bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan
Authors: Segi Naoki , Nakashima Hiroaki , Machino Masaaki , Ito Sadayuki , Yokogawa Noriaki , Sasagawa Takeshi , Funayama Toru , Eto Fumihiko , Watanabe Kota , Nori Satoshi , Furuya Takeo , Yunde Atsushi , Nakajima Hideaki , Hasegawa Tomohiko , Yamada Tomohiro , Terashima Yoshinori , Hirota Ryosuke , Suzuki Hidenori , Imajo Yasuaki , Ikegami Shota , Uehara Masashi , Tonomura Hitoshi , Sakata Munehiro , Hashimoto Ko , Onoda Yoshito , Kawaguchi Kenichi , Haruta Yohei , Suzuki Nobuyuki , Kato Kenji , Uei Hiroshi , Sawada Hirokatsu , Nakanishi Kazuo , Misaki Kosuke , Terai Hidetomi , Tamai Koji , Inoue Gen , Shirasawa Eiki , Kakutani Kenichiro , Iizuka Yoichi , Takasawa Eiji , Akeda Koji , Kiyasu Katsuhito , Tominaga Hiroyuki , Tokumoto Hiroto , Funao Haruki , Oshima Yasushi , Yoshii Toshitaka , Kaito Takashi , Sakai Daisuke , Ohba Tetsuro , Seki Shoji , Otsuki Bungo , Ishihara Masayuki , Miyazaki Masashi , Okada Seiji , Imagama Shiro , Kato Satoshi
Published: January 2023

Study Design

Retrospective multicenter study

Objectives

To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan.

Methods

The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients’ epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019).

Results

Both the number of patients and number of surgical patients showed a significant increasing trend ( P < .001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P = .001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P = .006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence.

Conclusions

Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.
Exploring the Correlations Between Measures of Listening Effort in Adults and Children: A Systematic Review with Narrative Synthesis
Authors: Shields Callum , Sladen Mark , Bruce Iain Alexander , Kluk Karolina , Nichani Jaya
Published: January 2023

Listening effort (LE) describes the cognitive resources needed to process an auditory message. Our understanding of this notion remains in its infancy, hindering our ability to appreciate how it impacts individuals with hearing impairment effectively. Despite the myriad of proposed measurement tools, a validated method remains elusive. This is complicated by the seeming lack of association between tools demonstrated via correlational analyses. This review aims to systematically review the literature relating to the correlational analyses between different measures of LE. Five databases were used– PubMed, Cochrane, EMBASE, PsychINFO, and CINAHL. The quality of the evidence was assessed using the GRADE criteria and risk of bias with ROBINS-I/GRADE tools. Each statistically significant analysis was classified using an approved system for medical correlations. The final analyses included 48 papers, equating to 274 correlational analyses, of which 99 reached statistical significance (36.1%). Within these results, the most prevalent classifications were poor or fair. Moreover, when moderate or very strong correlations were observed, they tended to be dependent on experimental conditions. The quality of evidence was graded as very low. These results show that measures of LE are poorly correlated and supports the multi-dimensional concept of LE. The lack of association may be explained by considering where each measure operates along the effort perception pathway. Moreover, the fragility of significant correlations to specific conditions further diminishes the hope of finding an all-encompassing tool. Therefore, it may be prudent to focus on capturing the consequences of LE rather than the notion itself.
A reflection on the essence of gratitude in palliative care: healing in severe disease and professional affirmation through accompanying patients until the end
Authors: Arantzamendi María , Aparicio Maria , Centeno Carlos , Sánchez-Migallón Sergio , Riojas Mariana , De Julián Victoria , Crespo Mariano
Published: January 2023

Background:

Gratitude has sparked interest in the world of health. It is considered as a personality characteristic or as an emotion. However, little has been explored in the context of the interpersonal relationship of caring. An exploration in the context of end of life is ground-breaking.

Objectives:

This study analyses and reflects on the object of gratitude from the perspective of both the persons being cared for and the professionals providing health care. What are patients and their family members grateful for in palliative care? What is the reason for gratitude? What do these health professionals perceive when there is gratitude? These questions were answered considering the gratitude generated in health care encounters, not gratitude as personality trait.

Methods:

The phenomenological approach was used starting from lived clinical experiences. In the light of the dialogue between clinical experiences and philosophy, this study proposes an explanation of the ‘real’ or essential object of gratitude in palliative care. It was conducted within the context of palliative care. The study materials were manifestations of gratitude expressed or felt in clinical encounters and published in newspapers or shared in daily encounters. These were the basis for analysis and reflection and interdisciplinary dialogue.

Findings:

The analyses performed indicated healing or deep relief in serious diseases as objects of gratitude according to patients’ perspective, and professional self-affirmation until the end according to the professionals’ perspective.

Conclusion:

The two perspectives shared an important common fact, namely, the need to consider the persons in their entirety, and the importance of not losing sight of the value they have. This concept would characterize the nature of gratitude, its object being the ‘objective good’ for patients, family members, and palliative care professionals.
Esophageal Inlet Patch: A Clinically Significant Entity in Advanced Pulmonary Disease and Lung Transplant Rejection
Authors: Iyer Neena R. , Afshar Kamyar , Joshua Jisha , Golts Eugene , Yung Gordon L. , Kafi Aarya , Conrad Douglas J. , Kunkel David C.
Published: January 2023

Background:

Esophageal inlet patch (IP) refers to heterotopic gastric mucosa in the cervical esophagus. Secretions from IP may produce symptoms of laryngopharyngeal reflux (LPR) and accelerate progression of lung disease. We aimed to characterize the significance of IP among patients with advanced pulmonary disease, including lung transplant (LTx) recipients, and to assess outcomes following IP ablation.

Methods:

We established and reviewed a prospective database of all patients with advanced pulmonary disease referred for GI motility evaluation for presence of IP over 7 years. Total IP size, results of pH testing, incidence of transplant rejection and mortality, and effects of IP ablation on symptoms were analyzed.

Results:

Twenty-seven (13 LTx recipients) of 440 pulmonary patients referred for upper endoscopy were found to have IPs, and 14 completed IP ablation (mean number of 1.7 sessions to ablate IP). Total IP size correlated with total acid exposure time ( P = .01) and symptoms of cough ( P < .00001), heartburn ( P = .0001), and globus ( P < .00001). Symptom severity of heartburn and dysphagia improved following IP ablation ( P = .04 and 0.008). Eight of 13 LTx patient with IP developed either acute or chronic rejection, with 3 cases of post-LTx mortality occurring in patients who did not undergo IP ablation.

Conclusions:

IP should be given careful consideration in patients with advanced pulmonary disease and lung transplant recipients, particularly if symptoms of cough, heartburn, or globus are present. Total IP size may be predictive of severity of LPR, and symptom recurrence should prompt re-examination for residual IP.
Risk Assessments in Orthognathic Surgery: A National Inpatient Sample (NIS) and Nationwide Ambulatory Surgery Sample (NASS) Analysis
Authors: Lopez Christopher D. , River Perla Krissia M. , Njoroge Moreen W. , Yusuf Cynthia T. , Yang Robin
Published: January 2023

Background:

Orthognathic surgery is an effective treatment for deformities involving the middle and lower third of the face. While orthognathic surgery has been demonstrated to have potential benefits, patients may be reluctant to proceed due to concerns regarding the outcome of the treatment, possibility of complications, length of hospitalization, and financial costs. This study aimed to determine whether systemic comorbidities as risk factors affect the outcomes, costs, and of surgical management for orthognathic patients.

Methods:

Patients who underwent orthognathic surgery, maxillary, mandibular, or both were identified from both the National Inpatient Sample (NIS) and the Nationwide Ambulatory Surgery Sample (NASS) Databases. A cross-sectional study was conducted involving patients who underwent orthognathic surgery between the years 2016 and 2018. Data collected included patient age, gender, race, median household income, insurance type, severity of illness, and comorbidities such as obstructive sleep apnea, smoking, hypertension, and diabetes. Multivariable regression was used to characterize the role of insurance status, median household income, comorbidities, and total charges in the inpatient setting versus the outpatient setting.

Results:

A total of 20 848 patients in the United States who underwent orthognathic surgery involving either single or double-jaw procedures were included. Diabetes ( P < .05), smoking ( P < .015), obesity ( P < .001), and Black race ( P < .001) were significantly associated with greater length of hospitalization. Patients who underwent isolated maxillary orthognathic procedures were less likely to incur increased costs due to obesity as a comorbid condition ( P < .001). Hispanic patients who underwent single-jaw surgeries, either maxillary or mandibular, had 93% increased odds of having higher total charges incurred ( P < .001).

Conclusion:

Longer hospital stays are associated with more comorbid conditions and more expensive and complex procedures. Comprehensive assessments of patients’ comorbidities may be useful for predicting the length of stay as well as risk stratification in orthognathic surgery.
Investigation of sound absorption capability of pine (Pinus densiflora) cone particles
Authors: Jang Eun-Suk , Kang Chun-Won
Published: January 2023

In this study, the sound absorption capability of pine (Pinus densiflora) cone particles was investigated as an alternative and eco-friendly, sound-absorbing material. The sound absorption coefficient of pine cone particles was examined after filling impedance tubes with 4, 6, 8, and 10 cm of particles. The sound absorption capability of 4 cm and 6 cm thickness was categorized as 0.5 M class, and that of 8 cm and 10 cm thickness was classed as 0.8 M class according to the KS F 3503 sound-absorbing capability classification of sound-absorbing materials. In particular, 10 cm pine cone particles demonstrated exceptional sound absorption capability in the range of 250–6400 Hz, with an average sound absorption coefficient of 0.6 or greater. In conclusion, pine cone particles were found to have excellent sound absorption capability. Thus, this work suggests that pine cone particles may be useful as an eco-friendly, sound-absorbing material.
Upper respiratory tract microbiota is associated with small airway function and asthma severity
Authors: Li Yi , Zou Congying , Li Jieying , Wang Wen , Guo Yue , Zhao Lifang , Jiang Chunguo , Zhao Peng , An Xingqin
Published: January 2023

Background

Characteristics of airway microbiota might influence asthma status or asthma phenotype. Identifying the airway microbiome can help to investigate its role in the development of asthma phenotypes or small airway function.

Methods

Bacterial microbiota profiles were analyzed in induced sputum from 31 asthma patients and 12 healthy individuals from Beijing, China. Associations between small airway function and airway microbiomes were examined.

Results

Composition of sputum microbiota significantly changed with small airway function in asthma patients. Two microbiome-driven clusters were identified and characterized by small airway function and taxa that had linear relationship with small airway functions were identified.

Conclusions

Our findings confirm that airway microbiota was associated with small airway function in asthma patients.
Testing for terrestrial and freshwater microalgae productivity under elevated CO2 conditions and nutrient limitation
Authors: Kryvenda Anastasiia , Tischner Rudolf , Steudel Bastian , Griehl Carola , Armon Robert , Friedl Thomas
Published: January 2023

Background

Microalgae CO2fixation results in the production of biomass rich in high-valuable products, such as fatty acids and carotenoids. Enhanced productivity of valuable compounds can be achieved through the microalgae’s ability to capture CO2efficiently from sources of high CO2contents, but it depends on the species. Culture collections of microalgae offer a wide variety of defined strains. However, an inadequate understanding of which groups of microalgae and from which habitats they originate offer high productivity under increased CO2concentrations hampers exploiting microalgae as a sustainable source in the bioeconomy.

Results

A large variety of 81 defined algal strains, including new green algal isolates from various terrestrial environments, were studied for their growth under atmospheres with CO2levels of 5–25% in air. They were from a pool of 200 strains that had been pre-selected for phylogenetic diversity and high productivity under ambient CO2. Green algae from terrestrial environments exhibited enhanced growth up to 25% CO2. In contrast, in unicellular red algae and stramenopile algae, which originated through the endosymbiotic uptake of a red algal cell, growth at CO2concentrations above 5% was suppressed. While terrestrial stramenopile algae generally tolerated such CO2concentrations, their counterparts from marine phytoplankton did not. The tests of four new strains in liquid culture revealed enhanced biomass and chlorophyll production under elevated CO2levels. The 15% CO2aeration increased their total carotenoid and fatty acid contents, which were further stimulated when combined with the starvation of macronutrients, i.e., less with phosphate and more with nitrogen-depleted culture media.

Conclusion

Green algae originating from terrestrial environments, Chlorophyceae and Trebouxiophyceae, exhibit enhanced productivity of carotenoids and fatty acids under elevated CO2concentrations. This ability supports the economic and sustainable production of valuable compounds from these microalgae using inexpensive sources of high CO2concentrations, such as industrial exhaust fumes.
Colonic TRPV4 overexpression is related to constipation severity
Authors: Mihara Hiroshi , Uchida Kunitoshi , Watanabe Yoshiyuki , Nanjo Sohachi , Sakumura Miho , Motoo Iori , Ando Takayuki , Minemura Masami , Muhammad Jibran Sualeh , Yamamoto Hiroyuki , Itoh Fumio , Yasuda Ichiro
Published: January 2023

Background

Chronic constipation is prevalent and involves both colon sensitivity and various changes in intestinal bacteria, particularly mucosa-associated microflora. Here we examined regulatory mechanisms of TRPV4 expression by co-culturing colon epithelial cell lines with intestinal bacteria and their derivatives. We also investigated TRPV4 expression in colon epithelium from patients with constipation.

Methods

Colon epithelial cell lines were co-cultured with various enterobacteria (bacterial components and supernatant), folate, LPS, or short chain fatty acids. TRPV4 expression levels and promoter DNA methylation were assessed using pyrosequencing, and microarray network analysis. For human samples, correlation coefficients were calculated and multiple regression analyses were used to examine the association between clinical background, rectal TRPV4 expression level and mucosa-associated microbiota.

Results

Co-culture of CCD841 cells with P. acnes, C. perfringens, or S. aureus transiently decreased TRPV4 expression but did not induce methylation. Co-culture with clinical isolates and standard strains of K. oxytoca, E. faecalis, or E. coli increased TRPV4 expression in CCD841 cells, and TRPV4 and TNF-alpha expression were increased by E. coli culture supernatants but not bacterial components. Although folate, LPS, IL-6, TNF-alpha, or SCFAs alone did not alter TRPV4 expression, TRPV4 expression following exposure to E. coli culture supernatants was inhibited by butyrate or TNF-alphaR1 inhibitor and increased by p38 inhibitor. Microarray network analysis showed activation of TNF-alpha, cytokines, and NOD signaling. TRPV4 expression was higher in constipated patients from the terminal ileum to the colorectum, and multiple regression analyses showed that low stool frequency, frequency of defecation aids, and duration were associated with TRPV4 expression. Meanwhile, incomplete defecation, time required to defecate, and number of defecation failures per 24 h were associated with increased E. faecalis frequency.

Conclusions

Colon epithelium cells had increased TRPV4 expression upon co-culture with K. oxytoca, E. faecalis, or E. coli supernatants, as well as TNFα-stimulated TNFαR1 expression via a pathway other than p38. Butyrate treatment suppressed this increase. Epithelial TRPV4 expression was increased in constipated patients, suggesting that TRPV4 together with increased frequency of E. faecalis may be involved in the pathogenesis of various constipation symptoms.
The effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy during COVID-19 pandemic: a ramdomized controlled trial
Authors: Shamsdanesh Shiva , Nourizadeh Roghaiyeh , Hakimi Sevil , Ranjbar Fatemeh , Mehrabi Esmat
Published: January 2023

Background

Successful breastfeeding is related to the psychosocial conditions of the mother. Covid19 pandemic resulted in psychological consequences in women during postpartum period. Maternal anxiety and distress reduce the chances of exclusive breastfeeding. The present study aimed to investigate the effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy (BSE) during COVID-19 pandemic.

Method

This randomized controlled clinical trial was conducted on 64 breastfeeding mothers referred to health care centers in Tabriz, Iran in 2021. Participants were assigned into the intervention and control groups in a ratio of 1: 1 using block randomization in a block size of 4 and 6. The intervention group participated in six individual 60–90 min sessions. Spielberger State-Trait Anxiety Inventory (STAI), postpartum distress (PMD), and BSE questionnaires were completed before and 4-week after the intervention by the control and intervention groups. Independent t-test and ANCOVA were used to compare the outcomes between two groups.

Results

According to the ANCOVA results by controlling the baseline values and after the intervention, the mean score of anxiety in the intervention group was lower than that in the control group [Adjusted Mean Difference (AMD): -13.82, 95%, confidence interval (CI): -12.35 to -15.29, (p < 0.001)]. Further, the mean score of postpartum distress after intervention was lower in the intervention group compared with that in the control group [AMD:5.31 95% CI: -3.00 to -7.37 (p < 0.001)]. After the intervention, the mean score of BSE in the intervention group was significantly higher than that in the control group [AMD: 25.57, 95% CI: 22.85 to 28.29 (p < 0.001)].

Conclusion

Stress management counseling can improve postpartum anxiety and distress and BSE and increase breastfeeding. However, more studies are needed for a definitive conclusion.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N6. Date of registration: 15/09/2021.
A meta-validated immune infiltration-related gene model predicts prognosis and immunotherapy sensitivity in HNSCC
Authors: Ding Yinghe , Chu Ling , Cao Qingtai , Lei Hanyu , Li Xinyu , Zhuang Quan
Published: January 2023

Background

Tumor microenvironment (TME) is of great importance to regulate the initiation and advance of cancer. The immune infiltration patterns of TME have been considered to impact the prognosis and immunotherapy sensitivity in Head and Neck squamous cell carcinoma (HNSCC). Whereas, specific molecular targets and cell components involved in the HNSCC tumor microenvironment remain a twilight zone.

Methods

Immune scores of TCGA-HNSCC patients were calculated via ESTIMATE algorithm, followed by weighted gene co-expression network analysis (WGCNA) to filter immune infiltration-related gene modules. Univariate, the least absolute shrinkage and selection operator (LASSO), and multivariate cox regression were applied to construct the prognostic model. The predictive capacity was validated by meta-analysis including external dataset GSE65858, GSE41613 and GSE686. Model candidate genes were verified at mRNA and protein levels using public database and independent specimens of immunohistochemistry. Immunotherapy-treated cohort GSE159067, TIDE and CIBERSORT were used to evaluate the features of immunotherapy responsiveness and immune infiltration in HNSCC.

Results

Immune microenvironment was significantly associated with the prognosis of HNSCC patients. Total 277 immune infiltration-related genes were filtered by WGCNA and involved in various immune processes. Cox regression identified nine prognostic immune infiltration-related genes (MORF4L2, CTSL1, TBC1D2, C5orf15, LIPA, WIPF1, CXCL13, TMEM173, ISG20) to build a risk score. Most candidate genes were highly expressed in HNSCC tissues at mRNA and protein levels. Survival meta-analysis illustrated high prognostic accuracy of the model in the discovery cohort and validation cohort. Higher proportion of progression-free outcomes, lower TIDE scores and higher expression levels of immune checkpoint genes indicated enhanced immunotherapy responsiveness in low-risk patients. Decreased memory B cells, CD8+ T cells, follicular helper T cells, regulatory T cells, and increased activated dendritic cells and activated mast cells were identified as crucial immune cells in the TME of high-risk patients.

Conclusions

The immune infiltration-related gene model was well-qualified and provided novel biomarkers for the prognosis of HNSCC.
Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial)
Authors: Aguirre-Allende Ignacio , Alkorta-Zuloaga Maialen , Iglesias-Gaspar Maria Teresa , Urreta-Ballobre Iratxe , García-Domínguez Amaia , Arteaga-Martin Xabier , Beguiristain-Gómez Adolfo , Medrano-Gómez Miguel Ángel , Ruiz-Montesinos Inmaculada , Riverola-Aso Ana Paula , Jiménez-Agüero Raúl , Enríquez-Navascués José María
Published: January 2023

Background

Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery.

Methods

Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation.

Results

Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015).

Conclusions

Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds.

Trial registration number: ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
Advanced neonatal procedural skills: a simulation-based workshop: impact and skill decay
Authors: Stritzke Amelie , Murthy Prashanth , Fiedrich Elsa , Assaad Michael-Andrew , Howlett Alexandra , Cheng Adam , Vickers David , Amin Harish
Published: January 2023

Background

Trainees aiming to specialize in Neonatal Perinatal Medicine (NPM), must be competent in a wide range of procedural skills as per the Royal College of Canada. While common neonatal procedures are frequent in daily clinical practice with opportunity to acquire competence, there are substantial gaps in the acquisition of advanced neonatal procedural skills. With the advent of competency by design into NPM training, simulation offers a unique opportunity to acquire, practice and teach potentially life-saving procedural skills. Little is known on the effect of simulation training on different areas of competence, and on skill decay.

Methods

We designed a unique simulation-based 4-h workshop covering 6 advanced procedures chosen because of their rarity yet life-saving effect: chest tube insertion, defibrillation, exchange transfusion, intra-osseus (IO) access, ultrasound-guided paracentesis and pericardiocentesis. Direct observation of procedural skills (DOPS), self-perceived competence, comfort level and cognitive knowledge were measured before (1), directly after (2), for the same participants after 9–12 months (skill decay, 3), and directly after a second workshop (4) in a group of NPM and senior general pediatric volunteers.

Results

The DOPS for all six procedures combined for 23 participants increased from 3.83 to 4.59. Steepest DOPS increase pre versus post first workshop were seen for Defibrillation and chest tube insertion. Skill decay was evident for all procedures with largest decrease for Exchange Transfusion, followed by Pericardiocentesis, Defibrillation and Chest Tube. Self-perceived competence, comfort and cognitive knowledge increased for all six procedures over the four time points. Exchange Transfusion stood out without DOPS increase, largest skill decay and minimal impact on self-assessed competence and comfort. All skills were judged as better by the preceptor, compared to self-assessments.

Conclusions

The simulation-based intervention advanced procedural skills day increased preceptor-assessed directly observed procedural skills for all skills examined, except exchange transfusion. Skill decay affected these skills after 9–12 months. Chest tube insertions and Defibrillations may benefit from reminder sessions, Pericardiocentesis may suffice by teaching once. Trainees’ observed skills were better than their own assessment. The effect of a booster session was less than the first intervention, but the final scores were higher than pre-intervention.

Trial Registration

Not applicable, not a health care intervention.
Ethics and governance of trustworthy medical artificial intelligence
Authors: Zhang Jie , Zhang Zong-ming
Published: January 2023

Background

The growing application of artificial intelligence (AI) in healthcare has brought technological breakthroughs to traditional diagnosis and treatment, but it is accompanied by many risks and challenges. These adverse effects are also seen as ethical issues and affect trustworthiness in medical AI and need to be managed through identification, prognosis and monitoring.

Methods

We adopted a multidisciplinary approach and summarized five subjects that influence the trustworthiness of medical AI: data quality, algorithmic bias, opacity, safety and security, and responsibility attribution, and discussed these factors from the perspectives of technology, law, and healthcare stakeholders and institutions. The ethical framework of ethical values-ethical principles-ethical norms is used to propose corresponding ethical governance countermeasures for trustworthy medical AI from the ethical, legal, and regulatory aspects.

Results

Medical data are primarily unstructured, lacking uniform and standardized annotation, and data quality will directly affect the quality of medical AI algorithm models. Algorithmic bias can affect AI clinical predictions and exacerbate health disparities. The opacity of algorithms affects patients’ and doctors’ trust in medical AI, and algorithmic errors or security vulnerabilities can pose significant risks and harm to patients. The involvement of medical AI in clinical practices may threaten doctors ‘and patients’ autonomy and dignity. When accidents occur with medical AI, the responsibility attribution is not clear. All these factors affect people’s trust in medical AI.

Conclusions

In order to make medical AI trustworthy, at the ethical level, the ethical value orientation of promoting human health should first and foremost be considered as the top-level design. At the legal level, current medical AI does not have moral status and humans remain the duty bearers. At the regulatory level, strengthening data quality management, improving algorithm transparency and traceability to reduce algorithm bias, and regulating and reviewing the whole process of the AI industry to control risks are proposed. It is also necessary to encourage multiple parties to discuss and assess AI risks and social impacts, and to strengthen international cooperation and communication.
The impact of distance education on nursing students course performance in a sino-foreign cooperative program during the onset of COVID-19: a quasi-experimental study
Authors: Zhang Yu , Zhang Ning , Liu Hongyuan , Kan Yinshi , Zou Yan
Published: January 2023

Background

The outbreak of COVID-19 changed many studies’ teaching mode in higher education profoundly, including nursing. This study evaluated the impact of distance education on the course performance of nursing students in a nursing fundamentals course during the epidemic of COVID-19.

Methods

This is a comparative prospective and retrospective quasi-experimental study. Nursing students in a Sino-foreign cooperative program were allocated to either an intervention group (distance education, n = 48) or control group (face-to-face teaching, n = 36). A self-efficacy questionnaire, an academic engagement scale and grades of the final written examination were used to evaluate the students’ self-efficacy, academic engagement and academic performance, respectively. The data in this study were analyzed by two independent sample t-tests and the Chi-square test.

Students experiencing distance teaching had worse academic performance (p = 0.001) and lower levels of learning behavior self-efficacy (p<0.05). The total score of academic engagement (p = 0.04) for students experiencing distance teaching were significantly lower than the scores of those students in the control group.

Conclusions

In the context of COVID-19, nursing students conducted using distance education had poor course performance.
Unravelling the impact of insecticide-treated bed nets on childhood malaria in Malawi
Authors: Tangena Julie-Anne A. , Mategula Donnie , Sedda Luigi , Atkinson Peter M.
Published: January 2023

Background

To achieve malaria elimination it is essential to understand the impact of insecticide-treated net (ITNs) programmes. Here, the impact of ITN access and use on malaria prevalence in children in Malawi was investigated using Malaria Indicator Survey (MIS) data.

Methods

MIS data from 2012, 2014 and 2017 were used to investigate the relationship between malaria prevalence in children (6–59 months) and ITN use. Generalized linear modelling (GLM), geostatistical mixed regression modelling and non-stationary GLM were undertaken to evaluate trends, spatial patterns and local dynamics, respectively.

Results

Malaria prevalence in Malawi was 27.1% (95% CI 23.1–31.2%) in 2012 and similar in both 2014 (32.1%, 95% CI 25.5–38.7) and 2017 (23.9%, 95% CI 20.3–27.4%). ITN coverage and use increased during the same time period, with household ITN access growing from 19.0% (95% CI 15.6–22.3%) of households with at least 1 ITN for every 2 people sleeping in the house the night before to 41.7% (95% CI 39.1–44.4%) and ITN use from 41.1% (95% CI 37.3–44.9%) of the population sleeping under an ITN the previous night to 57.4% (95% CI 55.0–59.9%). Both the geostatistical and non-stationary GLM regression models showed child malaria prevalence had a negative association with ITN population access and a positive association with ITN use although affected by large uncertainties. The non-stationary GLM highlighted the spatital heterogeneity in the relationship between childhood malaria and ITN dynamics across the country.

Conclusion

Malaria prevalence in children under five had a negative association with ITN population access and a positive association with ITN use, with spatial heterogeneity in these relationships across Malawi. This study presents an important modelling approach that allows malaria control programmes to spatially disentangle the impact of interventions on malaria cases.
Maternal colonization with group B Streptococcus and antibiotic resistance in China: systematic review and meta-analyses
Authors: Wang Jing , Zhang Yan , Lin Miao , Bao Junfeng , Wang Gaoying , Dong Ruirui , Zou Ping , Chen Yuejuan , Li Na , Zhang Ting , Su Zhaoliang , Pan Xiuzhen
Published: January 2023

Background

Maternal rectovaginal colonization with group B Streptococcus (GBS) or Streptococcus agalactiae is the most common pathway for this disease during the perinatal period. This meta-analysis aimed to summarize existing data regarding maternal colonization, serotype profiles, and antibiotic resistance in China.

Methods

Systematic literature reviews were conducted after searching 6 databases. Meta-analysis was applied to analyze colonization rate, serotype, and antimicrobial susceptibility of GBS clinical isolates in different regions of China. Summary estimates are presented using tables, funnel plots, forest plots, histograms, violin plots, and line plots.

Results

The dataset regarding colonization included 52 articles and 195 303 pregnant women. Our estimate for maternal GBS colonization in China was 8.1% (95% confidence interval [CI] 7.2%–8.9%). Serotypes Ia, Ib, III, and V account for 95.9% of identified isolates. Serotype III, which is frequently associated with the hypervirulent clonal complex, accounts for 46.4%. Among the maternal GBS isolates using multilocus sequence typing (MLST), ST19 (25.7%, 289/1126) and ST10 (25.1%, 283/1126) were most common, followed by ST12 (12.4%, 140/1126), ST17 (4.8%, 54/1126), and ST651 (3.7%, 42/1126). GBS was highly resistant to tetracycline (75.1% [95% CI 74.0–76.3%]) and erythromycin (65.4% [95% CI 64.5–66.3%]) and generally susceptible to penicillin, ampicillin, vancomycin, ceftriaxone, and linezolid. Resistance rates of GBS to clindamycin and levofloxacin varied greatly (1.0–99.2% and 10.3–72.9%, respectively). A summary analysis of the bacterial drug resistance reports released by the China Antimicrobial Resistance Surveillance System (CARSS) in the past 5 years showed that the drug resistance rate of GBS to erythromycin, clindamycin, and levofloxacin decreased slowly from 2018 to 2020. However, the resistance rates of GBS to all 3 antibiotics increased slightly in 2021.

Conclusions

The overall colonization rate in China was much lower than the global colonization rate (17.4%). Consistent with many original and review reports in other parts of the world, GBS was highly resistant to tetracycline. However, the resistance of GBS isolates in China to erythromycin and clindamycin was greater than in other countries. This paper provides important epidemiological information, to assist with prevention and treatment of GBS colonization in these women.
Quantifying the direct cost benefits of vestibular telemetry using the CAVA system to diagnose the causes of dizziness
Authors: Phillips John S , Newman Jacob
Published: January 2023

Background

It can be challenging to diagnose the cause of a patient’s dizziness. Patients face significant delays before receiving a correct diagnosis as they will undergo many diagnostic tests under several different medical specialities. As well as prolonging the suffering of patients, these problems place a significant financial burden on health services worldwide. We have developed a wearable medical device which has the potential to diagnose the cause of a patient’s dizziness using vestibular telemetry captured over a thirty-day period. We sought to quantify the potential direct cost savings of an alternative diagnostic pathway using our diagnostic device.

Methods

In this work, we identified the existing diagnostic pathways followed by patients reporting dizziness to their General Practitioner, and modelled the best and worst-case direct costs of providing a patient with a correct diagnosis. We estimated the potential cost of our alternative pathway, and calculated the cost savings this could provide to the NHS.

Results

The results show that our alternative diagnostic pathway could reduce the time and direct cost associated with providing a correct diagnosis. We present a potential indicative cost-saving of between £631 and £1305, per patient.

Conclusion

Our alternative diagnostic pathway would reduce the time taken to correctly diagnose patients with vertigo. This in turn would facilitate faster access to targeted treatments, reduce unnecessary interventions, and reduce the suffering of patients. These improvements would also lead to other savings, such as reducing the amount of sick leave taken by patients to attend appointments, and freeing up of NHS time to see other patients.
Proximal tubule-derived exosomes contribute to mesangial cell injury in diabetic nephropathy via miR-92a-1-5p transfer
Authors: Tsai Yi-Chun , Kuo Mei-Chuan , Hung Wei-Wen , Wu Ping-Hsun , Chang Wei-An , Wu Ling-Yu , Lee Su-Chu , Hsu Ya-Ling
Published: January 2023

Background

Diabetic nephropathy (DN) is an increasing threat to human health and regarded to be the leading cause of end-stage renal disease worldwide. Exosomes delivery may play a key role in cross-talk among kidney cells and the progression of DN. However, the mechanisms underlying exosomes in DN remain unclear.

Methods

The cross-disciplinary study, including in vivo, in vitro, and human studies was conducted to explore the cross-talk between proximal tubular epithelial cells (PTECs) and mesangial cells (MCs) in DN. We purified exosome from PTECs treated with high glucose and db/db mice and assessed their influences in the pathologic change of MCs and downstream signal pathway. Healthy individuals and type 2 diabetic patients were enrolled to examine the role of exosomes in clinical applications.

Results

High glucose stimulated PTECs to secrete exosomal miR-92a-1-5p, which was taken-up by glomerular MCs, inducing myofibroblast transdifferentiation (MFT) in vitro and in vivo. PTEC-released exosomal 92a-1-5p decreased reticulocalbin-3 expression, leading to endoplasmic reticulum (ER) stress by downregulating genes essential for ER homeostasis including calreticulin and mesencephalic astrocyte-derived neurotrophic factor. Treatment with miR-92a-1-5p inhibitor ameliorated kidney damage in db/db mice with DN. Urinary miR-92a-1-5p could predict kidney injury in type 2 diabetic patients.

Conclusions

PTEC-derived exosomal miR-92a-1-5p modulated the kidney microenvironment in vivo and in vitro models, which altered ER stress and MFT in MCs resulting in DN progression. Further blocking miR-92a-1-5p epigenetic regulatory network could be a potential therapeutic strategy to prevent the progression of DN.
A drug screening to identify novel combinatorial strategies for boosting cancer immunotherapy efficacy
Authors: Zhang Zongliang , Wang Guoqing , Zhong Kunhong , Chen Yongdong , Yang Nian , Lu Qizhong , Yuan Boyang , Wang Zeng , Li Hexian , Guo Liping , Zhang Ruyuan , Wu Zhiguo , Zheng Meijun , Zhao Shasha , Tang Xin , Shao Bin , Tong Aiping
Published: January 2023

Background

Chimeric antigen receptor (CAR) T cells and immune checkpoint blockades (ICBs) have made remarkable breakthroughs in cancer treatment, but the efficacy is still limited for solid tumors due to tumor antigen heterogeneity and the tumor immune microenvironment. The restrained treatment efficacy prompted us to seek new potential therapeutic methods.

Methods

In this study, we conducted a small molecule compound library screen in a human BC cell line to identify whether certain drugs contribute to CAR T cell killing. Signaling pathways of tumor cells and T cells affected by the screened drugs were predicted via RNA sequencing. Among them, the antitumor activities of JK184 in combination with CAR T cells or ICBs were evaluated in vitro and in vivo.

Results

We selected three small molecule drugs from a compound library, among which JK184 directly induces tumor cell apoptosis by inhibiting the Hedgehog signaling pathway, modulates B7-H3 CAR T cells to an effector memory phenotype, and promotes B7-H3 CAR T cells cytokine secretion in vitro. In addition, our data suggested that JK184 exerts antitumor activities and strongly synergizes with B7-H3 CAR T cells or ICBs in vivo. Mechanistically, JK184 enhances B7-H3 CAR T cells infiltrating in xenograft mouse models. Moreover, JK184 combined with ICB markedly reshaped the tumor immune microenvironment by increasing effector T cells infiltration and inflammation cytokine secretion, inhibiting the recruitment of MDSCs and the transition of M2-type macrophages in an immunocompetent mouse model.

Conclusion

These data show that JK184 may be a potential adjutant in combination with CAR T cells or ICB therapy.
Soluble PD-L1: a potential dynamic predictive biomarker for immunotherapy in patients with proficient mismatch repair colorectal cancer
Authors: He Yinjun , Zhang Xiang , Zhu Ming , He Wenguang , Hua Hanju , Ye Feng , Zhou Xile , Chen Nan , Li Yandong , Zhong Weixiang , Wu Guosheng , Cai Hui , Jiang Weiqin
Published: January 2023

Background

Circulating soluble programmed death ligand 1 (sPD-L1) can negatively regulate T-cell function and serve as a prognostic or predictive marker in a variety of cancers. However, rare studies have evaluated the potential roles of sPD-L1, and no study has estimated its predictive value for the efficacy of immune treatment in colorectal cancer (CRC).

Methods

Plasma samples from 192 CRC patients were used to estimate correlations between clinicopathological features and sPD-L1, secreted PD-L1 (secPD-L1) and exosomal PD-L1 (exoPD-L1). Baseline and posttreatment sPD-L1 levels were also investigated in 55 patients with metastatic CRC (mCRC) treated with chemotherapy ± targeted therapy and 40 patients with proficient mismatch repair (pMMR) mCRC treated with combination immunotherapy. Both sPD-L1 and secPD-L1 were quantified by enzyme-linked immunosorbent assay, while exoPD-L1 was analyzed using flow cytometry.

Results

secPD-L1 was the major component and positively correlated with sPD-L1 in CRC, while exoPD-L1 was almost undetectable. Higher levels of sPD-L1 were detected in patients with distant metastasis, especially those with distant lymph node metastasis and tissue combined positive score (CPS) instead of tumor proportion score (TPS). Chemotherapy or targeted therapy did not significantly impact sPD-L1 concentration. Progressive disease on combination immunotherapy was associated with an increase in sPD-L1 level, whereas no significant change was observed in patients with durable clinical benefit.

Conclusion

sPD-L1 mainly consisted of secPD-L1, and its level was higher in patients with distant metastasis, especially distant lymph node metastasis and positive CPS. sPD-L1 is a potential dynamic marker to identify rapid progression on combination immunotherapy and avoid ineffective treatment for pMMR CRC.
Prevalence and morbidity of neck pain: a cross-sectional study of 3000 elderly men
Authors: Damm Henrik , Jönsson Anette , Rosengren Björn E. , Jehpsson Lars , Ohlsson Claes , Ribom Eva , Mellström Dan , Karlsson Magnus K.
Published: January 2023

Background

The purpose of this study is to determine the prevalence and morbidity of neck pain with or without cervical rhizopathy, upper extremity motor deficit and/or thoracolumbar pain in elderly men.

Methods

We conducted a cross-sectional questionnaire study of 3,000 community-dwelling older men with a mean age of 75.4 ± 3.2 years (range 69–81) to determine if they had experienced neck pain with or without cervical rhizopathy/upper extremity motor deficit/thoracolumbar pain (yes/no) during the preceding 12 months, and if so, morbidity with the condition (no/minor/moderate/severe).

Results

Among the participants, 865 (29%) reported they had experienced neck and 1,619 (54%) thoracolumbar pain. Among the men with neck pain, 59% had experienced only neck pain, 17% neck pain and cervical rhizopathy and 24% neck pain, rhizopathy and motor deficit. For men with only neck pain, the morbidity was severe in 13%, for men with neck pain and rhizopathy it was 24%, and for men with pain, rhizopathy and motor deficit it was 46% (p < 0.001). Among the men with neck pain, 23% had experienced only neck pain and no thoracolumbar pain; the remaining 77% had both neck and thoracolumbar pain. The morbidity was severe in 10% of the men with neck pain but no thoracolumbar pain and 30% in men with neck and thoracolumbar pain (p < 0.001).

Conclusion

Neck pain in elderly men is common but symptoms and morbidity vary. For men who only have neck pain, 1/8 rated their morbidity as severe, while almost half who also had cervical rhizopathy and motor deficit and almost 1/3 of those who also had thoracolumbar pain reported severe morbidity.