bluuebunny/crossref_metadata_2025 huggingface dataset:
Acorus tatarinowii Schott extract reduces cerebral edema caused by ischemia–reperfusion injury in rats: involvement in regulation of astrocytic NKCC1/AQP4 and JNK/iNOS-mediated signaling
Authors: Lee Yu-Chen , Kao Shung-Te , Cheng Chin-Yi
Published: December 2020

Background

This study aimed to evaluate the effects of the Acorus tatarinowii Schott [Shi Chang Pu (SCP)] extract administered at the start of 2 h of middle cerebral artery occlusion (MCAo), followed by 3 d of reperfusion, and to determine mechanisms involved in anti-edema effects in the penumbra of the cerebral cortex.

Method

Rats were intraperitoneally administered the SCP extract at a dose of 0.25 g/kg (SCP-0.25 g), 0.5 g/kg (SCP-0.5 g), or 1 g/kg (SCP-1 g) at the start of MCAo.

Result

SCP-0.5 g and SCP-1 g treatments effectively reduced the cerebral infarct size, ameliorated cerebral edema, reduced blood–brain barrier permeability, and restored neurological function. SCP-0.5 g and SCP-1 g treatments markedly downregulated the levels of glial fibrillary acidic protein, Na+-K+-2Cl− cotransporter type 1 (NKCC1), aquaporin 4 (AQP4), phospho-c-Jun N-terminal kinase (p-JNK)/JNK, inducible nitric oxide synthase (iNOS), 3-nitrotyrosine, intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor-A (VEGF-A), and zonula occluden-1 (ZO-1) and upregulated ZO-3 expression in the penumbra of the cerebral cortex 3 d after reperfusion.

Conclusions

SCP-0.5 g and SCP-1 g treatments exert neuroprotective effects against cerebral infarction and cerebral edema partially by mitigating astrocytic swelling and blood–brain barrier disruption. Moreover, the anti-cerebral edema effects of SCP extract treatments are possibly associated with the downregulation of astrocytic NKCC1/AQP4 and JNK/iNOS-mediated ICAM-1/MMP-9 signaling in the penumbra of the cerebral cortex 3 d after reperfusion.
Simulation training for emergency skills: effects on ICU fellows’ performance and supervision levels
Authors: Zante Bjoern , Schefold Joerg C.
Published: December 2020

Background

The application of manual emergency skills is essential in intensive care medicine. Simulation training on cadavers may be beneficial. The aim of this study was to analyze a skill-training aiming to enhance ICU-fellows´ performance.

Methods

A skill-training was prepared for chest tube insertion, pericardiocentesis, and cricothyroidotomy. Supervision levels (SL) for entrustable professional activities (EPA) were applied to evaluate skill performance. Pre- and post-training, SL and fellows´ self- versus consultants´ external assessment was compared. Time on skill training was compared to conventional training in the ICU-setting.

Results

Comparison of pre/post external assessment showed reduced required SL for chest tube insertion, pericardiocentesis, and cricothyroidotomy. Self- and external assessed SL did not significantly correlate for pre-training/post-training pericardiocentesis and post-training cricothyroidotomy. Correlations were observed for self- and external assessment SL for chest tube insertion and pre-assessment for cricothyroidotomy. Compared to conventional training in the ICU-setting, chest tube insertion training may further be time-saving.

Conclusions

Emergency skill training separated from a daily clinical ICU-setting appeared feasible and useful to enhance skill performance in ICU fellows and may reduce respective SL. We observed that in dedicated skill-training sessions, required time resources would be somewhat reduced compared to conventional training methods.
Qualitative study of comprehension of heritability in genomics studies among the Yoruba in Nigeria
Authors:   the Indigene Study as part of the H3Africa Consortium, Taiwo Rasheed O. , Ipadeola John , Yusuf Temilola , Fagbohunlu Faith , Jenfa Gbemisola , Adebamowo Sally N. , Adebamowo Clement A.
Published: December 2020

Background

With growth of genomics research in Africa, concern has arisen about comprehension and adequacy of informed consent given the highly technical terms used in this field. We therefore decided to study whether there are linguistic and cultural concepts used to communicate heritability of characters, traits and diseases in an indigenous African population.

Methods

We conducted Focus Group Discussions among 115 participants stratified by sex, age and socio-economic status and Key Informant Interviews among 25 stakeholders and Key Opinion Leaders among Yoruba living in Ibadan, Nigeria. We used Atlas-ti v.8.3.17 software to analyze the data, using thematic approach.

Results

The study participants identified several linguistic and cultural concepts including words, proverbs, and aphorisms that are used to describe heritable characters, traits and diseases in their local dialect. These included words that can be appropriated to describe dominant and recessive traits, variations in penetrance and dilution of strength of heritable characteristics by time and inter-marriage. They also suggested that these traits are transmitted by “blood”, and specific partner’s blood may be stronger than the other regardless of sex.

Conclusions

Indigenous Yoruba populations have words and linguistic concepts that describe the heritability of characters, traits and diseases which can be appropriated to improve comprehension and adequacy of informed consent in genomics research. Our methods are openly available and can be used by genomic researchers in other African communities.
A plea to merge clinical and public health practices: reasons and consequences
Authors: Unger Jean-Pierre , Morales Ingrid , De Paepe Pierre , Roland Michel
Published: December 2020

Background

Revisiting professionalism, both as a medical ideal and educational topic, this paper asks whether, in the rise of artificial intelligence, healthcare commoditisation and environmental challenges, a rationale exists for merging clinical and public health practices. To optimize doctors’ impact on community health, clinicians should introduce public health thinking and action into clinical practice, above and beyond controlling nosocomial infections and iatrogenesis. However, in the interest of effectiveness they should do everything possible to personalise care delivery. To solve this paradox, we explore why it is necessary for the boundaries between medicine and public health to be blurred.

Main body

Proceeding sequentially, we derive standards for medical professionalism from care quality criteria, neo-Hippocratic ethics, public health concepts, and policy outcomes. Thereby, we formulate benchmarks for health care management and apply them to policy evaluation. During this process we justify the social, professional - and by implication, non-commercial, non-industrial - mission of healthcare financing and policies.

The complexity of ethical, person-centred, biopsychosocial practice requires a human interface between suffering, health risks and their therapeutic solution – and thus legitimises the medical profession’s existence. Consequently, the universal human right to healthcare is a right to access professionally delivered care. Its enforcement requires significant updating of the existing medical culture, and not just in respect of the man/machine interface. This will allow physicians to focus on what artificial intelligence cannot do, or not do well. These duties should become the touchstone of their practice, knowledge and ethics. Artificial intelligence must support medical professionalism, not determine it. Because physicians need sufficient autonomy to exercise professional judgement, medical ethics will conflict with attempts to introduce clinical standardisation as a managerial paradigm, which is what happens when industrial-style management is applied to healthcare.

Conclusion

Public healthcare financing and policy ought to support medical professionalism, alongside integrated clinical and public health practice, and its management. Publicly-financed health management should actively promote ethics in publicly- oriented services. Commercialised healthcare is antithetical to ethical medical, and to clinical / public health practice integration. To lobby governments effectively, physicians need to appreciate the political economy of care.
Integrating clinical and public health knowledge in support of joint medical practice
Authors: Unger Jean-Pierre , Morales Ingrid , De Paepe Pierre , Roland Michel
Published: December 2020

Background

Strong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives:

GPs are expected to practice community medicine;

Hospital specialists can be involved in disease control and health service organisation;

Doctors can teach, coach, evaluate, and coordinate care;

Clinicians should interpret protocols with reference to clinical epidemiology.

Public health physicians should tailor preventive medicine to individual health risks.

This paper is targeted at those practitioners and academics responsible for their teams’ professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health.

Main text

Based on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques.

The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories:

‘Know-how/practice techniques’, corresponding a.o. to behavioural, communication, and manual skills;

‘Procedural knowledge’ to choose and apply procedures that meet explicit quality criteria;

‘Practical knowledge’ to design new procedures and inform the design of established procedures in new contexts; and

Theoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures.

Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts.

Conclusion

Because the quality of care utilises the professionals’ skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities.
Improving the transition process to independent living for adolescents with profound intellectual disabilities. Experiences of parents and employees
Authors: Roos Eirik , Søndenaa Erik
Published: December 2020

Background

The transition process from the family home to independent living for young adults with profound intellectual disability (PID) becomes delayed. Those families face challenges that exceed those of typical families such as higher objective and subjective burden, more frequent psychological distress and lower social support. The aim of this study was to explore the collaboration process between parents and employees and identify factors that improve the transition with less burden.

Methods

A descriptive qualitative study was undertaken with 18 persons (9 parents and 9 employees) interviewed individually and in groups. In accordance with the municipality’s guidelines, families with a child with PID should apply for housing, when the child turns 16. The purpose is to ensure interdisciplinary collaboration, information flow and coordinated services according to family’s needs. The main question in the interviews was ‘What was your experience with cooperation in the transition process, and what would you do to improve this process?’ The interviews were analysed with a thematic approach using systematic text condensation.

Results

The parents experienced a lack of general information about the ‘housing waiting list’, level of services, and the plan for time of moving from the family home, and how to choose where and whom to live with. Parents described an unsustainable burden of care during the waiting period, and a family crisis caused the allocation of an apartment in a group house. Employees shared challenges to meet families’ wishes, as there were too few group homes. They experienced good collaboration with families and said they offered respite care, due to reduce parents’ burden of care. Employees experienced that PID adolescents developed skills, mastery and degrees of independence after completing a residency at the Folk High School.

Conclusions

To improve the transition process from family home to independent living for young adults with PID, the informants highlighted some factors to reduce the burden of care on families: 1) Systematic follow-up program for families to observe their needs at an early stage; 2) More available group houses; 3) Information about the housing priorities of the services and; 4) Educational preparation programs for families.
Psychomotor development and attention problems caused by a splicing variant of CNKSR2
Authors: Zhang Yi , Yu Tingting , Li Niu , Wang Jiwen , Wang Jian , Ge Yihua , Yao Ruen
Published: December 2020

Background

Mutations in CNKSR2 have been described in patients with neurodevelopmental disorders characterized by childhood epilepsy, language deficits, and attention problems. The encoded protein plays an important role in synaptic function.

Case presentation

Whole-exome sequencing was applied to detect pathogenic variants in a patient with clinical symptoms of psychomotor development, attention deficit, poor logical thinking ability, and an introverted personality, but without epilepsy or any significant electroencephalogram changes. Genetic study revealed a splicing mutation (c.1904 + 1G > A) and RT-PCR revealed aberrant splicing of exon 16, leading to a reading-frame shift and a truncated protein in the PH domain.

Conclusions

This is the first report of a splicing variant of CNKSR2, and the unique clinical features of this pedigree will help extend our understanding of the genetic and phenotypic spectra of CNKSR2-related disorders.
ETS1-activated SNHG10 exerts oncogenic functions in glioma via targeting miR-532-3p/FBXL19 axis
Authors: Jin Lide , Huang Shengquan , Guan Congjin , Chang Shun
Published: December 2020

Background

In past few years, long non-coding RNAs (lncRNAs) have been reported to play regulatory roles during cancer progression. LncRNA SNHG10 has been explored in several sorts of cancers. However, its detailed role and mechanism are still not well understood in glioma.

Methods

Expression levels of genes were evaluated by RT-qPCR. EdU, TUNEL, sphere formation, wound healing and transwell assays appraised the effect of SNHG10 on glioma cellular processes. The interaction between molecules was examined by ChIP, RIP, RNA pull down and luciferase reporter assays.

Results

High level of SNHG10 was detected in glioma cells. Functional assay confirmed that SNHG10 promoted the proliferation, migration, invasion and stemness of glioma cells. Moreover, miR-532-3p was validated to bind with SNHG10 and expressed at a low level in glioma cells. Importantly, miR-532-3p exerted inhibitory functions in glioma. Furthermore, it was found that FBXL19 targeted by miR-532-3p facilitated cell growth and stemness in glioma, and that SNHG10 worked in glioma by increasing FBXL19 expression through sequestering miR-532-3p. More importantly, ETS1 promoted the transcription of SNHG10 and it mediated contribution to the malignant behaviors of glioma cells by SNHG10/miR-532-3p/FBXL19 signaling.

Conclusion

SNHG10 was transcriptionally activated by ETS1 and played an oncogenic role in glioma by sponging miR-532-3p and up-regulating FBXL19.
Combined forced oscillation and fractional-order modeling in patients with work-related asthma: a case–control study analyzing respiratory biomechanics and diagnostic accuracy
Authors: Tuza Fábio Augusto d´Alegria , de Sá Paula Morisco , Castro Hermano A. , Lopes Agnaldo José , de Melo Pedro Lopes
Published: December 2020

Background

Fractional-order (FrOr) models have a high potential to improve pulmonary science. These models could be useful for biomechanical studies and diagnostic purposes, offering accurate models with an improved ability to describe nature. This paper evaluates the performance of the Forced Oscillation (FO) associated with integer (InOr) and FrOr models in the analysis of respiratory alterations in work-related asthma (WRA).

Methods

Sixty-two individuals were evaluated: 31 healthy and 31 with WRA with mild obstruction. Patients were analyzed pre- and post-bronchodilation. The diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUC). To evaluate how well do the studied models correspond to observed data, we analyzed the mean square root of the sum (MSEt) and the relative distance (Rd) of the estimated model values to the measured resistance and reactance measured values.

Results and discussion

Initially, the use of InOr and FrOr models increased our understanding of the WRA physiopathology, showing increased peripheral resistance, damping, and hysteresivity. The FrOr model (AUC = 0.970) outperformed standard FO (AUC = 0.929), as well as InOr modeling (AUC = 0.838) in the diagnosis of respiratory changes, achieving high accuracy. FrOr improved the curve fitting (MSEt = 0.156 ± 0.340;Rd = 3.026 ± 1.072) in comparison with the InOr model (MSEt = 0.367 ± 0.991;Rd = 3.363 ± 1.098). Finally, we demonstrated that bronchodilator use increased dynamic compliance, as well as reduced damping and peripheral resistance.

Conclusions

Taken together, these results show clear evidence of the utility of FO associated with fractional-order modeling in patients with WRA, improving our knowledge of the biomechanical abnormalities and the diagnostic accuracy in this disease.
Residential segregation, neighborhood violence and disorder, and inequalities in anxiety among Jewish and Palestinian-Arab perinatal women in Israel
Authors: Daoud Nihaya , Alfayumi-Zeadna Samira , Tur-Sinai Aviad , Geraisy Nabil , Talmud Ilan
Published: December 2020

Background

Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder.

Aims

We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality.

Methods

We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the “Family Relations, Violence and Health” study (2014–2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women.

Results

Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04–2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00–1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07–1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women.

Conclusions

Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.
Location inference for hidden population with online text analysis
Authors: Liu Chuchu , Cao Ziqiang , Lu Xin
Published: December 2020

Background

Understanding the geographic distribution of hidden population, such as men who have sex with men (MSM), sex workers, or injecting drug users, are of great importance for the adequate deployment of intervention strategies and public health decision making. However, due to the hard-to-access properties, e.g., lack of a sampling frame, sensitivity issue, reporting error, etc., traditional survey methods are largely limited when studying such populations. With data extracted from the very active online community of MSM in China, in this study we adopt and develop location inferring methods to achieve a high-resolution mapping of users in this community at national level.

Methods

We collect a comprehensive dataset from the largest sub-community related to MSM topics in Baidu Tieba, covering 628,360 MSM-related users. Based on users’ publicly available posts, we evaluate and compare the performances of mainstream location inference algorithms on the online locating problem of Chinese MSM population. To improve the inference accuracy, other approaches in natural language processing are introduced into the location extraction, such as context analysis and pattern recognition. In addition, we develop a hybrid voting algorithm (HVA-LI) by allowing different approaches to vote to determine the best inference results, which guarantees a more effective way on location inference for hidden population.

Results

By comparing the performances of popular inference algorithms, we find that the classic gazetteer-based algorithm has achieved better results. And in the HVA-LI algorithms, the hybrid algorithm consisting of the simple gazetteer-based method and named entity recognition (NER) is proven to be the best to deal with inferring users’ locations disclosed in short texts on online communities, improving the inferring accuracy from 50.3 to 71.3% on the MSM-related dataset.

Conclusions

In this study, we have explored the possibility of location inferring by analyzing textual content posted by online users. A more effective hybrid algorithm, i.e., the Gazetteer & NER algorithm is proposed, which is conducive to overcoming the sparse location labeling problem in user profiles, and can be extended to the inference of geo-statistics for other hidden populations.
Emerging nanomedicines for effective breast cancer immunotherapy
Authors: Bahreyni Amirhossein , Mohamud Yasir , Luo Honglin
Published: December 2020

Breast cancer continues to be the most frequently diagnosed malignancy among women, putting their life in jeopardy. Cancer immunotherapy is a novel approach with the ability to boost the host immune system to recognize and eradicate cancer cells with high selectivity. As a promising treatment, immunotherapy can not only eliminate the primary tumors, but also be proven to be effective in impeding metastasis and recurrence. However, the clinical application of cancer immunotherapy has faced some limitations including generating weak immune responses due to inadequate delivery of immunostimulants to the immune cells as well as uncontrolled modulation of immune system, which can give rise to autoimmunity and nonspecific inflammation. Growing evidence has suggested that nanotechnology may meet the needs of current cancer immunotherapy. Advanced biomaterials such as nanoparticles afford a unique opportunity to maximize the efficiency of immunotherapy and significantly diminish their toxic side-effects. Here we discuss recent advancements that have been made in nanoparticle-involving breast cancer immunotherapy, varying from direct activation of immune systems through the delivery of tumor antigens and adjuvants to immune cells to altering immunosuppression of tumor environment and combination with other conventional therapies.
Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work
Authors: Davitadze Arsen , Meylakhs Peter , Lakhov Aleksey , King Elizabeth J.
Published: December 2020

Background

Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger.

Methods

Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD.

Results

Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services.

Conclusions

Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.
Racial/ethnic differences in health-related quality of life among Hawaii adult population
Authors: Lim Eunjung , Davis James , Siriwardhana Chathura , Aggarwal Lovedhi , Hixon Allen , Chen John J.
Published: December 2020

Background

This study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity.

Methods

This study was conducted under a cross-sectional design. We used the 2011–2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson’s behavioral model on each distress measure by race/ethnicity.

Results

Among Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups.

Conclusions

This study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities.
Minimum clinical important difference for resilience scale specific to cancer: a prospective analysis
Authors: Ye Zeng Jie , Zhang Zhang , Tang Ying , Liang Jian , Zhang Xiao Ying , Hu Guang Yun , Sun Zhe , Liang Mu Zi , Yu Yuan Liang
Published: December 2020

Background

The minimum clinical important differences (MCIDs) of resilience instruments in patients with cancer have not been comprehensively described.
This study was designed to evaluate MCIDs of 10-item and 25-item resilience scales specific to cancer (RS-SC-10 and RS-SC-25).

Methods

From June 2015 to December 2018, RS-SCs were longitudinally measured in 765 patients with different cancer diagnoses at baseline (T0) and 3 months later (T1). The EORTC QLQ-C30, Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Allostatic Load Index were measured concurrently as anchors. Anchor-based methods (linear regression, within-group), distribution-based methods(within-group), and receiver operating characteristic curves (ROCs, within-subject) were performed to evaluate the MCIDs.

Results

623 of 765 (84.1%) patients had paired RS-SCs scores. Moderate correlations were identified between the change in RS-SCs and change in anchors (r = 0.38–0.44, all p < 0.001). Linear regression estimated + 8.9 and − 6.7 as the MCIDs of RS-SC-25, and + 3.4 and − 2.5 for RS-SC-10. Distribution-based methods estimated + 9.9 and − 9.9 as the MCIDs of RS-SC-25, and + 4.0 and − 4.0 for RS-SC-10. ROC estimated + 5.5 and − 4.5 as the MCIDs of RS-SC-25, and + 2.0 and − 1.5 for RS-SC-10.

Conclusions

The most reliable MCID is around 5 points for RS-SC-25 and 2 points for RS-SC-10. RS-SCs are more responsive to the worsening status of resilience in patients with cancer and these estimates could be useful in future resilience-based intervention trials.
Turnover among Australian general practitioners: a longitudinal gender analysis
Authors: Bardoel E. Anne , Russell Grant , Advocat Jenny , Mayson Susan , Kay Margaret
Published: December 2020

Background

Little is known about gender differences in general practitioner (GP) turnover. It is important to understand potential divergence given both the feminization of the Australian GP workforce and projected shortages of GPs.

Objective

There is increasing evidence that national health outcomes are related to the extent to which health care systems incorporate high quality primary care. Quality primary care is, in turn reliant on a stable general practice (GP) workforce. With the increasing feminization of medical schools, we sought to identify correlates of turnover in the GP workforce, separately for women and men, focusing particularly on part-time employment and child-rearing, and distinguishing effects related to either planned or unplanned turnover.

Methods

Annual responses from cohorts of at least 1900 women GPs and 2000 men GPs are used for up to eight waves of the Medicine in Australia—Balancing Employment and Life (MABEL) longitudinal survey of doctors. Descriptive and bivariate correlations are provided. Random effects ordered logit is applied to dependent variables for turnover intentions measuring intent to “leave direct care” or “leave medicine”. A behavioral measure of turnover is used in random effects logit regressions, with the exclusion or inclusion of the confounding intentions variables revealing correlates of unplanned or planned turnover.

Results

Part-time employment is associated with turnover intentions among both women (84% or 94% increase in the odds ratios or ORs) and particularly men (414% or 672%), and with actual turnover for women (150% or 49%) and for men (160% or 107%). Women GPs engage in more unplanned turnover than men: they are 85% more likely to engage in turnover after controlling for intentions. Unplanned turnover is concentrated among women below 40 years of age and with young children, even though both groups report below average turnover intentions.

Conclusion

Although further studies are needed to identify specific factors associated with GP turnover among women, the analysis highlights the need to focus on women GPs who are either young or have young children. Given the substantial personal and social investment required to produce GPs, it is wasteful to lose so many young women early in their careers.
A continuous data driven translational model to evaluate effectiveness of population-level health interventions: case study, smoking ban in public places on hospital admissions for acute coronary events
Authors: Bonakdari Hossein , Pelletier Jean-Pierre , Martel-Pelletier Johanne
Published: December 2020

Background

An important task in developing accurate public health intervention evaluation methods based on historical interrupted time series (ITS) records is to determine the exact lag time between pre- and post-intervention. We propose a novel continuous transitional data-driven hybrid methodology using a non-linear approach based on a combination of stochastic and artificial intelligence methods that facilitate the evaluation of ITS data without knowledge of lag time. Understanding the influence of implemented intervention on outcome(s) is imperative for decision makers in order to manage health systems accurately and in a timely manner.

Methods

To validate a developed hybrid model, we used, as an example, a published dataset based on a real health problem on the effects of the Italian smoking ban in public spaces on hospital admissions for acute coronary events. We employed a continuous methodology based on data preprocessing to identify linear and nonlinear components in which autoregressive moving average and generalized structure group method of data handling were combined to model stochastic and nonlinear components of ITS. We analyzed the rate of admission for acute coronary events from January 2002 to November 2006 using this new data-driven hybrid methodology that allowed for long-term outcome prediction.

Results

Our results showed the Pearson correlation coefficient of the proposed combined transitional data-driven model exhibited an average of 17.74% enhancement from the single stochastic model and 2.05% from the nonlinear model. In addition, data demonstrated that the developed model improved the mean absolute percentage error and correlation coefficient values for which 2.77% and 0.89 were found compared to 4.02% and 0.76, respectively. Importantly, this model does not use any predefined lag time between pre- and post-intervention.

Conclusions

Most of the previous studies employed the linear regression and considered a lag time to interpret the impact of intervention on public health outcome. The proposed hybrid methodology improved ITS prediction from conventional methods and could be used as a reliable alternative in public health intervention evaluation.
Can harmonisation of outcomes bridge the translation gap for pre-clinical research? A systematic review of outcomes measured in mouse models of type 2 diabetes
Authors: Harman Nicola L. , Sanz-Moreno Adrián , Papoutsopoulou Stamatia , Lloyd Katie A. , Ameen-Ali Kamar E. , Macleod Malcolm , Williamson Paula R.
Published: December 2020

Background

In pre-clinical research, systematic reviews have the potential to mitigate translational challenges by facilitating understanding of how pre-clinical studies can inform future clinical research. Yet their conduct is encumbered by heterogeneity in the outcomes measured and reported, and those outcomes may not always relate to the most clinically important outcomes. We aimed to systematically review outcomes measured and reported in pre-clinical in vivo studies of pharmacological interventions to treat high blood glucose in mouse models of type 2 diabetes.

Methods

A systematic review of pre-clinical in vivo studies of pharmacological interventions aimed at addressing elevated blood glucose in mouse models of type 2 diabetes was completed. Studies were screened for eligibility and outcomes extracted from the included studies. The outcomes were recorded verbatim and classified into outcome domains using an existing outcome taxonomy. Outcomes were also compared to those identified in a systematic review of registered phase 3/4 clinical trials for glucose lowering interventions in people with type 2 diabetes.

Results

Review of 280 included studies identified 532 unique outcomes across 19 domains. No single outcome, or domain, was measured in all studies and only 132 (21%) had also been measured in registered phase 3/4 clinical trials. A core outcome set, representing the minimum that should be measured and reported, developed for type 2 diabetes effectiveness clinical trials includes 18 core outcomes, of these 12 (71%) outcomes were measured and reported in one or more of the included pre-clinical studies.

Conclusions

There is heterogeneity of outcomes reported in pre-clinical research. Harmonisation of outcomes across the research pathway using a core outcome set may facilitate interpretation, evidence synthesis and translational success, and may contribute to the refinement of the use of animals in research.

Systematic review registration: The study was prospectively registered on the PROSPERO Database, registration number CRD42018106831
Toll-like receptor-mediated innate immunity against herpesviridae infection: a current perspective on viral infection signaling pathways
Authors: Zheng Wenjin , Xu Qing , Zhang Yiyuan , E Xiaofei , Gao Wei , Zhang Mogen , Zhai Weijie , Rajkumar Ronaldjit Singh , Liu Zhijun
Published: December 2020

Background

In the past decades, researchers have demonstrated the critical role of Toll-like receptors (TLRs) in the innate immune system. They recognize viral components and trigger immune signal cascades to subsequently promote the activation of the immune system.

Main body

Herpesviridae family members trigger TLRs to elicit cytokines in the process of infection to activate antiviral innate immune responses in host cells. This review aims to clarify the role of TLRs in the innate immunity defense against herpesviridae, and systematically describes the processes of TLR actions and herpesviridae recognition as well as the signal transduction pathways involved.

Conclusions

Future studies of the interactions between TLRs and herpesviridae infections, especially the subsequent signaling pathways, will not only contribute to the planning of effective antiviral therapies but also provide new molecular targets for the development of antiviral drugs.
Clinicopathological and immunohistochemical study of 29 cases of solid-pseudopapillary neoplasms of the pancreas in patients under 20 years of age along with detailed review of literature
Authors: Din Nasir Ud , Rahim Shabina , Abdul-Ghafar Jamshid , Ahmed Arsalan , Ahmad Zubair
Published: December 2020

Background

Pancreatic Solid Pseudopapillary Neoplasms (SPNs) are rare low-grade malignant tumors with a marked preponderance for young females. Objective was to describe the morphology, differential diagnosis, and prognosis of SPNs in patients under 20 years of age and present a detailed review of literature.

Methods

A total of 29 cases in patients under 20 years of age reported as SPN during the period January 2014 to December 2019, were included in the study. These included 19 resection specimens, 4 incision biopsies and 6 cases received as blocks for second opinion. Hematoxylin and eosin (H&E) slides as well as immunohistochemistry (IHC) slides of all cases were retrieved and reviewed by the authors. TFE3 and Progesterone Receptor were performed retrospectively.

Results

Twenty-eight of the 29 patients were females. Ages of patients ranged from 12 to 19 years. Nineteen cases were resections. Tail was the commonest location. Mean tumor size was 9.5 cm. In 89.5% cases, tumor was confined to the pancreas. In 2 cases, distant metastasis was present. In 2 cases, extension beyond pancreas was seen. Solid and pseudopapillary areas were seen in all cases while other features were variable. Beta catenin and Cyclin D1 were positive in most cases while TFE3 was positive in 57% cases. Progesterone Receptor (PR) was positive in all 13 cases in which it was performed. Follow up was available in 14 patients. Follow up period ranged from 3 to 70 months. Twelve were alive and well without recurrence or metastasis while 2 were alive with recurrence and metastasis to liver and omentum respectively.

Conclusions

Although many studies on SPNs have been published, surgeons, oncologists and even pathologists in this part of the world are often not aware of these rare tumors leading to inaccuracies and delays in diagnosis. In addition, this paper focusses on the interesting observation that the majority of SPNs diagnosed in our department during study period occurred in patients under 20 years of age (29 versus 21 in patients over 20). However, clinico-epidemiological, morphologic and prognostic features were similar in both age groups. Possibility of SPNs should always be considered in case of pancreatic neoplasms occurring in patients under 20 years of age as well. We believe that this is a very interesting and helpful study for the clinicians as well as the pathologists.
Influence of a metaphyseal sleeve on the stress-strain state of a bone-tumor implant system in the distal femur: an experimental and finite element analysis
Authors: Li Jian-jun , Tian Dong-mu , Yang Li , Zhang Jing-yu , Hu Yong-cheng
Published: December 2020

Background

Aseptic loosening of distal femoral tumor implants significantly correlates with the resection length. We designed a new “sleeve” that is specially engaged in the metaphysis at least 5 cm proximal to the knee joint line to preserve as much bone stock as possible. This study investigates the influence of a metaphyseal sleeve on the stress-strain state of a bone tumor implant system in the distal femur.

Methods

Cortex strains in intact and implanted femurs were predicted with finite element (FE) models. Moreover strains were experimentally measured in a cadaveric femur with and without a sleeve and stem under an axial compressive load of 1000 N. The FE models, which were validated by linear regression, were used to investigate the maximal von Mises stress and the implanted-to-intact (ITI) ratios of strain in the femur with single-legged stance loading under immediate postoperative and osseointegration conditions.

Results

Good agreement was noted between the experimental measurements and numerical predictions of the femoral strains (coefficient of determination (R2) ≥ 0.95; root-mean-square error (RMSE%) ≈ 10%). The ITI ratios for the metaphysis were between 13 and 28% and between 10 and 21% under the immediate postoperative and osseointegration conditions, respectively, while the ITI ratios for the posterior and lateral cortices around the tip of the stem were 110% and 119% under the immediate-postoperative condition, respectively, and 114% and 101% under the osseointegration condition, respectively. The maximal von Mises stresses for the implanted femur were 113.8 MPa and 43.41 MPa under the immediate postoperative and osseointegration conditions, which were 284% and 47% higher than those in the intact femur (29.6 MPa), respectively.

Conclusions

This study reveals that a metaphyseal sleeve may cause stress shielding relative to the intact femur, especially in the distal metaphysis. Stress concentrations might mainly occur in the posterior cortex around the tip of the stem. However, stress concentrations may not be accompanied by periprosthetic fracture under the single-legged stance condition.
Plasma and local expressions of CircRNA CDR1as are linked with disease severity in patients with non-traumatic osteonecrosis of femoral head
Authors: Jiang Bin , Zhu Shu-Hua , Zeng Ji-Yong , Mao Zheng
Published: December 2020

Objective

To investigate the correlation of plasma and local expressions of Circ CDR1as with disease severity in patients with non-traumatic osteonecrosis of femoral head (ONFH).

Methods

Ninety-nine non-traumatic ONFH patients receiving surgery and 99 healthy individuals were enrolled in our study. Plasma and local Circ CDR1as were detected using real-time quantitative PCR (RT-qPCR). Radiographic progression was determined using Association Research Circulation Osseous (ARCO) classification system. Harris hip score (HHS) and visual analogue scale (VAS) were used to assess the clinical severity. Receiver operating characteristic (ROC) curve was carried out to evaluate the diagnostic value of plasma Circ CDR1as with regard to the radiographic severity.

Results

Plasma Circ CDR1as expressions were significantly higher in non-traumatic ONFH patients compared with healthy controls. In non-traumatic ONFH patients, there were no significant differences of CircCDR1as expressions between patients with alcohol-induced ONFH and steroid-induced ONFH. CircCDR1as in local necrotic tissue were significantly higher than adjacent non-affected tissue. Plasma and local Circ CDR1as expressions in patients with ARCO phase 4 were markedly upregulated compared with ARCO phase 3; plasma and local Circ CDR1as expressions in patients with ARCO phase 3 were markedly upregulated compared with ARCO phase 1/2. Plasma and local CircCDR1as expressions were positively associated with ARCO classification. In addition, plasma and local Circ CDR1as expressions were positively correlated with VAS and HHS scores. ROC curve analysis indicated that plasma Circ CDR1as may act as a decent marker for radiographic progression in non-traumatic ONFH patients.

Conclusions

Both plasma and local expressions of CircRNA CDR1as are linked with disease severity in patients with non-traumatic ONFH.