bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of mortality for patients with COVID-19 and large vessel occlusion
Authors: Altschul David J , Esenwa Charles , Haranhalli Neil , Unda Santiago R , de La Garza Ramos Rafael , Dardick Joseph , Fernandez-Torres Jenelys , Toma Aureliana , Labovitz Daniel , Cheng Natalie , Lee Seon-Kyu , Brook Allan , Zampolin Richard
Published: August 2020

Background

This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic.

Methods

We performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data.

Results

Of 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality.

Conclusion

Patients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.
The discursive production of public inquiries: The case of Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse
Authors: Mitchell Matthew
Published: August 2020

Since the turn of the century, public inquiries into the perpetration and concealment of child sexual abuse within religious institutions have proliferated throughout Europe, North America and Australasia. This article examines the role that news media discourses might play in supporting this trend. Taking Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse as a case study, I compare how news media constructed its precipitating issue of child sexual abuse in the Catholic Church at two different points in time: the period surrounding the announcement of the Royal Commission and a period 10 years earlier when calls were made for a Royal Commission that were not actualised. I find that in the decade before the Royal Commission’s establishment news media deemed the Church capable of and responsible for delivering justice, and as such licensed it to respond to allegations of abuse internally. In the period surrounding the Royal Commission’s establishment, however, the Church was rendered complicit and had lost its authority to manage the issue internally, while the State had become marked as responsible for recourse instead. This suggests that the emergence of the Royal Commission was imbricated in broader discursive shifts regarding which institution was attributed the right and responsibility to respond. These findings both indicate that news media discourses may play a role in facilitating or inhibiting the emergence of public inquiries and also raise critical questions about the consequences of a discursive shift that centres the State as responsible for and capable of delivering justice in the aftermath of institutional child sexual abuse.
The responsibility of knowledge: Identifying and reporting students with evidence of psychological distress in large-scale school-based studies
Authors: Kern Margaret L , Cahill Helen , Morrish Lucy , Farrelly Anne , Shlezinger Keren , Jach Hayley
Published: August 2020

The use of psychometric tools to investigate the impact of school-based wellbeing programs raises a number of ethical issues around students’ rights, confidentiality and protection. Researchers have explicit ethical obligations to protect participants from potential psychological harms, but guidance is needed for effectively navigating disclosure of identifiable confidential information that indicates signs of psychological distress. Drawing on a large-scale study examining student, school, and system-based factors that impact the implementation of a school-based social and emotional learning program, we describe patterns of distress attained from quantitative and qualitative questions and describe the process that we evolved to monitor and disclose sensitive mental health information, providing one example of how researchers might effectively address the responsibilities that emerge when collecting sensitive information from students within an education system. The patterns and processes that emerged illustrate that the inclusion of mental distress information can elicit important insights, but also brings responsibilities for minimising risks and maximising benefits.
Reversal of age-associated oxidative stress in mice by PFT, a novel kefir product
Authors: Ghoneum Mamdooh , Abdulmalek Shaymaa , Pan Deyu
Published: August 2020

Introduction:

Oxidative stress is a key contributor to aging and age-related diseases. In the present study, we examine the protective effects of PFT, a novel kefir product, against age-associated oxidative stress using aged (10-month-old) mice.

Methods:

Mice were treated with PFT orally at a daily dose of 2 mg/kg body weight over 6 weeks, and antioxidant status, protein oxidation, and lipid peroxidation were studied in the brain, liver, and blood.

Results:

PFT supplementation significantly reduced the oxidative stress biomarkers malondialdehyde (MDA) and nitric oxide; reversed the reductions in glutathione (GSH) levels, total antioxidant capacity (TAC), and anti-hydroxyl radical (AHR) content; enhanced the antioxidant enzyme activities of glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD); inhibited the liver enzyme levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT); significantly reduced triglyceride (TG), total cholesterol (TC), and low density lipoprotein (LDL) levels; and significantly elevated high density lipoprotein (HDL) levels. Interestingly, PFT supplementation reversed the oxidative changes associated with aging, thus bringing levels to within the limits of the young control mice in the brain, liver, and blood. We also note that PFT affects the redox homeostasis of young mice and that it is corrected post-treatment with PFT.

Conclusion:

Our findings show the effectiveness of dietary PFT supplementation in modulating age-associated oxidative stress in mice and motivate further studies of PFT’s effects in reducing age-associated disorders where free radicals and oxidative stress are the major cause.
Managing COPD with expiratory or inspiratory pressure load training based on a prolonged expiration pattern
Authors: Miki Keisuke , Tsujino Kazuyuki , Miki Mari , Yoshimura Kenji , Kagawa Hiroyuki , Oshitani Yohei , Fukushima Kiyoharu , Matsuki Takanori , Yamamoto Yuji , Kida Hiroshi
Published: August 2020

Background

Exertional prolonged expiration should be identified as a therapeutic target in COPD. The efficacy of expiratory or inspiratory pressure load training (EPT/IPT) based on the degree of prolonged expiration was investigated.

Methods

A total of 21 patients with COPD were divided into two groups according to the exertional change in the inspiratory duty cycle (TI/Ttot). For 12 weeks, patients whose exertionalTI/Ttot decreased received EPT (EPT group, n=11, mean percentage forced expiratory volume in 1 s (%FEV1), 32.8%) and those whose exertionalTI/Ttot increased received IPT (IPT group, n=10, mean %FEV1, 45.1%).

Results

The therapeutic responses were as follows. In both groups, endurance time (EPT, +5.7 min, p<0.0001; IPT, +6.1 min, p=0.0004) on the constant work rate exercise test (WRET) and peak oxygen uptake increased (EPT, p=0.0028; IPT, p=0.0072). In the EPT group the following occurred: 1) soon after commencement of exercise with the constant WRET, the expiratory tidal volume (VTex) increased, reducing dyspnoea; 2)VTex and mean expiratory flow increased and then prolonged expiration (p=0.0001) improved at peak exercise with the incremental exercise test (ET); and 3) St. George's Respiratory Questionnaire total, activity and impact scores were improved. In the IPT group, on both the constant WRET and incremental ET, breathing frequency increased, which led to greater exercise performance with effort dyspnoea.

Conclusions

This study showed the benefits of EPT/IPT on exercise performance. If the choice of managing COPD with EPT/IPT is appropriate, inexpensive EPT/IPT may become widespread as home-based training.
Definitive surgery of primary lesion should be prioritized over preoperative chemotherapy to treat high-grade osteosarcoma in patients aged 41–65 years
Authors: Hayakawa Keiko , Matsumoto Seiichi , Ae Keisuke , Tanizawa Taisuke , Funauchi Yuki , Minami Yusuke , Saito Masanori , Okawa Atsushi
Published: August 2020

Background

Recently, the number of osteosarcomas in middle-aged and older patients has demonstrated an increasing trend; moreover, their results are comparatively worse than those of young patients. In Europe and the USA, the prognosis for osteosarcoma in middle-aged and older patients has improved with adjuvant chemotherapy. In Japan, however, the prognosis has remained poor.

Materials and Methods

We retrospectively analyzed the outcomes of osteosarcoma, especially in regards to preoperative chemotherapy, from January 1980 to July 2014. A total of 29 patients with high-grade osteosarcoma between the age of 40 and 65 years were included. We included patients without distant metastasis and with primary lesions that were deemed resectable. The mean age was 52.8 years (range 41–65 years), and the mean follow-up period was 103.2 months (range 5–314 months).

Results

Adjuvant chemotherapy was administered to 27 of 29 patients (93%), and 8 of 15 cases (53%) were able to undergo preoperative chemotherapy as planned, including CDDP. A major complication of chemotherapy was acute kidney injury due to CDDP (26%). The 5-year OS and 5-year EFS were 64.9% and 57.1%, respectively. After 2006, a policy to prioritize the resection of the primary lesion was implemented, and if the primary lesion was deemed resectable, preoperative chemotherapy was either not administered or administered for only a short duration. The 5-year OS after 2006 improved to 78.8%.

Conclusions

This study shows that administration of high-dose intensity preoperative chemotherapy was difficult in middle-aged and older patients due to their high rate of acute kidney injury by CDDP. For cases of osteosarcoma in middle-aged and older patients, if the primary lesion is resectable, preoperative chemotherapy should be minimized to prioritize the resection of the primary lesion. It was considered that, with appropriate measures to prevent complications, adjuvant chemotherapy may lead to improved prognosis.

Level of evidence

V.
Clinical and imaging profiles of pulmonary embolism: a single-institution experience
Authors: Al Dandan Omran , Hassan Ali , AbuAlola Hossain , Alzaki Alaa , Alwaheed Abrar , Alalwan Mohannad , Al Shammari Malak , AlShamlan Nouf , Alsaif Hind S.
Published: August 2020

Background

Pulmonary embolism (PE) is a common life-threatening condition with non-specific clinical presentations. The diagnosis of PE depends highly on imaging studies, which may also provide prognostic information. This study aimed to describe the clinical and imaging profiles of patients with PE, emphasizing the differences between central and peripheral PE.

Methods

After ethics review board approval, this retrospective observational study examined the non-negative results in adult patients who underwent computed tomography pulmonary angiography (CT-PA) at our hospital between May 2016 and December 2019. Demographic and clinical information and imaging findings were collected from the electronic medical records.

Results

The study included 85 cases that were identified after re-interpreting the 103 non-negative CT-PA scans. Six cases were excluded for incomplete data and 12 cases were false-positive. Central PE was found in 63.5% of the cases. Obesity was the most common risk factor seen in 37.6% of the cases. Furthermore, 9.4% of the patients had sickle cell disease, which tended to be associated with peripheral PE. There was no difference between the peripheral and central PE in most clinical and imaging parameters evaluated (P > 0.05). However, patients with isolated subsegmental PE were more likely to develop hemoptysis (P = 0.04).

Conclusion

This study suggests that patients with obesity and sickle cell disease constitute an important proportion of all PE cases. Furthermore, the clinical and imaging profiles in patients with peripheral PE are similar to those in patients with central PE. Future research should focus on the clinical value of peripheral PE in patients with sickle cell disease.
Transcriptomic analyses of Aedes aegypti cultured cells and ex vivo midguts in response to an excess or deficiency of heme: a quest for transcriptionally-regulated heme transporters
Authors: Eggleston Heather , Adelman Zach N.
Published: August 2020

Background

Aedes aegyptiis the principle vector of many arboviruses, including dengue virus and Zika virus, which are transmitted when an infected female mosquito takes a blood meal in order to initiate vitellogenesis. During blood digestion, ~ 10 mM heme-iron is ingested into the midgut lumen. While heme acts as both a nutrient and signaling molecule during blood digestion, it can also be highly toxic if left unchaperoned. Both signaling by, and degradation of, heme are intracellular processes, occurring in the nucleus and cytoplasm, respectively. However, the precise mechanism of heme uptake into the midgut epithelium is not currently known.

Results

We used next generation RNA sequencing with the goal to identify genes that code for membrane bound heme import protein(s) responsible for heme uptake into the midgut epithelium. Heme deprivation increased uptake of a heme fluorescent analog in cultured cells, while treatment of midguts with an excess of heme decreased uptake, confirming physiological changes were occurring in these heme-sensitive cells/tissues prior to sequencing. A list of candidate genes was assembled for each of the experimental sample sets, which included Aag2 and A20 cultured cells as well as midgut tissue, based on the results of a differential expression analysis, soft cluster analysis and number of predicted transmembrane domains. Lastly, the functions related to heme transport were examined through RNAi knockdown.

Conclusions

Despite a large number of transmembrane domain containing genes differentially expressed in response to heme, very few were highly differentially expressed in any of the datasets examined. RNAi knockdown of a subset of candidates resulted in subtle changes in heme uptake, but minimal overall disruption to blood digestion/egg production. These results could indicate that heme import inAe. aegyptimay be controlled by a redundant system of multiple distinct transport proteins. Alternatively, heme membrane bound transport inAe. aegypticould be regulated post-translationally.
Genome-wide analysis of long non-coding RNAs in adult tissues of the melon fly, Zeugodacus cucurbitae (Coquillett)
Authors: Li Wei-Jun , Song Yu-Jia , Han Hong-Liang , Xu Hui-Qian , Wei Dong , Smagghe Guy , Wang Jin-Jun
Published: August 2020

Background

Long non-coding RNAs (lncRNAs) are involved in many fundamental biological processes, such as transcription regulation, protein degradation, and cell differentiation. Information on lncRNA in the melon fly, Zeugodacus cucurbitae (Coquillett) is currently limited.

Results

We constructed 24 RNA-seq libraries from eight tissues (midgut, Malpighian tubules, fat body, ovary, and testis) of Z. cucurbitae adults. A total of 3124 lncRNA transcripts were identified. Among those, 1464 were lincRNAs, 1037 were intronic lncRNAs, 301 were anti-sense lncRNAs, and 322 were sense lncRNAs. The majority of lncRNAs contained two exons and one isoform. Differentially expressed lncRNAs were analyzed between tissues, and Malpighian tubules versus testis had the largest number. Some lncRNAs exhibited strong tissue specificity. Specifically expressed lncRNAs were identified and filtered in tissues of female and male Z. cucurbitae based on their expression levels. Four midgut-specific lncRNAs were validated by quantitative real-time polymerase chain reaction (RT-qPCR), and the data were consistent with RNA-seq data. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of targets of midgut-specific lncRNAs indicated an enrichment of the metabolic process.

Conclusions

This was the first systematic identification of lncRNA in the melon fly. Expressions of lncRNAs in multiple adult tissues were evaluated by quantitative transcriptomic analysis. These qualitative and quantitative analyses of lncRNAs, especially the tissue-specific lncRNAs in Z. cucurbitae, provide useful data for further functional studies.
Expression profiling of WD40 family genes including DDB1- and CUL4- associated factor (DCAF) genes in mice and human suggests important regulatory roles in testicular development and spermatogenesis
Authors: Mistry Bhavesh V. , Alanazi Maha , Fitwi Hanae , Al-Harazi Olfat , Rajab Mohamed , Altorbag Abdullah , Almohanna Falah , Colak Dilek , Assiri Abdullah M.
Published: August 2020

Background

The WD40-repeat containing proteins, including DDB1–CUL4-associated factors (DCAFs), are abundant and conserved proteins that play important roles in different cellular processes including spermatogenesis. DCAFs are subset of WD40 family proteins that contain WDxR motif and have been proposed to function as substrate receptor for Cullin4-RING-based E3 ubiquitin ligase complexes to recruit diverse proteins for ubiquitination, a vital process in spermatogenesis. Large number of WD40 genes has been identified in different species including mouse and human. However, a systematic expression profiling of WD40 genes in different tissues of mouse and human has not been investigated. We hypothesize that large number of WD40 genes may express highly or specifically in the testis, where their expression is uniquely regulated during testis development and spermatogenesis. Therefore, the objective of this study is to mine and characterize expression patterns of WD40 genes in different tissues of mouse and human with particular emphasis on DCAF genes expressions during mouse testicular development.

Results

Publically available RNA sequencing (RNA seq) data mining identified 347 and 349 WD40 genes in mouse and human, respectively. Hierarchical clustering and heat map analyses of RNA seq datasets revealed differential expression patterns of WD40 genes with around 60–73% of the genes were highly or specifically expressed in testis. Similarly, around 74–83% of DCAF genes were predominantly or specifically expressed in testis. Moreover, WD40 genes showed distinct expression patterns during embryonic and postnatal testis development in mice. Finally, different germ cell populations of testis showed specific patterns of WD40 genes expression. Predicted gene ontology analyses revealed more than 80% of these proteins are implicated in cellular, metabolic, biological regulation and cell localization processes.

Conclusions

We have identified large number of WD40 family genes that are highly or specifically expressed in the testes of mouse and human. Moreover, WD40 genes have distinct expression patterns during embryonic and postnatal development of the testis in mice. Further, different germ cell populations within the testis showed specific patterns of WD40 genes expression. These results provide foundation for further research towards understanding the functional genomics and molecular mechanisms of mammalian testis development and spermatogenesis.
Molecular evidence supports simultaneous association of the achlorophyllous orchid Chamaegastrodia inverta with ectomycorrhizal Ceratobasidiaceae and Russulaceae
Authors: Pecoraro Lorenzo , Wang Xiao , Venturella Giuseppe , Gao Wenyuan , Wen Tingchi , Gafforov Yusufjon , Gupta Vijai Kumar
Published: August 2020

Background

Achlorophyllous orchids are mycoheterotrophic plants, which lack photosynthetic ability and associate with fungi to acquire carbon from different environmental sources. In tropical latitudes, achlorophyllous forest orchids show a preference to establish mycorrhizal relationships with saprotrophic fungi. However, a few of them have been recently found to associate with ectomycorrhizal fungi and there is still much to be learned about the identity of fungi associated with tropical orchids. The present study focused on mycorrhizal diversity in the achlorophyllous orchidC. inverta, an endangered species, which is endemic to southern China. The aim of this work was to identify the main mycorrhizal partners ofC. invertain different plant life stages, by means of morphological and molecular methods.

Results

Microscopy showed that the roots of analysedC. invertasamples were extensively colonized by fungal hyphae forming pelotons in root cortical cells. Fungal ITS regions were amplified by polymerase chain reaction, from DNA extracted from fungal mycelia isolated from orchid root samples, as well as from total root DNA. Molecular sequencing and phylogenetic analyses showed that the investigated orchid primarily associated with ectomycorrhizal fungi belonging to a narrow clade within the family Ceratobasidiaceae, which was previously detected in a few fully mycoheterotrophic orchids and was also found to show ectomycorrhizal capability on trees and shrubs. Russulaceae fungal symbionts, showing high similarity with members of the ectomycorrhizal genusRussula, were also identified from the roots ofC. inverta, at young seedling stage. Ascomycetous fungi includingChaetomium,Diaporthe,Leptodontidium, andPhomopsisgenera, and zygomycetes in the genusMortierellawere obtained from orchid root isolated strains with unclear functional role.

Conclusions

This study represents the first assessment of root fungal diversity in the rare, cryptic and narrowly distributed Chinese orchidC. inverta. Our results provide new insights on the spectrum of orchid-fungus symbiosis suggesting an unprecedented mixed association between the studied achlorophyllous forest orchid and ectomycorrhizal fungi belonging to Ceratobasidiaceae and Russulaceae. Ceratobasidioid fungi as dominant associates in the roots ofC. invertarepresent a new record of the rare association between the identified fungal group and fully mycoheterotrophic orchids in nature.
OsCAF2 contains two CRM domains and is necessary for chloroplast development in rice
Authors: Shen Lan , Zhang Qiang , Wang Zhongwei , Wen Hongling , Hu Guanglian , Ren Deyong , Hu Jiang , Zhu Li , Gao Zhenyu , Zhang Guangheng , Guo Longbiao , Zeng Dali , Qian Qian
Published: August 2020

Background

Chloroplasts play an important role in plant growth and development. The chloroplast genome contains approximately twenty group II introns that are spliced due to proteins encoded by nuclear genes. CAF2 is one of these splicing factors that has been shown to splice group IIB introns in maize and Arabidopsis thaliana. However, the research of the OsCAF2 gene in rice is very little, and the effects of OsCAF2 genes on chloroplasts development are not well characterized.

Results

In this study, oscaf2 mutants were obtained by editing the OsCAF2 gene in the Nipponbare variety of rice. Phenotypic analysis showed that mutations to OsCAF2 led to albino leaves at the seeding stage that eventually caused plant death, and oscaf2 mutant plants had fewer chloroplasts and damaged chloroplast structure. We speculated that OsCAF2 might participate in the splicing of group IIA and IIB introns, which differs from its orthologs in A. thaliana and maize. Through yeast two-hybrid experiments, we found that the C-terminal region of OsCAF2 interacted with OsCRS2 and formed an OsCAF2-OsCRS2 complex. In addition, the N-terminal region of OsCAF2 interacted with itself to form homodimers.

Conclusion

Taken together, this study improved our understanding of the OsCAF2 protein, and revealed additional information about the molecular mechanism of OsCAF2 in regulating of chloroplast development in rice.
Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study
Authors: Lim Ming Jian , Tan Chin Wen , Tan Hon Sen , Sultana Rehena , Eley Victoria , Sng Ban Leong
Published: August 2020

Background

Accurate blood pressure (BP) measurement depends on appropriate cuff size and shape in relation to the arm. Arm dimensions outside the recommended range of cuff sizes or trunco-conical arms may result in inaccurate BP measurements. Measuring BP using finger cuffs is a potential solution. Arm cuff size is based on mid-arm circumference (MAC), and trunco-conicity is quantified by conicity index. We aimed to determine the correlation of MAC, body mass index (BMI), and weight with conicity index.

Methods

A prospective cohort study was conducted in the KK Women’s and Children’s Hospital where third trimester parturients scheduled for cesarean delivery were recruited after obtaining informed consent. Parturients were asked to rate their experience with time taken to obtain BP readings, cuff popping off during measurement, need to move the cuff from the upper arm to lower arm or leg, and need to change to a different cuff. Our primary outcome was the correlation between MAC and conicity index, calculated using Pearson’s correlation. The correlation between BMI and weight with conicity index was also determined.

Results

We enrolled 300 parturients. Moderate correlation was found between left MAC and left conicity index (r = 0.41, 95% CI 0.32 to 0.51), and right MAC and right conicity index (r = 0.39, 95% CI 0.29 to 0.48). Weight (r = 0.35 to 0.39) and BMI (r = 0.41 to 0.43) correlated with conicity index in this study. MAC of 1 parturient fell outside the recommended range for arm cuffs, but all parturients fit into available finger cuffs. Obese parturients had increased problems with arm cuffs popping off and needing a change of cuff.

Conclusions

BMI better correlated with conicity index compared to MAC or weight. Standard finger cuffs were suitable for all parturients studied and may be a suitable alternative.

Trial registration

Clinicaltrials.gov NCT04012151. Registered 9 Jul 2019
Informal and formal care among persons with dementia immediately before nursing home admission
Authors: Ydstebø Arnt Egil , Benth Jurate Šaltytė , Bergh Sverre , Selbæk Geir , Vossius Corinna
Published: August 2020

Background

Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network.

Methods

In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files.

Results

A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care.

Conclusion

Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis
Authors: Song Yu-Huan , Cai Guang-Yan , Xiao Yue-Fei , Chen Xiang-Mei
Published: August 2020

Background

Older haemodialysis patients accompany a high burden of functional impairment, limited life expectancy, and healthcare utilization. This meta-analysis aimed to evaluate how various risk factors influenced the prognosis of haemodialysis patients in late life, which might contribute to decision making by patients and care providers.

Methods

PubMed, Embase, and Cochrane Central were searched systematically for studies evaluating the risk factors for mortality in elderly haemodialysis patients. Twenty-eight studies were included in the present systematic review. The factors included age, cardiovascular disease, diabetes mellitus, type of vascular access, dialysis initiation time, nutritional status and geriatric impairments. Geriatric impairments included frailty, cognitive or functional impairment and falls. Relative risks with 95% confidence intervals were derived.

Results

Functional impairment (OR = 1.45, 95% CI: 1.20–1.75), cognitive impairment (OR = 1.46, 95% CI: 1.32–1.62) and falls (OR = 1.14, 95% CI: 1.06–1.23) were significantly and independently associated with increased mortality in elderly haemodialysis patients. Low body mass index conferred a mortality risk (OR = 1.43, 95% CI: 1.31–1.56) paralleling that of frailty as a marker of early death. The results also confirmed that the older (OR = 1.43, 95% CI: 1.22–1.68) and sicker (in terms of Charlson comorbidity index) (OR = 1.41, 95% CI: 1.35–1.50) elderly haemodialysis patients were, the more likely they were to die. In addition, increased mortality was associated with early-start dialysis (OR = 1.18, 95% CI: 1.01–1.37) and with the use of a central venous catheter (OR = 1.53, 95% CI: 1.44–1.62).

Conclusions

Multiple factors influence the risk of mortality in elderly patients undergoing haemodialysis. Geriatric impairment is related to poor outcome. Functional/cognitive impairment and falls in elderly dialysis patients are strongly and independently associated with mortality.
RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe
Authors: Nyati-Jokomo Zibusiso , Dabengwa Israel Mbekezeli , Makacha Liberty , Nyapwere Newton , Dube Yolisa Prudence , Chikoko Laurine , Vidler Marianne , Makanga Prestige Tatenda
Published: August 2020

Background

Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe.

Methods

We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12.

Results

Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge.

Conclusion

Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be a challenge because of maternal health care barriers such as poor road network, poor phone network, and the high cost of transport. There is a need to investigate the social determinants of access to maternity services to inform RoadMApp implementation.
Staging procedures fail to benefit women with borderline ovarian tumours who want to preserve fertility: a retrospective analysis of 448 cases
Authors: Li Na , Gou Jinhai , Li Lin , Ming Xiu , Hu Ting Wenyi , Li Zhengyu
Published: August 2020

Background

To evaluate the effect of clinicopathologic factors on the prognosis and fertility outcomes of BOT patients.

Methods

We performed a retrospective analysis of BOT patients who underwent surgical procedures in West China Second University Hospital from 2008 to 2015. The DFS outcomes, potential prognostic factors and fertility outcomes were evaluated.

Results

Four hundred forty-eight patients were included; 52 recurrences were observed. Ninety-two patients undergoing FSS achieved pregnancy. No significant differences in fertility outcomes were found between the staging and unstaged surgery groups. Staging surgery was not an independent prognostic factor for DFS. Laparoscopy resulted in better prognosis than laparotomy in patients with stage I tumours and a desire for fertility preservation.

Conclusion

Patients with BOT fail to benefit from surgical staging. Laparoscopy is recommended for patients with stage I disease who desire to preserve fertility. Physicians should pay more attention to risk of recurrence in patients who want to preserve fertility.
Raised CA19–9 and CEA have prognostic relevance in gallbladder carcinoma
Authors: Sachan Ashish , Saluja Sundeep Singh , Nekarakanti Phani Kumar , Nimisha  , Mahajan Bhawna , Nag Hirdaya H. , Mishra Pramod K.
Published: August 2020

Background

Role of tumor markers in gall bladder carcinoma (GBC) is not well established. We evaluated the prognostic value of carbohydrate antigen 19–9 (CA19–9) and carcinoma embryonic antigen (CEA) in patients with GBC.

Methods

Of the 225 patients of GBC enrolled,176 patients were included in the study (excluded 49 patients with jaundice). Patients were divided into 3 groups; resectablen = 92, unresectablen = 17, metastaticn = 67. The clinico-pathological characteristics, tumor markers and survival data were analysed. The cutoff values of CA19–9 & CEA for predicting metastases were computed using receiver operating characteristic curve. Kaplan Meir survival and Cox regression analysis were done for factors predicting survival and recurrence.

Results

The median value of Ca19–9 was significantly higher in metastatic group [resectable: 21.3, unresectable: 53.9 and metastatic: 79;p < 0.001] but not for CEA [3.5, 7.8 and 5 ng/ml (p = 0.20)]. A cutoff value of 72 IU/ml for CA19–9, 5 ng/ml for CEA had a sensitivity and specificity of 52 and 80%, 51 and 72% respectively for detection of metastatic disease. Median, 3-year & 5-year survival were significantly lower in patients with CEA > 4 (p = 0.041), Ca19.9 > 37 (p = 0.019), T3/T4 (p = 0.001), node positive (p = 0.001) and presence of perineural invasion (p = 0.001). However, on multivariate analysis, only Ca19.9 > 37 predicted recurrence (p = 0.002, HR 5.8).

Conclusions

Raised CA19.9 and CEA predict metastatic disease in patients with GBC without jaundice with a high specificity and may help in prognostication of the patient. CA19–9 was better than CEA in prediction of tumor burden and in predicting recurrence.
Optic nerve coloboma as extension of the phenotype of 22q11.23 duplication syndrome: a case report
Authors: Valencia-Peña Claudia , Jiménez-Sanchez Paula , Saldarriaga Wilmar , Payán-Gómez César
Published: August 2020

Background

22q11.2 duplication syndrome (Dup22q11.2) has reduced penetrance and variable expressivity. Those affected may have intellectual disabilities, dysmorphic facial features, and ocular alterations such as ptosis, hypertelorism, nystagmus, and chorioretinal coloboma. The prevalence of this syndrome is unknown, there are only approximately 100 cases reported. However Dup22q11.2 should have a similar prevalence of DiGeorge syndrome (1 in each 4000 new-borns), in which the same chromosomal region that is duplicated in Dup22q11.2 is deleted.

Case presentation

We report a patient with intellectual disability, psychomotor development delay, hearing loss with disyllable pronunciation only, hyperactivity, self-harm, hetero-aggressive behaviour, facial dysmorphism, left facial paralysis, post-axial polydactyly, and for the first time in patients with Dup22q11.2, optic nerve coloboma and dysplasia in optic nerve. Array comparative genomic hybridization showed a 22q11.23 duplication of 1.306 million base pairs.

Conclusions

New ocular findings in Dup22q11.2 syndrome, such as coloboma and dysplasia in the optic nerve, are reported here, contributing to the phenotypic characterization of a rarely diagnosed genetic syndrome. A complete characterization of the phenotype is necessary to increase the rate of clinical suspicion and then the genetic diagnostic. In addition, through bioinformatics analysis of the genes mapped to the 22q11.2 region, it is proposed that deregulation of the SPECC1L gene could be implicated in the development of ocular coloboma.
Intrasession repeatability of pupil size measurements under different light levels provided by a multidiagnostic device in healthy eyes
Authors: Piñero David P. , de Fez Dolores , Cabezos Inmaculada , López-Navarro Alberto , Caballero María T. , Camps Vicente J.
Published: August 2020

Background

The measurement of the pupillary function is an indispensable test in some eye examinations, being necessary the evaluation of the precision of instruments performing such measures. The aim of this study was to evaluate the intrasession repeatability of pupil size measurements provided by a multidiagnostic platform in a large sample of healthy eyes.

Methods

This prospective study enrolled 100 healthy eyes of 100 patients, with ages ranging from 23 to 65 years old. Repeated pupil size measures under photopic (P, 220 lx), mesopic (M, 160 lx), low mesopic (L, 70 lx), and scotopic conditions (S, 1 lx) were obtained with the VX120 system (Visionix-Luneau Technologies, Chartres, France) after a complete eye exam. Likewise, pupil size was also measured once in the fellow eye in a total of 75 eyes. The level of intrasession variability as well as differences between fellow eyes were evaluated.

Results

Most of differences between repeated measures did not exceed 0.5 mm (82% of S and 100% of P below this value). No significant differences between these repeated measures were found for S (p = 0.099) and L (p = 0.751). However, statistically significant differences were found between repeated measures for M (p = 0.002) and P (p = 0.003). The analysis of clinical relevance of differences between pairs (Passing-Bablok) only confirmed the clinical relevance of differences between the first and second repeated measurement of M. Concerning the comparative analysis between fellow eyes, no statistically significant differences in pupil size were found between right and left eyes in any light condition evaluated (p ≥ 0.227).

Conclusions

The VX120 system can provide consistent measurements of pupil size under scotopic, low mesopic and photopic conditions, with a relative limitation under mesopic conditions.
Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study
Authors: AlKetbi Latifa Mohammad Baynouna , Grivna Michal , Al Dhaheri Saeed
Published: August 2020

Background

Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE).

Methods

A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening.

Results

Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver’s distraction score, the likelihood of a car crash being reported increased by 4.9%.

Conclusion

Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.
What are the potential advantages and disadvantages of merging health insurance funds? A qualitative policy analysis from Iran
Authors: Bazyar Mohammad , Yazdi-Feyzabadi Vahid , Rahimi Nouroddin , Rashidian Arash
Published: August 2020

Background

In countries with health insurance systems, the number and size of insurance funds along with the amount of risk distribution among them are a major concern. One possible solution to overcome problems resulting from fragmentation is to combine risk pools to create a single pool. This study aimed to investigate the potential advantages and disadvantages of merging health insurance funds in Iran.

Methods

In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. To this end, sixty-seven face-to-face interviews were conducted. Moreover, a documentary review was used as a supplementary source of data collection. Content analysis using the ‘framework method’ was used to analyze the data. Four trustworthiness criteria, including credibility, transferability, dependability, and confirmability, were used to assure the quality of results.

Results

The potential consequences were grouped into seven categories, including stewardship, financing, population, benefit package, structure, operational procedures, and interaction with providers. According to the interviewees, controlling total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database; controlling the volume of provided health care services; making hospitals interact with single insurance with a single set of instructions for contracting, claiming review, and reimbursement; and reducing administrative costs were among the main benefits of merging health insurance funds. The interviewees enumerated the following drawbacks as well: the social security organization’s unwillingness to collect insurance premiums from private workers actively as before; increased dissatisfaction among population groups enjoying a generous basic benefits package; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on providers in case of delay in reimbursement with a single-payer system.

Conclusion

Merging health insurance schemes in Iran is influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen opponents’ objection, policy makers should act as brokers by taking into account contextual factors and adopting tailored policies to respectively maximize and minimize the potential benefits and drawbacks of consolidation in Iran.