bluuebunny/crossref_metadata_2025 huggingface dataset:
Defective expression of C20orf54 in esophageal dysplasia: a possible biomarker of esophageal carcinoma for early detection
Authors: Li Man , Kong Jing , Wang Lianghai , Yan Hongjuan , Liang Weihua , Wang Ning , Zhao Jin
Published: May 2022

Background

C20orf54 has been identified as an esophageal squamous cell carcinoma (ESCC) susceptibility gene in previous genome-wide association studies. Here, we attempted to clarify the expression level of C20orf54 in ESCC, non-tumoral esophageal tissues, and esophageal squamous intraepithelial neoplasia (ESIN).

Methods

We assessed C20orf54 expression in 146 ESCC, 108 non-tumoral esophageal tissues, and 148 ESIN using immunohistochemistry on tissue microarrays. We also evaluated the possible correlations of C20orf54 expression with clinicopathological characteristics. The survival rates were analyzed using the Kaplan-Meier method and log-rank test.

Results

C20orf54 expression was significantly lower in ESCC, high-grade ESIN, and low-grade ESIN than in the non-tumoral esophageal tissues. The level observed for ESCC was also significantly lower than that in low-grade ESIN and high-grade ESIN, whereas no difference was observed between high-grade ESIN and low-grade ESIN. Furthermore, the C20orf54 defective expression correlated significantly with differentiation, lymph node metastasis, and invasion depth. The overall survival time was inversely associated with lymph node metastasis, an advanced TNM stage (III + IV), and deeper invasion.

Conclusions

This study provides the first evidence of C20orf54 defective expression in ESCC and precancerous lesions, demonstrating a potential role in tumor progression and metastasis. C20orf54 could be used as a potential biomarker for the early detection of ESCC.
Relationship between training supervision and evolution of the density of GPs: a 3-year cohort study on French cities between 2018 and 2021
Authors: Taha Anas , Dawidowicz Sébastien , Orcel Véronique , Puszkarek Thibault , Bayen Marc , Bayen Sabine
Published: May 2022

Context

There is an uneven distribution of general practitioners (GPs) across territories of developed countries leading to inequalities in access to health care. Countries are implementing incentive or coercive policies depending on the characteristics of their health system. Several studies suggest that the location of practical training may influence the location of GPs’ practices. The objective of this study is to investigate the existence of a relationship between training supervision and evolution of the density of GPs in French municipalities between 2018 and 2021.

Methods

The evolution of the density of GPs in almost all French municipalities between 2018 and 2021 was followed up. A bivariate statistical analysis was carried out to look for a relationship between the evolution of the density of GPs and the number of training supervisors. Other bivariate analyses were carried out with other factors likely to influence the density of GPs, such as the existence of financial aid in the territory or the age of GPs. A multivariate analysis with all the significant variables in bivariate analysis was then carried out using the stepwise descending method.

Results

A total of 34 990 (99.9%) French municipalities were included in the follow-up. Among these, 9427 (26.9%) had a GP and 3866 (11%) had a GP involved in the training supervision. The density of GPs in French cities decreased on average by 2.17% between 2018 and 2021. Territories without training supervisors decreased by 4.63% while those with at least one increased by 1.36% (p < 0.01). This significant relationship was also found in multivariate analysis.

Conclusion

The training supervision is associated with a better evolution of density of GPs in French municipalities. This association persisted when other factors were considered. The results of this 3-year follow-up may lead us to consider the training supervision as a factor to regulate the distribution of GPs.
Quality of life after definitive linear accelerator-based stereotactic radiotherapy for prostate cancer: a longitudinal study
Authors: Yamashita Hideomi , Ogita Mami , Sawayanagi Subaru , Nozawa Yuki , Abe Osamu
Published: May 2022

Background

Prostate cancer is the second most common malignancy worldwide, and the majority of patients are diagnosed with localized disease. We examined patients’ quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer.

Methods

We included patients who were treated between 2016 and 2020. Inclusion criteria were adenocarcinoma of the prostate; class risk of low, intermediate, and high; and a World Health Organization performance status of 0–2. Quality of life was measured using the Functional Assessment of Cancer Therapy-Prostate (FACT-P).

Results

A total of 439 patients were treated with SBRT, with a median age of 73 years old. The median follow-up period was 34 months. FACT-P Trial Outcome Index (p < 0.0001), FACT-General (p = 0.0003), and FACT-P-Total (p < 0.0001) scores declined at 1 month post-SBRT, then recovered and returned to the same level as before treatment at 3–4 months post-SBRT. The decrease in quality of life in the first month was particularly remarkable in patients who received long-term hormone injections (36%). One month after the end of SBRT, about 22% of patients experienced "quite a bit” or more troubling side effects.

Conclusions

This study showed longitudinal changes in quality of life by FACT-P after SBRT for prostate cancer. Overall, prostate SBRT was well tolerated.
Modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure for complex lower extremity reconstruction
Authors: Zhou Hong-Xiang , He Liang , Yin Dong , Niu Yang , Jin Zhe , Li Jun-Jie , Wang Qian-Kun , Zhou Tao
Published: May 2022

Background

Complex lower limb reconstruction due to severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy.

Methods

Between January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injury underwent modified donor blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the posterior tibial artery of intact leg in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the tissue defect. The operation time, the intraoperative blood loss and the length of hospital stays were recorded. The vascular pedicle was divided 4 weeks after anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the donor posterior tibial artery during postoperative follow-up.

Results

All 22 flaps survived. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. The average operation time, intraoperative blood loss and length of hospital stays were 6.73 ± 1.49 h, 280.95 ± 59.25 ml and 30.55 ± 2.52 days, respectively. Eighteen flaps were designed in a single fashion, while four were in bilobed fashion. Twenty patients underwent fasciocutaneous flap transplantations, while two underwent musculocutaneous flap transplantations. Two cases developed local lysis of the flap which healed after further debridement. Direct suture of the incision after flap harvest was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients who had severe tibia bone defects. The blood flow of donor posterior tibial artery was confirmed in all patients during follow-ups. All patients recovered flap sensation at the final follow-up. The postoperative follow-ups ranged from 18 to 84 months, and no long-term complications were observed.

Conclusions

The modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair severe lower limb trauma with tibial artery occlusion which avoids sacrificing the major artery of the uninjured lower limb.
Unlocking sociocultural and community factors for the global adoption of genomic medicine
Authors: Chediak Lynsey , Bedlington Nicola , Gadson Ayesha , Kent Alastair , Khalek Aiedah Abdul , Rosen Luke , Rust Malisa , Shaikh Mohd. Farooq , Tan Meng Yoe , Wiafe Samuel Agyei , Baynam Gareth , Steward Charles A.
Published: May 2022

Advances in genomic sequencing and genetic testing are increasingly transforming the diagnosis and treatment of diseases—specifically, rare diseases. However, the application and benefit of such technologies remain inequitable globally. There is a clear and urgent need to provide genomic sequencing to people across the global population, including people living in under-resourced areas and/or underrepresented populations. Financial considerations are the most obvious barriers to the adoption of genomic medicine, yet there are many other factors that are not so obvious, such as geography, language, communication, and culture. Herein, we use the lens of rare diseases and focus on firstly, selected socio-cultural factors, and in particular stigma; and secondly, empowering community factors such as education, advocacy and connectivity amongst people living with rare diseases globally. These are critical areas of need and opportunity if genomic medicine is to achieve equitable and global adoption in the patient best-interest across low- middle- and high-income country health systems. Furthermore, we touch on specific child health aspects and how they can point towards opportunities to build on specific infrastructures.
Management of paediatric traumatic brain injury in Sweden: a national cross-sectional survey
Authors: Wickbom Fredrik , Persson Linda , Olivecrona Zandra , Undén Johan
Published: May 2022

Background

Previous studies have shown variations in management routines for children with traumatic brain injury (TBI) in Sweden. It is unknown if this management has changed after the publication of the Scandinavian Neurotrauma Committee guidelines in 2016 (SNC16). Also, knowledge of current practice routines may guide development of an efficient implementation strategy for the guidelines. The aim of this study is therefore to describe current management routines in paediatric TBI on a hospital/organizational level in Sweden. Secondary aims are to analyse differences in management over time, to assess the current dissemination status of the SNC16 guideline and to analyse possible variations between hospitals.

Methods

This is a sequential, cross-sectional, structured survey in five sections, covering initial management routines for paediatric TBI in Sweden. Respondents, with profound knowledge of local management routines and recommendations, were identified for all Swedish hospitals with an emergency department managing children (age 0–17 year) via phone/mail before distribution of the survey. Responses were collected via an on-line survey system during June 2020–March 2021. Data are presented as descriptive statistics and comparisons were made using Fisher exact test, when applicable.

Results

71 of the 76 identified hospitals managed patients with TBI of all ages and 66 responded (response rate 93%). 56 of these managed children and were selected for further analysis. 76% (42/55) of hospitals have an established guideline to aid in clinical decision making. Children with TBI are predominately managed by inexperienced doctors (84%; 47/56), primarily from non-paediatric specialities (75%; 42/56). Most hospitals (75%; 42/56) have the possibility to admit and observe children with TBI of varying degrees and almost all centres have complete access to neuroradiology (96%; 54/56). In larger hospitals, it was more common for nurses to discharge patients without doctor assessment when compared to smaller hospitals (6/9 vs. 9/47; p < 0.001). Presence of established guidelines (14/51 vs. 42/55; p < 0.001) and written observation routines (16/51 vs. 29/42; p < 0.001) in hospitals have increased significantly since 2006.

Conclusions

TBI management routines for children in Sweden still vary, with some differences occurring over time. Use of established guidelines, written observation routines and information for patients/guardians have all improved. These results form a baseline for current management and may also aid in guideline implementation.
From Wolf-Hirschhorn syndrome to NSD2 haploinsufficiency: a shifting paradigm through the description of a new case and a review of the literature
Authors: Wiel Luisa Cortellazzo , Bruno Irene , Barbi Egidio , Sirchia Fabio
Published: May 2022

Background

Wolf-Hirschhorn syndrome (WHS) is a well-defined disorder, whose core phenotype encompasses growth restriction, facial gestalt, intellectual disability and seizures. Nevertheless, great phenotypic variability exists due to the variable extent of the responsible 4p deletion. In addition, exome sequencing analyses, recently identified two genes, namely NSD2 and NELFA, whose loss-of-function variants contribute to a clinical spectrum consistent with atypical or partial WHS.

The observation of patients exhibiting clinical features resembling WHS, with only mild developmental delay and without the typical dysmorphic features, carrying microdeletions sparing NSD2, has lead to the hypothesis that NSD2 is responsible for the intellectual disability and the facial gestalt of WHS. While presenting some of the typical findings of WHS (intellectual disability, facial gestalt, microcephaly, growth restriction and congenital heart defects), NSD2-deleted children tend to display a milder spectrum of skeletal abnormalities, usually consisting of clinodactyly, and do not exhibit seizures.

We describe the clinical picture of a child with WHS due to a de novo mutation of NSD2 and discuss the clinical and diagnostic implications.

Case presentation

A 6-year-old boy was evaluated for a history of intrauterine growth restriction, low birth weight, neonatal hypotonia, and psychomotor delay. No episodes of seizure were reported. At physical examination, he displayed marphanoid habitus, muscle hypotrophy and facial dysmorphisms consisting in high frontal hairline, upslanting palpebral fissures and full lips with bifid ugula. Cryptorchidism, shawl scrotum, mild clinodactyly of the right little finger and bilateral syndactyly of the II and III toes with sandal gap were also noted. The radiographic essay demonstrated delayed bone age and echocardiography showed mild mitral prolapse. Whole genome sequencing analysis revealed a heterozygous de novo variant of NSD2 (c.2523delG).

Conclusions

Full WHS phenotype likely arises from the cumulative effect of the combined haploinsufficiency of several causative genes mapping within the 4p16.3 region, as a contiguous genes syndrome, with slightly different phenotypes depending on the specific genes involved in the deletion.

When evaluating children with pictures resembling WHS, in absence of seizures, clinicians should consider this differential diagnosis.
How much is the lack of retention evidence costing trial teams in Ireland and the UK?
Authors: Murphy Ellen , Shiely Frances , Treweek Shaun
Published: May 2022

Background

Evidence to support the use of many retention strategies in clinical trials is lacking. Despite this, trial teams still need to have some form of retention strategy in their trials to try and avoid high attrition rates. This study aimed to estimate how much this lack of retention evidence might be costing trials in Ireland and the UK.

Methods

We selected the top ten most routinely used retention strategies by Clinical Trial Units in the UK and made assumptions as to how each of these strategies was most likely to be implemented and the costs involved in doing this. We applied our costing model to a hypothetical trial scenario in both Ireland and the UK as well as to three published trial protocols. We developed the costing model and calculated the costs in Microsoft Excel.

Results

Retention strategies were often poorly specified, meaning we had to make assumptions about implementation and in some cases about the strategy itself. Based on our assumptions, some retention strategies can be extremely expensive; some of the costliest strategies included “data collection scheduled with routine care” (€900–€32,503.25), “a timeline of participant visits for sites”—with integrated participant reminder (€304.74–€14,803.70), and “routine site visits by CTU staff” and “investigator meetings face to face”, both costing (€777.67–€14,753.48). Others such as “telephone reminders for questionnaire response” (€34.58–€568.62), “a timeline of participant visits for sites”—site reminder alone (€79.18–€112.23), and “targeted recruitment of sites/GPs” (€30–€1620) were less costly compared to the other strategies.

Discussion

The resources invested in the use of some retention strategies may outweigh known or imagined benefits on retention. Where benefits are currently unknown, evaluation should be a priority.

Conclusion

More evaluation of the effectiveness and cost of trial retention strategies is needed to avoid widespread use of strategies that are both expensive and ineffective.
ACL Surgery Necessity in Non-Acute Patients (ACL SNNAP): a statistical analysis plan for a randomised controlled trial
Authors: Stokes Jamie R. , Beard David J. , Davies Loretta , Shirkey Beverly A. , Price Andrew , Cook Jonathan A. ,   The ACL SNNAP Study Group, Barker Karen , Carr Andrew , Cook Jonathan , Davies Loretta , Haddad Fares , Jackson William , Lamb Sallie , Leal Jose , Monk Paul , O’Leary Sean , Price Andrew , Wilson Chris
Published: May 2022

Background

Rupture of the anterior cruciate ligament (ACL) is a common injury, primarily affecting young, active individuals. Despite surgical intervention being the more common treatment for patients suffering ACL ruptures, current management is based on limited and generally low-quality evidence. We describe a statistical analysis plan (SAP) for the ACL SNNAP randomised controlled trial, which aims to investigate the necessity of surgical management in patients with ACL injuries.

Methods/design

ACL SNNAP is a pragmatic, multi-centre, superiority, parallel-group randomised controlled trial in participants with a symptomatic non-acute ACL deficient knee. Participants are allocated in a 1:1 ratio to either non-surgical management (rehabilitation) or surgical management (reconstruction) with the aim of assessing the efficacy and cost-effectiveness. The primary outcome of the study is the Knee Injury and Osteoarthritis Outcome Score (KOOS4) at 18 months post-randomisation. The KOOS4 score at 18 months will be evaluated using a linear regression model adjusting for recruitment centre and baseline KOOS4 scores, allowing for intra-centre correlation. A secondary analysis of the primary outcome will be carried out using an area under the curve (AUC) approach using treatment estimates obtained from a mixed model using baseline, 6 months, 12 months, and 18 months post-randomisation outcome data. Secondary outcomes will be measured at 18 months and will include return to activity/level of sport participation, intervention-related complications, the EQ-5D-5L questionnaire, all 5 individual subscales of the KOOS questionnaire, the ACL-QOL score, expectations of return to activity and cost-effectiveness of the interventions. Missing primary outcome data will be investigated through a sensitivity analysis. Full details of the planned methods for the statistical analysis of clinical outcomes are presented in this paper. The study protocol for the ACL SNNAP trial has been published previously.

Discussion

The methods of analysis for the ACL SNNAP trial have been described here to minimise the risk of data-driven results and reporting bias. Any deviations from the analysis methods described in this paper will be described in full and justified in the publications of the trial results.

Trial registration

ISRCTN ISRCTN10110685. Registered on 16 November 2016
Securing jugular central venous access devices with dressings fixed to a liquid adhesive in an intensive care unit population: a randomised controlled trial
Authors: Pearse India , Corley Amanda , Larsen Emily N. , Rickard Claire M. , Ware Robert S. , Campbell Jill , Coyer Fiona , Alexandrou Evan , O’Brien Catherine , Marsh Nicole
Published: May 2022

Background

Central venous access devices (CVADs) can have high rates of failure due to dressing-related complications. CVADs placed in the internal jugular vein are at particular risk of dressing failure-related complications, including catheter-associated bloodstream infection and medical adhesive-related skin injury. Application of Mastisol liquid adhesive (MLA) may reduce CVAD dressing failure and associated complications, by reducing the frequency of dressing changes. The aim of this study is to investigate whether, in an intensive care unit (ICU) population, standard dressing care with or without the addition of MLA, improves internal jugular CVAD dressing adherence.

Methods

This two-arm, parallel group randomised controlled trial will be conducted in three Australian ICUs. A total of 160 patients (80 per group) will be enrolled in accordance with study inclusion and exclusion criteria. Patients will be randomised to receive either (1) ‘standard’ (in accordance with local hospital policy) CVAD dressings (control) or (2) ‘standard’ dressings in addition to MLA (intervention). Patients will be followed from the time of CVAD insertion to 48 h after CVAD removal. The primary outcome is ‘dressing failure’ defined as requirement for initial CVAD dressing to be replaced prior to seven days (routine replacement).

Discussion

This study will be the first randomised controlled trial to evaluate the clinical effectiveness of MLA in the adult intensive care unit population and will also provide crucial data for patient-important outcomes such as infection and skin injury.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12621001012864. Registered on 2 August 2021
The effectiveness and cost-effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma patients with uncontrolled torso haemorrhage: study protocol for a randomised clinical trial (the UK-REBOA trial)
Authors: Jansen Jan O. , Cochran Claire , Boyers Dwayne , Gillies Katie , Lendrum Robbie , Sadek Sam , Lecky Fiona , MacLennan Graeme , Campbell Marion K. ,   the UK-REBOA Trial grantholders, Jansen Jan O. , Campbell Marion K. , Moran Chris , Brohi Karim , Lecky Fiona , Lendrum Robbie , MacLennan Graeme , Morrison Jonathan J. , Tai Nigel , Harris Tim , Norrie John , Boyers Dwayne , Paterson Alan , Welch Nick
Published: May 2022

Background

Haemorrhage is the most common cause of preventable death after injury. REBOA is a novel technique whereby a percutaneously inserted balloon is deployed in the aorta, providing a relatively quick means of temporarily controlling haemorrhage and augmenting cerebral and coronary perfusion, until definitive control of haemorrhage can be attained. The aim of the UK-REBOA trial is to establish the clinical and cost-effectiveness of a policy of standard major trauma centre treatment plus REBOA, as compared with standard major trauma centre treatment alone, for the management of uncontrolled torso haemorrhage caused by injury.

Methods

Pragmatic, Bayesian, group-sequential, randomised controlled trial, performed in 16 major trauma centres in England. We aim to randomise 120 injured patients with suspected exsanguinating haemorrhage to either standard major trauma centre care plus REBOA or standard major trauma centre care alone. The primary clinical outcome is 90-day mortality. Secondary clinical outcomes include 3-h, 6-h, and 24-h mortality; in-hospital mortality; 6-month mortality; length of stay (in hospital and intensive care unit); 24-h blood product use; need for haemorrhage control procedure (operation or angioembolisation); and time to commencement of haemorrhage control procedure (REBOA, operation, or angioembolisation). The primary economic outcome is lifetime incremental cost per QALY gained, from a health and personal social services perspective.

Discussion

This study, which is the first to randomly allocate patients to treatment with REBOA or standard care, will contribute high-level evidence on the clinical and cost-effectiveness of REBOA in the management of trauma patients with exsanguinating haemorrhage and will provide important data on the feasibility of implementation of REBOA into mainstream clinical practice.

Trial registration

ISRCTN16184981
Analysis of total phenolic contents, flavonoids, antioxidant and antibacterial activities of Croton macrostachyus root extracts
Authors: Ayele Dessie T. , Akele M. L. , Melese A. T.
Published: May 2022

Plants are good sources of various bioactive substances and have significant importance for the discovery of new drugs. In this study, Croton macrostachyus plant roots from six different sites in the Central Gondar Zone, Ethiopia, were collected; and their phenolic and flavonoid contents, as well as antioxidant and antibacterial activities were investigated. Total phenolics and flavonoid contents of the root extracts were determined by the Folin–Ciocalteu and aluminum chloride methods, respectively. The antioxidant activity was determined by the DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging method. Moreover, the antibacterial activities were evaluated by disk diffusion method. Results revealed that total polyphenols and flavonoid contents were in the range of 802 ± 53–1557 ± 75 mg GAE/100 g and 342 ± 26–745 ± 32 mg CE/100 g, respectively. Root extracts of C. macrostachyus were found to have higher antioxidant activities ranging from 3.53 ± 0.38 to 6.38 ± 0.62 mg AAE/g sample. They also showed inhibition zones of 5.8, 6.2, 5.9 and 6.0 mm for Staphylococcus aurous, Staphylococcus pneumonia, Escherichia coli and Klebsiella pneumonia, and had equivalent potency with the reference Gentamicin antibiotic. Pearson correlation result indicated a strong relationship between total polyphenol contents and their respective antioxidant activities. This study articulates that the root extracts accumulated a substantial quantity of polyphenols and bears a considerable antioxidant activity.
Artifact reduction in contrast-enhanced mammography
Authors: Gennaro Gisella , Baldan Enrica , Bezzon Elisabetta , Caumo Francesca
Published: May 2022

Objective

To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions.

Methods

A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as “Absent”, “Weak”, “Medium”, “Strong” in each artifact intensity category were compared between the two algorithms. P-values lower than 0.05 were considered statistically significant.

Results

The NEW algorithm succeeded in eliminating 84.5% of breast-in-breast artifacts, 84.2% of ripple artifacts, and 56.9% of skinfold enhancement artifacts versus STD DES images, and reduced the artifact intensity in 12.1%, 13.0%, and 28.8% of the images, respectively. The visibility of lesion contrast uptake was the same with the STD and the NEW algorithms.

Conclusion

The new dual-energy subtraction algorithm demonstrated to be effective in reducing/eliminating CEM-related artifacts while preserving lesion contrast enhancement.
Considering sex and gender in Epidemiology: a challenge beyond terminology. From conceptual analysis to methodological strategies
Authors: Colineaux Hélène , Soulier Alexandra , Lepage Benoit , Kelly-Irving Michelle
Published: May 2022

Background

Epidemiologists need tools to measure effects of gender, a complex concept originating in the social sciences which is not easily operationalized in the discipline. Our aim is to clarify useful concepts, measures, paths, effects, and analytical strategies to explore mechanisms of health difference between men and women.

Methods

We reviewed concepts to clarify their definitions and limitations for their translation into usable measures in Epidemiology. Then we conducted methodological research using a causal framework to propose methodologically appropriate strategies for measuring sex and gender effects in health.

Results

(1) Concepts and measures. We define gender as a set of norms prescribed to individuals according to their attributed-at-birth sex. Gender pressure creates a systemic gap, at population level, in behaviors, activities, experiences, etc., between men and women. A pragmatic individual measure of gender would correspond to the level at which an individual complies with a set of elements constituting femininity or masculinity in a given population, place and time. (2) Main analytical strategy. Defining and measuring gender are not sufficient to distinguish the effects of sex and gender on a health outcome. We should also think in terms of mechanisms, i.e., how the variables are linked together, to define appropriate analytical strategies. A causal framework can help us to conceptualize “sex” as a “parent” of a gender or gendered variable. This implies that we cannot interpret sex effects as sexed mechanisms, and that we can explore gendered mechanisms of sex-differences by mediation analyses. (3) Alternative strategy. Gender could also be directly examined as a mechanism, rather than through a variable representing its realization in the individual, by approaching it as an interaction between sex and social environment.

Conclusions

Both analytical strategies have limitations relative to the impossibility of reducing a complex concept to a single or a few measures, and of capturing the entire effect of the phenomenon of gender. However, these strategies could lead to more accurate analyses of the mechanisms underlying health differences between men and women.
Interaural time difference individualization in HRTF by scaling through anthropometric parameters
Authors: Gutierrez-Parera Pablo , Lopez Jose J. , Mora-Merchan Javier M. , Larios Diego F.
Published: May 2022

Head-related transfer function (HRTF) individualization can improve the perception of binaural sound. The interaural time difference (ITD) of the HRTF is a relevant cue for sound localization, especially in azimuth. Therefore, individualization of the ITD is likely to result in better sound spatial localization. A study of ITD has been conducted from a perceptual point of view using data from individual HRTF measurements and subjective perceptual tests. Two anthropometric dimensions have been demonstrated in relation to the ITD, predicting the subjective behavior of various subjects in a perceptual test. With this information, a method is proposed to individualize the ITD of a generic HRTF set by adapting it with a scale factor, which is obtained by a linear regression formula dependent on the two previous anthropometric dimensions. The method has been validated with both objective measures and another perceptual test. In addition, practical regression formula coefficients are provided for fitting the ITD of the generic HRTFs of the widely used Brüel & Kjær 4100 and Neumann KU100 binaural dummy heads.
Immune cells-derived exosomes function as a double-edged sword: role in disease progression and their therapeutic applications
Authors: Hazrati Ali , Soudi Sara , Malekpour Kosar , Mahmoudi Mohammad , Rahimi Arezou , Hashemi Seyed Mahmoud , Varma Rajender S.
Published: May 2022

Exosomes, ranging in size from 30 to 150 nm as identified initially via electron microscopy in 1946, are one of the extracellular vesicles (EVs) produced by many cells and have been the subject of many studies; initially, they were considered as cell wastes with the belief that cells produced exosomes to maintain homeostasis. Nowadays, it has been found that EVs secreted by different cells play a vital role in cellular communication and are usually secreted in both physiological and pathological conditions. Due to the presence of different markers and ligands on the surface of exosomes, they have paracrine, endocrine and autocrine effects in some cases. Immune cells, like other cells, can secrete exosomes that interact with surrounding cells via these vesicles. Immune system cells-derived exosomes (IEXs) induce different responses, such as increasing and decreasing the transcription of various genes and regulating cytokine production. This review deliberate the function of innate and acquired immune cells derived exosomes, their role in the pathogenesis of immune diseases, and their therapeutic appliances.
District-level religious composition and child health in India
Authors: Richards Bailey , Rao Krishna , Bishai David
Published: May 2022

Background

Community characteristics are a significant social determinant of child health. Little is known about the effects of social heterogeneity as a specific factor that might impact health. This paper aims to fill the void in research on the health effects of India’s district-level religious heterogeneity.

Methods

Weighted state fixed effects multivariate logistic regression was applied to India’s Third District Level Household Survey (2007–2008). The dependent variables were death of a child under five and indicators of healthcare utilization. The key independent variables were the proportions in the district who were Hindu, Muslim, Christian, Buddhist, and Sikh. The analysis controlled for generic community diversity, household religion, and socioeconomic status. Separate, sub-group analysis focused on Muslims only, Christians only, and Buddhists only.

Results

Multivariate fixed effects models show that a 1% point increase in the proportion of Muslim, Christian, or Buddhist households in a community is associated with respective odds ratios of child death of 1.008, 1.009, and 1.012 of experiencing the death of a child. The impact of a household’s own religious affiliation is statistically insignificant in these models. Higher proportions of Muslims and Christians in a community lower the odds of BCG (a vaccine for childhood tuberculosis) receipt and child healthcare-seeking.

Conclusions

Households residing where there are higher levels of religious minorities in India experience worse child survival. These effects are not mediated by the household’s own religious affiliation. There is evidence that health system performance and quality is systematically worse in communities with higher proportions of religious minorities. Our study can help policymakers identify communities where children may be at higher risk based on community heterogeneity and the potential for insufficient collective action. Policymakers might consider flagging these communities for special attention, because social heterogeneity is likely to be of long duration.
When to Extend Monitoring of Anti-drug Antibodies for High-risk Biotherapeutics in Clinical Trials: an Opinion from the European Immunogenicity Platform
Authors: Lotz Gregor P. , Benstein Karin , Bloem Karien , Buddiger Harm , Calonder Claudio , Elm Stefanie , Fernandez Elena , Goodman Joanne , Gorovits Boris , Grudzinska-Goebel Joanna , Janssen Melody , Jawa Vibha , Kramer Daniel , Luo Linlin , Malisauskas Mantas , Michaut Lydia , Schäfer Martin , Spindeldreher Sebastian , Ullmann Martin , Nana Weldingh Karin , Kromminga Arno , Snoeck Veerle
Published: May 2022

The determination of a tailored anti-drug antibody (ADA) testing strategy is based on the immunogenicity risk assessment to allow a correlation of ADAs with changes to pharmacokinetics, efficacy, and safety. The clinical impact of ADA formation refines the immunogenicity risk assessment and defines appropriate risk mitigation strategies. Health agencies request for high-risk biotherapeutics to extend ADA monitoring for patients that developed an ADA response to the drug until ADAs return to baseline levels. However, there is no common understanding in which cases an extension of ADA follow-up sampling beyond the end of study (EOS) defined in the clinical study protocol is required. Here, the Immunogenicity Strategy Working Group of the European Immunogenicity Platform (EIP) provides recommendations on requirements for an extension of ADA follow-up sampling in clinical studies where there is a high risk of serious consequences from ADAs. The importance of ADA evaluation during a treatment-free period is recognized but the decision whether to extend ADA monitoring at a predefined EOS should be based on evaluation of ADA data in the context of corresponding clinical signals. If the clinical data set shows that safety consequences are minor, mitigated, or resolved, further ADA monitoring may not be required despite potentially detectable ADAs above baseline. Extended ADA monitoring should be centered on individual patient benefit.
The investigation of the ignition mechanism of shocked 98 wt% hydrogen peroxide based on transmissivity measurement
Authors: Liao WenQiang , Sun YanYun , Wu Lang , Huang XiCheng , Fan ZhuoNing , Liu FuSheng , Zhang MingJian
Published: May 2022

The behavior of 98 wt% hydrogen peroxide in the delay period under shock loading was researched by optical transmissivity in situ detection system. The time evolution of the transmissivity of 98 wt% hydrogen peroxide in the delay period is firstly presented. The experimental phenomenon shows that when the shock pressure in hydrogen peroxide reaches the ignition level, a large number of clusters will be produced inside the hydrogen peroxide. The formation of new clusters provides the reserve of energy for ignition. Those clusters formed by hydrogen peroxide in the delay period may act as hot spots, which leads the homogeneous explosives to reach the heterogeneous state before ignition. This conclusion is reasonable for revealing the ignition mechanism of homogeneous explosive. The particle behavior in the delay period gives us a new method to detect the ignition pressure. The experiments also confirm that the ignition pressure of 98 wt% hydrogen peroxide is just between 9.3 GPa and 12.1 GPa.
Efficacy of Bariatric Surgery in the Treatment of Women With Obesity and Polycystic Ovary Syndrome
Authors: Hu Lili , Ma Li , Xia Xinyi , Ying Tao , Zhou Minzhi , Zou Shuhua , Yu Haoyong , Yin Jun
Published: May 2022

Context

The comparative effectiveness of drugs and surgical therapy for women with obesity and polycystic ovary syndrome (PCOS) has not been systematically compared.

Objective

We aimed to determine the difference in efficacy between drug and bariatric surgery therapy for women with obesity and PCOS.

Methods

This prospective nonrandomized trial enrolled 90 women aged 18 to 40 years with body mass index (BMI) ≥ 27.5 kg/m2 and waist circumference ≥ 85 cm and fulfilling the 2011 Chinese diagnostic criteria for PCOS; 81 subjects completed the study. In the drug group, patients were administered metformin and an oral contraceptive containing ethinyl-estradiol and cyproterone acetate for the first 6 months, and metformin alone for the second 6 months. In the surgical group, patients underwent laparoscopic sleeve gastrectomies. The follow-up period was 12 months. The main outcome was the complete remission of PCOS, requiring 6 consecutive regular menstruation cycles or spontaneous pregnancy.

Results

Median BMI at endpoint was 30.1 kg/m2 in the drug group and 23.7 kg/m2 in the surgical group; complete remission rate was 15% and 78%, respectively. Except endpoint BMI, no difference was observed in free androgen index, ovarian morphology, homeostasis model assessment for insulin resistance, and total weight loss between remission and nonremission patients. Logistic regression analyses also revealed that the final BMI was the major factor influencing the remission of PCOS. The cutoff points for the final BMI were 27.5 kg/m2 for the drug group and 26 kg/m2 for the surgical group. Overall, nearly 95% of patients with an endpoint BMI below the cutoff values achieved complete remission.

Conclusion

Complete remission of PCOS in patients with obesity depends on the final BMI after weight loss. Thus, bariatric surgery should be prioritized for these patients.
Making Medical Subjects: Regeneration, Experimentation, and Women in the Guatemalan Spring
Authors: Crafts Lydia
Published: May 2022

In the 1940s, US and Guatemalan doctors working with the Pan American Sanitary Bureau (PASB) intentionally exposed at least 1,308 Guatemalan sex workers, prisoners, hospital patients, and soldiers to three sexually transmitted infections (STIs)—syphilis, gonorrhea, and chancroid. The doctors aimed to study the transmission of disease and the effects of penicillin and other chemical solutions in preventing the spread of STIs. This article examines how US and Guatemalan doctors weaponized a bureaucratic registration system to study STIs at what they deemed their main vector—sex workers. The experiments served the purposes of the Guatemalan Revolution (1944–54), a democratizing moment when doctors and political leaders aimed to spur national regeneration. This essay argues that Guatemala's activist state was a critical enabling factor granting US researchers access to Guatemalans' genitals and blood for experimentation.
Earworm and Event
Authors: Priest Eldritch
Published: May 2022

In Earworm and Event Eldritch Priest questions the nature of the imagination in contemporary culture through the phenomenon of the earworm: those reveries that hijack our attention, the shivers that run down our spines, and the songs that stick in our heads. Through a series of meditations on music, animal mentality, abstraction, and metaphor, Priest uses the earworm and the states of daydreaming, mind-wandering, and delusion it can produce to outline how music is something that is felt as thought rather than listened to. Priest presents Earworm and Event as a tête-bêche—two books bound together with each end meeting in the middle. Where Earworm theorizes the entanglement of thought and feeling, Event performs it. Throughout, Priest conceptualizes the earworm as an event that offers insight into not only the way human brains process musical experiences, but how abstractions and the imagination play key roles in the composition and expression of our contemporary social environments and more-than-human milieus. Unconventional and ambitious, Earworm and Event offers new ways to interrogate the convergence of thought, sound, and affect.
Myriad Intimacies
Authors: Mani Lata
Published: May 2022

In Myriad Intimacies postcolonial theorist, spiritual practitioner, and filmmaker Lata Mani oscillates between text and video, poetry and prose, genre and form, register and voice, and secular and sacred to offer a transmedia exploration of the interrelatedness of lives, concepts, frameworks, and aspects of self. She draws on concepts from tantra—a philosophy that celebrates matter as alive, embodiment as sacred, and the senses as a form of intelligence—alongside feminist, critical race, and cultural theory to meditate on the ways in which everyone and everything exists in mutually constitutive interrelations. Addressing issues ranging from desire, the body, nature, and love, to otherness, identity politics, social justice, #MeToo, and the COVID-19 pandemic, Mani foregrounds the power and necessity of recognizing relationality as foundational. Throughout, she offers a way of reframing what we think we know and how we come to know it, demonstrating that it is only by acknowledging and embracing the indivisible and interdependent nature of existence that we restore our true intimacy with each other and the world.
Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1—Craniotomy
Authors: Shaftel Kelly A. , Cole Tyler S. , Jubran Jubran H. , Schriber Tyler D. , Little Andrew S.
Published: May 2022

BACKGROUND:

Despite patients experiencing high recurrence and readmission rates after surgical management of nontraumatic subdural hematomas (SDHs), few studies have examined the causes and predictors of unplanned readmissions in this population on a national scale.

OBJECTIVE:

To analyze independent factors predicting 30-day hospital readmissions after surgical treatment of nontraumatic SDH in patients who survived their index surgery and evaluate hospital readmission rates and charges.

METHODS:

Using the Nationwide Readmissions Database, we identified patients who underwent craniotomy for nontraumatic SDH evacuation (2010-2015) using a retrospective cohort observational study design. National estimates and variances within the cohort were calculated after stratifying, hospital clustering, and weighting variables.

RESULTS:

Among 49 013 patients, 10 643 (21.7%) had at least 1 readmission within 30 days of their index treatment and 38 370 (78.3%) were not readmitted. Annual readmission rates did not change during the study period (P = .74). The most common primary causes of 30-day readmissions were recurrent SDH (n = 3949, 37.1%), venous thromboembolism (n = 1373, 12.9%), and delayed hyponatremia and syndrome of inappropriate antidiuretic hormone secretion (n = 1363, 12.8%). Comorbidities that independently predicted readmission included congestive heart failure, chronic obstructive pulmonary disease, coagulopathy, diabetes mellitus, liver disease, lymphoma, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disease, psychosis, and renal failure (P ≤ .03). Household income in the 51st to 75th percentile was associated with a decreased risk of readmission.

CONCLUSION:

National trends in 30-day readmission rates after nontraumatic SDH treatment by craniotomy provide quality benchmarks that can be used to drive quality improvement efforts on a national level.