bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the Prognosis of Colon Cancer through Knowledge‐Based Clinical‐Molecular Integrated Analysis
Authors: Tong Danyang , Tian Yu , Ye Qiancheng , Li Jun , Ding Kefeng , Li Jingsong
Published: April 2021

Background. Colon cancer has high morbidity and mortality rates among cancers. Existing clinical staging systems cannot accurately assess the prognostic risk of colon cancer patients. This study was aimed at improving the prognostic performance of the colon cancer clinical staging system through knowledge‐based clinical‐molecular integrated analysis. Methods. 374 samples from The Cancer Genome Atlas Colon Adenocarcinoma (TCGA‐COAD) dataset were used as the discovery set. 98 samples from the Clinical Proteomic Tumor Analysis Consortium (CPTAC) dataset were used as the validation set. After converting gene expression data into pathway dysregulation scores (PDSs), the random survival forest and Cox model were used to identify the best prognostic supplementary factors. The corresponding clinical‐molecular integrated prognostic model was built, and the improvement of prognostic performance was assessed by comparing with the clinical prognostic model. Results. The PDS of 14 pathways played important roles in prognostic prediction together with clinical prognostic factors through the random survival forest. Further screening with the Cox model revealed that the PDS of the pathway hsa00532 was the best clinical prognostic supplementary factor. The integrated prognostic model constructed with clinical factors and the identified molecular factor was superior to the clinical prognostic model in discriminative performance. Kaplan‐Meier (KM) curves of patients grouped by PDS suggested that patients with a higher PDS had a poorer prognosis, and stage II patients could be distinctly distinguished. Conclusions. Based on the knowledge‐based clinical‐molecular integrated analysis, a clinical‐molecular integrated prognostic model and corresponding nomogram for colon cancer overall survival prognosis was built, which showed better prognostic performance than the clinical prognostic model. The PDS of the pathway hsa00532 is a considerable clinical prognostic supplementary factor for colon cancer and may represent a potential prognostic marker for stage II colon cancer. The PDS calculation involves only 16 genes, which supports its potential for clinical application.
Urinary Cotinine and Cotinine + Trans-3′-Hydroxycotinine (TNE-2) Cut-points for Distinguishing Tobacco Use from Nonuse in the United States: PATH Study (2013–2014)
Authors: Edwards Kathryn C. , Naz Tasmia , Stanton Cassandra A. , Goniewicz Maciej L. , Hatsukami Dorothy K. , Smith Danielle M. , Wang Lanqing , Villanti Andrea , Pearson Jennifer , Blount Benjamin C. , Bansal-Travers Maansi , Feng June , Niaura Raymond , Manderski Michelle T. Bover , Sosnoff Connie S. , Delnevo Cristine D. , Duffy Kara , Del Valle-Pinero Arseima Y. , Rostron Brian L. , Everard Colm , Kimmel Heather L. , van Bemmel Dana M. , Hyland Andrew
Published: April 2021

Background:

Determine the overall, sex-, and racially/ethnically-appropriate population-level cotinine and total nicotine equivalents (TNE-2, the molar sum of the two major nicotine metabolites) cut-points to distinguish tobacco users from nonusers across multiple definitions of use (e.g., exclusive vs. polytobacco, and daily vs. non-daily).

Methods:

Using Wave 1 (2013–2014) of the U.S. Population Assessment of Tobacco and Health (PATH) Study, we conducted weighted Receiver Operating Characteristic (ROC) analysis to determine the optimal urinary cotinine and TNE-2 cut-points, stratified by sex and race/ethnicity.

Results:

For past 30-day exclusive cigarette users, the cotinine cut-point that distinguished them from nonusers was 40.5 ng/mL, with considerable variation by sex (male: 22.2 ng/mL; female: 43.1 ng/mL) and between racial/ethnic groups (non-Hispanic other: 5.2 ng/mL; non-Hispanic black: 297.0 ng/mL). A similar, but attenuated, pattern emerged when assessing polytobacco cigarette users (overall cut-point = 39.1 ng/mL, range = 5.5 ng/mL–80.4 ng/mL) and any tobacco users (overall cut-point = 39.1 ng/mL, range = 4.8 ng/mL–40.0 ng/mL). Using TNE-2, which is less impacted by racial differences in nicotine metabolism, produced a comparable pattern of results although reduced the range magnitude.

Conclusions:

Because of similar frequency of cigarette use among polytobacco users, overall cut-points for exclusive cigarette use were not substantially different from cut-points that included polytobacco cigarette use or any tobacco use. Results revealed important differences in sex and race/ethnicity appropriate cut-points when evaluating tobacco use status and established novel urinary TNE-2 cut-points.

Impact:

These cut-points may be used for biochemical verification of self-reported tobacco use in epidemiologic studies and clinical trials.
Role of DNA Repair Variants and Diagnostic Radiology Exams in Differentiated Thyroid Cancer Risk: A Pooled Analysis of Two Case–Control Studies
Authors: Zidane Monia , Truong Thérèse , Lesueur Fabienne , Xhaard Constance , Cordina-Duverger Emilie , Boland Anne , Blanché Hélène , Ory Catherine , Chevillard Sylvie , Deleuze Jean-François , Souchard Vincent , Ren Yan , Zemmache Mohammed Zakarya , Canale Sandra , Borson-Chazot Françoise , Schvartz Claire , Mariné Barjoan Eugènia , Guizard Anne-Valérie , Laurent-Puig Pierre , Mulot Claire , Guibon Julie , Karimi Mojgan , Schlumberger Martin , Adjadj Elizabeth , Rubino Carole , Guenel Pascal , Cazier Jean-Baptiste , de Vathaire Florent
Published: April 2021

Background:

Given the increased use and diversity of diagnostic procedures, it is important to understand genetic susceptibility to radiation-induced thyroid cancer.

Methods:

On the basis of self-declared diagnostic radiology examination records in addition to existing literature, we estimated the radiation dose delivered to the thyroid gland from diagnostic procedures during childhood and adulthood in two case–control studies conducted in France. A total of 1,071 differentiated thyroid cancer (DTC) cases and 1,188 controls from the combined studies were genotyped using a custom-made Illumina OncoArray DNA chip. We focused our analysis on variants in genes involved in DNA damage response and repair pathways, representing a total of 5,817 SNPs in 571 genes. We estimated the OR per milli-Gray (OR/mGy) of the radiation dose delivered to the thyroid gland using conditional logistic regression. We then used an unconditional logistic regression model to assess the association between DNA repair gene variants and DTC risk. We performed a meta-analysis of the two studies.

Results:

The OR/mGy was 1.02 (95% confidence interval, 1.00–1.03). We found significant associations between DTC and rs7164173 in CHD2 (P = 5.79 × 10−5), rs6067822 in NFATc2 (P = 9.26 × 10−5), rs1059394 and rs699517 both in ENOSF1/THYS, rs12702628 in RPA3, and an interaction between rs7068306 in MGMT and thyroid radiation doses (P = 3.40 × 10−4).

Conclusions:

Our results suggest a role for variants in CDH2, NFATc2, ENOSF1/THYS, RPA3, and MGMT in DTC risk.

Impact:

CDH2, NFATc2, ENOSF1/THYS, and RPA3 have not previously been shown to be associated with DTC risk.
Dietary Patterns of Insulinemia, Inflammation and Glycemia, and Pancreatic Cancer Risk: Findings from the Women's Health Initiative
Authors: Jin Qi , Hart Phil A. , Shi Ni , Joseph Joshua J. , Donneyong Macarius , Conwell Darwin L. , Clinton Steven K. , Cruz-Monserrate Zobeida , Brasky Theodore M. , Tinker Lesley F. , Liu Simin , Shadyab Aladdin H. , Thomson Cynthia A. , Qi Lihong , Rohan Thomas , Tabung Fred K.
Published: April 2021

Background:

Pancreatic cancer risk is increasing in countries with high consumption of Western dietary patterns and rising obesity rates. We examined the hypothesis that specific dietary patterns reflecting hyperinsulinemia (empirical dietary index for hyperinsulinemia; EDIH), systemic inflammation (empirical dietary inflammatory pattern; EDIP), and postprandial glycemia [glycemic index (GI); glycemic load (GL)] are associated with pancreatic cancer risk, including the potential modifying role of type 2 diabetes (T2D) and body mass index (BMI).

Methods:

We calculated dietary scores from baseline (1993–1998) food frequency questionnaires among 129,241 women, 50–79 years-old in the Women's Health Initiative. We used multivariable-adjusted Cox regression to estimate HRs and 95% confidence intervals (95% CI) for pancreatic cancer risk.

Results:

During a median 19.9 years of follow-up, 850 pancreatic cancer cases were diagnosed. We observed no association between dietary scores and pancreatic cancer risk overall. However, risk was elevated among participants with longstanding T2D (present >3 years before pancreatic cancer diagnosis) for EDIH. For each 1 SD increment in dietary score, the HRs (95% CIs) were: EDIH, 1.33 (1.06–1.66); EDIP, 1.26 (0.98–1.63); GI, 1.26 (0.96–1.67); and GL, 1.23 (0.96–1.57); although interactions were not significant (all Pinteraction >0.05). Separately, we observed inverse associations between GI [0.86 (0.76–0.96), Pinteraction = 0.0068] and GL [0.83 (0.73–0.93), Pinteraction = 0.0075], with pancreatic cancer risk among normal-weight women.

Conclusions:

We observed no overall association between the dietary patterns evaluated and pancreatic cancer risk, although women with T2D appeared to have greater cancer risk.

Impact:

The elevated risk for hyperinsulinemic diets among women with longstanding T2D and the inverse association among normal-weight women warrant further examination.
Endogenous Progestogens and Colorectal Cancer Risk among Postmenopausal Women
Authors: Michels Kara A. , Geczik Ashley M. , Bauer Doug C. , Brinton Louise A. , Buist Diana S.M. , Cauley Jane A. , Dallal Cher M. , Falk Roni T. , Hue Trisha F. , Lacey James V. , LaCroix Andrea Z. , Tice Jeffrey A. , Xu Xia , Trabert Britton
Published: April 2021

Background:

The role of progestogens in colorectal cancer development is poorly characterized. To address this, our group developed a highly sensitive assay to measure concentrations of seven markers of endogenous progestogen metabolism among postmenopausal women.

Methods:

The markers were measured in baseline serum collected from postmenopausal women in a case-cohort study within the breast and bone follow-up to the fracture intervention trial (B∼FIT). We followed women not using exogenous hormones at baseline (1992–1993) for up to 12 years: 187 women with incident colorectal cancer diagnosed during follow-up and a subcohort of 495 women selected on strata of age and clinical center. We used adjusted Cox regression models with robust variance to estimate risk for colorectal cancer [hazard ratios (HR), 95% confidence intervals (CI)].

Results:

High concentrations of pregnenolone and progesterone were not associated with colorectal cancer [quintile(Q)5 versus Q1: pregnenolone HR, 0.71, 95% CI, 0.40–1.25; progesterone HR, 1.25; 95% CI, 0.71–2.22]. A trend of increasing risk was suggested, but statistically imprecise across quintiles of 17-hydroxypregnenolone (Q2 to Q5 HRs, 0.75–1.44; Ptrend, 0.06).

Conclusions:

We used sensitive and reliable assays to measure multiple circulating markers of progestogen metabolism. Progestogens were generally unassociated with colorectal cancer risk in postmenopausal women.

Impact:

Our findings are consistent with most prior research on circulating endogenous sex hormones, which taken together suggest that sex hormones may not be major drivers of colorectal carcinogenesis in postmenopausal women.
Cognitive and Behavioral Disorders in Patients with Precuneal Infarcts
Authors: Kumral Emre , Bayam Fatma Ece , Özdemir Hüseyin Nezih
Published: April 2021

Objective: Ischemic stroke of the precuneal cortex (PC) alone is extremely rare. This study aimed to evaluate the clinical, neurocognitive, and behavioral characteristics of isolated PC infarcts. Methods: We assessed neuropsychological and behavioral findings in 12 patients with isolated PC infarct among 3,800 patients with ischemic stroke. To determine the most frequently affected brain locus in patients, we first overlapped the ischemic area of patients with specific cognitive disorders and patients without specific cognitive disorders. Second, we compared both overlap maps using the “subtraction plot” function of MRIcroGL. Results: Patients showed various types of cognitive disorders. All patients experienced more than 1 category of cognitive disorder, except for 2 patients with only 1 cognitive disorder. Lesion topographical analysis showed that damage within the anterior precuneal region might lead to consciousness disorders (25%), self-processing impairment (42%), visuospatial disorders (58%), and lesions in the posterior precuneal region caused episodic and semantic memory impairment (33%). The whole precuneus is involved in at least one body awareness disorder. The cause of stroke was cardioembolism in 5 patients (42%), large artery disease in 3 (25%), and unknown in 4 (33%). Conclusions: This study showed a wide variety of neuropsychological and behavioral disorders in patients with precuneal infarct. Future studies are needed to achieve a proper definition of the function of the precuneus in relation to the extended cortical areas. PC region infarcts have been found to predict a source of embolism from the large arteries or heart.
Real-World Data on Clinical Outcomes of Patients with Liver Cancer: A Prospective Validation of the National Cancer Centre Singapore Consensus Guidelines for the Management of Hepatocellular Carcinoma
Authors: Chew Xin Hui , Sultana Rehena , Mathew Eshani N. , Ng David Chee Eng , Lo Richard H.G. , Toh Han Chong , Tai David , Choo Su Pin , Goh Brian Kim Poh , Yan Sean Xuexian , Loke Kelvin Siu Hoong , Thang Sue Ping , Gogna Apoorva , Venkatanarasimha Nanda Karaddi , Tong Aaron K.T. , Moe Fiona N.N. , Chua Jacelyn S.S. , Ang Reiko W.T. , Ong Aldwin D. , Ng Ashley W.Y. , Hoang Marjorie T.Q. , Too Chow Wei , Thng Choon Hua , Chan Wan Ying , Kee Wanyi , Chan Jaclyn H. M. , Irani Farah , Leong Sum , Lim Kiat Hon , Wang Michael L.C. , Chow Pierce K.H.
Published: April 2021

Introduction: Real-world management of patients with hepatocellular carcinoma (HCC) is crucially challenging in the current rapidly evolving clinical environment which includes the need for respecting patient preferences and autonomy. In this context, regional/national treatment guidelines nuanced to local demographics have increasing importance in guiding disease management. We report here real-world data on clinical outcomes in HCC from a validation of the Consensus Guidelines for HCC at the National Cancer Centre Singapore (NCCS). Method: We evaluated the NCCS guidelines using prospectively collected real-world data, comparing the efficacy of treatment received using overall survival (OS) and progression-free survival (PFS). Treatment outcomes were also independently evaluated against 2 external sets of guidelines, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC). Results: Overall treatment compliance to the NCCS guidelines was 79.2%. Superior median OS was observed in patients receiving treatment compliant with NCCS guidelines for early (nonestimable vs. 23.5 months p < 0.0001), locally advanced (28.1 vs. 22.2 months p = 0.0216) and locally advanced with macrovascular invasion (10.3 vs. 3.3 months p = 0.0013) but not for metastatic HCC (8.1 vs. 6.8 months p = 0.6300), but PFS was similar. Better clinical outcomes were seen in BCLC C patients who received treatment compliant with NCCS guidelines than in patients with treatment only allowed by BCLC guidelines (median OS 14.2 vs. 7.4 months p = 0.0002; median PFS 6.1 vs. 4.0 months p = 0.0286). Clinical outcomes were, however, similar for patients across all HKLC stages receiving NCCS-recommended treatment regardless of whether their treatment was allowed by HKLC. Conclusion: The high overall compliance rate and satisfactory clinical outcomes of patients managed according to the NCCS guidelines confirm its validity. This validation using real-world data considers patient and treating clinician preferences, thus providing a realistic analysis of the usefulness of the NCCS guidelines when applied in the clinics.
Avelumab in Combination with Axitinib as First-Line Treatment in Patients with Advanced Hepatocellular Carcinoma: Results from the Phase 1b VEGF Liver 100 Trial
Authors: Kudo Masatoshi , Motomura Kenta , Wada Yoshiyuki , Inaba Yoshitaka , Sakamoto Yasunari , Kurosaki Masayuki , Umeyama Yoshiko , Kamei Yoichi , Yoshimitsu Junichiro , Fujii Yosuke , Aizawa Mana , Robbins Paul B. , Furuse Junji
Published: April 2021

Introduction: Combining an immune checkpoint inhibitor with a targeted antiangiogenic agent may leverage complementary mechanisms of action for the treatment of advanced/metastatic hepatocellular carcinoma (aHCC). Avelumab is a human anti-PD-L1 IgG1 antibody with clinical activity in various tumor types; axitinib is a selective tyrosine kinase inhibitor of vascular endothelial growth factor receptors 1, 2, and 3. We report the final analysis from VEGF Liver 100 (NCT03289533), a phase 1b study evaluating safety and efficacy of avelumab plus axitinib in treatment-naive patients with aHCC. Methods: Eligible patients had confirmed aHCC, no prior systemic therapy, ≥1 measurable lesion, Eastern Cooperative Oncology Group performance status ≤1, and Child-Pugh class A disease. Patients received avelumab 10 mg/kg intravenously every 2 weeks plus axitinib 5 mg orally twice daily until progression, unacceptable toxicity, or withdrawal. Endpoints included safety and investigator-assessed objective response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and modified RECIST (mRECIST) for HCC. Results: Twenty-two Japanese patients were enrolled and treated with avelumab plus axitinib. The minimum follow-up was 18 months as of October 25, 2019 (data cutoff). Grade 3 treatment-related adverse events (TRAEs) occurred in 16 patients (72.7%); the most common (≥3 patients) were hypertension (n = 11 [50.0%]), palmar-plantar erythrodysesthesia syndrome (n = 5 [22.7%]), and decreased appetite (n = 3 [13.6%]). No grade 4 TRAEs or treatment-related deaths occurred. Ten patients (45.5%) had an immune-related AE (irAE) of any grade; 3 patients (13.6%) had an infusion-related reaction (IRR) of any grade, and no grade ≥3 irAE and IRR were observed. The objective response rate was 13.6% (95% CI: 2.9–34.9%) per RECIST 1.1 and 31.8% (95% CI: 13.9–54.9%) per mRECIST for HCC. Conclusion: Treatment with avelumab plus axitinib was associated with a manageable toxicity profile and showed antitumor activity in patients with aHCC.
Anesthesia for Maternal-Fetal Interventions: A Survey of Fetal Therapy Centers in the North American Fetal Therapy Network
Authors: Wood Cristina L. , Zuk Jeannie , Rollins Mark D. , Silveira Lori J. , Feiner John R. , Zaretsky Michael , Chatterjee Debnath
Published: April 2021

Introduction: A wide range of fetal interventions are performed across fetal therapy centers (FTCs). We hypothesized that there is significant variability in anesthesia staffing and anesthetic techniques. Methods: We conducted an online survey of anesthesiology directors at every FTC within the North American Fetal Therapy Network (NAFTNet). The survey included details of fetal interventions performed in 2018, anesthesia staffing models, anesthetic techniques, fetal monitoring, and postoperative management. Results: There was a 92% response rate. Most FTCs are located within an adult hospital and employ a small team of anesthesiologists. There is heterogeneity when evaluating anesthesiology fellowship training and staffing, indicating there is a multidisciplinary specialty team-based approach even within anesthesiology. Minimally invasive fetal interventions were the most commonly performed. The majority of FTCs also performed ex utero intrapartum treatment (EXIT) and open mid-gestation procedures under general anesthesia (GA). Compared to FTCs only performing minimally invasive procedures, FTCs performing open fetal procedures were more likely to have a pediatric surgeon as director and performed more minimally invasive procedures. Conclusions: There is considerable variability in anesthesia staffing, caseload, and anesthetic techniques among FTCs in NAFTNet. Most FTCs used maternal sedation for minimally invasive procedures and GA for EXIT and open fetal surgeries.
Recurrent Nephritis and/or Pulmonary Hemorrhage in Patients with Anti-Glomerular Basement Membrane Disease with and without ANCA Positivity
Authors: Droz Nicole , Katz Alexis , Patel Aditi , Briskin Isaac , Sedor John , Hajj Ali Rula A.
Published: April 2021

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is characterized by rapidly progressive glomerular nephritis with or without pulmonary hemorrhage with disease severity correlating with antibody titer. Following treatment, relapse is rare but has been reported in the literature. The objective of this study was to assess for clinical, serologic, and histologic differences associated with disease relapse in patients with anti-GBM disease. Methods: Patients seen at our facility between 1997 and 2017 were screened for anti-GBM disease by ICD 9/10 codes. They were included if the diagnosis was confirmed by a board-certified rheumatologist or nephrologist and had positive antibodies and/or biopsy results consistent with anti-GBM disease. Relapsing disease was defined as recurrence of pulmonary or renal manifestations after achieving remission following the initial presentation. All charts were reviewed for baseline demographics, clinical manifestations, and antibody positivity and compared between groups. Results: 40 patients were confirmed as having anti-GBM disease. Mean follow-up from disease onset to the date of last follow-up was 56.2 months. 8 patients had relapsing disease and 32 patients had nonrelapsing disease. Baseline characteristics and clinical manifestations were similar between groups. Patients with relapsing disease had a high incidence of anti-neutrophilic cytoplasmic antibody (ANCA) co-positivity as compared to nonrelapsing patients (50 vs. 15.6%, respectively, p = 0.059), but this did not reach statistical significance. In patients with relapsing disease, only one had positive anti-GBM antibodies at time of relapse. Conclusions: In this study, patients with relapsing disease had a high incidence of ANCA co-positivity (50%). In patients with newly diagnosed anti-GBM disease, ANCAs should be obtained to assess for the risk of relapse and to help guide long-term follow-up and treatment.
Ser ou não ser pescadora artesanal? Trabalho feminino, reconhecimento e representação social entre marisqueiras da Bacia de Campos, RJ
Authors: Cezar Lilian Sagio , Theis Rafaella
Published: April 2021

O presente texto descreve e analisa, a partir de uma perspectiva de gênero, as relações de trabalho das mulheres na pesca artesanal de Campos dos Goytacazes, RJ, tendo como foco o processo de participação e representação feminina no Grupo Gestor da Pesca Artesanal. A partir de pesquisa qualitativa e entrevistas narrativas, analisamos a recusa e interdição ao uso da identidade laboral de pescadora por meio do agenciamento das categorias nativas marisqueira(s), fundo(s) de quintal(is) e dona(s) de fundo de quintal. Esses dados descritivos foram cotejados e tensionados à teoria de divisão sexual do trabalho e à categoria analítica de gênero para compreender possíveis desigualdades e formas de (in)visibilização do trabalho feminino na pesca artesanal local. Este artigo é resultado de pesquisa financiada pelo Projeto de Educação Ambiental (PEA) Pescarte, que é uma medida de mitigação exigida pelo Licenciamento Ambiental Federal, conduzido pelo IBAMA.
Devoção e resistência: as táticas dos anfitriões da Folia de Reis na região metropolitana do Estado do Rio de Janeiro
Authors: Souza Luiz Gustavo Mendel
Published: April 2021

As Folias de Reis realizam circuitos de visitações às casas dos devotos em um período conhecido como giros ou jornadas, ocorrendo nas madrugadas dos fins de semana entre os dias 24 de dezembro e 6 de janeiro, dia dos Santos Reis. Para elaborar um estudo etnográfico que abarque a complexidade desse empreendimento devocional, divido este artigo em três partes: a primeira visa discutir quem são os devotos da Folia de Reis e seus papéis na execução da devoção; a segunda parte explora a ocupação dos espaços da casa e da rua no momento da realização dos giros da folia; e a parte final pauta-se na exploração das “táticas” (Certeau, 1994) praticadas pelos devotos anfitriões da bandeira para a garantia da integridade física e moral dos foliões e seus familiares durante o circuito ritual realizado na periferia da Região Metropolitana do Estado do Rio de Janeiro.
Pathological, molecular and phylogenic study of fowlpox virus in domesticated chickens of Tikrit City, Iraq
Authors: Hasan Ismael Ibrahim , Rasheed Saad Tawfik , Shakor Mohammed Khorshid
Published: April 2021

Fowlpox virus (FPV) is one of the viruses affecting chickens worldwide, causing pathological and economic losses in the poultry industry. Viral lesions are easily recognizable by the eye and usually appear in the featherless areas, especially the head. Moreover, the virus could lead to blindness and mortality in some cases. This study diagnosed the suspected fowlpox cases, identified and classified the causative agent. We also analyzed the differences and similarities of closely related viruses at the neighboring and regional countries. Fifty samples were collected from three locations of Tikrit city from the domesticated chickens, which showed cutaneous lesions. Virus DNA was extracted directly from tissue samples before the nested PCR technique was performed. The virion core protein (P4b) gene is partially sequenced and analyzed with routine histological sectioning. Results showed that the virus causes pock lesions of dermal hyperplasia and hyperkeratosis. Hyperplasia and congestion of the chorioallantoic membrane were also recorded. The study also showed that the DNA of FPV could be extracted directly from animal tissue without further purification. The sequence analysis showed that the FPV was confirmed in all samples clustered in clade A identical with Iranian and Egyptian isolates. In conclusion, this study approved that the virus belongs to the classical dermal type of poxviruses and the short genetic distances between viruses related to closely neighboring countries. We also concluded that the conservative P4b gene included mutation sites that make this gene practical for diagnosing the virus and phylogenetic analysis.
Análise de custos em unidade de Medicina Tradicional, Complementar e Integrativa no Brasil
Authors: Assunção Marcone César Tabosa , Aquino Camilla Maria Ferreira de , Sousa Islândia Maria Carvalho de , Carvalho Neto Manoel Raymundo de , Jordão Vitor Pereira , Bezerra Adriana Falangola Benjamin
Published: April 2021

OBJETIVO: Analisar os custos de um serviço especializado em Medicinas Tradicionais Complementares e Integrativas (MTCI) no Nordeste brasileiro, com o intuito de fornecer dados sobre o custo atrelado à implantação e manutenção de serviços dessa natureza e identificar o custo médio por usuário para o Sistema Único de Saúde. MÉTODOS: Trata-se de uma avaliação econômica do tipo parcial, com caráter descritivo, de natureza quantitativa, que utilizou dados secundários, posteriormente agrupados em planilhas do Microsoft Excel. O método utilizado para analisar tais custos foi o de custeio por absorção, a partir do qual o serviço foi dividido em três centros de custeio: produtivo, administrativo e auxiliar. RESULTADOS: Após a análise dos dados, o custo total do serviço em 2014 foi estimado em R$ 1.270.015,70, com proporção de 79,69% de custos diretos. O custo médio por usuário neste período foi R$ 36,79, considerando o total de 34.521 usuários em práticas individuais e coletivas. CONCLUSÕES: O serviço apresenta um custo por usuário compatível com um serviço especializado, contudo, as MTCI oferecem abordagem compreensiva e holística, as quais podem impactar de forma positiva a qualidade de vida.
Envelhecer com saúde: estratégias de ageing in place de uma população portuguesa com 65 anos ou mais
Authors: Bárrios Maria João , Marques Rita , Fernandes Ana Alexandre
Published: April 2021

OBJETIVO: Identificar as estratégias desenvolvidas por pessoas em processo de envelhecimento para se manter residindo na própria casa, apesar das fragilidades e das dificuldades com que deparam. MÉTODOS: A pesquisa foi realizada a partir de um inquérito a uma população com 65 anos ou mais no município português de Portimão. Os dados foram recolhidos por questionário, em 2017, e submetidos a análise estatística e análise de conteúdo. RESULTADOS: A maioria dos inquiridos tem habitação própria, onde se sente segura e satisfeita, e revela ter consciência e preocupação em relação às alterações que deve executar em sua casa para ali poder permanecer. Além das condições habitacionais e de habitabilidade, as condições de saúde, os recursos económicos, a rede social e os serviços disponíveis assumem um papel preponderante no envelhecimento na comunidade. CONCLUSÕES: Foi possível identificar uma diversidade nas estratégias utilizadas para permanecerem em suas casas à medida que envelhecem e uma multiplicidade de formas como mobilizaram os recursos que têm à disposição, bem como constrições do ageing in place.
Análise das inter-relações entre os fatores que influenciam a pressão arterial em adultos
Authors: Freire Rafael Silveira , Reis Vivianne Margareth Chaves Pereira , Brito Alexandre Botelho , Brito Maria Fernanda Santos Figueiredo , Pinho Lucinéia de , Silva Rosângela Ramos Veloso , Silveira Marise Fagundes
Published: April 2021

OBJETIVO: Investigar as inter-relações entre fatores sociodemográficos, comportamentais e clínicos associados à elevação da pressão arterial em adultos. MÉTODOS: Utilizaram-se dados de um estudo transversal de base populacional. Foi desenvolvido um modelo hipotético em que condição socioeconômica, consumo de frutas e vegetais, adiposidade e pressão arterial foram tratadas como variáveis latentes, e idade, sexo, glicemia, atividade física, tabagismo, consumo de álcool e controle da hipertensão arterial (HA) foram tratadas como variáveis observadas. Utilizou-se a modelagem de equação estrutural para ajustar o modelo final. RESULTADOS: Participaram do estudo 808 indivíduos, com idade média de 44,2 anos (DP = 17,8), sendo 52,7% do sexo feminino. Verificou-se que a idade exerceu efeito positivo sobre pressão arterial (β = 0,39), adiposidade (β = 0,44), g licemia (β = 0,26) e tabagismo (β = 0,30), e efeito negativo sobre atividade física (β = -0,17) e consumo de álcool (β = -0,09). O sexo masculino mostrou-se associado positivamente com a pressão arterial (β = 0,13), com o tabagismo (β = 0,28) e com o consumo de bebida alcoólica (β = 0,18). A adiposidade teve efeito positivo sobre a pressão arterial (β = 0,23) e a glicemia (β = 0,16), o consumo de álcool produziu efeito positivo sobre a adiposidade (β = 0,09), o consumo de frutas e vegetais exerceu efeito negativo sobre a pressão arterial (β = -0,11), e a condição socioeconômica teve efeito positivo sobre o consumo de frutas e vegetais (β = 0,47). O modelo estrutural foi ajustado pela variável controle médico da hipertensão, que apresentou efeito negativo sobre a pressão arterial (β = -0,10). CONCLUSÕES: Os resultados sugerem que o aumento da idade se associa ao aumento da pressão arterial, adiposidade, glicemia e tabagismo, assim como com a redução da atividade física e consumo de álcool. O sexo masculino associou-se com aumento da pressão arterial e maior uso de bebida alcoólica e cigarros. A adiposidade correlaciona-se ao aumento da pressão arterial e da glicemia, enquanto maior consumo de álcool associa-se com aumento da adiposidade e maior consumo de frutas e vegetais, assim como o controle ativo da hipertensão, correlaciona-se com redução da pressão arterial. A melhor condição socioeconômica mostrouse associada com maior consumo de frutas e vegetais.
Acesso à Atenção Primária à Saúde por idosos residentes em zona rural no Sul do Brasil
Authors: Ferreira Luiza Santos , Moreira Laísa Rodrigues , Paludo Simone dos Santos , Meucci Rodrigo Dalke
Published: April 2021

OBJETIVO: Caracterizar o acesso e utilização de serviços de saúde considerados como referência pela população rural idosa de um município do sul do Brasil, com cobertura de 100% da área rural pela Estratégia Saúde da Família (ESF), investigando os fatores associados à escolha da Unidade Básica de Saúde da Família (UBSF) como serviço de referência. MÉTODOS: Estudo transversal com amostragem sistemática dos domicílios da área rural do município de Rio Grande (RS), realizado em 2017, através de questionário padronizado, aplicado em domicílio. Foram realizadas análises descritivas referentes a perfil sociodemográfico; tipo de serviço de referência escolhido; e motivos de escolha/utilização do serviço de primeira opção e da UBSF mais próxima. Realizou-se regressão de Poisson para investigar fatores associados ao tipo de serviço de referência escolhido. RESULTADOS: Participaram do estudo 1.030 idosos, dos quais 61,4% indicaram a unidade básica como serviço de primeira opção/referência. Enquanto aqueles que escolheram ser atendidos na UBSF o faziam principalmente em razão da proximidade (82,6%), os demais procuraram outros locais pela percepção de maior facilidade (34,6%) e resolutividade (52,6%). Quase ⅔ dos entrevistados buscaram atendimento na UBSF no último ano, e os motivos foram diferentes entre aqueles que consideravam a unidade como referência (doença crônica) e aqueles que procuravam outro local (procedimentos). Além disso, quanto menor a idade, renda, escolaridade e distância residência-unidade, maior a probabilidade do idoso considerar a UBSF mais próxima como serviço de referência. CONCLUSÃO: A ESF tem conseguido atingir a parcela rural idosa em situação de vulnerabilidade, indo ao encontro de um sistema de saúde público equitativo. Todavia, novas avaliações para averiguar adequação e qualidade do atendimento se fazem necessárias, visto que estrutura social, fatores capacitantes (como condição econômica) e possíveis crenças sobre saúde ainda definem o padrão de escolha do serviço.
Participação social na gestão de tecnologias em saúde em âmbito federal no Brasil
Authors: Lopes Ana Carolina de Freitas , Novaes Hillegonda Maria Dutilh , Soárez Patricia Coelho de
Published: April 2021

OBJETIVO: Caracterizar e discutir os processos formais de participação social previstos e implementados pelas instituições Agência Nacional de Vigilância Sanitária (Anvisa), Comissão Nacional de Incorporação de Tecnologias no SUS (Conitec) e Agência Nacional de Saúde Suplementar (ANS). MÉTODOS: Estudo exploratório, descritivo, comparativo, conduzido por meio de análise de documentos publicados até 2018 no sítio eletrônico e da legislação específica de cada instituição. RESULTADOS: Os espaços de participação social identificados incluem a representação em colegiados e participação direta por meio de uma demanda inicial ou em consultas públicas, audiências públicas e ouvidorias. A Anvisa conduziu 187 consultas públicas entre 1999 e 2018, e contabilizou 10.699 contribuições. Em 76 (41%) consultas públicas não há informações sobre as contribuições recebidas. A Conitec conduziu 234 consultas públicas, e recebeu 53.174 contribuições entre 2011 e 2018. Identificou-se que 70 (23%) recomendações da Conitec foram emitidas sem consulta pública, e 26 (8%) recomendações preliminares foram alteradas após consulta pública. As alterações de recomendação aconteceram especialmente em casos com grande volume de contribuições. A ANS conduziu 8 consultas públicas sobre o rol de procedimentos e eventos em saúde entre 2000 e 2018, e recebeu pelo menos 31.498 contribuições. Em três consultas públicas não há informações sobre o número de contribuições recebidas. CONCLUSÕES: Observa-se recente avanço normativo e de desempenho institucional em favor da participação social em espaços decisórios notadamente técnicos, embora de forma bastante heterogênea entre as instituições analisadas. O poder deliberativo da participação social de influenciar as decisões em saúde ainda necessita de estudo aprofundado, incluindo a caracterização dos participantes e a legitimidade das decisões subsequentes.
Existe desigualdade socioeconômica na multimorbidade entre adultos brasileiros?
Authors: Costa Ândria Krolow , Bertoldi Andréa Dâmaso , Fontanella Andréia Turmina , Ramos Luiz Roberto , Arrais Paulo Sergio Dourado , Luiza Vera Lucia , Mengue Sotero Serrate , Nunes Bruno Pereira
Published: April 2021

OBJETIVO: Avaliar a prevalência de multimorbidade e a associação desta com indicadores socioeconômicos entre adultos brasileiros. MÉTODOS: Estudo transversal que utilizou dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil, realizada entre 2013 e 2014. Multimorbidade foi definida como a coexistência, no mesmo indivíduo, de duas ou mais doenças crônicas, e é mensurada a partir de uma lista de 14 morbidades (autorrelato de diagnóstico médico na vida). Classe econômica e escolaridade foram os indicadores socioeconômicos utilizados, sendo as desigualdades avaliadas pelo Slope Index of Inequality (SII) e pelo Concentration Index (CIX), estratificadas por sexo. RESULTADOS: O estudo considerou 23.329 mil adultos (52,8% de mulheres), com média de idade de 37,9 anos. Hipertensão e colesterol alto foram as condições mais prevalentes. A prevalência de multimorbidade foi de 10,9% (IC95% 10,1–11,7), representando, aproximadamente, 11 milhões de indivíduos no Brasil, sendo 14,5% (IC95% 13,5–15,4) entre mulheres e 6,8% (IC95% 5,9–7,8) entre homens. A ocorrência de multimorbidade foi similar segundo os indicadores socioeconômicos. Nas análises de desigualdade, observou-se diferença absoluta e relativa para homens com maior poder aquisitivo (SII = 3,7; IC95% 0,3–7,0) e maior escolaridade (CIX = 7,1; IC95% 0,9–14,7), respectivamente. CONCLUSÕES: A frequência de adultos brasileiros com multimorbidade é alta, principalmente em termos absolutos. Desigualdades socioeconômicas na multimorbidade foram observadas somente entre homens.
Os impactos da violência sexual vivida na infância e adolescência em universitários
Authors: Silva Flávia Calanca da , Monge Aline , Landi Carlos Alberto , Zenardi Gabriel Amaral , Suzuki Denise Chrysostomo , Vitalle Maria Sylvia de Souza
Published: April 2021

OBJETIVO: Investigar a prevalência de adolescentes e adultos jovens que foram vítimas de violência sexual em algum momento da vida e comparar a presença de sintomas depressivos e ansiosos, qualidade de vida e uso de álcool, tabaco e drogas ilícitas entre esta população e a que não sofreu abuso. MÉTODOS: Aplicaram-se questionários e instrumentos validados, em uma população de estudantes universitários, para avaliar: perfil e comportamento sexual, nível socioeconômico, presença ou não de violência sexual (Questionário sobre a Exposição a Eventos Traumatizantes), sintomas depressivos (Inventário de Depressão de Beck) e ansiosos (Inventário de Ansiedade de Beck), qualidade de vida (World Health Organization’s Quality of Life Assessment) e o uso ou abuso de tabaco, álcool e drogas ilícitas (Teste para Triagem do Envolvimento com Fumo, Álcool e Outras Drogas). RESULTADOS: Dos 858 alunos que responderam à pesquisa, 71 (8,3%) foram vítimas de violência sexual, sendo 52 meninas (73,2%). No grupo vítima de abuso havia mais alunos que já tinham tido a coitarca (p = 0,029), alunas que já engravidaram (p = 0,001), estudantes com maiores escores para sintomas depressivos (p < 0,001) e ansiosos (p = 0,001), alunos com pior qualidade de vida (p < 0,001) e que usavam mais tabaco (p = 0,008) e maconha (p = 0,025) bem como abusavam de hipnóticos ou sedativos (p = 0,048) que no grupo não vítima. CONCLUSÃO: Os impactos causados pelo abuso são diversos e afetam, mesmo no longo prazo, a vida dos sobreviventes. Abordar o tema e o discutir, amplamente, em todas as esferas da sociedade é uma forma de mobilizar, sensibilizar e instrumentalizar o coletivo, desmistificando o assunto e chamando atenção para essa importante questão social.
Randomized Trial of Etelcalcetide for Cardiac Hypertrophy in Hemodialysis
Authors: Dörr Katharina , Kammer Michael , Reindl-Schwaighofer Roman , Lorenz Matthias , Prikoszovich Thomas , Marculescu Rodrig , Beitzke Dietrich , Wielandner Alice , Erben Reinhold G. , Oberbauer Rainer
Published: April 2021

Rationale:

Left ventricular hypertrophy (LVH) is highly prevalent in patients with chronic kidney disease and increases their risk of cardiac events and mortality. FGF23 (fibroblast growth factor 23) and parathyroid hormone levels, which are associated with the development of LVH, rise progressively with declining renal function.

Objectives:

To determine whether FGF23 suppression by calcimimetic therapy may reduce LVH progression in comparison to FGF23 elevation under vitamin D analogs at equal parathyroid hormone suppression under either therapy as well as tight volume control.

Methods and Results:

We conducted a single-blinded trial with 1:1 block randomization to investigate the effect of the intravenous treatment with etelcalcetide versus alfacalcidol on LVH progression in 62 maintenance hemodialysis patients with secondary hyperparathyroidism and LVH. In the intention-to-treat analysis of 59 patients, the mean difference in the change of left ventricular mass index determined by cardiac magnetic resonance imaging from baseline to 12 months of treatment was −6.9 g/m
2
(95% CI, −12.6 to −1.2,
P
=0.022) in the etelcalcetide compared with the alfacalcidol group. The effect estimate was −8.2 g/m
2
(95% CI, −14 to −2.4) in the per-protocol analysis on 52 patients. The trajectories of parathyroid hormone, phosphate, and αKlotho were similar in both groups throughout follow-up. FGF23 levels, which showed a strong positive association with left ventricular mass index, were decreasing under etelcalcetide and increasing under alfacalcidol at similar parathyroid hormone suppression.

Mild hypocalcemia was the most common adverse event under etelcalcetide. Blood pressure and the distribution of antihypertensive medications were similar between groups.

Conclusions:

In this trial, we were able to show that FGF23 suppression by etelcalcetide inhibited the progression of LVH compared with alfacalcidol in hemodialysis patients. A successful prevention of increasing hypertrophy may reduce the risk of sudden cardiac death in this population.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03182699.
Decade‐Long Nationwide Trends and Disparities in Use of Comfort Care Interventions for Patients With Ischemic Stroke
Authors: Chu Kristie M. , Jones Erica M. , Meeks Jennifer R. , Pan Alan P. , Agarwal Kathryn L. , Taffet George E. , Vahidy Farhaan S.
Published: April 2021

Background

Stroke remains one of the leading causes of disability and death in the United States. We characterized 10‐year nationwide trends in use of comfort care interventions (CCIs) among patients with ischemic stroke, particularly pertaining to acute thrombolytic therapy with intravenous tissue‐type plasminogen activator and endovascular thrombectomy, and describe in‐hospital outcomes and costs.

Methods and Results

We analyzed the National Inpatient Sample from 2006 to 2015 and identified adult patients with ischemic stroke with or without thrombolytic therapy and CCIs using validated
International Classification of Diseases, Ninth Revision
(
ICD‐9
)
codes. We report adjusted odds ratios (ORs) and 95% CI of CCI usage across five 2‐year periods. Of 4 249 201 ischemic stroke encounters, 3.8% had CCI use. CCI use increased over time (adjusted OR, 4.80; 95% CI, 4.15–5.55) regardless of acute treatment type. Advanced age, female sex, White race, non‐Medicare insurance, higher income, disease severity, comorbidity burden, and discharge from non‐northeastern teaching hospitals were independently associated with receiving CCIs. In the fully adjusted model, thrombolytic therapy and endovascular thrombectomy, respectively, conferred a 6% and 10% greater likelihood of receiving CCIs. Among CCI users, there was a significant decline in in‐hospital mortality compared with all other dispositions over time (adjusted OR, 0.46; 95% CI, 0.38–0.56). Despite longer length of stay, CCI hospitalizations incurred 16% lower adjusted costs.

Conclusions

CCI use among patients with ischemic stroke has increased regardless of acute treatment type. Nonetheless, considerable disparities persist. Closing the disparities gap and optimizing access, outcomes, and costs for CCIs among patients with stroke are important avenues for further research.
IMPACTS OF TECHNOLOGICAL DEVELOPMENT ON EMPLOYMENT STRUCTURE OF TOURISM INDUSTRY
Authors: KÖMÜRCÜ Simge , İŞEVCAN ERTAMAY Selin , GÜLER Mehmet Emre
Published: April 2021

Purpose: Dynamic development of modern technology is undeniable, and applications resulting from modern technology have already influenced the employment of services in the tourism industry. The purpose of this study is to examine possible structural changes and provide resourceful perspectives with the extent of how far the technological advances brought by Industry 4.0 will substitute for the manpower.
Methodology: The research was conducted using a face-to-face interview technique, which is one of the methods of qualitative research in order to examine the effect of Industry 4.0 on the employment structures of the tourism industry in detail. Semi-structured interviews were conducted by adding some questions that made the study original.
Design/Approach: 17 semi-structured face to face interviews were conducted with tourism industry managers based in Turkey to find out foreseen impacts of current technological improvements on the labour structure of the tourism industry. The reason for conducting a semi-structured interview is that this technique allows the elaboration of the research by asking additional questions, although the questions are determined.
Findings: The results of this study indicate that dehumanization is not possible at all levels of tourism services, and technological developments lead to a task-sharing work environment between the manpower and robots. New occupations emerge while some are being eliminated. Demographic factors are prominent in the technological adaptation of both by customers and employees.
Originality: This study is important in terms of seeing the perspectives of manpower in tourism within the framework of smart industry development and seeing the needs for its development. The conclusion provides managerial and theoretical perspectives resulted from study findings.
Structure and Agency in Historical Materialism: A Response to Knafo and Teschke
Authors: Post Charles
Published: April 2021

This essay argues that Knafo and Teschke fundamentally misread Brenner’s original contribution to the transition debate. They equate his rejection of trans-historical or trans-modal laws of motion with the notion that social-property relations do not have strong rules of reproduction that structure the actions of agents and give rise to ‘developmental patterns’ specific to each form of social labour. Knafo and Teschke’s critique of Brenner’s analysis of capitalist expansion and crisis is also theoretically and empirically questionable.