bluuebunny/crossref_metadata_2025 huggingface dataset:
An analysis of COVID-19 information sources
Authors: Umeta Belachew , Mulugeta Temesgen , Mamo Girma , Alemu Sintayehu , Berhanu Nimona , Milkessa Gudina , Mengistu Birhanu , Melaku Tsegaye
Published: August 2022

﻿Abstract

Background

The COVID-19 pandemic has brought new situations that require the effective delivery of health information across the world and it’s important to offer clear, consistent, and credible information on the pandemic to mitigate and control the outbreak.

Aim

To assess COVID-19 information source, need and trust among the rural community of southwest Ethiopia.

Methods

A community-based cross-sectional study design was conducted among 634 rural communities of southwest Ethiopia. The data were collected by interviewing individuals from selected households and analyzed by SPSS version 26. A multivariable logistic regression model was used to assess factors affecting information needs.

Results

Radio 484 (76.3%) was mostly used as a source of information for COVID-19, and government 404 (63.7%) and health professionals 345 (57.7%) were trusted. However, only 10 (1.6%) of the participants acquired information from health professionals. Around 395 (62.3%) of the participants needed additional information on COVID-19. Around 230 (58.2%) and 186 (47.1%) of the participants required additional information on cause and sign and symptoms, respectively. Age of < 45 years old (AOR: 2.11, 95% CI: 1.43, 3.12, P < 0.001), and absence of formal education (AOR: 2.00, 95% CI: 1.35, 2.95, P: 0.001) were factors positively affecting the information needs of the participants on COVID-19. Church goers (AOR: 3.24; 95% CI: 2.03, 5.19; P < 0.001), television (AOR: 2.39; 95% CI: 1.63, 3.49; P < 0.001) and social media users (AOR: 4.52; 95% CI: 2.26, 9.04; P < 0.001) as source of information required additional information on COVID-19, and the participants that trusted social media (AOR: 2.52; 95% CI: 1.64, 3.87; P < 0.001) and friends/relatives (AOR: 2.95: 95% CI: 1.51, 5.76; P < 0.001) were also required additional information on COVID-19.

Conclusions

The popular sources of COVID-19-related information were radio and television. The participants trusted the government and health professionals on COVID-19. However, less than 2% of the participants had information from health professionals. The majority of the participants wanted to learn more about COVID-19. The areas the participants required additional information include cause and signs and symptoms. Age, educational status, trust in social media, trust in friends, using the church, television and social media as a source were factors associated with information needs.
Rehabilitation and return to sports after isolated meniscal repairs: a new evidence-based protocol
Authors: Calanna Filippo , Duthon Victoria , Menetrey Jacques
Published: August 2022

Purpose

Despite many protocols that have been proposed, there’s no consensus in the literature regarding the optimal rehabilitation program and return to sports (RTS) protocol following isolated meniscal repair. The aim of this current concept review is to look at the evidence of rehabilitation and RTS program after isolated meniscal repair, focusing on general and specific protocols per type of injury trying to give some guidelines based on the current state of knowledge.

Methods

A narrative literature review was performed searching PubMed database to identify relevant articles from January 1985 to October 2021 on rehabilitation and RTS after isolated meniscal repair. Randomized controlled trials (RCTs), prospective and retrospective cohort studies, case series, systematic reviews, meta-analyses, cadaveric studies and basic science studies were included.

Results

When the hoop tensile stress effect is preserved, an accelerated rehabilitation program may be suggested. Hence, partial weight bearing (20 kg) in association with ROM limited to 90° is allowed for the first four weeks, followed by weight bearing as tolerated.

In contrast, when circumferential hoop fibers are disrupted, a restricted rehabilitation protocol may be recommended. In this scenario no weight bearing is allowed for the first six weeks after the surgery and range of motion (ROM) is limited to 90°.

Conclusion

Biomechanical evidence suggests that tailoring an individualized protocol based upon the type of lesion and meniscus stability is reasonable.

Level of evidence

Level V.
Characterization of a novel GH10 alkali-thermostable xylanase from a termite microbiome
Authors: Mon Maria Laura , Marrero Díaz de Villegas Rubén , Campos Eleonora , Soria Marcelo A. , Talia Paola M.
Published: August 2022

The aim of the present study was to assess the biochemical and molecular structural characteristics of a novel alkali-thermostable GH10 xylanase (Xyl10B) identified in a termite gut microbiome by a shotgun metagenomic approach. This endoxylanase candidate was amplified, cloned, heterologously expressed in Escherichia coli and purified. The recombinant enzyme was active at a broad range of temperatures (37–60 ºC) and pH values (4–10), with optimal activity at 50 ºC and pH 9. Moreover, its activity remained at more than 80% of its maximum at 50 °C for 8 h. In addition, Xyl10B was found to be stable in the presence of salt and several ions and chemical reagents frequently used in the industry. These characteristics make this enzyme an interesting candidate for pulp and paper bleaching industries, since this process requires enzymes without cellulase activity and resistant to high temperatures and alkaline pH (thermo-alkaliphilic enzymes). The products of xylan hydrolysis by Xyl10B (short xylooligosaccharides, xylose and xylobiose) could be suitable for application as prebiotics and in the production of bioethanol.

Graphical Abstract
Impact of the dead-time correction method on quantitative 177Lu-SPECT (QSPECT) and dosimetry during radiopharmaceutical therapy
Authors: Desy Alessandro , Bouvet Guillaume F. , Lafrenière Nancy , Zamanian Atefeh , Després Philippe , Beauregard Jean-Mathieu
Published: August 2022

Background

Dead-time correction is required for accurate quantitative SPECT-based dosimetry in the context of personalised 177Lu radiopharmaceutical therapy. We aimed to evaluate the impact of applying dead-time correction on the reconstructed SPECT image versus on the acquisition projections before reconstruction.

Methods

Data from 16 SPECT/CT acquisitions of a decaying 177Lu-filled phantom (up to 20.75 GBq) and dual-timepoint SPECT/CT in 14 patients treated with personalised 177Lu peptide receptor radionuclide therapy were analysed. Dead time was determined based on the acquisition wide-spectrum count rate for each projection and averaged for the entire acquisition. Three dead-time correction methods (DTCMs) were used: the per-projection correction, where each projection was individually corrected before reconstruction (DTCM1, the standard of reference), and two per-volume methods using the average dead-time correction factor of the acquisition applied to all projections before reconstruction (DTCM2) or to the SPECT image after reconstruction (DTCM3). Relative differences in quantification were assessed for various volumes of interest (VOIs) on the phantom and patient SPECT images. In patients, the resulting dosimetry estimates for tissues of interest were also compared between DTCMs.

Results

Both per-volume DTCMs (DTCM2 and DTCM3) were found to be equivalent, with VOI count differences not exceeding 0.8%. When comparing the per-volume post-reconstruction DTCM3 versus the per-projection pre-reconstruction DTCM1, differences in VOI counts and absorbed dose estimates did not exceed 2%, with very few exceptions. The largest absorbed dose deviation was observed for a kidney at 3.5%.

Conclusion

While per-projection dead-time correction appears ideal for QSPECT, post-reconstruction correction is an acceptable alternative that is more practical to implement in the clinics, and that results in minimal deviations in quantitative accuracy and dosimetry estimates, as compared to the per-projection correction.
A deep learning-based whole-body solution for PET/MRI attenuation correction
Authors: Ahangari Sahar , Beck Olin Anders , Kinggård Federspiel Marianne , Jakoby Bjoern , Andersen Thomas Lund , Hansen Adam Espe , Fischer Barbara Malene , Littrup Andersen Flemming
Published: August 2022

Background

Deep convolutional neural networks have demonstrated robust and reliable PET attenuation correction (AC) as an alternative to conventional AC methods in integrated PET/MRI systems. However, its whole-body implementation is still challenging due to anatomical variations and the limited MRI field of view. The aim of this study is to investigate a deep learning (DL) method to generate voxel-based synthetic CT (sCT) from Dixon MRI and use it as a whole-body solution for PET AC in a PET/MRI system.

Materials and methods

Fifteen patients underwent PET/CT followed by PET/MRI with whole-body coverage from skull to feet. We performed MRI truncation correction and employed co-registered MRI and CT images for training and leave-one-out cross-validation. The network was pretrained with region-specific images. The accuracy of the AC maps and reconstructed PET images were assessed by performing a voxel-wise analysis and calculating the quantification error in SUV obtained using DL-based sCT (PETsCT) and a vendor-provided atlas-based method (PETAtlas), with the CT-based reconstruction (PETCT) serving as the reference. In addition, region-specific analysis was performed to compare the performances of the methods in brain, lung, liver, spine, pelvic bone, and aorta.

Results

Our DL-based method resulted in better estimates of AC maps with a mean absolute error of 62 HU, compared to 109 HU for the atlas-based method. We found an excellent voxel-by-voxel correlation between PETCTand PETsCT(R2 = 0.98). The absolute percentage difference in PET quantification for the entire image was 6.1% for PETsCTand 11.2% for PETAtlas. The regional analysis showed that the average errors and the variability for PETsCTwere lower than PETAtlasin all regions. The largest errors were observed in the lung, while the smallest biases were observed in the brain and liver.

Conclusions

Experimental results demonstrated that a DL approach for whole-body PET AC in PET/MRI is feasible and allows for more accurate results compared with conventional methods. Further evaluation using a larger training cohort is required for more accurate and robust performance.
Treatment and surveillance for non-muscle-invasive bladder cancer: a clinical practice guideline (2021 edition)
Authors: Jin Ying-Hui , Zeng Xian-Tao , Liu Tong-Zu , Bai Zhi-Ming , Dou Zhong-Ling , Ding De-Gang , Fan Zhi-Lu , Han Ping , Huang Yi-Ran , Huang Xing , Li Ming , Li Xiao-Dong , Li Yi-Ning , Li Xu-Hui , Liang Chao-Zhao , Liu Jiu-Min , Ma Hong-Shun , Qi Juan , Shi Jia-Qi , Wang Jian , Wang De-Lin , Wang Zhi-Ping , Wang Yun-Yun , Wang Yong-Bo , Wei Qiang , Xia Hai-Bo , Xing Jin-Chun , Yan Si-Yu , Zhang Xue-Pei , Zheng Guo-You , Xing Nian-Zeng , He Da-Lin , Wang Xing-Huan ,   the Chinese Urological Doctor Association (CUDA), Urological Association of Chinese Research Hospital Association (CRHA-UA), Uro-Health Promotive Association of China International Exchange, Promotive Association for Medical, Health Care (CPAM-UHPA)
Published: August 2022

Non-muscle invasive bladder cancer (NMIBC) is a major type of bladder cancer with a high incidence worldwide, resulting in a great disease burden. Treatment and surveillance are the most important part of NIMBC management. In 2018, we issued “Treatment and surveillance for non-muscle-invasive bladder cancer in China: an evidence-based clinical practice guideline”. Since then, various studies on the treatment and surveillance of NMIBC have been published. There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China. Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated. We formed a working group of clinical experts and methodologists. Through questionnaire investigation of clinicians including primary medical institutions, 24 clinically concerned issues, involving transurethral resection of bladder tumor (TURBT), intravesical chemotherapy and intravesical immunotherapy of NMIBC, and follow-up and surveillance of the NMIBC patients, were determined for this guideline. Researches and recommendations on the management of NMIBC in databases, guideline development professional societies and monographs were referred to, and the European Association of Urology was used to assess the certainty of generated recommendations. Finally, we issued 29 statements, among which 22 were strong recommendations, and 7 were weak recommendations. These recommendations cover the topics of TURBT, postoperative chemotherapy after TURBT, Bacillus Calmette–Guérin (BCG) immunotherapy after TURBT, combination treatment of BCG and chemotherapy after TURBT, treatment of carcinoma in situ, radical cystectomy, treatment of NMIBC recurrence, and follow-up and surveillance. We hope these recommendations can help promote the treatment and surveillance of NMIBC in China, especially for the primary medical institutions.
Beyond hemoglobin: uncovering iron deficiency and iron deficiency anemia using serum ferritin concentration among pregnant women in eastern Ethiopia: a community-based study
Authors: Fite Meseret Belete , Bikila Demiraw , Habtu Wossene , Tura Abera Kenay , Yadeta Tesfaye Assebe , Oljira Lemessa , Roba Kedir Teji
Published: August 2022

Background

Although the high burden of anemia among pregnant women in low-resource settings like Ethiopia is well documented, evidence is scarce on the underlying causes using biochemical tests. Therefore, this study assessed the iron status and factors associated with iron deficiency (ID) using serum ferritin concentration among pregnant women in Haramaya district, eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. The serum ferritin (SF) concentration was measured in the National Biochemical Laboratory of Ethiopia on a fully automated Cobas e411 (German, Japan Cobas 4000 analyzer series) immunoassay analyzer using the electro-chemiluminescence (ECL) method and standard procedures. A log-binomial regression analysis identified variables associated with iron deficiency, and defined as serum ferritin concentration < 15 μg/L (per the World Health Organization recommendation in developing countries). An adjusted risk ratio (aRR), and a 95% confidence interval (CI), were used to report associations. Finally, thep-value < 0.05 was the cut-off point for the significant association.

Results

A total of 446 pregnant women with a mean age of 24.78 (+ 5.20) were included in the study. A total of 236 (52.91%; 95% CI: 48.16–57.63) had iron deficiency. The overall prevalence of anemia and iron deficiency anemia (IDA) was 45.96% (95% CI: 41.32–50.71) and 28.03% (95% CI: 21.27–32.44), respectively. The risk of iron deficiency was more likely among women with low dietary diversity (aRR = 1.36; 95% CI = 1.07–1.72) and those who skipped meals (aRR = 1.29; 95% CI = 1.05–1.57), but less among women who had antenatal care (aRR = 0.73 (95% CI = 0.61–0.88).

Conclusion

More than half of the pregnant women in eastern Ethiopia had iron deficiency. Improving dietary diversity, meal frequency, and prenatal follow-up is essential to improve the high burden of ID and the adverse effect on pregnant women and the fetus. Moreover, a prospective study comparing maternal and perinatal outcomes among these spectra—iron depletion, ID, and IDA—is crucial for understanding their impact on maternal and perinatal mortality and morbidity.
Acute Neuromuscular, Physiological and Performance Responses After Strength Training in Runners: A Systematic Review and Meta-Analysis
Authors: de Carvalho e Silva Gustavo Ivo , Brandão Leandro Henrique Albuquerque , dos Santos Silva Devisson , de Jesus Alves Micael Deivison , Aidar Felipe J. , de Sousa Fernandes Matheus Santos , Sampaio Ricardo Aurélio Carvalho , Knechtle Beat , de Souza Raphael Fabricio
Published: August 2022

Background

Strength training (ST) is commonly used to improve muscle strength, power, and neuromuscular adaptations and is recommended combined with runner training. It is possible that the acute effects of the strength training session lead to deleterious effects in the subsequent running. The aim of this systematic review and meta-analysis was to verify the acute effects of ST session on the neuromuscular, physiological and performance variables of runners.

Methods

Studies evaluating running performance after resistance exercise in runners in the PubMed and Scopus databases were selected. From 6532 initial references, 19 were selected for qualitative analysis and 13 for meta-analysis. The variables of peak torque (PT), creatine kinase (CK), delayed-onset muscle soreness (DOMS), rating of perceived exertion (RPE), countermovement jump (CMJ), ventilation (VE), oxygen consumption (VO2), lactate (La) and heart rate (HR) were evaluated.

Results

The methodological quality of the included studies was considered reasonable; the meta-analysis indicated that the variables PT (p = 0.003), DOMS (p < 0.0001), CK (p < 0.0001), RPE (p < 0.0001) had a deleterious effect for the experimental group; for CMJ, VE, VO2, La, FC there was no difference. By qualitative synthesis, running performance showed a reduction in speed for the experimental group in two studies and in all that assessed time to exhaustion.

Conclusion

The evidence indicated that acute strength training was associated with a decrease in PT, increases in DOMS, CK, RPE and had a low impact on the acute responses of CMJ, VE, VO2, La, HR and submaximal running sessions.
Can fluoxetine mitigate mental health decline in musculoskeletal trauma patients: a pilot single-center randomized clinical trial
Authors: Lossada-Soto Elizabeth , Pazik Marissa , Horodyski Mary Beth , Vasilopoulos Terrie , de Faria Ludmila Barbosa , Mathews Carol , Hagen Jennifer
Published: August 2022

Background

Musculoskeletal trauma is one of the leading causes of disability in the USA and its negative quality of life impact extends beyond that of physical recovery. More than 50% of victims of musculoskeletal trauma suffer lasting mental health issues and post-traumatic stress disorder (PTSD) symptomology following their injury. These symptoms can develop across all spectrums of patients and are independent predictors of poor outcome. Access to mental health care is limited, expensive, and time intensive, and a large majority of the trauma population do not get to utilize this valuable resource. This leaves the burden of management on the orthopedic team, as they are often the only point of contact for the patient within the medical system.

Methods

This is a single-center, repeated measures, randomized controlled pilot study including up to 100 orthopedic trauma patients aged between 18 and 85 years of age. Subjects are approached during their index hospitalization and are randomized to one of two pharmaceutical interventions, fluoxetine (also known as Prozac) or calcium, for 9 months. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that is supported for the treatment of PTSD by the American Psychiatric Association. It is low-cost and has minimal side effects and withdrawal symptoms if stopped suddenly. Calcium is a supplement with minimal side effects that is used in our study for its bone-healing potential. Feasibility will be indexed by recruitment feasibility, randomization feasibility, medical adherence, anti-depressant side effects, and fracture union rate. Subjects will complete physical and mental health surveys at baseline, 2 weeks, 6 weeks, 3 months, 6 months, and 1 year.

Discussion

The goals of this exploratory clinical trial are to: develop a safe, feasible, and time-limited protocol effect of immediate (post-injury) treatment with fluoxetine for use by orthopedic providers and other non-mental health care providers treating victims of musculoskeletal trauma (Aim 1), and test the for preliminary effects of the protocol on development of PTSD symptomology and physical recovery in these patients (Aim 2). This study is novel in that it strives to prevent the development of symptomology from the time of injury and empowers surgeons to manage their patients in a more holistic manner.

Trial registration

ClinicalTrials.gov, NCT04850222. Registered on April 20, 2021.
Evaluation of the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo, Brazil
Authors: Barberia Lorena G. , de P. Moreira Natália , Kemp Brigina , de Sousa Mascena Veras Maria Amelia , Zamudio Marcela , Rosa Isabel Seelaender Costa , de J. Carvalho Rebeca , Sousa Tatiane C. M.
Published: August 2022

Background

Surveillance efforts are essential to pandemic control, especially where the state is the primary health provider, such as Brazil. When public health testing guidelines limit molecular tests, there are reductions in detection efforts aimed at early recognition, isolation, and treatment of those infected with the virus. This study evaluates the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo.

Methods

We conducted an interrupted time series analysis with a segmented regression model to analyze if changes in the state’s guidelines improved RT-PCR testing outcomes in Brazil’s most affluent and largest state, São Paulo. Anonymized daily data on the RT-PCR tests conducted in public laboratories belonging to the state-wide network from March 1, 2020 to June 5, 2021 were extracted from the Sao Paulo State open-source database, while the data on the genomic sequences were obtained from GISAID. We then aggregated these data for the 17 regional health departments in the state to evaluate regional-level outcomes.

Results

The public health system restricted RT-PCR testing to hospitalized cases in the first months. Testing was expanded to permit symptomatic testing of non-hospitalized persons only in July 2020, but a statistically significant increase in surveillance efforts was not observed. Case definition was expanded to allow case confirmation based on clinical, laboratory and image data criteria other than an RT-PCR test without increasing the testing effort for asymptomatic suspicious cases in September 2020. There was an increase in the mean volume of testing in each RHD, but the test positivity rate increased due to insufficient testing expansion. Results also show an uneven improvement in testing outcomes following these changes across the state’s regional health departments.

Conclusions

Evidence suggests that lower RT-PCR testing and genomic surveillance efforts are associated with areas characterized by a higher population concentration and a greater population reliance on the public health system. Our results highlight the need to structure health surveillance and information systems for disease control and prevention in emergency settings considering local demographics and vulnerabilities. In high prevalence settings, efforts at identifying and including vulnerable populations in routine and enhanced surveillance programs during COVID-19 must be significantly improved.
Diagnostic accuracy for colorectal cancer of a quantitative faecal immunochemical test in symptomatic primary care patients: a study protocol
Authors: Lööv Anna , Högberg Cecilia , Lilja Mikael , Theodorsson Elvar , Hellström Per , Metsini Alexandra , Olsson Louise
Published: August 2022

Background

There is increasing evidence supporting the use of faecal immunochemical tests (FIT) in patients reporting symptoms associated with colorectal cancer (CRC), but most studies until now have focused on selected subjects already referred for investigation. We therefore set out to determine the accuracy and predictive values of FIT in a primary care population.

Method

A prospective, multicentre, single-gated comparative diagnostic study on quantitative FIT in patients aged 40 years and above presenting in primary care with symptoms associated with CRC will be conducted. Patients representing the whole spectrum of severity of such symptoms met with in primary care will be eligible and identified by GPs.

Participants will answer a short form on symptoms during the last month. They will provide two faecal samples from two separate days. Analyses will be performed within 5 days (QuikRead go®, Aidian Oy). The analytical working range is 10–200 μg Hb/g faeces.

Reference test will be linked to the Swedish Colorectal Cancer Registry up to 2 years after inclusion. Accuracy, area under ROC curves, and predictive values will be calculated for one FIT compared to the highest value of two FIT and at cutoff < 10, 10–14.9, 15–19.9 and ≥ 20 μg Hb/g faeces. Subgroup analyses will be conducted for patients with anaemia and those reporting rectal bleeding. A model-based cost-effectiveness analysis based on the clinical accuracy study will be performed.

Based on previous literature, we hypothesized that the sensitivity of the highest value of two FIT at cutoff 10 μg Hb/g faeces will be 95% (95% CI + / − 15%). The prevalence of CRC in the study population was estimated to be 2%, and the rate of non-responders to be 1/6. In all, 3000 patients will be invited at 30 primary care centres.

Discussion

This study will generate important clinical real-life structured data on accuracy and predictive values of FIT in the most critical population for work-up of CRC, i.e. patients presenting with at times ambiguous symptoms in primary care. It will help establish the role of FIT in this large group.

Trial registration

NCT05156307. Registered on 14 December 2021—retrospectively registered.
Ischemic stroke in COVID-19 patients: a cross-sectional study from an Indonesian COVID-19 referral hospital
Authors: Hidayat Rakhmad , Widjaya Nita , Djuliannisaa Zlatikha , Mustika Alyssa Putri , Zairinal Ramdinal Aviesena , Diafiri Dinda , Mesiano Taufik , Kurniawan Mohammad , Rasyid Al , Harris Salim
Published: August 2022

Background

COVID-19 increases the risk of acute ischemic stroke. The objective of this study is to identify the risk factors, comorbidities, and outcomes in COVID-19 patients with acute ischemic stroke at University of Indonesia Hospital.

Results

The clinical condition of COVID-19 patients with ischemic stroke is more severe for patients older than 55 years (p < 0.05), patients at the critical COVID-19 clinical stage, and patients with atrial fibrillation (p < 0.05). The level of C-reactive protein (CRP) more than 60 mg/L correlated with the outcome of the patient as well.

Conclusion

The study concluded that, age, COVID-19 clinical degree, and atrial fibrillation significantly affect the outcome in COVID-19 patients with stroke.
Exposure to violence and the presence of suicidal and self-harm behaviour predominantly in Asian females: scoping review
Authors: Shoib Sheikh , Khan Sonia , Baiou Alaa , Chandradasa Miyuru , Swed Sarya , Turan Serkan , Yusha’u Armiya’u Aishatu
Published: August 2022

Background

Exposure to violence is associated with psychological distress, mental disorders such as depression, and suicidal behaviour. Most of the studies are conducted in the West, with limited publications from Asia. Thus, we conducted a scoping review of studies investigating the association between experiences of violence and later suicidal ideation/attempts from Asia in the twenty-first century.

Results

Many studies focused on domestic violence toward women in the Southeast Asian region. Sociocultural factors such as family disputes, public shaming, dowry, lack of education opportunities, and marriage life perceptions mediated the association. Many women exposed to violence and attempted suicide suffered from mental disorders such as depression, anxiety, and post-traumatic stress. The small number of suitable studies and the possible effect of confounders on participants were limitations in the review. Future studies would have to focus on specific types of violence and ethnoreligious beliefs.

Conclusion

Women in Asia exposed to violence appear to have an increased risk of suicidal behaviour and mental disorders. The early screening of psychological distress with culturally validated tools is essential for preventing suicides in Asian victims of violence.
Unmasking of a spinal dural AV fistula on MRI following steroid administration
Authors: Rodriguez Jose , Nagornaya Natalya , Margolesky Jason , Saigal Gaurav
Published: August 2022

Background

Spinal dural arteriovenous fistulas (dAVF) remain a rare, diagnostically challenging and possibly correctable condition with important prognostic outcomes dependent primarily on early detection and treatment.

Case presentation

We present a case of a 73-year-old male with progressively worsening neurological symptoms after steroid administration for a presumed diagnosis of transverse myelitis. This case is extremely unique, as the administration of steroids helped unmask an underlying spinal dural arteriovenous fistula by revealing characteristic imaging findings of a dAVF, not seen on the original MRI study.

Conclusion

In the setting of an unclear cause of transverse myelitis and worsening symptoms following steroid administration, the possibility of a ‘masked’ dural AVF should be considered and repeat imaging performed, which might help in the eventual diagnosis and definitive treatment of this elusive entity.
Development of curcumin-loaded liposomes in lysine–collagen hydrogel for surgical wound healing
Authors: Cardoso-Daodu Ibilola Mary , Ilomuanya Margaret Okonawan , Azubuike Chukwuemeka Paul
Published: August 2022

Background

A surgical wound is an incision made by a surgeon. Slow surgical wound healing may lead to chronic wounds which may be a potential health problem. The aim of this study is to formulate curcumin-loaded liposomes in lysine–collagen hydrogel for enhancing surgical wound healing. Curcumin-loaded liposomes were prepared using thin-film hydration method. The liposomal formulation was characterized by analysing its size, morphology, encapsulation efficiency, and in vitro release. The hydrogel base was prepared, and then, curcumin-loaded liposomes were infused to give formulation (F1). Curcumin-loaded liposomes were infused into the hydrogel base after which lysine and collagen were incorporated to give (F2), while (F3) comprised lysine and collagen incorporated in hydrogel base. All formulations were characterized by evaluation of the safety, stability, swelling index, pH, rheological properties, and in vivo wound healing assay. Histology and histomorphometry of tissue samples of wound area treated with formulations F1, F2, and F3 and the control, respectively, were examined.

Results

Curcumin-loaded liposomes were 5–10 µm in size, and the values for encapsulation efficiency and flux of the loaded liposomes are 99.934% and 51.229 µg/cm2/h, respectively. Formulations F1, F2, and F3 had a pH of 5.8. F1 had the highest viscosity, while F2 had the highest swelling index indications for efficient sustained release of drug from the formulation. The in vivo wound healing evaluation showed that curcumin-loaded liposomes in lysine–collagen hydrogel had the highest percentage wound contraction at 79.25% by day three post-surgical operation. Histological evaluation reflected a normal physiological structure of the layers of the epidermis and dermis after surgical wound healing in tissue samples from wound areas treated with formulations F1 and F2. The histomorphometrical values show highest percentage of collagen, lowest inflammatory rates, highest presence of microvessels, and re-epithelization rates at wound site in wounds treated with formulation F2 (curcumin-loaded liposomes in lysine–collagen hydrogel).

Conclusion

Curcumin-loaded liposomes in lysine–collagen hydrogel was found to be the most effective of the three formulations in promoting wound healing. Hence, this formulation can serve as a prototype for further development and has great potential as a smart wound dressing for the treatment of surgical wounds.
The role of supervisor work-life support on the correlation between work autonomy, workload and performance: perspective from Tanzania banking employees
Authors: Msuya Mwanaidi Shafii , Kumar Anitha Bommagowni
Published: August 2022

This research aims to assess the influence of supervisor work-life support on bank employees' performance linking work autonomy and employee workload in this relationship. A survey was conducted among bank employees in the Central Zone regions of Tanzania. Bank workers completed 417 survey questionnaires in total. The data was then analysed using structural equation modelling. The researchers use Smart PLS, a data analysis tool, to see if there are any theoretically supported connections between variables of interest. SPSS, on the other hand, handled data coding and descriptive statistics. The study results revealed that work autonomy mediated significantly the association among supervisor work-life support and work performance. Contrary to expectation, the linking of workload in the correlation between supervisor work-life support and work performance was negative and insignificant. Moreover, work autonomy and workload significantly influence bank employees’ job performance in this study. Similarly, the study findings indicated that supervisor work-life support positively impacts employee performance. The study has important implications for managers since it improves understanding of the strengths of their organizations' work-life practices. Such as workload and work autonomy when linked with supervisor work-life support on influencing employee job performance and developing new strategies that may enhance employee's well-being. Again, the findings imply that there should be supportive work-life practices that moderate the balance between home and work realms to attain effective organizational performance.
Clinical Activity of Mitogen-Activated Protein Kinase–Targeted Therapies in Patients With Non–V600 BRAF-Mutant Tumors
Authors: Dankner Matthew , Wang Yifan , Fazelzad Rouhi , Johnson Benny , Nebhan Caroline A. , Dagogo-Jack Ibiayi , Myall Nathaniel J. , Richtig Georg , Bracht Jillian W.P. , Gerlinger Marco , Shinozaki Eiji , Yoshino Takayuki , Kotani Daisuke , Fangusaro Jason R. , Gautschi Oliver , Mazieres Julien , Sosman Jeffrey A. , Kopetz Scott , Subbiah Vivek , Davies Michael A. , Groover Anna L. , Sullivan Ryan J. , Flaherty Keith T. , Johnson Douglas B. , Benedetti Andrea , Cescon David W. , Spreafico Anna , Zogopoulos George , Rose April A.N.
Published: August 2022

PURPOSE

Non-V600 mutations comprise approximately 35% of all BRAF mutations in cancer. Many of these mutations have been identified as oncogenic drivers and can be classified into three classes according to molecular characteristics. Consensus treatment strategies for class 2 and 3 BRAF mutations have not yet been established.

METHODS

We performed a systematic review and meta-analysis with published reports of individual patients with cancer harboring class 2 or 3 BRAF mutations from 2010 to 2021, to assess treatment outcomes with US Food and Drug Administration–approved mitogen-activated protein kinase (MAPK) pathway targeted therapy (MAPK TT) according to BRAF class, cancer type, and MAPK TT type. Coprimary outcomes were response rate and progression-free survival.

RESULTS

A total of 18,167 studies were screened, identifying 80 studies with 238 patients who met inclusion criteria. This included 167 patients with class 2 and 71 patients with class 3 BRAF mutations. Overall, 77 patients achieved a treatment response. In both univariate and multivariable analyses, response rate and progression-free survival were higher among patients with class 2 compared with class 3 mutations, findings that remain when analyses are restricted to patients with melanoma or lung primary cancers. MEK ± BRAF inhibitors demonstrated greater clinical activity in class 2 compared with class 3 BRAF-mutant tumors than BRAF or EGFR inhibitors.

CONCLUSION

This meta-analysis suggests that MAPK TTs have clinical activity in some class 2 and 3 BRAF-mutant cancers. BRAF class may dictate responsiveness to current and emerging treatment strategies, particularly in melanoma and lung cancers. Together, this analysis provides clinical validation of predictions made on the basis of a mutation classification system established in the preclinical literature. Further evaluation with prospective clinical trials is needed for this population.
Hypothalamic Overexpression of Makorin Ring Finger Protein 3 Results in Delayed Puberty in Female Mice
Authors: Roberts Stephanie A , Naulé Lydie , Chouman Soukayna , Johnson Tatyana , Johnson Marciana , Carroll Rona S , Navarro Victor M , Kaiser Ursula B
Published: August 2022

Makorin ring finger protein 3 (MKRN3) is an important neuroendocrine player in the control of pubertal timing and upstream inhibitor of gonadotropin-releasing hormone secretion. In mice, expression of Mkrn3 in the hypothalamic arcuate and anteroventral periventricular nucleus is high early in life and declines before the onset of puberty. Therefore, we aimed to explore if the persistence of hypothalamic Mkrn3 expression peripubertally would result in delayed puberty. Female mice that received neonatal bilateral intracerebroventricular injections of a recombinant adeno-associated virus expressing Mkrn3 had delayed vaginal opening and first estrus compared with animals injected with control virus. Subsequent estrous cycles and fertility were normal. Interestingly, male mice treated similarly did not exhibit delayed puberty onset. Kiss1, Tac2, and Pdyn mRNA levels were increased in the mediobasal hypothalamus in females at postnatal day 28, whereas kisspeptin and neurokinin B protein levels in the arcuate nucleus were decreased, following Mkrn3 overexpression, compared to controls. Cumulatively, these data suggest that Mkrn3 may directly or indirectly target neuropeptides of Kiss1 neurons to degradation pathways. This mouse model suggests that MKRN3 may be a potential contributor to delayed onset of puberty, in addition to its well-established roles in central precocious puberty and the timing of menarche.
Young Women Are Protected Against Vascular Insulin Resistance Induced by Adoption of an Obesogenic Lifestyle
Authors: Smith James A , Soares Rogerio N , McMillan Neil J , Jurrissen Thomas J , Martinez-Lemus Luis A , Padilla Jaume , Manrique-Acevedo Camila
Published: August 2022

Vascular insulin resistance is a feature of obesity and type 2 diabetes that contributes to the genesis of vascular disease and glycemic dysregulation. Data from preclinical models indicate that vascular insulin resistance is an early event in the disease course, preceding the development of insulin resistance in metabolically active tissues. Whether this is translatable to humans requires further investigation. To this end, we examined if vascular insulin resistance develops when young healthy individuals (n = 18 men, n = 18 women) transition to an obesogenic lifestyle that would ultimately cause whole-body insulin resistance. Specifically, we hypothesized that short-term (10 days) exposure to reduced ambulatory activity (from >10 000 to <5000 steps/day) and increased consumption of sugar-sweetened beverages (6 cans/day) would be sufficient to prompt vascular insulin resistance. Furthermore, given that incidence of insulin resistance and cardiovascular disease is lower in premenopausal women than in men, we postulated that young females would be protected against vascular insulin resistance. Consistent with this hypothesis, we report that after reduced ambulation and increased ingestion of carbonated beverages high in sugar, young healthy men, but not women, exhibited a blunted leg blood flow response to insulin and suppressed skeletal muscle microvascular perfusion. These findings were associated with a decrease in plasma adropin and nitrite concentrations. This is the first evidence in humans that vascular insulin resistance can be provoked by short-term adverse lifestyle changes. It is also the first documentation of a sexual dimorphism in the development of vascular insulin resistance in association with changes in adropin levels.
Update on Applications and Limitations of Perioperative Tranexamic Acid
Authors: Patel Prakash A. , Wyrobek Julie A. , Butwick Alexander J. , Pivalizza Evan G. , Hare Gregory M. T. , Mazer C. David , Goobie Susan M.
Published: August 2022

Tranexamic acid (TXA) is a potent antifibrinolytic with documented efficacy in reducing blood loss and allogeneic red blood cell transfusion in several clinical settings. With a growing emphasis on patient blood management, TXA has become an integral aspect of perioperative blood conservation strategies. While clinical applications of TXA in the perioperative period are expanding, routine use in select clinical scenarios should be supported by evidence for efficacy. Furthermore, questions regarding optimal dosing without increased risk of adverse events such as thrombosis or seizures should be answered. Therefore, ongoing investigations into TXA utilization in cardiac surgery, obstetrics, acute trauma, orthopedic surgery, neurosurgery, pediatric surgery, and other perioperative settings continue. The aim of this review is to provide an update on the current applications and limitations of TXA use in the perioperative period.
ONTraC: A 20-Year History of a Successfully Coordinated Provincewide Patient Blood Management Program: Lessons Learned and Goals Achieved
Authors: Pavenski Katerina , Howell Alanna , Mazer C. David , Hare Gregory M. T. , Freedman John
Published: August 2022

Our understanding of the risks associated with perioperative anemia and transfusion, in terms of increased morbidity and mortality, has evolved over the past 2 decades. By contrast, our understanding of the potential mechanisms of injury and optimal treatment strategies remains incomplete. As such, the important role of effective patient blood management (PBM) programs, which address both the effective treatment of anemia and minimizes the need for red blood cell (RBC) transfusion, is of central importance to optimizing patient care and improving patient outcomes. We report on important clinical outcomes of the Ontario Transfusion Coordinator (ONTraC Program), a network of 25 hospital sites, working in coordination over the past 20 years. Transfusion nurse coordinators were assigned to apply multimodal best practice in PBM (including recommended changes in surgical approach; diagnosis, assessment, and treatment of anemia; and adherence to more restrictive RBC transfusion thresholds). Data were collected on various clinical parameters. We further described lessons learned and difficulties encountered in this multisite PBM initiative. A significant reduction in RBC transfusions was observed for numerous indexed surgeries. For example, RBC transfusion rates for knee arthroplasty decreased from 25% in 2002 to 0.4% in 2020. For coronary artery bypass graft (CABG) surgery, transfusion rates decreased from 60% in 2002 to 27% in 2020. We also observed a decrease in RBC units utilized per transfused patient for knee (2.1 ± 0.5 [2002] vs 1.0 ± 0.6 [2020] units per patient) and CABG surgery (3.3 ± 0.6 [2002] vs 2.3 ± 1.9 [2020] units per patient). These reductions were associated with favorable clinical outcomes, including reduced length of hospital stay (P = .00003) and a reduced rate of perioperative infections (P < .001) for nontransfused versus transfused patients. These advances have been achieved with estimated savings in the tens of millions of dollars annually. Our experience and data support the hypothesis that instituting an integrated network of transfusion nurse coordinators can provide an effective provincewide PBM program, reduce RBC transfusions, improve some patient outcomes, and reduce health care costs, as an example of a “win-win-win” medical program.
Patients’ Choice, Consent, and Ethics in Patient Blood Management
Authors: Isbister James P. , Pearse Bronwyn L. , Delaforce Alana S. , Farmer Shannon L.
Published: August 2022

The goal of patient blood management (PBM) is to optimize clinical outcomes for individual patients by managing their blood as a precious and unique resource to be safeguarded and managed judiciously. A corollary to successful PBM is the minimization or avoidance of blood transfusion and stewardship of donated blood. The first is achieved by a multidisciplinary approach with personalized management plans shared and decided on with the patient or their substitute. It follows that the physician-patient relationship is an integral component of medical practice and the fundamental link between patient and doctor based on trust and honest communication.

Central to PBM is accurate and timely diagnosis based on sound physiology and pathophysiology as the bedrock on which scientifically based medicine is founded. PBM in all disease contexts starts with the questions, “What is the status of the patient’s blood?” “If there are specific abnormalities in the blood, how should they be managed?” and “If allogeneic blood transfusion is considered, is there no reasonable alternative therapy?” There are compelling scientific reasons to implement a nontransfusion default position when there is clinical uncertainty and questionable evidence of clinical efficacy for allogeneic blood transfusion due to known potential hazards.

Patients must be informed of their diagnosis, the nature, severity and prognosis of the disease, and treatment options along with risks and benefits. They should be involved in decision-making regarding their management. However, as part of this process, there are multifaceted medical, legal, ethical, and economic issues, encompassing shared decision-making, patient choice, and informed consent. Furthermore, variability in patient circumstances and preferences, the complexity of medical science, and the workings of health care systems in which consent takes place can be bewildering, not only for the patient but also for clinicians obtaining consent.

Adding “patient” to the concept of blood management differentiates it from “donor” blood management to avoid confusion and the perception that PBM is a specific medical intervention. Personalized PBM is tailoring the PBM to the specific characteristics of each patient. With this approach, there should be no difficulty addressing the informed consent and ethical aspects of PBM. Patients can usually be reassured that there is nothing out of order with their blood, in which case the focus of PBM is to keep it that way. In some circumstances, a hematologist may be involved as a patient’s blood advocate when abnormalities require expert involvement while the primary disease is being managed.