bluuebunny/crossref_metadata_2025 huggingface dataset:
“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review
Authors: Laurita Longo Valentina , Odjidja Emmanuel Nene , Beia Thierry Kamba , Neri Manuela , Kielmann Karina , Gittardi Irene , Di Rosa Amanda Isabella , Boldrini Michela , Melis Gian Benedetto , Scambia Giovanni , Lanzone Antonio
Published: December 2020

Background

Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study.

Methods

Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance.

Results

CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women’s attitudes towards pregnancy and childbirth.

Conclusion

Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guidelines.
Inhibitory effects of iron depletion plus eribulin on the breast cancer microenvironment
Authors: Goto Wataru , Kashiwagi Shinichiro , Asano Yuka , Takada Koji , Morisaki Tamami , Takahashi Katsuyuki , Fujita Hisakazu , Shibutani Masatsune , Amano Ryosuke , Takashima Tsutomu , Tomita Shuhei , Hirakawa Kosei , Ohira Masaichi
Published: December 2020

Background

Iron is required for the proliferation of cancer cells, and its depletion suppresses tumor growth. Eribulin mesylate (eribulin), a non-taxane microtubule inhibitor, disrupts the tumor microenvironment via vascular remodeling and obstruction of the epithelial-mesenchymal transition (EMT). Herein, we investigated the effects of the iron chelator on tumor-related properties of breast cancer cells and the effects of iron chelator plus eribulin on tumor growth in vivo.

Methods

Two triple-negative breast cancer (TNBC) cell lines, MDA-MB-231 and BT-549, and one hormone-receptor positive breast cancer cell line, MCF-7, were used in our study. Cell proliferation, cell migration, cell cycle position, and gene expression were analyzed via MTT assays, wound-healing assays, flow cytometry, and quantitative real-time-polymerase chain reaction, respectively. For the in vivo experiments, mice with breast cancer xenografts were treated with the inhibitors, alone or together, and tumor volume was determined.

Results

Iron chelator inhibited breast cancer cell proliferation and decreased the proportion of S-phase cells. Conversely, it induced hypoxia, angiogenesis, EMT, and immune checkpoints, as determined by quantifying the expression of marker mRNAs in MDA-MB-231 and MCF-7 cells. Eribulin suppressed the expression of the hypoxia and EMT related marker mRNAs in the presence of iron chelator. Iron chelator plus eribulin inhibited tumor growth in vivo to a greater extent than did either inhibitor alone.

Conclusions

Although iron chelator induces oncogenic events (hypoxia, angiogenesis, EMT, and immune checkpoints), it may be an effective treatment for breast cancer when administered in combination with eribulin.
Typology of psychiatric emergency services in the United Kingdom: a narrative literature review
Authors: Odejimi Opeyemi , Bagchi Dhruba , Tadros George
Published: December 2020

Background

Mental health crisis requiring emergency access to psychiatric service can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 h. Presently, several types of PESs are available in the United Kingdom (UK) with the aim of providing prompt and effective assessment and management of patients. Therefore, this study aims to provide a detailed narrative literature review of the various types of Psychiatric Emergency Service (PES) currently available in the UK.

Method

Electronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was conducted. Studies were included if it described a mental health service in the UK that provides immediate response in mental health crisis within the first 24 h. Excluded studies did not describe a PES, non-English, and were not conducted in UK.

Results

Nine types of PESs were found. Amongst the 9 services, more papers described crisis resolution home treatment. Majority of the papers reported services within England than other countries within the UK.

Conclusion

All types of PESs were described as beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of the various types of PESs. This may help inform researchers, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PESs meet the needs as well as aid recovery during crisis.
Challenges and management of laparoscopic treatment of pyonephrosis caused by calculi
Authors: Liu Jun , Chen Liang , An Lizhe , Ma Kai , Ye Xiongjun , Xu Qingquan , Huang Xiaobo , Xiong Liulin
Published: December 2020

Background

Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.

Methods

The clinical data of laparoscopic nephrolithotomy performed at Peking University People’s Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.

Results

Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5–4.5 h, 3.4 h, and 100–1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 5.3 days. One patient had a Clavien–Dindo Grade IIIb complication (severe hematuria), which required laparotomy, and was found that there was bleeding of ureteral stump. None of the patients experienced poor healing of endoscopic wounds.

Conclusion

For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.
Predicting hospitalization following psychiatric crisis care using machine learning
Authors: Blankers Matthijs , van der Post Louk F. M. , Dekker Jack J. M.
Published: December 2020

Background

Accurate prediction models for whether patients on the verge of a psychiatric criseis need hospitalization are lacking and machine learning methods may help improve the accuracy of psychiatric hospitalization prediction models. In this paper we evaluate the accuracy of ten machine learning algorithms, including the generalized linear model (GLM/logistic regression) to predict psychiatric hospitalization in the first 12 months after a psychiatric crisis care contact. We also evaluate an ensemble model to optimize the accuracy and we explore individual predictors of hospitalization.

Methods

Data from 2084 patients included in the longitudinal Amsterdam Study of Acute Psychiatry with at least one reported psychiatric crisis care contact were included. Target variable for the prediction models was whether the patient was hospitalized in the 12 months following inclusion. The predictive power of 39 variables related to patients’ socio-demographics, clinical characteristics and previous mental health care contacts was evaluated. The accuracy and area under the receiver operating characteristic curve (AUC) of the machine learning algorithms were compared and we also estimated the relative importance of each predictor variable. The best and least performing algorithms were compared with GLM/logistic regression using net reclassification improvement analysis and the five best performing algorithms were combined in an ensemble model using stacking.

Results

All models performed above chance level. We found Gradient Boosting to be the best performing algorithm (AUC = 0.774) and K-Nearest Neighbors to be the least performing (AUC = 0.702). The performance of GLM/logistic regression (AUC = 0.76) was slightly above average among the tested algorithms. In a Net Reclassification Improvement analysis Gradient Boosting outperformed GLM/logistic regression by 2.9% and K-Nearest Neighbors by 11.3%. GLM/logistic regression outperformed K-Nearest Neighbors by 8.7%. Nine of the top-10 most important predictor variables were related to previous mental health care use.

Conclusions

Gradient Boosting led to the highest predictive accuracy and AUC while GLM/logistic regression performed average among the tested algorithms. Although statistically significant, the magnitude of the differences between the machine learning algorithms was in most cases modest. The results show that a predictive accuracy similar to the best performing model can be achieved when combining multiple algorithms in an ensemble model.
Pornography use and sexting amongst children and young people: a systematic overview of reviews
Authors: Raine Gary , Khouja Claire , Scott Rachel , Wright Kath , Sowden Amanda J.
Published: December 2020

Background

Young people’s use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a ‘review of reviews’, which aimed to systematically identify and synthesise the evidence on pornography and sexting amongst young people. Here, we focus specifically on the evidence relating to young people’s use of pornography; involvement in sexting; and their beliefs, attitudes, behaviours and wellbeing to better understand potential harms and benefits, and identify where future research is required.

Methods

We searched five health and social science databases; searches for grey literature were also performed. Review quality was assessed and findings synthesised narratively.

Results

Eleven reviews of quantitative and/or qualitative studies were included. A relationship was identified between pornography use and more permissive sexual attitudes. An association between pornography use and stronger gender-stereotypical sexual beliefs was also reported, but not consistently. Similarly, inconsistent evidence of an association between pornography use and sexting and sexual behaviour was identified. Pornography use has been associated with various forms of sexual violence, aggression and harassment, but the relationship appears complex. Girls, in particular, may experience coercion and pressure to engage in sexting and suffer more negative consequences than boys if sexts become public. Positive aspects to sexting were reported, particularly in relation to young people’s personal relationships.

Conclusions

We identified evidence from reviews of varying quality that linked pornography use and sexting amongst young people to specific beliefs, attitudes and behaviours. However, evidence was often inconsistent and mostly derived from observational studies using a cross-sectional design, which precludes establishing any causal relationship. Other methodological limitations and evidence gaps were identified. More rigorous quantitative studies and greater use of qualitative methods are required.
Prolotherapy agent P2G is associated with upregulation of fibroblast growth factor-2 genetic expression in vitro
Authors: Johnston Elisha , Emani Chandrakanth , Kochan Andrew , Ghebrehawariat Kidane , Tyburski John , Johnston Michael , Rabago David
Published: December 2020

Purpose

Osteoarthritis (OA) is a prevalent, progressively degenerative disease. Researchers have rigorously documented clinical improvement in participants receiving prolotherapy for OA. The mechanism of action is unknown; therefore, basic science studies are required. One hypothesized mechanism is that prolotherapy stimulates tissue proliferation, including that of cartilage. Accordingly, this in vitro study examines whether the prolotherapy agent phenol-glycerin-glucose (P2G) is associated with upregulation of proliferation-enhancing cytokines, primarily fibroblast growth factor-2 (FGF-2).

Methods

Murine MC3T3-E1 cells were cultured in a nonconfluent state to retain an undifferentiated osteochondroprogenic status. A limitation of MC3T3-E1 cells is that they do not fully reproduce primary human chondrocyte phenotypes; however, they are useful for modeling cartilage regeneration in vitro due to their greater phenotypic stability than primary cells. Two experiments were conducted: one in duplicate and one in triplicate. Treatment consisted of phenol-glycerin-glucose (P2G, final concentration of 1.5%). The results were assessed by quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) to detect mRNA expression of the FGF-2, IGF-1, CCND-1 (Cyclin-D), TGF-β1, AKT, STAT1, and BMP2 genes.

Results

P2G - treated preosteoblasts expressed higher levels of FGF-2 than water controls (hour 24, p < 0.001; hour 30, p < 0.05; hour 38, p < 0.01). Additionally, CCND-1 upregulation was observed (p < 0.05), possibly as a cellular response to FGF-2 upregulation.

Conclusions

The prolotherapy agent P2G appears to be associated with upregulation of the cartilage cell proliferation enhancer cytokine FGF-2, suggesting an independent effect of P2G consistent with clinical evidence. Further study investigating the effect of prolotherapy agents on cellular proliferation and cartilage regeneration is warranted.
Genetic map construction and functional characterization of genes within the segregation distortion regions (SDRs) in the F2:3 populations derived from wild cotton species of the D genome
Authors: KIRUNGU Joy Nyangasi , MAGWANGA Richard Odongo , SHIRAKU Margaret Linyerera , LU Pu , MEHARI Teame Gereziher , XU Yuanchao , HOU Yuqing , AGONG Stephen Gaya , ZHOU Yun , CAI Xiaoyan , ZHOU Zhongli , WANG Kunbo , LIU Fang
Published: December 2020

Background

Segregation distortion (SD) is a common phenomenon among stable or segregating populations, and the principle behind it still puzzles many researchers. The F2:3progenies developed from the wild cotton species of the D genomes were used to investigate the possible plant transcription factors within the segregation distortion regions (SDRs). A consensus map was developed between two maps from the four D genomes, map A derived from F2:3progenies ofGossypium klotzschianumandG. davidsoniiwhile Map B fromG. thurberiandG. trilobumF2:3generations. In each map, 188 individual plants were used.

Results

The consensus linkage map had 1 492 markers across the 13 linkage groups with a map size of 1 467.445 cM and an average marker distance of 1.037 0 cM. Chromosome D502 had the highest percentage of SD with 58.6%, followed by Chromosome D507 with 47.9%. Six thousand and thirty-eight genes were mined within the SDRs on chromosome D502 and D507 of the consensus map. Within chromosome D502 and D507, 2 308 and 3 730 genes were mined, respectively, and were found to belong to 1 117 gourp out of which 622 groups were common across the two chromosomes. Moreover, genes within the top 9 groups related to plant resistance genes (R genes), whereas 188 genes encoding protein kinase domain (PF00069) comprised the largest group. Further analysis of the dominant gene group revealed that 287 miRNAs were found to target various genes, such as the gra-miR398, gra-miR5207, miR164a, miR164b, miR164c among others, which have been found to target top-ranked stress-responsive transcription factors such asNACgenes. Moreover, some of the stress- responsivecis-regulatory elements were also detected. Furthermore, RNA profiling of the genes from the dominant family showed that higher numbers of genes were highly upregulated under salt and osmotic stress conditions, and also they were highly expressed at different stages of fiber development.

Conclusion

The results indicated the critical role of the SDRs in the evolution of the key regulatory genes in plants.
Apparent diffusion coefficient for differentiating between benign and malignant hepatic focal lesions
Authors: Abugamra Sherif , Yassin Aya , Abdel-Rehim Asmaa Saber Mostafa , Sheha Dina Sayed
Published: December 2020

Background

The aim of this study was to prospectively evaluate the role of diffusion weight MRI (DWI) in the characterization of hepatic focal lesions by using apparent diffusion coefficient (ADC). Thirty patients (18 women, 12 men; mean age 48.5 years) with hepatic focal lesions were included in this study. Patients underwent DW MR imaging with the SPLICE sequence. ADC of each focal lesion carcinoma was calculated from DW MR Images obtained with low and high b values. ADCs were compared among pathological types of focal lesions.

Results

Among the 30 patients included in the study, 46 focal lesions were detected. Twenty-four lesions were metastatic lesions from primary cancer, 7 lesions were hepatocellular carcinoma (HCC), 9 lesions were hemangiomas, and 6 lesions were simple cysts. There was highly significant difference between the mean ADC of the malignant lesions (metastasis and HCC) and the mean ADC of benign lesions (hemangiomas and cysts). The ADC of malignant lesion was much less than that of benign lesion. The mean ADC of malignant lesions (n = 31) was 0.73 ± 0.19 × 10−3 mm2/s, and the mean ADC of benign lesions (n = 15) was 1.94 ± 0.68 × 10−3 mm2/s (p value < 0.001). There was no significant difference between the cysts and hemangiomas. There was no statistically significant difference between the metastases and hepatocellular carcinoma.

Conclusion

ADCs values were able to differentiate benign from malignant lesions. ADC should be considered in the work up of patients with hepatic focal lesions.
Assessing the nanotechnology on the grounds of costs, benefits, and risks
Authors: Pandey Garima , Jain Pallavi
Published: December 2020

Background

The technical innovations are based on the principles of science with the assurance of outweighing their cost and risk factors with the benefits to society. But sometimes, the innovation either itself becomes a risk or brings in some risk factors along with it. For most of the alleyway of an innovation from its emergence to its road to societal acceptance and adoption, the focus remains on the benefits majorly. Only when we are at the neck of the hour we think about some of the apparent cost and risk issues. The understanding, proper communication, and address of the basics of risk factors are necessarily required much in advance to deal with this issue.

Main body

Nanoparticles with very small size and huge surface area are being derived from various plants, microbes, chemical compounds, metals, and metal alloys. Without our realizations, nanotechnology has become a vital part of our day-to-day life, and nanoparticles are proving their worth in almost every field ranging from food, water, medicine, agriculture, construction, fashion, electronics, and computers to eco-remediation, but what about the costs involved and the risks associated? We strongly need to recognize these concerns and challenges, and it requires collaborative efforts from academicians, researchers, industries, government, and non-government organizations to involve people in dialogs to deal with them.

Conclusion

Through reviewing various studies and articles on nanotechnology, this review has shown that nanotechnology can productively be used to produce consumer goods for pharma, electronics, food, agriculture, aviation, construction, security, and remediation sectors which are advantages in their characteristics. Regarding the future of nanotechnology, we need to focus on assessment and management of risks associated for its promising market growth.

Graphical abstract
Roux En Y drainage of a large hepatic hydatid cyst as treatment for recalcitrant bile leak: a case report
Authors: Behera Saswati , Bawa Monika , Kanojia Ravi P. , Sood Ashwani , Samujh Ram
Published: December 2020

Background

Hydatid disease is relatively uncommon in children and thus rarely reported in literature. Pediatric patients with large hydatid cysts can have grave complications due to mass effect. Postoperative bile leak is the most common morbidity and continues to be a challenge for the treating surgeon.

Case presentation

A 7-year-old boy diagnosed with a giant hydatid cyst of the liver, almost replacing the right lobe, and underwent a laparotomy and excision of cyst with tube drainage. He developed postoperative major bile leak which did not subside even after a redo laparotomy and closure of the suspected bile leak areas. The child underwent a third laparotomy after a hepatobiliary scintigraphy (HIDA scan) which confirmed a persisting major leak. A Roux En Y cystojejunostomy was done this time which drained the bile adequately postoperatively with no evidence of bile in the subhepatic drain. Oral feeds were resumed on the fifth postoperative day. He was discharged in a satisfactory condition and is doing well in the follow-up. Repeat HIDA scan showed no evidence of spillage, with adequate bilio-enteric drainage.

Conclusion

Persistent major bile leak requiring ERCP with sphincterotomy can be managed successfully in children by internal drainage as Roux En Y cystojejunostomy.
Total, Bioavailable, and Free 25(OH)D Relationship with Indices of Bone Health in Elderly: A Randomized Controlled Trial
Authors: El Sabeh Malak , Ghanem Paola , Al-Shaar Laila , Rahme Maya , Baddoura Rafic , Halaby Georges , Singh Ravinder J , Vanderschueren Dirk , Bouillon Roger , El-Hajj Fuleihan Ghada
Published: December 2020

Context

Questions regarding the superiority of free and bioavailable 25-hydroxyvitamin D [25(OH)D] in predicting health outcomes remain unresolved.

Objective

This study investigates the impact of vitamin D variables—total, bioavailable, or free 25(OH)D—on indices of bone and mineral metabolism, at baseline and in response to 2 vitamin D doses.

Design

Our objectives are implemented as exploratory analyses on data collected in a 1-year, double-blind, randomized controlled trial completed in July 2014.

Setting

Participants were recruited from 3 major hospitals in an ambulatory setting.

Participants

Participants were >65 years of age, overweight, and had a baseline serum 25(OH)D between 10 and 30 ng/mL. A total of 221 participants completed the study.

Intervention

Subjects were randomized to receive calcium and oral vitamin D3 (600 IU/day or 3750 IU/day) supplementation.

Results

Participants who received the higher vitamin D dose had levels that were 1.3- to 1.4-fold higher than those taking the lower dose, for all variables (P value < 0.001). Serum values of bioavailable and free 25(OH)D were associated with total 25(OH)D, with r values of 0.942 and 0.943, respectively (P value < 0.001). Parathyroid hormone (PTH) was negatively associated with all vitamin D variables, with correlation coefficients ranging from −0.22 to −0.25, while calcium and bone turnover markers (carboxy-terminal collagen crosslinks and osteocalcin) did not. Only total 25(OH)D had a positive relationship with % change bone mineral density (BMD) at the femoral neck at 12 months, while only free and bioavailable 25(OH) had a positive relationship with % change total body BMD at 12 months.

Conclusion

Calculated free and bioavailable 25(OH)D do not appear to be superior to total 25(OH)D in predicting indices of bone health in an elderly population.
Isoform-specific Activities of Androgen Receptor and its Splice Variants in Prostate Cancer Cells
Authors: Nagandla Harika , Robertson Matthew J , Putluri Vasanta , Putluri Nagireddy , Coarfa Cristian , Weigel Nancy L
Published: December 2020

Androgen receptor (AR) signaling continues to drive castration-resistant prostate cancer (CRPC) in spite of androgen deprivation therapy (ADT). Constitutively active shorter variants of AR, lacking the ligand binding domain, are frequently expressed in CRPC and have emerged as a potential mechanism for prostate cancer to escape ADT. ARv7 and ARv567es are 2 of the most commonly detected variants of AR in clinical samples of advanced, metastatic prostate cancer. It is not clear if variants of AR merely act as weaker substitutes for AR or can mediate unique isoform-specific activities different from AR. In this study, we employed LNCaP prostate cancer cell lines with inducible expression of ARv7 or ARv567es to delineate similarities and differences in transcriptomics, metabolomics, and lipidomics resulting from the activation of AR, ARv7, or ARv567es. While the majority of target genes were similarly regulated by the action of all 3 isoforms, we found a clear difference in transcriptomic activities of AR versus the variants, and a few differences between ARv7 and ARv567es. Some of the target gene regulation by AR isoforms was similar in the VCaP background as well. Differences in downstream activities of AR isoforms were also evident from comparison of the metabolome and lipidome in an LNCaP model. Overall our study implies that shorter variants of AR are capable of mediating unique downstream activities different from AR and some of these are isoform specific.
Synthesis of Polymers with Regulated Repeating Structures by Utilizing Chain Walking Strategy
Authors: Takeuchi Daisuke
Published: December 2020

Pd-catalyzed reaction of olefins is sometimes accompanied by isomerization of the Pd center along the aliphatic chain (chain walking). The chain walking reaction enables synthesis of polyolefins with regulated structure, via C-C bond formation between vinyl or vinylene groups with the carbon atom at a remote position of the olefin monomers. The chain walking reaction also allows synthesis of poly(arylene alkenylene)s by three-component polycondensation of diiodoarenes, non-conjugated dienes and nucleophiles. Polycondensation of diols, diacids, and diamines with long alkylene chain, obtained by chain-walking alkoxycarbonylation, affords long-chain polyesters and polyamides.
CtIP-mediated alternative mRNA splicing fine-tunes the DNA damage response
Authors: Prados-Carvajal Rosario , Rodríguez-Real Guillermo , Gutierrez-Pozo Gabriel , Huertas Pablo
Published: December 2020

In order to survive to the exposure of DNA damaging agents, cells activate a complex response that coordinates the cellular metabolism, cell cycle progression, and DNA repair. Among many other events, recent evidence has described global changes in mRNA splicing in cells treated with genotoxic agents. Here, we explore further this DNA damage-dependent alternative splicing. Indeed, we show that both the splicing factor SF3B2 and the repair protein CtIP contribute to the global pattern of splicing both in cells treated or not to DNA damaging agents. Additionally, we focus on a specific DNA damage- and CtIP-dependent alternative splicing event of the helicase PIF1 and explore its relevance for the survival of cells upon exposure to ionizing radiation. Indeed, we describe how the nuclear, active form of PIF1 is substituted by a splicing variant, named vPIF1, in a fashion that requires both the presence of DNA damage and CtIP. Interestingly, timely expression of vPIF1 is required for optimal survival to exposure to DNA damaging agents, but early expression of this isoform delays early events of the DNA damage response. On the contrary, expression of the full length PIF1 facilitates those early events but increases the sensitivity to DNA damaging agents if the expression is maintained long-term.
Three years mortality analysis in general surgery patients
Authors: Kumar Dileep , Bukhari Hina , Qureshi M Shamim
Published: December 2020

Objective: Surgical patient mortality is progressively being measured for providing better management and care in different healthcare systems world-wide. The aim of this study was to assess mortality within a surgical department and to evaluate components associated with surgical and non- surgical deaths.

Methods: We retrospectively collected data including all admissions, both operative and non-operative, surgical procedures and reason of admission (for non-operative) and mortalities within three-year period (2015-2017) from Surgical Unit-2, JPMC Karachi. We assessed type of operations, admission, patient related factors including age, sex, co-morbid factors, reason, time and onset of presentation, operative notes, events, clinical cause and date/ time of death.

Results: The total admissions of 5730 patients were observed in surgical ward-2 during the period of 1st of January 2015 and 31st of December 2017. There were a total of 291 deaths during this period (5.07% overall mortality rate). GIT related (peritonitis/ obstruction) (58.41%), biliarytract/ pancreatic causes (10.9%), road traffic accidents/ blunt trauma (7.21%), firearm injuries (1.71%) followed by GIT malignancies (4.81%) and Non-GIT malignancies (2.06%) were observed to be the main/ leading causes of death. Of the 291 deaths, males were 179 (6.70%) and females were 112 (3.66%). Male to female ratio of morality came out to be 1.6:1. The cause of death in our patients was sepsis (58.41%), cardiopulmonary arrest (13.0%), trauma/ gunshot injuries 8.93%, advanced malignancies (6.87%), pulmonary embolism (6.18%), myocardial infarction (5.49%) and post op bleeding (1.03%). Mortality due to delayed presentation of patient i.e. after five days of onset of symptoms (62.88%), Surgical decision/ exploration after 24 hours (33.67%). The lack of availability of ICU/ HDU in hospital contributed (51.01%) to the total surgical mortality.

Conclusions: As per the study of three years (2015-2017) a fluctuating mortality pattern is observed. The increment of death was mainly among the unavoidable deaths such as GIT and Non GIT related sepsis, advanced malignancies, trauma and firearm injuries, pulmonary embolism myocardial infarction, a moderate role has also been played by miscellaneous group of patients. Delayed presentation of the patients after appearance of first symptom/ symptoms, delayed surgical decision/ exploration also came out to be significantly important factors in our studies elaborating the major difference in mortality rate.

doi: https://doi.org/10.12669/pjms.37.1.2040

How to cite this:Kumar D, Bukhari H, Qureshi S. Three years mortality analysis in general surgery patients. Pak J Med Sci. 2021;37(1):229-233. doi: https://doi.org/10.12669/pjms.37.1.2040

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis
Authors: Khan Adnan , Shafiq Ihtesham , Jan Muneeb , Hassan Zair
Published: December 2020

Objectives: To determine the changes produced in mitral valve morphology after Percutaneous Trans-Venous Mitral Commissurotomy.

Methods: Patients with mitral stenosis who underwent PTMC at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from 2006-2016 were included in this study. All the data were manually obtained from the electronic medical record (M.F.E.). Wilkin’s echocardiographic scoring system was used to assess the severity of mitral valve thickness, leaflet mobility, valvular calcification, and Subvalvular disease. The student t-test was used for mean comparison. P-value < 0.05 was considered significant.

Results: Of the total 229 patients, males were 96(41.9%), and females were 133(58.1%). The mean [SD] age of the patients was 25 ± 11years. The total Wilkin score was 7 ±1.5. 151(65.9%) were in New York Heart Association (NYHA) functional class III, and 78(34.1%) were in NYHA class IV. There was no immediate change after PTMC in systolic myocardial velocities (SV) measured at the lateral tricuspid annulus. The 2D mitral valve area increased from 0.98±0.94 cm2 to 1.78 ± 0.44 cm2 (P=0.001). Left Atrium diameter was 5.16±0.75 mm prior to PTMC, significantly decreased to 4.7± 0.7 mm (p=0.005) after PTMC. Ejection fraction (Left Ventricular Ejection Fraction) changed from 60.45± 8.25 mm Hg to 62.76±10 mm Hg (p=0.001). Mean Right Ventricular Ejection Fraction (RVEF) of patients before PTMC was 48.7 ± 4.7%, did not change significantly immediately after PTMC.

Conclusion: PTMC is associated with significant changes in mitral valve morphology in terms of splitting of the fused mitral commissures, increased MVA, improved leaflet excursion, and splitting of the subvalvular structures.

doi: https://doi.org/10.12669/pjms.37.1.2446

How to cite this:Khan A, Shafiq I, Jan M, Hassan Z. Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis. Pak J Med Sci. 2021;37(1):104-108.  doi: https://doi.org/10.12669/pjms.37.1.2446

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas
Authors: Munir Sohbia , Khan Sohail Ahmed , Hanif Hina , Khan Maria
Published: December 2020

Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard.

Methods: This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard.

Results: Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%.

Conclusions: MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas.

doi: https://doi.org/10.12669/pjms.37.1.2489

How to cite this:Munir S, Khan SA, Hanif H, Khan M. Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas. Pak J Med Sci. 2021;37(1):125-130. doi: https://doi.org/10.12669/pjms.37.1.2489

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy of YAG Laser Embolysis in Retinal Artery Occlusion
Authors: Mehboob Mohammad Asim , Khan Asfandyar , Mukhtar Ahsan
Published: December 2020

Objective: To compare the anatomical and functional success between conventional medical method and Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) laser embolysis in retinal artery occlusion.

Methods: This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi from July 2018 to May 2020. A total of 14 eyes of 14 patients were received with fovea involving branch or hemiretinal artery occlusion within 24 hours of onset of symptoms. They were divided randomly in two groups. Initial treatment was given to all cases, and seven eyes received Nd:YAG laser treatment for embolysis. Both groups were analysed for anatomical success (reperfusion) and functional success (defined as improvement in visual acuity to better than 6/60 on Snellen’s visual acuity chart from baseline visual acuity).

Results: In conventional group, anatomical success was achieved in 2 (28.6%) eyes, while significant visual improvement was seen in 3 (42.8%) eyes. In Nd:YAG laser embolysis group, anatomical success was achieved in 5 (71.4%) eyes, while significant visual improvement was seen in 6 (85.7%) eyes. All eyes which showed functional improvement underwent Nd:YAG laser embolysis within 6 hours of onset of symptoms.

Conclusions: Nd:YAG laser embolysis is more effective in management of fovea threatening retinal artery occlusion, as compared to conventional medical treatment, if performed within six hours of onset of symptoms.

doi: https://doi.org/10.12669/pjms.37.1.3196

How to cite this:Mehboob MA, Khan A, Mukhtar A. Efficacy of YAG Laser Embolysis in Retinal Artery Occlusion. Pak J Med Sci. 2021;37(1):71-75.  doi: https://doi.org/10.12669/pjms.37.1.3196

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A theoretical model for the prevention of Banana Moko (Musa AAB Simmonds)
Authors: Grajales Amorocho Marly , Muñoz Loaiza Anibal
Published: December 2020

A population simulation model with non-linear ordinary differential equations is presented, which interprets the dynamics of the banana Moko, with prevention of the disease and population of susceptible and infected plants over time. A crop with a variable population of plants and a logistic growth of replanting is assumed, taking into account the maximum capacity of plants in the delimited study area.
Rationale and design of a complex intervention measuring the impact and processes of social accountability applied to contraceptive programming: CaPSAI Project
Authors: Steyn Petrus S , Boydell Victoria , Cordero Joanna Paula , McMullen Heather , Habib Ndema , Nguyen Thi My Huong , Nai Dela , Shamba Donat , Kiarie James ,   CaPSAI Project
Published: December 2020

Background: There are numerous barriers leading to a high unmet need for family planning and contraceptives (FP/C).  These include limited knowledge and information, poor access to quality services, structural inefficiencies in service provision and inadequately trained and supervised health professionals. Recently, social accountability programs have shown promising results in addressing barriers to accessing sexual and reproductive health services. As a highly complex participatory process with multiple and interrelated components, steps and actors, studying social accountability poses methodological challenges. The Community and Provider driven Social Accountability Intervention (CaPSAI) Project study protocol was developed to measure the impact of a social accountability intervention on contraceptive uptake and use and to understand the mechanisms and contextual factors that influence and generate these effects (with emphasis on health services actors and community members).

Methods: CaPSAI Project is implementing a social accountability intervention where service users and providers assess the quality of local FP/C services and jointly identify ways to improve the delivery and quality of such services. In the project, a quasi-experimental study utilizing an interrupted time series design with a control group is conducted in eight intervention and eight control facilities in each study country, which are Ghana and Tanzania. A cross-sectional survey of service users and health care providers is used to measure social accountability outcomes, and a cohort of women who are new users of FP/C is followed up after the completion of the intervention to measure contraceptive use and continuation. The process evaluation utilizes a range of methods and data sources to enable a fuller description of how the findings were produced.

Conclusion: This complex study design could provide researchers and implementers with the means to better measure and understand the mechanisms and contextual factors that influence social accountability processes in reproductive health, adding important findings to the evidence base.
Apuntes para la contextualización de la creación literaria desde el margen: el neobarroco digital.
Authors: Gorgojo Iglesias Raisa
Published: December 2020

La democratización tecnológica abre la puerta a un análisis con perspectiva feminista, dado que las tradicionales trabas al acceso a la creación literaria parecen difuminarse. Esta es una propuesta para contextualizar los nuevos textos surgidos al margen de lo canónico y con soportes virtuales que pretende imbricar las teorías sobre Hipermodernismo y Neobarroco, que estudian el horror vacui de la narrativa actual, pero que no dialogan entre sí.
El rol de la mujer china a principios del siglo XX en la novela Bansheng yuan de Zhang Ailing.
Authors: Tejeda Martín Teresa Inés
Published: December 2020

En este artículo reflexionaremos, a través de la lectura Bansheng yuan, la primera novela larga de Zhang Ailing (Eileen Chang), sobre la situación de la mujer china en las primeras décadas del siglo XX. Con el análisis de los tres principales personajes femeninos nos centraremos en destacar dos aspectos que, a pesar de haber avanzado en la teoría, seguían lastrando la posición de la mujer en la práctica: la falta de independencia laboral y el matrimonio.
Las mujeres creadoras en la dramaturgia femenina de los Siglos de Oro y sus mecanismos de metateatralidad para reaccionar contra lo establecido.
Authors: Rodríguez Campillo María José
Published: December 2020

El objetivo principal de este artículo es realizar un análisis y posterior reflexión acerca del metateatro que podemos encontrar, de forma bastante abundante y sistemática, en la dramaturgia de Ana Caro. Así, pretendemos analizar sus obras teatrales, para demostrar cómo ella, bajo variadas estrategias metateatrales, nos está enviando un mensaje cuya ideología es distinta al de la misma época dentro del teatro escrito por hombres. La conclusión que extraemos en este artículo es que no está conforme con la manera de hacer teatro ni con la forma de pensar que tienen los hombres de su época y, por eso, intenta transgredir esas normas a través de la metateatralidad.
As Expressões Do Racismo Institucional Nas Universidades Federais Do Estado Do Rio De Janeiro: Mulheres Negras Trabalhadoras e Intelectuais
Authors: Henriques Cibele Da Silva
Published: December 2020

O presente artigo é fruto de reflexões sobre o objeto de pesquisa da tese de doutorado que consiste na análise das expressões do racismo institucional no cotidiano profissional das assistentes sociais das universidades federais do Estado do Rio de Janeiro, as quais têm promovido lutas pelo direito ao trabalho sem caráter doméstico, sem discriminações de classe, gênero, raça e etnia. Enfim, a obtenção de recursos que as instrumentalizem na luta contra o racismo institucional, tão funcional ao sistema capitalista e estrutural nas relações sociais na sociedade brasileira.
O AVANÇO DO ESTADO PENAL NO MUNDO E AS PARTICULARES DO BRASIL
Authors: Oliveira Inaê Soares
Published: December 2020

O presente artigo tem por objetivo elencar os elementos constituintes para o avanço do Estado penal no âmbito internacional e apreender suas particularidades em solo nacional. Para isto se valeu de pesquisa bibliográfica cujo foco de análise perpassou pela generalização da ideologia neoliberal como um elemento central para as modificações contemporâneas do Estado marcadas pela deterioração de esferas da vida e do trabalho, a destituição dos direitos sociais, a privatização das esferas estatais e a expansão do discurso da “lei e da ordem”, principalmente sobre as “classes perigosas”.
Ideias que convulsionam, práticas que conservam: o repertório de ideias na passagem do Império à República
Authors: Costa Milene Ribas da
Published: December 2020

A prática política no Brasil, ao longo do século XIX, foi orientada por ideias que, no plano teórico, arquitetaram um modelo de Estado à semelhança de experiências internacionais. No entanto, as condições reais, desconhecidas ou propositalmente ignoradas, acabaram por distanciar ideal do real. O presente artigo percorre algumas importantes contribuições da historiografia, assim como da sociologia e da ciência políticas, para debater o trânsito contínuo de ideais liberais, seja no momento da Independência, seja na passagem à República. A combinação, às vezes conflituosa, desses ideais com outras doutrinas, como o positivismo na sua concepção ortodoxa, também será discutida. Nessa costura de ideias liberais e positivistas, ocorre a mudança de regime e a República apresenta-se como mais um marco do processo de modernização conservadora do país.
O ideário de António Castro Fernandes na consolidação da experiência corporativa portuguesa
Authors: Aboim Pires Leonardo
Published: December 2020

O presente estudo pretende analisar e compreender as ideias que guiaram a atuação de António Castro Fernandes durante o Estado Novo (1933-1974), destacando a sua importância na formação do corporativismo português. Além da crítica aos erros do regime liberal, Castro Fernandes destacou-se pela aproximação ao modelo italiano, a sua perceção da esfera pública e a interação entre trabalho, quotidiano e propaganda. Por outras palavras, fazendo uso de uma abordagem exploratório-descritiva a partir de obras impressas e cartas particulares, este estudo procura descortinar as razões para a sua posição ideológica e como este concebia o corporativismo enquanto teoria, enquadrando-o no contexto da cronologia política do seu tempo.