bluuebunny/crossref_metadata_2025 huggingface dataset:
A refractory case of CDK4-amplified spinal astrocytoma achieving complete response upon treatment with a Palbociclib-based regimen:a case report
Authors: Lin Jietao , Yu Ling , Fu Yuanfeng , Chen Hanrui , Zheng Xinting , Wang Shutang , Gao Chan , Cao Yang , Lin Lizhu
Published: July 2020

Background

Spinal cord astrocytoma is a rare neoplasm, and patients usually recur within months after surgery. There is currently a lack of consensus regarding post-operative treatment. Clinical data on the activity of systemic treatment like chemoradiotherapy and anti-angiogenic agents also remained scant. Next-generation sequencing (NGS) -based genomic profiling thus may help identify potential treatment options for a subset of patients that harbor actionable genetic alterations.

Case presentation

We reported for the first time a refractory case of grade III spinal cord astrocytoma that underwent two surgeries but eventually progressed following post-operative chemoradiotherapy plus bevacizumab. Hybridization capture-based NGS using a 381-gene panel disclosed cyclin dependent kinase 4 (CDK4) amplification and after receiving a triplet regimen containg palbociclib for 15 months, the patient achieved complete response.

Conclusions

This case demonstrated the importance of genetic profiling and the benefit of a multi-modality treatment strategy in cancer management.
Head & neck acinar cell carcinoma: a population-based study using the seer registry
Authors: Yibulayin Feiluore , Feng Lei , Wang Meng , Lu Meng-meng , Luo Yuan , Liu Hui , Yang Zhi-cheng , Wushou Alimujiang
Published: July 2020

Background

To explore the clinicopathologic characteristics, treatment and prognostic factors of head and neck acinar cell carcinoma (HNACC) comprehensively.

Methods

A population-based study was conducted using data from the Surveillance, Epidemiology, and End Results database (1975–2016). Overall survival (OS) and HNACC-specific survival of patients with different clinicopathologic variables were compared using the Kaplan-Meier method and Cox multivariate regression.

Results

A total of 2624 primary HNACC cases (1052 males, 1572 females) were identified. There was a significant difference in gender distribution. Among the total cohort, 2416 cases originated from salivary glands, including 2325 parotid gland ACC cases. Regardless of confounding factors, the 10-year and 20-year disease-specific survival (DSS) was 93.6 and 90%, respectively. Surgery was favourably associated with better DSS and OS [HR = 0.13, P = 0.0092 and HR = 0.23, P = 0.0203]. Gender was the only demographic independent prognostic factor for both DSS and OS [Male vs female, HR = 3.3, P = 0.0028 for DSS; HR = 2.44, P = 0.0376 for OS]. Higher pathological grade was adversely associated with DSS and OS [Grade II, HR = 4.03, P = 0.0444; Grade III + IV, HR = 35.64, P = 0.0000 for DSS; Grade III + IV, HR = 4.49, P = 0.0000 for OS, Grade I as reference]. In addition, TNM/AJCC stage was commonly associated with prognosis.

Conclusion

Surgery was the only favourable prognostic indicator for both DSS and OS. Gender, age, pathological differentiation and TNM/AJCC stage were independent prognostic factors for survival.
Proteomics reveals a therapeutic vulnerability via the combined blockade of APE1 and autophagy in lung cancer A549 cells
Authors: Pan Shu-Ting , Zhou Ji , Yang Fang , Zhou Shu-Feng , Ren Tao
Published: July 2020

Background

Drug resistance is a major cause of therapeutic failure that is often associated with elevated autophagy and apurinic/apyrimidinic endonuclease 1 (APE1) expression. Herein, we investigated the role of APE1 and autophagy in A549 cells treated with cisplatin.

Methods

SILAC proteomics was applied to obtain a panoramic view of cisplatin treatment in KRASG12S-mutant A549 cells. Quantity analysis of cellular apoptosis and autophagy was based on flow cytometry. Western blotting was used to examine the expression levels of apoptosis- and autophagy-related proteins, as well as those of APE1. Knockdown of APE1 was achieved by RNA interference. Immunoprecipitation was further employed to reveal the molecular interaction of APE1, p53, and LC3 when A549 cells were exposed to cisplatin.

Results

SILAC proteomics revealed that 72 canonical pathways, including base excision repair (BER) and autophagy signalling pathways, were regulated after cisplatin treatment in A549 cells. Cisplatin markedly induced autophagy and apoptosis in A549 cells, accompanied by remarkable APE1 increase. Suppression of autophagy enhanced the inhibition effect of cisplatin on cell growth, proliferation, and colony formation; however, APE1 inhibition enhanced the expression of LC3-I/II, suggesting that APE1 and autophagy are compensatory for cell survival to evade the anticancer action of cisplatin. Immunoprecipitation results revealed the triple complex of APE1-p53-LC3 in response to cisplatin plus CQ in A549 cells. Dual inhibition of APE1 and autophagy significantly enhanced cisplatin-induced apoptosis, which eventually overcame drug resistance in cisplatin-resistant A549 cells.

Conclusions

Dual inhibition of APE1 and autophagy greatly enhances apoptosis in parental KRASG12S-mutant A549 cells and cisplatin-resistant A549 cells via regulation of APE1-p53-LC3 complex assembly, providing therapeutic vulnerability to overcome cisplatin resistance in the context of KRASG12S-mutant lung cancer.
Design of the PROstate cancer follow-up care in Secondary and Primary hEalth Care study (PROSPEC): a randomized controlled trial to evaluate the effectiveness of primary care-based follow-up of localized prostate cancer survivors
Authors: Wollersheim Barbara M. , van Asselt Kristel M. , van der Poel Henk G. , van Weert Henk C. P. M. , Hauptmann Michael , Retèl Valesca P. , Aaronson Neil K. , van de Poll-Franse Lonneke V. , Boekhout Annelies H.
Published: July 2020

Background

In its 2006 report,From cancer patient to cancer survivor: lost in transition, the U.S. Institute of Medicine raised the need for a more coordinated and comprehensive care model for cancer survivors. Given the ever increasing number of cancer survivors, in general, and prostate cancer survivors, in particular, there is a need for a more sustainable model of follow-up care. Currently, patients who have completed primary treatment for localized prostate cancer are often included in a specialist-based follow-up care program. General practitioners already play a key role in providing continuous and comprehensive health care. Studies in breast and colorectal cancer suggest that general practitioners could also consider to provide survivorship care in prostate cancer. However, empirical data are needed to determine whether follow-up care of localized prostate cancer survivors by the general practitioner is a feasible alternative.

Methods

This multicenter, randomized, non-inferiority study will compare specialist-based (usual care) versus general practitioner-based (intervention) follow-up care of prostate cancer survivors who have completed primary treatment (prostatectomy or radiotherapy) for localized prostate cancer. Patients are being recruited from hospitals in the Netherlands, and randomly (1:1) allocated to specialist-based (N = 195) or general practitioner-based (N = 195) follow-up care. This trial will evaluate the effectiveness of primary care-based follow-up, in comparison to usual care, in terms of adherence to the prostate cancer surveillance guideline for the timing and frequency of prostate-specific antigen assessments, the time from a biochemical recurrence to retreatment decision-making, the management of treatment-related side effects, health-related quality of life, prostate cancer-related anxiety, continuity of care, and cost-effectiveness. The outcome measures will be assessed at randomization (≤6 months after treatment), and 12, 18, and 24 months after treatment.

Discussion

This multicenter, prospective, randomized study will provide empirical evidence regarding the (cost-) effectiveness of specialist-based follow-up care compared to general practitioner-based follow-up care for localized prostate cancer survivors.

Trial registration

Netherlands Trial Registry, TrialNL7068(NTR7266). Prospectively registered on 11 June 2018
Association of anthropometric measures across the life-course with refractive error and ocular biometry at age 15 years
Authors: Bruce Alison , Mojarrad Neema Ghorbani , Santorelli Gillian
Published: July 2020

Background

A recent Genome-wide association meta-analysis (GWAS) of refractive error reported shared genetics with anthropometric traits such as height, BMI and obesity. To explore a potential relationship with refractive error and ocular structure we performed a life-course analysis including both maternal and child characteristics using data from the Avon Longitudinal Study of Parents and Children cohort.

Methods

Measures collected across the life-course were analysed to explore the association of height, weight, and BMI with refractive error and ocular biometric measures at age 15 years from 1613children. The outcome measures were the mean spherical equivalent (MSE) of refractive error (dioptres), axial length (AXL; mm), and radius of corneal curvature (RCC; mm). Potential confounding variables; maternal age at conception, maternal education level, parental socio-economic status, gestational age, breast-feeding, and gender were adjusted for within each multi-variable model.

Results

Maternal height was positively associated with teenage AXL (0.010 mm; 95% CI: 0.003, 0.017) and RCC (0.005 mm; 95% CI: 0.003, 0.007), increased maternal weight was positively associated with AXL (0.004 mm; 95% CI: 0.0001, 0.008). Birth length was associated with an increase in teenage AXL (0.067 mm; 95% CI: 0.032, 0.10) and flatter RCC (0.023 mm; 95% CI: 0.013, 0.034) and increasing birth weight was associated with flatter RCC (0.005 mm; 95% CI: 0.0003, 0.009). An increase in teenage height was associated with a lower MSE (− 0.007 D; 95% CI: − 0.013, − 0.001), an increase in AXL (0.021 mm; 95% CI: 0.015, 0.028) and flatter RCC (0.008 mm; 95% CI: 0.006, 0.010). Weight at 15 years was associated with an increase in AXL (0.005 mm; 95% CI: 0.001, 0.009).

Conclusions

At each life stage (pre-natal, birth, and teenage) height and weight, but not BMI, demonstrate an association with AXL and RCC measured at age 15 years. However, the negative association between refractive error and an increase in height was only present at the teenage life stage. Further research into the growth pattern of ocular structures and the development of refractive error over the life-course is required, particularly at the time of puberty.
Resilience, trauma, and hopelessness: protective or triggering factor for the development of psychopathology among migrants?
Authors: Gambaro Eleonora , Mastrangelo Martina , Sarchiapone Marco , Marangon Debora , Gramaglia Carla , Vecchi Camilla , Airoldi Chiara , Mirisola Concetta , Costanzo Gianfranco , Bartollino Silvia , Baralla Francesca , Zeppegno Patrizia
Published: July 2020

Background

Recently, many studies have investigated the role of migration on mental health. Nonetheless, only few focused on the consequences of childhood trauma, hopelessness, and resilience on migrants’ psychopathology, including psychiatric disorders and symptoms.

Method

119 migrants were recruited between May 2017 and April 2018, among those applying for assessment to the Mental Health Operational Unit of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy. Assessment included the following: Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), Connor-Davidson Resilience Scale (CD-RISC), Childhood Trauma Questionnaire (CTQ), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), Beck Hopelessness Scale (BHS), Beck’s Suicide Intent Scale (SIS), Brief Aggression Questionnaire (BAQ), Deliberate Self-Harm Inventory (DSHI).

Results

53.39% of migrants scored above the PCL-5 cut-off score (mean score was 39.45). SDS scores below the cutoff suggested the presence of depression in 42.37%, while According to SAS scores anxiety levels were low in 38.98% of migrants. During childhood, physical abuse and neglect were reported respectively by 56.78 and 69.49% of migrants.

Conclusion

We found that Post Traumatic Stress Disorders play the role of mediators for the relation between the childhood traumatic experiences and aggressiveness, anxious and depressive symptomatology, while hopelessness is a mediator between the childhood traumatic experiences and the development of depression in adulthood. Hopelessness seems to influence the strength of the relation between childhood traumatic experiences and the individual’s current intensity of suicidal attitudes, plans, and behaviors. Further developments and future perspectives of the research project are to address key gaps in the field of resilience by means of a longitudinal evaluation study in migrants, including a native population control group, acceding to NIHMP.
Motivations for people with cognitive impairment to complete an advance research directive – a qualitative interview study
Authors: Jongsma Karin , Perry Julia , Schicktanz Silke , Radenbach Katrin
Published: July 2020

Background

Research with persons with dementia is important to better understand the causes of dementia and to develop more effective diagnostics, therapies, and preventive measures. Advance Research Directives (ARDs) have been suggested as a possible solution to include persons with dementia in research in an ethically sound way. Little is known about how people, especially those affected by cognitive impairment, understand and regard the use of ARDs, as empirical studies are mainly conducted with healthy, non-cognitively impaired, participants.

Methods

This qualitative study, a sub-study of a larger study on the evaluation of ARDs in the context of dementia research in Germany, consists of semi-structured in-depth interviews with 24 persons with cognitive impairment.

Results

Our results indicate that most participants consider ARDs a valuable tool for allowing them to make their own decisions. Many would prefer to draft an ARD when they are still healthy or soon after the diagnosis of cognitive impairment. Participants suggested that the completion of ARDs can be advanced with the provision of practical support and increased dissemination of information on ARDs in society.

Conclusion

Persons with subjective or mild cognitive impairment (SCI/MCI) suggested several motivating factors and concerns for completing an ARD. Clinicians need to be trained to accommodate patients’ needs for sufficient and adequate information. Furthermore, a standardised, partly pre-formulated template could be helpful for drafting an ARD. As such tested templates are currently not yet available, this addresses the urgent need for more translational and implementation research for the use of ARDs.
An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study
Authors: Prior Susan , Maciver Donald , Aas Randi W. , Kirsh Bonnie , Lexen Annika , van Niekerk Lana , Irvine Fitzpatrick Linda , Forsyth Kirsty
Published: July 2020

Background

Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes.

Methods

This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education).

Results

Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001.

Conclusion

An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment.

Trial registration

NCT04083404 Registered 05 September 2019 (retrospectively registered).
Sustainable solid waste management Measures in Tanzania: an exploratory descriptive case study among vendors at Majengo market in Dodoma City
Authors: Nyampundu Kepha , Mwegoha William J. S. , Millanzi Walter C.
Published: July 2020

Background

Solid waste management is both an urban and rural problem because every person is considered a producer of wastes. It has been noted to be a global universal issue, which affects every individual, families, communities and governments and thus, needs to be addressed through sustainable strategies. This study aimed at characterizing solid wastes; assessing the levels of awareness of vendors on the sustainable solid waste management measures; and identifying techniques used to handle solid waste generated at the Majengo market in Dodoma City, Tanzania.

Methods

The study adopted an exploratory descriptive case study, with a mixed research approaches with a minimum sample of 196 conviniently selected respondents. Semi-structured questionnaires developed by the researcher were the main data collection tools to characterize solid wastes, measure levels of awareness about sustainable solid waste management approaches (SWM) and identify solid waste handling techniques among vendors at the market. Quantitative and Qualitative data were analyzed by using the Statistical Product for Social Sciences version 23 and thematic analysis respectively.

Results

Findings showed that 55% of vendors were males. Majority of the sampled vendors (56%) were not aware of SWM. On the other hand, crops/food and animal product remains were reported to be the most generated solid wastes (94.4%) with the rate of > 2 tons/day equivalent to 72.4% of the overall solid waste generation at the market. SWM services were reported to be provided by City council (85.7%) with the main equipment/tool used to store solid wastes (SW) being containers without lids (88.3%). The dumpsite was the main site for SW disposal (80.1%). Nevertheless, 92.9% of the sampled vendors reported that SWM strategies were there at the market though not adhered to accordingly.

Conclusion

Vendors were not aware of sustainable solid waste management measures existing at the market. However, vendors’ education levels and the duration of doing business at the market were related to their levels of awareness on SWM (p < 0.05). The SWM measures were found to exist at the market, however, they were not sustainable because it was reported that they were ineffectively and inefficiently used to control SW generation, collection, storage, and disposal. There is a need of regular awareness-raising activities about sustainable SWM measures among vendors. Moreover, city council and market authorities need to have sustainable and scheduled implementation, supervision, monitoring and evaluation of SWM measures to maintain the management of solid wastes at Majengo market premises.
Determinants of institutional delivery service utilization in Ethiopia: a population based cross sectional study
Authors: Berelie Yebelay , Yeshiwas Dawit , Yismaw Leltework , Alene Muluneh
Published: July 2020

Background

The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia.

Methods

Data were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chi-square test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals.

Result

The level of institutional delivery was 38.9%. Women’s who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73–3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32–3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10–10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women’s without formal education, giving birth at health facility was more likely for women’s who had primary education level (AOR = 1.77, 95% CI: 1.49–2.10), secondary education level (AOR = 3.79, 95% CI: 2.72–5.30), and higher education level (AOR = 5.86, 95% CI: 3.25–10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86–3.06) and middle (AOR = 1.66, 95% CI: 1.36–2.03) household wealth index were more likely to deliver at health facility compared to women’s who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level.

Conclusion

The level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.
Co-occurrence patterns and the large-scale spatial structure of benthic communities in seagrass meadows and bare sand
Authors: Kraan Casper , Thrush Simon F. , Dormann Carsten F.
Published: July 2020

Background

Species distribution models are commonly used tools to describe diversity patterns and support conservation measures. There is a wide range of approaches to developing SDMs, each highlighting different characteristics of both the data and the ecology of the species or assemblages represented by the data. Yet, signals of species co-occurrences in community data are usually ignored, due to the assumption that such structuring roles of species co-occurrences are limited to small spatial scales and require experimental studies to be detected. Here, our aim is to explore associations among marine sandy-bottom sediment inhabitants and test for the structuring effect of seagrass on co-occurrences among these species across a New Zealand intertidal sandflat, using a joint species distribution model (JSDM).

Results

We ran a JSDM on a total of 27 macrobenthic species co-occurring in 300,000 m2 of sandflat. These species represented all major taxonomic groups, i.e. polychaetes, bivalves and crustaceans, collected in 400 sampling locations. A number of significant co-occurrences due to shared habitat preferences were present in vegetated areas, where negative and positive correlations were approximately equally common. A few species, among them the gastropods Cominella glandiformis and Notoacmea scapha, co-occurred randomly with other seagrass benthic inhabitants. Residual correlations were less apparent and mostly positive. In bare sand flats shared habitat preferences resulted in many significant co-occurrences of benthic species. Moreover, many negative and positive residual patterns between benthic species remained after accounting for habitat preferences. Some species occurring in both habitats showed similarities in their correlations, such as the polychaete Aglaophamus macroura, which shared habitat preferences with many other benthic species in both habitats, yet no residual correlations remained in either habitat.

Conclusions

Firstly, analyses based on a latent variable approach to joint distributions stressed the structuring role of species co-occurrences beyond experimental scales. Secondly, results showed context dependent interactions, highlighted by species having more interconnected networks in New Zealand bare sediment sandflats than in seagrass meadows. These findings stress the critical importance of natural history to modelling, as well as incorporating ecological reality in SDMs.
Effects of two peroxide enzymatic denture cleaners on Candida albicans biofilms and denture surface
Authors: Han Ying , Liu Xiaodan , Cai Yu
Published: July 2020

Objective

To compare the antifungal action of two commercially available denture cleaning agents to that of standard clinical solutions, and determine their effects on the polymethyl methacrylate (PMMA) acrylic resin denture surface.

Methods

Candida albicans growth was analyzed by colony forming assay, and the methyl thiazolyl tetrazolium (MTT) assay was used to evaluate biofilm formation and cell adhesion. The morphology and roughness of PMMA acrylic resin surface was measured by scanning electron microscopy (SEM) images and stylus method.

Results

Clene®, Polident® and 3% NaHCO3 solutions showed significantly greater antifungal effects in terms of both inhibiting growth and biofilm formation. In addition, Clene® solution prevented adhesion of C. albicans on cell culture plates compared to filter-sterile tap water, whereas other reagents did not have an inhibitory effect. One-month immersion in the different cleaning reagents significantly inhibited fungal adhesion on the PMMA surface Clene®, Polident® and 3% NaHCO3 showed greater effect compared to PBS and filter-sterile tap water. Finally, none of the cleansing agents significantly affected the morphology and roughness of the PMMA surface.

Conclusion

Clene®, Polident® and 3% NaHCO3 solutions can inhibit C. albicans growth and biofilm formation to some extent on cell culture plates, and significantly inhibit fungal adhesion on the PMMA surface without affecting surface morphology and roughness.
Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review
Authors: Niazkhani Zahra , Toni Esmaeel , Cheshmekaboodi Mojgan , Georgiou Andrew , Pirnejad Habibollah
Published: July 2020

Background

Electronic personal health records (ePHRs) are defined as electronic applications through which individuals can access, manage, and share health information in a private, secure, and confidential environment. Existing evidence shows their benefits in improving outcomes, especially for chronic disease patients. However, their use has not been as widespread as expected partly due to barriers faced in their adoption and use. We aimed to identify the types of barriers to a patient, provider, and caregiver adoption/use of ePHRs and to analyze their extent in chronic disease care.

Methods

A systematic search in Medline, PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, and the Institute of Electrical and Electronics Engineers (IEEE) database was performed to find original studies assessing barriers to ePHR adoption/use in chronic care until the end of 2018. Two researchers independently screened and extracted data. We used the PHR adoption model and the Unified Theory of Acceptance and Use of Technology to analyze the results. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of evidence in the included studies.

Results

Sixty publications met our inclusion criteria. Issues found hindering ePHR adoption/use in chronic disease care were associated with demographic factors (e.g., patient age and gender) along with key variables related to health status, computer literacy, preferences for direct communication, and patient’s strategy for coping with a chronic condition; as well as factors related to medical practice/environment (e.g., providers’ lack of interest or resistance to adopting ePHRs due to workload, lack of reimbursement, and lack of user training); technological (e.g., concerns over privacy and security, interoperability with electronic health record systems, and lack of customized features for chronic conditions); and chronic disease characteristics (e.g., multiplicities of co-morbid conditions, settings, and providers involved in chronic care).

Conclusions

ePHRs can be meaningfully used in chronic disease care if they are implemented as a component of comprehensive care models specifically developed for this care. Our results provide insight into hurdles and barriers mitigating ePHR adoption/use in chronic disease care. A deeper understating of the interplay between these barriers will provide opportunities that can lead to an enhanced ePHR adoption/use.
Differentially private release of medical microdata: an efficient and practical approach for preserving informative attribute values
Authors: Lee Hyukki , Chung Yon Dohn
Published: July 2020

Background

Various methods based on k-anonymity have been proposed for publishing medical data while preserving privacy. However, the k-anonymity property assumes that adversaries possess fixed background knowledge. Although differential privacy overcomes this limitation, it is specialized for aggregated results. Thus, it is difficult to obtain high-quality microdata. To address this issue, we propose a differentially private medical microdata release method featuring high utility.

Methods

We propose a method of anonymizing medical data under differential privacy. To improve data utility, especially by preserving informative attribute values, the proposed method adopts three data perturbation approaches: (1) generalization, (2) suppression, and (3) insertion. The proposed method produces an anonymized dataset that is nearly optimal with regard to utility, while preserving privacy.

Results

The proposed method achieves lower information loss than existing methods. Based on a real-world case study, we prove that the results of data analyses using the original dataset and those obtained using a dataset anonymized via the proposed method are considerably similar.

Conclusions

We propose a novel differentially private anonymization method that preserves informative values for the release of medical data. Through experiments, we show that the utility of medical data that has been anonymized via the proposed method is significantly better than that of existing methods.
‘To give or not to give medication, that is the question.’ Healthcare personnel’s perceptions of factors affecting pro re nata medication in sheltered housing for older adults — a focus-group interview study
Authors: Nilsen Marianne Kollerøs , Sletvold Hege , Olsen Rose Mari
Published: July 2020

Background

Residents living in sheltered housing depend on help from healthcare personnel (HCP) with medication management, regarding regular long-term and pro re nata (PRN) medication. The HCP assess the need for PRN medication prior to administration to the residents. The purpose of this study was to describe HCP’s perceptions of factors affecting PRN medication management in sheltered housing for older adults.

Method

This was a qualitative study with five focus-group interviews with 22 HCP working in sheltered housing for older adults. The HCP were heterogenous regarding scholarly education and experiences, working in four different municipalities in mid-Norway, representing urban, sub-urban and rural districts. The analysis was inductive, based on qualitative, manifest, content analysis. The main outcome was HCP perceptions of the factors affecting PRN medication management in sheltered housing.

Results

Four main factors affecting the PRN medication management were identified in the data and were related to either: 1) the medication; 2) the resident; 3) the HCP; or 4) the organisation. These categories included 14 subcategories. Overall, the HCP described the management of PRN medication as a complex process, where the above factors all have impact on the residents’ health and safety.

Conclusion

HCP working in sheltered housing describe that PRN medication management is affected by numerous human factors, that consequently may affect patient outcomes and safety. HCP involved in PRN medication management should be aware of factors that affect their decision-making, and safe management requires a professional practice built on medicines competence, practical skills and experience.
Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study
Authors: Rocks Stephen , Glogowska Margaret , Stepney Melissa , Tsiachristas Apostolos , Fazel Mina
Published: July 2020

Background

In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England.

Methods

We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week’s users was collected.

Results

A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas.

Conclusions

The introduction of a SPA has the potential to improve young people’s access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations.
Correction to: Building a Children’s Health Service and System Research Strategy: development and integration in an Australian paediatric healthcare setting
Authors: Littlewood Robyn , Canfell Oliver J. , Tracey Frank
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Respiratory metabolites in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) can differentiate horses affected by severe equine asthma from healthy horses
Authors: Bazzano Marilena , Laghi Luca , Zhu Chenglin , Magi Gian Enrico , Tesei Beniamino , Laus Fulvio
Published: July 2020

Background

The use of an untargeted metabolomic approach to investigate biofluids of respiratory origin is of increasing interest in human and veterinary lung research. Considering the high incidence of equine asthma (> 14%) within horse population and the importance of this animal model for human disease, we aimed to investigate the metabolomic profile of bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) in healthy and asthmatic horses.

Results

On the basis of clinical, endoscopic and BALF cytology findings, 6 horses with severe asthma (Group A) and 6 healthy horses (Group C) were included in the study.1H-NMR analysis was used to identified metabolites in BALF and EBC samples. Metabolomic analysis allowed to identify and quantify 12 metabolites in BALF and seven metabolites in EBC. Among respiratory metabolites, myo-inositol, formate, glycerol and isopropanol in BALF, and methanol and ethanol in EBC, differed between groups (p < 0.05).

Conclusions

The application of metabolomic studies to investigate equine asthma using minimally invasive diagnostic methods, such as EBC metabolomics, provided promising results. According to our research, the study of selective profiles of BALF and EBC metabolites might be useful for identifying molecules like myo-inositol and methanol as possible biomarkers for airways diseases in horses.
The association between glucose-related variables and plaque morphology in patients with ST-segment elevated myocardial infarction
Authors: Liu Jinxin , Wang Shanjie , Cui Can , Cai Hengxuan , Sun Rong , Pan Weili , Fang Shaohong , Yu Bo
Published: July 2020

Background

Plaque rupture (PR) and plaque erosion (PE) are main causes of acute myocardial infarction with different demographic and histology characteristics and need different treatment strategy. PR and PE can be identified with optical coherence tomography (OCT) accurately, but convenient and effective noninvasive markers for them are rarely found. History of diabetes mellitus (DM) was reported to be a potential predictor of PR in ST-segment elevated myocardial infarction (STEMI) patients, but the predictive value of other glucose-related variables for it is still uncertain. Present study aimed to clear the relationship between some glucose-related variables and plaque morphology in patients with STEMI.

Methods

We consecutively enrolled 872 STEMI patients and divided them into PR group (n = 616) and PE group (n = 256) based on OCT diagnostic criteria. The relationship of glucose-related variables, including random plasma glucose on admission (ARPG), glycosylated hemoglobin (HbA1c), post-PCI fasting plasma glucose (PFPG), DM history, glucose variable tendency (GVT) and the acute-to-chronic glycemic ratio (A/C), to the PR risk of STEMI patients was analyzed. The correlation between the glucose-related variables and plaque morphology was analyzed meanwhile.

Results

Among the glucose-related variables, ARPG and GVT were confirmed to be independent predictors for PR after adjusting for other traditional risk factors in nondiabetic patients. The higher the ARPG level, the more PR risk the STEMI patients had. And high HbA1c and APPG were demonstrated to have a weak and positive correlation with lipid constituents and stenosis degree of culprit vessel.

Conclusions

Compared to HbA1c, DM history, and some other glucose-related variables, ARPG and GVT were risk factors for PR in STEMI patients, especially those without DM. And high HbA1c and ARPG were positively correlated with the development of vulnerable plaque in culprit vessels.

Trial registrationPresent study is a retrospective one and the population came from the EROSION study of our center previously. It was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University (Approval reference number, KY2017-249), and all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.
Measuring health-related quality of life in chronic otitis media in a Chinese population: cultural adaption and validation of the Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn)
Authors: Yang Ruizhe , Zhang Ying , Han Weiju , Li Yi , Li Shan , Ke Jia , Song Yu , Liu Junxiu , Röösli Christof , Huber Alexander M. , Bächinger David , Ma Furong
Published: July 2020

Background

The demand for assessing health-related quality of life (HRQoL) in chronic otitis media (COM) is increasing globally. The currently available Chinese-language patient-reported outcome measurement (PROM) specific for COM includes merely a limited range of related symptoms and dimensions. Hence, in this study, we aim to translate, culturally adapt, and validate the Zurich Chronic Middle Ear Inventory (ZCMEI-21) in Chinese, to enable a comprehensive evaluation of the patients’ subjective health outcome in COM.

Methods

We sampled and surveyed 223 COM patients at three tertiary referral centers in China, using the Chinese translation of ZCMEI-21 (ZCMEI-21-Chn) and the EQ-5D questionnaire, a generic measure of HRQoL. Confirmatory factor analysis (CFA) was performed to investigate the structural model fit to the dataset. Cronbach’s α and test-retest reliability coefficient were calculated to establish reliability, and correlation was tested between ZCMEI-Chn scores and EQ-5D scores for convergent validity.

Results

A total of 208 adult patients with COM were included, with a mean age of 46 years (SD 14 years) and a male proportion of 41% (85/208). A modified bifactor model with ωH of 0.65 and ECV of 0.47 was found to fit the scale scores, indicating fair general factor saturation and multidimensionality of the instrument. ZCMEI-21-Chn demonstrated good reliability (Cronbach’s α = 0.88, test-retest reliability = 0.88). The total scores of ZCMEI-21-Chn had a moderate correlation with a question directly addressing HRQoL (r = 0.40, p < 0.001), EQ-5D descriptive system score (r = 0.57, p < 0.001), and EQ-5D visual analogous scale (r = 0.30, p < 0.001).

Conclusions

The ZCMEI-21-Chn is valid, reliable and culturally adapted to Chinese adult patients with COM. This study offers clinicians an efficient and comprehensive instrument to quantify COM patients’ self-reported health outcomes, which could facilitate the standardization of HRQoL data aggregation in COM on a global scale.
A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis
Authors: Mao Xinyu , Xu Xinlei , Zhu Hua , Ji Chunpeng , Lu Xu , Wang Baolin
Published: July 2020

Background

Due to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). However, controversies still persist regarding the surgical efficacy and oncological safety of PPG.

Methods

Original studies comparing PPG and DG for EGC were searched in PubMed, Embase, and the Cochrane Register of Controlled Trials up to December 2019. The weight mean difference, standardized mean difference, or odds risk was used to calculate the short-term and long-term outcomes between the two groups.

Results

Twenty-one comparative studies comprising 4871 patients (1955 in the PPG group and 2916 in the DG group) were enrolled in this systematic review and meta-analysis. PPG showed longer hospital day, decreased harvested lymph nodes, and more delayed gastric emptying. However, PPG had the benefits of lower incidence of anastomosis leakage, early dumping syndrome, gastritis and bile reflux, and better recovery of total protein, albumin, hemoglobin, and weight. No difference was found in operative time, blood loss, and overall complications. Moreover, the long-term survival and recurrence rate were similar in two groups.

Conclusion

Owing to the non-inferiority of surgery and oncology outcomes and the superiority of function outcomes in PPG, we revealed that PPG can be clinically applicable instead of DG in EGC. However, more high-quality comparative studies and randomized clinical trials would be required for further confirmation.
Survival benefit of surgical resection after first-line triplet chemotherapy and bevacizumab in patients with initially unresectable metastatic colorectal cancer
Authors: Elshenawy Mahmoud A. , Badran Ahmed , Aljubran Ali , Alzahrani Ahmed , Rauf M. Shahzad , Eldali Abdelmoneim , Bazarbashi Shouki
Published: July 2020

Background

Surgical resection of metastatic disease in patients with initially non-resectable colorectal cancer (CRC) has improved overall survival. Intensified chemotherapy regimens have increased the probability of converting unresectable metastasis to resectable. Here, we report the result of combining intensive chemotherapy (triplet) and surgical resection of metastatic lesions in patients with metastatic CRC.

Patients and methods

Patients with unresectable metastatic CRC were enrolled in phase I/II trial of triplet chemotherapy consisting of capecitabine, oxaliplatin, irinotecan, and bevacizumab. Patients were given 5–8 cycles induction chemotherapy of the above regimen followed by maintenance capecitabine and bevacizumab until disease progression, unacceptable toxicity, or patient request. All patients were assessed at a multidisciplinary conference for possible surgical resection of their metastatic disease at the time of inclusion in the trial and 2 monthly intervals thereafter.

Patients who underwent R0 resection of their metastatic disease received adjuvant oxaliplatin and capecitabine to complete a total of 6 months of chemotherapy.

Results

Fifty-three patients were enrolled. The median age was 52 years (range 23–74), 29 (55%) were males, ECOG PS 0-1 was 13 (66%), 11 (42%) had a right-sided tumor, 29 (55%) had resection of their primary tumor, 22 (42%) had a single metastatic site, and 8 (15.1%) had a liver-limited disease.

Thirteen patients (24.5%) underwent surgical resection of residual metastatic disease +/− the primary tumor with 10 (18.9%) of them were R0.

The surgical group had a higher incidence of males compared to the non-surgical group (69.3% vs 47.2%, p = 0.2), equal performance status, lower median number of metastatic sites (1 vs 2, p = 0.09), higher mutant Kras (53.8% vs 34.2%, p = 0.3), and higher response rate (84.6% vs 56.2%, p = 0.3).

With a median follow-up duration of 89 months, the median PFS for the whole group was 16.1 months [95% confidence interval (CI) 9.1–20] and the median OS was 28.2 months (95% CI 22.5–53.3).

The median PFS for the surgery group was 18.9 months (95% CI 12.6–not reached) compared to 9.6 months (95% CI 7.0–18.3) for the non-surgical group, log-rank p = 0.0165. The median OS for both groups was not reached (95% CI 53.3–not reached) and 23.2 months (95% CI 17.0–28.4) respectively, log-rank p = 0.0006. Five-year PFS and OS for the surgery group were 46.2% and 67.6% respectively.

Conclusions

Patients with unresectable metastatic CRC and fit for triplet chemotherapy should have the benefit of combining this intensified regimen and surgical resection of their metastatic disease if possible.

Trial registration

Clinicaltrials.gov, NCT01311050, registered March 6, 2011, retrospectively registered.