bluuebunny/crossref_metadata_2025 huggingface dataset:
European Stroke Organisation (ESO) standard operating procedure for the preparation and publishing of guidelines
Authors: Steiner T , Dichgans M , Norrving B , Aamodt AH , Berge E , Christensen H , Fuentes B , Khatri P , Korompoki E , Martí-Fabregas J , Quinn T , Toni D , Zedde M , Sacco S , Turc G
Published: September 2021

The first European Stroke Organization (ESO) standard operating procedure (SOP) published in 2015 aimed at the implementation the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to provide evidence-based guidelines for stroke management. This second ESO-SOP is aiming at further increase of the practicability of ESO guidelines and its technical implications. Authors comprised of the members of the ESO guideline Board and ESO Executive Committee. The final document was agreed on by several internal reviews. The second SOP comprises of the following aspects: rational for the SOP, the introduction of expert consensus statements, types of guideline documents, structures involved and detailed description of the guideline preparation process, handling of financial and intellectual conflicts of interest (CoI), involvement of ESO members in the guideline process, review process, authorship and publication policy, updating of guidelines, cooperation with other societies, and dealing with falsified data. This second SOP supersedes the first SOP published in 2015.
Primary endoscopic bile duct stone removal for severe acute cholangitis: a retrospective study
Authors: Ishii Yu , Nakayama Akihiro , Nakatani Kei , Nishihara Shigetoshi , Oikawa Shu , Usami Tomono , Noguchi Toshihiro , Mitsui Yuta , Yoshida Hitoshi
Published: September 2021

Introduction:

While the Tokyo Guidelines 2018 suggest primary stone removal for mild to moderate cholangitis, a guideline for severe acute cholangitis is not mentioned. We, therefore, investigated the clinical outcomes of patients with severe acute cholangitis to confirm the usefulness and safety of primary stone removal.

Method:

This study included 104 severe acute cholangitis patients without gallstone pancreatitis diagnosed at our institution between January 2014 and December 2020. Patients with percutaneous transhepatic biliary drainage as the primary drainage, bile duct stenosis, and endoscopically unidentified bile duct stones were excluded from this study. The clinical results of 14 patients with primary stone removal (primary group) and 23 patients with elective stone removal (elective group) were then retrospectively examined (excluding abnormal values due to underlying diseases).

Results:

Upon comparing the patient characteristics between groups, the elective group had significantly higher cardiovascular dysfunction (57% vs 7%; p = 0.004), septic shock (39% vs 0%; p = 0.006), disseminated intravascular coagulation treatment (57% vs 14%; p = 0.016), and positive blood cultures (91% vs 43%; p = 0.006) than those in the primary group. Endoscopic sphincterotomy for naïve papilla (90% vs 21%; p = 0.01) and endoscopic nasobiliary drainage (50% vs 9%; p = 0.014) were higher in the primary group, while endoscopic biliary stenting (7% vs 87%; p < 0.001) was lower than that in the elective group.

Discussion:

There were no significant differences in adverse events or complete stone removal rates between the two groups. In the primary group, the period from the first endoscopic retrograde cholangiopancreatography to stone removal (0 days vs 12 days; p < 0.001) and hospitalization period (12 days vs 26 days; p = 0.012) were significantly shorter and the hospitalization cost ($7731 vs $18758; p < 0.001) was significantly lower than those in the elective group.

Conclusion:

If patients are appropriately selected, bile duct stones may be safely removed for the treatment of severe acute cholangitis.
Spontaneous spinal epidural hematoma: a case report
Authors: Sheng Ooi Chin , Wu Ren-Chieh , Chang I-Hsin
Published: September 2021

Background

Spinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma.

Case presentation

A 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery.

Conclusion

In patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.
Prevalence of urinary symptoms and infections among traditional tannery workers in the Fez city of Morocco: case–control study
Authors: Ilham Arhoune , Hasnae Hoummani , Btissam Arhoune , Leila Belaroussi , Samira El Fakir , Sanae Achour
Published: September 2021

Background

Many work activities such as leather tanning include hazards to work. Among these, biological hazards are particularly important and pose a serious problem to human health and environment. The aims of this study were to estimate the prevalence of dysuria and urinary tract infections among tannery workers and to identify their risk factors.

Methods

This observational survey was conducted among 220 tannery workers and 220 age-matched control group from Fez city in Morocco. Reported urinary symptoms, demographic and professional information were obtained by a standardized questionnaire collected from participants and were then compared among the two groups. The logistic regression model was used to explore the interaction between variables with significant association.

Results

The most common symptoms reported by tannery workers and controls were dysuria (36.4% vs. 1.8%, p < 0.001), voiding frequency (15.5% vs. 0.9%, p < 0.001) and incontinence (3.2% vs. 0.5%, p < 0.001). A positive urinary culture was seen in 3.64% of the tannery workers but not in the controls (0%). E-coli was the only species. Multivariate logistic regression showed that exposure to biological hazards increased significantly the odds of dysuria by 6.76 times (CI 1.112–41.78; p = 0.038) but rather, low or normal weight was a protective factor of dysuria (OR 0.53; CI 0.249–0.950; p = 0.035).

Conclusion

Multiple working conditions including exposure to biological hazards may cause an increase in urogenital disorders in the tannery workers. A significantly higher prevalence of urinary symptoms among male workers demand serious attention and further investigation.
Wolbachia-driven selective sweep in a range expanding insect species
Authors: Deng Junchen , Assandri Giacomo , Chauhan Pallavi , Futahashi Ryo , Galimberti Andrea , Hansson Bengt , Lancaster Lesley T. , Takahashi Yuma , Svensson Erik I. , Duplouy Anne
Published: September 2021

Background

Evolutionary processes can cause strong spatial genetic signatures, such as local loss of genetic diversity, or conflicting histories from mitochondrial versus nuclear markers. Investigating these genetic patterns is important, as they may reveal obscured processes and players. The maternally inherited bacterium Wolbachia is among the most widespread symbionts in insects. Wolbachia typically spreads within host species by conferring direct fitness benefits, and/or by manipulating its host reproduction to favour infected over uninfected females. Under sufficient selective advantage, the mitochondrial haplotype associated with the favoured maternally-inherited symbiotic strains will spread (i.e. hitchhike), resulting in low mitochondrial genetic variation across the host species range.

Method

The common bluetail damselfly (Ischnura elegans: van der Linden, 1820) has recently emerged as a model organism for genetics and genomic signatures of range expansion during climate change. Although there is accumulating data on the consequences of such expansion on the genetics of I. elegans, no study has screened for Wolbachia in the damselfly genus Ischnura. Here, we present the biogeographic variation in Wolbachia prevalence and penetrance across Europe and Japan (including samples from 17 populations), and from close relatives in the Mediterranean area (i.e. I. genei: Rambur, 1842; and I. saharensis: Aguesse, 1958).

Results

Our data reveal (a) multiple Wolbachia-strains, (b) potential transfer of the symbiont through hybridization, (c) higher infection rates at higher latitudes, and (d) reduced mitochondrial diversity in the north-west populations, indicative of hitchhiking associated with the selective sweep of the most common strain. We found low mitochondrial haplotype diversity in the Wolbachia-infected north-western European populations (Sweden, Scotland, the Netherlands, Belgium, France and Italy) of I. elegans, and, conversely, higher mitochondrial diversity in populations with low penetrance of Wolbachia (Ukraine, Greece, Montenegro and Cyprus). The timing of the selective sweep associated with infected lineages was estimated between 20,000 and 44,000 years before present, which is consistent with the end of the last glacial period about 20,000 years.

Conclusions

Our findings provide an example of how endosymbiont infections can shape spatial variation in their host evolutionary genetics during postglacial expansion. These results also challenge population genetic studies that do not consider the prevalence of symbionts in many insects, which we show can impact geographic patterns of mitochondrial genetic diversity.
CAMPAREE: a robust and configurable RNA expression simulator
Authors: Lahens Nicholas F. , Brooks Thomas G. , Sarantopoulou Dimitra , Nayak Soumyashant , Lawrence Cris , Mrčela Antonijo , Srinivasan Anand , Schug Jonathan , Hogenesch John B. , Barash Yoseph , Grant Gregory R.
Published: September 2021

Background

The accurate interpretation of RNA-Seq data presents a moving target as scientists continue to introduce new experimental techniques and analysis algorithms. Simulated datasets are an invaluable tool to accurately assess the performance of RNA-Seq analysis methods. However, existing RNA-Seq simulators focus on modeling the technical biases and artifacts of sequencing, rather than on simulating the original RNA samples. A first step in simulating RNA-Seq is to simulate RNA.

Results

To fill this need, we developed the Configurable And Modular Program Allowing RNA Expression Emulation (CAMPAREE), a simulator using empirical data to simulate diploid RNA samples at the level of individual molecules. We demonstrated CAMPAREE’s use for generating idealized coverage plots from real data, and for adding the ability to generate allele-specific data to existing RNA-Seq simulators that do not natively support this feature.

Conclusions

Separating input sample modeling from library preparation/sequencing offers added flexibility for both users and developers to mix-and-match different sample and sequencing simulators to suit their specific needs. Furthermore, the ability to maintain sample and sequencing simulators independently provides greater agility to incorporate new biological findings about transcriptomics and new developments in sequencing technologies. Additionally, by simulating at the level of individual molecules, CAMPAREE has the potential to model molecules transcribed from the same genes as a heterogeneous population of transcripts with different states of degradation and processing (splicing, editing, etc.). CAMPAREE was developed in Python, is open source, and freely available at https://github.com/itmat/CAMPAREE.
Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database
Authors: Zhang Chiyuan , Fu Zuli , Bai Hui , Lin Guoqiang , Shi Ruizheng , Chen Xuliang , Xu Qian
Published: September 2021

Background

Inflammation underlies both the pathogenesis and prognosis in patients with acute aortic dissection (AAD). This study aimed to assess the association of ICU admission of white blood cell count (WBCc) with post-discharge mortality in these patients.

Methods

Clinical data were extracted from the MIMIC-III V1.4 database. After adjusted to covariables, Cox regression analysis and Kaplan–Meier survival curve were performed to determine the relationship between WBCc on admission and post-discharge mortality (30-day, 90-day, 1-year and 5-year) in AAD patients. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were used to test the performance of WBCc in predicting mortality in AAD patients.

Results

A total of 325 eligible patients were divided into 2 groups: normal-WBCc group (≤ 11 k/uL) and high-WBCc group (> 11 K/uL). In univariate Cox regression analysis, high WBCc was significant risk predictor of 30-day, 90-day, 1-year and 5-year mortality [hazard ratio (HR), 95% CI, P 2.58 1.36–4.91 0.004; 3.16 1.76–5.70 0.000; 2.74 1.57–4.79 0.000; 2.10 1.23–3.54 0.006]. After adjusting for age and other risks, high WBCc remained a significant predictor of 30-day, 90-day and 1-year mortality in AAD patients (HR, 95% CI, P 1.994 1.058–3.76 0.033; 2.118 1.175–3.819 0.013; 2.37 1.343–4.181 0.003). The area under ROC curve of WBCc for predicting 30-day, 90-day, 1-year and 5-year mortality were 0.69, 0.70, 0.66 and 0.61, respectively. The results from subgroups analysis showed that there was no interaction in most strata and patients who were younger than 69 years of age or had history of respiratory disease with an elevated WBCc had an excess risk of 30-day mortality (HR, 95% CI, P 3.18 1.41–7.14 0.005; 3.84 1.05–14.13 0.043).

Conclusions

Higher than normal WBCc on admission may predict post-discharge mortality in patients with AAD.
Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?
Authors: Bhattarai Asmita , Dimitropoulos Gina , Marriott Brian , Paget Jaime , Bulloch Andrew G. M. , Tough Suzanne C. , Patten Scott B.
Published: September 2021

Background

Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. This study thus examined the ability of the ACEs checklist to predict ED visits within the subsequent year among children and adolescents presenting to mental health clinics with pre-existing mental health issues.

Methods

The study analyzed linked data (n = 6100) from two databases provided by Alberta Health Services (AHS). The Regional Access and Intake System (RAIS 2016–2018) database provided data on the predictors (ACE items, age, sex, residence, mental health program type, and primary diagnosis) regarding children and adolescents (aged 0–17 years) accessing addiction and mental health services within Calgary Zone, and the National Ambulatory Care Reporting System (NACRS 2016–2019) database provided data on ED visits. A 25% random sample of the data was reserved for validation purposes. Two Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, each employing a different method to tune the shrinkage parameter lambda (namely cross-validated and adaptive) and performing 10-fold cross-validation for a set of 100 lambdas in each model were examined.

Results

The adaptive LASSO model had a slightly better fit in the validation dataset than the cross-validated model; however, it still demonstrated poor discrimination (AUC 0.60, sensitivity 37.8%, PPV 49.6%) and poor calibration (over-triaged in low-risk and under-triaged in high-risk subgroups). The model’s poor performance was evident from an out-of-sample deviance ratio of − 0.044.

Conclusion

The ACEs checklist did not perform well in predicting ED visits among children and adolescents with existing mental health concerns. The diverse causes of ED visits may have hindered accurate predictions, requiring more advanced statistical procedures. Future studies exploring other machine learning approaches and including a more extensive set of childhood adversities and other important predictors may produce better predictions. Furthermore, despite highly significant associations being observed, ACEs may not be deterministic in predicting health-related events at the individual level, such as general ED use.
Gender discrepancy in the predictive effect of metabolic syndrome and its components on newly onset cardiovascular disease in elderly from rural China
Authors: Yu Shasha , Guo Xiaofan , Li GuangXiao , Yang Hongmei , Zheng Liqiang , Sun Yingxian
Published: September 2021

Background

This study aimed to estimate whether metabolic syndrome (MetS) and its components could be used to predict cardiovascular disease (CVD) in a longitudinal analysis in a rural elderly Chinese population.

Method

At baseline during 2012–2013, a total of 2486 elderly from rural Chinese were enrolled and were followed up during 2015–2017. Stroke and coronary heart disease (CHD) were included in CVD and were diagnosed by clinicians. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF) criteria were used to define MetS separately.

Result

Hazard ratios adjusting for CHD, stroke and CVD in those with MetS using the NCEP ATP III criteria in females were 1.27 (95 % CI 0.73, 2.21), 1.54 (95 % CI 0.99, 2.40) and 1.45 (95 % CI 1.00, 2.10), respectively; 1.33 (95 % CI 0.77, 2.32), 1.44 (95 % CI 0.92, 2.25) and 1.36 (95 % CI 0.94, 1.97), respectively, with the AHA/NHLBI criteria; and 1.10 (95 % CI 0.89,1.36), 1.62 (95 % CI 1.03, 2.55) and 1.36 (95 % CI 0.93, 1.97), respectively, with the IDF criteria. Additionally, abdominal obesity using the AHA/NHLBI criteria was significantly associated with the incidence of stroke (HR: 1.60; 95 % CI 1.01, 2.52). However, among rural elderly males, neither MetS nor its components predicted new-onset CVD.

Conclusions

MetS is correlated with high incidence of CVD among rural elderly female, and only using the NCEP ATP III criteria to define MetS could make the incidence of CVD obvious difference. In order to reduce rural elderly CVD, effective measures to prevent, diagnose, and treat MetS should be enacted in a timely manner, especially among females.
Relationship between Chinese Baijiu consumption and dental caries among 55- to 74-year-old adults in Guangdong, southern China: a cross-sectional survey
Authors: Huang Xiangyu , Liang Yihao , Fan Weihua , Liu Wei , Wu Buling , Li Jianbo
Published: September 2021

Background

Whether an association between alcohol consumption and dental caries exists is still unclear. Chinese Baijiu is the most common alcohol consumed by middle-aged and elderly Chinese individuals. This study aimed to assess the relationship between alcohol consumption (Chinese Baijiu) and dental caries in Guangdong Province, southern China.

Methods

A cross-sectional study was conducted in Guangdong Province using a multistage, stratified, equal-sized, random sampling strategy. In total, 576 individuals aged 55–74 were recruited to fill out a questionnaire through face-to-face and one-on-one interviews and to undergo a series of dental examinations with a Community Periodontal Index (CPI) probe. According to the standard for clinical dentition examination of the WHO 2013 criteria, the presence of dental caries was determined by the DFT/DFRoot (decayed-filled tooth/root) index. The ratios of males to females and urban people to countrymen were both 1:1. Then, the chi-square test and rank-sum tests were used to compare the differences in caries between subgroups, and multivariate logistic regression analyses, as well as negative binomial regression analyses, were executed to identify the potential relationship between alcohol consumption and caries.

Results

The prevalence of crown caries was 79.17% with a DFT index of 3.19, while that of root caries was 61.28% with a DFRoot index of 2.08. The prevalence and mean tooth of crown caries of females were higher than those of males. The prevalence and mean DFRoot of root caries in rural areas were higher than those in urban areas. The results of the multivariate logistic regression analysis and negative binomial regression analysis showed that there was a statistically significant negative correlation between the consumption frequency of Chinese Baijiu and caries (often vs. never/rarely, crown caries: odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.26–1.13, P = 0.103, incidence rate ratio (IRR) = 0.63, 95% CI: 0.44–0.92, P = 0.015; root caries: OR = 0.47, 95% CI: 0.24–0.93, P = 0.030, IRR = 0.52, 95% CI: 0.32–0.54, P = 0.008).

Conclusions

Within the limitations of this study, frequent consumption of Chinese Baijiu was a protective factor for caries in middle-aged and elderly people in Guangdong Province. However, considering the harm of alcohol to one’s general health, it is recommended to drink moderately and avoid alcohol abuse.
Association between frailty and mortality among patients with accidental hypothermia: a nationwide observational study in Japan
Authors: Takauji Shuhei , Hifumi Toru , Saijo Yasuaki , Yokobori Shoji , Kanda Jun , Kondo Yutaka , Hayashida Kei , Shimazaki Junya , Moriya Takashi , Yagi Masaharu , Yamaguchi Junko , Okada Yohei , Okano Yuichi , Kaneko Hitoshi , Kobayashi Tatsuho , Fujita Motoki , Shimizu Keiki , Yokota Hiroyuki , Yaguchi Arino
Published: September 2021

Background

Frailty has been associated with a risk of adverse outcomes, and mortality in patients with various conditions. However, there have been few studies on whether or not frailty is associated with mortality in patients with accidental hypothermia (AH). In this study, we aim to determine this association in patients with AH using Japan’s nationwide registry data.

Methods

The data from the Hypothermia STUDY 2018&19, which included patients of ≥18 years of age with a body temperature of ≤35 °C, were obtained from a multicenter registry for AH conducted at 120 institutions throughout Japan, collected from December 2018 to February 2019 and December 2019 to February 2020. The clinical frailty scale (CFS) score was used to determine the presence and degree of frailty. The primary outcome was the comparison of mortality between the frail and non-frail patient groups.

Results

In total, 1363 patients were included in the study, of which 920 were eligible for the analysis. The 920 patients were divided into the frail patient group (N = 221) and non-frail patient group (N = 699). After 30-days of hospitalization, 32.6% of frail patients and 20.6% of non-frail patients had died (p < 0.001). Frail patients had a significantly higher risk of 90-day mortality (Hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.25–2.17; p < 0.001). Based on the Cox proportional hazards analysis using multiple imputation, after adjustment for age, potassium level, lactate level, pH value, sex, CPK level, heart rate, platelet count, location of hypothermia incidence, and rate of tracheal intubation, the HR was 1.69 (95% CI, 1.25–2.29; p < 0.001).

Conclusions

This study showed that frailty was associated with mortality in patients with AH. Preventive interventions for frailty may help to avoid death caused by AH.
Impact of obstructive sleep apnea complicated with type 2 diabetes on long-term cardiovascular risks and all-cause mortality in elderly patients
Authors: Su Xiaofeng , Li Jian Hua , Gao Yinghui , Chen Kaibing , Gao Yan , Guo Jing Jing , Shi Min , Zou Xiao , Xu Weihao , Zhao Li Bo , Wang Huanhuan , Wang Yabin , Liu Juan , Xu Hu , Kong Xiaoxuan , Lin Junling , Qian Xiaoshun , Han Jiming , Liu Lin
Published: September 2021

Background

The prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.

Methods

From January 2015 to October 2017, 1113 eligible elderly patients with OSA, no history of cardiovascular, ≥60 years of age, and complete follow-up records were enrolled in this consecutive multicentre prospective cohort study. All patients had completed polysomnography (PSG) examinations. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to identify the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.

Results

A total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between type 2 diabetes and MACE (log-rank P = 0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR = 1.64, 95% CI:1.08–2.47, P = 0.019), hospitalisation for unstable angina (HR = 2.11, 95% CI:1.23–3.64, P = 0.007) and a composite of all events in elderly patients with OSA (HR = 1.70, 95% CI:1.17–2.49, P = 0.007). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P > 0.05). The subgroup analysis demonstrated that females (AHR = 2.46, 95% CI:1.17–5.19, P = 0.018), ≥ 70 years (AHR = 1.95, 95% CI:1.08–3.52, P = 0.027), overweight and obese (AHR = 2.04, 95% CI:1.29–3.33, P = 0.002) with mild OSA (AHR = 2.42, 95% CI: 1.03–5.71, P = 0.044) were at a higher risk for MACE by diabetes.

Conclusion

OSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.
Task matters: an investigation on the effect of different secondary tasks on dual-task gait in older adults
Authors: Goh Hui-Ting , Pearce Miranda , Vas Asha
Published: September 2021

Background

Dual-task gait performance declines as humans age, leading to increased fall risk among older adults. It is unclear whether different secondary cognitive tasks mediate age-related decline in dual-task gait. This study aimed to examine how type and difficulty level of the secondary cognitive tasks differentially affect dual-task gait in older adults.

Methods

Twenty young and twenty older adults participated in this single-session study. We employed four different types of secondary tasks and each consisted of two difficulty levels, yielding eight different dual-task conditions. The dual-task conditions included walking and 1) counting backward by 3 s or by 7 s; 2) remembering a 5-item or 7-item lists; 3) responding to a simple or choice reaction time tasks; 4) generating words from single or alternated categories. Gait speed and cognitive task performance under single- and dual-task conditions were used to compute dual-task cost (DTC, %) with a greater DTC indicating a worse performance.

Results

A significant three-way interaction was found for the gait speed DTC (p = .04). Increased difficulty in the reaction time task significantly increased gait speed DTC for older adults (p = .01) but not for young adults (p = .90). In contrast, increased difficulty level in the counting backward task significantly increased gait speed DTC for young adults (p = .03) but not for older adults (p = .85). Both groups responded similarly to the increased task difficulty in the other two tasks.

Conclusions

Older adults demonstrated a different response to dual-task challenges than young adults. Aging might have different impacts on various cognitive domains and result in distinctive dual-task gait interference patterns.
Does awareness of condition help people with mild-to-moderate dementia to live well? Findings from the IDEAL programme
Authors: Alexander Catherine M. , Martyr Anthony , Gamble Laura D. , Savage Sharon A. , Quinn Catherine , Morris Robin G. , Collins Rachel , Clare Linda ,   in collaboration with the IDEAL programme research team
Published: September 2021

Background

People living with dementia vary in awareness of their abilities. We explored awareness of the condition and diagnosis in people with mild-to-moderate dementia, and how this relates to quality of life, well-being, life satisfaction, and caregiver stress.

Methods

This study was a cross-sectional exploratory analysis of data from the IDEAL cohort, which recruited people with dementia living at home and available caregivers from 29 research sites in Great Britain. Our study included 917 people with mild-to-moderate dementia and 755 carers. Low and high awareness groups were derived from self-reported responses to a dementia representation measure. Logistic regression was used to explore predictors of awareness of condition and diagnosis using demographic, cognitive, functional and psychological measures, and the relationship with quality of life, well-being and life satisfaction (‘living well’), and caregiver stress.

Results

There were 83 people with low awareness of their condition. The remaining 834 people showed some awareness and 103 of these had high awareness of their condition and diagnosis. Psychosocial factors were stronger predictors of awareness than cognitive and functional ability. Those with higher awareness reported lower mood, and lower scores on indices of living well as well as lower optimism, self-efficacy and self-esteem. Low awareness was more likely in those aged 80y and above, and living in more socially deprived areas. No relationship was seen between caregiver stress and awareness.

Conclusions

Awareness of the condition and diagnosis varies in people with mild-to-moderate dementia and is relevant to the capability to live well. Awareness should be considered in person-centered clinical care.
Synergistic associations of visual and self-reported hearing acuity with low handgrip strength in older adults: a population-based cross-sectional study
Authors: Kim Seung Hoon , Hurh Kyungduk , Park Yoonsik , Jang Sung-In , Park Eun-Cheol
Published: September 2021

Background

It is unclear whether visual and hearing acuity are independently or synergistically associated with muscle strength. We aimed to examine the associations of visual and self-reported hearing acuity with low handgrip strength and the additive interaction between visual and hearing acuity on low handgrip strength in people over 60 years.

Method

Data of 3,075 individuals aged over 60 years from the 2017 and 2018 Korea National Health and Nutrition Examination Survey were used for this cross-sectional study. Low handgrip strength was defined based on the 20th percentile of the study population (< 30.4 kg for male and < 17.7 kg for female). Visual and self-reported hearing acuity were each divided into three categories: good, moderate, and impaired. Multiple logistic regression and relative excess risk due to interaction (RERI) were performed.

Results

Of the 3,075 participants, 993 (32.3 %) demonstrated low handgrip strength. Low handgrip strength was more prevalent in participants with moderate (adjusted odds ratio [AOR] = 1.54, 95 % confidence interval [CI] = 1.12–2.12) and impaired visual acuity (AOR = 2.00, 95 % CI = 1.34–2.96). Both moderate and impaired self-reported hearing acuity were significantly associated with low handgrip strength (moderate: AOR = 1.25, 95 % CI = 1.01–1.55; impaired: AOR = 1.66, 95 % CI = 1.15–2.38). The more severe the sensory function decline, the higher the association with muscle weakness. Moreover, combined sensory impairments were associated with deteriorating low handgrip strength (AOR = 8.38), with significantly strong additive interactions (RERI = 2.61, 95 % CI = 2.52–2.70).

Conclusions

Awareness is needed regarding the risk of reduced muscle strength in individuals with moderate and impaired sensory function. Older people with sensory function decline in clinical settings may benefit from programs such as exercise prescription to prevent muscle weakness.
Signal and morphological changes in the endolymph of patients with vestibular schwannoma on non-contrast 3D FLAIR at 3 Tesla
Authors: Osawa Iichiro , Kozawa Eito , Tanaka Sayuri , Kaizu Akane , Inoue Kaiji , Ikezono Tetsuo , Fujimaki Takamitsu , Niitsu Mamoru
Published: September 2021

Background

Non-contrast FLAIR revealed increased signal within the inner ear in patients with vestibular schwannoma, which is generally assumed to occur in the perilymph; however, the majority of previous studies did not differentiate between the endolymph and perilymph. Therefore, endolymph signal changes have not yet been investigated in detail. The purpose of the present study was three-fold: (1) to assess perilymph signal changes in patients with vestibular schwannoma on heavily T2-weighted (T2W) 3D FLAIR, also termed positive perilymphatic images (PPI), (2) to evaluate signal and morphological changes in the endolymph on PPI, and (3) to establish whether vertigo correlates with the signal intensity ratios (SIR) of the vestibular perilymph or vestibular endolymphatic hydrops.

Methods

Forty-two patients with unilateral vestibular schwannoma were retrospectively recruited. We semi-quantitatively and qualitatively evaluated the perilymph signal intensity on the affected and unaffected sides. We also quantitatively examined the signal intensity of the vestibular perilymph and assessed the relationship between vertigo and the SIR of the vestibular perilymph on the affected side. We semi-quantitatively or qualitatively evaluated the endolymph, and investigated whether vestibular hydrops correlated with vertigo.

Results

The perilymph on the affected side showed abnormal signal more frequently (signal intensity grade: overall mean 1.45 vs. 0.02; comparison of signal intensity: overall mean 36 vs. 0 cases) and in more parts (the entire inner ear vs. the basal turn of the cochlea and vestibule) than that on the unaffected side. No significant difference was observed in the SIR of the vestibular perilymph with and without vertigo (5.54 vs. 5.51, p = 0.18). The endolymph of the vestibule and semicircular canals showed the following characteristic features: no visualization (n = 4), signal change (n = 1), or vestibular hydrops (n = 10). A correlation was not observed between vestibular hydrops and vertigo (p = 1.000).

Conclusions

PPI may provide useful information on signal and morphological changes in the endolymph of patients with vestibular schwannoma. Further research is warranted to clarify the relationship between vertigo and the MR features of the inner ear.
3,4-diaminopyridine treatment for Lambert-Eaton myasthenic syndrome in adults: a meta-analysis of randomized controlled trials
Authors: Zhang Na , Hong Daojun , Ouyang Taohui , Meng Wei , Huang Jingwei , Li Meihua , Hong Tao
Published: September 2021

Background

Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of neuromuscular transmission. The objective was to examine the efficacy and safety of 3,4-diaminopyridine (3,4-DAP) in patients with LEMS.

Methods

We searched several databases to identify relevant studies, including PubMed, EMBASE, Web of Science, MEDLINE, Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Central Register of Controlled Trials(CENTRAL). The primary outcome, quantitative myasthenia gravis (QMG) score and the secondary outcome, compound muscle action potentials (CMAP) amplitude were pooled by meta-analysis.

Results

Six randomised controlled trials (RCTs) involving 115 patients with LEMS were included. QMG score showed a significant decrease (improvement) of 2.76 points (95 % CI, -4.08 to -1.45, p < 0.001) after treatment with 3, 4-DAP. Moreover, the overall mean CMAP amplitude improved significantly in LEMS patients with 3, 4-DAP treatment, compared with placebo treatment (mean difference 1.34 mV, 95 % CI, 0.98 to 1.70, p < 0.001). The overall assessment of all included trials showed a low risk of bias and low heterogeneity.

Conclusions

The pooled results of RCTs demonsrated with moderate to high evidence that 3,4-DAP has a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude.
Out-of-pocket medical expenses compared across five years for patients with one of five common cancers in Australia
Authors: Rodriguez-Acevedo Astrid J. , Chan Raymond J. , Olsen Catherine M. , Pandeya Nirmala , Whiteman David C. , Gordon Louisa G.
Published: September 2021

Background

Patient medical out-of-pocket expenses are thought to be rising worldwide yet data describing trends over time is scant. We evaluated trends of out-of-pocket expenses for patients in Australia with one of five major cancers in the first-year after diagnosis.

Methods

Participants from the QSKIN Sun and Health prospective cohort Study with a histologically confirmed breast, colorectal, lung, melanoma, or prostate cancer diagnosed between 2011 and 2015 were included (n = 1965). Medicare claims data on out-of-pocket expenses were analysed using a two-part model adjusted for year of diagnosis, health insurance status, age and education level. Fisher price and quantity indexes were also calculated to assess prices and volumes separately.

Results

On average, patients with cancer diagnosed in 2015 spent 70% more out-of-pocket on direct medical expenses than those diagnosed in 2011. Out-of-pocket expenses increased significantly for patients with breast cancer (mean AU$2513 in 2011 to AU$6802 in 2015). Out-of-pocket expenses were higher overall for individuals with private health insurance. For prostate cancer, expenses increased for those without private health insurance over time (mean AU$1586 in 2011 to AU$4748 in 2014) and remained stable for those with private health insurance (AU$4397 in 2011 to AU$5623 in 2015). There were progressive increases in prices and quantities of medical services for patients with melanoma, breast and lung cancer. For all cancers, prices increased for medicines and doctor attendances but fluctuated for other medical services.

Conclusion

Out-of-pocket expenses for patients with cancer have increased substantially over time. Such increases were more pronounced for women with breast cancer and those without private health insurance. Increased out-of-pocket expenses arose from both higher prices and higher volumes of health services but differ by cancer type. Further efforts to monitor patient out-of-pocket costs and prevent health inequities are required.
Prospective pharmacological methodology for establishing and evaluating anti-cancer drug resistant cell lines
Authors: Yu Hoon , Kim Dong-Jin , Choi Hye-Young , Kim So Myoung , Rahaman Md. Intazur , Kim Young-Hoon , Kim So Won
Published: September 2021

Background

Cell lines are often used to assess the resistance of anticancer drugs when in vivo analysis is not possible. However, the process for establishing anti-cancer drug resistance in cell cultures in vitro and the subsequent method of then evaluating resistance are not clearly established. Traditionally, the IC50 is the most commonly used indicator of resistance evaluation but it cannot represent the effectiveness of anti-cancer drugs in a clinical setting and lacks reliability because it is heavily affected by the cell doubling time. Hence, new indicators that can evaluate anti-cancer drug resistance are needed.

Methods

A novel resistance evaluation methodology was validated in this present study by establishing sunitinib resistance in renal cell carcinoma cells and assessing the cross-resistance of five different anti-cancer drugs.

Results

It was confirmed in this present study that the IC50 does not reflect the cell proliferation rates in a way that represents anti-cancer drug resistance. An alternative indicator that can also be clinically meaningful when using in vitro cell line systems is GI100. Additionally, the GR100 allows different cell populations to be calibrated on the same basis when multiple experimental results are compared.

Conclusion

Since the GR100 has properties that indicate the efficiency of anti-cancer drugs, both the efficacy and GR100 of a particular anti-cancer drug can be used to effectively assess the resistance.
The impact of childhood injury and injury severity on school performance and high school completion in Australia: a matched population-based retrospective cohort study
Authors: Mitchell Rebecca J. , Cameron Cate M. , McMaugh Anne , Lystad Reidar P. , Badgery-Parker Tim , Ryder Tayhla
Published: September 2021

Background

Exploring the impact of injury and injury severity on academic outcomes could assist to identify characteristics of young people likely to require learning support services. This study aims to compare scholastic performance and high school completion of young people hospitalised for an injury compared to young people not hospitalised for an injury by injury severity; and to examine factors influencing scholastic performance and school completion.

Method

A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for an injury during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy (NAPLAN) and generalised linear regression examined risk of not completing high school for injured young people compared to matched peers.

Results

Injured young people had a higher risk of not achieving the NMS compared to their matched peers for numeracy (ARR: 1.12; 95%CI 1.06–1.17), reading (ARR: 1.09; 95%CI 1.04–1.13), spelling (ARR: 1.13; 95%CI 1.09–1.18), grammar (ARR: 1.11; 95%CI 1.06–1.15), and writing (ARR: 1.07; 95%CI 1.04–1.11). As injury severity increased from minor to serious, the risk of not achieving the NMS generally increased for injured young people compared to matched peers. Injured young people had almost twice the risk of not completing high school at year 10 (ARR: 2.17; 95%CI 1.73–2.72), year 11 (ARR: 1.95; 95%CI 1.78–2.14) or year 12 (ARR: 1.93; 95%CI 1.78–2.08) compared to matched peers.

Conclusions

The identification of characteristics of young people most likely to encounter problems in the academic environment after sustaining an injury is important to facilitate the potential need for learning support. Assessing learning needs and monitoring return-to-school progress post-injury may aid identification of any ongoing learning support requirements.
Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation
Authors: Naccache Benjamin , Mesquida Laure , Raynaud Jean-Philippe , Revet Alexis
Published: September 2021

Background

Anorexia Nervosa (AN) is a key target for E-Health programs considering the many barriers hindering patients’ access to care and the disorder’s severity. Although these programs have become more common and effective, they often have low adherence, especially among youth. This can hinder their implementation and effectiveness in real-world settings. User experience partly overlaps with the acceptability field and may provide insight into factors affecting adherence and adoption of E-Health programs. This study aimed to explore early acceptability and user experience of a companion app prototype for adolescents with AN using user-centered design methods.

Methods

We developed a prototype containing self-help material and emotions and behaviors evaluation and management features. Then we conducted a mixed evaluation combining semi structured focus group interviews and questionnaires in a clinician group and an AN patient group. We analyzed data using thematic analysis and descriptive statistics.

Results

The app’s overall appeal was adequate. The user experience questionnaire revealed the weakest dimensions, including novelty, dependability, and efficiency versus stimulation (i.e., ability to induce motivation to use the product) and perspicuity (i.e., easy to understand, to get familiar with). The qualitative data analysis revealed three central axes: acceptability, features, and use. We identified acceptability barriers and facilitators such as the importance of design and customization, especially for adolescents. Psychoeducation was a major feature for participants, as patients highlighted the difficulties they encountered when seeking disorders-related information.

Conclusions

This study shows the importance of including users in the different stages of an e-health intervention development, in order to identify their needs, general use and compliance patterns, to improve adherence and adoption of the program and its effectiveness.
Sleep quality and associated factors among pregnant women attending antenatal care at Jimma Medical Center, Jimma, Southwest Ethiopia, 2020: cross-sectional study
Authors: Anbesaw Tamrat , Abebe Habtamu , Kassaw Chalachew , Bete Tilahun , Molla Alemayehu
Published: September 2021

Background

Sleep is a natural physiological process vital for the physical and mental wellbeing of pregnant women and their fetuses. Even though poor sleep quality is a common problem among pregnant women, it is not studied in developing countries including Ethiopia. Therefore, this study was aimed to assess the poor sleep quality and associated factors among pregnant women attending antenatal care at Jimma medical center, Jimma, Southwest Ethiopia, 2020.

Methods

A cross-sectional study design was conducted among 415 pregnant women at Jimma Medical Center (JMC). The study subjects were selected using a systematic random sampling technique. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality using face-to-face interviews. SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to sleep quality. In multivariable logistic regression variables with a p-value less than 0.05 was considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.

Results

The prevalence of poor sleep quality among pregnant women was found to be 30.8% (95% CI (26.5, 35.2). In multivariable analysis, age ≥ 30 years old (AOR = 1.94;95%CI:1.03,3.66), Multigravida (AOR = 1.90;95%CI:1.90,3.32),depression (AOR = 4.26;95%CI:2.54,7.14),stress (AOR = 1.85;95%CI:1.20,3.02) were variables significantly associated with poor sleep quality.

Conclusion

This study found a high prevalence of poor sleep quality among pregnant women. Older age, gravidity, depression, and stress were associated with poor sleep quality. It is better to have routine sleep pattern screening and teach sleep hygiene practice for pregnant women.