bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19
Authors: Turgutalp Kenan , Ozturk Savas , Arici Mustafa , Eren Necmi , Gorgulu Numan , Islam Mahmut , Uzun Sami , Sakaci Tamer , Aydin Zeki , Sengul Erkan , Demirelli Bulent , Ayar Yavuz , Altiparmak Mehmet Riza , Sipahi Savas , Mentes Ilay Berke , Ozler Tuba Elif , Oguz Ebru Gok , Huddam Bulent , Hur Ender , Kazancioglu Rumeyza , Gungor Ozkan , Tokgoz Bulent , Tonbul Halil Zeki , Yildiz Alaattin , Sezer Siren , Odabas Ali Riza , Ates Kenan
Published: January 2021

Background

Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19.

Methods

This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis.

Results

Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228–4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality.

Conclusion

Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.
A time series analysis of the relationship between ambient temperature and ischaemic stroke in the Ljubljana area: immediate, delayed and cumulative effects
Authors: Ravljen Mirjam , Bajrović Fajko , Vavpotič Damjan
Published: January 2021

Background

Stroke is a major health problem around the world. Several studies have examine the influence of ambient temperature on incidence of stoke, but they reported different results for different types of stroke and different geographical regions. Hence, effect of ambient temperature is still much of interest, when focusing on ischemic stroke (IS) in regions that have not been examined yet. The aim of our study is to analyse association between IS incidences and short, delayed and cumulative effect of average daily ambient temperature, humidity and pressure in central Europe. To the best of our knowledge, this is the first IS study conducted between 45° and 50° latitude where large part of Central European population resides.

Methods

We linked daily hospitals’ admission data for whole population and separately for two specific age groups with ambient temperature data. We considered patients coming from Ljubljana basin and its immediate surrounding. Data were gathered daily from January 2012 to December 2017. To measure the effect of average ambient temperature, humidity and pressure we used generalized linear model with a log-link-function and a Poisson distribution.

Results

The results of our study show a statistically significant immediate, delayed and cumulative effects of ambient temperatures on IS incidence for the whole population and the population older than 65 years. Specifically, 1 °C reduction in ambient temperature on a given day (Lag 0) increases the IS risk for approximately 5‰ (all population) or 6‰ (population older than 65 years). Similar effects were found for lags from 1 to 6. Analysis of time windows from 0 to 1 days up to 0–28 days also show statistically significant cumulative effect for the same two age groups. IS incidence was not found to be significantly related to pressure or humidity in any group.

Conclusion

The findings of this study may help healthcare authorities in central Europe improve existing stroke prevention measures and raise public awareness.
Association of gestational weight gain with cesarean section: a prospective birth cohort study in Southwest China
Authors: Huang Lujiao , Zhang Ju , Sun Hong , Dong Hongli , Li Run , Cai Congjie , Gao Yan , Wu Cheng , Lan Xi , Zeng Guo
Published: January 2021

Background

Cesarean section (CS) is a rising public health issue globally, and is particularly serious in China. Numerous studies have suggested that gestational weight gain (GWG) control may be an effective way to reduce the rate of CS. However, rare study has examined the association between GWG and CS among women in Southwest China. We proposed to examine their association based on a prospective birth cohort, and further to explore the optimal GWG range.

Methods

We retrieved data from a prospective birth cohort from Sichuan Provincial Hospital for Women and Children, Southwest China. Unconditional multivariable logistic regression was used to examine the association between GWG and CS by adjusting for potential confounders. In one analysis, we incorporated the GWG as a categorical variable according to the Institute of Medicine (IOM) recommendation, similar to the method used in the majority of previous studies. In the other analysis, we directly incorporated GWG as a continuous variable and natural cubic splines were used to characterize the potential nonlinear exposure-response relationship, aiming to identify the optimal GWG. We further stratified the above analysis by pre-pregnancy BMI and GDM, and then a heterogeneity test based on a multivariate meta-analysis was conducted to examine whether the stratum specific estimations agreed with each other.

Results

A total of 1363 participants were included. By adopting the IOM recommendation, the adjusted OR of CS was 0.63 (0.47, 0.84) for insufficient GWG and 1.42 (1.06, 1.88) for excessive GWG. After stratification by pre-pregnancy BMI, we found a higher risk of CS in associated with excessive GWG in the stratum of underweight compared with the other strata, which implied that pre-pregnancy BMI may be an effect modifier. By applying a flexible spline regression, the optimal GWG levels in terms of reducing the CS rate based on our data were more stringent than those of IOM recommendation, which were 9–12 kg for underweight women, < 19 kg for normal weight women and < 10 kg for overweight/obese women.

Conclusions

These results suggested that a more stringent recommendation should be applied in Southwest China, and that more attention should be given to underweight women.
Survey of UK health professionals supporting parents after loss from a twin pregnancy
Authors: Rankin Judith , Hayes Louise , Embleton Nicholas
Published: January 2021

Background

Bereavement from a twin pregnancy can result in complex emotions as parents are often caring for a surviving sibling while mourning the loss of their infant. Health professionals have reported feeling ill-equipped to deal with the specific needs of parents in this situation. Our aim was to ascertain the current knowledge, training needs and self-rated confidence of health professionals in providing support to parents who have experienced a loss from a twin pregnancy.

Methods

We used an online survey, sent by email via professional organisations and clinical networks, to neonatal and fetal medicine doctors, neonatal nurses, and midwives. Respondents provided anonymous responses to questions on their experience of training and knowledge of existing guidelines, confidence in supporting parents and current practice in their hospital neonatal unit.

Results

We received 293 responses. Less than half (47.3%) of respondents had received training for supporting parents and 62% felt more training and further guidelines were required. Less than a third of respondents reported having no or some confidence when providing emotional support to parents.

Conclusions

Current training and guidelines in the UK to support health professionals caring for parents who have experienced a loss from a twin pregnancy are inadequate. Guidelines for healthcare professionals who support parents experiencing the loss of a baby from a twin pregnancy are needed.
Survival benefit of ixazomib, lenalidomide and dexamethasone (IRD) over lenalidomide and dexamethasone (Rd) in relapsed and refractory multiple myeloma patients in routine clinical practice
Authors: Minarik Jiri , Pika Tomas , Radocha Jakub , Jungova Alexandra , Straub Jan , Jelinek Tomas , Pour Ludek , Pavlicek Petr , Mistrik Martin , Brozova Lucie , Krhovska Petra , Machalkova Katerina , Jindra Pavel , Spicka Ivan , Plonkova Hana , Stork Martin , Bacovsky Jaroslav , Capkova Lenka , Sykora Michal , Kessler Petr , Stejskal Lukas , Heindorfer Adriana , Ullrychova Jana , Skacel Tomas , Maisnar Vladimir , Hajek Roman
Published: January 2021

Background

We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice.

Methods

A total of 344 patients treated with IRD (N = 127) or RD (N = 217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient’s characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable and multivariable Cox proportional hazards models were used to evaluate the effect of treatment regimens and the significance of uneven variables. Statistical tests were performed at significance level 0.05.

Results

In the whole cohort, median PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1–3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51–0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0% in the IRD group vs 66.2% in the RD group with a complete response rate (CR) of 11.1% vs 8.8%, and very good partial response (VGPR) 22.2% vs 13.9%, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable.

Conclusions

Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.
Statin use is associated with a lower risk of recurrence after curative resection in BCLC stage 0-A hepatocellular carcinoma
Authors: Yang Shih-Yu , Wang Chih-Chi , Chen Kuang-Den , Liu Yueh-Wei , Lin Chih-Che , Chuang Ching-Hui , Tsai Yu-Chieh , Yao Chih-Chien , Yen Yi-Hao , Hsiao Chang-Chun , Hu Tsung-Hui , Tsai Ming-Chao
Published: January 2021

Background

Use of statins is associated with a reduced risk of hepatocellular carcinoma (HCC). However, the effect of statin use on HCC recurrence is unclear. This study aimed to evaluate the effect of statin use on recurrence after curative resection among patients with HCC.

Methods

We retrospectively assessed 820 patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A HCC who underwent primary resection between January 2001 and June 2016 at Kaohsiung Chang Gung Memorial Hospital. Exposure to statins was defined as use of a statin for at least 3 months before HCC recurrence. Factors that influenced overall survival (OS) and recurrence-free survival (RFS) were analyzed using Cox proportional hazards models.

Results

Of the 820 patients, 46 (5.6%) used statins (statin group) and 774 (94.4%) did not (non-statin group). During the mean follow-up of 76.5 months, 440 (53.7%) patients experienced recurrence and 146 (17.8%) patients died. The cumulative incidence of HCC recurrence was significantly lower in the statin group than the non-statin group (p = 0.001); OS was not significantly different between groups. In multivariate analysis, age (hazard ratio [HR]: 1.291; p = 0.010), liver cirrhosis (HR: 1.743; p < 0.001), diabetes (HR:1.418; p = 0.001), number of tumors (HR: 1.750; p < 0.001), tumor size (HR: 1.406; p = 0.004) and vascular invasion (HR: 1.659; p < 0.001) were independent risk factors for HCC recurrence, whereas statin use (HR: 0.354; p < 0.001) and antiviral therapy (HR: 0.613; p < 0.001) significantly reduced the risk of HCC recurrence. The statin group still had lower RFS than the non-statin group after one-to-four propensity score matching.

Conclusion

Statins may exert a chemo-preventive effect on HCC recurrence after curative resection.
Mental health planning at a very early stage of the COVID-19 crisis: a systematic review of online international strategies and recommendations
Authors: Almeda Nerea , García-Alonso Carlos , Salvador-Carulla Luis
Published: January 2021

Background

Mental health care systems have been dramatically affected by COVID-19. Containment measures have been imposed, with negative consequences on population mental health. Therefore, an increase in both symptomatology and mental disorder incidence is expected. This research aims to identify, describe and assess the empirical background on online strategies and recommendations developed by international organizations and governments to cope with the psychological impact of COVID-19 at a very early stage of the pandemic.

Methods

The PRISMA guidelines were adapted to review online documents. A new questionnaire was developed to identify the existence of common patterns in the selected documents. Questions were classified into three domains: COVID-19 information, mental health strategies and mental health recommendations. A two-step cluster analysis was carried out to highlight underlying behaviours in the data (patterns). The results are shown as spider graphs (pattern profiles) and conceptual maps (multidimensional links between questions).

Results

Twenty-six documents were included in the review. The questionnaire analysed document complexity and identified their common key mental health characteristics (i.e., does the respondent have the tools for dealing with stress, depression and anxiety?). Cluster analysis highlighted patterns from the questionnaire domains. Strong relationships between questions were identified, such as psychological tips for maintaining good mental health and coping with COVID-19 (question n° 4), describing some psychological skills to help people cope with anxiety and worry about COVID-19 (question n° 6) and promoting social connection at home (question n° 8).

Conclusions

When fast results are needed to develop health strategies and policies, rapid reviews associated with statistical and graphical methods are essential. The results obtained from the proposed analytical procedure can be relevant to a) classify documents according to their complexity in structuring the information provided on how to cope with the psychological impact of COVID-19, b) develop new documents according to specific objectives matching population needs, c) improve document design to face unforeseen events, and d) adapt new documents to local situations. In this framework, the relevance of adapting e-mental health procedures to community mental health care model principles was highlighted, although some problems related to the digital gap must be considered.
Intervention development of a brief messaging intervention for a randomised controlled trial to improve diabetes treatment adherence in sub-Saharan Africa
Authors: Leon Natalie , Namadingo Hazel , Bobrow Kirsty , Cooper Sara , Crampin Amelia , Pauly Bruno , Levitt Naomi , Farmer Andrew
Published: January 2021

Background

Brief messaging interventions, including Short Message Service (SMS) text-messages, delivered via mobile device platforms, show promise to support and improve treatment adherence. To understand how these interventions work, and to facilitate transparency, we need clear descriptions of the intervention development process.

Method

We describe and reflect on the process of designing and pretesting an evidence- and theory-informed brief messaging intervention, to improve diabetes treatment adherence in sub-Saharan Africa. We followed the stepwise approach recommended by the Medical Research Council, United Kingdom (MRC UK) Framework for Development and Evaluation of Complex Health Interventions and guidance for mobile health intervention development.

Results

We used a four-phase, iterative approach that first generated primary and secondary evidence on the lived experience of diabetes, diabetes treatment services and mobile-phone use. Second, we designed a type 2 diabetes-specific, brief text-message library, building on our previous hypertension text-message library, as well as drawing on the primary and secondary data from phase one, and on expert opinion. We then mapped the brief text-messages onto behaviour change (COM-B) theoretical constructs. Third, we refined and finalised the newly developed brief text-message library through stakeholder consultation and translated it into three local languages. Finally, we piloted the intervention by pre-testing the automated delivery of the brief text-messages in the trial sites in Malawi and South Africa. The final SMS text Adherence suppoRt for people with type 2 diabetes (StAR2D) intervention was tested in a randomised controlled trial in Malawi and South Africa (trial registration: ISRCTN70768808).

Conclusion

The complexity of public health interventions requires that we give more attention to intervention development work. Our documentation and reflection on the StAR2D intervention development process promotes transparency, replicability, assessment of intervention quality, and comparison with other studies.
Acute respiratory distress syndrome emerging after surgical debridement in a patient with extranodal natural killer/T cell lymphoma
Authors: Wang Wei , Li Zhi-Tao , Cui Nan-Nan , Wang Guo-Bin , Fu Shui-Qiao
Published: January 2021

Background

Extranodal natural killer/T cell lymphoma (ENKL) is a rare subtype of non-Hodgkin lymphoma, and lung involvement is extremely rare. The patients with pulmonary ENKL always presented unspecific symptoms of the respiratory system, such as cough with sputum and varying degrees of fever, while developing into acute respiratory distress (ARDS) was seldomly reported, especially promoted by the surgical procedure.

Case presentation

Here we describe a patient with nasal ENKL and most likely lung dissemination that was regarded as an infection at first. After nonresponse to a period of anti-infective therapy, this patient received surgical debridement. While the histopathology did not show the evidence of infection, but consistent with ENKL. The patient got refractory hypoxemia rapidly after surgery, with the LDH surging to a much higher level than before surgery. The ARDS was diagnosed, and he died on the 5th day after surgery. We postulate that ARDS was due to aggressive lymphoma proliferation promoted by the surgical procedure.

Conclusions

Pulmonary ENKL developing into ARDS was scarce, and was likely attributed to the aggressive tumor cell proliferation after surgery in this case.
Improvements in French risk stratification score were correlated with reductions in mean pulmonary artery pressure in pulmonary arterial hypertension: a subanalysis of the Japan Pulmonary Hypertension Registry (JAPHR)
Authors:   the Japan Pulmonary Hypertension Registry (JAPHR) Network, Tamura Yuichi , Kumamaru Hiraku , Abe Kohtaro , Satoh Toru , Miyata Hiroaki , Ogawa Aiko , Tanabe Nobuhiro , Hatano Masaru , Yao Atsushi , Tsujino Ichizo , Fukuda Keiichi , Kimura Hiroshi , Kuwana Masataka , Matsubara Hiromi , Tatsumi Koichiro
Published: January 2021

Background

Since there was no previous report, we analyzed the relationship between French Risk Stratification parameters in pulmonary arterial hypertension (PAH) and mean pulmonary arterial pressures (mPAP) using Japan PH Registry (JAPHR) national-wide cohort.

Methods

We enrolled 108 patients with PAH from JAPHR from previous reported cohort and analyzed the relations between French Risk Stratification scores and hemodynamic improvements.

Results

The ratio meeting 0 to 4 French Risk Stratification score was 21.3%, 31.5%, 32.4%, 13.0%, and 1.9% at baseline, and 6.5%, 23.2%, 33.3%, 23.2%, 13.9% at follow-up, respectively. The improvements in the number of criteria met were associated both with mPAP at follow-up (p = 0.03) and with the improvements in mPAP (p < 0.001).

Conclusion

The improvements in French Risk Stratification may become a marker of improved hemodynamics including mPAP.
Improving osteoarthritis management in primary healthcare: results from a quasi-experimental study
Authors: Østerås Nina , Blaker Irma Brandeggen , Hjortland Tore , Cottrell Elizabeth , Quicke Jonathan G. , Dziedzic Krysia S. , Blackburn Steven , Paulsen Aksel
Published: January 2021

Background

To improve quality of care for patients with hip and knee osteoarthritis (OA), general practitioners (GPs) and physiotherapists (PTs) in a Norwegian municipality initiated an intervention. The intervention aimed to increase provision of core OA treatment (information, exercise, and weight control) prior to referral for surgery, rational use of imaging for assessing OA and improve communication between healthcare professionals. This study assessed the effectiveness of this intervention.

Methods

Forty-eight PTs and one hundred one GPs were invited to the intervention that included two interactive workshops outlining best practice and an accompanying template for PT discharge reports. Using interrupted time series research design, the study period was divided into three: pre-implementation, transition (implementation) and post-implementation. Comparing the change between pre- and post-implementation, the primary outcome was patient-reported quality of OA care measured with the OsteoArthritis Quality Indicator questionnaire. Secondary outcomes were number of PT discharge reports, information included in GP referral letters to orthopaedic surgeon, the proportion of GP referral letters indicating use of core treatment, and the use of imaging within OA assessment. Analyses involved linear mixed and logistic regression models.

Results

The PT workshop had 30 attendees, and 31 PTs and 33 GPs attended the multidisciplinary workshop. Two hundred eight and one hundred twenty-five patients completed the questionnaire during pre- and post-implementation, respectively. The adjusted model showed a small, statistically non-significant, increase in mean total score for quality of OA care (mean change = 4.96, 95% CI -0.18, 10.12, p:0.057), which was mainly related to items on OA core treatment. Patients had higher odds of reporting receipt of information on treatment alternatives (odds ratio (OR) 1.9, 95% CI 1.08, 3.24) and on self-management (OR 2.4, 95% CI 1.33, 4.32) in the post-implementation phase. There was a small, statistically non-significant, increase in the proportion of GP referral letters indicating prior use of core treatment modalities. There were negligible changes in the number of PT discharge reports, in the information included in the GP referral letters, and in the use of imaging for OA assessment.

Conclusion

This study suggests that a primary care intervention including two inter-active workshops can shift the quality of care towards best practice recommendations.

Trial registration

ClinicalTrials.gov: NCT02876120.
Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience
Authors: Wang Xiaofei , Meng Yang , Liu Hao , Chen Hua , Wang Beiyu , Hong Ying
Published: January 2021

Background

Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR.

Methods

This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters.

Results

The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05).

Conclusion

CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.
Antivirals blocking entry of enteroviruses and therapeutic potential
Authors: Anasir Mohd Ishtiaq , Zarif Faisal , Poh Chit Laa
Published: January 2021

Viruses from the genus Enterovirus (EV) of the Picornaviridae family are known to cause diseases such as hand foot and mouth disease (HFMD), respiratory diseases, encephalitis and myocarditis. The capsid of EV is an attractive target for the development of direct-acting small molecules that can interfere with viral entry. Some of the capsid binders have been evaluated in clinical trials but the majority have failed due to insufficient efficacy or unacceptable off-target effects. Furthermore, most of the capsid binders exhibited a low barrier to resistance. Alternatively, host-targeting inhibitors such as peptides derived from the capsid of EV that can recognize cellular receptors have been identified. However, the majority of these peptides displayed low anti-EV potency (µM range) as compared to the potency of small molecule compounds (nM range). Nonetheless, the development of anti-EV peptides is warranted as they may complement the small-molecules in a drug combination strategy to treat EVs. Lastly, structure-based approach to design antiviral peptides should be utilized to unearth potent anti-EV peptides.
Study on the views and methods of ultrasonic screening and diagnosis for abnormal aortic arch in infants
Authors: He Xinjian , Chen Jiaoyang , Li Gaoyang
Published: January 2021

Background

The purpose of this study was to explore echocardiographic views and methods of aortic arch anomalies in infants, so as to improve the screening sensitivity and diagnostic accuracy.

Methods

140 children with abnormal aortic arch diagnosed by ultrasound in Children’s Hospital of Hebei Province from January 2014 to December 2019 were selected for retrospective analysis. All were confirmed by surgery or/and computerized tomography angiography. Series of views for aortic arch (the three-vessel and tracheal view, aortic arch short axis view, left aortic arch long axis view, aortic arch long axis continuous scan views) were performed in all cases on the basis of the routine views of echocardiography. The screening sensitivity and diagnostic coincidence rate of different echocardiographic views for aortic arch anomalies were analyzed.

Results

Among the 140 infants, right aortic arch were 21 cases (6/21 were accompanied by mirror branch and 15/21 were with aberrant left subclavian artery). Left aortic arch with aberrant right subclavian artery were 2 cases, and double aortic arch with both arches open were 20 cases. Double aortic arch with left arch atresia were 2 cases, and atresia of the proximal aorta with aortic arch dysplasia was 1 case. Coarctation of the aorta were 67 cases, and interruption of aortic arch were 27 cases. All the patients were correctly diagnosed except that 2 infants with interruption of aortic arch were incorrectly diagnosed as coarctation of the aorta, and 1 infant with coarctation of the aorta was misdiagnosed as interruption of aortic arch by echocardiography. The screening sensitivities of four views and four-view combination for abnormal aortic arch were 99.3, 73.6, 87.1, 99.3, and 100%; the diagnostic coincidence rates were 85.7, 27.1,66.4, 95.0%, and 97.9% respectively. On the basis of traditional left aortic long axis view, other three views had their own advantages. The screening sensitivity and diagnostic coincidence rate of four-view combination were significantly improved.

Conclusions

The three-vessel trachea view is simple and feasible, which is suitable for screening abnormal aortic arch. The combination of four views conduces to improving screening sensitivity and diagnostic accuracy of aortic arch abnormalities.
Assessing whether child and parent reports of the KINDL questionnaire measure the same constructs of quality of life in children with attention-deficit hyperactivity disorder
Authors: Alamolhoda Marzieh , Farjami Mohammad , Bagheri Zahra , Ghanizadeh Ahmad , Jafari Peyman
Published: January 2021

Background

Discrepancy between child self-report and parent proxy-report has long been documented in the health-related quality of life (HRQoL) measurement of children with chronic health conditions. This study aims to assess whether child and parent reports of the Kinder Lebensqualität fragebogen (KINDL) questionnaire measure the same construct of HRQoL in children with attention-deficit hyperactivity disorders (ADHD).

Methods

Participants were 122 Iranian children with ADHD and 127 of their parents, who completed the child and parent reports of the KINDL, respectively. Internal consistency of the child and parent reports were assessed by Cronbach's alpha. The intra-class correlation (ICC) coefficient and factor analysis were applied to assess whether the child self-report and the parent proxy-report measured the same construct of HRQoL. Additionally, convergent and discriminant validity were assessed using the Spearman correlation.

Results

The results of factor analysis revealed that the child self-report and parent proxy-report measure two different aspects of HRQoL. Moreover, both versions of the KINDL instrument showed excellent convergent and discriminant validity. The internal consistency was close to or greater than 0.7 for all domains of both child and parent reports.

Conclusions

Although the child self-report and the parent proxy-report of the Persian version of the KINDL have good psychometric properties, they are not interchangeable. This finding indicates that Iranian children with ADHD and their parents evaluate children's HRQoL from their own viewpoints.
How to promote exclusive breastfeeding in Ireland: a qualitative study on views of Chinese immigrant mothers
Authors: Chen Haoyue , Li Cheng , Zhou Qianling , Cassidy Tanya M. , Younger Katherine M. , Shen Siao , Kearney John M.
Published: January 2021

Background

The exclusive breastfeeding rate in Ireland is very low with extremely slow annual growth. The population of immigrants in Ireland is increasing. Improving exclusive breastfeeding practice among immigrants may contribute to the overall improvement of exclusive breastfeeding rates in Ireland. This study was conducted to elicit suggestions on improving exclusive breastfeeding rate for the first 6 months among Chinese immigrants in Ireland.

Methods

Fourteen semi-structured in-depth interviews were conducted with Chinese immigrant mothers residing in Ireland, who breastfed exclusively for 4 to 6 months. Interviews were recorded and transcribed in Chinese. Data were analyzed using a qualitative thematic analysis. Themes were developed through categorization of codes and via in-depth discussion between two researchers.

Results

Themes generated from the thematic content analysis were: 1) suggestions for new mothers: being strong mentally and getting support from family and friends; 2) suggestions for employers: creating a supportive workplace by setting up private rooms and breastmilk storage facilities; 3) suggestions for healthcare professionals: advocating breastfeeding in the hospital and addressing cultural differences by recruiting multilingual staff; 4) suggestions for the government: promoting breastfeeding by initiating societal and policy changes.

Conclusions

The key findings emerging from this study may be considered in the development of breastfeeding promotion strategies in Ireland. Our findings could also have implications for other English-speaking countries with low rates of exclusive breastfeeding.
BRD4 inhibition alleviates mechanical stress-induced TMJ OA-like pathological changes and attenuates TREM1-mediated inflammatory response
Authors: Huang Ziwei , Yang Ren , Zhang Lu , Zhu Mengjiao , Zhang Caixia , Wen Juan , Li Huang
Published: January 2021

The aim of this paper was to investigate the protective effects of bromodomain containing 4 (BRD4) inhibition on the temporomandibular joint osteoarthritis (TMJ OA) induced by compressive mechanical stress and to explore the underlying mechanism. In vivo, a rat model of TMJ compressive loading device was used and BRD4 inhibitor was injected into the TMJ region. HE staining and micro-CT analysis were used for histological and radiographic assessment. Immunohistochemistry and qPCR were performed to detect inflammatory cytokines expressions. High-throughput ChIP-sequencing screening was performed to compare the BRD4 and H3K27ac binding patterns between condylar cartilage from control and mechanical force groups. In vitro, the mandibular condylar chondrocytes were treated with IL-1β. Small Interference RNA (siRNA) infection was used to silencing BRD4 or TREM1. qPCR was performed to detect inflammatory cytokines expressions. Our study showed that BRD4 inhibition can alleviate the thinning of condylar cartilage and subchondral bone resorption, as well as decrease the inflammatory factors expression both in vivo and in vitro. ChIP-seq analysis showed that BRD4 was more enriched in the promoter region of genes related to the stress and inflammatory pathways under mechanical stress in vivo.Trem1, a pro-inflammatory gene, was screened out from the overlapped BRD4 and H3K27ac increased binding sites, andTrem1mRNA was found to be regulated by BRD4 inhibition both in vivo and in vitro. TREM1 inhibition reduced the expression of inflammatory factors induced by IL-1β in vitro. In summary, we concluded that BRD4 inhibition can protect TMJ OA-like pathological changes induced by mechanical stress and attenuate TREM1-mediated inflammatory response.
Interfollicular epidermal stem-like cells for the recreation of the hair follicle epithelial compartment
Authors: Abreu Carla M. , Pirraco Rogério P. , Reis Rui L. , Cerqueira Mariana T. , Marques Alexandra P.
Published: January 2021

Background

Hair follicle (HF) development and growth are dependent on epithelial-mesenchymal interactions (EMIs). Dermal papilla (DP) cells are recognized as the key inductive mesenchymal player, but the ideal source of receptive keratinocytes for human HF regeneration is yet to be defined. We herein investigated whether human interfollicular epidermal keratinocytes with stem-like features (EpSlKCs), characterized by a α6bri/CD71dim expression, can replace human hair follicular keratinocytes (HHFKCs) for the recreation of the HF epithelium and respective EMIs.

Methods

The α6bri/CD71dim cellular fraction was selected from the whole interfollicular keratinocyte population through fluorescence-activated cell sorting and directly compared with follicular keratinocytes in terms of their proliferative capacity and phenotype. The crosstalk with DP cells was studied in an indirect co-culture system, and EpSlKC hair forming capacity tested in a hair reconstitution assay when combined with DP cells.

Results

EpSlKCs exhibited a phenotypic profile similar to follicular keratinocytes and were capable of increasing DP cell proliferation and, for short co-culture times, the number of alkaline phosphatase-active cells, suggesting an improvement of their inductivity. Moreover, the recreation of immature HFs and sebaceous glands was observed after EpSlKC and DP cell co-grafting in nude mice.

Conclusions

Our results suggest that EpSlKCs are akin to follicular keratinocytes and can crosstalk with DP cells, contributing to HF morphogenesis in vivo, thus representing an attractive epithelial cell source for hair regeneration strategies.
The Relationship between Perceptions of Instructional Practices and Student Self-Efficacy In Guided-Inquiry Laboratory Courses
Authors: Beck Christopher W. , Blumer Lawrence S.
Published: January 2021

Variation in individual student perceptions of instructional practices within a course were significantly related to differences in student self-efficacy at the end of the semester. Self-efficacy was unrelated to average student perceptions and faculty perceptions of their own practices across courses.
Subcutaneous Rituximab-MiniCHOP Compared With Subcutaneous Rituximab-MiniCHOP Plus Lenalidomide in Diffuse Large B-Cell Lymphoma for Patients Age 80 Years or Older
Authors: Oberic Lucie , Peyrade Frederic , Puyade Mathieu , Bonnet Christophe , Dartigues-Cuillères Peggy , Fabiani Bettina , Ruminy Philippe , Maisonneuve Hervé , Abraham Julie , Thieblemont Catherine , Feugier Pierre , Salles Gilles , Bijou Fontanet , Pica Gian-Matteo , Damaj Gandhi , Haioun Corinne , Casasnovas René-Olivier , Farhat Hassan , Le Calloch Ronan , Waultier-Rascalou Agathe , Malak Sandra , Paget Jerome , Gat Elodie , Tilly Hervé , Jardin Fabrice
Published: January 2021

PURPOSE:

The prognosis of elderly patients with diffuse large B-cell lymphoma (DLBCL) is worse than that of young patients. An attenuated dose of chemotherapy—cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-miniCHOP)—is a good compromise between efficacy and safety in very elderly patients. In combination with R-CHOP (R2-CHOP), lenalidomide has an acceptable level of toxicity and may mitigate the negative prognosis of the non–germinal center B-cell–like phenotype. The Lymphoma Study association conducted a multicentric, phase III, open-label, randomized trial to compare R-miniCHOP and R2-miniCHOP.

PATIENTS AND METHODS:

Patients of age 80 years or older with untreated DLBCL were randomly assigned into the R-miniCHOP21 group or the R2-miniCHOP21 group for six cycles and stratified according to CD10 expression and age. The first cycle of rituximab was delivered by IV on D1 after a prephase and then delivered subcutaneously on D1 of cycles 2-6. Lenalidomide was delivered at a dose of 10 mg once daily on D1-D14 of each cycle. The primary end point was overall survival (OS).

RESULTS:

A total of 249 patients with new DLBCL were randomly assigned (127 R-miniCHOP and 122 R2-miniCHOP). The median age was 83 years (range, 80-96), and 55% of the patients were classified as non-GCB. The delivered dose for each R-miniCHOP compound was similar in both arms. Over a median follow-up of 25.1 months, the intention-to-treat analysis revealed that R2-miniCHOP did not improve OS (2-year OS 66% in R-miniCHOP and 65.7% in R2-miniCHOP arm, P = .98) in the overall population or in the non-GCB population. Grade 3-4 adverse events occurred in 53% of patients with R-miniCHOP and in 81% of patients with R2-miniCHOP.

CONCLUSION:

The addition of lenalidomide to R-miniCHOP does not improve OS. Rituximab delivered subcutaneously was safe in this population.
No Venous Thromboembolism Increase Among Transgender Female Patients Remaining on Estrogen for Gender-Affirming Surgery
Authors: Kozato Aki , Fox G W Conner , Yong Patrick C , Shin Sangyoon J , Avanessian Bella K , Ting Jess , Ling Yiwei , Karim Subha , Safer Joshua D , Pang John Henry
Published: January 2021

Background

Both surgery and exogenous estrogen use are associated with increased risk of venous thromboembolism (VTE). However, it is not known whether estrogen hormone therapy (HT) exacerbates the surgery-associated risk among transgender and gender nonbinary (TGNB) individuals. The lack of published data has contributed to heterogeneity in perioperative protocols regarding estrogen HT administration for TGNB patients undergoing gender-affirming surgery.

Methods

A single-center retrospective chart review was performed on all TGNB patients who underwent gender-affirming surgery between November 2015 and August 2019. Surgery type, preoperative HT regimen, perioperative HT regimen, VTE prophylaxis management, outcomes, and demographic data were recorded.

Results

A total of 919 TGNB patients underwent 1858 surgical procedures representing 1396 unique cases, of which 407 cases were transfeminine patients undergoing primary vaginoplasty. Of the latter, 190 cases were performed with estrogen suspended for 1 week prior to surgery, and 212 cases were performed with HT continued throughout. Of all cases, 1 patient presented with VTE, from the cohort of transfeminine patients whose estrogen HT was suspended prior to surgery. No VTE events were noted among those who continued HT. Mean postoperative follow-up was 285 days.

Conclusions

Perioperative VTE was not a significant risk in a large, homogenously treated cohort of TGNB patients independent of whether HT was suspended or not prior to surgery.
Generation of β Cells from iPSC of a MODY8 Patient with a Novel Mutation in the Carboxyl Ester Lipase (CEL) Gene
Authors: Pellegrini Silvia , Pipitone Giovanni B , Cospito Alessandro , Manenti Fabio , Poggi Gaia , Lombardo Marta T , Nano Rita , Martino Gianvito , Ferrari Maurizio , Carrera Paola , Sordi Valeria , Piemonti Lorenzo
Published: January 2021

Context

Maturity-onset diabetes of the young (MODY) 8 is a rare form of monogenic diabetes characterized by a mutation in CEL (carboxyl ester lipase) gene, which leads to exocrine pancreas dysfunction, followed by β cell failure. Induced pluripotent stem cells can differentiate into functional β cells. Thus, β cells from MODY8 patients can be generated in vitro and used for disease modelling and cell replacement therapy.

Methods

A genetic study was performed in a patient suspected of monogenic diabetes.

Results

A novel heterozygous pathogenic variant in CEL (c.1818delC) was identified in the proband, allowing diagnosis of MODY8. Three MODY8-iPSC (induced pluripotent stem cell) clones were reprogrammed from skin fibroblasts of the patient, and their pluripotency and genomic stability confirmed. All 3 MODY8-iPSC differentiated into β cells following developmental stages. MODY8-iPSC–derived β cells were able to secrete insulin upon glucose dynamic perifusion. The CEL gene was not expressed in iPSCs nor during any steps of endocrine differentiation.

Conclusion

iPSC lines from a MODY8 patient with a novel pathogenic variant in the CEL gene were generated; they are capable of differentiation into endocrine cells, and β cell function is preserved in mutated cells. These results set the basis for in vitro modelling of the disease and potentially for autologous β cell replacement.
The Effects of Coronavirus Disease 2019 on Pediatric Anesthesiologists: A Survey of the Members of the Society for Pediatric Anesthesia
Authors: Margolis Rebecca D. , Strupp Kim M. , Beacham Abbie O. , Yaster Myron , Austin Thomas M. , Macrae Andrew W. , Diaz-Berenstain Laura , Janosy Norah R.
Published: January 2021

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic has affected the personal and professional lives of all health care workers. Anesthesiologists frequently perform virus-aerosolizing procedures (eg, intubation and extubation) that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, depression, assessed job satisfaction, and explored financial impact.

METHODS:

After receiving approval from the SPA Committees for Research and Quality and Safety and the Colorado Multiple Institutional Review Board, we e-mailed a questionnaire to all 3245 SPA members. The survey included 22 questions related to well-being and 13 questions related to effects of COVID-19 on current and future practice, finances, retirement planning, academic time and productivity, and clinical and home responsibilities. To address low initial response rates and quantify nonresponse bias, we sent a shortened follow-up survey to a randomly selected subsample (n = 100) of SPA members who did not respond to the initial survey. Response differences between the 2 cohorts were determined.

RESULTS:

A total of 561 (17%) members responded to the initial questionnaire. Because of COVID-19, 21.7% of respondents said they would change their clinical responsibilities, and 10.6% would decrease their professional working time. Women were more likely than men to anticipate a future COVID-19–related job change (odds ratio [OR] = 1.92, 95% confidence interval [CI], 1.12-2.63; P = .011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI, 1.74-4.00; P < .001). Additionally, 14.2% of respondents planned to retire early, and 11.9% planned to retire later. Women and non-White respondents had higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI, 1.06-2.94, P = .026 and OR = 1.82, 95% CI, 1.08-3.04, P = .017, respectively), and 25.1% of all respondents felt socially isolated. In addition, both changes in retirement planning and future occupational planning were strongly associated with total job satisfaction scores (both P < .001).

CONCLUSIONS:

The COVID-19 pandemic has affected the personal and professional lives of pediatric anesthesiologists, albeit not equally, as women and non-Whites have been disproportionately impacted. The pandemic has significantly affected personal finances, home responsibilities, and retirement planning; reduced clinical and academic practice time and responsibilities; and increased feelings of social isolation, stress, burnout, and depression/anxiety.