bluuebunny/crossref_metadata_2025 huggingface dataset:
A step-by-step guide for the diagnosis and management of hyponatraemia in patients with stroke
Authors: Barkas Fotios , Anastasiou Georgia , Liamis George , Milionis Haralampos
Published: April 2023

Hyponatraemia is common in patients with stroke and associated with adverse outcomes and increased mortality risk. The present review presents the underlying causes and provides a thorough algorithm for the diagnosis and management of hyponatraemia in stroke patients. Concomitant diseases and therapies, such as diabetes, chronic kidney disease and heart failure, along with diuretics, antidepressants and proton pump inhibitors are the most common causes of hyponatraemia in community. In the setting of acute stroke, the emergence of hyponatraemia might be attributed to the administration of hypotonic solutions and drugs (ie. mannitol and antiepileptics), poor solute intake, infections, as well as stroke-related conditions or complications, such as the syndrome of inappropriate secretion of antidiuretic hormone, cerebral salt wasting syndrome and secondary adrenal insufficiency. Diagnostically, the initial step is to differentiate hypotonic from non-hypotonic hyponatraemia, usually caused by hyperglycaemia or recent mannitol administration in patients with stroke. Determining urine osmolality, urine sodium level and volume status are the following steps in the differentiation of hypotonic hyponatraemia. Of note, specific parameters, such as fractional uric acid and urea excretion, along with plasma copeptin concentration, may further improve the diagnostic yield. Therapeutic options are based on the duration and symptoms of hyponatremia. In the case of acute or symptomatic hyponatraemia, hypertonic saline administration is recommended. Hypovolaemic chronic hyponatremia is treated with isotonic solution administration. Although fluid restriction remains the first-line treatment for the rest forms of chronic hyponatraemia, therapies increasing renal free water excretion may be necessary. Loop diuretics and urea serve this purpose in patients with stroke, whereas sodium-glucose transport protein-2 inhibitors appear to be a promising therapy. Nevertheless, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in such patients. Randomized trials designed to compare therapeutic strategies in managing hyponatraemia in patients with stroke are required.
Observational Study Examining Kidney Transplantation Outcomes Following Donation From Individuals That Died of Drug Toxicity in British Columbia, Canada
Authors: Xie Max Wenheng , Kennan Sean Patrick , Slaunwhite Amanda , Rose Caren
Published: April 2023

Background:

The illicit drug toxicity (overdose) crisis has worsened across Canada, between 2016 and 2021 more than 28 000 individuals have died of drug toxicity. Organ donation from persons who experience drug toxicity death has increased in recent years.

Objective:

This study examines whether graft loss after kidney transplantation differed by donor cause of death.

Design:

Retrospective cohort.

Setting:

Provincial transplant program of British Columbia, Canada.

Patients:

Transplant recipients who received kidney transplantation from deceased donors aged 12 to 70 years between 2013 and 2019 (N = 1012).

Measurements:

Transplant recipient all cause graft loss (graft loss due to any cause including death) was compared by donor cause of death from drug toxicity or other.

Methods:

Five-year Kaplan-Meier estimates of all-cause graft survival, and 3-year complete as well as stratified inverse probability of treatment weighted Cox proportional hazards models were conducted.

Results:

Drug toxicity death donors donated to 25% (252/1012) of kidney transplantations. Drug toxicity death donors were more likely to be young, white, males, with fewer comorbidities such as diabetes or hypertension but were more likely to have a terminal serum creatinine ≥1.5 mg/dL or be hepatitis C virus (HCV) positive. Unadjusted 5-year estimate of all-cause graft survival was 97% for recipients of drug toxicity donor kidneys and 83% for recipients of non-drug toxicity donor kidneys ( P < .001). Recipients of drug toxicity death donor kidneys had decreased risk of all cause graft loss compared to recipients of non-drug toxicity death donor kidneys (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.12-0.77, P = .012). This is primarily due to the reduced risk of all-cause graft loss for recipients of younger (≤35 years) drug toxicity death donor kidneys (HR: 0.05, 95% CI: 0.00-0.55, P = .015).

Limitations:

Potential selection bias, potential unmeasured confounding.

Conclusions:

Donation after drug toxicity death is safe and should be considered more broadly to increase deceased donor kidney donation.
Methods and Processes for First Nations Health Curriculum Development for Nursing, Medicine, Dentistry and Allied Health Entry-Level Programs: A Scoping Review
Authors: Godwin Shirley , Hyett Nerida , McMahon Mishel , McKinstry Carol , Long Natasha , Whiteside Mary , Bruce Chris
Published: April 2023

The inclusion of First Nations health curricula in programs is critical for the development of culturally safe graduates, however, less is known about how to embed content into curriculum in ways that reflect best practice and pedagogy. The aim of this scoping review was to describe methods and processes of First Nations health curriculum development in nursing, medical, dentistry, and allied health entry-level programs in international peer-reviewed journals. Systematic searches of databases were completed including CINAHL, Proquest, Medline, and Informit; with additional searches in Google Scholar and First Nations-led journals. A total of 104 articles met inclusion criteria; the majority relating to medicine ( n = 38) and nursing/midwifery ( n = 17) student cohorts. Methods and processes for embedding First Nations health content are described, including First Nations-led development and co-leadership, resulting in a suggested model for curriculum development. Evidence-informed curriculum development is critical to ensure effective methods and processes are adopted and cultural safety learning outcomes are achieved.
The Offsetting Impact of Dependency and Urbanization on Mean Years of Schooling: A Scaling Analysis of 97 Countries
Authors: Chang Yu Sang , Kim Moon Jung , Kim Su Min , Jo Sung Jun
Published: April 2023

The indicator “mean years of schooling (MYS)” has been one of two education indicators in the Human Development Index calculated by UNDP since 2010. In view of greatly expanded role of education in modern development, this study develops a multivariate panel regression model of socio-economic factors where changing rate of MYS becomes the dependent variable. This research develops a model of socio-economic determining factors where changing the rate of MYS is the dependent variable. The proposed model will include five independent variables to assess the impact on MYS for 97 countries from 1995 to 2017. The most important finding is that dependency with a negative impact on MYS was the most influential factor, followed by urbanization with a positive impact on MYS. The impact from income with a positive impact and population with a negative impact was the third most important factor depending on the income and urbanization subgroup. This study highlighted the offsetting impact of dependency rate and urbanization rate to length of education depending on the income and urbanization subgroups of countries. However, the general policy implications proposed here are subjected to substantial revision if the analysis of scaling results from income and urbanization subgroup analysis are incorporated, because the impact from these two offsetting factors would vary widely depending on the particular subgroup.
Psychological Safety and Creativity in Teams: A Mediated Moderation Model of Shared Leadership and Team Diversity
Authors: Sharma Suryakant , Mehta Sunita
Published: April 2023

The current study extends the literature on psychological safety and team creativity by exploring the questions of whether, how and when psychological safety influences team creativity positively. Specifically, the current study proposes that psychological safety has a positive impact on team creativity and this impact is mediated by shared leadership. Furthermore, the study introduces team diversity as a potential moderator in the relationships between psychological safety and team creativity through shared leadership. It is found that the direct effect of psychological safety on team creativity is more positive when team members perceive high diversity. Using a sample of 135 members working in teams in R&D departments in the electronics industry, the hypotheses were largely supported. Theoretical contributions, practical implications and future research directions are discussed.
Determining the Time Required to Achieve Clinically Significant Outcomes on the PROMIS Upper Extremity Questionnaire After Arthroscopic Rotator Cuff Repair
Authors: Polce Evan M. , Vadhera Amar S. , Fu Michael C. , Singh Harsh , Haunschild Eric D. , Garrigues Grant E. , Yanke Adam B. , Forsythe Brian , Cole Brian J. , Verma Nikhil N.
Published: April 2023

Background:

Clinically significant outcome (CSO) thresholds for the Patient-Reported Outcome Measurement Information System–Upper Extremity (PROMIS–UE) score have been previously defined after arthroscopic rotator cuff repair (RCR). However, the time required to achieve CSOs for the PROMIS–UE score is unknown.

Purpose:

To (1) determine the time required to achieve the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) score thresholds after RCR for the PROMIS–UE questionnaire and (2) identify patient factors associated with earlier or delayed achievement of these clinical benchmarks.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A prospectively maintained institutional database was retrospectively reviewed for consecutive patients who underwent RCR between January 2018 and January 2019. Patients were included if they completed the PROMIS–UE questionnaire both preoperatively and at standardized postoperative time intervals: 5 to 7 months (6-month time point), 11 to 13 months (1-year time point), and ≥23 months (2-year time point). Kaplan-Meier survival curves with interval censoring were used to define the cumulative percentage of patients who achieved the MCID, SCB, and PASS. Patient variables associated with earlier or delayed achievement of the MCID, SCB, and PASS were determined using Weibull parametric survival regression analysis.

Results:

Included were 105 patients undergoing RCR (age, 57.3 ± 10.3 years; body mass index, 31.5 ± 6.1 kg/m2). By 2-year follow-up, the cumulative percentage of patients achieving the MCID, SCB, and PASS was 86.7%, 76.2%, and 74.3%, respectively. The mean time required to reach the MCID, SCB, and PASS score thresholds was 9.5 ± 3.8, 10.3 ± 4.4, and 9.8 ± 4.6 months, respectively. Factors associated with delayed achievement of CSOs included greater baseline PROMIS–UE score (MCID and SCB) and workers’ compensation insurance (PASS). Greater baseline PROMIS–UE scores were associated with earlier achievement of the PASS.

Conclusion:

Most patients achieved CSOs for the PROMIS–UE within 12 months of RCR. Patient-specific factors found to be associated with earlier or delayed achievement of CSOs can be used to inform patient discussions on the expected timeline for recovery after RCR.
Antenatal Education Services in Oman: A Descriptive Qualitative Inquiry of Healthcare Provider's Perspective
Authors: AlDughaishi Maha Yaqoub Khasib , Seshan Vidya , Matua Gerald Amandu
Published: April 2023

Introduction

To ensure positive pregnancy and birth outcomes, healthcare providers working in antenatal clinics are expected to provide regular antenatal education to enable early detection and timely treatment of pregnancy-related morbidities to prevent complications during labor, birth, and postnatal period. Although antenatal education and services are provided through standard programs in developed countries, presently there are no well-structured programs in many developing countries. The study compares the current service with the national and international guidelines.

Objective

To identify the current practices of healthcare providers in antenatal education service in Oman with the aim of identifying any major implementation gaps.

Methods

A qualitative inquiry was implemented through semi-structured in-depth interviews guided by open-ended questions. The study population were healthcare providers who routinely provide antenatal services at healthcare facilities. A purposive non-probability sampling technique was used to select the key informants. Data was analyzed manually using the thematic analysis framework.

Results

The antenatal education services provided fall under four themes: In relation to “Education for safe pregnancy,” the findings revealed that healthcare providers did not adequately address the needs. In relation to “Education for Safe labor and Birth,” the pregnant women are briefed with inadequate information about labor and birth during the antenatal period. In relation to “Education related to Postpartum,” healthcare providers generally do not provide information regarding pregnant women's psychological wellbeing, breastfeeding, family planning, hygiene, and nutrition during antenatal visits. In relation to “Education related to Newborn Care,” the study findings indicate that contrary to what was stipulated by the WHO (2016) to establish antenatal educational programs to help pregnant women gain the skills and knowledge regarding proper newborn care, our findings demonstrated a lack of education about newborn care by providers.

Conclusion

The findings have the capacity to contribute towards the development of remedial strategies to improve maternal and neonatal outcomes in Oman. This can be achieved by addressing the practice gaps identified when comparing the current practices with international standards.
Use of caller ID and text messaging from cell phones to increase response rates in patient surveys
Authors: Peters Luke E , Zhao Jie , Gelzinnis Scott , Smith Stephen R , Martin Jennifer , Pockney Peter
Published: April 2023

Background: High response rates for patient surveys are required in medical literature to ensure non-response bias is minimised. It is often difficult to achieve a satisfactory response rate as patient engagement in surveys is decreasing. A major barrier to phone surveys is getting patients to answer calls from unknown numbers.

Purpose: To design a methodology which boosts response rates for telephone-based patient surveys.

Research Design: We prospectively analysed the effectiveness of our methodology for increasing patient participation using caller ID and text messanging.

Study Sample: Two waves totalling 1313 patients were contacted for participation in a patient survey for a descriptive quantitative and qualitative cohort study using our developed methadology.

Data Analysis: We analysed the timepoints at which successful contact was made when using caller ID and text messanging.

Results: We achieved a call answer rate of 85.4%, which was a 70.8% increase when compared to a similar patient cohort contacted via blocked caller ID (i.e. with privacy settings).

Conclusion: We have developed a simple, inexpensive methodology which, when tested outside the Australian setting and for other projects, shows promise for increasing patient survey response rate.
Survival after cancer-related venous thrombosis: the Scandinavian Thrombosis and Cancer Study
Authors: Crobach Monique J. T. , Anijs Rayna J. S. , Brækkan Sigrid K. , Severinsen Marianne T. , Hammerstrøm Jens , Skille Hanne , Kristensen Søren R. , Paulsen Benedikte , Tjønneland Anne , Versteeg Henri H. , Overvad Kim , Hansen John-Bjarne , Næss Inger A. , Cannegieter Suzanne C.
Published: April 2023

Patients with cancer have an increased risk of developing venous thromboembolism (VTE), and this combination is reported to result in poorer survival compared with cancer alone. This study aimed to investigate the impact of VTE on the survival of patients with cancer in a general population. The Scandinavian Thrombosis and Cancer (STAC) cohort, a population-based cohort including 144 952 participants without previous VTE or cancer, was used. During follow-up, cancer and VTE incidences were registered. “Cancer-related VTE” was defined as VTE diagnosed in patients with overt or occult cancer. The survival of participants without cancer and/or VTE (“disease-free”) was compared with the survival of participants with cancer and cancer-related VTE. Cox regression models with cancer and VTE as time-varying exposures were performed to calculate hazard ratios for death. Subanalyses were performed across cancer types and stages and VTE type (deep vein thrombosis or pulmonary embolism). During follow-up (mean, 11.7 years), 14 621 participants developed cancer, and 2444 developed VTE, of which 1241 were cancer-related. The mortality rates (per 100 person years) for disease-free participants, VTE only, cancer only, and cancer-related VTE were 0.63, 5.0, 9.2, and 45.3, respectively. Compared with patients with cancer only, the risk of death for patients with cancer-related VTE was increased 3.4-fold. Within all cancer types, the occurrence of VTE increased the mortality risk 2.8- to 14.7-fold. In a general population, patients with cancer with VTE had a 3.4-fold higher mortality risk than patients with cancer without VTE, independent of cancer type.
Cluster headache and kynurenines
Authors: Tuka Bernadett , Körtési Tamás , Nánási Nikolett , Tömösi Ferenc , Janáky Tamás , Veréb Dániel , Szok Délia , Tajti János , Vécsei László
Published: April 2023

Background

The glutamatergic neurotransmission has important role in the pathomechanism of primary headache disorders. The kynurenine metabolites derived from catabolism of tryptophan (Trp) have significant involvement not only in glutamatergic processes, but also in the neuroinflammation, the oxidative stress and the mitochondrial dysfunctions. Previously we identified a depressed peripheral Trp metabolism in interictal period of episodic migraineurs, which prompted us to examine this pathway in patients with episodic cluster headache (CH) as well. Our aims were to compare the concentrations of compounds both in headache-free and attack periods, and to find correlations between Trp metabolism and the clinical features of CH. Levels of 11 molecules were determined in peripheral blood plasma of healthy controls (n = 22) and interbout/ictal periods of CH patients (n = 24) by neurochemical measurements.

Findings

Significantly decreased L-kynurenine (KYN,p < 0.01), while increased quinolinic acid (QUINA,p < 0.005) plasma concentrations were detected in the interbout period of CH patients compared to healthy subjects. The levels of KYN are further reduced during the ictal period compared to the controls (p < 0.006). There was a moderate, negative correlation between disease duration and interbout QUINA levels (p < 0.048,R =  − 0.459); and between the total number of CH attacks experienced during the lifetime of patients and the interbout KYN concentrations (p < 0.024,R =  − 0.516). Linear regression models revealed negative associations between age and levels of Trp, kynurenic acid, 3-hdyroxyanthranilic acid and QUINA in healthy control subjects, as well as between age and ictal level of anthranilic acid.

Conclusions

Our results refer to a specifically altered Trp metabolism in CH patients. The onset of metabolic imbalance can be attributed to the interbout period, where the decreased KYN level is unable to perform its protective functions, while the concentration of QUINA, as a toxic compound, increases. These processes can trigger CH attacks, which may be associated with glutamate excess induced neurotoxicity, neuroinflammation and oxidative stress. Further studies are needed to elucidate the exact functions of these molecular alterations that can contribute to identify new, potential biomarkers in the therapy of CH.
Prediction of hot spots in protein–DNA binding interfaces based on discrete wavelet transform and wavelet packet transform
Authors: Sun Yu , Wu Hongwei , Xu Zhengrong , Yue Zhenyu , Li Ke
Published: April 2023

Background

Identification of hot spots in protein–DNA binding interfaces is extremely important for understanding the underlying mechanisms of protein–DNA interactions and drug design. Since experimental methods for identifying hot spots are time-consuming and expensive, and most of the existing computational methods are based on traditional protein–DNA features to predict hot spots, unable to make full use of the effective information in the features.

Results

In this work, a method named WTL-PDH is proposed for hot spots prediction. To deal with the unbalanced dataset, we used the Synthetic Minority Over-sampling Technique to generate minority class samples to achieve the balance of dataset. First, we extracted the solvent accessible surface area features and structural features, and then processed the traditional features using discrete wavelet transform and wavelet packet transform to extract the wavelet energy information and wavelet entropy information, and obtained a total of 175 dimensional features. In order to obtain the best feature subset, we systematically evaluate these features in various feature selection strategies. Finally, light gradient boosting machine (LightGBM) was used to establish the model.

Conclusions

Our method achieved good results on independent test set with AUC, MCC and F1 scores of 0.838, 0.533 and 0.750, respectively. WTL-PDH can achieve generally better performance in predicting hot spots when compared with state-of-the-art methods. The dataset and source code are available at https://github.com/chase2555/WTL-PDH.
ARNTL2 upregulation of ACOT7 promotes NSCLC cell proliferation through inhibition of apoptosis and ferroptosis
Authors: Wang Tao , Wang Kai , Zhu Xu , Chen Nan
Published: April 2023

Background

Recent studies have reported that the circadian transcription factor aryl hydrocarbon receptor nuclear translocator like 2 (ARNTL2) promotes the metastatic progression of lung adenocarcinoma. However, the molecular mechanisms of ARNTL2 in non-small cell lung cancer (NSCLC) cell growth and proliferation remain to be explored.

Methods

The expression of ARNTL2 and acyl-CoA thioesterase 7 (ACOT7) in lung cancer patients was analyzed based on TCGA database. Gain-of-function of ARNTL2 and ACOT7 was conducted by transfecting the cells with plasmids or lentivirus. Knockdown assay was carried out by siRNAs. Western blot and qRT-PCR were performed to check the protein and mRNA expression. Dual luciferase and ChIP-qPCR assay was applied to check the interaction of ARNTL2 on ACOT7’s promoter sequence. Triglyceride level, MDA production, the activity of casapase 3 to caspase 7, and lipid ROS were measured by indicated assay kit. Cellular function was detected by CCK8, colony formation and flow cytometry analysis of cell death and cell cycle.

Results

We demonstrated that ARNTL2 upregulation of ACOT7 was critical for NSCLC cell growth and proliferation. Firstly, overexpression of ARNTL2 conferred the poor prognosis of LUAD patients and supported the proliferation of NSCLC cells. Based on molecular experiments, we showed that ARNTL2 potentiated the transcription activity of ACOT7 gene via direct binding to ACOT7’s promoter sequence. ACOT7 high expression was correlated with the worse prognosis of LUAD patients. Gain-of-function and loss-of-function experiments revealed that AOCT7 contributed to NSCLC cell growth and proliferation. ACOT7 regulated the apoptosis and ferroptosis of NSCLC cells, while exhibited no effect on cell cycle progression. ACOT7 overexpression also potentiated fatty acid synthesis and suppressed lipid peroxidation. Lastly, we showed that ARNTL2 knockdown and overexpression inhibited and promoted the cellular triglyceride production and subsequent cell proliferation, which could be reversed by ACOT7 overexpression and knockdown.

Conclusion

Our study illustrated the oncogenic function of ARNTL2/ACOT7 axis in the development of NSCLC. Targeting ARNTL2 or ACOT7 might be promising therapeutic strategies for NSCLC patients with highly expressed ARNTL2.
Risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery
Authors: Wang Lu , Chen Bin , Liu Tao , Luo Taijun , Kang Wanli , Liu Wei
Published: April 2023

Background

To investigate the risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery.

Methods

A total of 215 elderly patients who underwent thoracic surgery between May 2022 and October 2022 were recruited in this prospective observational study. Cognitive function was tested by MoCA tests that were performed by the same trained physician before surgery, on postoperative day 4 (POD4), and on postoperative day 30 (POD30). Univariate and multivariate logistic regression models were used to analyze the risk factors for DNR.

Results

A total of 154 patients (55.8% men) with an average age of 67.99 ± 3.88 years were finally included. Patients had an average preoperative MoCA score of 24.68 ± 2.75. On the 30th day after surgery, 26 (16.88%) patients had delayed postoperative cognitive recovery, and 128 (83.12%) had postoperative cognitive function recovery. Diabetes mellitus (OR = 6.508 [2.049–20.664], P = 0.001), perioperative inadvertent hypothermia (< 35℃) (OR = 5.688 [1.693–19.109], P = 0.005), history of cerebrovascular events (OR = 10.211 [2.842–36.688], P < 0.001), and VICA (sevoflurane combined with propofol anesthesia) (OR = 5.306 [1.272–22.138], P = 0.022) resulted as independent risk factors of delayed neurocognitive recovery. On the POD4, DNR was found in 61 cases (39.6%), and age ≥ 70 years (OR = 2.311 [1.096–4.876], P = 0.028) and preoperative NLR ≥ 2.5 (OR = 0.428 [0.188–0.975], P = 0.043) were identified as independent risk factors.

Conclusions

The risk factors for delayed neurocognitive recovery in elderly patients undergoing thoracic surgery include diabetes, perioperative inadvertent hypothermia (< 35℃), VICA (sevoflurane combined with propofol anesthesia), and history of cerebrovascular events.
Prognostic value of fibrinogen-to-albumin ratio combined with coronary calcification score in patients with suspected coronary artery disease
Authors: Tian Xin-Xin , Luo Jun-Yi , Liu Fen , Qiu Ya-Jing , Luo Fan , Zeng Lu , Zhang Zhuo-Ran , Yang Yi-Ning , Li Xiao-Mei
Published: April 2023

Objective

The aim of this work was to evaluate the predictive value of FAR combined with CACS for MACCEs.

Background

The fibrinogen-albumin-ratio (FAR), a novel biomarker of inflammation, is associated with the severity of coronary artery disease (CAD). Coronary calcification score (CACS) is associated with the severity of coronary stenosis and is closely related to the prognosis of CAD patients. What is the prognostic value of FAR in patients with chest pain, which has not been reported. This study aims to evaluate the relationship between CACS and FAR and their impact on prognosis in patients with suspected CAD.

Methods

We used information from 12,904 individuals who had coronary computed tomography angiography (CTA) for chest pain and tracked down any significant adverse cardiac and cerebrovascular events (MACCEs). The following formula was used to calculate FAR: fibrinogen (g/L)/albumin (g/L). Patients were separated into groups with greater levels of FAR (FAR-H) and lower levels of FAR (FAR-L) in accordance with the ideal cut-off value of FAR for MACCEs prediction. In addition, patients were divided into three groups based on their CACS scores (CACS ≤ 100, 100 < CACS ≤ 400, and CACS > 400).

Results

4946 patients [62(55–71) years, 64.4% male] were ultimately enrolled in the present study. During follow-up, a total of 234 cases (4.7%) of MACCEs were documented. Linear regression analysis results showed that CACS (R2 = 0.004, Standard β = 0.066,P < 0.001) was positively associated with FAR in patients with chest pain.Compared to ones with FAR-L, FAR-H had an increased risk for MACCEs (adjusted HR 1.371(1.053–1.786)P = 0.019). Multivariate Cox regression showed that age (adjusted HR 1.015 95% CI 1.001–1.028;p = 0.03), FAR (adjusted HR 1.355 95% CI 1.042–1.763;p = 0.023),FBG (adjusted HR 1.043 95% CI 1.006–1.083;p = 0.024) and CACS (adjusted HR 1.470 95% CI 1.250–1.727;p < 0.001) were the independent risk factors for MACCEs. The FAR and CACS significantly improved MACCEs risk stratification, contributing to substantial net reclassification improvement ( NRI 0.122, 95% CI 0.054–0.198,P < 0.001) and integrated discrimination improvement(IDI 0.011, 95% CI 0.006–0.017,P < 0.001).

Conclusion

FAR was an independent risk factor for MACCEs. The results showed that CACS was positively associated with FAR in patients with suspected CAD. A higher level of FAR and heavier coronary calcification burden was associated with worse outcomes among patients with suspected CAD. FAR and CACS improved the risk identification of patients with suspected CAD, leading to a significant reclassification of MACCEs.
Design and analysis of outcomes following SARS-CoV-2 infection in veterans
Authors: Smith Valerie A. , Berkowitz Theodore S. Z. , Hebert Paul , Wong Edwin S. , Niederhausen Meike , Pura John A. , Berry Kristin , Green Pamela , Korpak Anna , Fox Alexandra , Baraff Aaron , Hickok Alex , Shahoumian Troy A , Bohnert Amy S.B. , Hynes Denise M. , Boyko Edward J. , Ioannou George N. , Iwashyna Theodore J. , Bowling C. Barrett , O’Hare Ann M. , Maciejewski Matthew L.
Published: April 2023

Background

Understanding how SARS-CoV-2 infection impacts long-term patient outcomes requires identification of comparable persons with and without infection. We report the design and implementation of a matching strategy employed by the Department of Veterans Affairs’ (VA) COVID-19 Observational Research Collaboratory (CORC) to develop comparable cohorts of SARS-CoV-2 infected and uninfected persons for the purpose of inferring potential causative long-term adverse effects of SARS-CoV-2 infection in the Veteran population.

Methods

In a retrospective cohort study, we identified VA health care system patients who were and were not infected with SARS-CoV-2 on a rolling monthly basis. We generated matched cohorts within each month utilizing a combination of exact and time-varying propensity score matching based on electronic health record (EHR)-derived covariates that can be confounders or risk factors across a range of outcomes.

Results

From an initial pool of 126,689,864 person-months of observation, we generated final matched cohorts of 208,536 Veterans infected between March 2020-April 2021 and 3,014,091 uninfected Veterans. Matched cohorts were well-balanced on all 37 covariates used in matching after excluding patients for: no VA health care utilization; implausible age, weight, or height; living outside of the 50 states or Washington, D.C.; prior SARS-CoV-2 diagnosis per Medicare claims; or lack of a suitable match. Most Veterans in the matched cohort were male (88.3%), non-Hispanic (87.1%), white (67.2%), and living in urban areas (71.5%), with a mean age of 60.6, BMI of 31.3, Gagne comorbidity score of 1.4 and a mean of 2.3 CDC high-risk conditions. The most common diagnoses were hypertension (61.4%), diabetes (34.3%), major depression (32.2%), coronary heart disease (28.5%), PTSD (25.5%), anxiety (22.5%), and chronic kidney disease (22.5%).

Conclusion

This successful creation of matched SARS-CoV-2 infected and uninfected patient cohorts from the largest integrated health system in the United States will support cohort studies of outcomes derived from EHRs and sample selection for qualitative interviews and patient surveys. These studies will increase our understanding of the long-term outcomes of Veterans who were infected with SARS-CoV-2.
Cause-specific excess mortality after hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)
Authors: Holvik Kristin , Ellingsen Christian Lycke , Solbakken Siri Marie , Finnes Trine Elisabeth , Talsnes Ove , Grimnes Guri , Tell Grethe S. , Søgaard Anne-Johanne , Meyer Haakon E.
Published: April 2023

Background

Information on cause of death may help appraise the degree to which the high excess mortality after hip fracture reflects pre-existing comorbidities or the injury itself. We aimed to describe causes of death and cause-specific excess mortality through the first year after hip fracture.

Methods

For studying the distribution of causes of death by time after hip fracture, we calculated age-adjusted cause-specific mortality at 1, 3, 6 and 12 months in patients hospitalized with hip fracture in Norway 1999–2016. Underlying causes of death were obtained from the Norwegian Cause of Death Registry and grouped by the European Shortlist for Causes of Death. For estimating excess mortality, we performed flexible parametric survival analyses comparing mortality hazard in patients with hip fracture (2002–2017) with that of age- and sex matched controls drawn from the Population and Housing Census 2001.

Results

Of 146,132 Norwegians with a first hip fracture, a total of 35,498 (24.3%) died within one year. By 30 days post-fracture, external causes (mainly the fall causing the fracture) were the underlying cause for 53.8% of deaths, followed by circulatory diseases (19.8%), neoplasms (9.4%), respiratory diseases (5.7%), mental and behavioural disorders (2.0%) and diseases of the nervous system (1.3%). By one-year post-fracture, external causes and circulatory diseases together accounted for approximately half of deaths (26.1% and 27.0%, respectively). In the period 2002–2017, cause-specific one-year relative mortality hazard in hip fracture patients vs. population controls ranged from 1.5 for circulatory diseases to 2.5 for diseases of the nervous system in women, and correspondingly, from 2.4 to 5.3 in men.

Conclusions

Hip fractures entail high excess mortality from all major causes of death. However, the traumatic injury of a hip fracture is the most frequently reported underlying cause of death among older patients who survive less than one year after their fracture.
The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units
Authors: Safavi Ali , Molavynejad Shahram , Rashidi Mahboobeh , Asadizaker Marziyeh , Maraghi Elham
Published: April 2023

Background and aim

Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU).

Materials and Methods

In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients’ demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study.

Results

The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001).

Conclusions

The implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.
A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial
Authors: Abdel Hamid Ahmed Sherif , El Zeneiny Hazem , Fathy Ahmed , Nawara Maii
Published: April 2023

Background

The Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor.

Aim

This pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids.

Methods

This is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate.

Results

The induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups’ mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05).

Conclusion

Propranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval.

Trial registration

We retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841
Quantification of mitochondrial cfDNA reveals new perspectives for early diagnosis of colorectal cancer
Authors: Linke Christian , Hunger Richard , Reinwald Mark , Deckert Markus , Mantke René
Published: April 2023

Background

To unravel how the integrity of nuclear and mitochondrial circulating cell-free DNA (cfDNA) contributes to its plasma quantity in colorectal cancer (CRC) patients.

Methods

CfDNA from plasma samples of 80 CRC patients stratified by tumour stage and 50 healthy individuals were extracted. Total cfDNA concentration was determined and equal template concentrations (ETC) were analyzed by quantitative real-time PCR (qPCR) resulting in small and long fragments of KRAS, Alu and MTCO3. The obtained data was also examined relative to the total cfDNA concentration (NTC) and diagnostic accuracy was estimated using receiver operating characteristics.

Results

Total cfDNA levels were significantly higher in CRC group compared to healthy control and increased with tumour stage. Long nuclear fragment levels were significantly lower in CRC patients in ETC but not NTC condition. The integrity indices of nuclear cfDNA decreased from controls to patients with highly malignant tumor. Mitochondrial cfDNA fragment quantities were strongly reduced in early and late stages of tumor patients and prognostic value was higher in ETC. Predictive models based on either ETC or NTC predictor set showed comparable classification performance.

Conclusion

Increased blood cfDNA concentration in late UICC stages inversely correlate with nuclear cfDNA integrity index and suggest that necrotic degradation is not a major cause for higher total cfDNA quantity. The diagnostic and prognostic value of MTCO3 is highly significant in early stages of CRC and can be evaluated more comprehensively, using ETC for qPCR analysis.

Trial registration

The study was registered retrospectively on DRKS, the german register for clinical trials (DRKS00030257, 29/09/2022).
Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica
Authors: Gómez Mario J. , Barboza Luis A. , Vásquez Paola , Moraga Paula
Published: April 2023

Background

Childhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.

Methods

A Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.

Results

Average years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.

Conclusions

Especially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.
Time outdoors positively associates with academic performance: a school-based study with objective monitoring of outdoor time
Authors: Wang Jingjing , Sankaridurg Padmaja , Naduvilath Thomas , Li Wayne , Morgan Ian G. , Rose Kathryn A. , Weng Rebecca , Xu Xun , He Xiangui
Published: April 2023

Background

To explore the relationship between outdoor time and academic performance among school-aged children.

Methods

This study was designed as a cross-sectional study. Data were derived from a school-based prospective children myopia intervention study (STORM). Outdoor time was recorded by self-developed algorithm-validated wristwatches in real-time and calculated as the cumulative average of 10 months. The academic performance was recorded and provided by the participating schools and further standardized. Other information was collected using an online standardized questionnaire. Mixed-effects model and B-Spline method were used to investigate the association between time spent on different types of daily activity, including outdoor activity and academic performance.

Results

A total of 3291 children with mean age 9.25 years were included in the final analysis. Overall, outdoor time was associated with academic performance in a non-linear manner; specifically, not exceeding 2.3 h per day, outdoor time was positively associated with academic performance; exceeding 2.3 h per day, this association became non-significant. Likewise, daily sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner, resulting in turning points of 11.3 and 1.4 h per day, respectively. Separate analysis showed that outdoor time and sleep duration but not out-of-school learning time were positively associated with academic performance in Chinese, mathematics and English.

Conclusion

Outdoor time, sleep duration and out-of-school learning time were associated with academic performance in a non-linear manner. Promotion of outdoor time may not negatively impact on academic performance.

Trial registration

Our study was registered in ClinicalTrials.gov (Identifier: NCT02980445).
The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success
Authors: Eksombatchai Dararat , Sukkratok Chalermwut , Sutherasan Yuda , Junhasavasdikul Detajin , Theerawit Pongdhep
Published: April 2023

Background

Several parameters are used to predict successful extubation but their accuracy varies among studies. We hypothesized that combining conventional and diaphragmatic parameters would be more effective than using just one. Our primary objective was to evaluate the performance of the respiratory rate in relation to the diaphragm thickening fraction (RR/DTF) ratio to predict the success of extubation.

Methods

We enrolled 130 adult patients who required invasive mechanical ventilation, planned to be extubated, and used a spontaneous breathing trial (SBT) in the intensive care unit from July 2020 to April 2022. We measured the conventional parameters and the diaphragmatic parameters 2 h after SBT. The RR/DTF was calculated by dividing the respiratory rate (RR) by the diaphragm thickening fraction (DTF). The definition of weaning success is successful extubation within 48 h.

Results

Of 130 patients, 8 patients (6.2%) were reintubated within 48 h. The RR/DTF was significantly lower in the successful extubation group than in the extubation failure group (right hemidiaphragm; 0.47 (0.33–0.64) vs 1.1 (0.6–2.32), p < 0.001 and left hemidiaphragm; 0.45 (0.31–0.65) vs 0.78 (0.48–1.75), p < 0.001). The right RR/DTF using a cut-off point at ≤ 0.81 had a sensitivity of 87.7%, a specificity of 75%, and areas under the receiver operating characteristic curve (AUROC) of 0.762 for predicting successful extubation (p = 0.013). The sensitivity, specificity, and AUROC for predicting extubation success of right DTF at a cut-off point of ≥ 26.2% were 84.3%, 62.5%, and 0.775, respectively (p = 0.009).

Conclusion

The RR/DTF ratio is a promising tool for predicting extubation outcome. Additionally, using RR/DTF was more reliable than conventional or diaphragmatic parameters alone in predicting extubation success.
Causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury
Authors: Fu Shilong , Hou Pengwei , Wang Guofeng , Wang Shousen
Published: April 2023

Background

The purpose of this retrospective study was to evaluate the causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury (TBI).

Methods

A total of 219 patients with TBI who underwent initial unilateral intracranial supratentorial surgery between January 2016 to November 2021 were included. We evaluated the causes of an unplanned second craniotomy in 40 patients, and analyzed the risk factors for a contralateral second craniotomy in 21 patients using a multivariate logistic regression analysis.

Results

The most common cause for an unplanned second craniotomy was delayed or enlarged hematoma in the non-operation area (26/40; 65%), followed by recurrent hematoma in the operation area (8/40; 20%), ipsilateral massive cerebral infarction (3/40; 7.5%), diffuse brain swelling (2/40; 5%) and enlarged cerebral contusion (1/40; 2.5%). Multivariate logistic regression analysis showed that a contralateral craniocerebral injury feature (CCIF) (OR = 13.175), defined on preoperative computerized tomography scanning, was independent risk factor for a contralateral second craniotomy.

Conclusions

An unplanned second craniotomy in patients with TBI was mainly related to delayed or enlarged hematoma. An increased risk of a contralateral second craniotomy occurs in patients with CCIF.