bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary resistance to first-generation EGFR-TKIs induced by MDM2 amplification in NSCLC
Authors: Sun Dantong , Zhu Yan , Zhu Jingjuan , Tao Junyan , Wei Xiaojuan , Wo Yang , Hou Helei
Published: July 2020

Introduction

Targeted therapy for NSCLC is rapidly evolving. EGFR-TKIs benefit NSCLC patients with sensitive EGFR mutations and significantly prolong survival. However, 20–30% of patients demonstrate primary resistance to EGFR-TKIs, which leads to the failure of EGFR-TKI treatment. The mechanisms of primary resistance to EGFR-TKIs require further study.

Methods

Targeted sequencing was used for the detection of genomic alterations among patients in our center. Regular cell culture and transfection with plasmids were used to establish NSCLC cell lines over-expressing MDM2 and vector control. We used the MTT assays to calculate the inhibition rate after exposure to erlotinib. Available datasets were used to determine the role of MDM2 in the prognosis of NSCLC.

Results

Four patients harboring concurrent sensitive EGFR mutations and MDM2 amplifications demonstrated insensitivity to EGFR-TKIs in our center. In vitro experiments suggested that MDM2 amplification induces primary resistance to erlotinib. Over-expressed MDM2 elevated the IC50 value of erlotinib in HCC2279 line and reduced the inhibition rate. In addition, MDM2 amplification predicted a poor prognosis in NSCLC patients and was associated with a short PFS in those treated with EGFR-TKIs. The ERBB2 pathway was identified as a potential pathway activated by MDM2 amplification could be the focus of further research.

Conclusion

MDM2 amplification induces the primary resistance to EGFR-TKIs and predicts poor prognosis in NSCLC patients. MDM2 may serve as a novel biomarker and treatment target for NSCLC. Further studies are needed to confirm the mechanism by which amplified MDM2 leads to primary resistance to EGFR-TKIs.
Nondestructive evaluation of oviposition behavior of the bamboo powderpost beetle, Dinoderus minutus, using X-ray computed tomography and acoustic emission
Authors: Watanabe Hiroki , Yanase Yoshiyuki , Fujii Yoshihisa
Published: July 2020

In this study, X-ray computed tomography (CT) and acoustic emission (AE) monitoring were used to nondestructively analyze the oviposition behavior of the bamboo powderpost beetle,Dinoderus minutus, which takes place inside bamboo culms. Newly mated adult females ofD. minutuswere singly exposed to a bamboo piece, obtained from culms ofmadake(Phyllostachys bambusoides), and were kept at a temperature of 28 °C and a relative humidity of 65% with a photoperiod ofL12:D12. The bamboo pieces were subjected to X-ray CT scanning every 2–5 days, and they were also monitored continuously using AE. The behavior of males after mating was also analyzed in a similar manner. Oviposition tunnels bored across the bamboo vascular bundles and eggs deposited in the metaxylem vessels were visualized in the CT images. The females lived for 75 ± 17 days (mean ± SD) after mating, and they created tunnels that were 116.4 ± 52.1 mm in length and 177.2 ± 78.9 mm3in volume and laid 253.1 ± 125.3 eggs in total. Using AE monitoring, the tunneling activity of the females was detected. The AE data indicated that continuous tunneling activity of the females was separated by regular short pauses, lasting approximately 1 h, occurring at intervals of around 2 days. The tunneling activity of the females did not exhibit clear circadian rhythms, suggesting that it was unaffected by external photoperiod. The males tunneled more slowly than the females and had no preference to the boring direction, and their activities were in synchronization with the photoperiod.
Examining gender differences of social media use for activity planning and travel choices
Authors: Karatsoli Maria , Nathanail Eftihia
Published: July 2020

Background

The explosive growth of social media has rendered them powerful communication channels. User generated content is an important source of inspiration and influence among web friends, it generates new activities and consequently affects mobility decisions. Whether to visit a place, or how to get to a place of interest are decisions that can be triggered through people’s interactions on social media.

Objective

The main objective of this paper is to investigate the influence of social media use on activity planning and travel arrangements for women and men.

Methods

An online survey was conducted to examine the social media use and the impact of the shared content for women and men, on the phase before any activity in an urban environment. Inferential statistics were applied to detect gender differences in a sample size comprised of 804 respondents.

Result

The significant results showed that the variables gender and social media use for activity planning and travel arrangements are associated with each other. Results have also indicated that the influence of reviews and ratings, photos/ videos and proposed transport mode on activity planning is gender dependent. Photos/ videos influence more often both women (m=3.47) and men (m=3.00) than reviews and ratings (m=3.21 for women and 2.94 for men). Both these contents influence more than proposed transport mode (m=2.62 and 2.37 for women and men).

Conclusion

The analysis of the results indicated that before an activity, both women and men tend to use majorly social media for activity planning and travel arrangements, while photos/videos influence women’s decisions more often than men.Travel arrangements of the majority of respondents would be influenced by a post of a designated account related to transport. Finally, social media use affects travel arrangements of both women and men more before performing an activity rather than during.
Modelling the shape of the pig scapula
Authors: Nordbø Øyvind
Published: July 2020

Background

The shape of pig scapula is complex and is important for sow robustness and health. To better understand the relationship between 3D shape of the scapula and functional traits, it is necessary to build a model that explains most of the morphological variation between animals. This requires point correspondence, i.e. a map that explains which points represent the same piece of tissue among individuals. The objective of this study was to further develop an automated computational pipeline for the segmentation of computed tomography (CT) scans to incorporate 3D modelling of the scapula, and to develop a genetic prediction model for 3D morphology.

Results

The surface voxels of the scapula were identified on 2143 CT-scanned pigs, and point correspondence was established by predicting the coordinates of 1234 semi-landmarks on each animal, using the coherent point drift algorithm. A subsequent principal component analysis showed that the first 10 principal components covered more than 80% of the total variation in 3D shape of the scapula. Using principal component scores as phenotypes in a genetic model, estimates of heritability ranged from 0.4 to 0.8 (with standard errors from 0.07 to 0.08). To validate the entire computational pipeline, a statistical model was trained to predict scapula shape based on marker genotype data. The mean prediction reliability averaged over the whole scapula was equal to 0.18 (standard deviation = 0.05) with a higher reliability in convex than in concave regions.

Conclusions

Estimates of heritability of the principal components were high and indicated that the computational pipeline that processes CT data to principal component phenotypes was associated with little error. Furthermore, we showed that it is possible to predict the 3D shape of scapula based on marker genotype data. Taken together, these results show that the proposed computational pipeline closes the gap between a point cloud representing the shape of an animal and its underlying genetic components.
RainDrop: Rapid activation matrix computation for droplet-based single-cell RNA-seq reads
Authors: Niebler Stefan , Müller André , Hankeln Thomas , Schmidt Bertil
Published: July 2020

Background

Obtaining data from single-cell transcriptomic sequencing allows for the investigation of cell-specific gene expression patterns, which could not be addressed a few years ago. With the advancement of droplet-based protocols the number of studied cells continues to increase rapidly. This establishes the need for software tools for efficient processing of the produced large-scale datasets. We address this need by presenting RainDrop for fast gene-cell count matrix computation from single-cell RNA-seq data produced by 10x Genomics Chromium technology.

Results

RainDrop can process single-cell transcriptomic datasets consisting of 784 million reads sequenced from around 8.000 cells in less than 40 minutes on a standard workstation. It significantly outperforms the established Cell Ranger pipeline and the recently introduced Alevin tool in terms of runtime by a maximal (average) speedup of 30.4 (22.6) and 3.5 (2.4), respectively, while keeping high agreements of the generated results.

Conclusions

RainDrop is a software tool for highly efficient processing of large-scale droplet-based single-cell RNA-seq datasets on standard workstations written in C++. It is available at https://gitlab.rlp.net/stnieble/raindrop.
Eravacycline susceptibility was impacted by genetic mutation of 30S ribosome subunits, and branched-chain amino acid transport system II carrier protein, Na/Pi cotransporter family protein in Staphylococcus aureus
Authors: Wang Zhanwen , Lin Zhiwei , Bai Bing , Xu Guangjian , Li Peiyu , Yu Zhijian , Deng Qiwen , Shang Yongpeng , Zheng Jinxin
Published: July 2020

Background

Our previous research indicated the excellent in vitro antibacterial activity of Eravacycline (Erava) and its heteroresistance frequency against clinical Staphylococcus aureus isolates. In this study, we further aimed to investigate the mechanisms of Erava resistance and heteroresistance in S. aureus. Eight parental S. aureus isolates were induced under Erava pressure in vitro and the Erava-resistant isolates were selected and identified. Then, the genetic mutations of 30S ribosomal subunits were analyzed by PCR and sequence alignment. RT-qPCR analysis were performed to compare the relative expression of eight candidate genes impacting the susceptibility of tetracycline (Tet) between the resistant or heteroresistant and parental isolates. Furthermore, the in vitro overexpression vectors of three selected candidate genes were constructed to test their impact on the heteroresistance and resistance of Erava in S. aureus.

Results

The MICs elevation in Erava-induced resistant S. aureus isolates were identified and the increasing MICs values of another two Tet class antibiotics, including both omadacycline (Omada) and tigecycline (Tige) were also tested. Genetic mutations in 30S ribosomal protein S10 were found frequently in Erava-derived resistant isolates. RT-qPCR analysis and the in vitro overexpression experiments indicated that USA300HOU_RS00550 (an Na/Pi cotransporter family protein) and USA300HOU_RS01625 (a branched-chain amino acid transport system II carrier protein) contributed to Erava heteroresistance in S. aureus.

Conclusion

Genetic mutation of 30S ribosome subunits contributed to Erava resistance, and the transcriptional overexpression of USA300HOU_RS01625 and USA300HOU_RS00550 also participated in the occurrence of Erava heteroresistance in S. aureus.
Cow manure application effectively regulates the soil bacterial community in tea plantation
Authors: Zhang Shuning , Sun Litao , Wang Yu , Fan Kai , Xu Qingshan , Li Yusheng , Ma Qingping , Wang Jiguo , Ren Wanming , Ding Zhaotang
Published: July 2020

Background

Cow manure is not only an agricultural waste, but also an organic fertilizer resource. The application of organic fertilizer is a feasible practice to mitigate the soil degradation caused by overuse of chemical fertilizers, which can affect the bacterial diversity and community composition in soils. However, to our knowledge, the information about the soil bacterial diversity and composition in tea plantation applied with cow manure fertilization was limited. In this study, we performed one field trial to research the response of the soil bacterial community to cow manure fertilization compared with urea fertilization using the high-throughput sequencing technique of 16S rRNA genes, and analyzed the relationship between the soil bacterial community and soil characteristics during different tea-picking seasons using the Spearman’s rank correlation analysis.

Results

The results showed that the soil bacterial communities were dominated by Proteobacteria, Bacteroidetes, Acidobacteria and Actinobacteria across all tea-picking seasons. Therein, there were significant differences of bacterial communities in soils with cow manure fertilization (CMF) and urea fertilization (UF) in three seasons: the relative abundance of Bacteroidetes in CMF was significantly higher than that in UF and CK in spring, and the relative abundance of Proteobacteria and Bacteroidetes in CMF was significantly higher than that in UF and CK in autumn. So, the distribution of the dominant phyla was mainly affected by cow manure fertilization. The diversity of bacterial communities in soils with cow manure fertilization was higher than that in soils with urea fertilization, and was the highest in summer. Moreover, soil pH, OM and AK were important environmental properties affecting the soil bacterial community structure in tea plantation.

Conclusions

Although different fertilizers and seasons affect the diversity and structure of soil microorganisms, the application of cow manure can not only improve the diversity of soil bacteria, but also effectively regulate the structure of soil bacterial community in tea plantation. So, cow manure fertilization is more suitable for tea plantation.
A comparison of residual diagnosis tools for diagnosing regression models for count data
Authors: Feng Cindy , Li Longhai , Sadeghpour Alireza
Published: July 2020

Background

Examining residuals is a crucial step in statistical analysis to identify the discrepancies between models and data, and assess the overall model goodness-of-fit. In diagnosing normal linear regression models, both Pearson and deviance residuals are often used, which are equivalently and approximately standard normally distributed when the model fits the data adequately. However, when the response vari*able is discrete, these residuals are distributed far from normality and have nearly parallel curves according to the distinct discrete response values, imposing great challenges for visual inspection.

Methods

Randomized quantile residuals (RQRs) were proposed in the literature by Dunn and Smyth (1996) to circumvent the problems in traditional residuals. However, this approach has not gained popularity partly due to the lack of investigation of its performance for count regression including zero-inflated models through simulation studies. Therefore, we assessed the normality of the RQRs and compared their performance with traditional residuals for diagnosing count regression models through a series of simulation studies. A real data analysis in health care utilization study for modeling the number of repeated emergency department visits was also presented.

Results

Our results of the simulation studies demonstrated that RQRs have low type I error and great statistical power in comparisons to other residuals for detecting many forms of model misspecification for count regression models (non-linearity in covariate effect, over-dispersion, and zero inflation). Our real data analysis also showed that RQRs are effective in detecting misspecified distributional assumptions for count regression models.

Conclusions

Our results for evaluating RQRs in comparison with traditional residuals provide further evidence on its advantages for diagnosing count regression models.
The Strengths and Difficulties Questionnaire is a usable way to address mental health at well-child visits in general practice - a qualitative study of feasibility
Authors: Stokholm Julie Ravneberg , Lykke Kirsten
Published: July 2020

Background

Mental health problems is frequent among children and psychopathology in early childhood seems to predict mental disorders in adulthood. All Danish children are offered seven free well-child visits at their General Practitioner (GP) during their first 5 years of life. GPs have a unique position to address mental health problems at the well-child visits, but they lack a systematic approach when assessing children’s mental health. The purpose of this study was to investigate if the Strengths and Difficulties Questionnaire (SDQ) is a usable way to address preschool children’s mental health in general practice.

Methods

A qualitative study of feasibility. Parents completed an online version of the SDQ at home. At the well-child visit, the GP used the SDQ results as a basis for a talk about the child’s mental health. Afterwards the author JS conducted semistructured interviews with both the parent and the GP over the phone. The interviews were descriptively analyzed using the Framework Approach.

Results

Five primary care centres with 22 general practitioners in both Copenhagen and Region Zealand participated. Twenty four parents completed the SDQ and were interviewed. Participating parents and GPs agreed, that the SDQ introduced mental health as a natural and important part of the well-child visit. Online access had clear advantages: time for reflection at home and preparation, plus a clear result summary for the GP. Some of the GPs were worried that the questionnaire would be too time consuming, and might compromise the individualistic style of general practice. Some parents were worried if children with minor problems would be diagnosed.

Conclusions

The online SDQ was well-accepted and feasible in daily practice. Implementing the SDQ into the well-child visit could strengthen the focus on the child’s mental health. However, before the SDQ can be generally implemented a guideline on how to utilize it in the well-child visit is needed, as well as studies of efficacy in this setting.

Trial registration

Not relevant.
Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms
Authors: Fried Dennis , McAndrew Lisa M. , Helmer Drew A. , Markowitz Sarah , Quigley Karen S.
Published: July 2020

Background

Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms.

Methods

This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre- and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures.

Results

Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R2Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R2Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R2Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R2Δ = .01, p = .16), one-year after deployment.

Conclusions

Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.
Management and treatment of HIV: are primary care clinicians prepared for their new role?
Authors: Wijesinghe Sampath , Alexander Jeffrey L.
Published: July 2020

Background

Current literature suggests the number of HIV clinicians in the United States is diminishing. There are 294,834 primary care providers (PCP) in the United States, and, of these, 3101 provide care to HIV-positive patients. More PCPs to treat and manage HIV patients may be the solution to alleviate the HIV provider shortage. However, PCPs also face challenges, including workforce shortages. We surveyed PCPs to determine perceived barriers, beliefs, and attitudes about their readiness to manage and treat HIV patients.

Methods

Following a quantitative, descriptive, cross-sectional survey design, currently practicing clinicians in primary care (physicians, residents, physician assistants, family nurse practitioners) were emailed a link to the study survey. Three hundred forty-seven family medicine clinicians from 47 states met the study inclusion criteria.

Results

Most (245/347, 70.6%) of the PCPs agreed that PCPs should take care of HIV patients. PCPs practicing HIV medicine (n = 171) were more likely than those not practicing HIV medicine (n = 176) to agree that PCPs should help with the HIV provider shortage (U = 10,384, p < 0.001) and that PCPs are the best solution to the HIV provider shortage (U = 10,294, p < 0.001). The majority (206, 59.4%) believed PCPs are the best solution for the HIV provider shortage. Of 133 physician assistants (PAs) and family nurse practitioners (NPs), seventy (52.6%) believed they could be ready to manage HIV patients with some training.

Conclusion

The HIV provider shortage in the United States is likely to continue. To alleviate the provider shortage, PCPs should be offered additional training, decreased workload, and increased compensation when treating and managing HIV patients. Also, encouraging PAs and family NPs to be involved with HIV medicine may be a solution.
Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy
Authors: Cheikh Hassan Hicham I , Chen Jenny HC , Murali Karumathil
Published: July 2020

Background

Renal replacement therapy (RRT) places a burden on patients, and geographical relocation for easier access to healthcare facilities is a necessity for some. Incidence and factors associated with relocation has not been comprehensively examined at a national level. We aimed to determine proportion, incidence, characteristics of RRT patients who relocate and relocation rate by remoteness of residence and dialysis modality.

Methods

Retrospective cohort analysis using Australian and New Zealand Dialysis and Transplant Registry to examine RRT patients in Australia from January 2005 to December 2015. Relocation incidence was calculated for remoteness of residence and RRT modality as rate per 100 patient years. Factors associated with relocation were examined using competing risk regression models with death as a competing event.

Results

Of 24,676 incident patients on RRT, 5888 (23.9%) relocated with a median time of 1.6 years [IQR 0.7–3.4] years. Relocation incidence was 7.9 per 100 patient years and increased from major cities to very remote regions (7.2 to 48.8 per 100 patient years respectively, p < 0.001). Remoteness of residence was associated with geographical relocation in competing risk analysis especially in remote (SHR 1.20, 95%CI 1.01, 1.41 p = 0.034) and very remote regions (SHR 3.51 95% 3.05, 4.04 p < 0.001). Aboriginal or Torres Strait Islander ethnicity, compared to Caucasian, was independently associated with relocation (SHR 1.18, 95% CI 1.06,1.31, p = 0.002) while transplant patients were less likely to relocate compared to haemodialysis patients (HR 0.37, 95%CI 0.34, 0.39, p < 0.001).

Conclusions

Relocation in patients receiving RRT is associated with remoteness of residence, RRT modality and ethnicity. Reasons for relocation and its impact on patient wellbeing and outcome should be further explored.
The correlation analysis between the Oxford classification of Chinese IgA nephropathy children and renal outcome - a retrospective cohort study
Authors: Wu Heyan , Xia Zhengkun , Gao Chunlin , Zhang Pei , Yang Xiao , Wang Ren , Wang Meiqiu , Peng Yingchao
Published: July 2020

Background

The 2016 Oxford Classification’s MEST-C scoring system predicts outcomes in adults with IgA nephropathy (IgAN), but it lacks tremendous cohort validation in children with IgAN in China. We sought to verify whether the Oxford classification could be used to predict the renal outcome of children with IgAN.

Methods

In this retrospective cohort study, 1243 Chinese IgAN children who underwent renal biopsy in Jinling Hospital were enregistered from 2000 to 2017. The combined endpoint was defined as either a ≥ 50% reduction in estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD). We probed into the relevance betwixt the Oxford classification and renal prognosis.

Results

There were 29% of children with mesangial proliferation(M1), 35% with endocapillary proliferation (E1), 37% with segmental sclerosis/adhesion lesion (S1), 23% with moderate tubular atrophy/interstitial fibrosis (T1 25–50% of cortical area involved), 4.3% with severe tubular atrophy/interstitial fibrosis (T2 > 50% of cortical area involved), 44% with crescent in< 25% of glomeruli(C1), and 4.6% with crescent in> 25% of glomeruli (C2). All children were followed for a medial of 7.2 (4.6–11.7) years, 171 children (14%) arrived at the combined endpoint. The multivariate COX regression model revealed that the presence of lesions S (HR2.7,95%CI 1.8 ~ 4.2, P<0.001) and T (HR6.6,95%CI 3.9 ~ 11.3, P<0.001) may be the reason for poorer prognosis in the whole cohort. In contrast, C lesion showed a significant association with the outcome only in children received no immunosuppressive treatment.

Conclusions

This study revealed that S and T lesions were useful as the long-term renal prognostic factors among Chinese IgAN children.
Bilateral thalamic lesions in a patient with probable acute disseminating encephalomyelitis: a case report
Authors: Zheng Yiming , Zhang Wei , Hao Hongjun , Gao Feng
Published: July 2020

Background

Bilateral thalamic lesions are rare. Here, we describe a case of probable acute disseminating encephalomyelitis (ADEM) with symmetrical bilateral thalamic lesions.

Case presentation

An 85-year-old man presented with weakness of the lower limbs and urinary retention for 1 day, soon followed by coma. He had an H1N1 influenza vaccination 3 months ago. A lumbar puncture showed positive oligoclonal bands and negative results for anti-AQP4 antibodies. A head MRI demonstrated focal symmetrical bilateral thalamic lesions. An MRI of the thoracic spinal cord showed longitudinally extensive lesions in the spinal cord. He was diagnosed with probable ADEM. Despite being treated with IVIG, the patient remained unconscious and died a month later from pneumonia.

Conclusions

In cases with bilateral thalamic lesions, the possibility of ADEM should be considered. The characteristics of the thalamic lesions and imaging findings in other parts of the brain or spinal cord should be taken into account in association with the clinical and laboratory information in making a correct diagnosis.
Applying the WHO ICD-PM classification system to stillbirths in a major referral Centre in Northeast Nigeria: a retrospective analysis from 2010-2018
Authors: Dase Eseoghene , Wariri Oghenebrume , Onuwabuchi Egwu , Alhassan Jacob A. K. , Jalo Iliya , Muhajarine Nazeem , Okomo Uduak , ElNafaty Aliyu U.
Published: July 2020

Background

Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system.

Methods

This was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths’ records. Cause of death was assigned via consensus using the ICD-PM classification system.

Results

There were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000 births (95% CI: 53, 71)], and 2015 [65 per 1000 births (95% CI, 55, 76)]. Antepartum and intrapartum stillbirths were almost equally prevalent (48% vs 52%). Maternal medical and surgical conditions (M4) were the commonest (69.3%) cause of antepartum stillbirths while complications of placenta, cord and membranes (M3) accounted for the majority (45.8%) of intrapartum stillbirths and the trends were similar between 2010 and 2018. Antepartum and intrapartum fetal causes of stillbirths were mainly due to prematurity which is a disorder of fetal growth (A5 and I6).

Conclusions

Most causes of stillbirths in our setting are due to preventable causes and the trends have remained unabated between 2010 and 2018. Progress toward global SBR targets are off-track, requiring more interventions to halt and reduce the high SBR.
Impact of the faecal immunochemical test on colorectal cancer survival
Authors: Gutierrez-Stampa María Angeles , Aguilar Vanessa , Sarasqueta Cristina , Cubiella Joaquín , Portillo Isabel , Bujanda Luis
Published: July 2020

Background

There is already evidence that the faecal immunochemical test (FIT) is a useful tool for the diagnosis of colorectal cancer (CRC) that helps to identify symptomatic patients requiring early colonoscopy. Although the recommendation to use FIT is widely accepted, there are no data concerning whether this strategy improves patient survival.The objective was to assess whether the survival is higher if CRC patients have been first diagnosed by FIT (as compared with the rest of patients with CRC).

Methods

We identified all cases of CRC diagnosed between 2009 and 2016 in Donostialdea (Spain), excluding all the CRC detected in population screening. We focused on symptomatic patients. One thousand five hundred twenty-seven cases of CRC were divided into two groups based on the route to diagnosis: group 1: individuals who tested positive in a FIT during the year before diagnosis, and group 2: others.Survival was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for differences between groups due to other variables associated with survival.

Results

One thousand nine hundred sixty-seven cases of invasive CRC were identified, of which 22.4% were detected in population screening. Of the 1527 cases diagnosed in symptomatic patients, 317 patients had undergone a FIT in the year before the diagnosis of CRC. In 279 cases(18.3%), the result had been positive and this was the first step towards their CRC diagnosis (group 1). Group 2 was composed of the 1248 cases of CRC (81.7%). Considering these cases, 1210 patients with CRC did not undergo any FIT while 38 patients presented a negative result in the year before the diagnosis. The rate of early-stage disease (stage I or II) was higher in group 1 (51.3% vs 45.5% in group 2) (p = 0.04). Furthermore, the 3-year survival was longer in group 1 (72% vs 59% in group 2) (HR 1.50; 95% CI 1.22–1.84).The variables independently associated with worse survival were: group 2, age > 70 years and stage at the moment of diagnosis.

Conclusions

The use of FIT as a diagnostic strategy in symptomatic patients may improve survival in CRC. Nonetheless,FIT is still not widely used in our region.
Incidence and risk factors associated with postoperative delirium following primary elective total hip arthroplasty: a retrospective nationwide inpatient sample database study
Authors: Yang Qinfeng , Wang Jian , Huang Xusheng , Xu Yichuan , Zhang Yang
Published: July 2020

Background

Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database.

Methods

A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated.

Results

A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P < 0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors.

Conclusions

The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences.
“How I whiten my teeth”: YouTube™ as a patient information resource for teeth whitening
Authors: Simsek Huseyin , Buyuk Suleyman Kutalmış , Cetinkaya Ebru , Tural Mubin , Koseoglu Murside Seda
Published: July 2020

Background

YouTube™ is the world’s second most popular website after Google on the Internet. The aim of this study was to assess the quality and content of information YouTube™ videos for patients seeking information about teeth whitening.

Methods

The keyword ‘teeth whitening’ was searched on YouTube™. YouTube™ was filtered by the relevance, and the first 100 videos that met the inclusion criteria were evaluated. The included videos were analyzed for views, duration, time since video upload, likes/dislikes, number of comments, source, material types (dental, natural, and other). Also, video purpose was analyzed under nine categories (definition, material preparation, the procedure of application, material comparison, before/after comparison, symptoms, post-op experience, commercial, educational). Each video was classified according to the quality of information content as ‘good’, ‘moderate’, or ‘poor’. The Kruskal-Wallis test, Fischer’s Exact test and Spearman correlation analyses were performed.

Results

Most videos were uploaded by laypersons (60.0%). The definition of teeth whitening was the most commonly covered topic (74.0%), followed by the procedure of application (54.0%), and post-op experience (36.0%). Only 12% of videos were classified as having good information quality content, 53% moderate, and 35% were rated as poor information content. Poor-information content videos had a significantly higher number of viewing rates than the other groups (P = 0.002), besides the duration was significantly higher in poor-information content videos (P =0.002). There was a significant relationship between the quality of video information and material types (P <0.001).

Conclusions

YouTube™ should not be used as a thoroughly reliable and accurate source for patient information about teeth whitening. More informative and reliable content YouTube™ videos about teeth whitening should be uploaded by professionals.
Phyllanthus amarus prevents LPS-mediated BV2 microglial activation via MyD88 and NF-κB signaling pathways
Authors: Ismail Elysha Nur , Jantan Ibrahim , Vidyadaran Sharmili , Jamal Jamia Azdina , Azmi Norazrina
Published: July 2020

Background

Phyllanthus amarushas been shown to attenuate lipopolysaccharide (LPS)-induced peripheral inflammation but similar studies in the central nervous system are scarce. The aim of the present study was to investigate the neuroprotective effects of 80% ethanol extract ofP. amarus(EPA) in LPS-activated BV2 microglial cells.

Methods

BV2 microglial cells c for 24 h, pre-treated with EPA for 24 h prior to LPS induction for another 24 h. Surface expression of CD11b and CD40 on BV2 cells was analyzed by flow cytometry. ELISA was employed to measure the production of pro-inflammatory mediators i.e. nitric oxide (NO) and tumor necrosis factor (TNF)-α. Western blotting technique was used to determine the expression of inducible nitric oxide synthase (iNOS), myeloid differentiation protein 88 (MYD88), nuclear factor kappa B (NF-κB), caspase-1, and mitogen activated protein kinase (MAPK).

Results

Qualitative and quantitative analyses of the EPA using a validated ultra-high pressure liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method indicated the presence of phyllanthin, hypophyllanthin, niranthin, ellagic acid, corilagin, gallic acid, phyltetralin, isolintetralin and geraniin. EPA suppressed the production of NO and TNFα in LPS-activated BV2 microglial cells. Moreover, EPA attenuated the expression of MyD88, NF-κB and MAPK (p-P38, p-JNK and p-ERK1/2). It also inhibited the expression of CD11b and CD40. EPA protected against LPS-induced microglial activation via MyD88 and NF-κB signaling in BV2 microglial cells.

Conclusions

EPA demonstrated neuroprotective effects against LPS-induced microglial cells activation through the inhibition of TNFα secretion, iNOS protein expression and subsequent NO production, inhibition of NF-κB and MAPKs mediated by adapter protein MyD88 and inhibition of microglial activation markers CD11b and CD40.
Becoming a coach: experiences of faculty educators learning to coach medical students
Authors: Brooks Joanna Veazey , Istas Kathryn , Barth Bradley E.
Published: July 2020

Background

Despite the growth of coaching in medical education, many questions remain about the process of becoming a coach for medical students. We sought to understand the process through which faculty acclimated to this new role, and what benefits and challenges they experienced.

Methods

A multi-phase qualitative focus group study was conducted with 20 faculty at one medical school in the United States during the initial year coaching was implemented. Focus group transcripts were analyzed using the constant comparative approach to inductively identify themes from the data.

Results

Four main benefits were reported by faculty: student guidance, identifying student issues early, helping students develop work-life balance, and fostering clinician connectivity, which was seen as benefitting both students and faculty. The two main challenges were uncertainty regarding how adaptive the coaching sessions should be, and difficulty engaging in some of the roles simultaneously, like mentoring and supervision.

Conclusions

Schools that develop academic medical student coaching programs should design faculty support around coaching and recognize that the process of becoming a coach may not be or feel straightforward for faculty. Overall, faculty found coaching to be rewarding despite challenges they experienced.
The law and problematic marketing by private umbilical cord blood banks
Authors: Murdoch Blake , Marcon Alessandro R , Caulfield Timothy
Published: July 2020

Background

Private umbilical cord blood banking is a for-profit industry in which parents pay to store blood for potential future use. Governments have noted the tendency for private banks to oversell the potential for cord blood use, especially in relation to speculative cell therapies not yet supported by clinical evidence. We assessed the regulatory landscape governing private cord bank marketing in Canada.

Main body

Because the problematic marketing of private cord blood banking for future use often relates to speculative future cell therapies that do not exist and are not being advertised for current clinical use, most private blood bank marketing seems to fall outside Health Canada’s regulatory scope. However, this problematic marketing is regulated by the Competition Bureau pursuant to the Competition Act. While representations relating to future hypothetical treatments may not always be subject to the legal requirement for claim substantiation, the law also prohibits individuals and companies from knowingly or recklessly making representations that are “false or misleading in a material respect.” A representation is materially false or misleading when it could “influence a consumer’s behavior or purchasing decisions,” and consumers are likely to be considered to be “credulous and inexperienced” for the purposes of assessing an advertisement’s general impression. Because all of the potential benefit of the banking is derived from the potential future use of the biological material for health interventions directed toward the customers and their relatives, and because we know the best available medical evidence indicates a very low probability of utility in this context, we can say with confidence that some private cord blood banking claims are materially misleading. Moreover, to the extent that medical professionals are involved in private bank interactions with customers or hold ownership stakes in private banks, they are subject to professional codes, standards of practice, and potentially fiduciary obligations that further prohibit misleading marketing.

Conclusions

Private cord blood bank marketing that advertises hypothetical future treatments can be misleading and may influence consumer behaviour. This marketing may breach existing advertising law. Regulatory bodies should enforce the law in order to help prevent public health and personal financial harm.
Emotions and feelings in critical and emergency caring situations: a qualitative study
Authors: Jiménez-Herrera María F. , Llauradó-Serra Mireia , Acebedo-Urdiales Sagrario , Bazo-Hernández Leticia , Font-Jiménez Isabel , Axelsson Christer
Published: July 2020

Background

Moral emotions are a key element of our human morals. Emotions play an important role in the caring process. Decision-making and assessment in emergency situations are complex and they frequently result in different emotions and feelings among health-care professionals.

Methods

The study had qualitative deductive design based on content analysis. Individual interviews and focus groups were conducted with sixteen participants.

Results

The emerging category “emotions and feelings in caring” has been analysed according to Haidt, considering that moral emotions include the subcategories of “Condemning emotions”, “Self-conscious emotions”, “Suffering emotions” and “Praising emotions”. Within these subcategories, we found that the feelings that nurses experienced when ethical conflicts arose in emergency situations were related to caring and decisions associated with it, even when they had experienced situations in which they believed they could have helped the patient differently, but the conditions at the time did not permit it and they felt that the ethical conflicts in clinical practice created a large degree of anxiety and moral stress. The nurses felt that caring, as seen from a nursing perspective, has a sensitive dimension that goes beyond the patient’s own healing and, when this dimension is in conflict with the environment, it has a dehumanising effect. Positive feelings and satisfaction are created when nurses feel that care has met its objectives and that there has been an appropriate response to the needs.

Conclusions

Moral emotions can help nurses to recognise situations that allow them to promote changes in the care of patients in extreme situations. They can also be the starting point for personal and professional growth and an evolution towards person-centred care.
Lived experiences: a focus group pilot study within the MentALLY project of mental healthcare among European users
Authors: Axelsson Malin , Schønning Viktor , Bockting Claudi , Buysse Ann , Desmet Mattias , Dewaele Alexis , Giovazolias Theodoros , Hannon Dewi , Kafetsios Konstantinos , Meganck Reitske , Ntani Spyridoula , Rutten Kris , Triliva Sofia , Van Beveren Laura , Vandamme Joke , Øverland Simon , Hensing Gunnel
Published: July 2020

Background

Mental healthcare is an important component in societies’ response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems.

Method

In total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N = 7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes.

Results

The theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential.

Conclusion

Facilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.