bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting the effect of exploitation and exploration on performance: A meta-analysis
Authors: Marín-Idárraga Diego Armando , Hurtado González José Manuel , Cabello Medina Carmen
Published: December 2020

From a contingency view, we aim to contribute to a better understanding of how exploitation and exploration influence performance. By conducting a meta-analysis, we aim to answer the following research question: How do substantive moderators (slack resources, organizational structure, inter-organizational relationships, competitive intensity, and environmental dynamism), extrinsic moderators (region, size, and sector) and methodological moderators (data sources and performance measurement) affect the impact of exploitation and exploration on performance? The results of the meta-analysis, including 328 correlations, 102 studies, and a sample of 41,298 cases, suggest that the influence of exploitation and exploration on performance depends on the presence of the moderating factors included in our analysis. Furthermore, some of these factors are relevant for explaining a better performance of exploitation versus exploration, while other moderators do not determine a different effect of exploitation and exploration on performance.

JEL CLASSIFICATION

M10; M19; O3
Emission rate assessment of airborne brake particles by characterization of the pad and disc surfaces from a pin-on-disc tribometer
Authors: Philippe Florian , Xiang Maiqi , Morgeneyer Martin , Chen Yan-Ming , Charles Pierre , Guingand Frédéric , Bressot Christophe
Published: December 2020

Particles from brake, road and tire wear contribute to about half of the emissions (PM10) of particulate traffic pollution. It is estimated that 50 to 70% of the brake debris material is transformed into an emission of polydisperse aerosols. In order to improve the understanding of the brake debris generation and its dependency on the brake material, the wear of a disc and a brake pad from a standard production car were studied. The disc was made of perlitic cast iron with lamellar graphite and subjected to standard braking cycles. Microscopic evaluation was performed on the disc track, as well as analyses by Energy Dispersive Spectroscopy (EDS). Finally, a metallographic section has been made in the longitudinal direction of friction to better understand the morphology. The study focuses on disc surface oxidation and morphology of a thin layer on both disc and pin surface. Particle concentrations increase with the friction power and the area of contact surface. The observations show that the generation of particles can be the result of the oxidation of the disc surface during friction by two- and three-body abrasion when braking.
Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays
Authors: Pang Calver , Aqil A. , Mannan A. , Thomas G. , Hossain F. S.
Published: December 2020

Background

Hip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture.

Methods

Patients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday).

Results

A total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36–1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37–1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33–1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35–1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29–1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11–3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11–6.11, p = 0.028) and age (1.08, 95% CI 1.04–1.13, p < 0.001).

Conclusion

The evidence for a ‘weekend effect’ in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade.

Level of evidence

Level 3.
Fracture–dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system
Authors: Artiaco Stefano , Fusini Federico , Sard Arman , Dutto Elisa , Massè Alessandro , Battiston Bruno
Published: December 2020

Background

Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture–dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture–dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts.

Methods

A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture–dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture–dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures].

Results

Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture–dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture–dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors’ knowledge, allowed us to include all types of dislocation and fracture–dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture–dislocations) of the forearm joint.

Conclusions

All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture–dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment.

Level of evidence

V.
RETRACTED ARTICLE: M1 Macrophage-Derived Exosomal MicroRNA-326 Suppresses Hepatocellular Carcinoma Cell Progression Via Mediating NF-κB Signaling Pathway
Authors: Bai Zhen-zi , Li Hong-yan , Li Cheng-hua , Sheng Chuan-lun , Zhao Xiao-nan
Published: December 2020

Accumulating evidence has shown that microRNA (miR) derived from M1 macrophage-derived exosomes can regulate the progression of hepatocellular carcinoma (HCC). However, the effect of miR-326 derived from M1 macrophage-derived exosomes on HCC has not been reported. Therefore, the objective of the present study was to explore the mechanism of exosomal miR-326 from M1 macrophages in regulating HCC cell progression. RT-qPCR detected miR-326 expression in HCC cell lines. miR-326 expression in HCC was altered by transfection, and the effect of miR-326 on CD206 and NF-κB expression, cell proliferation, colony formation, migration, apoptosis and invasion was detected. Subsequently, exosomes were isolated from M1 macrophages. RT-qPCR identified miR-326 expression in M1 macrophage-derived exosomes. miR-326 expression in M1 macrophage-derived exosomes was changed by transfection. M1 macrophage-derived exosomes were co-cultured with HCC cells to figure out their effects on the biological progress of HCC cells. Finally, in vivo experiments were performed to verify the in vitro results. MiR-326 was decreased in HCC cells and enriched in M1 macrophage-derived exosomes. Up-regulating miR-326 would inhibit HCC cell proliferation, colony formation, migration, invasion, and CD206 and NF-κB expression and promoted apoptosis, and inhibited the growth of HCC tumors in vivo, while down-regulating miR-326 showed opposite effects. M1 macrophage-derived exosomes inhibited HCC cell proliferation, colony formation, migration, invasion, and CD206 and NF-κB expression and enhanced apoptosis, while overexpression of miR-326 enhanced the effect of M1 macrophage-derived exosomes on HCC cells. It is revealed that M1 macrophages-derived exosomal miR-326 suppresses proliferation, migration and invasion as well as advances apoptosis of HCC through down-regulating NF-κB expression.
Current diagnostic tools and management modalities of Nocardia keratitis
Authors: Soleimani Mohammad , Masoumi Ahmad , Khodavaisy Sadegh , Heidari Mostafa , Haydar Ali A. , Izadi Alireza
Published: December 2020

Nocardia species are an uncommon but important cause of keratitis. The purpose of this review is to discus previous published papers relation to the epidemiology, etiology, diagnosis and management of Nocardia keratitis. Nocardia asteroides is the most frequently reported from Nocardia keratitis. Pain, photophobia, blepharospasm and lid swelling are mainly clinical manifestations. Usual risk factors for Nocardia keratitis are trauma, surgery, corticosteroids, and contact lens wear. Several antibiotics were used for treatment of Nocardia infection but according to studies, topical amikacin is the drug of choice for Nocardia keratitis. Topical steroid should not prescribe in these patients. In conclusion, although Nocardia keratitis is rare, early diagnosis and treatment are essential to prevent any scar formation and preserve a good visual acuity.
A novel computational model for predicting potential LncRNA-disease associations based on both direct and indirect features of LncRNA-disease pairs
Authors: Xiao Yubin , Xiao Zheng , Feng Xiang , Chen Zhiping , Kuang Linai , Wang Lei
Published: December 2020

Background

Accumulating evidence has demonstrated that long non-coding RNAs (lncRNAs) are closely associated with human diseases, and it is useful for the diagnosis and treatment of diseases to get the relationships between lncRNAs and diseases. Due to the high costs and time complexity of traditional bio-experiments, in recent years, more and more computational methods have been proposed by researchers to infer potential lncRNA-disease associations. However, there exist all kinds of limitations in these state-of-the-art prediction methods as well.

Results

In this manuscript, a novel computational model named FVTLDA is proposed to infer potential lncRNA-disease associations. In FVTLDA, its major novelty lies in the integration of direct and indirect features related to lncRNA-disease associations such as the feature vectors of lncRNA-disease pairs and their corresponding association probability fractions, which guarantees that FVTLDA can be utilized to predict diseases without known related-lncRNAs and lncRNAs without known related-diseases. Moreover, FVTLDA neither relies solely on known lncRNA-disease nor requires any negative samples, which guarantee that it can infer potential lncRNA-disease associations more equitably and effectively than traditional state-of-the-art prediction methods. Additionally, to avoid the limitations of single model prediction techniques, we combine FVTLDA with the Multiple Linear Regression (MLR) and the Artificial Neural Network (ANN) for data analysis respectively. Simulation experiment results show that FVTLDA with MLR can achieve reliable AUCs of 0.8909, 0.8936 and 0.8970 in 5-Fold Cross Validation (fivefold CV), 10-Fold Cross Validation (tenfold CV) and Leave-One-Out Cross Validation (LOOCV), separately, while FVTLDA with ANN can achieve reliable AUCs of 0.8766, 0.8830 and 0.8807 in fivefold CV, tenfold CV, and LOOCV respectively. Furthermore, in case studies of gastric cancer, leukemia and lung cancer, experiment results show that there are 8, 8 and 8 out of top 10 candidate lncRNAs predicted by FVTLDA with MLR, and 8, 7 and 8 out of top 10 candidate lncRNAs predicted by FVTLDA with ANN, having been verified by recent literature. Comparing with the representative prediction model of KATZLDA, comparison results illustrate that FVTLDA with MLR and FVTLDA with ANN can achieve the average case study contrast scores of 0.8429 and 0.8515 respectively, which are both notably higher than the average case study contrast score of 0.6375 achieved by KATZLDA.

Conclusion

The simulation results show that FVTLDA has good prediction performance, which is a good supplement to future bioinformatics research.
Characteristics of the completed chloroplast genome sequence of Xanthium spinosum: comparative analyses, identification of mutational hotspots and phylogenetic implications
Authors: Raman Gurusamy , Park Kyu Tae , Kim Joo-Hwan , Park SeonJoo
Published: December 2020

Background

The invasive speciesXanthium spinosumhas been used as a traditional Chinese medicine for many years. Unfortunately, no extensive molecular studies of this plant have been conducted.

Results

Here, the complete chloroplast (cp) genome sequence ofX. spinosumwas assembled and analyzed. The cp genome ofX. spinosumwas 152,422 base pairs (bp) in length, with a quadripartite circular structure. The cp genome contained 115 unique genes, including 80 PCGs, 31 tRNA genes, and 4 rRNA genes. Comparative analyses revealed thatX. spinosumcontains a large number of repeats (999 repeats) and 701 SSRs in its cp genome. Fourteen divergences (Π > 0.03) were found in the intergenic spacer regions. Phylogenetic analyses revealed thatPartheniumis a sister clade to bothXanthiumandAmbrosiaand an early-diverging lineage of subtribe Ambrosiinae, although this finding was supported with a very weak bootstrap value.

Conclusion

The identified hotspot regions could be used as molecular markers for resolving phylogenetic relationships and species identification in the genusXanthium.
Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study
Authors: Czajka Szymon , Ziębińska Katarzyna , Marczenko Konstanty , Posmyk Barbara , Szczepańska Anna J. , Krzych Łukasz J.
Published: December 2020

Background

There are several scores used for in-hospital mortality prediction in critical illness. Their application in a local scenario requires validation to ensure appropriate diagnostic accuracy. Moreover, their use in assessing post-discharge mortality in intensive care unit (ICU) survivors has not been extensively studied. We aimed to validate APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed adult ICU in Poland. APACHE II, APACHE III and SAPS II scores, with corresponding predicted mortality ratios, were calculated for 303 consecutive patients admitted to a 10-bed ICU in 2016. Short-term (in-hospital) and long-term (12-month post-discharge) mortality was assessed.

Results

Median APACHE II, APACHE III and SAPS II scores were 19 (IQR 12–24), 67 (36.5–88) and 44 (27–56) points, with corresponding in-hospital mortality ratios of 25.8% (IQR 12.1–46.0), 18.5% (IQR 3.8–41.8) and 34.8% (IQR 7.9–59.8). Observed in-hospital mortality was 35.6%. Moreover, 12-month post-discharge mortality reached 17.4%. All the scores predicted in-hospital mortality (p < 0.05): APACHE II (AUC = 0.78; 95%CI 0.73–0.83), APACHE III (AUC = 0.79; 95%CI 0.74–0.84) and SAPS II (AUC = 0.79; 95%CI 0.74–0.84); as well as mortality after hospital discharge (p < 0.05): APACHE II (AUC = 0.71; 95%CI 0.64–0.78), APACHE III (AUC = 0.72; 95%CI 0.65–0.78) and SAPS II (AUC = 0.69; 95%CI 0.62–0.76), with no statistically significant difference between the scores (p > 0.05). The calibration of the scores was good.

Conclusions

All the scores are acceptable predictors of in-hospital mortality. In the case of post-discharge mortality, their diagnostic accuracy is lower and of borderline clinical relevance. Further studies are needed to create scores estimating the long-term prognosis of subjects successfully discharged from the ICU.
There’s just not enough time: a mixed methods pilot study of hepatitis C virus screening among baby boomers in primary care
Authors: Kasting Monica L. , Rathwell Julie , Gabhart Kaitlyn M. , Garcia Jennifer , Roetzheim Richard G. , Carrasquillo Olveen , Giuliano Anna R. , Vadaparampil Susan T.
Published: December 2020

Background

Liver cancer rates are rising and hepatitis C virus (HCV) is the primary cause. The CDC recommends a one-time HCV screening for all persons born 1945–1965 (baby boomers). However, 14% of baby boomers have been screened. Few studies have examined primary care providers’ (PCP) perspectives on barriers to HCV screening. This study examines current HCV screening practices, knowledge, barriers, and facilitators to HCV screening recommendation for baby boomers among PCPs.

Methods

We conducted a mixed methods pilot study of PCPs. Quantitative: We surveyed PCPs from 3 large academic health systems assessing screening practices, knowledge (range:0–9), self-efficacy to identify and treat HCV (range:0–32), and barriers (range:0–10). Qualitative: We conducted interviews assessing patient, provider, and clinic-level barriers to HCV screening for baby boomers in primary care. Interviews were audio recorded, transcribed, and analyzed with content analysis.

Results

The study sample consisted of 31 PCPs (22 survey participants and nine interview participants). All PCPs were aware of the birth cohort screening recommendation and survey participants reported high HCV testing recommendation, but qualitative interviews indicated other priorities may supersede recommending HCV testing. Provider knowledge of viral transmission was high, but lower for infection prevalence. While survey participants reported very few barriers to HCV screening in primary care, interview participants provided a more nuanced description of barriers such as lack of time.

Conclusions

There is a need for provider education on both HCV treatment as well as how to effectively recommend HCV screening for their patients. As HCV screening guidelines continue to expand to a larger segment of the primary care population, it is important to understand ways to improve HCV screening in primary care.
Training primary healthcare workers in China’s township hospitals: a mixed methods study
Authors: Zhao Xuan , Wang Haipeng , Li Juan , Yuan Beibei
Published: December 2020

Background

Primary health care (PHC) was a keystone toward achieving universal health coverage and Sustainable Development Goals (SDGs). China has made efforts to strengthen its PHC institutions. As part of such efforts, regular in-service training is crucial for primary healthcare workers (PHWs) to strengthen their knowledge and keep their skills up to date.

Objective

To investigate if and how the existing training arrangements influenced the competence and job satisfaction of PHWs in township hospitals (THs).

Methods

A mixed method approach was employed. We analyzed the associations between in-service training and competence, as well as between in-service training and job satisfaction of PHWs using logistic regression. Interviews were recorded, transcribed, and analyzed using NVivo12 to better understand the trainings and the impacts on PHWs.

Results

The study found that training was associated with competence for all the types of PHWs except nurses. The odds of higher competence for physicians who received long-term training were 3.60 (p < 0.01) and that of those who received both types of training was 2.40 (p < 0.01). PHWs who received short-term training had odds of higher competence significantly (OR = 1.710, p < 0.05). PHWs who received training were more satisfied than their untrained colleagues in general (OR = 1.638, p < 0.01). Specifically, physicians who received short-term training (OR = 1.916, p < 0.01) and who received both types of training (OR = 1.941, p < 0.05) had greater odds of general job satisfaction. The odds ratios (ORs) of general job satisfaction for nurses who received short-term training was 2.697 (p < 0.01), but this association was not significant for public health workers. The interview data supported these results, and revealed how training influenced competence and satisfaction.

Conclusions

Considering existing evidence that competence and satisfaction serve as two major determinants of health workers’ performance, to further improve PHWs’ performance, it is necessary to provide sufficient training opportunities and improve the quality of training.
Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population
Authors: Lu Ting-Yu , Chen Jen-Hao , Du Je-Kang , Lin Ying-Chun , Ho Pei-Shan , Lee Chien-Hung , Hu Chih-Yang , Huang Hsiao-Ling
Published: December 2020

Background

The impact of poor oral health on older adults’ quality of life is a public health problem. In this study, the mediating effects of dental status, occlusal condition, dysphagia, and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) were assessed in the older adult population.

Methods

Stratified cluster sampling was used to recruit 1076 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected according to their geographic classifications (urban, rural, or mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia, dysphagia and depression was collected through face-to-face interviews. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using the Geriatric Oral Health Assessment Index. Hierarchical regression models were used to assess the relationships between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL.

Results

Participants with xerostomia exhibited a 0.20 OHRQoL reduction (p < .001) compared with patients with no xerostomia, and the direct effect accounted for 83.3% of the total effect. Dysphagia and masticatory performance were found to exert significant mediating effects on the association between xerostomia and OHRQoL (βs = 0.20 and − 0.12, respectively; both p < .001; βs = 0.06 and − 0.09, respectively; both p < .05). Moreover, potential mediating effects of the number of functional teeth (βs = − 0.11 and − 0.43, respectively; both p < .001) and occlusal condition (βs = 0.09 and 0.13, respectively; both p < .05) on the relationship between xerostomia and masticatory performance were noted.

Conclusions

Dysphagia and masticatory performance may serve as pathways through which xerostomia affects quality of life. Early oral function intervention may be a valuable and actionable target for older adults to maintain quality of life. Our results further suggest that checkup and screening for oral dysfunction are essential to prevent or delay the onset of complications.
A risk score based on pediatric sequential organ failure assessment predicts 90-day mortality in children with Klebsiella pneumoniae bloodstream infection
Authors: Li Shuang , Liu Jingxian , Chen Feng , Cai Kang , Tan Jintong , Xie Wei , Qian Rong , Liu Xiaoqin , Zhang Wenhong , Du Huimin , Liu Ying , Huang Lisu
Published: December 2020

Background

Klebsiella pneumoniae bloodstream infection (Kp-BSI) is a serious threat to pediatric patients. The objective of this study was to explore the risk factors, validate the prediction efficiency of pediatric Sequential Organ Failure Assessment (SOFA) and establish better early predictors of mortality in pediatric patients with Kp-BSI.

Methods

All children diagnosed with Kp-BSI were included in this retrospective cohort study from January 2009 to June 2019. Basic characteristics, symptoms and physical examinations, treatments, laboratory statistics, and SOFA at the onset of Kp-BSI were recorded. The Cox proportional hazard model and receiver operating characteristic curves were used to assess the association between the variables and the 90-day mortality and their predictive value. DeLong’s test of receiver operating characteristic curves and integrated discrimination improvement index were used to determine the improvement in predictive capacity of the modified SOFA models. A predictive score was developed using multivariate logistic regression.

Results

Of the 146 children enrolled, 33 (22.6%) patients died within 90 days. Hospitalization in the last 6 months, intra-abdominal source of infection, presence of organ failure, and altered levels of blood biomarkers, including C-reactive protein, albumin, and lactate were significant risk factors for 90-day mortality. The area under the curve (AUC) of SOFA for predicting 90-day mortality was 0.80 (95% CI 0.71–0.89). Moreover, we found that a prediction model combining SOFA with two other parameters, namely hospitalization in the last 6 months and intra-abdominal source of infection, was better at predicting mortality (AUC = 0.89, 95% CI 0.82–0.96; sensitivity = 0.86; specificity = 0.84). According to this novel risk model, we defined three statistically different groups: low-risk, medium-risk and high-risk groups, with an observed 90-day mortality of 5.4, 35.7, and 72.0%, respectively. With reference to the low-risk patients, the medium-risk and high-risk groups had a higher mortality, with hazard ratios of 8.36 (95% CI 3.60–27.83) and 20.27 (95% CI 7.47–54.95), respectively.

Conclusions

The modified SOFA may be better than the original score to predict 90-day mortality in pediatric patients with Kp-BSI. Future prospective studies are required to validate this novel scoring system in external cohorts.
“Side effects--part of the package”: a mixed methods approach to study adverse events among patients being programmatically treated for DR-TB in Gujarat, India
Authors: Jakasania Arjunkumar , Shringarpure Kalpita , Kapadia Dixit , Sharma Radhika , Mehta Kedar , Prajapati Arpit , Kathirvel Soundappan
Published: December 2020

Background

High rates of Adverse Events (AEs) during treatment is one of the leading causes of unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB). However, information related to AEs is not systematically collected and managed under programmatic setting. The present study assessed the a) incidence and pattern of adverse events in first three months of DR-TB treatment initiation; b) treatment seeking behaviour for AE management; and c) explore the challenges in seeking treatment and reporting AEs.

Methods

This mixed methods study included all patients diagnosed and initiated on treatment under RNTCP during July–September 2018 at Ahmedabad DR-TB centre. The patients were interviewed telephonically and assessed for all AEs experienced by them. In-depth interviews and key-informant interviews were conducted among patients, DOTS supervisors and programme staff (treatment supervisors, medical officer and district program managers).

Results

Total 207 AEs were reported by the 74 DR-TB patients. All patients experienced at least one AE during initial treatment period. Incidence rate of AEs (experienced) was 3.11 (1st month-4.6, 2nd month-2.7, 3rd month-2.02) per 100 person days. Of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and sub-themes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, and past treatment experience; 2) Health system related- lack of guidelines and training for AE management, 3) Poor coordination between hospital and tuberculosis centre.

Conclusion

The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient and orientation of the health systems is the need of the hour. An efficient real-time reporting and management of AE should be developed and tested for effective DR-TB control.
High prevalence of SARS-CoV-2 infection among symptomatic healthcare workers in a large university tertiary hospital in São Paulo, Brazil
Authors: Buonafine Carolina Palamin , Paiatto Beatriz Nobre Monteiro , Leal Fabyano Bruno , de Matos Samantha Faria , de Morais Camila Ohomoto , Guerra Giovanna Guazzelli , Martuchelli Marcus Vinicius Vidal , Oliveira Danielle Bruna Leal , Durigon Edison Luiz , Soares Camila Pereira , Candido Erika Donizette , Telezynski Bruna Larotonda , Sáfadi Marco Aurélio Palazzi , Almeida Flávia Jacqueline
Published: December 2020

Background

Brazil became the epicenter of the COVID-19 pandemic in Latin America since May 2020, reporting the highest number of cases and deaths in the region. Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection, experiencing a significant burden from COVID-19. Identifying and understanding the clinical characteristics and risk factors associated with infection are of paramount importance to inform screening strategies and infection control practices in this scenario. The aims of this study were to investigate the prevalence and clinical characteristics of HCWs with COVID-19 symptoms.

Methods

Between March 21st and May 22nd, 2020 a cross-sectional study was performed in a tertiary university hospital in São Paulo. Prevalence of SARS-CoV-2 infection among HCWs with COVID-19 symptoms was determined by RT-PCR testing on nasopharyngeal and oropharyngeal samples. Participants were asked to complete an electronic structured questionnaire including clinical and demographic data.

Results

Overall, 125 (42.37%) of 295 symptomatic HCWs tested positive for SARS-CoV-2. Over the 10-week study period, positivity rates varied from 22.2% (95% CI 15.9–60.3%) in the second week to 55.9% (95% CI 43.2–68.6%) in the sixth week, reaching a plateau (38–46%) thereafter. Median (SD) age was 34.2 (9.9) years and 205 (69.5%) were female. We did not find significant differences in the prevalence of the most commonly reported underlying medical condition among healthcare workers that tested positive or negative for SARS-CoV-2 infection. After multivariable analysis, using logistic regression, anosmia (adjusted OR 4.4 95% CI 2.21–8.74) and ocular pain (adjusted OR 1.95 95% CI 1.14–3.33) were the only symptoms independently associated with positivity for SARS-CoV-2 infection. Follow-up information on clinical outcomes showed that 9 (7.2%) HCWs were hospitalized (seven were male) and 2 (1.6%) died.

Conclusions

The findings of this study confirmed the high burden of SARS-CoV-2 infection among healthcare workers in the hardest hit city by the pandemic in Latin America. Anosmia and ocular pain were symptoms independently associated with COVID-19 diagnosis. In low and middle-income countries, where limited availability of tests is frequent, these findings may contribute to optimize a targeted symptom-oriented screening strategy.
Prevalence and predictors of alternative diagnoses on whole-leg ultrasound negative for acute deep venous thrombosis
Authors: Beller Ebba , Becher Mattes , Meinel Felix G. , Kröger Jens-Christian , Rajagopal Rengarajan , Höft Raimund , Weber Marc-André , Heller Thomas
Published: December 2020

Background

To investigate the prevalence, spectrum, and predictors of alternative diagnoses explaining leg symptoms in patients negative for suspected acute deep venous thrombosis (DVT), which can be detected with whole-leg ultrasound.

Methods

We retrospectively analyzed a cohort of 789 patients (median age 70 years, 50.6% women) evaluated with a whole-leg ultrasound examination for suspected acute DVT within one year. All findings in the radiology report were analyzed and electronic chart review was performed to collect clinical information.

Results

Ultrasound was negative for acute DVT in 531 patients (67.3%). Among these, alternative diagnoses explaining leg symptoms were seen in 349 patients (65.7%). The most frequent alternative diagnoses were chronic venous insufficiency (147 patients, 27.7%), followed by lymphedema (48 patients, 9.0%) and chronic post-thrombotic changes (41 patients, 7.7%). Patients with alternative diagnoses were older (median 71 vs. 66 years, p = 0.0226), as well as more likely to present with leg swelling (39.5% vs. 23.1%, p = 0.0002), difference in leg circumference (25.5% vs. 14.8%, p = 0.0055) and redness (7.7% vs. 2.7%, p = 0.0213) than patients without alternative diagnosis. Independent predictors of finding alternative diagnoses on whole-leg ultrasound were older age (odds ratio 1.014 per year, p = 0.0119), leg swelling (OR 1.949, p = 0.0020) and history of previous DVT (OR 2.235, p = 0.0154).

Conclusions

Alternative diagnoses explaining leg symptoms can be detected on whole-leg ultrasound in two thirds of patients with no evidence of acute DVT. Our data supports performing a comprehensive ultrasound evaluation beyond the venous system, particularly, in older patients, who present with leg swelling and a past history of DVT.
Separate and combined effects of cold dialysis and intradialytic exercise on the thermoregulatory responses of hemodialysis patients: a randomized-cross-over study
Authors: Krase Argyro A. , Flouris Andreas D. , Karatzaferi Christina , Giannaki Christoforos D. , Stefanidis Ioannis , Sakkas Giorgos K.
Published: December 2020

Background

The separate and combined effects of intradialytic exercise training (IET) and cold dialysis (CD) on patient thermoregulation remain unknown. This study assessed the thermoregulatory responses of hemodialysis patients under four different hemodialysis protocols: a) one typical dialysis (TD) protocol (dialysate temperature at 37 °C), b) one cold dialysis (CD) protocol (dialysate temperature at 35 °C), c) one typical dialysis protocol which included a single exercise bout (TD + E), d) one cold dialysis protocol which included a single exercise bout (CD + E).

Methods

Ten hemodialysis patients (57.2 ± 14.9 years) participated in this randomized, cross-over study. Core and skin temperatures were measured using an ingestible telemetric pill and by four wireless iButtons attached on the skin, respectively. Body heat storage (S) calculated using the thermometric method proposed by Burton.

Results

The TD and TD + E protocols were associated with increased S leading to moderate effect size increases in core body temperature (as high as 0.4 °C). The low temperature of the dialysate during the CD and the CD + E protocols prevented the rise in S and core temperature (p > 0.05), even during the period that IET took place.

Conclusions

TD and IET are accompanied by a moderate level of hyperthermia, which can be offset by CD. We recommended that CD or with IET can prevent the excessive rise of S.

Trial registration

Clinical Trial Registry number: NCT03905551 (clinicaltrials.gov), DOR: 05/04/2019,
Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018
Authors: Amjad Aaisha , Imran Abeeha , Shahram Nabeeha , Zakar Rubeena , Usman Ahmed , Zakar Muhammad Zakria , Fischer Florian
Published: December 2020

Background

Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018.

Methods

Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990–91, 2006–07, 2012–13 and 2017–18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR).

Results

The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births.

Conclusions

The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.
LAD1 expression is associated with the metastatic potential of colorectal cancer cells
Authors: Moon Byul , Yang Suk-Jin , Park Seong Min , Lee Sang-Hyun , Song Kyu Sang , Jeong Eun-Jeong , Park Mijin , Kim Jang-Seong , Yeom Young Il , Kim Jung-Ae
Published: December 2020

Background

Anchoring filament protein ladinin-1 (LAD1) was related to the aggressive progression of breast, lung, laryngeal and thyroid cancers. However, the association of LAD1 with colorectal cancer remained unknown. Here, to determine the relationship of LAD1 with colorectal cancer progression, we explored the effect of LAD1 loss on the malignant features of colorectal cancer cells.

Methods

We constructed LAD1-depleted cell lines and examined the effect of LAD1 deficiency on the phenotypic and molecular features of colorectal cancer cells in vitro. The function of LAD1 in metastasis in vivo was examined by establishing a spleen-to-liver metastasis mouse model. LAD1 protein expression in colorectal cancer patient specimens was assessed by immunohistochemistry of tumor microarrays.

Results

We found that LAD1 was abundant in most colorectal cancer cells. In addition, high expression of LAD1 significantly correlated with poor patient outcome. LAD1 depletion inhibited the migration and invasion of two different colorectal cancer cell lines, SW620 and Caco-2, without affecting their proliferation. In addition, LAD1 loss led to defects in liver metastasis of SW620 cells in the mouse model. Immunohistochemistry of colorectal cancer tissues revealed LAD1 enrichment in metastatic tissues compared to that in primary tumor and normal tissues.

Conclusion

These results suggest that LAD1 expression is associated with the metastatic progression of colorectal cancer by promoting the migration and invasion of cancer cells.
Pulmonary cavitation in patients with thyroid cancer receiving antiangiogenic agents
Authors: Datar Saumil , Cabanillas Maria , Dadu Ramona , Ost David , Grosu Horiana B.
Published: December 2020

Background

Thyroid malignancies are among the most common endocrine cancers worldwide. Owing to the angiogenic nature of these malignancies, tyrosine kinase inhibitors (TKIs) are an attractive potential treatment. However, TKIs have been associated with an increased risk of tumor cavitation, in turn linked to poor outcomes, in patients with malignancies in the lungs, where thyroid cancer commonly metastasizes.

Method

We performe d a retrospective cohort study of patients with thyroid cancer and evidence of metastatic disease to the lung that were treated with multi-targeted antiangiogenic TKIs. The primary objective of this study was to determine the incidence of pulmonary cavitation. The secondary objective was to evaluate the effect of pulmonary cavitation on survival.

Results

Of the 83 patients with pulmonary nodules, 10 developed cavitation during treatment. Of these 83 patients, two patients had to stop the treatment due to pneumothorax. Additionally, cavitation did not demonstrate any significant effect on survival.

Conclusion

In patients with thyroid cancer and evidence of metastatic disease to the chest, the use of multi-targeted TKIs led to cavitations that were not uncommon but clinical consequences were marginal. Treatment was stopped only in two patients that developed pneumothorax, however the small sample is a strong limitation of our study.
Are tumor-associated micro-angiogenesis and lymphangiogenesis considered as the novel prognostic factors for patients with Xp11.2 translocation renal cell carcinoma?
Authors: Ma Wenliang , Yang Jun , Liu Ning , Pu Xiaohong , Qu Feng , Xu Linfeng , Zhao Xiaozhi , Li Xiaogong , Zhang Gutian , Guo Hongqian , Li Dongmei , Gan Weidong
Published: December 2020

Background

Tumor micro-angiogenesis and lymphangiogenesis are effective prognostic predictors in many solid malignancies. However, its role on Xp11.2 translocation RCC has not been fully elucidated. Herein, we purposed to explore the correlation between quantitative parameters of tumor-related micro-angiogenesis or lymphangiogenesis and the prognosis of Xp11.2 translocation renal cell carcinoma (Xp11.2 translocation RCC).

Methods

Tissue samples were obtained from 34 Xp11.2 translocation RCC and 77 clear cell renal cell carcinoma (ccRCC) between January 2007 and December 2018. Micro-angiogenesis was detected using CD34 antibody and quantified with microvessel density (MVD) and microvessel area (MVA), while the lymphangiogenesis in RCC was immunostained with D2–40 antibody and assessed using lymphatic vessel density (LVD) and lymphatic vessel area (LVA). The Kaplan-Meier method of survival analysis was used to estimate prognosis, and both univariate and multivariate analysis was performing using the Cox proportional hazards.

Results

The MVD and MVA of Xp11.2 translocation RCC in two detected areas (intratumoral and peritumoral area) were not significantly different from that of ccRCC (all P > 0.05). Notably, D2–40-positive lymphatic vessels of Xp11.2 translocation RCC were highly detected in the peritumoral area compared to the intratumoral area. Interestingly, the peritumoral LVD and LVA of Xp11.2 translocation RCC were higher than that of ccRCC (all P < 0.05). Furthermore, both intratumoral MVD or MVA and peritumoral LVD or LVA were significantly associated with pT stage, pN stage, cM stage, AJCC stage, and WHO/ISUP grade (all P < 0.05). Univariate analysis of Cancer-specific survival (CSS) revealed that CSS was substantially longer in patients with low intratumoral MVD or MVA than in patients with high intratumoral MVD or MVA (P = 0.005 and P = 0.001, respectively). Lastly, the Cox proportional hazards model in CSS demonstrated that both intratumoral MVD or MVA and peritumoral LVD or LVA were not independent prognostic parameters (all P > 0.05).

Conclusions

This study outlines that Xp11.2 translocation RCC is a highly vascularized solid RCC, characterized by rich lymph vessels in the peritumoral area. Quantitative parameters of micro-angiogenesis and lymphangiogenesis could not be considered as novel prognostic factors for patients with xp11.2 translocation RCC.
Early macrophage infiltrates impair pancreatic cancer cell growth by TNF-α secretion
Authors: Tekin Cansu , Aberson Hella L. , Bijlsma Maarten F. , Spek C. Arnold
Published: December 2020

Background

Pancreatic ductal adenocarcinoma (PDAC) is a grim disease with high mortality rates. Increased macrophage influx in PDAC is a common hallmark and associated with poor prognosis. Macrophages have high cellular plasticity, which can differentiate into both anti- and pro-tumorigenic properties. Here, we investigated how naïve (M0) macrophages differ from other macrophages in their anti-tumorigenic activities.

Methods

In vitro BrdU proliferation and Annexin V cell death analyses were performed on PANC-1 and MIA PaCa-2 PDAC cell lines exposed to conditioned medium of different macrophage subsets. Macrophage secreted factors were measured by transcript analysis and ELISA. Therapeutic antibodies were used to functionally establish the impact of the identified cytokine on PDAC proliferation.

Results

Proliferation and cell death assays revealed that only M0 macrophages harbor anti-tumorigenic activities and that M1, M2, and TAMs do not. mRNA analysis and ELISA results suggested TNF-α as a potential candidate to mediate M0 macrophage induced cell death. To demonstrate the importance of TNF-α in M0 macrophage-induced cell death, PANC-1 and MIA PaCa-2 cell-lines were exposed to M0 macrophage conditioned medium in the presence of the TNF-α inhibitor Infliximab, which effectively diminished the anti-tumor activities of M0 macrophages.

Conclusion

Newly tumor-infiltrated naive M0 macrophages exert anti-tumorigenic activities via TNF-α secretion. Their subsequent differentiation into either M1, M2, or TAM subsets reduces TNF-α levels, thereby abolishing their cytotoxic activity on PDAC cells. These data suggest that reestablishing TNF-α secretion in differentiated macrophages might yield a therapeutic benefit.