initiated ANC during the first trimester were 3.60 times more likely to receive ≥5 doses compared with those who initiated ANC during the second or third trimester (p = 0.022). Making ≥8 ANC visits did not increase the chances of taking ≥5 doses of SP.

Conclusion

Health promotion programmes targeting mothers with no formal education could increase their awareness about the importance of ANC services including uptake of IPTp-SP.
Influence of established and subjectively perceived as well as evaluated individual characteristics on the utilization of mental health services among individuals with depressive disorders: protocol of a longitudinal study examining how to supplement the “behavioral model of health services use” and on need-congruent use of mental health services
Authors: Reinhold Anna Katharina , Magaard Julia Louise , Brütt Anna Levke
Published: February 2021

Background

Approximately one out of every three people in Germany who meets the diagnostic criteria for major depression has contact with mental health services. Therefore, according to treatment guidelines, two thirds of all individuals with depression are insufficiently treated. In the past, the subjective perspective of people who (do not) make use of mental health services has been neglected. Factors related to the use of health services are described in Andersen’s Behavioral Model of Health Services Use (ABM). The aim of this study is to supplement operationalizations of subjectively perceived and evaluated individual characteristics in the ABM and to evaluate whether the supplemented model can better explain mental health services use in individuals with depression than established operationalizations.

Methods

A representative telephone study with two measurement points will be conducted. In an explanatory mixed-methods design, qualitative interviews will be added to further interpret the quantitative data. A nationwide sample scoring 5 or more on the Patient Health Questionnaire (PHQ-9) will be recruited and interviewed via telephone at T0 and 12 months later (T1). Data on established and subjective characteristics as well as mental health service use will be collected. At T1, conducting a diagnostic interview (Composite International Diagnostic Interview, DIA-X-12/M-CIDI) enables the recording of 12-month diagnoses according to DSM-IV-TR criteria. Ideally, n = 768 datasets will be available and analyzed descriptively by means of regression analysis. Up to n = 32 persons who use or do not use depression-specific health services incongruent with their objective or subjective needs will be interviewed (face-to-face) to better explain their behavior. In addition, theories of non-need-based mental health service use are developed within the framework of the grounded theory-based analysis of the qualitative interviews.

Discussion

The study intends to contribute to the theoretical foundation of health services research and to specify the characteristics described in the ABM. Thus, after completion of the study, a further sophisticated and empirically tested model will be available to explain mental health services. The identified modifiable influencing factors are relevant for the development of strategies to increase mental health service use in line with the objective and subjective needs of individuals with depression.
A data quality assessment to inform hypertension surveillance using primary care electronic medical record data from Alberta, Canada
Authors: Garies Stephanie , McBrien Kerry , Quan Hude , Manca Donna , Drummond Neil , Williamson Tyler
Published: February 2021

Background

Hypertension is a common chronic condition affecting nearly a quarter of Canadians. Hypertension surveillance in Canada typically relies on administrative data and/or national surveys. Routinely-captured data from primary care electronic medical records (EMRs) are a complementary source for chronic disease surveillance, with longitudinal patient-level details such as sociodemographics, blood pressure, weight, prescribed medications, and behavioural risk factors. As EMR data are generated from patient care and administrative tasks, assessing data quality is essential before using for secondary purposes. This study evaluated the quality of primary care EMR data from one province in Canada within the context of hypertension surveillance.

Methods

We conducted a cross-sectional, descriptive study using primary care EMR data collected by two practice-based research networks in Alberta, Canada. There were 48,377 adults identified with hypertension from 53 clinics as of June 2018. Summary statistics were used to examine the quality of data elements considered relevant for hypertension surveillance.

Results

Patient year of birth and sex were complete, but other sociodemographic information (ethnicity, occupation, education) was largely incomplete and highly variable. Height, weight, body mass index and blood pressure were complete for most patients (over 90%), but a small proportion of outlying values indicate data inaccuracies were present. Most patients had a relevant laboratory test present (e.g. blood glucose/glycated hemoglobin, lipid profile), though a very small proportion of values were outside a biologically plausible range. Details of prescribed antihypertensive medication, such as start date, strength, dose, frequency, were mostly complete. Nearly 80% of patients had a smoking status recorded, though only 66% had useful information (i.e. categorized as current, past, or never), and less than half had their alcohol use described; information related to amount, frequency or duration was not available.

Conclusions

Blood pressure and prescribed medications in primary care EMR data demonstrated good completeness and plausibility, and contribute valuable information for hypertension epidemiology and surveillance. The use of other clinical, laboratory, and sociodemographic variables should be used carefully due to variable completeness and suspected data errors. Additional strategies to improve these data at the point of entry and after data extraction (e.g. statistical methods) are required.
Clinical evaluation of pulmonary hypertension using patient-reported outcomes: a cross-sectional study
Authors: Amor-García Miguel Ángel , Ibáñez-García Sara , García-González Xandra , Mombiela Teresa , Villanueva-Bueno Cristina , Herranz-Alonso Ana , Sanjurjo-Sáez María
Published: February 2021

Background

Patients with pulmonary hypertension (PH) have progressive and disabling symptoms, as well as a burden of treatments and a difficult clinical evaluation that make health-related quality of life a particularly relevant endpoint in this disease. The objective of the study was to evaluate patient-reported outcomes of patients receiving specific treatment for PH in a tertiary hospital using a specific questionnaire (Cambridge Pulmonary Hypertension Outcome Review-CAMPHOR) in the pharmacy consultation.

Methods

A cross-sectional, observational, descriptive study was conducted. It included all patients receiving specific treatment for PH in a tertiary hospital in Madrid, Spain. The inclusion period comprised between August to December 2019. CAMPHOR questionnaires containing three domains: symptoms, activities and quality of life were completed by the patients at the pharmacy consultation. Demographic and clinical variables, including WHO Functional Class (WHO FC), PH-specific tests and hemodynamic parameters, were recorded. Non-parametric analyses to assess relations between variables and CAMPHOR domains were performed.

Results

Thirty-six patients consented to participate in the study and completed the questionnaire. Median scores for symptoms, activities, and quality of life domains were 5.5 (2.5–10), 8.0 (4.5–10.5) and 3.5 (1–7.5), respectively. Statistically significant differences were found in the three domains when comparing by WHO FC, in the activities domain for 6-m walking test and in the quality of life domain for patients who had emergency visits or hospitalizations in the last year.

Conclusions

The CAMPHOR questionnaire could be useful as a complementary test to achieve an integrated evaluation of PH patients, who could complete it easily during their routine pharmacy visits.
Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy
Authors: Sisa K. , Huoponen S. , Ettala O. , Antila H. , Saari T. I. , Uusalo P.
Published: February 2021

Background

Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols.

Methods

We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated.

Results

We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups.

Conclusion

Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.
Overlap of burnout-depression symptoms among Chinese neurology graduate students in a national cross-sectional study
Authors: Zhou Wei , Pu Juncai , Zhong Xiaogang , Yang Wensong , Teng Teng , Fan Li , Wang Haiyang , Tian Lu , Liu Yiyun , Xie Peng
Published: February 2021

Background

The overlap of burnout and depression is a phenomenon that can effectively reflect the psychological state of a group. However, whether burnout is a type of depression is still debated in current research. The high incidence of burnout and depressive symptoms among medical students indicates that it is urgent to provide appropriate health services for them. However, the proportion of burnout and depression in the overlapping symptoms experienced by medical students, and the characteristics of the relative influencing factors, remain unclear. Therefore, we addressed these issues for neurology graduate students in China.

Methods

Using data from a cross-sectional survey of Chinese neurology graduate students, a diagnostic model was established according to their burnout and/or depression symptoms. Burnout was assessed by using the Maslach Burnout Inventory. Depression symptoms were assessed with a two-item depression screening tool for primary care evaluation of mental disorders. Univariate analyses with chi-squared tests were conducted to assess associations between variables. Multinomial logistic regression models were used to analyze the effects of multiple factors on dependent variables. The factors included demographic information and three medical-study related problems.

Results

In total, 32.2% of surveyed students evidenced overlapping burnout and depression symptoms. Students with depressive symptoms tended to be included in the burnout students’ category. In the regression model, being unmarried, having children, and career choice regret were related to students who had only burnout, while the students with overlapping symptoms were affected by more factors such as family income, the consideration of dropping out once.

Conclusions

The symptoms and related factors of burnout and depression among Chinese neurology postgraduates have obvious overlap and show a significant trend. The occurrence of depressive symptoms among medical students is closely related to whether they are burned out. Students with only burnout were common, but students with only depressive symptoms were uncommon. Finally, burnout may be a pre-depression state.
Computer-based test (CBT) and OSCE scores predict residency matching and National Board assessment results in Japan
Authors: Horita Shoko , Park Yoon-Soo , Son Daisuke , Eto Masato
Published: February 2021

Context

The Japan Residency Matching Program (JRMP) launched in 2003 and is now a significant event for graduating medical students and postgraduate residency hospitals. The environment surrounding JRMP changed due to Japanese health policy, resulting in an increase in the number of unsuccessfully-matched students in the JRMP. Beyond policy issues, we suspected there were also common characteristics among the students who do not get a match with residency hospitals.

Methods

In total 237 out of 321 students at The University of Tokyo Faculty of Medicine graduates from 2018 to 2020 participated in the study. The students answered to the questionnaire and gave written consent for using their personal information including the JRMP placement, scores of the pre-clinical clerkship (CC) Objective Structured Clinical Examinations (OSCE), the Computer-Based Test (CBT), the National Board Examination (NBE), and domestic scores for this study. The collected data were statistically analyzed.

Results

The JRMP placements were correlated with some of the pre-CC OSCE factors/stations and/or total scores/global scores. Above all, the result of neurological examination station had most significant correlation between the JRMP placements. On the other hand, the CBT result had no correlation with the JRMP results. The CBT results had significant correlation between the NBE results.

Conclusions

Our data suggest that the pre-clinical clerkship OSCE score and the CBT score, both undertaken before the clinical clerkship, predict important outcomes including the JRMP and the NBE. These results also suggest that the educational resources should be intensively put on those who did not make good scores in the pre-clinical clerkship OSCE and the CBT to avoid the failure in the JRMP and the NBE.
Patient privacy and autonomy: a comparative analysis of cases of ethical dilemmas in China and the United States
Authors: Zhang Hui , Zhang Hongmei , Zhang Zhenxiang , Wang Yuming
Published: February 2021

Background

Respect for patients’ autonomy is usually considered to be an important ethical principle in Western countries; privacy is one of the implications of such respect. Healthcare professionals frequently encounter ethical dilemmas during their practice. The past few decades have seen an increased use of courts to resolve intractable ethical dilemmas across both the developed and the developing world. However, Chinese and American bioethics differ largely due to the influence of Chinese Confucianism and Western religions, respectively, and there is a dearth of comparative studies that explore cases of ethical dilemmas between China and the United States.

Methods

This paper discusses four typical cases with significant social impact. First, it compares two cases concerning patient privacy: the “Shihezi University Hospital Case”, in which a patient was used as a clinical teaching object without her permission, and the “New York-Presbyterian Hospital Case”, in which the hospital allowed the filming of a patient’s treatment without his consent. Second, it compares two cases regarding patient autonomy and potentially life-saving medical procedures: the “Case of Ms. L”, concerning a cohabitant’s refusal to sign a consent form for a pregnant woman’s caesarean, and the “Case of Mrs. V”, concerning a hospital’s insistence upon a blood transfusion for a dissenting patient. This paper introduces the supporting and opposing views for each case and discusses their social impact. It then compares and analyses the differences between China and the United States from cultural and legislative perspectives.

Conclusions

Ethical dilemmas have often occurred in China due to the late development of bioethics. However, the presence of bioethics earlier in the US than in China has not spared the US of ethical dilemmas. This paper highlights lessons and inspiration from the cases for healthcare professionals and introduces readers to the role and weight of privacy and autonomy in China and in the US from the perspectives of different cultures, religions and laws.
Development and evaluation of a monoclonal antibody-based competitive ELISA for the detection of antibodies against H7 avian influenza virus
Authors: Li Yuan , Ye Hongliu , Liu Meng , Song Suquan , Chen Jin , Cheng Wangkun , Yan Liping
Published: February 2021

Background

H7 subtype avian influenza has caused great concern in the global poultry industry and public health. The conventional serological subtype-specific diagnostics is implemented by hemagglutination inhibition (HI) assay despite lengthy operation time. In this study, an efficient, rapid and high-throughput competitive enzyme-linked immunosorbent assay (cELISA) was developed for detection of antibodies against H7 avian influenza virus (AIV) based on a novel monoclonal antibody specific to the hemagglutinin (HA) protein of H7 AIV.

Results

The reaction parameters including antigen coating concentration, monoclonal antibody concentration and serum dilution ratio were optimized for H7 antibody detection. The specificity of the cELISA was tested using antisera against H1 ~ H9, H11 ~ H14 AIVs and other avian viruses. The selected cut-off values of inhibition rates for chicken, duck and peacock sera were 30.11, 26.85 and 45.66% by receiver-operating characteristic (ROC) curve analysis, respectively. With HI test as the reference method, the minimum detection limits for chicken, duck and peacock positive serum reached 20, 21and 2− 1HI titer, respectively. Compared to HI test, the diagnostic accuracy reached 100, 98.6, and 99.3% for chicken, duck and peacock by testing a total of 400 clinical serum samples, respectively.

Conclusions

In summary, the cELISA assay developed in this study provided a reliable, specific, sensitive and species-independent serological technique for rapid detection of H7 antibody, which was applicable for large-scale serological surveillance and vaccination efficacy evaluation programs.
A novel recessive PDZD7 bi-allelic mutation in an Iranian family with non-syndromic hearing loss
Authors: Fahimi Hossein , Behroozi Samira , Noavar Sadaf , Parvini Farshid
Published: February 2021

Background

Autosomal recessive non-syndromic hearing loss (ARNSHL) is genetically and phenotypically heterogeneous with over 110 genes causally implicated in syndromic and non-syndromic hearing loss. Here, we investigate the genetic etiology of deafness in two GJB2 and GJB6 negative patients presenting with pre-lingual, progressive, severe hearing loss.

Methods

Targeted exome sequencing (TES) using Next Generation Illumina Sequencing was used to analyze the exonic and some other important genomic regions of 154 genes in the proband. Subsequently, the mutation found was confirmed by Sanger sequencing in other affected sibling and healthy family members. The possible impact of the reported mutation on the corresponding protein was also evaluated by using bioinformatics tools. Moreover, the affected patients underwent audiological and ophthalmic evaluations.

Results

TES identified a novel homozygous missense mutation c.251T>C (p.I84T) in exon 3 of PDZD7 gene. In addition, segregation and phenotype-genotype correlation analysis as well as in-silico evaluations confirmed the autosomal recessive inheritance pattern and disease-causing nature of mutation found.

Conclusions

In overall, our finding could expand the pathogenic mutations spectrum and strengthens the clinical importance of the PDZD7 gene in ARNSHL patients. It can also aid to conduct genetic counseling, prenatal diagnosis and clinical management of these types of genetic disorders.
Performance of the recommended ESC/EASD cardiovascular risk stratification model in comparison to SCORE and NT-proBNP as a single biomarker for risk prediction in type 2 diabetes mellitus
Authors: Prausmüller Suriya , Resl Michael , Arfsten Henrike , Spinka Georg , Wurm Raphael , Neuhold Stephanie , Bartko Philipp E. , Goliasch Georg , Strunk Guido , Pavo Noemi , Clodi Martin , Hülsmann Martin
Published: February 2021

Background

Recently, the European Society of Cardiology (ESC) and European Association for the Society of Diabetes (EASD) introduced a new cardiovascular disease (CVD) risk stratification model to aid further treatment decisions in individuals with diabetes. Our study aimed to investigate the prognostic performance of the ESC/EASD risk model in comparison to the Systematic COronary Risk Evaluation (SCORE) risk model and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in an unselected cohort of type 2 diabetes mellitus (T2DM).

Methods and results

A total of 1690 T2DM patients with a 10-year follow up for fatal CVD and all-cause death and a 5-year follow up for CVD and all-cause hospitalizations were analyzed. According to ESC/EASD risk criteria 25 (1.5%) patients were classified as moderate, 252 (14.9%) high, 1125 (66.6%) very high risk and 288 (17.0%) were not classifiable. Both NT-proBNP and SCORE risk model were associated with 10-year CVD and all-cause death and 5-year CVD and all-cause hospitalizations while the ESC/EASD model was only associated with 10-year all-cause death and 5-year all-cause hospitalizations. NT-proBNP and SCORE showed significantly higher C-indices than the ESC/EASD risk model for CVD death [0.80 vs. 0.53, p < 0.001; 0.64 vs. 0.53, p = 0.001] and all-cause death [0.73, 0.66 vs. 0.52, p < 0.001 for both]. The performance of SCORE improved in a subgroup without CVD aged 40–64 years compared to the unselected cohort, while NT-proBNP performance was robust across all groups.

Conclusion

The new introduced ESC/EASD risk stratification model performed limited compared to SCORE and single NT-proBNP assessment for predicting 10-year CVD and all-cause fatal events in individuals with T2DM.