bluuebunny/crossref_metadata_2025 huggingface dataset:
Valve-in-Valve for Failing Mitral Bioprosthesis With Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction
Authors: Ben-Dor Itsik , Weissman Gaby , Case Brian C. , Satler Lowell F. , Waksman Ron , Rogers Toby
Published: October 2021

Transcatheter mitral valve replacement (TMVR) is a new approach for treating failed bioprosthetic valves, annuloplasty repairs, and mitral annular calcification. Computed tomography is the key in procedure planning and guiding to identify patients at high risk of anatomic complications, in particular, for left ventricular outflow tract (LVOT) obstruction. There are several methods to reduce the risk of LVOT obstruction. A simple option is preemptive alcohol septal ablation, but this needs to be done prior to the TMVR procedure. Intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction (LAMPOON), a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR, can be done anterograde or retrograde but requires leaflet traversal, which is technically challenging. In this article, we describe a case of valve-in-valve TMVR in a patient with high risk for LVOT obstruction and a novel simple technique—tip-to-base LAMPOON.
Response to antiseizure medications in epileptic patients with malformation of cortical development
Authors: Chen Wei , Jin Bo , Aung Thandar , He Chenmin , Chen Cong , Wang Shan , Ding Yao , Ding Fang , Wang Chao , Li Hong , Jiang Biao , Zheng Zhe , Dai Haibin , Zhu Junming , Geng Yu , Ding Meiping , Wang Shuang
Published: October 2021

Background:

Malformation of cortical development (MCD) is one of the most common causes of pharmacoresistant epilepsy. Improving the knowledge of antiseizure medications (ASMs) treatment response in epileptic patients with MCD is crucial for optimal treatment options, either pharmacological therapy or non-pharmacological intervention.

Aim:

To investigate the patterns of medical treatment outcome and the predictors for seizure freedom (SF) with ASM regimens in epilepsy caused by MCD.

Methods:

The epileptic patients with MCD were consecutively enrolled from March 2013 to June 2019. SF was defined as no seizures for at least 12 months or three times the longest pretreatment inter-seizure interval, whichever was longer. Outcomes were classified into three patterns: pattern A: patients achieved SF at one point and remained so throughout follow-up; pattern B: patients’ seizures fluctuated between periods of SF and relapse; pattern C: SF never attained. The terminal SF was defined if the patients remained SF at the last follow-up visit.

Results:

A total of 164 epileptic patients with MCD were included. Pattern A was observed in 22, pattern B in 42, and pattern C in 100 patients. SF was ever achieved in 64 (pattern A and B) patients. Twenty-nine patients had terminal SF after a median follow-up time of 4.3 years. With continuing ASM treatment, seizure relapse risk was very low after a 5-year seizure-free period. The pretreatment seizure frequency was the only independent predictor for pattern A and seizure relapse. Sodium channel blockers monotherapy (33.8%) was more effective than levetiracetam (4.5%) in rendering SF in the initial ASM regimen.

Conclusion:

Medical treatment can be successful in a minority of epileptic patients with MCD, and pretreatment seizure frequency helps to predict the treatment outcome. An unequal efficacy of ASMs in epilepsy caused by MCD suggests etiological evaluation is vital in the management of focal epilepsy.
What Can a Song Bring? Balancing Out the Picture in Pandemic
Authors: Carless David
Published: October 2021

How might we personally and collectively contain the burnout and emotional depletion that has arisen as a consequence of COVID-19? For some, the pandemic has been a further stressor on top of pre-existing trauma. Under these circumstances, how can we continue our work of intervening into the challenges and demands that face our communities? Here, I turn to a song – called It’s Alright – written and sung not only as a response, but also as a survival strategy. I try to let its sentiments and sensations wash over me to calm my nervous system. I sing it as a way to self-soothe, to stabilise. I sing it with and for you, on the chance it might be of service.
Comparison of colors, microstructure, chemical composition and thermal properties of bamboo fibers and parenchyma cells with heat treatment
Authors: Wu Jieyu , Zhong Tuhua , Zhang Wenfu , Shi Jiangjing , Fei Benhua , Chen Hong
Published: October 2021

The effects of heat treatment at various temperatures on mechanically separated bamboo fibers and parenchyma cells were examined in terms of color, microstructure, chemical composition, crystallinity, and thermal properties. The heat-treated parenchyma cells and fibers were characterized by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), chemical composition analysis, and thermogravimetric analysis (TGA). The results revealed that the colors of bamboo fibers and parenchyma cells were darkened as treatment temperature increased. The microstructure of the treated fibers and parenchyma cells slightly changed, yet the shape of starch granules in parenchyma cells markedly altered at a temperature of above 160 °C. The chemical compositions varied depending on the heat treatment temperature. When treated at 220 °C, the cellulose content was almost unchanged in fibers but increased by 15% in parenchyma cells; the hemicellulose content decreased and the lignin content increased regardless of fibers and parenchyma cells. The cellulose crystal structure was nearly unaffected by heat treatment, but the cellulose crystallinity of fibers changed more pronouncedly than that of parenchyma cells. The thermal stability of parenchyma cells after heat treatment was affected more substantially compared to fibers.
From digestion and absorption to innate immunity and health care: water and food intake may contribute to IL-22 in ILC3-dependent mucosal immunity in the jejunum
Authors: Watanabe-Asaka Tomomi , Hayashi Moyuru , Maejima Daisuke , Kawai Yoshiko , Ohhashi Toshio
Published: October 2021

In this review, with our current studies we demonstrated medical evidence that water and food intake are useful for IL-22-related mucosal immunity-dependent maintenance of health care. The traditional Japanese health care practices recommend daily consumption of suitable volume of water. However, immunological mechanisms that support of the traditional practices are still unsolved. We focused on type 3 innate lymphoid cells (ILC3s), because the ILC3s are mainly housed in the lamina propria of the jejunum. IL-22 released from the ILC3 is transported through mesenteric lymph in collaboration with the albumin-mediated movement of consumed water. Thus, water intake-mediated upregulation of IL-22-dependent mucosal immunity contributes to the traditional Japanese health care practices. We also reviewed current studies that food intake-mediated increase in VIP-dependent neuronal activity in the small intestine and the food intake included with tryptophan-derived metabolites may accelerate the IL-22 in ILC3s-dependent mucosal immunity and then contribute in keeping health care.
Circall: fast and accurate methodology for discovery of circular RNAs from paired-end RNA-sequencing data
Authors: Nguyen Dat Thanh , Trac Quang Thinh , Nguyen Thi-Hau , Nguyen Ha-Nam , Ohad Nir , Pawitan Yudi , Vu Trung Nghia
Published: October 2021

Background

Circular RNA (circRNA) is an emerging class of RNA molecules attracting researchers due to its potential for serving as markers for diagnosis, prognosis, or therapeutic targets of cancer, cardiovascular, and autoimmune diseases. Current methods for detection of circRNA from RNA sequencing (RNA-seq) focus mostly on improving mapping quality of reads supporting the back-splicing junction (BSJ) of a circRNA to eliminate false positives (FPs). We show that mapping information alone often cannot predict if a BSJ-supporting read is derived from a true circRNA or not, thus increasing the rate of FP circRNAs.

Results

We have developed Circall, a novel circRNA detection method from RNA-seq. Circall controls the FPs using a robust multidimensional local false discovery rate method based on the length and expression of circRNAs. It is computationally highly efficient by using a quasi-mapping algorithm for fast and accurate RNA read alignments. We applied Circall on two simulated datasets and three experimental datasets of human cell-lines. The results show that Circall achieves high sensitivity and precision in the simulated data. In the experimental datasets it performs well against current leading methods. Circall is also substantially faster than the other methods, particularly for large datasets.

Conclusions

With those better performances in the detection of circRNAs and in computational time, Circall facilitates the analyses of circRNAs in large numbers of samples. Circall is implemented in C++ and R, and available for use at https://www.meb.ki.se/sites/biostatwiki/circall and https://github.com/datngu/Circall.
The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study
Authors: Myoga Yoshinori , Manabe Haruhiko , Osaki Yoneatsu
Published: October 2021

Background

Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications.

Methods

We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications.

Results

Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48–71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications.

Conclusions

Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.
The BrAID study protocol: integration of machine learning and transcriptomics for brugada syndrome recognition
Authors: Morales M. A. , Piacenti M. , Nesti M. , Solarino G. , Pieragnoli P. , Zucchelli G. , Del Ry S. , Cabiati M. , Vozzi F.
Published: October 2021

Background

Type 1 Brugada syndrome (BrS) is a hereditary arrhythmogenic disease showing peculiar electrocardiographic (ECG) patterns, characterized by ST-segment elevation in the right precordial leads, and risk of Sudden Cardiac Death (SCD). Furthermore, although various ECG patterns are described in the literature, different individual ECG may show high-grade variability, making the diagnosis problematic. The study aims to develop an innovative system for an accurate diagnosis of Type 1 BrS based on ECG pattern recognition by Machine Learning (ML) models and blood markers analysis trough transcriptomic techniques.

Methods

The study is structured in 3 parts: (a) a retrospective study, with the first cohort of 300 anonymized ECG obtained in already diagnosed Type 1 BrS (75 spontaneous, 150 suspected) and 75 from control patients, which will be processed by ML analysis for pattern recognition; (b) a prospective study, with a cohort of 11 patients with spontaneous Type 1 BrS, 11 with drug-induced Type 1 BrS, 11 suspected BrS but negative to Na + channel blockers administration, and 11 controls, enrolled for ECG ML analysis and blood collection for transcriptomics and microvesicles analysis; (c) a validation study, with the third cohort of 100 patients (35 spontaneous and 35 drug-induced BrS, 30 controls) for ML algorithm and biomarkers testing.

Discussion

The BrAID system will help clinicians improve the diagnosis of Type 1 BrS by using multiple information, reducing the time between ECG recording and final diagnosis, integrating clinical, biochemical and ECG information thus favoring a more effective use of available resources.

Trial registrationClinical Trial.gov, NCT04641585. Registered 17 November 2020,https://clinicaltrials.gov/ct2/show/NCT04641585
Determinants of time-to-disposition in patients who underwent CT for pulmonary embolism: a retrospective study
Authors: Hassan Ali , Al Dandan Omran , Awary Khaled , Bukhamsin Besma , Bukhamseen Reema , Alzaki Alaa , Al-Sulaibeekh Amal , Alsaif Hind S.
Published: October 2021

Background

Pulmonary embolism (PE) is a common life-threatening medical emergency that needs prompt diagnosis and management. Providing urgent care is a key determinant of quality in the emergency department (ED) and time-based targets have been implemented to reduce length of stay and overcrowding. The study aimed to determine factors that are associated with having a time-to-disposition of less than 4 h in patients with suspected PE who underwent computed tomography pulmonary angiography (CT-PA) to confirm the diagnosis.

Methods

After obtaining approval from the ethics committee, we conducted a retrospective observational study by examining CT-PA scans that was performed to rule out PE in all adult patients presenting at the ED between January 2018 and December 2019. Demographic information and clinical information, as well as arrival and disposition times were collected from electronic health records. Multivariable regression analysis was used to identify the independent factors associated with meeting the 4-h target in the ED.

Results

In total, the study involved 232 patients (76 men and 156 women). The median length of stay in the ED was 5.2 h and the 4-h target was achieved in 37% of patients. Multivariable logistic regression analysis revealed that a positive CT-PA scan for PE was independently associated with meeting the four-hour target in the ED (odds ratio [OR]: 2.2; 95% CI: 1.1–4.8). Furthermore, Hemoptysis was the only clinical symptom that served as an independent factor associated with meeting the 4-h target in the ED (OR: 10.4; 95% CI: 1.2–90.8).

Conclusion

Despite the lower number of staff and higher volume of patients on weekends, patients who presented on weekends had shorter stays and were more likely to meet the 4-h target. Careful clinical assessment, prior to requesting a CT-PA scan, is crucial, since negative CT-PA scans may be associated with failure to meet the 4-h target.
Barriers and facilitators to cardiopulmonary resuscitation within pre-hospital emergency medical services: a qualitative study
Authors: Dehghan-Nayeri Nahid , Nouri-Sari Hassan , Bahramnezhad Fatemeh , Hajibabaee Fatemeh , Senmar Mojtaba
Published: October 2021

Background

Out-of-hospital cardiopulmonary arrest is a common and fatal problem. Rescuing patients with this problem by pre-hospital emergency medical services is associated with various barriers and facilitators. Identifying these barriers as well as the facilitators in a qualitative and an information-rich way will help to improve the quality of performing the maneuver and to increase the patients’ survival. Therefore, the current study was qualitatively conducted with the aim of identifying the factors affecting the cardiopulmonary resuscitation within the pre-hospital emergency medical services.

Methods

This qualitative study was conducted using a content analysis approach in Iran in 2021. The participants were 16 Iranian emergency medical technicians who were selected through a purposive sampling method. For data collection, in-depth and semi-structured interviews were conducted. For data analysis, the Elo and Kyngäs method was applied.

Results

The mean participants’ age was 33.06 ± 7.85 years, and their mean work experience was 10.62 ± 6.63 years. The collected information was categorized into one main category called “complex context of the cardiopulmonary resuscitation” and 5 general categories with 17 subcategories. These categories and subcategories include patient condition (patient’s underlying diseases, age, high weight, number of children, and place of living), dominant atmosphere in companions at home (companions’ feeling of agitation, companions doing harm, and companions helping), policy (educational policy, human resource policy, up-to-date equipment and technology, and do-not-resuscitate policy), performance of the out-of-organizational system (disorganization in the patient handover process, and cooperation of the support organizations), and conditions related to the treatment team (conscience, cultural dominance, and shift burden).

Conclusions

The results showed that the conditions related to the patient and his/her companions, as well as the organizational factors such as the policies and the out-of-organizational factors act as the barriers and the facilitators to the cardiopulmonary resuscitation within pre-hospital emergency medical services. Therefore, the barriers can be modified and the facilitators can be enhanced by taking various measures such as educating, human resource policy-making, upgrading the equipment, and considering appropriate management policies.
Intestinal microbiota has important effect on severity of hand foot and mouth disease in children
Authors: Shen Chenguang , Xu Yi , Ji Jingkai , Wei Jinli , Jiang Yujin , Yang Yang , Yang Minghui , Huang Huaxin , Zou Rongrong , Fang Chunxiao , Zeng Fansen , Yang Fengxia , Wang Xinfa , Yuan Jing , Li Jianmin , Wang Xianfeng , Yang Huanming , Gong Sitang , Wang Hui , Xia Huimin , Ma Jinmin , Liu Yingxia
Published: October 2021

Background

The incidence of hand foot and mouth disease (HFMD) has increased in recent years, making it a very common childhood illness worldwide. The relationship between different enterovirus genotypes and disease severity is not clearly understood. Given that enteroviruses are transmitted through the gastrointestinal tract, we hypothesized that variation in intestinal microorganisms of the host might play a role in the prognosis of HFMD.

Methods

We carried out a meta-transcriptomic-wide association study of fecal samples obtained from a cohort of children (254 patients, 227 tested positive for enterovirus, including 16 patients co-infectied with 2 kinds of enterovirus) with mild and severe HFMD and healthy controls.

Results

We found there was no significant difference in the amount of each virus type between the mild and severe cases. Genes of enterovirus 71 (EV71) and coxsackievirus A (CV-A) from the severe and mild cases did not show significant clustering.Clostridiumsp. L2-50 andBacteroides stercorisATCC 43183 were enriched in the guts of children with severe HFMD and KEGG enrichment was found between mild and severe cases.

Conclusions

Intestinal microorganisms appear to interact with enterovirus to determine the progression of HFMD. Genes ofBacteroidesandClostridiummay be used as predictive markers for a more efficient prognosis and intervention. The enrichment of intestinal bacteria genes with functions may facilitate the development of severe symptoms for HFMD patients.
A novel gene expression signature-based on B-cell proportion to predict prognosis of patients with lung adenocarcinoma
Authors: Zhang Yi , Yin Xuewen , Wang Qi , Song Xuming , Xia Wenjie , Mao Qixing , Chen Bing , Liang Yingkuan , Zhang Te , Xu Lin , Jiang Feng , Xu Xinyu , Dong Gaochao
Published: October 2021

Background

This study aimed to develop a reliable immune signature based on B-cell proportion to predict the prognosis and benefit of immunotherapy in LUAD.

Methods

The proportion of immune cells in the TCGA-LUAD dataset was estimated using MCP-counter. The Least Absolute Shrinkage and Selector Operation was used to identify a prognostic signature and validated in an independent cohort. We used quantitative reverse transcription-polymerase chain reaction (qRT-PCR) data and formalin-fixed paraffin-embedded (FFPE) specimens immunohistochemistry to illustrate the correlation between prognostic signature and leukocyte migration.

Results

We found that the relative abundance of B lineage positively correlated with overall survival. Then, we identified a 13-gene risk-score prognostic signature based on B lineage abundance in the testing cohort and validated it in a cohort from the GEO dataset. This model remained strongly predictive of prognoses across clinical subgroups. Further analysis revealed that patients with a low-risk score were characterized by B-cell activation and leukocyte migration, which was also confirmed in FFPE specimens by qRT-PCR and immunohistochemistry. Finally, this immune signature was an independent prognostic factor in the composite nomogram of clinical characteristics.

Conclusions

In conclusion, the 13-gene immune signature based on B-cell proportion may serve as a powerful prognostic tool in LUAD.
Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial
Authors: Ulziibat Munkhtulga , Munkhuu Bayalag , Bataa Ariun-Erdene , Schmid Raoul , Baumann Thomas , Essig Stefan
Published: October 2021

Background

Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial.

Methods

Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The “swaddling” group (n = 40) was swaddled in the common traditional Mongolian method for a month while the “non-swaddling” group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf’s “non-Type 1” hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated.

Results

Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43).

Conclusions

Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH.

Trial registration

Retrospectively registered,ISRCTN11228572.
Determinants of HPV-vaccination uptake and subgroups with a lower uptake in the Netherlands
Authors: de Munter A. C. , Klooster T. M. Schurink-van t , van Lier A. , Akkermans R. , de Melker H. E. , Ruijs W. L. M.
Published: October 2021

Background

In the Netherlands, the HPV-vaccine uptake was 52% during the 2009 catch-up campaign (birth cohorts 1993–1996). This increased to 61% in the regular immunization program (birth cohorts 2000–2001). However for birth cohorts 2003–2004 the uptake declined to 45.5%. With this study we aimed to gain insight into social, economic and cultural determinants that are associated with HPV-vaccination uptake and which subgroups with a lower HPV-vaccination uptake can be identified. In addition, we investigated whether the influence of these factors changed over time.

Methods

To study the determinants of HPV-vaccine uptake we performed a database study using different aggregation levels, i.e. individual level, postal code level and municipality level. All Dutch girls who were invited for HPV-vaccination through the National Immunization Program in the years 2012, 2014 and 2017 (i.e. birth cohorts 1999, 2001 and 2004, respectively) were included in the study population. We conducted multilevel logistic regression analyses to analyze the influence of the determinants on HPV-vaccination uptake, taking into account that the delivery of HPV-vaccine was nested within municipalities.

Results

Results showed that in particular having not received a MMR-vaccination, having one or two parents born in Morocco or Turkey, living in an area with lower socioeconomic status and higher municipal voting proportions for Christian political parties or populist parties with liberal-conservative views were associated with a lower HPV-vaccination uptake. Besides some changes in political preferences of the population and changes in the association between HPV uptake and urbanization level we found no clear determinants which could possibly explain the decrease in the HPV-vaccination uptake.

Conclusions

In this study we identified current social, economic and cultural determinants that are associated with HPV-vaccination uptake and which low-vaccination subgroups can be identified. However, no clear determinants were found which could explain the decrease in the HPV-vaccination uptake. Tailored information and/or consultation for groups that are associated with a lower HPV-vaccination uptake might help to increase the HPV-vaccination uptake in the future.
Exploring the concept inability to work fulltime in the context of work disability assessments: a qualitative study
Authors: Boersema Henk-Jan , Abma Femke I. , Hoekstra Tialda , Roelofs Pepijn D. D. M. , Brouwer Sandra
Published: October 2021

Background

In many countries inability to work fulltime is recognized as an important concept in work disability assessments. However, consensus is lacking regarding the concept and how it should be assessed. This study seeks to conceptualize and operationalize the concept of inability to work fulltime, and includes perspectives of both patients and physicians. Research questions involve identifying: 1. key elements, 2. measurable indicators, and 3. valid methods for assessing indicators of inability to work fulltime.

Methods

We used a qualitative study with a thematic content analysis design to conceptualize inability to work fulltime, based on nineteen semi-structured interviews conducted among insurance and occupational health physicians, and representatives of patient organizations.

Results

Inability to work fulltime is conceptualized as a complex concept which is strongly individually determined and variable due to time and underlying disease. Key dimensions of inability to work fulltime included besides the disease itself, also personal factors like psychological and lifestyle factors, as well as environmental factors related to the work situation and social context. Fatigue, cognitive impairments, and restrictions in functioning in- and outside work were reported as important measurable indicators. A combined use of self-assessment, assessment interviews, and testing, and assessment in the actual (work) setting was identified for assessing these indicators.

Conclusion

Taking into account the complex and variable nature of inability to work fulltime, we found it advisable to use multiple methods and multiple time points for the assessment. Results of this study provide starting points for further research on the operationalization of inability to work fulltime in a work disability context.
Effect of counselling during pulmonary rehabilitation on self-determined motivation to be physically active for people with chronic obstructive pulmonary disease: a pragmatic RCT
Authors: Rausch Osthoff Anne-Kathrin , Beyer Swantje , Gisi David , Rezek Spencer , Schwank Ariane , Meichtry André , Sievi Noriane A. , Hess Thomas , Wirz Markus
Published: October 2021

Background

Counselling is considered to be a promising approach to increasing physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). The aim of the current study was to investigate whether a PA counselling program for people with COPD, when embedded in a comprehensive outpatient pulmonary rehabilitation (PR) program, increased their daily PA.

Methods

A two-armed, single blind randomized controlled trial was conducted as a component of a 12-week outpatient pulmonary rehabilitation program. The participants randomized into the intervention group received five counselling sessions, based on the principles of motivational interviewing (MI), with a physiotherapist. The participants’ steps per day and other proxies of PA were measured using an accelerometer (SenseWear Pro®) at baseline, at the end of the PR program, and three months later. The group-by-time interaction effect was analyzed.

Results

Of the 43 participants,17 were allocated to the intervention group and 26 to the usual-care control group (mean age 67.9 ± 7.9; 21 (49%) males; mean FEV1 predicted 47.1 ± 18.6). No difference between groups was found for any measure of PA at any point in time.

Conclusions

In this study, counselling, based on MI, when embedded in a comprehensive PR program for people with COPD, showed no short-term or long-term effects on PA behavior. To investigate this potentially effective counselling intervention and to analyze the best method, timing and tailoring of an intervention embedded in a comprehensive outpatient PR program, further adequately powered research is needed.

Trial registration: Clinical Trials.gov NCT02455206 (05/21/2015), Swiss National Trails Portal SNCTP000001426 (05/21/2015).
Defining matrix Gla protein expression in the Dunkin-Hartley guinea pig model of spontaneous osteoarthritis
Authors: Ma Xun , Zhang Zhan , Kang Xinyuan , Deng Chunbo , Sun Yingwei , Li Yanjun , Huang Desheng , Liu Xueyong
Published: October 2021

Background

Matrix Gla (γ-carboxyglutamate) protein (MGP) is considered a strong inhibitor of ectopic calcification, and it has been associated with OA severity, although not conclusively. We utilized male Dunkin-Hartley (DH) guinea pigs to investigate the expression of MGP throughout aging and disease pathogenesis in a spontaneous model.

Method

Twenty-five male DH guinea pigs were obtained and nurtured to several timepoints, and then randomly and equally divided by age into five subgroups (1-, 3-, 6-, 9-, and 12-months, with the 1-month group as the reference group). DH guinea pigs in each group were euthanized at the designated month-age and the left or right medial tibial plateaus cartilages were randomly excised. OA severity was described by modified Mankin Score (MMS) at microscopy (Safranin O/Fast Green stain). Proteomic evaluation using isobaric tags for relative and absolute quantification (iTRAQ) was performed to validate the age-related changes in the MGP profiles, and immunohistochemistry (IHC) methods were applied for semi-quantitative determination of MGP expression in articular cartilage.

Results

The histopathologic findings validated the increasing severity of cartilage degeneration with age in the DH guinea pigs. The MMS showed significant, stepwise (every adjacent comparison P < 0.05) disease progression with month-age. The iTRAQ indicated that MGP levels increased significantly with advancing age (P < 0.05), as supported by the IHC result (P < 0.05).

Conclusion

Increased expression of MGP in male DH guinea pigs was present throughout aging and disease progression and may be link to increased OA severity. Further studies are needed to investigate and confirm the association between MGP levels and OA severity.
Feasibility of MRI for the evaluation of interosseous ligament vertical segment via subtalar arthroscopy correlation: comparison of 2D and 3D MR images
Authors: Jung Hong-Geun , Moon Sung Gyu , Yoon Deuk Young , Jang Hyemin , Kang Ji Hee
Published: October 2021

Background

Interosseous ligament vertical segment (IOLV) and calcaneofibular ligament (CFL) have been reported to be important in stabilizing the subtalar joint. Unlike CFL, there is not much information regarding the comparison of MRI results with surgical evaluation of IOLV and the comparison between 2D and 3D MRI on IOLV evaluation. The feasibility of MRI in IOLV evaluation has yet to be reported. The purpose of this study was to evaluate the validity and reliability of MRI in IOLV tear detection via correlation with arthroscopic results. We also compared the diagnostic performance of 2D and 3D MR images.

Methods

In this retrospective study, 52 patients who underwent subtalar arthroscopy after ankle MRI were enrolled. Arthroscopic results confirmed IOLV tear in 25 cases and intact IOLV in 27 cases. Two radiologists independently evaluated the IOLV tears using only conventional 2D images, followed by isotropic 3D images, and comparison with arthroscopic results.

Results

Only the 2D sequences interpreted by two readers showed a sensitivity of 64.0–96.0%, a specificity of 29.6–44.4%, a positive predictive value of 51.6–56.4%, and a negative predictive value of 57.1–88.9%. Addition of isotropic 3D sequences changed the sensitivity to 60.0–80.0%, specificity to 63.0–77.8%, positive predictive value to 64.3–76.9%, and negative predictive value to 66.7–80.8%. The overall diagnostic performance of isotropic 3D sequences (AUC values: 0.679–0.816) was higher than that of 2D sequences (AUC values: 0.568–0.647). Inter-observer and intra-observer agreement between the two readers was moderate-to-good for both 2D and 3D sequences. The diagnostic accuracy in 19 patients with tarsal sinus fat obliteration tended to increase from 26.3–42.1% to 57.9–73.7% with isotropic 3D sequences compared with 2D sequences.

Conclusions

Isotropic 3D MRI was feasible for the assessment of IOLV tear prior to subtalar arthroscopy. Additional 3D sequences showed higher diagnostic accuracy compared with conventional 2D sequences in IOLV evaluation. Isotropic 3D sequences may be more valuable in detecting IOLV tear in case of tarsal sinus fat obliteration.
Splenic volume and splenic vein diameter are independent pre-operative risk factors of portal vein thrombosis after splenectomy: a retrospective cohort study
Authors: Péré Guillaume , Basselerie Hubert , Maulat Charlotte , Pitocco Armando , Leblanc Pierrick , Philis Antoine , Julio Charles Henri , Tuyeras Géraud , Buscail Etienne , Carrere Nicolas
Published: October 2021

Background

Portal vein thrombosis (PVT) is a common complication following splenectomy. It affects between 5 and 55% of patients undergoing surgery with no clearly defined pre-operative risk factors. The aim of this study was to determine the pre-operative risk factors of PVT.

Patients and method

Single centre, retrospective study of data compiled for every consecutive patient who underwent splenectomy at Toulouse University Hospital between January 2009 and January 2019. Patients with pre- and post-surgical CT scans have been included.

Results

149 out of 261 patients were enrolled in the study (59% were males, mean age 52 years). The indications for splenectomy were splenic trauma (30.9%), malignant haemopathy (26.8%) and immune thrombocytopenia (8.0%). Twenty-nine cases of PVT (19.5%) were diagnosed based on a post-operative CT scan performed on post-operative day (POD) 5. Univariate analysis identifies three main risk factors associated with post-operative PVT: estimated splenic weight exceeding 500 g with an OR of 8.72 95% CI (3.3–22.9), splenic vein diameter over 10 mm with an OR of 4.92 95% CI (2.1–11.8) and lymphoma with an OR of 7.39 (2.7–20.1). The role of splenic vein diameter with an OR of 3.03 95% CI (1.1–8.6), and splenic weight with an OR of 5.22 (1.8–15.2), as independent risk factors is confirmed by multivariate analysis. A screening test based on a POD 5 CT scan with one or two of these items present could indicate sensitivity of 86.2% and specificity of 86.7%.

Conclusion

This study suggests that pre-operative CT scan findings could predict post-operative PVT. A CT scan should be performed on POD 5 if a risk factor has been identified prior to surgery.
An informatics consult approach for generating clinical evidence for treatment decisions
Authors: Lai Alvina G. , Chang Wai Hoong , Parisinos Constantinos A. , Katsoulis Michail , Blackburn Ruth M. , Shah Anoop D. , Nguyen Vincent , Denaxas Spiros , Davey Smith George , Gaunt Tom R. , Nirantharakumar Krishnarajah , Cox Murray P. , Forde Donall , Asselbergs Folkert W. , Harris Steve , Richardson Sylvia , Sofat Reecha , Dobson Richard J. B. , Hingorani Aroon , Patel Riyaz , Sterne Jonathan , Banerjee Amitava , Denniston Alastair K. , Ball Simon , Sebire Neil J. , Shah Nigam H. , Foster Graham R. , Williams Bryan , Hemingway Harry
Published: October 2021

Background

An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis.

Methods

We examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems.

Results

We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39–1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49–0.76) and ischaemic stroke (HR = 0.27, CI 0.08–0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results.

Conclusion

We performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on ‘patients like me’. We identify the key challenges in offering such an Informatics Consult as a service.
Examining health facility financing in Kenya in the context of devolution
Authors: Kairu Angela , Orangi Stacey , Mbuthia Boniface , Ondera Joanne , Ravishankar Nirmala , Barasa Edwine
Published: October 2021

Background

How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.

Methods

We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data.

Results

Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities.

Conclusion

The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.
Comparative analysis on lung transcriptome of Mycoplasma ovipneumoniae (Mo) - infected Bashbay sheep and argali hybrid sheep
Authors: Li Zengqiang , Du Zhihui , Li Jie , Sun Yanming
Published: October 2021

Background

Bashbay sheep (Bbs) has a certain degree of resistance to Mycoplasma ovipneumoniae (Mo), however, Argali hybrid sheep (Ahs) is susceptible to Mo. To understand the molecular mechanisms underlying the difference of the susceptibility for Mo infection, RNA-sequencing technology was used to compare the transcriptomic response of the lung tissue of Mo-infected Bbs and Ahs.

Results

Six Bbs and six Ahs were divided into experimental group and control group respectively, all of them were experimentally infected with Mo by intratracheal injection. For collecting lung tissue samples, three Bbs and three Ahs were sacrificed on day 4 post-infection, and the others were sacrificed on day 14 post-infection. Total RNA extracted from lung tissue were used for transcriptome analyses based on high-throughput sequencing technique and bioinformatics. The results showed that 212 (146 up-regulated, 66 down-regulated) DEGs were found when comparing transcriptomic data of Bbs and Ahs at 4th dpi, besides, 311 (158 up-regulated, 153 down-regulated) DEGs were found at 14th dpi. After GO analysis, three main GO items protein glycosylation, immune response and positive regulation of gene expression were found related to Mo infection. In addition, there were 20 DEGs enriched in these above items, such as SPLUC1 (BPIFA1), P2X7R, DQA, HO-1 and SP-A (SFTPA-1).

Conclusions

These selected 20 DEGs associated with Mo infection laid the foundation for further study on the underlying molecular mechanism involved in high level of resistance to Mo expressed by Bbs, meanwhile, provided deeper understandings about the development of pathogenicity and host-pathogen interactions.
Nanofiber-based systems intended for diabetes
Authors: Maleki Hassan , Khoshnevisan Kamyar , Sajjadi-Jazi Sayed Mahmoud , Baharifar Hadi , Doostan Maryam , Khoshnevisan Nazanin , Sharifi Farshad
Published: October 2021

Diabetic mellitus (DM) is the most communal metabolic disease resulting from a defect in insulin secretion, causing hyperglycemia by promoting the progressive destruction of pancreatic β cells. This autoimmune disease causes many severe disorders leading to organ failure, lower extremity amputations, and ultimately death. Modern delivery systems e.g., nanofiber (NF)-based systems fabricated by natural and synthetic or both materials to deliver therapeutics agents and cells, could be the harbinger of a new era to obviate DM complications. Such delivery systems can effectively deliver macromolecules (insulin) and small molecules. Besides, NF scaffolds can provide an ideal microenvironment to cell therapy for pancreatic β cell transplantation and pancreatic tissue engineering. Numerous studies indicated the potential usage of therapeutics/cells-incorporated NF mats to proliferate/regenerate/remodeling the structural and functional properties of diabetic skin ulcers. Thus, we intended to discuss the aforementioned features of the NF system for DM complications in detail.

Graphic abstract
Catalytically active gold clusters with atomic precision for noninvasive early intervention of neurotrauma
Authors: Zhang Yunguang , Sun Si , Liu Haile , Ren Qinjuan , Hao Wenting , Xin Qi , Xu Jiangang , Wang Hao , Zhang Xiao-Dong
Published: October 2021

Background

Neurotrauma is a worldwide public health problem which can be divided into primary and secondary damge. The primary damge is caused by external forces and triggers the overproduction of peroxides and superoxides, leading to long-lasting secondary damage including oxidative stress, wound infection and immunological reactions. The emerging catalysts have shown great potential in the treatment of brain injury and neurogenic inflammation, but are limited to biosafety issues and delivery efficiency.

Results

Herein, we proposed the noninvasive delivery route to brain trauma by employing highly active gold clusters with enzyme-like activity to achieve the early intervention. The decomposition rate to H2O2 of the ultrasmall gold clusters is 10 times that of glassy carbon (GC) electrodes, indicating excellent catalytic activity. The gold clusters can relieve the oxidative stress and decrease the excessive O2·− and H2O2 both in vitro and in vivo. Besides, gold clusters can accelerate the wound healing of brain trauma and alleviate inflammation via inhibiting the activation of astrocytes and microglia through noninvasive adminstration. decrease the peroxide and superoxide of brain tissue.

Conclusions

Present work shows noninvasive treatment is a promising route for early intervention of brain trauma.