bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Changes in Bladder Morphology Over Time in Cervical Cancer Patients
Authors: Jin Fu , Liu Qiang , Luo Huanli , Zhu Rui , Mou Yanhong , Wu Yongzhong , Wang Ying
Published: June 2021

Objectives:

Continuous surveillance of bladder volume (BV) is beneficial during the treatment of various urogenital diseases because the bladder is always changing its position, size and even shape at different filling phases. For this purpose, we quantified the motion of the urinary bladder.

Methods:

Daily ultrasound measurements and weekly cone-beam computed tomography scans were obtained from 89 patients in the supine position. BV, bladder centroid positions, and triaxial lengths in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were compared across different time points.

Results:

BV linearly increased over time, and the mean urinary filling rate ( vtot) was correlated with the patients’ age and water consumption. The greatest bladder centroid motion occurred longitudinally, with less movement observed laterally. The maximum bladder centroid movement was 18.8 ± 2.2 mm inferiorly and 1.8 ± 0.9 mm posteriorly for every 10% decrease in BV. The rates of changes in triaxial lengths differed across the 4 filling phases. The rate was the largest at a BV range of 10-80 mL, especially in the LR direction, with values of 5.9 ± 1.0, 3.6 ± 1.0, and 3.9 ± 1.0 mm per every 10-mL BV increase for LR, AP, and SI, respectively. With bladder filling (<80 mL), the maximum increase in triaxial length was observed in the SI direction and the rates of all changes considerably decreased, especially at BV > 600 mL.

Conclusion:

The vtot could be used to evaluate the temporal changes in the bladder. The spatial changes should be assessed according to different filling phases based on the centroid position and triaxial lengths.
Demonstration of an Analytic Process using Home Health Care Electronic Health Records: A Case Example Exploring the Prevalence of Patients with a Substance Use History and a Venous Access Device
Authors: Byon Ha Do , Ahn Soojung , LeBaron Virginia , Yan Guofen , Grider Ronald , Crandall Mary
Published: June 2021

Electronic health records (EHR) are an important, but underutilized source for home health care research and practice improvement. Although the use of EHR is more efficient than prospective data collection, an analysis of EHR data can be complex and time-consuming. To demonstrate the overall process, we describe a secondary analysis of EHR data that explored the prevalence of home health care patients with a substance use history (SUH) and a venous access device (VAD). We detail our process of EHR data extraction, management, and analysis to assist researchers and clinicians interested in similar work. The example analysis showed that that 10.6% of adult home health care patients had a SUH, 8.8% had a long-term VAD, and 1.3% had both. EHRs can be a valuable data source for home health care research and quality improvement projects, but a systematic and thoughtful strategy is needed to fully leverage their potential.
The significance of primary monocanalicular silicone tube intubation in late surgical treatment in children
Authors: Sahan Berna , Ciftci Ferda
Published: June 2021

Purpose:

To evaluate the effect of monocanalicular silicone tube intubation outcomes as an initial surgical treatment in children older than 1 year old with primary nasolacrimal obstruction.

Methods:

Probing or monocanalicular silicone tube intubation was performed as primary surgical treatment on 12–48 months old children with primary nasolacrimal obstruction. Probing was performed on 53 eyes of 43 patients and silicone tube intubation on 45 eyes of 39 patients. Treatment was considered successful after improvement in patient complaints, the presence of normal tear meniscus, and normal results of fluorescein disappearance time test. Retrospective treatment success was compared between two groups according to age groups.

Results:

Treatment success was 79.1% in the probing group and 92.3% in the silicone tube intubation group. The success of the treatment was evaluated separately in the groups of 12 to <24 months, 24 to <36 months, and 36 to <48 months, and although the success level of the silicone tube intubation group was consistently found to be higher, the difference was not statistically significant. Treatment success decreased statistically significantly in the probing group with increased age of the patients, especially after 24 months. There was no such statistically significant decrease in the silicone tube intubation group.

Conclusion:

The choice of monocanalicular silicone tube intubation for primary surgical treatment in children with primary nasolacrimal obstruction provides success without the need for repetitive surgical interventions, especially in children older than 24 months.
Entrapment of fractured balloon after angioplasty in an AV access using a covered stent
Authors: Krishnamurthy Sudarshan , Sama Nidhi Reddy , Soundararajan Ramesh
Published: June 2021

Fracture of the angioplasty balloon is a known complication during endovascular procedures in arteriovenous (AV) fistulas and grafts. We describe a case of a patient with end-stage renal disease (ESRD) on dialysis with a brachiocephalic AV fistula that had become dysfunctional. After a percutaneous angioplasty procedure during balloon withdrawal, a portion of the balloon fractured and separated due to the balloon being caught in the struts of a previously placed bare metal stent. A covered stent was used to contain the segment of the fractured balloon to the wall of the fistula. The use of a covered stent in jailing the fractured balloon to prevent further complications is not well described. This strategy may be implemented in some circumstances such as this case to avoid surgical interventions.
Social inequality in type 2 diabetes mellitus in the Faroe Islands: a cross-sectional study
Authors: Honnudóttir Vár , Hansen Louise , Veyhe Anna Sofía , Andersen Ingelise , Weihe Pál , Strøm Marin , Mohr Magni
Published: June 2021

Aims: The Faroe Islands is considered a homogeneous society and has a low Gini coefficient, but the knowledge about the social distribution of health and disease is sparse. In a large population-based sample we investigated: (a) the association between socioeconomic position defined by level of education and the prevalence of type 2 diabetes mellitus by self-report in the Faroe Islands; and (b) to what degree lifestyle factors mediate the association. Methods: We used cross-sectional data from the population-based Public Health Survey Faroes 2015 ( n=1095). We present odds ratios for type 2 diabetes mellitus by socioeconomic position from logistic regression models. In our main model we adjusted for potential confounders and in a secondary model we additionally adjusted for potential mediating lifestyle factors. Results: Individuals with middle and low levels of education display higher odds ratios of type 2 diabetes mellitus of 2.80 (95% confidence interval 1.32–5.92) and 4.65 (95% confidence interval 1.93–11.17) in adjusted analysis, respectively, compared to their counterparts with high education. After adjustment for potentially mediating lifestyle factors the estimates were attenuated slightly, but a significant statistical association remained, with lifestyle-related mediating factors in total explaining 21% for middle education and 34% for low education participants. Conclusions: Our results demonstrate that there may be a social gradient in the distribution of type 2 diabetes mellitus in the Faroe Islands, and that the association is partly mediated by lifestyle factors.
Energy models for cost-optimal analysis: Development and calibration of residential reference building models for Northern Cyprus
Authors: Dakyen Manta Marcelinus , Dagbasi Mustafa , Özdenefe Murat
Published: June 2021

Ambitious energy efficiency goals constitute an important roadmap towards attaining a low-carbon society. Thus, various building-related stakeholders have introduced regulations targeting the energy efficiency of buildings. However, some countries still lack such policies. This paper is an effort to help bridge this gap for Northern Cyprus, a country devoid of building energy regulations that still experiences electrical energy production and distribution challenges, principally by establishing reference residential buildings which can be the cornerstone for prospective building regulations. Statistical analysis of available building stock data was performed to determine existing residential reference buildings. Five residential reference buildings with distinct configurations that constituted over 75% floor area share of the sampled data emerged, with floor areas varying from 191 to 1006 m2. EnergyPlus models were developed and calibrated for five residential reference buildings against yearly measured electricity consumption. Values of Mean Bias Error (MBE) and Cumulative Variation of Root Mean Squared Error CV(RMSE) between the models’ energy consumption and real energy consumption on monthly based analysis varied within the following ranges: (MBE)monthly from –0.12% to 2.01% and CV(RMSE)monthly from 1.35% to 2.96%. Thermal energy required to maintain the models' setpoint temperatures for cooling and heating varied from 6,134 to 11,451 kWh/year.
Examining Burmese students’ multilingual practices and identity positionings at a border high school in China
Authors: Li Jia , Ai Bin , Xu Cora Lingling
Published: June 2021

This study explores a cohort of Burmese students’ lived experiences at a border high school in China and demonstrates that their multilingual practices and identity positionings constitute exclusionary effects that limit their interactions with their local Chinese teachers and peers. The paper argues that these Burmese students’ in-group interactions reproduce the process of exclusion, further complicating their identity positionings. This paper confirms the established fact that transnational students are marginalized in a variety of national contexts in complex ways, and draws attention to in-group differences among transnational students with diverse backgrounds. These findings have implications for multilingual practices and education policy makers, and for a more inclusive pedagogical approach to reducing marginalization and educating students of diverse linguistic, cultural, and racial backgrounds for global citizenship.
Alleviating confounding in spatio-temporal areal models with an application on crimes against women in India
Authors: Adin Aritz , Goicoa Tomás , Hodges James S , Schnell Patrick M , Ugarte María D
Published: June 2021

Assessing associations between a response of interest and a set of covariates in spatial areal models is the leitmotiv of ecological regression. However, the presence of spatially correlated random effects can mask or even bias estimates of such associations due to confounding effects if they are not carefully handled. Though potentially harmful, confounding issues have often been ignored in practice leading to wrong conclusions about the underlying associations between the response and the covariates. In spatio-temporal areal models, the temporal dimension may emerge as a new source of confounding, and the problem may be even worse. In this work, we propose two approaches to deal with confounding of fixed effects by spatial and temporal random effects, while obtaining good model predictions. In particular, restricted regression and an apparently—though in fact not—equivalent procedure using constraints are proposed within both fully Bayes and empirical Bayes approaches. The methods are compared in terms of fixed-effect estimates and model selection criteria. The techniques are used to assess the association between dowry deaths and certain socio-demographic covariates in the districts of Uttar Pradesh, India.
Researching With Poetic and Artistic Dispositifs
Authors: Marxen Eva , González Luis F. , Cortés Reslie , Valencia Mazzanti Cristina , Matsuo Renata
Published: June 2021

This article presents the experience of the workshop Investigar con dispositivos artísticos y poéticos (Researching with poetic and artistic dispositifs), carried out in the special interest group A Day in Spanish and Portuguese (ADISP), in the frame of the Fifteenth International Congress of Qualitative Inquiry (ICQI), in 2019. The goal of this workshop was to show the panorama of the uses and implications of the arts, poetry, and narratives as a methodological strategy in qualitative research. The theoretical framework to development the workshop included the poetic inquiry approach and the artistic dispositif. The experience of the workshop shows the social, political, and critical impact of combining art and poetry. This combination allows researchers to go beyond more traditional research practices such as interviews and ethnographies. We hope to contribute to promote these alternative methodologies in the Latin American researchers’ communities and audiences.
Polydisperse spray flame ignition by a pulsed heat flux
Authors: Kats G , Greenberg JB
Published: June 2021

A mathematical analysis of the ignition of a polydisperse spray/air mixture by an infinite surface heated in a pulsed manner is presented. In contrast to previous work in the literature, the entire history of the ignition process is accounted for starting from the flame-embryo progenitor stage, through the thermal runaway stage to the final flame propagation stage. For tractability at the current stage, the chemical kinetics is taken to be that of a single global reaction. The spray is modeled using the sectional approach and the influence of fuel spray characteristics on ignition is determined. Good agreement was found between the theoretical predictions and full numerical simulations. Delay in ignition due to the build-up of vapor from the fuel droplets as well as heat loss to the droplets for evaporation are found to play a significant role under certain operating conditions. Comparison between the critical energy flux and the initial spray polydispersity revealed small differences for larger values of the pulse duration but more significant minor differences for smaller pulse durations. Despite these seemingly minor differences, it was shown that the initial spray polydispersity can have a critical influence on whether flame ignition will occur or fail, even for sprays having the same initial SMD.
Cultivating Student Belonging and School Connectedness
Authors: Mazyck Donna
Published: June 2021

The effect on students from the COVID-19 pandemic, violence related to racism, and loss of customary school routines may cause loss of both school connection and a sense of belonging. School nurses can positively influence student belonging and school connection as they encounter students throughout in-person school and virtual school environments. School nurses build connections with students whom they know and outreach to students whom they identify as vulnerable in the areas of belonging and school connectedness. With a mind-set of the Framework for 21st Century School Nursing Practice and in collaboration with a school team implementing a multitiered system of support, school nurses intentionally outreach and cultural sensitivity to grow positive school climate that benefits students.
Correction to: Impact of concurrency on the performance of a whole exome sequencing pipeline
Authors: Dall’Olio Daniele , Curti Nico , Fonzi Eugenio , Sala Claudia , Remondini Daniel , Castellani Gastone , Giampieri Enrico
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.
Prevalence and risk factors for antibiotic utilization in Chinese children
Authors: Guo Shasha , Sun Qiang , Zhao Xinyang , Shen Liyan , Zhen Xuemei
Published: June 2021

Background

Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China.

Methods

English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis.

Results

Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver’s self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue.

Conclusion

The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.
Recent trends in cardiovascular disease deaths: a state specific perspective
Authors: Manemann Sheila M. , Gerber Yariv , Bielinski Suzette J. , Chamberlain Alanna M. , Margolis Karen L. , Weston Susan A. , Killian Jill M. , Roger Véronique L.
Published: June 2021

Background

The rate of decline in cardiovascular disease (CVD) mortality has lessened nationally. How these findings apply to specific states or causes of CVD deaths is not known. Examining these trends at the state level is important to plan local interventions.

Methods

We analyzed CVD mortality trends in Minnesota (MN) using the U.S. Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Trends were analyzed by age, sex, type of CVD and location of death.

Results

CVD mortality rates in MN declined in 2000–2009 and then leveled off in 2010–2018, paralleling national rates. Age- and sex-adjusted CVD mortality decreased by 3.7% per year in 2000–2009 (average annual percent changes [AAPC]: -3.7; 95% CI: − 4.8, − 2.6) with no change observed in 2010–2018. Those aged 65–84 years had the most rapid early decline in CVD mortality (AAPC: -5.9, 95% CI: − 6.2, − 5.7) and had less improvement in 2010–2018 (AAPC: -1.8, 95% CI: − 2.2, − 1.5), and the younger age group (25–64 years) now experiences the most adverse trends (AAPC: 1.2, 95% CI: 0.7–1.8). Coronary heart disease (CHD) and cerebrovascular disease had the largest relative decreases in mortality in 2000–2009 (CHD AAPC: -5.2; 95% CI: − 6.5,-3.9; cerebrovascular disease AAPC: -4.4, 95% CI: − 5.2, − 3.6) with no change 2010–2018. Heart failure (HF)/cardiomyopathy followed similar trends with a 2.5% decrease (AAPC 95% CI: − 3.5, − 1.5) per year in 2000–2009 and no change in 2010–2018. Deaths from other CVD also decreased in the early time period (AAPC: -1.6, 95% CI: − 2.7, − 0.5) but increased in 2010–2018 (AAPC: 1.9, 95% CI: 0.5, 3.3). In- and out-of-hospital death rates improved in 2000–2009 with a slowing in improvement for in-hospital death and no further improvement for out-of-hospital death in 2010–2018.

Conclusion

Concerning CVD mortality trends occurred in MN. In the most recent decade (2010–2018) mortality from all CVD subtypes plateaued or even increased. CVD mortality among the younger age groups increased as well. These data are congruent with adverse national trends supporting their generalizability. These adverse trends underscore the urgent need for CVD prevention and treatment, as well as continued surveillance to assess progress at the state and national level.
Determinants of clinical practice guidelines’ utilization for the management of musculoskeletal disorders: a scoping review
Authors: Sorondo Delphine , Delpierre Cyrille , Côté Pierre , Salmi Louis-Rachid , Cedraschi Christine , Taylor-Vaisey Anne , Lemeunier Nadège
Published: June 2021

Context

Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence.

Aim

To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs.

Method

A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles.

RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language.

Conclusion

Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice.
Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data
Authors: Rasella Davide , Alves Flávia Jôse Oliveira , Rebouças Poliana , de Jesus Gabriela Santos , Barreto Maurício L. , Campello Tereza , Paixao Enny S.
Published: June 2021

Background

Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years.

Methods

The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables.

Results

BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07).

Conclusion

Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.
Diastolic dysfunction in a pre-clinical model of diabetes is associated with changes in the cardiac non-myocyte cellular composition
Authors: Cohen Charles D. , De Blasio Miles J. , Lee Man K. S. , Farrugia Gabriella E. , Prakoso Darnel , Krstevski Crisdion , Deo Minh , Donner Daniel G. , Kiriazis Helen , Flynn Michelle C. , Gaynor Taylah L. , Murphy Andrew J. , Drummond Grant R. , Pinto Alexander R. , Ritchie Rebecca H.
Published: June 2021

Background

Diabetes is associated with a significantly elevated risk of cardiovascular disease and its specific pathophysiology remains unclear. Recent studies have changed our understanding of cardiac cellularity, with cellular changes accompanying diabetes yet to be examined in detail. This study aims to characterise the changes in the cardiac cellular landscape in murine diabetes to identify potential cellular protagonists in the diabetic heart.

Methods

Diabetes was induced in male FVB/N mice by low-dose streptozotocin and a high-fat diet for 26-weeks. Cardiac function was measured by echocardiography at endpoint. Flow cytometry was performed on cardiac ventricles as well as blood, spleen, and bone-marrow at endpoint from non-diabetic and diabetic mice. To validate flow cytometry results, immunofluorescence staining was conducted on left-ventricles of age-matched mice.

Results

Mice with diabetes exhibited hyperglycaemia and impaired glucose tolerance at endpoint. Echocardiography revealed reduced E:A and e’:a’ ratios in diabetic mice indicating diastolic dysfunction. Systolic function was not different between the experimental groups. Detailed examination of cardiac cellularity found resident mesenchymal cells (RMCs) were elevated as a result of diabetes, due to a marked increase in cardiac fibroblasts, while smooth muscle cells were reduced in proportion. Moreover, we found increased levels of Ly6Chi monocytes in both the heart and in the blood. Consistent with this, the proportion of bone-marrow haematopoietic stem cells were increased in diabetic mice.

Conclusions

Murine diabetes results in distinct changes in cardiac cellularity. These changes—in particular increased levels of fibroblasts—offer a framework for understanding how cardiac cellularity changes in diabetes. The results also point to new cellular mechanisms in this context, which may further aid in development of pharmacotherapies to allay the progression of cardiomyopathy associated with diabetes.
Ectopic pregnancy: a single-center experience over ten years
Authors: Al Naimi Ammar , Moore Pablo , Brüggmann Dörthe , Krysa Lisa , Louwen Frank , Bahlmann Franz
Published: June 2021

Purpose

The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality.

Methods

This was a retrospective analysis of pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA).

Results

The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10− 5) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04.

Conclusion

EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.
GnRH agonist and hCG (dual trigger) versus hCG trigger for follicular maturation: a systematic review and meta-analysis of randomized trials
Authors: Hu Kai-Lun , Wang Siwen , Ye Xiaohang , Zhang Dan , Hunt Sarah
Published: June 2021

Background

Traditionally, final follicular maturation is triggered by a single bolus of human chorionic gonadotropin (hCG). This acts as a surrogate to the naturally occurring luteinizing hormone (LH) surge to induce luteinization of the granulosa cells, resumption of meiosis and final oocyte maturation. More recently, a bolus of gonadotropin-releasing hormone (GnRH) agonist in combination with hCG (dual trigger) has been suggested as an alternative regimen to achieve final follicular maturation.

Methods

This study was a systematic review and meta-analysis of randomized trials evaluating the effect of dual trigger versus hCG trigger for follicular maturation on pregnancy outcomes in women undergoing in vitro fertilization (IVF). The primary outcome was the live birth rate (LBR) per started cycle.

Results

A total of 1048 participants were included in the analysis, with 519 in the dual trigger group and 529 in the hCG trigger group. Dual trigger treatment was associated with a significantly higher LBR per started cycle compared with the hCG trigger treatment (risk ratio (RR) = 1.37 [1.07, 1.76], I2 = 0%, moderate evidence). There was a trend towards an increase in both ongoing pregnancy rate (RR = 1.34 [0.96, 1.89], I2 = 0%, low evidence) and implantation rate (RR = 1.31 [0.90, 1.91], I2 = 76%, low evidence) with dual trigger treatment compared with hCG trigger treatment. Dual trigger treatment was associated with a significant increase in clinical pregnancy rate (RR = 1.29 [1.10, 1.52], I2 = 13%, low evidence), number of oocytes collected (mean difference (MD) = 1.52 [0.59, 2.46), I2 = 53%, low evidence), number of mature oocytes collected (MD = 1.01 [0.43, 1.58], I2 = 18%, low evidence), number of fertilized oocytes (MD = 0.73 [0.16, 1.30], I2 = 7%, low evidence) and significantly more usable embryos (MD = 0.90 [0.42, 1.38], I2 = 0%, low evidence).

Conclusion

Dual trigger treatment with GnRH agonist and HCG is associated with an increased live birth rate compared with conventional hCG trigger.

Trial registration

CRD42020204452.
Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach
Authors: Brown Elizabeth A. , White Brandi M. , Jones Walter J. , Gebregziabher Mulugeta , Simpson Kit N.
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.
Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review
Authors: Wang Zhongzheng , Chen Wei , Zhu Yanbin , Tian Siyu , Zhao Kuo , Guo Jialiang , Hou Zhiyong , Zhang Qi , Zhang Yingze
Published: June 2021

Background

Tibial shaft fractures (TSFs) combined with occult posterior malleolar fractures (PMFs) are becoming widely recognized in the field of orthopedics. The purpose of this study was to determine the clinical incidence, missed diagnosis rate, and treatment strategies of this combined injury.

Methods

PubMed, Cochrane, and MEDLINE Ovid databases were searched for articles of English language from 1988 to 2020, identifying 1549 papers.

Results

Twenty-one of the 1278 identified studies were eligible for inclusion. Each study reported on the incidence of this combined injury, and 12 studies documented the missed diagnosis rate. Seventeen studies reported surgical intervention strategies for PMFs. In the present review, PMFs frequently occurred in spiral TSFs (70%), especially distal third spiral TSFs (70.4%), based on CT scans or additional MRI. Based on the original X-ray detection, approximately 50% of PMFs were missed in patients with a combined injury. In addition, the treatment strategies for PMFs were inconsistent. Most studies (11/17) believe that specific surgical management needs to be developed based on the fragment size, displacement, and stability of the PMF.

Conclusions

For patients with TSFs, spiral TSFs, especially distal third spiral TSFs, are closely related to PMFs and are often not sufficiently diagnosed by X-ray alone. Advanced CT and MRI examinations can significantly reduce the missed diagnosis rate of occult PMFs. According to available literature, the treatment strategy for PMFs associated with TSFs is questionable without convincing evidence of benefit.
Hypoxic tumor-derived exosomal miR-31-5p promotes lung adenocarcinoma metastasis by negatively regulating SATB2-reversed EMT and activating MEK/ERK signaling
Authors: Yu Fengqiang , Liang Mingqiang , Huang Yu , Wu Weidong , Zheng Bin , Chen Chun
Published: June 2021

Background

Exosomes have emerged as critical mediators of intercellular communication. Hypoxia is widely recognized as a key regulator of tumor aggressiveness, and significantly affects exosome release by tumor cells. However, the effects of exosomes derived from hypoxic lung adenocarcinoma (LUAD) cells are poorly understood.

Methods

Samples of miRNA isolated from hypoxic LUAD cell-derived exosomes (HExo) and normoxic LUAD cell-derived exosomes (NExo) were sequenced to identify miRNAs that might mediate tumor progression. Exosomal miRNA was co-cultured with LUAD cells to assess its biological effects on cell migration and metastasis both in vitro and in vivo. The cellular target of exosomal miRNA was confirmed by dual-luciferase assays. Western blot studies showed that exosomal miRNA regulated the related pathway. The availability of circulating exosomal miRNA derived from plasma was also evaluated.

Results

We found that HExo could significantly enhance the migration and invasion of normoxic LUAD cells. MiRNA sequencing results suggested that miR-31-5p was largely internalized within HExo and could be taken up by normoxic LUAD cells. Exosomal miR-31-5p was found to directly target Special AT-Rich Sequence-Binding Protein 2 (SATB2)-revered epithelial mesenchymal transition and significantly increase activation of MEK/ERK signaling, thereby contributing to tumor progression both in vitro and in vivo. Furthermore, higher levels of circulating exosomal miR-31-5p were detected in LUAD patients, especially in patients with metastatic disease.

Conclusions

Our findings demonstrate that exosomal miR-31-5p exerts a crucial role in LUAD progression, and could serve as a diagnostic biomarker for LUAD.
Clinical trial reporting performance of thirty UK universities on ClinicalTrials.gov—evaluation of a new tracking tool for the US clinical trial registry
Authors: Keestra Sarai Mirjam , Rodgers Florence , Lenz Daphne , Osborne Rhiannon , Bruckner Till , Lee Sean
Published: June 2021

Clinical trial transparency forms the foundation of evidence-based medicine, and trial sponsors, especially publicly funded institutions such as universities, have an ethical and scientific responsibility to make the results of clinical trials publicly available in a timely fashion. We assessed whether the thirty UK universities receiving the most Medical Research Council funding in 2017–2018 complied with World Health Organization best practices for clinical trial reporting on the US Clinical Trial Registry (ClinicalTrials.gov). Firstly, we developed and evaluated a novel automated tracking tool (clinical-trials-tracker.com) for clinical trials registered on ClinicalTrials.gov. This tracker identifies the number of due trials (whose completion lies more than 395 days in the past) that have not reported results on the registry and can now be used for all sponsors. Secondly, we used the tracker to determine the number of due clinical trials sponsored by the selected UK universities in October 2020. Thirdly, using the FDAAA Trials Tracker, we identified trials sponsored by these universities that are not complying with reporting requirements under the Food and Drug Administration Amendments Act 2007. Finally, we quantified the average and median number of days between primary completion date and results posting. In October 2020, the universities included in our study were sponsoring 1634 due trials, only 1.6% (n = 26) of which had reported results within a year of completion. 89.8% (n = 1468) of trials remained unreported, and 8.6% (n = 140) of trials reported results late. We also identified 687 trials that contained inconsistent data, suggesting that UK universities often fail to update their data adequately on ClinicalTrials.gov. The mean reporting delay after primary completion for trials that posted results was 981 days, the median 728 days. Only four trials by UK universities violated the FDAAA 2007. We suggest a number of reasons for the poor reporting performance of UK universities on ClinicalTrials.gov: (i) efforts to improve clinical trial reporting in the UK have to date focused on the European clinical trial registry (EU CTR), (ii) the absence of a tracking tool for timely reporting on ClinicalTrials.gov has limited the visibility of institutions’ reporting performance on the US registry and (iii) there is currently a lack of repercussions for UK sponsors who fail to report results on ClinicalTrials.gov which should be addressed in the future.
Genome-wide association analysis of metabolic syndrome quantitative traits in the GENNID multiethnic family study
Authors: Wan Jia Y. , Goodman Deborah L. , Willems Emileigh L. , Freedland Alexis R. , Norden-Krichmar Trina M. , Santorico Stephanie A. , Edwards Karen L. ,   American Diabetes GENNID Study Group, Boerwinkle Eric , Buse John , DeFronzo Ralph , Ehrmann David , Elbein Steven C. , Fujimoto Wilfred , Kahn Steven E. , Hanis Craig L. , Mulivor Richard A. , Beck Jeanne C. , Norris Jill , Alan Permutt M. , Behn Philip , Raffel Leslie , Robbins David C.
Published: June 2021

Background

To identify genetic associations of quantitative metabolic syndrome (MetS) traits and characterize heterogeneity across ethnic groups.

Methods

Data was collected from GENetics of Noninsulin dependent Diabetes Mellitus (GENNID), a multiethnic resource of Type 2 diabetic families and included 1520 subjects in 259 African-American, European-American, Japanese-Americans, and Mexican-American families. We focused on eight MetS traits: weight, waist circumference, systolic and diastolic blood pressure, high-density lipoprotein, triglycerides, fasting glucose, and insulin. Using genotyped and imputed data from Illumina’s Multiethnic array, we conducted genome-wide association analyses with linear mixed models for all ethnicities, except for the smaller Japanese-American group, where we used additive genetic models with gene-dropping.

Results

Findings included ethnic-specific genetic associations and heterogeneity across ethnicities. Most significant associations were outside our candidate linkage regions and were coincident within a gene or intergenic region, with two exceptions in European-American families: (a) within previously identified linkage region on chromosome 2, two significant GLI2-TFCP2L1 associations with weight, and (b) one chromosome 11 variant near CADM1-LINC00900 with pleiotropic blood pressure effects.

Conclusions

This multiethnic family study found genetic heterogeneity and coincident associations (with one case of pleiotropy), highlighting the importance of including diverse populations in genetic research and illustrating the complex genetic architecture underlying MetS.
WhatsApp Tele-Medicine – usage patterns and physicians views on the platform
Authors: Barayev Edward , Shental Omri , Yaari Dotan , Zloczower Elchanan , Shemesh Itai , Shapiro Michael , Glassberg Elon , Magnezi Racheli
Published: June 2021

Background

Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp — a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations.

Methods

A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019.

Results

Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week.

Conclusions

In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients’ medical records, while providing adequate compensation for those providing the service during and after work hours.
Developing a topic-based repository of clinical trial individual patient data: experiences and lessons learned from a pilot project
Authors: Medley Nancy , Cuthbert Anna , Crew Richard , Stewart Lesley , Smith Catrin Tudur , Alfirevic Zarko
Published: June 2021

Background

Building a dataset of individual participant data (IPD) for meta-analysis represents considerable research investment as well as collaboration across multiple institutions and researchers. Making arrangements to curate and share the dataset beyond the IPD meta-analysis project for which it was established, for reuse in future research projects, would maximise the value of this investment.

Methods

Our aim was to establish the Cochrane repository for individual patient data from clinical trials in pregnancy and childbirth (CRIB) as an example of how an IPD repository could become part of Cochrane infrastructure. We believed that establishing CRIB under Cochrane auspices would engender trust and encourage trial investigators to share data, and at the same time position Cochrane to take steps towards expanding the number of reviews with IPD synthesis.

Results

CRIB was designed as a web-based platform to receive, host and facilitate onward sharing of de-identified data. Development was not straightforward and we did not fully achieve our aim as intended. We describe the challenges encountered and suggest ways that future repositories might overcome these. In particular, securing the legal agreements required to facilitate data sharing proved to be the main barrier, being time-consuming and more complex than anticipated.

Conclusions

We would recommend that researchers conducting IPD meta-analysis should consider discussing the option to transfer the curated IPD datasets to a repository at the end of the initial meta-analysis and this should be recognised within the data sharing agreements made with the original data contributors.
Hermite–Hadamard-type inequalities for interval-valued preinvex functions via Riemann–Liouville fractional integrals
Authors: Sharma Nidhi , Singh Sanjeev Kumar , Mishra Shashi Kant , Hamdi Abdelouahed
Published: June 2021

In this paper, we introduce $(h_{1},h_{2})$
(

h
1

,

h
2

)
-preinvex interval-valued function and establish the Hermite–Hadamard inequality for preinvex interval-valued functions by using interval-valued Riemann–Liouville fractional integrals. We obtain Hermite–Hadamard-type inequalities for the product of two interval-valued functions. Further, some examples are given to confirm our theoretical results.
Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation
Authors: Dalkner Nina , Wagner-Skacel Jolana , Ratzenhofer Michaela , Fellendorf Frederike , Lenger Melanie , Maget Alexander , Tmava-Berisha Adelina , Pilz René , Queissner Robert , Hamm Carlo , Bengesser Susanne , Platzer Martina , Birner Armin , Reininghaus Eva
Published: June 2021

Background

The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group.

Methods

An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2).

Results

At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients.

Conclusions

There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.