bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-monitoring of blood pressure among women with hypertensive disorders of pregnancy: a systematic review
Authors: Yeh Ping Teresa , Rhee Dong Keun , Kennedy Caitlin Elizabeth , Zera Chloe A. , Lucido Briana , Tunçalp Özge , Gomez Ponce de Leon Rodolfo , Narasimhan Manjulaa
Published: May 2022

Background

The World Health Organization (WHO) recommends self-monitoring of blood pressure (SMBP) for hypertension management. In addition, during the COVID-19 response, WHO guidance also recommends SMBP supported by health workers although more evidence is needed on whether SMBP of pregnant individuals with hypertension (gestational hypertension, chronic hypertension, or pre-eclampsia) may assist in early detection of pre-eclampsia, increase end-user autonomy and empowerment, and reduce health system burden. To expand the evidence base for WHO guideline on self-care interventions, we conducted a systematic review of SMBP during pregnancy on maternal and neonatal outcomes.

Methods

We searched for publications that compared SMBP with clinic-based monitoring during antenatal care. We included studies measuring any of the following outcomes: maternal mortality, pre-eclampsia, long-term risk and complications, autonomy, HELLP syndrome, C-section, antenatal hospital admission, adverse pregnancy outcomes, device-related issues, follow-up care with appropriate management, mental health and well-being, social harms, stillbirth or perinatal death, birthweight/size for gestational age, and Apgar score. After abstract screening and full-text review, we extracted data using standardized forms and summarized findings. We also reviewed studies assessing values and preferences as well as costs of SMBP.

Results

We identified 6 studies meeting inclusion criteria for the effectiveness of SMBP, 6 studies on values and preferences, and 1 study on costs. All were from high-income countries. Overall, when comparing SMBP with clinic-monitoring, there was no difference in the risks for most of the outcomes for which data were available, though there was some evidence of increased risk of C-section among pregnant women with chronic hypertension. Most end-users and providers supported SMBP, motivated by ease of use, convenience, self-empowerment and reduced anxiety. One study found SMBP would lower health sector costs.

Conclusion

Limited evidence suggests that SMBP during pregnancy is feasible and acceptable, and generally associated with maternal and neonatal health outcomes similar to clinic-based monitoring. However, more research is needed in resource-limited settings.

Systematic review registration

PROSPERO CRD42021233839.
Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana
Authors: Dzomeku Veronica Millicent , Mensah Adwoa Bemah Boamah , Nakua Emmanuel Kweku , Agbadi Pascal , Okyere Joshua , Donkor Peter , Lori Jody R.
Published: May 2022

Background

Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility.

Methods

We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study.

Results

The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building.

Conclusion

We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.
Optimal surveillance of intraductal papillary mucinous neoplasms of the pancreas focusing on remnant pancreas recurrence after surgical resection
Authors: Fuji Tomokazu , Umeda Yuzo , Takagi Kosei , Yoshida Ryuichi , Yoshida Kazuhiro , Yasui Kazuya , Matsumoto Kazuyuki , Kato Hironari , Yagi Takahito , Fujiwara Toshiyoshi
Published: May 2022

Background

The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence, including de novo lesions, is essential, optimal surveillance protocols have not been established.

Aim and methods

This study aimed to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one patients of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence.

Results

The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n = 42), high-grade dysplasia (HAD, n = 19), and invasive carcinoma (IPMC, n = 30). Recurrence was observed in 26 patients (29%), of which recurrence was seen at Rem-Panc in 19 patients (21%) and Ex-Panc in 7 patients (8%). The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs. 35 months, p < 0.001; median OS 25 months vs. 72 months, p < 0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no repeat pancreatectomy (MST 36 months vs. 15.5 months, p = 0.033). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p = 0.002) and positive surgical margin (HR 4.4, p = 0.018) were identified as risk factors for Rem-Panc recurrence.

Conclusions

The risk factors for Rem-Panc and Ex-Panc recurrence differ. Therefore, optimal surveillance on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.
Validation of genomic and transcriptomic models of homologous recombination deficiency in a real-world pan-cancer cohort
Authors: Leibowitz Benjamin D. , Dougherty Bonnie V. , Bell Joshua S. K. , Kapilivsky Joshuah , Michuda Jackson , Sedgewick Andrew J. , Munson Wesley A. , Chandra Tushar A. , Dry Jonathan R. , Beaubier Nike , Igartua Catherine , Taxter Timothy
Published: May 2022

Background

With the introduction of DNA-damaging therapies into standard of care cancer treatment, there is a growing need for predictive diagnostics assessing homologous recombination deficiency (HRD) status across tumor types. Following the strong clinical evidence for the utility of DNA-sequencing-based HRD testing in ovarian cancer, and growing evidence in breast cancer, we present analytical validation of the Tempus HRD-DNA test. We further developed, validated, and explored the Tempus HRD-RNA model, which uses gene expression data from 16,750 RNA-seq samples to predict HRD status from formalin-fixed paraffin-embedded tumor samples across numerous cancer types.

Methods

Genomic and transcriptomic profiling was performed using next-generation sequencing from Tempus xT, Tempus xO, Tempus xE, Tempus RS, and Tempus RS.v2 assays on 48,843 samples. Samples were labeled based on theirBRCA1, BRCA2and selected Homologous Recombination Repair pathway gene (CDK12, PALB2, RAD51B, RAD51C, RAD51D) mutational status to train and validate HRD-DNA, a genome-wide loss-of-heterozygosity biomarker, and HRD-RNA, a logistic regression model trained on gene expression.

Results

In a sample of 2058 breast and 1216 ovarian tumors, BRCA status was predicted by HRD-DNA with F1-scores of 0.98 and 0.96, respectively. Across an independent set of 1363 samples across solid tumor types, the HRD-RNA model was predictive of BRCA status in prostate, pancreatic, and non-small cell lung cancer, with F1-scores of 0.88, 0.69, and 0.62, respectively.

Conclusions

We predict HRD-positive patients across many cancer types and believe both HRD models may generalize to other mechanisms of HRD outside of BRCA loss. HRD-RNA complements DNA-based HRD detection methods, especially for indications with low prevalence of BRCA alterations.
Risk assessment and prediction for lung cancer among Hong Kong Chinese men
Authors: Tse Lap Ah , Wang Feng , Wong Martin Chi-sang , Au Joseph Siu-kei , Yu Ignatius Tak-sun
Published: May 2022

Objective

Most of the previous risk prediction models for lung cancer were developed from smokers, with discriminatory power ranging from 0.57 to 0.72. We constructed an individual risk prediction model for lung cancer among the male general population of Hong Kong.

Methods

Epidemiological data of 1,069 histology confirmed male lung cancer cases and 1,208 community controls were included in this analysis. Residential radon exposure was retrospectively reconstructed based on individual lifetime residential information. Multivariable logistic regression with repeated cross-validation method was used to select optimal risk predictors for each prediction model for different smoking strata. Individual absolute risk for lung cancer was estimated by Gail model. Receiver-operator characteristic curves, area under the curve (AUC) and confusion matrix were evaluated to demonstrate the model performance and ability to differentiate cases from non-cases.

Results

Smoking and smoking cessation, education, lung disease history, family history of cancer, residential radon exposure, dietary habits, carcinogens exposure, mask use and dust control in workplace were selected as the risk predictors for lung cancer. The AUC of estimated absolute risk for all lung cancers was 0.735 (95% CI: 0.714–0.756). Using 2.83% as the cutoff point of absolute risk, the predictive accuracy, positive predictive value and negative predictive value were 0.715, 0.818 and 0.674, respectively.

Conclusion

We developed a risk prediction model with moderate discrimination for lung cancer among Hong Kong males. External validation in other populations is warranted for this model in future studies.
Place of the partial dopamine receptor agonist aripiprazole in the management of schizophrenia in adults: a Delphi consensus study
Authors: Llorca Pierre-Michel , Nuss Philippe , Fakra Éric , Alamome Isabelle , Drapier Dominique , El Hage Wissam , Jardri Renaud , Mouchabac Stéphane , Rabbani Marc , Simon Nicolas , Vacheron Marie-Noëlle , Azorin Jean-Michel
Published: May 2022

Background

Aripiprazole is a second-generation antipsychotic, efficacious in patients with schizophrenia during acute episodes. Due to its pharmacological profile, aripiprazole may be of interest in patients with specific clinical profiles who have not been studied extensively in randomised clinical trials.

Objectives

To capture experience with aripiprazole in everyday psychiatric practice using the Delphi method in order to inform decision-making on the use of aripiprazole for the treatment of patients with schizophrenia in clinical situations where robust evidence from clinical trials is lacking.

Methods

The scope of the survey was defined as the management of schizophrenia in adults. A systematic literature review was performed to identify the different clinical situations in which aripiprazole has been studied, and to describe the level of clinical evidence. Clinical profiles to include in the Delphi survey were selected if there was a clear interest in terms of medical need but uncertainty over the efficacy of aripiprazole. For each clinical profile retained, five to seven specific statements were generated and included in a questionnaire. The final 41-item questionnaire was proposed to a panel of 406 French psychiatrists with experience in the treatment of schizophrenia. Panellists rated their level of agreement using a Likert scale. A second round of voting on eleven items was organised to clarify points for which a consensus was not obtained in the first round.

Results

Five clinical profiles were identified in the literature review (persistent negative symptoms, pregnancy, cognitive dysfunction, addictive comorbidity and clozapine resistance). Sixty-two psychiatrists participated in the first round of the Delphi survey and 33 in the second round. A consensus was obtained for 11 out of 41 items in the first round and for 9/11 items in the second round. According to the panellists’ clinical experience, aripiprazole can be used as maintenance treatment for pregnant women, is relevant to preserve cognitive function and can be considered an option in patients with a comorbid addictive disorder or with persistent negative symptoms.

Conclusion

These findings may help physicians in choosing relevant ways to use aripiprazole and highlight areas where more research is needed to widen the evidence base.
Associations between neighborhood built, social, or toxicant conditions and child externalizing behaviors in the Detroit metro area: a cross-sectional study of the neighborhood ‘exposome’
Authors: Pearson Amber L. , Shewark Elizabeth A. , Burt S. Alexandra
Published: May 2022

Background

The specific ‘active ingredients’ through which neighborhood disadvantage increases risk for child psychopathology remains unclear, in large part because research to date has nearly always focused on poverty to the exclusion of other neighborhood domains. The objective of this study was to evaluate whether currently assessed neighborhood built, social, or toxicant conditions were associated with child externalizing psychopathology outcomes separately, and in a combined model, using data from the Detroit-metro county area.

Methods

We conducted principal components analyses for built, social, or toxicant conditions. Next, we fitted separate multiple regression models for each of the child externalizing psychopathology measures (oppositional defiant and conduct problems) as a function of built, social, or toxicant components.

Results

We found that built features (more non-profits, churches, and alcohol outlets, and less agriculture and vacant properties) were associated with conduct problems, while toxicant conditions (high percent industrial, toxins released and number of pre-1978 structures) were associated with oppositional defiance problems. There was no significant association between greenspace or social conditions and child externalizing outcomes. When examined simultaneously, only the significant independent association between built conditions and conduct problems remained.

Conclusions

Built, social, and toxicant neighborhood conditions are not interchangeable aspects of a given neighborhood. What’s more, built features are uniquely associated with child externalizing outcomes independently of other neighborhood characteristics. Future research should consider how changes in the built conditions of the neighborhood (e.g., development, decay) serve to shape child externalizing behaviors, with a focus on identifying potentially actionable elements.
COVID-19 needs no passport: the interrelationship of the COVID-19 pandemic along the U.S.-Mexico border
Authors: Filosa John N. , Botello-Mares Adrian , Goodman-Meza David
Published: May 2022

Objectives

To investigate the impact of the COVID-19 pandemic along the U.S.-Mexico border region and evaluate the relationship of COVID-19 related mortality, socioeconomic status, and vaccination.

Methods

We used indirect standardization to age-adjust mortality rates and calculate standardized mortality ratios [SMR] in both countries. To examine the impact of socioeconomic factors, we calculated the Human Development Index (HDI) by county/municipality. We performed linear regression to understand the relationship between mortality, vaccination, and HDI. We used choropleth maps to visualize the trends seen in the region.

Results

Between January 22nd, 2020 and December 1st, 2021, surges of cases and deaths were similar in dyad cities along the U.S.-Mexico border visualizing the interconnectedness of the region. Mortality was higher in U.S. counties along the border compared to the national average (SMR 1.17, 95% CI 1.15–1.19). In Mexico, border counties had a slightly lower mortality to the national average (SMR 0.94, 95% CI 0.93–0.95). In U.S. border states, SMR was shown to negatively correlate with human development index (HDI), a socioeconomic proxy, resulting in a higher SMR in the border region compared to the rest of the counties. Conversely in Mexican border states, there was no association between SMR and HDI. Related to vaccination, U.S. counties along the border were vaccinated at a greater percentage than non-border counties and vaccination was negatively correlated with HDI. In Mexico, states along the border had a higher ratio of vaccinations per person than non-border states.

Conclusions

The U.S.-Mexico border is a divide of incredible importance not only to immigration but as a region with unique social, economic, environmental, and epidemiological factors that impact disease transmission. We investigated how the COVID-19 pandemic followed trends of previously studied diseases in the corridor such as tuberculosis, HIV, and influenza H1N1. These data state how targeted intervention along the U.S.-Mexico border region is a necessity when confronting COVID-19 and have implications for future control of infectious diseases in the region.
Comparison of pre-chop technique using a reverse chopper and classic stop-and-chop technique in the treatment of high myopia associated with nuclear cataract
Authors: Yang Ke , Li Jiaxin , Zhang Weihua , Liu Zhanjiang , Song Chenjie , Zhao Yang
Published: May 2022

Background

To evaluate the safety and efficacy of the pre-chop technique using a novel reverse chopper vs. the classic stop-and-chop technique in phacoemulsification for patients with high myopia and associated grade III–IV nuclear cataracts.

Methods

In this prospective cohort study, a total of 44 consecutive patients (44 eyes) with grade III–IV nuclear cataracts who were admitted to our hospital for cataract surgery between March 2018 and September 2018 were enrolled. All patients had ocular axial length > 27 mm and myopic refraction more than -10 diopters. Patients were randomly divided into a pre-chop group and stop-and-chop group using a randomization table. Nucleus splitting was performed surgically in both groups using either the pre-chop technique with reverse chopper or the classic stop-and-chop technique.

Results

Postoperative visual acuity was significantly improved in both groups compared with preoperative values. Significantly better visual acuity, lower degree of corneal edema and lower rates of corneal endothelial cell loss were observed in the pre-chop group compared to those in the classic stop-and-chop group. No complications were reported in either group.

Conclusions

In treating patients with high myopia associated with grade III–IV cataracts, the pre-chop technique using a reverse chopper reduces damage to corneal endothelial cells and improves visual acuity better than the classic stop-and-chop technique.
Prevalence and associated factors of erectile dysfunction in men with type 2 diabetes mellitus in eastern Sudan
Authors: Omar Saeed M. , Musa Imad R. , Idrees Maysoon B. , Abdelbagi Omer , Adam Ishag
Published: May 2022

Background

Diabetes mellitus (DM) is a global health threat and burden that is associated with many chronic complications. Erectile dysfunction (ED) among patients with DM is one of these complications. There is no published data on ED in Sudan; hence, we conducted this study to evaluate the prevalence of ED and the associated factors in patients with type 2 diabetes mellitus (T2DM) in eastern Sudan.

Methods

We performed a cross-sectional study. Data on blood glucose level, cholesterol level, anthropometric and demographic characteristics, results of the International Index of Erectile Function (IIEF-5) questionnaire, and clinical history were obtained.

Results

A total of 334 men with T2DM with a median (interquartile range [IQR]) age of 55.0 (±10.0) years were enrolled in the study. The median (IQR) of the duration of DM was 7.0 (±8) years, and 260 (77.8%) had uncontrolled T2DM. The median (IQR) body mass index was 24.5 (±4.9) kg/m2.

Of the participants, 81 (24.3%) had severe ED, 52 (15.6%) had moderate ED, 75 (22.5%) had mild to moderate ED, and 63 (13.9%) had mild ED. Of the 334 men, 271 (81.1%) had ED. Logistic regression analysis showed that age (adjusted Odds Ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.01–1.14), duration of DM (AOR = 1.26, 95% CI = 1.06–1.51), and cholesterol levels (AOR = 3.53, 95% CI = 1.75–7.11) were positively associated with ED. Moreover, poor glycaemic control (AOR = 3.38, 95% CI = 1.70–6.71, P < 0.001) was significantly associated with ED.

Conclusion

There is a high prevalence of ED among patients with T2DM in eastern Sudan. Age, duration of DM, and cholesterol were positively associated with ED.
The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study
Authors: Rezazadeh Fahimeh , Esnaashari Negin , Azad Azita , Emad Sara
Published: May 2022

Background

Temporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.

Materials and methods

Thirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance andt-tests.

Results

The results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 andP = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 andP = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).

Conclusions

It can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.

Trial registrationThe local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).
The relationship between the severity of perimenstrual symptoms and a regular exercise habit in Japanese young women: a cross-sectional online survey
Authors: Mizuta Rami , Maeda Noriaki , Komiya Makoto , Suzuki Yuta , Tashiro Tsubasa , Kaneda Kazuki , Tsutsumi Shogo , Ishihara Honoka , Kuroda Sayo , Urabe Yukio
Published: May 2022

Background

Experiencing perimenstrual symptoms is a major health concern for young women. Women in the reproductive age experience menstruation about once a month, and many experience perimenstrual symptoms. Drug therapies such as painkillers (commonly used) and hormonal medications help to achieve symptomatic relief from perimenstrual symptoms. However, many women are concerned about tolerance and compliance of the drugs used to treat perimenstrual symptoms and lack awareness on how to cope with perimenstrual symptoms. If the association between exercise habits and the severity of symptoms is emphasized in young women, methods for coping with perimenstrual symptoms can be established, not relying only on pharmaceuticals. The objective of this study was to determine the differences in the severity of perimenstrual symptoms in young Japanese women with and without a regular exercise habit.

Methods

A cross-sectional study using an online survey was sent among 500 Japanese women aged 18–25 years. The severity of perimenstrual symptoms was assessed using the Menstrual Distress Questionnaire (MDQ). The differences in MDQ scores between those with and without exercise habits (exercise for more than 30 min for 2 days a week) were compared using the chi-square test and Mann–Whitney U test. The logistic regression analysis detected subscales of the premenstrual and menstrual symptoms affected by an exercise habit.

Results

282 (56.4%) young Japanese women were answered this survey. Respondents were divided into the exercise group (n = 157) and the non-exercise group (n = 125). The exercise group had significantly low premenstrual and menstrual MDQ scores. The results of the logistic regression analysis stated that the subscale related to negative emotion before menstruation was associated with an exercise habit. In the analysis performed during menstruation, a statistically significant association was detected between an exercise habit and a behavioral change such as avoiding interaction with others.

Conclusions

This study suggested that exercise habits may reduce the severity of perimenstrual symptoms and could help to develop a non-pharmacological coping strategy. In addition, this study provides useful information for young women who want to prevent perimenstrual symptoms but do not have an exercise habit. Further, it may encourage young women to start exercising.
Perceived social support and coping style as mediators between resilience and health-related quality of life in women newly diagnosed with breast cancer: a cross-sectional study
Authors: Zhou Kaina , Ning Fan , Wang Xiao , Wang Wen , Han Dongfang , Li Xiaomei
Published: May 2022

Background

Breast cancer may impair health-related quality of life (HRQoL). We examined the mediating roles of perceived social support (PSS) and coping style (CS) in the relationship between resilience and HRQoL in newly diagnosed breast cancer patients.

Methods

Following a cross-sectional design, 431 patients completed a survey at two hospitals in Shaanxi Province, China. Four validated self-report measures assessed HRQoL, psychological resilience, PSS, and CS. A one-samplet-test analyzed differences between resilience, PSS, and CS in breast cancer patients and the corresponding norm. Multivariate linear regression analyzed the independent predictors of HRQoL. The mediating roles of PSS and CS between resilience and HRQoL were investigated using structural equation modeling (SEM).

Results

Participants had significantly lower scores for resilience and PSS, and higher scores for the avoidance and resignation CSs than their corresponding norm. SEM analysis showed resilience had significant direct effects on PSS (Bs: 0.59, 95% CI 0.49, 0.68,P = 0.003), CS (confrontation: 0.53 (0.44, 0.62),P = 0.001; resignation: − 0.66 (− 0.74, − 0.57),P = 0.002), and HRQoL (Bs range from 0.44 to 0.63,P < 0.05). Resilience had significant indirect effects (Bs range from 0.09 to 0.27), and PSS and CS had significant direct effects on HRQoL (P < 0.05).

Conclusions

Newly diagnosed breast cancer patients had lower resilience and PSS, and higher negative CSs, suggesting that PSS and CS mediated the influence of resilience on HRQoL. A multimodal intervention program focusing on PSS and CS might improve the positive influences of resilience on HRQoL in breast cancer patients.
Health care workers’ perspectives on care for patients with injection drug use associated infective endocarditis (IDU-IE)
Authors: Butt Saira , McClean Mitchell , Turner Jane , Roth Sarah , Rollins Angela L.
Published: May 2022

Background

Despite high morbidity and mortality, patients with injection drug use associated infective endocarditis (IDU-IE) lack standardized care, and experience prolonged hospitalization and variable substance use disorder (SUD) management.

Our study’s objective was to elicit perspectives of health care workers (HCWs) who deliver care to this population by understanding their perceived patient, provider, and system-level resources and barriers.

Methods

This qualitative study included interviews of HCWs providing care to patients with IDU-IE from January 2017 to December 2019 at a single Midwest academic center. Based on electronic medical record queries to determine high and low rates of referral to SUD treatment, HCWs were selected using stratified random sampling followed by convenience sampling of non-physician HCWs and a patient. Study participants were recruited via email and verbal consent was obtained. The final sample included 11 hospitalists, 3 specialists (including 2 cardiovascular surgery providers), 3 case managers, 2 social workers, 1 nurse, and 1 patient. Qualitative semi-structured interviews explored challenges and resources related to caring for this population. Qualitative Data Analysis (QDA) Minor Lite was used for thematic data using an inductive approach.

Results

Three major thematic categories emerged relative to patient-level barriers (e.g., pain control, difficult patient interactions, social determinants of health), provider-level barriers (e.g., inequity, expectations for recovery, varying levels of hope, communication style, prescribing medication for SUD), and system-level barriers (e.g., repeat surgery, placement, resources for SUD and mental health). The need to address underlying SUD was a prominent theme.

Conclusion

Practical steps we can take to improve treatment for this population include training and coaching HCWs on a more person-centered approach to communication and transparent decision-making around pain management, surgery decisions, and expectations for SUD treatment.
Safety and tolerability of pirfenidone in asbestosis: a prospective multicenter study
Authors: Miedema Jelle R. , Moor Catharina C. , Veltkamp Marcel , Baart Sara , Lie Natascha S. L. , Grutters Jan C. , Wijsenbeek Marlies S. , Mostard Rémy L. M.
Published: May 2022

Background

Pirfenidone slows down disease progression in idiopathic pulmonary fibrosis (IPF). Recent studies suggest a treatment effect in progressive pulmonary fibrosis other than IPF. However, the safety and effectiveness of pirfenidone in asbestosis patients remain unclear. In this study, we aimed to investigate the safety, tolerability and efficacy of pirfenidone in asbestosis patients with a progressive phenotype.

Methods

This was a multicenter prospective study in asbestosis patients with progressive lung function decline. After a 12-week observational period, patients were treated with pirfenidone 801 mg three times a day. Symptoms and adverse events were evaluated weekly and patients completed online patient-reported outcomes measures. At baseline, start of therapy, 12 and 24 weeks, in hospital measurement of lung function and a 6 min walking test were performed. Additionally, patients performed daily home spirometry measurements.

Results

In total, 10 patients were included of whom 6 patients (66.7%) experienced any adverse events during the study period. Most frequently reported adverse events were fatigue, rash, anorexia and cough, which mostly occurred intermittently and were reported as not very bothersome. No significant changes in hospital pulmonary function (forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), 6 min walking test or patient-reported outcomes measures before and after start of pirfenidone were found. Home spirometry demonstrated a FVC decline in 12 weeks before start of pirfenidone, while FVC did not decline during the 24 week treatment phase, but this difference was not statistically significant.

Conclusions

Treatment with pirfenidone in asbestosis has an acceptable safety and tolerability profile and home spirometry data suggest this antifibrotic treatment might attenuate FVC decline in progressive asbestosis.

Trial registration MEC-2018-1392; EudraCT number: 2018-001781-41
SEVA-Cpf1, a CRISPR-Cas12a vector for genome editing in cyanobacteria
Authors: Baldanta Sara , Guevara Govinda , Navarro-Llorens Juana María
Published: May 2022

Background

Cyanobacteria are photosynthetic autotrophs that have tremendous potential for fundamental research and industrial applications due to their high metabolic plasticity and ability to grow using CO2 and sunlight. CRISPR technology using Cas9 and Cpf1 has been applied to different cyanobacteria for genome manipulations and metabolic engineering. Despite significant advances with genome editing in several cyanobacteria strains, the lack of proper genetic toolboxes is still a limiting factor compared to other model laboratory species. Among the limitations, it is essential to have versatile plasmids that could ease the benchwork when using CRISPR technology.

Results

In the present study, several CRISPR-Cpf1 vectors were developed for genetic manipulations in cyanobacteria using SEVA plasmids. SEVA collection is based on modular vectors that enable the exchangeability of diverse elements (e.g. origins of replication and antibiotic selection markers) and the combination with many cargo sequences for varied end-applications. Firstly, using SEVA vectors containing the broad host range RSF1010 origin we demonstrated that these vectors are replicative not only in model cyanobacteria but also in a new cyanobacterium specie, Chroococcidiopsis sp., which is different from those previously published. Then, we constructed SEVA vectors by harbouring CRISPR elements and showed that they can be easily assimilated not only by conjugation, but also by natural transformation. Finally, we used our SEVA-Cpf1 tools to delete the nblA gene in Synechocystis sp. PCC 6803, demonstrating that our plasmids can be applied for CRISPR-based genome editing technology.

Conclusions

The results of this study provide new CRISPR-based vectors based on the SEVA (Standard European Vector Architecture) collection that can improve editing processes using the Cpf1 nuclease in cyanobacteria.
Dual-functional alginate and collagen–based injectable hydrogel for the treatment of cancer and its metastasis
Authors: Hwang Juyoung , An Eun-Koung , Zhang Wei , Kim Hyo Jeong , Eom Youngho , Jin Jun-O.
Published: May 2022

Background

Immunotherapies have been gaining attention for the prevention of cancer recurrence and metastasis. Cancer immunotherapy can induce memory cells to target cancer-specific antigens and, thus, selectively kill cancer cells. However, there are difficulties in inducing cancer antigen–specific immunity due to limited knowledge regarding cancer antigens. In this study, we synthesized a dual-functional hydrogel to induce antigen generation and immune activation.

Results

To elicit a cancer self-antigen–specific immune response, we synthesized an alginate-collagen–based injectable hydrogel, called thermally responsive hydrogel (pTRG), which was incorporated with indocyanine green and the immune stimulator polyinosinic:polycytidylic acid (poly I:C). pTRG was evaluated for its anticancer and anti-metastatic effects against CT-26 carcinoma and 4T1 breast tumor in mice by combining photothermal therapy (PTT) and immunotherapy. Near-infrared (NIR) irradiation promoted temperature elevation in pTRG, consequently exerting a therapeutic effect on mouse tumors. Lung metastasis was prevented in cured CT-26 tumor-injected mice following pTRG treatment via cancer antigen–specific T cell immunity. Moreover, pTRG successfully eliminated the original tumor in 4T1 tumor-bearing mice via PTT and protected them from lung metastasis. To further evaluate the carrier function of TRGs, different types of immunotherapeutic molecules were incorporated into TRGs, which led to the effective elimination of the first CT-26 tumor and the prevention of lung metastasis.

Conclusions

Our data demonstrate that TRG is a efficient material not only for treating primary tumors but also for preventing metastasis and recurrence.
Elaborate design of shell component for manipulating the sustained release behavior from core–shell nanofibres
Authors: Liu Yubo , Chen Xiaohong , Gao Yuhang , Yu Deng-Guang , Liu Ping
Published: May 2022

Background

The diversified combination of nanostructure and material has received considerable attention from researchers to exploit advanced functional materials. In drug delivery systems, the hydrophilicity and sustained–release drug properties are in opposition. Thus, difficulties remain in the simultaneous improve sustained–release drug properties and increase the hydrophilicity of materials.

Methods

In this work, we proposed a modified triaxial electrospinning strategy to fabricate functional core–shell fibres, which could elaborate design of shell component for manipulating the sustained-release drug. Cellulose acetate (CA) was designed as the main polymeric matrix, whereas polyethylene glycol (PEG) was added as a hydrophilic material in the middle layer. Cur, as a model drug, was stored in the inner layer.

Results

Scanning electron microscopy (SEM) results and transmission electron microscopy (TEM) demonstrated that the cylindrical F2–F4 fibres had a clear core–shell structure. The model drug Cur in fibres was verified in an amorphous form during the X-ray diffraction (XRD) patterns, and Fourier transformed infrared spectroscopy (FTIR) results indicated good compatibility with the CA matrix. The water contact angle test showed that functional F2–F4 fibres had a high hydrophilic property in 120 s and the control sample F1 needed over 0.5 h to obtain hydrophilic property. In the initial stage of moisture intrusion into fibres, the quickly dissolved PEG component guided the water molecules and rapidly eroded the internal structure of functional fibres. The good hydrophilicity of F2–F4 fibres brought relatively excellent swelling rate around 4600%. Blank outer layer of functional F2 fibres with 1% PEG created an exciting opportunity for providing a 96 h sustained-release drug profile, while F3 and F4 fibres with over 3% PEG provided a 12 h modified drug release profile to eliminate tailing–off effect.

Conclusion

Here, the functional F2–F4 fibres had been successfully produced by using the advanced modified triaxial electrospinning nanotechnology with different polymer matrices. The simple strategy in this work has remarkable potential to manipulate hydrophilicity and sustained release of drug carriers, meantime it can also enrich the preparation approaches of functional nanomaterials.

Graphical Abstract
Minimal extrathyroidal extension is associated with lymph node metastasis in single papillary thyroid microcarcinoma: a retrospective analysis of 814 patients
Authors: Song Ra-Yeong , Kim Hee Sung , Kang Kyung Ho
Published: May 2022

Background

Extrathyroidal extension (ETE) is considered a major prognostic factor in papillary thyroid carcinoma (PTC). Patients with gross ETE are at increased risk of recurrence and mortality. The importance of minimal ETE still remains controversial, especially in patients with papillary thyroid microcarcinoma (PTMC). The purpose of this study was to evaluate the association between ETE and lymph node (LN) metastasis in single PTMC.

Methods

A retrospective analysis was performed of 1994 patients underwent thyroidectomy for PTC between 2012 and 2016 in a single institution. Patients with combined thyroid carcinoma of other types and those who underwent completion thyroidectomy were excluded. After further exclusion of PTC larger than 1 cm and multifocal tumors, 814 patients with single PTMC were included in the study.

Results

72.9% patients had no ETE, 25.1% minimal ETE, and 2.1% gross ETE. ETE was associated with lymphatic invasion, perineural invasion, and vascular invasion. Patients with minimal and gross ETE were also more likely to have LN metastasis, including lateral neck metastasis, compared to those without ETE. In univariate analysis, LN metastasis was associated with male gender, conventional PTC, lymphatic invasion, perineural invasion, and ETE. In multivariate analysis, male gender (OR = 1.987; 95% CI 1.369–2.884), lymphatic invasion (OR = 4.389; 95% CI 1.522–12.658), perineural invasion (OR = 6.545; 95% CI 1.262–33.948), and minimal ETE (OR = 1.852; 95% CI 1.298–2.643) were found to be independent risk factors of LN metastasis.

Conclusions

Minimal ETE is associated with LN metastasis in single PTMC, compared to no ETE. Minimal ETE should be considered in the management of patients with single PTMC, whether surgical or during active surveillance.
Comparison of predictors for early and late mortality in adults commencing HIV antiretroviral therapy in Zimbabwe: a retrospective cohort study
Authors: Byers Bradley W. , Drak Douglas , Shamu Tinei , Chimbetete Cleophas , Dahwa Rumbi , Gracey David M.
Published: May 2022

Background

People living with HIV (PLWHIV) commencing antiretroviral therapy (ART) in sub-Saharan Africa experience significant mortality within the first year. Previously, identified risk factors for mortality may be biased towards these patients, as compared to those who experience late mortality.

Aim

To compare risk factors for early and late mortality in PLWHIV commencing ART.

Methods

A retrospective cohort study of ART-naïve patients aged ≥ 18 years from an outpatient HIV clinic in Zimbabwe. Data were collected between January 2010 and January 2019. Predictors for early (≤ 1 year) and late mortality (> 1 year) were determined by multivariable cox proportional hazards analyses, with patients censored at 1 year and landmark analysis after 1 year, respectively.

Results

Three thousand and thirty-nine PLWHIV were included in the analysis. Over a median follow-up of 4.6 years (IQR 2.5–6.9), there was a mortality rate of 8.8%, with 50.4% of deaths occurring within 1 year. Predictors of early mortality included CD4 count < 50 cells/µL (HR 1.84, 95% CI 1.24–2.72, p < 0.01), WHO Stage III (HR 2.05, 95% CI 1.28–3.27, p < 0.01) or IV (HR 2.83, 95% CI 1.67–4.81, p < 0.01), and eGFR < 90 mL/min/1.73 m2 (HR 2.48, 95% CI 1.56–3.96, p < 0.01). Other than age (p < 0.01), only proteinuria (HR 2.12, 95% CI 1.12–4.01, p = 0.02) and diabetes mellitus (HR 3.51, 95% CI 1.32–9.32, p = 0.01) were associated with increased risk of late mortality.

Conclusions

Traditional markers of mortality risk in patients commencing ART appear to be limited to early mortality. Proteinuria and diabetes are some of the few predictors of late mortality, and should be incorporated into routine screening of patients commencing ART.
Developing a new predictive index for anastomotic leak following the anastomosis of esophageal atresia: preliminary results from a single centre
Authors: Hong Song-Ming , Chen Qiang , Cao Hua , Hong Jun-Jie , Huang Jin-Xi
Published: May 2022

Background

The aim of this study was to determine a predictive index for the risk of anastomotic leak following esophageal atresia anastomosis,

Methods

This article reviewed the clinical data of 74 children with esophageal atresia in Fujian Children's hospital. The risk factors for anastomotic leak were analysed, and a new predictive index was proposed.

Results

The incidence of anastomotic leak was 29.7% after anastomosis in 74 children with esophageal atresia. Birth weight and gap length were risk factors for anastomotic leak. Logistic regression analysis showed that birth weight (Wald 2 = 4.528,P = 0.033, OR = 0.273) was a protective factor for anastomotic leak, whereas gap length (Wald 2 = 7.057,P = 0.008, OR = 2.388) was a risk factor for anastomotic leak. The ratio of gap length to birth weight had a positive predictive effect on the occurrence of anastomotic leak (AUC = 0.732,P = 0.002).

Conclusion

Birth weight and gap length are important predictors of anastomotic leak in esophageal atresia. Measurement of the ratio of gap length to birth weight is a helpful predictive index for anastomotic leak following the anastomosis of esophageal atresia.
Lutein levels in arterial cord blood correlate with neurotrophic calcium binding S100B protein in healthy preterm and term newborns
Authors: Picone Simonetta , Ritieni Alberto , Graziani Giulia , Paolillo Piermichele , D’Adamo Ebe , Botondi Valentina , Panichi Daniele , Torresi Sara , David Daniela , di Ludovico Armando , Chiarelli Francesco , Gazzolo Diego
Published: May 2022

Background

S100B is an established biomarker of brain development and damage. Lutein (LT) is a naturally occurring xanthophyll carotenoid mainly concentrated in the central nervous system (CNS), but its neurotrophic role is still debated. We investigated whether LT cord blood concentrations correlate with S100B in a cohort of preterm and term healthy newborns.

Methods

We conducted a prospective study on the distribution of LT and S100B in arterial cord blood of healthy preterm (n = 50) and term (n = 50) newborns.

Results

S100B and LT showed a pattern of concentration characterized by higher levels (P < 0.01, for all) at 33-36 weeks gestation (GA) followed by a progressive decrease (P < 0.01, for all) from 37 onwards with a dip at term. Both S100B and LT were gender-dependent with significantly (P < 0.01, for all) higher levels in females in preterm and term groups. S100B (R = 0.68; P < 0.001) and LT (R = 0.40; P = 0.005) correlated with GA at sampling. A positive significant correlation (R = 0.87; P < 0.001) between S100B and LT was found.

Conclusions

The present data showing a correlation between S100B and LT supports the notion of a LT trophic role in the CNS. Further investigations in high-risk infants are needed to elucidate LT involvement in the pathophysiological cascade of events leading to CNS development and damage.