bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Gender Equality and Husband Support in the Use of Postpartum Family Planning (PPFP)
Authors: Widyastuti Yani , Akhyar Muhammad , Setyowati Retno , Mulyani Sri
Published: July 2023

Introduction

Postpartum family planning (PPFP) has been reported to decrease the risk of stunting by increasing the interval between pregnancies by 0.9 percent every month. In Indonesia, the prevalence of stunting affects 21.6% in 2022; however, it is expected that by 2024, the figure would drop to 14%.

Objective

This study aims to analyze the relationship between gender equality and husband support in the use of PPFP.

Methods

The study was conducted using a cross-sectional method and took place from August to October 2022. The participants comprised 210 women who had given birth in the first 4 to 12 months in Kulon Progo, Yogyakarta, Indonesia. The data was collected from women who visited the pediatrics and family planning clinics of community health centers from August to October 2022, using a structured questionnaire and analyzed using both the Chi-Square Test and Binary Logistic Regression Analysis.

Results

The results showed that 38.1% of the participants used PPFP. The estimated results reveal that variables such as education, husband support, gender equality, home visits, and postnatal visits ( p < 0.05) influenced the implementation of postpartum contraception. While other variables such as age, occupation, income, number of children, and parity did not affect the model ( p > 0.05).

Conclusion

Participating in postpartum family planning requires the husband's support and gender equality. We recommend a deliberate effort on improving postnatal mothers using postpartum family planning, one of the strategies is to increase intensive outreach to pregnant women with higher education to their husbands about the importance of postpartum family planning.
Reimagining LRA in the Spirit of a Transcendent Approach to Literacy
Authors: Waldron Chad H. , Willis Arlette , Tatum Alfred , Salas Rachel G. , Coleman James Joshua , Croom Marcus , Deroo Matthew R. , Hikida Michiko , Machado Emily , Smith Patriann , Zaidi Rahat
Published: July 2023

This invited paper highlights the reflections of expert panelists who were spontaneously called upon, graciously accepted, and quickly organized to respond thoughtfully and compellingly to Dr. Arlette Willis' powerful and timely Oscar Causey address at the 2022 Literacy Research Association (LRA) annual conference. In her address, Dr. Willis issued a clarion call for a Transcendent Approach to Literacy (TAL) to a space where “We re-create literacy as an equitable and moral construct” (Willis, 2023, p. 133). This paper comprises Dr. Alfred Tatum's comprehensive introduction, the cogent reflections on TAL by panelists Dr. Josh Coleman, Dr. Marcus Croom, Dr. Matthew Deroo, Dr. Michiko Hikida, Dr. Emily Machado, Dr. Patriann Smith, Dr. Chad Waldron, and Dr. Rahat Zaidi, and Dr. Willis' eloquent epilogue. In her epilogue, she provides not an ending but the genesis of a movement forward for the LRA community to “be brave” and actively and genuinely engage in a TAL that “democratizes literacy, declaring literacy belongs to all.”
The long shadow of the repressive state: Militarized policing and the eviction crisis
Authors: Flierl Laura
Published: July 2023

This article is concerned with the often-overlooked role of repressive state agencies in the current eviction and gentrification crisis. Intervening into contemporary research, it provides an empirically based argument to re-include law enforcement into critical housing research for what the police essentially is: a political actor in the evictions crisis in its own right, central to reproducing racial capitalism in the realm of housing. Combining movement-produced data from anti-eviction struggles in Barcelona with US police record research in Oakland, the article shows how law enforcement’s policing and military upgrading determines the course of forced removals, much prior to a judge’s order. Examples of police activity illustrate how officers use the significant discretion afforded to them by the law to execute extralegal evictions of primarily poor women and racialized populations, seeking to secure above all that any ‘opting out’ of capitalist, patriarchal and racist power structures is repressed by state violence.
Surgical resection therapy of a rare presentation of persistent Mullerian duct syndrome: a case review
Authors: Faria Iwens Moreira de , Souza Augusto Machado de , Júnior Luiz Rodrigues Pereira , Leite Gabriel Gomes Vieira Ribeiro
Published: July 2023

Persistent Mullerian Duct Syndrome (PMDS) is an extremely rare disease with less than 300 cases recorded in medical literature. Our patient was a 37 year old male who presented at the medical office with hematospermia as his sole complaint. He had previously undergone left orchidopexy and presented with hypotrophic left testicle and right testicle agenesis. PMDS differential was considered with the clear observation of a uterus-like structure during pelvic ultrasonography. The organs were later studied in magnetic resonance imaging and confirmed by post-surgery anatomopathological examination. Patient was discharged 24 h after surgery and developed azoospermia post-surgery.
Assessment of Virtual Mindfulness-Based Training for Health Care Professionals: Improved Self-Reported Respiration Rates, Perceived Stress, and Resilience
Authors: Merrigan Justin J. , Quatman-Yates Catherine , Caputo Jacqueline , Daniel Kayla , Briones Nadia , Sen Ilayda , Bretz Slate , Duchemin Anne-Marie , Steinberg Beth , Hagen Joshua A. , Klatt Maryanna
Published: July 2023

Background

Mindfulness in Motion (MIM) is a workplace resilience-building intervention that has shown reductions in perceived stress and burnout, as well as increased resilience and work engagement in health care workers.

Objective

To evaluate effects of MIM delivered in a synchronous virtual format on self-reported respiratory rates (RR), as well as perceived stress and resiliency of health care workers.

Methods

Breath counts were self-reported by 275 participants before and after 8 weekly MIM sessions. MIM was delivered virtually in a group format as a structured, evidence-based workplace intervention including a variety of mindfulness, relaxation, and resilience-building techniques. Participants counted their breaths for 30 seconds, which was then multiplied by 2 to report RR. Additionally, participants completed Perceived Stress Scale and Connor–Davidson Resiliency Scale.

Results

According to mixed effect analyses there were main effects of MIM Session (P < .001) and Weeks (P < .001), but no Session by Week interaction (P = .489) on RR. On average, RR prior to MIM sessions were reduced from 13.24 bpm (95% CI = 12.94, 13.55 bpm) to 9.69 bpm (95% CI = 9.39, 9.99 bpm). When comparing average Pre-MIM and Post-MIM RR throughout the MIM intervention, Week-2 (mean = 12.34; 95% CI = 11.89, 12.79 bpm) was not significantly different than Week-1 (mean = 12.78; 95% CI = 12.34, 13.23 bpm), but Week-3 through Week-8 demonstrated significantly lower average Pre-MIM and Post-MIM RR compared to Week-1 (average weekly difference range: 1.36 to 2.48 bpm, P < .05). Perceived stress was reduced from Week-1 (17.52 ± 6.25) to after Week-8 (13.52 ± 6.04; P < .001), while perceived resiliency was increased from Week-1 (11.30 ± 5.14) to after Week-8 (19.29 ± 2.58); P < .001).

Conclusion

Thus far, completion of MIM sessions has shown acute and long-term effects on self-reported RR, but more research is required to determine the extent of improved parasympathetic (relaxed) states. Collectively, this work has shown value for mind–body stress mitigation and resiliency-building in high stress acute health care environments.
Provincializing Dracula urbanism
Authors: Colven Emma
Published: July 2023

In this commentary, I respond to and extend Wilson and Wyly's ‘Dracula urbanism’ by drawing on feminist, postcolonial, and urban political ecology critiques of global urbanism. To do so, I firstly provincialize Dracula urbanism to reframe this notion as a situated form of knowledge. I then examine how vampires specific to Indonesian and Malay cultures might reveal different insights into the nature of capitalist urbanization. I close with a call for urban scholars to engage more closely with critical perspectives from urban studies that continue to occupy the margins of the field. I also invite careful consideration and reflexivity as to the work we achieve by coining new urbanisms.
A Large Idiopathic Arteriovenous Malformation of the Right Lung, Which Was Mistaken for Lung Cancer
Authors: Quarato Carla Maria Irene , Taurchini Marco , Ferretti Gianmaria , Simeone Anna , Ciccarese Giovanni , Dimitri Lucia , Fuso Paolo , Sperandeo Marco
Published: July 2023

A 53-year-old male was admitted to the hospital because of retrosternal and epigastric pain radiating to the back. Radiologic images showed a homogeneous soft tissue mass in the right upper lobe that was initially misdiagnosed as a lung cancer. Fortunately, a careful Doppler examination identified two vascular structures within the lesion. This diagnostic study suggested the execution of a more appropriate computed tomography angiography (CTA). The examination confirmed the diagnosis of a simple pulmonary arteriovenous malformation (AVM). The patient underwent embolization of the arterial side of the AVM and finally a posterolateral mini-thoracotomy to remove the lesion.
Establishing minimally important differences for cardiac MRI end-points in pulmonary arterial hypertension
Authors: Alabed Samer , Garg Pankaj , Alandejani Faisal , Dwivedi Krit , Maiter Ahmed , Karunasaagarar Kavita , Rajaram Smitha , Hill Catherine , Thomas Steven , Gossling Rebecca , Sharkey Michael J. , Salehi Mahan , Wild Jim M. , Watson Lisa , Hameed Abdul , Charalampopoulos Athanasios , Lu Haiping , Rothman Alex M.K. , Thompson A.A. Roger , Elliot Charlie A. , Hamilton Neil , Johns Christopher S. , Armstrong Iain , Condliffe Robin , van der Geest Rob J. , Swift Andrew J. , Kiely David G.
Published: July 2023

Background

Cardiac magnetic resonance (CMR) is the gold standard technique to assess biventricular volumes and function, and is increasingly being considered as an end-point in clinical studies. Currently, with the exception of right ventricular (RV) stroke volume and RV end-diastolic volume, there is only limited data on minimally important differences (MIDs) reported for CMR metrics. Our study aimed to identify MIDs for CMR metrics based on US Food and Drug Administration recommendations for a clinical outcome measure that should reflect how a patient “feels, functions or survives”.

Methods

Consecutive treatment-naïve patients with pulmonary arterial hypertension (PAH) between 2010 and 2022 who had two CMR scans (at baseline prior to treatment and 12 months following treatment) were identified from the ASPIRE registry. All patients were followed up for 1 additional year after the second scan. For both scans, cardiac measurements were obtained from a validated fully automated segmentation tool. The MID in CMR metrics was determined using two distribution-based (0.5sdand minimal detectable change) and two anchor-based (change difference and generalised linear model regression) methods benchmarked to how a patient “feels” (emPHasis-10 quality of life questionnaire), “functions” (incremental shuttle walk test) or “survives” for 1-year mortality to changes in CMR measurements.

Results

254 patients with PAH were included (mean±sdage 53±16 years, 79% female and 66% categorised as intermediate risk based on the 2022 European Society of Cardiology/European Respiratory Society risk score). We identified a 5% absolute increase in RV ejection fraction and a 17 mL decrease in RV end-diastolic or end-systolic volumes as the MIDs for improvement. Conversely, a 5% decrease in RV ejection fraction and a 10 mL increase in RV volumes were associated with worsening.

Conclusions

This study establishes clinically relevant CMR MIDs for how a patient “feels, functions or survives” in response to PAH treatment. These findings provide further support for the use of CMR as a clinically relevant clinical outcome measure and will aid trial size calculations for studies using CMR.
Using the 6-min walk test to assess the clinical response to mepolizumab and conventional therapy in severe eosinophilic asthma
Authors: Lombardi Carlo , Berti Alvise , Cottini Marcello , Roca Elena , Ventura Laura
Published: July 2023

Background

Severe asthma limits exercise to avoid respiratory symptoms. The objective of the present study was to investigate the role of the 6-min walk test (6MWT) in severe asthma.

Methods

Consecutive patients with severe eosinophilic asthma were enrolled. A 6MWT was performed before and after 12 months. Inhaled therapy dose, oral corticosteroids dose, pulmonary function tests, eosinophil blood count, fractional exhaled nitric oxide (FeNO), Asthma Control Test (ACT) score and responses to the Asthma Quality of Life Questionnaire (AQLQ) were also recorded.

Results

Of the 22 patients enrolled, 13 were treated with mepolizumab 100 mg every 4 weeks in addition to conventional therapy and nine with conventional therapy only. The majority of the patients were treated with high-dose inhaled corticosteroids/long-acting β-agonists/long-acting muscarinic receptor antagonists, while approximately half were on continuous oral corticosteroids. After 12 months, the mepolizumab group only showed a significant improvement in pulmonary function tests (percentage forced expiratory volume in 1 s and percentage forced expiratory flow at 25–75% forced vital capacity (FEF25–75%), both p<0.001; percentage forced vital capacity, p<0.01) and clinical laboratory parameters (eosinophil count,FeNOmeasured at a flow rate of 50 mL·s−1, ACT and AQLQ, p<0.001). No significant changes in the proportion of patients using continuous oral corticosteroids and high-dose inhaled corticosteroids/long-acting β-agonists/long-acting muscarinic receptor antagonists were observed in either group (p>0.05). By paired comparisons, statistically significant improvements of the mean 6-min walk distance (6MWD) were observed in the mepolizumab (p<0.001) and conventional therapy (p<0.01) groups, while no improvement was seen in dyspnoea Borg scale, heart rate, percentage oxygen saturation or systolic and diastolic blood pressure. 6MWD showed significant direct correlations with ACT (r=0.5998, p<0.001), AQLQ (r=0.3978, p=0.009) and FEF25–75%(r=0.3589, p=0.017).

Conclusions

The 6MWT could complement severe asthma assessment and be relevant in evaluating the objective response to treatment, including biological therapies like mepolizumab.
VGAEDTI: drug-target interaction prediction based on variational inference and graph autoencoder
Authors: Zhang Yuanyuan , Feng Yinfei , Wu Mengjie , Deng Zengqian , Wang Shudong
Published: July 2023

Motivation

Accurate identification of Drug-Target Interactions (DTIs) plays a crucial role in many stages of drug development and drug repurposing. (i) Traditional methods do not consider the use of multi-source data and do not consider the complex relationship between data sources. (ii) How to better mine the hidden features of drug and target space from high-dimensional data, and better solve the accuracy and robustness of the model.

Results

To solve the above problems, a novel prediction model named VGAEDTI is proposed in this paper. We constructed a heterogeneous network with multiple sources of information using multiple types of drug and target dataIn order to obtain deeper features of drugs and targets, we use two different autoencoders. One is variational graph autoencoder (VGAE) which is used to infer feature representations from drug and target spaces. The second is graph autoencoder (GAE) propagating labels between known DTIs. Experimental results on two public datasets show that the prediction accuracy of VGAEDTI is better than that of six DTIs prediction methods. These results indicate that model can predict new DTIs and provide an effective tool for accelerating drug development and repurposing.
scQCEA: a framework for annotation and quality control report of single-cell RNA-sequencing data
Authors: Nassiri Isar , Fairfax Benjamin , Lee Angela , Wu Yanxia , Buck David , Piazza Paolo
Published: July 2023

Background

Systematic description of library quality and sequencing performance of single-cell RNA sequencing (scRNA-seq) data is imperative for subsequent downstream modules, including re-pooling libraries. While several packages have been developed to visualise quality control (QC) metrics for scRNA-seq data, they do not include expression-based QC to discriminate between true variation and background noise.

Results

We present scQCEA (acronym of the single-cell RNA sequencing Quality Control and Enrichment Analysis), an R package to generate reports of process optimisation metrics for comparing sets of samples and visual evaluation of quality scores. scQCEA can import data from 10X or other single-cell platforms and includes functions for generating an interactive report of QC metrics for multi-omics data. In addition, scQCEA provides automated cell type annotation on scRNA-seq data using differential gene expression patterns for expression-based quality control. We provide a repository of reference gene sets, including 2348 marker genes, which are exclusively expressed in 95 human and mouse cell types.

Using scRNA-seq data from 56 gene expressions and V(D)J T cell replicates, we show how scQCEA can be applied for the visual evaluation of quality scores for sets of samples. In addition, we use the summary of QC measures from 342 human and mouse shallow-sequenced gene expression profiles to specify optimal sequencing requirements to run a cell-type enrichment analysis function.

Conclusions

The open-source R tool will allow examining biases and outliers over biological and technical measures, and objective selection of optimal cluster numbers before downstream analysis. scQCEA is available at https://isarnassiri.github.io/scQCEA/ as an R package. Full documentation, including an example, is provided on the package website.
Use of research electronic data capture (REDCap) in a sequential multiple assignment randomized trial (SMART): a practical example of automating double randomization
Authors: Lee Carol A. , Gamino Danilo , Lore Michelle , Donelson Curt , Windsor Liliane C.
Published: July 2023

Background

Adaptive interventions are often used in individualized health care to meet the unique needs of clients. Recently, more researchers have adopted the Sequential Multiple Assignment Randomized Trial (SMART), a type of research design, to build optimal adaptive interventions. SMART requires research participants to be randomized multiple times over time, depending upon their response to earlier interventions. Despite the increasing popularity of SMART designs, conducting a successful SMART study poses unique technological and logistical challenges (e.g., effectively concealing and masking allocation sequence to investigators, involved health care providers, and subjects) in addition to other challenges common to all study designs (e.g., study invitations, eligibility screening, consenting procedures, and data confidentiality protocols). Research Electronic Data Capture (REDCap) is a secure, browser-based web application widely used by researchers for data collection. REDCap offers unique features that support researchers’ ability to conduct rigorous SMARTs. This manuscript provides an effective strategy for performing automatic double randomization for SMARTs using REDCap.

Methods

Between January and March 2022, we conducted a SMART using a sample of adult (age 18 and older) New Jersey residents to optimize an adaptive intervention to increase COVID-19 testing uptake. In the current report, we discuss how we used REDCap for our SMART, which required double randomization. Further, we share our REDCap project XML file for future investigators to use when designing and conducting SMARTs.

Results

We report on the randomization feature that REDCap offers and describe how the study team automated an additional randomization that was required for our SMART. An application programming interface was used to automate the double randomizations in conjunction with the randomization feature provided by REDCap.

Conclusions

REDCap offers powerful tools to facilitate the implementation of longitudinal data collection and SMARTs. Investigators can make use of this electronic data capturing system to reduce errors and bias in the implementation of their SMARTs by automating double randomization.

Trial registration

The SMART study was prospectively registered at Clinicaltrials.gov; registration number: NCT04757298, date of registration: 17/02/2021.
Efficacy and safety of atezolizumab plus bevacizumab treatment for advanced hepatocellular carcinoma in the real world: a single-arm meta-analysis
Authors: Gao Xiaoqiang , Zhao Rui , Ma Huaxing , Zuo Shi
Published: July 2023

Background

Atezolizumab plus bevacizumab was approved in 2020 as a first-line treatment for advanced hepatocellular carcinoma (HCC). The purpose of this study was to assess the curative effect and tolerability of the combination treatment in advanced HCC.

Methods

Web of Science, PubMed and Embase were retrieved for qualified literatures on the treatment of advanced HCC with atezolizumab plus bevacizumab until September 1, 2022. The outcomes included pooled overall response (OR), complete response (CR), partial response (PR), median overall survival (mOS), median progression-free survival (mPFS), and adverse events (AEs).

Results

Twenty-three studies, comprising 3168 patients, were enrolled. The pooled OR, CR, and PR rates of the long-term (more than six weeks) therapy response based on Response Evaluation Criteria in Solid Tumors (RECIST) were 26%, 2%, and 23%, respectively. The pooled OR, CR, and PR rates of the short-term (six weeks) therapeutic response evaluated with RECIST were 13%, 0%, and 15%, respectively. The pooled mOS and mPFS were 14.7 months and 6.66 months, respectively. During the treatment, 83% and 30% of patients experienced any grade AEs and grade 3 and above AEs, respectively.

Conclusions

Atezolizumab in combination with bevacizumab showed good efficacy and tolerability in the treatment of advanced HCC. Compared with short-term, non-first-line, and low-dose therapy, atezolizumab plus bevacizumab in long-term, first-line, and standard-dose treatment for advanced HCC showed a better tumor response rate.
Blood eosinophil related to maternal allergic rhinitis is associated with the incidence of allergic rhinitis in offspring: COCOA study
Authors: Choi Eun-A , Nah Geumkyung , Chang Woo-Sung , Lee So-Yeon , Suh Dong In , Kim Kyung Won , Shin Youn Ho , Ahn Kangmo , Hong Soo-Jong , Kim Young Youl , Lee Hye-Ja
Published: July 2023

Objective

The identification of allergic rhinitis (AR) in early life is important for the target of intervention. AR is caused by various environmental factors, including house dust mites. We investigated the relationship between the Dermatophagoides farinae (Der f)-IgE and eosinophil in mothers with AR at delivery and the eosinophil levels and AR incidence in children.

Methods

The study participants were 983 mother–child pairs from the COhort for Childhood Origin of Asthma and Allergic Diseases. AR was diagnosed by a doctor at delivery in mother and at 3 years of age in offspring. The association between eosinophil level and AR was assessed using logistic regression analysis.

Results

The Der f-IgE level in mother having AR at delivery was associated with the mother’s eosinophil level, and the mother’s eosinophil level was associated with the child’s eosinophil level both at age 1 and 3. The risk of AR at age 3 in children was increased according to increased eosinophil levels in mothers at delivery and in children both aged 1 and 3 years (adjusted odds ratio [aOR] and 95% confidence interval [CI]: 2.57 [1.14–5.78], 2.28 [1.02–5.13], respectively). The risk of childhood AR at the age of 3 is increased when both mothers and children have high eosiniophils (aOR and 95% CI: 2.62 [1.01–6.79], 1.37 [0.98–1.91]).

Conclusions

Der f-IgE in mothers at delivery was related to eosinophil levels in mothers with AR and higher level of eosinophils in both mother and children was associated with the increased risk of AR incidence at the first 3 years of life of children.
Longitudinal significance of six-minute walk test in patients with nontuberculous mycobacterial pulmonary disease: an observational study
Authors: Morita Atsuho , Yagi Kazuma , Asakura Takanori , Namkoong Ho , Sato Yasunori , Ogawa Takunori , Kusumoto Tatsuya , Suzuki Shoji , Tanaka Hiromu , Lee Ho , Okamori Satoshi , Azekawa Shuhei , Nakagawara Kensuke , Kaji Masanori , Nagao Genta , Funatsu Yohei , Kimizuka Yoshifumi , Kamata Hirofumi , Nishimura Tomoyasu , Ishii Makoto , Fukunaga Koichi , Hasegawa Naoki
Published: July 2023

Background

The long-term exercise tolerance changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are of great interest because of its chronic course. This study aimed to characterize the associations between changes over time in six-minute walking test (6MWT) parameters and clinical parameters in patients with NTM-PD.

Methods

Overall, 188 patients with NTM-PD, visiting outpatient clinics at Keio University Hospital from April 2012 to March 2020 were included in the study. Data were collected using the St. George’s Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), blood tests, and the 6MWT at registration and at least once after that. The association of the anchors and clinical indicators with the 6MWT parameters was assessed.

Results

The median age [interquartile range] of the patients was 67 [63–74] years. The median baseline six-minute walk distance (6MWD) and final Borg scale (FBS) were 413 [361–470] m and 1 [0–2], respectively. In the correlation analysis, ΔSGRQ total/year (yr), Δforced vital capacity (FVC, % predicted)/yr, Δforced expiratory volume in 1 s (FEV1, % predicted)/yr, and Δdiffusing capacity for carbon monoxide (DLCO, % predicted)/yr correlated with both Δ6MWD/yr and ΔFBS/yr in the longitudinal analysis (|Rho| > 0.20). When stratified into three quantiles of changes in each anchor, the 6MWT parameters worsened over time in the bottom 25% group by mixed-effects model. Specifically, Δ6MWD was affected by SGRQ activity, SGRQ impacts, PFT (FVC, FEV1, and DLCO), and C-reactive protein (CRP). ΔFBS was affected by all SGRQ components, total score, and PFT. Anchor scores and variables at baseline that worsened Δ6MWD were higher SGRQ scores, lower FVC (% predicted), lower DLCO (% predicted), higher Krebs von den Lungen-6, old age, and undergoing treatment at registration. Similarly, these clinical parameters and elevated CRP, excluding undergoing treatment at registration, worsened ΔFBS.

Conclusions

The decreased walking distance and exacerbation of dyspnea on exertion over time in patients with NTM-PD may reflect a deterioration of health-related quality of life and pulmonary function. Thus, the change in 6MWT over time can be used as an indicator to accurately assess the patient’s condition and tailor their healthcare environment.
Isolated adrenocorticotropic hormone deficiency following immune checkpoint inhibitors treatment often occurs in polyglandular endocrinopathies
Authors: Chen Hong , Zhang Lei , Zhao Lin , Li Xiaomu
Published: July 2023

Background

With the increasing application of immune checkpoint inhibitors (ICI) in cancer therapy, the occurrence of isolated adrenocorticotropic hormone deficiency (IAD), as an adverse effect, is also on the rise. Nevertheless, there are only a few studies regarding IAD induced by ICI. This study aimed at investigating the characteristics of IAD induced by ICI and its relationship with other endocrine adverse events.

Methods

A retrospective study was conducted in the Endocrinology Department from January 2019 to August 2022 to investigate characteristics of patients with IAD. Clinical features, laboratory findings and treatment information were collected. All patients underwent a follow-up of 3-6-month.

Results

28 patients with IAD were enrolled. All patients received treatment with anti-PD-1/ PD-L1. The median occurrence time of IAD was 24 (18–39) weeks after initiation of ICI treatment. Over half of the patients (53.5%) had an additional endocrinopathy, including primary hypothyroidism and fulminant type 1 diabetes mellitus (FT1DM), while other types of endocrinopathies were not identified. The interval between the occurrences of two gland damages was between 4 and 21 weeks or simultaneous. Primary hypothyroidism (46.4%) was more prevalent than FT1DM (7.1%). Fatigue and nausea were common symptoms, with a frequent occurrence of hyponatremia. All patients continued on oral glucocorticoids during follow-up.

Conclusions

IAD induced by ICI could manifest independently, or more frequently in combination with hypothyroidism or FT1DM. This damage could happen at any point of ICI treatment. Given that IAD can be life-threatening, it is critical to evaluate pituitary function dynamically in patients undergoing immunotherapy.
How do peer group reflection meetings support medical students’ learning and personal development during clinical rotations?
Authors: van den Eertwegh Valerie , Stalmeijer Renée E.
Published: July 2023

Background

Medical schools look to support students in coping with challenges and stressors related to clinical rotations. One potential approach is implementing Intervision Meetings (IM): a peer group reflection method during which students address challenging situations and personal development issues with peers, guided by a coach. Its implementation and perceived effectiveness in undergraduate medical education has however not yet been widely studied and described. This study evaluates how students perceive the effect of a three-year IM-programme during their clinical rotations, and explores which processes and specific factors support students’ personal development and learning during clinical rotations.

Methods

Using an explanatory Mixed Methodology, medical students participating in IM were asked to evaluate their experiences through a questionnaire at three time points. Questionnaire results were further explored through three focus groups. Data were analysed using descriptive statistics and thematic analysis.

Results

Three hundred fifty seven questionnaires were filled out by students across the three time points. Students perceived IM to contribute to their ability to cope with challenging situations during clinical rotations. Participants in the focus groups described how IM created an increase in self-awareness by active self-reflection supported by peers and the coach. Sharing and recognizing each other’s’ situations, stories or problems; as well as hearing alternative ways of coping, helped students to put things into perspective and try out alternative ways of thinking or behaving.

Conclusions

IM can help students to better deal with stressors during clinical rotations and approach challenges as learning opportunities under the right circumstances. It is a potential method medical schools can use to aid their students on their journey of personal and professional development.
What is the mind map of the hospital’s future changes in a developing country like Iran? A qualitative study
Authors: Masoud Ali , Dehnavieh Reza , Yazdi-Feyzabadi Vahid , Poursheikhali Atousa , Noori Hekmat Somayeh , kazemi Mohammad , Moghadam Mina Ghasemi
Published: July 2023

Background

Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions.

Methods

This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software.

Results

In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts’ opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental.

Conclusions

Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.
Overlapping research efforts in a global pandemic: a rapid systematic review of COVID-19-related individual participant data meta-analyses
Authors: Maxwell Lauren , Shreedhar Priya , Levis Brooke , Chavan Sayali Arvind , Akter Shaila , Carabali Mabel
Published: July 2023

Background

Individual participant data meta-analyses (IPD-MAs), which involve harmonising and analysing participant-level data from related studies, provide several advantages over aggregate data meta-analyses, which pool study-level findings. IPD-MAs are especially important for building and evaluating diagnostic and prognostic models, making them an important tool for informing the research and public health responses to COVID-19.

Methods

We conducted a rapid systematic review of protocols and publications from planned, ongoing, or completed COVID-19-related IPD-MAs to identify areas of overlap and maximise data request and harmonisation efforts. We searched four databases using a combination of text and MeSH terms. Two independent reviewers determined eligibility at the title-abstract and full-text stages. Data were extracted by one reviewer into a pretested data extraction form and subsequently reviewed by a second reviewer. Data were analysed using a narrative synthesis approach. A formal risk of bias assessment was not conducted.

Results

We identified 31 COVID-19-related IPD-MAs, including five living IPD-MAs and ten IPD-MAs that limited their inference to published data (e.g., case reports). We found overlap in study designs, populations, exposures, and outcomes of interest. For example, 26 IPD-MAs included RCTs; 17 IPD-MAs were limited to hospitalised patients. Sixteen IPD-MAs focused on evaluating medical treatments, including six IPD-MAs for antivirals, four on antibodies, and two that evaluated convalescent plasma.

Conclusions

Collaboration across related IPD-MAs can leverage limited resources and expertise by expediting the creation of cross-study participant-level data datasets, which can, in turn, fast-track evidence synthesis for the improved diagnosis and treatment of COVID-19.

Trial registration

10.17605/OSF.IO/93GF2.
The importance of context—a qualitative study exploring healthcare practitioners’ experiences of working with patients at home after a stroke
Authors: Elf Marie , Rasoal Dara , Zingmark Magnus , Kylén Maya
Published: July 2023

Background

Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients’ homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients’ records.

Methods

Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients’ opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

Results

The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient’s self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

Conclusions

Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.
Therapeutic properties of Helicobacter pylori-derived vacuolating cytotoxin A in an animal model of chronic allergic airway disease
Authors: Raspe Jonas , Schmitz Mona S. , Barbet Kimberly , Caso Georgia C. , Cover Timothy L. , Müller Anne , Taube Christian , Reuter Sebastian
Published: July 2023

Background

It has previously been shown that the Helicobacter pylori (H. pylori)-derived molecule vacuolating cytotoxin A (VacA) could be suitable for the treatment of allergic airway disease. The therapeutic activity of the protein, which acts through modulation of dendritic cells (DC) and regulatory T cells (Tregs), was demonstrated in murine short-term acute models. The aim of this study is to further evaluate the therapeutic potential of VacA by determining the effectiveness of different application routes and the suitability of the protein for treating the chronic phase of allergic airway disease.

Methods

VacA was administered by the intraperitoneal (i.p.), oral (p.o.) or intratracheal (i.t.) routes, and long-term therapeutic effectiveness, allergic airway disease hallmarks, and immune phenotype were analyzed in murine models of acute and chronic allergic airway disease.

Results

Administration of VacA via the i.p., p.o or i.t. routes was associated with a reduction in airway inflammation. The i.p. route showed the most consistent effect in reducing airway inflammation and i.p. treatment with VacA was the only treatment that significantly reduced mucus cell hyperplasia. In a murine model of chronic allergic airway disease, both short- and long-term treatment with VacA showed a therapeutic effect, with a reduction in a variety of asthma hallmarks, including bronchoalveolar lavage eosinophilia, lung inflammation and goblet cell metaplasia. Short-term treatment was associated with induction of Tregs, while repetitive long-term administration of VacA influenced immunological memory in the lung.

Conclusions

In addition to showing therapeutic efficacy in short-term models, treatment with VacA also appeared to be effective in suppressing inflammation in a chronic airway disease model. The observation that treatment was effective after administration via several different routes highlights the potential of VacA as a therapeutic agent with different routes of administration in humans.
Visit-to-visit HbA1c variability is associated with aortic stiffness progression in participants with type 2 diabetes
Authors: Fang Qianhua , Shi Juan , Zhang Jia , Peng Ying , Liu Cong , Wei Xing , Hu Zhuomeng , Sun Lin , Hong Jie , Gu Weiqiong , Wang Weiqing , Zhang Yifei
Published: July 2023

Background

Glycemic variability plays an important role in the development of cardiovascular disease (CVD). This study aims to determine whether long-term visit-to-visit glycemic variability is associated with aortic stiffness progression in participants with type 2 diabetes (T2D).

Methods

Prospective data were obtained from 2115 T2D participants in the National Metabolic Management Center (MMC) from June 2017 to December 2022. Two brachial-ankle pulse wave velocity (ba-PWV) measurements were performed to assess aortic stiffness over a mean follow-up period of 2.6 years. A multivariate latent class growth mixed model was applied to identify trajectories of blood glucose. Logistic regression models were used to determine the odds ratio (OR) for aortic stiffness associated with glycemic variability evaluated by the coefficient of variation (CV), variability independent of the mean (VIM), average real variability (ARV), and successive variation (SV) of blood glucose.

Results

Four distinct trajectories of glycated hemoglobin (HbA1c) or fasting blood glucose (FBG) were identified. In the U-shape class of HbA1c and FBG, the adjusted ORs were 2.17 and 1.21 for having increased/persistently high ba-PWV, respectively. Additionally, HbA1c variability (CV, VIM, SV) was significantly associated with aortic stiffness progression, with ORs ranging from 1.20 to 1.24. Cross-tabulation analysis indicated that the third tertile of the HbA1c mean and VIM conferred a 78% (95% confidence interval [CI] 1.23–2.58) higher odds of aortic stiffness progression. Sensitivity analysis demonstrated that the SD of HbA1c and the highest HbA1c variability score (HVS) were significantly associated with the adverse outcomes independent of the mean of HbA1c during the follow-up.

Conclusions

Long-term visit-to-visit HbA1c variability was independently associated with aortic stiffness progression, suggesting that HbA1c variability was a strong predictor of subclinical atherosclerosis in T2D participants.
TRAF2 promotes M2-polarized tumor-associated macrophage infiltration, angiogenesis and cancer progression by inhibiting autophagy in clear cell renal cell carcinoma
Authors: Xu Yawei , Li Lei , Yang Wuping , Zhang Kenan , Zhang Zedan , Yu Chaojian , Qiu Jianhui , Cai Lin , Gong Yanqing , Zhang Zheng , Zhou Jingcheng , Gong Kan
Published: July 2023

Background

The management of advanced clear cell renal cell carcinoma (ccRCC) remains a major challenge in clinical practice, and the construction of more reliable prognostic prediction models and the further elucidation of key molecular mechanisms of tumor progression are topics in urgent need of in-depth investigation.

Methods

We used CIBERSORT to estimate the proportion of 22 tumor-infiltrating immune cell types in the TCGA-KIRC cohort. Weighted gene co-expression network analysis, least absolute shrinkage and selection operator regression analysis were used to build risk prediction models. Expression patterns and clinical significance of TRAF2 were determined through bioinformatics analysis, real-time qPCR, Western Blot, immunohistochemistry. GSEA analysis, transmission electron microscopy, 2D/3D colony formation assay, cell migration and invasion assay, and tube-formation assay were used to investigate the underlying function and mechanism of the TRAF2/M2 macrophage/autophagy axis.

Results

We constructed a novel prognostic prediction model based on M2 macrophage-related genes, which was identified as an accurate, independent and specific prognostic risk model for ccRCC patients. A reliable nomogram was constructed to predict 1-, 3-, and 5-year overall survival for patients with ccRCC. As one of the constituent genes of the risk model, TRAF2 was determined to be upregulated in ccRCC and associated with poor clinical prognosis. We found that TRAF2 promotes malignant progression of ccRCC by regulating macrophage polarization, migration and angiogenesis. Mechanistically, we found that TRAF2 promotes the polarization of M2 macrophages, and this chemotaxis is achieved in an autophagy-dependent pathway. Orthotopic tumor growth assay results revealed that TRAF2 plays a key role as a promotor of ccRCC growth and metastasis.

Conclusions

In conclusion, this risk model is highly predictive of prognostic in ccRCC patients, which is expected to promote improved treatment evaluation and comprehensive management of ccRCC. Moreover, our findings reveal that the TRAF2/M2 macrophage/autophagy axis plays a key regulatory role in the malignant progression of ccRCC, and suggest that TRAF2 is a potential novel therapeutic target for advanced ccRCC.
Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®
Authors: Helsloot Dries , Fitzgerald Mark , Lefering Rolf , Verelst Sandra , Missant Carlo ,   the TraumaRegister DGU
Published: July 2023

Background

To which extent trauma- induced disturbances in ionized calcium (iCa2+) levels have a linear relationship with adverse outcomes remains controversial. The goal of this study was to determine the association between the distribution and accompanying characteristics of transfusion-independent iCa2+ levels versus outcome in a large cohort of major trauma patients upon arrival at the emergency department.

Methods

A retrospective observational analysis of the TraumaRegister DGU® (2015–2019) was performed. Adult major trauma patients with direct admission to a European trauma centre were selected as the study cohort. Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy, and need for transfusion were considered as relevant outcome parameters. The distribution of iCa2+ levels upon arrival at the emergency department was calculated in relation to these outcome parameters. Multivariable logistic regression analysis was performed to determine independent associations.

Results

In the TraumaRegister DGU® 30 183 adult major trauma patients were found eligible for inclusion. iCa2+ disturbances affected 16.4% of patients, with hypocalcemia (< 1.10 mmol/l) being more frequent (13.2%) compared to hypercalcemia (≥ 1.30 mmol/l, 3.2%).

Patients with hypo- and hypercalcemia were both more likely (P < .001) to have severe injury, shock, acidosis, coagulopathy, transfusion requirement, and haemorrhage as cause of death. Moreover, both groups had significant lower survival rates. All these findings were most distinct in hypercalcemic patients. When adjusting for potential confounders, mortality at 6 h was independently associated with iCa2+ < 0.90 mmol/L (OR 2.69, 95% CI 1.67–4.34; P < .001), iCa2+ 1.30–1.39 mmol/L (OR 1.56, 95% CI 1.04–2.32, P = 0.030), and iCa2+  ≥ 1.40 mmol/L (OR 2.87, 95% CI 1.57–5.26; P < .001). Moreover, an independent relationship was determined for iCa2+ 1.00–1.09 mmol/L with mortality at 24 h (OR 1.25, 95% CI 1.05–1.48; P = .0011), and with in-hospital mortality (OR 1.29, 95% CI 1.13–1.47; P < .001). Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L had an independent association with coagulopathy and transfusion.

Conclusions

Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality. Further research is needed to confirm whether iCa2+ levels change dynamically and are more a reflection of severity of injury and accompanying physiological derangements, rather than an individual parameter that needs to be corrected as such.

Graphical Abstract