bluuebunny/crossref_metadata_2025 huggingface dataset:
Distribution of microbiota in cervical preneoplasia of racially disparate populations
Authors: Vikramdeo Kunwar Somesh , Anand Shashi , Pierce Jennifer Young , Singh Ajay Pratap , Singh Seema , Dasgupta Santanu
Published: October 2022

Backgrounds

Microbiome dysbiosis is an important contributing factor in tumor development and thus may be a risk predictor for human malignancies. In the United States, women with Hispanic/Latina (HIS) and African American (AA) background have a higher incidence of cervical cancer and poorer outcomes than Caucasian American (CA) women.

Methods

Here, we assessed the distribution pattern of microbiota in cervical intraepithelial neoplasia (CIN) lesions obtained from HIS (n = 12), AA (n = 12), and CA (n = 12) women, who were screened for CC risk assessment. We employed a 16S rRNA gene sequencing approach adapted from the NIH-Human Microbiome Project to identify the microbial niche in all CIN lesions (n = 36).

Results

We detected an appreciably decreased abundance of beneficial Lactobacillus in the CIN lesions of the AA and HIS women compared to the CA women. Differential abundance of potentially pathogenic Prevotella, Delftia, Gardnerella, and Fastidiosipila was also evident among the various racial groups. An increased abundance of Micrococcus was also evident in AA and HIS women compared to the CA women. The detection level of Rhizobium was higher among the AA ad CA women compared to the HIS women. In addition to the top 10 microbes, a unique niche of 27 microbes was identified exclusively in women with a histopathological diagnosis of CIN. Among these microbes, a group of 8 microbiota; Rubellimicrobium, Podobacter, Brevibacterium, Paracoccus, Atopobium, Brevundimonous, Comamonous, and Novospingobium was detected only in the CIN lesions obtained from AA and CA women.

Conclusions

Microbial dysbiosis in the cervical epithelium represented by an increased ratio of potentially pathogenic to beneficial microbes may be associated with increased CC risk disparities. Developing a race-specific reliable panel of microbial markers could be beneficial for CC risk assessment, disease prevention, and/or therapeutic guidance.
Impact of transitioning to virtual delivery of a cardiovascular health improvement program for Latinos during the COVID-19 pandemic
Authors: Iglesias Amelia , Ambrose Ashley , Coronel-Mockler Stephanie , Kilbourn Kristin , Bonaca Marc P. , Estacio Raymond O. , Krantz Mori J.
Published: October 2022

Background

Community Heart Health Actions for Latinos at Risk (CHARLAR) is a promotora-led cardiovascular disease (CVD) risk-reduction program for socio-demographically disadvantaged Latinos and consists of 11 skill-building sessions. The COVID-19 pandemic has led to worsening health status in U.S. adults and necessitated transition to virtual implementation of the CHARLAR program.

Methods

A mixed-methods approach was used to evaluate virtual delivery of CHARLAR. Changes in health behaviors were assessed through a pre/post program survey. Results from virtual and historical (in-person delivery) were compared. Key informant interviews were conducted with promotoras and randomly selected participants and then coded and analyzed using a thematic approach.

Results

An increase in days of exercise per week (+ 1.52), daily servings of fruit (+ 0.60) and vegetables (+ 0.56), and self-reported general health (+ 0.38), were observed in the virtual cohort [all p < 0.05]. A numeric decrease in PHQ-8 (-1.07 p = 0.067) was also noted. The historical cohort showed similar improvements from baseline in days of exercise per week (+ 0.91), daily servings of fruit (+ 0.244) and vegetables (+ 0.282), and PHQ-8 (-1.89) [all p < 0.05]. Qualitative interviews revealed that the online format provided valuable tools supporting positive behavior change. Despite initial discomfort and technical challenges, promotoras and participants adapted and deepened valued relationships through additional virtual support.

Conclusion

Improved health behaviors and CVD risk factors were successfully maintained through virtual delivery of the CHARLAR program. Optimization of virtual health programs like CHARLAR has the potential to increase reach and improve CVD risk among Latinos.
Establishment and application of information-based training and assessment platform for clinical nursing operation technology
Authors: Zheng Xing , Ma Aixia , Huang Jingai , Liu Chunlan
Published: October 2022

Background

The paper version of the training assessment was time-consuming and labor-consuming. It is an inevitable trend to change the appraisal method utilizing information technology. This study aimed to realize convenient and rapid management of the whole process of clinical nursing operation technology through information-based training and assessment platform.

Methods

Combined with the operation mode of clinical nursing operation skills and set the basic functions of the information platform of clinical nursing operation training and assessment, the information-based training and evaluation platform for clinical nursing operation skills was established. The platform was officially operated in a tertiary level A general hospital in Shandong Province in 2018.

Results

The information-based training and assessment platform is composed of Management Center (Computer Terminal) and a client terminal (APP terminal). The computer terminal contains 11 modules, and the APP terminal contains 8 modules. By December 2020, a total of 12,619 nurses had completed the training in nursing operation skills, and a total of 11,986 nurses had completed the examination. The examination results of nursing operation skills of the same nurses in 2018 were significantly higher than those in 2017(P < 0.05), and the error rate was significantly lower (P < 0.05). From 2016 to 2020, the scores of nasal feeding, CPR, and respiratory airbag of N1 level nurses significantly increased after using the information-based training and Assessment Platform (P < 0.05).

Conclusion

Based on the information terminal training assessment can realize the management of the whole process of clinical nursing operation technology training and assessment, which is better than the traditional method, and is a very practical and convenient clinical training and assessment method.
Measuring continuity of ambulatory cardiovascular care: a cross-sectional study on the applicability of the Nijmegen Continuity Questionnaire in Germany
Authors: Hennrich Patrick , Arnold Christine , Koetsenruijter Jan , Wensing Michel
Published: October 2022

Background

Chronic cardiovascular diseases demand continuous care from general practitioners and medical specialists. Especially in fragmented healthcare systems, such as in Germany, a large body of research is devoted to the improvement of care continuity. Meanwhile, measuring continuity of care itself has been a challenge due to the absence of validated instruments. In 2011, the Dutch Nijmegen Continuity Questionnaire (NCQ) was developed and validated to measure continuity of care across care settings from the patients’ perspectives in the Netherlands. Its applicability in other countries and health systems, however, has rarely been tested. We therefore aimed at assessing the applicability of the Nijmegen Continuity Questionnaire to the German health care context. 

Methods

We translated and applied the original NCQ to an ambulatory cardiovascular care setting in Germany. Qualitative interview data and quantitative survey data on our adaptation were collected from patients in 27 general practices within the German states of Baden-Wuerttemberg and Rhineland-Palatinate. Qualitative data on understandability and clearness of the questionnaire was obtained using semi-structured telephone interviews and think aloud-protocols. Quantitative data was obtained through an anonymous written questionnaire containing the translated NCQ items to assess applicability of our translation. We performed confirmatory and exploratory factor analyses based on the original NCQ-structure mapped to general practitioners and an aggregated analysis of general practitioners and cardiologists combined.

Results

A total of 6 patients participated in the interviews and a total of 435 patients participated in the written survey. The interviews showed that, overall, patients had little difficulties comprehending and answering to our translation of the NCQ. The confirmatory factor analyses then showed that the structure of the original NCQ with 12 items and 3 latent factors can also be found in the German context. However, a simpler 2-factor-structure would also fit well with the data.

Conclusion

A German translation of the NCQ yielded a factor structure comparable to the original version and proved to be understandable for patients.

Trial registration

The project underlying the study was registered on November 7, 2019 in the German Clinical Trials Register (www.drks.de) under ID: DRKS00019219.
Development and operationalization of a data framework to assess quality of integrated diabetes care in the fragmented data landscape of Belgium
Authors: Buffel Veerle , Danhieux Katrien , Bos Philippe , Remmen Roy , Van Olmen Josefien , Wouters Edwin
Published: October 2022

Background

To assess the quality of integrated diabetes care, we should be able to follow the patient throughout the care path, monitor his/her care process and link them to his/her health outcomes, while simultaneously link this information to the primary care system and its performance on the structure and organization related quality indicators. However the development process of such a data framework is challenging, even in period of increasing and improving health data storage and management. This study aims to develop an integrated multi-level data framework for quality of diabetes care and to operationalize this framework in the fragmented Belgium health care and data landscape.

Methods

Based on document reviews, iterative working group discussions and expert consultations, theoretical approaches and quality indicators were identified and assessed. After mapping and assessing the validity of existing health information systems and available data sources through expert consultations, the theoretical framework was translated in a data framework with measurable quality indicators. The construction of the data base included sampling procedures, data-collection, and several technical and privacy-related aspects of linking and accessing Belgian datasets.

Results

To address three dimensions of quality of care, we integrated the chronic care model and cascade of care approach, addressing respectively the structure related quality indicators and the process and outcome related indicators. The corresponding data framework is based on self-collected data at the primary care practice level (using the Assessment of quality of integrated care tool), and linked health insurance data with lab data at the patient level.

Conclusion

In this study, we have described the transition of a theoretical quality of care framework to a unique multilevel database, which allows assessing the quality of diabetes care, by considering the complete care continuum (process and outcomes) as well as organizational characteristics of primary care practices.
Development and validation of a simple tool composed of items on dyspnea, respiration rates, and C-reactive protein for pneumonia prediction among acute febrile respiratory illness patients in primary care settings
Authors: Ding Fengming , Han Lei , Yin Dongning , Zhou Yan , Ji Yong , Zhang Pengyu , Wu Wensheng , Chen Jijing , Wang Zufang , Fan Xinxin , Zhang Guoqing , Zhang Min
Published: October 2022

Background

Acute febrile respiratory illness (AFRI) patients are susceptible to pneumonia and suffer from significant morbidity and mortality throughout the world. In primary care settings, the situation is worse. Limited by computerized tomography resources and physician experiences, AFRI patients in primary care settings may not be diagnosed appropriately, which would affect following treatment. In this study, we aimed to develop and validate a simple prediction model to help physicians quickly identify AFRI patients of pneumonia risk in primary care settings.

Methods

A total of 1977 AFRI patients were enrolled at two fever clinics in Shanghai, China, and among them, 727 patients who underwent CT scans were included in the analysis. Acute alveolar or interstitial infiltrates found on CT images were diagnosed with pneumonia. Characteristics and blood parameters were compared between pneumonia and non-pneumonia patients. Then a multivariable model for pneumonia prediction was developed through logistic regression analysis. Its value for pneumonia prediction was prospectively assessed in an external multi-center population, which included 1299 AFRI patients in primary settings from 5 different provinces throughout China.

Results

In the model development population, pneumonia patients (n = 227) had a longer duration of fever; higher frequencies of purulent sputum, dyspnea, and thoracic pain; and higher levels of respiration rates and C-reactive protein (CRP) than non-pneumonia patients (n = 500). Logistic regression analysis worked out a model composed of items on dyspnea, respiration rates > 20/min, and CRP > 20 mg/l (DRC) for pneumonia prediction with an area under curve (AUC) of 0.8506. In the external validation population, the predictive accuracy of the DRC model was the highest when choosing at least one positive item (1 score) as a cut-off point with a sensitivity of 87.0% and specificity of 80.5%. DRC scores increased with pneumonia severity and lung lobe involvement and showed good performance for both bacterial and viral pneumonia. For viral pneumonia, dyspnea plus respiration rates > 20/min had good predictive capacity regardless of CRP concentration.

Conclusions

DRC model is a simple tool that predicts pneumonia among AFRI patients, which would help physicians utilize medical resources rationally in primary care settings.
Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis
Authors: Choi Hayoung , Kim Sang Hyuk , Han Kyungdo , Park Tai Sun , Park Dong Won , Moon Ji-Yong , Kim Sang-Heon , Kim Tae-Hyung , Sohn Jang Won , Yoon Ho Joo , Lee Hyun
Published: October 2022

Background:

Although cardiovascular comorbidities negatively impact survival in patients with bronchiectasis, there is limited evidence to recommend exercise in this population. We aimed to evaluate whether exercise habit changes are related to reduced cardiovascular disease risk and explore an optimal exercise amount.

Methods:

This study identified 165,842 patients with newly diagnosed bronchiectasis during 2010–2016 who underwent two health examinations and were followed up until December 2020. The exposure was the change in weekly habits of moderate- or vigorous-intensity physical activity between the two examinations, classified into non-exercisers and exercisers (further classified into new exercisers, exercise dropouts, and exercise maintainers). The amount of exercise was measured using metabolic equivalents of task (MET). The outcome was the incidence of myocardial infarction (MI) or stroke.

Results:

During a mean of 6.2 ± 2.1 follow-up years, 4,233 (2.6%) and 3,745 (2.3%) of patients with bronchiectasis had MI or stroke, respectively. Compared to non-exercisers, exercisers had a significantly lower risk of MI or stroke by 9–28% (p < 0.001 for both). Among exercisers, exercise maintainers showed the lowest risk of MI (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.64–0.81) and stroke (aHR, 0.72; 95% CI, 0.64–0.82) compared to non-exercisers. Regarding exercise amount, a significant risk reduction was observed only in patients with bronchiectasis who exercised for ≥ 500 MET-min/wk.

Conclusion:

Exercise was associated with a reduced risk of cardiovascular diseases in patients with bronchiectasis. In particular, the risk was lowest in exercise maintainers, and cardiovascular risk reduction was significant when exercising more than 500 MET-min/wk.
TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy
Authors: Salvatori Benedetta , Linder Tina , Eppel Daniel , Morettini Micaela , Burattini Laura , Göbl Christian , Tura Andrea
Published: October 2022

Background

The triglyceride-glucose index (TyG) has been proposed as a surrogate marker of insulin resistance, which is a typical trait of pregnancy. However, very few studies analyzed TyG performance as marker of insulin resistance in pregnancy, and they were limited to insulin resistance assessment at fasting rather than in dynamic conditions, i.e., during an oral glucose tolerance test (OGTT), which allows more reliable assessment of the actual insulin sensitivity impairment. Thus, first aim of the study was exploring in pregnancy the relationships between TyG and OGTT-derived insulin sensitivity. In addition, we developed a new version of TyG, for improved performance as marker of insulin resistance in pregnancy.

Methods

At early pregnancy, a cohort of 109 women underwent assessment of maternal biometry and blood tests at fasting, for measurements of several variables (visit 1). Subsequently (26 weeks of gestation) all visit 1 analyses were repeated (visit 2), and a subgroup of women (84 selected) received a 2 h-75 g OGTT (30, 60, 90, and 120 min sampling) with measurement of blood glucose, insulin and C-peptide for reliable assessment of insulin sensitivity (PREDIM index) and insulin secretion/beta-cell function. The dataset was randomly split into 70% training set and 30% test set, and by machine learning approach we identified the optimal model, with TyG included, showing the best relationship with PREDIM. For inclusion in the model, we considered only fasting variables, in agreement with TyG definition.

Results

The relationship of TyG with PREDIM was weak. Conversely, the improved TyG, called TyGIS, (linear function of TyG, body weight, lean body mass percentage and fasting insulin) resulted much strongly related to PREDIM, in both training and test sets (R2 > 0.64, p < 0.0001). Bland–Altman analysis and equivalence test confirmed the good performance of TyGIS in terms of association with PREDIM. Different further analyses confirmed TyGIS superiority over TyG.

Conclusions

We developed an improved version of TyG, as new surrogate marker of insulin sensitivity in pregnancy (TyGIS). Similarly to TyG, TyGIS relies only on fasting variables, but its performances are remarkably improved than those of TyG.
Scientific evidence invalidates health assumptions underlying the FCC and ICNIRP exposure limit determinations for radiofrequency radiation: implications for 5G
Authors:   International Commission on the Biological Effects of Electromagnetic Fields (ICBE-EMF), Belyaev Igor , Blackman Carl , Chamberlin Kent , DeSalles Alvaro , Dasdag Suleyman , Fernández Claudio , Hardell Lennart , Héroux Paul , Kelley Elizabeth , Kesari Kavindra , Maisch Don , Mallery-Blythe Erica , Melnick Ronald L. , Miller Anthony , Moskowitz Joel M. , Sun Wenjun , Yakymenko Igor
Published: October 2022

In the late-1990s, the FCC and ICNIRP adopted radiofrequency radiation (RFR) exposure limits to protect the public and workers from adverse effects of RFR. These limits were based on results from behavioral studies conducted in the 1980s involving 40–60-minute exposures in 5 monkeys and 8 rats, and then applying arbitrary safety factors to an apparent threshold specific absorption rate (SAR) of 4 W/kg. The limits were also based on two major assumptions: any biological effects were due to excessive tissue heating and no effects would occur below the putative threshold SAR, as well as twelve assumptions that were not specified by either the FCC or ICNIRP. In this paper, we show how the past 25 years of extensive research on RFR demonstrates that the assumptions underlying the FCC’s and ICNIRP’s exposure limits are invalid and continue to present a public health harm. Adverse effects observed at exposures below the assumed threshold SAR include non-thermal induction of reactive oxygen species, DNA damage, cardiomyopathy, carcinogenicity, sperm damage, and neurological effects, including electromagnetic hypersensitivity. Also, multiple human studies have found statistically significant associations between RFR exposure and increased brain and thyroid cancer risk. Yet, in 2020, and in light of the body of evidence reviewed in this article, the FCC and ICNIRP reaffirmed the same limits that were established in the 1990s. Consequently, these exposure limits, which are based on false suppositions, do not adequately protect workers, children, hypersensitive individuals, and the general population from short-term or long-term RFR exposures. Thus, urgently needed are health protective exposure limits for humans and the environment. These limits must be based on scientific evidence rather than on erroneous assumptions, especially given the increasing worldwide exposures of people and the environment to RFR, including novel forms of radiation from 5G telecommunications for which there are no adequate health effects studies.
The impact of peer support work on the mental health of peer support specialists
Authors: Poremski Daniel , Kuek Jonathan Han Loong , Yuan Qi , Li Ziqiang , Yow Kah Lai , Eu Pui Wai , Chua Hong Choon
Published: October 2022

Background

Peers support specialists have positive impacts on the mental health of their service users. However, less is known about how their mental health changes as a result of their activities.

Methods

We followed 10 peer support specialists over their first year of employment and interviewed them thrice. We used grounded theory to analyse the way in which the health of participants changed.

Results

Self-reported mental health of our participants did not change over the course of the study. However, the role did help participants grow and learn about their condition and their strengths. While sharing their past experiences could be taxing, they learned how to harness their recovery journey without risking relapse.

Conclusion

Entering the role of a peer support specialist does not appear to negatively impact mental health, but might enhance insight and resilience. However, this appears to occur in individuals who already possess an inclination toward introspection.
Individualizing mechanical ventilation: titration of driving pressure to pulmonary elastance through Young’s modulus in an acute respiratory distress syndrome animal model
Authors: Mingote Álvaro , Marrero García Ramsés , Santos González Martín , Castejón Raquel , Salas Antón Clara , Vargas Nuñez Juan Antonio , García-Fernández Javier
Published: October 2022

Background

Mechanical ventilation increases the risk of lung injury (VILI). Some authors propose that the way to reduce VILI is to find the threshold of driving pressure below which VILI is minimized. In this study, we propose a method to titrate the driving pressure to pulmonary elastance in an acute respiratory distress syndrome model using Young’s modulus and its consequences on ventilatory-induced lung injury.

Material and methods

20 Wistar Han male rats were used. After generating an acute respiratory distress syndrome, two groups were studied: (a) standard protective mechanical ventilation: 10 rats received 150 min of mechanical ventilation with driving pressure = 14 cm H2O, tidal volume < 6 mL/kg) and (b) individualized mechanical ventilation: 10 rats received 150 min of mechanical ventilation with an individualized driving pressure according to their Young’s modulus. In both groups, an individualized PEEP was programmed in the same manner. We analyzed the concentration of IL-6, TNF-α, and IL-1ß in BAL and the acute lung injury score in lung tissue postmortem.

Results

Global driving pressure was different between the groups (14 vs 11 cm H2O, p = 0.03). The individualized mechanical ventilation group had lower concentrations in bronchoalveolar lavage of IL-6 (270 pg/mL vs 155 pg/mL, p = 0.02), TNF-α (292 pg/mL vs 139 pg/mL, p < 0.01) and IL-1ß (563 pg/mL vs 131 pg/mL, p = 0.05). They presented lower proportion of lymphocytes (96% vs 79%, p = 0.05) as well as lower lung injury score (6.0 points vs 2.0 points, p = 0.02).

Conclusion

In our model, individualization of DP to pulmonary elastance through Young’s modulus decreases lung inflammation and structural lung injury without a significant impact on oxygenation.
Integrating electrical impedance tomography and transpulmonary pressure monitoring to personalize PEEP in hypoxemic patients undergoing pressure support ventilation
Authors: Slobod Douglas , Leali Marco , Spinelli Elena , Grieco Domenico Luca , Spadaro Savino , Mauri Tommaso
Published: October 2022

Monitoring with electrical impedance tomography (EIT) during a decremental PEEP trial has been used to identify the PEEP that yields the optimal balance of pulmonary overdistension and collapse. This method is based on pixel-level changes in respiratory system compliance and depends on fixed or measured airway driving pressure. We developed a novel approach to quantify overdistension and collapse during pressure support ventilation (PSV) by integrating transpulmonary pressure and EIT monitoring and performed pilot tests in three hypoxemic patients. We report that our experimental approach is feasible and capable of identifying a PEEP that balances overdistension and collapse in intubated hypoxemic patients undergoing PSV.
Senescence-accelerated mice prone 8 (SAMP8) in male as a spontaneous osteoarthritis model
Authors: Sanada Yohei , Ikuta Yasunari , Ding Chenyang , Shinohara Masahiro , Yimiti Dilimulati , Ishitobi Hiroyuki , Nagira Keita , Lee Minjung , Akimoto Takayuki , Shibata Sachi , Ishikawa Masakazu , Nakasa Tomoyuki , Matsubara Kiminori , Lotz Martin K. , Adachi Nobuo , Miyaki Shigeru
Published: October 2022

Background

Animal models of spontaneous osteoarthritis (OA) are sparse and not well characterized. The purpose of the present study is to examine OA-related changes and mechanisms in senescence-accelerated mouse prone 8 (SAMP8) that displays a phenotype of accelerated aging. 

Methods

Knees of male SAMP8 and SAM-resistant 1 (SAMR1) mice as control from 6 to 33 weeks of age were evaluated by histological grading systems for joint tissues (cartilage, meniscus, synovium, and subchondral bone), and µCT analysis. Gene expression patterns in articular cartilage were analyzed by real-time PCR. Immunohistochemistry was performed for OA-related factors, senescence markers, and apoptosis.

Results

Starting at 14 weeks of age, SAMP8 exhibited mild OA-like changes such as proteoglycan loss and cartilage fibrillation. From 18 to 33 weeks of age, SAMP8 progressed to partial or full-thickness defects with exposure of subchondral bone on the medial tibia and exhibited synovitis. Histological scoring indicated significantly more severe OA in SAMP8 compared with SAMR1 from 14 weeks [median (interquartile range): SAMR1: 0.89 (0.56–1.81) vs SAMP8: 1.78 (1.35–4.62)] to 33 weeks of age [SAMR1: 1.67 (1.61–1.04) vs SAMP8: 13.03 (12.26–13.57)]. Subchondral bone sclerosis in the medial tibia, bone mineral density (BMD) loss of femoral metaphysis, and meniscus degeneration occurred much earlier than the onset of cartilage degeneration in SAMP8 at 14 weeks of age.

Conclusions

SAMP8 are a spontaneous OA model that is useful for investigating the pathogenesis of primary OA and evaluating therapeutic interventions.
Severe extra-glandular involvement and pleural effusions complicating primary Sjogren’s syndrome: a case report
Authors: Abou Ziki Maen D. , Taoutel Roy , Hong Julian C. , Podell David N.
Published: October 2022

Background

Sjogren’s syndrome, an autoimmune disease of the exocrine glands, results in keratoconjunctivitis sicca, xerostomia, and dental caries. It is often overlooked, considered by clinicians to be a benign disease. However, it can cause life-threatening extra-glandular complications that affect multiple organ systems.

Case presentation

Here we present a 78-year-old Caucasian woman with a history of primary Sjogren’s syndrome (pSS) whose symptoms of keratoconjunctivitis sicca were managed managed conservatively. She was evaluated for sub-acute shortness of breath. Imaging showed severe bronchiectasis with features of lymphocytic interstitial pneumonia. She also had exudative bilateral pleural effusions and skin ulcers, likely vasculitic in origin. The workup was significant for anti-Ro antibody, pancytopenia, hypocomplementia, cryoglobulinemia and monoclonal gammopathy, all of which reflect disease severity. Although there was no evidence of malignancy, she developed B-cell non-Hodgkin lymphoma during follow-up.

Conclusions

Primary Sjogren’s syndrome can result in severe multi-organ disease. Pleural effusions are a rare complication of pSS, with only ten cases reported in the literature over the last 30 years, and tend to respond well to steroids. Prognostic biomarkers for disease severity include hypocomplementia, cryoglobulinemia, monoclonal gammopathy, and hypergammaglobulinemia. In this report we review the literature and the management of the disease.
Adrenal infarction secondary to methamphetamine use: a case report and review of the literature
Authors: Sapkota Surendra , David Sarah , Sharma Sandipa , Shrestha Suraj , Kalla Abhishek
Published: October 2022

Background

An acute abdomen can have a variety of causes. A commonly missed cause of abdominal pain is direct substance abuse and its sequelae. The use of methamphetamine is rising in the United States resulting in significant morbidity and mortality. There has been no reported case of methamphetamine-induced adrenal infarction based on an extensive review of available literature.

Case presentation

We present a case of a 34-year-old Hispanic man who presented with acute abdominal pain secondary to adrenal infarction in the setting of methamphetamine use. Left paraumbilical tenderness was present on abdominal examination. Contrast-enhanced CT of the abdomen and pelvis revealed internal hypoenhancement of the left adrenal gland, consistent with acute left adrenal infarction. The patient was managed with enoxaparin and apixaban.

Conclusion

Substance abuse, especially among young patients, can at times present with acute abdomen. This mandates physicians to be vigilant and take into consideration the history of substance abuse and relevant investigations. Timely diagnosis and management can prevent life-threatening complications.
A novel C-type lectin from Trichinella spiralis mediates larval invasion of host intestinal epithelial cells
Authors: Hao Hui Nan , Song Yan Yan , Ma Kai Ning , Wang Bo Ning , Long Shao Rong , Liu Ruo Dan , Zhang Xi , Wang Zhong Quan , Cui Jing
Published: October 2022

The aim of this study was to investigate the characteristics of a novel type C lectin from Trichinella spiralis (TsCTL) and its role in larval invasion of intestinal epithelial cells (IECs). TsCTL has a carbohydrate recognition domain (CRD) of C-type lectin. The full-length TsCTL cDNA sequence was cloned and expressed in Escherichia coli BL21. The results of qPCR, Western blotting and immunofluorescence assays (IFAs) showed that TsCTL was a surface and secretory protein that was highly expressed at the T. spiralis intestinal infective larva (IIL) stages and primarily located at the cuticle, stichosome and embryos of the parasite. rTsCTL could specifically bind with IECs, and the binding site was localized in the IEC nucleus and cytoplasm. The IFA results showed that natural TsCTL was secreted and bound to the enteral epithelium at the intestinal stage of T. spiralis infection. The rTsCTL had a haemagglutinating effect on murine erythrocytes, while mannose was able to inhibit the rTsCTL agglutinating effect for mouse erythrocytes. rTsCTL accelerated larval intrusion into the IECs, whereas anti-rTsCTL antibodies and mannose significantly impeded larval intrusion in a dose-dependent manner. The results indicated that TsCTL specifically binds to IECs and promotes larval invasion of intestinal epithelium, and it might be a potential target of vaccines against T. spiralis enteral stages.
YOLO-LRDD: a lightweight method for road damage detection based on improved YOLOv5s
Authors: Wan Fang , Sun Chen , He Hongyang , Lei Guangbo , Xu Li , Xiao Teng
Published: October 2022

In computer vision, timely and accurate execution of object identification tasks is critical. However, present road damage detection approaches based on deep learning suffer from complex models and computationally time-consuming issues. To address these issues, we present a lightweight model for road damage identification by enhancing the YOLOv5s approach. The resulting algorithm, YOLO-LRDD, provides a good balance of detection precision and speed. First, we propose the novel backbone network Shuffle-ECANet by adding an ECA attention module into the lightweight model ShuffleNetV2. Second, to ensure reliable detection, we employ BiFPN rather than the original feature pyramid network since it improves the network's capacity to describe features. Moreover, in the model training phase, localization loss is modified to Focal-EIOU in order to get higher-quality anchor box. Lastly, we augment the well-known RDD2020 dataset with many samples of Chinese road scenes and compare YOLO-LRDD against several state-of-the-art object detection techniques. The smaller model of our YOLO-LRDD offers superior performance in terms of accuracy and efficiency, as determined by our experiments. Compared to YOLOv5s in particular, YOLO-LRDD improves single image recognition speed by 22.3% and reduces model size by 28.8% while maintaining comparable accuracy. In addition, it is easier to implant in mobile devices because its model is smaller and lighter than those of the other approaches.
Resource allocation for UAV-assisted backscatter communication
Authors: Wang Zhengqiang , Hong Duan , Fan Zifu , Wan Xiaoyu , Xu Yongjun , Duo Bin
Published: October 2022

As a promising new technology for green communication, backscatter communication has attracted wide attention in academics and industry. This paper studies the resource allocation problem for an unmanned aerial vehicle (UAV)-assisted backscatter communication network. The UAV acts as an airborne mobile base station and broadcasts signals to the ground backscatter devices (BDs), which transmit the data signals to the backscatter receiver (BR) in a backscattered manner. Specifically, the ground-based BDs communicate with the BR using a dynamic protocol based on time division multiple access. Considering the fairness among BDs, we aim to investigate maximizing the minimum (max–min) rate of the proposed network by jointly optimizing backscatter device scheduling, reflection coefficient, UAV’s power control, and UAV’s trajectory. The optimization problem is a non-convex problem, which is challenging to obtain the optimal solution. Therefore, we propose an efficient iterative algorithm to decompose the optimization problem into four subproblems by the block coordinate descent method. The variables are alternatively optimized by the interior point method and successive convex approximation techniques in each iteration. Finally, simulation results show that the max–min rate of the system obtained by the proposed scheme outperforms other benchmark schemes.
The state of health in Belgium, 1990–2019: a benchmarking analysis based on the Global Burden of Disease 2019 study
Authors: Ghattas Jinane , Gorasso Vanessa , De Pauw Robby , Thunus Sophie , Speybroeck Niko , Devleesschauwer Brecht
Published: October 2022

Background

In a context of decreasing resources and growing health needs, evidence-based health and care policies are essential. This study aims to assess the health trends in Belgium between 1990 and 2019, to compare the Belgian health status to that of the EU-15 countries, and to identify the main drivers in trends over time and country differences within the EU-15.

Methods

We extracted estimates from the GBD 2019 study via the GBD results tool and visualization tools. We compared the Belgian health status with 14 European Union comparator countries between 1990 and 2019, and decomposed the time trends and country differences into the unique contributions of the different underlying causes of death and disability.

Results

Life expectancy (LE) in Belgium improved significantly between 1990 and 2019 for both men and women. Belgium age-standardised mortality rates dropped significantly for men (-40%) and women (-33%) between 1990 and 2019. Overall, Belgium age-standardised disability-adjusted life year (DALY) rates dropped by 23%. This decrease is mainly due to decreasing trends in age-standardised years of life lost (YLL) rates while age-standardised years lived with disability (YLD) rates remained stable. Compared to EU-15, Belgium’s ranking in terms of age-standardised DALY rates worsened for both men and women in 2019. Self-harm and falls are major causes of disease burden, with DALY rates that are higher than in many other EU-15 countries, indicating a realistic potential for improvement. Lung cancer DALY rates remain worrisome for men, and even show an increasing trend for women. Increasing trends of headache disorders, drug use disorders, and diabetes, require further attention.

Conclusion

Non-communicable diseases remain the main contributors for health burden in Belgium, with disability accounting for an increasingly larger share of the disease burden. Despite considerable improvements, Belgium’s ranking for DALYs decreased between 1990 and 2019 compared to the EU-15. This study identified priority causes of disease burden based on their contributions to current evolutions and EU-15 differences. Since many of these causes are considered to be avoidable, primary and secondary prevention are crucial elements for reducing the burden of disease on the healthcare system.
The damage and reconstruction of the Kumamoto earthquake: an analysis on the impact of changes in expenditures with multi-regional input–output table for Kumamoto Prefecture
Authors: Takeda Kenta , Inaba Kazuo
Published: October 2022

The Kumamoto earthquake which occurred in April 2016 measured twice the maximum seismic intensity of 7, causing serious damage to the Kumamoto Prefecture. This study mainly focuses on the demand side of expenditures, estimating the monthly expenditures for 1 year before and after the earthquake. Then, using the multi-regional input–output table for Kumamoto Prefecture, we analyzes the ripple effects by region of the changes in monthly expenditures due to the earthquake. Expenditures in the prefecture in fiscal year 2016 by month decreased by a cumulative total of 592 billion yen because of the earthquake, which generated a value-added loss of 348 billion yen. On the other hand, expenditures increased by a cumulative total of 648 billion yen caused by reconstruction demand, inducing 375 billion yen in value-added gains. Thus, net increase of the value-added of 27 billion yen occupied 10.9% of net increase of the gross prefectural domestic product between fiscal years 2015–2016. The fluctuation of expenditures, induced production, and induced value-added caused by the earthquake is huge. Although the damage to the prefectural economy was severe, reconstruction demand exceeded it, resulting in a quick recovery. However, at the same time, there was a confirmed delay in restoration in industries that were almost unrelated to reconstruction and in regions with a heavy concentration of damage.
Bell's palsy misdiagnosis: Characteristics of occult tumors causing facial paralysis
Authors: Chung Eun-Jae , Matic Damir , Fung Kevin , MacNeil S. Danielle , Nichols Anthony C. , Kiwan Ruba , Tay KengYeow , Yoo John
Published: October 2022

Objective

The aim of this study was to report the incidence and clinical course of a series of patients who were misdiagnosed with Bell's palsy and were eventually proven to have occult neoplasms.

Methods

Two hundred forty patients with unilateral facial paralysis who were assessed at the facial nerve reanimation clinic, Victoria Hospital, London Health Science Centre, from 2008 through 2017 were reviewed. Persistent paralysis without recovery was the presenting complaint.

Results

Nine patients (3.8%) who were proven to have occult neoplasms initially presented with a diagnosis of Bell's palsy. The mean diagnostic delay was 43.5 months. Four patients were proven to have skin cancers, 3 patients had parotid cancers, and 2 patients had facial nerve schwannomas as a final diagnosis. Initial magnetic resonance imaging (MRI) was performed in all 9 patients and 8 underwent a follow-up MRI. An occult tumor was identified upon review of the original MRI in one patient and at follow-up MRI in 8 patients. The mean time interval between the initial and follow-up imaging was 30.8 months. The disease status at most recent follow-up were no evidence of disease in 2 patients (22%) and alive with disease in 7 patients (78%). An irreversible, progressive pattern of facial paralysis combined with pain, multiple cranial neuropathies or history of skin cancer were predictable risk factors for occult tumors. Seven out of the 9 patients (77.8%) underwent at least one type of facial reanimation surgery, and the final subjective results by the surgeon were available for 5 patients. Three out of the 5 (60%) patients who were available for final subjective analysis were reported as Grade III according to the modified House-Brackmann scale.

Conclusion

Occult facial nerve neoplasm should be suspected in patients with progressive and irreversible facial paralysis but the diagnosis may only become evident with follow-up imaging. Facial reanimation surgery is a satisfactory option for these patients.

Graphical Abstract
Mental health outcomes and workplace quality of life among South African pharmacists during the COVID-19 pandemic: a cross-sectional study
Authors: Dhindayal Sherishka , Letsoalo Marothi P. , Gengiah Tanuja N.
Published: October 2022

Background

The effect of the COVID-19 pandemic on the mental health of healthcare workers is gaining attention globally. This study assessed the quality-of-working life (QoWL) and prevalence of, and risk factors for anxiety, depression and stress among South African pharmacists.

Methods

An online survey, after stratification by province, was sent to 3435 (target = 2454) randomly selected pharmacists between 14 April to 18 May 2021. Sociodemographic data were collected and mental health was assessed using the 7-item Generalized Anxiety Disorder scale, the 9-item Patient Health Questionnaire, Perceived Stress Scale and a modified Work-Related Quality-of-Life tool. Prevalence of anxiety, depression, stress and QoWL was estimated. A multivariate logistic regression analysis identified factors associated with mental health outcomes.

Results

A total of 953/2454 pharmacists (38.8%) responded. Of these, 56.5% were 40 years or younger, 78.5% were female, 45.4% were White race and 44.5% were practicing in a community pharmacy setting. Pharmacists demonstrated symptoms of anxiety (n = 605, 66.1%), depression (n = 561, 62.9%), stress (n = 642, 73.8%) and low QoWL (n = 409, 51.3%). Significant risk factors (aOR; 95%CI) for anxiety, depression and stress were female gender (1.96;1.36–2.83,1.84;1.27–2.67,1.58;1.05–2.38, history of mental health conditions (2.50; 1.52–4.13, 3.68; 2.19–6.19, 3.34;1.85–6.03) and significant COVID-19 mitigation changes to pharmacy practice (2.70; 1.36–5.38, 4.23; 2.06–8.70, 3.14;1.44–6.82), respectively. Practice changes were also associated with a low QoWL (5.19; 2.40–11.8). Compared to their Black/African colleagues, Indian pharmacists were at higher risk for anxiety (1.82; 1.03–3.23) and stress symptoms (2.28; 1.21–4.32), while risk for depression was significant amongst White pharmacists (1.86; 1.05–3.32). Pharmacists living apart from family were at significant risk for anxiety (1.66; 1.15–2.41), depression (1.52; 1.06–2.18) and low QoWL (1.60; 1.10–2.34).

Conclusions

COVID-19 pandemic has had a significant negative impact on the mental health of South African pharmacists. Interventions to support the psychological well-being and improve QoWL of pharmacists are needed.
Thermospheric wind response to a sudden ionospheric variation in the trough: event at a pseudo-breakup during geomagnetically quiet conditions
Authors: Oyama Shin-ichiro , Vanhamäki Heikki , Cai Lei , Aikio Anita , Rietveld Michael , Ogawa Yasunobu , Raita Tero , Kellinsalmi Mirjam , Kauristie Kirsti , Kozelov Boris , Shinbori Atsuki , Shiokawa Kazuo , Tsuda Takuo T. , Sakanoi Takeshi
Published: October 2022

The thermospheric wind response to a sudden westward turning of the ion velocity at a high latitude was studied by analyzing data obtained with a Fabry–Perot interferometer (FPI; 630 nm), Dynasonde, and Swarm A & C satellites during a conjunction event. The event occurred during a geomagnetically quiet period (Kp = 0 +) through the night, but some auroral activity occurred in the north. The collocated FPI and Dynasonde measured the thermospheric wind (U) and ionospheric plasma velocity (V), respectively, in the F region at the equatorward trough edge. A notable scientific message from this study is the possible role of thermospheric wind in the energy dissipation process at F-region altitude. The FPI thermospheric wind did not instantly follow a sudden V change due to thermospheric inertia in the F region. At a pseudo-breakup during the event, V suddenly changed direction from eastward to westward within 10 min. U was concurrently accelerated westward, but its development was more gradual than that of V, with U remaining eastward for a while after the pseudo-breakup. The delay of U is attributed to the thermospheric inertia. During this transition interval, U∙V was negative, which would result in more efficient generation of frictional heating than the positive U∙V case. The sign of U∙V, which is related to the relative directions of the neutral wind and plasma drift, is important because of its direct impact on ion-neutral energy exchange during collisions. This becomes especially important during substorm events, where rapid plasma velocity changes are common. The sign of U∙V may be used as an indicator to find the times and locations where thermospheric inertia plays a role in the energy dissipation process.

Graphical Abstract
The combined value of mpUS and mpMRI-TRUS fusion for the diagnosis of clinically significant prostate cancer
Authors: Zhang Xin , Hong Hua , Liang Danyan
Published: October 2022

Objective

To evaluate the combined efficacy of multiparametric ultrasonography (mpUS) and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI-TRUS) fusion for detecting clinically significant prostate cancer (csPCa).

Methods

From November 2019 to September 2021, biopsy-naïve patients underwent mpMRI-TRUS fusion imaging combined with mpUS-guided targeted biopsies (TB) and systematic biopsies (SB). To further evaluate the additional diagnostic value of mpUS, the imaging features of 202 focus obtained from fusion imaging were assessed. The diagnostic accuracies of mpMRI-TRUS fusion imaging and the combination of mpMRI-TRUS fusion imaging with mpUS for csPCa were comparatively evaluated.

Results

A total of 202 prostate lesions (160 patients) were included in the final analysis, of which 105 were csPCa, 16 were ciPCa, and 81 were noncancerous. The median patient age was 69 (65–73) years and the median tPSA was 22.07 (11.22–62.80) ng/mL. For csPCa, the detection rate of TB was higher than that of SB (50.0% vs. 45.5%, p < 0.05). The imaging characteristics of mpUS in the PCa and non-PCa groups were significantly different (p < 0.001). When compared with mpMRI-TRUS fusion imaging, the positive predictive value, false positive rate, and area under the curve (AUC) of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased by 11.30%, decreased by 19.58%, and increased from 0.719 to 0.770 (p < 0.05), respectively.

Conclusion

TB can improve the detection rate of csPCa and hence can be effectively used in the diagnosis and risk assessment of csPCa. The mpUS-enriched valuable diagnostic information for mpMRI-TRUS fusion imaging and their combination showed a higher diagnostic value for csPCa, which can guide subsequent clinical treatment.