bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Mutual Funds’ Exposure to Financial Stress Predict Their Future Returns? Evidence From China
Authors: Zhu Sha , Lai Fujun , Deng Jie , Wang Qian
Published: October 2021

How macroeconomic risk affects asset prices is an important issue in the academic and industrial fields. This paper measures Chinese financial stress (CFSI) by constructing a new index, and empirically verifies the pricing relationship between financial stress and Chinese mutual fund returns. First, we use eight source variables, which are the driving forces of financial market risk and financial stability, from bank, security, and foreign exchange markets, to build a new index representing financial stress. In addition, we estimate mutual funds’ exposure to financial stress and find that the resulting financial stress betas explain a significant proportion of the cross-sectional dispersion in mutual fund returns. Moreover, this result also remains robust when we conduct tests using other macroeconomic indices or control for the Fama–French and Carhart four factors. Hence, we argue that financial stress is a powerful determinant of cross-sectional differences in Chinese mutual fund returns and plays an important role in the sustainable development of financial markets.
The Robust Causal Relationships Among Domestic Tourism Demand, Carbon Emissions, and Economic Growth in China
Authors: Wang Yonglian , Wang Lijun , Liu Han , Wang Yongjing
Published: October 2021

Green and low-carbon development has become a compelling trend of our time. To formulate policies for development and also reduction of carbon emissions, quantifying the trend of tourism in green sustainable development is an essential issue for China, which is undergoing an economic transformation. This study first measured China’s domestic tourism carbon emissions through a bottom-up approach and then used the robust Granger causality test on annual data from 1993 to 2019 to investigate the relationships among China’s domestic tourism revenue, carbon emissions, and economic growth. The empirical results show that: (1) Carbon emissions of the domestic tourism industry are growing steadily, and the carbon emissions of the transportation industry determine the trend of the total carbon emissions of the domestic tourism industry, (2) long-term equilibrium relationships exist among China’s domestic tourism, carbon emissions, and economic growth, and (3) bidirectional causal relationships among economic growth, carbon emissions, and domestic tourism revenue have been detected with the robust Granger causality test, and the time-varying causal relationships may change markedly in these times of significant events and policy changes. Therefore, policymakers should coordinate the relationships among domestic tourism revenue, carbon emissions, and economic growth, in an effort to promote the development of sustainable tourism in China.
The Impact of the Third Mission on Teaching and Research Performance: Evidence From Academic Scholars in an Emerging Country
Authors: Nguyen Quoc Anh , Le Minh Thang , Pham Hiep-Hung
Published: October 2021

Despite the plethora of empirical evidence on the associations between the third mission of academic scholars (i.e., academic engagement, academic commercialization, and public engagement) and their performance regarding two other missions (teaching and research), we have not known much about such relationships in the context of emerging countries such as Vietnam. To examine this problem, we delivered a survey with 245 Vietnamese academic scholars. Findings extracted from exploratory factor analysis revealed that the third mission of Vietnamese academic scholars might be divided into two distinct factors: (i) academic engagement and commercialization and (ii) public engagement and extra work. Subsequently, results of multiple regression revealed that while both academic engagement and commercialization, public engagement and extra work, as well as the interaction of these two factors, have positive impacts on research performance, only the second factor has a positive impact on teaching performance. This study extended the current mixed understandings on the associations among the three missions of academic scholars with evidence from an emerging country such as Vietnam. This study also provides implications for stakeholders, including policymakers, university leaders, and industry practitioners.
Psycholinguistic Norms for 3,783 Two-Character Words in Simplified Chinese
Authors: Song Dangui , Li Degao
Published: October 2021

Over 70% of the more than 56,000 most frequently used words in simplified Chinese are two-character words (2C-words). The present study collected data on subtitle frequency, number of strokes, number of meanings, familiarity, concreteness, imageability, age of acquisition, subjective frequency, subjective number of meanings (sNOMs), compositionality, emotional experience rating, sensory experience rating (SER), and semantic transparency (ST) for 3,783 commonly used 2C-words. Correlative patterns were identified between the 13 variables, all of which, with the exception of imageability, SER, and sNOM, were significantly predictive of the changes in participants’ RTs in LDs on the target words. In conclusion, skilled readers’ awareness of 2C-words’ features such as concreteness, imageability, compositionality, sNOM, and ST is closely associated with their semantic perception of the constituent characters.
Increased Lower Extremity Injury Risk Associated With Player Load and Distance in Collegiate Women’s Soccer
Authors: Xiao Michelle , Nguyen Jessica N. , Hwang Calvin E. , Abrams Geoffrey D.
Published: October 2021

Background:

There is limited research regarding the impact of workload on injury risk specific to women’s soccer. Wearable global positioning system (GPS) units can track workload metrics such as total distance traveled and player load during games and training sessions. These metrics can be useful in predicting injury risk.

Purpose:

To examine the relationship between injury risk and player workload as collected from wearable GPS units in National Collegiate Athletic Association (NCAA) Division I women’s soccer players.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) for 65 NCAA Division I women’s soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3-, and 4-week loads and acute-to-chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and noninjured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-week accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using 2-sample t tests.

Results:

There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours “on-legs” exposure time; 34 noncontact and 19 contact injuries). The prior 2-week (7242 vs 6613 m/s2; P = .02), 3-week (10,533 vs 9718 m/s2; P = .02), and 4-week (13,819 vs 12,892 m/s2; P = .04) accumulated player loads and 2-week (62.40 vs 57.25 km; P = .04), 3-week (90.97 vs 84.10 km; P = .03), and 4-week (119.31 vs 111.38 km; P = .05) accumulated total distances were significantly higher for injured players compared with noninjured players during the same time frames. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and noninjured players for both the rolling averages and EWMA calculations.

Conclusion:

Higher accumulated player load and total distance, but not ACWR, were associated with injury in women’s soccer players.
What Is Women’s Work? Reflections from Four North Indian Urban Clusters
Authors: Kapur Devesh , Vaishnav Milan , Verley Dawson
Published: October 2021

The actual extent of the female employment challenge in India is much debated. Data on female labour force participation (FLFP) in India is hampered by shortcomings in data validity and data accuracy. The objective of this article is to explore challenges to data accuracy through two potential sources of error: measurement error and reporting error. Drawing on a unique source of granular survey data from households in four north Indian urban clusters, we demonstrate that the precise nature of the survey employed has meaningful impacts on the reporting of FLFP. Furthermore, the gender composition of respondents also seems to matter although, after controlling for gender, self-reporting is indistinguishable from proxy reporting.
Swachh Survekshan Needs to Clean up its Methodology: An Assessment of Ranks as Performance Incentives for Indian Cities
Authors: Sharma Karnamadakala Rahul
Published: October 2021

The Government of India is increasingly using ranks to incentivise sub-units of government. The largest such exercise, the Swachh Survekshan, has been conducted since 2016 and aims to incentivise cities to compete on and improve waste management and sanitation outcomes. Using publicly available Swachh Survekshan data, this article suggests that the current scoring methodology provides weak signals to urban local bodies (ULBs) and citizens on performance metrics. In particular, it shows that the ranks are not consistent and stable across years, there are severe discrepancies in data between components of the awarded score, and that the current methodology favours larger cities. Caution must be exercised, therefore, in interpreting the current methodology as fostering competition. More crucially, a ranking exercise is unlikely to succeed as a policy tool unless it is implemented as one component of a broader effort to improve ULB capacity on managing administrative data.
Implementation and outcomes of complementary therapies in hospice care: an integrative review
Authors: Dingley Catherine , Ruckdeschel Angela , Kotula Keshia , Lekhak Nirmala
Published: October 2021

Complementary therapies are increasingly integrated into hospice care, emphasizing the need to examine the evidence regarding implementation and effects on end-of-life outcomes. This review synthesizes the evidence regarding the implementation of complementary therapies and effects on end-of-life outcomes in hospice care. Whittemore and Knafl’s five-step integrative review process was applied. Using predefined search terms, research-based articles between 2006 and 2020 were reviewed. Twenty-three quantitative/mixed method studies conducted across eight countries met the final review criteria. Most commonly used complementary therapies were music, biofield therapies (reiki, therapeutic touch), and massage therapy. Most studies reported significant findings on physical symptoms (pain, dyspnea, fatigue, gastrointestinal symptoms, agitation) and/or psychosocial/spiritual symptoms (anxiety, depression, spirituality, well-being, quality of life); 40% of studies had both significant and nonsignificant findings. Methodological limitations included study design (few randomized controlled trials), small sample size, high attrition rate, lack of racial/ethnic diversity, unstandardized intervention implementation, and multiple outcome measurement instruments. Complementary therapies are promising components of hospice care; however, rigorous studies are needed to validate the effect on end-of-life outcomes and determine the most efficacious implementation. Complementary therapy studies face challenges consistent with end-of-life research; however, efforts to design rigorous trials and address methodological issues are required to enhance the state of the science.
The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital
Authors: Guo Jiamei , Zheng Anhai , He Jinglan , Ai Ming , Gan Yao , Zhang Qi , Chen Lulu , Liang Sisi , Yu Xiaoyu , Kuang Li
Published: October 2021

Background

Antenatal depression has become a common and serious problem, significantly affecting maternal and fetal health. However, evaluation and intervention methods for pregnant women in obstetric clinics are inadequate. This study aimed to determine the prevalence of and risk factors for depression among all pregnant women at their first attending antenatal care in the obstetrics clinic, a comprehensive teaching hospital, southwest of China.

Methods

From June to December 2019, 5780 pregnant women completed online psychological assessments, and data from 5728 of the women were analyzed. The women were categorized into two groups according to the presence or absence of depression. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a cutoff point of 10 for depression. Anxiety and somatic symptoms were measured by the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-15 (PHQ-15), respectively. Univariate analysis and binary logistic regression analysis were used to determine the association among antenatal depression, anxiety, somatic symptoms and participants’ characteristics.

Results

The prevalence of antenatal depression among all the pregnant women at their first attending antenatal care was 16.3%, higher in the first trimester (18.1%). Anxiety symptoms (Mild anxiety AOR = 2.937; 95% CI: 2.448–3.524) and somatic symptoms (Mild somatic symptoms AOR = 3.938; 95% CI: 2.888–3.368) were major risk factors for antenatal depression among women and the risk increased more with the anxiety level or somatic symptoms level. Gestational weeks (second trimester AOR = 0.611; 95% CI: 0.483–0.773; third trimester AOR = 0.337; 95% CI: 0.228–0.498) and urban residence (AOR = 0.786; 95% CI: 0.652–0.947) were protective factors for antenatal depression among women.

Conclusions

About one in six pregnant women would experience depression, and special attention should be paid to some risk factors (i.e., early pregnancy, anxiety symptoms, somatic symptoms, rural residence). Online psychological assessments might be a time-saving and convenient screening method for pregnant women in obstetric clinics.
Nomogram to predict overall survival based on the log odds of positive lymph nodes for patients with endometrial carcinosarcoma after surgery
Authors: Gao Linzhi , Lyu Jun , Luo Xiaoya , Zhang Dong , Jiang Guifang , Zhang Xian , Gao Xuesong , Zheng Shaolie , Wang Xiaoyu , Shen Yuan
Published: October 2021

Purpose

Aims to compare the prognostic performance of the number of positive lymph nodes (PLNN), lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) and establish a prognostic nomogram to predict overall survival (OS) rate for patients with endometrial carcinosarcoma (ECS).

Methods

Patients were retrospectively obtained from Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2015. The prognostic value of PLNN, LNR and LODDS were assessed. A prediction model for OS was established based on univariate and multivariate analysis of clinical and demographic characteristics of ECS patients. The clinical practical usefulness of the prediction model was valued by decision curve analysis (DCA) through quantifying its net benefits.

Results

The OS prediction accuracy of LODDS for ECS is better than that of PLNN and LNR. Five factors, age, tumor size, 2009 FIGO, LODDS and peritoneal cytology, were independent prognostic factors of OS. The C-index of the nomogram was 0.743 in the training cohort. The AUCs were 0.740, 0.682 and 0.660 for predicting 1-, 3- and 5-year OS, respectively. The calibration plots and DCA showed good clinical applicability of the nomogram, which is better than 2009 FIGO staging system. These results were verified in the validation cohort. A risk classification system was built that could classify ECS patients into three risk groups. The Kaplan-Meier curves showed that OS in the different groups was accurately differentiated by the risk classification system and performed much better than FIGO 2009.

Conclusion

Our results indicated that LODDS was an independent prognostic indicator for ECS patients, with better predictive efficiency than PLNN and LNR. A novel prognostic nomogram for predicting the OS rate of ECS patients was established based on the population in the SEER database. Our nomogram based on LODDS has a more accurate and convenient value for predicting the OS of ECS patients than the FIGO staging system alone.
Tachycardia and hypertension enhance tracer efflux from the spinal cord
Authors: Liu Shinuo , Bilston Lynne E. , Stoodley Marcus A. , Hemley Sarah J.
Published: October 2021

Background

Disruption of cerebrospinal fluid (CSF)/interstitial fluid (ISF) exchange in the spinal cord is likely to contribute to central nervous system (CNS) diseases that involve abnormal fluid accumulation, including spinal cord oedema and syringomyelia. However, the physiological factors that govern fluid transport in the spinal cord are poorly understood. The aims of this study were to determine the effects of cardiac pulsations and respiration on tracer signal increase, indicative of molecular movement following infusion into the spinal cord grey or white matter.

Methods

In Sprague Dawley rats, physiological parameters were manipulated such that the effects of spontaneous breathing (generating alternating positive and negative intrathoracic pressures), mechanical ventilation (positive intrathoracic pressure only), tachycardia (heart atrial pacing), as well as hypertension (pharmacologically induced) were separately studied. Since fluid outflow from the spinal cord cannot be directly measured, we assessed the molecular movement of fluorescent ovalbumin (AFO-647), visualised by an increase in tracer signal, following injection into the cervicothoracic spinal grey or white matter.

Results

Tachycardia and hypertension increased AFO-647 tracer efflux, while the concomitant negative and positive intrathoracic pressures generated during spontaneous breathing did not when compared to the positive-pressure ventilated controls. Following AFO-647 tracer injection into the spinal grey matter, increasing blood pressure and heart rate resulted in increased tracer movement away from the injection site compared to the hypotensive, bradycardic animals (hypertension: p = 0.05, tachycardia: p < 0.0001). Similarly, hypertension and tachycardia produced greater movement of AFO-647 tracer longitudinally along the spinal cord following injection into the spinal white matter (p < 0.0001 and p = 0.002, respectively). Tracer efflux was strongly associated with all blood vessel types.

Conclusions

Arterial pulsations have profound effects on spinal cord interstitial fluid homeostasis, generating greater tracer efflux than intrathoracic pressure changes that occur over the respiratory cycle, demonstrated by increased craniocaudal CSF tracer movement in the spinal cord parenchyma.
Influence of traumatic brain injury on extracellular tau elimination at the blood–brain barrier
Authors: Eisenbaum Maxwell , Pearson Andrew , Gratkowski Arissa , Mouzon Benoit , Mullan Michael , Crawford Fiona , Ojo Joseph , Bachmeier Corbin
Published: October 2021

Repetitive head trauma has been associated with the accumulation of tau species in the brain. Our prior work showed brain vascular mural cells contribute to tau processing in the brain, and that these cells progressively degenerate following repetitive mild traumatic brain injury (r-mTBI). The current studies investigated the role of the cerebrovasculature in the elimination of extracellular tau from the brain, and the influence of r-mTBI on these processes. Following intracranial injection of biotin-labeled tau, the levels of exogenous labeled tau residing in the brain were elevated in a mouse model of r-mTBI at 12 months post-injury compared to r-sham mice, indicating reduced tau elimination from the brain following head trauma. This may be the result of decreased caveolin-1 mediated tau efflux at the blood–brain barrier (BBB), as the caveolin inhibitor, methyl-β-cyclodextrin, significantly reduced tau uptake in isolated cerebrovessels and significantly decreased the basolateral-to-apical transit of tau across an in vitro model of the BBB. Moreover, we found that the upstream regulator of endothelial caveolin-1, Mfsd2a, was elevated in r-mTBI cerebrovessels compared to r-sham, which coincided with a decreased expression of cerebrovascular caveolin-1 in the chronic phase following r-mTBI (> 3 months post-injury). Lastly, angiopoietin-1, a mural cell-derived protein governing endothelial Mfsd2a expression, was secreted from r-mTBI cerebrovessels to a greater extent than r-sham animals. Altogether, in the chronic phase post-injury, release of angiopoietin-1 from degenerating mural cells downregulates caveolin-1 expression in brain endothelia, resulting in decreased tau elimination across the BBB, which may describe the accumulation of tau species in the brain following head trauma.
The role of patient-derived ovarian cancer organoids in the study of PARP inhibitors sensitivity and resistance: from genomic analysis to functional testing
Authors: Tao Mengyu , Wu Xia
Published: October 2021

Epithelial ovarian cancer (EOC) harbors distinct genetic features such as homologous recombination repair (HRR) deficiency, and therefore may respond to poly ADP-ribose polymerase inhibitors (PARPi). Over the past few years, PARPi have been added to the standard of care for EOC patients in both front-line and recurrent settings. Next-generation sequencing (NGS) genomic analysis provides key information, allowing for the prediction of PARPi response in patients who are PARPi naïve. However, there are indeed some limitations in NGS analyses. A subset of patients can benefit from PARPi, despite the failed detection of the predictive biomarkers such as BRCA1/2 mutations or HRR deficiency. Moreover, in the recurrent setting, the sequencing of initial tumor does not allow for the detection of reversions or secondary mutations restoring proficient HRR and thus leading to PARPi resistance. Therefore, it becomes crucial to better screen patients who will likely benefit from PARPi treatment, especially those with prior receipt of maintenance PARPi therapy. Recently, patient-derived organoids (PDOs) have been regarded as a reliable preclinical platform with clonal heterogeneity and genetic features of original tumors. PDOs are found feasible for functional testing and interrogation of biomarkers for predicting response to PARPi in EOC. Hence, we review the strengths and limitations of various predictive biomarkers and highlight the role of patient-derived ovarian cancer organoids as functional assays in the study of PARPi response. It was found that a combination of NGS and functional assays using PDOs could enhance the efficient screening of EOC patients suitable for PARPi, thus prolonging their survival time.
Increased radiographic progression of distal hand osteoarthritis occurring during biologic DMARD monotherapy for concomitant rheumatoid arthritis
Authors: Lechtenboehmer C. A. , Burkard T. , Reichenbach S. , Walker U. A. , Burden A. M. , Hügle T.
Published: October 2021

Objectives

A considerable proportion of patients with rheumatoid arthritis (RA) also suffer from hand osteoarthritis (OA). We here assess the association between conventional synthetic (cs) and biological (b) disease-modifying antirheumatic drugs (DMARDs) and radiographic distal interphalangeal-(DIP) OA in patients with RA.

Methods

Adult RA patients from a longitudinal Swiss registry of rheumatic diseases who had ≥ 2 hand radiographs were included at the first radiograph and followed until the outcome or the last radiograph. Patients were grouped into two cohorts based on whether DIP OA was present or absent at cohort entry (cohorts 1 and 2, respectively). Modified Kellgren-Lawrence scores (KLS) were obtained by evaluating DIP joints for the severity of osteophytes, joint space narrowing, subchondral sclerosis, and erosions. KLS ≥ 2 in ≥ 1 DIP joint indicated incident or existing OA, and increase of ≥ 1 in KLS in ≥ 1 DIP joint indicated progression in existing DIP OA. Time-varying Cox regression and generalized estimating equation (GEE) analyses were performed. We estimated hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) of DIP OA incidence (cohort 2), or progression (cohort 1), in bDMARD monotherapy, bDMARD/csDMARD combination therapy, and past or never DMARD use, when compared to csDMARD use. In post hoc analyses, we descriptively and analytically assessed the individual KLS features in cohort 1.

Results

Among 2234 RA patients with 5928 radiographs, 1340 patients had DIP OA at baseline (cohort 1). Radiographic progression of DIP OA was characterized by new or progressive osteophyte formation (666, 52.4%), joint space narrowing (379, 27.5%), subchondral sclerosis (238, 17.8%), or erosions (62, 4.3%). bDMARD monotherapy had an increased risk of radiographic DIP OA progression compared to csDMARD monotherapy (adjusted HR 1.34 [95% CI 1.07–1.69]). The risk was not significant in csDMARD/bDMARD combination users (HR 1.12 [95% CI 0.96–1.31]), absent in past DMARD users (HR 0.96 [95% CI 0.66–1.41]), and significantly lower among never DMARD users (HR 0.54 [95% CI 0.33–0.90]). Osteophyte progression (HR 1.74 [95% CI 1.11–2.74]) was the most significantly increased OA feature with bDMARD use compared to csDMARD use. In 894 patients without initial DIP OA (cohort 2), the risk of incident OA did not differ between the treatment groups. The results from GEE analyses corroborated all findings.

Conclusions

These real-world RA cohort data indicate that monotherapy with bDMARDs is associated with increased radiographic progression of existing DIP OA, but not with incident DIP OA.
Chemorefractory extranodal nasal-type natural-killer/T-cell lymphoma with great response to pembrolizumab in a young patient: a case report
Authors: Adabifirouzjaei Fatemeh , Khazai Bharam , Azami Ghazaleh , Shoja-e-Razavi Ghazaleh
Published: October 2021

Introduction

Extranodal, natural-killer/T-cell lymphoma of nasal type is a rare but aggressive disease usually presenting as progressive necrotic lesions in the nasal cavity that responds poorly to chemotherapy. In this paper, we report a relapsing, chemorefractory case of extranodal natural-killer/T-cell lymphoma responding to checkpoint inhibitor immunotherapy with pembrolizumab.

Case presentation

A 32-year-old Hispanic woman with a history of recurrent sinusitis and preseptal abscess presented with a hoarse voice, swelling around the right eye, and diplopia. Laryngoscopy showed infiltrating tissue extending to bilateral laryngeal ventricles and false vocal cords. On immunohistochemical examination of laryngeal biopsy, the neoplastic cells showed positivity for CD3 (cytoplasmic), CD7, CD56, granzyme B, CD30, and Epstein–Barr virus-encoded ribonucleic acid (RNA). Extranodal natural-killer/T-cell lymphoma, nasal type, was confirmed. In the absence of distant organ involvement, the decision was to perform chemotherapy with etoposide, ifosfamide, mesna, cisplatin, and dexamethasone (VIPD protocol) followed by concurrent chemoradiation with weekly doses of cisplatin and two cycles of VIPD as adjuvant treatment. However, 1 month after completion of the treatment; disease recurrence was demonstrated. The patient was scheduled to receive salvage chemotherapy with steroid, methotrexate, ifosfamide, L- asparaginase, and etoposide (SMILE) protocol and CD30-targeting monoclonal antibodies. However, the mass was chemorefractory without response to either l-asparaginase-based salvage chemotherapy in combination with high-dose methotrexate or brentuximab vedotin. However, this case of chemorefractory extranodal natural-killer/T-cell lymphoma, nasal type, responded well to the novel drug pembrolizumab, which was able to control the disease.

Conclusion

Checkpoint inhibitors are potential treatment option in selected chemorefractory extranodal natural-killer/T-cell lymphoma, nasal type, cases.
Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France
Authors: Sanchez Marc-Antoine , Vuagnat Albert , Grimaud Olivier , Leray Emmanuelle , Philippe Jean-Marc , Lescure François-Xavier , Boutonnet Mathieu , Coignard Hélène , Hibon Agnès Ricard , Sanchez Stephane , Pottecher Julien
Published: October 2021

Background

The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to.

Method

A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality.

Results

In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period.

Conclusions

Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients.
Mapping multicenter randomized controlled trials in anesthesiology: a scoping review
Authors: Boet Sylvain , Burns Joseph K. , Cheng-Boivin Olivia , Khan Hira , Derry Kendra , Diep Deric , Djokhdem Abdul Hadi , Um Sung Wook , Huang Johnny W. , Paré Danica , Deng Mimi , Begunova Liza , Fei Linda Yi Ning , Bezzahou Maryam , Andrahennadi Pium Sonali , Grose Elysia , Abebe Ruth G , Mansour Fadi , Talbot Zoé , Dion Pierre-Marc , Kaur Manvinder , Choueiry Justen , Etherington Cole
Published: October 2021

Background

Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes.

Methods

Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥ 16 years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively.

Results

We included 638 multicentre randomized controlled trials (n patients = 615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy (n studies = 361 [56.6%]; n patients = 244,610 [39.7%]), followed by anesthetic technique (n studies = 80 [12.5%], n patients = 48,455 [7.9%]). Interventions were most often implemented intraoperatively (n studies = 233 [36.5%]; n patients = 175,974 [28.6%]). Studies typically involved multiple types of surgeries (n studies = 187 [29.2%]; n patients = 206 667 [33.5%]), followed by general surgery only (n studies = 115 [18.1%]; n patients = 201,028 [32.6%]) and orthopedic surgery only (n studies = 94 [14.7%]; n patients = 34,575 [5.6%]). Functional status was the most commonly investigated outcome (n studies = 272), followed by patient experience (n studies = 168), and mortality (n studies = 153).

Conclusions

This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes.
Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial
Authors: Boden I. , Reeve J. , Robertson I. K. , Browning L. , Skinner E. H. , Anderson L. , Hill C. , Story D. , Denehy L.
Published: October 2021

Background

Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown.

Methods

This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression.

Results

Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains.

Conclusions

Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions.

Trial registration

ANZCTR 12613000664741; 19/06/2013.
Sulfur-doped carbon dots synthesis under microwave irradiation as turn-off fluorescent sensor for Cr(III)
Authors: Kamali Siti Raudhatul , Chen Chang-Nan , Agrawal Dinesh Chandra , Wei Tai-Huei
Published: October 2021

This study synthesized a facile and high sensitive fluorescent probe based on sulfur-doped carbon dots (S-CDs) using a one-step microwave irradiation method. The probe exhibited a strong blue emission and a high quantum yield (QY) of 36.40%. In the detection, the presence of trivalent chromium (Cr(III)) strongly quenched the PL intensity of S-CDs by the inner filter effect (IFE) quenching mechanism of Cr(III) on the S-CDs. The S-CDs exhibited good sensitivity to turn-off Cr(III) detection with a linear range concentration of 0–45 μM and a detection limit of 0.17 μM. Furthermore, the proposed method has been successfully applied for Cr(III) detection in natural water samples with the 93.68–106.20% recoveries.
The association between culture positivity and long-term mortality in critically ill surgical patients
Authors: Wu Yu-Cheng , Wong Li-Ting , Wu Chieh-Liang , Chao Wen-Cheng
Published: October 2021

Background

The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients.

Methods

We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI).

Results

A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness.

Conclusions

We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.
Age moderates the relationships between obesity, glucose variability, and intensive care unit mortality: a retrospective cohort study
Authors: Lu Lusi , Lu Yifeng , Gao Chenlu , Zhang Nan
Published: October 2021

Background

Although the associations between obesity, glucose variability (GV), and Intensive Care Unit (ICU) mortality have been studied extensively, whether age moderates these associations is not well understood.

Materials and methods

The medical records of 1062 patients, who were admitted into ICU at Sir Run Run Shaw Hospital (Zhejiang, China), were studied. Logistic regression was used to test the associations between obesity, GV, and ICU mortality. Furthermore, the moderation effect of age was tested.

Results

After controlling for covariates, the underweight group had the highest odds of death (OR 2.38, 95% CI 1.43–3.95, p < 0.001) in comparison with the control group (overweight). However, normal weight (OR 1.29, 95% CI 0.88–1.89, p = 0.185) and obese (OR 1.08, 95% CI 0.61–1.90, p = 0.790) groups had similar odds of death, compared to the overweight group. Age significantly moderated the association between obesity and mortality, where being overweight was more advantageous than being normal weight in older adults (B = 0.03, SE = 0.01, OR 1.03, 95% CI 1.001–1.06, p = 0.045). Meanwhile, higher GV predicted greater mortality in adjusted models (OR 1.23, 95% CI 1.06–1.42, p = 0.005). We also found an interaction between age and GV (B = − 0.01, SE = 0.01, OR 0.99, 95% CI 0.98–0.999, p = 0.025), which suggested that the association between GV and mortality becomes weaker with increasing age.

Conclusions

With increasing age, the association between BMI and mortality becomes stronger and the association between glucose variability and mortality becomes weaker. Future studies should investigate the underlying mechanisms of such phenomenon and the causal relationship between obesity, GV, and ICU mortality.
Women’s career confidence in a fixed, sexist STEM environment
Authors: Clark Sheri L. , Dyar Christina , Inman Elizabeth M. , Maung Nina , London Bonita
Published: October 2021

Background

Innovation in STEM (science, technology, engineering, and math) fields in the U.S. is threatened by a lack of diversity. Social identity threat research finds messages in the academic environment devalue women and underrepresented groups in STEM, creating a chilly and hostile environment. Research has focused on the mechanisms that contribute to STEM engagement and interest at the K-12 and undergraduate level, but the mechanisms that predict sustained engagement at the graduate level have not been studied.

Results

In a longitudinal study of doctoral students in STEM disciplines, we demonstrate that students’ beliefs that their STEM colleagues believe intelligence is a fixed (vs. malleable) trait undermine women’s engagement in STEM. Specifically, perceiving a fixed ability environment predicts greater perceptions of sexism, which erode women’s self-efficacy and sense of belongingness and lead women to consider dropping out of their STEM career.

Conclusion

These findings identify one potential pathway by which women leave their STEM fields, perpetuating gender disparities in STEM.
An overview on current molecular tools for heterologous gene expression in Trichoderma
Authors: Tomico-Cuenca Irene , Mach Robert L. , Mach-Aigner Astrid R. , Derntl Christian
Published: October 2021

Fungi of the genus Trichoderma are routinely used as biocontrol agents and for the production of industrial enzymes. Trichoderma spp. are interesting hosts for heterologous gene expression because their saprotrophic and mycoparasitic lifestyles enable them to thrive on a large number of nutrient sources and some members of this genus are generally recognized as safe (GRAS status). In this review, we summarize and discuss several aspects involved in heterologous gene expression in Trichoderma, including transformation methods, genome editing strategies, native and synthetic expression systems and implications of protein secretion. This review focuses on the industrial workhorse Trichoderma reesei because this fungus is the best-studied member of this genus for protein expression and secretion. However, the discussed strategies and tools can be expected to be transferable to other Trichoderma species.
A case of laparoscopic partial hepatic S7 resection for postoperative liver metastasis of rectal malignant melanoma
Authors: Takahashi Makoto , Morita Yasuhiro , Hayashi Tatsuya , Yanagibashi Susumu , Sato Shunsuke , Sasaki Shu , Takuma Kunio , Okada Haruka
Published: October 2021

Background

Anorectal malignant melanoma (ARMM) has an extremely poor prognosis, and there is no report of resection of liver metastases so far. We report herein a rare case of postoperative laparoscopic partial hepatic S7 resection for rectal malignant melanoma.

Case presentation

A 51-year-old female patient with a diagnosis of an ARMM underwent a laparoscopic rectal amputation. Eleven months later, computed tomography (CT) revealed a 14-mm nodule in liver segment 7 (S7), which was diagnosed as a hepatic recurrence of the ARMM. Because no other recurrences were found, a laparoscopic partial resection of S7 was performed. Pathological analysis found intracellular melanin deposition, and immunostaining was S-100 (+), HMB-45 (+), and SOX-10 (+). Based on these findings, a liver metastasis of malignant melanoma was diagnosed. The patient is alive 7 months after the second surgery and has so far experienced no recurrences.

Conclusion

We reported an extremely rare case of a laparoscopic resection of a liver metastasis following surgery for ARMM.
More than just a urinary catheter: achieving hemostasis using Foley catheter in deep cerebral cavities—technical nuances
Authors: Sanjeevi Venkatesan , Roopesh Kumar V. R.
Published: October 2021

Background

Achieving hemostasis during neurosurgical procedures within deep seated tumors is of paramount importance. Chemical methods like using ORC and gel foam are preferred to bipolar cautery as bipolar cautery causes thermal injury to the normal eloquent surrounding white matter fibers, thereby causing significant morbidities. In addition to the chemical methods, we advocate a new relatively simple mechanical method by using small size Foley catheter inflated with saline can achieve hemostasis in case of deep locating brain tumor surgery with diffuse oozing from the tumor bed and surrounding white matter tissues are of concern. The balloon tamponade effect of the inflated Foley catheter helps in achieving complete hemostasis without damaging the surrounding normal white matter parenchyma.

Case presentation

A 52-years-old female admitted with history of progressive drowsiness and altered sensorium. Brain MRI was done showing large right-sided trigonal meningioma. Right parieto-occipital craniotomy was done, through the superior parietal lobe, corticotomy was done, and tumor was reached. Gentle retraction was done using curved blades in between the tumor and normal brain parenchyma. During surgery, following tumor removal, there was a diffuse oozing from tumor bed and the surrounding stretched white matter fibers. Hemostasis was attempted with chemical methods like ORC and gel foam. We avoided bipolar cautery to prevent thermal injury to the normal stretched eloquent white matter, as bleeding was not settled over the period of 45 min using chemical methods. Then, we placed a 10 F size Foley catheter in the tumor cavity and inflated with 6 ml of saline over the period of 10 min. Prior to Foley placement, we coated ORC over the tumor bed and the surrounding white matter. This achieved hemostasis to a significant extent and the same was repeated for another 10 min, and finally, complete hemostasis was achieved. Postoperative period went uneventful. Patient was discharged with good neurological recovery.

Conclusion

Inflatable Foley catheter balloon is a simple, cost-effective technique for achieving hemostasis in deep white matter tumors in addition to the routinely available hemostatic techniques.
Σύγχρονες τάσεις στο ελληνικό κουκλοθέατρο.
Authors: Παρούση Αντιγόνη , Λενακάκης Αντώνης
Published: October 2021

Σε μια χρονική περίοδο όπου ανατροπές κοινωνικών και πολιτικών αυτονόητων βάζουν σε δοκιμασία την τέχνη του κουκλοθέατρου, την εκπαίδευση και κατά μείζονα λόγo τη σχέση του θεάτρου με την εκπαίδευση, η ψηφιακή έκδοση αυτού του τόμου φιλοδοξεί να παρουσιάσει προς ένα ευρύ κοινό το «σήμερα» του ελληνικού κουκλοθέατρου, το οποίο διαφέρει κατά πολύ από τη στερεοτυπική εικόνα  που κυκλοφορεί σε μεγάλο μέρος του εκπαιδευτικού κόσμου. Ο τόμος φιλοδοξεί να αποτυπώσει, κατά το δυνατόν, τη δυναμική της ύπαρξής του και της ιστορία του, μια ιστορία που πείθει ότι όσο κι αν υποτιμήθηκε ως θεατρικό είδος, όσους αποκλεισμούς και αν δέχτηκε, είναι εδώ και συνεχίζει να ψυχαγωγεί αλλά και να «διαβρώνει» με τα ιδιαίτερα χαρακτηριστικά του τόσο τους χώρους της εκπαίδευσης όσο και αυτούς των άλλων τεχνών.

[Για την αγγλική έκδοση του τόμου δείτε εδώ: https://doi.org/10.12681/ecdnkua.192]