bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating an International Facial Trauma Course for Surgeons: Did We Make a Difference?
Authors: Younas Ayesha , Shah Irfan , Lim Thiam Chye , Figari Marcelo , Louie Gorman , Matic Damir , van der Tas Justin T. , Wolvius Eppo B. , McVicar Iain
Published: May 2021

Study Design:

Retrospective data analysis study.

Objective:

Attending continuing professional development (CPD) and continuing medical education (CME) activities is a necessity for practicing surgeons in most parts of the world. To enhance best practices in conducting CME/CPD, objective evaluation of these events is crucial. This article aims to evaluate one such international standardized CPD course conducted for facial surgeons across the globe. The Management of Facial Trauma course was developed by an international planning committee of experienced surgeons and has been implemented in all regions of the world.

Method:

This 2-day course is delivered using a combination of short lectures, small group discussions, and practical hands-on activities. Data collected from pre- and post-course evaluations of 86 Management of Facial Trauma courses conducted worldwide from 2017-2019 were collated and analyzed.

Results:

Participant demographics and experience levels varied slightly across the regions. Evaluation of the course effectiveness revealed overall high ratings for educational impact, content usefulness, and faculty performance.

Conclusion:

Our results indicated that this standardized course met the audience needs and enabled participants to plan changes in clinical practice. In addition, it confirmed that the course was relevant across different specialties and across different cultures and countries.
Morphometric evaluation and measurements of primary pterygium by anterior segment optical coherence tomography and its relation with astigmatism
Authors: Raj Anuradha , Dhasmana Renu , Bahadur Harsh
Published: May 2021

Purpose:

To evaluate the relationship between measurements and various morphometric parameters of primary pterygium on anterior segment optical coherence tomography(AS-OCT) and refractive and keratometric astigmatism.

Methods:

In this cross-sectional study, patients with primary pterygium were included. The AS-OCT parameters of pterygium consisting of epithelial thickness near apex(µm), apical or head thickness(µm), its thickness at limbus(µm), horizontal length of pterygium(mm), central corneal thickness (µm) and maximum pterygium thickness(mm) were evaluated.

Results:

Sixty three patients comprising of 63 eyes with a primary pterygium were studied. The mean keratometric and refractive astigmatism were 1.69 ± 3.15 Diopter(D) and0.5 ± 1.4D, respectively. There was a significant association between pterygium grade and stocker’s line with keratometric astigmatism ( p = 0.02, 0.00) respectively. Vertical and horizontal length on slit lamp and horizontal length on AS-OCT showed significant association with keratometric astigmatism ( p = 0.05, 0.00,0.00), respectively. Limbal thickness on AS-OCT showed significant positive correlation with refractive astigmatism ( r = 0.29, p = 0.02).

Conclusion:

The pterygium grade influences the keratometric astigmatism. Increased limbal thickness of pterygium on AS-OCT leads to more refractive astigmatism.
Effect of face-layer moisture content and face–core–face ratio of mats on the temperature and vapor pressure behavior during hot-pressing of wood-based panel manufacturing
Authors: Murayama Kazushige , Kukita Kensuke , Kobori Hikaru , Kojima Yoichi , Suzuki Shigehiko , Miyamoto Kohta
Published: May 2021

Wood-based panels are made by consolidating mats of resinous wooden raw materials under a hot-pressing process. This study investigates the effect of face-layer moisture content (MC) and face–core–face (FCF) ratio of mats on the temperature and vapor pressure behavior during the hot-pressing process. Raising the face-layer MC and lowering the face-layer thickness was expected to reduce the time of reaching 100 °C in the hot-pressing process. When the temperature rise was limited or the core temperature decreased after reaching 100 °C (defined as plateau in this study), the mats with 25% and 30% face-layer MC with 1:2:1 FCF ratio reached the highest plateau core temperature, but required a longer time to complete the plateau. The relationship between core plateau temperature and maximum core vapor pressure was well described by the Antoine equation, which empirically models the vapor pressure as a function of temperature. The Antoine equation held across both face-layer MC series (varying face-layer MC at constant FCF ratio) and FCF series (varying FCF ratio at constant face-layer MC). The mat with 20% face-layer MC and 1:2:1 FCF ratio reached 180 °C within the shortest time, regardless of the evaluation conditions.
Bone mineral density in elite masters athletes: the effect of body composition and long-term exercise
Authors: Kopiczko Anna , Adamczyk Jakub Grzegorz , Gryko Karol , Popowczak Marek
Published: May 2021

Background

The purpose of the study was to examine how bone mineral density (BMD) is related to body composition depending on the practiced sport (endurance, speed-power, throwing sports) in participants of the World Masters Athletics Championship.

Methods

Dual-energy X-ray absorptiometry (DXA) was used to determine BMD and bone mass (BMC). Body composition was analyzed by means of the JAWON Medical X-scan analyzer using bioelectrical impedance methods. Percentage body fat (%BF), body fat mass (BFM), lean body mass (LBM), total body water (TBW), soft lean mass (SLM), intracellular water (ICW), and extracellular water (ECW) were evaluated.

Results

Among men, the most important variables affecting the BMD norm were LBM (OR = 32.578; p = 0.023), ECW (OR = 0.003; p = 0.016) and ICW (OR = 0.011; p = 0.031), in the distal part and SLM (OR = 5.008; p = 0.020) and ICW (0.354, p = 0.008) in the proximal part. In women, the most important predictors of normal BMD were ICW (OR = 10.174; p = 0.003) and LBM (OR = 0.470; p = 0.020) in the distal part and ICW (OR = 5.254; p = 0.038) in the proximal part.

Conclusion

The representatives of strength based events had the most advantageous BMD levels. The condition of bone tissue evaluated by BMC and BMD of the forearm in masters athletes was strongly determined by the level of lean body components and the type of sports training associated with the track and field event. In the most important predictors of the BMD norm were also hydration components ECW and ICW. However, this relationship requires more research on the nature and mechanisms of these interactions.
Isolated renal hydatid cyst misdiagnosed and treated as a cystic renal tumor: a diagnostic pitfall
Authors: Hamdani Moez , Bdioui Ahlem , Belkacem Oussama , Jelidi Nizar , Baccouche Atika , Majdoub Wiem , Belhaj Salah Sihem Hmissa
Published: May 2021

Background

The hydatid disease is a parasitic infestation caused by the larval stage of Echinococcus granulosus. The renal location of this infectious disease is uncommon compared to hepatic or pulmonary ones. Most patients remain asymptomatic for years and hydatiduria is the only pathognomonic clinical symptom. We report a rare case of renal hydatid cyst misdiagnosed and treated as a renal tumor.

Case presentation

A 45-year-old woman with no significant medical or surgical history presented with left lumber pain with hematuria. Magnetic Resonance Imaging (MRI) displayed a left renal mass with cystic and solid components, showing discreet enhancement, classified as Bosniak IV. The diagnosis of renal malignant tumor was made. The patient underwent a lumbotomy. Intraoperatively, the mass was adherent to the perirenal fat and seemed to invade the adrenal gland. An enlarged left nephrectomy with surrenalectomy was performed. The gross specimen showed a superior polar renal cyst (9 × 7 × 6cm). The cyst had a thick wall and contained multiple internal smaller cysts recalling the appearance of the hydatid cyst. The microscopic study showed a cyst wall consisting of acellular eosinophilic laminated membrane lined by a thin germinal layer from which merge daughter cysts. This cyst wall is surrounded by a dense fibrovascular tissue with chronic inflammatory cells. The diagnosis of renal hydatic cyst was made.

Conclusion

Although the renal hydatid cyst is relatively rare, this diagnosis must be considered in patients with renal cystic masses, especially endemic countries. Preoperative diagnosis is challenging, especially in type IV cysts which can mimic a renal tumor and lead to overtreatment.
A sequence-based multiple kernel model for identifying DNA-binding proteins
Authors: Qian Yuqing , Jiang Limin , Ding Yijie , Tang Jijun , Guo Fei
Published: May 2021

Background

DNA-Binding Proteins (DBP) plays a pivotal role in biological system. A mounting number of researchers are studying the mechanism and detection methods. To detect DBP, the tradition experimental method is time-consuming and resource-consuming. In recent years, Machine Learning methods have been used to detect DBP. However, it is difficult to adequately describe the information of proteins in predicting DNA-binding proteins. In this study, we extract six features from protein sequence and use Multiple Kernel Learning-based on Centered Kernel Alignment to integrate these features. The integrated feature is fed into Support Vector Machine to build predictive model and detect new DBP.

Results

In our work, date sets of PDB1075 and PDB186 are employed to test our method. From the results, our model obtains better results (accuracy) than other existing methods on PDB1075 ($$84.19\%$$

84.19
%

) and PDB186 ($$83.7\%$$

83.7
%

), respectively.

Conclusion

Multiple kernel learning could fuse the complementary information between different features. Compared with existing methods, our method achieves comparable and best results on benchmark data sets.
The holobiont transcriptome of teneral tsetse fly species of varying vector competence
Authors: Medina Munoz Miguel , Brenner Caitlyn , Richmond Dylan , Spencer Noah , Rio Rita V. M.
Published: May 2021

Background

Tsetse flies are the obligate vectors of African trypanosomes, which cause Human and Animal African Trypanosomiasis. Teneral flies (newly eclosed adults) are especially susceptible to parasite establishment and development, yet our understanding of why remains fragmentary. The tsetse gut microbiome is dominated by two Gammaproteobacteria, an essential and ancient mutualist Wigglesworthia glossinidia and a commensal Sodalis glossinidius. Here, we characterize and compare the metatranscriptome of teneral Glossina morsitans to that of G. brevipalpis and describe unique immunological, physiological, and metabolic landscapes that may impact vector competence differences between these two species.

Results

An active expression profile was observed for Wigglesworthia immediately following host adult metamorphosis. Specifically, ‘translation, ribosomal structure and biogenesis’ followed by ‘coenzyme transport and metabolism’ were the most enriched clusters of orthologous genes (COGs), highlighting the importance of nutrient transport and metabolism even following host species diversification. Despite the significantly smaller Wigglesworthia genome more differentially expressed genes (DEGs) were identified between interspecific isolates (n = 326, ~ 55% of protein coding genes) than between the corresponding Sodalis isolates (n = 235, ~ 5% of protein coding genes) likely reflecting distinctions in host co-evolution and adaptation. DEGs between Sodalis isolates included genes involved in chitin degradation that may contribute towards trypanosome susceptibility by compromising the immunological protection provided by the peritrophic matrix. Lastly, G. brevipalpis tenerals demonstrate a more immunologically robust background with significant upregulation of IMD and melanization pathways.

Conclusions

These transcriptomic differences may collectively contribute to vector competence differences between tsetse species and offers translational relevance towards the design of novel vector control strategies.
Acute kidney injury in children with COVID-19: a retrospective study
Authors: Kari Jameela Abdulaziz , Shalaby Mohamed A , Albanna Amr S , Alahmadi Turki S , Alherbish Adi , Alhasan Khalid A
Published: May 2021

Background

Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.

Methods

This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging.

Results

Of 89 children included, 19 (21 %) developed AKI (52.6 % stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15 % vs. 1.5 %). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32 % vs. 2.8 %,p < 0.001) and mortality (42 % vs. 0 %,p < 0.001). However, AKI was not associated with prolonged hospitalization (58 % vs. 40 %,p = 0.163) or development of MIS-C (10.5 % vs. 1.4 %,p = 0.051). No patient in the AKI group required renal replacement therapy. Residual renal impairment at discharge occurred in 9 % of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.

Conclusions

AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.
Anti-fibrotic potential of erythropoietin signaling on bone marrow derived fibrotic cell
Authors: Iwata Yasunori , Sakai Norihiko , Nakajima Yuki , Oshima Megumi , Nakagawa-Yoneda Shiori , Ogura Hisayuki , Sato Koichi , Minami Taichiro , Kitajima Shinji , Toyama Tadashi , Yamamura Yuta , Miyagawa Taro , Hara Akinori , Shimizu Miho , Furuichi Kengo , Wada Takashi
Published: May 2021

Introduction

The number of patients with end stage kidney disease (ESKD) are increasing world-side. While interstitial fibrosis (IF) is a common step for the progression to ESKD, therapeutic options for IF is still limited in clinical settings. We have reported that bone marrow-derived fibrotic cell, fibrocyte, is involved in the pathogenesis of kidney fibrosis. Also recent studies revealed that erythropoietin has protective effect on kidney diseases. However, it is unknown whether erythropoietin (EPO) inhibits fibrosis in progressive kidney injury. Therefore, we explored the impacts of EPO on kidney fibrosis with focusing on fibrocyte.

Method

Fibrocyte was differentiated from peripheral mononuclear cells of healthy donor. Fibrocyte was stimulated with transforming growth factor beta (TGF)-β with/without EPO treatment. Moreover, the therapeutic effect of EPO was evaluated in murine unilateral ureteral obstruction (UUO) model.

Result

TGF-β stimulation increased the expression of COL1 mRNA in fibrocyte. EPO signal reduced the expression of COL1 mRNA in dose dependent manner. EPO reduced mitochondrial oxidative stress and ameliorated mitochondrial membrane depolarization induced by TGF-β stimulation. Moreover, EPO reduced the mRNA expression of mitochondria related molecules, TRAF6, in fibrocyte. In addition, the count of CD45+/αSMA + double-positive fibrocyte was decreased in the EPO-administered UUO kidneys.

Conclusion

EPO signals function to prevent kidney fibrosis, particularly in fibrocyte. Regulating the renal accumulation of fibrocyte is a part of the anti-fibrotic functions of EPO.
Identification of the prognostic value of ferroptosis-related gene signature in breast cancer patients
Authors: Wang Ding , Wei Guodong , Ma Ju , Cheng Shuai , Jia Longyuan , Song Xinyue , Zhang Ming , Ju Mingyi , Wang Lin , Zhao Lin , Xin Shijie
Published: May 2021

Background

Breast cancer (BRCA) is a malignant tumor with high morbidity and mortality, which is a threat to women’s health worldwide. Ferroptosis is closely related to the occurrence and development of breast cancer. Here, we aimed to establish a ferroptosis-related prognostic gene signature for predicting patients’ survival.

Methods

Gene expression profile and corresponding clinical information of patients from The Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO) database. The Least absolute shrinkage and selection operator (LASSO)-penalized Cox regression analysis model was utilized to construct a multigene signature. The Kaplan-Meier (K-M) and Receiver Operating Characteristic (ROC) curves were plotted to validate the predictive effect of the prognostic signature. Gene Ontology (GO) and Kyoto Encyclopedia of Genes, Genomes (KEGG) pathway and single-sample gene set enrichment analysis (ssGSEA) were performed for patients between the high-risk and low-risk groups divided by the median value of risk score.

Results

We constructed a prognostic signature consisted of nine ferroptosis-related genes (ALOX15, CISD1, CS, GCLC, GPX4, SLC7A11, EMC2, G6PD and ACSF2). The Kaplan-Meier curves validated the fine predictive accuracy of the prognostic signature (p < 0.001). The area under the curve (AUC) of the ROC curves manifested that the ferroptosis-related signature had moderate predictive power. GO and KEGG functional analysis revealed that immune-related responses were largely enriched, and immune cells, including activated dendritic cells (aDCs), dendritic cells (DCs), T-helper 1 (Th1), were higher in high-risk groups (p < 0.001). Oppositely, type I IFN response and type II IFN response were lower in high-risk groups (p < 0.001).

Conclusion

Our study indicated that the ferroptosis-related prognostic signature gene could serve as a novel biomarker for predicting breast cancer patients’ prognosis. Furthermore, we found that immunotherapy might play a vital role in therapeutic schedule based on the level and difference of immune-related cells and pathways in different risk groups for breast cancer patients.
Genomic stratification based on microenvironment immune types and PD-L1 for tailoring therapeutic strategies in bladder cancer
Authors: Lyu Xintong , Wang Ping , Qiao Qiao , Jiang Yuanjun
Published: May 2021

Background

The tumour microenvironment (TME) not only plays a role during tumour progression and metastasis but also profoundly influences treatment efficacy. Environment-mediated drug resistance is a result of crosstalk between tumour cells and stroma. The presence of a “stromal exhaustion” response is suggested by the T cell exhaustion signature and PD-L1 expression. The prognostic role of PD-L1 in bladder cancer has been investigated in previous studies, but the results remain inconclusive. For a more comprehensive study, we discuss potential strategies to improve effectiveness in patients with various TME statuses and PD-L1 expression levels.

Methods

We estimated the prognostic role of PD-L1 using immunohistochemistry and identified four immune subtypes according to the type of stromal immune modulation and PD-L1 expression status.

Results

Patients in the PD-L1-low-exhausted group had the worst prognosis and showed the worst antigen-presenting cell (APC) immunosuppression status. The PD-L1-low-exhausted group showed the highest amount of infiltration by macrophage M2 cells, naïve B cells and resting mast cells. The TMB and the effectiveness of anti-PD-1 treatment were significantly increased in the PD-L1-high expression groups compared with the PD-L1-low expression groups. In the PD-L1-high groups, patients who underwent chemotherapy exhibited better overall survival rates than patients who did not undergo chemotherapy, whereas there was no significant difference in the PD-L1-low groups. We performed gene set enrichment analysis (GSEA) to explore the critical pathways that were active in the PD-L1-low-exhausted group, including the myogenesis, epithelial-mesenchymal transition and adipogenesis pathways. Copy number variations (CNVs) were related to the expression levels of differentially expressed genes upregulated in the PD-L1-low-exhausted group, including LCNL1, FBP1 and RASL11B. In addition, RASL11B played a role in predicting overall survival according to The Cancer Genome Atlas data, and this finding was validated in the PD-L1-low-exhausted group in the Gene Expression Omnibus database (GEO).

Conclusion

The immune environment of tumours plays an important role in the therapeutic response rate, and defining the immune groups plays a critical role in predicting disease outcome and strategy effectiveness.
Predicting breast cancer drug response using a multiple-layer cell line drug response network model
Authors: Huang Shujun , Hu Pingzhao , Lakowski Ted M.
Published: May 2021

Background

Predicting patient drug response based on a patient’s molecular profile is one of the key goals of precision medicine in breast cancer (BC). Multiple drug response prediction models have been developed to address this problem. However, most of them were developed to make sensitivity predictions for multiple single drugs within cell lines from various cancer types instead of a single cancer type, do not take into account drug properties, and have not been validated in cancer patient-derived data. Among the multi-omics data, gene expression profiles have been shown to be the most informative data for drug response prediction. However, these models were often developed with individual genes. Therefore, this study aimed to develop a drug response prediction model for BC using multiple data types from both cell lines and drugs.

Methods

We first collected the baseline gene expression profiles of 49 BC cell lines along with IC50 values for 220 drugs tested in these cell lines from Genomics of Drug Sensitivity in Cancer (GDSC). Using these data, we developed a multiple-layer cell line-drug response network (ML-CDN2) by integrating a one-layer cell line similarity network based on the pathway activity profiles and a three-layer drug similarity network based on the drug structures, targets, and pan-cancer IC50 profiles. We further used ML-CDN2 to predict the drug response for new BC cell lines or patient-derived samples.

Results

ML-CDN2 demonstrated a good predictive performance, with the Pearson correlation coefficient between the observed and predicted IC50 values for all GDSC cell line-drug pairs of 0.873. Also, ML-CDN2 showed a good performance when used to predict drug response in new BC cell lines from the Cancer Cell Line Encyclopedia (CCLE), with a Pearson correlation coefficient of 0.718. Moreover, we found that the cell line-derived ML-CDN2 model could be applied to predict drug response in the BC patient-derived samples from The Cancer Genome Atlas (TCGA).

Conclusions

The ML-CDN2 model was built to predict BC drug response using comprehensive information from both cell lines and drugs. Compared with existing methods, it has the potential to predict the drug response for BC patient-derived samples.
Secondary choroidal neovascularization due to choroidal osteoma after 9 years follow-up
Authors: Zhang Yun , Fang Jia , Zhao Shixin , She Xiangjun , Wang Jun , Shen Lijun
Published: May 2021

Background

Choroidal osteoma is a benign intraocular tumor that can increase risk of developing choroidal neovascularization. The visual prognosis is influenced by the tumor location, decalcification status, overlying RPE atrophy, presence of choroidal neovascularization, persistence of subretinal fluid and occurrence of subretinal hemorrhages.

Case presentation

The authors present a 40-year-old woman diagnosed with choroidal osteoma of the right eye. Her best corrected visual acuity was 12/20 but decreased to 5/20 due to secondary choroidal neovascularization after 8 years follow up. Fundus examination revealed an enlarged choroidal osteoma in most margins at posterior pole with schistose hemorrhage beside macula. Optical coherence tomography angiography revealed unique features in the vascular changes of choroidal neovascularization in choroidal osteoma in the outer retinal layer and choroid capillary layers, and subretinal neovascularization. Indocyanine green fluorescence angiography showed there was hypo-fluorescence at the peripapillary with faint hyper-fluorescence at the macular, corresponding to the location on the fundus photograph. The patient received 3 injections of intravitreal ranibizumab. After 1 year follow up, her visual acuity of the right eye was 18/20 and the CNV had regressed.

Conclusions

We present the findings and treatment of a case of choroidal osteoma with secondary choroidal neovascularization. Optical coherence tomography angiography combined with FFA and ICGA is used to analysis the characteristics of secondary choroidal neovascularization. Optical coherence tomography angiography can reveal some unique characteristics in the vascular changes compared to fundus fluorescein angiography.
A de novo 10q11.23q22.1 deletion detected by whole genome mate-pair sequencing: a case report
Authors: Fu Dalin , Lin Weisheng , Lu Fen , Du Senjie , Zhu Min , Zhao Xiaoke , Tang Jian , Chen Chuan , Chui Xiaoli , Tang Shanmei , Wang Kai , Yang Chuanchun , Han Bei
Published: May 2021

Background

Interstitial deletions of chromosome band 10q11-q22 was a genomic disorder distinguished by developmental delay, congenital cleft palate and muscular hypotonia. The phenotypes involved were heterogeneous, hinge on the variable breakpoints and size.

Case presentation

Here, we presented a patient with soft palate cleft, growth and development delay. The patient was a 2 years and 5 months girl who was not able to walk unless using a children’s crutches to support herself. Whole-exome sequencing (WES) and whole-genome mate-pair sequencing (WGMS) were both performed by next generation sequencing (NGS). A 20.76 Mb deletion at 10q11.23q22.1 (seq[GRCh37/hg19]del(10)(50,319,387-71,083,899) × 1) was revealed by the WGMS, which was verified as de novo by quantitative polymerase chain reaction (QPCR).

Conclusion

Children with 10q11-q22 deletions greater than 20 MB have never been reported before, and we are the first to report and provide a detailed clinical phenotype, which brings further knowledge of 10q11-q22 deletions.
Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders
Authors: Penas Patricia , Uriarte Jose-Juan , Gorbeña Susana , Slade Mike , Moreno-Calvete María-Concepción , Iraurgi Ioseba
Published: May 2021

Background

Personal recovery has become an increasingly important approach in the care of people with severe mental disorders and consequently in the orientation of mental health services. The objective of this study was to assess the personal recovery process in people using mental health services, and to clarify the role of variables such as symptomatology, self-stigma, sociodemographic and treatment.

Methods

Standardised measures of personal recovery process, clinical recovery, and internalized stigma were completed by a sample of 312 participants in a Severe Mental Disorder program.

Results

Users valued most the recovery elements of: improving general health and wellness; having professionals who care; hope; and sense of meaning in life. Significant discrepancies between perceived experience and relative importance assigned to each of the components of the REE were observed. Regression modeling (χ2 = 6.72,p = .394; GFI = .99, SRMR = .03) identified how positive discrepancies were associated with a higher presence of recovery markers (β = .12,p = .05), which in turn were negatively related to the derived symptomatology index (β = −.33,p < .001). Furthermore, the relationship between clinical and personal recovery was mediated by internalized stigma.

Conclusions

An improvement in psychiatric services should be focused on recovery aspects that have the greatest discrepancy between importance and experience, in particular social roles, basic needs and hope. Personal and clinical recovery are correlated, but the relationship between them is mediated by internalized stigma, indicating the need for clinical interventions to target self-stigma.
Correction to: Inequalities in the utilisation of maternal health Care in Rural India: Evidences from National Family Health Survey III & IV
Authors: Ali Balhasan , Chauhan Shekhar
Published: May 2021

An amendment to this paper has been published and can be accessed via the original article.
Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort
Authors: Westerlind Emma , Palstam Annie , Sunnerhagen Katharina S. , Persson Hanna C.
Published: May 2021

Background

The impact of Covid-19 and its long-term consequences is not yet fully understood. Sick leave can be seen as an indicator of health in a working age population, and the present study aimed to investigate sick-leave patterns after Covid-19, and potential factors predicting longer sick leave in hospitalised and non-hospitalised people with Covid-19.

Methods

The present study is a comprehensive national registry-based study in Sweden with a 4-month follow-up. All people who started to receive sickness benefits for Covid-19 during March 1 to August 31, 2020, were included. Predictors of sick leave ≥1 month and long Covid (≥12 weeks) were analysed with logistic regression in the total population and in separate models depending on inpatient care due to Covid-19.

Results

A total of 11,955 people started sick leave for Covid-19 within the inclusion period. The median sick leave was 35 days, 13.3% were on sick leave for long Covid, and 9.0% remained on sick leave for the whole follow-up period. There were 2960 people who received inpatient care due to Covid-19, which was the strongest predictor of longer sick leave. Sick leave the year prior to Covid-19 and older age also predicted longer sick leave. No clear pattern of socioeconomic factors was noted.

Conclusions

A substantial number of people are on sick leave due to Covid-19. Sick leave may be protracted, and sick leave for long Covid is quite common. The severity of Covid-19 (needing inpatient care), prior sick leave, and age all seem to predict the likelihood of longer sick leave. However, no socioeconomic factor could clearly predict longer sick leave, indicating the complexity of this condition. The group needing long sick leave after Covid-19 seems to be heterogeneous, indicating a knowledge gap.
Understanding mobile application development and implementation for monitoring Posyandu data in Indonesia: a 3-year hybrid action study to build “a bridge” from the community to the national scale
Authors: Rinawan Fedri Ruluwedrata , Susanti Ari Indra , Amelia Indah , Ardisasmita Mulya Nurmansyah , Widarti  , Dewi Rima Kusumah , Ferdian Dani , Purnama Wanda Gusdya , Purbasari Ayi
Published: May 2021

Background

Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu (Posyandu/Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia.

Methods

A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition.

Results

(1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs’ knowledge (p = 0.000) and skills (p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia.

Conclusions

The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs’ book. Hence, its implementation is promising for use at the national level.
Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study
Authors: Ruan Sheng-Yuan , Huang Chun-Ta , Chien Ying-Chun , Huang Chun-Kai , Chien Jung-Yien , Kuo Lu-Cheng , Kuo Ping-Hung , Ku Shih-Chi , Wu Huey-Dong
Published: May 2021

Background

Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described.

Methods

In this retrospective cohort study, we described etiology-associated heterogeneity in gas exchange abnormality (PaO2/FiO2 [P/F] and ventilatory ratios), hemodynamic instability, non-pulmonary organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score, biomarkers of inflammation and coagulation, and 30-day mortality. Linear regression was used to model the trajectory of P/F ratios over time. Wilcoxon rank-sum tests, Kruskal–Wallis rank tests and Chi-squared tests were used to compare between-etiology differences.

Results

From 1725 mechanically ventilated patients in the ICU, we identified 258 (15%) with ARDS. Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. Compared with pneumonia associated ARDS, extra-pulmonary sepsis associated ARDS had a greater P/F ratio recovery rate (difference = 13 mmHg/day, p = 0.01), more shock (48% versus 73%, p = 0.01), higher non-pulmonary SOFA scores (6 versus 9 points, p < 0.001), higher d-dimer levels (4.2 versus 9.7 mg/L, p = 0.02) and higher mortality (43% versus 67%, p = 0.02). In pneumonia associated ARDS, there was significant difference in proportion of shock (p = 0.005) between bacterial and non-bacterial pneumonia.

Conclusion

This study showed that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia. Future studies on ARDS should consider reporting etiology-specific data and exploring possible effect modification associated with etiology.
Design and evaluation of a learning assignment in the undergraduate medical curricula on the four dimensions of care: a mixed method study
Authors: Pieters Jolien , Verstegen Daniëlle M. L. , Dolmans Diana H. J. M. , Warmenhoven Franca C. , van den Beuken - van Everdingen Marieke H. J.
Published: May 2021

Background

Chronic and palliative care are rapidly gaining importance within the physician’s range of duties. In this context, it is important to address the four dimensions of care: physical, psychological, social, and spiritual. Medical students, however, feel inadequately equipped to discuss these dimensions with the patient. To bridge this gap, a new assignment was developed and implemented, in which students talked to a chronic or palliative patient about the four dimensions of care during an internship. This study, reports the evaluation of this assignment by students and teachers using a design-based approach.

Methods

Mixed methods were used, including a) student questionnaires, b) student focus groups, c) teacher interviews, and d) student’s written reflections. Two researchers performed analyses of the qualitative data from the focus groups, interviews, and written reflections using qualitative research software (ALTLAS.TI). Descriptive statistics were computed for the quantitative data using SPSS 21.0.

Results

Students and teachers valued talking to an actual patient about the four dimensions of care. Reading and providing peer feedback on each other’s reports was considered valuable, especially when it came to the diversity of illnesses, the way that patients cope and communication techniques. The students considered reflection useful, especially in the group and provided it was not too frequent. All the dimensions were addressed in the interviews, however the spiritual dimension was found to be the most difficult to discuss. The analysis of the written reflections revealed an overlap between the social and spiritual dimensions. Students pay a lot of attention to the relationship between the illness and the patient’s daily life, but the reflections do often not show insight in the potential relationship between the four dimensions and decisions in patient care.

Conclusions

During internships, medical students can practice talking about four dimensions of care with a chronically ill or palliative patient. Due to the format, it can be implemented across existing internships with relatively little extra time and effort. Reflection, peer feedback, and group discussion under the guidance of a teacher are important additions.
The connected patient project: moving towards a population-based primary health care research registry
Authors: Coe Dorothy , Birt Angela , Forbes Gareth , Ling Jonathan , Foster Michael , Robson Stephen , McDonald Joe , Yiannakou Yan
Published: May 2021

Background

The NHS pledges to give all patients access to clinical research. In England, 32% of General Practices are research active and only 14% of patients engage in research. This project aimed to evaluate consent-for-contact and communication in primary care patients.

Methods

An explanatory mixed methods study of patients and staff within a single general practice. The study included all patients over the age of 18 years, and excluded those on the palliative care register and those unable to give informed consent. The questionnaire asked recipients to indicate their preferred contact method and data-sharing permissions with three organisations: NHS, Universities and Commercial Companies. Survey recipients and staff were invited to take part in a semi-structured interview. Interviews explored project acceptability, feasibility and reasoning behind choices made. Statistical data were triangulated with interview data.

Results

The target patient population was 4678, 24% (n = 1148) responded. Seven hundred and three gave permission for at least one of the organisations to contact them. Older people were more likely to respond than young people, (p < 0.001). There was a trend for more women than men to give permissions however, in the 70 years plus age group this was reversed. Short message service was the preferred method of communication (48% n = 330), but those aged 70 years and over, preferred letter (p = 0.001). Interviews suggested patients felt the project was primarily about improving communication and secondly access to research. Patients trusted the NHS and university researchers. Staff interviewees found the project was less onerous than expected. Barriers to wider rollout included workload and the fragmented nature of NHS digital systems.

Conclusions

A registry of patients was established; however, the response rate of 24% needs increasing before wider adoption. Health promotion and chronic disease-based research may recruit better when based in primary health care. Older demographics would be more likely to volunteer for research. NHS and academic researchers are trusted, commercial organisations less so. The move to digitalise communication methods has the potential to marginalise older women. Findings were used to drive forward two novel developments: a consent registry (Research+Me) and a federation-wide participant identification process.
The expression profiles and prognostic values of HSP70s in hepatocellular carcinoma
Authors: Wang Ben , Lan Tian , Xiao Han , Chen Zhong-Huo , Wei Chao , Chen Lei-Feng , Guan Jia-Fu , Yuan Rong-Fa , Yu Xin , Hu Zhi-Gang , Wu Hua-Jun , Dai Zhi , Wang Kai
Published: May 2021

Background

The HSP70 family of heat shock protein plays a critical role in protein synthesis and transport to maintain protein homeostasis. Several studies have indicated that HSP70s are related to the development and occurrence of various cancers.

Methods

The relationship between the overall survival rate of hepatocellular carcinoma patients and the expression of 14 HSP70s from multiple databases, such as TCGA, ONCOMINE, cBioPortal was investigated. Western Blot and PCR were used to evaluate HSPA4 and HSPA14 expressions in various HCC cells to identify suitable cell lines for further experiments .Wound-healing assays, Transwell assays and EdU assays were used to verify the effects of HSPA4 and HSPA14 on the function of hepatocellular carcinoma cells, and statistical analysis was performed.

Results

Hepatocellular carcinoma tissues significantly expressed the 14 HSP70s compared to the normal samples. Besides, the high HSPA1A, HSPA1B, HSPA4, HSPA5, HSPA8, HSPA13, and HSPA14 expressions were inversely associated with the overall survival rate of patients, tumor grade, and cancer stage. A PPI regulatory network was constructed using the 14 HSP70s proteins with HSPA5 and HSPA8 at the network center. Univariate and multivariate analyses showed that HSPA4 and HSPA14 could be independent risk factors for the prognosis of hepatocellular carcinoma patients. Cell experiments have also confirmed that reducing HSPA4 and HSPA14 expressions can inhibit the invasion, metastasis, and proliferation of hepatocellular carcinoma cells.

Conclusions

Therefore, the HSP70s significantly influence the occurrence and development of hepatocellular carcinoma. For instance, HSPA4 and HSPA14 can be novel therapeutic targets and prognostic biomarkers for hepatocellular carcinoma.
The application of drones for mosquito larval habitat identification in rural environments: a practical approach for malaria control?
Authors: Stanton Michelle C. , Kalonde Patrick , Zembere Kennedy , Hoek Spaans Remy , Jones Christopher M.
Published: May 2021

Background

Spatio-temporal trends in mosquito-borne diseases are driven by the locations and seasonality of larval habitat. One method of disease control is to decrease the mosquito population by modifying larval habitat, known as larval source management (LSM). In malaria control, LSM is currently considered impractical in rural areas due to perceived difficulties in identifying target areas. High resolution drone mapping is being considered as a practical solution to address this barrier. In this paper, the authors’ experiences of drone-led larval habitat identification in Malawi were used to assess the feasibility of this approach.

Methods

Drone mapping and larval surveys were conducted in Kasungu district, Malawi between 2018 and 2020. Water bodies and aquatic vegetation were identified in the imagery using manual methods and geographical object-based image analysis (GeoOBIA) and the performances of the classifications were compared. Further, observations were documented on the practical aspects of capturing drone imagery for informing malaria control including cost, time, computing, and skills requirements. Larval sampling sites were characterized by biotic factors visible in drone imagery and generalized linear mixed models were used to determine their association with larval presence.

Results

Imagery covering an area of 8.9 km2 across eight sites was captured. Larval habitat characteristics were successfully identified using GeoOBIA on images captured by a standard camera (median accuracy = 98%) with no notable improvement observed after incorporating data from a near-infrared sensor. This approach however required greater processing time and technical skills compared to manual identification. Larval samples captured from 326 sites confirmed that drone-captured characteristics, including aquatic vegetation presence and type, were significantly associated with larval presence.

Conclusions

This study demonstrates the potential for drone-acquired imagery to support mosquito larval habitat identification in rural, malaria-endemic areas, although technical challenges were identified which may hinder the scale up of this approach. Potential solutions have however been identified, including strengthening linkages with the flourishing drone industry in countries such as Malawi. Further consultations are therefore needed between experts in the fields of drones, image analysis and vector control are needed to develop more detailed guidance on how this technology can be most effectively exploited in malaria control.
Metformin reduces androgen receptor and upregulates homeobox A10 expression in uterine endometrium in women with polycystic ovary syndrome
Authors: Ohara Miki , Yoshida-Komiya Hiromi , Ono-Okutsu Miho , Yamaguchi-Ito Akiko , Takahashi Toshifumi , Fujimori Keiya
Published: May 2021

Background

Polycystic ovary syndrome (PCOS) causes anovulation and is associated with a reduced clinical pregnancy rate. Metformin, which is widely used for treating PCOS, can lead to successful pregnancy by restoring the ovulation cycle and possibly improving endometrial abnormality during the implantation period. However, the mechanism by which metformin improves endometrial abnormality remains unknown. Women with PCOS have an aberrant expression of steroid hormone receptors and homeobox A10 (HOXA10), which is essential for embryo implantation in the endometrium.

Methods

In this study, we examined whether metformin affects androgen receptor (AR) and HOXA10 expression in PCOS endometrium in vivo and in human endometrial cell lines in vitro. Expression of AR and HOXA10 was evaluated by immunohistochemistry, fluorescent immunocytochemistry, and western blot analysis.

Results

AR expression was localized in both epithelial and stromal cells; however, HOXA10 expression was limited to only stromal cells in this study. In women with PCOS, 3 months after metformin treatment, the expression of AR was reduced in epithelial and stromal cells in comparison to their levels before treatment. In contrast, HOXA10 expression in the stromal cells with metformin treatment increased in comparison to its level before treatment. Further, we showed that metformin counteracted the testosterone-induced AR expression in both Ishikawa cells and human endometrial stromal cells (HESCs); whereas, metformin partly restored the testosterone-reduced HOXA10 expression in HESCs in vitro.

Conclusions

Our results suggest that metformin may have a direct effect on the abnormal endometrial environment of androgen excess in women with PCOS.

Trial registration

The study was approved by the Ethical Committee of Fukushima Medical University (approval no. 504, approval date. July 6, 2006), and written informed consent was obtained from all patients. https://www.fmu.ac.jp/univ/sangaku/rinri.html