bluuebunny/crossref_metadata_2025 huggingface dataset:
The healing response of LAMax LAAC™ left atrial appendage occluder in a canine model: the potential influence of the implantation technique on the healing response
Authors: Wu Xiaoxia , Ma Dongxing , Wan Tao , Meng Yuezhi , Chen Yilong , Shen Yejia , Huang Wei
Published: June 2022

Background

Device-associated thrombus are potential causes for thromboembolic events post left atrial appendage closure (LAAC), and correlated with the complete endothelialization of the device surface. Our aim was to evaluate the endothelialization of LAMax LAAC™ occluder surface and analyze the potential influence of the implantation technique on the healing response.

Methods

A total of 29 healthy dogs (28.0 ± 3.7 kg) were implanted with the devices successfully after ensuring COVER signs was met (Concavity of the disc, Oversizing by 20–50%, Verifying position, Ensuring stability, Residual flow < 5 mm by transesophageal echocardiographic (TEE) examination), and sacrificed at < 24 h, 1-, 2-, 3-, and 6-months. Gross examinations were conducted to evaluate healing response.

Results

The mean diameters of LAA orifice measured by angiography and TEE were 19.0 ± 2.9 mm and 16.6 ± 2.9 mm (P < 0.05), respectively. TEE found that the discs in 18 dogs (62.1%) were completely pulled into the LAA with concavity and in 11 dogs incompletely pulled into the LAA with suboptimally concavity, while 5 of them had residual flow. Gross examinations showed that the complete endothelialization on the device surface with concaved disc was found at 1-month after LAAC. Microscopic examinations confirmed complete healing on the device with optimal closure effect.

Conclusions

The good healing response and the optimal closure effect were observed using the LAMax device in a canine model by following the COVER implantation technique.
Endoscopic nasobiliary drainage-based saline-injection ultrasound: an imaging technique for remnant stone detection after retrograde cholangiopancreatography
Authors: Wu XiaoDong , Wu ShuoDong , Tang ShaoShan
Published: June 2022

Background

The purpose of this retrospective study aimed to assess the accuracy of detection of remnant common bile duct (CBD) stones by injecting saline through endoscopic nasobiliary drainage (ENBD) tubes under transabdominal ultrasound (US) guidance.

Method

Stone extraction and ENBD are regularly achieved through endoscopic retrograde cholangiopancreatography (ERCP) in patients with CBD stones. At 1–3  days thereafter, routine US studies were performed and repeated, using ENBD tubal saline injections (20–100  mL).

Results

A total of 302 patients underwent standard ERCP stone extractions in conjunction with occlusion cholangiograms, routine US testing, and ENBD-based saline-injection US exams. By occlusion cholangiogram, remnant stones were suspected in 31 (10.3%) patients in total of 302, and 26 (83.8%) were verified as true positives (sensitivity, 50.9%; specificity, 98.0%). Routine US studies proved suspicious in 13 (4.3%) patients in total of 302, and 12 (92.3%) were verified as true positives (sensitivity, 23.5%; specificity, 99.6%). Using ENBD-based saline-injection US, suspected stones were identified in 50 (16.6%) patients in total of 302, and 46 (92%) were verified as true positives (sensitivity, 90.1%; specificity, 98.4%). The sensitivity of ENBD-based saline-injection US significantly surpassed that of occlusion cholangiogram (p < 0.001) and routine US (p < 0.001).

Conclusion

Detection of remnant CBD stones via ENBD-based saline-injection US is a valid, inexpensive, and repeatable means of patient screening that is non-invasive, radiation-free, and dynamically informative. This may help improve the accuracy of detecting remnant CBD stones after ERCP.
Needs, benefits, and issues related to home adaptation: a user-centered case series applying a mixed-methods design
Authors: Schorderet Chloé , Ludwig Catherine , Wüest Frederic , Bastiaenen Caroline H. G. , de Bie Robert A. , Allet Lara
Published: June 2022

Introduction

Home adaptation can be a key contributor to successfully aging at home, allowing older adults to remain in a familiar environment while maintaining their quality of life and well-being despite progressing functional difficulties. Although several theoretical studies on home adaptations exist, the benefits of custom home adaptations remain poorly evaluated. The present study's primary aims were to explore older adults' expectations and needs regarding home adaptations and evaluate the impact of individualized home adaptations on quality of life, fear of falling, independence, and difficulties using adapted rooms. Its secondary aim was to describe the barriers and facilitators of home adaptation.

Method

The 15 homes in this case series were adapted using an inclusive, interdisciplinary approach. Adaptations' effects were assessed using a parallel mixed-methods design. Quantitative and qualitative data were collected using questionnaires and semi-structured interviews. An architect and a health professional visited each home twice to assess the older adult's expectations and needs, evaluate the home's technical aspects, and co-create an adaptation plan with that study participant. They assessed the older adult's perceived quality of life, fear of falling, independence, and difficulties using the rooms needing adaptations. Inhabitants received two more visits after the adaptations (one or two months and six months later) to assess their benefits.

Results

Most homes had their bathroom adapted. Participants reported improved safety, independence, ease of use, positive feelings, and comfort. They also reported lower perceived levels of difficulties during the activities of daily living in the adapted rooms (reductions of 93.4% [SD = 12.7] of bathrooms and 100% of kitchens), an improvement in quality of life of 9.8% (SD = 27.6), and a reduction in fear of falling of 12.5% (SD = 9.7).

Conclusion

Home adaptations are beneficial to older adults' activities of daily living and improve their quality of life; however, several factors hinder the implementation of those adaptations.
Extracorporeal membrane oxygenation rescue for severe pneumocystis pneumonia with the Macklin effect: a case report
Authors: Huang Guoqing , Zhou Liping , Yang Ning , Wu Ping , Mo Xiaoye
Published: June 2022

Background

Pneumocystis jirovecii pneumonia (PJP) in an immunocompromised host is often associated with the Macklin effect, which can progress to spontaneous pneumomediastinum (SPM), subcutaneous emphysema (SCE), and pneumothorax (PNX). Diagnosing the causative organism of these conditions in non-HIV infected patients and treating hypoxemia while preventing further lung damage can be challenging. This study examines the case of a non-HIV infected male with SPM, SCE, and PNX secondary to severe Pneumocystis jirovecii (PJ) infection.

Case presentation

A 53-year-old male with pure red cell aplasia (PRCA) was admitted with fever, dry cough, and shortness of breath. His respiratory function progressively deteriorated due to the development of SPM, SCE, and PNX, eventually requiring endotracheal intubation and invasive ventilation. As a result of high pressure in his airways occasioned by lung recruitment maneuvers, his pulmonary parameters worsened, necessitating veno-venous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The early initiation of VV-ECMO facilitated ultra-protective lung ventilation and prevented the progression of SPM, SCE, and PNX. Traditional diagnostic assays were unrevealing, whereupon the patient resorted to the metagenomic next-generation sequencing technology for uncovering potential pathogens. Consequently, we detected a significantly higher infection by PJ in the patient’s bronchoscopy lavage fluid. Finally, the patient was successfully treated with appropriate antimicrobials and was decannulated after nine days of ECMO support.

Conclusions

SPM, SCE, and PNX are rare clinical manifestations of PJP. However, they can be considered as poor prognostic factors of the infection. Physicians should, therefore, be alert to the possibility of PJP in immunocompromised patients.
A novel mutation of KCNJ1 identified in an affected child with nephrolithiasis
Authors: Yang Saisai , Yao Guanghui , Chen Xin , Shi Huirong , Lou Chihhong , Ren Shumin , Jiao Zhihui , Wang Cong , Kong Xiangdong , Wu Qinghua
Published: June 2022

Nephrolithiasis is not common in children, but the incidence is gradually increased in these years. Urinary tract malformations, urinary infection, dietary habits, geographic region and genetic factor are involved in the etiology of nephrolithiasis. For the affected child, it is especially important to elucidate the etiology, which may provide an accurate diagnosis, a personalized therapy and effective follow-up strategy. Here to seek the etiology of a ten-year-old boy incidentally found with nephrolithiasis, next generation sequencing (NGS) including a panel with 248 genes involved in hereditary kidney diseases was performed for the boy and identified two mutations of KCNJ1, c.89G > A (p.C30Y) and c.65G > T (p.R22M), and the later was a novel missense mutation originated from his father. The child was confirmed with type II Bartter syndrome (BS) caused by KCNJ1 mutations. Our study suggests that BS may be difficult to get diagnosed at an early stage based on clinical manifestations or biochemical laboratory tests, and NGS is an efficient way to determine the etiology and provide further treatment and guide fertility counseling for the affected family.
One case of arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome featuring an incomplete and mild phenotype
Authors: Yu Lianhu , Li Dan , Zhang Ting , Xiao Yongmei , Wang Yizhong , Ge Ting
Published: June 2022

Background

Arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome is a rare disease with a high mortality rate caused by VPS33B or VIPAS39 mutations. ARC syndrome typically presents with arthrogryposis, renal tubular leak and neonatal cholestatic jaundice, and most patients with this disease do not survive beyond one year.

Case presentation

Here, we report the case of a 13-year-old girl with ARC featuring an incomplete and mild phenotype with novel compound heterozygous mutations of VPS33B. The patient presented with arthrogryposis (claw-shaped limbs), ichthyosis, jaundice, and pruritus. Laboratory tests revealed highly evaluated levels of total bilirubin (TB), direct bilirubin (DB), and total bile acid (TBA) as well as normal levels of gamma-glutamyltransferase (GGT). However, signs of renal dysfunction, as well as other manifestations of ARC syndrome, including nervous system abnormalities, deafness, and failure to thrive, were not observed. The patient’s clinical symptoms of jaundice and pruritus were significantly alleviated by administration of ursodeoxycholic acid. Whole-exome sequencing (WES) revealed novel compound heterozygous mutations of VPS33B, c.1081 C > T (p.Q361X,257)/c.244 T > C (p.C82R). Both variants were predicted to be pathogenic in silico and have never been reported previously. To date, the patients’ cholestatic jaundice has been well controlled with continuous treatment of ursodeoxycholic acid.

Conclusions

We report the case of a Chinese female with ARC including novel compound heterozygous mutations of VPS33B and an incomplete and mild phenotype. Early diagnosis and suitable symptomatic therapies are critical for the management of ARC patients with mild manifestations and prolonged lifespan.
Transcranial doppler as screening method for sickling crises in children with sickle cell anemia: a latin America cohort study
Authors: Modolo Gabriel Pinheiro , Luvizutto Gustavo José , Hamamoto Filho Pedro Tadao , Braga Gabriel Pereira , Bazan Silmeia Garcia Zanati , Ferreira Natalia Cristina , de Souza Juli Thomaz , Winckler Fernanda Cristina , Macedo de Freitas Carlos Clayton , Hokama Newton Key , Vidal Edison Iglesias de Oliveira , Bazan Rodrigo
Published: June 2022

Background

Sickle cell anemia (SCA) is the leading cause of childhood stroke. We aimed to evaluate whether altered cerebral flow velocities, as measured by transcranial Doppler (TCD), are associated with vaso-occlusive complications in addition to stroke in pediatric SCA patients.

Methods

We evaluated 37 children aged between 2 and 16 years with SCA who underwent screening for TCD between January 2012 and October 2018. Genotypic profiles and demographic data were collected, TCD examinations were performed during follow-up, and the presence of sickling crises was compared. Survival analyses were performed using simple frailty models, in which each predictor variable was analyzed separately in relation to the occurrence of a sickling crisis.

Results

The variables related to sickle cell crises in the univariate analysis were peak systolic velocity (PSV) in the middle cerebral artery (MCA), hazard ratio (HR) 1.01 (1.00—1.02) p = 0.04; end-diastolic velocity (EDV) in the MCA, HR 1.02 (1.01—1.04) p = 0.01; time average mean maximum velocity (TAMMV) in the basilar artery (BA), HR 1.02 (1.00—1.04) p = 0.04; hemoglobin, HR 0.49 (0.38—0.65) p < 0.001; hematocrit, HR 0.78 (0.71—0.85) p < 0.001; leukocyte counts, HR 1.1 (1.05—1.15) p < 0.001; platelets counts, HR 0.997 (0.994—0.999) p = 0.02; and reticulocyte numbers, HR 1.14 (1.06—1.23) p < 0.001.

Conclusions

Our results indicate PSV and EDV in the MCA and TAMMV in the BA as markers of risk for the occurrence of sickling crises in SCA.
French adaptation and validation of the Panic Disorder Severity Scale—self-report
Authors: Roberge Pasquale , Marx Patricia , Couture Jonathan , Carrier Nathalie , Benoît Annie , Provencher Martin D. , Antony Martin M. , Norton Peter J.
Published: June 2022

Background

The aims of this study were to conduct a cross-cultural validation of the Panic Disorder Severity Scale – Self-Report (PDSS-SR) and to examine psychometric properties of the French-Canadian version.

Methods

A sample of 256 adults were included in the validation study based on data from the baseline interview of a clinical trial on transdiagnostic cognitive-behavioral therapy for mixed anxiety disorders. Participants completed the Anxiety and Related Disorders Interview Schedule (ADIS-5), and self-report instruments including the PDSS-SR, Beck Anxiety Inventory (BAI), Mobility Inventory for Agoraphobia (MIA), Sheehan Disability Scale (SDS), Patient Health Questionnaire (PHQ-9), Social Phobia Inventory (SPIN), Insomnia Severity Index (ISI) and Penn State Worry Questionnaire (PSWQ). The cross-cultural adaptation in French of the PDSS-SR included a rigorous back-translation process, with an expert committee review. Sensitivity to change was also examined with a subgroup of patients (n = 72) enrolled in the trial.

Results

The French version of the PDSS-SR demonstrated good psychometric properties. The exploratory factor analysis supported a one factor structure with an eigenvalue > 1 that explained 64.9% of the total variability. The confirmatory factor analysis (CFA) corroborated a one-factor model with a good model fit. Internal consistency analysis showed a .91 Cronbach’s alpha. The convergent validity was adequate with the ADIS-5 clinical severity ratings for panic disorder (r = .56) and agoraphobia (r = .39), as well as for self-report instruments [BAI (r = .63), MIA (accompanied: r = .50; alone: r = .47) and SDS (r = .37)]. With respect to discriminant validity, lower correlations were found with the SPIN (r = .17), PSWQ (r = .11), ISI (r = .19) and PHQ-9 (r = .28). The optimal threshold for probable diagnosis was 9 for the PDSS-SR and 4 for the very brief 2-item version. The French version showed good sensitivity to change.

Conclusions

The French version of the PDSS-SR has psychometric properties consistent with the original version and constitutes a valid brief scale to assess the severity of panic disorder and change in severity over time, both in research and clinical practice.
A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda
Authors: Muziki Jean d’Amour , Uwera Thaoussi , Niyonsenga Japhet , Nshimiyimana Augustin , Sebatukura Siméon Gitimbwa , Mutabaruka Jean
Published: June 2022

Background

Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies.

Methods

This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows.

Results

Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants.

Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources.

Discussion

Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.
How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study
Authors: Malkomsen A , Røssberg JI , Dammen T , Wilberg T , Løvgren A , Ulberg R , Evensen J
Published: June 2022

Background

Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD).

Methods

Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.

Results

Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth.

Conclusions

These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts.

Trial registration

Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.
Postoperative shoulder balance in Lenke type 1 adolescent idiopathic scoliosis patients with large thoracic curve (Cobb angle ≥ 70 degrees): a radiographic study
Authors: Jiang Jun , Chen Xu , Qiu Yong , Wang Bin , Yu Yang , Zhu Ze-zhang
Published: June 2022

Background

Large amounts of thoracic curve correction had been considered as a risk factor for postoperative shoulder imbalance (PSI) in adolescent idiopathic scoliosis (AIS) patients. This study aims to evaluate postoperative shoulder balance in Lenke type 1 AIS patients with large thoracic curve (Cobb angle ≥ 70 degrees) and compared it with those with moderate thoracic curve (Cobb angle < 70 degrees).

Methods

A total of 47 Lenke type 1 AIS patients underwent posterior correction surgery between Sept. 2016 to Nov. 2018 in our institution were included. All these patient were divided into 2 groups based on the severity of main thoracic (MT) curve. Group A consisted of 25 cases with MT curve equal to or more than 70 degree while Group B consisted of 22 cases with MT curve less than 70 degree. Proximal thoracic (PT) Cobb angle, MT Cobb angle, MT apical vertebral translation (AVT), T2-T5 kyphosis, T5-T12 kyphosis, and radiographic shoulder height (RSH) were compared between these 2 groups preoperatively, immediately after surgery, and at a minimum of two-year follow-up.

Results

Although all the correction of PT Cobb angle (15.8° ± 6.0° vs 12.5° ± 3.6°, P = 0.028), that of MT Cobb angle 47.3° ± 9.1° vs 30.9° ± 6.7°, P < 0.001) and that of MT AVT (35.1 mm ± 16.0 mm vs 24.1 mm ± 8.9 mm, P = 0.007) were significantly larger in Group A when compared with Group B, RSH was comparable between these 2 groups at last follow up (7.5 mm ± 7.4 mm vs 9.2 mm ± 4.2 mm P = 0.363). Most of the patients gained satisfactory shoulder balance with only 7 cases with minimal PSI in group A (28%) and only 6 cases with minimal PSI in group B (27.3%) at last follow-up (P > 0.05).

Conclusions

Although Lenke type 1 AIS patients with large thoracic curve had more amounts of MT curve correction when compared with those with moderate thoracic curve, it did not lead to higher incidence of PSI if the correction rate is proper.
Bifocal femoral lengthening assisted by preoperative 3-dimensional design in the restoration of posttraumatic limb length discrepancy
Authors: Yushan Maimaiaili , Hamiti Yimurang , Yalikun Ainizier , Lu Cheng , Yusufu Aihemaitijiang
Published: June 2022

Background

To assess the clinical outcomes of preoperative three-dimensional planning followed by bifocal femoral lengthening in the treatment of posttraumatic limb length discrepancy (LLD).

Methods

A total of 8 eligible patients with posttraumatic femoral LLD > 6 cm were admitted to our institution from January 2015 to January 2018 and treated by bifocal femoral lengthening with the assistance of 3-dimensional imaging technology. The following data were collected: detailed demographic information, the amount of lengthening, external fixation time (EFT), external fixation index (EFI), postoperative bone and functional outcomes, and complications in the follow-up period.

Results

All included patients were successfully followed up for in an average of 55.4 ± 6.7 months after removal of the external fixator. There were six males and two females with an average age of 38.4 ± 12.2 years. The mean preoperative LLD was 69.2 ± 6.2 mm. The mean lengthening amount was 67.5 ± 6.9 mm. The mean EFT was 180.1 ± 20.2 days. The EFI was 26.73 ± 1.36 days/cm on average. All patients achieved satisfactory postoperative bone and functional outcomes. No major complications such as nerve or vascular injury were observed.

Conclusions

Bifocal femoral lengthening with preoperative three-dimensional design provided precise surgical guidance and resulted in satisfactory postoperative outcomes, demonstrating that it is an effective treatment for posttraumatic femoral LLD.
The association between early marriage and mental disorder among young migrant and non-migrant women: a Norwegian register-based study
Authors: Hynek Kamila Angelika , Abebe Dawit Shawel , Liefbroer Aart C. , Hauge Lars Johan , Straiton Melanie Lindsay
Published: June 2022

Background

Marriage is considered beneficial for mental health when stable and of high quality. Yet, it is unclear whether marriage is equally advantageous for everyone regardless of marital timing or migrant background. This study aimed to investigate the association between early marriage and mental disorder, defined by outpatient mental healthcare (OPMH) service use, and whether the association varies between migrant and non-migrant women.

Methods

Using data from four Norwegian national registers, we applied discrete-time logistic regression analyses to study the aims of interest, among 602 473 young women aged 17–35 years. All women were followed from 2006 or the year they turned 17, and until first OPMH consultation, 2015 (study end), the year they turned 35, when emigrated, died, or changed marital status from married to separated, divorced, or widowed.

Results

Results show that unmarried and early married women had increased odds of mental disorder when compared to on-time married women. However, the differences between the early and on-time married women were explained by differences in educational level. There was no significant interaction between marital status and migrant background.

Conclusions

Differences in mental health between early- and on time married women are attributed to poorer educational attainment of women who marry early. Furthermore, migrant background seems to have a limited role in the association between marital timing and mental disorder. The promotion of formal education among young women could contribute to the accumulation of socioeconomic and psychosocial resources, thus, reducing the risk of mental disorder, also among early married women.
Endometrial ablation plus levonorgestrel releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding: study protocol of a multicentre randomised controlled trial; MIRA2 trial
Authors: Oderkerk Tamara J. , Beelen Pleun , Geomini Peggy M. A. J. , Herman Malou C. , Leemans Jaklien C. , Duijnhoven Ruben G. , Bosmans Judith E. , Pannekoek Justine N. , Clark Thomas J. , Mol Ben Willem J. , Bongers Marlies Y.
Published: June 2022

Background

It is estimated that between 12 to 25% of women who undergo an endometrial ablation for heavy menstrual bleeding (HMB) are dissatisfied after two years because of recurrent menstrual bleeding and/or cyclical pelvic pain, with around 15% of these women ultimately having a hysterectomy. The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) immediately after endometrial ablation may inactivate residual untreated endometrium and/or inhibit the regeneration of endometrial tissue. Furthermore, the LNG-IUS may prevent agglutination of the uterine walls preventing intrauterine adhesion formation associated with endometrial ablation. In these ways, insertion of an LNG-IUS immediately after endometrial ablation might prevent subsequent hysterectomies because of persisting uterine bleeding and cyclical pelvic pain or pain that arises de novo. Hence, we evaluate if the combination of endometrial ablation and an LNG-IUS is superior to endometrial ablation alone in terms of reducing subsequent rates of hysterectomy at two years following the initial ablative procedure.

Methods/design

We perform a multicentre randomised controlled trial in 35 hospitals in the Netherlands. Women with heavy menstrual bleeding, who opt for treatment with endometrial ablation and without contraindication for an LNG-IUS are eligible. After informed consent, participants are randomly allocated to either endometrial ablation plus LNG-IUS or endometrial ablation alone. The primary outcome is the hysterectomy rate at 24 months following endometrial ablation. Secondary outcomes include women’s satisfaction, reinterventions, complications, side effects, menstrual bleeding patterns, quality of life, societal costs.

Discussion

The results of this study will help clinicians inform women with HMB who opt for treatment with endometrial ablation about whether concomitant use of the LNG-IUS is beneficial for reducing the need for hysterectomy due to ongoing bleeding and/or pain symptoms.

Trial registration Dutch Trial registration: NL7817. Registered 20 June 2019, https://www.trialregister.nl/trial/7817.
The barriers and facilitators of developing clinical competence among master’s graduates of gerontological nursing: a qualitative descriptive study
Authors: Alavi Negin Masoudi , Nabizadeh‑Gharghozar Zohreh , Ajorpaz Neda Mirbagher
Published: June 2022

Background

Clinical competence development is a main goal of specialized nursing courses. Nonetheless, some master’s graduates of gerontological nursing programs have inadequate Clinical competence. The aim of this study was to explore the barriers and the facilitators to clinical competence development among the master’s graduates of gerontological nursing.

Method

This qualitative descriptive study was conducted in 2020. Participants were twenty nursing master’s students, master’s graduates, and instructors of gerontological nursing. They were purposively selected from several faculties of nursing and midwifery in Tehran, Isfahan, and Kashan, Iran. Semi-structured interviews were held for data collection and the conventional content analysis proposed by Graneheim and Lundman was used for data analysis. Data were managed using the MAXQDA 10 software.

Results

The main barriers to clinical competence development were students’ neglectfulness towards learning, inefficiency of educational system, and ineffective management. The main facilitators to clinical competence development were effective educational planning and management improvement.

Conclusion

There are different personal, educational, and managerial barriers and facilitators to clinical competence development among master’s graduates of gerontological nursing. Effective educational planning and management improvement are needed for clinical competence development among master’s students and graduates of gerontological nursing.
“Everything has been tried and his heart can’t recover…”: A Descriptive Review of “Do Everything!” in the Archive of Ontario Consent and Capacity Board
Authors: Yim Holly , Hashmi Syeda Shanza , Dewar Brian , Dyason Claire , Kyeremanteng Kwadwo , Lamb Susan , Shamy Michel
Published: June 2022

Background

In end-of-life situations, the phrase “do everything” is sometimes invoked by physicians, patients, or substitute decision-makers (SDM), though its meaning is ambiguous. We examined instances of the phrase “do everything” in the archive of the Ontario Consent and Capacity Board (CCB) in Canada, a tribunal with judicial authority to adjudicate physician–patient conflicts in order to explore its potential meanings.

Methods

We systematically searched the CCB’s online public archive from its inception to 2018 for any references to “do everything” in the context of critical care medicine and end-of-life care. Two independent assessors reviewed decisions, collected characteristics, and identified key themes.

Results

Of 598 cases in the archive, 41 referred to “do everything” in end-of-life situations. The phrase was overwhelmingly invoked by SDMs (38/41, 93%), typically to advocate for life-prolonging measures that contradicted physician advice. Physicians generally related “doing everything” to describe the interventions they had already performed (3/41, 7%), using it to recommend focusing on patients’ quality of life. SDMs were generally reluctant to accept death, whereas physicians found prolonging life at all costs to be morally distressing. The CCB did not interpret appeals to “do everything” legally but followed existing laws by deferring to patients’ prior wishes whenever known, or to concepts of “best interests” when not. The CCB generally recommended against life-prolonging measures in these cases (26/41, 63%), focusing on patients’ “well-being” and “best interests.”

Conclusions

In this unique sample of cases involving conflict surrounding resuscitation and end-of-life care, references to “do everything” highlighted conflicts over quantity versus quality of life. These appeals were associated with signs of cognitive distress on the behalf of SDMs who were facing the prospect of a patient’s death, whereas physicians identified moral distress related to the prolongation of patients’ suffering through their use of life-sustaining interventions. This divergence in perspectives on death versus suffering was consistently the locus of conflict. These findings support the importance of tools such as the Serious Illness Conversation Guide that can be used by physicians to direct conversations on the patients’ goals, wishes, trade-offs, and to recommend a treatment plan that may include palliative care.

Trial Registration

Not applicable.
Development and usability testing of tools to facilitate incorporating intersectionality in knowledge translation
Authors: Sibley Kathryn M. , Kasperavicius Danielle , Rodrigues Isabel Braganca , Giangregorio Lora , Gibbs Jenna C. , Graham Ian D. , Hoens Alison M. , Kelly Christine , Lalonde Dianne , Moore Julia E. , Ponzano Matteo , Presseau Justin , Straus Sharon E.
Published: June 2022

Background

The field of knowledge translation (KT) has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality, a concept introduced by Black feminist scholars, emphasizes how human experience is shaped by combinations of social factors (e.g., ethnicity, gender) embedded in systemic power structures. Its use has the potential to advance equity considerations in KT. Our objective was to develop and conduct usability testing of tools to support integrating intersectionality in KT through three key phases of KT: identifying the gap; assessing barriers to knowledge use; and selecting, tailoring, and implementing interventions.

Methods

We used an integrated KT approach and assembled an interdisciplinary development committee who drafted tools. We used a mixed methods approach for usability testing with KT intervention developers that included semi-structured interviews and the System Usability Scale (SUS). We calculated an average SUS score for each tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the feedback to revise tools, which were formatted by a graphic designer.

Results

Nine people working in Canada joined the development committee. They drafted an intersectionality primer and one tool that included recommendations, activities, reflection prompts, and resources for each of the three implementation phases. Thirty-one KT intervention developers from three countries participated in usability testing. They suggested the tools to be shorter, contain more visualizations, and use less jargon. Average SUS scores of the draft tools ranged between 60 and 78/100. The development committee revised and shortened all tools, and added two, one-page summary documents. The final toolkit included six documents.

Conclusions

We developed and evaluated tools to help embed intersectionality considerations in KT. These tools go beyond recommending the use of intersectionality to providing practical guidance on how to do this. Future work should develop guidance for enhancing social justice in intersectionality-enhanced KT.
Evidence for an expanded hypertension care cascade in low- and middle-income countries: a scoping review
Authors: Peters Michael A. , Noonan Caitlin M. , Rao Krishna D. , Edward Anbrasi , Alonge Olakunle O.
Published: June 2022

Background

With nearly 90% of annual hypertension-related deaths occurring in low- and middle-income countries (LMICs), there is an urgent need to measure the coverage of health services that effectively manage hypertension. However, there is little agreement on how to define effective coverage and the existing hypertension care cascade (hypertension prevalence, percent aware, percent treated, and percent controlled) does not account for the quality of care received by patients. This study reviews definitions of effective coverage and service quality for hypertension management services and proposes an expanded hypertension care cascade to improve measurement of health systems performance.

Methods

A systematic scoping review of literature published in six electronic databases between January 2000 and October 2020 identified studies that defined effective coverage of hypertension management services or integrated dimensions of service quality into population-based estimates of hypertension management in LMICs. Findings informed an expanded hypertension care cascade from which quality-adjusted service coverage can be calculated to approximate effective coverage.

Results

The review identified 18 relevant studies, including 6 that defined effective coverage for hypertension management services and 12 that reported a measure of service quality in a population-based study. Based on commonly reported barriers to hypertension management, new steps on the proposed expanded care cascade include (i) population screened, (ii) population linked to quality care, and (iii) population adhering to prescribed treatment.

Conclusion

There is little consensus on the definition of effective coverage of hypertension management services, and most studies do not describe the quality of hypertension management services provided to populations. Incorporating aspects of service quality to the hypertension care cascade allows for the calculation of quality-adjusted coverage of relevant services, enabling an appropriate measurement of health systems performance through effective coverage.
Arctiin-reinforced antioxidant microcarrier antagonizes osteoarthritis progression
Authors: Liu Yang , Hou Mingzhuang , Pan Zejun , Tian Xin , Zhao Zhijian , Liu Tao , Yang Huilin , Shi Qin , Chen Xi , Zhang Yijian , He Fan , Zhu Xuesong
Published: June 2022

Loss of extracellular matrix (ECM) of cartilage due to oxidative stress injury is one of the main characteristics of osteoarthritis (OA). As a bioactive molecule derived from the traditional ChineseBurdock, arctiin exerts robust antioxidant properties to modulate redox balance. However, the potential therapeutic effects of arctiin on OA and the underlying mechanisms involved are still unknown. Based on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) tool,Burdock-extracted small molecule arctiin was identified as a potential anti-arthritic component. In vitro,treatment using arctiin rescued the interleukin (IL)-1β-induced activation of proteinases and promoted the cartilage ECM synthesis in human chondrocytes. In vivo,intraperitoneal injection of arctiin ameliorated cartilage erosion and encountered subchondral bone sclerosis in the post-traumatic OA mice. Transcriptome sequencing uncovered that arctiin-enhanced cartilage matrix deposition was associated with restricted oxidative stress. Mechanistically, inhibition of nuclear factor erythroid 2-related factor 2 (NRF2) abolished arctiin-mediated anti-oxidative and anti-arthritic functions. To further broaden the application prospects, a gellan gum (GG)-based bioactive gel (GG-CD@ARC) encapsulated with arctiin was made to achieve long-term and sustained drug release. Intra-articular injection of GG-CD@ARC counteracted cartilage degeneration in the severe (12 weeks) OA mice model. These findings indicate that arctiin may be a promising anti-arthritic agent. Furthermore, GG-modified bioactive glue loaded with arctiin provides a unique strategy for treating moderate to severe OA.

Graphical Abstract
Fabrication of avidin-stabilized gold nanoclusters with dual emissions and their application in biosensing
Authors: Tang Zhenrong , Chen Fengjiao , Wang Dan , Xiong Dongmei , Yan Shaoying , Liu Shengchun , Tang Hua
Published: June 2022

Protein-stabilized gold nanoclusters (Prot-Au NCs) have been widely used in biosensing and cell imaging owing to their excellent optical properties and low biotoxicity. However, several Prot-Au NCs reported in the literature do not retain the biological role of the protein, which greatly limits their ability to directly detect biomarkers. This study demonstrated for the first time the successful synthesis of dual-function avidin-stabilized gold nanoclusters (Av–Au NCs) using a one-pot method. The resulting Av–Au NCs exhibited intense blue and red emissions under 374 nm excitation. Furthermore, the Av–Au NCs retained the native functionality of avidin to bind to biotin. When DNA strands modified with biotin at both ends (i.e., linker chains) were mixed with Av–Au NCs, large polymers were formed, indicating that Av–Au NCs could achieve fluorescence signal amplification by interacting with biotin. Taking advantage of the aforementioned properties, we constructed a novel enzyme-free fluorescent biosensor based on the Av–Au NCs-biotin system to detect DNA. The designed fluorescent biosensor could detect target DNA down to 0.043 nM, with a wide line range from 0.2 nM to 20 µM. Thus, these dual-functional Av–Au NCs were shown to be an excellent fluorescent material for biosensing.

Graphic abstract
The predictors of COVID-19 mortality among health systems parameters: an ecological study across 203 countries
Authors: Neogi Sutapa Bandyopadhyay , Pandey Shivam , Preetha G. S. , Swain Sumant
Published: June 2022

Background

Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design.

Methodology

Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately.

Results

Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability.

Conclusion

To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.
Increased susceptibility of irradiated mice to Aspergillus fumigatus infection via NLRP3/GSDMD pathway in pulmonary bronchial epithelia
Authors: Wu Dong-Ming , He Miao , Zhao Yang-Yang , Deng Shi-Hua , Liu Teng , Zhang Ting , Zhang Feng , Wang Yuan-Yi , Xu Ying
Published: June 2022

Background

Aspergillus fumigatus infection is difficult to diagnose clinically and can develop into invasive pulmonary aspergillosis, which has a high fatality rate. The incidence of Aspergillus fumigatus infection has increased die to widespread application of radiotherapy technology. However, knowledge regarding A. fumigatus infection following radiation exposure is limited, and the underlying mechanism remains unclear. In this study, we established a mouse model to explore the effect of radiation on A. fumigatus infection and the associated mechanisms.

Methods

In this study, a mouse model of A. fumigatus infection after radiation was established by irradiating with 5 Gy on the chest and instilling 5 × 107/ml Aspergillus fumigatus conidia into trachea after 24 h to explore the effect and study its function and mechanism. Mice were compared among the following groups: normal controls (CON), radiation only (RA), infection only (Af), and radiation + infection (RA + Af). Staining analyses were used to detect infection and damage in lung tissues. Changes in protein and mRNA levels of pyroptosis-related molecules were assessed by western blot analysis and quantitative reverse transcription polymerase chain reaction, respectively. Protein concentrations in the serum and alveolar lavage fluid were also measured. An immunofluorescence colocalization analysis was performed to confirm that NLRP3 inflammasomes activated pyroptosis.

Results

Radiation destroyed the pulmonary epithelial barrier and significantly increased the pulmonary fungal burden of A. fumigatus. The active end of caspase-1 and gasdermin D (GSDMD) were highly expressed even after infection. Release of interleukin-18 (IL-18) and interleukin-1β (IL-1β) provided further evidence of pyroptosis. NLRP3 knockout inhibited pyroptosis, which effectively attenuated damage to the pulmonary epithelial barrier and reduced the burden of A. fumigatus.

Conclusions

Our findings indicated that the activation of NLRP3 inflammasomes following radiation exposure increased susceptibility to A. fumigatus infection. Due to pyroptosis in lung epithelial cells, it resulted in the destruction of the lung epithelial barrier and further damage to lung tissue. Moreover, we found that NLRP3 knockout effectively inhibited the pyroptosis and reducing susceptibility to A. fumigatus infection and further lung damage. Overall, our results suggest that NLRP3/GSDMD pathway mediated-pyroptosis in the lungs may be a key event in this process and provide new insights into the underlying mechanism of infection.
Isolation and identification of a new strain of nervous necrosis virus from the big-belly seahorse Hippocampus abdominalis
Authors: Chen Xinxin , Qi Jianfei , He Libin , Luo Huiyu , Lin Jinbo , Qiu Fengyan , Wang Qing , Zheng Leyun
Published: June 2022

Background

Betanodaviruses, members of the Nodaviridae family, are the causative agents of viral nervous necrosis in fish, resulting in great economic losses worldwide.

Methods

In this study, we isolated a virus strain named seahorse nervous necrosis virus (SHNNV) from cultured big-belly seahorses Hippocampus abdominalis in Xiamen city, Fujian Province, China. Virus isolation, PCR detection, phylogenetic analysis, qRT-PCR, fluorescence in situ hybridization and histology were used for virus identification and analysis of virus histopathology. Furthermore, an artificial infection experiment was conducted for virulence testing.

Results

Brain and eye tissue homogenates of diseased big-belly seahorses were inoculated onto a grouper spleen (GS) cell monolayer at 28 °C. Tissue homogenates induced obvious cytopathic effects in GS cells. PCR and sequencing analyses revealed that the virus belonged to Betanodavirus and shared high sequence identity with red-spotted grouper nervous necrosis virus isolates. qRT-PCR and fluorescence in situ hybridization revealed that SHNNV mainly attacked the brain and eye. Histopathological examination revealed that the virus led to cytoplasmic vacuolation in the brain and retinal tissues. Infection experiments confirmed that SHNNV was highly infectious, causing massive death in big-belly seahorses.

Conclusion

A novel seahorse betanodavirus from the big-belly seahorse cultured in China was discovered. This finding will contribute to the development of efficient strategies for disease management in aquaculture.