bluuebunny/crossref_metadata_2025 huggingface dataset:
Conditional donation: Is it justifiable to have different policies for different kinds of tissue?
Authors: Jenkins Simon Paul , Moorlock Greg
Published: December 2022

The question of whether donors should be able to set conditions on who can receive their tissue has been discussed by bioethicists, but so far there has been little consideration of whether the answer to this question should be different depending on the type of tissue under discussion. In this article, we compare the donation of organs with the donation of reproductive material such as sperm, eggs, and embryos, exploring possible arguments for allowing donors to set conditions in one case but not the other. After considering arguments from procreative liberty, special parental obligations, and donors meeting their genetic offspring, we find that there is no ethically defensible reason to have different policies between these two cases. As a consequence, we conclude that jurisdictions operating with this inconsistency should consider moving their policies into better alignment. We also make some recommendations for the standardisation of the terminology around conditional donation.
Folate Metabolism in Hepatocellular Carcinoma. What Do We Know So Far?
Authors: Quevedo-Ocampo Jaqueline , Escobedo-Calvario Alejandro , Souza-Arroyo Verónica , Miranda-Labra Roxana U. , Bucio-Ortiz Leticia , Gutiérrez-Ruiz María C. , Chávez-Rodríguez Lisette , Gomez-Quiroz Luis E.
Published: December 2022

Cancer cells are characterized by accelerated proliferation and an outstanding adaptation of their metabolic pathways to meet energy demands. The folate cycle, also known as folate metabolism or one-carbon metabolism, through enzymatic interconversions, provides metabolites necessary for nucleotide synthesis, methylation, and reduction power, helping to maintain the high rate of proliferation; therefore, the study of this metabolic pathway is of great importance in the study of cancer. Moreover, multiple enzymes involved in this cycle have been implicated in different types of cancer, corroborating the cell's adaptations under this pathology. During the last decade, nonalcoholic fatty liver disease has emerged as the leading etiology related to the rise in the incidence and deaths of hepatocellular carcinoma. Specifically, cholesterol accumulation has been a determinant promoter of tumor formation, with solid evidence that an enriched-cholesterol diet plays a crucial role in accelerating the development of an aggressive subtype of hepatocellular carcinoma compared to other models. In this review, we will discuss the most recent findings to understand the contribution of folate metabolism to cancer cells and tumor microenvironment while creating a link between the dynamics given by cholesterol and methylenetetrahydrofolate dehydrogenase 1-like, a key enzyme of the cycle located in the mitochondrial compartment.
Measurement of the Balance Stability Angle to Predict the Stability Ratio in Patients With Recurrent Anterior Shoulder Dislocation: A Novel Computed Tomography–Based Protocol
Authors: Hu Qingxiang , Zhang Guangcheng , Wu Di , Zhang Haoyu , Hu Hai , Zhan Shi , He Yaohua
Published: December 2022

Background:

The stability ratio (SR) is an important biomechanical parameter for evaluating glenoid stability in patients with recurrent anterior shoulder dislocation (RASD), and it cannot be practically and conveniently measured in clinical scenarios.

Purpose:

To investigate a novel computed tomography (CT)–based protocol to estimate the SR efficiently.

Study Design:

Descriptive laboratory study.

Methods:

A total of 102 patients with RASD were included. Demographic information, CT scans, and bone defect area (BDA) were collected. The new protocol, based on balance stability angle (BSA) measurements on CT, was conducted to estimate the SR (SRCT) by 2 surgeons independently. Biomechanical testing was then performed on patient-specific 3-dimensional (3D)–printed glenoid models to calculate the SR (SR3Dprint), which was used to (1) analyze the reliability of SRCT and (2) examine if the BDA could predict SR3Dprint. To validate whether the 3D-printed glenoid could reflect the actual biomechanical properties of the shoulder, the SR from 5 cadaveric glenoid specimens (SRcadaver) was also calculated and compared with that from the 3D-printed glenoid (SR3Dprint) under 6 osteotomy conditions. Linear regression and intraclass correlation coefficients (ICCs) were used for statistical analysis.

Results:

The interrater reliability of SRCT measurements was high (ICC = 0.95). SRCT was highly correlated with SR3Dprint ( R 2 = 0.86; ICC = 0.92). The mean BDA was 11.44% ± 6.72% by the linear ratio method, with a weak correlation with SR3Dprint ( R 2 = 0.31; ICC = -0.46). The cadaveric validation experiment indicated that SRcadaver was highly correlated with SR3Dprint ( R 2 = 0.86; ICC = 0.77).

Conclusion:

Results indicated that (1) the proposed CT-based protocol of obtaining BSA measurements is promising for the SR estimation in patients with RASD, (2) the BDA was not an effective parameter to predict the biomechanical SR, and (3) the 3D-printed glenoid could reflect the biomechanical properties of cadaveric shoulders regarding the SR estimation.

Clinical Relevance:

Traditional BDA measurements cannot accurately reflect the biomechanical stability of the glenoid. The newly proposed CT-based protocol is practical for surgeons to estimate the SR.
Interventions to Improve Social Climate in Acute Mental Health Inpatient Settings: Systematic Review of Content and Outcomes
Authors: Dickens Geoffrey L. , Johnson Alisha , Steel Kelly , Everett Bronwyn , Tonkin Matthew
Published: December 2022

Introduction

Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings.

Methods

Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed.

Results

Twenty-three papers met inclusion criteria of which 20 used a pretest–posttest study design and three employed randomized and/or controlled designs. Interventions were environmental/structural, operational/process-oriented and developmental/person-oriented in nature and they ranged in complexity. The Ward Atmosphere Scale was the most common outcome measure used. Following quality assessment, six studies were judged to be sufficiently robust in terms of quality, theory-base, user-inclusion, and outcomes evaluation to contribute credibly to the evidence base. Of these, four complex person- and process-oriented intervention studies and two less complex structural/environmental intervention studies resulted in positive outcomes.

Conclusion

There is limited strong evidence that interventions positively influence measures of ward social climate in acute adult mental health settings. Such measures should not be the sole criterion of success when evaluating change. Decisions about implementing change to improve social climate should be informed by meaningful proxy measures including the views and preferences of service users and other stakeholders. Studies using stronger designs are required to establish the ability of interventions to improve social climate.
Dying and death reimagined
Authors: Abel Julian , Kellehear Allan
Published: December 2022

This article presents an interview with lead authors Dr Libby Sallnow and Dr Richard Smith of the ‘Report of the Lancet Commission on the Value of death: bring death back to life’ published in January 2022. The authors are interviewed by Julian Abel, Director of ‘Compassionate Communities UK’, and Allan Kellehear the Co-Editor-in-Chief of ‘Palliative Care & Social Practice’. The interview covers the reasons why the authors believe it is now time to review our major ways of providing care at the end of life including the current efforts in palliative care. The interview also underlines the important points made in the Report, provides reflections on some of its limitations, and suggests the role readers may play in contributing to the Report’s recommendations and challenges.
Overlapping features of therapy-related and de novo NPM1-mutated AML
Authors: Othman Jad , Meggendorfer Manja , Tiacci Enrico , Thiede Christian , Schlenk Richard , Dillon Richard , Stasik Sebastian , Venanzi Alessandra , Bertoli Sarah , Delabesse Eric , Dumas Pierre-Yves , Pigneux Arnaud , Bidet Audrey , Gilkes Amanda F. , Thomas Ian , Voso Maria Teresa , Rambaldi Alessandro , Brunetti Lorenzo , Perriello Vincenzo M. , Andresen Vibeke , Gjertsen Bjorn T. , Martelli Maria Paola , Récher Christian , Röllig Christoph , Bornhäuser Martin , Serve Hubert , Müller-Tidow Carsten , Baldus Claudia D. , Haferlach Tortsten , Russell Nigel , Falini Brunangelo
Published: December 2022

NPM 1-mutated acute myeloid leukemia (AML) shows unique features. However, the characteristics of “therapy-related” NPM1-mutated AML (t-NPM1 AML) are poorly understood. We compared the genetics, transcriptional profile, and clinical outcomes of t-NPM1 AML, de novo NPM1-mutated AML (dn-NPM1 AML), and therapy-related AML (t-AML) with wild-type NPM1 (t-AML). Normal karyotype was more frequent in t-NPM1 AML (n = 78/96, 88%) and dn-NPM1 (n = 1986/2394, 88%) than in t-AML (n = 103/390, 28%; P < .001). DNMT3A and TET2 were mutated in 43% and 40% of t-NPM1 AML (n = 107), similar to dn-NPM1 (n = 88, 48% and 30%; P > 0.1), but more frequently than t-AML (n = 162; 14% and 10%; P < 0.001). Often mutated in t-AML, TP53 and PPM1D were wild-type in 97% and 96% of t-NPM1 AML, respectively. t-NPM1 and dn-NPM1 AML were transcriptionally similar, (including HOX genes upregulation). At 62 months of median follow-up, the 3-year overall survival (OS) for t-NPM1 AML (n = 96), dn-NPM1 AML (n = 2394), and t-AML (n = 390) were 54%, 60%, and 31%, respectively. In multivariable analysis, OS was similar for the NPM1-mutated groups (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.65-1.25; P = .45), but better in t-NPM1 AML than in t-AML (HR, 1.86; 95% CI, 1.30-2.68; P < .001). Relapse-free survival was similar between t-NPM1 and dn-NPM1 AML (HR, 1.02; 95% CI, 0.72-1.467; P = .90), but significantly higher in t-NPM1 AML versus t-AML (HR, 1.77; 95% CI, 1.19-2.64; P = .0045). t-NPM1 and dn-NPM1 AML have overlapping features, suggesting that they should be classified as a single disease entity.
Investigation on the applicability of a long-range reverse-transcription quantitative polymerase chain reaction assay for the rapid detection of active viruses
Authors: Yasuura Masato , Nakaya Yuki , Ashiba Hiroki , Fukuda Takashi
Published: December 2022

Background

Although conventional polymerase chain reaction (PCR) methods are widely used in diagnosis, the titer of the pathogenic virus is difficult to determine based on the PCR. In our prior report, a long-range reverse-transcription quantitative PCR (LR-RT-qPCR) assay was developed to assess the titer of UV-irradiated influenza A virus (IAV) rapidly. In this research, we focused on whether the LR-RT-qPCR assay could evaluate the titer of IAV inactivated by other methods.

Methods

IAV was inactivated by: heating at 100 °C for periods ranging from 1 to 15 min, treating with 0.12% sodium hypochlorite for periods ranging from 3 to 30 min, or treating with 70% ethanol for periods ranging from 10 to 30 min. Fifty percent tissue culture infectious dose (TCID50) assay was performed to confirm the efficacy of the inactivation methods, followed by LR-RT-qPCR to investigate the correlation between infectivity and copy number.

Results

One minute heating, 3 min sodium hypochlorite treatment, or 10 min ethanol treatment was sufficient to deactivate IAV. Changes before and after the inactivations in the copy numbers on LR-RT-qPCR were significantly different among the inactivation methods. Heat-inactivation drastically decreased the copy number to below the cutoff value around 5 copies/μL after 5 min treatment. The inactivation time of heating estimated using LR-RT-qPCR was marginally higher than that determined using TCID50. However, the treatments with sodium hypochlorite or ethanol moderately and minimally affected the copy numbers obtained using LR-RT-qPCR (~ 1 digit or no copy number decrease), respectively.

Conclusions

In addition to good applicability in UV-irradiation previously reported, the LR-RT-qPCR method is suitable for evaluating the effect of heat-inactivation on IAV infectivity. However, minor modifications may be made and investigated in the future to reduce the time intervals with TCID50. Although this method is not applicable for the ethanol inactivation, rapid evaluation of the effects of chlorination on IAV can be determined by comparing copy numbers before and after treatment using the LR-RT-qPCR method.
Transcriptome analysis provides insights into light condition effect on paclitaxel biosynthesis in yew saplings
Authors: Li Taotao , Li Bingbing , Liao Chunli , Zhang Huamin , Wang Lianzhe , Fu Taotao , Xue Shouyu , Sun Tao , Xu Xiaolan , Fan Xin , Li Le , Liu Genglin , Yang Fengling , Ma Xuan
Published: December 2022

Background

Taxus is a rare gymnosperm plant that is the sole producer of the anticancer drug paclitaxel. The growth and development of Taxus is affected by environmental factors such as light. However, little is known about how light conditions affect growth and metabolic processes, especially paclitaxel biosynthesis.

Results

In this study, we applied three different light conditions to Taxus chinensis young saplings and investigated the physiological response and gene expression. Our observations showed that exposure to high light led to oxidative stress, caused photoinhibition, and damaged the photosynthetic systems in T. chinensis. The paclitaxel content in T. chinensis leaves was significantly decreased after the light intensity increased. Transcriptomic analysis revealed that numerous genes involved in paclitaxel biosynthesis and phenylpropanoid metabolic pathways were downregulated under high light. We also analyzed the expression of JA signaling genes, bHLH, MYB, AP2/ERF transcription factors, and the CYP450 families that are potentially related to paclitaxel biosynthesis. We found that several CYP450s, MYB and AP2/ERF genes were induced by high light. These genes may play an important role in tolerance to excessive light or heat stress in T. chinensis.

Conclusions

Our study elucidates the molecular mechanism of the effects of light conditions on the growth and development of T. chinensis and paclitaxel biosynthesis, thus facilitating the artificial regeneration of Taxus and enhancing paclitaxel production.
Time-dependent risk of COVID-19 death with overwhelmed health-care capacity in Japan, 2020–2022
Authors: Hayashi Katsuma , Nishiura Hiroshi
Published: December 2022

Background

It has been descriptively argued that the case fatality risk (CFR) of coronavirus disease (COVID-19) is elevated when medical services are overwhelmed. The relationship between CFR and pressure on health-care services should thus be epidemiologically explored to account for potential epidemiological biases. The purpose of the present study was to estimate the age-dependent CFR in Tokyo and Osaka over time, investigating the impact of caseload demand on the risk of death.

Methods

We estimated the time-dependent CFR, accounting for time delay from diagnosis to death. To this end, we first determined the time distribution from diagnosis to death, allowing variations in the delay over time. We then assessed the age-dependent CFR in Tokyo and Osaka. In Osaka, the risk of intensive care unit (ICU) admission was also estimated.

Results

The CFR was highest among individuals aged 80 years and older and during the first epidemic wave from February to June 2020, estimated as 25.4% (95% confidence interval [CI] 21.1 to 29.6) and 27.9% (95% CI 20.6 to 36.1) in Tokyo and Osaka, respectively. During the fourth wave of infection (caused by the Alpha variant) in Osaka the CFR among the 70s and ≥ 80s age groups was, respectively, 2.3 and 1.5 times greater than in Tokyo. Conversely, despite the surge in hospitalizations, the risk of ICU admission among those aged 80 and older in Osaka decreased. Such time-dependent variation in the CFR was not seen among younger patients < 70 years old. With the Omicron variant, the CFR among the 80s and older in Tokyo and Osaka was 3.2% (95% CI 3.0 to 3.5) and 2.9% (95% CI 2.7 to 3.1), respectively.

Conclusion

We found that without substantial control, the CFR can increase when a surge in cases occurs with an identifiable elevation in risk—especially among older people. Because active treatment options including admission to ICU cannot be offered to the elderly with an overwhelmed medical service, the CFR value can potentially double compared with that in other areas of health care under less pressure.
Detecting immunoglobulin G4-related intracranial arteriopathy with magnetic resonance vessel wall imaging: a preliminary experience in two cases
Authors: Mitani Koki , Funaki Takeshi , Tanji Masahiro , Onizawa Hideo , Yoshifuji Hajime , Fushimi Yasutaka , Torimaki Shinya , Yoshida Kazumichi , Miyamoto Susumu
Published: December 2022

Background

Detecting immunoglobulin G4 (IgG4)-related intracranial arteriopathy, a rare neurovascular complication of IgG4-related disease, is challenging. While magnetic resonance (MR) vessel wall imaging (VWI) can visualize various neurovascular pathologies, its application to this arteriopathy has not been reported as of this writing.

Case presentation

A 74-year-old male and a 65-year-old female manifested multiple cranial nerve palsy and neck pain, respectively. Both cases exhibited multiorgan masses with markedly elevated serum IgG4 levels and were clinically diagnosed with IgG4-related disease. Three-dimensional T1-weighted black blood VWI with and without contrast agent identified intracranial vascular lesions characterized as nearly-circumferential mural thickening with homogeneous contrast enhancement in the internal carotid and vertebral arteries; some of the lesions had been unrecognized with screening MR angiography due to expansive remodeling. The former patient underwent corticosteroid therapy, and VWI after treatment revealed decreased mural thickening and enhancement.

Conclusion

Further studies to elucidate characteristic findings of VWI might contribute to early detection of this treatable pathology.
Antenatal care utilization during the COVID-19 pandemic: an online cross-sectional survey among Filipino women
Authors: de Guzman Glaiza S. , Banal-Silao Maria Jesusa B.
Published: December 2022

Background

The COVID-19 pandemic resulted in unprecedented challenges to healthcare systems worldwide, including interruption of antenatal care services. The study aimed to determine the utilization of antenatal care services of Filipino women during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among postpartum women using an online self-administered survey in the Philippines from January 1 to March 31, 2022. The questionnaire used to assess health-seeking behavior was validated before the survey proper. Women aged 18 to 45 years who delivered in 2021 were recruited. The participants answered a structured questionnaire to assess their access, perceptions, and utilization of antenatal care. Utilization of antenatal care was evaluated using standard measures, including the timing of initiation of antenatal care, number of subsequent visits, and place of consults. The factors affecting the adequacy of antenatal care were determined for each variable through simple logistic regression.

Results

A total of 318 women were enrolled in the study. All the respondents agreed on the necessity of antenatal care. However, only 46.37% had six or more in-person antenatal visits, with the majority attended to by midwives at community health centers. Most respondents (71.38%) initiated antenatal care during the first trimester. Almost half reported deferrals of visits mainly due to lockdown restrictions, transportation problems, and financial issues. Positive predictors of adequate antenatal care were prior pregnancies (OR 1.80, 95% CI 1.11–9.20 for 2–3 prior pregnancies; OR 3.02, 95% CI 1.45–6.29 for 4 or more prior pregnancies), live births (OR 1.67, 95% CI 1.04–2.69 for 2–3 prior live births; OR 2.46, 95% CI 1.17–5.16 for 4 or more prior live births), having living children (OR 1.74, 95% CI 1.09–2.79), spousal support (OR 1.75, 95% CI 1.01–3.03 for married women; OR 1.89, 95% CI 1.09–3.28 for women with common-law partners), history of obstetric complications (OR 2.82, 95% CI 1.33–5.97), and use of private vehicles (OR 2.65, 95% CI 1.05–6.68). Negative predictors were employment (OR 0.37, 95% CI 0.22–0.63) and medical examination prior to pregnancy (OR 0.36, 95% CI 0.23–0.58).

Conclusion

Despite an overall positive perception of the necessity of antenatal care, utilization has been inadequate in more than half of the respondents. Various individual, facility, and policy-level factors affected the utilization of services during the pandemic. There is a need to augment antenatal care services in the country by mitigating barriers to access. The public health response should strengthen collaborative efforts with primary-level healthcare to increase service provision, especially to more vulnerable populations.
The incidence and risk factors of meconium amniotic fluid in singleton pregnancies: an experience of a tertiary hospital in Iran
Authors: Shekari Mitra , Jahromi Malihe Shirzadfard , Ranjbar Amene , Mehrnoush Vahid , Darsareh Fatemeh , Roozbeh Nasibeh
Published: December 2022

Background

Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development; however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies.

Methods

This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors.

Results

Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20–34 years old (aOR: 3.07, 95% CI: 1.87–4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76–8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92–9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11–4.99).

Conclusions

Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.
Regular lung recruitment maneuvers during high-frequency oscillatory ventilation in extremely preterm infants: a randomized controlled trial
Authors: Werther Tobias , Kueng Erik , Aichhorn Lukas , Pummer Linda , Goeral Katharina , Berger Angelika , Hermon Michael , Klebermass-Schrehof Katrin
Published: December 2022

Background

Lung recruitment maneuvers (LRMs) improve lung volume at initiation of high-frequency oscillatory ventilation (HFOV), but it is unclear when to repeat LRMs. We evaluated the efficiency of scheduled LRMs.

Methods

In a randomized controlled trial, extremely preterm infants on HFOV received either LRMs at 12-hour intervals and when clinically indicated (intervention) or only when clinically indicated (control). The primary outcome was the cumulative oxygen saturation index (OSI) over HFOV time, limited to 7 days. Additionally, LRMs were analyzed with respect to OSI improvement.

Results

Fifteen infants were included in each group. The mean (SD) postmenstrual age and weight at HFOV start were 23 + 6 (0 + 5) weeks and 650 (115) g in the intervention group and 24 + 4 (0 + 6) weeks (p = 0.03) and 615 (95) g (p = 0.38) in the control group. The mean (SD) cumulative OSI amounted to 4.95 (1.72) in the intervention versus 5.30 (2.08) in the control group (p = 0.61). The mean (SD) number of LRMs in 12 h was 1.3 (0.2) in the intervention versus 1.1 (0.5) in the control group (p = 0.13). Performing LRM when FiO2 > 0.6 resulted in a mean OSI reduction of 3.6.

Conclusion

Regular versus clinically indicated LRMs were performed with equal frequency in preterm infants during HFOV, and consequently, no difference in lung volume was observed. LRMs seem to be most efficient at high FiO2.

Trial registration

ClinicalTrials.gov ID: NCT04289324 (28/02/2020).
The costs of interventions for type 2 diabetes mellitus, hypertension and cardiovascular disease in South Africa – a systematic literature review
Authors: Masuku Sithabiso D. , Lekodeba Nkgomeleng , Meyer-Rath Gesine
Published: December 2022

Background

In the context of a move to universal health coverage, three separate systematic reviews were conducted to summarise available evidence on the direct costs of interventions for type 2 diabetes mellitus, hypertension, and cardiovascular disease in South Africa.

Methods

PubMed® and Web of Science was searched for literature published between 01 and 1995 and 27 October 2022. Additionally, reference and citations lists of retrieved articles and experts were consulted. We also tracked reference lists of previous, related systematic reviews. Eligible publications were cost analyses of clinical interventions targeted at adults age 15 + reporting primary estimates of in- and out-of-hospital costs from a provider perspective. Costs were extracted and converted to 2021 US dollars, and article methodological and reporting quality was appraised using the 2013 CHEERS checklist.

Results

Of the 600, 1,172 and 1,466 identified publications for type 2 diabetes mellitus, hypertension, and cardiovascular disease, respectively, 10, 12, and 17 met full inclusion criteria. 60% of articles reported cardiovascular disease costs, 52% were of good reporting quality, and 10%, 50%, and 39% of type 2 diabetes mellitus, hypertension and cardiovascular disease papers reported private-sector costs only. Hypertension drug costs ranged from $2 to $85 per person-month, while type 2 diabetes mellitus drug costs ranged between $57 and $630 per person-year (ppy). Diabetes-related complication treatment costs ranged from $55 for retinopathy treatment to $25,193 ppy for haemodialysis, while cardiovascular disease treatment costs were between $160 and $37,491 ppy. Drugs and treatment of complications were major cost drivers for hypertension and type 2 diabetes mellitus, while hospitalisation drove cardiovascular disease costs.

Conclusion

The intervention costs of type 2 diabetes mellitus, hypertension and cardiovascular disease care have received more attention recently, particularly diabetes-related complications and cardiovascular disease. However, 39% of identified cardiovascular disease treatment costs used a private sector perspective, leaving significant research gaps in the public sector and the cheaper to treat hypertension and type 2 diabetes mellitus. This review fills an information gap regarding the intervention costs of these diseases in South Africa.
Impact of national COVID-19 restrictions on incidence of notifiable communicable diseases in England: an interrupted time series analysis
Authors: Nash Katrina , Lai Jo , Sandhu Karanbir , Chandan Joht Singh , Shantikumar Saran , Ogunlayi Fatai , Coleman Paul C.
Published: December 2022

Background

Non-pharmaceutical interventions (NPIs), such as travel restrictions, social distancing and isolation policies, aimed at controlling the spread of COVID-19 may have reduced transmission of other endemic communicable diseases, such as measles, mumps and meningitis in England.

Methods

An interrupted time series analysis was conducted to examine whether NPIs was associated with trends in endemic communicable diseases, using weekly reported cases of seven notifiable communicable diseases (food poisoning, measles, meningitis, mumps, scarlet fever and pertussis) between 02/01/2017 to 02/01/2021 for England.

Results

Following the introduction of COVID-19 restrictions, there was an 81.1% (95% CI; 77.2–84.4) adjusted percentage reduction in the total number of notifiable diseases recorded per week in England. The greatest decrease was observed for measles, with a 90.5% percentage reduction (95% CI; 86.8–93.1) from 42 to 5 cases per week. The smallest decrease was observed for food poisoning, with a 56.4% (95%CI; 42.5–54.2) decrease from 191 to 83 cases per week.

Conclusions

A total reduction in the incidence of endemic notifiable diseases was observed in England following the implementation of public health measures aimed at reducing transmission of SARS-COV-2 on March 23, 2020. The greatest reductions were observed in diseases most frequently observed during childhood that are transmitted via close human-to-human contact, such as measles and pertussis. A less substantive reduction was observed in reported cases of food poisoning, likely due to dining services (i.e., home deliveries and takeaways) remaining open and providing a potential route of transmission. This study provides further evidence of the effectiveness of non-pharmaceutical public health interventions in reducing the transmission of both respiratory and food-borne communicable diseases.
AO distractor and manual traction reduction techniques repair in distal tibial fractures: a comparative study
Authors: Wu Hao-Jun , He Yan-Xia , Hang Chen , Hao Lin , Lin Ting-Kui
Published: December 2022

Background

Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation. The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures.

Methods

Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader.

Results

Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p = 0.019, 0.018 and 0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p = 0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p = 0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening > 10 mm.

Conclusion

Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.
OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score
Authors: Spiegl Ulrich J. , Behr Lars , Osterhoff Georg , Rupprecht Gunnar , Scheyerer Max J. , Katscher Sebastian
Published: December 2022

Objectives

The purpose of this study was to investigate whether the addition of computed tomography (CT) to magnetic resonance imaging (MRI) improves the accuracy of classifying osteoporotic vertebral body fractures (OVBF).

Methods

A retrospective analysis of a prospective single-center database has been performed. All consecutive patients who had suffered an acute thoracolumbar OVBF in one level II spine center between 2017 and 2019 were analyzed. Thereby, fractures of type OF 1 and OF 5 were excluded. All fractures were initially classified by 5 board-certified orthopaedic surgeons based on MRI and conventional radiographs. Afterwards a reclassification including CT scans were performed. Differences in OF classification and OF score values between both measurements were analyzed.

Results

A total of 61 patients were analyzed with a mean age 75.8 years (SD: 8.8 years). In 82.9% of the cases, there was no difference in OF classification comparing classification based only on MRI versus MRI + CT. A difference of more than two OF types was observed in less than 1% of all ratings. The inter-rater reliabilities of the OF classification based on CT + MRI and MRI alone were 0.63 and 0.49, respectively. In 97.5% of the cases there was no therapy-relevant difference of the treatment recommendation with respect of a surgical or nonoperative treatment recommendation based on the OF score.

Conclusion

In terms of the OF classification and the OF score, the addition of CT add limited value compared to conventional radiographs and MRI only. Additionally, there is only a minor rate of disagreement in treatment recommendations when adding a CT.
Palliative care outpatients in a German comprehensive cancer center—identifying indicators for early and late referral
Authors: Müller S. , Fink M. , Hense J. , Comino M. R. Salvador , Schuler M. , Teufel M. , Tewes M.
Published: December 2022

Purpose

Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center.

Methods

Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3–12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal–Wallis test was used to determine symptom severity and laboratory parameter in each referral category.

Results

LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER.

Conclusion

A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.
Sexual dysfunction in women with genital warts: a systematic review
Authors: Adeli Mohadese , Moghaddam-Banaem Lida , Shahali Shadab
Published: December 2022

Purpose

To provide an understanding of the changes in sexual function in women with genital warts.

Methods

In this review study, databases searched included: PubMed, Science Direct, Scopus, Web of Science, Cochrane Library of Systematic Reviews, Google Scholar, ProQuest, Wiley, and Highwire Press. No study design limitations were applied to the initial search, and qualitative and quantitative studies published between 2005 and 2021 were included.

Results

19 articles were selected and analyzed narratively. The quality of the studies was almost good. The findings were classified into three groups: The prevalence of sexual dysfunction in women with genital warts (GWs) and Human Papillomavirus (HPV); Types of sexual dysfunction in women with genital warts, and associated factors; Psychosexual effects of genital warts.

Conclusion

This study provides up-to-date evidence of the changes in sexual function in women with genital warts. Although the results of most studies showed that women with genital warts experienced sexual dysfunction in almost all dimensions, differences in study design and study population made it difficult to determine the specific type of disorder such as libido, or arousal disorders in these women. Based on the findings of this review, more research in this field is recommended for the future.

Systematic review registration: (PROSPERO: CRD42020188584, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=188584).
Value of endometrial thickness for the detection of endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women
Authors: Zhang Linna , Guo Ying , Qian Guxia , Su Tao , Xu Hong
Published: December 2022

Background

The role of transvaginal sonography (TVS) in screening endometrial cancer and hyperplasia is significant in postmenopausal women. The objective of this study is to determine the endometrium thickness (ET) cut-off to distinguish premalignancy and malignancy in asymptomatic postmenopausal women.

Methods

We retrospectively evaluated data of 968 eligible patients among 2537 asymptomatic postmenopausal women with ET ≥ 5 mm examined by TVS who were subjected to hysteroscopy and endometrial biopsy between January 1, 2017, and June 30, 2020 in an urban tertiary specialized hospital in China. The patients were divided into two groups according to the pathology outcomes: benign, and atypical hyperplasia (AH) and endometrial carcinoma (EC). The risk factors and the optimal cut-off of ET for detecting AH and EC were determined by logistic regression analysis and receiver operating characteristic curve.

Results

2537 patients were offered hysteroscopy during a 42-month period. Finally, 968 patients were included for further analysis. Of these, 8 (0.8%) women were diagnosed with EC and 5 (0.5%) women with AH. The mean ET of AH and EC group was substantially higher than that in benign group (10.4 mm vs. 7.7 mm, P < 0.05). ET was significantly correlated with AH and EC shown by logistic regression analysis with an odds ratio (OR) of 1.252 (95% confidence interval [CI] 1.107–1.416, P < 0.001). The optimal cut-off value for AH and EC was found to be 8 mm with the maximum AUC of 0.715 (95% CI 0.686–0.743, P < 0.001), with a sensitivity of 0.846, a specificity of 0.609, positive likelihood ratio (LR+) of 2.164 and negative likelihood ratio (LR−) of 0.253.

Conclusion

An ET cut-off of ≥ 8 mm shows a reasonable performance to detect AH and EC in asymptomatic postmenopausal women, thereby avoiding more invasive endometrial biopsy.
Conservative non-pharmacological interventions in women with pelvic floor dysfunction: a systematic review of qualitative studies
Authors: Fernandes Ana Carolina Nociti Lopes , Palacios-Ceña Domingo , Pena Caroline Caetano , Duarte Thaiana Bezerra , de la Ossa Aura Maria Paternina , Jorge Cristine Homsi
Published: December 2022

Background

Women’s adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options.

Methods

A systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed.

Results

It was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women’s experience with PFMT. The findings were synthesized as follows: I) women’s experience of manual interventions; II) women’s experience using vaginal devices changes according to health professional attitudes; III) women’s experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women’s perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women’s adherence; VIII) strategies used by women to include PFMT in their routine.

Conclusion

Women’s experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).
Brain edema after oocyte retrieval: a case report
Authors: Fan Lijuan , Wen Wen , Zhou Hanying
Published: December 2022

Background

Brain edema is a rare and serious complication of assisted reproductive technology (ART). The increased intracranial pressure and injured brain parenchyma are life-threatening and may even result in death. The pathogenesis may involve increased vascular permeability mediated by vascular endothelial growth factor and other vasoactive substances, including interleukin 6, interleukin 1β, angiotensin II, insulin-like growth factor 1, transforming growth factor β, and the renin–angiotensin system.

Case presentation

We presented a unique case report of a 29-year-old woman developed sudden irritability, blurred consciousness, and vomiting 8 h after oocyte retrieval. Blood examinations showed hyponatremia and cranial computed tomography showed swelling of the brain parenchyma. After therapeutic use of hypertonic saline and mannitol infusion, the patient’s consciousness recovered and her neurological state improved.

Conclusions

Brain edema is a rare and serious complication of ART. Quick infusion of hypertonic salt solution and mannitol is a key treatment. A good prognosis can be achieved after prompt treatment.
Antimalarial and immunomodulatory potential of chalcone derivatives in experimental model of malaria
Authors: Sinha Shweta , Medhi Bikash , Radotra B. D. , Batovska Daniela I. , Markova Nadezhda , Bhalla Ashish , Sehgal Rakesh
Published: December 2022

Background

Malaria is a complex issue due to the availability of few therapies and chemical families against Plasmodium and mosquitoes. There is increasing resistance to various drugs and insecticides in Plasmodium and in the vector. Additionally, human behaviors are responsible for promoting resistance as well as increasing the risk of exposure to infections. Chalcones and their derivatives have been widely explored for their antimalarial effects. In this context, new derivatives of chalcones have been evaluated for their antimalarial efficacy.

Methods

BALB/c mice were infected withP. bergheiNK-65. The efficacy of the three most potent chalcone derivations (1, 2, and 3) identified after an in vitro compound screening test was tested. The selected doses of 10 mg/kg, 20 mg/kg, and 10 mg/kg were studied by evaluating parasitemia, changes in temperature, body weights, organ weights, histopathological features, nitric oxide, cytokines, and ICAM-1 expression. Also, localization of parasites inside the two vital tissues involved during malaria infections was done through a transmission electron microscope.

Results

All three chalcone derivative treated groups showed significant (p < 0.001) reductions in parasitemia levels on the fifth and eighth days of post-infection compared to the infected control. These derivatives were found to modulate the immune response in aP. bergheiinfected malaria mouse model with a significant reduction in IL-12 levels.

Conclusions

The present study indicates the potential inhibitory and immunomodulatory actions of chalcones against the rodent malarial parasiteP. berghei.
The effect of access to electronic resources during examination on medical and dental students scores in summative assessment: quasi experimental study
Authors: Al-Sharbatti Shatha , Hamdy Hossam , Kassab Salah Eldin , Venkatramana Manda
Published: December 2022

Background

Access to electronic (E) resources has become an indispensable requirement in medical education and practice.

Objective

Our objective was to assess the effect of E-resources access during examination on end-course-exam scores of medical and dental students.

Methods

A quasi-experimental study which included two cohorts of medical (n = 106 & 85) and three cohorts of dental students (n = 66, 64 and 69) who took end-course- exams. Each exam was composed of two- parts (Part I and II), that encompassed equal number of questions and duration. Access to E-resources was allowed in part-II only. Items Difficulty Index (DI), Discrimination Index, (DisI), Point Biserial, (PBS) and cognitive level were determined.

Results

The study included 390 students. The proportion of items at various levels of DI, DisI, and PBS and the average values for item DI, DisI in both parts of each exam were comparable. The average scores in part-II were significantly higher than part-I (P < 0.001, < 0.001 and 0.04) and lower-order cognitive-level items scores were higher in three exams (P < 0.0001, 0.0001, 0.0001). Higher- order cognitive level items scores were comparable between part I and II in all courses. The significant factor for change in marks were questions cognitive level and type of the course.

Conclusion

Access to E-resources during examination does not make a significant difference in scores of higher-order cognitive level items. Question cognitive level and course type were the significant factors for the change in exam scores when accessing E-resources. Time-restricted E-resources accessed tests that examine higher cognitive level item had no significant academic integrity drawback.