bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypogammaglobulinemia secondary to B-cell depleting therapies in neuroimmunology: Comparing management strategies
Authors: Kelly Hannah , Vishnevetsky Anastasia , Chibnik Lori B. , Levy Michael
Published: June 2023

Background

Anti-CD20 agents are commonly used in MS, NMOSD, and MOGAD. Few studies have compared strategies to address hypogammaglobulinemia.

Objective

To compare strategies to manage secondary hypogammaglobulinemia in neuroimmunology patients, including reducing anti-CD20 dose and dosing frequency, IVIG/SCIG, anti-CD20 cessation, and DMT switches.

Methods

All MS, NMOSD, and MOGAD patients at our institution with hypogammaglobulinemia on anti-CD20 agents from 2001 to 2022 were analyzed. The median change in IgG, infection frequency, and infection severity before and after the treatment was calculated.

Results

In total, 257 patients were screened, and 30 had a treatment for hypogammaglobulinemia. IVIG/SCIG yielded the largest increase in IgG per year (674.0 mg/dL), followed by B-cell therapy cessation (34.7 mg/dL), and DMT switch (5.9 mg/dL). Dose reduction had the largest decrease in yearly infection frequency (2.7 fewer infections), followed by IVIG/SCIG (2.5 fewer), DMT switch (2 fewer), and reduced dosing frequency (0.5 fewer). Infection grade decreased by 1.9 for reduced dosing frequency (less severe infections), by 1.3 for IVIG/SCIG, and by 0.6 for DMT switch.

Conclusion

This data suggests that IVIG/SCIG may yield the greatest recovery in IgG while also reducing infection frequency and severity. Stopping anti-CD20 therapy and/or switching DMTs also increase IgG and may lower infection risk.
Scientists as Influencers: The Role of Source Identity, Self-Disclosure, and Anti-Intellectualism in Science Communication on Social Media
Authors: Zhang Annie Li , Lu Hang
Published: June 2023

As social media become increasingly important for science communication, scientists are grappling with their new role on these platforms. While some have called for the increased presence and training of scientists on social media, others prefer to leverage the influence of social media influencers for science communication. This study explores the effects of source identity (scientist or influencer) and self-disclosure type (personal or professional) on perceptions of authenticity and expertise, as well as parasocial interactions. In an online between-subjects experiment ( N = 1579), participants rated scientists on Twitter as more authentic and qualified than influencers, and rated Twitter profiles with professional self-disclosure as more qualified than profiles with personal self-disclosure. Subsequently, participants indicated stronger parasocial interactions, higher information-seeking intentions, and higher prosocial intentions. Anti-intellectualism was found to moderate these relationships. These findings suggest that scientists can employ certain strategies as they seek to establish themselves and reach wider audiences on social media platforms.
Educational freedom and educational ideals in the Netherlands
Authors: Broer NA (Nico) , van der Walt JL (Hannes) , Wolhuter CC (Charl)
Published: June 2023

The Netherlands has a unique dual education system. The government funds both public and private schools. Parents have much freedom to set up schools to realize their religious ideals. The freedom of education enshrined in the Dutch Constitution is controversial. The question has arisen as to whether the government should fund private schools. This paper describes what the Dutch freedom of education entails, gives an overview of educational ideals and mentions some areas where freedom of education is under threat. The conclusion is that although schools still have a great deal of freedom, this is decreasing, and alertness is required.
Comparing and mapping difference indices of debate quality on Twitter
Authors: Reveilhac Maud
Published: June 2023

Albeit the measurement of debate quality is not a new endeavour, this paper raises two research questions for which we still have limited knowledge: What are important and reliable indicators of debate quality on social media? How does debate quality relate to individual factors on social media? First, we empirically analysed how two well-established discourse’ quality indices (the DQI and CC index) correlate to each other using a random sample of 1000 tweets selected from the full history of tweets written by Swiss elected politicians between 2011 and 2021. While the sample was automatically coded for CC using LIWC, we manually annotated the tweets according to an adapted version of the DQI for social media texts. Second, we conducted a correspondence analysis to investigate the relations between these dimensions, additional debate quality features, as well as individual political factors. Results show a good correlation between both indices ( r up to 0.46), while also highlighting their respective weaknesses. Furthermore, the results highlight the necessity to include alternative dimensions of debate quality (such as emotion and inclusive or exclusive views) to enhance future measurements of debate quality in the realm of social media.
Case of Spontaneous Pneumothorax After Recent COVID Pneumonia Hospitalization
Authors: Brus Hope , Henderson Trevor , Miller Nathaniel E.
Published: June 2023

An elderly man with COPD and heart failure was admitted to the Family Medicine Inpatient Service from the Emergency Department (ED) after experiencing acute onset of shortness of breath at home. He had recently been briefly hospitalized with COVID pneumonia. Upon arrival in the ED, he was requiring continuous positive airway pressure to maintain oxygen saturations. Overall, physical exam was notable for mild respiratory distress. Lab evaluation was unremarkable, but chest x-ray showed a right sided pneumothorax. Spontaneous pneumothoraces have been described in post-COVID cases, with COPD and mechanical ventilation thought to be risk factors. Treatment consists of supportive cares, needle decompression and thoracostomy if necessary. Providers should be aware of this rare albeit serious complication and monitor higher risk patients appropriately.
Supporting Teacher Redesign Teams: A Descriptive Framework for Role Enactment of Academic Developers as Facilitators
Authors: Detienne Loulou , Rotsaert Tijs , Schellens Tammy
Published: June 2023

In order to achieve educational changes, professional development initiatives are needed. Recently more emphasis is placed on methods in which teachers are engaged in collaborative discourse. One potential strategy for this is the use of Teacher redesign Teams (TrDT), in which the support of an academic developer is imperative for its effectiveness. Previous studies show diversified findings on role categorization and role uptake of academic developers. This study attempts to apply the existing frameworks and provides a better understanding of the varying role of a TrDT facilitator in a university setting. During two focus groups, data was collected from the university facilitators ( n = 10) who had been supporting TrDTs for 1 year. In addition, audio recordings were gathered of TrDT conversations. A thematic analysis of the collected qualitative data results in an alternative extended framework specifically altered to the roles of an academic developer in a university setting. According to our study, the facilitator can take on eight different roles, ranging from coordinating and organizing meetings and building bridges with stakeholders to being a representative, located at different levels, going from meso to micro level. In addition, the ADDIE-model for instructional design can be used to structure the implementation of innovative learning approaches.
Finding the Seat With the Best View: Stage-View Preference for Orchestra
Authors: Chen Yuxiao , Cabrera Densil , Yadav Manuj
Published: June 2023

In a concert auditorium, conditions at different seats vary greatly, and are mostly affected by the view of the stage and the received sound of the performance, the former of which has been much less studied. With a focus on visual seat location, this study systematically investigates the effects of three visual factors: distance, lateral angle, and vertical angle, on the subjective seat preference of a symphony music performance, with one additional reference auditory factor: loudness (audio gain). Experimental investigation used virtual reality presentations of a 3D static orchestra on a stage with simplified orchestral audio, so that each factor could be changed independently. Results show that all factors significantly affect preference: smaller distances, smaller lateral angles, and vertical angles around 18° are preferred. Experiment results agree with those of an online questionnaire using corresponding stage-view images. A prediction model based on the results is proposed.
COVID-19 vaccine acceptance and its determinants among residents of Ambo Town, West Shewa, Oromia Region, Ethiopia: cross-sectional survey
Authors: Beressa Tamirat Bekele , Tafa Milkessa , Geresu Gudeta Duga , Bacha Amente Jorise , Gadisa Diriba Alemayehu
Published: June 2023

Background:

Vaccines against COVID-19 are critical for preventing and managing COVID-19 because immunization is one of the most active and cost-effective health strategies for infectious disease prevention. Knowing the community’s willingness and factors affecting COVID-19 vaccine acceptance will support the design of effective promotion strategies. Therefore, this study was aimed at assessing COVID-19 vaccine acceptance and its determinants among the Ambo Town community.

Method:

A community-based, cross-sectional study was conducted using structured questionnaires from 1 to 28 February 2022. Four kebeles were selected randomly, and the systematic random sampling procedure was used to select the households. SPSS-25 software was used for data analysis. Ethical approval was received from the Institutional Review Committee of the College of Medicine and Health Sciences of Ambo University, and data were kept confidential.

Result:

Of the 391 participants, 385 (98.5%) of the respondents were not vaccinated for COVID-19, and around 126 (32.2%) of the respondents said that they would receive the vaccine if the government provided it. The multivariate logistic regression analysis revealed that males were 1.8 times more likely to accept the COVID-19 vaccine (adjusted odds ratio (AOR) = 1.8, 95% CI: 1.074–3.156) as compared to females. The acceptance of the COVID-19 vaccine was lower by 60% in those who tested for COVID-19 as compared to those who were not tested (AOR = 0.4, 95% CI: 0.27–0.69). Moreover, the participants who had chronic diseases were two times more likely to accept the vaccine. Acceptance of the vaccine was reduced by half among those who believed that there was a scarcity of data on its safety (AOR = 0.5, 95% CI: 0.26–0.80).

Conclusion:

The prevalence of COVID-19 vaccination acceptance was low. To enhance the acceptance of the COVID-19 vaccine, the government and different stakeholders should strengthen public education using mass media about the advantages of getting the COVID-19 vaccination.
Keep Your Eyes on the Prize: A goals-based approach to studying social movements in markets
Authors: Leitzinger Jocelyn , Waeger Daniel
Published: June 2023

Prior research on social movements and markets has thus far paid only scant attention to movement goals. In the few instances that goals are considered, the focus is on how goals provide a shared purpose to movement participants, and not on their substantive nature or ‘content’. In contrast, our review of the movements and markets literature suggests that the substantive nature of movement goals is critical because it provides a more comprehensive understanding of different market-based movements and their interactions with market actors – ultimately impacting the consequences for movements and their targets. We develop a social movement typology using a goals-based perspective to distinguish between three types of movement: alteration movements, whose goal is to alter or change the practices of markets or their actors; creation movements whose goal is to create new market categories as a means of addressing their grievances; and elimination movements whose goal is to eradicate or remove products, industries, or markets altogether. We propose that the relationship between these types of movement and market actors goes through a four-stage life cycle – emergence, action, interaction and settlement – and that initial variation in movement goals shapes differences in the movement–market relationship at each stage of this life cycle.
The Dengue Prevalence and Mortality Rate Surpass COVID-19 in Bangladesh: Possible Strategies to Fight Against a Double-Punch Attack
Authors: Shayla Tasnim Ahmed , Paul Mishu , Sayma Nusrat Jahan , Suhee Farhana Islam , Islam Md. Rabiul
Published: June 2023

Dengue is a vector-borne viral disease caused by multiple serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) of the dengue virus. It has been a public health concern since 2000 in Bangladesh. However, Bangladesh experienced a higher prevalence and death rate in the year 2022 than the previous year surpassing the COVID-19 situation. While climatic factors had always been a prominent reason for dengue incidence, reports stated that DEN 4 serotype was identified for the first time in the country, which made the dengue cases worse. In this article, we presented the 5 years prevalence of hospitalization and death cases owing to dengue fever and also provided a comparison of death cases caused by dengue and COVID-19 in Bangladesh. We described the possible reasons for the sudden surges of dengue infection and mentioned the actions led by the government to deal with this dengue occurrence. Lastly, we recommend a few strategies to counter the future outbreak of dengue infection in the country.
Lipid metabolism and antioxidant system contribute to salinity tolerance in halophytic grass seashore paspalum in a tissue-specific manner
Authors: Pan Ling , Hu Xu , Liao Li , Xu Tingchen , Sun Quanquan , Tang Minqiang , Chen Zhenbang , Wang Zhiyong
Published: June 2023

Soil salinization is a growing issue that limits agriculture globally. Understanding the mechanism underlying salt tolerance in halophytic grasses can provide new insights into engineering plant salinity tolerance in glycophytic plants. Seashore paspalum (Paspalum vaginatum Sw.) is a halophytic turfgrass and genomic model system for salt tolerance research in cereals and other grasses. However, the salt tolerance mechanism of this grass largely unknown. To explore the correlation between Na+ accumulation and salt tolerance in different tissues, we utilized two P. vaginatum accessions that exhibit contrasting tolerance to salinity. To accomplish this, we employed various analytical techniques including ICP-MS-based ion analysis, lipidomic profiling analysis, enzyme assays, and integrated transcriptomic and metabolomic analysis. Under high salinity, salt-tolerant P. vaginatum plants exhibited better growth and Na+ uptake compared to salt-sensitive plants. Salt-tolerant plants accumulated heightened Na+ accumulation in their roots, leading to increased production of root-sourced H2O2, which in turn activated the antioxidant systems. In salt-tolerant plants, metabolome profiling revealed tissue-specific metabolic changes, with increased amino acids, phenolic acids, and polyols in roots, and increased amino acids, flavonoids, and alkaloids in leaves. High salinity induced lipidome adaptation in roots, enhancing lipid metabolism in salt-tolerant plants. Moreover, through integrated analysis, the importance of amino acid metabolism in conferring salt tolerance was highlighted. This study significantly enhances our current understanding of salt-tolerant mechanisms in halophyte grass, thereby offering valuable insights for breeding and genetically engineering salt tolerance in glycophytic plants.
Insight into pathogenomics and phylogeography of hypervirulent and highly-lethal Mycobacterium tuberculosis strain cluster
Authors: Mokrousov Igor , Vyazovaya Anna , Shitikov Egor , Badleeva Maria , Belopolskaya Olesya , Bespiatykh Dmitry , Gerasimova Alena , Ioannidis Panayotis , Jiao Weiwei , Khromova Polina , Masharsky Aleksey , Naizabayeva Dinara , Papaventsis Dimitrios , Pasechnik Oksana , Perdigão João , Rastogi Nalin , Shen Adong , Sinkov Viacheslav , Skiba Yuriy , Solovieva Natalia , Tafaj Silva , Valcheva Violeta , Kostyukova Irina , Zhdanova Svetlana , Zhuravlev Viacheslav , Ogarkov Oleg
Published: June 2023

Background

. The Mycobacterium tuberculosis Beijing genotype is globally spread lineage with important medical properties that however vary among its subtypes. M. tuberculosis Beijing 14717-15-cluster was recently discovered as both multidrug-resistant, hypervirulent, and highly-lethal strain circulating in the Far Eastern region of Russia. Here, we aimed to analyze its pathogenomic features and phylogeographic pattern.

Results

. The study collection included M. tuberculosis DNA collected between 1996 and 2020 in different world regions. The bacterial DNA was subjected to genotyping and whole genome sequencing followed by bioinformatics and phylogenetic analysis. The PCR-based assay to detect specific SNPs of the Beijing 14717-15-cluster was developed and used for its screening in the global collections. Phylogenomic and phylogeographic analysis confirmed endemic prevalence of the Beijing 14717-15-cluster in the Asian part of Russia, and distant common ancestor with isolates from Korea (> 115 SNPs). The Beijing 14717-15-cluster isolates had two common resistance mutations RpsL Lys88Arg and KatG Ser315Thr and belonged to spoligotype SIT269. The Russian isolates of this cluster were from the Asian Russia while 4 isolates were from the Netherlands and Spain. The cluster-specific SNPs that significantly affect the protein function were identified in silico in genes within different categories (lipid metabolism, regulatory proteins, intermediary metabolism and respiration, PE/PPE, cell wall and cell processes).

Conclusions

. We developed a simple method based on real-time PCR to detect clinically significant MDR and hypervirulent Beijing 14717-15-cluster. Most of the identified cluster-specific mutations were previously unreported and could potentially be associated with increased pathogenic properties of this hypervirulent M. tuberculosis strain. Further experimental study to assess the pathobiological role of these mutations is warranted.
Prevalence of abnormal glucose values and gestational diabetes mellitus among pregnant women in Xi’an from 2015 to 2021
Authors: Meng Gai Li , Wang Qi , Kang Ru , Cheng Xiao Yue , Yang Jun Lan , Xie Yun
Published: June 2023

Background

Pregnant women with gestational diabetes mellitus (GDM) often have an increased risk of adverse pregnancy outcomes. The purpose of this study was to explore the prevalence and characteristics of GDM in Xi’an from 2015 to 2021 since the implementation of China’s “Two-Child policy” and to provide a clinical basis for the management of GDM.

Methods

We analyzed the oral glucose tolerance test (OGTT) results of 152,836 pregnant women who underwent routine prenatal examination at the Northwest Women and Children’s Hospital from 2015 to 2021. Additionally, we analyzed the GDM prevalence and characteristics.

Results

The prevalence of GDM in the Xi’an urban area was 24.66% and exhibited an increasing trend annually (χ2 for trend = 43.922, p < 0.001) and with age (χ2 for trend = 2527.000, p < 0.001). Consistent with this, the proportion of pregnant women aged 18–25 and 26–30 years decreased significantly with the annual growth (χ2 for trend = 183.279, p < 0.001 and χ2 for trend = 33.192, p < 0.001, respectively). The proportion of pregnant women aged 31–35 and 36–42 years increased gradually annually (χ2 for trend = 134.436, p < 0.001and χ2 for trend = 44.403, p < 0.001, respectively). Of the pregnant women diagnosed with GDM, 71.15% (65.05–74.95%) had abnormal fasting plasma glucose (FPG) values. The highest percentage of patients had a single abnormal OGTT value (68.31%; 65.77–70.61%), followed by two (20.52%; 18.79–22.55%) and three (11.17%; 10.11–11.85%) abnormal values (FPG and 1-h and 2-h plasma glucose (PG).

Conclusion

The prevalence of GDM among pregnant women in Xi’an region was high, and it had a increasing trend over the period from 2015 to 2021. Notably, the proportion of elder pregnant women, aged 31–42 years, presented a significant rise after the implementation of the universal two-child policy. On the basis of the high incidence of GDM among elder pregnant women and the high rate of abnormal OGTT values (numbe ≥ 2) in pregnant women diagnosed with GDM, the management of GDM should be intensified, and relevant departments should pay more attention to pregnant women of advanced age.
Knockout of PERK protects rat Müller glial cells against OGD-induced endoplasmic reticulum stress-related apoptosis
Authors: Wang Xiaorui , Zhu Xinxing , Huang Guangqian , Wu Lili , Meng Zhiyong , Wu Yuyu
Published: June 2023

Background

The pathological basis for many retinal diseases, retinal ischemia is also one of the most common causes of visual impairment. Numerous ocular diseases have been linked to Endoplasmic reticulum(ER)stress. However, there is still no clear understanding of the relationship between ER stress and Müller glial cells during retinal ischemia and hypoxia. This study examined the effects of ER stress on autophagy and apoptosis-related proteins, as well as the microtubule-related protein tau in rMC-1 cells.

Methods

rMC-1 cells were cultured in vitro. RT-PCR、immunofluorescence and Western blotting revealed the expression levels of associated mRNAs and proteins, and the CCK-8 and flow cytometry assays detected cell apoptosis.

Results

The results showed that under OGD(Oxygen-glucose deprivation) conditions, the number of rMC-1 cells was decreased, the PERK/eIF2a pathway was activated, and the expressions of p-tau, LC3、Beclin1 and Caspase-12 proteins were increased. After the PERK knockout, the expression of the above proteins was decreased, and the apoptosis was also decreased.

Conclusion

According to the findings of this study, specific downregulation of PERK expression had an anti-apoptotic effect on OGD-conditioned rMC-1 cells. There is a possibility that this is one of the mechanisms of MG cell apoptosis during retinal ischemic injury.
Infant feeding practices and parental perceptions during the 2022 United States infant formula shortage crisis
Authors: Cernioglo Karina , Smilowitz Jennifer T.
Published: June 2023

Background

In May of 2022, parents living in the United States experienced a dramatic infant formula shortage caused by supply chain issues and the recall of several infant formula products over contamination concerns.

Methods

An anonymous, electronic, cross-sectional survey was designed to understand infant feeding practices, parental experience and perceived support during the crisis.

Results

Ninety-nine parents that lived in the U.S. and fulfilled study criteria completed the survey. 66% of respondents were female, and 75% of respondents were recipients of the Special Supplemental Nutrition Program for Women Infant Children (WIC). Parental mean age was 30.0 years, and the mean infant age was 26.8 weeks. The number of individuals that used at least one unsafe infant feeding practice increased from 8% before the infant formula shortage to 48.5% during the shortage (p < 0.001). 79% of parents fed their infants U.S. infant formula brands and 39% of parents fed their infants imported infant formula brands before the shortage which were significantly reduced during the shortage to 27% (p < 0.005) and 11% (p < 0.005), respectively. The percentage of parents that reported infant feeding practices before and during the infant formula shortage significantly increased from 2 to 28% for banked donor milk use (p < 0.005); 5–26% for use of human milk from informal sharing (p < 0.005); and 2–29% for use of watered-down infant formula (p < 0.005). The resources that parents reported as most helpful in navigating the crisis differed by parental sex and WIC recipient status and included other parents, friends, and family; lactation consultants; healthcare providers; and WIC.

Conclusions

Our study found that feeding practices in response to the infant formula shortage may pose health risks to infants including nutrition and food insecurity. These data suggest the need for policy changes within regulatory and the healthcare system to provide families with clinical prenatal and postnatal lactation support, access to pasteurized banked donor milk, and access to more commercially available products.
A comparative retrospective study on the prevalence and therapeutic treatment of dental agenesis between healthy children and children with systemic disease or congenital malformation
Authors: Nadolinski Mirja , Schlenz Maximiliane Amelie , Rahman Alexander , Krämer Norbert , Schulz-Weidner Nelly
Published: June 2023

Background

Dental agenesis (DA) in the permanent dentition is one of the most common dental anomalies, with a prevalence up to 2–10%. Therefore, the aim of this retrospective study was to investigate the prevalence and therapeutic treatment of DA in healthy children (HC) compared to children with systemic disease or congenital malformation (SD/CM).

Methods

Out of 3407 patients treated at the Department of Paediatric Dentistry of the Justus Liebig University Giessen (Germany) between January 2015 and December 2020, a total of 1067 patients (594 female, 473 male) aged between 4.5 and 18 years were included in this study due to DA. Besides the patients’ general medical history and therapeutic treatments, panoramic radiographs were analysed.

Results

In contrast to the HC group with 9.7% DA, the SD/CM group showed a significantly higher prevalence of DA (19.8%; p < 0.05). The latter group was further classified into children with ectodermal dysplasia (4.4%), down syndrome (8.2%), cleft lip and palate (4.4%), intellectual disability/developmental delay (16.4%), and other genetic/organic diseases without intellectual disability (45.9%). Regarding therapeutic treatments, the HC group (59.5%) was significantly more often treated with an orthodontic gap opening compared to the SD/CM group (42.6%; p < 0.05), followed by orthodontic gap closing 36.5% in the HC group and 22.9% in the SD/CM group (p < 0.05), whereas no treatment was predominantly performed in the SD/CM group (37.7%) compared to the HC group (4%; p < 0.05). Furthermore, 50% in the SD/CM group required general anaesthesia for therapeutic treatment (vs. 8.1% in the HC group; p < 0.05).

Conclusions

Children with SD/CM suffered more often from DA compared to HC that underlines multi- and interdisciplinary treatment of utmost importance. Furthermore, due to intellectual disability, common treatment methods can be complicated by insufficient compliance. This fact underlines the importance of an early attempt to establish the necessary cooperation enabling children with SD/CM to receive therapy.
Shared genetic architecture between mental health and the brain functional connectome in the UK Biobank
Authors: Roelfs Daniel , Frei Oleksandr , van der Meer Dennis , Tissink Elleke , Shadrin Alexey , Alnaes Dag , Andreassen Ole A. , Westlye Lars T. , Kaufmann Tobias
Published: June 2023

Psychiatric disorders are complex clinical conditions with large heterogeneity and overlap in symptoms, genetic liability and brain imaging abnormalities. Building on a dimensional conceptualization of mental health, previous studies have reported genetic overlap between psychiatric disorders and population-level mental health, and between psychiatric disorders and brain functional connectivity. Here, in 30,701 participants aged 45–82 from the UK Biobank we map the genetic associations between self-reported mental health and resting-state fMRI-based measures of brain network function. Multivariate Omnibus Statistical Test revealed 10 genetic loci associated with population-level mental symptoms. Next, conjunctional FDR identified 23 shared genetic variants between these symptom profiles and fMRI-based brain network measures. Functional annotation implicated genes involved in brain structure and function, in particular related to synaptic processes such as axonal growth (e.g. NGFR and RHOA). These findings provide further genetic evidence of an association between brain function and mental health traits in the population.
Musculoskeletal pain in health professionals at the end of their studies and 1 year after entry into the profession: a multi-center longitudinal questionnaire study from Switzerland
Authors: Bucher Thomas , Volken Thomas , Pfeiffer Fabian , Schaffert René
Published: June 2023

Background

Musculoskeletal pain, especially back pain, is common among health care professionals (HP). For prevention purposes, it is important to know whether HP develop their symptoms before or after entering the health care workforce. Cross-sectional studies among HP cannot answer this question. This follow-up study measures the prevalence and individual course of musculoskeletal pain among full-time HP students at the end of their studies and one year after entering the health care workforce.

Method

Self-reported one-year prevalence for low back pain, neck/shoulder pain, pain in arms/hands, and pain in legs/feet was collected at two timepoints from 1046 participating HP using an online questionnaire. Participants were asked whether their musculoskeletal pain was related to study or work conditions. Generalized estimating equation (GEE) models of the binomial family with log link were used to estimate adjusted prevalence and corresponding normal based 95% confidence intervals were derived using the bootstrap method with 1000 replications.

Results

The prevalence of low back pain as well as neck and shoulder pain was very high at baseline and follow-up in all full-time students and later HP. Prevalence for pain in arms/hands, legs/feet was low and there were significant differences between the professions. HP clearly associated their low back pain and neck/shoulder pain with study and work conditions; HP strongly associated pain in arms/hands, legs/feet only with work conditions.

Conclusion

Many HP suffer from back/neck/shoulder pain already as students before starting their professional career. The prevention of back/neck/shoulder pain must be part of the education of all health professions at universities. As an example of best practice, universities should incorporate ergonomic measures and exercises into the daily routine of training health professionals. The effects of physically demanding professional tasks on the upper and lower extremities need to be investigated in further studies to take preventive measures.
Biomechanical effect of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion: a finite element study
Authors: Wei Wei , Wang Tianhao , Liu Jianheng , Mao Keya , Pan Chun’ang , Li Hui , Zhao Yongfei
Published: June 2023

Background

Adjacent segment degeneration (ASD) is a common complication of lumbar interbody fusion; the paraspinal muscles significantly maintain spinal biomechanical stability. This study aims to investigate the biomechanical effects of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion (PLIF).

Methods

Data from a lumbosacral vertebral computed tomography scan of a healthy adult male volunteer were used to establish a normal lumbosacral vertebral finite element model and load the muscle force of the multifidus. A normal model, an L4/5 PLIF model (PFM) based on a preserved proximal multifidus, a total laminectomy PLIF model (TLPFM), and a hemi-laminectomy PLIF model based on a severed proximal multifidus were established, respectively. The range of motion (ROM) and maximum von Mises stress of the upper and lower adjacent segments were analyzed along with the total work of the multifidus muscle force.

Results

This model verified that the ROMs of all segments with four degrees of freedom were similar to those obtained in previous research data, which validated the model. PLIF resulted in an increased ROM and maximum von Mises stress in the upper and lower adjacent segments. The ROM and maximum von Mises stress in the TLPFM were most evident in the upper adjacent segment, except for lateral bending. The ROM of the lower adjacent segment increased most significantly in the PFM in flexion and extension and increased most significantly in the TLPFM in lateral bending and axial rotation, whereas the maximum von Mises stress of the lower adjacent segment increased the most in the TLPFM, except in flexion. The muscle force and work of the multifidus were the greatest in the TLPFM.

Conclusions

PLIF increased the ROM and maximum von Mises stress in adjacent cranial segments. The preservation of the proximal multifidus muscle contributes to the maintenance of the physiological mechanical behavior of adjacent segments, thus preventing the occurrence and development of ASD.
Tumor attachment to Major intrahepatic vascular for Colorectal liver metastases
Authors: Liu Wei , Cui Yong , Wu Xiao-Gang , Chen Feng-Lin , Wang Kun , Sun Ying-Shi , Xing Bao-Cai
Published: June 2023

Background

Colorectal liver metastases attached major intrahepatic vessels has been considered to be a risk factor for survival outcome after liver resection. The present study aimed to clarify the outcomes of R1 surgery (margin < 1 mm) in CRLM patients, distinguishing parenchymal margin R1 and attached to major intrahepatic vessels R1.

Methods

In present study, 283 CRLM patients who were evaluated to be attached to major intrahepatic vessels initially and underwent liver resection following preoperative chemotherapy. They were assigned to two following groups: R0 (n = 167), R1 parenchymal (n = 58) and R1 vascular (n = 58). The survival outcomes and local recurrence rates were analyzed in each group.

Results

Overall, 3- and 5-year overall survival rates after liver resection were 53.0% and 38.2% (median overall survival 37 months). Five-year overall survival was higher in patients with R0 than parenchymal R1 (44.9%% vs. 26.3%, p = 0.009), whereas there was no significant difference from patients with vascular R1 (34.3%, p = 0.752). In the multivariable analysis, preoperative chemotherapy > 4 cycles, clinical risk score 3–5, RAS mutation, parenchymal R1 and CA199 > 100 IU/ml were identified as independent predictive factors of overall survival (p < 0.05). There was no significant difference for local recurrence among three groups.

Conclusion

Parenchymal R1 resection was independent risk factor for CRLM. Vascular R1 surgery achieved survival outcomes equivalent to R0 resection. Non-anatomic liver resection for CRLM attached to intrahepatic vessels might be pursued to increase patient resectability by preoperative chemotherapy.
Does diet and activity lead to difference in resting energy expenditure in obese women?
Authors: Masoumi Zahra Taghadomi , Pishva Hamideh
Published: June 2023

Background

Obesity is considered as a risk factor for metabolic and chronic diseases. Reduction in resting energy expenditure (REE) may increase risk of obesity. Our study was carried out to investigate dietary, biochemical, anthropometric and body composition parameters and physical activity in obese women with normal and low resting energy expenditure.

Methods

A total forty nine subjects (women, 30-50 years old) were enrolled and divided into three groups. Anthropometric, body composition parameters, resting energy expenditure, Fasting blood lipid profile, dietary intake and physical activity were measured.

Results

Although, fat mass and fat-free mass were significantly increased in obese groups, there was no significant difference in body composition between two obese groups (p-value = 0.10, 0.27). Measured resting energy expenditure was significantly decreased in obese with low REE compare to other groups (p-value < 0.001). There was no significant difference in energy intake and macronutrients between groups. There was a significant difference in T3 between obese subjects with low REE compared to obese group with normal REE (p-value < 0.001). There was no significant difference in lipid profile between two obese groups. Also there was a significant difference in LDL, cholesterol and triacylglycerol between obese subjects with low REE compared to normal weight group. Moreover, there was a significant difference in cholesterol and triacylglycerol between obese subjects with normal REE compared to normal weight group. Our finding showed there was no significant difference in physical activity between three groups.

Conclusions

Dietary intake and physical activity may relate to metabolism and energy expenditure. It is interesting that in some obese people resting energy expenditure was much lower compared to other obese people; however, there was no significant difference in their body composition, age, sex, dietary intake, lipid profile and physical activity. Thus it should investigate the role of other factors involved in different REE in subjects with obesity.
A new portable Fresnel magnifying loupe for nystagmus observation: a clinical education and clinical practice setting study
Authors: Tsunoda Reiko , Fushiki Hiroaki , Tanaka Ryozo , Endo Mayumi
Published: June 2023

Background

Dizziness is a common complaint of patients treated by primary care physicians. It is predominantly caused by peripheral vestibular disorders; however, central nervous system disorders should be excluded. Examination of the eye movements and nystagmus can help differentiate the disorders of the central nervous system from the peripheral vestibular disorders; however, it is often not performed appropriately. In medical education practice, nystagmus observation may facilitate an understanding of vestibular function and nystagmus characteristics. Thus, we proposed a medical education practice to master nystagmus observation using a recently developed portable Fresnel magnifying loupe that could be shielded by one eye.

Methods

Thirty-three students from the Department of Physical Therapy and the Department of Speech, Language, and Hearing Therapy of the Mejiro University participated in this study. Postrotatory nystagmus was measured and compared using the new loupe and control methods, namely the naked eye and Frenzel goggles; we rated the ease of visibility using a five-point scale.

Results

The number of detected cases of nystagmus was significantly higher with the new loupe than with the naked eye (p = 0.001). In addition, there were no significant differences in the nystagmus counts between the observations using the new loupe and Frenzel goggles (p = 0.087). No significant difference was observed in the visibility of eye movements between the loupe and naked eye (p = 1.00). The Frenzel goggles provided better visibility compared to that by the loupe (p = 0.034); however, none of the participants reported poor visibility using any of these methods.

Conclusions

Our newly developed Fresnel loupe allows for the observation of nystagmus counts a level of reduction in fixation suppression similar to that of Frenzel goggles in an educational practice setting. Furthermore, it enables the detection of significantly more nystagmus counts compared to that by the naked eye. It offers several advantages over Frenzel goggles, including its lightweight, thin, durable, and portable design. Additionally, the loupe does not rely on a power source and can be used under normal room lighting conditions.

Trial registration

This study was approved by the Medical Research Ethics Committee of Mejiro University (approval number: 21medicine-021).
Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China
Authors: Li Qiaosheng , Fan Xiaoqi , Jian Weiyan
Published: June 2023

Background

Diagnosis-Related-Group (DRG) payment is considered a crucial means of addressing the rapid increases of medical cost and variation in cost. This paper analyzes the impact of DRG payment on variation in hospitalization expenditure in China.

Method

Patients with chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI) in a Chinese City Z were selected. Patients in the fee-for-service (FFS) payment group and the DRG payment group were used as the control group and intervention group, respectively, and propensity-score-matching (PSM) was conducted. Interquartile distance (IQR), standard deviation (SD) and concentration index were used to analyze variation and trends in terms of hospitalization expenditure across the different groups.

Results

After DRG payment reform, the SD of hospitalization expenditure in respect of the COPD, AMI and CI patients in City Z decreased by 11,094, 4,833 and 4,987 CNY, respectively. The concentration indices of hospitalization expenditures for three diseases are all below 0 (statistically significant), with the absolute value tending to increase year by year.

Conclusion

DRG payment can be seen to guide medical service providers to provide effective treatment that can improve the consistency of medical care services, bringing the cost of medical care closer to its true clinical value.
A new dyslipidemia-based scoring model to predict transplant-free survival in patients with hepatitis E-triggered acute-on-chronic liver failure
Authors: Chen Chong , Zhu Aihong , Ye Shanke , Li Weixia , Fei Ling , Huang Qin , Chen Liang
Published: June 2023

Background/Aims

Hepatitis E virus (HEV)-triggered acute-on-chronic liver failure (ACLF) has unacceptably high short-term mortality. However, it is unclear whether the existing predictive scoring models are applicable to evaluate the prognosis of HEV-triggered ACLF.

Methods

We screened datasets of patients with HEV-triggered ACLF from a regional tertiary hospital for infectious diseases in Shanghai, China, between January 2011 and January 2021. Clinical and laboratory parameters were recorded and compared to determine a variety of short-term mortality risk factors, which were used to develop and validate a new prognostic scoring model.

Results

Out of 4952 HEV-infected patients, 817 patients with underlying chronic liver disease were enrolled in this study. Among these, 371 patients with HEV-triggered ACLF were identified and allocated to the training set (n = 254) and test set (n = 117). The analysis revealed that hepatic encephalopathy (HE), ascites, triacylglycerol and apolipoprotein A (apoA) were associated with 90-day mortality (P < 0.05). Based on these significant indicators, we designed and calculated a new prognostic score = 0.632 × (ascites: no, 1 point; mild to moderate, 2 points; severe, 3 points) + 0.865 × (HE: no, 1 point; grade 1–2, 2 points; grade 3–4, 3 points) − 0.413 × triacylglycerol (mmol/L) − 2.171 × apoA (g/L). Compared to four well-known prognostic models (MELD score, CTP score, CLIF-C OFs and CLIF-C ACLFs), the new scoring model is more accurate, with the highest auROCs of 0.878 and 0.896, respectively, to predict 28- and 90-day transplantation-free survival from HEV-triggered ACLF. When our model was compared to COSSH ACLF IIs, there was no significant difference. The test data also demonstrated good concordance.

Conclusions

This study is one of the first to address the correlation between hepatitis E and serum lipids and provides a new simple and efficient prognostic scoring model for HEV-triggered ACLF.
Intersections between syndemic conditions and stages along the continuum of overdose risk among women who inject drugs in Mexicali, Mexico
Authors: Gonzalez-Nieto Pablo , Salimian Anabel , Arredondo Jaime , Angulo Lourdes , García de Loera Alejandra , Slim Said , Shoptaw Steve , Cambou Mary C. , Pitpitan Eileen V. , Goodman-Meza David
Published: June 2023

Background

Research on women who inject drugs is scarce in low- and middle-income countries. Women experience unique harms such as sexism and sexual violence which translate into negative health outcomes. The present work aims to provide insight into the experiences of women who inject drugs at the US–Mexico border to identify social and health-related risk factors for overdose to guide harm reduction interventions across the Global South.

Methods

We recruited 25 women ≥ 18 years of age accessing harm reduction and sexual health services at a non-governmental harm reduction organization, “Verter”, in Mexicali, Mexico. We employed purposeful sampling to recruit women who inject drugs who met eligibility criteria. We collected quantitative survey data and in-depth interview data. Analyses of both data sources involved the examination of descriptive statistics and thematic analysis, respectively, and were guided by the syndemic and continuum of overdose risk frameworks.

Results

Survey data demonstrated reports of initiating injection drug use at a young age, experiencing homelessness, engaging in sex work, being rejected by family members, experiencing physical violence, injecting in public spaces, and experiencing repeated overdose events. Interview data provided evidence of stigma and discrimination toward women, a lack of safe spaces and support systems, risk of overdose-related harms, sexual violence, and the overall need for harm reduction services.

Conclusion

Women who inject drugs in Mexicali describe experiences of violence, overdose, and public injecting. Women are particularly vulnerable in the Mexicali context, as this area faces a noticeable lack of health and social services. Evidenced-based harm reduction strategies such as safe consumption sites and overdose prevention strategies (e.g., naloxone distribution and training) may benefit this population. Evidence from local organizations could help close the gap in service provision in low-resource settings like Mexico, where government action is almost nonexistent.
Risk of thrombotic events in immune thrombocytopenia patients treated with thrombopoietic agents: a systematic review and meta-analysis
Authors: Dong Yu , Xia Zhinan , Zhou Jie , Hu Yutao , Yue Ming , Wang Yuyong , Hu Mengjiao
Published: June 2023

Background

Immune thrombocytopenia (ITP), which is a well-known hemorrhagic disorder characterized by low platelet counts, has been shown to be associated with the risk of thrombosis. Thrombopoietic agents (TAs) are extensively used as second-line treatments for ITP, effectively reducing the risk of hemorrhage. However, thrombosis, a potential adverse effect of TAs, raises clinical challenges.

Methods

The MEDLINE(PubMed), Embase, and the Cochrane Library databases were systematically searched for relevant studies, including both single-arm trials and randomized controlled trials (RCTs), without language restrictions.

Results

A total of 17 RCTs comprising 2,105 patients and 29 single-arm trials comprising 3,227 patients were included. In the single-arm meta-analysis, the pooled rate of overall thrombotic events in ITP patients receiving TAs was 2.2% (95% CI 1.0% − 3.7%). In RCTs, a higher incidence of thrombosis (33/1425 vs. 4/680) and higher risk ratios (RR) of overall, arterial, and venous thrombotic events (1.73, 95% CI [0.88, 3.39], P = 0.113; RR 1.98, 95% CI [0.80, 4.92], P = 0.141; RR 1.06, 95% CI [0.46, 2.41], P = 0.895, respectively) were observed in the TAs group than in the control group, although the differences were not significant. Subgroup analysis demonstrated that hetrombopag was the only TA with no increased thrombotic risk (rate 0.3% 95% CI [0.0 − 1.5%]; RR 0.76, 95% CI [0.03, 18.41], P = 0.864) compared to eltrombopag, avatrombopag, romiplostim, and rhTPO. Subgroup analyses also revealed that ITP patients with advanced age (3.7% vs. 1.3%, P = 0.132) or with a thrombotic history (3.0% vs. 1.4%, P = 0.257), and patients who received TAs therapy for a long duration (4.7% vs. 0.1%, P < 0.001) had an increased risk of thrombosis.

Conclusion

Our findings suggest ITP patients treated with TAs have a nonsignificantly higher risk of overall, arterial, and venous thrombotic events. Furthermore, hetrombopag is the recommended TA to avoid thrombophilia. Patients receiving long-term TAs, as well as elderly ITP patients or those with a history of thrombosis, face an increased thrombotic risk. In general, clinicians should consider potential thrombotic risks, address underlying risk factors, and ensure ongoing monitoring and follow-up when treating ITP patients with TAs.