bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review
Authors: Ohikere Kabiru , Veracruz Nicolette , Wong Robert J.
Published: September 2022

Prevalence of cirrhosis and hepatic encephalopathy (HE) in older patients receiving care in long-term care settings is unknown. This systematic review aimed to identify potential factors associated with HE and cognitive impairment in older patients with cirrhosis. A PubMed search of English-language articles published between January 1, 2000, and November 3, 2021, was conducted to identify studies in adults with cirrhosis relevant to cognitive impairment and/or HE (e.g., fall, frailty, and sarcopenia). Of 2,879 English-language publications, 24 were included. In patients with cirrhosis, falls were increased in the presence of HE and were associated with increased injury risk. Frailty was associated with HE development and cognitive impairment in patients with cirrhosis. Further, cognitive impairment and frailty were predictive of HE-related hospitalizations. Sarcopenia increased the risk of developing HE. Furthermore, specific medications increased the risk of developing HE. Risk reduction and management of patients with HE are critical to prevent negative outcomes.
Cognition is a Critical Vital Sign for Older Adults: The Need for Early Detection of Cognitive Impairment is Now
Authors: Hilsabeck Robin C. , Lacritz Laura H. , Colvin Mary K. , Espe-Pfeifer Patricia , Sperling Scott A. , Arnett Peter A. , Perry William
Published: September 2022

The number of older adults in America is increasing every year, and in just over one decade, people aged 65 and older will surpass the number of children under age 18 for the first time in history. Along with the aging of America comes increase in the prevalence of cognitive impairment because age is the primary risk factor for neurodegenerative conditions such as Alzheimer disease and related disorders. There is an urgent need to identify cognitive impairment as early as possible so interventions can be deployed to reduce the associated medical, behavioral, and economic burden on patients, families, and society in general. Launching public health campaigns, investing in a workforce that is trained and incentivized to detect and manage cognitive impairment, and leveraging technology to facilitate and improve early detection are a few strategies that may help address this growing healthcare crisis.
Limitations of the Sum-and-Alpha Approach to Measurement in Behavioral Research
Authors: McNeish Daniel
Published: September 2022

Many behavioral researchers are interested in measuring constructs such as mood, affect, or cognition—all of which cannot be observed directly. Instead, researchers administer items from surveys, tests, or scales to indirectly measure aspects of the construct. Psychometrics is a branch of statistics dedicated to determining whether scores created from item responses are reasonably capturing the intended construct. However, several review papers have shown that behavioral research frequently does not engage with psychometrics and instead creates scores by assigning numerical values to item responses, summing item responses, and reporting reliability of summed scores without any assessment of whether scores are valid. Despite the popularity of this approach, it can limit the informativeness and generalizability of conclusions in behavioral research. The goal of this paper is to raise awareness of these issues with policymakers and other consumers of research and to encourage producers of research to consider readily available, more rigorous approaches.
Behavioral Economic Demand: How Simulated Behavioral Tasks Can Inform Health Policy
Authors: Reed Derek D , Gelino Brett W , Strickland Justin C
Published: September 2022

Consumers decide what to purchase, under conditions of constraint (e.g., commodity price). According to behavioral economic demand, commodity purchase task (CPT) can measure hypothetical decisions about purchases under varied simulated policy conditions (e.g., introduction of new cigarette taxes, happy hour drinking specials). These tasks permit rapid data collection without sacrificing methodological rigor or the validity of conclusions reached. The CPT allows researchers to simulate new policies, to determine their relative risks and benefits, thus offering an opportunity to optimize prior to rollout. Behavioral outcomes related to consumer purchases also make the CPT data readily translatable to policymakers, including constituent health behavior. This article provides a background on CPTs, a review of literature related to policy-aimed CPTs, and a start on best practices for other behavioral scientists interested in applying CPT to inform public policy efforts. It also serves as a primer for policymakers seeking to evaluate usage of this tool.
Functional connectivity and structural changes of thalamic subregions in episodic migraine
Authors: Yang Ying , Xu Huang , Deng Ziru , Cheng Wenwen , Zhao Xiuxiu , Wu Yan , Chen Yuhua , Wei Gui , Liu Ying
Published: September 2022

Background

The thalamus plays a crucial role in transmitting nociceptive information to various cortical regions involving migraine-related allodynia and photophobia. Abnormal structural and functional alterations related to the thalamus have been well established. However, it is unknown whether the brain structure and function of the thalamic subregions are differentially affected in this disorder. In this study, we aimed to clarify this issue by comparing the structure and function of 16 thalamic subregions between patients with episodic migraine (EM) and healthy controls (HCs).

Methods

Twenty-seven patients with EM and 30 sex-, age- and education-matched HCs underwent resting-state functional and structural magnetic resonance imaging scans. Functional connectivity (rsFC), grey matter volume (GMV), and diffusion tensor imaging (DTI) parameters of each subregion of the thalamus were calculated and compared between the two groups. Furthermore, correlation analyses between neuroimaging changes and clinical features were performed in this study.

Results

First, compared with HCs, patients with EM exhibited decreased rsFC between the anterior-medial-posterior subregions of the thalamus and brain regions mainly involved in the medial system of the pain processing pathway and default mode network (DMN). Second, for the whole thalamus and each of its subregions, there were no significant differences in GMV between patients with EM and HCs (P > 0.05, Bonferroni corrected). Third, there was no significant difference in DTI parameters between the two groups (P > 0.05). Finally, decreased rsFC was closely related to scores on the Hamilton Rating Scale for Anxiety (HAMA) and Big Five Inventory (BFI) scales.

Conclusion

Selective functional hypoconnectivity in the thalamic subregions provides neuroimaging evidence supporting the important role of thalamocortical pathway dysfunction in episodic migraine, specifically, that it may modulate emotion and different personality traits in migraine patients.
Effects of calcium cyanamide on Collembola in a standardized field study. Part 2: lessons learned for chemical risk assessment in field studies with soil invertebrates
Authors: Römbke J. , van der Veen A. , Ebke P. , Stegger P.
Published: September 2022

Background

Data from a one-year field study on the effect of a fertilizer (calcium cyanamide, trade name: Perlka®) on Collembola served as the basis for a broader discussion on performance and evaluation of these data for terrestrial risk assessment according to the REACH regulations) of the European Union.

Performance

Details of the technical performance of this study have been described in Part 1 of this article. In this part, the experiences made in this very large field study with a non-pesticide (i.e., a fertilizer) is discussed in a wider context, in particular by asking: Is the existing information suitable for preparing a field test guideline for Collembola – and, secondly, would such a guideline be suitable for improving current REACH and/or EFSA guidelines for testing very different chemicals in the soil compartment?

Results

By discussing individually the most important properties of such studies we could show that by combining experiences from earthworm field studies, literature, and our field study higher-tier testing with Collembola is not only technically possible, but also suitable for the evaluation of chemicals in soil (i.e., similar to existing OECD approaches for earthworms).

Conclusion

Due to our experience as well as information from literature, we could show that such Collembola field studies are suitable for improving risk assessment procedures in the soil compartment. This is in particular true, when realizing that the long-term protection of soil biodiversity is of high value both from an ecological as well as an ecotoxicological point of view. Thus, a specific Collembolan field test guideline is urgently needed.
In silico prediction, characterization, docking studies and molecular dynamics simulation of human p97 in complex with p37 cofactor
Authors: Mirzadeh Abolfazl , Kobakhidze George , Vuillemot Rémi , Jonic Slavica , Rouiller Isabelle
Published: September 2022

Background

The AAA + ATPase p97 is an essential unfoldase/segragase involved in a multitude of cellular processes. It functions as a molecular machine critical for protein homeostasis, homotypic membrane fusion events and organelle biogenesis during mitosis in which it acts in concert with cofactors p47 and p37. Cofactors assist p97 in extracting and unfolding protein substrates through ATP hydrolysis. In contrast to other p97ʼs cofactors, p37 uniquely increases the ATPase activity of p97. Disease-causing mutations in p97, including mutations that cause neurodegenerative diseases, increase cofactor association with its N-domain, ATPase activity and improper substrate processing. Upregulation of p97 has also been observed in various cancers. This study aims towards the characterization of the protein–protein interaction between p97 and p37 at the atomic level. We defined the interacting residues in p97 and p37. The knowledge will facilitate the design of unique small molecules inhibiting this interaction with insights into cancer therapy and drug design.

Results

The homology model of human p37 UBX domain was built from the X-ray crystal structure of p47 C-terminus from rat (PDB code:1S3S, G) as a template and assessed by model validation analysis. According to the HDOCK, HAWKDOCK, MM-GBSA binding free energy calculations and Arpeggio, we found that there are several hydrophobic and two hydrogen-bonding interactions between p37 UBX and p97 N-D1 domain. Residues of p37 UBX predicted to be involved in the interactions with p97 N-D1 domain interface are highly conserved among UBX cofactors.

Conclusion

This study provides a reliable structural insight into the p37-p97 complex binding sites at the atomic level though molecular docking coupled with molecular dynamics simulation. This can guide the rational design of small molecule drugs for inhibiting mutant p97 activity.
Identification of intraoperative management strategies that have a differential effect on patients with reduced left ventricular ejection fraction: a retrospective cohort study
Authors: Maile Michael D. , Mathis Michael R. , Jewell Elizabeth S. , Mentz Graciela B. , Engoren Milo C.
Published: September 2022

Background

There are few data to guide the intraoperative management of patients with reduced left ventricular ejection fraction (LVEF). This study aimed to describe how patients with reduced LVEF are managed differently and to identify and treatments had a different risk profile in this population.

Methods

We performed a retrospective cohort study of adult patients who underwent general anesthesia for non-cardiac surgery. The effect of anesthesia medications and fluid balance was compared between those with and without a reduced preoperative LVEF. The primary outcome was a composite of acute kidney injury, myocardial injury, pulmonary complications, and 30-day mortality. Multivariable logistic regression was used to adjust for confounders. Treatments that affected patients with reduced LVEF differently were defined as those associated with the primary outcome that also had a significant interaction with LVEF.

Results

A total of 9420 patients were included. Patients with reduced LVEF tended to have a less positive fluid balance. Etomidate, calcium, and phenylephrine were use more frequently, while propofol and remifentanil were used less frequently. Remifentanil affected patients with reduced LVEF differently than those without (interaction term OR 2.71, 95% CI 1.30–5.68,p = 0.008). While the use of remifentanil was associated with fewer complications in patients with normal systolic function (OR 0.54, 95% CI 0.42–0.68,p < 0.001), it was associated with an increase in complications in patients with reduced LVEF (OR = 3.13, 95% CI 3.06–5.98,p = 0.026).

Conclusions

Patients with a reduced preoperative LVEF are treated differently than those with a normal LVEF when undergoing non-cardiac surgery. An association was found between the use of remifentanil and an increase in postoperative adverse events that was unique to this population. Future research is needed to determine if this relationship is secondary to the medication itself or reflects a difference in how remifentanil is used in patients with reduced LVEF.
Comparison of the efficacy of ultrasound-guided erector spinae plane block and thoracic paravertebral block combined with intercostal nerve block for pain management in video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial
Authors: Sun Lingling , Mu Jing , Gao Bin , Pan Yuexian , Yu Lang , Liu Yang , He Huanzhong
Published: September 2022

Background

The objective of this study was to compare analgesic efficacy of erector spinae plane block(ESPB) and thoracic paravertebral block(TPVB) combined with intercostal nerve block(ICNB) after video assisted thoracoscopic surgery(VATS).

Methods

Patients were enrolled into three groups according to analgesia technique as ICNB, TPVB + ICNB or ESPB + ICNB: respectively Group C(n = 58), Group T (n = 56) and Group E (n = 59). Patients were followed up by a trained data investigator at 2, 6, 8, 12, 24, 48 h after surgery, and the visual analog scale(VAS) at rest and coughing were recorded. The moderate and severe pain mean VAS ≥ 4 when coughing. The postoperative opioids consumption, incidence of postoperative nausea and vomiting (PONV), supplementary analgesic requirements within 48 h, length of stay in PACU, ambulation time, postoperative days in hospital and potential side effects, such as hematoma, hypotension, bradycardia, hypersomnia, uroschesis, pruritus and apnea were recorded.

Results

The incidence of moderate-to-severe pain was no significant difference between 3 groups in 24 h and 48 h (P = 0.720). There was no significant difference among the 3 groups in the resting pain intensity at 2, 6, 8, 12, 24 and 48 h after surgery(P > 0.05). In 2-way analysis of variance, the VAS when coughing in Group T were lower than that in Group C (mean difference = 0.15, 95%CI, 0.02 to 0.29; p = 0.028). While no difference was found when comparing Group E with Group C or Group T(P > 0.05). There was no difference between the three groups in the sufentanil consumption( within 24 h p = 0.472, within 48 h p = 0.158) and supplementary analgesic requirements(p = 0.910). The incidence of PONV and the length of stay in PACU, ambulation time and postoperative days in hospital were comparable in the 3 groups(P > 0.05). Two patients from Group T developed hematoma at the site of puncture.

Conclusions

The present randomized trial showed that the analgesic effect of TPVB + ICNB was superior to that of INCB after VATS, the analgesic effect of ESPB was equivalent to that of TPVB and ICNB.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2100049578. Registered 04 Aug 2020 Retrospectively registered.
Machine learning prediction of postoperative major adverse cardiovascular events in geriatric patients: a prospective cohort study
Authors: Peng Xiran , Zhu Tao , Wang Tong , Wang Fengjun , Li Ke , Hao Xuechao
Published: September 2022

Background

Postoperative major adverse cardiovascular events (MACEs) account for more than one-third of perioperative deaths. Geriatric patients are more vulnerable to postoperative MACEs than younger patients. Identifying high-risk patients in advance can help with clinical decision making and improve prognosis. This study aimed to develop a machine learning model for the preoperative prediction of postoperative MACEs in geriatric patients.

Methods

We collected patients’ clinical data and laboratory tests prospectively. All patients over 65 years who underwent surgeries in West China Hospital of Sichuan University from June 25, 2019 to June 29, 2020 were included. Models based on extreme gradient boosting (XGB), gradient boosting machine, random forest, support vector machine, and Elastic Net logistic regression were trained. The models’ performance was compared according to area under the precision-recall curve (AUPRC), area under the receiver operating characteristic curve (AUROC) and Brier score. To minimize the influence of clinical intervention, we trained the model based on undersampling set. Variables with little contribution were excluded to simplify the model for ensuring the ease of use in clinical settings.

Results

We enrolled 5705 geriatric patients into the final dataset. Of those patients, 171 (3.0%) developed postoperative MACEs within 30 days after surgery. The XGB model outperformed other machine learning models with AUPRC of 0.404(95% confidence interval [CI]: 0.219–0.589), AUROC of 0.870(95%CI: 0.786–0.938) and Brier score of 0.024(95% CI: 0.016–0.032). Model trained on undersampling set showed improved performance with AUPRC of 0.511(95% CI: 0.344–0.667,p < 0.001), AUROC of 0.912(95% CI: 0.847–0.962,p < 0.001) and Brier score of 0.020 (95% CI: 0.013–0.028,p < 0.001). After removing variables with little contribution, the undersampling model showed comparable predictive accuracy with AUPRC of 0.507(95% CI: 0.338–0.669,p = 0.36), AUROC of 0.896(95%CI: 0.826–0.953,p < 0.001) and Brier score of 0.020(95% CI: 0.013–0.028,p = 0.20).

Conclusions

In this prospective study, we developed machine learning models for preoperative prediction of postoperative MACEs in geriatric patients. The XGB model showed the best performance. Undersampling method achieved further improvement of model performance.

Trial registration

The protocol of this study was registered atwww.chictr.org.cn(15/08/2019, ChiCTR1900025160)
The effects of morning/afternoon surgeries on the early postoperative sleep quality of patients undergoing general anesthesia
Authors: Hou Haitao , Wu Shujing , Qiu Yuxue , Song Fenxiang , Deng Liqin
Published: September 2022

Objective

This study aimed to investigate the effects of morning and afternoon surgeries on the early postoperative sleep function in patients undergoing general anesthesia.

Methods

Fifty nine patients, aged 18–60 years, American society of anaesthesiologists (ASA) grade I or II, Body mass index of 18.5–28 kg/m2, undergoing laparoscopic myomectomy under total intravenous anesthesia, were included in the study. These patients were divided into two groups according to the start time of anesthesia: morning surgery group (group A, 8:00–12:00) and afternoon surgery group (group P, 14:00–18:00). The sleep conditions of the two groups of patients were evaluated by the Athens Insomnia Scale (AIS) one day before and one day after the operation. A total score of > 6 was regarded as postoperative sleep disturbance. The incidences of sleep disturbance one day after the operation in two groups were compared. The bispectral Index assessed the patient’s total sleep duration, sleep efficiency, and overall quality of sleep from 21:00 to 6:00 on the first night after surgery. Plasma concentrations of melatonin and cortisol at 6:00 am 1 day before surgery, 1 day after surgery were measured by ELISA, and rapid random blood glucose was measured.

Results

The total AIS score, overall quality of sleep, total sleep duration, and final awakening earlier than desired scores of the two groups of patients on the first night after surgery were significantly increased compared with preoperative scores (P < 0.01). In group P, the sleep induction and the physical and mental functioning during the day scores increased significantly after surgery compared with preoperative scores (P < 0.05). The postoperative AIS scores in group P increased significantly compared with those in group A (P < 0.01). The incidence of postoperative sleep disturbances (70.0%) in group P was significantly higher than that in group A (37.9%) (P < 0.05). Compared with group A, the total sleep duration under BIS monitoring in group P was significantly shorter, the sleep efficiency and the overall quality of sleep was significantly reduced (P < 0.01). Compared with those in group A, the level of melatonin on 1 d after surgery in group P was significantly decreased, and the level of cortisol in group P was significantly increased. There were no significant differences between the two groups in the levels of postoperative blood glucose and pain.

Conclusion

Both morning and afternoon surgeries have significant impacts on the sleep function in patients undergoing general anesthesia, while afternoon surgery has a more serious impact on sleep function.

Trial registration

ClinicalTrials, NCT04103528. Registered 24 September 2019—Retrospectively registered, http://www.ClinicalTrials.gov/ NCT04103528.
Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity—a technical simulation
Authors: Finke Simon-Richard , Schroeder Daniel C. , Ecker Hannes , Böttiger Bernd W. , Herff Holger , Wetsch Wolfgang A.
Published: September 2022

Purpose

Aspiration is a feared complication that may occur during airway management, and can significantly contribute to morbidity and mortality. Availability of a suctioning device with a suction catheter capable of clearing the airway is mandatory for airway management. However, suction performance may be significantly different amongst different suction catheters. The aim of this study was to compare suction rates of a standard 14 Ch suction catheter (SC), a Yankauer catheter (Y) and a DuCanto catheter (DC) using 4 fluids with different viscosity.

Methods

In this simulation trial, 4 preparations with standardized viscosity were prepared using a Xanthane-based medical fluid thickener. Lowest viscosity was achieved using tap water without thickener, syrup-like viscosity was achieved by adding 10 g per liter tap water, honey-like viscosity was achieved by adding 20 g per liter, and a pudding-like viscosity was achieved by adding 30 g of thickening powder per liter tap water. Each preparation was suctioned for 15 s with the three different suctioning devices. Measurements were repeated four times. The amount of removed preparation by suctioning was measured using a tared scale.

Results

Suction rates for water were 580 ± 34 mg for SC, 888 ± 5 mg for Y and 1087 ± 15 for DC; for syrup-like viscosity it was 383 ± 34(SC) vs. 661 ± 64(Y) vs. 935 ± 42(DC); for honey-like viscosity it was 191 ± 21(SC) vs. 426 ± 34(Y) vs. 590 ± 68(DC); and for pudding-like viscosity 74 ± 13(SC) vs. 164 ± 6(Y) vs. 211 ± 8(DC).

Conclusion

Suctioning liquids of different viscosity, the new DuCanto catheter was more effective than the Yankauer catheter that was more effective than a standard suctioning catheter. The relative superiority of the DuCanto was highest in fluids with high viscosity.
Effect of metformin on left ventricular mass and functional parameters in non-diabetic patients: a meta-analysis of randomized clinical trials
Authors: Kamel Ahmed M. , Sabry Nirmeen , Farid Samar
Published: September 2022

Background

Left ventricular hypertrophy is a common finding in patients with ischemic heart disease and is associated with mortality in patients with cardiovascular disease (CVD). Metformin, an antidiabetic drug, has been shown to reduce oxidative stress and left ventricular mass index (LVMI) in animal hypertrophy models. We summarized evidence regarding the effect of metformin on LVMI and LVEF.

Methods

Electronic databases were searched for randomized clinical trials (RCTs) that used metformin in non-diabetic patients with or without pre-existing CVD. The standardized mean change using change score standardization (SMCC) was calculated for each study. The random-effects model was used to pool the SMCC across studies. Meta-regression analysis was used to assess the association of heart failure (HF), metformin dose, and duration with the SMCC.

Results

Data synthesis from nine RCTs (754 patients) showed that metformin use resulted in higher reduction in LVMI after 12 months (SMCC = −0.63, 95% CI − 1.23; − 0.04, p = 0.04) and an overall higher reduction in LVMI (SMCC = −0.5, 95% CI − 0.84; − 0.16, p < 0.01). These values equate to absolute values of 11.3 (95% CI 22.1–0.72) and 8.97 (95% CI 15.06–2.87) g/m2, respectively. The overall improvement in LVEF was also higher in metformin users after excluding one outlier (SMCC = 0.26, 95% CI 0.03–0.49, P = 0.03) which translates to a higher absolute improvement of 2.99% (95% CI 0.34; 5.63). Subgroup analysis revealed a favorable effect for metformin on LVEF in patients who received > 1000 mg/day (SMCC = 0.28, 95% CI 0.04; 0.52, P = 0.04), and patients with HF (SMCC = 0.23; 95% CI 0.1; 0.36; P = 0.004). These values translate to a higher increase of 2.64% and 3.21%, respectively.

Conclusion

Results suggest a favorable effect for metformin on LVMI and LVEF in patients with or without pre-existing CVD. Additional trials are needed to address the long-term effect of metformin.

Registration The study was registered on the PROSPERO database with the registration number CRD42021239368 (https://www.crd.york.ac.uk/prospero).
The value of time-dependent risk predictions in a screening context - a comprehensive simulation analysis validated on German cancer registry data
Authors: Voelkel Vinzenz , Draeger Teresa , van Mossel Sietse , Siesling Sabine , Koffijberg Hendrik
Published: September 2022

Background

Risk-prediction tools allow classifying individuals into risk groups based on risk thresholds. Such risk categorization is often used to inform screening schemes by offering screening only to individuals at increased risk of harmful events. Adding information concerning an individual’s risk development over time would allow assessing not just who to screen but also when to screen. This paper illustrates the value of personalised, time-dependent risk predictions to optimize risk-based screening schemes.

Methods

In a simulation analysis, two different time-dependent risk-based screening approaches are compared to another risk-based, but time-independent approach regarding their impact on screening efficiency. For this purpose, 81 scenarios featuring 5000 patients with five consecutive annual risk estimations for a hypothetical diseaseDare simulated, using different parameters to model disease progression and risk distribution. This simulation analysis is validated using a real-world clinical case study based on German breast cancer patients and the INFLUENCE-nomogram for locoregional breast cancer recurrence.

Results

If individual risk estimations were used to personalise screening for a disease D aiming at detecting a 90% of curable cases, more than 20% of screening examinations could be avoided relative to a conventional uninformed approach, depending on the simulated scenario. Whereas an individual but time-independent approach is associated with acceptable saving potentials in case of a relatively homogenous risk distribution, the time-dependent approaches are superior when the complexity of a scenario increases. With slowly progressing diseases, risk-accumulation over time needs to be considered to achieve the highest screening efficiency on population level, for rapidly progressing diseases, an interval-specific approach is superior. The possible benefits of time-dependent risk-based screening were confirmed in the real-world clinical case study.

Conclusions

Appropriate approaches to use time-dependent risk predictions may considerably enhance screening efficiency on individual and population level. Therefore, predicting risk development over time should be supported by future prediction tools and be incorporated in decision algorithms.
Conclusiveness, linguistic characteristics and readability of Cochrane plain language summaries of intervention reviews: a cross-sectional study
Authors: Banić Aleksandra , Fidahić Mahir , Šuto Jelena , Roje Rea , Vuka Ivana , Puljak Livia , Buljan Ivan
Published: September 2022

Background

One of the most important formats to disseminate the evidence in health to different populations are Cochrane Plain Language Summaries (PLSs). PLSs should be written in a simplified language, easily understandable and providing clear message for the consumer. The aim of this study was to examine the extent to which PLSs are customized for lay persons, specifically by providing conclusive, comprehensible, and readable messages.

Methods

The study analyzed Cochrane PLSs of interventional studies (N = 4360) in the English language published from 1995 to 2019. We categorized the conclusiveness into one of the following categories: “positive”, “positive inconclusive”, “no evidence”, “no opinion”, “negative”, “negative inconclusive”, “unclear”, “equal”, “equal inconclusive”. Language characteristics were analyzed using Linguistic Inquiry and Word Count (LIWC) software. The level of readability was measured by SMOG (Simple Measure of Gobbledygook) index, indicating the number of years of education required to read the text. For each PLS, we also collected the following data: Cochrane Review Network, year of publication and number of authors.

Results

Most of the PLSs (80%) did not have a conclusive message. In 53% PLSs there was no concluding opinion about the studied intervention or the conclusion was unclear. The most frequent conclusiveness category was “no opinion” (30%), and its frequency increased over time. The conclusiveness categories were similarly dispersed across Cochrane Networks. PLSs were written in an objective style, with high levels of analytical tone and clout above neutral, but a lower relation to authenticity and tone. The median number of years of non-specific education needed to read the PLSs was 14.9 (IQR 13.8 to 16.1), indicating that the person needs almost 15 years of general education to read the content with ease.

Conclusion

Most of the Cochrane PLSs provided no concluding opinion or unclear conclusion regarding the effects of analyzed intervention. Analysis of readability indicated that they may be difficult to read for the lay population without medical education. Our results indicate that PLSs may not be so plain, and that the writing of Cochrane PLSs requires more effort. Tools used in this study could improve PLSs and make them better suited for lay audiences.
Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective study
Authors: Yao Weijie , Wang Genwang , Wang Qi , Wang Feng , Wang Zuoquan , Wang Zuozheng
Published: September 2022

Background

The effectiveness of pancreatic duct (PD) stenting in the early stages of acute pancreatitis (AP) remains controversial. This study aimed to investigate the efficacy and safety of PD stenting in the early stages of AP.

Methods

This is a retrospective cohort study. The clinical data of 131 patients with AP from 2018 to 2019 were analysed and divided into two groups: the study group (n = 46, PD stenting) and the control group (n = 85, standard treatment).

Results

There was a statistically significant reduction in pain relief, oral refeeding, hospitalization, and intensive care unit (ICU) stay in the study group compared with that of the control group (P < 0.05). There were no significant differences in the incidence of complications between the two groups. Further multivariate analysis of risk factors for new-onset organ failure showed that the control group (odds ratio [OR] (95% confidence interval [CI]): 6.533 (1.104–70.181)) and a higher level of haematocrit (HCT) at admission (HCT > 46.1%, OR (95%CI): 8.728 (1.264–116.767)) were independent risk factors.

Conclusions

In the early phase of AP, PD stenting has the potential to reduce pain relief time, oral refeeding time, ICU stay time, and overall hospital stay time. This finding highlights a new route for the treatment of AP.
The effect of the inclusion of trunk-strengthening exercises to a multimodal exercise program on physical activity levels and psychological functioning in older adults: secondary data analysis of a randomized controlled trial
Authors: Shahtahmassebi Behnaz , Hatton Jacinta , Hebert Jeffrey J. , Hecimovich Mark , Correia Helen , Fairchild Timothy J.
Published: September 2022

Background

Engaging in multimodal exercise program helps mitigate age-related decrements by improving muscle size, muscle strength, balance, and physical function. The addition of trunk-strengthening within the exercise program has been shown to significantly improve physical functioning outcomes. Whether these improvements result in improved psychological outcomes associated with increased physical activity levels requires further investigation. We sought to explore whether the inclusion of trunk-strengthening exercises to a multimodal exercise program improves objectively measured physical activity levels and self-reported psychological functioning in older adults.

Method

We conducted a secondary analysis within a single-blinded parallel-group randomized controlled trial. Sixty-four healthy older (≥ 60 years) adults were randomly allocated to a 12-week walking and balance exercise program with (n = 32) or without (n = 32) inclusion of trunk strengthening exercises. Each program involved 12 weeks of exercise training, followed by a 6-week walking-only program (identified as detraining). Primary outcome measures for this secondary analysis were physical activity (accelerometry), perceived fear-of-falling, and symptoms of anxiety and depression.

Results

Following the 12-week exercise program, no significant between-group differences were observed for physical activity, sedentary behaviour, fear-of-falling, or symptoms of anxiety or depression. Significant within-group improvements (adjusted mean difference [95%CI]; percentage) were observed in moderate-intensity physical activity (6.29 [1.58, 11.00] min/day; + 26.3%) and total number of steps per min/day (0.81 [0.29 to 1.33] numbers or + 16.3%) in trunk-strengthening exercise group by week 12. With respect to within-group changes, participants in the walking-balance exercise group increased their moderate-to-vigorous physical activity (MVPA) (4.81 [0.06 to 9.56] min/day; + 23.5%) and reported reduction in symptoms of depression (-0.26 [-0.49 to -0.04] points or -49%) after 12 weeks of the exercise program. The exercise-induced increases in physical activity levels in the trunk-strengthening exercise group were abolished 6-weeks post-program completion. While improvements in physical activity levels were sustained in the walking-balance exercise group after detraining phase (walking only).

Conclusions

The inclusion of trunk strengthening to a walking-balance exercise program did not lead to statistically significant between-group improvements in physical activity levels or psychological outcomes in this cohort following completion of the 12-week exercise program.

Trial registration

Australian and New Zealand Clinical Trials Registry (ACTRN12613001176752), registered on 28/10/2013.
Effect of insomnia in the major depressive disorder
Authors: Xu Guohong , Li Xiaoling , Xu Caixia , Xie Guojun , Liang Jiaquan
Published: September 2022

Background

People with sleep problems are more likely to have mental disorders. This study aimed to assess the effect of insomnia on the prognosis of patients with major depressive disorder (MDD).

Methods

We divided the patients into three groups according to the Insomnia Severity Index (ISI) scores. In addition, we compared the results of the Hamilton Depression Scale (HAMD) and Symptom Checklist-90 (SCL-90) scores. We evaluated the effect of insomnia at the 2nd, 4th, and 8th-week follow-up on the prognosis of MDD.

Results

Fifty-five patients between 19 and 58 years old, with a diagnosis of MDD via the Structured Clinical Interview for the Diagnostic and Statistical Manual-5 (DSM-5). The ISI scores of the moderate and severe group decreased significantly (P < 0.05) in the 2nd week compared to the baseline. The HAMD scores in all groups improved significantly in the 2nd week.

Conclusions

This study was inspired to assess insomnia as a comorbid disorder for patients with MDD, which may bring poor treatment consequences.
Power spectral analysis of heart rate variability is useful as a screening tool for detecting sympathetic and parasympathetic nervous dysfunctions in Parkinson’s disease
Authors: Miyagi Tomo , Yamazato Masanobu , Nakamura Takuto , Tokashiki Takashi , Namihira Yukihiro , Kokuba Kazuhito , Ishihara Satoshi , Sakima Hirokuni , Ohya Yusuke
Published: September 2022

Background

Parkinson’s disease (PD) is a progressive neurodegenerative disorder that causes motor symptoms and autonomic dysfunction. However, autonomic function tests commonly performed in PD can only evaluate either the sympathetic or parasympathetic nervous system. Therefore, the purpose of this pilot study is to investigate whether power spectral analysis of heart rate variability could detect both sympathetic and parasympathetic nervous dysfunctions in patients with PD.

Methods

Seventeen patients with PD and 11 healthy control subjects underwent electrocardiogram recording for the spectral analysis of heart rate variability to obtain values of low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.4 Hz) powers. Moreover, we examined the coefficient of variation of R–R intervals (CVRR) as a parameter of parasympathetic function in all participants and performed 123I-metaiodobenzylguanidine scintigraphy to measure the heart-to-mediastinum ratio as a parameter of cardiac sympathetic innervation in patients with PD.

Results

The median age of control subjects and PD patients was 63 and 66 years old, respectively. The median Hoehn and Yahr scale of PD patients was stage 2. The values of resting LF and HF powers widely varied. The median values of resting LF powers of control subjects and PD patients and those of HF powers were 169 and 70 ms2, 279 and 65 ms2, respectively, the difference was statistically insignificant. Approximately 41% of patients with PD had values below the first quartile of resting LF powers (< 58 ms2) or HF powers (< 50 ms2); however, no control subject had such low values. Positive correlations were found between resting LF powers and heart-to-mediastinum ratios of 123I-metaiodobenzylguanidine uptake (r = 0.6) and between resting HF powers and CVRRs (r = 0.7). The resting LF power was also associated with CVRRs and constipation. Furthermore, a positive correlation was observed between resting LF powers and resting HF powers in patients with PD (r = 0.8).

Conclusions

The power spectral analysis of heart rate variability may be useful as a screening tool for detecting autonomic dysfunctions by detecting low resting LF and HF powers in patients with PD. Sympathetic and parasympathetic nerves may be concurrently damaged in patients with PD.
Evaluation of the epidemiologic, clinical, radiologic, and treatment methods of patients with subacute and chronic meningitis
Authors: Bineshfar Niloufar , Rezaei Ali , Mirahmadi Alireza , Shokouhi Shervin , Gharehbagh Farid Javandoust , Haghighi Mehrdad , Harandi Ali Amini , Shojaei Maziar , Ramezani Mahtab , Zoghi Anahita , Gharagozli Kourosh , Lotfollahi Legha , Darazam Ilad Alavi
Published: September 2022

Background

Meningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis.

Methods

We extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study.

Results

Headache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens.

Conclusions

The most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.
Performance of whole-genome promoter nucleosome profiling of maternal plasma cell-free DNA for prenatal noninvasive prediction of fetal macrosomia: a retrospective nested case-control study in mainland China
Authors: Lu Qianwen , Guo Zhiwei , Zhang Jun , Wang Ke , Tian Qi , Liu Siping , Li Kun , Xu Cailing , Li Caimin , Lv Zenglu , Zhang Zhigang , Yang Xuexi , Yang Fang
Published: September 2022

Background

Fetal macrosomia is common occurrence in pregnancy, which is associated with several adverse prognosis both of maternal and neonatal. While, the accuracy of prediction of fetal macrosomia is poor. The aim of this study was to develop a reliable noninvasive prediction classifier of fetal macrosomia.

Methods

A total of 3600 samples of routine noninvasive prenatal testing (NIPT) data at 12+ 0–27+ 6 weeks of gestation, which were subjected to low-coverage whole-genome sequencing of maternal plasma cell-free DNA (cfDNA), were collected from three independent hospitals. We identified set of genes with significant differential coverages by comparing the promoter profiling between macrosomia cases and controls. We selected genes to develop classifier for noninvasive predicting, by using support vector machine (SVM) and logistic regression models, respectively. The performance of each classifier was evaluated by area under the curve (AUC) analysis.

Results

According to the available follow-up results, 162 fetal macrosomia pregnancies and 648 matched controls were included. A total of 1086 genes with significantly differential promoter profiling were found between pregnancies with macrosomia and controls (p < 0.05). With the AUC as a reference，the classifier based on SVM (CMA-A2) had the best performance, with an AUC of 0.8256 (95% CI: 0.7927–0.8586).

Conclusions

Our study provides that assessing the risk of fetal macrosomia by whole-genome promoter nucleosome profiling of maternal plasma cfDNA based on low-coverage next-generation sequencing is feasible.
Optimizing MATRix as remission induction in PCNSL: de-escalated induction treatment in newly diagnosed primary CNS lymphoma
Authors: Wendler Julia , Fox Christopher P. , Valk Elke , Steinheber Cora , Fricker Heidi , Isbell Lisa K. , Neumaier Simone , Okosun Jessica , Scherer Florian , Ihorst Gabriele , Cwynarski Kate , Schorb Elisabeth , Illerhaus Gerald
Published: September 2022

Background

Primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (PCNSL) is a rare disorder with an increasing incidence over the past decades. High-level evidence has been reported for the MATRix regimen (high-dose methotrexate (HD-MTX), high-dose AraC (HD-AraC), thiotepa and rituximab) followed by high-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) supporting this approach to be considered a standard therapy in newly diagnosed PCNSL patients ≤ 70 years. However, early treatment-related toxicities (predominantly infectious complications), occurring in up to 28% per MATRix cycle, diminish its therapeutic success. Furthermore, sensitivity to first-line treatment is an independent prognostic factor for improved overall survival (OS) in PCNSL. Thus, patients achieving early partial remission (PR) after 2 cycles of MATRix might be over-treated with 4 cycles, in the context of consolidation HCT-ASCT.

Methods

This is an open-label, multicentre, randomized phase III trial with two parallel arms. 326 immunocompetent patients with newly diagnosed PCNSL will be recruited from 37 German, 1 Austrian and 12 UK sites. Additional IELSG (International Extranodal Lymphoma Study Group) sites are planned. The objective is to demonstrate superiority of a de-escalated and optimised remission induction treatment strategy, followed by HCT-ASCT. Randomization (1:1) will be performed after completion of all screening procedures. Patients in Arm A (control treatment) will receive 4 cycles of MATRix. Patients in Arm B (experimental treatment) will receive a pre-phase (R/HD-MTX), followed by 2 cycles of MATRix. Patients in both arms achieving PR or better will proceed to HCT-ASCT (BCNU, thiotepa). The primary endpoint of the study is event-free-survival (EFS), defined as time from randomization to premature end of treatment due to any reason, lymphoma progression or death whichever occurs first. Secondary endpoints include OS, progression free survival (PFS), toxicity, neurocognitive impairment and quality of life. Minimal follow-up is 24 months.

Discussion

Current treatment options for PCNSL in patients ≤ 70 years have improved remarkably over recent years. However, the potential efficacy benefits are offset by an increased incidence of short-term toxicities which can impact on treatment delivery and hence on survival outcomes. In patients ≤ 70 years with newly diagnosed PCNSL addressing the need to reduce treatment-related toxicity by de-escalating and optimising the induction phase of treatment, is a potentially attractive treatment strategy.

Trial registration

German clinical trials registry DRKS00022768 registered June 10th, 2021.