bluuebunny/crossref_metadata_2025 huggingface dataset:
Different genome-wide transcriptome responses of Nocardioides simplex VKM Ac-2033D to phytosterol and cortisone 21-acetate
Authors: Shtratnikova Victoria Yu , Sсhelkunov Mikhail I. , Fokina Victoria V. , Bragin Eugeny Y. , Shutov Andrey A. , Donova Marina V.
Published: January 2021

Background

Bacterial degradation/transformation of steroids is widely investigated to create biotechnologically relevant strains for industrial application. The strain of Nocardioides simplex VKM Ac-2033D is well known mainly for its superior 3-ketosteroid Δ1-dehydrogenase activity towards various 3-oxosteroids and other important reactions of sterol degradation. However, its biocatalytic capacities and the molecular fundamentals of its activity towards natural sterols and synthetic steroids were not fully understood. In this study, a comparative investigation of the genome-wide transcriptome profiling of the N. simplex VKM Ac-2033D grown on phytosterol, or in the presence of cortisone 21-acetate was performed with RNA-seq.

Results

Although the gene patterns induced by phytosterol generally resemble the gene sets involved in phytosterol degradation pathways in mycolic acid rich actinobacteria such as Mycolicibacterium, Mycobacterium and Rhodococcus species, the differences in gene organization and previously unreported genes with high expression level were revealed. Transcription of the genes related to KstR- and KstR2-regulons was mainly enhanced in response to phytosterol, and the role in steroid catabolism is predicted for some dozens of the genes in N. simplex. New transcription factors binding motifs and new candidate transcription regulators of steroid catabolism were predicted in N. simplex.

Unlike phytosterol, cortisone 21-acetate does not provide induction of the genes with predicted KstR and KstR2 sites. Superior 3-ketosteroid-Δ1-dehydrogenase activity of N. simplex VKM Ac-2033D is due to the kstDs redundancy in the genome, with the highest expression level of the gene KR76_27125 orthologous to kstD2, in response to cortisone 21-acetate. The substrate spectrum of N. simplex 3-ketosteroid-Δ1-dehydrogenase was expanded in this study with progesterone and its 17α-hydroxylated and 11α,17α-dihydroxylated derivatives, that effectively were 1(2)-dehydrogenated in vivo by the whole cells of the N. simplex VKM Ac-2033D.

Conclusion

The results contribute to the knowledge of biocatalytic features and diversity of steroid modification capabilities of actinobacteria, defining targets for further bioengineering manipulations with the purpose of expansion of their biotechnological applications.
Association of a multiple-step action with cervical lymph node yield of oral cancer patients in an Asian country
Authors: Yang Ching-Chieh , Kang Bor-Hwang , Liu Wen-Shan , Yin Chun-Hao , Lee Ching-Chih
Published: January 2021

Background

High quality lymph node (LN) yield could increase survival, however strategies to improve LN yield have been seldom reported. This study aimed to assess the multiple-step action to promote quality of neck dissection in oral cancer.

Methods

A total of 400 patients with oral cancer who underwent primary tumor resection and neck dissection, including elective and radical neck dissection, were recruited after propensity score matching by clinical T and N categories between January 2009 and September 2018. Patients were treated by two independent departments in our institute. A multiple-step action was initiated in October 2015 in one department, and another department was as a control group. The impact of multiple-step action on LN yield and regional recurrence were analyzed using multivariate analysis and difference-in-differences (DID) linear regression analysis.

Results

The mean patient age was 55.2 + 11.1 years, and 92% were male. A total of 180 (45%) patients had T3-4 disease, and 129 (32%) patients had N2-3 disease. The multivariate linear regression and DID analyses revealed that multiple-step action had a positive effect on LN yield. A net improvement of LN yield with a coefficient of 13.78 (p < 0.001) after launching multiple-step action (since October 2015) was observed. A borderline protective effect of multiple-step action for cN0 patients with a reduced regional recurrence rate of 11.6% (p = 0.072) through DID analysis was noted.

Conclusions

Multiple-step action was associated with increased LN yield and decreased regional recurrence in patients with oral cancer. The observed activity may promote surgeons to improve the quality of neck dissections, is feasible, and could be applied to a widespread patient population.
Investigating the status of marital burnout and related factors in married women referred to health centers
Authors: Nejatian Mahbobeh , Alami Ali , Momeniyan Vahideh , Delshad Noghabi Ali , Jafari Alireza
Published: January 2021

Background

Marital burnout is an important issue in marriage and many factors play an important role in this phenomenon. The aim of this study was to determine the status of marital burnout and the factors affecting married women who were referred to health centers because of it.

Methods

In this study, 936 women were selected by multistage sampling and data collection was performed using questionnaires of demographic and couple burnout. Data analysis was performed using SPSS software version 24.

Results

The mean (± SD) of marital burnout, in this study, was 55.46 (± 18.03) (out of 147 score). There was a significant relationship between the level of women's education with total marital burnout, and the subscales of somatic and emotional burnout (P < 0.05). A significant relationship was also observed between mandatory marriage and total marital burnout, as well as subscales of somatic, emotional, and psychological burnout (P < 0.05). A significant relationship was detected and observed between women's participation in training courses of communication skills and total marital burnout, inclusive of the subscales regarding psychological burnout (P < 0.05). The results of linear regression showed a significant relationship between mandatory in marriage, marital satisfaction, marriage duration, and husband's level of education with women's marital burnout. The variables were finally able to predict 12% of marital burnout variance. It should be noted that marital satisfaction had a higher effect on predicting marital burnout (P < 0.001).

Conclusions

Marital satisfaction was one of the effective factors in predicting marital burnout, so it can be concluded that it is necessary to pay more attention to this issue. Educational programs and examining the factors that enhance marital satisfaction are needed to prevent and reduce marital burnout in married couples.
A governmental program to encourage medical students to deliver primary prevention: experiment and evaluation in a French faculty of medicine
Authors: Le Roux Enora , Mari Muro Marta , Mognon Kore , Saïd Mélèa , Caillavet Viviane , Matheron Sophie , Ledoux Séverine , Decq Philippe , Vorspan Florence , Le Strat Yann , Delaugerre Constance , Le Bras Morgane , Alberti Corinne , Ruszniewski Philippe , Zerr Philippe , Faye Albert
Published: January 2021

Background

A public health student service was set up by the French government in 2018 with the aim of increasing awareness of primary health promotion among the 47,000 students of medicine and other health professions. It is an annual program involving community-based actions on nutrition, physical activity, addiction or sexuality. Our objective was to evaluate its implementation at local level and the different experiences of the stakeholders.

Methods

A quasi-experimental study using process evaluation was performed in a Faculty of Medicine in Paris. Quantitative and qualitative data were collected from medical students who carried out preventive health actions, in the institutions in which the actions took place and from a subsample of beneficiaries.

Results

One hundred and eight actions were carried out by 341 students in 23 educational or social institutions, mostly high schools (n = 12, 52%). Two thirds of the students did not feel sufficiently prepared to deliver preventive health interventions (65.7%, 224/341); however the beneficiaries found that the interventions were good (278/280, 99,2%). Nineteen (83%) of the host institutions agreed to welcome health service students again, of which 9 required some modifications. For students, the reporting of a satisfactory health service experience was associated with the reporting of skills or knowledge acquisition (p < 0.01). Delivering actions in high schools and to a medium-sized number of beneficiaries per week was associated with students’ satisfaction. No effect of gender or theme of prevention was observed. For 248/341 (72.7%) students, the public health service program prompts them to address prevention issues in the future.

Conclusion

The public health service undertaken by medical students through the program is a feasible and acceptable means of delivering preventive actions. Reinforcement of training and closer interaction with the host institutions would improve results.
Digital learning designs in physiotherapy education: a systematic review and meta-analysis
Authors: Ødegaard Nina Bjerketveit , Myrhaug Hilde Tinderholt , Dahl-Michelsen Tone , Røe Yngve
Published: January 2021

Background

Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education.

Methods

The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses.

Results

Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching.

Conclusions

The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students’ learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments.
An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility
Authors: Brook Judy , Aitken Leanne M. , MacLaren Julie-Ann , Salmon Debra
Published: January 2021

Aims

To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre.

Background

Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses.

Methods

This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention.

Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019.

Results

One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession.

Conclusion

Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.
Financial incentives to improve glycemic control in African American adults with type 2 diabetes: a pilot randomized controlled trial
Authors: Egede Leonard E. , Campbell Jennifer A. , Walker Rebekah J. , Dawson Aprill Z. , Williams Joni S.
Published: January 2021

Background

Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. However, there is limited data on optimal structure for financial incentives and whether financial incentives are effective in African Americans with type 2 diabetes. This pilot study evaluated impact of three financial incentive structures on glycemic control in this population.

Methods

Sixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3 months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3 months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3 months. The primary outcome was HbA1c reduction within each group at 3 months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group.

Results

The mean age for the sample was 57.9 years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3 months with the greatest reduction from baseline in the group with incentives for multiple components: Group 1 mean reduction = 1.25, Group 2 mean reduction = 1.73, Group 3 mean reduction = 1.74.

Conclusion

Financial incentives led to significant reductions in HbA1c from baseline within each group. Incentives for multiple components led to the greatest reductions from baseline. Structured financial incentives that reward home monitoring, attendance of telephone education sessions, and lifestyle modification to lower HbA1c are viable options for glycemic control in African Americans with type 2 diabetes.

Trial registration

Trial registration: NCT02722499. Registered 23 March 2016, url.
Estimation of healthcare‐related charges in women with BRCA mutations and breast cancer
Authors: Biskupiak Joseph , Unni Sudhir , Telford Claire , Yoo Minkyoung , Ye Xiangyang , Deka Rishi , Brixner Diana , Stenehjem David
Published: January 2021

Background

Breast cancer costs were estimated at $16.5 billion in 2010 and were higher than other cancer costs. There are limited studies on breast cancer charges and costs by BRCA mutations and receptor status. We examined overall health care and breast cancer-related charges by BRCA status (BRCAm vs. BRCAwt), receptor status (HER2+ vs. HER2-), and treatment setting (neoadjuvant vs. adjuvant).

Methods

Retrospective cohort study of charge data from 1995-2014 in an academic medical center. Facilities, physician, pharmacy, and diagnosis-related charges were presented as mean and median charges with standard deviation (SD) and interquartile ranges (25%-75%). Wilcoxon rank-sum test was used to assess statistically significant differences in charges between comparators.

Results

Total median breast-cancer related charges were $65,414 for BRCAm and $54,635 for BRCAwt (p=0.19); however all-cause charges were higher for BRCAm patients ($145,066 vs. $119,119, p<0.001). HER2+ status was associated with higher median breast cancer charges ($152,159 vs. $44,087, p<0.0001) that was driven by the charges for biological agents. Patients initially seen in the neoadjuvant setting had higher mean breast cancer charges than in the adjuvant setting ($117,922 vs. $80,061, p<0.0001).

Conclusion

BRCA mutation status was not associated with higher breast cancer charges but HER2+ status had significantly higher charges, due to charges for biological agents. Patients who initially received neoadjuvant treatment had significantly higher overall treatment charges than adjuvant therapy patients. With the advent of novel therapies for BRCAm, the economic impact of these treatments will be important to consider relative to their survival benefits.
An approach to exploring associations between hospital structural measures and patient satisfaction by distance‐based analysis
Authors: Okuda Masumi , Yasuda Akira , Tsumoto Shusaku
Published: January 2021

Background

Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital structural measures but reports on the structure of patient satisfaction with respect to similarities among domains are scarce. This study is to explore by distance-based analysis whether similarities among patient-satisfaction domains are influenced by hospital structural measures, and to design a model evaluating relationships between the structure of patient satisfaction and hospital structural measures.

Methods

The Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital structural measures, followed by three different distance-based analyses - clustering, correspondence analysis, and ordinal multidimensional scaling – for robustness to identify homogenous groups with respect to similarities.

Results

Of 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital structural measures. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital structural measures, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital structural measures.

Conclusions

Distance-based analysis can reveal the hidden structure of patient satisfaction. This study suggests that hospital structural measures including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.
Current cancer driver variant predictors learn to recognize driver genes instead of functional variants
Authors: Raimondi Daniele , Passemiers Antoine , Fariselli Piero , Moreau Yves
Published: January 2021

Background

Identifying variants that drive tumor progression (driver variants) and distinguishing these from variants that are a byproduct of the uncontrolled cell growth in cancer (passenger variants) is a crucial step for understanding tumorigenesis and precision oncology. Various bioinformatics methods have attempted to solve this complex task.

Results

In this study, we investigate the assumptions on which these methods are based, showing that the different definitions of driver and passenger variants influence the difficulty of the prediction task. More importantly, we prove that the data sets have a construction bias which prevents the machine learning (ML) methods to actually learn variant-level functional effects, despite their excellent performance. This effect results from the fact that in these data sets, the driver variants map to a few driver genes, while the passenger variants spread across thousands of genes, and thus just learning to recognize driver genes provides almost perfect predictions.

Conclusions

To mitigate this issue, we propose a novel data set that minimizes this bias by ensuring that all genes covered by the data contain both driver and passenger variants. As a result, we show that the tested predictors experience a significant drop in performance, which should not be considered as poorer modeling, but rather as correcting unwarranted optimism. Finally, we propose a weighting procedure to completely eliminate the gene effects on such predictions, thus precisely evaluating the ability of predictors to model the functional effects of single variants, and we show that indeed this task is still open.
Native-like membrane models of E. coli polar lipid extract shed light on the importance of lipid composition complexity
Authors: Pluhackova Kristyna , Horner Andreas
Published: January 2021

Background

Lipid-protein interactions stabilize protein oligomers, shape their structure, and modulate their function. Whereas in vitro experiments already account for the functional importance of lipids by using natural lipid extracts, in silico methods lack behind by embedding proteins in single component lipid bilayers. However, to accurately complement in vitro experiments with molecular details at very high spatio-temporal resolution, molecular dynamics simulations have to be performed in natural(-like) lipid environments.

Results

To enable more accurate MD simulations, we have prepared four membrane models of E. coli polar lipid extract, a typical model organism, each at all-atom (CHARMM36) and coarse-grained (Martini3) representations. These models contain all main lipid headgroup types of the E. coli inner membrane, i.e., phosphatidylethanolamines, phosphatidylglycerols, and cardiolipins, symmetrically distributed between the membrane leaflets. The lipid tail (un)saturation and propanylation stereochemistry represent the bacterial lipid tail composition of E. coli grown at 37∘C until 3/4 of the log growth phase. The comparison of the Simple three lipid component models to the complex 14-lipid component model Avanti over a broad range of physiologically relevant temperatures revealed that the balance of lipid tail unsaturation and propanylation in different positions and inclusion of lipid tails of various length maintain realistic values for lipid mobility, membrane area compressibility, lipid ordering, lipid volume and area, and the bilayer thickness. The only Simple model that was able to satisfactory reproduce most of the structural properties of the complex Avanti model showed worse agreement of the activation energy of basal water permeation with the here performed measurements. The Martini3 models reflect extremely well both experimental and atomistic behavior of the E. coli polar lipid extract membranes. Aquaporin-1 embedded in our native(-like) membranes causes partial lipid ordering and membrane thinning in its vicinity. Moreover, aquaporin-1 attracts and temporarily binds negatively charged lipids, mainly cardiolipins, with a distinct cardiolipin binding site in the crevice at the contact site between two monomers, most probably stabilizing the tetrameric protein assembly.

Conclusions

The here prepared and validated membrane models of E. coli polar lipids extract revealed that lipid tail complexity, in terms of double bond and cyclopropane location and varying lipid tail length, is key to stabilize membrane properties over a broad temperature range. In addition, they build a solid basis for manifold future simulation studies on more realistic lipid membranes bridging the gap between simulations and experiments.
Culturable bacteria associated with Anopheles darlingi and their paratransgenesis potential
Authors: Rocha Elerson Matos , Marinotti Osvaldo , Serrão Deidre Machado , Correa Laura Viana , Katak Ricardo de Melo , de Oliveira Juan Campos , Muniz Veranilce Alves , de Oliveira Marta Rodrigues , do Nascimento Neto Joaquim Ferreira , Pessoa Marcos Cézar Fernandes , Roque Rosemary Aparecida , da Mota Adolfo Jose , Onorati Piero , Souza-Neto Jayme A. , Terenius Olle , Tadei Wanderli Pedro
Published: January 2021

Background

Malaria remains a major public health problem in South America, mostly in the Amazon region. Among newly proposed ways of controlling malaria transmission to humans, paratransgenesis is a promising alternative. Paratransgenesis aims to inhibit the development of parasites within the vector through the action of genetically modified bacteria. The first step towards successful paratransgenesis in the Amazon is the identification of Anopheles darlingi symbiotic bacteria, which are transmitted vertically among mosquitoes, and are not pathogenic to humans.

Methods

Culturable bacteria associated with An. darlingi and their breeding sites were isolated by conventional microbiological techniques. Isolated strains were transformed with a GFP expressing plasmid, pSPT-1-GFP, and reintroduced in mosquitoes by feeding. Their survival and persistence in the next generation was assessed by the isolation of fluorescent bacteria from eggs, larvae, pupae and adult homogenates.

Results

A total of 179 bacterial strains were isolated from samples from two locations, Coari and Manaus. The predominant genera identified in this study were Acinetobacter, Enterobacter, Klebsiella, Serratia, Bacillus, Elizabethkingia, Stenotrophomonas and Pantoea. Two isolated strains, Serratia-Adu40 and Pantoea-Ovo3, were successfully transformed with the pSPT-1-GFP plasmid and expressed GFP. The fluorescent bacteria fed to adult females were transferred to their eggs, which persisted in larvae and throughout metamorphosis, and were detected in adult mosquitoes of the next generation.

Conclusion

Serratia-Adu40 and Pantoea-Ovo3 are promising candidates for paratransgenesis in An. darlingi. Further research is needed to determine if these bacteria are vertically transferred in nature.
Realizing the right to health in Latin America, equitably
Authors: Villar Uribe Manuela , Escobar Maria-Luisa , Ruano Ana Lorena , Iunes Roberto F.
Published: January 2021

This special issue “Realizing the Right to Health in Latin America and the Caribbean” provides an overview of one of the most challenging objectives of health systems: equity and the realization of the right to health. In particular, it concentrates on the issues associated with such a challenge in countries suffering of deep inequity. The experience in Latin America and the Caribbean demonstrates that the efforts of health systems to achieve Universal Health Coverage are necessary but not sufficient to achieve an equitable realization of the right to health for all. The inequitable realization of all other human rights also determines the realization of the right to health.
Identification of a prognostic gene signature of colon cancer using integrated bioinformatics analysis
Authors: Fang Zhengyu , Xu Sumei , Xie Yiwen , Yan Wenxi
Published: January 2021

Background

Colon cancer is a worldwide leading cause of cancer-related mortality, and the prognosis of colon cancer is still needed to be improved. This study aimed to construct a prognostic model for predicting the prognosis of colon cancer.

Methods

The gene expression profile data of colon cancer were obtained from the TCGA, GSE44861, and GSE44076 datasets. The WGCNA module genes and common differentially expressed genes (DEGs) were used to screen out the prognosis-associated DEGs, which were used to construct a prognostic model. The performance of the prognostic model was assessed and validated in the TCGA training and microarray validation sets (GSE38832 and GSE17538). At last, the model and prognosis-associated clinical factors were used for the construction of the nomogram.

Results

Five colon cancer-related WGCNA modules (including 1160 genes) and 1153 DEGs between tumor and normal tissues were identified, inclusive of 556 overlapping DEGs. Stepwise Cox regression analyses identified there were 14 prognosis-associated DEGs, of which 12 DEGs were included in the optimized prognostic gene signature. This prognostic model presented a high forecast ability for the prognosis of colon cancer both in the TCGA training dataset and the validation datasets (GSE38832 and GSE17538; AUC > 0.8). In addition, patients’ age, T classification, recurrence status, and prognostic risk score were associated with the prognosis of TCGA patients with colon cancer. The nomogram was constructed using the above factors, and the predictive 3- and 5-year survival probabilities had high compliance with the actual survival proportions.

Conclusions

The 12-gene signature prognostic model had a high predictive ability for the prognosis of colon cancer.
Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis
Authors: Tajima Yosuke , Hanai Tsunekazu , Katsuno Hidetoshi , Masumori Koji , Koide Yoshikazu , Ashida Keigo , Matsuoka Hiroshi , Hiro Junichiro , Endo Tomoyoshi , Kamiya Tadahiro , Chong Yongchol , Maeda Kotaro , Uyama Ichiro
Published: January 2021

Background

Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis.

Case presentation

A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis.

Conclusion

Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.
Influence of age, stigma and social support on male temporary ejaculation failure on IVF oocyte retrieval day
Authors: Wang Jinluan , Xue Mingyue
Published: January 2021

Objective

To explore the social and psychological factors associated with male Temporary Ejaculation Failure (TEF) during In Vitro Fertilization (IVF), with the goal of providing a theoretical basis for clinical intervention and treatment.

Methods

The study included 75 TEF patients and 223 non-TEF patients undergoing IVF treatment at the center of reproduction and genetics of Integrated Chinese and Western medicine in the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from May 2019 to May 2020. A questionnaire survey was then administered to the study subjects. The questionnaires included general information, Perceived Stress Scale (PSS), Stigma Questionnaire, Perceived Social Support Scale (PSSS), and Positive Psychological Capital Questionnaire (PPQ). Logistic regression analysis was then used to analyze the social psychological factors associated with the research objectives.

Results

Comparison of social demographic factors and clinical data between TEF group and non-TEF group: there were significant differences in the age and educational level between the two groups (P< 0.05), and the average age of the TEF group (37.01±7.11) was significantly higher than that of the non-TEF group (34.89±6.24). In addition, patients with high school or technical secondary school education levels had the lowest probability of TEF(X2=7.662, P=0.022). 2. The difference of related social and psychological factors between the two groups: the scores of perceived stress (17.57±6.51) and stigma (4.52±3.87) in the TEF group were significantly higher than those in the non-TEF group, which were (15.50±5.00, P< 0.05) and (2.61±3.52, P< 0.05), respectively. On the other hand, the scores of social support (55.31±14.04) and psychological capital (121.73±25.93) in the TEF group were significantly lower than those in the non-TEF group, which were (60.74±10.93, P< 0.05) and (130.31±17.32, P< 0.05), respectively. Results Obtained after conducting univariate logistic regression analysis indicated that age (OR=1.051, P=0.016), perceived stress (OR=1.073, P=0.005), stigma (OR=1.139, P< 0.001), family support (OR=0.901, P< 0.001), friend support (OR=0.932, P=0.023), other support (OR=0.915, P=0.004), self-efficacy (OR=0.947, P=0.009), resilience (OR=0.947, P=0.013), hope (OR=0.930, P=0.002), and optimism (OR=0.953, P=0.032) can all significantly affect male TEF.4. Moreover, the multivariate logistic regression analysis results indicated that age (OR=1.071, P=0.002) and stigma (OR=1.132, P=0.003) can positively predict TEF, while family support (OR=0.877, P=0.012) can negatively predict TEF.

Conclusions

The results obtained in this study have indicated that age and stigma are independent risk factors for male TEF, while family support is a protective factor of TEF. Analyzing the treatment of TEF from a socio-psychological perspective provides a new intervention target for effectively reducing its incidence, thereby helping to improve the success rate of IVF.
QALY league table of Iran: a practical method for better resource allocation
Authors: Hashempour Reza , Raei Behzad , Safaei Lari Majid , Abolhasanbeigi Gallezan Nasrin , AkbariSari Ali
Published: January 2021

Background

The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table.

Methods

A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal.

Results

In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR.

Conclusions

However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.
On the role of bacterial metalloproteases in COVID-19 associated cytokine storm
Authors: Földvári-Nagy László , Schnabel Tamás , Dörnyei Gabriella , Korcsmáros Tamás , Lenti Katalin
Published: January 2021

The cytokine release syndrome or cytokine storm, which is the hyper-induction of inflammatory responses has a central role in the mortality rate of COVID-19 and some other viral infections. Interleukin-6 (IL-6) is a key player in the development of cytokine storms. Shedding of interleukin-6 receptor (IL-6Rα) results in the accumulation of soluble interleukin-6 receptors (sIL-6R). Only relatively few cells express membrane-bound IL-6Rα. However, sIL-6R can act on potentially all cells and organs through the ubiquitously expressed gp130, the coreceptor of IL-6Rα. Through this, so-called trans-signaling, IL-6–sIL-6R is a powerful factor in the development of cytokine storms and multiorgan involvement. Some bacteria (e.g.,Serratia marcescens,Staphylococcus aureus,Pseudomonas aeruginosa,Listeria monocytogenes), commonly considered to cause co-infections during viral pneumonia, can directly induce the shedding of membrane receptors, including IL-6Rα, or enhance endogenous shedding mechanisms causing the increase of sIL-6R level. Here we hypothesise that bacteria promoting shedding and increase the sIL-6R level can be an important contributing factor for the development of cytokine storms. Therefore, inhibition of IL-6Rα shedding by drastically reducing the number of relevant bacteria may be a critical element in reducing the chance of a cytokine storm. Validation of this hypothesis can support the consideration of the prophylactic use of antibiotics more widely and at an earlier stage of infection to decrease the mortality rate of COVID-19.
Radiotherapy and the gut microbiome: facts and fiction
Authors: Liu Jing , Liu Chao , Yue Jinbo
Published: January 2021

An ever-growing body of evidence has linked the gut microbiome with both the effectiveness and the toxicity of cancer therapies. Radiotherapy is an effective way to treat tumors, although large variations exist among patients in tumor radio-responsiveness and in the incidence and severity of radiotherapy-induced side effects. Relatively little is known about whether and how the microbiome regulates the response to radiotherapy. Gut microbiota may be an important player in modulating “hot” versus “cold” tumor microenvironment, ultimately affecting treatment efficacy. The interaction of the gut microbiome and radiotherapy is a bidirectional function, in that radiotherapy can disrupt the microbiome and those disruptions can influence the effectiveness of the anticancer treatments. Limited data have shown that interactions between the radiation and the microbiome can have positive effects on oncotherapy. On the other hand, exposure to ionizing radiation leads to changes in the gut microbiome that contribute to radiation enteropathy. The gut microbiome can influence radiation-induced gastrointestinal mucositis through two mechanisms including translocation and dysbiosis. We propose that the gut microbiome can be modified to maximize the response to treatment and minimize adverse effects through the use of personalized probiotics, prebiotics, or fecal microbial transplantation. 16S rRNA sequencing is the most commonly used approach to investigate distribution and diversity of gut microbiome between individuals though it only identifies bacteria level other than strain level. The functional gut microbiome can be studied using methods involving metagenomics, metatranscriptomics, metaproteomics, as well as metabolomics. Multiple ‘-omic’ approaches can be applied simultaneously to the same sample to obtain integrated results. That said, challenges and remaining unknowns in the future that persist at this time include the mechanisms by which the gut microbiome affects radiosensitivity, interactions between the gut microbiome and combination treatments, the role of the gut microbiome with regard to predictive and prognostic biomarkers, the need for multi “-omic” approach for in-depth exploration of functional changes and their effects on host-microbiome interactions, and interactions between gut microbiome, microbial metabolites and immune microenvironment.
Clinical predictors of pathological good response in locally advanced rectal cancer
Authors: Shao Kongfeng , Zheng Rong , Li Anchuan , Li Xiaobo , Xu Benhua
Published: January 2021

Purpose

The aim of this study was to identify the clinical predictors of pathological good response (PGR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) to clarify the indications for local excision.

Methods and materials

A total of 173 patients with LARC (cT3–4/N +) who were treated with nCRT followed by surgery were enrolled in our retrospective study. Patients were categorized into two groups according to the different tumor responses of surgical pathology. Stage ypT0–1N0 was defined as the group with PGR, and stage ypT2–4N0/ypTanyN + was the defined as the pathological poor response (PPR) group, and the potential predictors were compared.

Results

Of 173 patients, PGR was achieved in 57 patients (32.95%). The distance from the inferior margin of the tumor to the anal verge, cT classification, pretreatment carcinoembryonic antigen (CEA) and the interval from the end of radiation to surgery were correlated with pathological response. In the multivariate analysis, the distance from anal verge < 5 cm (OR = 0.443, p = 0.019), pretreatment CEA < 5 ng/mL (OR = 0.412, p = 0.015) and the interval from the end of radiation to surgery ≥ 84 days (OR = 2.652, p = 0.005) were independent predictors of PGR.

Conclusions

The distance from the inferior margin of the tumor to the anal verge, pretreatment CEA and the interval from the end of radiation to surgery were significant predictors of PGR in LARC. A prospective study is needed to further validate these results in the future.
Utilisation of distally based sural fasciocutaneous flaps in lower extremity reconstruction: a single-centre experience with 88 paediatric patients
Authors: Luo Zhaobiao , Ni Jiangdong , Lv Guohua , Wei Jianwei , Liu Lihong , Peng Ping , Dong Zhonggen
Published: January 2021

Background

No large series have analysed distally based sural fasciocutaneous (DBSF) flaps in paediatric patients. The aims of this study were to assess the reliability and analyse the potential risk factors for these flaps and to describe complications in the donor site and the functional follow-up results.

Methods

Between June 2002 and November 2017, 88 DBSF flaps were used to reconstruct soft tissue defects in paediatric patients. Potential risk factors, reconstruction outcomes, and complications in the donor site of the flaps were analysed.

Results

Among the 88 flaps, partial necrosis developed in 8 flaps (9.1%). The partial necrosis rate was significantly higher in flaps with the top edge located in the 9th zone (26.1%), with a length-width ratio (LWR) ≥ 5:1 (28.6%), and with a dimension of the skin island ≥ 100 cm2 (22.7%). Partial necrosis did not occur in flaps with a dimension of the skin island < 80.0 cm2 or with a skin-island width < 7.0 cm. The reconstruction outcomes in most paediatric patients were evaluated as “excellent” or “good”. The incidence of obvious scarring was higher in the donor site.

Conclusions

Partial necrosis of DBSF flaps will significantly increase when the top edge of the flap is located in the 9th zone, when the LWR of the flap is ≥ 5:1, or when the dimension of the skin island is ≥ 100.0 cm2. Flaps with a skin-island width < 7.0 cm or with a dimension of the skin island < 80 cm2 are relatively safe and reliable.
The mechanism of electroacupuncture for depression on basic research: a systematic review
Authors: Han Xuke , Gao Yang , Yin Xuan , Zhang Zhangjin , Lao Lixing , Chen Qiu , Xu Shifen
Published: January 2021

Background

Electroacupuncture (EA) is generally accepted as a safe and harmless treatment option for alleviating depression. However, there are several challenges related to the use of EA. Although EA has been shown to be effective in treating depression, the molecular mechanism is unclear.

Objective

To reveal the therapeutic effect of EA and its possible mechanism in the treatment of depression.

Search strategy

We performed a systematic search according to PRISMA guidelines. We electronically searched PubMed, Web of Science (WOS), the China National Knowledge Infrastructure (CNKI), Wanfang Data Information Site and the VIP information database for animal studies in English published from the inception of these databases to December 31, 2019.

Inclusion criteria

Electronic searches of PubMed, WOS, the CNKI, Wanfang and the VIP database were conducted using the following search terms: (depression OR depressive disorder OR antidepressive), (rat OR mouse) AND (acupuncture OR EA).

Data extraction and analysis

The data were extracted primarily by one author, and a follow-up review was conducted by the other authors.

Results

Twenty-eight articles met the inclusion criteria. The most commonly used method for inducing depression in animal models was 21 days of chronic unpredictable mild stress. For the depression model, the most commonly selected EA frequency was 2 Hz. Among the 28 selected studies, 11 studies observed depression-related behaviors and used them as indicators of EA efficacy. The other 17 studies focused on mechanisms and assessed the indexes that exhibited abnormalities that were known to result from depression and then returned to a normal range after EA treatment. Treatment of depression by EA involves multiple therapeutic mechanisms, including inhibition of HPA axis hyperactivity and inflammation, regulation of neuropeptides and neurotransmitters, modulation of the expression of particular genes, restoration of hippocampal synaptic plasticity, increased expression of BDNF, and regulation of several signaling pathways.

Conclusions

This review reveals that the mechanisms underlying the effect of acupuncture involve multiple pathways and targets, suggesting that acupuncture is a wholistic treatment for people rather than for diseases. Our findings also explain why acupuncture can treat various disorders in addition to depression.