bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated right ventricular Takotsubo cardiomyopathy in Guillain–Barré syndrome
Authors: Song Xiaojing , Chi Cheng , Song Junxian , Zhu Jihong
Published: December 2022

Background

Takotsubo cardiomyopathy can present itself in the most varied clinical forms, with extremely variable electrocardiogram anomalies and presence of comorbidities with a significant systemic commitment. Guillain–Barré Syndrome concomitant with isolated right ventricular Takotsubo cardiomyopathy is a rare entity. Here we present a patient with Guillain–Barré syndrome who had electrocardiogram abnormalities consistent with isolated right ventricular Takotsubo cardiomyopathy which have not been described in literature. This case report may prompt early identification of right ventricular involvement in neurological comorbidities, especially if the electrocardiogram is not frankly suggestive of an acute ischemic condition linked to coronary artery disease.

Case presentation

A 37-year-old woman was misdiagnosed as acute coronary syndrome because of abnormally elevated troponin T level and electrocardiogram findings in the Emergency Department. Due to absence of any significant stenosis in the main coronary artery, the primary diagnosis was ruled out. Based on reanalysis of the ECG abnormalities, the patient was diagnosed as a case of isolated right ventricular Takotsubo cardiomyopathy in Guillain–Barré Syndrome. This case demonstrates the importance of electrocardiogram as a critical tool to identify isolated right ventricular Takotsubo cardiomyopathy in Guillain–Barré Syndrome. Indeed, in this case, the electrocardiogram abnormalities were distributed beyond the territory of a single coronary artery distribution.

Conclusions

The described electrocardiogram findings of isolated right ventricular Takotsubo cardiomyopathy in Guillain–Barré Syndrome may facilitate identification of right ventricular involvement in neurological diseases.
Anemia and opportunistic infections in hospitalized people living with HIV: a retrospective study
Authors: Xie Bo , Huang Wei , Hu Yanling , Dou Yanyun , Xie Luman , Zhang Yong , Qin Shanfang , Lan Ke , Pang Xianwu , Qiu Hong , Li Lanxiang , Wei Xihua , Liu Zengjing , Meng Zhihao , Lv Jiannan
Published: December 2022

Background

There is a high prevalence of anemia among people living with HIV in Guangxi, China. Therefore, we investigated anemia and opportunistic infections in hospitalized people living with HIV and explored the risk factors related to anemia in people living with HIV to actively prevent anemia in people living with HIV.

Methods

We retrospectively studied people living with HIV admitted to Guangxi Chest Hospital from June 2016 to October 2021. Detailed information on the sociodemographic and clinical features of the participants was collected. The X2 test was used to compare the prevalence between the anemic and non-anemic groups. The logistic regression analysis was applied to exclude confounding factors and identify factors related to anemia.

Results

Among 5645 patients with HIV, 1525 (27.02%) had anemia. The overall prevalence of mild, moderate, and severe anemia was 4.66%, 14.08%, and 8.27%, respectively. The factors significantly related to increased risk of anemia were CD4 count < 50 cells/µl (aOR = 2.221, 95% CI = [1.775, 2.779]), CD4 count 50–199 cells/µl (aOR = 1.659, 95% CI = [1.327, 2. 073]), female (aOR = 1.644, 95% CI = [1.436, 1.881]) co-infected with HCV (aOR = 1.465, 95% CI = [1.071, 2.002]), PM (aOR = 2.356, 95% CI = [1.950, 2.849]), or TB (aOR = 1.198, 95% CI = [1.053, 1.365]).

Conclusions

Within Guangxi of China, 27.02% of hospitalized people living with HIV presented with anemia. Most patients with anemia were in the mild to moderate stage. The low CD4 count, female gender, and concomitant infection with Penicillium marneffei, Hepatitis C virus, or Tuberculosis were independent correlates of anemia. Thus, these findings would be helpful to clinicians in preventing and intervening in anemia in people living with HIV.
Cost-effectiveness of 3-months isoniazid and rifapentine compared to 9-months isoniazid for latent tuberculosis infection: a systematic review
Authors: Lai Wendy A. , Brethour Kaitlyn , D’Silva Olivia , Chaisson Richard E. , Zwerling Alice A.
Published: December 2022

Background

We conducted a systematic review examining the cost effectiveness of a 3-month course of isoniazid and rifapentine, known as 3HP, given by directly observed treatment, compared to 9 months of isoniazid that is directly observed or self-administered, for latent tuberculosis infection. 3HP has shown to be effective in reducing progression to active tuberculosis and like other short-course regimens, has higher treatment completion rates compared to standard regimens such as 9 months of isoniazid. Decision makers would benefit from knowing if the higher up-front costs of rifapentine and of the human resources needed for directly observed treatment are worth the investment for improved outcomes.

Methods

We searched PubMed, Embase, CINAHL, LILACS, and Web of Science up to February 2022 with search concepts combining latent tuberculosis infection, directly observed treatment, and cost or cost-effectiveness. Studies included were in English or French, on human subjects, with latent tuberculosis infection, provided information on specified anti-tubercular therapy regimens, had a directly observed treatment arm, and described outcomes with some cost or economic data. We excluded posters and abstracts, treatment for multiple drug resistant tuberculosis, and combined testing and treatment strategies. We then restricted our findings to studies examining directly-observed 3HP for comparison. The primary outcome was the cost and cost-effectiveness of directly-observed 3HP.

Results

We identified 3 costing studies and 7 cost-effectiveness studies. The 3 costing studies compared directly-observed 3HP to directly-observed 9 months of isoniazid. Of the 7 cost-effectiveness studies, 4 were modelling studies based in high-income countries; one study was modelled on a high tuberculosis incidence population in the Canadian Arctic, using empiric costing data from that setting; and 2 studies were conducted in a low-income, high HIV-coinfection rate population. In five studies, directly-observed 3HP compared to self-administered isoniazid for 9 months in high-income countries, has incremental cost-effectiveness ratios that range from cost-saving to $5418 USD/QALY gained. While limited, existing evidence suggests 3HP may not be cost-effective in low-income, high HIV-coinfection settings.

Conclusion

Cost-effectiveness should continue to be assessed for programmatic planning and scale-up, and may vary depending on existing systems and local context, including prevalence rates and patient expectations and preferences.
People with diabetes adherence to drug, dietary, and lifestyle changes in Erbil city, Iraq
Authors: Saleh Abubakir Majeed
Published: December 2022

Background

Since diabetes has serious complications that might result in life-long handicaps or even death, it is vital to ensure that people have reasonable control of the disease, which is eventually by good adherence to drugs, diet, and a good lifestyle. People non-adherence to any part of the therapy program for diabetes might result in worsening the condition. This study aimed to evaluate the compliance of people with diabetes to drug, diet, and lifestyle changes in Erbil city, Iraq.

Patients and methods

A descriptive cross-sectional study was conducted among a sample of 288 people with diabetes visiting Layla Qasim Health Center for people with diabetes in Erbil city, Iraq. Data were collected by interviewing the participants and filling out a questionnaire. The survey demonstrated the socio-demographic status, history, information about the participant's condition, frequency of self-monitoring, medication use, the impact of the surroundings and people's concerns, diet, and lifestyle of the participants.

Results

Of 202 participants responded to the questionnaire, 56.9% were female. The mean age was 52.53 ± 13.882 years. 85.6% of the participants were taking the medication regularly, and 78.8% of the participants followed a recommended diet by their doctors. Only 56.4% were exercising, with a majority being male, 70.1%.A strong association was found between gender and doing exercise, educational level and taking the medication regularly, duration of the disease, and following the recommended diet.

Conclusions

The adherence to taking the medication regularly is high, in which single most important cause is following up with their doctors. In contrast, adherence to lifestyle recommendations was suboptimal and essential in managing diabetes. Another reason is that educational level plays a role in understanding the importance of following the recommended lifestyle by the doctor.
Career expectations and the motivating factors for studying dentistry in Libya
Authors: Arhoma Niroz , Tantawi Maha El , Arheiam Arheiam
Published: December 2022

Introduction

This study investigated entry-level dental students’ motives for studying dentistry at the University of Benghazi (UoB), Libya and career expectations among recent UoB graduates in an atypical context during the time of political unrest and identified factors associated with these motives. 

Methods

A cross-sectional survey was conducted in 2021–2022 for all entry-level dental students and recent dental graduates of UoB. A self-administered survey explored motives for studying dentistry, career expectation and associated factors. The questions were adopted from previous studies and pre-validated for use among Libyan students. Motives and career expectations were summarized, and their association with potential associated factors were assessed using chi-square test at p ≤ 0.05.

Results

One hundred eighty-four entry-level students and 156 recent graduates completed the surveys, response rates = 73.6% and 62.4%, respectively. The main motives to study dentistry were the desire to work in the healthcare field (183, 99.4%), interest in scientific knowledge (178, 96.7%) and because there were various dental specialities (168, 91.3%). The most common career expectations were setting up a business (107, 68.6%) and establishing a dental clinic (105, 67.3%). In addition, preference for working in the public sector (106, 67.9%), work-life balance (102, 65.4%) and financial gain (94, 60.3%) were the main factors associated with career expectations.

Conclusion

The main motive to join a dental school in Libya was academic interest. However, recent graduates showed more pragmatic expectations related to private practice ownership.
Moving toward a standardized diagnostic statement of pituitary adenoma using an information extraction model: a real-world study based on electronic medical records
Authors: Zhou Jingya , Guo Xiaopeng , Duan Lian , Yao Yong , Shang Yafei , Wang Yi , Xing Bing
Published: December 2022

Purpose

Diagnostic statements for pituitary adenomas (PAs) are complex and unstandardized. We aimed to determine the most commonly used elements contained in the statements and their combination patterns and variations in real-world clinical practice, with the ultimate goal of promoting standardized diagnostic recording and establishing an efficient element extraction process.

Methods

Patient medical records from 2012 to 2020 that included PA among the first three diagnoses were included. After manually labeling the elements in the diagnostic texts, we obtained element types and training sets, according to which an information extraction model was constructed based on the word segmentation model “Jieba” to extract information contained in the remaining diagnostic texts.

Results

A total of 576 different diagnostic statements from 4010 texts of 3770 medical records were enrolled in the analysis. The first ten diagnostic elements related to PA were histopathology, tumor location, endocrine status, tumor size, invasiveness, recurrence, diagnostic confirmation, Knosp grade, residual tumor, and refractoriness. The automated extraction model achieved F1-scores that reached 100% for all ten elements in the second round and 97.3–100.0% in the test set consisting of an additional 532 diagnostic texts. Tumor location, endocrine status, histopathology, and tumor size were the most commonly used elements, and diagnoses composed of the above elements were the most frequent. Endocrine status had the greatest expression variability, followed by Knosp grade. Among all the terms, the percentage of loss of tumor size was among the highest (21%). Among statements where the principal diagnoses were PAs, 18.6% did not have information on tumor size, while for those with other diagnoses, this percentage rose to 48% (P < 0.001).

Conclusion

Standardization of the diagnostic statement for PAs is unsatisfactory in real-world clinical practice. This study could help standardize a structured pattern for PA diagnosis and establish a foundation for research-friendly, high-quality clinical information extraction.
Key informants’ perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting
Authors: Arije Olujide , Hlungwani Tintswalo , Madan Jason
Published: December 2022

Background

Integrating the care of adolescents and young people into existing public health facilities requires deliberate efforts to address challenges related to policy and service provision. This study assessed key informants’ perspectives on policy- and service-level challenges, and opportunities, for implementing a strategic framework for adolescent and youth-friendly health services (AYFHS) in public health facilities in a Nigerian setting.

Methods

Seventeen key informants were interviewed including members of the Adolescent sexual and reproductive health (ASRH) Technical Working Group (TWG), program managers of non-governmental organizations (NGO), State and local level health officials, and youth representatives, in Ogun State, Southwest Nigeria.

Result

Findings from this study indicate that some health workers continue to have a negative attitude toward young people’s sexual and reproductive health. There was some level of inclusion of adolescents and young people living with disabilities in ASRH programming which is welcome and extremely important. Some of the challenges in ASRH service provision included insufficient coordination of activities of donors/partners working in the adolescent health space. Also found was the missed opportunity to strengthen policy implementation with research, and the need for increased focus on mental health, substance use, and other aspects of adolescent and young people’s health. There was noted the opportunity to explore the Basic Health Care Provisions Funds (BHCPF) as a new source of funding for health services for AYP in Nigeria.

Conclusion

This study provided the context of the implementation of a strategic framework for adolescent reproductive health in a Nigerian setting from the perspectives of policy and service-level stakeholders. Opportunities for improving program delivery identified include ensuring research-based policy implementation and seeking program sustainability through tapping into new sources of funding.
Landmarks in pancreatic cancer studies
Authors: Xu Fan , Huang Min , Bai Yun , Yin Xueshi , Yan Jingzhe , Liu Fangfang , Chen Jie , Weng Xiechuan
Published: December 2022

Pancreatic cancer is a rare but fatal disease. Patients present advanced disease due to the lack of or typical symptoms when the tumor is still localized. A high-quality image processing system has been in practice to detect the pancreatic tumor and determine the possibility of surgery, and preoperative methods, such as ERCP are increasingly used to complement the staging modality. Pancreaticoduodenectomy is one of the complicated surgeries with potential morbidity. The minimally invasive pancreatic resections, both robot-assisted and laparoscopic, have become a part of standard surgical practice worldwide over the last decade. Moreover, advancements in adjuvant chemotherapy have improved the long-term outcomes in current clinical practice. The systemic conservative treatment, including targeted agents, remains the mainstay of treatment for patients with advanced disease. An increasing number of studies are focused on modulating the pancreatic tumor microenvironment to improve the efficacy of the immunotherapeutic strategies. Herein, the role of preoperative therapy, the novel surgical strategy, and individualized systemic treatment in pancreatic cancer is investigated. Also, the randomized controlled studies that have defined the neoadjuvant and surgical management of pancreatic cancer have been summarized.
The “goldfish bowl”: a qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting
Authors: Bardwell Geoff , Mansoor Manal , Van Zwietering Ashley , Cleveland Ellery , Snell Dan , Kerr Thomas
Published: December 2022

Background

A growing body of research has focused on contextual factors that shape health and well-being of people who use drugs (PWUD). However, most of this research focuses on large cities and less is known about the effects of social and structural contexts on drug use and associated risks in rural Canadian settings. Therefore, we undertook this study to examine rural-specific contextual factors that affect the day-to-day experiences of PWUD.

Methods

Twenty-seven qualitative semi-structured interviews were conducted with PWUD in a rural and coastal setting in British Columbia, Canada. Participants had to be ≥ 19 years old, used illegal opioids and/or stimulants regularly, and lived in the qathet region. Interview transcripts were coded based on themes identified by the research team.

Results

Participants described progressive shifts in politics and culture in the qathet region while also identifying resource scarcity, homelessness, and changes in the drug supply, where illicit drug contents have become highly toxic and unpredictable. Participants discussed the qualities of a small community where everyone knows each other and there is a lack of privacy and confidentiality around drug use, which resulted in experiences of stigma, discrimination, and surveillance. Participants also reported rural-specific policing issues and experiences of surveillance on ferries when traveling to larger cities to purchase drugs. This led to significantly higher drug prices for PWUD due to the time dedication and criminalized risks associated with drug possession and trafficking.

Conclusions

Our findings illustrate the unique experiences faced by PWUD in a rural and coastal setting. The “goldfish bowl” effect in this rural community created heightened social and structural surveillance of PWUD, which led to a variety of negative consequences. There is a clear need for interventions to address the larger contextual drivers affecting people who use drugs in rural settings, including decriminalization and peer-led anti-stigma strategies, in order to improve the lives of PWUD.
Pericyte infection by HIV-1: a fatal attraction
Authors: Naranjo Oandy , Torices Silvia , Clifford Paul R. , Daftari Manav T. , Osborne Olivia M. , Fattakhov Nikolai , Toborek Michal
Published: December 2022

While HIV-1 is primarily an infection of CD4 + T cells, there is an emerging interest towards understanding how infection of other cell types can contribute to HIV-associated comorbidities. For HIV-1 to cross from the blood stream into tissues, the virus must come in direct contact with the vascular endothelium, including pericytes that envelope vascular endothelial cells. Pericytes are multifunctional cells that have been recognized for their essential role in angiogenesis, vessel maintenance, and blood flow rate. Most importantly, recent evidence has shown that pericytes can be a target of HIV-1 infection and support an active stage of the viral life cycle, with latency also suggested by in vitro data. Pericyte infection by HIV-1 has been confirmed in the postmortem human brains and in lungs from SIV-infected macaques. Moreover, pericyte dysfunction has been implicated in a variety of pathologies ranging from ischemic stroke to diabetes, which are common comorbidities among people with HIV-1. In this review, we discuss the role of pericytes during HIV-1 infection and their contribution to the progression of HIV-associated comorbidities.
Localization and surgical approach to mediastinal parathyroid glands
Authors: Makey Ian A. , Geldmaker Laura E. , Casler John D. , El-Sayed Ahmed Magdy M. , Jacob Samuel , Thomas Mathew
Published: December 2022

Background

Hyperactive parathyroid glands (PTGs) are in the mediastinum 4.3% of the time. Historically, localization and resection of these glands can be challenging.

Methods

We searched all operative notes involving a thoracic surgeon and a preoperative diagnosis of hyperparathyroidism from 2001 to 2019.

Results

Eighty-five cases were reviewed, of which 63 were included. Only 14 patients (22%) had de novo hyperparathyroid operations. Seventeen patients (27%) had single-photon emission computed tomography with computed tomography fusion (SPECT-CT) as the only preoperative localization test (excluding chest radiography and ultrasound), and all were resected successfully. The initial surgical approach was transcervical for 16 (27%) patients, however only 7 remained transcervical. 4 (6%) patients had an exploration in which the target lesion was resected but it was not parathyroid tissue.

Conclusion

Most patients presenting with mediastinal PTG have had prior HPT surgery. The trend toward more focused HPT surgery may mean more de novo mediastinal PTG resections. An unambiguous functional and anatomic localization test, such as a spect-ct scan, is the best predictor of a successful resection. Ambiguous or discordant scans should be approached cautiously, and additional confirmatory tests are recommended. For suspected PTG located in the thymus, the thoracic surgeon should choose the most familiar approach to achieve complete thymectomy.
An online behavior change intervention to promote physical activity in adults with asthma: study protocol for a multicenter randomized controlled trial
Authors: de Oliveira Joice Mara , Karloh Manuela , Matias Thiago Sousa , Barbosa Graziele Besen , Freitas Patricia Duarte , Carvalho Celso R. F. , Furlanetto Karina Couto
Published: December 2022

Background

Behavior change interventions have been the focus of recent studies, and the COVID-19 pandemic highlighted the importance of online interventions. However, no previous studies have investigated behavior change techniques to improve physical activity in adults with asthma through online intervention.

Methods

This double-blind clinical trial will investigate the effectiveness of an online behavior change intervention in increasing physical activity and reducing sedentary behavior in adults with asthma, as well as in improving other clinical outcomes in short and medium terms. Patients with clinically stable moderate to severe asthma, who are physically inactive and do not have cardiovascular and/or osteoneuromuscular impairments will be randomized into control or intervention groups (23 in each). Both groups will carry out an online educational program (1 h). Additionally, the intervention group will receive weekly individual online sessions for 12 weeks of motivation-based behavior change intervention to promote an increase in physical activity and reduce sedentary behavior based on both self-determination theory and transtheoretical model. The intervention group will also receive an activity monitor with specific strategies related to it. Both groups will be reassessed immediately after the intervention and 6 months after that. The primary outcomes are physical activity and sedentary behavior, which will be objectively assessed by a triaxial accelerometer (Actigraph wGT3X-BT). Secondary outcomes are Asthma Control Questionnaire, Incremental Step Test, Sit-To-Stand, Timed Up-and-Go, 4-Metre Gait Speed, Asthma Quality of Life Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Actiwatch 2, and the Hospital Anxiety and Depression Scale.

Discussion

The intervention is unprecedented and was carefully developed to joint most characteristics and techniques of both behavioral strategies (transtheoretical model and self-determination theory). Therefore, this intervention has the potential to improve physical activity levels and asthma management and reduce sedentary behavior. As a consequence, this novel intervention will improve global health in this population and support its use in clinical practice. The intervention will be carried out online with direct weekly contact with the therapist. Consequently, it has low implementation costs, might improve patient’s attendance, and has the potential to be largely offered elsewhere.

Trial registration

ClinicalTrials.govNCT05241223. Registered on January 22, 2022.
Full-endoscopic versus conventional microsurgical therapy of lumbar disc herniation: a prospective, controlled, single-center, comprehensive cohort trial (FEMT-LDH trial)
Authors: Saravi Babak , Ülkümen Sara , Couillard-Despres Sebastien , Hassel Frank , Lang Gernot
Published: December 2022

Background

Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic approaches represent a promising alternative to the well-established microsurgical technique. However, high-grade evidence comparing these techniques is still scarce.

Methods

Patients presenting with lumbar disc herniation will be included. The intervention group will obtain full-endoscopic disc decompression, whereas the control group will be treated by microsurgical disc decompression. We will apply a comprehensive cohort study design involving a randomized and a prospective non-randomized study arm. Patients who do not consent to be randomized will be assigned to the non-randomized arm. The primary outcome will be the Oswestry Disability Index (ODI). Secondary outcomes involve the visual analog scale (VAS) of pain and the SF-36 health questionnaire. Furthermore, clinical characteristics including duration of hospital stay, operation time, and complications as well as laboratory markers, such as C-reactive protein, white blood cell counts, and interleukin 6 will be determined and compared.

Discussion

This study will significantly contribute to the current evidence available in the literature by evaluating the outcome of the full-endoscopic technique against the gold standard for lumbar disc herniation in a clinically relevant study setup. Additionally, the study design allows us to include patients not willing to be randomized in a prospective parallel study arm and to evaluate the impact of randomization on outcomes and include. The results could help to improve the future therapy in patients suffering from lumbar disc herniation.

Trial registration

This study was prospectively registered in The German Clinical Trials Register (DRKS), a German WHO primary registry, under the registration number: DRKS00025786. Registered on July 7, 2021.
An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study
Authors: Inoue Kenji , Chieh Jack Tan Wei , Yeh Lim Chiw , Chiang Shuo-Ju , Phrommintikul Arintaya , Suwanasom Pannipa , Kasim Sazzli , Ahmad Bakhtiar , Idrose Alzamani Mohammad , Salleh Farina Mohd , Oyamada Shunsuke , Hirano Yohei , Ouchi Shohei , Terakura Moriyuki , Yokoyama Naoyuki , Kozuma Ken , Nanasato Mamoru , Higuchi Ryosuke , Yumoto Kazuhiko , Fukuzawa Tomoyuki , Shimada Issei , Giannitsis Evangelos , Twerenbold Raphael , Minamino Tohru
Published: December 2022

Background

More than half of the world’s population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data.

Methods

The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2021 and Apr 2024 were included. Initially, all clusters will apply “usual care” according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED.

Conclusions

This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
Characterization of a novel AA3_1 xylooligosaccharide dehydrogenase from Thermothelomyces myriococcoides CBS 398.93
Authors: Zhao Hongbo , Karppi Johanna , Nguyen Thi Truc Minh , Bellemare Annie , Tsang Adrian , Master Emma , Tenkanen Maija
Published: December 2022

Background

The Carbohydrate-Active enZymes (CAZy) auxiliary activity family 3 (AA3) comprises flavin adenine dinucleotide-dependent (FAD) oxidoreductases from the glucose–methanol–choline (GMC) family, which play auxiliary roles in lignocellulose conversion. The AA3 subfamily 1 predominantly consists of cellobiose dehydrogenases (CDHs) that typically comprise a dehydrogenase domain, a cytochrome domain, and a carbohydrate-binding module from family 1 (CBM1).

Results

In this work, an AA3_1 gene from T. myriococcoides CBS 398.93 encoding only a GMC dehydrogenase domain was expressed in Aspergillus niger. Like previously characterized CDHs, this enzyme (TmXdhA) predominantly accepts linear saccharides with β-(1 → 4) linkage and targets the hydroxyl on the reducing anomeric carbon. TmXdhA was distinguished, however, by its preferential activity towards xylooligosaccharides over cellooligosaccharides. Amino acid sequence analysis showed that TmXdhA possesses a glutamine at the substrate-binding site rather than a threonine or serine that occupies this position in previously characterized CDHs, and structural models suggest the glutamine in TmXdhA could facilitate binding to pentose sugars.

Conclusions

The biochemical analysis of TmXdhA revealed a catalytic preference for xylooligosaccharide substrates. The modeled structure of TmXdhA provides a reference for the screening of oxidoreductases targeting xylooligosaccharides. We anticipate TmXdhA to be a good candidate for the conversion of xylooligosaccharides to added-value chemicals by its exceptional catalytic ability.
Therapy sculpts the complex interplay between cancer and the immune system during tumour evolution
Authors: Thol Kerstin , Pawlik Piotr , McGranahan Nicholas
Published: December 2022

Cancer development is an evolutionary process. A key selection pressure is exerted by therapy, one of the few players in cancer evolution that can be controlled. As such, an understanding of how treatment acts to sculpt the tumour and its microenvironment and how this influences a tumour’s subsequent evolutionary trajectory is critical. In this review, we examine cancer evolution and intra-tumour heterogeneity in the context of therapy. We focus on how radiotherapy, chemotherapy and immunotherapy shape both tumour development and the environment in which tumours evolve and how resistance can develop or be selected for during treatment.
Nonlinear analysis in p-vector spaces for single-valued 1-set contractive mappings
Authors: Yuan George Xianzhi
Published: December 2022

The goal of this paper is to develop some fundamental and important nonlinear analysis for single-valued mappings under the framework ofp-vector spaces, in particular, for locallyp-convex spaces for$0 < p \leq 1$0<p≤1. More precisely, based on the fixed point theorem of single-valued continuous condensing mappings in locallyp-convex spaces as the starting point, we first establish best approximation results for (single-valued) continuous condensing mappings, which are then used to develop new results for three classes of nonlinear mappings consisting of 1) condensing; 2) 1-set contractive; and 3) semiclosed 1-set contractive mappings in locallyp-convex spaces. Next they are used to establish the general principle for nonlinear alternative, Leray–Schauder alternative, fixed points for nonself mappings with different boundary conditions for nonlinear mappings from locallyp-convex spaces, to nonexpansive mappings in uniformly convex Banach spaces, or locally convex spaces with the Opial condition. The results given by this paper not only include the corresponding ones in the existing literature as special cases, but are also expected to be useful tools for the development of new theory in nonlinear functional analysis and applications to the study of related nonlinear problems arising from practice under the general framework ofp-vector spaces for$0< p \leq 1$0<p≤1.

Finally, the work presented by this paper focuses on the development of nonlinear analysis for single-valued (instead of set-valued) mappings for locallyp-convex spaces. Essentially, it is indeed the continuation of the associated work given recently by Yuan (Fixed Point Theory Algorithms Sci. Eng. 2022:20, 2022); therein, the attention is given to the study of nonlinear analysis for set-valued mappings in locallyp-convex spaces for$0 < p \leq 1$0<p≤1.
Histamine and gamma-aminobutyric acid in the nervous system of Pygospio elegans (Annelida: Spionidae): structure and recovery during reparative regeneration
Authors: Starunova Zinaida I. , Shunkina Ksenia V. , Novikova Elena L. , Starunov Viktor V.
Published: December 2022

Background

In recent two decades, studies of the annelid nervous systems were revolutionized by modern cell labeling techniques and state-of-the-art microscopy techniques. However, there are still huge gaps in our knowledge on the organization and functioning of their nervous system. Most of the recent studies have focused on the distribution of serotonin and FMRFamide, while the data about many other basic neurotransmitters such as histamine (HA) and gamma-aminobutyric acid (GABA) are scarce.

Results

Using immunohistochemistry and confocal microscopy we studied the distribution of histamine and gamma-aminobutyric acid in the nervous system of a spionid annelid Pygospio elegans and traced their redevelopment during reparative regeneration. Both neurotransmitters show specific patterns in central and peripheral nervous systems. HA-positive cells are concentrated mostly in the brain, while GABA-positive cell somata contribute equally to brain and segmental ganglia. Some immunoreactive elements were found in peripheral nerves. Both substances were revealed in high numbers in bipolar sensory cells in the palps. The first signs of regenerating HAergic and GABAergic systems were detected only by 3 days after the amputation. Further redevelopment of GABAergic system proceeds faster than that of HAergic one.

Conclusions

Comparisons with other annelids and mollusks examined in this respect revealed a number of general similarities in distribution patterns of HAergic and GABAergic cells in different species. Overall, the differences in the full redevelopment of various neurotransmitters correlate with neuronal development during embryogenesis. Our results highlight the importance of investigating the distribution of different neurotransmitters in comparative morphological and developmental studies.
Dielectric dispersion model including polarization response of a shape distribution
Authors: Hou Chang-Yu , Freed Denise E.
Published: December 2022

Formation evaluation based on the complex dielectric dispersion in the megahertz to gigahertz frequency range has become a useful method for obtaining formation properties with the development of several logging tools. Such an evaluation relies on fitting the measured dielectric signals to a dielectric dispersion model and inverting for model parameters directly associated with certain formation petrophysical properties: the water-filled porosity, the brine salinity, and a water-phase tortuosity exponent. Hence, a model that can faithfully describe the dielectric dispersion governed by those formation properties is of importance for such a practice. By incorporating the polarization response of grains with a distribution of shapes, we have improved upon a widely accepted dielectric dispersion model, the bimodal model. To efficiently approximate the overall polarization response of ensembles of grains with continuous shape distributions, we establish two approaches that use a finite number of grain shapes: a Padé approximation and samplings with a Gauss quadrature rule. The latter method provides greater flexibility in what type of shape distribution can be introduced and how they are introduced. By adopting a specific class of shape distributions sampled with a Gauss quadrature rule, a new dielectric dispersion model for brine-saturated rocks is developed using a differential effective medium approach. The new model has the same number of model parameters and should have similar use cases, clay-free clastic and carbonate formations without complex pore structures, as those of the bimodal model. By fitting our model to available core measurements, the new model better describes the dielectric dispersion of brine-saturated rocks over a broader frequency range in comparison to the bimodal model, while giving good inverted petrophysical parameters. Based on the scaling behavior of the Maxwell-Wagner polarization, the new model would be more adequate for describing the dielectric dispersion of rocks saturated with higher salinity brine.
A Learning Health System Approach to Cancer Survivorship Care Among LGBTQ+ Communities
Authors: Dunne Will , Adebayo Nihmotallahi , Danner Sankirtana , Post Sharon , O'Brian Catherine , Tom Laura , Osei Cassandra , Blum Cori , Rivera Juan , Molina Elena , Trosman Julia , Weldon Christine , Ekong Abbey , Adetoro Elizabeth , Rapkin Bruce , Simon Melissa A.
Published: December 2022

PURPOSE:

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals who receive primary care services at community health centers are often referred to external specialty care centers after cancer diagnosis, upon which primary care services are disrupted and may be discontinued because of gaps in communication between primary and oncologic care providers. This qualitative study evaluated barriers and facilitators to effective care coordination for LGBTQ+ patients with cancer and the utility of a novel cancer care coordination tool to mitigate identified barriers.

MATERIALS AND METHODS:

Semistructured interviews with LGBTQ+ cancer survivors, caregivers to LGBTQ+ persons, clinical team members who provide care to LGBTQ+ patients, and members of community-based organizations that work with LGBTQ+ patients were conducted. Interview analysis was a multistage process, wherein a constant comparison approach was used. Transcripts were reviewed and coded using Atlas.ti Cloud.

RESULTS:

A total of 26 individuals were interviewed: 10 patients, four caregivers, 10 clinical care team members, and two community organization representatives. Interview analysis yielded insight regarding (1) LGBTQ+ patient experiences engaging with primary and oncologic care at the clinic level and (2) perceptions of patient-provider and provider-provider communication and coordination.

CONCLUSION:

Interview findings indicate a need for further development of interventions aimed at improving care coordination, patient experience, and outcomes in the cancer care continuum for LGBTQ+ patients. Learning health systems, like the one studied, show great potential for contributing to the development of such interventions.
Vitamin D Deficiency Reduces Postthyroidectomy Protracted Hypoparathyroidism Risk. Is Gland Preconditioning Possible?
Authors: Martín-Román Lorena , Colombari Renan , Fernández-Martínez María , Amunategui-Prats Iñaki , Escat-Cortés José Luis , Zaraín-Obrador Leire , Mercader-Cidoncha Enrique
Published: December 2022

Context

Hypoparathyroidism is the most frequent complication after total thyroidectomy (PT-hypoPTH). After 1 year, most patients recover parathyroid function; however, the implicated physiologic dynamics remain unknown. Vitamin D deficiency (VDD) is the main cause of secondary hyperparathyroidism. Whether this compensatory hyperparathyroidism could influence parathyroid function recovery (PFR) in the setting of PT-hypoPTH has not been studied.

Objective

This work aimed to evaluate the effect of preoperative VDD on PFR.

Methods

A retrospective study was conducted with a prospectively maintained database including patients undergoing a total thyroidectomy between May 2014 and June 2019. Preoperative vitamin D (25(OH)D) less than 20 mg/mL was defined as VDD. Intact PTH less than 14 pg/mL on postoperative day 1 was defined as PT-hypoPTH. Transient PT-hypoPTH displayed PFR within the first year (early recovery: < 30 days; protracted recovery: > 30 days) whereas definite PT-hypoPTH did not. Survival analysis evaluated the effect of preoperative VDD on PFR, and a binary logistic regression model identified associated factors.

Results

A total of 397 patients were identified. The observed rates of transient, protracted, and definite PT-hypoPTH were 32.9%, 15.1%, and 5.2%, respectively. Rates of VDD were higher in the early-recovery PT-hypoPTH group (55.2% vs 31.5%; P = .01). Preoperative VDD was associated with faster PFR (19 vs 35 days; P = .03) and behaved as a protective factor for protracted PT-hypoPTH (odds ratio 0.47; 95% CI, 0.25-0.881; P = .016) in the multivariable analysis.

Conclusion

Preoperative VDD could act as a preconditioning factor of the parathyroid glands prior to the surgical aggression exerted against them during surgery aiding PFR. Basic research studies and prospective clinical trials are needed to explain the underlying physiological mechanisms and to provide further evidence to improve clinical management.
A DUSP6 inhibitor suppresses inflammatory cardiac remodeling and improves heart function after myocardial infarction
Authors: Zhang Zongwang , Chen Yang , Zheng Lixia , Du Jianyong , Wei Shicheng , Zhu Xiaojun , Xiong Jing-Wei
Published: December 2022

Acute myocardial infarction (MI) results in loss of cardiomyocytes and abnormal cardiac remodeling with severe inflammation and fibrosis. However, how cardiac repair can be achieved by timely resolution of inflammation and cardiac fibrosis remains incompletely understood. Our previous findings have shown that dual-specificity phosphatase 6 (DUSP6) is a regeneration repressor from zebrafish to rats. In this study, we found that intravenous administration of the DUSP6 inhibitor (E)-2-benzylidene-3-(cyclohexylamino)-2,3-dihydro-1H-inden-1-one (BCI) improved heart function and reduced cardiac fibrosis in MI rats. Mechanistic analysis revealed that BCI attenuated macrophage inflammation through NF-κB and p38 signaling, independent of DUSP6 inhibition, leading to the downregulation of various cytokines and chemokines. In addition, BCI suppressed differentiation-related signaling pathways and decreased bone-marrow cell differentiation into macrophages through inhibiting DUSP6. Furthermore, intramyocardial injection of poly (D, L-lactic-co-glycolic acid)-loaded BCI after MI had a notable effect on cardiac repair. In summary, BCI improves heart function and reduces abnormal cardiac remodeling by inhibiting macrophage formation and inflammation post-MI, thus providing a promising pro-drug candidate for the treatment of MI and related heart diseases.

This article has an associated First Person interview with the first author of the paper.
Legal Markets
Authors: Hadfield Gillian K.
Published: December 2022

The existence of an effective legal system is assumed throughout economic analysis, and yet there has been little study of the economics of legal markets themselves. Research to date has focused narrowly on the economics of markets for lawyers. In this review, I distinguish legal markets from the market for lawyers and show how excessive regulation of our legal markets—by lawyers themselves—distorts economic activity and growth. It does so primarily by inhibiting investment in the legal and regulatory technologies needed to respond to the transformation of the economy wrought by globalization, digitization, aspirations for inclusion, and the coming of artificial intelligence. (JEL J44, K00, K40, L84)
Measurement Systems
Authors: Schennach Susanne
Published: December 2022

Economic models often depend on quantities that are unobservable, either for privacy reasons or because they are difficult to measure. Examples of such variables include human capital (or ability), personal income, unobserved heterogeneity (such as consumer “types”), et cetera. This situation has historically been handled either by simply using observable imperfect proxies for each of the unobservables, or by assuming that such unobservables satisfy convenient conditional mean or independence assumptions that enable their elimination from the estimation problem. However, thanks to tremendous increases in both the amount of data available and computing power, it has become possible to take full advantage of recent formal methods to infer the statistical properties of unobservable variables from multiple imperfect measurements of them. The general framework used is the concept of measurement systems in which a vector of observed variables is expressed as a (possibly nonlinear or nonparametric) function of a vector of all unobserved variables (including unobserved error terms or “disturbances” that may have nonadditively separable affects). The framework emphasizes important connections with related fields, such as nonlinear panel data, limited dependent variables, game theoretic models, dynamic models, and set identification. This review reports the progress made toward the central question of whether there exist plausible assumptions under which one can identify the joint distribution of the unobservables from the knowledge of the joint distribution of the observables. It also overviews empirical efforts aimed at exploiting such identification results to deliver novel findings that formally account for the unavoidable presence of unobservables. (JEL C30, C55, C57, D12, E21, E23, J24)