bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging detected radiation-induced changes in patients with proton radiation-treated arteriovenous malformations
Authors: Correia de Verdier Maria , Ronne-Engström Elisabeth , Borota Ljubisa , Nilsson Kristina , Blomquist Erik , Wikström Johan
Published: November 2021

Background

Treatment of intracranial arteriovenous malformations (AVMs) includes surgery, radiation therapy, endovascular occlusion, or a combination. Proton radiation therapy enables very focused radiation, minimizing dose to the surrounding brain.

Purpose

To evaluate the presence of radiation-induced changes on post-treatment MRI in patients with AVMs treated with proton radiation and to compare these with development of symptoms and nidus obliteration.

Material and Methods

Retrospective review of pre- and post-treatment digital subtraction angiography and MRI and medical records in 30 patients with AVMs treated with proton radiation. Patients were treated with two or five fractions; total radiation dose was 20–35 physical Gy. Vasogenic edema (minimal, perinidal, or severe), contrast enhancement (minimal or annular), cavitation and nidus obliteration (total, partial, or none) were assessed.

Results

26 of 30 patients (87%) developed MRI changes. Vasogenic edema was seen in 25 of 30 (83%), abnormal contrast enhancement in 18 of 26 (69%) and cavitation in 5 of 30 (17%). Time from treatment to appearance of MRI changes varied between 5 and 25 months (median 7, mean 10). Seven patients developed new or deteriorating symptoms that required treatment with corticosteroids; all these patients had extensive MRI changes (severe vasogenic edema and annular contrast enhancement). Not all patients with extensive MRI changes developed symptoms. We found no relation between MRI changes and nidus obliteration.

Conclusion

Radiation-induced MRI changes are seen in a majority of patients after proton radiation treatment of AVMs. Extensive MRI changes are associated with new or deteriorating symptoms.
What is pneumonia?
Authors: Waterer Grant
Published: November 2021

The diagnosis of pneumonia is both simple and complex. Recent research is challenging our concept of pneumonia and radiological gold standards that have underpinned research for decades. In particular, the accuracy of chest radiographs in diagnosing pneumonia is now highly questionable when compared with computed tomography scans. Depending on the question being asked, pneumonia can be defined in clinical, pathological, radiological, or microbiological contexts, or frequently a combination of all of these. However, while the field is changing, until we have new studies defining pneumonia in new ways, clinicians can be reassured that existing guidelines based on �old� standards remain as valid as they have always been.
The Atomic Rearrangement of GaN-Based Multiple Quantum Wells in H2/NH3 Mixed Gas for Improving Structural and Optical Properties
Authors: Ben Yuhao , Liang Feng , Zhao Degang , Yang Jing , Liu Zongshun , Chen Ping
Published: November 2021

In this work, three GaN-based multiple quantum well (MQW) samples are grown to investigate the growth techniques of high-quality MQWs at low temperature (750 °C). Instead of conventional temperature ramp-up process, H2/NH3 gas mixture was introduced during the interruption after the growth of InGaN well layers. The influence of hydrogen flux was investigated. The cross-sectional images of MQW via transmission electron microscope show that a significant atomic rearrangement process happens during the hydrogen treatment. Both sharp interfaces of MQW and homogeneous indium distribution are achieved when a proper proportion of hydrogen was used. Moreover, the luminescence efficiency is improved strongly due to suppressed non-radiative recombination process and a better homogeneity of MQWs. Such kind of atomic rearrangement process is mainly caused by the larger diffusion rate of gallium and indium adatoms in H2/NH3 mixed gas, which leads to a lower potential barrier energy to achieve thermodynamic steady state. However, when excessive hydrogen flux is introduced, the MQW will be partly damaged, and the luminescence performance will deteriorate.
Genetic predisposition to impaired metabolism of the branched chain amino acids, dietary intakes, and risk of type 2 diabetes
Authors: Wang Weiqi , Liu Zengjiao , Liu Lin , Han Tianshu , Yang Xue , Sun Changhao
Published: November 2021

Background and objectives

Circulating branched chain amino acids (BCAAs) increase the risk of type 2 diabetes (T2D). The genetic variants in the BCAA metabolic pathway influence the individual metabolic ability of BCAAs and may affect circulating BCAA levels together with dietary intakes. So, we investigated whether genetic predisposition to impaired BCAA metabolism interacts with dietary BCAA intakes on the risk of type 2 diabetes and related parameters.

Methods

We estimated dietary BCAA intakes among 434 incident T2D cases and 434 age-matched controls from The Harbin Cohort Study on Diet, Nutrition and Chronic Non-Communicable Diseases. The genetic risk score (GRS) was calculated on the basis of 5 variants having been identified in the BCAA metabolic pathway. Multivariate logistic regression models and general linear regression models were used to assess the interaction between dietary BCAAs and GRS on T2D risk and HbA1c.

Results

Dietary BCAAs significantly interact with metabolism related GRS on T2D risk and HbA1c (p for interaction = 0.038 and 0.015, respectively). A high intake of dietary BCAAs was positively associated with diabetes incidence only among high GRS (OR 2.40, 95% CI 1.39, 4.12, P for trend = 0.002). Dietary BCAAs were associated with 0.14% elevated HbA1c (p = 0.003) and this effect increased to 0.21% in high GRS (p = 0.003). Furthermore, GRS were associated with 9.19 μmol/L higher plasma BCAA levels (p = 0.006, P for interaction = 0.015) only among the highest BCAA intake individuals.

Conclusions

Our study suggests that genetic predisposition to BCAA metabolism disorder modifies the effect of dietary BCAA intakes on T2D risk as well as HbA1c and that higher BCAA intakes exert an unfavorable effect on type 2 diabetes risk and HbA1c only among those with high genetic susceptibility.
Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review
Authors: Cam Henrik , Kempen Thomas Gerardus Hendrik , Eriksson Helena , Abdulreda Kanar , Franzon Kristin , Gillespie Ulrika
Published: November 2021

Background

The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used.

The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests.

Methods

We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test.

Results

A total of 699 patients were included. The patients’ mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83).

Conclusions

The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty
Authors: Liang Hong , Li Xiaoping , Lin Xiaoye , Ju Yanmin , Leng Jiyan
Published: November 2021

Background

Frailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and compared the receiver operating characteristic curve of different nutritional indexes for frailty.

Methods

This cross-sectional study included 179 inpatients aged ≥65 years old. Frailty was measured using Fried Frailty Phenotype, handgrip strength was measured using JAMAR@Plus and the 4.57 m usual gait speed was measured using a stopwatch. Comprehensive nutritional assessment refers to the application of Mini Nutritional Assessment (MNA) to assess the nutritional status of patients.

Results

Compared with the non-frailty group, the upper arm circumference, calf circumference, hemoglobin, albumin, prealbumin, cholesterol and low density lipoprotein in the frailty group were lower (P < 0.05). Comprehensive nutritional assessment, whether as a categorical variable or a continuous variable, was significantly correlated with frailty (P < 0.05). Model1 showed that the risk of frailty in malnourished patients was 3.381 times higher than that in well nourished patients (P = 0.036). Model2 showed that the risk of frailty decreased by 13.8% for every 1 point increase in MNA score (P = 0.009). The area under the curves of albumin, prealbumin and hemoglobin was larger (AUC > 0.65), AUC was 0.718, 0.693 and 0.743, respectively.

Conclusions

Our results suggest that malnutrition is closely related to frailty. As for single nutritional indexes, albumin, prealbumin and hemoglobin were found to be associated with frailty. Further cohort studies are needed to verify their ability to screen for frailty.
Seroprevalence of anti-SARS-CoV-2 antibodies and risk factors among healthy blood donors in Luanda, Angola
Authors: Sebastião Cruz S. , Galangue Manuela , Gaston Celestina , Van-Dunen Rui , Quivinja Joltim , Lunbungululo Emiliana , Alfredo Domingos , Sozinho Alberto , Teixeira Alice , Manico Eunice , Machado Deodete , Mateus António , David Zinga , Paixão Joana , Neto Zoraima , de Vasconcelos Jocelyne Neto , Morais Joana
Published: November 2021

Background

SARS-CoV-2 emerged in China and spread throughout the world due to its rapid transmission. The exposure rate in the healthy population is unknown, mainly in resource-limited countries. Herein, we estimated the seroprevalence of anti-SARS-CoV-2 antibodies and risk factors among blood donors in Luanda, the capital city of Angola.

Methods

This was a retrospective study conducted with 343 blood donors. Chi-square and logistic regression were calculated to predict the independent variable for SARS-CoV-2 infection and deemed significant when p < 0.05.

Results

Seroprevalence of anti-SARS-CoV-2 was 4.7%. Positivity rates varied to age groups (3.5–14.3%), gender (0–5%), area of residence (3.1–.6%), educational level (5.1–10.2%), occupation (4.4–7.7%), and the blood donor category (2.0–5.1%). Past and recent infections were detected in 3.2% and 1.5%, respectively. Blood donors under the age of 20 years (OR: 4.58, p = 0.241) and from non-urbanized areas (OR: 1.86, p = 0.293) presented a high risk related to infection. The infection was higher in blood group A and lower in blood group O. The risk of SARS-CoV-2 infection has increased from January 2020 (OR: 0.03, p = 0.001) to August 2020 (OR: 0.57, p = 0.426).

Conclusions

We provide an estimate of the exposure of healthy blood donors in Luanda. Also, we detected anti-SARS-CoV-2 in January 2020, indicating that the SARS-CoV-2 could have been imported during the first month of 2020. Further studies should be performed to assess the exposure rate in different groups from Angola.
Knockdown of circSMAD2 inhibits the tumorigenesis of gallbladder cancer through binding with eIF4A3
Authors: Qin Yiyu , Zheng Yongliang , Huang Cheng , Li Yuanyuan , Gu Min , Wu Qin
Published: November 2021

Background

Gallbladder cancer (GBC) is the seventh most common gastrointestinal cancer worldwide. This study aimed to investigate the function of circSMAD2 in GBC.

Methods

To investigate the function of circSMAD2 in GBC, the level of circSMAD2 in GBC cells was detected by RT-qPCR. CCK-8 assay was performed to investigate the cell viability. Cell apoptosis was tested by flow cytometry. In addition, transwell assay was used to detect the cell migration and invasion. RIP and RNA pull-down were used to explore the relation among circSMAD2, eIF4A3 and SMAD2. Meanwhile, xenograft mice model was established to investigate the function of circSMAD2 in GBC.

Results

The data revealed that circSMAD2 was upregulated in GBC, and circSMAD2 knockdown significantly inhibited the viability of GBC cells. In addition, circSMAD2 siRNA notably induced the apoptosis in GBC cells. The migration and invasion of GBC cells were obviously suppressed in the presence of circSMAD2 siRNA. Meanwhile, circSMAD2 suppressed the binding between eukaryotic translation initiation factor 4A3 (eIF4A3) and SMAD2 through binding with eIF4A3. Knockdown of circSMAD2 notably inhibited the expression of SMAD2 in GBC cells, and SMAD2 overexpression partially reversed the anti-tumor effect of circSMAD2 knockdown. Finally, circSMAD2 siRNA significantly inhibited the tumor growth of GBC in vivo.

Conclusion

Knockdown of circSMAD2 inhibits the tumorigenesis of gallbladder cancer through binding with eIF4A3. Thus, our study provided a new strategy for the treatment of GBC.
Clinical experience of use of percutaneous peripheral arterial cannulation in sick neonates in a developing country
Authors: Shah Sachin , Kaul Amita , Mishra Shambhavi , Pawale Shridhar
Published: November 2021

Background

Continuous invasive arterial monitoring is necessary in sick neonates needing hemodynamic and ventilatory support. The primary objective of our study was to describe clinical experience with percutaneous peripheral arterial cannulation (PAC) in sick neonates.

Methods

Neonates needing PAC were prospectively enrolled in the study. Inclusion criteria were: neonates needing respiratory support (invasive or non-invasive), neonates requiring vasoactive medications or neonate likely to need more than 5 sampling pricks in 24 h.

Results

One hundred eight neonates (93.1%) needed cannulation of one arterial site while 8 (6.9%) needed cannulation of 2 arterial sites, thus giving a total of 124 cannulations. Out of the 124 cannulations, 102 (82%) were performed in first attempt, while 22 (18%) cannulations needed 2 or more attempts. Serious complications like discolouration of digits, blanching of skin or bleeding were seen in 6 (4.9%) cannulations. These resolved after removal of arterial line and no long term consequences were noted. On comparing neonates having radial arterial cannulation(n = 108) with posterior tibial arterial cannulation (n = 16) there was no difference in duration of arterial line between radial artery group (mean, SD 53.30 ± 22.56) and posterior tibial artery group (mean, SD 48.25 ± 27.39). However, more attempts were needed to cannulate post tibial artery (mean, SD 2.25 ± 1.32) as compared to radial artery (mean 1.22 ± 0.789) and this difference was statistically significant (MD -1.02, 95% CI − 1.75 to − 0.30). There was no difference in incidence of serious complications between the radial artery group (3.7%, n = 4) as compared to posterior tibial group (5.5%, n = 1, OR 0.57, 95% CI 0.06–5.51, p = 0.63).

Conclusions

Peripheral arterial cannulation is a safe method for hemodynamic monitoring and blood sampling in sick neonates. Complications can be minimized by diligent monitoring and proactive removal of line if there is damping of tracing.
Comparison of physical and psychological health outcomes for motorcyclists and other road users after land transport crashes: an inception cohort study
Authors: Sharwood Lisa N. , Kifley Annette , Craig Ashley , Gopinath Bamini , Jagnoor Jagnoor , Cameron Ian D.
Published: November 2021

Background

Serious injuries and fatalities among vulnerable road users on two wheeled motorised vehicles have increased across Australia and internationally in the past decade yet fallen for motor vehicle occupants. Almost half of all reported motorcycle injury crashes cause serious injury or death, nearly double that of motor vehicle police-reported crashes. This study explores associations with sociodemographic and pre-injury health characteristics and health outcomes after a road traffic injury; aiming to compare motorcyclists with other road users and inform recovery care.

Methods

An inception cohort study recruited 1854 individuals aged > 17 years, injured following land-transport crashes in New South Wales, Australia (July 2013–November 2016). Interviews conducted at baseline, 6-and 12-months post-injury elicited demographic, socioeconomic, and self-reported health conditions.

Results

Primary analysis involved 1854 participants who were recruited at baseline as three distinct road user groups; 628 (33.9%) motorcyclists, 927 (50%) vehicle occupants and 299 (16.1%) bicyclists. At baseline, injury patterns differed significantly between road user groups; motorcyclists were more than twice as likely to sustain lower extremity injury (p < 0.001); to have more severe injury severity scores (p < 0.001) and longer hospital stays versus vs vehicle occupants and bicyclists (< 0.001) across these measures. Injured motorcyclists were predominantly male (88.1%, p < 0.001), were younger on average (38 years) than bicyclists (41.5 years), had lower income and education levels, and poorer pre-injury physical health than other road user groups. Despite these differences, at 12 months post-injury motorcyclists had better physical health (SF12-PCS 2.07 (0.77, 3.36), p = 0.002) and reported lower pain scores (− 0.51 (− 0.83, − 0.2), p < 0.001) than vehicle occupants. Motorcyclists displayed less evidence of psychological distress than vehicle occupants, but more than bicyclists across several measures used.

Conclusions

Road user types differ in important characteristics, including pre-injury health status and recovery after injury. As vulnerable road users experiencing transport crash and considering their higher initial injury severity, the degree of recovery among motorcyclists compared with other user types is remarkable and unexplained. Health and recovery outcomes after land-transport crashes is least favourable among vehicle occupants despite their higher levels of protection in a crash. This information is valuable for targeting early intervention strategies by road user type during the post-crash care phase, to improve long-term recovery.
Mutual relationships between SARS-CoV-2 test numbers, fatality and morbidity rates
Authors: Korneta Piotr , Zawiła-Niedźwiecki Janusz , Domański Jarosław
Published: November 2021

Background

The number of SARS-CoV-2 tests conversely to other factors, such as age of population or comorbidities, influencing SARS-CoV-2 morbidity and fatality rates, can be increased or decreased by decision makers depending on the development of the pandemic, operational capacity, and financial restraints. The key objective of this study is to identify and describe, within the probabilistic approach, the relationships between SARS-CoV-2 test numbers and the mortality and morbidity rates.

Methods

The study is based on a statistical analysis of 1058 monthly observations relating to 107 countries, from six different continents, in an 11-month period from March 2020 to January 2021. The variable utilised can be defined as the number of tests performed in a given country in 1 month, to the number of cases reported in a prior month and morbidities and mortalities per 1 million population. The probabilities of different mortality and morbidity rates for different test numbers were determined by moving percentiles and fitted by the power law and by the three-segment piecewise-linear approximation based on Theil Sen trend lines.

Results

We have identified that for a given probability the dependence of mortality and morbidity rates on SARS-CoV-2 test rates follows a power law and it is well approximated by the three Theil Sen trend lines in the three test rate ranges. In all these ranges Spearman rho and Kendall tau-b rank correlation coefficients of test numbers and morbidity with fatality rates have values between − 0.5 and − 0.12 with p-values below 0.002.

Conclusions

According to the ABC classification: the most important, moderately important, and relatively unimportant ranges of test numbers for managing and control have been indicated based on the value of the Theil Sen trend line slope in the three SARS-CoV-2 test rate ranges identified. Recommendations for SARS-CoV-2 testing strategy are provided.
“I felt very small and embarrassed by the health care provider when I requested to be tested for syphilis”: barriers and facilitators of regular syphilis and HIV testing among female sex workers in Uganda
Authors: Muhindo Richard , Mujugira Andrew , Castelnuovo Barbara , Sewankambo Nelson K. , Parkes-Ratanshi Rosalind , Tumwesigye Nazarius Mbona , Nakku-Joloba Edith , Kiguli Juliet
Published: November 2021

Background

Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda.

Methods

Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis.

Results

Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators.

Conclusions

HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.
Surgical treatment of stoma-related hernias: retrospective cohort study of damage claims to the Swedish National Patient Insurance Company 2010–2016
Authors: Nyman Johan , Lindmark Mikael , Gunnarsson Ulf , Strigård Karin
Published: November 2021

Background

Parastomal hernia and stoma-site hernia are common stoma complications. Parastomal hernia repair is associated with high complication and recurrence rates. Insurance data can provide novel information on the consequences of perioperative complications from the patient’s point of view. The aim was to investigate what types of complications associated with stoma-related hernia surgery that cause patients to apply for economic compensation through the patient insurance system and to investigate demographic and clinical differences among cases based on gender and type of center at which the surgery was performed.

Methods

A national patient damage claim database was searched for ICD-10 codes related to parastomal and stoma-site hernia surgery over a seven-year period. Medical records were screened for claims associated with parastomal hernia repair, relocation or reversal due to parastomal hernia, or stoma-site hernia repair. Claims were classified according to one of four primary complaints: surgical, anesthetic, medical or other. Clinical and demographic differences between genders and hospital types were investigated. Reasons for non-compensation were analyzed.

Results

Thirty claims met the inclusion criteria. Eighteen were related to parastomal hernia repair, seven to stoma-site hernia repair, three to stoma reversal and two to relocation due to parastomal hernia. Twenty-five claims were primarily surgical, two related to anesthesia and three classified as other. Seven claims were granted compensation. No demographic or clinical differences were found apart from female gender being associated with previous parastomal hernia repair [6 women and 0 men (p = 0.02)].

Conclusion

Surgical complaints predominated. Few claims were compensated, reflecting the complexity and unsatisfactory outcomes of these procedures. Many claims were identified in relation to the incidence of stoma-related hernia surgery.

Trial registration

Due to its retrospective and descriptive nature, the study was not registered in any registry.
Exploring the factors that affect the transition from student to health professional: an Integrative review
Authors: Opoku Eric Nkansah , Khuabi Lee-Ann Jacobs-Nzuzi , Van Niekerk Lana
Published: November 2021

Abstract

Background

The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice.

Methods

Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this review. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach.

Results

Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates.

Conclusion

The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.
An exploratory study on needs for clinical research training: data from Chinese hospitals
Authors: Liu Wei , Huang Wei , Liu Chang , Li Pei , Chen Jing
Published: November 2021

Objective

Through preliminary investigation of needs for clinical research training, to provide some initial evidence for design and operation of clinical research training programs in China.

Methods

An online questionnaire containing 23 questions about demographics, current practice of clinical research and needs for clinical research training was formulated to collect data from physicians and researchers in hospital. Convenience sampling was adopted.

Results

A total of 600 valid questionnaires were collected, including 507 from physicians, 58 from full-time clinical researchers and 35 from full-time basic medical researchers. Results showed that 14 % of the participants never participated in any clinical research, difficulties in data statistics were reported by more than 70 % of participants, and over 50 % reported training needs for cohort and biobank construction, data management and clinical study design. As to the training form, a combined on-line lecture with off-line communication is preferred. As for the content of the training program, strategies for literature reading and grant writing are highly demanded.

Conclusions

In China, even physicians in top hospitals tend to encounter various difficulties when conducting clinical research. This study highlights the importance of systematic training for future physician scientists in China, with a particular focus on data statistics, cohort and biobank construction and data management.
Interpretable time-aware and co-occurrence-aware network for medical prediction
Authors: Sun Chenxi , Dui Hongna , Li Hongyan
Published: November 2021

Background

Disease prediction based on electronic health records (EHRs) is essential for personalized healthcare. But it’s hard due to the special data structure and the interpretability requirement of methods. The structure of EHR is hierarchical: each patient has a sequence of admissions, and each admission has some co-occurrence diagnoses. However, the existing methods only partially model these characteristics and lack the interpretation for non-specialists.

Methods

This work proposes a time-aware and co-occurrence-aware deep learning network (TCoN), which is not only suitable for EHR data structure but also interpretable: the co-occurrence-aware self-attention (CS-attention) mechanism and time-aware gated recurrent unit (T-GRU) can model multilevel relations; the interpretation path and the diagnosis graph can make the result interpretable.

Results

The method is tested on a real-world dataset for mortality prediction, readmission prediction, disease prediction, and next diagnoses prediction. Experimental results show that TCoN is better than baselines with 2.01% higher accuracy. Meanwhile, the method can give the interpretation of causal relationships and the diagnosis graph of each patient.

Conclusions

This work proposes a novel model—TCoN. It is an interpretable and effective deep learning method, that can model the hierarchical medical structure and predict medical events. The experiments show that it outperforms all state-of-the-art methods. Future work can apply the graph embedding technology based on more knowledge data such as doctor notes.
Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul’s and Ayder Hospitals, Ethiopia
Authors: Bisrat Alemayehu , Minda Dagne , Assamnew Bekalu , Abebe Biruk , Abegaz Teshome
Published: November 2021

Background

In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans.

Methods

A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented.

Results

St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system.

Conclusion

Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system.
Transforming growth factor-β1 decreases erythropoietin production through repressing hypoxia-inducible factor 2α in erythropoietin-producing cells
Authors: Shih Hong-Mou , Pan Szu-Yu , Wu Chih-Jen , Chou Yu-Hsiang , Chen Chun-Yuan , Chang Fan-Chi , Chen Yi-Ting , Chiang Wen-Chih , Tsai Hsing-Chen , Chen Yung-Ming , Lin Shuei-Liong
Published: November 2021

Background

Renal erythropoietin (EPO)-producing (REP) cells produce EPO through hypoxia-inducible factor (HIF) 2α-activated gene transcription. Insufficient EPO production leads to anemia in patients with chronic kidney disease. Although recombinant EPO is effective to improve anemia, no reliable REP cell lines limit further progress of research and development of novel treatment.

Methods

We screened Epo mRNA expression in mouse fibroblast cell lines. Small interfering RNA specific for HIF1α or HIF2α was transfected to study Epo expression in C3H10T1/2 cells. The effect of transforming growth factor-β1 (TGF-β1) on HIF-EPO axis was studied in C3H10T1/2 cells and mice.

Results

Similar to mouse REP pericytes, C3H10T1/2 cells differentiated to α-smooth muscle actin+ myofibroblasts after exposure to TGF-β1. Specific HIF knockdown demonstrated the role of HIF2α in hypoxia-induced Epo expression. Sustained TGF-β1 exposure increased neither DNA methyltransferase nor methylation of Epas1 and Epo genes. However, TGF-β1 repressed HIF2α-encoding Epas1 promptly through activating activin receptor-like kinase-5 (ALK5), thereby decreasing Epo induction by hypoxia and prolyl hydroxylase domain inhibitor roxadustat. In mice with pro-fibrotic injury induced by ureteral obstruction, upregulation of Tgfb1 was accompanied with downregulation of Epas1 and Epo in injured kidneys and myofibroblasts, which were reversed by ALK5 inhibitor SB431542.

Conclusion

C3H10T1/2 cells possessed the property of HIF2α-dependent Epo expression in REP pericytes. TGF-β1 induced not only the transition to myofibroblasts but also a repressive effect on Epas1-Epo axis in C3H10T1/2 cells. The repressive effect of TGF-β1 on Epas1-Epo axis was confirmed in REP pericytes in vivo. Inhibition of TGF-β1-ALK5 signaling might provide a novel treatment to rescue EPO expression in REP pericytes of injured kidney.
Effect of PLC-β1/CaM signaling pathway mediated by AT1R on the occurrence and development of hepatocellular carcinoma
Authors: Xu Zhou-wei , Liu Na-na , Wang Xing-yu , Ding Bai-cheng , Zhang Hai-feng , Li Ying , Sun Wu-yi , Wei Wei
Published: November 2021

Objective

To study the roles of AT1R, PLC-β1, CaM and other related signal molecules in the formation and development of hepatocellular carcinoma (HCC) and their correlation.

Methods

ELISA and immunohistochemistry were used to analyze the expressions of target proteins in serum and liver tissue of HCC patients, and the correlation between AT1R, PLC-β1 and CaM and postoperative survival status of patients was followed up and determined. CCK-8 method was used to screen the doses of Ang II and candesartan sensitive to HepG2 and HCCLM3 cells. Transwell experiment was used to observe the effects of different drugs on the migration and invasion activity of HCC cells. Meanwhile, flow cytometry and Western blot were used to detect the expression levels of AT1R, PLC-β1 and CaM in the cells. Then PLC-β1 siRNA was selected to transfect HCC cells, so as to further clarify the mechanism of the above signal proteins. HepG2 cells were inoculated under the hepatic capsule of mice to induce the formation of HCC in situ. Ang II and candesartan were used to stimulate HCC mice to observe the difference in liver appearance and measure the liver index. Finally, ELISA and immunofluorescence experiments were selected to analyze the levels of target proteins in mouse serum and liver tissue.

Results

The expression levels of target proteins in serum and liver tissue of HCC patients were significantly increased, and the postoperative survival time of patients with high expression of AT1R, PLC-β1 or CaM was obviously shortened. Ang II and candesartan could significantly promote and inhibit the motility of HCC cells, and had different effects on the levels of AT1R, PLC-β1 and CaM in cells. However, in hepatocellular carcinoma cells transfected with PLC-β1 siRNA, the intervention ability of drugs was obviously weakened. Ang II could significantly promote the formation and progression of mouse HCC, while candesartan had the opposite effect. Meanwhile, medications could affect the expressions of target proteins in mouse serum and liver tissue.

Conclusion

AT1R, PLC-β1 and CaM may be risk factors affecting the formation and prognosis of HCC, and the PLC-β1/CaM signaling pathway mediated by AT1R is an important way to regulate the migration and invasion activity of HCC cells.
The tumor suppressor activity of DLC1 requires the interaction of its START domain with Phosphatidylserine, PLCD1, and Caveolin-1
Authors: Sanchez-Solana Beatriz , Wang Dunrui , Qian Xiaolan , Velayoudame Parthibane , Simanshu Dhirendra K. , Acharya Jairaj K. , Lowy Douglas R.
Published: November 2021

Background

DLC1, a tumor suppressor gene that is downregulated in many cancer types by genetic and nongenetic mechanisms, encodes a protein whose RhoGAP and scaffolding activities contribute to its tumor suppressor functions. The role of the DLC1 START (StAR-related lipid transfer; DLC1-START) domain, other than its binding to Caveolin-1, is poorly understood. In other START domains, a key function is that they bind lipids, but the putative lipid ligand for DLC1-START is unknown.

Methods

Lipid overlay assays and Phosphatidylserine (PS)-pull down assays confirmed the binding of DLC1-START to PS. Co-immunoprecipitation studies demonstrated the interaction between DLC1-START and Phospholipase C delta 1 (PLCD1) or Caveolin-1, and the contribution of PS to those interactions. Rho-GTP, cell proliferation, cell migration, and/or anchorage-independent growth assays were used to investigate the contribution of PS and PLCD1, or the implications of TCGA cancer-associated DLC1-START mutants, to DLC1 functions. Co-immunoprecipitations and PS-pull down assays were used to investigate the molecular mechanisms underlying the impaired functions of DLC1-START mutants. A structural model of DLC1-START was also built to better understand the structural implications of the cancer-associated mutations in DLC1-START.

Results

We identified PS as the lipid ligand for DLC1-START and determined that DLC1-START also binds PLCD1 protein in addition to Caveolin-1. PS binding contributes to the interaction of DLC1 with Caveolin-1 and with PLCD1. The importance of these activities for tumorigenesis is supported by our analysis of 7 cancer-associated DLC1-START mutants, each of which has reduced tumor suppressor function but retains wildtype RhoGAP activity. Our structural model of DLC1-START indicates the mutants perturb different elements within the structure, which is correlated with our experimental findings that the mutants are heterogenous with regard to the deficiency of their binding properties. Some have reduced PS binding, others reduced PLCD1 and Caveolin-1 binding, and others are deficient for all of these properties.

Conclusion

These observations highlight the importance of DLC1-START for the tumor suppressor function of DLC1 that is RhoGAP-independent. They also expand the versatility of START domains, as DLC1-START is the first found to bind PS, which promotes the binding to other proteins.
How children with juvenile idiopathic arthritis view participation and communication in healthcare encounters: a qualitative study
Authors: Lundberg Veronica , Eriksson Catharina , Lind Torbjörn , Coyne Imelda , Fjellman-Wiklund Anncristine
Published: November 2021

Background

Children report that they do not participate in their healthcare as much as they want, despite having the lawful right to form their own views and the right to express those views freely in all matters affecting them. Children and parents appeared to be more satisfied when healthcare professionals (HCP) use a participatory style in healthcare encounters.

Aim

To explore how children, adolescents and young adults with Juvenile Idiopathic Arthritis (JIA) and parents of children with JIA view their participation and communication in healthcare encounters with healthcare professionals.

Methods

Using a qualitative study design, participatory workshops were held separately for children and young adults with JIA and parents of children with JIA. The workshop data were analysed with Graneheim and Lundman’s Qualitative Content Analysis resulting in one main theme and two subthemes.

Results

The theme “Feeling alienated or familiar with healthcare encounters” illuminates how children felt alienated at healthcare encounters if they found the encounters emotionally distressing. Children could withhold information regarding their health and function from both HCPs and their family and friends. The subtheme “Distancing oneself from healthcare” describe why children felt reluctant to engage in the healthcare encounters and experienced difficulty expressing how they really felt. The subtheme “Being a normal event in life” describe how children felt more comfortable over time engaging with HCPs when they knew what would happen, and felt that HCPs gave them the necessary support they needed to participate.

Conclusions

Children’s participation in healthcare encounters varied depending if children felt alienated or familiar to the healthcare situations. Children distance themselves and are reluctant to engage in healthcare encounters if they find them emotionally distressing and feel disregarded. Over time, children can become more familiar and at ease with healthcare situations when they feel safe and experience personal and positive encounters. When the children are prepared for the encounter, provided with the space and support they want and receive tailored help they are more enabled to participate.
Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study
Authors: Dorcélus Ludentz , Bernard Joseph , Georgery Constant , Vanessa Clerveau
Published: November 2021

Background

Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti.

Methods

A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St. Therese Hospital in Hinche, Haiti. A total of 426 potential participants were approached during their follow-up visits from June to August 2019, of whom 411 participated in the study. After giving informed consent, study participants completed a structured interview that included the Self-Report Item Scale (SRIS), a standard measure, to assess adherence. Socio-demographic, economic and clinical factors were assessed for their association with adherence.

Results

The 411 participating patients represented 39% of the patient population at the TB/HIV clinic during the timeframe of the study. The mean age was 43.7 years (range: 19–80), 65.5% were female and 78.1% had only achieved a primary level of schooling. Nearly 78% had received ART for less than 10 years, 3.41% reported having poor adherence and 28% less than excellent adherence. Factors related to poor adherence in bivariate analysis were age less than 40 years (OR: 6.32, 95% CI 2.04–10.58, p < 0.01) and inability to meet basic needs (OR: 2.70, 95% CI 1.04–7.0, p = 0.03).

Conclusions

To improve medication adherence, the hospital should strengthen patient counselling of younger recipients of ART and provide financial assistance and other social service interventions. Studies should be implemented in other HIV management centers in Haiti and similar contexts to examine barriers to ART adherence with the goal of improving prognosis and survival in the long-term among PLH in resource-limited setting.