bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparing for the Improving Medicare Post-Acute Care Transformation Act
Authors: Sockolow Paulina , Yang Yushi
Published: June 2021

The Improving Medicare Post–Acute Care Transformation Act, which mandates electronic sharing of standardized patient data by post–acute care clinical settings, will likely spur further health information technology adoption and evaluation. To support evaluation, the study objective was to clarify components of an evidence-based health information technology evaluation framework, Health Information Technology Reference-based Evaluation Framework, by using the framework in home healthcare and incorporating a sociotechnical perspective in the health information technology evaluation. With 36 observations among three diverse home healthcare agencies, researchers conducted a recorded think-aloud process as nurses documented the home healthcare admission in the EHR. Thematic analysis revealed 15 themes that provided clarification for almost one-third of Health Information Technology Reference-based Evaluation Framework components and added a new concept. All themes reflected a sociotechnical perspective. The new theme added to the Health Information Technology Reference-based Evaluation Framework reflected the sociotechnical perspective: routine use. We anticipate the enhanced Health Information Technology Reference-based Evaluation Framework to be used by evaluators from diverse disciplines, to further facilitate context-dependent health information technology adoption in post–acute care settings.
Expression of cathepsins B and D by cancer stem cells in head and neck metastatic malignant melanoma
Authors: Sangster Adam B. , Chang-McDonald Bridget , Patel Josie , Bockett Nicholas , Paterson Erin , Davis Paul F , Tan Swee T.
Published: June 2021

We have previously demonstrated cancer stem cell (CSC) subpopulations in head and neck metastatic malignant melanoma (HNmMM), and the expression of components of the renin–angiotensin system (RAS) by these CSCs. Cathepsins B, D and G are involved in carcinogenesis and constitute bypass loops of the RAS. This study investigated the expression and localization of cathepsins B, D and G, in relation to these CSCs. Immunohistochemical staining demonstrated expression of cathepsins B, D and G in HNmMM sections from all 20 patients. Western blotting confirmed the presence of cathepsins B and D proteins in all six HNmMM tissue samples and four HNmMM-derived primary cell lines. RT-qPCR showed transcript expression of cathepsins B, D and G in all six HNmMM tissue samples, and cathepsins B and D but not cathepsin G in all four HNmMM-derived primary cell lines. Enzymatic activity assays demonstrated cathepsins B and D were active in all six HNmMM tissue samples. Immunofluorescence staining performed on two of the HNmMM tissue samples demonstrated expression of cathepsins B and D by the CSCs, and cathepsin G by cells within the peritumoral stroma. Our novel findings suggest the possibility of targeting these CSCs by modulation of paracrine RAS signaling.
Knockdown of Long Noncoding RNA Abhd11os Attenuates Myocardial Ischemia/Reperfusion Injury by Inhibiting Apoptosis in Cardiomyocytes
Authors: Liu Xuelan , Hua Ying , Hu Manman , Wu Kaiyuan , Zhao Liyun , Xuan Maozheng , Li Bin
Published: June 2021

Long noncoding RNA is one potential target for the treatment of various disorders. Here, we explored the role of Abhd11os in ischemia/reperfusion-induced myocardial injury, and preliminarily explored the regulatory mechanisms. Relative Abhd11os expression level was examined by qRT-PCR. Western blot was done to measure the expression of apoptotic-related proteins. Cell counting kit-8 assay and flow cytometry were performed to detect cell viability and apoptosis, respectively. ELISA assay was used to ensure the levels of lactate dehydrogenase, creatine kinase, and cardiac troponin I in serum. Besides, the infarct sizes were confirmed by 2,3,5-triphenyltetrazolium chloride and Evans blue staining. Apoptotic rate of cardiomyocytes in myocardial tissues was evaluated by TUNEL assay. Here, increased Abhd11os expression was found in rat myocardial ischemia/reperfusion injury (MIRI) model and hypoxia/reoxygenation-treated cardiomyocytes. Subsequently, our data in vitro showed that upregulation of Abhd11os inhibited proliferation of cardiomyocytes, but promoted cell apoptosis. In animal experiments, myocardial infarct size in MIRI rats was reduced by Abhd11os knockdown. Moreover, downregulation of Abhd11os inhibited apoptosis of cardiomyocytes. Overall, our results revealed that knockdown of Abhd11os could notably attenuate hypoxia/reoxygenation-induced myocardial injury through suppressing apoptosis of cardiomyocytes. These data suggest that Abhd11os may be a potential target for MIRI therapy.
Analytical validation of a laboratory-development multigene pharmacogenetic assay
Authors: Rosas-Alonso Rocío , Queiruga Javier , Arias Pedro , del Monte Álvaro , Yuste Fernando , Rodríguez-Antolín Carlos , Losantos-Garcia Itsaso , Borobia Alberto M. , Rodríguez-Nóvoa Sonia
Published: June 2021

Objective

The implementation of pharmacogenetics (PGx) in clinical practice is an essential tool for personalized medicine. However, clinical laboratories must validate their procedures before being used to perform PGx studies in patients, in order to confirm that they are adequate for the intended purposes.

Methods

We designed a validation process for our in-house pharmacogenetic PCR-based method assay.

Results

The concordance to reference, repeatability and reproducibility was 100%. Sensitivity and specificity were 100% for the detection of variant diplotypes in CYP2C9, CYP3A5, TPMT, DPYD and UGT1A1 genes. The sensitivity was lower in the detection of CYP2C19 variants due to a limitation in the design that prevents the detection of CYP2C19 *2/*10 diplotype.

Conclusions

The success of implementing clinical pharmacogenetic testing into routine clinical practice is dependent on the precision of genotyping. Limitations must be bearing in mind to guarantee the quality of PGx assays in clinical laboratory practice. We provided objective evidence that the necessary requirements in our laboratory-development assay were fulfilled.
C677T and A1298C MTHFR gene polymorphisms and response to fluoropyrimidine-based chemotherapy in Mestizo patients with metastatic colorectal cancer
Authors: Ramos-Esquivel Allan , Chinchilla-Monge Ricardo , Abbas Jad , Valle Marta
Published: June 2021

Objective

To assess the association between C677T and A1298C methylenetetrahydrofolate reductase (MTHFR) single-nucleotide polymorphisms (SNPs) and response to first-line fluoropyrimidine-based chemotherapy for metastatic colorectal adenocarcinoma.

Methods

A total of 68 patients were prospectively followed up in San Juan de Dios Hospital (San José, Costa Rica) from January 2019 to November 2020. Patients received first-line therapy with capecitabine or 5-fluorouracil in combination with oxaliplatin or irinotecan. Germline and somatic DNA was extracted from blood samples and paraffin-embedded tissue, respectively. Overall response rate (partial response + complete response) was assessed according to RECIST 1.1 criteria. Cox regression models were performed to identify the effect of MTHFR C677T and A1298C SNPs on progression-free survival (PFS) and overall survival (OS) (NCT registration number: 03852290).

Results

Patients harboring one or both T alleles of the MTHFR C677T SNP had better overall response than homozygous wild-type individuals [odds ratio (OR): 3.21; 95% confidence interval (CI), 1.05–9.81; P = 0.03]. No association was found between the MTHFR A1298C genotypes and overall response (OR: 0.75; 95% CI, 0.26–2.20; P = 0.60). Patients with the MTHFR 677 TT and CT genotypes had longer PFS than CC individuals (hazard ratio: 0.53; 95% CI, 0.28–0.98; P = 0.045), even after adjustment for confounders (hazard ratio: 0.50; 95% CI, 0.25–0.98; P = 0.04). We found no association between the MTHFR A1298C SNP and PFS (hazard ratio: 1.35; 95% CI, 0.72–2.55; P = 0.34). None of the SNPs was associated with OS.

Conclusion

Patients carrying at least one mutant allele of the MTHFR C677T SNP had a better overall response and longer PFS than wild-type homozygous patients.
Evaluation of an Online Course in 5 Languages for Inpatient Cardiac Care Providers on Promoting Cardiac Rehabilitation
Authors: Heald Fiorella A. , de Araújo Pio Carolina Santiago , Liu Xia , Theurel Fernando Rivera , Pavy Bruno , Grace Sherry L.
Published: June 2021

Purpose:

Evidence proves that health care providers should promote cardiac rehabilitation (CR) to patients face-to-face to increase CR enrollment. An online course was designed to promote this at the bedside; it is evaluated herein in terms of reach, effect on knowledge, attitudes, discussion self-efficacy and practices, and satisfaction.

Methods:

Design was observational, one-group pre- and post-test. Some demographics were requested from learners taking all language versions of the 20-min course: English, Portuguese, French, Spanish, and simplified Chinese, available at: https://globalcardiacrehab.com/CR-Utilization. Investigator-generated items in the pre- and post-test and evaluation survey administered using Google Forms were based on Kirkpatrick's training evaluation model.

Results:

The course was initiated by 522 learners from 33 of 203 (16%) countries; most commonly female (n = 341, 65%) nurses (n = 180, 34%) from high-income countries (n = 259, 57%) completing the English (n = 296, 57%) and Chinese (n = 108, 21%) versions. A total of 414 (79%) learners completed the post-test and 302 (58%) completed the evaluation. Median CR attitudes were 5 of 5 on the Likert scale at pre-test, suggesting some selection bias. Mean CR knowledge ([7.22 ± 2.14]/10), discussion self-efficacy ([3.86 ± 0.85]/5), and practice ([4.13 ± 1.11]/5) significantly improved after completion of the course (all P < .001). Satisfaction was high regardless of language version ([4.44 ± 0.64]/5; P = .593).

Conclusions:

This free, open-access course is effective in increasing CR knowledge, self-efficacy, and encouragement practices among participating inpatient cardiac providers, with high satisfaction. While testing impact on actual CR use is needed, it should be more broadly disseminated to increase reach, in an effort to increase patient enrollment in CR, to reduce morbidity and mortality.
Women Have Lower Mortality Than Men After Attending a Long-Term Medically Supervised Exercise Program
Authors: de Souza e Silva Christina Grüne , Nishijuka Fabio Akio , de Castro Claudia Lucia Barros , Franca João Felipe , Myers Jonathan , Laukkanen Jari Antero , de Araújo Claudio Gil Soares
Published: June 2021

Purpose:

Medically supervised exercise programs (MSEPs) are equally recommended for men and women with cardiovascular disease (CVD). Aware of the lower CVD mortality in women, we hypothesized that among patients attending a MSEP, women would also have better survival.

Methods:

Data from men and women, who were enrolled in a MSEP between 1994 and 2018, were retrospectively analyzed. Sessions included aerobic, resistance, flexibility and balance exercises, and cardiopulmonary exercise test was performed. Date and underlying cause of death were obtained. Kaplan-Meier methods and Cox proportional hazards regression were used for survival analysis.

Results:

A total of 2236 participants (66% men, age range 33-85 yr) attended a median of 52 (18, 172) exercise sessions, and 23% died during 11 (6, 16) yr of follow-up. In both sexes, CVD was the leading cause of death (39%). Overall, women had a more favorable clinical profile and a longer survival compared to men (HR = 0.71: 95% CI, 0.58-0.85; P < .01). When considering those with coronary artery disease and similar clinical profile, although women had a lower percentage of sex- and age-predicted maximal oxygen uptake at baseline than men (58 vs 78%; P < .01), after adjusting for age, women still had a better long-term survival (HR = 0.68: 95% CI, 0.49-0.93; P = .02).

Conclusion:

Survival after attendance to a long-term MSEP was better among women, despite lower baseline cardiorespiratory fitness. Future studies should address whether men and women would similarly benefit when participating in an MSEP.
Intrafamilial Spread and Altered Symptomatology of SARS-CoV-2, During Predominant Circulation of Lineage B.1.1.7 Variant in Israel
Authors: Somekh Ido , Sharabi Assaf , Dory Yahav , Simões Eric A. F. , Somekh Eli
Published: June 2021

The dynamics of intrafamilial spread of SARS-CoV-2 during January–February 2021 when variant B.1.1.7 predominated were compared with data from April to May 2020, when other circulating variants prevailed. Much higher intrafamilial transmission rates among all age groups, in particular in young children, and lower rates of sensory impairment were demonstrated during January–February 2021.
Rotavirus Infection, Illness, and Vaccine Performance in Malnourished Children: A Review of the Literature
Authors: Burnett Eleanor , Parashar Umesh D. , Tate Jacqueline E.
Published: June 2021

Live, oral rotavirus vaccines are more effective at preventing rotavirus disease in countries with low child mortality compared with high child mortality. Among several hypotheses, poorer protection in malnourished children, who are more prevalent in countries with high child mortality, may partially explain this difference. We conducted a literature search to identify articles with a laboratory-confirmed rotavirus endpoint that evaluated differences by malnutrition status in rotavirus vaccine effectiveness and vaccine efficacy (VE) or the prevalence of rotavirus infection or illness among children <5 years old. We identified 7 analyses from 11 countries published from 2007 to 2019 that stratified rotavirus VE by malnutrition status. Among well-nourished children, VE point estimates ranged from 71% to 84% in observational studies and 26% to 61% in clinical trials. Among malnourished children, they ranged from −28% to 45% in observational studies and −3% to 61% in clinical trials. The relative difference between VE in well-nourished and malnourished children by length-for-age ranged from 37% to 64%, by weight-for-age ranged from 0% to 107%, and by weight-for-height ranged from −65% to 137%. We identified 3 cohort and 6 cross-sectional studies of natural rotavirus infection and illness and none reported that malnourished children were more susceptible to rotavirus infection or illness than well-nourished children. Overall, rotavirus vaccines may offer less protection to children with malnutrition than well-nourished children. As malnourished children often have worse outcomes from diarrhea, high rotavirus vaccine coverage and a better understanding of the performance of oral rotavirus vaccines in this population is important, though our finding that malnourished children may be less susceptible to rotavirus provides important context and information for vaccine evaluation design.
Psychometric Testing of the Self-care of Hypertension Inventory Version 3.0
Authors: Dickson Victoria Vaughan , Fletcher Jason , Riegel Barbara
Published: June 2021

In this updated Self-care of Hypertension Inventory Version 3.0 (SC-HI v3.0), items were added to better reflect the Theory of Self-care of Chronic Illness and revised based on recent research. The reorganized and expanded SC-HI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.

Objective

To evaluate the psychometric properties of the SC-HI v3.0, we conducted exploratory factor analyses. Here, we report on its reliability and construct validity.

Methods

A sample of 200 adults with chronic hypertension completed a sociodemographic survey and the SC-HI v3.0. Exploratory factor analyses were conducted on item sets using principal factor method for analyzing the correlation matrix. Reliability was calculated using common factor coefficient of determinacy for multidimensional scales, for which values greater than 0.80 are considered adequate.

Results

The sample was 83.4% non-Hispanic White; 56% were women, with a mean age of 62.2 ± 12.5 years. The self-care maintenance scale (mean, 75.9 ± 13.6) had adequate reliability (ρ = 0.81, 0.80) for a 2-dimensional model of self-care maintenance identified as autonomous and consultative behaviors. The new self-care monitoring scale (mean score, 58.5 ± 21.99) had a single-factor solution with very good reliability (ρ = 0.94). The self-care management scale (mean score, 64.5 ± 19.5) had a single-factor solution, with moderate to strong factor loadings (0.22–0.68) and acceptable reliability (ρ = 0.84).

Conclusions

Initial testing suggests that the SC-HI v3.0 is a sound measure of the essential elements of self-care for adults with chronic hypertension. With the new self-care monitoring scale, the SC-HI v3.0 is a valid reflection of the theory on which it is based.
Implementation of Patient Safety Structures and Processes in the Patient-Centered Medical Home
Authors: Oberlander Tyler , Scholle Sarah Hudson , Marsteller Jill , Barr Michael S. , Dy Sydney Morss
Published: June 2021

Although most patient–clinician interactions occur in ambulatory care, little research has addressed measuring ambulatory patient safety or how primary care redesign such as the patient-centered medical home (PCMH) addresses patient safety. Our objectives were to identify PCMH standards relevant to patient safety, construct a measure of patient safety activity implementation, and examine differences in adoptions of these activities by practice and community characteristics. Using a consensus process, we selected elements among a widely adopted, nationally representative PCMH program representing activities that, according to a physician panel, represented patient safety overall and in four domains (diagnosis, treatment delays, medications, and communication and coordination) and generated a score for each. We then evaluated this score among 5,007 practices with the highest PCMH recognition level. Implementation of patient safety activities varied; the few military practices (2.4%) had the highest, and community clinics the lowest, patient safety score, both overall (82.0 and 72.0, respectively, p < .001) and across specific domains. Other practice and community characteristics were not associated with the patient safety score. Understanding better what factors are associated with implementation of patient safety activities may be a key step in improving ambulatory patient safety.
Value-Based Purchasing Programs (VBPs)
Authors: Roman Sheila H. , Major Catherine Eikel
Published: June 2021

Quality measurement is an intrinsic component of value-based purchasing, yet the quality measures currently in use for Value-Based Purchasing Programs (VBPs) are generally derived from a potpourri of measures originally built for other purposes. Only a handful of VBPs have definitively shown savings or expanded nationally. We suggest that to shift the health care reimbursement system in the United States to paying for value, quality measures used in VBPs should be vetted as “fit for purpose.” We advocate that quality measures deemed “fit” for VBPs be defined primarily by the impact of the quality measures on providers, patients, the provider-patient relationship and what matters to patients. We define 5 attributes of quality measures we believe necessary to link the actions of providers and patients and lead to value for our health care system. “Fit for purpose” quality measures should focus health care delivery on value improvement and create a culture of value in our health care system.
Mental Health Outcomes Among British Healthcare Workers—Lessons From the First Wave of the Covid-19 Pandemic
Authors: Debski Maciej , Abdelaziz Hesham K. , Sanderson Jo , Wild Susan , Assaf Omar , Wiper Andrew , Nabi Amjad , Abdelrahman Amr , Eichhofer Jonas , Skailes Geraldine , Gardner Jim , Moynes Kevin , Goode Grahame , Pathan Tayeem , Patel Billal , Kumar Somnath , Taylor Rebecca , Galasko Gavin , More Ranjit , Chalil Shajil , Choudhury Tawfiq
Published: June 2021

Objective:

To ascertain the level of psychological distress, using validated psychology tools, among British National healthcare workers (HCW) during the first wave of the Covid-19 crisis.

Methods:

A multi-centre, anonymized, all-comer staff survey across 3 hospitals in Lancashire, England during the Covid-19 first wave (April to June 2020), consisting of Patient Health Questionnaire (PHQ-9), Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Events Scale (IES-6).

Results:

Among 1113 HCW, median (IQR) PHQ-9, GAD-7, PSS-10, and IES-6 score was 7 (3 to 11), 6 (3 to 11), 19 (13 to 24), and 9 (5 to 14), respectively. Potential predictors of higher levels of psychological distress included living alone, disabled dependents, history of depression/anxiety, and being female.

Conclusions:

The study indicates a high prevalence of psychological distress during the acute Covid-19 period among HCW, identifies groups at risk and areas of future research.
Healthy Habits in Firefighters: Assessment in Shift Days Versus Days Off
Authors: López-Bermudo Lucía , Gómez-Landero Luis Arturo
Published: June 2021

Objective:

The aim of this study was to compare dietary habits, sleep habits, and injury incidence between shift days and days off among Spanish firefighters.

Methods:

24-Hour dietary recalls, and sleep and injury questionnaires on both days were collected from 28 Sevillian professional firefighter, as well as anthropometric measurements and a physical activity questionnaire.

Results:

Firefighters consumed 433 more kilocalories (P < 0.001), 2.4% and 3.1% more kilocalories from fat and monounsaturated fatty acids, respectively (P < 0.05), had 3.7 times greater chance of being injured and slept 2 hours and 18 minutes less (P < 0.001) in their shift days. Higher body fat percentages were found in older and less active firefighters.

Conclusions:

Shift work appears to influence their dietary habits, injury incidence, and sleep habits, so measures to alleviate the consequences of shift work in firefighters should be taken.
Identifying an Optimal Cut-Off Point for Musculoskeletal Pain in the Upper Extremities to Prevent Lowered Work Performance
Authors: Kwon Suyoung , Lee Soo-Jeong , de Castro A.B. , Herting Jerald R. , Bao Stephen , Johnson Kurt
Published: June 2021

Objective:

This study identified when musculoskeletal pain (MSP) in the upper extremities indicates lowered work performance to gauge when secondary prevention of musculoskeletal disorders is needed.

Methods:

Seven hundred thirty-three subjects from 12 manufacturing or healthcare facilities in Washington state participated. Work performance was measured by the Disabilities of the Arm, Shoulder and Hand work module (DASH-Work). Each DASH-Work score was compared to the mean among U.S. workers to determine if workers had lowered work performance. ROC curve analysis was conducted to find the cut-off in a composite MSP index (summing MSP intensities in shoulders, elbows/forearms, and hands/wrists; range 0 to 24) to detect lowered work performance.

Results:

The MSP index score of 2 achieved the best balance between sensitivity (0.79) and specificity (0.69) in detecting lowered work performance.

Conclusions:

To prevent reduced work performance, moderate or multisite pain may require proper management.
Chronic Disease, Allergies, and Increased Years of Running Are Risk Factors Predicting Gradual Onset Running-Related Injuries in Ultramarathon Runners—SAFER XIX Study in 29 585 Race Entrants
Authors: Mokwena Patience L. , Schwellnus Martin P. , Van Rensburg Audrey J. , Ramagole Dimakatso A. , Boer Pieter , Jordaan Esme
Published: June 2021

Objectives:

To identify risk factors that predict gradual onset running-related injuries (GORRIs) in ultramarathon runners entering a mass community-based event.

Design:

Descriptive cross-sectional study.

Setting:

Two Oceans 56 km ultramarathon 2012 to 2015.

Participants:

Race entrants (n = 42 003) completed a compulsory pre-race medical history questionnaire; 29 585 (70.4%) of entrants consented.

Dependent/Outcome Variable:

A history of GORRIs in the past 12 months among race entrants.

Main Outcome Measures:

In a multi-variate model, runner demographics, training variables (years of recreational running, weekly running distance, training running speed), history of chronic disease (composite score), and history of allergies were included as factors predicting GORRIs. Prevalence (%) and prevalence ratios (PR, 95% CIs) are reported.

Results:

The lifetime prevalence of GORRIs in ultramarathon runners was 24.4%. Independent factors predicting GORRIs were: higher chronic disease composite score (PR = 2.05 times increase risk for every 2 additional chronic diseases; P < 0.0001), history of allergies (PR = 1.66; P < 0.0001), increased years of recreational running (PR = 1.07 times increased risk for every 5 year increase in running; P < 0.0001), lower average weekly running distance (PR = 0.98 times decreased risk for every 15 km increase weekly running distance; P < 0.0001), and slower average training running speed (PR = 0.96 times decreased risk for every km/h increase in training running speed; P < 0.0001).

Conclusions:

Novel risk factors predicting GORRIs are increased number of chronic diseases and a history of allergies. These factors, together with training variables (years of recreational running, weekly running distance, and training running speed) can be targeted to develop and implement injury prevention, treatment, and rehabilitation interventions in ultramarathon runners.
Effect of Genetic Polymorphism of the CYP2D6 Gene on the Efficacy and Safety of Fluvoxamine in Major Depressive Disorder
Authors: Zastrozhin Michael , Skryabin Valentin , Smirnov Valeriy , Zastrozhina Anastasiya , Grishina Elena , Ryzhikova Kristina , Bure Irina , Golovinskii Pavel , Koporov Sergey , Bryun Evgeniy , Sychev Dmitry
Published: June 2021

Background:

Previous studies have shown that cytochrome P450 2D6 (CYP2D6) is involved in the metabolism of fluvoxamine, the activity of which is highly dependent, inter alia, on the polymorphism of the gene encoding it. The objective of our study was to investigate the effect of 1846G>A polymorphism of the CYP2D6 gene on the efficacy and safety of fluvoxamine, using findings on CYP2D6 enzymatic activity and on CYP2D6 expression level in patients with depressive disorders comorbid with alcohol use disorder.

Study question:

Efficacy and safety of fluvoxamine depend on the polymorphism of CYP2D6 gene in patients with major depressive disorder.

Study design:

Our study enrolled 96 male patients with depressive disorders comorbid with alcohol use disorder. Patients were examined on days 1, 9, and 16 of fluvoxamine therapy.

Measures and Outcomes:

Treatment efficacy was evaluated using the validated psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels, we performed the real-time polymerase chain reaction. The activity of CYP2D6 was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of given isoenzyme and its metabolite in urine (6-hydroxy-1,2,3,4-tetrahydro-β-carboline/pinoline ratio).

Results:

Our study revealed the statistically significant results for the treatment efficacy evaluation [the Hamilton Depression Rating Scale scores at the end of the treatment course: (GG) 2.0 (1.0–4.0) and (GA) 5.0 (4.0–7.0), P < 0.001]. Analysis of the results of the pharmacotranscriptomic part of the study did not show the statistically significant difference in the hsa-miR-370-3p plasma levels in patients with different genotypes: (GG) 26.9 (15.0–32.2), (GA) 31.8 (22.7–33.7), P = 0.247. In addition, we evaluated the relationship between the CYP2D6 enzymatic activity (as evaluated by 6-hydroxy-1,2,3,4-tetrahydro-β-carboline/pinoline ratio measurement) and the hsa-miR-370-3p plasma concentration: rs = −0.243, P = 0.017.

Conclusions:

The effect of genetic polymorphism of the CYP2D6 gene on the efficacy and safety profiles of fluvoxamine was demonstrated in a group of 96 patients with depressive disorders comorbid with alcohol use disorder.
A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults
Authors: Madre Chrystele , Mašić Mario , Prlenda-Touilleux Daniela , Brueckner Annecarin , Koletzko Sibylle , Fabre Alexandre , Viala Jérome , Lima Rosa , Enaud Raphael , Lemale Julie , Kolho Kaija-Leena , Bergoin Charlotte , Martinez-Vinson Christine , Dugelay Emmanuelle , Alvisi Patrizia , Aloi Marina , Miele Erasmo , Duclaux-Loras Remi , Nachury Maria , Languepin Jane , Willot Stephanie , Dupont-Lucas Claire , Mosca Alexis , Tzivinikos Christos , Shamasneh Ibrahim , Kolaček Sanja , Hugot Jean-Pierre
Published: June 2021

Objectives:

Digestive perianastomotic ulcerations (DPAU) resembling Crohn disease lesions are long-term complications of intestinal resections, occurring in children and young adults. They are known to be uncommon, severe and difficult to treat.

Methods:

In the absence of recommendations, we performed a large European survey among the members of the ESPGHAN working group on inflammatory bowel disease (IBD) in order to collect the experience of expert pediatric gastroenterologists on DPAU.

Results:

Fifty-one patients (29 boys and 22 girls) were identified from 19 centers in 8 countries. Most patients were followed after necrotizing enterocolitis (n = 20) or Hirschsprung disease (n = 11). The anastomosis was performed at a median age (interquartile range) of 6 [1–23] months, and first symptoms occurred 39 [22–106] months after surgery. Anemia was the most prevalent symptom followed by diarrhea, abdominal pain, bloating, and failure to thrive. Hypoalbuminemia, elevated CRP, and fecal calprotectin were common. Deep ulcerations were found in 59% of patients usually proximally to the anastomosis (68%). During a median follow-up of 40 [19–67] months, treatments reported to be the most effective included exclusive enteral nutrition (31/35, 88%), redo anastomosis (18/22, 82%), and alternate antibiotic treatment (37/64, 58%).

Conclusions:

Unfortunately, persistence of symptoms, failure to thrive, and abnormal laboratory tests at last follow-up in most of patients show the burden of DPAU lacking optimal therapy and incomplete understanding of the pathophysiology.
Gastrointestinal Perspective of Coronavirus Disease 2019 in Children—An Updated Review
Authors: Assa Amit , Benninga Marc A. , Borrelli Osvaldo , Broekaert Ilse , de Carpi Javier Martin , Saccomani Marco Deganello , Dolinsek Jernej , Mas Emmanuel , Miele Erasmo , Thomson Mike , Tzivinikos Christos
Published: June 2021

Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.
Integrating Sexually Transmitted Infection Testing and Treatment With Routine HIV Care in Gaborone, Botswana
Authors: Carveth-Johnson Tembe , Dunin De Skrzynno Sophie , Wynn Adriane , Moshashane Neo , Ramontshonyana Kehumile , Lebelonyane Refeletswe , Mussa Aamirah , Ramogola-Masire Doreen , Klausner Jeffrey , Morroni Chelsea
Published: June 2021

Background

Sexually transmitted infection (STI) testing is not routinely offered in many countries, and management is symptoms based. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are associated with an increased risk of HIV transmission. We assess the feasibility and acceptability of integrating CT/NG testing into routine HIV care in Botswana, as well as the prevalence and correlates of CT/NG infections.

Method

A prospective study was conducted at an HIV clinic in Gaborone between February and October 2019. Eligibility criteria included the following: ≥18 years, HIV infected, and not treated for CT/NG in the past month. Participants self-collected samples and responded to a questionnaire on sociodemographic and health characteristics. Samples were processed using the GeneXpert. Patients were offered same-day results in person or by telephone. Those who tested positive were treated.

Results

Of 806 patients informed of the study, 526 (65%) expressed interest and 451 (60%) were enrolled. The median age was 48 years, and 66% were women. All participants provided self-collected samples, were successfully tested, and received results. Almost all reported sample self-collection was easy. The prevalence of CT/NG was 5%. Most participants (73%) with a positive result were asymptomatic. Among infected, 20 (91%) received same-day results and all were treated. Younger age, female sex, and pain during sex were associated with having CT/NG.

Conclusions

Integrating STI testing into routine HIV care was feasible, self-collecting specimens was highly acceptable, but uptake of testing was low. Where blanket screening to the entire clinic population may not be feasible because of resource limitation, one strategy could be to prioritize sexually active patients, younger patients, and women.
Diagnostic Accuracy of Rapid Point-of-Care Tests for Detecting Active Syphilis: A Systematic Review and Meta-Analysis
Authors: Angel-Müller Edith , Grillo-Ardila Carlos Fernando , Amaya-Guio Jairo , Torres-Montañez Nicolas
Published: June 2021

Background

Syphilis represents an important cause of morbidity and mortality. Point-of-care (POC) test offers the advantages of diagnosing the condition and the possibility of starting treatment immediately.

Methods

MEDLINE, Embase, CENTRAL, LILACS, World Health Organization International Clinical Trials Registry Platform, Web of Science, OpenGrey, and DARE were searched without language restrictions from inception to September 30, 2020. Diagnostic test accuracy studies that enrolled men and nonpregnant women of reproductive age under field conditions were analyzed. Only studies wherein all the patients had undergone a rapid POC test and those that included the reference standard (treponemal plus nontreponemal test) were eligible for inclusion. Studies were independently assessed for inclusion, data extraction, and bias risk. The data from these studies were extracted for meta-analyses. The quality of the evidence was assessed using the GRADE approach. Registration Prospero CRD42018107532.

Results

Nine studies with 9666 participants were included. Nine POC brands were assessed. Sensitivities of the tests ranged from 0.67 to 1.00 and specificities from 0.93 to 1.00. The mean sensitivity and specificity of all the included studies was 0.86 (95% confidence interval, 0.79–0.91) and 0.98 (95% confidence interval, 0.96–0.99), respectively.

Conclusions

Based on the results of this systematic review, the POC test for syphilis showed good sensitivity and excellent specificity.
High Number of Positive Rapid Plasma Reagin With Low Titers Using the Automated AIX 1000 RPR System
Authors: Palavecino Elizabeth L. , Soltani Sohaila , Keller Ryan , Elliott Stephanie , McNeil Candice J.
Published: June 2021

This study evaluated the performance of manual rapid plasma reagin (RPR) and automated AIX1000 RPR tests for the diagnosis of syphilis. Manual RPR showed a 3% reactive result compared with 5.8% for the automated test mainly because of RPR reactive results with low titers not confirmed by Treponema pallidum particle agglutination.
Decreasing Chlamydial Reinfections in a Female Urban Population
Authors: Suarez Jennifer Denise , Snackey Alvarez Kristin , Anderson Sharon , King Helen , Kirkpatrick Emily , Harms Michael , Martin Robert , Adhikari Emily
Published: June 2021

Background

Chlamydia is the most reported bacterial sexually transmitted infection (STI). The rates of chlamydia rose by 19% between 2011 and 2018. The STI National Strategic Plan (2021–2025), encourages coordinated solutions to address STIs and reduce disparities in disadvantaged populations.

Methods

We implemented institutional policy changes, clinical decision support, including a Best Practice Advisory, and defaulted SmartSet with provider and patient education for women's health clinics at a large county health system. The advisory prompted providers to follow best practices when treating Chlamydia trachomatis infections. New C. trachomatis diagnosis cohorts were compared preintervention and postintervention for 6-month reinfection rates and patient and expedited partner treatment (EPT) practices.

Results

Five hundred and nineteen women were included in the final analysis. Six-month chlamydia reinfection was lower in the postintervention cohort after adjusting for age (12.3% [26/211] vs 6.5% [20/308], P = 0.02). There was an increase in directly observed therapy of primary patients (17.5% [37/211] vs 77.3% [238/308], P < 0.001), an increase in EPT prescriptions written (4.3% [9/211] vs 79.5% [245/308], P < 0.0001), and a decrease of partners referred out for treatment (61.6% [130/211] vs 5.2% [16/308], P < 0.001) when compared with the control group. The majority of EPT was patient-delivered partner therapy postintervention (3.3% [7/211] vs 69.2% [213/308], P < 0.001).

Conclusions

A multifaceted, streamlined approach was effective in changing provider practices in the treatment of C. trachomatis. Increased rates of directly observed therapy for primary patient treatment and increased rates of patient-delivered partner therapy were observed postimplementation in addition to lower 6-month reinfection rates in a public women's health clinic setting.
Gut Microbiota in Psychiatric Disorders: A Systematic Review
Authors: Chen Long Long , Abbaspour Afrouz , Mkoma George F. , Bulik Cynthia M. , Rück Christian , Djurfeldt Diana
Published: June 2021

Objective

This systematic review sought to comprehensively summarize gut microbiota research in psychiatric disorders following PRISMA guidelines.

Methods

Literature searches were performed on databases using keywords involving gut microbiota and psychiatric disorders. Articles in English with human participants up until February 13, 2020, were reviewed. Risk of bias was assessed using a modified Newcastle-Ottawa Scale for microbiota studies.

Results

Sixty-nine of 4231 identified studies met the inclusion criteria for extraction. In most studies, gut microbiota composition differed between individuals with psychiatric disorders and healthy controls; however, limited consistency was observed in the taxonomic profiles. At the genus level, the most replicated findings were higher abundance of Bifidobacterium and lower abundance of Roseburia and Faecalibacterium among patients with psychiatric disorders.

Conclusions

Gut bacteria that produce short-chain fatty acids, such as Roseburia and Faecalibacterium, could be less abundant in patients with psychiatric disorders, whereas commensal genera, for example, Bifidobacterium, might be more abundant compared with healthy controls. However, most included studies were hampered by methodological shortcomings including small sample size, unclear diagnostics, failure to address confounding factors, and inadequate bioinformatic processing, which might contribute to inconsistent results. Based on our findings, we provide recommendations to improve quality and comparability of future microbiota studies in psychiatry.
Harnessing Life’s Slings and Arrows: The Science and Opportunities for Mindfulness Meditation During a Global Pandemic and Beyond
Authors: Loucks Eric B. , Rosenkranz Melissa A. , Creswell J. David
Published: June 2021

We are at a difficult time in history with societal increases in stress, loneliness, and psychopathology, along with high rates of obesity, sedentary lifestyles, and chronic pain. Mindfulness interventions offer promise to address these societal issues. However, in order to make best use of the opportunities revealed by our current challenges, we must: (1) tackle these issues head-on with inclusive, innovative, and creative experimental designs and interventions, and (2) collectively adhere to rigorous, high quality methods so as to provide an evidence-based integration of mindfulness interventions into mainstream medicine and public health.

We find there are several areas for which important advances are happening, including sampling socially diverse populations, examining mechanisms of action, pain management, and health behaviors. Furthermore, rigorous methods, including measurement, causal inference from control groups, delivery and scalability of mindfulness interventions, and effect modifiers to determine who mindfulness programs work best for are also gaining traction. This special issue on Mindfulness: Biobehavioral Mechanisms and Health Outcomes attends to many of these issues, several of which are highlighted in this editorial perspective.
A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy
Authors: Cabañas Weisz Laura M. , Guarin Diego L. , Townley William A.
Published: June 2021

Background

Facial palsy causes devastating disability due to loss of facial function as well as social and psychological impairment. Cheek slings are a secondary technique that provide static support to the midface. This study aimed to describe our technique and compare a traditional sling material (tensor fascia lata) with a porcine-derived acellular dermal matrix alternative (Strattice).

Methods

A 5-year case-control retrospective review of consecutive static cheek slings in a tertiary cancer and facial palsy center was performed. Demographic data, risk factors, and complications were collected and compared. Improvement in static smile position was assessed by Emotrics (Massachusetts Eye and Ear Infirmary, Boston, MA) at 3 months. Long-term sling failure was assessed by need for reoperation.

Results

The study group comprised 41 patients on which 33 autogenous fascia lata slings and 12 Strattice slings were performed. Medium-term improvement in static smile position was similar between the 2 groups (judged by the Emotrics software), as was complication rate (P = 0.496). Need for revision due to stretching was higher in the Strattice group but did not achieve significance (P = 0.087). Mean follow-up was 38.02 ± 19.17 months. Twelve of 41 patients were deceased at study conclusion.

Conclusions

Fascia lata and Strattice slings provide satisfactory results in restoring symmetry at rest and functional oral competence. Our results suggest that Strattice is a safe sling material with an acceptable risk profile and comparable medium-term maintenance of tensile strength to fascia lata, and should be considered where life expectancy, donor site morbidity, and procedure length are important considerations.
Safeguarding Skin Grafts
Authors: Patel Benjamin J. , Asher Christian M. , Bystrzonowski Nicola , Healy Ciaran
Published: June 2021

Background

Effective skin graft fixation is vital in preventing sheering forces, seroma, and hematoma from compromising graft take. Yet, selecting the ideal technique for securing skin grafts remains a contentious subject, with significant variation in practice existing between surgeons. There is, therefore, benefit to be derived from assessing the literature for evidence-based recommendations to guide the decision-making process.

Methods

A search of Medline and Embase was performed using appropriate key terms, yielding 419 articles. Reference lists were analyzed. Inclusion and exclusion criteria were composed. Level I to III studies, as defined by the Centre for Evidence-Based Medicine, that compared skin graft fixation methods were analyzed. Rayyan QCRI was used for abstract and title screening. After full text screening, 41 studies were included for qualitative analysis. All included randomized control trials (RCTs) were assessed for risk of bias using the Cochrane Risk-of-Bias 2 (ROB2) tool.

Results

We identified 4 groups of fixation technique: “tie-over bolster” (TOB), “no TOB,” “adhesive glues,” and “negative pressure wound therapy” (NPWT). Twelve studies compared TOB with no TOB, with no difference in graft take demonstrated. Sixteen studies compared adhesive glues with traditional methods, with no difference in graft take demonstrated. Thirteen studies compared NPWT with traditional methods, with enhanced graft take demonstrated. Risk of bias was deemed low in 1 of 13 RCTs.

Conclusions

Based on the current evidence, only NPWT is associated with enhanced graft take. However, there is a scarcity of robust level I evidence comparing different fixation techniques, meaning that strong recommendations cannot be made. We propose examples of hypothesis-driven RCTs, in predetermined clinical settings, based on the theoretical benefits of the techniques that would add value to clinical practice.
NPWT Resource Use Compared With Conventional Wound Treatment in Subcutaneous Abdominal Wounds With Healing Impairment After Surgery
Authors: Seidel Dörthe , Lefering Rolf
Published: June 2021

Objective:

To compare resource utilization of NPWT and CWT for SAWHI after surgery

Summary of Background Data:

NPWT is widely used in the management of complex wounds but high-level evidence of its resource use remains sparse.

Methods:

The multicenter, multinational, randomized clinical SAWHI study enrolled a total of 539 consecutive, compliant adult patients with SAWHI after surgery without fascial dehiscence between August 2, 2011, and January 31, 2018. Patients were randomly assigned to NPWT and CWT stratified by study site and wound size using a centralized web-based tool. Evaluation of direct resource use comprised inpatient and outpatient time, personnel and material for wound treatment, and associated wound-related procedures. The resource use analysis was primarily based on the per protocol population (NPWT 157; CWT 174).

Results:

Although treatment length within 42 days was significantly shorter in the NPWT arm {Mean [Standard deviation (SD)] NPWT 22.8 (13.4); CWT 30.6 (13.3); P < 0.001 U-test}, hospitalization time was shorter with CWT [Mean (SD) NPWT 13.9 (11.1); CWT 11.8 (10.8); P = 0.047 U-test]. Significantly more study participants were outpatient with CWT [N=167 (96.0%)] than with NPWT [N = 140 (89.2%) (P = 0.017)]. Time for dressing changes per study participant [Mean (SD) (min) NPWT N = 133, 196 (221.1); CWT N = 152, 278 (208.2); P < .001 U-test] and for wound-related procedures [Mean (SD) (min) NPWT 167 (195); CWT 266 (313); P < 0.001 U-test] was significantly lower with NPWT.

Conclusions:

NPWT reduces resource use and maybe an efficient treatment alternative to CWT for SAWHI after surgery.