bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel germline BRCA2 mutation in a Chinese patient with prostate cancer sensitive to platinum chemotherapy: a case report
Authors: Jiang Lijuan , Bai Zunguang , Zhu Shoulun , Zhao Tingting , Yang Yining , Li Zhiyong , Chen Dong , Wu Zhiming , Wang Yanjun , Zhou Fangjian , Li Yonghong
Published: August 2021

Background

Germline BRCA2 mutation is associated with an aggressive prostate cancer phenotype and indicates higher risk for hereditary cancer. Recently, numerous studies have attempted to identify the genomic landscape of prostate cancer to better understand the genomic drivers of this disease and look for the molecular targets to guide treatment selection.

Case presentation

We report a 67-year-old patient diagnosed with prostate cancer who experienced rapid disease progression after androgen deprivation therapy and subsequent docetaxel treatment. The patient had a strong family history of malignancy as his mother was diagnosed with breast cancer and his father was died of lung cancer. Next generation sequencing demonstrated a novel pathogenic germline BRCA2 mutation (p.Gly2181Glufs*10) in the patient. His mother with breast cancer and his son were found to have the same BRCA2 mutation. The patient experienced impressive and durable responses to carboplatin treatment.

Conclusions

This case demonstrated that the carboplatin could have a dramatic antitumor effect on patients with prostate cancer with germline BRCA2 mutations and family history will help to ensure that patients and their families can be provided with proper genetic counseling.
Men’s reproductive coercion of women: prevalence, experiences, and coping strategies—a mixed method study in urban health facilities in León, Nicaragua
Authors: Brenner Cecilia , Ugarte William J. , Carlsson Ida , Salazar Mariano
Published: August 2021

Background

Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women’s reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC.

Methods

A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18–35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis.

Results

Ever RC prevalence was 17.4% (95% CI, 13.8–21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4–16.3) or ever experiencing CS (11.8%, 95% CI 8.7–15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2–16.0) than above. Twelve months PP (7.4%, 95% CI 5.0–10.5) and CS (8.7%, 95% CI 6.1–12.0) were also similar. Women’s higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women’s long-term fertility autonomy.

Conclusions

Our facility-based study showed that men’s RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women’s reproductive autonomy.
Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis
Authors: Ma Huijuan , Lin Li , Zhang Suofei , Lei Lei , Huang Jinyu , Lu Fang , Luo Yu
Published: August 2021

Background

Military nurses should possess the competency to provide quality care in both clinical and military nursing contexts. This study aimed to identify the competencies of military nurses in general hospitals.

Methods

A qualitative study was carried out using a qualitative content analysis. We purposefully sampled and interviewed 21 nurses in general hospitals in China.

Results

The data analysis revealed 40 competencies, which were categorised into four main categories according to the Onion Model. These categories were motive (mission commitment), traits (perseverance, flexibility, etc.), self-identity of dual roles (obedience, empathy, etc.), as well as knowledge, skills and abilities (clinical and military nursing knowledge and skills, basic nursing ability, professional development ability, leadership and management ability).

Conclusions

Existing knowledge of competencies of military nurses in general hospitals is limited. A detailed exploration of this topic can provide guidance for recruitment, competency assessment, and competency building.
Operational experiences associated with the implementation of near point-of-care early infant diagnosis of HIV in Myanmar: a qualitative study
Authors: Yee Win Lei , Htay Hla , Mohamed Yasmin , Nightingale Claire E. , Tin Htay Htay , Thein Win , Kyaw Latt Latt , Yee Win Win , Aye Moe Myat , Badman Steven G. , Vallely Andrew J. , Anderson David , Kelly-Hanku Angela , Luchters Stanley
Published: August 2021

Background

Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIV-exposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation.

We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 Qual test (Cepheid, Sunnyvale, CA, USA) for early infant diagnosis (EID) as part of routine services in four public hospitals in Myanmar.

Methods

This sub-study was part of a randomised controlled stepped-wedge trial (Australian and New Zealand Clinical Trials Registry, number 12616000734460) designed to investigate the impact of POC testing for EID in Myanmar and Papua New Guinea. Infants recruited during the intervention phase underwent POC testing at the participating hospitals as part of routine care. Semi-structured interviews with 23 caregivers, 12 healthcare providers and 10 key informants were used to explore experiences of POC-EID testing. The research team and hospital staff documented and discussed implementation challenges throughout the study.

Results

Overall, caregivers and healthcare workers were satisfied with the short turnaround time of the POC test. Occasional delays in POC testing were mostly attributable to late receipt of samples by laboratory technicians and communication constraints among healthcare staff. Hospital staff valued technical assistance from the research group and the National Health Laboratory. Despite staff shortages and infrastructure challenges such as unreliable electricity supply and cramped space, healthcare workers and caregivers found the implementation of the POC test to be feasible at pilot sites.

Conclusions

As plans for national scale-up evolve, there needs to be a continual focus on staff training, communication pathways and infrastructure. Other models of care, such as allowing non-laboratory-trained personnel to perform POC testing, and cost effectiveness should also be evaluated.
Sustainability of hospital-based midwife-led antenatal care consultation — a qualitative study
Authors: Siegle Anja , Sayn-Wittgenstein Friederike Zu , Roes Martina
Published: August 2021

Background

All evidence-based knowledge and improvement strategies for quality care must be implemented so patients can benefit from them. In Germany, national expert standards (NES) contribute to quality care in nursing and midwifery. The NES defines for several action levels a dedicated level of quality, which is operationalized by structure, process, and outcome (SPO) criteria. An NES to promote normal childbirth was developed and implemented in 2014. The first action level involves midwife-led antenatal consultation (ML-AC) being conducted in a structured way. Most implementation processes aim to accomplish sustainability, but implementation studies rarely use definitions or a theory of sustainability, even when assessing sustainability. This lack led to the assumption that intervention sustainability after implementation is still a largely unexplored domain. The aim of this study is to investigate the sustainability of midwife-led antenatal consultation (ML-AC) implemented at two hospitals, in Germany.

Methods

In a qualitative approach, 34 qualitative interviews were conducted (between March and October 2017) using semi-structured interview guides. All interviews were transcribed verbatim, anonymized and analyzed thematically using framework method. Four groups of stakeholders in two hospitals offering ML-AC were interviewed: managers (n = 8), midwives conducting ML-AC (n = 10), pregnant women who attended ML-AC (n = 8), and physicians working in obstetrics (n = 8) at the hospitals.

Results

The interviewees identified key benefits of ML-AC on a personal and unit level, e.g., reduced obstetric interventions, easier admission processes. Furthermore, the participants defined key requirements that are needed for routinized and institutionalized ML-AC, such as allocating working time for ML-AC, and structural organization of ML-AC. All study participants saw a need to establish secure long-term funding. Additionally, the interviewed staff members stated that ML-AC topics need evaluating and adapting in the future.

Conclusions

Implementing ML-AC in the hospital setting has led to manifold benefits. However, reimbursement through the health care system will be needed to sustain ML-AC.

Hospitals implementing ML-AC will need to be aware that adaptations of the NES are necessary to accomplish routinization and institutionalization. After initial implementation, sustaining ML-AC will generally require on-going monitoring and evaluating of benefits, routinization/institutionalization and further development.
Comparison of maternal and child health service performances following a leadership, management, and governance intervention in Ethiopia: a propensity score matched analysis
Authors: Argaw Mesele Damte , Desta Binyam Fekadu , Muktar Sualiha Abdlkader , Abera Wondwosen Shiferaw , Beshir Ismael Ali , Otoro Israel Ataro , Samuel Asegid , Rogers Deirdre , Eifler Kristin
Published: August 2021

Background

Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing the work climate, and creating responsive health systems. Hence, the Ethiopian Ministry of Health with the support of the USAID Transform: Primary Health Care project has been implementing LMG interventions to improve performances of primary healthcare entities. The purpose of this evaluation was to compare maternal and child health service performances and overall health system strengthening measurement results of primary health care entities by LMG intervention exposed groups.

Methods

The study used a cross-sectional study design with a propensity matched score analysis, and was conducted from August 28, 2017, to September 30, 2018, in Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and Peoples’ (SNNP) regions. Data collection took place through interviewer and self-administered questionnaires among 227 LMG intervention exposed and 227 non-exposed health workers. Propensity score matched analysis was used to balance comparison groups with respect to measured covariates.

Results

The mean overall maternal and child health key performance indicator score with standard deviation (± SD) for the LMG intervention exposed group was 63.86 ± 13.16 and 57.02 ± 13.71 for the non-exposed group. The overall health system strengthening score for the LMG intervention exposed group (mean rank = 269.31) and non-exposed group (mean rank = 158.69) had statistically significant differences (U = 10.145, z = − 11.175, p = 0.001). In comparison with its counterpart, the LMG exposed group had higher average performances in 3.54, 3.51, 2.64, 3.00, 1.07, and 3.34 percentage-points for contraceptive acceptance rate, antenatal care, skilled birth attendance, postnatal care, full immunization, and growth monitoring services, respectively.

Conclusion

There were evidences on the positive effects of the LMG intervention on increased maternal and child health services performances at primary healthcare entities. Moreover, health facilities with LMG intervention exposed health workers had higher and statistically significant differences in management systems, work climates, and readiness to face new challenges. Therefore, this study generated evidence for integrating LMG interventions to improve the performance of primary healthcare entities and maternal and child service uptake of community members, which contributes to the reduction of maternal and child deaths.
An alternating active-dormitive strategy enables disadvantaged prey to outcompete the perennially active prey through Parrondo’s paradox
Authors: Wen Tao , Koonin Eugene V. , Cheong Kang Hao
Published: August 2021

Background

Dormancy is widespread in nature, but while it can be an effective adaptive strategy in fluctuating environments, the dormant forms are costly due to the inability to breed and the relatively high energy consumption. We explore mathematical models of predator-prey systems, in order to assess whether dormancy can be an effective adaptive strategy to outcompete perennially active (PA) prey, even when both forms of the dormitive prey (active and dormant) are individually disadvantaged.

Results

We develop a dynamic population model by introducing an additional dormitive prey population to the existing predator-prey model which can be active (active form) and enter dormancy (dormant form). In this model, both forms of the dormitive prey are individually at a disadvantage compared to the PA prey and thus would go extinct due to their low growth rate, energy waste on the production of dormant prey, and the inability of the latter to grow autonomously. However, the dormitive prey can paradoxically outcompete the PA prey with superior traits and even cause its extinction by alternating between the two losing strategies. We observed higher fitness of the dormitive prey in rich environments because a large predator population in a rich environment cannot be supported by the prey without adopting an evasive strategy, that is, dormancy. In such environments, populations experience large-scale fluctuations, which can be survived by dormitive but not by PA prey.

Conclusion

We show that dormancy can be an effective adaptive strategy to outcompete superior prey, recapitulating the game-theoretic Parrondo’s paradox, where two losing strategies combine to achieve a winning outcome. We suggest that the species with the ability to switch between the active and dormant forms can dominate communities via competitive exclusion.
Comparative kinetics of SARS-CoV-2 anti-spike protein RBD IgGs and neutralizing antibodies in convalescent and naïve recipients of the BNT162b2 mRNA vaccine versus COVID-19 patients
Authors: Trougakos Ioannis P. , Terpos Evangelos , Zirou Christina , Sklirou Aimilia D. , Apostolakou Filia , Gumeni Sentiljana , Charitaki Ioanna , Papanagnou Eleni-Dimitra , Bagratuni Tina , Liacos Christine-Ivy , Scorilas Andreas , Korompoki Eleni , Papassotiriou Ioannis , Kastritis Efstathios , Dimopoulos Meletios A.
Published: August 2021

Background

Coronavirus SARS-CoV-2, the causative agent of COVID-19, has caused a still evolving global pandemic. Given the worldwide vaccination campaign, the understanding of the vaccine-induced versus COVID-19-induced immunity will contribute to adjusting vaccine dosing strategies and speeding-up vaccination efforts.

Methods

Anti-spike-RBD IgGs and neutralizing antibodies (NAbs) titers were measured in BNT162b2 mRNA vaccinated participants (n = 250); we also investigated humoral and cellular immune responses in vaccinated individuals (n = 21) of this cohort 5 months post-vaccination and assayed NAbs levels in COVID-19 hospitalized patients (n = 60) with moderate or severe disease, as well as in COVID-19 recovered patients (n = 34).

Results

We found that one (boosting) dose of the BNT162b2 vaccine triggers robust immune (i.e., anti-spike-RBD IgGs and NAbs) responses in COVID-19 convalescent healthy recipients, while naïve recipients require both priming and boosting shots to acquire high antibody titers. Severe COVID-19 triggers an earlier and more intense (versus moderate disease) immune response in hospitalized patients; in all cases, however, antibody titers remain at high levels in COVID-19 recovered patients. Although virus infection promotes an earlier and more intense, versus priming vaccination, immune response, boosting vaccination induces antibody titers significantly higher and likely more durable versus COVID-19. In support, high anti-spike-RBD IgGs/NAbs titers along with spike (vaccine encoded antigen) specific T cell clones were found in the serum and peripheral blood mononuclear cells, respectively, of vaccinated individuals 5 months post-vaccination.

Conclusions

These findings support vaccination efficacy, also suggesting that vaccination likely offers more protection than natural infection.

Graphical abstract
Improved production of 2′-fucosyllactose in engineered Saccharomyces cerevisiae expressing a putative α-1, 2-fucosyltransferase from Bacillus cereus
Authors: Xu Mingyuan , Meng Xiangfeng , Zhang Weixin , Shen Yu , Liu Weifeng
Published: August 2021

Background

2′-fucosyllactose (2′-FL) is one of the most abundant oligosaccharides in human milk. It constitutes an authorized functional additive to improve infant nutrition and health in manufactured infant formulations. As a result, a cost-effective method for mass production of 2′-FL is highly desirable.

Results

A microbial cell factory for 2′-FL production was constructed in Saccharomyces cerevisiae by expressing a putative α-1, 2-fucosyltransferase from Bacillus cereus (FutBc) and enhancing the de novo GDP-l-fucose biosynthesis. When enabled lactose uptake, this system produced 2.54 g/L of 2′-FL with a batch flask cultivation using galactose as inducer and carbon source, representing a 1.8-fold increase compared with the commonly used α-1, 2-fucosyltransferase from Helicobacter pylori (FutC). The production of 2′-FL was further increased to 3.45 g/L by fortifying GDP-mannose synthesis. Further deleting gal80 enabled the engineered strain to produce 26.63 g/L of 2′-FL with a yield of 0.85 mol/mol from lactose with sucrose as a carbon source in a fed-batch fermentation.

Conclusion

FutBc combined with the other reported engineering strategies holds great potential for developing commercial scale processes for economic 2′-FL production using a food-grade microbial cell factory.
Improvement of FK506 production via metabolic engineering-guided combinational strategies in Streptomyces tsukubaensis
Authors: Wu Qing-Bin , Zhang Xiao-Ying , Chen Xin-Ai , Li Yong-Quan
Published: August 2021

Background

FK506, a macrolide mainly with immunosuppressive activity, can be produced by various Streptomyces strains. However, one of the major challenges in the fermentation of FK506 is its insufficient production, resulting in high fermentation costs and environmental burdens. Herein, we tried to improve its production via metabolic engineering-guided combinational strategies in Streptomyces tsukubaensis.

Results

First, basing on the genome sequencing and analysis, putative competitive pathways were deleted. A better parental strain L19-2 with increased FK506 production from 140.3 to 170.3 mg/L and a cleaner metabolic background was constructed. Subsequently, the FK506 biosynthetic gene cluster was refactored by in-situ promoter-substitution strategy basing on the regulatory circuits. This strategy enhanced transcription levels of the entire FK506 biosynthetic gene cluster in a fine-tuning manner and dramatically increased the FK506 production to 410.3 mg/mL, 1.41-fold higher than the parental strain L19-2 (170.3 mg/L). Finally, the FK506 production was further increased from 410.3 to 603 mg/L in shake-flask culture by adding L-isoleucine at a final concentration of 6 g/L. Moreover, the potential of FK506 production capacity was also evaluated in a 15-L fermenter, resulting in the FK506 production of 830.3 mg/L.

Conclusion

From the aspects of competitive pathways, refactoring of the FK506 biosynthetic gene cluster and nutrients-addition, a strategy for hyper-production and potentially industrial application of FK506 was developed and a hyper-production strain L19-9 was constructed. The strategy presented here can be generally applicable to other Streptomyces for improvement of FK506 production and streamline hyper-production of other valuable secondary metabolites.
Multifunctional AIE iridium (III) photosensitizer nanoparticles for two-photon-activated imaging and mitochondria targeting photodynamic therapy
Authors: Cai Xuzi , Wang Kang-Nan , Ma Wen , Yang Yuanyuan , Chen Gui , Fu Huijiao , Cui Chunhui , Yu Zhiqiang , Wang Xuefeng
Published: August 2021

Developing novel photosensitizers for deep tissue imaging and efficient photodynamic therapy (PDT) remains a challenge because of the poor water solubility, low reactive oxygen species (ROS) generation efficiency, serve dark cytotoxicity, and weak absorption in the NIR region of conventional photosensitizers. Herein, cyclometalated iridium (III) complexes (Ir) with aggregation-induced emission (AIE) feature, high photoinduced ROS generation efficiency, two-photon excitation, and mitochondria-targeting capability were designed and further encapsulated into biocompatible nanoparticles (NPs). The Ir-NPs can be used to disturb redox homeostasis in vitro, result in mitochondrial dysfunction and cell apoptosis. Importantly, in vivo experiments demonstrated that the Ir-NPs presented obviously tumor-targeting ability, excellent antitumor effect, and low systematic dark-toxicity. Moreover, the Ir-NPs could serve as a two-photon imaging agent for deep tissue bioimaging with a penetration depth of up to 300 μm. This work presents a promising strategy for designing a clinical application of multifunctional Ir-NPs toward bioimaging and PDT.
What can the neurological manifestations of COVID-19 tell us: a meta-analysis
Authors: He Yuanyuan , Bai Xiaojie , Zhu Tiantian , Huang Jialin , Zhang Hong
Published: August 2021

Background

Covid-19 became a global pandemic in 2019. Studies have shown that coronavirus can cause neurological symptoms, but clinical studies on its neurological symptoms are limited. In this meta-analysis, we aimed to summarize the various neurological manifestations that occurred in COVID-19 patients and calculate the incidence of various neurological manifestations. At the same time, we further explored the mechanism of nervous system injury and prognosis in COVID-19 patients in combination with their nervous system manifestations. This study provides a reference for early clinical identification of COVID-19 nervous system injury in the future, so as to achieve early treatment and reduce neurological sequelae.

Methods

We systematically searched all published English literature related to the neurological manifestations of COVID-19 from January 1, 2020, to April 30, 2021, in Pubmed, Embase, and Cochrane Library. The keywords used were COVID-19 and terminology related to the nervous system performance. All included studies were selected by two independent reviewers using EndNote and NoteExpress software, any disagreement was resolved by consensus or by a third reviewer, and the selected data were then collected for meta-analysis using a random-effects model.

Results

A total of 168 articles (n = 292,693) were included in the study, and the meta-analysis showed that the most common neurological manifestations of COVID-19 were myalgia(33%; 95%CI 0.30–0.37; I2 = 99.17%), smell impairment(33%; 95%CI 0.28–0.38; I2 = 99.40%), taste dysfunction(33%; 95%CI 0.27–0.39; I2 = 99.09%), altered mental status(32%; 95%CI 0.22–0.43; I2 = 99.06%), headache(29%; 95%CI 0.25–0.33; I2 = 99.42%), encephalopathy(26%; 95%CI 0.16–0.38; I2 = 99.31%), alteration of consciousness(13%; 95%CI 0.08–0.19; I2 = 98.10%), stroke(12%; 95%CI 0.08–0.16; I2 = 98.95%), dizziness(10%; 95%CI 0.08–0.13; I2 = 96.45%), vision impairment(6%; 95%CI 0.03–0.09; I2 = 86.82%), intracerebral haemorrhage(5%; 95%CI 0.03–0.09; I2 = 95.60%), seizure(4%; 95%CI 0.02 -0.05; I2 = 98.15%), encephalitis(2%; 95%CI 0.01–0.03; I2 = 90.36%), Guillan-Barré Syndrome (GBS) (1%; 95%CI 0.00–0.03; I2 = 89.48%).

Conclusions

Neurological symptoms are common and varied in Covid-19 infections, and a growing number of reports suggest that the prevalence of neurological symptoms may be increasing. In the future, the role of COVID-19 neurological symptoms in the progression of COVID-19 should be further studied, and its pathogenesis and assessment methods should be explored, to detect and treat early neurological complications of COVID-19 and reduce mortality.
Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches
Authors: Zaripova Lina N. , Midgley Angela , Christmas Stephen E. , Beresford Michael W. , Baildam Eileen M. , Oldershaw Rachel A.
Published: August 2021

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatological disorder and is classified by subtype according to International League of Associations for Rheumatology criteria. Depending on the number of joints affected, presence of extra-articular manifestations, systemic symptoms, serology and genetic factors, JIA is divided into oligoarticular, polyarticular, systemic, psoriatic, enthesitis-related and undifferentiated arthritis. This review provides an overview of advances in understanding of JIA pathogenesis focusing on aetiology, histopathology, immunological changes associated with disease activity, and best treatment options. Greater understanding of JIA as a collective of complex inflammatory diseases is discussed within the context of therapeutic interventions, including traditional non-biologic and up-to-date biologic disease-modifying anti-rheumatic drugs. Whilst the advent of advanced therapeutics has improved clinical outcomes, a considerable number of patients remain unresponsive to treatment, emphasising the need for further understanding of disease progression and remission to support stratification of patients to treatment pathways.
Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study
Authors: Hoben Matthias , Ginsburg Liane R. , Norton Peter G. , Doupe Malcolm B. , Berta Whitney B. , Dearing James W. , Keefe Janice M. , Estabrooks Carole A.
Published: August 2021

Background

Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides’ involvement in formal communications about resident care.

Methods

Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019–03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention.

Results

We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3.

Conclusions

Theory-informed feedback provides long-lasting improvement in care aides’ involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study—as does possible post-intervention spread of our intervention to simple feedback homes.
Radiographic analysis of the sacral-2-alar screw trajectory
Authors: Zhao Yulin , Yuan Baisheng , Han Yijun , Zhang Binglei
Published: August 2021

Purpose

To explore the feasibility of sacral-2-alar (S2-alar) screw placement by measuring the length, diameter, and angle of the screw trajectory on computed tomography (CT).

Methods

This study selected 100 Han-nationality adults in northern China with a normal spine and pelvis. CT data were imported into PHILIPS software for reconstructing the 3D digital images. The optimal S2-alar screw trajectory was imitated on CT. Parameters including the length of the screw trajectory, sagittal angle, coronal angle, distance between the entry point and the spinous process, and minimum diameter of the screw trajectory were measured to evaluate the application of S2-alar screws.

Results

In total, 48 males and 52 females were included. The average length of the left screw trajectory was 47.18 ± 3.91 mm. The sagittal angle was 29.06 ± 4.00°. The coronal angle was 13.31 ± 6.95°. The distance between the entry point and the spinous process was 21.0 (3.7) mm. The minimum diameter of the screw trajectory was 17.1 (2.3) mm. The average length of the right screw trajectory was 45.46 ± 4.37 mm. The sagittal angle was 23.33 ± 4.26°. The coronal angle was 14.88 ± 6.84°. The distance between the entry point and the spinous process was 22.8 (2.9) mm. The minimum diameter of the screw trajectory was 16.9 (3.1) mm. In women, the average length of the left screw trajectory was 44.80 ± 3.66 mm. The sagittal angle was 32.14 ± 5.48°. The coronal angle was 16.04 ± 7.74°. The distance between the entry point and the spinous process was 21.8 (2.8) mm. The minimum diameter of the screw trajectory was 17.1 (5) mm. The average length of the right screw trajectory was 44.01 ± 3.72 mm. The sagittal angle was 25.12 ± 5.19. The coronal angle was 16.67 ± 8.34°. The distance between the entry point and the spinous process was 21.6 (2.7) mm. The minimum diameter of the screw trajectory was 17 (4.5) mm. As seen from the data, there were significant differences in the minimum diameter of the screw trajectory in both males and females. In females, there were also significant differences between the left and right sides in the coronal angle. Between males and females, there were statistically significant differences in the length of the screw trajectory. There were no statistically significant differences in the other parameters between males and females.

Conclusion

The optimal screw trajectory of the S2-alar screw can be found on CT. The length and deflection angle of the screw meet the clinical requirements. This method is easy to perform and feasible for clinical application.
Cellular and pathological heterogeneity of primary tauopathies
Authors: Chung Dah-eun Chloe , Roemer Shanu , Petrucelli Leonard , Dickson Dennis W.
Published: August 2021

Microtubule-associated protein tau is abnormally aggregated in neuronal and glial cells in a range of neurodegenerative diseases that are collectively referred to as tauopathies. Multiple studies have suggested that pathological tau species may act as a seed that promotes aggregation of endogenous tau in naïve cells and contributes to propagation of tau pathology. While they share pathological tau aggregation as a common feature, tauopathies are distinct from one another with respect to predominant tau isoforms that accumulate and the selective vulnerability of brain regions and cell types that have tau inclusions. For instance, primary tauopathies present with glial tau pathology, while it is mostly neuronal in Alzheimer’s disease (AD). Also, morphologies of tau inclusions can greatly vary even within the same cell type, suggesting distinct mechanisms or distinct tau conformers in each tauopathy. Neuropathological heterogeneity across tauopathies challenges our understanding of pathophysiology behind tau seeding and aggregation, as well as our efforts to develop effective therapeutic strategies for AD and other tauopathies. In this review, we describe diverse neuropathological features of tau inclusions in neurodegenerative tauopathies and discuss what has been learned from experimental studies with mouse models, advanced transcriptomics, and cryo-electron microscopy (cryo-EM) on the biology underlying cell type-specific tau pathology.
Clinical features and outcomes of 1845 patients with follicular lymphoma: a real-world multicenter experience in China
Authors: Zha Jie , Fan Liyuan , Yi Shuhua , Yu Haifeng , Zheng Zhong , Xu Wei , Deng Manman , Lin Zhijuan , Li Zhifeng , Ping Lingyan , He Xiaohua , Chen Feili , Xie Ying , Chen Biyun , Zhang Huilai , Wang Li , Ding Kaiyang , Li Wenyu , Yang Haiyan , Zhao Weili , Qiu Lugui , Li Zhiming , Song Yuqin , Xu Bing
Published: August 2021

Clinical features and outcomes of FL patients in Chinese population are limited, thus promoting us to perform this analysis on a large cohort of 1845 patients with FL enrolled from nine medical centers nationwide in China. In this cohort, the median age of patients at diagnosis was 53 years, which was comparable to that reported previously for Chinese FL patients (49–51 years) but younger than that for Western FL patients (60–65 years). In contrast with Western patients, Chinese FL patients more likely involved extranodal sites but less frequently infiltrated bone marrow. Other clinical characteristics were comparable between two populations. In this study, 91% of patients were managed with chemotherapy, yielding 72% and 46% of overall-response rate and complete remission. After median 55-month follow-up, 5-year progressive-free and overall survival were 61% and 89%, respectively. Both were analogous to those reported in prior Chinese and Western studies. Consistent with published data, addition of rituximab into both induction (Ri) and maintenance (Rm) treatment led to the most favorable outcomes. Interestingly, Ri only had better outcomes than Rm only. Notably, 7% of patients experienced histologic transformation (HT) and correlated with poor survival. Of the transformed FL cases, 3% and 4% of HT events occurred prior to or post-treatment, respectively. Importantly, the latter displayed worse outcomes than the former. Altogether, this study provides real-world information of the largest cohort of FL patients so far in China, which might lay a foundation for clinical investigation of Chinese FL in future.
Targeting autonomic flexibility to enhance cognitive training outcomes in older adults with mild cognitive impairment: study protocol for a randomized controlled trial
Authors: Lin Feng V. , Heffner Kathi , Gevirtz Richard , Zhang Zhengwu , Tadin Duje , Porsteinsson Anton
Published: August 2021

Importance

Cognitive training with components that can further enhance the transferred and long-term effects and slow the progress of dementia is needed for preventing dementia.

Objective

The goal of the study is to test whether improving autonomic nervous system (ANS) flexibility via a resonance frequency breathing (RFB) training will strengthen the effects of a visual speed of processing (VSOP) cognitive training on cognitive and brain function, and slow the progress of dementia in older adults with mild cognitive impairment (MCI).

Design

Stage II double-blinded randomized controlled trial. The study was prospectively registered at ClinicalTrials.gov, with registration approved on 21 August 2020 (No. NCT04522791).

Setting

Study-related appointments will be conducted on-site at University of Rochester Medical Center locations. Data collection will be conducted from August 2020 to February 2025.

Participants

Older adults with MCI (n = 114) will be randomly assigned to an 8-week combined intervention (RFB+VSOP), VSOP with guided imagery relaxation (IR) control, and a IR-only control, with periodical booster training sessions at follow-ups. Mechanistic and distal outcomes include ANS flexibility, measured by heart rate variability, and multiple markers of dementia progress. Data will be collected across a 14-month period.

Discussion

This will be among the first RCTs to examine in older persons with MCI a novel, combined intervention targeting ANS flexibility, an important contributor to overall environmental adaptation, with an ultimate goal for slowing neurodegeneration.

Trial registration

ClinicalTrials.gov NCT04522791. Registered on 21 August 2020

Protocol version: STUDY00004727; IRB protocol version 2, approved on 30 July 2020.
Transcutaneous electrical acupoint stimulation for postoperative cognitive dysfunction in geriatric patients with gastrointestinal tumor: a randomized controlled trial
Authors: Xi Lijuan , Fang Fang , Yuan Haijuan , Wang Daorong
Published: August 2021

Background

This study aimed to evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in older patients who were diagnosed with gastrointestinal tumor and received radical resection of gastrointestinal tumors under general anesthesia.

Methods

A total of 68 patients who received radical resection of gastrointestinal tumors under general anesthesia were randomly divided into two groups. TEAS group patients received TEAS treatment. The treatment time was 30 min before the induction of anesthesia until the end of the surgery, 1 day before operation and from the first day to the third day after the operation. Except on the day of surgery, we treated the patients for 30 min once a day. In the sham TEAS group, the electronic stimulation was not applied and the treatment was the same as the TEAS group. The primary outcome was perioperative cognition evaluated by the Mini-Mental State Examination (MMSE) and secondary outcomes were the perioperative level of interleukin-6 (IL-6), S100 calcium-binding protein β (S100β), and C-reactive protein (CRP).

Results

The postoperative score of MMSE, orientation, memory, and short-term recall in the sham TEAS group was significantly lower than the preoperative and TEAS group (P < 0.05). The incidence of POCD in the TEAS group (21.88%) was lower than those in the sham TEAS group (40.63%). S100β, IL-6, and CRP in the TEAS group were significantly lower than those in the sham TEAS group on the third day after the operation (P< 0.05). Postoperative S100β, IL-6, and CRP in two groups were significantly higher than those before operation except for S100β on the third day after the operation in the TEAS group (P < 0.05).

Conclusions

Perioperative TEAS treatment reduced the postoperative inflammatory response and increased the postoperative cognitive function score and decrease the incidence of POCD in geriatric patients with gastrointestinal tumor.

Trial registration

ClinicalTrials.gov NCT04606888. Registered on 27 October 2020. https://register.clinicaltrials.gov.
Application of virtual reality on non-drug behavioral management of short-term dental procedure in children
Authors: Ran Longkuan , Zhao Nan , Fan Lin , Zhou Pinping , Zhang Chao , Yu Cong
Published: August 2021

Background

Due to the inherent characteristics of immersion, imagination, and interactivity in virtual reality (VR), it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental procedures in children.

Methods

A randomized clinical trial design was carried out on 120 children aged between 4 and 8 years to identify the comparative efficacy of VR and tell-show-do (TSD) to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children. The levels of operative anxiety and pain were assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Wong Baker FACES Pain Rating Scale (WBFS), respectively. The Frankl Behavior Rating Scale (FBRS) was tested before and during dental procedures. The length of the dental procedure was compared between both groups after treatment.

Results

The average anxiety and behavioral scores of the VR group significantly reduced compared with the control. The decreased anxiety score for the VR group and control group were 8 (7, 11) and 5 (5, 7), p < 0.05. The compliance scores of the control group during treatment were 3 (2, 3), and the same in the VR intervention were 3 (3, 4), p = 0.02. A significant reduction in pain was observed when using VR distraction (p < 0.05). Comparing the length of the dental procedure, the VR group (19.0 2 ± 5.32 min) had a shorter treatment time than the control group (27.80 ± 10.40 min).

Conclusion

The use of VR significantly reduced the anxiety and pain of children and the length of the dental procedure and improved the compliance of children that underwent short-term dental procedures without an adverse reaction.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2000029802. Registered on February 14, 2020
Sequencing of methylase-accessible regions in integral circular extrachromosomal DNA reveals differences in chromatin structure
Authors: Chen Weitian , Weng Zhe , Xie Zhe , Xie Yeming , Zhang Chen , Chen Zhichao , Ruan Fengying , Wang Juan , Sun Yuxin , Fang Yitong , Guo Mei , Tong Yiqin , Li Yaning , Tang Chong
Published: August 2021

Background

Although extrachromosomal DNA (ecDNA) has been intensively studied for several decades, the mechanisms underlying its tumorigenic effects have been revealed only recently. In most conventional sequencing studies, the high-throughput short-read sequencing largely ignores the epigenetic status of most ecDNA regions except for the junctional areas.

Methods

Here, we developed a method of sequencing enzyme-accessible chromatin in circular DNA (CCDA-seq) based on the use of methylase to label open chromatin without fragmentation and exonuclease to enrich ecDNA sequencing depth, followed by long-read nanopore sequencing.

Results

Using CCDA-seq, we observed significantly different patterns in nucleosome/regulator binding to ecDNA at a single-molecule resolution.

Conclusions

These results deepen the understanding of ecDNA regulatory mechanisms.
Effectiveness of a proteoliposome-based vaccine against salmonid rickettsial septicaemia in Oncorhynchus mykiss
Authors: Caruffo Mario , Vidal Sonia , Santis Leonardo , Siel Daniela , Pérez Oliver , Huenchullan Paula R. , Sáenz Leonardo
Published: August 2021

Salmonid rickettsial septicaemia (SRS) is a contagious disease caused by Piscirickettsia salmonis, an intracellular bacterium. SRS causes an estimated economic loss of $700 million USD to the Chilean industry annually. Vaccination and antibiotic therapy are the primary prophylactic and control measures used against SRS. Unfortunately, commercially available SRS vaccines have not been shown to have a significant effect on reducing mortality. Most vaccines contain whole inactivated bacteria which results in decreased efficacy due to the limited ability of the vaccine to evoke a cellular mediated immune response that can eliminate the pathogen or infected cells. In addition, SRS vaccine efficacy has been evaluated primarily with Salmo salar (Atlantic salmon). Vaccine studies using Oncorhynchus mykiss (rainbow trout) are scarce, despite SRS being the leading cause of infectious death for this species. In this study, we evaluate an injectable vaccine based on P. salmonis proteoliposome; describing the vaccine security profile, capacity to induce specific anti-P. salmonis IgM and gene expression of immune markers related to T CD8 cell-mediated immunity. Efficacy was determined by experimental challenge with P. salmonis intraperitoneally. Our findings indicate that a P. salmonis proteoliposome-based vaccine is able to protect O. mykiss against challenge with a P. salmonis Chilean isolate and causes a specific antibody response. The transcriptional profile suggests that the vaccine is capable of inducing cellular immunity. This study provides new insights into O. mykiss protection and the immune response induced by a P. salmonis proteoliposome-based vaccine.
Buffer evaluation model and scheduling strategy for video streaming services in 5G-powered drone using machine learning
Authors: Su Yu , Wang Shuijie , Cheng Qianqian , Qiu Yuhe
Published: August 2021

With regard to video streaming services under wireless networks, how to improve the quality of experience (QoE) has always been a challenging task. Especially after the arrival of the 5G era, more attention has been paid to analyze the experience quality of video streaming in more complex network scenarios (such as 5G-powered drone video transmission). Insufficient buffer in the video stream transmission process will cause the playback to freeze [1]. In order to cope with this defect, this paper proposes a buffer starvation evaluation model based on deep learning and a video stream scheduling model based on reinforcement learning. This approach uses the method of machine learning to extract the correlation between the buffer starvation probability distribution and the traffic load, thereby obtaining the explicit evaluation results of buffer starvation events and a series of resource allocation strategies that optimize long-term QoE. In order to deal with the noise problem caused by the random environment, the model introduces an internal reward mechanism in the scheduling process, so that the agent can fully explore the environment. Experiments have proved that our framework can effectively evaluate and improve the video service quality of 5G-powered UAV.