bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for gastric cancer: a large-scale, population-based case-control study
Authors: Zhang Rui , Li He , Li Ni , Shi Ju-Fang , Li Jiang , Chen Hong-Da , Yu Yi-Wen , Qin Chao , Ren Jian-Song , Chen Wan-Qing , He Jie
Published: July 2021

Background:

Early detection of gastric cancer (GC) has been the topic of major efforts in China. This study aimed to explore the risk factors associated with GC and to provide evidence for the selection of a high-risk population of GC.

Methods:

Based on the cancer screening cohort of the National Cancer Screening Program in Urban China, GC patients diagnosed by endoscopy and pathological examinations constituted the case group, and controls were 1:3 matched by sex and age (±5 years) individually. The variables were selected by univariable analysis of factors such as body mass index (BMI), dietary habits, lifestyle, stomach disease history, and family history of GC; and multivariable logistic regression was used to analyze the influencing factors of GC and to calculate the odds ratio (OR) of related factors and its 95% confidence interval (CI).

Results:

A total of 215 GC cases and 645 matched healthy controls were included in the final analysis, with a median age of 61 years for the case and control groups. Overall analysis showed that high educational level (above primary school) (OR = 0.362, 95% CI = 0.219–0.599, P < 0.001), overweight/obesity (BMI ≥24 kg/m2; OR = 0.489, 95% CI = 0.329–0.726, P < 0.001), cigarette smoking (OR = 3.069, 95% CI = 1.700–5.540, P < 0.001), alcohol consumption (OR = 1.661, 95% CI = 1.028–2.683, P = 0.038), history of stomach disease (OR = 6.917, 95% CI = 4.594–10.416, P < 0.001), and family history of GC in first-degree relatives (OR = 4.291, 95% CI = 1.661–11.084, P = 0.003) were significantly correlated with the occurrence of GC. Subgroup analyses by age and gender indicated that GC risk was still increased in the presence of a history of stomach disease. A history of chronic gastritis, gastric ulcer, or gastric polyposis was positively associated with GC, with adjusted ORs of 4.155 (95% CI = 2.711–6.368), 1.839 (95% CI = 1.028–3.288), and 2.752 (95% CI = 1.197–6.326).

Conclusions:

Subjects who smoke, drink, with history of stomach disease and family history of GC in first-degree relatives are the high-risk populations for GC. Therefore, attention should be paid to these subjects for GC screening.
Concurrent Nab-paclitaxel and Radiotherapy
Authors: Arscott William T. , Nead Kevin T. , Bear Adham , Venigalla Sriram , Shabason Jacob , Lukens John N. , Plastaras John P. , Wojcieszynski Andrzej , Metz James , O’Hara Mark , Reiss Kim A. , Teitelbaum Ursina , Loaiza-Bonilla Arturo , Drebin Jeffrey , Lee Major K. , Shroff Stuti G. , Ben-Josef Edgar
Published: July 2021

Purpose:

This study evaluates the toxicity and tumor response with concurrent nab-paclitaxel chemoradiotherapy (CRT) compared with standard (5-fluorouracil or gemcitabine) CRT.

Materials and Methods:

Fifty patients with borderline resectable or unresectable pancreatic adenocarcinoma from 2014 to 2017 were divided into 2 groups: concurrent nab-paclitaxel (100 to 125 mg/m2 weekly) CRT (median: 2.1 Gy fraction size and 52.5 Gy total) or standard CRT (median: 1.8 Gy fraction size, 54.5 Gy total). The primary endpoint was toxicity, and secondary endpoints were local failure and conversion to resectability. Comparisons were made using rank-sum or Fisher exact test and multivariable competing risk regression for the cumulative incidence of local failure.

Results:

There were 28 patients in the nab-paclitaxel CRT group and 22 in the standard CRT group; 88% had the unresectable disease. The median follow-up was 18 months. The median duration of chemotherapy before concurrent CRT was 1.9 and 2.3 months in the nab-paclitaxel and standard CRT groups (P=0.337), and radiotherapy dose was 52.5 Gy (range, 52.5 to 59.4 Gy) and 54.5 Gy (range, 45.0 to 59.4 Gy), respectively. There were no statistically significant grade ≥2 toxicities. The nab-paclitaxel CRT group experienced a nonstatistically significant lower incidence of local failure (hazard ratio=0.91, 95% confidence interval: 0.27-3.03, P=0.536). More patients in the nab-paclitaxel CRT group proceeded to surgery (9/28 compared with 3/22 in the standard CRT, P=0.186); of which 6 (25%) in the nab-paclitaxel CRT and 2 (10%) in the standard CRT groups were initially unresectable.

Conclusions:

Nab-paclitaxel CRT had similar toxicity compared with standard CRT in the treatment of borderline resectable or unresectable pancreatic cancer. Its use was associated with an arithmetically lower cumulative incidence of local failure and an arithmetically higher conversion to resectability, both of which were not statistically significant.
Bipolar Depression: A Historical Perspective of the Current Concept, with a Focus on Future Research
Authors: Martino Diego J. , Valerio Marina P.
Published: July 2021

The aim of this narrative review is to trace the origin of the concept of bipolar depression and to expose some of its limitations. Bipolar depression is a broad clinical construct including experiences ranging from traditional melancholic and psychotic episodes ascribed to “manic-depressive insanity,” to another heterogeneous group of depressive episodes originally described in the context of binary models of unipolar depression (e.g., psychogenic depression, neurotic depression). None of the available empirical evidence suggests, however, that these subsets of “bipolar” depression are equivalent in terms of clinical course, disability, family aggregation, and response to treatment, among other relevant diagnostic validators. Therefore, the validity of the current concept of bipolar depression should be a matter of concern. Here, we discuss some of the potential limitations that this broad construct might entail in terms of pathophysiological, clinical, and therapeutic aspects. Finally, we propose a clinical research program for bipolar depression in order to delimit diagnostic entities based on empirical data, with subsequent validation by laboratory or neuroimaging biomarkers. This process will then aid in the development of more specific treatments.
Empathy During Patient-Provider Interactions for Women With Chronic Pelvic Pain: A Qualitative Study
Authors: Kays Pamela
Published: July 2021

Background:

Despite 25 years of evidence emphasizing problematic health care experiences for women with chronic pelvic pain and the benefits of clinical empathy and patient-centered care, negative patient-provider interactions for women with chronic pelvic pain persist.

Purpose:

The purpose of the current study was to investigate the lived experiences of patient-provider interactions from the perspective of women with chronic pelvic pain.

Subjects:

Thirteen women aged 18 to 65 years who had chronic pelvic pain for a minimum of 6 months and who had pursued medical consultation/care were included.

Materials/Methods:

This phenomenological qualitative study used semi-structured, in-depth interviews. A topic guide was used for interview questions and consisted of 5 semi-structured questions with probes, as necessary. Each participant was interviewed face-to-face and one-on-one, and interviews were audio-recorded. Qualitative data analysis software was used to manually code and analyze the data through thematic nodes using an open and inductive approach and constant comparison to facilitate interpretive phenomenological analysis.

Results:

Participants described negative patient-provider interactions during their health care encounters through patterns of health care provider behaviors and traits with a particular lack of empathy.

Conclusions:

These findings highlight the need for improved integration of research into health care provider education to develop empathetic patient-provider interactions. Provider effort to help may be a major component missing in negative patient-provider interactions for this population. Cultivating positive patient-provider interactions can advance best practices and ultimately result in the best care for women with chronic pelvic pain.
A mild deficiency of ADAMTS13 is associated with severity in COVID-19: comparison of the coagulation profile in critically and noncritically ill patients
Authors: Martín-Rojas Reyes María , Chasco-Ganuza Maite , Casanova-Prieto Sara , Delgado-Pinos Valeria Estefanía , Pérez-Rus Gloria , Duque-González Patricia , Sancho Milagros , Díez-Martín José Luis , Pascual-Izquierdo Cristina
Published: July 2021

Early descriptions of COVID-19 associated coagulopathy identified it as a disseminated intravascular coagulation (DIC). However, recent studies have highlighted the potential role of endothelial cell injury in its pathogenesis, and other possible underlying mechanisms are being explored. This study aimed to analyse the coagulation parameters of critically and noncritically ill patients with COVID-19 bilateral pneumonia, determine if coagulation factors consumption occurs and explore other potential mechanisms of COVID-19 coagulopathy. Critically and noncritically ill patients with a diagnosis of COVID-19 bilateral pneumonia were recruited. For each patient, we performed basic coagulation tests, quantification of coagulation factors and physiological inhibitor proteins, an evaluation of the fibrinolytic system and determination of von Willebrand Factor (vWF) and ADAMTS13. Laboratory data were compared with clinical data and outcomes. The study involved 62 patients (31 ICU, 31 non-ICU). The coagulation parameters assessment demonstrated normal median prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) in our cohort and all coagulation factors were within normal range. PAI-1 median levels were elevated (median 52.6 ng/ml; IQR 37.2–85.7), as well as vWF activity (median 216%; IQR 196–439) and antigen (median 174%; IQR 153.5–174.1). A mild reduction of ADAMTS13 was observed in critically ill patients and nonsurvivors. We demonstrated an inverse correlation between ADAMTS13 levels and inflammatory markers, D-dimer and SOFA score in our cohort. Elevated vWF and PAI-1 levels, and a mild reduction of ADAMTS13 in the most severe patients, suggest that COVID-19 coagulopathy is an endotheliopathy that has shared features with thrombotic microangiopathy.
Coronavirus disease 2019 respiratory failure: what is the best supportive care for patients who require ICU admission?
Authors: Sweeney Daniel A. , Malhotra Atul
Published: July 2021

Purpose of review

Currently, there is no cure for SARS-CoV-2 infection, yet hospital mortality rates for COVID-19 have improved over the course of the pandemic and may be due in part to improved supportive care in the ICU. This review highlights the evidence for and against various ICU supportive therapies for the treatment of critically ill patients with COVID-19.

Recent findings

Early in the pandemic, there was great interest in novel ICU supportive care, both for the benefit of the patient, and the safety of clinicians. With a few exceptions (e.g. prone ventilation of nonintubated patients), clinicians abandoned most of these approaches (e.g. early intubation, avoidance of high flow or noninvasive ventilation). Standard critical care measures, especially for the treatment of severe viral respiratory infection including acute respiratory distress syndrome (ARDS) were applied to patients with COVID-19 with apparent success.

In general, the COVID-19 pandemic reaffirmed the benefits of standard supportive care for respiratory failure and in particular, recent advances in ARDS treatment. Prone ventilation of nonintubated patients, an approach that was adopted early in the pandemic, is associated with improvement in oxygenation, but its impact on clinical outcome remains unclear. Otherwise, prone mechanical ventilation and avoidance of excessive tidal volumes, conservative fluid management, antibiotic stewardship and early evaluation for extracorporeal membrane oxygenation (ECMO) -- basic tenants of severe respiratory infections and ARDS care -- remain at the core of management of patients with severe COVID-19.
Brief intervention of low carbohydrate dietary advice: clinic results and a review of the literature
Authors: Oliver David , Andrews Kim
Published: July 2021

Purpose of review

The purpose of the review is to assess the efficacy of a brief intervention of low carbohydrate dietary advice for weight loss in patients with a raised body mass index (BMI) (>25 kg/m2) during routine patient appointments in primary care.

Recent findings

Brief interventions in primary care have been shown to be a valuable tool in supporting patients to make lifestyle changes. Low carbohydrate diets have been successful in helping patients lose weight.

The authors carried out a retrospective observational study based on the electronic records from a single general practitioner surgery with 7,500 patients in Essex, UK. Low carbohydrate dietary advice was given opportunistically to patients with a raised BMI, over an 18 month period, with advice and weights recorded. In total, 774 patients were given low carbohydrate dietary advice. Overall, 1103 kg of weight was lost by 339 patients, there was a median weight loss of 2.5 kg (interquartile range 0.0–6.0 kg) and a mean weight loss of 3.3 kg.

There is no published literature available assessing the efficacy of brief interventions of low carbohydrate dietary advice. Our clinic results indicate that this may be an effective weight loss tool in primary care.
Nonprofit Hospital Community Benefits
Authors: Santos Tatiane , Lindrooth Richard C.
Published: July 2021

Background:

Nonprofit hospitals (NFPs) are required to provide community benefits, which have been historically focused on provision of medical care, to keep their tax exemption status. To increase hospital investment in community health, the Patient Protection and Affordable Care Act required NFPs to conduct community health needs assessments and address identified needs. Some states have leveraged this provision to encourage collaboration between NFPs and local health departments (LHDs) in local health planning.

Objective:

The objective of this study was to examine the association of NFP-LHD collaboration in local health planning targeting drug use, with drug-induced mortality.

Research Design:

We conducted difference-in-differences analyses using drug-induced mortality data from 2009 to 2016, encompassing the first 3 years after NFP-LHD collaboration in local health planning specific to drug use. We evaluated drug-induced mortality in 22 counties in which collaboration was required in comparison with that in 198 control counties. We used data collected from implementation strategy reports by NFPs and combined it with data on hospital characteristics, as well as state-level and county-level factors associated with drug-induced mortality.

Measures:

The primary outcome was county-level drug-induced mortality per 100,000 population.

Results:

Counties, in which NFP-LHD collaboration in local health planning was required and in which NFPs and LHDs jointly prioritized drug use, experienced a deceleration in drug-induced mortality of ~8 deaths per 100,000 population compared with the mortality rate they would have experienced without collaboration.

Conclusions:

Collaboration between NFPs and LHDs to address drug use was associated with a deceleration in drug-induced mortality. Policymakers can leverage community benefit regulation to encourage NFP-LHD collaboration in local health planning.
Learning about Kawasaki disease from COVID-19 and the Multisystem Inflammatory Syndrome in Children
Authors: Gorelik Mark
Published: July 2021

Purpose of review

Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel syndrome that has appeared in the wake of the severe acute respiratory syndrome coronavirus -2 pandemic, with features that overlap with Kawasaki disease (KD). As a result, new interest and focus have arisen in KD, and specifically mechanisms of the disease.

Recent findings

A major question in the literature on the nature of MIS-C is if, and how, it may be related to KD. This has been explored using component analysis type studies, as well as other unsupervised analysis, as well as direct comparisons. At present, the answer to this question remains opaque, and several studies have interpreted their findings in opposing ways. Studies seem to suggest some relationship, but that MIS-C and KD are not the same syndrome.

Study of MIS-C strengthens the likelihood that KD is a postinfectious immune response, and that perhaps multiple infectious agents or viruses underlie the disease. MIS-C and KD, while not the same disease, could plausibly be sibling disorders that fall under a larger syndrome of postacute autoimmune febrile responses to infection, along with Kawasaki shock syndrome.
Making Research Flourish Through ESPGHAN
Authors: Gasparetto Marco , Strisciuglio Caterina , Assa Amit , Gerasimidis Kostantinos , Giachero Federica , Novak Jan , Robinson Philip , Tél Bálint , Zilbauer Matthias , Jenke Andreas
Published: July 2021

Recent research breakthroughs have emerged from applied basic research throughout all scientific areas, including adult and paediatric gastroenterology, hepatology and nutrition (PGHAN). The research landscape within the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) is also inevitably changing from clinical research to studies involving applied laboratory research. This position paper aims to depict the current status quo of basic science and translational research within ESPGHAN, and to delineate how the society could invest in research in the present and future time. The paper also explores which research areas in the field of PGHAN represent the current and future priorities, and what type of support is needed across the ESPGHAN working groups (WGs) and special interest groups (SIGs) to fulfil their research goals.
Theory of Mind in Somatization and Depression
Authors: Cetin Sahabettin , Sozeri Varma Gulfizar , Toker Ugurlu Tugce , Ozdel Ismail Osman
Published: July 2021

Although mentalization is important in somatic symptom disorder (SSD) and major depressive disorder (MDD), it is not fully understood. In this study, we aimed to investigate the relation between somatic and depressive symptoms with mentalization. A total of 48 patients diagnosed with SSD, 50 patients diagnosed with MDD, and 50 healthy individuals, participated the study. The Montgomery-Asperg Depression Scale, Symptom Checklist-90 Revised, and Reading the Mind in the Eyes Test (RMET) were applied to the participants. The patients with SSD showed significantly the lowest performance of theory of mind. There was no significant difference between MDD and healthy controls. High somatization score was found to be a predictor for low RMET scores (95% confidence interval, −0.339; p = 0.014). Mentalization deficit seems to be associated with somatization rather than depression.
Review: Sport Performance and the Two-visual-system Hypothesis of Vision: Two Pathways but Still Many Questions
Authors: Mann David L. , Fortin-Guichard Daniel , Nakamoto Hiroki
Published: July 2021

SIGNIFICANCE

The two-visual-system hypothesis (TVSH) provides a framework for understanding the nature of the visual information athletes are likely to rely on during competition. If valid, the framework provides a valuable means of evaluating the likely efficacy of different vision training tools that claim to improve the sport performance of athletes.

The TVSH has been used to explain that many of the existing methods of testing and training vision may be ineffective to improve on-field sport performance. The TVSH suggests that the visual pathway used to control actions on-field may be different—and rely on different visual information—to the pathway often tested and trained off-field. However, the central claims of the TVSH are increasingly questioned, and this has implications for our understanding of vision and sport performance. The aim of this article is to outline the implications of the TVSH for the visual control of actions in sport. We first provide a summary of the TVSH and outline how the visual information used to control actions might differ from that usually tested. Second, we look at the evidence from studies of sports that are (and are not) consistent with the TVSH and the implications they have for training vision. Finally, we take a wider look at the impact of the TVSH on the sport sciences and other complementary theories that hold implications for training vision to improve sport performance.
Feasibility and impact of near-point-of-care integrated tuberculosis/HIV testing in Malawi and Zimbabwe
Authors: Wang Melody , Boeke Caroline E. , Rioja Maria Rosezoil , Maparo Tatenda , Banda Clement , Chavula Chancy , Gunda Andrews , Isaac Jean , Mangwiro Alexio , Mangwendeza Phibeon Munyaradzi , Mtaula Jonathan , Mwase Christopher , Doi Naoko , Peter Trevor , Kandulu James , Simbi Raiva , Khan Shaukat , Sacks Jilian A.
Published: July 2021

Objectives:

Near-point-of-care (POC) testing for early infant diagnosis (EID) and viral load expedites clinical action and improves outcomes but requires capital investment. We assessed whether excess capacity on existing near-POC devices used for TB diagnosis could be leveraged to increase near-POC HIV molecular testing, termed integrated testing, without compromising TB services.

Design:

Preimplementation/postimplementation studies in 10 health facilities in Malawi and 8 in Zimbabwe.

Methods:

Timeliness of EID and viral load test results and clinical action were compared between centralized and near-POC testing using Somers’ D tests (continuous indicators) and risk ratios (RR, binary indicators); TB testing/treatment rates and timeliness were analyzed preintegration/postintegration.

Results:

With integration, average device utilization increased but did not exceed 55%. Despite the addition of HIV testing, TB test volumes, timeliness, and treatment initiations were maintained. Although few HIV-positive infants were identified, near-POC EID testing improved treatment initiation within 1 month by 57% compared with centralized EID [Malawi RR: 1.57, 95% confidence interval (CI) 0.98–2.52], and near-POC viral load testing significantly increased the proportion of patients with elevated viral load receiving clinical action within 1 month (Zimbabwe RR: 5.26, 95% CI 3.38–8.20; Malawi RR: 3.90, 95% CI 2.58–5.91).

Conclusion:

Integrating TB/HIV testing using existing multidisease platforms is feasible and enables increased access to rapid diagnostics without disrupting existing TB services. Our results serve as an example of a novel, efficient implementation model that can increase access to critical testing services across disease silos and should be considered for additional clinical applications.
Brief Report: HIV Diagnoses Among Persons Who Inject Drugs by the Urban-Rural Classification—United States, 2010–2018
Authors: Lyss Sheryl B. , Zhang Tianchi , Oster Alexandra M.
Published: July 2021

Background:

After many years of decline, HIV diagnoses attributed to injection drug use in the United States increased in 2015, the year of a large outbreak among persons who inject drugs (PWIDs) in Indiana. We assessed trends in HIV diagnoses among PWID across the urban–rural continuum.

Methods:

We conducted national and county-level analyses of diagnoses among persons aged ≥13 years with HIV attributed to injection drug use only and reported to the National HIV Surveillance System through December 2019; county of residence at diagnosis was classified according to the Centers for Disease Control and Prevention's National Center for Health Statistics Urban–Rural Classification Scheme. National trends for diagnoses occurring during 2010–2014 and 2014–2018 were assessed by the estimated annual percentage change (EAPC). Counties were considered to have an “alert” (ie, an increase above baseline) if the number of 2019 diagnoses among PWID was >2 SDs and >2 diagnoses greater than the mean of annual diagnoses during 2016–2018.

Results:

Nationally, HIV diagnoses among PWID declined 33% during 2010–2014 from 3314 to 2220 (EAPC: −9.7%; 95% confidence interval: −10.8 to −8.6); EAPCs declined significantly in 5 of 6 urban–rural strata. During 2014–2018, diagnoses increased 11% to 2465 (EAPC: 2.4%; 95% confidence interval: 1.1 to 3.8); EAPCs were >0 for all urban–rural strata, although most were nonsignificant. Alerts were detected in 23 counties, representing 5 urban–rural strata.

Conclusions:

Vigilance is needed for increases in HIV among PWID in counties across the urban–rural continuum, particularly those with indicators of increased drug use. Prompt detection, investigation, and response are critical for stemming transmission.
Alveolar echinococcosis: what triggers emergence in North America, Central Europe and Asia?
Authors: Gottstein Bruno , Deplazes Peter
Published: July 2021

Purpose of review

Infection with the larval (metacestode) stage of Echinococcus multilocularis causes alveolar echinococcosis (AE), a serious hepatic disorder. The parasite has increased its infection extensity in wildlife and domestic dogs, mainly due to urbanization and spatial extension of wildlife hosts in Europe, Asia as well as North America, resulting in emerging infection risk for humans.

Recent findings

In hyperendemic areas such as Kyrgyzstan and China, ecological and socioeconomic changes have been associated with the unpredictable increase of AE cases. In North America, the appearance of the European-like genotype is of concern. In Europe, the annual increase of human case numbers reached a plateau even in hyperendemic situations. Therefore, we conclude that most of the exposed individuals are resistant to parasite invasion and/or to disease development. Thus, AE develops in a few healthy individuals, but preferentially in immunosuppressed patients.

In the future, improved diagnostic strategies will allow more precise estimations of transmission routes including the role of food, water and direct dog contact, which should yield improved public health recommendations. Finally, understanding protective innate and acquired immune mechanisms as well as parasite-driven immune-evasion processes will be essential to develop curative therapies in nonoperable patients and, futuristically, appropriate vaccines.
Lip Anthropometry of Healthy Turkish Young Adults
Authors: Bahşi Ilhan , Orhan Mustafa , Kervancioğlu Piraye , Uçar Hadice , Karatepe Şeyma , Sayin Semih
Published: July 2021

The lips play an important role in evaluating and recognizing the craniofacial complex and our perception of facial beauty and attractiveness. The aim of this study was to evaluate the anthropometric measurements of the lips of Turkish young adults and to look for sexual dimorphism. Anterior view photographs were taken of 100 females and 100 males who volunteered to participate in the study. Seven landmarks were determined, stomion (st), sublabiale (sl), subnasale (sn), labiale superius (ls), labiale inferius (li), crista philtre (cp), and chelion (ch). Then, using these landmarks, lower lip height (st-sl), upper lip height (sn-st), philtrum length (sn-ls), upper vermilion height (ls-st), lower vermilion height (li-st), cutaneous lower lip height (li-sl), philtrum width (cp-cp), and mouth width (ch-ch) were measured. It was observed that there was a statistical difference between genders in the parameters of st-sl, sn-st, sn-ls, li-sl, and ch-ch (P= 0.001, for these parameters). Besides, using these distances, 6 anthropometric ratios (ls-st/li-st, sn-ls/ls-st, li-sl/li-st, sn-st/st-sl, cp-cp/ch-ch, and ls-li/ch-ch) were calculated. Among the ratios investigated, sn-ls/ls-st, li-sl/li-st, and cp-cp/ch-ch were statistically significantly larger in males compared females (P = 0.012,P = 0.002, andP = 0.001, respectively). We believe that the results obtained in this study regarding lip anthropometry will help determine the standard values that can be used for the Turkish population aged 18 to 25.
Nursing Difficulties and Issues in Endoscopic Sedation
Authors: Matsubayashi Miki , Nakamura Keiko , Sugawara Miki , Kamishima Shigeko
Published: July 2021

Gastrointestinal endoscopic treatments have increased in Japan. Respiratory depression is as an unexpected development during sedation. This study aimed to clarify the sedation-related difficulties encountered by nurses involved in endoscopic treatment. Participants were five nurses who had worked for more than a year in the endoscopy department of a gastrointestinal endoscopy specialist guidance facility in Sapporo. Semistructured interviews were conducted. The number of recording units obtained was 129, which were divided into 12 categories and subdivided into 42 subcategories. The nursing practice difficulties related to sedation in endoscopic treatment were classified into two major categories: “difficulties in nursing practice” and “system difficulties.” All of the “difficulty in nursing practice” items were role-fulfilling difficulties involved in protecting patient safety and reducing anxiety and discomfort. Four of these items reflected difficulties related particularly to the role of the nurse in charge of the sedated patient in the endoscopy room. To reduce the difficulties encountered by nurses, a treatment environment system must be devised to ensure patient safety and improve the education support system for nurses with regard to sedation.
PRISM: A Novel Human Islet Isolation Technique
Authors: Doppenberg Jason B. , Engelse Marten A. , de Koning Eelco J.P.
Published: July 2021

Background.

Successful pancreatic islet isolations are a key requirement for islet transplantation in selected patients with type 1 diabetes. However, islet isolation is a technically complex, time-consuming, and manual process. Optimization and simplification of the islet isolation procedure could increase islet yield and quality, require fewer operators, and thus reduce cost.

Methods.

We developed a new, closed system of tissue collection, washing, buffer change, and islet purification termed PancReatic Islet Separation Method (PRISM). In the developmental phase, pump and centrifuge speed was tested using microspheres with a similar size, shape, and density as digested pancreatic tissue. After optimization, PRISM was used to isolate islets from 10 human pancreases.

Results.

Islet equivalents viability (fluorescein diacetate/propidium iodide), morphology, and dynamic glucose-stimulated insulin secretion were evaluated. PRISM could be performed by 1 operator in 1 flow cabinet. A similar islet yield was obtained using PRISM compared to the traditional islet isolation method (431 234 ± 292 833 versus 285 276 ± 197 392 islet equivalents, P = 0.105). PRISM islets had similar morphology and functionality.

Conclusions.

PRISM is a novel islet isolation technique that can significantly improve islet isolation efficiency using fewer operators.
Novel methods of teaching psychiatry to medical and postgraduate students
Authors: Jayaram Mahesh , Shields Greg , Buisman-Pijlman Femke
Published: July 2021

Purpose of review

Global burden of mental illness remains at an all-time high and provision of timely good quality care is a challenge globally. Current methods of medical and post-graduate education in psychiatry worldwide have been inadequate in treating those with mental illness. Enormous gaps exist in provision of high-quality teaching, particularly in poorer countries with many having no access to ongoing teaching and training.

Recent findings

Technology and changes to curriculum design have transformed student experiences and highlighted the value of online learning. There are many models to consider from and we describe the development process for these, which also highlight why some can be superior to classroom-based learning. New innovations have significantly enhanced engagement and reach thereby bringing students across the globe into an interconnected community and putting them in touch with world experts. Although some of these options may be expensive, many can be made affordable and accessible.

It is possible to use innovations in online education to ensure high-quality teaching is available globally. A high touch model may be suitable when resources permit, and otherwise low touch scalable models provide options for increasing reach. Together, these models provide optimism for improving standards of global psychiatric training.
Treatment adherence and tolerability of immediate- and prolonged-release lithium formulations in a sample of bipolar patients: a prospective naturalistic study
Authors: Barbuti Margherita , Colombini Paola , Ricciardulli Sara , Amadori Salvatore , Gemmellaro Teresa , De Dominicis Francesco , Della Rocca Filippo , Petrucci Alessandra , Schiavi Elisa , Perugi Giulio
Published: July 2021

The aim of this study was to compare treatment adherence and tolerability of different lithium formulations in 70 bipolar patients receiving lithium therapy for the first time. During the 1-year follow-up, information was collected regarding patient’s clinical course, therapeutic adherence, side effects of the treatment and serum levels of lithium, creatinine and thyroid-stimulating hormone. At baseline, 30 patients (43%) were on prolonged-release lithium formulations and 40 (57%) on immediate-release formulations. At the final evaluation, 37 patients (53%) were considered lost to follow-up. Both prolonged- and immediate-release patients showed significant improvement in the Functioning Assessment Short Test and in the Clinical Global Impressions for Bipolar Disorder scores during the follow-up. At the first follow-up visit, the mean plasma lithium level of prolonged-release patients was higher than immediate-release patients (0.61 vs. 0.47, respectively; P = 0.063), as well as the therapeutic adherence (85 vs. 64%, respectively; P = 0.089). Fine tremor and gastrointestinal symptoms were more frequent in immediate-release patients than in prolonged-release patients at each follow-up visit, with the sole exception of gastrointestinal symptoms at the last evaluation. Prolonged-release lithium therapy could provide potential advantages over immediate-release formulations. Future naturalistic studies and clinical trials with a longer follow-up duration are needed.
Dyadobacter subterraneus sp. nov., isolated from hydrocarbon-polluted groundwater from an oil refinery in Hungary
Authors: Szabó István , Al-Omari Jafar , Szerdahelyi Gábor Soma , Radó Júlia , Kaszab Edit , Táncsics András , Szoboszlay Sándor , Kriszt Balázs
Published: July 2021

A Gram-stain-negative, aerobic, non-spore-forming, rod-shaped bacterial strain (UP-52T) was isolated from hydrocarbon-polluted groundwater located near an oil refinery in Tiszaujvaros, Hungary. Phylogenetic analysis based on 16S rRNA gene sequences indicated that the isolate belongs to the genus

Dyadobacter

in the family

Cytophagaceae

. Its closely related species are

Dyadobacter frigoris

(98.00 %),

Dyadobacter koreensis

(97.64 %),

Dyadobacter psychrophilus

(97.57 %),

Dyadobacter ginsengisoli

(97.56 %) and

Dyadobacter psychrotolerans

(97.20 %). The predominant fatty acids are summed feature 3 (C16 : 1
 ω7c and/or C16 : 1
 ω7c/C16 : 1 
ω6c), C15 : 0 iso, C16 : 1
 ω5c and C17 : 0 iso 3OH. The predominant respiratory quinone detected in strain UP-52T is quinone MK-7. The dominant polar lipids are glycolipid, phosphoaminolipid, phospholipid and aminolipid. The DNA G+C content is 40.0 mol%. Flexirubin-type pigment was present. Based on these phenotypic, chemotaxonomic and phylogenetic results, UP-52T represents a novel species of the genus

Dyadobacter

, for which the name Dyadobacter subterraneus sp. nov. is proposed. The type strain is UP-52T (=NCAIM B.02653T=CCM 9030T).
Acceptable performance of the Abbott ID NOW among symptomatic individuals with confirmed COVID-19
Authors: Stokes William , Berenger Byron M. , Singh Takshveer , Adeghe Ifueko , Schneider Angela , Portnoy Danielle , King Teagan , Scott Brittney , Pabbaraju Kanti , Shokoples Sandy , Wong Anita A. , Gill Kara , Turnbull LeeAnn , Hu Jia , Tipples Graham
Published: July 2021

Introduction. The ID NOW is FDA approved for the detection of SARS-CoV-2 in symptomatic individuals within the first 7 days of symptom onset for COVID-19 if tested within 1 h of specimen collection.

Gap statement. Clinical data on the performance of the ID NOW are limited, with many studies varying in their study design and/or having small sample size.

Aim. In this study we aimed to determine the clinical performance of the ID NOW compared to conventional RT-PCR testing.

Methodology. Adults with COVID-19 in the community or hospital were recruited into the study. Paired throat swabs were collected, with one throat swab transported immediately in an empty sterile tube to the laboratory for ID NOW testing, and the other transported in universal transport media and tested by an in-house SARS-CoV-2 RT-PCR assay targeting the E gene.

Results. In total, 133 individuals were included in the study; 129 samples were positive on either the ID NOW and/or RT-PCR. Assuming any positive result on either assay represents a true positive, positive per cent agreement (PPA) of the ID NOW compared to RT-PCR with 95 % confidence intervals was 89.1 % (82.0–94.1%) and 91.6 % (85.1–95.9%), respectively. When analysing individuals with symptom duration ≤7 days and who had the ID NOW performed within 1 h (n=62), ID NOW PPA increased to 98.2 %.

Conclusion. Results from the ID NOW were reliable, especially when adhering to the manufacturer’s recommendations for testing.
Safety and Immunogenicity of Nanocovax, a SARS-CoV-2 Recombinant Spike Protein Vaccine
Authors: Nguyen Thuy P. , Do Quyet , Phan Lan T. , Dinh Duc V. , Khong Hiep , Hoang Luong V. , Nguyen Thuong V. , Pham Hung N. , Chu Men V. , Nguyen Toan T. , Le Tri M. , Tuyen N.T. , Dinh Thanh T. , Vo Thuong V. , Vu Thao T. , Nguyen Quynh B.P. , Phan Vuong T. , Nguyen Luong V. , Nguyen Giang T. , Tran Phong M. , Nghiem Thuan D. , Tran Tien V. , Nguyen Tien G. , Tran Tuynh Q. , Nguyen Linh T. , Do Anh T. , Nguyen Dung D. , Ho Son A. , Nguyen Viet T. , Pham Dung T. , Tran Hieu B. , Vu Son T. , Tran Su X. , Do Trung M. , Tran Ton , Cao Thang M. , Dao Huy M. , Nguyen Thao T.T. , Doan Uyen Y , Le Vy T.T. , Tran Linh P. , Nguyen Ngoc M. , Nguyen Ngoc T. , Pham Hang T.T. , Nguyen Quan H. , Nguyen Hieu T. , Trinh Hung T. , Nguyen Hang L.K. , Tran Vinh T. , Tran Mai T.N. , Nguyen Truc T.T. , Ha Phat T. , Huynh Hieu T. , Nguyen Khanh D. , Doan Chung C. , Do Si M.
Published: July 2021

Background

Nanocovax is a recombinant severe acute respiratory syndrome coronavirus 2 subunit vaccine composed of full-length prefusion stabilized recombinant SARS-CoV-2 spike glycoproteins (S-2P) and aluminum hydroxide adjuvant.

Methods

We conducted a dose-escalation, open label trial (phase 1) and a randomized, double-blind, placebo-controlled trial (phase 2) to evaluate the safety and immunogenicity of the Nanocovax vaccine (in 25 microgram (mcg), 50 mcg, and 75 mcg doses, aluminum hydroxide adjuvanted). In phase 1, 60 participants received two intramuscular injection of the vaccine following dose-escalation procedure. The primary outcomes were reactogenicity and laboratory tests to evaluate the vaccine safety. In phase 2 which involved in 560 healthy adults, the primary outcomes are vaccine safety; and anti-S IgG antibody response. Secondary outcomes were surrogate virus neutralization, wild-type SARS-CoV-2 neutralization, and T-cell responses by intracellular staining (ICS) for interferon gamma (IFNg). We performed primary analyses at day 35 and day 42.

Results

For phase 1 study, no serious adverse events (SAE) were observed for all 60 participants. Most adverse events (AE) were grade 1 and disappeared shortly after injection. For phase 2 study, after randomization, 480 participants were assigned to receive the vaccine with adjuvant, and 80 participants were assigned to receive placebo. Reactogenicity was absent or mild in the majority of participants and of short duration (mean, ≤3 days). Unsolicited adverse events were mild in most participants. There were no serious adverse events related to Nanocovax. Regarding the immunogenicity, Nanocovax induced robust anti-S antibody responses. There was no statistical difference in antibody responses among dose strengths on Day 42, in terms of anti S-IgG level and neutralizing antibody titer.

Conclusions

Up to 42 days, Nanocovax vaccine was safe, well tolerated and induced robust immune responses. We propose using Nanocovax 25 mcg for Phase 3 to evaluate the vaccine efficacy. (Research funded by Nanogen Pharmaceutical Biotechnology JSC., and the Ministry of Science and Technology of Vietnam;ClinicalTrials.govnumber,NCT04683484.)
Immunogenicity and safety of a third dose, and immune persistence of CoronaVac vaccine in healthy adults aged 18-59 years: interim results from a double-blind, randomized, placebo-controlled phase 2 clinical trial
Authors: Pan Hongxing , Wu Qianhui , Zeng Gang , Yang Juan , Jiang Deyu , Deng Xiaowei , Chu Kai , Zheng Wen , Zhu Fengcai , Yu Hongjie , Yin Weidong
Published: July 2021

Background

Large-scale vaccination is being implemented globally with CoronaVac, an inactivated vaccine against coronavirus disease 2019 (COVID-19). Immunogenicity and safety profiles of homologous two-dose schedules have been published. We report interim results of immune persistence, and the immunogenicity and safety of a third dose of CoronaVac.

Methods

In this ongoing, placebo-controlled, double-blind phase 2 trial in 18-to-59-year-olds, we randomly assigned subjects, 1:1:1:1, to one of four schedules to receive a third dose, 28 days or 6 months after two two-dose regimens (14-day or 28-day apart): schedule 1: days 0, 14, 42; schedule 2: days 0, 14, 194; schedule 3: days 0, 28, 56; schedule 4: days 0, 28, 208. For each schedule, participants were randomly assigned to either a medium-dose group (3 μg per 0.5 mL of aluminum hydroxide diluent per dose), a high-dose group (6 μg), or a placebo group (2:2:1). The primary outcome was geometric mean titers (GMTs) of neutralizing antibody to live SARS-CoV-2.

Results

Overall, 540 participants received a third dose. In the 3 μg group, neutralizing antibody titers induced by the first two doses declined after 6-8 months to below the seropositive cutoff (GMT: 4.1 [95%CI 3.3-5.2] for Schedule 2 and 6.7 [95%CI 5.2-8.6] for Schedule 4). When a third dose was given 6-8 months after a second dose, GMTs assessed 14 days later increased to 137.9 [95%CI 99.9-190.4] for Schedule 2, and 143.1 [95%CI 110.8-184.7] for Schedule 4, approximately 3-fold above Schedule 1 and Schedule 3 GMTs after third doses. Similar patterns were observed for the 6 μg group. The severity of solicited local and systemic adverse reactions reported within 28 days after the third dose were grade 1 to grade 2 in all vaccination cohorts. None of the fourteen serious adverse events were considered to be related to vaccination.

Conclusions

A third dose of CoronaVac administered 6 or more months after a second dose effectively recalled specific immune response to SARS-CoV-2, resulting in a remarkable increase in antibody levels, and indicating that a two-dose schedule generates good immune memory. Optimizing the timing of a booster dose should take into account immunogenicity, vaccine efficacy/effectiveness, local epidemic situation, infection risk, and vaccine supply. (Funded by the National Key Research and Development Program, Beijing Science and Technology Program and National Science Fund for Distinguished Young Scholars; ClinicalTrials.gov number, NCT04352608.)
Running related biomechanical risk factors for overuse injuries in distance runners: A systematic review considering injury specificity and the potentials for future research
Authors: Willwacher Steffen , Kurz Markus , Robbin Johanna , Thelen Matthias , Hamill Joseph , Kelly Luke , Mai Patrick
Published: July 2021

Objective

To identify and evaluate the evidence of the most relevant running-related risk factors (RRRFs) for running-related overuse injuries (ROIs) and to suggest future research directions.

Design

Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236832)

Data sources

Pubmed. Connected Papers. The search was performed in February 2021.

Eligibility criteria

English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic RRRF. An RRRF needed to be identified in at least one prospective or two retrospective studies.

Results

Sixty-two articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some RRRFs appeared for several ROIs, most RRRFs were specific for a particular ROI. The biomechanical measurements performed in many studies would have allowed for consideration of many more RRRFs than have been reported, highlighting a potential for more effective data usage in the future.

Conclusion

This study offers a comprehensive overview of RRRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. Future work should use macroscopic (big data) approaches involving long-term data collections in the real world and microscopic approaches involving precise stress calculations using recent developments in biomechanical modelling. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
The impact of large mobile air purifiers on aerosol concentration in classrooms and the reduction of airborne transmission of SARS-CoV-2
Authors: Duill F. F. , Schulz F. , Jain A. , Krieger L. , van Wachem B. , Beyrau F.
Published: July 2021

In the wake of the SARS-CoV-2 pandemic, an increased risk of infection by virus-containing aerosols indoors is assumed. Especially in schools, the duration of stay is long and the number of people in the rooms is large, increasing the risk of infection. This problem particularly affects schools without pre-installed ventilation systems that are equipped with filters and/or operate with fresh air. Here, the aerosol concentration is reduced by natural ventilation. In this context, we are investigating the effect of large mobile air purifiers (AP) with HEPA filters on particle concentration and their suitability for classroom use in a primary school in Germany. The three tested APs differ significantly in their air outlet characteristics. Measurements of the number of particles, the particle size distribution, and the CO2 concentration were carried out in the classroom with students (April/May 2021) and with an aerosol generator without students. In this regard, the use of APs leads to a substantial reduction in aerosol particles. At the same time, the three APs are found to have differences in their particle decay rate, noise level, and flow velocity. In addition to the measurements, the effect of various influencing parameters on the potential inhaled particle dose was investigated using a calculation model. The parameters considered include the duration of stay, particle concentration in exhaled air, respiratory flow rate, virus lifetime, ventilation interval, ventilation efficiency, AP volumetric flow, as well as room size. Based on the resulting effect diagrams, significant recommendations can be derived for reducing the risk of infection from virus-laden aerosols. Finally, the measurements were compared to computational fluid dynamics (CFD) modeling, as such tools can aid the optimal placement and configuration of APs and can be used to study the effect of the spread of aerosols from a source in the classroom.