bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-efficacy and Emotional Distress in a Cohort With Patellofemoral Pain
Authors: Hott Alexandra , Pripp Are Hugo , Juel Niels Gunnar , Liavaag Sigurd , Brox Jens Ivar
Published: March 2022

Background:

Patellofemoral pain (PFP) is commonly described and approached in biomechanical terms despite strong evidence that psychosocial factors such as kinesiophobia, emotional distress, and self-efficacy are important in long-standing musculoskeletal pain.

Purpose:

To describe levels of self-efficacy, emotional distress, kinesiophobia, and widespread pain in a cohort with long-standing PFP and determine their association with measures of pain, function, and health-related quality of life.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Included were 112 patients with PFP (age range, 16-40 years) who had been recruited to a randomized controlled trial. Seven baseline factors (patient sex, pain duration, number of pain sites throughout the body, kinesiophobia [Tampa Scale of Kinesiophobia], emotional distress [Hopkins Symptom Checklist], self-efficacy, and knee extension strength) were investigated for associations with the following outcomes: symptoms of PFP (Anterior Knee Pain Scale), pain (worst and usual), and health-related quality of life (5-level EuroQol-5 Dimensions [EQ-5D-5L]). We used bivariate models and multivariable linear regression models with a stepwise backward removal method to find associations with the outcomes. Internal validation was conducted, and adjusted coefficients after shrinkage are presented.

Results:

Of the study patients, 28% reported emotional distress (Hopkins Symptom Checklist ≥1.75), 69% reported multiple pain sites, and 33% had widespread pain. The kinesiophobia score was elevated, with a mean score of 35.4 ± 8.2. Self-efficacy was strongly associated with better function (Anterior Knee Pain Scale) and health-related quality of life (EQ-5D-5L) as well as lower pain scores in bivariate and multivariable models. Self-efficacy and emotional distress explained 50% of the variance in health-related quality of life (EQ-5D-5L).

Conclusion:

Our findings support other studies of PFP suggesting elevated levels of kinesiophobia and emotional distress and higher rates of widespread pain compared with the general population or pain-free controls. Higher self-efficacy was associated with better function and health-related quality of life. Together with emotional distress, it explained half the variance of health-related life quality. The results underline the importance of approaching these patients in a biopsychosocial model.

Registration:

NCT02114294 ( ClinicalTrials.gov identifier).
Exploring the Impact of Internal Communication on Employee Psychological Well-Being During the COVID-19 Pandemic: The Mediating Role of Employee Organizational Trust
Authors: Qin Yufan Sunny , Men Linjuan Rita
Published: March 2022

This study examines whether and how internal communication at different levels (i.e., corporate symmetrical communication and supportive peer communication) interact to influence employee psychological well-being during the COVID-19 pandemic. This study also reveals the mediating effects of employee organizational trust in this process, which helps explain how internal communication influences employee psychological well-being. An online survey was conducted with 393 employees across various industries in the United States. The key findings showed that supportive peer communication was positively associated with employee mental wellness. In addition, increased organizational trust positively mediated the effects of both corporate symmetrical communication and supportive peer communication on employee psychological well-being. This study advances understanding of employee psychological well-being by examining the impact of internal communication. The results of this study also provide practical implications regarding how to promote employee psychological wellness by creating an effective internal communication environment at both corporate and peer levels to cultivate employee organizational trust.
The Need for Modification: The Impact of COVID-19 on Pitch Competitions
Authors: Smith Douglass , Muldoon Jeffrey , Lakshmikanth Geethalakshmi S.
Published: March 2022

COVID-19 has had a dramatic impact on academics. Academic programs that require experiential learning, such as entrepreneurship, were presented with severe problems. At the time, the pandemic hit, Liguori and Winkler (2020) speculated on how entrepreneurship professors would respond to the challenge. Our article is an examination of how COVID-19 has impacted pitch competitions, a vital part of the entrepreneurship curriculum. We found that COVID-19 shut down pitch competitions for a year, and they returned last year using virtual web conferencing technologies such as Zoom. Our findings indicate that COVID-19 caused permanent changes to pitch competitions even though directors and other stakeholders may desire traditional face-to-face interactions.
Predictors of Recurrence in Symptomatic Large Artery Atherosclerosis and Cryptogenic Strokes—A Comparative Study
Authors: Lotlikar Radhika Sanjay , Saikiran Karkala , George Jithin , Namboodiri Narayanan , Sylaja P. N. , Sreedharan Sapna Erat
Published: March 2022

Background and Purpose:

Ischemic stroke has highest recurrence risk in the first-year, ranging from 5.7% to 14%, depending on etiology, with highest reported following cardioembolism and large artery atherosclerosis (LAA), while it is not negligible in cryptogenic strokes. We evaluated the utility of clinical, imaging parameters along with electrographic and echocardiographic biomarkers of atrial dysfunction in 2 etiological groups, namely LAA and cryptogenic strokes and compared the predictors of recurrence risk at 1 year.

Methodology:

All acute ischemic strokes admitted to Comprehensive Stroke Care Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India for 1 year (July 2019 till June 2020) with 1 year completed follow-up were screened from electronic records. Strokes secondary to LAA and undetermined cause were compared for their clinical, imaging, and cardiac variables to predict risk of recurrence in the first year.

Results:

Of the 179 patients, 93 had strokes secondary to LAA and 86 had cryptogenic strokes (CS). Seventy-five patients had more than 1 event at presentation/follow-up. Recurrence risk did not differ between the 2 etiological subgroups at 1 year. Hypertension ( P = .016), multiple territory strokes ( P = .02), and dilated left ventricle (LA) chamber ( P = .047) were independently associated with recurrence risk in the entire cohort as well as within the undetermined group. Early hospitalization within 48 h reduced the overall recurrence risk ( P = .01), thus emphasizing the role of early etiological evaluation and initiation of secondary prevention in reducing future events, irrespective of etiology.

Conclusion:

In optimally managed LAA and cryptogenic strokes, presence of hypertension, multiterritorial infarcts, and dilated LA chambers increases the recurrence risk pointing to a likely cardiac substrate itself contributing to future stroke risk.
Penile Dysmorphophobia With Recurrent Koro: A Case Report
Authors: Chowdhury Arabinda N. , Bandyopadhyay Gautam Kumar , Brahma Arabinda
Published: March 2022

A case of penile dysmorphophobia with recurrent Koro is presented. Different clinical and diagnostic issues relating to the interrelationship of obsessive-compulsive disorder-spectrum, body-dysmorphic disorders, and Koro are discussed.
What is the Surgeon’s Duty to Disclose COVID-19 Diagnosis?
Authors: Jazayeri Hossein E. , Lopez Joseph , Goldman Edward B. , Shenaq Deana , Schechter Loren , Dorafshar Amir H. , Vercler Christian J.
Published: March 2022

The current global pandemic raises myriad ethical issues for plastic surgeons. One not often discussed is that of an individual’s right to privacy when regarding health-related issues, the individual’s obligation to public health concerns, and the surgeon’s responsibility to their patients. Through a series of vignettes and discussion the nuances of those ethical responsibilities are explored.
One planet: one health. A call to support the initiative on a global science–policy body on chemicals and waste
Authors: Brack Werner , Barcelo Culleres Damia , Boxall Alistair B. A. , Budzinski Hélène , Castiglioni Sara , Covaci Adrian , Dulio Valeria , Escher Beate I. , Fantke Peter , Kandie Faith , Fatta-Kassinos Despo , Hernández Félix J. , Hilscherová Klara , Hollender Juliane , Hollert Henner , Jahnke Annika , Kasprzyk-Hordern Barbara , Khan Stuart J. , Kortenkamp Andreas , Kümmerer Klaus , Lalonde Brice , Lamoree Marja H. , Levi Yves , Lara Martín Pablo Antonio , Montagner Cassiana C. , Mougin Christian , Msagati Titus , Oehlmann Jörg , Posthuma Leo , Reid Malcolm , Reinhard Martin , Richardson Susan D. , Rostkowski Pawel , Schymanski Emma , Schneider Flurina , Slobodnik Jaroslav , Shibata Yasuyuki , Snyder Shane Allen , Fabriz Sodré Fernando , Teodorovic Ivana , Thomas Kevin V. , Umbuzeiro Gisela A. , Viet Pham Hung , Yew-Hoong Karina Gin , Zhang Xiaowei , Zuccato Ettore
Published: March 2022

The chemical pollution crisis severely threatens human and environmental health globally. To tackle this challenge the establishment of an overarching international science–policy body has recently been suggested. We strongly support this initiative based on the awareness that humanity has already likely left the safe operating space within planetary boundaries for novel entities including chemical pollution. Immediate action is essential and needs to be informed by sound scientific knowledge and data compiled and critically evaluated by an overarching science–policy interface body. Major challenges for such a body are (i) to foster global knowledge production on exposure, impacts and governance going beyond data-rich regions (e.g., Europe and North America), (ii) to cover the entirety of hazardous chemicals, mixtures and wastes, (iii) to follow a one-health perspective considering the risks posed by chemicals and waste on ecosystem and human health, and (iv) to strive for solution-oriented assessments based on systems thinking. Based on multiple evidence on urgent action on a global scale, we call scientists and practitioners to mobilize their scientific networks and to intensify science–policy interaction with national governments to support the negotiations on the establishment of an intergovernmental body based on scientific knowledge explaining the anticipated benefit for human and environmental health.
Ultra-low dose external beam radiotherapy for presumed choroidal lymphoma: a case report
Authors: Flanagan Jeremy P. M. , Ng Michael , Kibrom Awet Z. , Filshie Robin J. A. , Stawell Richard J. , O’Day Roderick F.
Published: March 2022

Primary choroidal lymphoma is a rare, slowly progressive intraocular malignancy. Most are low grade B cell lymphomas, often involving tissues adjacent to the choroid such as the subconjunctival space, lacrimal gland or orbit. Ideally, these lesions are biopsied to establish histopathological diagnosis. The most accessible ocular structure is biopsied. Obtaining tissue by transvitreal choroidal biopsy imparts a small but significant risk of ocular morbidity, including the need for multiple surgeries, retinal detachment and vision loss.

External beam radiotherapy (EBRT) is a common and effective treatment of low-grade lymphomas. EBRT has been found to very successfully treat primary marginal zone lymphomas of the ocular adnexa, which are typically of the same cell type as most primary choroid lymphomas. Ultra-low dose EBRT, most commonly using a total dose of 4 Gy, has been shown to be as effective as higher doses of radiotherapy for follicular or marginal zone lymphomas. The use of this low dose regimen for conjunctival lymphomas has been recently explored. The role of EBRT, and especially ultra-low dose EBRT, for treatment of primary choroidal lymphoma has been confined to case reports.

We describe a case of presumed primary choroidal lymphoma diagnosed on clinical findings alone as the risks of ocular biopsy were deemed too high, and report outcome following treatment with ultra-low dose EBRT.
DrGA: cancer driver gene analysis in a simpler manner
Authors: Nguyen Quang-Huy , Nguyen Tin , Le Duc-Hau
Published: March 2022

Background

To date, cancer still is one of the leading causes of death worldwide, in which the cumulative of genes carrying mutations was said to be held accountable for the establishment and development of this disease mainly. From that, identification and analysis of driver genes were vital. Our previous study indicated disagreement on a unifying pipeline for these tasks and then introduced a complete one. However, this pipeline gradually manifested its weaknesses as being unfamiliar to non-technical users, time-consuming, and inconvenient.

Results

This study presented an R package named DrGA, developed based on our previous pipeline, to tackle the mentioned problems above. It wholly automated four widely used downstream analyses for predicted driver genes and offered additional improvements. We described the usage of the DrGA on driver genes of human breast cancer. Besides, we also gave the users another potential application of DrGA in analyzing genomic biomarkers of a complex disease in another organism.

Conclusions

DrGA facilitated the users with limited IT backgrounds and rapidly created consistent and reproducible results. DrGA and its applications, along with example data, were freely provided athttps://github.com/huynguyen250896/DrGA.
Genome-wide recombination map construction from single sperm sequencing in cattle
Authors: Yang Liu , Gao Yahui , Li Mingxun , Park Ki-Eun , Liu Shuli , Kang Xiaolong , Liu Mei , Oswalt Adam , Fang Lingzhao , Telugu Bhanu P. , Sattler Charles G. , Li Cong-jun , Cole John B. , Seroussi Eyal , Xu Lingyang , Yang Lv , Zhou Yang , Li Li , Zhang Hongping , Rosen Benjamin D. , Van Tassell Curtis P. , Ma Li , Liu George E.
Published: March 2022

Background

Meiotic recombination is one of the important phenomena contributing to gamete genome diversity. However, except for human and a few model organisms, it is not well studied in livestock, including cattle.

Results

To investigate their distributions in the cattle sperm genome, we sequenced 143 single sperms from two Holstein bulls. We mapped meiotic recombination events at high resolution based on phased heterozygous single nucleotide polymorphism (SNP). In the absence of evolutionary selection pressure in fertilization and survival, recombination events in sperm are enriched near distal chromosomal ends, revealing that such a pattern is intrinsic to the molecular mechanism of meiosis. Furthermore, we further validated these findings in single sperms with results derived from sequencing its family trio of diploid genomes and our previous studies of recombination in cattle.

Conclusions

To our knowledge, this is the first large-scale single sperm whole-genome sequencing effort in livestock, which provided useful information for future studies of recombination, genome instability, and male infertility.
Plastome phylogenomics and historical biogeography of aquatic plant genus Hydrocharis (Hydrocharitaceae)
Authors: Li Zhi-Zhong , Lehtonen Samuli , Gichira Andrew W. , Martins Karina , Efremov Andrey , Wang Qing-Feng , Chen Jin-Ming
Published: March 2022

Background

HydrocharisL. andLimnobiumRich. are small aquatic genera, including three and two species, respectively. The taxonomic status, phylogenetic relationships and biogeographical history of these genera have remained unclear, owing to the lack of Central African endemicH. chevalierifrom all previous studies. We sequenced and assembled plastomes of all threeHydrocharisspecies andLimnobium laevigatumto explore the phylogenetic and biogeographical history of these aquatic plants.

Results

All four newly generated plastomes were conserved in genome structure, gene content, and gene order. However, they differed in size, the number of repeat sequences, and inverted repeat borders. Our phylogenomic analyses recovered non-monophyleticHydrocharis. The African speciesH. chevalieriwas fully supported as sister to the rest of the species, andL. laevigatumwas nested inHydrocharisas a sister toH.dubia.Hydrocharis-Limnobiuminitially diverged from the remaining genera at ca. 53.3 Ma, then began to diversify at ca. 30.9 Ma. The biogeographic analysis suggested thatHydrocharisprobably originated in Europe and Central Africa.

Conclusion

Based on the phylogenetic results, morphological similarity and small size of the genera, the most reasonable taxonomic solution to the non-monophyly ofHydrocharisis to treatLimnobiumas its synonym. The African endemicH. chevalieriis fully supported as a sister to the remaining species.Hydrocharismainly diversified in the Miocene, during which rapid climate change may have contributed to the speciation and extinctions. The American species of formerLimnobiumprobably dispersed to America through the Bering Land Bridge during the Miocene.
A nationwide registry study on heart failure in Norway from 2008 to 2018: variations in lookback period affect incidence estimates
Authors: Ødegaard Kristina Malene , Lirhus Sandre Svatun , Melberg Hans Olav , Hallén Jonas , Halvorsen Sigrun
Published: March 2022

Background

The incidence of heart failure (HF) has declined in Europe during the past two decades. However, incidence estimates from registry-based studies may vary, partly because they depend on retrospective searches to exclude previous events. The aim of this study was to assess to what extent different lookback periods (LPs) affect temporal trends in incidence, and to identify the minimal acceptable LP. Further, we wanted to estimate temporal trends in incidence and prevalence of HF in a nationwide population, using the minimal acceptable LP.

Methods

We identified all in- and out-patient contacts for HF in Norway during 2008 to 2018 from the Norwegian Patient Registry. To calculate the influence of varying LP on incident cases, we defined 2018 with 10 years of LP as a reference and calculated the relative difference by using one through 9 years of lookback. Temporal trends in incidence rates were estimated with sensitivity analyses applying varying LPs and different case definitions. Standardised incidence rates and prevalence were calculated by applying direct age- and sex-standardization to the 2013 European Standard Population.

Results

The overestimation of incident cases declined with increasing number of years included in the LP. Compared to a 10-year LP, application of 4, 6, and 8 years resulted in an overestimation of incident cases by 13.5%, 6.2% and 2.3%, respectively. Temporal trends in incidence were affected by the number of years in the LP and whether the LP was fixed or varied. Including all available data mislead to conclusions of declining incidence rates over time due to increasing LPs.

Conclusions

When taking the number of years with available data and HF mortality and morbidity into consideration, we propose that 6 years of fixed lookback is sufficient for identification of incident HF cases. HF incidence rates and prevalence increased from 2014 to 2018.

Trial registration

Retrospectively registered.
The association between skinfold thicknesses and estimated glomerular filtration rate in adolescents: a cross-sectional study
Authors: Yang Yongchang , Wu Yubin
Published: March 2022

Background

Obesity is one of the causes of glomerular hyperfiltration. Studies on the relationship between body fat content and glomerular hyperfiltration have been limited to special children. Therefore, we aimed to evaluate the correlation between skinfold thickness, which represents body fat content, and estimated glomerular filtration rate (eGFR).

Methods

The cross-sectional study included 6655 participants (3532 boys and 3123 girls; age: 12 − 17.99 years); data was obtained from the National Health and Nutrition Examination Survey (NHANES; 2001–2010). The independent variables were subscapular skinfold thickness and triceps skinfold thickness. The dependent variable was eGFR. We used multivariate linear regression models to evaluate their associations and also performed subgroup analyses.

Results

After adjusting for age, standing height, race, family income, blood urea nitrogen and uric acid variables, multivariate regression analysis identified that triceps skinfold thickness and subscapular skinfold thickness were positively correlated with eGFR and glomerular hyperfiltration in boys. In subgroup analyses stratified by age and body mass index, triceps skinfold thickness was also associated with glomerular hyperfiltration in boys. There was a linear relationship between triceps skinfold thickness and eGFR in boys (β = 0.389, P < 0.001) and girls (β = 0.159, P = 0.0003).

Conclusions

Triceps skinfold thickness and subscapular skinfold thickness are positively correlated with eGFR and glomerular hyperfiltration in US male adolescents. In all adolescents, there is a linear relationship between triceps skinfold thickness and eGFR.
Association of triglyceride-glucose index and stroke recurrence among nondiabetic patients with acute ischemic stroke
Authors: Yang Xiaomeng , Wang Guangyao , Jing Jing , Wang Anxin , Zhang Xiaoli , Jia Qian , Meng Xia , Zhao Xingquan , Liu Liping , Li Hao , Wang Yongjun , Wang Yilong
Published: March 2022

Backgroud and purpose

Triglyceride-glucose (TyG) index has been considered a surrogate marker of insulin resistance. We investigated the association between TyG index and stroke recurrence and compared the effectiveness of TyG index with homeostasis model assessment of insulin resistance (HOMA-IR) in predicting stroke recurrence and death in nondiabetic acute ischemic stroke patients.

Methods

Nondiabetic acute ischemic stroke patients from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry were included. TyG index was performed and classified into four groups by quartiles. The outcomes were stroke recurrence and death within 1 year. The association between TyG index and the risk of stroke recurrence and death were analyzed by Cox regression models. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the prediction of TyG index and HOMA-IR for stroke recurrence and death. Delong test was used for comparing the differences between area under the curve (AUC) of TyG index and HOMA-IR.

Results

Among the 1226 patients included, the median (interquartile range) of TyG index was 5.8 (5.5–6.2). Both the third and fourth quartiles of TyG index were associated with an increased risk of stroke recurrence (adjusted hazard ratio 2.04, 95% confidence interval 1.26–3.31; adjusted hazard ratio 1.86, 95% confidence interval 1.13–3.06). Patients with fourth quartiles of TyG index were associated with a higher mortality risk (adjusted hazard ratio, 2.91; 95% confidence interval, 1.62–2.53). Regarding stroke recurrence within 1 year, the AUC (95% confidence interval) of the ROC curve for the TyG index was similar to that of the HOMA-IR[0.56 (0.52–0.61) vs 0.57 (0.52–0.61);P = 0.93]. Regarding death within 1 year, the AUCs (95% confidence interval) of the ROC curve for the TyG index and HOMA-IR were 0.55 (0.50–0.61) and 0.59 (0.53–0.64), respectively (P = 0.32).

Conclusions

Elevated TyG index was associated with an increased risk of stroke recurrence and death. However, neither of TyG nor HOMA-IR can be a qualified predictor of stroke recurrence and death in nondiabetic acute ischemic stroke patients.
Different inflammatory blood markers correlate with specific outcomes in incident HPV-negative head and neck squamous cell carcinoma: a retrospective cohort study
Authors: Boscolo-Rizzo Paolo , D’Alessandro Andrea , Polesel Jerry , Borsetto Daniele , Tofanelli Margherita , Deganello Alberto , Tomasoni Michele , Nicolai Piero , Bossi Paolo , Spinato Giacomo , Menegaldo Anna , Ciorba Andrea , Pelucchi Stefano , Bianchini Chiara , Cazzador Diego , Ramaciotti Giulia , Lupato Valentina , Giacomarra Vittorio , Molteni Gabriele , Marchioni Daniele , Fabbris Cristoforo , Occhini Antonio , Bertino Giulia , Fussey Jonathan , Tirelli Giancarlo
Published: March 2022

Background

Inflammatory blood markers have been associated with oncological outcomes in several cancers, but evidence for head and neck squamous cell carcinoma (HNSCC) is scanty. Therefore, this study aims at investigating the association between five different inflammatory blood markers and several oncological outcomes.

Methods

This multi-centre retrospective analysis included 925 consecutive patients with primary HPV-negative HNSCC (median age: 68 years) diagnosed between April 2004 and June 2018, whose pre-treatment blood parameters were available. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammatory marker (SIM), and systemic immune-inflammation index (SII) were calculated; their associations with local, regional, and distant failure, disease-free survival (DFS), and overall survival (OS) was calculated.

Results

The median follow-up was 53 months. All five indexes were significantly associated with OS; the highest accuracy in predicting patients’ survival was found for SIM (10-year OS = 53.2% for SIM < 1.40 and 40.9% for SIM ≥ 2.46; c-index = 0.569) and LMR (10-year OS = 60.4% for LMR ≥ 3.76 and 40.5% for LMR < 2.92; c-index = 0.568). While LMR showed the strongest association with local failure (HR = 2.16; 95% CI:1.22–3.84), PLR showed the strongest association with regional (HR = 1.98; 95% CI:1.24–3.15) and distant failure (HR = 1.67; 95% CI:1.08–2.58).

Conclusion

Different inflammatory blood markers may be useful to identify patients at risk of local, regional, or distant recurrences who may benefit from treatment intensification or intensive surveillance programs.
High Intensity Aerobic exercise training and Immune cell Mobilization in patients with lung cancer (HI AIM)—a randomized controlled trial
Authors: Holmen Olofsson Gitte , Mikkelsen Marta Kramer , Ragle Anne-Mette , Christiansen Anne Birgitte , Olsen Anne Pries , Heide-Ottosen Lise , Horsted Cecilia Bech , Pedersen Cia Moon Scharbau , Engell-Noerregaard Lotte , Lorentzen Torben , Persson Gitte Fredberg , Vinther Anders , Nielsen Dorte Lisbet , thor Straten Per
Published: March 2022

Background

The increasing role of exercise training in cancer care is built on evidence that exercise can reduce side effects of treatment, improve physical functioning and quality of life. We and others have shown in mouse tumor models, that exercise leads to an adrenalin-mediated increased influx of T and NK cells into the tumor, altering the tumor microenvironment (TME) and leading to reduced tumor growth. These data suggest that exercise could improve immune responses against cancer cells by increase immune cell infiltration to the tumor and potentially having an impact on disease progression. Additionally, there are data to suggest that infiltration of T and NK cells into the TME is correlates with response to immune checkpoint inhibitors in patients. We have therefore initiated the clinical trial HI AIM, to investigate if high intensity exercise can mobilize and increase infiltration of immune cells in the TME in patients with lung cancer.

Methods

HI AIM (NCT04263467) is a randomized controlled trial (70 patients, 1:1) for patients with non-small cell lung cancer. Patients in the treatment arm, receive an exercise-intervention consisting of supervised and group-based exercise training, comprising primarily intermediate to high intensity interval training three times per week over 6 weeks. All patients will also receive standard oncological treatments; checkpoint inhibitors, checkpoint inhibitors combined with chemotherapy or oncological surveillance. Blood samples and biopsies (ultrasound guided), harvested before, during and after the 6-week training program, will form basis for immunological measurements of an array of immune cells and markers. Primary outcome is circulating NK cells. Secondary outcome is other circulating immune cells, infiltration of immune cells in tumor, inflammatory markers, aerobic capacity measured by VO2 max test, physical activity levels and quality of life measured by questionnaires, and clinical outcomes.

Discussion

To our knowledge, HI AIM is the first project to combine supervised and monitored exercise in patients with lung cancer, with rigorous analyses of immune and cancer cell markers over the course of the trial. Data from the trial can potentially support exercise as a tool to mobilize cells of the immune system, which in turn could potentiate the effect of immunotherapy.

Trial registration

The study was prospectively registered at ClinicalTrials.gov on February 10th 2020, ID: NCT04263467. https://clinicaltrials.gov/ct2/show/NCT04263467
Comparison of tumors with HER2 overexpression versus HER2 amplification in HER2-positive breast cancer patients
Authors: Horimoto Yoshiya , Ishizuka Yumiko , Ueki Yuko , Higuchi Toru , Arakawa Atsushi , Saito Mitsue
Published: March 2022

Background

Human epidermal growth factor receptor 2 (HER2)-positive tumors are defined by protein overexpression (3+) or gene amplification using immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH), respectively. HER2-positive tumors have historically included both IHC(3+) and IHC(2+, equivocal)/FISH(+) tumors and received the same treatment. Differences in biology between these two tumor types, however, are poorly understood. Considering anti-HER2 drugs bind directly to HER2 protein on the cell surface, we hypothesized anti-HER2 therapies would be less effective in IHC(2+)/FISH(+) tumors than in IHC(3+) tumors, leading to differences in patient outcomes.

Methods

A total of 447 patients with HER2-positive invasive carcinoma who underwent curative surgery were retrospectively investigated. HER2 status was assessed in surgical specimens, except in patients who received neo-adjuvant chemotherapy, where biopsy specimens were employed.

Results

Age, tumor size, lymph node status and ER status were independent factors relating to disease-free-survival, but no difference was observed between IHC(3+) and IHC(2+)/FISH(+) tumors. Kaplan-Meier analysis found patient outcomes did not differ, even after stratifying into those that did (n = 314), or did not (n = 129), receive chemotherapy with anti-HER2 drugs. In 134 patients who received NAC, pathological complete response rates in IHC(3+) and IHC(2+)/FISH(+) tumors were 45% and 21%, respectively. Survival after developing metastasis was significantly shorter in the IHC(2+)/FISH(+) group.

Conclusions

The prognosis of patients with IHC(2+)/FISH(+) tumors did not differ from IHC(3+) tumors. However, the significance of HER2 protein overexpression in relation to treatment response remains unclear and warrants further investigations.
Prevalence and determinants of fever, ARI and diarrhea among children aged 6–59 months in Bangladesh
Authors: Rahman Azizur , Hossain Md. Moyazzem
Published: March 2022

Background

Although efforts have been made by the international community to improve childhood health, risk factors linked with the healthiness of preschool-age children in low and middle-income countries (LMICs) are very diverse. Therefore, this paper examines the prevalence and determinants of fever, acute respiratory infection and diarrhea of preschool children in Bangladesh.

Methods

A sample of 8,421 children from the latest country representative BDHS-2017–18 survey was analyzed by utilizing both the bivariate and multivariate techniques.

Results

The results revealed that about 4.7, 33.1, and 35.8% of the children aged under 5 years had suffered from diarrhea, fever and ARI respectively during the 2 weeks preceding the date of the survey. Demographic, socio-economic, and community and health characteristics likely to play an important role in suffering under-five children from diarrhea, fever, and ARI in Bangladesh. The child’s age of 13–24 months, delivery by cesarean section, unsafe drinking water, unhygienic toilet facility, low level of family wealth index and parental education, a higher number of living children in the household, rural residency and regional difference were all found to be most crucial determinants of the occurrences of fever, ARI and diarrhea.

Conclusion

Interventions should focus on improving these significant demographic, socioeconomic, and community and health risk factors. A special attention is necessary to the people who live in rural areas and geospatially disadvantaged regions.
Dose error reduction software in medication safety risk management – optimising the smart infusion pump dosing limits in neonatal intensive care unit prior to implementation
Authors: Kuitunen Sini , Kärkkäinen Krista , Linden-Lahti Carita , Schepel Lotta , Holmström Anna-Riia
Published: March 2022

Background

Smart infusion pumps with dose error reduction software can be used to prevent harmful medication errors. The aim of this study was to develop a method for defining and assessing optimal dosing limits in a neonatal intensive care unit’s smart infusion pump drug library by using simulation-type test cases developed based on medication error reports.

Methods

This mixed-methods study applied both qualitative and quantitative methods. First, wrong infusion rate-related medication errors reported in the neonatal intensive care unit during 2018–2019 were explored by quantitative descriptive analysis and qualitative content analysis to identify the error mechanisms. The researchers developed simulation-type test cases with potential errors, and a literature-based calculation formula was used to set upper soft limits to the drug library. The limits were evaluated by conducting programming of pumps without errors and with potential errors for two imaginary test patients (1 kg and 3.5 kg).

Results

Of all medication errors reported in the neonatal intensive care unit, 3.5% (n = 21/601) involved an error or near-miss related to wrong infusion rate. Based on the identified error mechanisms, 2-, 5-, and 10-fold infusion rates, as well as mix-ups between infusion rates of different drugs, were established as test cases. When conducting the pump programming for the test cases (n = 226), no alerts were triggered with infusion rates responding to the usual dosages (n = 32). 73% (n = 70/96) of the erroneous 2-, 5-, and 10-fold infusion rates caused an alert. Mix-ups between infusion rates triggered an alert only in 24% (n = 24/98) of the test cases.

Conclusions

Simulation-type test cases can be applied to assess the appropriateness of dosing limits within the neonatal intensive care unit’s drug library. In developing the test cases, combining hospital’s medication error data to other prospective data collection methods is recommended to gain a comprehensive understanding on mechanisms of wrong infusion rate errors. After drug library implementation, the alert log data and drug library compliance should be studied to verify suitability of dosing limits.
Immune alveolitis in interstitial lung disease: an attractive cytological profile in immunocompromised patients
Authors: Moui Antoine , Dirou Stéphanie , Sagan Christine , Liberge Renan , Defrance Claire , Arrigoni Pierre-Paul , Morla Olivier , Kandel-Aznar Christine , Cellerin Laurent , Cavailles Arnaud , Eschapasse Emmanuel , Morio Florent , Gourraud Pierre-Antoine , Goronflot Thomas , Tissot Adrien , Blanc François-Xavier
Published: March 2022

Background

Bronchoalveolar lavage (BAL) is a major diagnostic tool in interstitial lung disease (ILD). Its use remains largely quantitative, usually focused on cell differential ratio. However, cellular morphological features provide additional valuable information. The significance of the “immune alveolitis” cytological profile, characterized by lymphocytic alveolitis with activated lymphocytes and macrophages in epithelioid transformation or foamy macrophages desquamating in cohesive clusters with lymphocytes, remains unknown in ILD. Our objective was to describe patients’ characteristics and diagnoses associated with an immune alveolitis profile in undiagnosed ILD.

Methods

We performed a monocentric retrospective observational study. Eligible patients were adults undergoing diagnostic exploration for ILD and whose BAL fluid displayed an immune alveolitis profile. For each patient, we collected clinical, radiological and biological findings as well as the final etiology of ILD.

Results

Between January 2012 and December 2018, 249 patients were included. Mean age was 57 ± 16 years, 140 patients (56%) were men, and 65% of patients were immunocompromised. The main etiological diagnosis wasPneumocystispneumonia (PCP) (24%), followed by drug-induced lung disease (DILD) (20%), viral pneumonia (14%) and hypersensitivity pneumonitis (HP) (10%). All PCP were diagnosed in immunocompromised patients while HP was found in only 8% of this subgroup. DILD and viral pneumonia were also commonly diagnosed in immunocompromised patients (94% and 80%, respectively).

Conclusion

Our study highlights the additional value of BAL qualitative description in ILD. We suggest incorporating the immune alveolitis profile for the diagnosis and management of ILD, especially in immunocompromised patients, since it guides towards specific diagnoses.
Hospitalization for computer-assisted hexapod ring fixation application – analyses of patient variability, peri-operative complications, hospital costs, and discharge status
Authors: Reid J. Spence , Vanderkarr Mollie , Ray Bidusee , Chitnis Abhishek , Holy Chantal E. , Sparks Charisse
Published: March 2022

Background

Computer-assisted hexapod ring fixation systems (HRF) are used for multiple conditions and in very diverse patient populations. This study analyzes perioperative outcomes following HRF application based on patient etiology and clinical presentation.

Methods

Data from patients in the Premier Hospital Billing Database between 2007–2019 undergoing HRF application were analyzed for the duration of patients’ hospitalizations. Patients were grouped based on etiology: acquired deformity, arthrosis, congenital deformity, deep infection, infected nonunion, fracture, nonunion, and other post-operative complications. Demographics, comorbidities, operating room time (ORT), length of stay (LOS), peri-operative complications, and hospital costs were estimated using generalized linear models. Logistic regression evaluated factors associated with peri-operative complications.

Results

One thousand eight hundred eighteen patients (average age: 46.9, standard deviation (SD) (19.6) – 38.9% female) were included in the study, and included 72% fracture cases, 9.6% deep infection, 10.2% deformity (acquired: 5.9%, congenital: 4.3%), 4.2% nonunions, 2% arthrosis and 1.4% other sequelas from prior fractures. Comorbidities varied across diagnosis categories and age, 40% adults and 86% pediatric had no comorbidities. Pediatric cases mostly suffered from obesity (16.1%) and pulmonary disease (10.7%). Complicated diabetes was present in 45.9% of arthropathy and 34.3% of deep infection patients. ORT, LOS and inflation-adjusted hospital costs for all patients averaged 277.7 min (95% Confidence interval (CI): 265.1–290.3), 7.07 days (95% CI: 6.6–7.5) and $41,507 (95%CI: $39,728-$43,285), respectively, but were highest in patients with deep infection (ORT: 369 min (95%CI: $321.0-$433.8); LOS: 14.4 days (95%CI: $13.7-$15.1); Cost: $54,666 (95%CI: $47,960-$63,553)). The probability of having an intraoperative complication averaged 35% (95%CI: 28%-43%) in adult patients with deep infection vs 7% (95%CI: 2%-20%) in pediatric cases treated for congenital deformity. The risk for intraoperative complications was mostly associated with preexisting comorbidities, an Elixhauser > 5 was the most predictive risk factor for complications (odds ratios: 4.53 (95%CI: 1.71–12.00, p = 0.002).

Conclusions

There is important heterogeneity among HRF patients. Adults with HRF for fracture, deep infection and arthrosis are at far greater risk for peri-operative complications vs. patients with deformity, especially pediatric deformity cases, mostly due to existing comorbidities and age. Device-specific HRF clinical studies cannot be generalized beyond their exact patient population.
Granular cell odontogenic tumor: report of a rare case and a review of literature
Authors: Etemadi Sh Milad , Razavi Sayed Mohammad , Ghazavi Olia , Nikbakht Mohammad Hossein
Published: March 2022

Background

Granular cell odontogenic tumor (GCOT) is a rare neoplasm with about 45 cases reported in the literature. It usually occurs in the posterior mandible of middle-aged women.

Case presentation

We report a case of asymptomatic GCOT in the posterior mandible of a 28 years old female and provide a literature review of GCOT cases. Some unusual features such as root resorption, displacement of inferior tooth canal, and multilocular appearance were considerable in this case.

Conclusions

Complete surgical excision of the lesion was beneficial for the patient.
Sexual Assault of Women in the region of Kairouan, Tunisia: an 8-year retrospective study on epidemiological and medicolegal characteristics
Authors: Brahim Oumeima , Turki Elyes , Chebbi Elaa , Fersi Oumayma , Fatnassi Ridha
Published: March 2022

Background

Despite the abundance of studies reporting the prevalence of women's sexual abuse all over the world, there is a real lack of such reports in developing countries in general and Arab-Muslim societies in particular. However, due to the little number of published studies in Tunisia, and the absence of a national database, data on female sexual assaults are still underestimated, which is a gap that needs to be filled in order to make specific preventive actions. We aim to identify the pattern of female victims of sexual abuse in the governorate of Kairouan (Tunisia) in order to provide recommendations for prevention.

Methods

Retrospective data were collected on all-female sexual assault victims, particularly rape, presented to the Department of Forensic Medicine of the University Hospital Ibn El Jazzar of Kairouan (Tunisia), during an 8-year period, from 2009 to 2016.

Results

Two hundred and sixteen victims were included. Age ranged from 3 to 82 years with a mean age of 20.4 years. Victims were single in 84.3%, unmarried in 90.7% and they lived in rural areas in the majority of cases. Rape was committed by a single individual in 94.9% of cases, and the assailant was a stranger in only 26.8%. The assault occurred most frequently in the assailant's home (73.6%) or the public places (11.6%). Evidence of recent acute general body trauma was found in 41.2% of the victims, and the most common injuries were located on the thigh, upper arm, and chest. In 28.1% of the cases, injuries were seen in the face and the neck. Genital examination showed that 188 victims (87%) had a tear in the hymenal membrane and only 13% of victims had intact hymenal membrane. A complacent hymen was noted in 2.3%. A recent anal lesion was seen in 8.3% of the cases. Cytology was performed on 78 victims. In 22 cases (28.2%), sperm could be detected in vaginal swabs up to 3 days post-assault, and pregnancy was seen in 7.4% of assault victims.

Conclusion

Sexual abuse represents a human rights and public health problem that is thriving in a culture of silence, particularly in the Arab region. There is a particular need to create a Tunisian national database on female sexual assaults, in order to centralize data and provide holistic follow-up for specific preventive measures. Finally, efficient management of such cases will need, in addition to legislation, a partnership between the various actors involved in taking care of the victims (health care professionals, the police, social specialists, and psychologists). In addition, civil societies are key partners to break the silence, support this issue, and raise awareness.
Medical student’s perception of the COVID-19 pandemic effect on their education and well-being: a cross-sectional survey in the United States
Authors: Chakladar Jaideep , Diomino Anthony , Li Wei Tse , Tsai Joseph C. , Krishnan Aswini R. , Zou Angela E. , Kharidia Khush , Baig Farhan A. , Householder Sarah , Kuo Selena Z. , Chandrasekar Shyam , Chang Eric Y. , Ongkeko Weg M.
Published: March 2022

Background

The effects of drastic curricular changes necessitated by the COVID-19 pandemic on medical students’ education and wellbeing have remained largely unstudied. Out study aimed to characterize how medical students were affected by the pandemic, specifically how limitations introduced by the pandemic may have affected the quality, delivery, and experience of medical education.

Methods

Three hundred students from 5 U.S. allopathic medical schools were surveyed to determine students’ perceptions about their quality of medical education, professional development, and mental health during the COVID-19 pandemic (October 2020-December 2020).

Results

A large majority of students report that while lecture-based learning has not been significantly affected by the pandemic, small-group and clinical learning have greatly declined in quality. Students also reported higher levels of depression, anxiety, and uncertainty with regards to their futures as physicians.

Conclusions

The COVID-19 pandemic has greatly affected the medical student education and wellbeing. Although medical schools have implemented measures to continue to train medical students as effectively as they can, further strategies must be devised to ensure the well-being of students in the present and for future national emergencies.
Factors influencing the mutual-support willingness and needs among the rural elderly in Hunan Province, China: a cross-sectional study
Authors: Yao Ke-ru , Yin Xin-hong , Luo Qin , Tang Xi , Tan Xiu-zhu
Published: March 2022

Background

This study aimed to assess the influence factors of the mutual-support willingness and identify the mutual-support needs of elderly living in rural areas of Hunan Province, China.

Methods

Using the Chi-square test and logistic regression to analyze factors influencing Participants’ mutual-support willingness and needs.

Results

Factors influencing the mutual-support willingness and needs included individual characteristics, family environment, and so on. And the rural elderly’s demand for mutual-support is at a relatively high level. The total score for social support for the aged was 36.944 ± 6.487, at a moderate level.

Conclusions

It is necessary to objectively evaluate the factors related to mutual-support willingness and needs and take steps to enhance social support and meet elderly the needs of mutual-support, which is of great significance for improving the happiness of the elderly in their later years and alleviating the crisis of population aging in China.