bluuebunny/crossref_metadata_2025 huggingface dataset:
Oblique Cutting Based Mechanical Model for Insertion Torque of Dental Implant
Authors: Li Luli , Zhang Song , Li Quhao , Bian Cuirong , Zhang Airong
Published: May 2022

The insertion torque of a dental implant is an important indicator for the primary stability of dental implants. Thus, the preoperative prediction for the insertion torque is crucial to improve the success rate of implantation surgery. In this present research, an alternative method for prediction of implant torque was proposed. First, the mechanical model for the insertion torque was established based on an oblique cutting process. In the proposed mechanical model, three factors, including bone quality, implant geometry and surgical methods were considered in terms of bone-quality coefficients, chip load and insertion speeds, respectively. Then, the defined bone-quality coefficients for cancellous bone with the computed tomography (CT) value of 235–245, 345–355 and 415–425 Hu were obtained by a series of insertion experiments of IS and ITI implants. Finally, the insertion experiments of DIO implants were carried out to verify the accuracy of developed model. The predicted insertion torques calculated by the mechanical model were compared with those acquired by insertion experiments, with good agreement, the relative error being less than 15%. This method allows the insertion torque for different implant types to be quickly established and enhances prediction accuracy by considering the effects of implants’ geometries and surgical methods.
In-vitro and in-silico antibacterial activity of Azadirachta indica (Neem), methanolic extract, and identification of Beta.d-Mannofuranoside as a promising antibacterial agent
Authors: Altayb Hisham N. , Yassin Nijood F. , Hosawi Salman , Kazmi Imran
Published: May 2022

Background

Antimicrobial resistance became the leading cause of death globally, resulting in an urgent need for the discovery of new, safe, and efficient antibacterial agents. Compounds derived from plants can provide an essential source of new types of antibiotics. A. indica (neem) plant is rich in antimicrobial phytoconstituents. Here, we used the sensitive and reliable gas chromatography-mass spectrometry (GC–MS) approach, for the quantitative and quantitative determination of bioactive constituents in methanolic extract of neem leaves grown in Sudan. Subsequently, antibacterial activity, pharmacokinetic and toxicological properties were utilized using in silico tools.

Results

The methanolic extract of neem leaves was found to have antibacterial activity against all pathogenic and reference strains. The lowest concentration reported with bacterial activity was 3.125%, which showed zones of inhibition of more than 10 mm on P. aeruginosa, K. pneumoniae, Citrobacter spp., and E. coli, and 8 mm on Proteus spp., E. faecalis, S. epidermidis, and the pathogenic S. aureus. GC–MS analysis revealed the presence of 30 chemical compounds, including fatty acids (11), hydrocarbons (9), pyridine derivatives (2), aldehydes (2), phenol group (1), aromatic substances (1), coumarins (1), and monoterpenes (1). In silico and in vitro tools revealed that.beta.d-Mannofuranoside, O-geranyl was the most active compound on different bacterial proteins. It showed the best docking energy (-8 kcal/mol) and best stability with different bacterial essential proteins during molecular dynamic (MD) simulation. It also had a good minimum inhibitory concentration (MIC) (32 μg/ml and 64 μg/ml) against S. aureus (ATCC 25,923) and E. coli (ATCC 25,922) respectively.

Conclusion

The methanolic extract of A. indica leaves possessed strong antibacterial activity against different types of bacteria. Beta.d-Mannofuranoside, O-geranyl was the most active compound and it passed 5 rules of drug-likeness properties. It could therefore be further processed for animal testing and clinical trials for its possible use as an antibacterial agent with commercial values.
Elevated effluent potassium concentrations predict the development of postreperfusion hyperkalemia in deceased liver transplantation: a retrospective cohort study
Authors: Zhang Liang , Xue Fu-Shan , Tian Ming , Zhu Zhi-Jun
Published: May 2022

Background

Postreperfusion hyperkalemia (PRHK) has garnered increasing attention in regard to deceased liver transplantation (LT), especially for LT using the expanded criteria donor grafts. However, the impact of the effluent potassium (eK+) concentration on PRHK has been largely overlooked. We evaluated whether elevated eK+ concentrations are associated with PRHK in deceased LT.

Methods

In this single-institution, retrospective cohort study, we included all adults who underwent deceased LT with intraoperative eK+ concentration monitoring between November 2016 and December 2018. The eK+ concentrations were obtained from the effluent samples collected following a standard portal vein flush. PRHK was defined as any serum potassium (sK+) level of > 5.5 mmol/L following reperfusion. Logistic regression was performed to identify predictors for PRHK, and linear regression was used to examine predictors of the maximum percentage increase in the sK+ level following reperfusion.

Results

Of the 86 patients who met the inclusion criteria, 54 (62.8%) developed PRHK. Independent predictors for PRHK included greater graft weight (OR 1.283 [95% CI 1.029–1.599] per 100 g, P = 0.027), an elevated eK+ concentration (OR 1.291 [95% CI 1.068–1.561] per mol/L, P = 0.008), and a higher sK+ level before reperfusion (OR 4.459 [95% CI 1.543–12.884] per mol/L, P = 0.006). An eK+ concentration of more than 6.9 mmol/L had a sensitivity of 59.26% and a specificity of 78.12% for predicting PRHK (area under the receiver operating characteristic curve, 0.694). Multiple linear regression analyses indicated that the eK+ and sK+ levels before reperfusion were significant predictors of the maximum percentage increase in the sK+ level following reperfusion. In addition, PRHK was associated with an increased risk of postreperfusion significant arrhythmias, severe postreperfusion syndrome, and postoperative early allograft dysfunction.

Conclusions

This study shows that the eK+ concentration could predict the risk of PRHK in deceased LT. Further prospective studies are warranted to clarify these associations.
Relationship between risk, cumulative burden of exacerbations and mortality in patients with COPD: modelling analysis using data from the ETHOS study
Authors: Rhodes Kirsty , Jenkins Martin , de Nigris Enrico , Aurivillius Magnus , Ouwens Mario
Published: May 2022

Background

The major drivers of cost-effectiveness for chronic obstructive pulmonary disease (COPD) therapies are the occurrence of exacerbations and deaths. Exacerbations, including acute and long-term events, can cause worsening of COPD and lead to an increased risk of further exacerbations, and ultimately may elevate the risk of death. In contrast to this, health economic models are based on COPD severity progression. In this post hoc analysis of the ETHOS study, we focus on the progression of COPD due to exacerbations and deaths.

Methods

We fitted semi-parametric and fully parametric multi-state Markov models with the following five progressive states: State 1, no exacerbation; State 2, 1 moderate exacerbation; State 3, ≥ 2 moderate exacerbations; State 4, ≥ 1 severe exacerbations; State 5, death. The models only allowed a patient to transition to a worsened health state, and transitions did not necessarily have to be to the next adjacent state. We used the multi-state models to analyse data from ETHOS, a phase III, 52-week study assessing the efficacy and safety of triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate in moderate-to-very severe COPD.

Results

The Weibull multi-state Markov model showed good fit of the data. In line with clinical evidence, we found a higher mortality risk after a severe exacerbation (11.4-fold relative ratio increase [95% CI, 7.7–17.0], 6.4-fold increase [95% CI, 3.8–10.8] and 5.4-fold increase [95% CI, 2.9–10.3] relative to no exacerbations, 1 moderate exacerbation or ≥ 2 moderate exacerbations, respectively). One moderate exacerbation increased mortality risk 1.8-fold (95% CI, 1.1–2.9) vs no exacerbations. We also found a higher risk of severe exacerbation and mortality following ≥ 2 moderate exacerbations.

Conclusion

Multi-state modelling of patients with COPD in ETHOS found an acute and chronic effect of severe exacerbations on mortality risk. Risk was also increased after a moderate exacerbation. Clinical management with effective pharmacotherapies should be optimised to avoid even moderate exacerbations. Modelling with exacerbations could be an alternative to current COPD models focused on disease progression.

Trial registration

NCT02465567
Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China
Authors: Miao Wenqing , Zhang Xiyu , Shi Baoguo , Tian Wanxin , Wu Bing , Lai Yongqiang , Li Yuze , Huang Zhipeng , Xia Qi , Yang Huiqi , Ding Fan , Shan Linghan , Xin Ling , Miao Jingying , Zhang Chenxi , Li Ye , Li Xiaodong , Wu Qunhong
Published: May 2022

Objective

Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to.

Methods

The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE.

Results

The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents’ Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30–3.24) and 2.16 times (95% CI 1.81–2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them.

Conclusions

Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.
An unexpected transition to virtual care: family medicine residents’ experience during the COVID-19 pandemic
Authors: Smith Neale , Newton Christie , Barbacuta Demetra , Tseng Olivia Ling-I
Published: May 2022

Background

The global COVID-19 pandemic led to rapid changes in both medical care and medical education, particularly involving the rapid substitution of virtual solutions for traditional face-to-face appointments. There is a need for research into the effects and impacts of such changes. The objective of this article investigates the perspectives of Family Medicine Residents in one university program in order to understand the impact of this transition to virtual care and learning.

Methods

This is a qualitative focus group study. Four focus groups, stratified by site type (Rural = 1; Semi-Urban = 1; Urban = 2) were conducted, with a total of 25 participants. Participants were either first or second-year Residents in Family Medicine. Focus group recordings were analyzed thematically, based upon a five-level socio-ecological model (individual, family, organization, community, environment and policy context).

Results

Two main themes were identified: (1) Residents’ experiences of Virtual Learning and Virtual Care, and (2) Living and Learning in Pandemic Times. In the first theme, Residents reported challenges both individually, in their family context, and in their training organizations. Of particular concern was the loss of hands-on experience with clinical skills such as conducting physical examinations. In the second theme, Residents reported disruption of self-care routines and family life. These Residents were unable to engage in the relationships outside of the workplace with their preceptors and peers which they had expected, and which play key roles in social support as well as in future decisions about practice location.

Conclusions

While many patients appreciated virtual care, in the eyes of these Residents it is not the ideal modality for learning the practice of Family Medicine, and they awaited a return to normal times. Despite this, the pandemic has pointed out important ways in which residency training needs to adapt to an evolving world.
A cross-sectional study evaluating cardiovascular risk and statin prescribing in the Canadian Primary Care Sentinel Surveillance Network database
Authors: Johnston Ian S. , Miles Brendan , Soos Boglarka , Garies Stephanie , Perez Grace , Queenan John A. , Drummond Neil , Singer Alexander
Published: May 2022

Background

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Canada. Assessment and management of CVD risk is essential in reducing disease burden. This includes both clinical risk factors and socioeconomic factors, though few studies report on socioeconomic status in relation to CVD risk and treatment. The primary objective of this study was to estimate the cardiovascular risk of patients attending primary care practices across Canada; secondly, to evaluate concordance with care indicators suggested by current clinical practice guidelines for statin prescribing according to patients’ cardiovascular risk and socioeconomic status.

Methods

This cross-sectional observational study used the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which is comprised of clinical data from primary care electronic medical records. Patients aged 35-75y with at least one visit to their primary care provider between 2012 and 2016 were included. Patients were assigned to a CVD risk category (high, medium, low) and a deprivation quintile was calculated for those with full postal code available. Descriptive analyses were used to determine the proportion of patients in each risk category. Logistic regression was used to evaluate the consistency of statin prescribing according to national clinical guidelines by risk category and deprivation quintile.

Results

A total of 324,526 patients were included. Of those, 116,947 (36%) of patients were assigned to a high CVD risk category, primarily older adults, males, and those with co-morbidities. There were statistically significant differences between least (quintile 1) and most (quintile 5) deprived socioeconomic quintiles, with those at high CVD risk disproportionately in Q5 (odds ratio 1.4). Overall, 48% of high-risk patients had at least one statin prescription in their record. Patients in the lower socioeconomic groups had a higher risk of statin treatment which deviated from clinical guidelines.

Conclusions

Primary care patients who are at high CVD risk are more often male, older, have more co-morbidities and be assigned to more deprived SES quintiles, compared to those at low CVD risk. Additionally, patients who experience more challenging socioeconomic situations may be less likely to receive CVD treatment that is consistent with care guidelines.
Bedside rationing and moral distress in nephrologists in sub- Saharan Africa
Authors: Ashuntantang Gloria , Miljeteig Ingrid , Luyckx Valerie A.
Published: May 2022

Background

Kidney diseases constitute an important proportion of the non-communicable disease (NCD) burden in Sub-Saharan Africa (SSA), though prevention, diagnosis and treatment of kidney diseases are less prioritized in public health budgets than other high-burden NCDs. Dialysis is not considered cost-effective, and for those patients accessing the limited service available, high out-of-pocket expenses are common and few continue care over time. This study assessed challenges faced by nephrologists in SSA who manage patients needing dialysis. The specific focus was to investigate if and how physicians respond to bedside rationing situations.

Methods

A survey was conducted among a randomly selected group of nephrologists from SSA. The questionnaire was based on a previously validated survey instrument. A descriptive and narrative approach was used for analysis.

Results

Among 40 respondents, the majority saw patients weekly with acute kidney injury (AKI) or end-stage kidney failure (ESKF) in need of dialysis whom they could not dialyze. When dialysis was provided, clinical compromises were common, and 66% of nephrologists reported lack of basic diagnostics and medication and > 80% reported high out-of-pocket expenses for patients. Several patient-, disease- and institutional factors influenced who got access to dialysis. Patients’ financial constraints and poor chances of survival limited the likelihood of receiving dialysis (reported by 79 and 78% of nephrologists respectively), while a patient’s being the family bread-winner increased the likelihood (reported by 56%). Patient and institutional constraints resulted in most nephrologists (88%) frequently having to make difficult choices, sometimes having to choose between patients. Few reported existence of priority setting guidelines. Most nephrologists (74%) always, often or sometimes felt burdened by ethical dilemmas and worried about patients out of hospital hours. As a consequence, almost 46% of nephrologists reported frequently regretting their choice of profession and 26% had considered leaving the country.

Conclusion

Nephrologists in SSA face harsh priority setting at the bedside without available guidance. The moral distress is high. While publicly funded dialysis treatment might not be prioritized in essential health care packages on the path to universal health coverage, the suffering of the patients, families and the providers must be acknowledged and addressed to increase fairness in these decisions.
How to predict the electronic health literacy of Chinese primary and secondary school students?: establishment of a model and web nomograms
Authors: Xie Tao , Zhang Ning , Mao Ying , Zhu Bin
Published: May 2022

Background

The internet has become an important resource for the public to obtain health information. Therefore, the ability to obtain and use such resources has become important for health literacy. This study aimed to establish a prediction model of Chinese students’ electronic health literacy (EHL) to guide government policymaking and parental interventions, identify the predictors of EHL in Chinese students using random forests, and establish a corresponding prediction model to help policymakers and parents determine whether primary and secondary school students have high EHL.

Methods

This is a cross-sectional study. From June to August 2021, a cluster sample survey was conducted with 1,300 students from seven primary and secondary schools in Shaanxi Province, China. We evaluated 1,235 primary and secondary school students using the e-health literacy scale. The data were divided into training and testing datasets in a 70:30 ratio for further analysis using random forest. The predictive accuracy of the score was measured using the area under the receiver operating characteristic curve. We also used decision curve analysis to determine the usefulness of the prediction model by quantifying the net benefits at different threshold probabilities in the validation dataset. 

Results

We found that 33.6% of students had high EHL. The univariate analysis showed that age (P < 0.001), grade (P < 0.001), employment status (P < 0.001), household location (P < 0.001), parental phubbing behavior (P < 0.001), and general self-efficacy (P < 0.001) were significantly associated with EHL. A random forest classification model was developed with the training dataset (872 students), and seven variables were confirmed as important: age, grade, employment status, father education level, game time, parental phubbing behavior, and general self-efficacy. The validation of the model showed good discrimination, with an area under the curve of 0.975 in the training dataset and 0.738 in the testing dataset. The model was translated into an online risk calculator, which is freely available (https://xietao.shinyapps.io/DynNomapp/).

Conclusions

In this study, an intuitive tool to predict the EHL of Chinese primary and secondary school students was developed and validated.
Women's awareness of ovarian cancer risk factors and symptoms in Western Iran in 2020–2021
Authors: Maryam Babaei , Fatemeh Salmani , Nourossadat Kariman , Saeideh Nasiri , Giti Ozgoli
Published: May 2022

Objectives

This study aimed to investigate awareness of women living in the western region of Iran about warning signs and risk factors for ovarian cancer.

Methods

This cross-sectional, descriptive-analytical study was conducted in Sanandaj and Kermanshah, Iran, 2020 and 2021. In this study, 1081 women aged 18–70 years were selected as the sample to fill out the electronic version of the Ovarian Cancer Awareness Measure (OCAM) to identify the significant variables of ovarian cancer warning signs and risk factors. The obtained data were statistically analyzed by descriptive statistics and ordinal logistic regression in SPSS 19.

Results

In this study, 60.9% of the participants had medium awareness of the subject. The results indicated that participants with higher educational attainment (P < 0.05) and those with a history of cancer (P < 0.001) showed higher knowledge of cancer. The lowest level of awareness of symptoms was associated with acute symptoms such as dysphagia (swallowing problems) most days, persistent bloating, a sense of abdominal fullness or heaviness, and frequent urination. Moreover, the lowest awareness of risk factors was related to the history of IVF treatments and the application of talcum powder to the genital area.

Conclusion

The study findings showed that women living in the western region of Iran have moderate awareness of ovarian cancer and insufficient knowledge of cancer warning signs; this suggests that it is necessary to train Iranian women to raise awareness of the signs and risk factors for ovarian cancer.
Multisource feedback in medical students’ workplace learning in primary health care
Authors: Björklund Karin , Stenfors Terese , Nilsson Gunnar H. , Leanderson Charlotte
Published: May 2022

Background

In medical students’ workplace learning, feedback is important for effective learning regarding communication and clinical skills. The provision of multisource feedback (MSF) in clinical practice with focus on the patient’s perspective is rarely addressed in the literature. The overall objective was to explore the experience of MSF in medical students’ clinical learning in primary healthcare (PHC).

Methods

In the study, patients provided feedback by use of the Patient Feedback in Clinical Practice (PFCP) questionnaire. By use of adapted PFCP questionnaire versions peers and clinical supervisors provided feedback and students performed a self-evaluation. The MSF learning activity was evaluated using surveys (4-point Likert scale/open-ended questions), (students (n = 26), peers (n = 9) and clinical supervisors (n = 7)). Data were analysed using descriptive and qualitative content analysis.

Results

Results (mean 4-point Likert scale) from participants evaluation of the MSF learning activity visualises the value of feedback in terms of patient-centred communication (students 3.50, peers 2.44 and clinical supervisors 3.57), guidance for further training (students 3.14, peers 2.89 and clinical supervisors 3.00) and clarification of pedagogical assignment (students 3.14, peers 2.89 and clinical supervisors 3.00). Thematic analysis of participants’ free-text answers in the evaluation surveys resulted in three themes: (1) applicability of the MSF, (2) MSF – collaborative learning process and (3) MSF as a facilitator in students’ clinical skills development. The participants experienced that the written MSF provided multi-facetted perspectives, which contributed to students’ and peers’ clinical and communication learning. MSF experience also enhanced clinical supervisors’ feedback regarding communication skills, targeting the supervisors’ pedagogical assignment.

Conclusion

Our findings indicate that MSF provided directly after a patient encounter, using the PFCP questionnaire as feedback provider, could be an adequate learning activity for medical students’ workplace learning. The MSF, provided through the PFCP questionnaire, was experienced to neutralise and operationalise the provision of concrete feedback, facilitating peers’ learning and clinical supervisors’ tuition. The results visualise the importance of patients in MSF, as a valuable resource in students’ workplace learning. Our study implies that this learning activity could be an applicable tool to facilitate learning and pedagogic development in clinical education in PHC.
Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure
Authors: Park Kye-Yeung , Shin Jinho , Park Hoon-Ki , Kim Yu Mi , Hwang Seon Young , Shin Jeong-Hun , Heo Ran , Ryu Soorack , Mercer Stewart W.
Published: May 2022

Background

No validated tool is available to assess patients’ perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure—originally developed in English and widely used internationally—and to examine its reliability and validity.

Methods

The CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach’s alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure.

Results

The Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach’s alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77–0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett’s test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit.

Conclusion

This study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.
The mediating effect of psychological capital on the relationship between psychological stress and distress among chinese nursing students: a cross-sectional study
Authors: Sun Feifei , Wang Aiqing , Xue Jiaomei , Su Jing , Hu Chuanfen , Lu Qinghua
Published: May 2022

Background

With the COVID-19 outbreak in China, the Chinese government took measures to prevent and control the spread of the virus. In-person teaching was replaced by distance learning, which was an unknown challenge for students. In this context, little is known about the perceived distress of nursing students and the relationship between psychological capital, perceived distress, and psychological stress. This study examined the relationship between psychological capital, psychological distress, and perceived stress, and the mediating role of psychological capital in the relationship between perceived stress and psychological distress among nursing students.

Methods

This cross-sectional survey was conducted between January and December 2020 using a convenience sampling method involving 359 undergraduate and specialist nursing students at a tertiary hospital in Shandong Province. Standardised instruments were used to measure psychological capital, psychological stress, and perceived stress. We used SPSS 24.0 and PROCESS macro to analyse the data.

Results

There was a statistically significant difference in perceived stress among students based on whether they liked the nursing profession (P < 0.01). Relative to nursing college students, undergraduates experienced significantly higher levels of perceived stress (P < 0.01). Nevertheless, there were no significant differences in perceived stress according to gender, place of residence, and being an only child. Psychological distress was positively correlated (r = 0.632, p < 0.001) with perceived stress (r =-0.662, p < 0.001), whereas it was negatively correlated with psychological capital. Psychological capital played a potential mediating role in the relationship between psychological distress and perceived stress.

Conclusions

Psychological distress was negatively correlated with psychological capital, and positively correlated with perceived stress. Mediation analyses indicated that psychological capital partially mediated the relationship between perceived stress and psychological distress. Educators should therefore heed students’ perceived stress and develop appropriate mental health counselling programmes for students in the curriculum that could help them reduce their psychological distress. In clinical practice, nursing managers must take effective measures, such as skills training, to improve the psychological capital of nursing students and reduce the negative impact of their psychological distress.
Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study
Authors: Verville Leslie , Cancelliere Carol , Connell Gaelan , Lee Joyce , Mior Silvano , Munce Sarah , Kay Robin , Côté Pierre
Published: May 2022

Background

Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway’s improvement.

Methods

We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a ‘web’ of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena.

Results

Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement.

Conclusions

End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers.
Recommendations for environmental risk assessment of gene drive applications for malaria vector control
Authors: Connolly John B. , Mumford John D. , Glandorf Debora C. M. , Hartley Sarah , Lewis Owen T. , Evans Sam Weiss , Turner Geoff , Beech Camilla , Sykes Naima , Coulibaly Mamadou B. , Romeis Jörg , Teem John L. , Tonui Willy , Lovett Brian , Mankad Aditi , Mnzava Abraham , Fuchs Silke , Hackett Talya D. , Landis Wayne G. , Marshall John M. , Aboagye-Antwi Fred
Published: May 2022

Building on an exercise that identified potential harms from simulated investigational releases of a population suppression gene drive for malaria vector control, a series of online workshops identified nine recommendations to advance future environmental risk assessment of gene drive applications.
Crosstalk of hepatocyte nuclear factor 4a and glucocorticoid receptor in the regulation of lipid metabolism in mice fed a high-fat-high-sugar diet
Authors: Lu Hong , Lei Xiaohong , Winkler Rebecca , John Savio , Kumar Devendra , Li Wenkuan , Alnouti Yazen
Published: May 2022

Background

Hepatocyte nuclear factor 4α (HNF4α) and glucocorticoid receptor (GR), master regulators of liver metabolism, are down-regulated in fatty liver diseases. The present study aimed to elucidate the role of down-regulation of HNF4α and GR in fatty liver and hyperlipidemia.

Methods

Adult mice with liver-specific heterozygote (HET) and knockout (KO) of HNF4α or GR were fed a high-fat-high-sugar diet (HFHS) for 15 days. Alterations in hepatic and circulating lipids were determined with analytical kits, and changes in hepatic mRNA and protein expression in these mice were quantified by real-time PCR and Western blotting. Serum and hepatic levels of bile acids were quantified by LC-MS/MS. The roles of HNF4α and GR in regulating hepatic gene expression were determined using luciferase reporter assays.

Results

Compared to HFHS-fed wildtype mice, HNF4α HET mice had down-regulation of lipid catabolic genes, induction of lipogenic genes, and increased hepatic and blood levels of lipids, whereas HNF4α KO mice had fatty liver but mild hypolipidemia, down-regulation of lipid-efflux genes, and induction of genes for uptake, synthesis, and storage of lipids. Serum levels of chenodeoxycholic acid and deoxycholic acid tended to be decreased in the HNF4α HET mice but dramatically increased in the HNF4α KO mice, which was associated with marked down-regulation of cytochrome P450 7a1, the rate-limiting enzyme for bile acid synthesis. Hepatic mRNA and protein expression of sterol-regulatory-element-binding protein-1 (SREBP-1), a master lipogenic regulator, was induced in HFHS-fed HNF4α HET mice. In reporter assays, HNF4α cooperated with the corepressor small heterodimer partner to potently inhibit the transactivation of mouse and human SREBP-1C promoter by liver X receptor. Hepatic nuclear GR proteins tended to be decreased in the HNF4α KO mice. HFHS-fed mice with liver-specific KO of GR had increased hepatic lipids and induction of SREBP-1C and PPARγ, which was associated with a marked decrease in hepatic levels of HNF4α proteins in these mice. In reporter assays, GR and HNF4α synergistically/additively induced lipid catabolic genes.

Conclusions

induction of lipid catabolic genes and suppression of lipogenic genes by HNF4α and GR may mediate the early resistance to HFHS-induced fatty liver and hyperlipidemia.

Graphical abstract
Magnetic resonance guided adaptive stereotactic body radiotherapy for lung tumors in ultracentral location: the MAGELLAN trial (ARO 2021-3)
Authors: Regnery Sebastian , Ristau Jonas , Weykamp Fabian , Hoegen Philipp , Sprengel Simon David , Paul Katharina Maria , Buchele Carolin , Klüter Sebastian , Rippke Carolin , Renkamp Claudia Katharina , Pohl Moritz , Meis Jan , Welzel Thomas , Adeberg Sebastian , Koerber Stefan Alexander , Debus Jürgen , Hörner-Rieber Juliane
Published: May 2022

Background

Stereotactic Body Radiotherapy (SBRT) is a standard treatment for inoperable primary and secondary lung tumors. In case of ultracentral tumor location, defined as tumor contact with vulnerable mediastinal structures such as the proximal bronchial tree (PBT) or esophagus, SBRT is associated with an increased risk for severe complications. Magnetic resonance (MR)-guided SBRT can mitigate this risk based on gated dose delivery and daily plan adaptation. The MAGELLAN trial aims to find the maximum tolerated dose (MTD) of MR-guided SBRT of ultracentral lung tumors (ULT).

Patients and methods

MAGELLAN is a prospective phase I dose escalation trial. A maximum of 38 patients with primary and secondary ULT with a tumor size ≤ 5 cm will be enrolled. Ultracentral location is defined as an overlap of the planning target volume (PTV) with the PBT or esophagus. Patients are treated at a 0.35 Tesla MR-linac (MRIdian® Linac, ViewRay Inc.
) employing a gating strategy and daily plan adaptation. Dose escalation starts at 10 × 5.5 Gy (biologically effective dose BED3/10: 155.83 Gy/85.25 Gy), may proceed up to 10 × 6.5 Gy (BED3/10: 205.83 Gy/107.25 Gy) and is guided by a customized time-to-event continual reassessment method (TITE CRM) with backup element, which alternately assigns patients to dose escalation and backup cohorts.

Discussion

The results of the MAGELLAN trial will guide further research and clinical implementation of MR-guided SBRT as ablative treatment of ULT.
Moreover, the combination of MR-guided radiotherapy with TITE-CRM including a backup element may serve as blueprint for future radiation dose escalation studies in critical locations.

Trial Registration

Registered at ClinicalTrials.gov: NCT04925583 on 14th June 2021.
Targeting TROY-mediated P85a/AKT/TBX3 signaling attenuates tumor stemness and elevates treatment response in hepatocellular carcinoma
Authors: Liu Beilei , Fang Xiaona , Kwong Dora Lai-Wan , Zhang Yu , Verhoeft Krista , Gong Lanqi , Zhang Baifeng , Chen Jie , Yu Qianqian , Luo Jie , Tang Ying , Huang Tuxiong , Ling Fei , Fu Li , Yan Qian , Guan Xin-Yuan
Published: May 2022

Background

Previous in vitro hepatocyte differentiation model showed that TROY was specifically expressed in liver progenitor cells and a small proportion of hepatocellular carcinoma cells, suggesting that TROY may participate in hepatocellular carcinoma (HCC) stemness regulation. Here, we aim to investigate the role and mechanism of TROY in HCC pathogenesis.

Method

Bioinformatics analysis of the TCGA dataset has been used to identify the function and mechanism of TROY. Spheroid, apoptosis, and ALDH assay were performed to evaluate the stemness functions. Validation of the downstream pathway was based on Western blot, co-immunoprecipitation, and double immunofluorescence.

Results

HCC tissue microarray study found that a high frequency of TROY-positive cells was detected in 53/130 (40.8%) of HCC cases, which was significantly associated with poor prognosis and tumor metastasis. Functional studies revealed that TROY could promote self-renewal, drug resistance, tumorigenicity, and metastasis of HCC cells. Mechanism study found that TROY could interact with PI3K subunit p85α, inducing its polyubiquitylation and degradation. The degradation of p85α subsequently activate PI3K/AKT/TBX3 signaling and upregulated pluripotent genes expression including SOX2, NANOG, and OCT4, and promoted EMT in HCC cells. Interestingly, immune cell infiltration analysis found that upregulation of TROY in HCC tissues was induced by TGF-β1 secreted from CAFs. PI3K inhibitor wortmannin could effectively impair tumor stemness to sorafenib.

Conclusion

We demonstrated that TROY is an HCC CSC marker and plays an important role in HCC stemness regulation. Targeting TROY-positive CSCs with PI3K inhibitor wortmannin combined with chemo- or targeted drugs might be a novel therapeutic strategy for HCC patients.

Graphical abstract
Recreational climbers are more conscientious than recreational athletes–a case control study
Authors: Steinmetz Gino , Assmann Mara , Hubert Jan , Saul Dominik
Published: May 2022

Background

Physiological characteristics of climbers have been extensively studied, while the personality of climbers remains poorly understood. Personality research in sports is an established field, predicting long-term success as well as short-term behavior. The goal of our study was to examine recreational climbers’ personality and gain a better understanding of what makes them reach new heights.

Methods

We analyzed a cohort of 50 recreational climbers and 50 non-climbing athletes (control) regarding their personality characteristics. We assessed the BMI, the self-reported climbing grade, and the years of climbing experience. To evaluate the personality of recreational climbers and athletes, we used the German version of the Big Five Inventory (BFI-2), which summarizes the personality in five main categories.

Results

Recreational climbers scored significantly higher in conscientiousness than non-climbing athletes (p = 0.04), there was no significant difference between the other four main personality traits. Female climbers scored significantly higher in conscientiousness than male climbers (p = 0.02), while female athletes scored higher in openness than male athletes (p < 0.01). The climbing group displayed a small but significant negative correlation between conscientiousness and BMI (r = -0.39; p < 0.01).

Conclusion

In conclusion, the personality of recreational climbers and recreational athletes differs in conscientiousness, with the climbers showing higher scores. Regarding gender, we found higher levels of conscientiousness in female climbers and higher openness in female athletes in comparison to their male counterparts. A negative correlation between BMI and conscientiousness of the climbers was detected.
Does caffeine ingestion affect the lower-body post-activation performance enhancement in female volleyball players?
Authors: Filip-Stachnik Aleksandra , Spieszny Michał , Stanisz Lidia , Krzysztofik Michał
Published: May 2022

Background

Post-activation performance enhancement (PAPE) is a physiological phenomenon that acutely improves voluntary muscular performance following a conditioning activity. A large and growing body of literature has investigated different strategies to induce a PAPE stimulus; however, little attention has been given to whether acute caffeine ingestion could augment the effect of PAPE on subsequent performance. This study evaluated the acute effects of caffeine ingestion and back squat conditioning activity on subsequent countermovement jump (CMJ) performance in female semi-professional volleyball players.

Methods

Fourteen resistance-trained female volleyball players (26 ± 3 years) performed 3 different testing conditions in randomized order: where each ingested 6 mg/kg of caffeine (CAF) or placebo (PLAC) and performed a single set of back squats at 80%1RM until mean movement velocity dropped by 10% as the conditioning activity or a control (CTRL) condition where participants did not ingest any supplement and did not perform the conditioning activity. CMJ height was examined at baseline and in 2 min intervals until 10 min postconditioning activity. Furthermore, due to the wide inter-individual variation in optimal recovery time of PAPE response, the baseline and best post-conditioning activity performance were also analyzed.

Results

The Friedman test revealed a significant difference in jump height within CTRL (p = 0.002) and CAF (p = 0.001) conditions, but no significant difference was found within the PAP condition. The post hoc showed a significant decrease in jump height in 8th min in CTRL condition (p = 0.022, effect size [ES] = −0.31), a significant increase in jump height in 2nd min in CAF condition (p = 0.013, ES = 0.3), without differences in PLAC condition in comparison to baseline values. Moreover, a significant jump height increases from baseline to best performance post conditioning activity value for CAF (p = 0.001, ES = 0.39) and PLAC (p = 0.001, ES = 0.3) condition, but no significant difference was found for the CTRL condition.

Conclusions

The single set of heavy-loaded back squats with controlled velocity used as a conditioning activity in the current study enhanced subsequent CMJ performance in female volleyball players with no additional effect of caffeine.
Ischemic stroke and intestinal flora: an insight into brain–gut axis
Authors: Hu Wenjie , Kong Xiangyi , Wang Hui , Li Yunqing , Luo Yimin
Published: May 2022

Stroke is a type of cerebrovascular disease that significantly endangers human health and lowers quality of life. This understandably places a heavy burden on society and families. In recent years, intestinal flora has attracted increasing attention from scholars worldwide, and its association with ischemic stroke is becoming a hot topic of research amongst researchers in field of stroke. After suffering from a stroke, intestinal microbial dysbiosis leads to increased intestinal permeability and activation of the intestinal immune system, which in turn leads to ectopic intestinal bacteria and pro-inflammatory cells that enter brain tissue through the damaged blood-brain barrier. This exacerbates ischemia-reperfusion injury. Interestingly, after a stroke, some metabolites produced by the intestinal flora attenuate ischemia-reperfusion injury by suppressing the post-stroke inflammatory response and promotes the repair of neurological function. Here we elucidate the changes in gut flora after occurrence of a stroke and highlight the immunomodulatory processes of the post-stroke gut flora.
Cardioprotective effects of sodium thiosulfate against doxorubicin-induced cardiotoxicity in male rats
Authors: Shekari Maryam , Gortany Narges Khalilian , Khalilzadeh Mina , Abdollahi Alireza , Ghafari Homanaz , Dehpour Ahmad Reza , Ghazi-Khansari Mahmoud
Published: May 2022

Background

Doxorubicin (DOX) is an effective antitumor agent, but its clinical usage is limited due to adverse cardiotoxic effects. Several compounds have been studied to reduce DOX cardiotoxicity to improve its therapeutic index. This study was aimed to investigate the protective effects of sodium thiosulfate (STS) pre-treatment against DOX-induced cardiomyopathy in rats.

Methods

Male Wistar rats were randomized into 4 groups: control (saline), DOX (2.5 mg/kg, 3 times per week, intraperitoneal [i.p.]), STS (300 mg/kg, 3 times per week, i.p), and DOX + STS (30 min prior to DOX injection, 3 times per week, i.p.) over a period of 2 weeks. The body weight, electrocardiography, histopathology, papillary muscle contractility, and oxidative stress biomarkers in heart tissues were assessed.

Results

The results indicated that STS significantly improved the body weight (P < 0.01), decreased QRS complex and QT interval on ECG (P < 0.05 and P < 0.001, respectively), as well as declined the papillary muscle excitation, and increased its contraction (P < 0.01) compared to DOX-treated rats. STS strongly suppressed oxidative stress induced by DOX through the significant improvement of the cardiac tissue antioxidant capacity by increasing glutathione, superoxide dismutase (P < 0.001), and decreasing the level of lipid peroxidation (P < 0.01).

Conclusion

Taken together, the results of this study demonstrated that STS showed potent cardioprotective effects against DOX-induced cardiotoxicity by suppressing oxidative stress.