bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016
Authors: Chen Chunlin , Duan Hui , Zhang Wenling , Zhao Hongwei , Wang Li , Kang Shan , Lin Lihong , Zhao Weidong , Ni Yan , Li Donglin , Chen Jiaming , Fan Huijian , Chen Xiaolin , Bin Xiaonong , Lang Jinghe , Liu Ping
Published: October 2021

Background

Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.

Methods

We retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China.

Results

Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity.

Conclusion

Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.
Whole genome copy number analyses reveal a highly aberrant genome in TP53 mutant lung adenocarcinoma tumors
Authors: Bjaanæs Maria Moksnes , Nilsen Gro , Halvorsen Ann Rita , Russnes Hege G. , Solberg Steinar , Jørgensen Lars , Brustugun Odd Terje , Lingjærde Ole Christian , Helland Åslaug
Published: October 2021

Background

Genetic alterations are common in non-small cell lung cancer (NSCLC), and DNA mutations and translocations are targets for therapy. Copy number aberrations occur frequently in NSCLC tumors and may influence gene expression and further alter signaling pathways. In this study we aimed to characterize the genomic architecture of NSCLC tumors and to identify genomic differences between tumors stratified by histology and mutation status. Furthermore, we sought to integrate DNA copy number data with mRNA expression to find genes with expression putatively regulated by copy number aberrations and the oncogenic pathways associated with these affected genes.

Methods

Copy number data were obtained from 190 resected early-stage NSCLC tumors and gene expression data were available from 113 of the adenocarcinomas. Clinical and histopathological data were known, and EGFR-, KRAS- and TP53 mutation status was determined. Allele-specific copy number profiles were calculated using ASCAT, and regional copy number aberration were subsequently obtained and analyzed jointly with the gene expression data.

Results

The NSCLC tumors tissue displayed overall complex DNA copy number profiles with numerous recurrent aberrations. Despite histological differences, tissue samples from squamous cell carcinomas and adenocarcinomas had remarkably similar copy number patterns. The TP53-mutated lung adenocarcinomas displayed a highly aberrant genome, with significantly altered copy number profiles including gains, losses and focal complex events. The EGFR-mutant lung adenocarcinomas had specific arm-wise aberrations particularly at chromosome7p and 9q. A large number of genes displayed correlation between copy number and expression level, and the PI(3)K-mTOR pathway was highly enriched for such genes.

Conclusions

The genomic architecture in NSCLC tumors is complex, and particularly TP53-mutated lung adenocarcinomas displayed highly aberrant copy number profiles. We suggest to always include TP53-mutation status when studying copy number aberrations in NSCLC tumors. Copy number may further impact gene expression and alter cellular signaling pathways.
Novel chemotherapeutic agent FX-9 activates NF-κB signaling and induces G1 phase arrest by activating CDKN1A in a human prostate cancer cell line
Authors: Weiner F. , Schille J. T. , Koczan D. , Wu X.-F. , Beller M. , Junghanss C. , Hewicker-Trautwein M. , Murua Escobar H. , Nolte I.
Published: October 2021

Background

The aminoisoquinoline FX-9 shows pro-apoptotic and antimitotic effects against lymphoblastic leukemia cells and prostate adenocarcinoma cells. In contrast, decreased cytotoxic effects against non-neoplastic blood cells, chondrocytes, and fibroblasts were observed. However, the actual FX-9 molecular mode of action is currently not fully understood.

Methods

In this study, microarray gene expression analysis comparing FX-9 exposed and unexposed prostate cancer cells (PC-3 representing castration-resistant prostate cancer), followed by pathway analysis and gene annotation to functional processes were performed. Immunocytochemistry staining was performed with selected targets.

Results

Expression analysis revealed 0.83% of 21,448 differential expressed genes (DEGs) after 6-h exposure of FX-9 and 0.68% DEGs after 12-h exposure thereof. Functional annotation showed that FX-9 primarily caused an activation of inflammatory response by non-canonical nuclear factor-kappa B (NF-κB) signaling. The 6-h samples showed activation of the cell cycle inhibitor CDKN1A which might be involved in the secondary response in 12-h samples. This secondary response predominantly consisted of cell cycle-related changes, with further activation of CDKN1A and inhibition of the transcription factor E2F1, including downstream target genes, resulting in G1-phase arrest. Matching our previous observations on cellular level senescence signaling pathways were also found enriched. To verify these results immunocytochemical staining of p21 Waf1/Cip1 (CDKN1A), E2F1 (E2F1), PAI-1 (SERPNE1), and NFkB2/NFkB p 100 (NFKB2) was performed. Increased expression of p21 Waf1/Cip1 and NFkB2/NFkB p 100 after 24-h exposure to FX-9 was shown. E2F1 and PAI-1 showed no increased expression.

Conclusions

FX-9 induced G1-phase arrest of PC-3 cells through activation of the cell cycle inhibitor CDKN1A, which was initiated by an inflammatory response of noncanonical NF-κB signaling.
Rare single nucleotide variants in COL5A1 promoter do not play a major role in keratoconus susceptibility associated with rs1536482
Authors: Skorodumova Liubov O. , Belodedova Alexandra V. , Sharova Elena I. , Zakharova Elena S. , Iulmetova Liliia N. , Bikbov Mukharram M. , Usubov Emin L. , Antonova Olga P. , Selezneva Oksana V. , Levchenko Anastasia , Fedorenko Olga Yu , Ivanova Svetlana A. , Gainetdinov Raul R. , Malyugin Boris E.
Published: October 2021

Background

Keratoconus is a chronic degenerative disorder of the cornea characterized by thinning and cone-shaped protrusions. Although genetic factors play a key role in keratoconus development, the etiology is still under investigation. The occurrence of single-nucleotide polymorphisms (SNPs) associated with keratoconus in Russian patients is poorly studied. The purpose of this study was to validate whether three reported keratoconus-associated SNPs (rs1536482 near the COL5A1 gene, rs2721051 near the FOXO1 gene, rs1324183 near the MPDZ gene) are also actual for a Russian cohort of patients. Additionally, we investigated the COL5A1 promoter sequence for single-nucleotide variants (SNVs) in a subgroup of keratoconus patients with at least one rs1536482 minor allele (rs1536482+) to assess the role of these SNVs in keratoconus susceptibility associated with rs1536482.

Methods

This case-control study included 150 keratoconus patients and two control groups (main and additional, 205 and 474 participants, respectively). We performed PCR targeting regions flanking SNVs and the COL5A1 promoter, followed by Sanger sequencing of amplicons. The additional control group was genotyped using an SNP array.

Results

The minor allele frequency was significantly different between the keratoconus and control cohorts (main and combined) for rs1536482, rs2721051, and rs1324183 (p-value < 0.05). The rare variants rs1043208782 and rs569248712 were found in the COL5A1 promoter in two out of 94 rs1536482+ keratoconus patients.

Conclusion

rs1536482, rs2721051, and rs1324183 were associated with keratoconus in a Russian cohort. SNVs in the COL5A1 promoter do not play a major role in keratoconus susceptibility associated with rs1536482.
Diffusion tensor imaging based multiparametric characterization of renal lesions in infants with urinary tract infections: an explorative study
Authors: Simrén Yvonne , Stokland Eira , Hansson Sverker , Hebelka Hanna , Svensson Par-Arne , Lagerstrand Kerstin M.
Published: October 2021

Background

Conventional diffusion weighted imaging (DWI) is a promising non-invasive tool in the evaluation of infants with symptomatic urinary tract infections (UTI). The use of multiparametric diffusion tensor imaging (DTI) provides further information on renal pathology by reflecting renal microstructure. However, its potential to characterize and distinguish between renal lesions, such as acute pyelonephritic lesions, permanent renal damages or dysplastic changes has not been shown. This study aimed to evaluate the potential of multiparametric DTI for characterization of renal lesions with purpose to distinguish acute pyelonephritis from other renal lesions in young infants with their first UTI.

Methods

Nine kidneys in seven infants, age 1.0–5.6 months, with renal lesions i.e. uptake reductions, on acute scintigraphy performed after their first UTI, were included. The DTI examinations were performed during free breathing without sedation. The signal in the lesions and in normal renal tissue was measured in the following images: b0, b700, apparent diffusion coefficient (ADC), and fractional anisotropy (FA). In addition, DTI tractographies were produced for visibility.

Results

There was a difference between lesions and normal tissue in b700 signal (197 ± 52 and 164 ± 53, p = 0.011), ADC (1.22 ± 0.11 and 1.45 ± 0.15 mm2/s, p = 0.008), and FA (0.18 ± 0.03 and 0.30 ± 0.10, p = 0.008) for all nine kidneys. Six kidneys had focal lesions with increased b700 signal, decreased ADC and FA indicating acute inflammation. In three patients, the multiparametric characteristics of the lesions were diverging.

Conclusion

Multiparametric DTI has the potential to further characterize and distinguish acute pyelonephritis from other renal lesions in infants with symptomatic UTI.
Cultural variation in factors associated with sudden infant death during sleep
Authors: Ahn Young Mee , Yang Kyung-moo , Ha Hong Il , Cho Jung Ae
Published: October 2021

Background

Despite the significant reduction decades ago in sudden unexpected death in infancy (SUDI), decline of rates has slowed and stalled in some countries, including the USA. This led to an appreciation of ethnic variations in SUDI rates and the need to increase cultural sensitivity regarding sleep practices and circumstantial factors of SUDI. The study explored SUDI-related factors, in journal articles from two geo-cultural regions (Asian and Western countries), particularly for factors related to infant sleep practices.

Methods

A systematic review was conducted to identify SUDI-related factors in articles from PubMed, Scopus, and the Korean Citation Index from January 1992 to April 2019. From each article, SUDI-related factors were retrieved and categorized through the identification, aggregation, and categorization of factors into the areas of the triple risk model (TRM) of SUDI by their meanings and commonality. Significant trends in the frequency of factors were analyzed across time and between the two geo-cultural regions (Asian and Western countries) of article.

Results

From a review of 218 articles (38 Asian and 180 Western articles), 84 SUDI-related factors were identified: 39 factors for TRM 1, 44 factors for TRM 2, and one factor for TRM 3. Four of the top-ranked 10 factors were found in both cultural zones: sleep position, male sex, bed-sharing, and genetics. Both cultural zones identified sleep position (44.0%), bed-sharing (22.0%), and rooming-in (16.5%) as the three most important sleep-related factors for SUDI. Variations between the cultural zones were observed in the place of SUDI occurrence, overheating, swaddling or bedding standards, and smoking.

Conclusions

Regardless of the urgent need to identify SUDI-related factors in low-SUDI societies, Asian cultures showed a significant lack of articles on SUDI. Several sociocultural issues were recognized such as the meaning of bed-sharing and rooming-in, along with residential styles and traditional health beliefs on sleep-related SUDI factors. Particularly little attention towards smoking was found in Asian articles in terms of frequency, suggesting the need to enhance SUDI reduction strategies by incorporating gender-sensitive smoking cessation interventions. This review of SUDI factors requests child health professionals to be alert to sociocultural variations in sleep practices and SUDI factors.
LGBT+ inclusion and human rights in Thailand: a scoping review of the literature
Authors: Newman Peter A. , Reid Luke , Tepjan Suchon , Akkakanjanasupar Pakorn
Published: October 2021

Background

Globally, LGBT+ people continue to struggle to achieve full realization of their human rights. Amid reported health and mental health disparities, and economic insecurity, we conducted a scoping review to explore the breadth of the literature, map and summarize the evidence, and identify knowledge gaps on LGBT+ inclusion and human rights in Thailand.

Methods

We conducted a scoping review in accordance with the methodology developed by the Joanna Briggs Institute and PRISMA-ScR guidelines. We systematically searched 16 databases for peer-reviewed literature, and government and nongovernmental organization websites for grey literature, published in English or Thai from January 1, 2000–August 21, 2020. Two reviewers independently screened studies according to pre-set criteria. We abstracted and analyzed data on publication characteristics and focal populations, and synthesized findings in six domains of LGBT+ inclusion: political and civic participation, education, family, personal security and violence, economic well-being, and health.

Results

The review captured 3327 results in total, which was scoped to 76 peer-reviewed articles and 39 grey literature sources, the majority published after 2010. Gay men and transgender women were the primary focal populations in the peer-reviewed literature, LGBT+ people as a whole in the grey literature. Health was the predominant domain across publications. Key findings include the absence of generalized antidiscrimination legislation for LGBT+ individuals and lack of recourse for transgender individuals to change their legal gender; multifaceted stigma and discrimination in the educational system; social isolation and exclusion in families; disproportionate prevalence of sexual violence and reluctance to report to police; discrimination and marginalization in employment; and LGBT+ disparities in health and mental health.

Conclusions

Future research and programmatic initiatives on LGBT+ inclusion in Thailand should aim to address: 1) understudied populations—lesbian and bisexual women, transmasculine persons; 2) underrepresented topics, including constraints to LGBT+ advocacy; 3) strategic policy initiatives around anti-discrimination laws and legal recognition of same-sex marriage and families; and 4) the need for consistent collection of disaggregated data on LGBT+ persons in education, family, economic, personal security/violence, and health domains in order to assess indicators of inclusion and progress in advancing human rights for LGBT+ people in Thailand.
Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)
Authors: Shibre Gebretsadik , Zegeye Betregiorgis , Ahinkorah Bright Opoku , Idriss-Wheeler Dina , Keetile Mpho , Yaya Sanni
Published: October 2021

Background

Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania.

Methods

Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance.

Results

Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern.

Conclusion

A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.
Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons
Authors: Xu Ting , Jia Xiaojun , Chen Shuanghong , Xie Yingying , Tong K. K. , Iezzi Tony , Jackson Todd
Published: October 2021

Background

Objectively measured differences in physical activity (PA) and sleep have been documented among people with osteoarthritis (OA) and rheumatoid arthritis (RA) compared to non-arthritic controls. However, it is not clear whether OA and RA subgroups also differ on these indexes or the extent to which distinct arthritis subgroups versus controls can be accurately identified on the basis of objective PA and sleep indexes compared to self-report responses on questionnaires. This study addressed these gaps.

Methods

This case-control study comprised Chinese adults with OA (N = 40) or RA (N = 40) diagnoses based on physician assessments as well as a control group of adults without chronic pain (N = 40). All participants wore a Sensewear Armband (SWA) for consecutive 7 days and completed the International Physical Activity Questionnaire Short Form-Chinese as well as Pittsburgh Sleep Diary to obtain objective and subjective PA and sleep data, respectively.

Results

There were no differences between the three groups on any self-report indexes of PA or sleep. Conversely, OA and RA subgroups displayed significantly lower PA levels and more sleep problems than controls did on a majority of SWA indexes, though arthritis subgroups were not differentiated from one another on these measures. Logistic regression analyses indicated four non-multicollinear SWA indexes (i.e., steps, active energy expenditure, vigorous activity, time awake after sleep onset) correctly identified the subgroup membership of 75.0–82.5% of participants with RA or OA while classification accuracy results were attenuated for controls.

Conclusions

Where possible, objective measures should be used to assess PA and sleep of adults with OA and RA while particular self-report PA questionnaires should be used sparingly.
Non Hodgkin lymphoma in Lebanon: a retrospective epidemiological study between 1984 and 2019
Authors: Touma Elsie , Antoun Leony , Hallit Souheil , Nasr Fadi , Massoud Marcel , El Othman Radwan , Chahine Georges
Published: October 2021

Background

Lymphomas are ranked as the fifth most common cancer in Lebanon. There is concern about the need of information regarding the prevalence of lymphoid neoplasm particularly Non-Hodgkin lymphoma (NHL) subtypes in the Lebanese population. This study intended to establish a descriptive status of NHL histological subtypes distribution in Lebanon thus identifying the most common types, knowing that the literature is poor regarding the distribution of lymphoid malignancies particularly NHLs in Lebanon.

Methods

A bicenter retrospective descriptive study was performed. Patients aged above 18, diagnosed with NHL between January 1984 and March 2019 and registered in two Lebanese Medical centers were included in this study; 699 medical files were reviewed and the baseline characteristics of the disease were collected. Histological classification was based on the Working Formulation (WF) and World Health Organization (WHO) classification systems, whereas staging was based on the Ann Arbor system. Disease status was monitored with imaging studies.

Results

The mean age at diagnosis was 53.52 ± 17.46 years in the studied population, with 380 (54.4%) males and 319 (45.6%) females. B-cell lymphoma (BCL) accounted for 86.3% while T-cell neoplasms accounted for 13.7%. The most common subtype was diffuse large B-cell lymphoma (DLBCL) (54%) followed by follicular lymphoma (FL) (17.2%). Mantle cell lymphoma (MCL) represented 3% of all BCL and small lymphocytic lymphoma (SLL) comprised less than 2%. Mucosa-associated lymphoid tissue (MALT) and Burkitt’s lymphomas represented 3 and 1.7% respectively. 36.5% of the patients had extranodal disease at diagnosis. High-grade tumor represented 80.1% with 33.1% stage IV disease.

Conclusion

These observations indicate that the epidemiological patterns of NHLs in Lebanon were comparable to Western countries. Aggressive lymphomas account for the majority of NHLs in Lebanon.
“Y no quedó nada, nada de la casa, todo salió volando” (And there was nothing left, nothing of the house, everything flew away): a critical medical ecological perspective on the lived experience of hurricane María in Puerto Rico
Authors: Vega Ocasio D. , Pérez Ramos J. G. , Dye T. D. V.
Published: October 2021

Background

Ecological disasters create dramatic changes as man-made and natural ecosystems adapt to their effects. In 2017, Hurricanes Irma and María devastated Puerto Rico. Public focus after such traumatic ecological events often neglects pre-existing community dynamics, heterogeneity of lived experience, and complexity of decision-making in the disaster context. We intended to better understand the lived experience of this ecological trauma in communities across ecosystems in Puerto Rico and among those displaced to Florida.

Method

We used the Critical Medical Ecological (CME) framework to assess the relative contribution of ecological dimensions on lived experience across community levels and time. We used qualitative methods with emic coding and etic mapping of salient constructs to the ecological model. In total, 96 people participated in 23 discussion encounters. Two people coded interviews in Spanish using Dedoose. We identified common themes in sequential order mapped to elements of the CME to approximate the participants’ temporal experience.

Results

Codes applied to the period of the hurricane’s landfall, traverse, and exit were markedly distinct from the other two periods (before and after) examined in this study: the experience of the hurricane’s strike was highly personal and, at this level, reflected a mix of sociocultural, biological, and abiotic factors. After the hurricanes, social and community factors re-emerged while new risks and conditions arose that were biological (e.g., leptospirosis, no food or water) or abiotic (e.g., unusable roads/bridges, structures destroyed), but created ongoing stressors and social needs for communities. As we found, the dynamics of the social and household landscape sometimes involved the decision to leave Puerto Rico altogether, or forced people to continually face and adapt to the ongoing collapse in basic services that were only slowly and differentially restored.

Conclusion

Lived experience across each stage of the hurricanes differed substantially from one another. Communities disrupted by ecological disaster are also frequently entangled within global economic and political histories and dependencies that could preclude recovery. Island nations are especially vulnerable to both climate-induced ecological change and political-economic exploitation. The ongoing health effect of the hurricane remains palpable in many communities of Puerto Rico and among the diaspora in Florida.
Association of Daytime Napping with chronic diseases among Tibetan people in China: a cross-sectional study
Authors: Ciren Wangla , Nima Qucuo , Li Yajie , He Ruifeng , Suolang Deji , Ciren Zhuoga , Wangqing Pingcuo , Fan Chaonan , Yang Dan , Wu Kunpeng , Liu Meijing , Zhou Junmin
Published: October 2021

Background

Obesity, diabetes, and hypertension, as three of the most prevalent chronic diseases, remain a daunting health challenge. However, to our knowledge, no study has made a thorough examination of the association between the three chronic diseases and daytime napping, a widely accepted behavior in many countries. This is especially necessary among Tibetan populations, whose lifestyles and health outcomes may be unique, yet patterns of chronic diseases and napping are under-examined. Thus, we sought to explore the aforementioned association in the Tibetan population of China.

Methods

A total of 2902 participants aged 45–79 in 2019 were included. Multivariate logistic regressions were conducted in 2020. The sex disparity was examined through interaction and stratified analyses.

Results

Hypertension (40.7%) was more prevalent than obesity (20.2%) and diabetes (21.6%). Comparing to non-nappers, those who napped were more likely to have any conditions (OR = 1.30, 95% CI = 1.04–1.62 for 1–59 min/day group and OR = 1.40, 95% CI = 1.10–1.80 for ≥60 min/day group). Participants who had 1–59 min/day of napping were more likely to develop obesity (OR = 1.37, 95% CI = 1.07–1.75), and ≥ 60 min/day of napping was associated with diabetes (OR = 1.33, 95% CI = 1.01–1.74). The interactions between napping and sex were not statistically significant in the models.

Conclusions

The study revealed napping was unfavorably associated with obesity, diabetes, and any conditions in Tibetan people living on the Tibetan Plateau. Future interventions regarding the three chronic diseases may pay more attention to napping.

Trial registration

Not applicable.
Association between social integration and medical returns among the migrant elderly following children to Jinan City China
Authors: Zhao Jinfeng , Kong Fanlei , Li Shixue
Published: October 2021

Background

Studies had shown that social integration was related to the utilization of medical services. Few studies investigated the relationship between social integration and medical returns among the elderly. None research had ever clarified the effect of social integration on medical returns among the migrant elderly following children (MEFC) to new cities. This study aimed to explore the association between social integration and medical returns among the MEFC in Jinan, China.

Method

This cross-sectional study included 627 MEFC in Jinan China. Social integration was evaluated by economic integration, acculturation, and identification. Medical return was assessed by asking the subjects whether go back to hometown to use the medical services when ill. Chi-squared test and multivariable logistic regression were applied to analyze the association between social integration and medical returns of the MEFC.

Results and discussion

It was found that 20.3% of the MEFC had a medical return. As for social integration, those who had not joined local medical insurance (OR = 3.561, 95% CI 1.577–8.039, p = 0.002) and were unwilling to stay for a long time (OR = 2.600, 95% CI 1.620–4.174, p = 0.001) were more likely to have a medical return. Furthermore, our findings showed that the MEFC who were accompanied by one or more (OR = 1.568, 95% CI 1.027–2.392, p = 0.037) were more likely to have a medical return than those who migrated alone.

Conclusion

Negative relationship between social integration and medical returns was found among the MEFC, which means the better social integration of the MEFC would generally have fewer medical return, as well as the better refunding connections of the medical insurance between the current residence and hometown.
Impact of valvular heart disease on hip replacement: a retrospective nationwide inpatient sample database study
Authors: Lian Qiang , Wang Jian , Lian Yun , Yang Qinfeng , Zhao Mingchen , Zhang Yang
Published: October 2021

Background

To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty.

Methods

This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time.

Results

VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12–1.18]), elective admission (OR = 0.78 [0.76–0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03–1.08]), large-volume hospitals (OR = 1.13 [1.1–1.2]), teaching hospitals (OR = 5 4.4 [2.9–6.7]), and hospital location in urban areas (OR = 1.22 [1.2–1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87–3.04]), acute pulmonary edema (OR = 1.13 [1.06–1.21]), acute cerebrovascular event (OR = 1.22 [1.16–1.74]), and acute renal failure (OR = 1.22 [1.17–1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8–0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27–4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32–2.8]) and elective admission (OR = 0.51 [0.36–0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76–3.53]) and acute hepatic failure (OR = 7.69 [1.8–32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost.

Conclusion

VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.
Are leisure-time and work-related activities associated with low back pain during pregnancy?
Authors: Caputo Eduardo L. , Domingues Marlos R. , Bertoldi Andrea D. , Ferreira Paulo H. , Ferreira Manuela L. , Shirley Debra , da Silva Marcelo C.
Published: October 2021

Background

Although working activities are associated with several pregnancy outcomes, there is scarce information regarding the association between working activities and low back pain (LBP) during pregnancy. This study aimed to investigate whether leisure-time and work-related physical activities during pregnancy are associated with LBP.

Methods

Data from the 2015 Pelotas Birth Cohort study were used. Demographic, socioeconomic, gestational, leisure-time (prior to and during pregnancy) and work-related (days of work, hours of work, standing and heavy lifting) physical activity data were collected at birth. LPB was assessed in the 12-month follow-up period.

Results

Leisure-time physical activity either prior to and during pregnancy was not associated with LBP. Working during pregnancy, days of work and standing position at work were not associated with self-reported LBP during pregnancy. However, working more than 8 h per day and always lifting heavy objects at work increased the odds ratio for LBP (OR 1.30 95%CI: 1.04; 1.63; and OR: 1.39 95%CI 1.08; 1.81, respectively). In addition, women who had lifted heavy objects often/always, reported an increase in pain intensity.

Conclusion

Working during pregnancy and days worked per week were not related to experiencing LBP. However, women who worked more than 8 h per day, as well as women who lifted heavy objects at work on a regular basis, were more likely to experience pregnancy-related LBP.
Exploring changes, and factors associated with changes, in behavioural determinants from a low-cost, scalable education intervention about knee osteoarthritis: An observational cohort study
Authors: Egerton Thorlene , Bolton Joanne , Short Camille E. , Bennell Kim L.
Published: October 2021

Objective

To explore the relationships between participant characteristics, perceptions of a short educational video about osteoarthritis and its management, and immediate changes in behavioural determinants for effective self-management behaviours.

Methods

Seventy-eight participants with knee OA (77% female, mean age 63.0 ± 8.7) watched the 9-min video that included evidence-based content and was designed to foster empowerment to self-manage effectively. Data were collected by online questionnaire at baseline and immediately after watching the video. Associations were tested between baseline health and information processing characteristics (health literacy, need for cognition), perceptions of the video (enjoyment, helpfulness, believability, novelty and relevance) and pre-post changes in behavioural determinants (self-efficacy for managing arthritis, attitude to self-management or ‘activation’, and importance/confidence for physical activity).

Results

All behavioural determinants improved immediately after watching the video. Positive perceptions were associated with greater improvements in self-efficacy for arthritis (Spearman’s rho, ρ = 0.26–0.47). Greater perceived relevance was associated with increased self-rated importance of being physically active (ρ = 0.43). There were small positive associations between health literacy domains related to health information and positive viewer perceptions of the video. People with higher need for cognition may achieve greater improvement in confidence to be physically active (ρ = 0.27).

Conclusion

The educational video may help achieve outcomes important for increasing self-management behaviours in people with knee osteoarthritis. Positive perceptions appear to be important in achieving these improvements. People with lower health literacy and lower need for cognition may respond less well to this information about knee osteoarthritis delivered in this way.
Laparoscopic transgastric necrosectomy in treatment of walled-off pancreatic necrosis with sinistral portal hypertension
Authors: Cao Feng , Li Ang , Wang Xiaohui , Gao Chongchong , Li Jia , Li Fei
Published: October 2021

Background

Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear.

Methods

WON patients with sinistral portal hypertension treated in our department between January 2011 and December 2018 were included and retrospectively analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups.

Results

312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p = 0.04) and similar severe complication (Clavien–Dindo ≥ III) rate (12.5% vs 19.0%, p = 0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p = 1.00) and mortality (9.5% vs 9.4%, p = 1.00). After 39 (11–108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups.

Conclusion

From current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.
Plate osteosynthesis of single metacarpal fracture: WALANT technique is a cost-effective approach to reduce postoperative pain and discomfort in contrast to general anesthesia and wrist block
Authors: Lin Yen-Chang , Chen Wei-Chieh , Chen Chun-Yu , Kuo Shyh-Ming
Published: October 2021

Background

The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures.

Methods

We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment.

Results

A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery.

Conclusions

The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.
Potential for treatment benefit of STING agonists plus immune checkpoint inhibitors in oral squamous cell carcinoma
Authors: Zhu Chao , Li Jiang , Yao Mianfeng , Fang Changyun
Published: October 2021

Background

DNA-sensing receptor cyclic GMP–AMP synthase (cGAS) and its downstream signaling effector stimulator of interferon genes (STING) present a novel role in anti-tumor immunity. Recently, the combination of cGAS-STING agonists and immunotherapy achieved promising results in some tumor types. The correlation between cGAS-STING signaling pathway and the tumor immune microenvironment in patients with oral squamous cell carcinoma (OSCC) is unclear.

Methods

We utilized RNA sequencing and clinical data of OSCC patients from the TCGA database to investigate the correlation between cGAS-STING signaling pathway and the tumor immune microenvironment. Six cGAS-STING related genes were obtained from previous studies to establish the enrichment score of cGAS-STING pathway. The differences in survival rate, immune cell infiltration, immune-related genes expression and immune-related biological pathways were studied in the cGAS-STING clusters.

Results

We observed a better prognosis of OSCC patients in the cGAS-STING high cluster. The infiltration ratio of immune cells and the expression profiles of immune-related genes were elevated when the cGAS-STING pathway is activated. The differentially expressed genes between high and low cGAS-STING clusters were enriched in immune-related biological pathways.

Conclusions

Our findings suggest the potential benefit of combining STING agonists and immune checkpoint inhibitors in OSCC patients.
Mapping the health systems response to violence against women: key learnings from five LMIC settings (2015–2020)
Authors: Sikder Shegufta Shefa , Ghoshal Rakhi , Bhate-Deosthali Padma , Jaishwal Chandni , Roy Nobhojit
Published: October 2021

Background

Violence against women (VAW) is a global challenge, and the health sector is a key entry point for survivors to receive care. The World Health Organization adopted an earlier framework for health systems response to survivors. However, documentation on the programmatic rollout of health system response to violence against women is lacking in low and middle-income countries. This paper studies the programmatic roll out of the health systems response across select five low- and middle-income countries (LMIC) and identifies key learnings.

Methods

We selected five LMIC settings with recent or active programming on national-level health system response to VAW from 2015 to 2020. We synthesized publicly available data and program reports according to the components of the WHO Health Systems Framework. The countries selected are Bangladesh, Brazil, Nepal, Rwanda, and Sri Lanka.

Results

One-stop centers were found to be the dominant model of care located in hospitals in four countries. Each setting has implemented in-service training as key to addressing provider knowledge, attitudes and practice; however, significant gaps remain in addressing frequent staff turnover, provision of training at scale, and documentation of the impact of training. The health system protocols for VAW address sexual violence but do not uniformly include clinical and health policy responses for emotional or economic violence. Providing privacy to survivors within health facilities was a universal challenge.

Conclusion

Significant efforts have been made to address provider attitudes towards provision of care and to protocolize delivery of care to survivors, primarily through one-stop centers. Further improvements can be made in data collection on training impact on provider attitudes and practices, in provider identification of VAW survivors, and in prioritization of VAW within health system budgeting, staffing, and political priorities. Primary health facilities need to provide first-line support for survivors to avoid delays in response to all forms of VAW as well as for secondary prevention.
Undergraduate palliative care education in the United Arab Emirates: a nationwide assessment of medical school deans
Authors: Harhara Thana , Ibrahim Halah
Published: October 2021

Background

The provision of comprehensive, high quality palliative care (PC) is a global public health concern. In the United Arab Emirates (UAE), palliative medicine services are limited, and most patients in need of PC are treated in the acute hospital setting, where health professionals of all specialties provide treatment. Improving end-of-life care requires teaching medical students, residents, and other healthcare professionals about PC. The purpose of this study was to assess the current status of PC education in medical schools in the UAE, and to identify barriers to successful implementation of a PC and end-of-life curriculum.

Methods

The authors conducted semi-structured interviews with deans from all medical schools in the UAE. Data were analyzed using qualitative content analysis.

Results

All medical school deans in our study recognized the importance of inculcating palliative and end-of-life care into the undergraduate curriculum, but there was substantial variability in implementation, with opportunities for improvement. Barriers to the successful implementation of an undergraduate PC curriculum include (1) lack of student awareness and interest in PC, (2) inconsistent clinical exposure to PC, (3) lack of specialized PC faculty, (4) limited clinical facilities for PC training, (5) lack of a multidisciplinary approach to PC education, and (6) cultural barriers to PC education.

Conclusions

Understanding challenges to teaching PC in the undergraduate medical curriculum can help inform educational interventions to improve PC knowledge and skills for UAE medical students. Curricular and policy reform are necessary to educate a future generation of health professionals, who can provide high quality palliative care services to UAE patients and their families.