bluuebunny/crossref_metadata_2025 huggingface dataset:
Health economic perspective on a community-based intervention for older people at risk of care dependency – results of a prospective quasi-experimental study
Authors: Lampe David , Hasemann Lena , Nebling Thomas , Thiem Ulrich , Greiner Wolfgang
Published: November 2022

This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization ( OR = 1.153; 95% CI: 0.971–1.369, p = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp( ß) = 1.078; 95% CI: 1.011–1.149; p = .022). A non-significant mean difference in costs of €1,183 (95% CI: €−261.6 to €2,627.6, p = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making.

Trial registration: The study was registered at the German Clinical Trials Register (DRKS00027866).
Architecture, tactics and mobility – Appropriating space at a transport hub in Shanghai
Authors: Hua Xia , Lee Kah-Wee
Published: November 2022

Although public transport development has been widely addressed in extant urban research, everyday practices in transport spaces and their broader implications for urbanizing China are relatively less studied. Building on de Certeau’s concept of “tactics” and the literature on urban mobility, this study employs spatial analysis and ethnography to investigate the case of the Shanghainan Railway Station (SHNS) in China that had become underused after its traffic was directed away to new stations in the same network. By 2017, this decline had turned an architectural icon designed for efficiency and speed into a place where many unlikely social groups gathered daily. We followed a charity team serving the homeless seeking shelter there to understand how this modern structure was appropriated to cater to those who survived in the trails of development. The case of the SHNS reveals the uneven consequences of urbanization brought about by increasing connectivity in Chinese society and highlights how tactics can be a form of social infrastructure exhibiting degrees of institutional stability and translocal solidarities. It also points to the theoretical significance of turning our attention from the frontier to the trail of development as a productive space where the state, civil society and marginalized emerge temporarily in pastoral forms.
The Diagnostic Value of Echocardiography Performed by an Emergency Medicine Physician in the Diagnosis of Acute Coronary Syndrome: A Comparative Study With Cardiologist
Authors: Çevrim Özgür , Boydak Bahar , Yürüktümen Aslıhan , Kiyan G.Selahattin , Ersel Murat , Uz İlhan , Özçete Enver , Başol Güneş
Published: November 2022

Objective:

Early recognition of acute coronary syndromes (ACSs) is crucial in the emergency department. This study was designed to determine the diagnostic value of echocardiography, which was performed by an emergency medicine (EM) physician, to diagnosis ACS.

Materials and Methods:

This prospective and cross-sectional study was conducted between June 2011 and December 2011. All patients who were admitted with chest pain, to the EM department, and fulfilled the inclusion criteria were enrolled in this study. The focused echocardiography was performed by the EM physician. All echocardiography videos recorded were shown to the cardiologist. The final comments were compared with EM physician’s early findings.

Results:

Out of 48 patients, four were diagnosed with ACS. Three out of four patients diagnosed with ACS were detected by the EM physician with echocardiography. The EM physician’s prediction value with echocardiography in ACS diagnosis was 75% (95% confidence interval [CI] range 59%–100%), and the negative predictive value was 97% (95% CI range 77,9%-100%). There was no major cardiac event in the patient in whom the EM physician failed to detect a wall motion defect.

Conclusion:

Echocardiography is a bedside, noninvasive test for diagnosis of ACS. The EM physician who participated in this study was able to recognize ACS with the absence of a segmental wall motion defect, as well as the cardiologist providing the final report.
Longitudinal Changes in Cardiac Function Based on Serial Tissue Doppler and Doppler Imaging for Patients With Sickle Cell Anemia
Authors: Giray Dilek , Unal Selma , Demetgül Hasan , Karpuz Derya , Hallioglu Olgu
Published: November 2022

Objective:

The aim was to evaluate the long-term changes in systolic and diastolic functions with tissue Doppler imaging in children with sickle cell anemia.

Materials and Methods:

In this study, myocardial performance index of ventricles and mitral and tricuspid valve E/A ratios were calculated. Wall motion velocities of the interventricular septum, right and left ventricles, and mitral and tricuspid annulus were assessed during the systole (Sm), the early diastole (Em), and the late diastole (Am) with pulsed Doppler echocardiography.

Results:

These diagnostic parameters were obtained from 38 patients (mean 12.5 ± 3.2 years old) who were reached after a mean 6.7 years in long-term follow-up. Left ventricular and septal end-systolic and end-diastolic diameters, and right and left ventricular myocardial performance index were higher in patients ( P < .05 and P = .001, respectively). The Em, Am, and Sm velocities of the right ventricle and septum were significantly lower in the patients at the baseline measures ( P < .05) and all these velocities decreased significantly in patients over time compared with their baseline values ( P < .05). In addition, it was observed that myocardial performance index values of the right and left ventricles increased significantly over time ( P < .05).

Conclusion:

This is the first study reflecting the age-related changes in global systolic and diastolic functions in sickle cell anemia by serial imaging.
Trigeminal ganglion itself can be a viable target to manage trigeminal neuralgia
Authors: KC Elina , Islam Jaisan , Park Young Seok
Published: November 2022

Excruciating trigeminal neuralgia (TN) management is very difficult and severely affects the patient’s quality of life. Earlier studies have shown that the trigeminal ganglion (TG) comprises several receptors and signal molecules that are involved in the process of peripheral sensitization, which influences the development and persistence of neuropathic pain. Targeting TG can modulate this sensitization pathway and mediate the pain-relieving effect. So far,there are few studies in which modulation approaches to TG itself have been suggested so far. “Trigeminal ganglion modulation” and “trigeminal neuralgia” were used as search phrases in the Scopus Index and PubMed databases to discover articles that were pertinent to the topic. In this review, we address the role of the trigeminal ganglion in TN and underlying molecules and neuropeptides implicated in trigeminal pain pathways in processing pathological orofacial pain. We also reviewed different modulation approaches in TG for TN management. Furthermore, we discuss the prospect of targeting trigeminal ganglion to manage such intractable pain.
Tracking the evolution of non-headache symptoms through the migraine attack
Authors: Messina Roberta , Cetta Ilaria , Colombo Bruno , Filippi Massimo
Published: November 2022

Background

The migraine attack is classically divided into the prodromal, aura, headache and postdromal phase. Previous studies have highlighted non-headache symptoms associated with migraine occurring during the prodromal or postdromal phase. This study aimed to track the evolution of non-headache symptoms throughout all phases of the migraine attack. We also wished to delineate the phenotype of patients with more symptomatic migraine episodes and explore the association between non-painful symptoms and migraine disease activity and patients’ disability.

Methods

Two-hundred and twenty-five migraine patients were enrolled and were asked to recall retrospectively whether non-headache symptoms occurred during the prodromal, headache and postdromal phase of their attacks. The occurrence of symptoms during the different migraine phases was tested using the Cochran’s Q tests, Cohen’s and Fleiss’ kappa. Differences between groups according to the presence of non-headache symptoms through the entire migraine attack and correlations between the frequency of non-headache symptoms experienced during all phases and patients’ disease activity and disability were also assessed.

Results

Ninety-nine percent of patients reported having at least one non-headache symptom in one phase of the migraine attack and 54% of patients had at least one non-headache symptom occurring during all phases of migraine. The occurrence of non-headache symptoms was different throughout the three phases of migraine, being higher during the headache phase than during the prodromal and postdromal phases. Symptoms with the highest co-occurrence throughout all migraine phases were neck stiffness, thirst and abdominal pain. Patients who experienced non-headache symptoms during all three phases of migraine were more frequently females, had a higher disability, were suffering from chronic migraine and had more frequently medication overuse headache.

Conclusion

Migraine is a complex neurological disorder with a wide constellation of non-headache symptoms that can affect the burden of the disease. A better characterization of the evolution of non-headache symptoms through the different phases of migraine can enrich our knowledge on migraine pathophysiology and improve the management of the disease.
The effect of ketamine versus tramadol on prophylactic post-spinal shivering in those patients undergoing orthopedic surgery: a prospective cohort study design, 2020
Authors: Gemechu Ashebir Debalike , Gebremedhin Tsegaye Demeke , Andebiku Andualem Assefa , Solomon Fithamlak , Sorsa Abebe
Published: November 2022

Background

Post-spinal shivering is a common complication after spinal anesthesia with a high incidence among orthopedic patients. Untreated shivering may predispose to exacerbation of wound pain, increased metabolic demand, oxygen consumption, and hemostatic dysfunction. Various studies have been done on the effectiveness of preventing post-spinal shivering using ketamine and other drugs. However, little information on better prophylactic agents in terms of effectiveness and availability. Therefore, this study was intended to compare 0.25 mg/kg of Ketamine (K) versus 0.5 mg/kg of Tramadol (T) for the prevention of post-spinal shivering.

Method

A prospective cohort study design was employed on 516 patients undergoing orthopedic surgery under spinal anesthesia, and they were selected by a consecutive sampling technique. Patients were divided into two groups based on the anesthetist in charge. Patients who received an intravenous prophylactic dose of Ketamine before spinal anesthesia are called Ketamine groups and patients who received Tramadol are called Tramadol groups (control). The severity and incidence of shivering, blood pressure, heart rate, and axillary body temperature were measured and recorded for one hour at 10-min intervals during the intraoperative period. Descriptive statistics, chi-square, independent t-test, and multivariable logistic regression were used. Significance was declared at a p-value lower than 0.05.

Results

The overall incidence of post-spinal shivering was 187 (36.2%), of which it was 74 (28.7%) on ketamine and 113 (43.8%) on tramadol with a p-value of 0.001. The incidence of nausea and vomiting was 157 (60.9%) on tramadol and 8 (3.1%) on ketamine, with a p-value of 0.001. Patients aged 18–35 years (AOR 0.08 (0.02, 0.27), 36–55 years (AOR 0.24, 0.07, 0.81), and those patients with a prolonged duration of surgery (AOR 1.47 (1.37–1.58)) were more likely to experience post-spinal shivering. And Low-dose ketamine has a protective effect against developing post-spinal shivering with an AOR of 0.427 (0.28–0.63).

Conclusion

Low-dose ketamine is more effective in reducing the incidence and severity of shivering after spinal anesthesia. Therefore, we recommend using low-dose ketamine to be effective as a prophylactic for post-spinal shivering in those patients undergoing orthopedic surgery under spinal anesthesia.
Investigation on an outbreak of cutaneous anthrax in a county of Shandong Province, China, 2021
Authors: Yu Xiaolin , Fang Ming , Wang Shuang , Li Zhong , Cheng Lixiao , Liu Zhaoshan , Zhang Dandan , Dong Dandan , Kou Zengqiang
Published: November 2022

Background

In order to verify the existence of an anthrax outbreak, determine its scope, grasp the epidemiological characteristics and find out the cause of the outbreak and recommend preventive and control measures.

Methods

Etiological hypothesis was developed through descriptive epidemiological methods. Hypotheses were tested by analyzing epidemiological methods by comparing the differences in the incidence of different exposure types. Nucleic acid detection and bacterial isolation and culture in the BSL-2 laboratories. SPSS 21 was used to conduct statistical analysis.

Results

A total of 126 family, workshop, shop environment samples and meat samples were collected, and 6 samples were collected from skin lesions of suspected cutaneous anthrax cases. 41 samples were positive by rPCR and 8 strains of Bacillus anthracis were cultivated. Participated in slaughtering, cutting beef of sick cattles was significantly associated with cutaneous anthrax (RR 3.75, 95% CI 1.08–13.07), this behavior is extremely dangerous.

Conclusions

Comprehensive analysis of laboratory results and epidemiological survey results and environmental assessments, we judge this epidemic to be an outbreak of cutaneous anthrax, associated with slaughtering and other processes from infected cattle imported from other province.
Association between isolated maternal hypothyroxinemia during the first trimester and adverse pregnancy outcomes in Southern Chinese women: a retrospective study of 7051 cases
Authors: Li Ping , Cui Jinhui , Li Ling , Chen Xinjuan , Ouyang Liping , Fan Jianhui , Lin Shuo
Published: November 2022

Background

The association between isolated maternal hypothyroxinemia (IMH) and adverse pregnancy outcomes is still controversial. This study aimed to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes in southern Chinese women.

Methods

This was a hospital-based, retrospective cohort study. The records of 7051 women, including 1337 IMH women and 5714 euthyroid women who had a singleton pregnancy and accepted routine prenatal service at the Third Affiliated Hospital of Sun Yat-Sen University from January 2015 to September 2018, were extracted from the electronic medical records system in this study. Thyroid functions [thyroid-stimulating hormone (TSH), free thyroxine (fT4) and anti-thyroperoxidase autoantibody (TPO-Ab)] had to be measured before 13 weeks and 6 days of gestation. The chi-square test and multivariate logistic regression analysis were applied to evaluate the association between IMH during the first trimester and adverse pregnancy outcomes.

Results

Prepregnancy obesity [prepregnancy body mass index (preBMI) ≥ 25 kg/m2] was found to be more common in the IMH group (11.2% vs. 6.1%) (P < 0.05). The prevalence of gestational diabetes mellitus (GDM), postpartum haemorrhage (PPH), macrosomia and large for gestational age (LGA) was higher in the IMH group. However, after using multivariate logistic regression analysis to adjust for confounders (maternal age, educational levels and preBMI), only LGA was shown to be associated with an increased risk in IMH women [adjusted OR: 1.27 (95% CI 1.044–1.566)]. The prevalence of preterm delivery (either < 37 or < 34 weeks), gestational hypertension, preeclampsia, placenta previa, placental abruption, premature rupture of membrane (PROM), intrauterine growth restriction (IUGR), polyhydramnios, stillbirth, small for gestational age (SGA) and low Apgar score did not increase.

Conclusion

IMH during the first trimester did not increase any risk of adverse pregnancy outcomes in southern Chinese women except LGA.
The utilization of transperineal ultrasound following fetal heart deceleration after epidural analgesia: a case report
Authors: Feng Shimiao , Gu Juan
Published: November 2022

Background

We report a case of fetal heart rate decelerations and relaxation of pelvic muscles and fetal descent using transperineal ultrasound after initiation of epidural labor analgesia.

Case presentation

A 32-year-old woman, G1P0 with gestational age of 40 weeks, required epidural analgesia when her cervical dilatation was 2 cm. Baseline transperineal ultrasound examination was performed before epidural puncture. The fetal heart rate tracing was normal before the initiation of analgesia. Approximately 10 min after the epidural administration of the loading dose, the patient reported onset of analgesia and the FHR tracing showed variable-decelerations. There was no hypotension or evidence of uterine tachysystole. Transperineal ultrasound was performed again after epidural analgesia took effect. The anteroposterior diameter of the levator hiatus increased from 5.3 to 6.6 cm and angle of progress increased from 116°to 133°. The relaxation of pelvic muscle and rapid descent of fetal head may have contributed to the FHR deceleration. The midwife elevated the fetal head through the vagina with her hand, and the FHR recovered soon thereafter.

Conclusions

Changes in fetal heart rate after initiation of neuraxial analgesia are unpredictable. In addition to FHR and tocodynametric monitoring, performing TPU may helpful in distinguishing the reasons for FHR change and initiating corresponding corrective measures.
Functions of retinal astrocytes and Müller cells in mammalian myopia
Authors: Zhang Xuhong , Yu Xin , Wen Yingying , Jin Le , Zhang Liyue , Zhu Hong , Zhang Dongyan , Xie Chen , Guo Dongyu , Tong Jianping , Shen Ye
Published: November 2022

Background

Changes in the retina and choroid blood vessels are regularly observed in myopia. However, if the retinal glial cells, which directly contact blood vessels, play a role in mammalian myopia is unknown. We aimed to explore the potential role and mechanism of retinal glial cells in form deprived myopia.

Methods

We adapted the mice form-deprivation myopia model by covering the right eye and left the left eye open for control, measured the ocular structure with anterior segment optical coherence tomography, evaluated changes in the morphology and distribution of retinal glial cells by fluorescence staining and western blotting; we also searched the online GEO databases to obtain relative gene lists and confirmed them in the form-deprivation myopia mouse retina at mRNA and protein level.

Results

Compared with the open eye, the ocular axial length (3.54 ± 0.006 mm v.s. 3.48 ± 0.004 mm, p = 0.027) and vitreous chamber depth (3.07 ± 0.005 mm v.s. 2.98 ± 0.006 mm, p = 0.007) in the covered eye became longer. Both glial fibrillary acidic protein and excitatory amino acid transporters 4 elevated. There were 12 common pathways in human myopia and anoxic astrocytes. The key proteins were also highly relevant to atropine target proteins. In mice, two common pathways were found in myopia and anoxic Müller cells. Seven main genes and four key proteins were significantly changed in the mice form-deprivation myopia retinas.

Conclusion

Retinal astrocytes and Müller cells were activated in myopia. They may response to stimuli and secretory acting factors, and might be a valid target for atropine.
Aggressive behaviors and associated factors in Chinese left-behind adolescents: a cross-sectional study
Authors: Yang Fang , Jin Zhiyu , He Jing , Han Bingsong , Huang Xinyuan , Chen Kun , Wang Jiana
Published: November 2022

Background

To examine whether the levels of aggressive behaviors and other individual and contextual variables differ between left-behind adolescents (LBA) and not left-behind adolescents (NLBA) and explore associations between aggression and other constructs among them.

Methods

A cross-sectional study was conducted and 4530 school adolescents aged 9–18 years in north and south of China were randomly selected. The levels of aggressive behavior, personality and family and classroom environment were compared between LBA and NLBA and also the associated factors of aggression.

Results

The total scores of aggressive behaviors were 6.33 ± 6.35 (Mean ± SD) in LBA and 5.78 ± 6.16 (Mean ± SD) in NLBA. Multiple linear regression models revealed that neuroticism and psychoticism were positively associated with aggressive behaviors for LBA with similar results of NLBA. Cohesion was negatively associated with aggressive behaviors, and conflict and achievement had positive effects in NLBA. Organization had a negative effect in LBA. Uncertainty and dissatisfaction had positive effects on aggression both in LBA and NLBA.

Conclusion

This study found a slightly higher level of aggressive behaviors in LBA comparing with NLBA. Personality was the mainly associated factor of aggression, but class-based interventions were more practical for aggressive behaviors in Chinese LBA.
Efficacy of computer- and/or internet-based cognitive-behavioral guided self-management for depression in adults: a systematic review and meta-analysis of randomized controlled trials
Authors: Mamukashvili-Delau Megi , Koburger Nicole , Dietrich Sandra , Rummel-Kluge Christine
Published: November 2022

Background

Depression is a worldwide disease. CBT-based self-help treatment allows patients with mild to moderate depression symptoms to improve their depression or to bridge the waiting- or pandemic period until they receive further clinical treatment.

Objective

This systematic review and meta-analysis aims to explore the efficacy, acceptability and improvement in quality of life of computer-delivered and/or internet-based CBT self-help interventions with minimal guidance (up to 10 min) for depression. The second aim was to compare the effectiveness of reducing depression symptoms at post-treatment of treatment by the type of minimal guidance: (1) e-mail, (2) telephone calls, (3) e-mail and telephone together, or (4) face-to-face.

Methods

The Cochrane depression, anxiety, and neurosis review group’s specialized register electronic searches, grey literature, reference lists and correspondence were used to search for published and unpublished RCTs that reported efficacy of computer- and/or internet-based CBT self-help treatments for depression with minimal guidance up to 10 min per week. Methodological quality of included studies was evaluated with Cochrane Collaboration tools for assessing risk of bias. The meta-analysis was accomplished using the RevMen software.

Results

In total, 2809 study abstracts were checked for eligibility. Out of these, 19 studies (21 samples) with a total of 3226 participants were included. The results showed that concerning efficacy, the treatment group is superior to the control group with a medium to large effect size of 0.65. Also, treatment groups with combined guidance by e-mail and telephone calls together had greater effects (SMD -0.76) than groups with other types of minimal guidance (guided by e-mail SMD -0.63; guided face to-face SMD – 0.66; guided by telephone calls SMD -0.49). Findings showed also, that iCBT with minimal guidance had small but statistically significant effect size of 0.28 in improving quality of life. Moreover, there were higher drop-out rates in the treatment condition (RR 1.36) than in the control groups.

Conclusions

The results of this meta-analysis support the efficacy of computer- and/or internet-based CBT self-help programs with minimal weekly guidance up to only 10 min for improving depression symptoms at post-treatment for adults.

In addition, the results are pointing towards two practical implications. Firstly, depressed persons can use self-help treatment with minimal guidance at home to improve their symptoms or to bridge the waiting time – or pandemic period – before they receive professional face-to-face treatment. Secondly, it can help clinicians to make the decision about using CBT-based self-help treatments for patients that do not need urgent professional treatment, or to combine it with face-to-face therapy.
An analysis on the roles and involvements of different stakeholders in the provision of adolescent sexual and reproductive health services in Southeast Nigeria
Authors: Agu Chibuike , Mbachu Chinyere , Agu Ifunanya , Iloabachie Ugenyi , Onwujekwe Obinna
Published: November 2022

Introduction

Sexual and reproductive health of young people involve a lot of stakeholders, traverse different sectors, and cut across all levels of government. For a clearer understanding of the activities of these stakeholders in adolescent sexual and reproductive health (ASRH) services, this paper was designed to explore the positions, attitudes and involvements of government/public institutions and non-governmental organizations (NGOs) in ASRH policy-making processes and implementations in Ebonyi State, Nigeria.

Methods

The evidence was generated from a cross-sectional qualitative study, with data collected through in-depth interviews and focus group discussions from 81 and 59 stakeholders in adolescent sexual and reproductive health, respectively. A mapping tool was used for the stakeholder analysis.

Results

The State Ministry of Health (MOH) was identified as playing a major role in ASRH policy development and so was categorized as a ‘savior’. However, out of nine public institutions, four were categorized as ‘trip wire’ because they had non-supportive attitudes, weak powers and passive interests in ASRH policies and programs. All the NGOs were categorized as ‘friend’, because of their weak, but favorable disposition to ASRH policy-making processes. Regarding the implementation of ASRH programs, most public institutions were categorized as ‘savior’. Similarly, most of the institutions were classified as ‘trip wire’ at the local government level, in relation to ASRH policy development. Only, the offices of traditional rulers/village heads and local government administrative secretaries were regarded as ‘friend’, while the public schools were classified as an ‘acquaintance’. Concerning the implementation of ASRH programs at this level, public secondary schools, the offices of local government administrative secretaries and local government focal persons on ASRH were categorized as ‘savior’, while town union/ward development chairmen were considered ‘friend’. Few stakeholders, including, religious leaders were classified as ‘savior’ regarding engagement with local authorities on ASRH matters.

Conclusion

Although key stakeholders appear to play supportive roles in the implementation of ASRH programs in Ebonyi State, many of the relevant government and non-government institutions are not involved in the policy-making process. There is a need for more intentional and active involvement of relevant stakeholders in policy-making for better ownership and sustainability of ASRH interventions.
Time-dependent efficacy and safety of tooth bleaching with cold plasma and H2O2 gel
Authors: Yang Xiaohui , Sun Ke , Zhu Weidong , Li Yinglong , Pan Jie
Published: November 2022

Background

Hydrogen peroxide (H2O2) is the commonly used bleaching agent for teeth. But it is highly corrosive to teeth for the high concentration. The cold atmospheric pressure plasma has been witnessed a novel tooth bleaching technology and could help strengthen the bleaching effect when combined with H2O2. However, the efficacy and safety might highly correlated with processing time. The present study aims to evaluate the time-dependent efficacy and safety of tooth bleaching with cold plasma and H2O2 gel in vitro.

Methods

The H2O2 concentrations of the gel used in the study are 6%, 15%, 25% and 35%, respectively and the treatment time varies from 5 to 20 min. The tooth bleaching effect was evaluated by a Crystaleye Spectrophotometer and the overall change of the colorimetric value based on three independent measurements. Meanwhile, the microhardness, roughness and tooth temperature were evaluated. The surface morphology and the elemental composition were determined by scanning electron microscope and energy-dispersive X-ray spectroscopy.

Results

5 min bleaching treatment contributed to 60% of the bleaching effect maximum, the 10 min effect was close to 15 min effect. Meanwhile, the microhardness reduced and roughness increased under a treatment which was longer than 20 min. Tooth pulp chamber temperature was keeping in a safe range within 20 min treatment.

Conclusion

5–10 min was the best treatment time from which we can get an ideal tooth bleaching effect and less influence on tooth enamel and pulp tissue when using cold plasma and H2O2 gel.
Effectiveness and cost effectiveness of palliative care interventions in people with chronic heart failure and their caregivers: a systematic review
Authors: Hicks Stephanie , Davidson Martin , Efstathiou Nikolaos , Guo Ping
Published: November 2022

Background

Chronic heart failure is a common condition, and its prevalence is expected to rise significantly over the next two decades. Research demonstrates the increasing multidimensional needs of patients and caregivers. However, access to palliative care services for this population has remained poor. This systematic review was to provide an evidence synthesis of the effectiveness and cost-effectiveness of palliative care interventions for people with chronic heart failure and their caregivers.

Methods

Relevant publications were identified via electronic searches of MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL and HMIC from inception to June 2019. Grey literature databases, reference list, and citations of key review articles were also searched. Quality was assessed using the Revised Cochrane Risk of Bias Tool.

Results

Of the 2083 records, 18 studies were identified including 17 having randomised controlled trial (RCT) designs and one mixed methods study with an RCT component. There was significant heterogeneity in study settings, control groups, interventions delivered, and outcome measures used. The most commonly assessed outcome measures were functional status (n = 9), psychological symptoms (n = 9), disease-specific quality of life (n = 9), and physical symptom control (n = 8). The outcome measures with the greatest evidence for benefit included general and disease-specific quality of life, psychological symptom control, satisfaction with care, physical symptom control, medical utilisation, and caregiver burden. Moreover, the methodological quality of these studies was mixed, with only four having an overall low risk of bias and the remaining studies either demonstrating high risk of bias (n = 10) or showing some concerns (n = 4) due to small sample sizes and poor retention. Only two studies reported on economic costs. Both found statistically significant results showing the intervention group to be more cost effective than the control group, but the quality of both studies was at high risk of bias.

Conclusions

This review supports the role of palliative care interventions in patients with chronic heart failure and their caregivers across various outcomes, particularly quality of life and psychological wellbeing. Due to the highly heterogeneous nature of palliative care interventions, it is not possible to provide definitive recommendations as to what guise palliative care interventions should take to best support the complex care of this population. Considerable future research, particularly focusing on quality of care after death and the caregiver population, is warranted.
Water extract from artichoke ameliorates high-fat diet-induced non-alcoholic fatty liver disease in rats
Authors: Deng Aihua , Liu Fengying , Tang Xuchong , Wang Yun , Xie Peng , Yang Qifu , Xiao Bing
Published: November 2022

Background

The “multiple-hit” hypothesis is currently the most widely accepted theory for non-alcoholic fatty liver disease (NAFLD) pathogenesis. The present study aimed to investigate the effects of the water extract of artichoke (WEA) on NAFLD and its underlying mechanism.

Methods

Rats were fed a high-fat diet (HFD) for 8 weeks to induce NAFLD and then treated with WEA at three doses (0.4, 0.8, and 1.6 g/kg body weight, BW) for 8 weeks. At the end of the intervention, serum biochemical parameters, hepatic antioxidant capacity, hepatic levels of pro-inflammatory cytokines, liver histopathology, hepatic inflammatory gene and lipid metabolism gene expression, and Akt and p-Akt (S473) protein levels were determined.

Results

The body weight, liver weight, liver triglyceride (TG) and serum levels of TG, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin were all significantly reduced in the WEA-treated groups (0.8 and 1.6 g/kg BW) compared with the HFD group (P < 0.01). A significant decrease in hepatic content of malondialdehyde (P < 0.01) and glutathione (P < 0.01), as well as a significant increase in liver superoxide dismutase activity (P < 0.01) were observed in WEA-treated groups (0.8 and 1.6 g/kg BW) compared to the HFD group. In addition, there was a marked decrease in the hepatic levels of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) in the WEA-treated groups compared to the HFD group (P < 0.01). In line with these findings, the histopathology of the livers of rats treated with WEA (0.8 and 1.6 g/kg BW) showed a decrease in steatosis, ballooning, and lobular inflammation. Mechanistically, the reduced hepatic TG content might be related to the downregulation of lipogenic genes (SREBP1c, FASN, SCD1) and upregulation of lipolytic gene (PPARα), and the improved insulin signaling might be associated with the observed increase in antioxidant activity and reduction in inflammation in the WEA-treated groups.

Conclusion

The hepatoprotective role of WEA in NAFLD may be attributed to its anti-steatotic, antioxidant, anti-inflammatory, and anti-insulin resistance effects.
Retraction Note: Sedum sarmentosum Bunge extract ameliorates lipopolysaccharide- and D-galactosamine-induced acute liver injury by attenuating the hedgehog signaling pathway via regulation of miR-124 expression
Authors: Hao Li , Liu Ming-wei , Gu Song-tao , Huang Xue , Deng Hong , Wang Xu
Published: November 2022

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12906-020-2873-1.
Economic Burden of Diabetic Mellitus Among Patients on Follow-up Care in Hospitals of Southwest Shewa Zone, Central Ethiopia
Authors: Zawudie Addisu Bogale , Daka Dawit Wolde , Teshome Dejene , Ergiba Meskerem Seboka
Published: November 2022

Background

Diabetes has emerged as one of the most serious health issues of the twenty-first century. Diabetes and its complications expose individuals and their families to catastrophic healthcare costs, which have a severe impact on the country's economy. Though the prevalence of diabetes is rising quicker in Ethiopia, little is known about its economic impact. Hence, this study aimed to determine the total cost of diabetic mellitus and associated factors among patients attending hospitals in Southwest Shewa zone, Central Ethiopia.

Methods

The study was conducted among diabetes patients who were on care and treatment from September to October 2020. Direct costs were calculated using the micro-costing technique, while indirect costs were calculated using the human capital approach. The statistical significance of cost difference between the groups of patient characteristics was determined using Wilcoxon and Kruskal-Wallis mean rank sum tests, and the factors associated with a total cost of illness were identified with Generalized Linear Model (GLM).

Results

Out of the planned patients, 398 have responded and were included in the analysis; making a response rate of 98.5%. The mean monthly total cost of diabetic mellitus was US$ 37.7(95% CI, 23.45–51.95). Direct and indirect costs constituted 76.2% and 23.8% of the total cost, respectively. The mean direct and indirect cost of diabetic mellitus per patient per month was US$ 28.73(95% CI, 17.17–40.29) and US$ 9.50 (95% CI, 1.99–16.99) respectively. Statistical mean cost differences were observed by gender, age groups, family size, and comorbidities. The total cost of illness was associated with residence (p=0.007), family size (p=0.001), presence of co-morbidities (p=0.04), and history of ever-stopping treatments (p<0.0001).

Conclusions

The total cost of diabetes condition was relatively high compared to other related literatures. The medical expenditures accounted for most direct costs for diabetic patients. As a result, the government should provide sufficient resources to safeguard patients against catastrophic medical costs. Efforts should be made to enhance access to diabetes care, and the supply of diabetic medications at all levels of health facilities.
Establishment of a medical device adverse event management system for hospitals
Authors: Sun Jing , Pan Jin , Jin Yile , Zhang Qian , Lv Yingying , Feng Jingyi
Published: November 2022

Background

The management of medical device adverse event (MDAE) is one of the most important aspects of improving medical quality and safety management. Nonetheless, hospitals still lack standardized and unified initiatives to improve MDAE management.

Methods

This study, thus, established a MDAE monitoring system on May 1 in 2011 for suspected adverse events and designed a hospital-based dynamic warning system, aiming to standardize the process of MDAE handling and provide real-time monitoring for MDAEs in a hospital. This system was used in the First Affiliated Hospital of Zhejiang University School of Medicine. Numbers and the compound growth rate of MDAE reports from 2010 to 2020 were compared to test the effectiveness of the MDAE monitoring system. Numbers of MDAE reported to the National Adverse Event Monitoring System were also compared over 2013 to 2020, due to the loss of data before 2013 after shutdown of the old system. Efficacy and usability of the hospital-based dynamic warning system was then verified by analyzing risk and warning levels of MDAEs in 2020. Descriptive statistics was used for data analysis in this study.

Results

Results showed that the compound annual growth rates of MDAE reports and those submitted to the National Adverse Event Monitoring System from 2013 to 2020 were 35.0% and 31.5%, respectively. A standardized management of MDAE with full participant, timely response and effective feedback was formed in the hospital by establishment of the MDAE system.

Conclusions

This system effectively improved the monitoring level of MDAEs, helping to improve early detection, early warning, and early intervention of risk of medical device. This study may provide suggestions for medical institutions to establish a MDAE monitoring system, and may promote development of medical quality and safety management for hospitals to some extent.
Metabolic engineering of Clostridium autoethanogenum for ethyl acetate production from CO
Authors: Dykstra James C. , van Oort Jelle , Yazdi Ali Tafazoli , Vossen Eric , Patinios Constantinos , van der Oost John , Sousa Diana Z. , Kengen Servé W. M.
Published: November 2022

Background

Ethyl acetate is a bulk chemical traditionally produced via energy intensive chemical esterification. Microbial production of this compound offers promise as a more sustainable alternative process. So far, efforts have focused on using sugar-based feedstocks for microbial ester production, but extension to one-carbon substrates, such as CO and CO2/H2, is desirable. Acetogens present a promising microbial platform for the production of ethyl esters from these one-carbon substrates.

Results

We engineered the acetogen C. autoethanogenum to produce ethyl acetate from CO by heterologous expression of an alcohol acetyltransferase (AAT), which catalyzes the formation of ethyl acetate from acetyl-CoA and ethanol. Two AATs, Eat1 from Kluyveromyces marxianus and Atf1 from Saccharomyces cerevisiae, were expressed in C. autoethanogenum. Strains expressing Atf1 produced up to 0.2 mM ethyl acetate. Ethyl acetate production was barely detectable (< 0.01 mM) for strains expressing Eat1. Supplementation of ethanol was investigated as potential boost for ethyl acetate production but resulted only in a 1.5-fold increase (0.3 mM ethyl acetate). Besides ethyl acetate, C. autoethanogenum expressing Atf1 could produce 4.5 mM of butyl acetate when 20 mM butanol was supplemented to the growth medium.

Conclusions

This work offers for the first time a proof-of-principle that autotrophic short chain ester production from C1-carbon feedstocks is possible and offers leads on how this approach can be optimized in the future.
Mediating oxidative stress enhances α-ionone biosynthesis and strain robustness during process scaling up
Authors: Huang Ching-Ning , Lim Xiaohui , Ong Leonard , Lim Chinchin , Chen Xixian , Zhang Congqiang
Published: November 2022

Background

α-Ionone is highly valued in cosmetics and perfumery with a global usage of 100–1000 tons per year. Metabolic engineering by microbial fermentation offers a promising way to produce natural (R)-α-ionone in a cost-effective manner. Apart from optimizing the metabolic pathways, the approach is also highly dependent on generating a robust strain which retains productivity during the scale-up process. To our knowledge, no study has investigated strain robustness while increasing α-ionone yield.

Results

Built on our previous work, here, we further increased α-ionone yield to 11.4 mg/L/OD in 1 mL tubes by overexpressing the bottleneck dioxygenase CCD1 and re-engineering the pathway, which is  > 65% enhancement as compared to our previously best strain. However, the yield decreased greatly to 2.4 mg/L/OD when tested in 10 mL flasks. Further investigation uncovered an unexpected inhibition that excessive overexpression of CCD1 was accompanied with increased hydrogen peroxide (H2O2) production. Excessive H2O2 broke down lycopene, the precursor to α-ionone, leading to the decrease in α-ionone production in flasks. This proved that expressing too much CCD1 can lead to reduced production of α-ionone, despite CCD1 being the rate-limiting enzyme. Overexpressing the alkyl hydroperoxide reductase (ahpC/F) partially solved this issue and improved α-ionone yield to 5.0 mg/L/OD in flasks by reducing oxidative stress from H2O2. The strain exhibited improved robustness and produced  ~ 700 mg/L in 5L bioreactors, the highest titer reported in the literature.

Conclusion

Our study provides an insight on the importance of mediating the oxidative stress to improve strain robustness and microbial production of α-ionone during scaling up. This new strategy may be inspiring to the biosynthesis of other high-value apocarotenoids such as retinol and crocin, in which oxygenases are also involved.
CAR-T cell combination therapy: the next revolution in cancer treatment
Authors: Al-Haideri Maysoon , Tondok Santalia Banne , Safa Salar Hozhabri , maleki Ali Heidarnejad , Rostami Samaneh , Jalil Abduladheem Turki , Al-Gazally Moaed E. , Alsaikhan Fahad , Rizaev Jasur Alimdjanovich , Mohammad Talar Ahmad Merza , Tahmasebi Safa
Published: November 2022

In recent decades, the advent of immune-based therapies, most notably Chimeric antigen receptor (CAR)-T cell therapy has revolutionized cancer treatment. The promising results of numerous studies indicate that CAR-T cell therapy has had a remarkable ability and successful performance in treating blood cancers. However, the heterogeneity and immunosuppressive tumor microenvironment (TME) of solid tumors have challenged the effectiveness of these anti-tumor fighters by creating various barriers. Despite the promising results of this therapeutic approach, including tumor degradation and patient improvement, there are some concerns about the efficacy and safety of the widespread use of this treatment in the clinic. Complex and suppressing tumor microenvironment, tumor antigen heterogeneity, the difficulty of cell trafficking, CAR-T cell exhaustion, and reduced cytotoxicity in the tumor site limit the applicability of CAR-T cell therapy and highlights the requiring to improve the performance of this treatment. With this in mind, in the last decade, many efforts have been made to use other treatments for cancer in combination with tuberculosis to increase the effectiveness of CAR-T cell therapy, especially in solid tumors. The combination therapy results have promising consequences for tumor regression and better cancer control compared to single therapies. Therefore, this study aimed to comprehensively discuss different cancer treatment methods in combination with CAR-T cell therapy and their therapeutic outcomes, which can be a helpful perspective for improving cancer treatment in the near future.
Intercellular crosstalk between cancer cells and cancer-associated fibroblasts via extracellular vesicles
Authors: Naito Yutaka , Yoshioka Yusuke , Ochiya Takahiro
Published: November 2022

Intercellular communication plays an important role in cancer initiation and progression through direct contact and indirect interactions, such as via secretory molecules. Cancer-associated fibroblasts (CAFs) are one of the principal components of such communication with cancer cells, modulating cancer metastasis and tumour mechanics and influencing angiogenesis, the immune system, and therapeutic resistance. Over the past few years, there has been a significant increase in research on extracellular vesicles (EVs) as regulatory agents in intercellular communication. EVs enable the transfer of functional molecules, including proteins, mRNAs and microRNAs (miRNAs), to recipient cells. Cancer cells utilize EVs to dictate the specific characteristics of CAFs within the tumour microenvironment, thereby promoting cancer progression. In response to such “education” by cancer cells, CAFs contribute to cancer progression via EVs. In this review, we summarize experimental data indicating the pivotal roles of EVs in intercellular communication between cancer cells and CAFs.