bluuebunny/crossref_metadata_2025 huggingface dataset:
Decrease in incidence of oral anticoagulant-related intracerebral hemorrhage over the past decade in the Netherlands
Authors: Peeters Michaël TJ , Vroman Florence , Schreuder Tobien AHCML , van Oostenbrugge Robert J , Staals Julie
Published: February 2022

Background

Data on oral anticoagulant-related (OAC) intracerebral hemorrhage (ICH) incidence are scarce. Most studies on incidence time trends were performed before the introduction of Direct Oral Anticoagulants (DOACs). Between 2008 and 2018, the number of OAC-users in the Netherlands increased by 63%, with the number of DOAC-users almost equaling that of Vitamin K Antagonists (VKA)-users. We aimed to determine the recent total and OAC-related ICH incidence and assess changes over the last decade, including the effect of DOAC introduction.

Methods

All adult non-traumatic ICH patients presenting in any of three hospitals in the enclosed region of South-Limburg, the Netherlands, were retrospectively included, during two 3-year time periods: 2007–2009 and 2017–2019. OAC-related ICH was defined as ICH in patients using VKAs or DOACs. We calculated the incidence rate ratio (IRR) between the two study periods.

Results

In the 2007–2009 period, we registered 652 ICHs of whom 168 (25.8%) were OAC-related (all VKA). In the 2017–2019 period, we registered 522 ICHs, 121 (23.2%) were OAC-related (70 VKA and 51 DOAC). In 2007–2009, the annual incidence of total ICH and OAC-related ICH was 40.9 and 10.5 per 100,000 person-years, respectively, which decreased to 32.4 and 7.5 per 100,000 person-years in 2017–2019. The IRR for total ICH and OAC-related ICH was 0.67 (95%-CI: 0.60–0.75) and 0.58 (0.46–0.73), respectively.

Conclusion

Both total ICH and OAC-related ICH incidence decreased over the past decade in South-Limburg, the Netherlands, despite the aging population and increasing number of OAC-users. The introduction of DOACs, and possibly an improved cardiovascular risk management and change in OAC prescription pattern, could explain these findings.
Employment Scenario in Indian Punjab: Some Disquieting Features
Authors: Singh Satinder , Singh Jatinder
Published: February 2022

This article aims at analysing the changing dynamics of employment across sectors and sub-sectors in Punjab and explore the factors determining workforce participation. NSSO unit level data and the PLFS data have been used for the period 2004–05 to 2017–18. Besides performing trend analysis, econometric analysis was carried-out to identify the determinants of employment. Evidence reveals that the employment avenues generated by non-farm sectors (industry and services) during the reference period remained insufficient to absorb the workforce leaving agriculture sector. Thus, a massive employment loss has been observed in the recent decade, and youth in the state remained the worst sufferer. The sub-sectors that have experienced absolute decline in employment include food & other products, textile products, wood & paper, metals & plastic, electronics, electrical medical machinery in case of manufacturing sector and transport, health and education and other services in the tertiary sector. Accordingly, unemployment in Punjab in general and youth in particular reached above the national average. This article draws some implications caused by rising unemployment in the state.
Meetei Women in the Political Sphere of Manipur
Authors: Rojibala Ningombam
Published: February 2022

History has its testimony to the active participation of Meetei women during social and political crises in the conflict-ridden society of Manipur. The historic events of Nupi lal (women’s war) 1904 and 1939 during the British colonial period of Manipur and the nude protest by a group of Meetei women at the western gate of Kangla in 2004 are worth mentioning. Such an active engagement of Meetei women in the political sphere of society, which is considered to be the world of men, makes them appear to challenge the delineation of the two worlds—‘ghar and bahir’, the home and the world—delineated for women and men, respectively. While it would be facile to judge the status of Meetei women based on their ostensibly visible appearances, there is no simple answer to the question of whether they are/are not bound by the boundaries of the home and the world. This article investigates the nature of Meetei women’s engagement in the political sphere to see if their actions are in strict adherence to feminist political ideologies. This article also problematizes the straitjacketing of binaries of protector/protected, victim/agent, public/private and oppressor/victim.
Does assertive mental health care make a difference to children in out-of-home care? A pilot study
Authors: Devlin Róisín , Jairam Rajeev , Asghari Mona , Eapen Valsamma
Published: February 2022

Background: Children in out-of-home care (OOHC) experience poor mental health. With the number of Australian children in OOHC rising, accessible and effective interventions are needed to address this escalating predicament. South Western Sydney Child & Adolescent Mental Health Service (CAMHS) collaborated with the local statutory child protection agency, developing a specialized assertive mental health team supporting children in OOHC (OOHC MHT). This study outlines the characteristics of the first cohort of children referred to the OOHC MHT and the impact of intervention in improving outcomes, warranting ongoing provision of this service. Methodology: A two-part study was used to compare the psychosocial and emotional wellbeing of children referred to the OOHC MHT (OOHC group) against CAMHS-referred children who had not experienced OOHC (Control group). Evaluation of the OOHC MHT’s intervention was conducted by measuring Health of the Nation Outcome Scale-Child and Adolescent (HoNOSCA) and Child Global Assessment Scale (CGAS) scores over the first year of treatment. Results: The OOHC group demonstrated significantly higher levels of emotional, behavioural and social problems compared to the control group through their HoNOSCA score on admission (OOHC Group: M = 24.9; SD = 5.3, Control Group: M = 16.7; SD = 5.7; p = .001) and CGAS (OOHC Group: M = 40.5; SD = 7.9, Control Group: M = 50.3; SD = 7.9; p = .001). Significant improvements in the OOHC group’s HoNOSCA (T1 = 24.9, T3 = 17.0) and CGAS (T1 = 40.5, T3 = 52.8) measures were observed over the first year of treatment. Conclusion: Children in OOHC referred to CAMHS present with poorer mental health and psychosocial functioning than referred children who have not experienced OOHC. Assertive intervention was associated with improvement in social, emotional and behavioural problems and reduction in psychosocial impairment, suggesting the benefit of such an intervention both state-wide, and nationally.
The Contribution of a Solid Breast Mass Gray-Scale Histographic Analysis in Ascertaining a Benign-Malignant Differentiation
Authors: Ucar Huseyin , Kacar Emre , Karaca Rukan
Published: February 2022

Objective:

The aim of this study was to determine the efficiency of a fat-lesion histographic analysis (FLHA) to make a benign-malignant differentiation, for patients with a breast mass. In addition, it was important to examine the relationship between FLHA rates and Breast Imaging–Reporting and Data System (BI-RADS) scoring.

Materials and Methods:

This was a retrospective study conducted by examining the breast ultrasonograms (BUS) and histopathologic data of 76 women, having at least one solid breast mass. The patients were grouped according to their histopathologic diagnoses and BUS BI-RADS scores. The recorded digital gray-scale images were transferred to a workstation to quantitatively measure tissue echogenicity. The breast masses and adjacent adipose tissue were evaluated using the ImageJ analysis program, and gray-scale histographic analysis values were generated. The FLHA rate was determined by dividing the fat tissue histographic value by the mass-lesion histographic value. Statistical analysis was performed using this value as well as the patients’ histopathologic data and BUS BI-RADS score.

Results:

A complementary effect was noted using FLHA rates with the BUS BI-RADS criteria, and a statistically significant difference was detected between benign and malignant histopathology groups ( P < .001). Similarly, the malignant histopathologic diagnosis with BI-RADS 4 and benign histopathologic diagnosis with BI-RADS 4 groups were related ( P < .001). The correlation between BI-RADS criteria and FLHA rates demonstrated a significant difference between BI-RADS 3 and BI-RADS 5 ( P < .001), and BI-RADS 4 and BI-RADS 5 for FLHA rates ( P = .002).

Conclusion:

It was determined that using the FLHA rate was a complement to the BUS BI-RADS criteria. In this cohort, there was a statistically significant difference in predicting possible malignancy in all BI-RADS classes.
The Sonographic Evaluation of Gestational Age: A Comparative Study Utilizing Different Biometric Measurement Indices and Fetal Kidney Length
Authors: Dahmarde Hamid , Noori Jafar
Published: February 2022

Objective:

Various indices have been introduced for estimating sonographic gestational age and have demonstrated varied diagnostic accuracy. The aim of this study was to evaluate the correlation of fetal kidney length (FKL) with some other traditional measurement parameters in determining an accurate gestational age.

Materials and Methods:

In this prospective study, healthy pregnant women, who had completed a scheduled and routine obstetrical sonogram, were included. During the sonogram, the measurement indices, biparietal diameter (BPD), abdominal circumference (AC), crown rump length (CRL), head circumference (HC), femur length (FL), and FKL were analyzed. The obstetrical measurements had been taken every 4 weeks from the 20th week of the pregnancy, until the end of the pregnancy (e.g., 20th, 24th, 28th, 32nd, 36th, 40th weeks). After data collection, the measurement data were analyzed with SPSS software.

Results:

There were significant ( P < .05) high strength of associations between FKL and the routine measurements of BPD ( r = 0.668), AC ( r = 0.770), CRL ( r = 0.792), HC ( r = 0.791), and FL ( r = 0.803).

Conclusion:

These results suggest possible significant positive relationships between FKL and BPD, AC, CRL, HC, and FL. It can be assumed that FKL might be a suitable index for determining gestational age especially in the late second and third trimester, when other measurement indices are less accurate.
First-degree relationships and genotyping errors deciphered by a high-density SNP array in a Duroc × Iberian pig cross
Authors: Gomez-Raya L. , Gómez Izquierdo E. , de Mercado de la Peña E. , Garcia-Ruiz F. , Rauw W.M.
Published: February 2022

Background

Two individuals with a first-degree relationship share about 50 percent of their alleles. Parent–offspring relationships cannot be homozygous for alternative alleles (genetic exclusion).

Methods

Applying the concept of genetic exclusion to HD arrays typed in animals for experimental purposes or genomic selection allows estimation of the rate of rejection of first-degree relationships as the rate at which two individuals typed for a large number of Single Nucleotide Polymorphisms (SNPs) do not share at least one allele. An Expectation–Maximization algorithm is applied to estimate parentage. In addition, genotyping errors are estimated in true parent–offspring relationships. Samples from nine candidate Duroc sires and 55 Iberian dams producing 214 Duroc × Iberian barrows were typed for the HD porcine Affymetrix array.

Results

We were able to establish paternity and maternity of 75 and 85 piglets, respectively. Rate of rejection in true parent–offspring relationships was estimated as 0.000735. This is a lower bound of the genotyping error since rate of rejection depends on allele frequencies. After accounting for allele frequencies, our estimate of the genotyping error is 0.6%. A total of 7,744 SNPs were rejected in five or more true parent–offspring relationships facilitating identification of “problematic” SNPs with inconsistent inheritance in multiple parent–offspring relationships.

Conclusions

This study shows that animal experiments and routine genotyping in genomic selection allow to establish or to verify first-degree relationships as well as to estimate genotyping errors for each batch of animals or experiment.
Mechanisms of magnoliae cortex on treating sarcopenia explored by GEO gene sequencing data combined with network pharmacology and molecular docking
Authors: Zhao Xingqi , Yuan Feifei , Wan Haoyang , Qin Hanjun , Jiang Nan , Yu Bin
Published: February 2022

Background

Administration of Magnoliae Cortex (MC) could induce remission of cisplatin-induced sarcopenia in mice, however, whether it is effective on sarcopenia patients and the underlying mechanisms remain unclear.

Methods

Sarcopenia related differentially expressed genes were analysed based on three Gene Expression Omnibus (GEO) transcriptome profiling datasets, which was merged and de duplicated with disease databases to obtain sarcopenia related pathogenic genes. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were than performed to analyse the role of proteins encoded by sarcopenia related pathogenic genes and the signal regulatory pathways involved in. The main active components and target proteins of MC were obtained by searching traditional Chinese medicine network databases (TCMSP and BATMAN-TCM). MC and sarcopenia related pathogenic genes shared target proteins were identified by matching the two. A protein–protein interaction network was constructed subsequently, and the core proteins were filtered according to the topological structure. GO and KEGG analysis were performed again to analyse the key target proteins and pathways of MC in the treatment of sarcopenia, and build the herbs-components-targets network, as well as core targets-signal pathways network. Molecular docking technology was used to verify the main compounds-targets.

Results

Sarcopenia related gene products primarily involve in aging and inflammation related signal pathways. Seven main active components (Anonaine, Eucalyptol, Neohesperidin, Obovatol, Honokiol, Magnolol, and beta-Eudesmol) and 26 target proteins of MC-sarcopenia, of which 4 were core proteins (AKT1, EGFR, INS, and PIK3CA), were identified. The therapeutic effect of MC on sarcopenia may associate with PI3K-Akt signaling pathway, EGFR tyrosine kinase inhibitor resistance, longevity regulating pathway, and other cellular and innate immune signaling pathways.

Conclusion

MC contains potential anti-sarcopenia active compounds. These compounds play a role by regulating the proteins implicated in regulating aging and inflammation related signaling pathways, which are crucial in pathogenesis of sarcopenia. Our study provides new insights into the development of a natural therapy for the prevention and treatment of sarcopenia.
Population genomics of Zea species identifies selection signatures during maize domestication and adaptation
Authors: Xu Gen , Zhang Xuan , Chen Wenkang , Zhang Renyu , Li Zhi , Wen Weiwei , Warburton Marilyn L. , Li Jiansheng , Li Huihui , Yang Xiaohong
Published: February 2022

Background

Maize (Zea mays L. ssp. mays) was domesticated from teosinte (Zea mays ssp. parviglumis) about 9000 years ago in southwestern Mexico and adapted to a range of environments worldwide. Researchers have depicted the maize domestication and adaptation processes over the past two decades, but efforts have been limited either in sample size or genetic diversity. To better understand these processes, we conducted a genome-wide survey of 982 maize inbred lines and 190 teosinte accessions using over 40,000 single-nucleotide polymorphism markers.

Results

Population structure, principal component analysis, and phylogenetic trees all confirmed the evolutionary relationship between maize and teosinte, and determined the evolutionary lineage of all species within teosinte. Shared haplotype analysis showed similar levels of ancestral alleles from Zea mays ssp. parviglumis and Zea mays ssp. mexicana in maize. Scans for selection signatures identified 394 domestication sweeps by comparing wild and cultivated maize and 360 adaptation sweeps by comparing tropical and temperate maize. Permutation tests revealed that the public association signals for flowering time were highly enriched in the domestication and adaptation sweeps. Genome-wide association study identified 125 loci significantly associated with flowering-time traits, ten of which identified candidate genes that have undergone selection during maize adaptation.

Conclusions

In this study, we characterized the history of maize domestication and adaptation at the population genomic level and identified hundreds of domestication and adaptation sweeps. This study extends the molecular mechanism of maize domestication and adaptation, and provides resources for basic research and genetic improvement in maize.
Exosomes derived from human placental mesenchymal stem cells ameliorate myocardial infarction via anti-inflammation and restoring gut dysbiosis
Authors: Yang Libo , Wang Ting , Zhang Xiaoxia , Zhang Hua , Yan Ning , Zhang Guoshan , Yan Ru , Li Yiwei , Yu Jingjing , He Jun , Jia Shaobin , Wang Hao
Published: February 2022

Background

Myocardial infarction (MI) represents a severe cardiovascular disease with limited therapeutic agents. This study was aimed to elucidate the role of the exosomes derived from human placental mesenchymal stem cells (PMSCs-Exos) in MI.

Methods

PMSCs were isolated and cultured in vitro, with identification by both transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). To further investigate the effects of PMSC-Exos on MI, C57BL/6 mice were randomly divided into Sham group, MI group, and PMSC-Exos group. After 4 weeks of the intervention, cardiac function was assessed by cardiac echocardiography, electrocardiogram and masson trichrome staining; lipid indicators were determined by automatic biochemical instrument; inflammatory cytokines were measured by cytometric bead array (CBA); gut microbiota, microbial metabolites short chain fatty acids (SCFAs) as well as lipopolysaccharide (LPS) were separately investigated by 16S rRNA high throughput sequencing, gas chromatography mass spectrometry (GC–MS) and tachypleus amebocyte lysate kit; transcriptome analysis was used to test the transcriptional components (mRNA\miRNA\cirRNA\lncRNA) of PMSC-Exos.

Results

We found that human PMSC-Exos were obtained and identified with high purity and uniformity. MI model was successfully established. Compared to MI group, PMSC-Exos treatment ameliorated myocardial fibrosis and left ventricular (LV) remodeling (P < 0.05). Moreover, PMSC-Exos treatment obviously decreased MI molecular markers (AST/BNP/MYO/Tn-I/TC), pro-inflammatory indicators (IL-1β, IL-6, TNF-α, MCP-1), as well as increased HDL in comparison with MI group (all P < 0.05). Intriguingly, PMSC-Exos intervention notably modulated gut microbial community via increasing the relative abundances of Bacteroidetes, Proteobacteria, Verrucomicrobia, Actinobacteria, Akkermansia, Bacteroides, Bifidobacterium, Thauera and Ruminiclostridium, as well as decreasing Firmicutes (all P < 0.05), compared with MI group. Furthermore, PMSC-Exos supplementation increased gut microbiota metabolites SCFAs (butyric acid, isobutyric acid and valeric acid) and decreased LPS in comparison with MI group (all P < 0.05). Correlation analysis indicated close correlations among gut microbiota, microbial SCFAs and inflammation in MI.

Conclusions

Our study highlighted that PMSC-Exos intervention alleviated MI via modulating gut microbiota and suppressing inflammation.
Answering complex hierarchy questions in network meta-analysis
Authors: Papakonstantinou Theodoros , Salanti Georgia , Mavridis Dimitris , Rücker Gerta , Schwarzer Guido , Nikolakopoulou Adriani
Published: February 2022

Background

Network meta-analysis estimates all relative effects between competing treatments and can produce a treatment hierarchy from the most to the least desirable option according to a health outcome. While about half of the published network meta-analyses present such a hierarchy, it is rarely the case that it is related to a clinically relevant decision question.

Methods

We first define treatment hierarchy and treatment ranking in a network meta-analysis and suggest a simulation method to estimate the probability of each possible hierarchy to occur. We then propose a stepwise approach to express clinically relevant decision questions as hierarchy questions and quantify the uncertainty of the criteria that constitute them. The steps of the approach are summarized as follows: a) a question of clinical relevance is defined, b) the hierarchies that satisfy the defined question are collected and c) the frequencies of the respective hierarchies are added; the resulted sum expresses the certainty of the defined set of criteria to hold. We then show how the frequencies of all possible hierarchies relate to common ranking metrics.

Results

We exemplify the method and its implementation using two networks. The first is a network of four treatments for chronic obstructive pulmonary disease where the most probable hierarchy has a frequency of 28%. The second is a network of 18 antidepressants, among which Vortioxetine, Bupropion and Escitalopram occupy the first three ranks with frequency 19%.

Conclusions

The developed method offers a generalised approach of producing treatment hierarchies in network meta-analysis, which moves towards attaching treatment ranking to a clear decision question, relevant to all or a subset of competing treatments.
An investigation into the optimal wear time criteria necessary to reliably estimate physical activity and sedentary behaviour from ActiGraph wGT3X+ accelerometer data in older care home residents
Authors: Airlie Jennifer , Forster Anne , Birch Karen M.
Published: February 2022

Background

Research protocols regarding the use of ActiGraph wGT3X+ accelerometers in care home residents are yet to be established. The purpose of this study was to identify the minimal wear time criteria required to achieve reliable estimates of physical activity (PA) and sedentary behaviour (SB) in older care home residents.

Methods

Ninety-four older adults from 14 care homes wore an ActiGraph wGT3X+ accelerometer on the right hip for 7 consecutive days. A pragmatic, staged approach was adopted in order to explore the effect of: monitoring day; minimum daily wear time and number of wear days on estimates of four outcomes derived from the accelerometer data: counts.day− 1, counts.minute− 1, PA time and SB time.

Results

Data from 91 participants (mean age: 84 ± 9 years, 34% male) was included in the analysis. No effect of monitoring day was observed. Lowering the daily wear time to ≥ 8 h (compared to ≥10 h) had no effect on the outcomes of interest. Four days of monitoring was sufficient to provide reliable estimates of all four outcomes.

Conclusion

In this study, a minimum wear time criterion of ≥ 8 h on any 4 days was required to derive reliable estimates of PA and SB from ActiGraph wGT3X+ accelerometer data in older care home residents.
Dosimetric analysis of radiation-induced brainstem necrosis for nasopharyngeal carcinoma treated with IMRT
Authors: Fan Xigang , Huang Yecai , Xu Peng , Min Yanmei , Li Jie , Feng Mei , Xu Guohui , Lang Jinyi
Published: February 2022

Background

Radiation-induced brainstem necrosis (RIBN) is a late life-threatening complication that can appear after treatment in patients with nasopharyngeal carcinoma (NPC). However, the relationship between RIBN and radiation dose is not still well-defined.

Methods

During January 2013 and December 2017, a total of 1063 patients with NPC were treated at Sichuan cancer hospital with IMRT. A total of 479 patients were eligible for dosimetric analysis. Dosimetric parameters of the RIBN, Dmax(the maximum dose), D0.1c (maximum average dose delivered to a 0.1-cc volume), D1cc, D2cc, D3cc, D5cc, D10cc and Dmean (mean does) were evaluated and recorded. ROC curve was used to analyze the area under curve (AUC) and cutoff points. Logistic regression for screening dose-volume parameter and logistic dose response model were used to predict the incidence of brainstem necrosis.

Results

Among the 479 patients with NPC, 6 patients were diagnosed with RIBN, the incidence of RIBN was 1.25% (6/479), and the median time to RIBN after treatment was 28.5 months (range 18–48 months). The dose of the brainstem in patients with RIBN were higher than that in patients without necrosis. ROC curve showed that the area under the curve (AUC) of Dmax was the largest (0.987). Moreover, logistic stepwise regression indicated that Dmax was the most important dose factor. The RIBN incidence at 5% over 5 years (TD5/5) and 50% incidence over 5 years (TD50/5) was 69.59 Gy and76.45 Gy, respectively.

Conclusions

Brainstem necrosis is associated with high dose irritation. Dmax is the most significant predictive dosimetric factor for RIBN. Dmax of brainstem should be considered as the dose limitation parameter. We suggest that the limitation dose for brainstem was Dmax < 69.59 Gy.
A review of economic evaluations of health care for people at risk of psychosis and for first-episode psychosis
Authors: Shields Gemma E. , Buck Deborah , Varese Filippo , Yung Alison R. , Thompson Andrew , Husain Nusrat , Broome Matthew R. , Upthegrove Rachel , Byrne Rory , Davies Linda M.
Published: February 2022

Background

Preventing psychotic disorders and effective treatment in first-episode psychosis are key priorities for the National Institute for Health and Care Excellence. This review assessed the evidence base for the cost-effectiveness of health and social care interventions for people at risk of psychosis and for first-episode psychosis.

Methods

Electronic searches were conducted using the PsycINFO, MEDLINE and Embase databases to identify relevant published full economic evaluations published before August 2020. Full-text English-language studies reporting a full economic evaluation of a health or social care intervention aiming to reduce or prevent symptoms in people at risk of psychosis or experiencing first-episode psychosis were included. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms based on the NHS Economic Evaluation Database (EED) handbook and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist for economic evaluations. The protocol was registered on the PROSPERO database (CRD42018108226). Results were summarised qualitatively.

Results

Searching identified 1,628 citations (1,326 following the removal of duplications). After two stages of screening 14 studies met the inclusion criteria and were included in the review. Interventions were varied and included multidisciplinary care, antipsychotic medication, psychological therapy, and assertive outreach. Evidence was limited in the at-risk group with only four identified studies, though all interventions were found to be cost-effective with a high probability (> 80%). A more substantial evidence base was identified for first-episode psychosis (11 studies), with a focus on early intervention (7/11 studies) which again had positive conclusions though with greater uncertainty.

Conclusions

Study findings generally concluded interventions were cost-effective. The evidence for the population who are at-risk of psychosis was limited, and though there were more studies for the population with first-episode psychosis, limitations of the evidence base (including generalisability and heterogeneity across the methods used) affect the certainty of conclusions.
Prevalence of eosinophilic, atopic, and overlap phenotypes among patients with severe asthma in Saudi Arabia: a cross-sectional study
Authors: Al-Jahdali Hamdan , Wali Siraj , Albanna Amr S. , Allehebi Riyad , Al-Matar Hussein , Fattouh Mohamed , Beekman Maarten
Published: February 2022

Background

Eosinophilia is a significant factor in asthma severity; however, the prevalence of severe eosinophilic asthma in Saudi Arabia is largely unknown. We aimed to determine the prevalence of the eosinophilic (defined in this study as ≥ 300 cells/mm3 in blood), atopic (atopic phenotype 1, defined in this study as > 100 IU/mL total serum IgE; atopic phenotype 2, defined in this study as > 150 IU/mL), and overlap phenotypes among patients with severe asthma in Saudi Arabia.

Methods

A cross-sectional study was conducted in centers specialized in severe asthma management. Patients aged ≥ 12 years with severe asthma were enrolled. Study patients responded to the Global Initiative for Asthma 2018 assessment of asthma control questionnaire and provided study investigators with current information related to the study objectives. Additional medical record data and a blood sample for total serum IgE and complete blood count were collected.

Results

A total of 101 patients were enrolled; 83% were female and the mean (standard deviation) age was 48.7 (13.2) years. Forty-five (45%) patients had the eosinophilic phenotype, 50 (50%) had atopic phenotype 1, and 25 (25%) had phenotypic overlap (eosinophilic and atopic 1). Forty-one (41%) patients had atopic phenotype 2 and 23 (23%) had phenotypic overlap (eosinophilic and atopic 2). Asthma control and oral corticosteroid use patterns were similar and there were no significant differences in number of asthma exacerbations across phenotypes.

Conclusions

In Saudi Arabia, 45% of patients with severe asthma had the eosinophilic phenotype, which is most likely an underestimation as no clinical features of eosinophilia were taken into account in the definition of eosinophilia. Approximately half of them had phenotypic overlap with the atopic phenotype.

Trial registration NCT03931954; ClinicalTrials.gov, April 30, 2019.
Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture
Authors: Lai Oujie , Zhang Xinliang , Hu Yong , Sun Xiaoyang , Zhu Binke , Dong Weixin , Yuan Zhenshan
Published: February 2022

Background

To retrospectively compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF).

Methods

Forty patients affected by OTBF with mean age of 61.85 years were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared.

Results

The mean operative time and blood loss were 89.71 ± 7.62 min and 143.75 ± 42.51 ml for SSFK group, respectively; 111.69 ± 12.25 min (P < 0.01) and 259.38 ± 49.05 ml (P < 0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, significant loss of Cobb angle and AVH ratio were observed for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group.

Conclusions

Both SSFK and LF are safe and effective for treatment of OTBF. Comparatively, SSFK is less invasive and can preserve more motion segments, which may be a more valuable surgical option in some elderly patients. A high-quality randomized controlled study is required to confirm our finding in the future.
Laminate veneer ceramics in aesthetic rehabilitation of teeth with fluorosis: a 10-year follow-up study
Authors: Demirekin Zeynep Basagaoglu , Turkaslan Suha
Published: February 2022

Background

Fluorosis is one of the color anomalies seen in teeth. White lines and blurred areas associated with mild fluorosis are barely noticeable; in its severe form, tooth enamel surface changes ranging from staining and pitting may be observed. The treatment of fluorosis not only provides aesthetic and functional correction but also helps to improve the patient's self-esteem.

Methods

The present retrospective study evaluated the clinical quality, success rate, and estimated survival of porcelain laminate veneers in teeth with anterior fluorosis. Three hundred fifty-eight porcelain laminate veneers (254 in the anterior maxilla and 104 in the mandible) were "functional" restorations that covered the incisal edge and part of the palatal/lingual side of the tooth with a 1 mm high palatal bevel. Ceramic veneers were fabricated with lithium disilicate reinforced glass–ceramic material (IPS e.max Press, Ivoclar Vivadent, Schaan, Liechtenstein). The modified United States Public Health Service criteria were used for clinical evaluation of the restorations.

Results

On the basis of these criteria, marginal adaptation, color match, marginal discoloration, surface roughness, restoration fracture, tooth fracture, restoration wear, antagonist tooth wear, caries and postoperative sensitivity were evaluated yearly. The survival rate in the current study was ≥ 0.997 for 10 years.

Conclusions

The results of this clinical study should encourage clinicians to consider ceramic veneers over crown restorations when restoring the smile of patients with advanced fluorosis.
Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key
Authors: Schults Jessica A. , Kleidon Tricia M. , Gibson Victoria , Ware Robert S. , Monteagle Emily , Paterson Rebecca , Charles Karina , Keys Adam , McBride Craig A. , McTaggart Steven , Lawton Benjamin , Macfarlane Fiona , Sells Chloe , Rickard Claire M. , Ullman Amanda J.
Published: February 2022

Objective

To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.

Methods

Mixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia.

Results

Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February–April 2020) involving 21 stakeholders culminating in the co-production of the “DIVA Key”. The DIVA Key was evaluated between May–December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63–0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2–27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8–10]; 8 [8–10 respectively).

Conclusion

The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
Implementation of a campus-based and peer-delivered HIV self-testing intervention to improve the uptake of HIV testing services among university students in Zimbabwe: the SAYS initiative
Authors: Mukora-Mutseyekwa Fadzai , Mundagowa Paddington Tinashe , Kangwende Rugare Abigail , Murapa Tsitsi , Tirivavi Mandla , Mukuwapasi Waraidzo , Tozivepi Samantha Nokuthula , Uzande Charles , Mutibura Queen , Chadambuka Elizabeth Marian , Machinga Mazvita
Published: February 2022

Background

The uptake of HIV testing services among adolescents and young adults in Zimbabwe is low due to stigma associated with the risk of mental and social harm. The WHO recommends HIV self-testing (HIVST) as an innovative approach to improve access to HIV testing for this hard-to-reach populations. This study describes the development and implementation of a coordinated multifaceted and multidisciplinary campus-based approach to improve the uptake of HIV testing among university students in Zimbabwe.

Methods

We utilized both quantitative and qualitative methods guided by the Exploration, Preparation, Implementation, and Sustainment Framework. A formative survey, in-depth interviews, and a scoping review were conducted as part of the situation analysis. Implementers (peer educators and health workers) were trained and community dialogue sessions were conducted to ascertain the determinants (enablers and barriers) influencing both the inner and outer contexts. Self-test kits were disbursed over 6 months before a summative evaluation survey was conducted. Qualitative data were analyzed thematically while the chi-squared test was used to analyze quantitative data.

Results

The formative evaluation showed that 66% of students intended to test and 44% of the enrolled students collected HIVST test kits. Giving comprehensive and tailored information about the intervention was imperative to dispel the initial skepticism among students. Youth-friendly and language-specific packaging of program materials accommodated the students. Despite the high acceptability of the HIVST intervention, post-test services were poorly utilized due to the small and isolated nature of the university community. Implementers recommended that the students seek post-test services off-site to ensure that those with reactive results are linked to treatment and care.

Conclusions

Peer-delivered HIVST using trained personnel was acceptable among adolescents and young adults offered the intervention at a campus setting. HIVST could increase the uptake of HIV testing for this population given the stigma associated with facility-based HTS and the need for routine HIV testing for this age group who may not otherwise test. An off-site post-test counseling option is likely to improve the implementation of a campus-based HIVST and close the linkage to treatment and care gap.
On multifactorial drivers for malaria rebound in Brazil: a spatio-temporal analysis
Authors: Ayala Mario J. C. , Bastos Leonardo S. , Villela Daniel A. M.
Published: February 2022

Background

Malaria incidence in Brazil reversed its decreasing trend when cases from recent years, as recent as 2015, exhibited an increase in the Brazilian Amazon basin, the area with the highest transmission of Plasmodium vivax and Plasmodium falciparum. In fact, an increase of more than 20% in the years 2016 and 2017 revealed possible vulnerabilities in the national malaria-control programme.

Methods

Factors potentially associated with this reversal, including migration, economic activities, and deforestation, were studied. Past incidences of malaria cases due to P. vivax and P. falciparum were analysed with a spatio-temporal Bayesian model using more than 5 million individual records of malaria cases from January of 2003 to December of 2018 in the Brazilian Amazon to establish the municipalities with unexpected increases in cases.

Results

Plasmodium vivax incidence surpassed the past trends in Amazonas (AM), Amapá (AP), Acre (AC), Pará (PA), Roraima (RR), and Rondônia (RO), implying a rebound of these states between 2015 and 2018. On the other hand, P. falciparum also surpassed the past trends in AM, AC, AP, and RR with less severity than P. vivax incidence. Outdoor activities, agricultural activities, accumulated deforestation, and travelling might explain the rebound in malaria cases in RR, AM, PA, and RO, mainly in P. vivax cases. These variables, however, did not explain the rebound of either P. vivax and P. falciparum cases in AC and AP states or P. falciparum cases in RR and RO states.

Conclusion

The Amazon basin has experienced an unexpected increase in malaria cases, mainly in P. vivax cases, in some regions of the states of Amazonas, Acre, Pará, Amapá, Roraima, and Rondônia from 2015 to 2018 and agricultural activities, outdoor activities, travelling activities, and accumulated deforestation appear linked to this rebound of cases in particular regions with different impact. This shows the multifactorial effects and the heterogeneity of the Amazon basin, boosting the necessity of focusing the malaria control programme on particular social, economic, and environmental conditions.
The El Valor de Nuestra Salud clustered randomized controlled trial store-based intervention to promote fruit and vegetable purchasing and consumption
Authors: Ayala Guadalupe X. , Pickrel Julie L. , Baquero Barbara , Sanchez-Flack Jennifer , Lin Shih-Fan , Belch George , Rock Cheryl L. , Linnan Laura , Gittelsohn Joel , Ji Ming , Elder John P. , Mayer Joni
Published: February 2022

Background

Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months.

Trial design

Clustered randomized controlled trial

Methods

Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors.

Results

The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects.

Conclusions

Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products).

Trial registration

NCT01475526
Outcomes of transitional care programs on adolescent chronic inflammatory systemic diseases: systematic review and meta-analyses
Authors: García-Rodríguez Fernando , Raygoza-Cortez Karina , Moreno-Hernandez Lesli , García-Pérez Rodrigo , Garza Lopez Leticia Elizabeth , Arana-Guajardo Ana Cecilia , Jáquez-Quintana Joel Omar , Villarreal-Treviño Ana Victoria , de la O-Cavazos Manuel Enrique , Rubio-Pérez Nadina
Published: February 2022

Background

Patients with juvenile chronic inflammatory systemic diseases (jCID) are vulnerable to many circumstances when transitioning to adult-centered healthcare; this increases the burden of disease and worsen their quality of life.

Methods

MEDLINE, Embase, Web of Science and Scopus were searched from inception to March 16th, 2021. We included observational, randomized controlled trials and quasi-experimental studies that evaluated a transitional care program for adolescents and young adults with jCIDs. We extracted information regarding health-related quality of life, disease activity, drop-out rates, clinical attendance rates, hospital admission rates, disease-related knowledge, surgeries performed, drug toxicity and satisfaction rates.

Results

Fifteen studies met our inclusion criteria. The implementation of transition programs showed a reduction on hospital admission rates for those with transition program (OR 0.28; 95% CI 0.13 to 0.61; I 2 = 0%; p = 0.97), rates of surgeries performed (OR 0.26; 95% CI 0.12 to 0.59; I 2 = 0%; p = 0.50) and drop-out rates from the adult clinic (OR 0.23; 95% CI 0.12 to 0.46; I 2 = 0%; p = 0.88). No differences were found in other outcomes.

Conclusion

The available body of evidence supports the implementation of transition programs as it could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates.
Morphologically, immunohistochemically and PCR proven lymphocytic viral peri-, endo-, myocarditis in patients with fatal COVID-19
Authors: Kogan Evgeniya , Berezovskiy Yuriy , Blagova Olga , Kukleva Anna , Semyonova Lyudmila , Gretsov Evgeniy , Ergeshov Atadzhan
Published: February 2022

Background

Despite a reported cardiac injury in patients with new coronavirus infection, the possibility and specifics of genuine viral myocarditis in COVID-19 remains not fully clear.

Purpose

To study the presence of SARS-CoV-2 in the myocardium and the morphological properties of myocarditis in patients with severe coronavirus infection (COVID-19).

Methods

Autopsy data of eight elderly patients (75.6 ± 7.4 years), four male and four female, with severe new coronavirus infection were studied. The lifetime diagnosis of COVID-19 is based on a positive result of the PCR study. The inclusion criterion was the presence of morphological signs of myocarditis according to the Dallas criteria. A standard histological examination included staining by hematoxylin and eosin, toluidin blue and Van Gieson. An immunohistochemical study was performed using antibodies to CD3, CD 68, CD20, perforin, toll-like receptor (TLR) types 4 and 9. PCR in real-time was performed to determine the viral RNA in the myocardium.

Results

All patients had severe bilateral viral pneumonia. In all cases, myocarditis was not clinically diagnosed. Morphological examination of the heart found signs of active lymphocytic myocarditis. PCR identified the SARS-Cov2 RNA in all cases. There were also signs of destructive coronaritis in all cases, thrombovasculitis, lymphocytic pericarditis (in 3 cases) and endocarditis (in 2 cases). The absence of neutrophils confirms the aseptic nature of inflammation. An immunohistochemical study showed the CD3-positive T lymphocytes in the infiltrates. Increased expression of TLR type 4 and less 9 was also detected.

Conclusion

Morphological and immunohistochemical evidence of myocarditis in COVID-19 was presented. Lymphocytic infiltrations and positive PCR confirm the viral nature of inflammation. Myocarditis in COVID-19 is also characterized by coronaritis with microvascular thrombosis and associated with lymphocytic endo- and pericarditis.