bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the performance of temporal pattern discovery: new application using statins and rhabdomyolysis in OMOP databases
Authors: Lavallee M. , Yu T. , Evans L. , Van Hemelrijck M. , Bosco C. , Golozar A. , Asiimwe A.
Published: February 2022

Background

Temporal pattern discovery (TPD) is a method of signal detection using electronic healthcare databases, serving as an alternative to spontaneous reporting of adverse drug events. Here, we aimed to replicate and optimise a TPD approach previously used to assess temporal signals of statins with rhabdomyolysis (in The Health Improvement Network (THIN) database) by using the OHDSI tools designed for OMOP data sources.

Methods

We used data from the Truven MarketScan US Commercial Claims and the Commercial Claims and Encounters (CCAE). Using an extension of the OHDSI ICTemporalPatternDiscovery package, we ran positive and negative controls through four analytical settings and calculated sensitivity, specificity, bias and AUC to assess performance.

Results

Similar to previous findings, we noted an increase in the Information Component (IC) for simvastatin and rhabdomyolysis following initial exposure and throughout the surveillance window. For example, the change in IC was 0.266 for the surveillance period of 1–30 days as compared to the control period of − 180 to − 1 days. Our modification of the existing OHDSI software allowed for faster queries and more efficient generation of chronographs.

Conclusion

Our OMOP replication matched the we can account forwe can account for of the original THIN study, only simvastatin had a signal. The TPD method is a useful signal detection tool that provides a single statistic on temporal association and a graphical depiction of the temporal pattern of the drug outcome combination. It remains unclear if the method works well for rare adverse events, but it has been shown to be a useful risk identification tool for longitudinal observational databases. Future work should compare the performance of TPD with other pharmacoepidemiology methods and mining techniques of signal detection. In addition, it would be worth investigating the relative TPD performance characteristics using a variety of observational data sources.
Pattern of utilization, disease presentation, and medication prescribing and dispensing at 51 primary healthcare centers during the Hajj mass gathering
Authors: Yezli Saber , Yassin Yara , Mushi Abdulaziz , Almuzaini Yasir , Khan Anas
Published: February 2022

Background

The majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources during the pilgrimage.

Method

We investigated the pattern of disease presentation, caseload, and medication prescribing and dispensing at 51 PHCCs during the 2019 Hajj. Data on patients’ demographics, diagnoses, and prescribed medications were retrieved from each PHCC’s electronic records and analyzed. Data were also used to calculate six of the World Health Organization (WHO) indicators for drug use at these facilities.

Results

Data were captured for 99,367 patients who were mostly Hajj pilgrims (95.4%), male (69.1%) from the Eastern Mediterranean (60.8%) and had a mean age of 46.6 years (SD = 14.9). Most patients (85.2%) were seen in Mina and towards the end of Hajj. The majority of patients (96.0%) had a single diagnosis; most commonly, respiratory (45.0%), musculoskeletal (17.2%), and skin (10.5%) diseases. Patients were prescribed 223,964 medications, mostly analgesics (25.1%), antibacterials for systemic use (16.5%), anti-inflammatory and antirheumatic products (16.4%), and cough and cold preparations (11.9%). On average, 2.25 (SD = 0.94) medications were prescribed per consultation, with low (1.3%) prevalence of polypharmacy. An antibiotic and an injectable were prescribed in 43.6 and 2.67% of patient encounters, respectively. Most (92.7%) of the prescribed drugs were actually dispensed, in an average time of 8.06 min (SD = 41.4). All PHCCs had a copy of the essential drugs list available, on which all the prescribed drugs appeared.

Conclusion

Respiratory illnesses are the main reason for PHCCs visits during Hajj, and analgesics and antibiotics are the most common medications prescribed to pilgrims. Our results, including the calculated WHO drug use indicators, contribute to evidence-based optimization of primary healthcare services during Hajj.
Case report and successful management of canine aortic endocarditis caused by Actinomyces neuii subsp. anitratus (Winkia neuii subsp. anitrata)
Authors: Giannoulopoulos G. , Errington K.
Published: February 2022

Background

Canine aortic valve endocarditis carries a poor prognosis. In the current literature there are only two reports of infectious endocarditis associated with Actinomyces; Actinomyces turicensis and an Actinomyces-like organism. Endocarditis due to Actinomyces neuii subsp. anitratus (now known as Winkia neuii subsp. anitrata) has rarely been reported in humans, and to the best of our knowledge, has never been reported in dogs.

Case presentation

A 4 year-3 months old female neutered Great Dane presented with lethargy, hyporexia, ‘praying position’ stance, acute onset of cherry eye and pyrexia. A subtle diastolic heart murmur was detected on thoracic auscultation and echocardiology revealed an irregular lesion adhered to the ventricular aspect of the aortic valve, suggestive of aortic valve endocarditis. Peripheral blood was collected for blood culture. Following 10 days of incubation, blood cultures yielded a growth of aerobic gram-positive filamentous rods which were further biochemically (BioMerieux API Coryne profiling strip) identified as Actinomyces neuii subsp. anitratus. The patient was treated with marbofloxacin and amoxicillin/clavulanic acid for five consecutive months. On repeat echogram, following treatment completion, there was no evidence of aortic valve endocarditis. To the best of our knowledge this is the first case report documenting successful treatment of aortic valve endocarditis caused by Actinomyces neuii subsp. anitratus in a dog.

Conclusions

Despite the poor prognosis of canine infectious aortic valve endocarditis, patients with Actinomyces neuii subsp. anitratus infection might have a favourable outcome. It is therefore important identifying the underling infectious cause, as it may have a significant impact on prognosis and treatment outcome when it is caused by Actinomyces neuii subsp. anitratus.
Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair
Authors: Feng Shi-Ming , Chen Jie , Ma Chao , Migliorini Filippo , Oliva Francesco , Maffulli Nicola
Published: February 2022

Background

The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients.

Methods

This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.

Results

Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups.

Conclusion

In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome.

Level of Evidence

Level III, a retrospective comparative study.
Protocol for a cluster randomized control trial of the impact of the Breaking the Man Code workshops on adolescent boys’ intentions to seek help
Authors: King Kylie , Schlichthorst Marisa , Chondros Patty , Rice Simon , Clark Anna , Le Long Khanh-Dao , Mihalopoulos Cathrine , Pirkis Jane
Published: February 2022

Background

Males in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men’s wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys.Breaking the Man Codeworkshops, delivered byTomorrow Manin Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in theBreaking the Man Codeworkshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop.

Methods

A stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group.

Discussion

TheBreaking the Man Codeworkshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need forTomorrow Manto introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12620001134910). Registered on 30 October 2020
A novel DNA methylation signature associated with lymph node metastasis status in early gastric cancer
Authors: Chen Shang , Yu Yanqi , Li Tao , Ruan Weimei , Wang Jun , Peng Quanzhou , Yu Yingdian , Cao Tianfeng , Xue Wenyuan , Liu Xin , Chen Zhiwei , Yu Jiang , Fan Jian-Bing
Published: February 2022

Background

Lymph node metastasis (LNM) is an important factor for both treatment and prognosis of early gastric cancer (EGC). Current methods are insufficient to evaluate LNM in EGC due to suboptimal accuracy. Herein, we aim to identify methylation signatures for LNM of EGC, facilitate precision diagnosis, and guide treatment modalities.

Methods

For marker discovery, genome-wide methylation sequencing was performed in a cohort (marker discovery) using 47 fresh frozen (FF) tissue samples. The identified signatures were subsequently characterized for model development using formalin-fixed paraffin-embedded (FFPE) samples by qPCR assay in a second cohort (model development cohort, n = 302, training set: n = 151, test set: n = 151). The performance of the established model was further validated using FFPE samples in a third cohorts (validation cohort, n = 130) and compared with image-based diagnostics, conventional clinicopathology-based model (conventional model), and current standard workups.

Results

Fifty LNM-specific methylation signatures were identified de novo and technically validated. A derived 3-marker methylation model for LNM diagnosis was established that achieved an AUC of 0.87 and 0.88, corresponding to the specificity of 80.9% and 85.7%, sensitivity of 80.6% and 78.1%, and accuracy of 80.8% and 83.8% in the test set of model development cohort and validation cohort, respectively. Notably, this methylation model outperformed computed tomography (CT)-based imaging with a superior AUC (0.88 vs. 0.57, p < 0.0001) and individual clinicopathological features in the validation cohort. The model integrated with clinicopathological features demonstrated further enhanced AUCs of 0.89 in the same cohort. The 3-marker methylation model and integrated model reduced 39.4% and 41.5% overtreatment as compared to standard workups, respectively.

Conclusions

A novel 3-marker methylation model was established and validated that shows diagnostic potential to identify LNM in EGC patients and thus reduce unnecessary gastrectomy in EGC.
The outcome of using intravenous immunoglobulin (IVIG) in critically ill COVID-19 patients’: a retrospective, multi-centric cohort study
Authors: Salehi Mohammadreza , Barkhori Mehni Mahdi , Akbarian Mohammadmehdi , Fattah Ghazi Samrand , Khajavi Rad Nasim , Moradi Moghaddam Omid , Jamali Moghaddam SaeedReza , Hosseinzadeh Emam Masoumeh , Abtahi Sayed Hamidreza , Moradi Maryam , Ghiasvand Fereshteh
Published: February 2022

Background

During the COVID-19 pandemic, different treatments have been used in critically ill patients. Using intravenous immunoglobulin (IVIG) has been suggested in various studies as an effective option. Our study aims to access the efficacy of IVIG in critically ill COVID-19 patients.

Methods

In this retrospective matched cohort study, records of three tertiary centers with a large number of COVID-19 admissions were evaluated and used. Based on treatment options, patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using an independent t test and one-way analysis of variance (ANOVA) to compare the outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.

Results

The duration of hospitalization in the IVIG group was significantly longer than standard treatment (13.74 days vs. 11.10 days, p < 0.05). There was no significant difference between the two groups in ICU length of stay, the number of intubated patients, and duration of mechanical ventilation (p > 0.05). Also, initial outcomes in IVIG subgroups were compared separately with the standard treatment group. The results indicated that only the duration of hospitalization in the IVIG subgroup with medium dose is significantly longer than the standard treatment group (p < 0.01).

Conclusion

Our data indicate that the use of IVIG in critically ill COVID-19 patients could not be beneficial, based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation, and even mortality rate.
Laser desorption/ionization mass spectrometry of L-thyroxine (T4) using combi-matrix of α-cyano-4-hydroxycinnamic acid (CHCA) and graphene
Authors: Noh Joo-Yoon , Kim Moon-Ju , Park Jong-Min , Yun Tae-Gyeong , Kang Min-Jung , Pyun Jae-Chul
Published: February 2022

An optimal combi-matrix for MALDI-TOF mass spectrometry was presented for the analysis of L-thyroxine (T4) in human serum. For the selection of the optimal combi-matrix, several kinds of combi-matrices were prepared by mixing the conventional organic matrix of CHCA with nanomaterials, such as graphene, carbon nanotubes, nanoparticles of Pt and TiO2. In order to select the optimal combi-matrix, the absorption at the wavelength of laser radiation (337 nm) for the ionization of sample was estimated using UV–Vis spectrometry. And, the heat absorption properties of these combi-matrices were also analyzed using differential scanning calorimetry (DSC), such as onset temperature and fusion enthalpy. In the case of the combi-matrix of CHCA and graphene, the onset temperature and fusion enthalpy were observed to be lower than those of CHCA, which represented the enhanced transfer of heat to the analyte in comparison with CHCA. From the analysis of optical and thermal properties, the combi-matrix of CHCA and graphene was selected to be an optimal combination for the transfer of laser energy during MALDI-TOF mass spectrometry. The feasibility of the combi-matrix composed of CHCA and graphene was demonstrated for the analysis of T4 molecules using MALDI-TOF mass spectrometry. The combi-matrix of CHCA and graphene was estimated to have an improved limit of detection and a wider detection range in comparison with other kinds of combi-matrices. Finally, the MALDI-TOF MS results of T4 analysis using combi-matrix were statistically compared with those of the conventional immunoassay.
(Re-)Designing a measure of student’s attitudes toward science: a longitudinal psychometric approach
Authors: Tai Robert H. , Ryoo Ji Hoon , Skeeles-Worley Angela , Dabney Katherine P. , Almarode John T. , Maltese Adam V.
Published: February 2022

Background

Capturing measures of students’ attitudes toward science has long been a focus within the field of science education. The resulting interest has led to the development of many instruments over the years. There is considerable disagreement about how attitudes should be measured, and especially whether students’ attitudes toward science can or should be measured unidimensionally, or whether separate attitude dimensions or subscales should be considered. When it is agreed upon that the attitudes toward science construct should be measured along separate subscales, there is no consensus about which subscales should be used.

Methods

A streamlined version of the modified Attitudes Towards Science Inventory (mATSI), a widely used science measurement instrument, was validated for a more diverse sample as compared to the original study (Weinburgh and Steele in Journal of Women and Minorities in Science and Engineering 6:87–94, 2000). The analytical approach used factor analyses and longitudinal measurement invariance. The study used a sample of 2016 self-reported responses from 6 and 7th grade students. The factor analysis elucidated the factor structure of students’ attitudes toward science, and some modifications were made in accordance with the results. Measurement invariance analysis was used to confirm the stability of the measure.

Results

Our results support that the subscales, anxiety toward science and value and enjoyment of science, are two factors and stable over time.

Conclusions

Our results suggest that our proposed modified factor structure for students’ attitudes toward science is reliable, valid, and appropriate for use in longitudinal studies. This study and its resulting streamlined mATSI survey could be of value to those interested in studying student engagement and measuring middle-school students' attitudes toward science.
Neuronal GRK2 regulates microglial activation and contributes to electroacupuncture analgesia on inflammatory pain in mice
Authors: Chen Yu , Zhou Yang , Li Xiao-Chen , Ma Xue , Mi Wen-Li , Chu Yu-Xia , Wang Yan-Qing , Mao-Ying Qi-Liang
Published: February 2022

Background

G protein coupled receptor kinase 2 (GRK2) has been demonstrated to play a crucial role in the development of chronic pain. Acupuncture is an alternative therapy widely used for pain management. In this study, we investigated the role of spinal neuronal GRK2 in electroacupuncture (EA) analgesia.

Methods

The mice model of inflammatory pain was built by subcutaneous injection of Complete Freund’s Adjuvant (CFA) into the plantar surface of the hind paws. The mechanical allodynia of mice was examined by von Frey test. The mice were subjected to EA treatment (BL60 and ST36 acupuncture points) for 1 week. Overexpression and downregulation of spinal neuronal GRK2 were achieved by intraspinal injection of adeno associated virus (AAV) containing neuron-specific promoters, and microglial activation and neuroinflammation were evaluated by real-time PCR.

Results

Intraplantar injection with CFA in mice induced the decrease of GRK2 and microglial activation along with neuroinflammation in spinal cord. EA treatment increased the spinal GRK2, reduced neuroinflammation, and significantly decreased CFA-induced mechanical allodynia. The effects of EA were markedly weakened by non-cell-specific downregulation of spinal GRK2. Further, intraspinal injection of AAV containing neuron-specific promoters specifically downregulated neuronal GRK2, and weakened the regulatory effect of EA on CFA-induced mechanical allodynia and microglial activation. Meanwhile, overexpression of spinal neuronal GRK2 decreased mechanical allodynia. All these indicated that the neuronal GRK2 mediated microglial activation and neuroinflammation, and subsequently contributed to CFA-induced inflammatory pain.

Conclusion

The restoration of the spinal GRK2 and subsequent suppression of microglial activation and neuroinflammation might be an important mechanism for EA analgesia. Our findings further suggested that the spinal GRK2, especially neuronal GRK2, might be the potential target for EA analgesia and pain management, and we provided a new experimental basis for the EA treatment of pain.
Why a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children
Authors: Kandil Ali I. , Ok Michale S. , Baroch Kelly A. , Subramanyam Rajeev , Mahmoud Mohamed A. , McAuliffe John J.
Published: February 2022

BACKGROUND:

Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children.

METHODS:

This prospective double-blind crossover study enrolled children (≤18 years old) receiving general anesthesia for elective ABR testing. All subjects received both sevoflurane and propofol anesthesias in the same ABR testing session. Deidentified ABR data were reviewed by 5 audiologists (blinded to anesthetic and patient) to determine threshold levels for hearing loss. The primary outcome was qualitative interpretability (false positive) of ABR click-testing.

RESULTS:

Each patient was tested at 4 different intensities in each ear: generating 624 records under each anesthetic, for a total of 1248 records. A few patients were tested at 5 different intensities in a single ear accounting for the additional 11 records, yielding 1259 records. Under sevoflurane anesthesia, 21 of the same patients (37 ears) were identified with abnormal ABR levels consistent with hearing loss (one or both ears). The probability of a patient being diagnosed with hearing “loss” in one or both ears was significantly less with propofol versus sevoflurane anesthesia (mid P =.0312). If patients with bilateral loss are compared, the mid P value is 0.0098. The effect size based on patients was medium to large, with a minimum value of Cohen w = 0.320.

CONCLUSIONS:

Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children.
Achieving Greater Health Equity: An Opportunity for Anesthesiology
Authors: Diallo Mofya S. , Tan Jonathan M. , Heitmiller Eugenie S. , Vetter Thomas R.
Published: February 2022

Anesthesiology and anesthesiologists have a tremendous opportunity and responsibility to eliminate health disparities and to achieve health equity. We thus examine health disparity and health equity through the lens of anesthesiology and the perspective of anesthesiologists. In this paper, we define health disparity and health care disparities and provide tangible, representative examples of the latter in the practice of anesthesiology. We define health equity, primarily as the desired antithesis of health disparity. Finally, we propose a framework for anesthesiologists, working toward mitigating health disparity and health care disparities, advancing health equity, and documenting improvements in health care access and health outcomes. This multilevel and interdependent framework includes the perspectives of the patient, clinician, group or department, health care system, and professional societies, including medical journals. We specifically focus on the interrelated roles of social identity and social determinants of health in health outcomes. We explore the foundational role that clinical informatics and valid data collection on race and ethnicity have in achieving health equity. Our ability to ensure patient safety by considering these additional patient-specific factors that affect clinical outcomes throughout the perioperative period could substantially reduce health disparities. Finally, we explore the role of medical journals and their editorial boards in ameliorating health disparities and advancing health equity.
External Validation of a Neural Network Model in Aneurysmal Subarachnoid Hemorrhage: A Comparison With Conventional Logistic Regression Models
Authors: Feghali James , Sattari Shahab Aldin , Wicks Elizabeth E. , Gami Abhishek , Rapaport Sarah , Azad Tej D. , Yang Wuyang , Xu Risheng , Tamargo Rafael J. , Huang Judy
Published: February 2022

BACKGROUND:

Interest in machine learning (ML)–based predictive modeling has led to the development of models predicting outcomes after aneurysmal subarachnoid hemorrhage (aSAH), including the Nijmegen acute subarachnoid hemorrhage calculator (Nutshell). Generalizability of such models to external data remains unclear.

OBJECTIVE:

To externally validate the performance of the Nutshell tool while comparing it with the conventional Subarachnoid Hemorrhage International Trialists (SAHIT) models and to review the ML literature on outcome prediction after aSAH and aneurysm treatment.

METHODS:

A prospectively maintained database of patients with aSAH presenting consecutively to our institution in the 2013 to 2018 period was used. The web-based Nutshell and SAHIT calculators were used to derive the risks of poor long-term (12-18 months) outcomes and 30-day mortality. Discrimination was evaluated using the area under the curve (AUC), and calibration was investigated using calibration plots. The literature on relevant ML models was surveyed for a synopsis.

RESULTS:

In 269 patients with aSAH, the SAHIT models outperformed the Nutshell tool (AUC: 0.786 vs 0.689, P = .025) in predicting long-term functional outcomes. A logistic regression model of the Nutshell variables derived from our data achieved adequate discrimination (AUC = 0.759) of poor outcomes. The SAHIT models outperformed the Nutshell tool in predicting 30-day mortality (AUC: 0.810 vs 0.636, P < .001). Calibration properties were more favorable for the SAHIT models. Most published aneurysm-related ML-based outcome models lack external validation and usable testing platforms.

CONCLUSION:

The Nutshell tool demonstrated limited performance on external validation in comparison with the SAHIT models. External validation and the dissemination of testing platforms for ML models must be emphasized.
Frailty in Very Elderly Patients is Not Associated with Adverse Surgical or Oncological Outcomes in Extremity Surgery for Soft Tissue Sarcoma
Authors: Sivarajah Gausihi , Davies Emma , Hurley Anna , Strauss Dirk C. , Smith Myles J. F. , Hayes Andrew J.
Published: February 2022

Background

While surgery remains the mainstay of treatment for limb sarcoma, extreme old age is a relative contraindication to oncological surgery.

Methods

Patients >80 years referred with primary extremity soft-tissue sarcoma (ESTS) between 2007 and 2016 were retrospectively reviewed. Prognostic variables, including ASA status and Clinical Frailty Scores, were collected. Endpoints were perioperative morbidity, locoregional (LRR) and distant recurrence (DR), disease-specific survival (DSS) adjusted using competing risk modelling, and overall survival (OS).

Results

A total of 141 primary tumours were identified, with 116 undergoing resections. Main motives for nonoperative management were severe frailty or significant comorbidity (56.0%). The operative group had a median age of 84 (range 80-96) years and median follow-up of 16 months (range 0-95). 45.7% of patients received radiotherapy. Median hospital stay was 7 (range 0-40) days, with frailty (p = 0.25) and ASA (p = 0.28) not associated with prolonged admission. 12.9% developed significant complications, with one perioperative mortality.

24.1% had LRR, occurring at a median of 14.5 months. All patients with reported DR (28.4%), except one, died of their disease. Frailty did not confer a significant difference in adjusted LRFS (p = 0.95) and DMFS (p = 0.84). One- and 5-year adjusted DSS and OS was 87.0% versus 74.9% and 62.3% versus 27.4%, respectively. Frailty (CFS ≥4) was associated with worse OS (hazard ratio [HR] 2.49; 95% confidence interval [CI] 1.51-4.12; p < 0.001), however not with adjusted DSS (p = 0.16). Nonoperative management conferred a 1- and 5-year adjusted DSS was 58.3% and 44.4%, respectively.

Conclusions

Extremity surgery for sarcoma is well tolerated in the frail very elderly population with low morbidity and comparable oncological outcomes.
Facile Post-synthesis and Redox Behavior of π-Expanded Ferrocene and ansa-Ferrocene
Authors: Morimoto Hirofumi , Matsuo Kyohei , Hayashi Hironobu , Yamada Hiroko , Aratani Naoki
Published: February 2022

A new π-extended ferrocene and a transannular ansa-ferrocene have been successfully synthesized by post-synthesis via one-pot reaction of a 1,1′-diborylferrocene with 1,8-dibromonaphthalene under Suzuki-Miyaura-Heck coupling conditions. Both compounds in the neutral and one-electron oxidized forms characterized by single-crystal X-ray analysis and UV-vis-NIR absorption revealed the structure-property relationships.
Turbulence modeling of micropolar flows
Authors: Σοφιάδης Γεώργιος
Published: February 2022

Μικροπολικά μπορούν να θεωρηθούν όλα τα ρευστά που δεν είναι ομογενή, αλλά έχουν εσωτερική μικροδομή που γενικά μπορεί να κινηθεί ανεξάρτητα από την κίνηση της συνεχούς φάσης. Τέτοια ρευστά αφορούν όλο το φάσμα εφαρμογών της ρευστομηχανικής, και για παράδειγμα είναι το αίμα, τα πυκνά διαλύματα και τα διαλύματα πολυμερών. Στην παρούσα εργασία έγινε για πρώτη φορά λεπτομερείς υπολογιστική μελέτη της τυρβώδους ροής μικροπολικών ρευστών, και χρησιμοποιήθηκε η συνήθης ροή σε κανάλι για να μπορεί να συγκριθεί εύκολα στις αντίστοιχες συνθήκες με Νευτωνικά και μη ρευστά. Αρχικά η αξιοπιστία της υπολογιστικής μεθόδου πιστοποιήθηκε μέσα από την σύγκριση των αποτελεσμάτων σε μια τυπική βιολογική ροή, όπως είναι η ροή του αίματος μέσα από την καρωτίδα. Τα αποτελέσματα των πειραμάτων στην γεωμετρία της καρωτίδας δείξανε πως λαμβάνοντας υπ’ όψη την μικροπολική μικροπεριστροφή του ρευστού, η ταχύτητα του αίματος αυξάνεται στο κέντρο της διατομής, ενώ μειώνεται κοντά στα τοιχώματα σε σχέση με τη συμπεριφορά των Νευτωνικών ρευστών. Αποτελέσματα που επαληθεύουν υπάρχοντα πειραματικά αποτελέσματα. Τα φαινόμενα αυτά μπορούν να οδηγήσουν στην εναπόθεση μεγαλύτερης ποσότητας αρτηριακής πλάκας στο σύστημα, γεγονός το οποίο έχει άμεση επίδραση στην υγεία. Στη συνέχεια, μελετήθηκε η μικροπολική τύρβη σε μια τυπική γεωμετρία καναλιού τύπου Poiseuille. Αρχικά ο αριθμός Reynolds κρατήθηκε σταθερός, Re = 5600, ενώ μελετήθηκε η επίδραση της αύξησης του μικροπολικού ιξώδους. Τα αποτελέσματα συγκρίθηκαν με αντίστοιχα Νευτωνικών ρευστών, πολυμερών αλλά και πυκνών εναιωρημάτων. Από τη σύγκριση διάφορων τυρβωδών ποσοτήτων προέκυψε πως τα μικροπολικά ρευστά οδηγούν σε αύξηση του συντελεστή της οπισθέλκουσας, συμπεριφορά παρόμοια με αυτή των πυκνών υγρών εναιωρημάτων. Επίσης, όσο αυξάνεται το μικροπολικό ιξώδες τόσο περισσότερο αυξάνονται οι τιμές της οπισθέλκουσας ταχύτητας αλλά και του τανυστή των μικροπολικών τάσεων ο οποίος είναι υπεύθυνος για την αύξηση της έντασης των φαινομένων τύρβης πολύ κοντά στον τοίχο σε σχέση με τα πολυμερή και Νευτωνικά ρευστά.Τέλος, μελετήθηκε η συνδυασμένη επίδραση του αριθμού Reynolds καθώς αυξήθηκε από 3300 στις 13800 για την αύξηση του μικροπολικού ιξώδους. Για μια ακόμη φορά παρατηρήθηκε αύξηση του συντελεστή οπισθέλκουσας δύναμης καθώς αυξάνεται το μικροπολικό ιξώδες αλλά και ο αριθμός Reynolds. Όταν όμως στο μικροπολικό ιξώδες δοθούν ικανά μεγάλες τιμές και ο αριθμός Reynolds είναι επίσης μεγάλος, τότε παρατηρείται μια ανάστροφη συμπεριφορά με τον συντελεστή οπισθέλκουσας, αλλά και την ταχύτητα σε μονάδες τοίχου να μειώνονται αντίστοιχα. Η ανάλυση των τάσεων οδηγεί στο συμπέρασμα πως ο τανυστής των μικροπολικών τάσεων επηρεάζει την τύρβη κυρίως κοντά στα τοιχώματα. Το αποτέλεσμα αυτό εξηγείται περαιτέρω από την ανάλυση της εξίσωσης ενέργειας, όπου φαίνεται πως η αύξηση της προσφοράς ενέργειας από τον μικροπολικό όρο κοντά στον τοίχο, οδηγεί στην μετατόπιση της έντασης της τύρβης μακριά από τον τοίχο.
Corporate governance and shareholders’ confidence in cooperative corporations: a systematic literature review
Authors: Thangaveloo Arasu , Dorasamy Magiswary , Bin Ahmad Abdul Aziz , Marimuthu Siva Barathi , Jayabalan Jayamalathi
Published: February 2022

Background: The confidence of Bottom 40 (B40) shareholders is crucial for cooperative corporation’s sustenance within wider corporate governance. An in-depth study on cooperatives is needed, as they play a crucial role in the Malaysian economic system and contribute greatly to the country’s social development. However, in the current landscape, confidence among shareholders is at stake. This study aims to identify the research gap into corporate governance for cooperative corporations  in relation to B40 shareholder confidence, as well as identify current study challenges and develop a conceptual framework for future research.

Methods: We conducted a systematic literature review, with the use of agency theory to assess shareholders’ confidence. Emerald, ProQuest, InderScience, Scopus and Science Direct were the online databases used in this study to search  five  keyword phrases: corporate governance, confidence, cooperative, agency theory and Bottom 40% (B40) household. Tranfield’s five stages were used to conduct the systematic review.

Results: Only 5 of the 324 studies assess shareholders’ confidence in cooperatives, as well as one paper on B40 and two papers on agency theory. Our review presents three major findings. First, research in the context of B40 shareholder’s confidence in cooperative corporations  is limited. Second, the challenges related to shareholders’ confidence in B40 are major issues in the context. Third, research on agency theory in the context of shareholders’ confidence within cooperative corporations and corporate governance is still scant.

Conclusions: This review urges the research community to conduct more studies based on the highlighted research gaps.
Effectiveness and safety profile of mesenchymal stem cell secretome as a treatment for severe cases of COVID-19: a randomized controlled trial
Authors: Abdullah Murdani , Pawitan Jeanne Adiwinata , Irawan Cosphiadi , - Rahyussalim , Aditianingsih Dita , Liem Isabella Kurnia , Sinto Robert , Susilo Adityo , Yulianti Mira , Handayani Raden Rara Diah , Pratomo Irandi Putra , Burhan Erlina , Damayanti Triya , Wibowo Heri , Dilogo Ismail Hadisoebroto
Published: February 2022

Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19. 

Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome.

Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups.

Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.
A STUDY OF CATASTROPHIC HEALTH EXPENDITURES IN INDIA - EVIDENCE FROM NATIONALLY REPRESENTATIVE SURVEY DATA: 2014-2018
Authors: Sriram Shyamkumar , Albadrani Muayad
Published: February 2022

Abstract

Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE).

Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of ‘catastrophic’ health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures.

Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE.

Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
Case Report: Glans penile necrosis in a patient with SARS-CoV-2 and leprosy infection
Authors: Ismy Jufriady , Khalilullah Said Alfin , Bahagianto Aditya Fajar
Published: February 2022

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was firstly identified in China and has been declared a global pandemic. Several serious extrapulmonary manifestations due to SARS-CoV-2 infection have also been reported and associated with hypercoagulability thrombotic vasculopathy. In addition, cases of Mycobacterium-leprae infection have also been known associated with blood coagulation abnormality.

Methods: Here, we report a 56-year-old male with coronavirus disease-19 (COVID-19) with concomitant leprosy infection with manifestation of glans penile necrosis, presented to the emergency department with acute penile pain. This case is unique because no occlusion blood flow to the penile was observed in the radiographic imaging. We described the potential pathophysiology in this case through a literature review.

Results: The patient received treatment according to the COVID-19 protocol and was given low molecular weight heparin (LMWH) therapy for 4 days. During the follow up, the clinical and functional condition of the penis showed significant improvement.

Conclusions: Microthrombus involvement, platelet abnormalities and impaired hemostasis due to SARS-CoV-2 and leprosy co-infection are the hypothesis in this case report.
How psychiatrists’ attitudes towards multi-source feedback including patient feedback influenced the educational value: a qualitative study
Authors: Murton Claudia , Spowart Lucy , Anderson Merryn
Published: February 2022

Background:  Multi-source feedback (MSF) is well-established in psychiatric training. However, evidence on the educational impact is not definitive and there is scanty evidence exploring its value for professional development of psychiatry trainees in the United Kingdom (UK). Evidence suggests the MSF tool currently used is not suitable for specialist trainees.

This qualitative research project explored psychiatric doctors’ attitudes towards MSF with patient feedback, to determine how this influenced the feedback’s educational usefulness.

Methods: A qualitative study using a phenomenological approach based on a constructivist approach. Purposive sampling identified trainee psychiatrists who completed a more extensive MSF, including patient feedback, than they currently use. They discussed their results in supervised sessions to plan how to use the feedback. Semi-structured interviews were conducted separately with trainees and their supervisors following completion of MSF. The data was analysed thematically. The study was completed in 2020.

Results: Seven trainees and five supervisors participated. Four themes were identified. Most had positive opinions about the educational usefulness of MSF, including patient feedback, and made changes to their behaviour following the feedback. Interviewees valued patient feedback and identified it as important in psychiatry. Most valued their patient feedback over their colleague feedback. The complexities of patient feedback in psychiatry and how this may influence the educational usefulness of the feedback were discussed in detail.

Conclusions: Findings suggest a need to review the current system of MSF in psychiatry in order to maximise educational benefits. In particular, this research points to the benefits of psychiatric trainees engaging with patient feedback.
A culturally competent approach to teach humanities in international medical school: potential frameworks and lessons learned
Authors: Daher-Nashif Suhad , Kane Tanya
Published: February 2022

Background: This paper describes the development of a culturally competent medical humanities course for second and third-year medical students at the ethnically diverse College of Medicine at Qatar University. First taught in 2016, the elective seminar “Medicine and the Arts” was restructured in 2017 to cultivate an appreciation of the symbiotic relationship between medicine, art, and humanities, and to foster cultural competence among the students.

Methods: Results and tips are based on our experiences and past reports.

Results: In designing a course for students immersed in an Arab-Muslim context, we encountered two challenges: the discipline’s privileging of a predominantly Western canon of arts and humanities, and the largely Euro-American-centric and unilateral framing of concepts e.g., the doctor-patient relationship, patient-centered approach, patient experiences, and meanings of health and illness. To circumvent these challenges, we followed the Purnell Model for Cultural Competence, adopted the interdisciplinary approach, and employed an intersectionality framework to build and deliver a culturally competent course exploring the nexus of arts, humanities, and medicine.

In addition to these tips on which frameworks to adopt and how to structure the course, we recommend a visual literacy workshop to help them develop the ability to recognize and understand ideas conveyed through art. Furthermore, we recommend deep conversations about artistic portrayals of medicine from different cultural contexts as tools for developing cultural awareness. Lastly, we recommend that these discussions adopt a student-centered approach, where students inform about their experiences and their own health and illness determinants, in order to develop their knowledge and practice of holism and patient centered approach, and other issues related to humanities and social sciences.     

Conclusions:Adopting and implementing a culturally competent approach to medical education, alongside interdisciplinary and intersectionality concepts, are potential conceptual frameworks to structure a course that uses art to inform about medical humanities.
Life cycle analysis of the solar thermochemical energy storage scheme SOCRATCES
Authors: Hritz Sara , Eusha Muhammad , Mir Faraz Rasheed , Schories Gerhard
Published: February 2022

Background: SOCRATCES is an environment-friendly thermochemical solar energy storage scheme based on calcium-looping [1]. It involves capturing of solar energy using an endothermic splitting of calcium carbonator into calcium oxide and carbon dioxide, and a subsequent exothermic combination of these two products to reproduce calcium carbonate in a cyclic process [2]. The life cycle analysis of this concept, which has generated substantial interest in recent years, is extremely important in its holistic assessment [3].

Methods: The methodology followed was based on the international standards ISO 14040:2006 and 14044:2006, considering three different scales – the pilot plant in Seville, Spain [1] and two industrial-scale sizes with 10 and 100 MW. The data for calculating the environmental impact was compiled by the consortium involved in the project SOCRATCES (EU GA 727348) and the previously developed deliverables [4] in the project. Additional information that was not covered during the work of the project was taken from different literature resources. For the calculation of the LCA, the software Umberto® LCA+ was utilized.

Results: The results showed that the technology is comparable to alternative energy storage approaches in terms of the environmental impact assessment. It is located in the lower region of CO2-Eq output per kWh produced electricity and has significantly lower toxicity impact. When the eco-efficiency factor is brought into consideration, it emerged that the technology is considerably superior to competing alternatives, which comes from the higher storage time compared to other technologies.

Conclusions: The Stirling engine appears to be a sound choice, in terms of conversion efficiency, at comparatively low temperatures, to be integrated with an exothermic reactor, at least at small-scale applications.