bluuebunny/crossref_metadata_2025 huggingface dataset:
Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis
Authors: Cuzzolin Marco , Secco Davide , Guerra Enrico , Altamura Sante Alessandro , Filardo Giuseppe , Candrian Christian
Published: October 2021

Background:

Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.

Purpose:

To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com , clinicaltrials.gov , greylit.org , opengrey.eu , and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.

Results:

Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score ( P = .02), Mayo Elbow Performance Index ( P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).

Conclusion:

The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.
Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center
Authors: Best Raymond , Meister Anorte , Meier Malin , Huth Jochen , Becker Ulrich
Published: October 2021

Background:

Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge.

Purpose/Hypothesis:

The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient’s functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery.

Results:

A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores ( P = .003; r = –0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores ( P = .525; r = –0.06).

Conclusion:

Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.
Assessing Facilitators and Barriers to Referral of Children Under the Age of Five Years at Ndirande Health Centre in Blantyre, Malawi
Authors: Kaunda Wezzie , Umali Thokozani , Chirwa Marumbo Eve , Nyondo-Mipando Alinane Linda
Published: October 2021

Patient referrals among health facilities are initiated to maximize receipt of quality care at a proper level within the health system. This study explored the processes, factors that influence, and strategies for referral of children from Ndirande Health Centre to Queen Elizabeth Central Hospital in Blantyre, Malawi. We drew a purposive sample comprising health care workers, mothers, fathers, ambulance drivers, and Health Center Advisory Committee (HCAC) members and held 19 in-depth interviews and 1 focus group discussion in August 2020. The referral process is influenced by the availability of motor and bicycle ambulances that are well equipped with medical equipment, delay in seeking health services, uptake of referral, and community support. Education and communication with the community and parents respectively optimize the process of referral. There is a need to improve the referral system of under-five children by instituting a policy that is functional while addressing the main barriers.
Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making
Authors: Lin Jody L. , Lipstein Ellen A. , Wittenberg Eve , Tay Djin , Lundstrom Robert , Lundstrom Gari Lyn , Sediqzadah Saadia , Wright Davene R.
Published: October 2021

A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
“The Heart is a House”: A Heuristic for Generating Cardiac Differential Diagnoses
Authors: Sengupta Malavika Pia , Crawford Timothy N , Leeds Frederic Stuart
Published: October 2021

BACKGROUND

Differential diagnosis (DDx) is a core clinical reasoning skill that all medical students and physicians must acquire and develop. Metamemory techniques (MMTs), including mnemonic devices and other heuristics, are frequently taught to students as a means of enhancing DDx generation. The Heart is A House (HIAH) , an MMT that works by prompting students to think about cardiac disease in terms of four structural subsystems, can be used to facilitate the generation of cardiac differentials, but its efficacy has not been studied.

METHODS

In a 3-hour DDx workshop, second-year medical students were given a brief case vignette of a patient with chest pain and dyspnea and asked to generate initial differential diagnoses before and after learning HIAH. Descriptive statistics and paired T-tests were used to compare the sizes of cardiac-only and total differentials pre-/post-HIAH. Cardiac diagnoses were classified according to the structural categories described by HIAH, and Simpson's Diversity Index (SDI) was used to evaluate the effect of HIAH on the variety of cardiac diagnoses produced.

RESULTS

All students in the course ( N = 111) submitted pre-post differential lists. The mean number of diagnoses included in their differentials did not change significantly after exposure to HIAH (7.98 vs. 8.71, P = .09). However, the number of potentially correct cardiac diagnoses increased from 1.79 to 4.75 ( P < .0001), and the variety of structure/function cardiac categories considered by students increased more than twofold (from an SDI of 0.16 to 0.4, P < .0001). These increases were accompanied by a small increase in incorrect diagnoses ( + 2.47%, P = .0003) and a larger decrease in potentially correct noncardiac diagnoses (−41.88%, P < .0001).

CONCLUSION

The use of HIAH was associated with an increase in the size and variety of cardiac differentials. This increase may have come at the cost of a reduced noncardiac differential. Educators may find HIAH useful for guiding students as they reason through cases involving potential cardiac etiologies. As with all heuristics, care must be exercised to avoid introducing unwanted bias.
Multispecies Conservation Movements and the Redefinition of Urban Nature at Berlin's Tempelhof Airfield
Authors: Carver Evan H. , Gardner Chase
Published: October 2021

The “ecological turn” in urban planning ( Scott and Lennon, 2016 ) has led to increased recognition of ecosystem services, experiments with green infrastructure, and other efforts to “re-nature” the city. These trends, however, often sidestep the inherently political nature of the “natural,” overlook the role that sensory qualities and the phenomenological experience of space play in planning, and fail to recognize the agency of non-human actors in shaping urban natures. Here, we argue that grassroots urban conservation movements can offer a partial corrective, but that in doing so they can also introduce new contradictions and entrench different hegemonic structures. Drawing on actor-network theory and other more-than-human ontologies, we show this using the case of Tempelhof Airfield, a former airport in Berlin, Germany, which was preserved via a referendum as public open space. We trace the referendum campaign and analyze the policies enacted through it — which did not restore or remediate the brownfield but rather declared it to be worth preserving on ecological grounds in its current state. We argue that this was only possible due to the lively presence of non-human entities at the field, particularly the Eurasian skylark, an “endangered” species, which, by not being too scarce, actualizes an interspecies conception of urban nature by resonating with human sensory experiences of the landscape. While such multispecies assemblages represent an exciting possible future for urban environmental movements, we warn that their contradictions and reliance on endangered species regulations result in a brittle conservation situation in which a hegemonic species with particular affective affinities and cultural importance to humans is being protected in favor of other, perhaps more threatened species, and in which a particular type of landscape is being preserved in favor of one which might support more species or more effectively counteract climate change.
Almost disarmed: Politics and violence in the final years of the Argentine organization Montoneros (1979–1983)
Authors: Slipak Daniela
Published: October 2021

In this article, I analyze the debates, declarations, and silences surrounding the issue of violence during the final years of the Argentine insurgent group Montoneros (1979–1983). I examine the official documents and bulletins written while the group was in exile, as well as the statements and publications of dissident groups (the Peronismo Montonero Auténtico of 1979 and the Montoneros 17 de Octubre of 1980) and other critical groups (the Agrupación Eva Perón of 1980). From a political theory perspective, I will focus on the specificity of this space of belonging, its symbols, its representations, and its actions. In this study, I intend to (a) shed light on the final stage of the Montoneros organization, which, with few exceptions, has not been subjected to historiographical or sociological analysis, or studied by political science and (b) contribute to a deeper understanding of the dissolution processes undergone by armed insurgent groups in Latin America in the 1960s and 1970s.
GFICLEE: ultrafast tree-based phylogenetic profile method inferring gene function at the genomic-wide level
Authors: Fang Yang , Li Menglong , Li Xufeng , Yang Yi
Published: October 2021

Background

Phylogenetic profiling is widely used to predict novel members of large protein complexes and biological pathways. Although methods combined with phylogenetic trees have significantly improved prediction accuracy, computational efficiency is still an issue that limits its genome-wise application.

Results

Here we introduce a new tree-based phylogenetic profiling algorithm named GFICLEE, which infers common single and continuous loss (SCL) events in the evolutionary patterns. We validated our algorithm with human pathways from three databases and compared the computational efficiency with current tree-based with 10 different scales genome dataset. Our algorithm has a better predictive performance with high computational efficiency.

Conclusions

The GFICLEE is a new method to infers genome-wide gene function. The accuracy and computational efficiency of GFICLEE make it possible to explore gene functions at the genome-wide level on a personal computer.
The resistance of peanut to soil-borne pathogens improved by rhizosphere probiotics under calcium treatment
Authors: Zhang Wei , Zhang Bo-wen , Deng Jie-fu , Li Lin , Yi Tu-yong , Hong Yan-yun
Published: October 2021

Background

Peanut (Arachis hypogaea L.) is an important oil and economic crop. Calcium modulates plants in response to abiotic stresses and improves plant resistance to pathogens. Enrichment of beneficial microorganisms in the rhizosphere is associated with plant disease resistance and soil development. The purpose of this study was to analyze the differences in peanut rhizosphere microbial community structure between the calcium treatment and the control during two growth stages and to explain why calcium application could improve the resistance of peanuts to soil-borne pathogens.

Results

The 16S rDNA amplicon sequencing of rhizosphere microbiome showed that calcium application significantly enriched Serratia marcescens and other three dominant strains at the seedling stage. At the pod filling stage, ten dominant stains such as Sphingomonas changbaiensis and Novosphingobium panipatense were enriched by calcium. Serratia marcescens aseptic fermentation filtrate was mixed with PDA medium and inoculated with the main soil-borne pathogens in the seedling stage, which could inhibit the growth of Fusarium solani and Aspergillus flavus. The aseptic fermentation filtrate of Novosphingobium panipatense was mixed with PDA medium and inoculated with the main soil-borne pathogens in the pod filling stage, which could inhibit the growth of Sclerotium rolfsii and Leptosphaerulina arachidicola.

Conclusions

Calcium application increases the resistance of peanuts to soil-borne pathogens by enriching them with specific dominant bacteria.
Technical challenges regarding the use of formalin-fixed paraffin embedded (FFPE) tissue specimens for the detection of bacterial alterations in colorectal cancer
Authors: Lam Suk Yee , Ioannou Athanasia , Konstanti Prokopis , Visseren Thijmen , Doukas Michail , Peppelenbosch Maikel Petrus , Belzer Clara , Fuhler Gwenny Manel
Published: October 2021

Background

Formalin-fixed paraffin embedded (FFPE) tissues may provide an exciting resource to study microbial associations in human disease, but the use of these low biomass specimens remains challenging. We aimed to reduce unintentional bacterial interference in molecular analysis of FFPE tissues and investigated the feasibility of conducting quantitative polymerase chain reaction (qPCR) and 16S rRNA amplicon sequencing using 14 colorectal cancer, 14 normal adjacent and 13 healthy control tissues.

Results

Bacterial contaminants from the laboratory environment and the co-extraction of human DNA can affect bacterial analysis. The application of undiluted template improves bacterial DNA amplification, allowing the detection of specific bacterial markers (Escherichia coli and Faecalibacterium prausnitzii) by qPCR. Nested and non-nested PCR-based 16S rRNA amplicon sequencing approaches were employed, showing that bacterial communities of tissues and paired paraffin controls cluster separately at genus level on weighted Unifrac in both non-nested (R2 = 0.045; Pr(> F) = 0.053) and nested (R2 = 0.299; Pr(> F) = 0.001) PCR datasets. Nevertheless, considerable overlap of bacterial genera within tissues was seen with paraffin, DNA extraction negatives (non-nested PCR) or PCR negatives (nested PCR). Following mathematical decontamination, no differences in α- and β diversity were found between tumor, normal adjacent and control tissues.

Conclusions

Bacterial marker analysis by qPCR seems feasible using non-normalized template, but 16S rRNA amplicon sequencing remains challenging. Critical evaluation of laboratory procedures and incorporation of positive and negative controls for bacterial analysis of FFPE tissues are essential for quality control and to account for bacterial contaminants.
Genomic convergence between Akkermansia muciniphila in different mammalian hosts
Authors: Geerlings Sharon Y. , Ouwerkerk Janneke P. , Koehorst Jasper J. , Ritari Jarmo , Aalvink Steven , Stecher Bärbel , Schaap Peter J. , Paulin Lars , de Vos Willem M. , Belzer Clara
Published: October 2021

Background

Akkermansia muciniphila is a member of the human gut microbiota where it resides in the mucus layer and uses mucin as the sole carbon, nitrogen and energy source. A. muciniphila is the only representative of the Verrucomicrobia phylum in the human gut. However, A. muciniphila 16S rRNA gene sequences have also been found in the intestines of many vertebrates.

Results

We detected A. muciniphila-like bacteria in the intestines of animals belonging to 15 out of 16 mammalian orders. In addition, other species belonging to the Verrucomicrobia phylum were detected in fecal samples. We isolated 10 new A. muciniphila strains from the feces of chimpanzee, siamang, mouse, pig, reindeer, horse and elephant. The physiology and genome of these strains were highly similar in comparison to the type strain A. muciniphila MucT. Overall, the genomes of the new strains showed high average nucleotide identity (93.9 to 99.7%). In these genomes, we detected considerable conservation of at least 75 of the 78 mucin degradation genes that were previously detected in the genome of the type strain MucT.

Conclusions

The low genomic divergence observed in the new strains may indicate that A. muciniphila favors mucosal colonization independent of the differences in hosts. In addition, the conserved mucus degradation capability points towards a similar beneficial role of the new strains in regulating host metabolic health.
Exploration of the anti-insomnia mechanism of Ganoderma by central-peripheral multi-level interaction network analysis
Authors: Qiu Yu , Mao Zhu-Jun , Ruan Ye-Ping , Zhang Xin
Published: October 2021

Background

Ganoderma(Lingzhiin Chinese) has shown good clinical outcomes in the treatment of insomnia, restlessness, and palpitation. However, the mechanism by whichGanodermaameliorates insomnia is unclear. We explored the mechanism of the anti-insomnia effect ofGanodermausing systems pharmacology from the perspective of central-peripheral multi-level interaction network analysis.

Methods

The active components and central active components ofGanodermawere obtained from the TCMIP and TCMSP databases, then screened to determine their pharmacokinetic properties. The potential target genes of these components were identified using the Swiss Target Prediction and TCMSP databases. The results were matched with the insomnia target genes obtained from the GeneCards, OMIM, DisGeNET, and TCMIP databases. Overlapping targets were subjected to multi-level interaction network analysis and enrichment analysis using the STRING, Metascape, and BioGPS databases. The networks analysed were protein-protein interaction (PPI), drug-component-target gene, component-target gene-organ, and target gene-extended disease; we also performed gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses.

Results

In total, 34 sedative-hypnotic components (including 5 central active components) were identified, corresponding to 51 target genes. Multi-level interaction network analysis and enrichment analysis demonstrated thatGanodermaexerted an anti-insomnia effect via multiple central-peripheral mechanisms simultaneously, mainly by regulating cell apoptosis/survival and cytokine expression through core target genes such as TNF, CASP3, JUN, and HSP90αA1; it also affected immune regulation and apoptosis. Therefore,Ganodermahas potential as an adjuvant therapy for insomnia-related complications.

Conclusion

Ganodermaexerts an anti-insomnia effect via complex central-peripheral multi-level interaction networks.
Workplace violence and influencing factors among paramedic pre hospital paramedic personnel (city and road) in Iran: a quality content analysis
Authors: Hadian Marziye , Jabbari Alireza , Sheikhbardsiri Hojjat
Published: October 2021

Background

The goal of every emergency department is to provide the highest quality services in the shortest time using limited resources. However, occupational violence is so prevalent among pre-hospital paramedic personnel that some experts claim that it is impossible to find pre-hospital personnel without an experience of violence in the workplace. Therefore, it seems necessary to investigate the causes of violence among this population group and find ways to control it.

Aim

The present study aimed to investigate the Violence and influencing factors among paramedic pre-hospital personnel.

Method

This qualitative study was conducted to explore the views of a group of pre-hospital paramedic personnel (n = 45) selected through purposive sampling. The data was collected through in-depth and semi-structured interviews and analyzed using Graneheim and Lundman’s conventional content analysis methods. The trial version of MAXQDA 16 software was used to manage the coding process.

Results

Based on the results of the analysis of data collected from prehospital paramedic personnel, three main categories including: human factors, organizational factors, and environmental factors and 20 subcategories were detected.

Conclusion

If authorities neglect violence in the workplace and do not take serious actions to prevent it, violence and, more importantly, “hostility” will gradually prevail in the workplace. It also increases the stress and anxiety of staff and consequently severely deteriorates their job performance. Hence, authorities are strongly recommended not to ignore this issue and, instead, take measures, for instance hold workshops, to train personnel about the techniques of anger and violence control.
Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study
Authors: Chen Chuang-Wei , Lu Tzung-Ju , Hsiao Koung-Hung
Published: October 2021

Background

This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy.

Methods

This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes.

Results

All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups.

Conclusion

The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.
Incidence and determinants of adverse outcomes among women who were managed for eclampsia in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia
Authors: Getaneh Yisfa , Fekadu Elfalet , Jemere Adamu Takele , Mengistu Zelalem , Tarekegn Gebrekidan Ewnetu , Oumer Mohammed
Published: October 2021

Background

The incidence of eclampsia and its adverse maternal outcomes are very high in developing countries, particularly in Subsaharan African Countries. Identifying predictors for adverse maternal outcomes of eclampsia has paramount importance for helping health care providers to optimize their management outcomes. Therefore, this study aimed to assess the incidence of adverse maternal outcomes of eclampsia and its determinant factors.

Methods

A retrospective follow-up study design was applied. The data were extracted from patient charts using a structured, pre-tested, questionnaire. Descriptive analyses (frequencies, means, and standard deviation) were calculated, and bi-variable and multivariable logistic regression models were used to testing the association between independent variables and an outcome variable. After the data were coded and entered into Epi-Info Version 7.2 Software, the data were analyzed using STATA Version 14 Statistical Software.

Results

The magnitude of eclampsia was 5.36 per 1000 pregnancies (95% CI: 4.72, 6.10). The incidence of adverse maternal outcomes in eclamptic mothers was 53.7% (95% CI: 47.02, 60.24%). After adjusting for covariates maternal age 30–34, AOR 5.4 [95% CI = 1.02, 28.6]; age above 34, AOR 10.5 [95% CI = 1.3, 88.6]; gravidity 2–4, AOR 0.3 [95% CI = 0.1, 0.9]; 10 or more convulsions, AOR 4.6 [95% CI = 1.4, 14.9]; mild pyrexia, AOR 20.4 [95% CI = 3.7, 112.7]; moderate pyrexia, AOR 14.6 [95% CI = 1.7125.1]; platelet count below 50,000 cells/mm3, AOR 34.9 [95% CI = 3.6, 336.2]; platelet count between 50,000 and 99,000 cells/mm3, AOR 24.5 [95%CI = 5.4111.6]; and stillbirth of the current pregnancy, AOR 23.2 [95%CI = 2.1257.5] were strong predictors of adverse maternal outcomes in eclamptic mothers.

Conclusions

The incidence of adverse maternal outcomes of eclampsia was found to be high compared to similar studies discussed in this study. This study recommends early identification of patients with the risk factors (having many convulsions, high body temperature, low platelet count, patient age above 30 years, and 2–4 pregnancies), strengthening the referral system, and advocation of research on the area of adverse maternal outcomes and thereby encourage evidence-based medicine.
Association between sitting time at work and the onset of major depressive episode: a 1-year prospective cohort study using the Bayesian regression
Authors: Watanabe Kazuhiro , Kawakami Norito
Published: October 2021

Background

Although sedentary behavior is associated with the onset of major depressive disorder, it remains unclear whether sedentary behavior at work increases the risk of depression. The present study used the Bayesian approach to investigate the association between sitting time at work and the onset of major depressive episode (MDE).

Methods

A 1-year prospective cohort study was conducted among 233 Japanese workers without MDE (response rate: 4.3%). MDE onset was assessed using the self-reported WHO Composite International Diagnostic Interview version 3.0. A Bayesian Cox proportional hazard model was used to estimate the hazard ratio (HR) between long sitting time at work and MDE onset.

Results

A total of 231 workers were included in the analysis. During the follow-up, 1621 person-months were observed, and six participants experienced MDE onset. Incident rates per months were 0.34, 0.11, and 1.02% in short (< 7.2 h per day), medium (7.2–9.5 h), and long (9.5+ h) sitting time at work, respectively. The estimated median posterior probability distribution of the HR of long sitting time was 3.00 (95% highest density interval [HDI]: 0.73–12.03). The estimated median remained positive after adjustment for physical activity level and other covariates (HR = 2.11, 95% HDI: 0.42–10.22). The 10-base Bayesian factor for H1 (HR = 1.00) compared with the alternatives (H0, HR = 1.00) was 0.68 in the adjusted model. The analysis, which treated sitting time at work as a continuous variable, estimated that the median of the posterior probability distribution of the HR of sitting time was 0.79 (95% HDI: 0.58–1.07. The 10-base Bayesian factor was 2.73 in the linear association.

Conclusions

Long sitting time at work (9.5+ h per day) might be associated with MDE onset among workers. However, the linear association indicated conflicting results. Non-linear associations between sitting time and MDE onset might explain this inconsistency. The evidence for an adverse association between sitting time at work and MDE onset remains inconclusive.
The association of parity/live birth number with incident type 2 diabetes among women: over 15 years of follow-up in The Tehran Lipid and Glucose Study
Authors: Moazzeni Seyyed Saeed , Hizomi Arani Reyhane , Asgari Samaneh , Azizi Fereidoun , Hadaegh Farzad
Published: October 2021

Background

Childbearing may increase the future risk of developing type 2 diabetes mellitus (T2DM) in mothers. However, the issue is not clear completely and not investigated in the Middle East, a region with a high burden of T2DM. In the current study, we examined the association of parity/live birth number with incident T2DM among Iranian women.

Methods

The study population included 2552 women aged 30–65 years recruited in 1999–2001 and were followed for incident T2DM by 3-year intervals. Multivariable Cox proportional hazard models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the parity/live birth number for incident T2DM. Parity number was defined as the number of live childbirth (number of live birth) plus the number of stillbirth (defined as birth of an infant that died after the 20th week of pregnancy in the uterus).

Results

During a median follow-up of 15.4 years, 557 incident T2DM cases have occurred. After adjustment for potential T2DM risk factors and reproductive factors, each additional parity caused a 9% higher risk for incident T2DM. Moreover, compared to women with one parity, those with 3 and ≥ 4 parity had HRs of 1.73 [95% CI: 1.06–2.83] and 2.23 [1.36–3.65], respectively. After further adjustment for body mass index (BMI) and waist circumference, although the HRs were attenuated prominently, parity ≥ 4 was associated with significantly higher risk (HR: 1.72 [1.05–2.83]); even after further adjustment for triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C), the risk remained marginally significant (HR: 1.64 [1.00–2.70; P value: 0.051]). For the number of live birth, the results were also similar. Moreover, in a sensitivity analysis, when we considered BMI change during follow-up as another covariate, generally, the effect sizes did not change; the trend of HRs across categories of parity number remained marginally significant (P value: 0.064).

Conclusions

During a long-term follow-up, after adjustment for potential T2DM risk factors, reproductive factors, obesity indices, and TG/HDL-C (insulin resistance surrogate), we demonstrated that higher parity/live birth numbers could be associated with increased risk of T2DM development among Iranian women. Moreover, even after further adjustment for BMI change, the suggestive higher risk was still found.
Curriculum development on the human rights of people with disabilities for future medical education: using a modified Delphi
Authors: Lee Bomyee , Park So-Youn
Published: October 2021

Background

In order for doctors to effectively provide medical services to patients with disabilities, an understanding of this population is necessary, along with the knowledge, attitudes, and technical abilities necessary to address health problems associated with each type of disability. One way of doing this is by educating doctors about disabilities and ensuring their frequent contact with people with disabilities while they are in medical school. Therefore, this study aimed to develop a systematic medical education curriculum to enhance doctors’ understanding of people with disabilities.

Methods

The authors conducted a systematic literature review to develop and verify the basic framework of the educational content and curriculum. Two surveys were also developed using the Delphi method to evaluate the adequacy and necessity of educational topics. Items with a content validity ratio equal to or greater than the minimum value were considered valid. Survey panels comprised academic experts and health care practitioners who were working with people with disabilities. We conducted two surveys, one for a basic and the other for an advanced course, in which 13 to 16 respondents took part.

Results

The authors selected 13 topics for the ‘Basic Introductory Course’ and included general educational content on the health rights of people with disabilities focused on improving students’ knowledge of disabilities. The authors also selected 12 topics for the ‘Care and Communication for Patients with Disabilities Course’ designed to improve students’ understanding of interviewing and communicating with patients with disabilities.

Conclusions

In Korea, disability has received little attention in the medical curriculum to date. The curriculum developed in this study provides preliminary data for guiding future directions in medical education and developing specific support plans for an education that promotes people with disabilities’ health rights.
The value of a new prognostic model developed by lymphocyte-monocyte ratio and platelet-monocyte ratio in peripheral T-cell lymphoma
Authors: Zhang Yan , Shi Yuanfei , Shen Huafei , Shou Lihong , Fang Qiu , Zheng Xiaolong , Zhu Mingyu , Huang Xin , Huang Jiansong , Li Li , Zhou De , Zhu Lixia , Zhu Jingjing , Ye Xiujin , Jin Jie , Xie Wanzhuo
Published: October 2021

Peripheral T-cell lymphoma(PTCL) is a group of lymphoproliferative tumors originated from post-thymic T cells or mature natural killer (NK) cells. It shows highly aggressive clinical behaviour, resistance to conventional chemotherapy, and a poor prognosis. Although a few prognostic models of PTCL have been established in retrospective studies, some high-risk patients still can not be screened out. Therefor we retrospectively studied 347 newly diagnosed PTCL patients and assessed the prognostic role of lymphocyte-monocyte ratio (LMR) and platelet-monocyte ratio (PMR) in the complete response (CR) and survival of PTCL patients. Patients with LMR ≤ 1.68 and PMR ≤ 300 achieved a lower CR rate and a poor survival. In multivariate analysis, LMR ≤ 1.68 (HR = 1.751, 95% CI 1.158–2.647, p < 0.05) and PMR ≤ 300 (HR = 1.762, 95% CI 1.201–2.586, p < 0.05) were independently associated with short survival. On this basis, a new prognostic model of PTCL was established to screen out high-risk patients. In our "Peripheral Blood Score (PBS)" model, three groups were identified at low risk (178 patients, 51.3%, score 0), intermediate risk (85 patients, 24.5%, score 1), and high risk (84 patients, 24.2%, score 2), having a 1-year OS of 86%, 55.3% and 22.6% (p < 0.05), and a 3-year OS of 43.4%, 20% and 13.1% (p < 0.05), respectively. Optimal strategies for identifying high-risk patients with PTCL are urgently needed. Our new PBS model is simple, inexpensive and widely available to screen out the high risk patients.
Chemoprotective and chemosensitizing effects of apigenin on cancer therapy
Authors: Nozhat Zahra , Heydarzadeh Shabnam , Memariani Zahra , Ahmadi Amirhossein
Published: October 2021

Background

Therapeutic resistance to radiation and chemotherapy is one of the major obstacles in cancer treatment. Although synthetic radiosensitizers are pragmatic solution to enhance tumor sensitivity, they pose concerns of toxicity and non-specificity. In the last decades, scientists scrutinized novel plant-derived radiosensitizers and chemosensitizers, such as flavones, owing to their substantial physiological effects like low toxicity and non-mutagenic properties on the human cells. The combination therapy with apigenin is potential candidate in cancer therapeutics. This review explicates the combinatorial strategies involving apigenin to overcome drug resistance and boost the anti-cancer properties.

Methods

We selected full-text English papers on international databases like PubMed, Web of Science, Google Scholar, Scopus, and ScienceDirect from 1972 up to 2020. The keywords included in the search were: Apigenin, Chemoprotective, Chemosensitizing, Side Effects, and Molecular Mechanisms.

Results

In this review, we focused on combination therapy, particularly with apigenin augmenting the anti-cancer effects of chemo drugs on tumor cells, reduce their side effects, subdue drug resistance, and protect healthy cells. The reviewed research data implies that these co-therapies exhibited a synergistic effect on various cancer cells, where apigenin sensitized the chemo drug through different pathways including a significant reduction in overexpressed genes, AKT phosphorylation, NFκB, inhibition of Nrf2, overexpression of caspases, up-regulation of p53 and MAPK, compared to the monotherapies. Meanwhile, contrary to the chemo drugs alone, combined treatments significantly induced apoptosis in the treated cells.

Conclusion

Briefly, our analysis proposed that the combination therapies with apigenin could suppress the unwanted toxicity of chemotherapeutic agents. It is believed that these expedient results may pave the path for the development of drugs with a high therapeutic index. Nevertheless, human clinical trials are a prerequisite to consider the potential use of apigenin in the prevention and treatment of various cancers. Conclusively, the clinical trials to comprehend the role of apigenin as a chemoprotective agent are still in infancy.

Graphical Abstract
Gene augmented nuclear-targeting sonodynamic therapy via Nrf2 pathway-based redox balance adjustment boosts peptide-based anti-PD-L1 therapy on colorectal cancer
Authors: Wan Guoyun , Chen Xuheng , Wang Haijiao , Hou Shenglei , Wang Qian , Cheng Yuanyuan , Chen Qian , Lv Yingge , Chen Hongli , Zhang Qiqing
Published: October 2021

Background

Colorectal cancer is known to be resistant to immune checkpoint blockade (ICB) therapy. Sonodynamic therapy (SDT) has been reported to improve the efficacy of immunotherapy by inducing immunogenic cell death (ICD) of cancer. However, the SDT efficacy is extremely limited by Nrf2-based natural redox balance regulation pathway in cancer cells in response to the increased contents of reactive oxygen species (ROS). Nuclear-targeting strategy has shown unique advantages in tumor therapy by directly destroying the DNA. Thus it can be seen that Nrf2-siRNA augmented nuclear-targeting SDT could boost ICB therapy against colorectal cancer.

Results

The nuclear-targeting delivery system TIR@siRNA (TIR was the abbreviation of assembled TAT-IR780) with great gene carrier capacity and smaller diameter (< 60 nm) was designed to achieve the gene augmented nuclear-targeting SDT facilitating the anti-PD-L1 (programmed cell death-ligand-1) therapy against colorectal cancer. In CT26 cells, TIR@siRNA successfully delivered IR780 (the fluorescent dye used as sonosensitizer) into cell nucleus and Nrf2-siRNA into cytoplasm. Under US (utrasound) irradiation, TIR@siRNA notably increased the cytotoxicity and apoptosis-inducing activity of SDT through down-regulating the Nrf2, directly damaging the DNA, activating mitochondrial apoptotic pathway while remarkably inducing ICD of CT26 cells. In CT26 tumor-bearing mice, TIR@siRNA mediated gene enhanced nuclear-targeting SDT greatly inhibited tumor growth, noticeably increased the T cell infiltration and boostedDPPA-1 peptide-based anti-PD-L1 therapy to ablate the primary CT26 tumors and suppress the intestinal metastases.

Conclusions

All results demonstrate that TIR@siRNA under US irradiation can efficiently inhibit the tumor progression toward colorectal CT26 cancer in vitro and in vivo by its mediated gene augmented nuclear-targeting sonodynamic therapy. Through fully relieving the immunosuppressive microenvironment of colorectal cancer by this treatment, this nanoplatform provides a new synergistic strategy for enhancing the anti-PD-L1 therapy to ablate colorectal cancer and inhibit its metastasis.

Graphical Abstract
Potential causal effect of physical activity on reducing the risk of dementia: a 6-year cohort study from the Japan Gerontological Evaluation Study
Authors: Sato Koryu , Kondo Naoki , Hanazato Masamichi , Tsuji Taishi , Kondo Katsunori
Published: October 2021

Background

The causal effect of physical activity on reducing dementia risk has been questioned due to the possibility of reverse causation. This study examined the potential causal effects of physical activity on reducing dementia risk using residency in a snowy area as an instrumental variable (IV) representing the physical activity of older adults.

Methods

We used cohort data from the Japan Gerontological Evaluation Study, a longitudinal cohort enrolling people aged 65 or older who were physically and cognitively independent in 2013; study participants were followed for an average of 5.7 years. Participants in the present study included 73,260 individuals living in 19 municipalities in Japan. Physical activity was measured by self-report questionnaires and the incidence of dementia was ascertained by linking participants to the public registries of long-term care insurance. IV estimation was obtained from a piecewise Cox proportional hazard model using a two-stage regression procedure.

Results

During the study period, we ascertained 8714 cases (11.9%) of dementia onset. In the IV analysis, we found that the frequency of physical activity per week was negatively associated with dementia risk, though the association weakened over time (Year 1: hazard ratio = 0.53, 95% confidence interval: 0.39–0.74; Year 4: 0.69, 0.53–0.90; Year 6: 0.85, 0.66–1.10).

Conclusions

Our IV analysis indicated a potential causal effect of physical activity on reducing dementia risk that persisted for at least 4 years of follow-up. Thus, we conclude that physical activity should be recommended for older adults to reduce dementia risk.
Molecular identification and prevalence of trypanosomes in cattle distributed within the Jebba axis of the River Niger, Kwara state, Nigeria
Authors: Habeeb Issa Funsho , Chechet Gloria Dada , Kwaga Jacob K. P.
Published: October 2021

Background

Trypanosomiasis is a fatal disease that threatens the economy of at least 37 countries in sub-Saharan Africa, particularly with regard to livestock farming. In this study, we investigated the prevalence of trypanosome infection in cattle, and molecularly identified the species of trypanosomes in infected cattle and the spatial distribution of trypanosome-infected herds along the Jebba axis of the River Niger.

Methods

A randomized cross-sectional study was conducted along the Jebba axis of the River Niger by screening cattle from 36 herd clusters by nested PCR using ITS-1 generic primers. Data generated were analysed using the Chi-square test at a 95% confidence interval.

Results

Microscopic examination revealed three infected cattle out of 398 examined, representing 0.8% prevalence. Twelve animals (3.0%) were positive by PCR. Our results showed a decline in the packed cell volume of infected animals (24.7%). The infection rates were categorized as single infection in 11/12 (91.7%) and mixed infection in 1/12 (8.3%). Animals were most frequently infected byTrypanosoma congolense(50.0%), withT. congolenseSavannah being the most prevalent subspecies (71.4%). Aside from the infection rate by age (10.0%) and relative distance of animals from the River Niger (56.2%), statistical differences in every other parameter tested were based on mere probabilistic chance. Spatial data showed that the disease was prevalent among herds located less than 3 km from the River Niger.

Conclusions

Six species of trypanosomes were identified in cattle herds along the Jebba axis of the River Niger, withT. congolensebeing the most prevalent. Age and relative distance of herds from the River Niger may be risk factors for trypanosome infection in cattle herds in this area.

Graphical abstract