bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the use of 3D printing in mathematics education: A scoping review
Authors: Kit Ng Davy Tsz , Tsui Ming Fung , Yuen Manwai
Published: October 2022

Thanks to the fourth industrial revolution, 3D printing has become a fast-emerging technology that is widely applied across industries. In mathematics education, 3D printing is an innovative way to visualize mathematics concepts (e.g., geometry, calculus) that enables students to develop mathematical and design thinking, as well as digital skills and mindsets. Through digital maker education, students can apply multidisciplinary knowledge to build prototypes and create 3D objects that bring many new opportunities in mathematics formal/informal learning. However, to our knowledge, there is no existing review summarizing the existing evidence of how 3D printing has been applied in mathematics education. As such, this review aims to give a synthesis of the up-to-date literature in the burgeoning topic of using 3D printing in mathematics education. A systematic review was conducted to examine the thematic and content analysis of 30 empirical papers from 2015 to 2022. The review aims to evaluate and analyze different types of participants, methodological approaches, challenges, pedagogies, and technologies used in the selected studies. Although 3D printing has a bright prospect to revolutionize mathematics education, there are still many challenges such as hardware and software optimization, processing, formatting, printing, and maintenance issues. After all, a set of recommendations were listed to guide future researchers and educators to use 3D printing effectively in mathematics education.
Delving into the shadow: Mathematics teachers’ perspectives on the impact of private supplementary tutoring in Ireland
Authors: Prendergast Mark , O’Meara Niamh , Duffy Laura , O’Rourke Iseult
Published: October 2022

Private supplementary tutoring (PT; often referred to in Ireland as “grinds”) can be defined as education outside the formal schooling system where a tutor teaches a particular subject(s) in exchange for financial gain. While PT has long been popular in East Asian countries, its provision has become a widespread phenomenon both internationally and at all levels of the Irish education system in recent years, no more so than for the subject of mathematics. However, few empirical studies have been conducted thus far on its impact. In this paper, the authors sought to investigate mathematics teachers’ perceptions of the impact of the grinds culture on the subject at the secondary level in Ireland. The data was gathered using an online survey designed by the authors and circulated to secondary mathematics teachers in November 2020. The findings from responding teachers ( n = 305) revealed mixed views, with both positive and negative impacts identified. Many teachers acknowledged the benefits of one-to-one support that grinds can provide and the resulting increase in students’ confidence in the subject. However, teachers also determined that grinds can cause some students to disengage in class and to be less responsible for their own individual work ethics.
1-year mortality in lung cancer in France according to key timepoints of care pathways
Authors: Rivière Axelle , Lecuyer Anne Isabelle , Laurent Emeline , Lefebvre Carole , Lecomte Thierry , Olivier Elodie , Carmier Delphine , Plantier Laurent , Grammatico-Guillon Leslie
Published: October 2022

Background

It is unclear whether delays in care affect prognosis of patients with lung cancer. The primary objective of this study was to describe the care pathway of patients diagnosed with lung cancer in a French region. Secondary objectives were to identify markers associated with 1) time from imaging to treatment and 2) with 1-year survival.

Methods

In a retrospective cohort study, clinical data from multidisciplinary team meetings for all incident lung cancer cases discussed in 2018 in one French region were matched with medico-administrative data from the National Health Insurance Database. Care pathway time intervals were estimated for small cell lung cancer (SCLC), resected nonsmall cell lung cancer (NSCLC) and unresected NSCLC. Factors associated with delay in the care pathway were identified using linear regression; 1-year survival was analysed using Cox modelling.

Results

A total of 685 patients were included. Median time between imaging and treatment was 49 days (interquartile range: 33–73), and was lower in cases of metastatic disease, SCLC and private care. At 1 year, 48% had died (resected NSCLC 12%). In unresected NSCLC, time from diagnostic imaging to first treatment <49 days was associated with a higher risk of death. Time intervals were similar in patients with squamous cell carcinomaversusadenocarcinoma or undifferentiated carcinoma.

Discussion

Time intervals in the care pathways of lung cancer were similar to previous reports, confirming the robustness of retrospective databases. In unresectable NSCLC, rapid care was not associated with better survival.
Multidisciplinary rehabilitation in intensive care for COVID-19: randomised controlled trial
Authors: Carvalho Ana Cristina , Moreira Jorge , Cubelo Pedro , Cantista Pedro , Aguiar Branco Catarina , Guimarães Bruno
Published: October 2022

Coronavirus disease 2019 (COVID-19) has led to an increasing number of patients in intensive care units (ICUs). The size of this post-ICU cohort will be unprecedented, with many patients vulnerable to post-intensive care syndrome. We analysed the respiratory and functional effects of a multidisciplinary rehabilitation programme on functional performance, in patients hospitalised in the ICU due to COVID-19.

We conducted a randomised controlled clinical trial. 96 patients who fulfilled the eligibility criteria were randomised into control or intervention group. The control group received standard of care in the ICU, and the intervention group received a functional and respiratory rehabilitation protocol that included medical, nursing, physiotherapy and occupational therapy interventions.

At discharge, the intervention group showed significantly better muscular strength and respiratory capacity, and significantly fewer days of hospitalisation (12.90±5.8versus15.60±6.7 days, p=0.037). At the 4- and 12-week follow-up, we applied our main outcome measure, the 6-min walk test (6MWT). The intervention group had significantly better results than the control group on the 6MWT at the 4-week follow-up (604±67versus571±57 m, p=0.018) and at the 12-week follow-up (639±53versus611±67 m, p=0.025).

These results support the role of a multidisciplinary rehabilitation programme in COVID-19 patients hospitalised in the ICU and adds evidence that the implementation of rehabilitation programmes in ICUs could result in beneficial outcomes for critically ill patients.
Neighbourhood disadvantage impacts on pulmonary function in patients with sarcoidosis
Authors: Goobie Gillian C. , Ryerson Christopher J. , Johannson Kerri A. , Keil Spencer , Schikowski Erin , Khalil Nasreen , Marcoux Veronica , Assayag Deborah , Manganas Hélène , Fisher Jolene H. , Kolb Martin R.J. , Chen Xiaoping , Gibson Kevin F. , Kass Daniel J. , Zhang Yingze , Lindell Kathleen O. , Nouraie S. Mehdi
Published: October 2022

Background

This multicentre, international, prospective cohort study evaluated whether patients with pulmonary sarcoidosis living in neighbourhoods with greater material and social disadvantage experience worse clinical outcomes.

Methods

The area deprivation index and the Canadian Index of Multiple Deprivation evaluate neighbourhood-level disadvantage in the US and Canada, with higher scores reflecting greater disadvantage. Multivariable linear regression evaluated associations of disadvantage with baseline forced vital capacity (FVC) or diffusing capacity of the lung for carbon monoxide (DLCO) and linear mixed effects models for associations with rate of FVC orDLCOdecline, and competing hazards models were used for survival analyses in the US cohort, evaluating competing outcomes of death or lung transplantation. Adjustments were made for age at diagnosis, sex, race and smoking history.

Results

We included 477 US and 122 Canadian patients with sarcoidosis. Higher disadvantage was not associated with survival or baseline FVC. The highest disadvantage quartile was associated with lower baselineDLCOin the US cohort (β = −6.80, 95% CI −13.16 to −0.44, p=0.04), with similar findings in the Canadian cohort (β = −7.47, 95% CI −20.28 to 5.33, p=0.25); with more rapid decline in FVC andDLCOin the US cohort (FVC β = −0.40, 95% CI −0.70 to −0.11, p=0.007;DLCOβ = −0.59, 95% CI −0.95 to −0.23, p=0.001); and with more rapid FVC decline in the Canadian cohort (FVC β = −0.80, 95% CI −1.37 to −0.24, p=0.003).

Conclusion

Patients with sarcoidosis living in high disadvantage neighbourhoods experience worse baseline lung function and more rapid lung function decline, highlighting the need for better understanding of how neighbourhood-level factors impact individual patient outcomes.
Estimating the effect size of a hidden causal factor between SNPs and a continuous trait: a mediation model approach
Authors: Ding Zhuoran , Ritchie Marylyn D. , Voight Benjamin F. , Hwang Wei-Ting
Published: October 2022

Background

Observational studies and Mendelian randomization experiments have been used to identify many causal factors for complex traits in humans. Given a set of causal factors, it is important to understand the extent to which these causal factors explain some, all, or none of the genetic heritability, as measured by single-nucleotide polymorphisms (SNPs) that are associated with the trait. Using the mediation model framework with SNPs as the exposure, a trait of interest as the outcome, and the known causal factors as the mediators, we hypothesize that any unexplained association between the SNPs and the outcome trait is mediated by an additional unobserved, hidden causal factor.

Results

We propose a method to infer the effect size of this hidden mediating causal factor on the outcome trait by utilizing the estimated associations between a continuous outcome trait, the known causal factors, and the SNPs. The proposed method consists of three steps and, in the end, implements Markov chain Monte Carlo to obtain a posterior distribution for the effect size of the hidden mediator. We evaluate our proposed method via extensive simulations and show that when model assumptions hold, our method estimates the effect size of the hidden mediator well and controls type I error rate if the hidden mediator does not exist. In addition, we apply the method to the UK Biobank data and estimate parameters for a potential hidden mediator for waist-hip ratio beyond body mass index (BMI), and find that the hidden mediator has a large effect size relatively to the effect size of the known mediator BMI.

Conclusions

We develop a framework to infer the effect of potential, hidden mediators influencing complex traits. This framework can be used to place boundaries on unexplained risk factors contributing to complex traits.
Differential associations between simple physical performance tests with global and specific cognitive functions in cognitively normal and mild cognitive impairment: a cross-sectional cohort study of Asian community-dwelling older adults
Authors: Ng Ted Kheng Siang , Han Madeline Fu Yun , Loh Ping Yeap , Kua Ee Heok , Yu Junhong , Best John R. , Mahendran Rathi
Published: October 2022

Background

Physical performance declines and executive dysfunctions are predictors of dementia. However, their associations are not well understood in Asian older adults without dementia (cognitively normal [CN] and mild cognitive impairment [MCI]), especially in a single study.

Objective

Examine the associations between physical performance measures with executive function (EF)-based and non-EF-based neurocognitive tests and whether preclinical dementia cognitive status i.e., CN and MCI, moderated these associations.

Methods

We examined cross-sectional cohort of 716 community-dwelling older adults without dementia (CN = 562 and MCI = 154) using multivariable linear regression models. We associated three simple physical performance measures, namely timed-up-and-go (TUG), fast gait speed (FGS), and 30-s chair stand test (30 s-CST), with a comprehensive neurocognitive test battery measuring EF and non-EF cognitive functions. Moderating effects of cognitive status on the associations were examined. In all models, we controlled for pertinent covariates, including age, education, medical and psychiatric status.

Results

Upon controlling for covariates, TUG was most strongly and positively associated with multiple EF-based neurocognitive tests, followed by FGS, with 30 s-CST having the weakest associations. For all physical performance measures, no significant associations with non-EF-based neurocognitive tests were detected. Cognitive status significantly moderated the associations between all physical measures and several neurocognitive tests, with stronger associations in the MCI than CN.

Conclusion

Compared to FGS and 30 s-CST, TUG had the most robust associations with multiple EF-based cognitive functions. Given their differential associations with global and detailed neurocognitive tests and significant moderating effects of cognitive status, findings highlight a need to carefully consider the choices of simple physical performance tests when using these tests with a heterogenous group of community-dwelling older adults without dementia.
Feasibility, acceptability, and preliminary effectiveness of the adapted Namaste Care program delivered by caregivers of community-dwelling older persons with moderate to advanced dementia: a mixed methods feasibility study
Authors: Yous Marie-Lee , Ploeg Jenny , Kaasalainen Sharon , McAiney Carrie , Fisher Kathryn
Published: October 2022

Background

Caregivers have considerable responsibilities in supporting persons in advanced stages of dementia, however they receive little education. Namaste Care is a multisensory program originally designed to be delivered by healthcare providers in long-term care homes for persons with advanced dementia. The program has not yet been adapted and evaluated for use by caregivers of persons with moderate to advanced dementia living at home. The purpose of this feasibility study is to determine the feasibility, acceptability and preliminary effectiveness of the adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia.

Methods

This feasibility study, with a one-group before-after design and interviews, was part of a larger study using a multiphase mixed methods design. A total of 12 caregivers delivered the program over three months. Caregivers completed questionnaires on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Caregivers participated in interviews at the 3-month follow-up to explore acceptability and perceived benefit. Descriptive statistics and paired t-tests were used to analyze quantitative data. A secondary analysis used multiple imputation to explore the impact of missing data. Experiential thematic analysis was used in analyzing qualitative data.

Results

The adapted Namaste Care program was judged to be feasible, given that all caregivers used it at least twice a week over the 3-month period. The retention rate of caregivers was 83% (10 of 12). Caregivers perceived that the program was practical, enhanced the wellbeing of persons with dementia, and brought them closer in their relationships with persons with dementia. There were no statistically significant changes for quality of life, perceptions of caregiving, self-efficacy, or burden outcomes. Multiple imputation results revealed promising findings for an improvement in caregiver wellbeing related to quality of life.

Conclusions

The adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia was feasible and acceptable. The program has the potential to enhance the quality of life and other outcomes of caregivers, however there is a need to conduct a larger trial that is adequately powered to detect these effects.
Rusty pipe syndrome: a case report and review of the literature
Authors: Tang Huanna , Zhu Wenting , Chen Jianpeng , Zhang Dan
Published: October 2022

Background

Painless bloody nipple discharge is often classified as pathological due to its association with malignant lesions. However, it can also be a completely harmless condition. Rusty pipe syndrome is a rare cause of benign, self-limiting bloody nipple discharge during late pregnancy and early lactation. Given that rusty pipe syndrome is not described in conventional textbooks, we thought it would be appropriate to bring this benign disease to the notice of readers.

Case presentation

A 31-year-old G1P1 female delivered an infant with a birth weight of 3000 g via cesarean section at 39 weeks of gestation. The baby was admitted to the pediatric intensive care unit for a suspected oblique inguinal hernia. The mother had bilateral painless bloody nipple discharge when she started to express milk. A physical examination uncovered no signs of inflammation, engorgement, palpable mass, tenderness, cracks or ulcers. A breast ultrasound and cytological analysis revealed no signs of a neoplasm. Without any medical intervention, the color of the rusty milk changed from dark brown to light brown during hospitalization and finally resolved six days postpartum.

Conclusion

Rusty pipe syndrome is a self-limiting benign condition that should be considered in the differential diagnosis of bloody nipple discharge. Awareness of this rare disease by medical professionals would be extremely beneficial for avoiding unneeded examinations and discontinuity of exclusive breastfeeding.
A dyadic survey study of partner engagement in and patient receipt of guideline-recommended colorectal cancer surveillance
Authors: Veenstra Christine M. , Ellis Katrina R. , Abrahamse Paul , Ward Kevin C. , Morris Arden M. , Hawley Sarah T.
Published: October 2022

Background

We investigated whether partner (spouse or intimate partner) engagement in colorectal cancer (CRC) surveillance is associated with patient receipt of surveillance.

Methods

From 2019 to 2020 we surveyed Stage III CRC survivors diagnosed 2014–2018 at an academic cancer center, a community oncology practice and the Georgia SEER registry, and their partners. Partner engagement was measured across 3 domains: Informed about; Involved in; and Aware of patient preferences around surveillance. We evaluated bivariate associations between domains of partner engagement and independent partner variables. Analysis of variance and multivariable logistic regression were used to compare domains of engagement with patient-reported receipt of surveillance.

Results

501 patients responded (51% response rate); 428 had partners. 311 partners responded (73% response rate). Partners were engaged across all domains. Engagement varied by sociodemographics. Greater partner involvement was associated with decreased odds of receipt of composite surveillance (OR 0.67, 95% CI 0.48–0.93) and trended towards significance for decreased odds of receipt of endoscopy (OR 0.60, 95% CI 0.34–1.03) and CEA (OR 0.75, 95% CI 0.55–1.04). Greater partner awareness was associated with increased odds of patients’ receipt of endoscopy (OR 2.18, 95% CI 1.15–4.12) and trended towards significance for increased odds of receipt of composite surveillance (OR 1.30, 95% CI 0.91–2.04).

Conclusion

Partners are engaged (informed, involved, and aware) in CRC surveillance. Future research to develop dyadic interventions that capitalize on the positive aspects of partner engagement may help partners effectively engage in surveillance to improve patient care.
Clinical and prognostic analysis of 42 children with malignant rhabdoid tumor of the kidney: a 7-year retrospective multi-center study
Authors: Zhanghuang Chenghao , Zhang Zhaoxia , Zeng Li , Yan Bing , Tang Haoyu , Wang Jinkui , Liu Xing , Wei Guanghui , He Dawei
Published: October 2022

Objective

To discuss the clinical and prognostic indicators of pediatric malignant rhabdoid tumor of the kidney (MRTK), and to increase the understanding of the occurrence and development of MRTK.

Methods

From July 2014 to September 2021, all cases were confirmed by postoperative pathological examination. Among the 42 patients, there were 25 males and 17 females, with a median age of 10 (1–84) months. Abdominal mass or hematuria were the main clinical manifestations. Preoperative chemotherapy was performed in 9 cases (VC). The tumor stages were stage I-IV. Preoperative metastasis was found in 9 cases; the most common site was the lung. Postoperative patients received conventional chemotherapy, including VDACE regimen and UH-1 regimen. Among the 42 children in this group, survival at follow-up in this study was 26.2%(11/42).

Results

Preoperative anemia was found by univariate analysis, hypertension and hypercalcemia had shorter survival time. In addition, tumor-related factors had a significant impact on survival, with incomplete tumor resection, lymph node metastasis, stage III-IV had a lower survival rate. The impact of postoperative factors on survival included postoperative complications had a lower survival rate. The children were younger than 12 months, preoperative metastasis, no chemotherapy was performed after surgery was an independent risk factor for the prognosis of MRTK.

Conclusion

The main clinical manifestations about MRTK were abdominal mass and hematuria. Preoperative chemotherapy did not significantly improve the prognosis. Postoperative chemotherapy can significantly improve the survival rate. Diagnosis depends on clinical manifestations, imaging, histopathology, immunohistochemistry and other comprehensive judgment. Age less than 12 months, preoperative metastasis, and no postoperative chemotherapy were independent risk factors for prognosis.
Public beliefs about the consequences of living with obesity in the Republic of Ireland and Northern Ireland
Authors: Spyreli Eleni , McGowan L , Heery E , Kelly A , Croker H , Lawlor C , O’Neill R , Kelleher CC , McCarthy M , Wall P , Heinen MM
Published: October 2022

Background

This study aimed to capture public beliefs about living with obesity, examine how these beliefs have changed over time and to explore whether certain characteristics were associated with them in a nationally representative sample of adults from the Republic of Ireland (RoI) and Northern Ireland (NI).

Methods

A cross-sectional survey employed a random quota sampling approach to recruit a nationally representative sample of 1046 adults across NI and RoI. Telephone interviews captured information on demographics; health behaviours & attitudes; and beliefs about the consequences of obesity (measured using the Obesity Beliefs Scale). Univariable analyses compared beliefs about the consequences of living with obesity between participants with a self-reported healthy weight and those living with overweight or obesity, and non-responders (those for whom weight status could not be ascertained due to missing data). Multiple linear regression examined associations between obesity-related beliefs and socio-demographics, self-rated health and perceived ability to change health behaviours. Multiple linear regression also compared changes in obesity-related beliefs between 2013 and 2020 in the RoI.

Results

Higher endorsement of the negative outcomes of obesity was significantly associated with living with a healthy weight, higher self-rated health, dietary quality and perceived ability to improve diet and physical activity. Those who lived with overweight, with obesity and non-responders were less likely to endorse the negative consequences of obesity. Those living with obesity and non-responders were also more likely to support there is an increased cost and effort in maintaining a healthy weight. Comparison with survey data from 2013 showed that currently, there is a greater endorsement of the health benefits of maintaining a healthy weight (p < 0001), but also of the increased costs associated with it (p < 0001).

Conclusion

Beliefs about the consequences of maintaining a healthy body weight are associated with individuals’ weight, self-rated health, diet and perceived ease of adoption of dietary and exercise-related improvements. Beliefs about the health risks of obesity and perceived greater costs associated with maintaining a healthy weight appear to have strengthened over time. Present findings are pertinent to researchers and policy makers involved in the design and framing of interventions to address obesity.
Calcaneous interlocking nail treatment for calcaneous fracture: a multiple center retrospective study
Authors: Peng Ye , Wang Junsong , Feng Bo , Li Yunshou , Zhu Yunlong , Yuan Weiqing , Teng Lei , Zhu Chengming , Shi Bin , Zhang Lihai
Published: October 2022

Background

Minimally invasive treatments for calcaneous fractures have the same outcomes and fewer complications. However, they are technically demanding, and there are a lack reduction tools. To overcome these problems, a calcaneous interlocking nail system was developed that can make reduction and fixation minimally invasive and effective. We retrospectively studied the calcaneous fracture variables intraoperatively and followed up to evaluate the outcomes of patients treated with the calcaneous interlocking nail system.

Methods

All patients in 7 institutions between October 2020 and May 2021 who had calcaneous fractures treated with calcaneous interlocking nails were retrospectively analyzed. The patient characteristics, including age, sex, injury mechanism, Sanders type classification, smoking status, and diabetes were recorded. The calcaneous interlocking nail and standard surgical technique were introduced. The intraoperative variables, including days waiting for surgery, surgery time, blood loss, incision length, and fluoroscopy time, were recorded. The outcomes of complications, AOFAS scores and VAS scores were recorded and compared with other similar studies.

Results

Fifty-nine patients were involved in this study; 54 were male; 5 were female; and they had an average age of 47.5 ± 9.2 years (range 25–70). 2 of these fractures were Sanders type I, 28 of these fractures were Sanders type II, 27 of these fractures were Sanders type III, and 2 of these were Sanders type IV. The surgery time was 131.9 ± 50.5 (30–240) minutes on average. The blood loss was 36.9 ± 41.1 (1-250) ml. The average incision length was 3.5 ± 1.8 (1–8) cm; 57 were sinus tarsi incisions; and 2 were closed fixations without incisions. The average fluoroscopy time was 12.3 ± 3.6 (10–25) seconds during the surgery. The VAS score of patients on the day after surgery was 2.4 ± 0.7 (1–3). The AOFAS ankle-hindfoot score in patients who had a follow-up of at 12 months was 93.3 ± 3.6(85–99). During the follow-up, all patients’ functional outcomes were good. One patient had a superficial infection. The rate of complications of the 59 patients was 1.7% (1/59).

Conclusion

The calcaneous interlocking nail system can have satisfactory reduction and fixation in calcaneous fractures, even in Sanders type IV. The outcomes of follow-up showed good function. The calcaneous interlocking nail could be an alternative method for minimally invasive calcaneous fracture fixation.
Sex differences in patients’ recovery following an acute Achilles tendon rupture – a large cohort study
Authors: Larsson Elin , Brorsson Annelie , Carling Malin , Johansson Christer , Carmont Michael R , Nilsson Helander Katarina
Published: October 2022

Introduction

The incidence of Achilles tendon ruptures (ATR) has increased over the past few decades. Treatment may be individualised based upon multiple factors including age, pre-injury activity level and the separation of the ruptured tendon ends. Several studies indicate that women may have a poorer self-reported and clinical outcome compared with men, but the number of women in these studies is often small due to the different incidence of ATR between the genders.

Aims

The primary aim of this study was to evaluate whether there is a difference in self-reported outcome after an acute ATR between women and men at one to five years following injury. The second aim was to compare the outcome between the surgically and non-surgically treated patients.

Methods

Data were obtained from the medical charts of patients treated for an acute ATR between 1 and 2015 and 31 December 2020 at Sahlgrenska University Hospital/Mölndal. The Achilles tendon total rupture score (ATRS) and additional questions relating to treatment and recovery were determined. A multiple regression analysis was performed to isolate the impact of sex when comparing the patient-reported outcome between women and men.

Results

A total of 856 patients were included of which 66% participated prospectively. Sex, BMI and age were found to be significant factors influencing the total ATRS score. Female gender resulted in a lower ATRS, 7.8 points (CI = 3.3 to 12.3), than male gender. It was found that treatment did not significantly predict the results of the ATRS.

Conclusion

To our knowledge, this is the first report with a larger number of women included showing that female sex predicts inferior self-reported results after an acute ATR.
Association between metabolically healthy obesity and risk of atrial fibrillation: taking physical activity into consideration
Authors: Wang Ruoting , Olier Ivan , Ortega-Martorell Sandra , Liu Yingxin , Ye Zebing , Lip Gregory YH , Li Guowei
Published: October 2022

The modification of physical activity (PA) on the metabolic status in relation to atrial fibrillation (AF) in obesity remains unknown. We aimed to investigate the independent and joint associations of metabolic status and PA with the risk of AF in obese population. Based on the data from UK Biobank study, we used Cox proportional hazards models for analyses. Metabolic status was categorized into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). PA was categorized into four groups according to the level of moderate-to-vigorous PA (MVPA): none, low, medium, and high. A total of 119,424 obese participants were included for analyses. MHO was significantly associated with a 35% reduced AF risk compared with MUO (HR = 0.65, 95% CI: 0.57–0.73). No significant modification of PA on AF risk among individuals with MHO was found. Among the MUO participants, individuals with medium and high PA had significantly lower AF risk compared with no MVPA (HR = 0.84, 95% CI: 0.74–0.95, and HR = 0.87, 95% CI: 0.78–0.96 for medium and high PA, respectively). As the severity of MUO increased, the modification of PA on AF risk was elevated accordingly. To conclude, MHO was significantly associated with a reduced risk of AF when compared with MUO in obese participants. PA could significantly modify the relationship between metabolic status and risk of AF among MUO participants, with particular benefits of PA associated with the reduced AF risk as the MUO severity elevated.
Matrix stiffness-dependent STEAP3 coordinated with PD-L2 identify tumor responding to sorafenib treatment in hepatocellular carcinoma
Authors: Wang Shunxi , Chen Long , Liu Wanqian
Published: October 2022

Background

Ferroptosis have been implicated in tumorigenesis, tumor progression, and chemo- and immuno-therapy in cirrhotic hepatocellular carcinoma (HCC), indicating its association with matrix stiffness and clinical benefit of targeting drugs or immune checkpoint inhibitor. Here, we postulated that increased matrix stiffness reduces ferroptosis and impairs tumor immunity by regulating the expression of ferroptosis- and immune-related genes in HCC, which might be a robust predictor of therapeutic efficacy.

Methods

Using publicly available tissue microarray datasets, liver cancer rat model, and clinical specimen, ferroptosis-related differential genes in HCV-infected cirrhotic HCC and its mechanical heterogeneous pattern of expression were screened and identified. Further investigation on the underlying mechanism of matrix stiffness-regulated ferroptosis and the expression of immune mediator were performed. Finally, threshold analysis of HCC cases with sorafenib treatment revealed the value of clinical applications of these potential predictors.

Results

STEAP3 was identified as the ferroptosis-related differential genes in HCV-infected cirrhotic HCC. Stiffer matrix decreased STEAP3 in the invasive front area of HCC and the liver cirrhotic tissue. Contrarily, softer matrix induced STEAP3 in the central area of HCC and the normal liver tissue. Immunological correlation of STEAP3 in cirrhotic HCC showed that STEAP3-mediated immune infiltration of CD4+ T and CD8+ T cells, macrophages, neutrophils, and dendritic cells and HCC prognosis, predicting to regulate immune infiltration. Overexpression of STEAP3 induced ferroptosis and inhibited the expression of immune mediator of PD-L2 on a stiff matrix. Especially, the ferroptosis- and immune-related gene predictive biomarker (FIGPB), including STEAP3 and PD-L2, predicts better clinical benefit of sorafenib in HCC patients.

Conclusions

This finding identifies matrix stiffness impairs ferroptosis and anti-tumor immunity by mediating STEAP3 and PD-L2. More importantly, coordinated with PD-L2, matrix stiffness-dependent STEAP3 could be applied as the independent predictors to favorable sorafenib response, and thus targeting it could be a potential diagnosis and treatment strategy for HCC.
NO2 and PM2.5 air pollution co-exposure and temperature effect modification on pre-mature mortality in advanced age: a longitudinal cohort study in China
Authors: Ji John S. , Liu Linxin , Zhang Junfeng , Kan Haidong , Zhao Bin , Burkart Katrin G. , Zeng Yi
Published: October 2022

Background

There is a discourse on whether air pollution mixture or air pollutant components are causally linked to increased mortality. In particular, there is uncertainty on whether the association of NO2 with mortality is independent of fine particulate matter (PM2.5). Furthermore, effect modification by temperature on air pollution-related mortality also needs more evidence.

Methods

We used the Chinese Longitudinal Healthy Longevity Study (CLHLS), a prospective cohort with geographical and socio-economic diversity in China. The participants were enrolled in 2008 or 2009 and followed up in 2011-2012, 2014, and 2017-2018. We used remote sensing and ground monitors to measure nitrogen dioxide (NO2), fine particulate matter (PM2.5) , and temperature. We used the Cox-proportional hazards model to examine the association between component and composite air pollution and all-cause mortality, adjusted for demographic characteristics, lifestyle, geographical attributes, and temperature. We used the restricted cubic spline to visualize the concentration–response curve.

Results

Our study included 11 835 individuals with an average age of ﻿86.9 (SD: 11.4) at baseline. Over 55 606 person-years of follow-up, we observed 8 216 mortality events. The average NO2 exposure was 19.1 μg/m3 (SD: 14.1); the average PM2.5 exposure was 52.8 μg/m3 (SD: 15.9). In the single pollutant models, the mortality HRs (95% CI) for 10 μg/m3 increase in annual average NO2 or PM2.5 was 1.114 (1.085, 1.143) and 1.244 (1.221, 1.268), respectively. In the multi-pollutant model co-adjusting for NO2 and PM2.5, the HR for NO2 turned insignificant: 0.978 (0.950, 1.008), but HR for PM2.5 was not altered: 1.252 (1.227, 1.279). PM2.5 and higher mortality association was robust, regardless of NO2. When acccounting for particulate matter, NO2 exposure appeared to be harmful in places of colder climates and higher seasonal temperature variation.

Conclusions

We see a robust relationship of PM2.5 exposure and premature mortality in advance aged individuals, however, NO2 exposure and mortality was only harmful in places of colder climate such as northeast China, indicating evidence of effect modification by temperature. Analysis of NO2 without accounting for its collinearity with PM2.5, may lead to overestimation.
Pulmonary papillary adenoma with malignant potential: a case report and literature review
Authors: Liu Ping , Feng Junjian , Yang Min , Chen Jingqiu , Fu Luyao , Lu Junxu
Published: October 2022

Background

Pulmonary papillary adenoma is a rare benign tumor in the periphery of the lung. We report a 66-year-old female patient with a tumor in the lower lobe of the right lung and present the clinicopathological features and review the literature.

Case presentation

A tumor in the lower lobe of the right lung was found incidentally on chest X-ray during the physical examination of the patient, and the patient occasionally had a dry cough that was not treated. The tumor was clearly demarcated and lobulated on CT scan. After 2 years of follow-up, the boundary of the tumor was still clear, with more lobulations and the enhanced scan showed uniform enhancement. Grossly, the tumor had a granular cut surface and was easy to fall off, which was helpful for the diagnosis of papillary adenoma during intraoperative frozen examination. Under the microscope, most areas of the tumor had the typical morphological structure of papillary adenoma. However, the tumor locally protruded into the surrounding lung tissue, accompanied by crowded cells and high cell proliferation index. It was suggested that this case of papillary adenoma had malignant potential and needed active intervention and treatment.

Conclusion

Pulmonary papillary adenoma is a rare epithelial tumor with malignant potential. Surgical treatment should be performed as soon as possible after diagnosis to prevent malignant transformation.
Uterine choriocarcinoma arising from serous carcinoma in a postmenopausal woman: an analysis of next-generation sequencing and PD-L1 immunochemistry
Authors: Li Meiping , Bao Lei , Lu Bo , Ge Wenshun , Ren Lifang
Published: October 2022

Background

Uterine somatic choriocarcinoma is a rare, clinically aggressive malignant tumor. They frequently concur with other cancer. However, the molecular pathogenesis between somatic choriocarcinoma and the concurrent carcinoma has rarely been addressed to date.

Case presentation

We report a 68-years old Chinese woman with a uterine choriocarcinoma arising from serous carcinoma. The patient underwent radical surgery including total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node resection. She received 10 courses of post-operative chemotherapy. She died of disease 13 months after her surgery. Microscopically, the tumor showed a biphasic pattern of choriocarcinoma and serous carcinoma. The choriocarcinomatous component showed a combination of cytotrophoblast, intermediate trophoblast and syncytiotrophoblast with hemorrhage and necrosis. The component of serous carcinoma was characterized by solid sheets of small cells with marked nuclear atypia and occasional glandular and papillary formation. PD-L1 was exclusively expressed in the choriocarcinomatous component. Next-generation sequencing revealed that the genetic abnormalities were overlapping between the two components.
Two cases of spindle cell tumors with S100 and CD34 co-expression showing novel RAF1 fusions
Authors: Gong Li-Hua , Liu Wei-Feng , Niu Xiao-Hui , Ding Yi
Published: October 2022

Background

Recently, a novel group of CD34 and S100 co-expression spindle cell tumors with distinctive stromal and perivascular hyalinization harboring recurrent gene fusions involving RET, RAF1, BRAF, and NTRK1/2 gene has been identified.

Case presentation

In this study, we reported two Chinese male patients with soft tissue tumors presenting in the right knee joint and the left thigh, respectively. For both patients, the tumors were completely excised with clear margin. Microscopically, case 1showed morphological overlap with neurofibroma, and case 2 showed overlap with lipomatous solitary fibrous tumor. Both tumors showed co-expression of S100 and CD34, and absence of SOX10. Genomic profiling with DNA-based next-generation sequencing (NGS) assay was performed and revealed KIF5B-RAF1 (K16:R8) and TLN2-RAF1 (T54:R8) rearrangements. RNA-based NGS and RT-PCR were performed to confirm the gene fusion.

Conclusions

Though systemic therapy was not indicated in these two patients, identification of targetable kinase fusions may help to refine tumors with an ambiguous immunoprofile, and provides suggestions for targeted therapy in rare aggressive cases.
Comparison of in vivo hindfoot joints motion changes during stance phase between non‐flatfoot and stage II adult acquired flatfoot
Authors: Deng Zhenhan , Cai Zijun , Chen Siyu , Liu Yan , Chen Fanglin , Deng Zhiqin , Li Yusheng , Xu Jian
Published: October 2022

Background

To compare the kinematic characteristics of hindfoot joints in stage II adult acquired flatfoot deformity (AAFD) with those of non‐flatfoot through the 3D‐to‐2D registration technology and single fluoroscopic imaging system.

Methods

Eight volunteers with stage II AAFD and seven volunteers without stage II AAFD were recruited and CT scans were performed bilateral for both groups in neutral positions. Their lateral dynamic X‐ray data during the stance phase, including 14 non‐flatfeet and 10 flatfeet, was collected. A computer‐aided simulated light source for 3D CT model was applied to obtain the virtual images, which were matched with the dynamic X‐ray images to register in the “Fluo” software, so that the spatial changes during the stance phase could be calculated.

Results

During the early‐stance phase, the calcaneous was more dorsiflexed, everted, and externally‐rotated relative to the talus in flatfoot compared with that in non‐flatfoot (p < 0.05). During the mid‐stance phase, the calcaneous was more dorsiflexed and everted relative to the talus in flatfoot compared with that in non‐flatfoot (p < 0.05); however, the rotation did not differ significantly between the two groups (p > 0.05). During the late‐stance phase, the calcaneous was more plantarflexed, but less inverted and internally‐rotated, relative to the talus in flatfoot compared with that in non‐flatfoot (p < 0.05). During the early‐ and mid‐stance phase, the navicular was more dorsiflexed, everted, and externally‐rotated relative to the talus in flatfoot compared with that in non‐flatfoot (p < 0.05). During the late‐stance phase, the navicular was more plantarflexed, but less inverted and internally‐rotated, relative to the talus in flatfoot compared with that in non‐flatfoot (p < 0.05). There was no difference in the motion of cuboid between the two groups during the whole stance phase (p > 0.05).

Conclusions

During the early‐ and mid‐stance phase, excessive motion was observed in the subtalar and talonavicular joints in stage II AAFD. During the late‐stance phase, the motion of subtalar and talonavicular joints appeared to be in the dysfunction state. The current study helps better understanding the biomechanics of the hindfoot during non‐flatfoot and flatfoot condition which is critical to the intervention to the AAFD using conservative treatment such as insole or surgical treatment for joint hypermotion.
Ten areas for ICU clinicians to be aware of to help retain nurses in the ICU
Authors: Vincent Jean-Louis , Boulanger Carole , van Mol Margo M. C. , Hawryluck Laura , Azoulay Elie
Published: October 2022

Shortage of nurses on the ICU is not a new phenomenon, but has been exacerbated by the COVID-19 pandemic. The underlying reasons are relatively well-recognized, and include excessive workload, moral distress, and perception of inappropriate care, leading to burnout and increased intent to leave, setting up a vicious circle whereby fewer nurses result in increased pressure and stress on those remaining. Nursing shortages impact patient care and quality-of-work life for all ICU staff and efforts should be made by management, nurse leaders, and ICU clinicians to understand and ameliorate the factors that lead nurses to leave. Here, we highlight 10 broad areas that ICU clinicians should be aware of that may improve quality of work-life and thus potentially help with critical care nurse retention.
Comorbidity phenotypes and risk of mortality in patients with osteoarthritis in the UK: a latent class analysis
Authors: Zemedikun Dawit T. , Lee Helena , Nirantharakumar Krishnarajah , Raza Karim , Chandan Joht Singh , Lord Janet M. , Jackson Thomas A.
Published: October 2022

Background

Osteoarthritis (OA) is a common chronic condition but its association with other chronic conditions and mortality is largely unknown. This study aimed to use latent class analysis (LCA) of 30 comorbidities in patients with OA and matched controls without OA to identify clusters of comorbidities and examine the associations between the clusters, opioid use, and mortality.

Methods

A matched cohort analysis of patients derived from the IQVIA Medical Research Data (IMRD-UK) database between 2000 and 2019. 418,329 patients with newly diagnosed OA were matched to 243,170 patients without OA to identify comorbidity phenotypes. Further analysis investigated the effect of opioid use on mortality in individuals with OA and their matched controls.

Results

The median (interquartile range (IQR)) number of comorbidities was 2 (1–4) and 1 (0–3) in the OA and control groups respectively. LCA identified six comorbidity phenotypes in individuals with and without OA. Clusters with a high prevalence of comorbidities were characterised by hypertension, circulatory, and metabolic diseases. We identified a comorbidity cluster with the aforementioned comorbidities plus a high prevalence of chronic kidney disease, which was associated with twice the hazard of mortality in hand OA with a hazard ratio (HR) (95% CI) of 2.53 (2.05–3.13) compared to the hazard observed in hip/knee OA subtype 1.33 (1.24–1.42). The impact of opioid use in the first 12 months on hazards of mortality was significantly greater for weak opioids and strong opioids across all groups HR (95% CI) ranging from 1.11 (1.07–11.6) to 1.80 (1.69–1.92)). There was however no evidence of association between NSAID use and altered risk of mortality.

Conclusion

This study identified six comorbidity clusters in individuals with OA and matched controls within this cohort. Opioid use and comorbidity clusters were differentially associated with the risk of mortality. The analyses may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.