bluuebunny/crossref_metadata_2025 huggingface dataset:
Is there an association between multiple sclerosis and osteoarthritis in Germany? A retrospective cohort study of 8,600 patients from Germany
Authors: Jacob Louis , Smith Lee , Koyanagi Ai , Haro Josep Maria , Konrad Marcel , Tanislav Christian , Kostev Karel
Published: June 2021

Objectives

The goal of this retrospective cohort study was to investigate the multiple sclerosis-osteoarthritis relationship in adults followed in general practices in Germany.

Methods

Patients aged 18-70 years who were diagnosed for the first time with multiple sclerosis in one of 1,193 general practices in Germany between 2005 and 2018 (index date) were included in this retrospective cohort study. Patients without multiple sclerosis were matched (1:1) to those with multiple sclerosis by sex, age, index year, general practice, obesity, injuries, and other types of arthritis (index date: a randomly selected visit date). The association between multiple sclerosis and the 10-year incidence of osteoarthritis was analyzed using Cox regression models.

Results

There were 4,300 patients with multiple sclerosis and 4,300 patients without multiple sclerosis included in this study. The proportion of women was 69.3% and mean (SD) age was 43.6 (12.6) years. There was no significant association between multiple sclerosis and incident osteoarthritis in the overall sample (HR = 0.95, 95% CI: 0.83-1.09) as well as sex and age subgroups.

Conclusions

Based on these findings, multiple sclerosis is not significantly associated with osteoarthritis. Further studies of longitudinal nature are warranted to corroborate or invalidate these results.
Investor Sentiments and Fama–French Five-Factor Premia
Authors: Habibah Ume , Bhayo Mujeeb-u-Rehman , Iqbal Muhammad Shahid
Published: June 2021

This study provides new insights to predict the excess return of a security. As if factor premia are getting influenced by the sentiments that means sentiments are ultimately affecting the excess return of a security. To meet the objective, a composite index developed by Baker and Wurgler is used as sentiment proxy. Monthly data are used from July 1965 to September 2015 in U.S. context. Granger casualty, Vector Autoregression (VAR), and Fama–Macbeth regression are applied to get the results. Results show that investor sentiments significantly drive the Fama factors’ premia: size premium and profitability premium. Sentiments also contain some information to explain the investment premia but fail to explain the market risk premium and value premium. Furthermore, results suggest that sentiments increase the explanatory power of model measured by R square. In short, this study suggests that investor sentiments play a role in explaining the Fama–French five-factor premia.
Environmental Beliefs and Pro-Environmental Behavioral Intention of an Environmentally Themed Exhibition Audience: The Mediation Role of Exhibition Attachment
Authors: Li Xi , Yu Runzhe , Su Xinwei
Published: June 2021

Many scholars have focused on the role of exhibitions in business promotion, and numerous studies have been conducted. The exhibition may influence the audience’s behaviors through the dissemination of information and ideas, but few researchers have looked into this further. There is a distinct lack of research on the process of exhibition influencing people’s behavioral intentions. Based on the belief–emotion–norm theoretical model, this study integrates environmental beliefs, exhibition attachment, and an audience’s environmental behavior intentions into a research model to explain how the exhibition affects the audience. The Macau International Environmental Cooperation Forum & Exhibition attendees served as the research object in the current empirical study. The study’s findings suggest that audiences’ environmental beliefs may have a significant and positive impact on their attachment to environmentally themed exhibitions as well as their environmental behavioral intentions. This study also confirmed that attachment to exhibitions, a temporary space, can play an important mediating role between environmental beliefs and intentions to engage in pro-environmental behavior. The exhibition dependency, in particular, acts as a mediator between environmental beliefs and pro-environmental behavior intentions. Although the mediating effect of exhibition identity is insignificant, exhibition dependence–exhibition identity as a whole has a partial mediating effect in the process of influencing exhibition audiences’ environmental behavior. This research helps to improve our understanding of how environmentally themed exhibitions influence audience behavior. It also has implications for exhibition organizers in terms of better exhibition planning, more effective information transmission, and influencing audience behavior.
Does the Dark Side of Personality Traits Explain Compulsive Smartphone Use of Higher Education Students? The Interaction Effect of Dark Side of Personality with Desirability and Feasibility of Smartphone Use
Authors: Farhat Kashif , Aslam Wajeeha , Arif Imtiaz , Ahmed Zohaib
Published: June 2021

Research on compulsive use of smartphones amongst students largely remains unexplored. The study seeks to investigate the feasibility and desirability motives—instant gratification, mood regulations, convenience, flow and personality—to understand the compulsive use of smartphones. The results of the useful data of 200 respondents following purposive sampling design, provided evidence of instant gratification, mood regulation and convenience motives, which significantly explain flow and compulsive smartphone use. Personality of users also appeared as a significant moderator between flow and compulsive smartphone use. The findings of the study reveal that the personality of smartphone users enhances the propensity to build compulsive smartphone use. Additionally, the findings reveal the double-edged sword impact of flow in forming compulsive smartphone use and allowing smartphone brands to design phones that help phone users to develop self-control over their behaviours related to using smartphones.
Clinical outcome and risk factor predictive for failure of autologous PRP injections for low-to-moderate knee osteoarthritis
Authors: Alessio-Mazzola Mattia , Lovisolo Stefano , Sonzogni Beatrice , Capello Andrea Giorgio , Repetto Ilaria , Formica Matteo , Felli Lamberto
Published: June 2021

Purpose:

To report the 5-year clinical efficacy of PRP intra articular injections in knee osteoarthritis (OA) and to investigate the risk factors predictive for treatment failure and poor clinical outcome.

Methods:

We retrospectively evaluated 118 patients treated for low to moderate knee OA demonstrated by X-Ray and magnetic resonance imaging (MRI) with autologous PRP injection from 2014 to 2018 with a mean 51.1 ± 14.8 (range 29 to 89) months follow-up. All the patients were evaluated with Lysholm and WOMAC score. The role of Kellgren Lawrence (KL) grade, patello-femoral (PF) degeneration, age, body mass index (BMI), relevant comorbilities, smoking status, gender, previous surgery or conservative measures were analyzed with univariate and multivariate analysis.

Results:

There was a significant improvement of all outcome measures at final follow-up and high satisfaction rate (79.7%). The overall failure rate was of 15.3% after a mean of 57.7 ± 15.1 (range 33 to 85) months. The BMI and the KL grade were identified as significant independent risk factor related to failure of autologous PRP injection. Patients under 60 reported significantly higher Tegner activity scale ( p = 0.032) at final follow-up. Patients with KL grade 3 and patients with PF MRI-KL grade 3 had significantly lower Lysholm scores ( p = 0.026 and p = 0.042 respectively) at final assessment. Younger patients with lower BMI and lower grade of radiographic OA had significantly longer therapeutic benefit ( p < 0.05).

Conclusion:

Intra articular PRP injections led to a significant clinical improvement in middle-aged adults with a low to moderate knee OA. BMI and high KL grade have been identified as significant risk factors predictive for failure at mid-term follow-up.
Risk-Managed Momentum: An Evidence from Indian Stock Market
Authors: Singh Simarjeet , Walia Nidhi , Panda Pradiptarathi , Gupta Sanjay
Published: June 2021

Relative momentum strategies yield large and substantial profits in the Indian Stock Market. Nevertheless, relative momentum profits are negatively skewed and prone to occasional severe losses. By taking into consideration 450 stocks listed on the Bombay Stock Exchange, the present study predicts the timing of these huge momentum losses and proposes a simple risk-managed momentum approach to avoid these losses. The proposed risk-managed momentum approach not only doubles the adjusted Sharpe ratio but also results in significant improvements in downside risks. In contrast to relative momentum payoffs, risk-managed momentum payoffs remain substantial even in extended time frames. The study’s findings are particularly relevant for asset management companies, fund houses and financial academicians working in the area of asset anomalies.
Technical Efficiency and Total Factor Productivity Growth of Indonesian Manufacturing Industry: Does Openness Matter?
Authors: Yasin Mohammad Zeqi
Published: June 2021

In this paper, we examine the contribution of openness variables such as import, export, absorptive capacity and foreign-shared capital to Indonesian firms’ technical efficiency and total factor productivity (TFP) growth. We use the most recent firm-level panel data of 23 subsectors in the manufacturing industry over the period from 2008 to 2015. We employ time-varying stochastic production frontier to examine factors affecting technical efficiency and to decompose the components of TFP growth. The results reveal that export and absorptive capacity alone contribute to the efficiency improvement of the firms under study. To speak specifically of foreign firms, they contribute to improving efficiency if they interact with absorptive capacity and imported raw material intensity. We identify that, on an average, the manufacturing industry in Indonesia experienced positive TFP growth. However, among 23 subsectors, there are only few subsectors that benefitted from the openness variables. In 2014, 15 out of 23 subsectors experienced negative TFP growth. This implies that, in 2014, there were some macroeconomic issues regarding the contracted policy, for example, the subsidy removal and the basic electricity tariff.

JEL Classifications: C23, D24, F23, O14
Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis
Authors: Fernandes Tiago Lazzaretti , Moreira Hugo Henrique , Andrade Renato , Sasaki Sandra Umeda , Bernardo Wanderley Marques , Pedrinelli André , Espregueira-Mendes João , Hernandez Arnaldo José
Published: June 2021

Background:

There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.

Purpose:

To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction.

Study Design:

Systematic review; Level of evidence, 3.

Methods:

A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials.

Results:

Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, –0.14; 95% confidence interval, –0.27 to –0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test.

Conclusion:

Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.
Personal Music Players and Hearing Loss: The HUNT Cohort Study
Authors: Engdahl Bo , Aarhus Lisa
Published: June 2021

It is unclear whether the current average use of personal music players (PMPs) including mobile phones has affected hearing in the general population. The association between the use of PMPs and hearing loss was assessed in a large population cross-sectional and follow-up study with the following distribution: cross-sectional (2018): n = 26,606, 56% women, mean age 54 years and 20-year follow-up (baseline 1998): n = 12,115, 57% women, mean age at baseline 43 years. Hearing threshold was determined as pure-tone average over the frequencies 3, 4, and 6 kHz. We used linear regression to assess relationships between hearing threshold and PMP use (yes), duration (1–2/2–6/>6 h per week), or sound volume (low/medium/high), with nonuse as reference. The PMP use increased from 8% in 1998 to 30% in 2018. Compared with nonusers, neither use nor duration was related to hearing threshold. As to sound volume, listening at low levels was associated with better thresholds (−2.5 dB [−4.1 to −0.8]), while listening at high levels was associated with worse thresholds (1.4 dB [0.1 to 2.8]). We adjusted for age, sex, baseline hearing threshold, education, noise exposure, ear infections, head injury, and daily smoking. The association with sound volume was nearly twice as strong when adjusting for hearing threshold at baseline. Accordingly, the possibility of reverse causality was reduced although not eliminated by the follow-up design. This large population study showed no association between normal PMP use and 20-year progression in hearing; however users listening to high levels increased their hearing threshold.
Testing a Theoretical Assumption of a Learning-Trajectories Approach in Teaching Length Measurement to Kindergartners
Authors: Sarama Julie , Clements Douglas H. , Baroody Arthur J. , Kutaka Traci S. , Chernyavskiy Pavel , Shi Jackie , Cong Menglong
Published: June 2021

We tested a specific theoretical assumption of a learning trajectories (LTs) approach to curriculum and teaching in the domain of early length measurement. Participating kindergartners (n = 189) were assigned to one of three conditions: LT, reverse-order (REV), or business-as-usual (BAU). LT and REV students received one-on-one instruction using the same activities from a length LT, while the REV condition reversed the LT order. At posttest, LT and REV children exhibited significantly greater learning relative to BAU peers. But importantly, LT children outperformed their REV peers. We conclude that instruction following LTs (i.e., providing instruction just beyond a child’s present level of thinking, progressing through the levels in order as the child advances) may promote more learning than an equivalent amount of instruction using the same activities but that are not theoretically sequenced.
The Use of Ethnography in Maternity Care
Authors: Coates Dominiek , Catling Christine
Published: June 2021

While the value of ethnography in health research is recognized, the extent to which it is used is unclear. The aim of this review was to map the use of ethnography in maternity care, and identify the extent to which the key principles of ethnographies were used or reported. We systematically searched the literature over a 10-year period. Following exclusions we analyzed 39 studies. Results showed the level of detail between studies varied greatly, highlighting the inconsistencies, and poor reporting of ethnographies in maternity care. Over half provided no justification as to why ethnography was used. Only one study described the ethnographic approach used in detail, and covered the key features of ethnography. Only three studies made reference to the underpinning theoretical framework of ethnography as seeking to understand and capture social meanings. There is a need to develop reporting guidelines to guide researchers undertaking and reporting on ethnographic research.
Optimizing Remote Learning: Leveraging Zoom to Develop and Implement Successful Education Sessions
Authors: Ohnigian Sarah , Richards Jeremy B , Monette Derek L , Roberts David H
Published: June 2021

Virtual meeting platforms, such as Zoom, have become essential to medical education during the SARS-CoV-2 pandemic. However, many medical educators do not have experience planning or leading these sessions. Despite the prevalence of Zoom learning, there has been little published on best practices. In this article we describe best practices for using Zoom for remote learning, acknowledging technical considerations, and recommending workflows for designing and implementing virtual sessions. Furthermore, we discuss the important role of cognitive learning theory and how to incorporate these key pedagogical insights into a successful virtual session. While eventually in-person classrooms will open, virtual teaching will remain a component of medical education. If we utilize these inventive tools creatively and functionally, then virtual learning can augment and elevate the practice of medical education.
Lessons Learnt from the COVID-19 Pandemic: Starting Residency in a Foster Institution
Authors: Tan Jiekai , Wee Lin , Li-Ann Chia Faith , Khoon Ng Wee
Published: June 2021

In Singapore, the Ministry of Health (MOH) raised the public health response level from DORSCON (Disease Outbreak Response System Condition) ‘Yellow’ to ‘Orange’ on 7 February 2020. This instituted strict movement restrictions for all healthcare workers to minimise cross-institutional transmission of COVID-19, creating a unique scenario where many residents physically located in different healthcare institutions at the start of DORSCON Orange were unable to return to their matched Sponsoring Institutions (SIs) to begin residency training in July 2020. Residents faced multiple administrative and emotional challenges as a result of freezing of cross-institutional movement. These challenges included concerns with regards to meeting training requirements (due to different modes of assessment, and posting structures between the 3 SIs) and concerns with regards to emotional support (due to starting residency in an unfamiliar environment where the resident may have less pre-existing connections/support). These challenges were swiftly addressed by the strong support of foster and parent institutions, and close communication between the leadership of the 3 SIs. Lessons learnt from the current pandemic include the need for a common online platform across the 3 SIs with regards to assessment forms, importance of sharing teaching materials between the different SIs and the need for close collaboration between parent and foster SIs with regards to balancing training requirements versus the needs posed by a pandemic situation on the healthcare structure.
Stable and Functional Anatomical Chest Wall Reconstruction Using a Novel Prosthetic Construct
Authors: Lendzion Rebecca J , Varey Alexander , Sandler Gideon
Published: June 2021

Resection of neoplastic chest wall lesions is associated with high surgical morbidity and can result in complete full thickness defects. Defects can be challenging to reconstruct and require a multidisciplinary surgical approach. The goals of chest wall resection are to optimize oncological outcomes while also minimizing functional disturbance. We report a novel technique, using a Titanium and Polymethyl-methacrylate (PMMA) construct for an antero–lateral chest wall reconstruction following resection of a locally recurrent malignant Phyllodes tumour. This approach to reconstruction provides stability, allows chest wall excursion and minimizes post-operative pain.
Gratification Disorder Associated With Perineal Irritation in Young Children: Management and Short-Term Outcome
Authors: Moktan Sherina , Karki Utkarsh , Bista Isha , Devkota Narmada
Published: June 2021

Masturbatory behaviors occur as a part of psychosexual development in young children, but if such behaviors exceed resulting in discomfort and disability, it is known as gratification disorder. Children with such genital self-stimulatory behaviors are infrequently seen and diagnosed in Asian outpatient settings, possibly due to prevalent stigma. We report the cases of 3 children of 3, 4, and 8 - year-old with the diagnosis of gratification disorder based on comprehensive history-taking, general physical examination, and neurological examination along with videotape recording of the event. Investigations such as electroencephalogram (EEG), urinary microscopic examination, and culture were also conducted in each case. Clinical history, examination, and investigations such as EEG and urinary examination were reviewed. Behavior therapy and psychoeducation were successful in alleviating the disorder and allaying parental fears of taboo in all these cases. There was significant improvement in self-genital stimulatory behavior in all 3 cases at 3 months follow-up.
Demystifying Dhat Syndrome: A Two-Session Therapy Proposal
Authors: Innamuri Raviteja , Ramaswamy Deepa
Published: June 2021

Dhat syndrome is a common semen-loss related physical and psychological distress usually reported by young males. The treatment mainly centres around nonpharmacological strategies such as psychoeducation. Most of the patients present as outpatients to alternative medicine or nonpsychiatry branches and treatment is usually not delivered. Some of the reasons may include perceived need for longer duration of sessions with the patient, available literature with complex psychiatric jargon and barriers to treatment due to stigma attached to psychiatry. This article presents a two session therapy proposal for Dhat syndrome that could be useful as a brief intervention over tele-consultations, and in consultation liaison clinics by nonpsychiatrists as well.
Mitochondrial enrichment in infertile patients: a review of different mitochondrial replacement therapies
Authors: Rodríguez-Varela Cristina , Herraiz Sonia , Labarta Elena
Published: June 2021

Poor ovarian responders exhibit a quantitative reduction in their follicular pool, and most cases are also associated with poor oocyte quality due to patient’s age, which leads to impaired in vitro fertilisation outcomes. In particular, poor oocyte quality has been related to mitochondrial dysfunction and/or low mitochondrial count as these organelles are crucial in many essential oocyte processes. Therefore, mitochondrial enrichment has been proposed as a potential therapy option in infertile patients to improve oocyte quality and subsequent in vitro fertilisation outcomes. Nowadays, different options are available for mitochondrial enrichment treatments that are encompassed in two main approaches: heterologous and autologous. In the heterologous approach, mitochondria come from an external source, which is an oocyte donor. These techniques include transferring either a portion of the donor’s oocyte cytoplasm to the recipient oocyte or nuclear material from the patient to the donor’s oocyte. In any case, this approach entails many ethical and safety concerns that mainly arise from the uncertain degree of mitochondrial heteroplasmy deriving from it. Thus the autologous approach is considered a suitable potential tool to improve oocyte quality by overcoming the heteroplasmy issue. Autologous mitochondrial transfer, however, has not yielded as many beneficial outcomes as initially expected. Proposed mitochondrial autologous sources include immature oocytes, granulosa cells, germline stem cells, and adipose-derived stem cells. Presently, it would seem that these autologous techniques do not improve clinical outcomes in human infertile patients. However, further trials still need to be performed to confirm these results. Besides these two main categories, new strategies have arisen for oocyte rejuvenation by improving patient’s own mitochondrial function and avoiding the unknown consequences of third-party genetic material. This is the case of antioxidants, which may enhance mitochondrial activity by counteracting and/or preventing oxidative stress damage. Among others, coenzyme-Q10 and melatonin have shown promising results in low-prognosis infertile patients, although further randomised clinical trials are still necessary.
A protocol for the evaluation of the process and impact of embedding formal and experiential Public and Patient Involvement training in a structured PhD programme
Authors: Foley Louise , Kiely Bridget , Croke Aisling , Larkin James , Smith Susan M , Clyne Barbara , Pierce Maria , Murphy Edel ,   on behalf of the Collaborative Doctoral Award in Multimorbidity (CDA-MM) Team
Published: June 2021

Background:

Incorporating Public and Patient Involvement (PPI) into doctoral research is valued by PhD scholars. The importance of providing early career researchers with appropriate education and training to develop skills to conduct meaningful involvement has been articulated. The Collaborative Doctoral Award in MultiMorbidity (CDA-MM) PhD programme embedded formal PPI training as a postgraduate education component. Four PhD scholars taking part in the CDA-MM established a PPI panel comprising people, and carers of people, living with multimorbidity (≥2 chronic conditions), presenting an opportuning for experiential PPI training. The proposed study aims to evaluate the process and impact of formal and experiential PPI training during a PhD programme.

Design:

Embedding PPI training in a PhD programme is a novel approach. This evaluation will include a process evaluation to provide an understanding of the workings of the PPI panel and explore the experiences of key stakeholders involved, and an impact evaluation to assess the impact of embedding PPI training in a PhD programme. This study is a longitudinal mixed-methods evaluation, conducted over 24 months. Participants include PhD scholars, PPI contributors and PhD supervisors. An independent researcher not aligned with the CDA-MM will lead the evaluation. Data collection methods include focus groups, individual interviews, an impact log and group reflections. Qualitative data will be analysed using thematic and content analysis and quantitative data will be analysed using descriptive statistics.

Discussion:

This evaluation will report the learnings from embedding formal and experiential PPI training and education across a PhD programme.
Priming with intranasal lactobacilli prevents Pseudomonas aeruginosa acute pneumonia in mice
Authors: Fangous Marie-Sarah , Gosset Philippe , Galakhoff Nicolas , Gouriou Stéphanie , Guilloux Charles-Antoine , Payan Christopher , Vallet Sophie , Héry-Arnaud Geneviève , Le Berre Rozenn
Published: June 2021

Background

Increasing resistance to antibiotics ofPseudomonas aeruginosaleads to therapeutic deadlock and alternative therapies are needed. We aimed to evaluate the effects ofLactobacillusclinical isolates in vivo,through intranasal administration on a murine model ofPseudomonas aeruginosapneumonia.

Results

We screened in vitro 50 pulmonary clinical isolates ofLactobacillusfor their ability to decrease the synthesis of two QS dependent-virulence factors (elastase and pyocyanin) produced byPseudomonas aeruginosastrain PAO1.

Two blends of threeLactobacillusisolates were then tested in vivo: one with highly effective anti-PAO1 virulence factors properties (blend named L.rff forL. rhamnosus, twoL. fermentumstrains), and the second with no properties (blend named L.psb, forL. paracasei, L. salivariusandL. brevis). Each blend was administered intranasally to mice 18 h prior to PAO1 pulmonary infection. Animal survival, bacterial loads, cytological analysis, and cytokines secretion in the lungs were evaluated at 6 or 24 h post infection with PAO1.

Intranasal priming with both lactobacilli blends significantly improved 7-day mice survival from 12% for the control PAO1 group to 71 and 100% for the two groups receiving L.rff and L.psb respectively. No mortality was observed for both control groups receiving either L.rff or L.psb. Additionally, the PAO1 lung clearance was significantly enhanced at 24 h. A 2-log and 4-log reduction was observed in the L.rff + PAO1 and L.psb + PAO1 groups respectively, compared to the control PAO1 group. Significant reductions in neutrophil recruitment and proinflammatory cytokine and chemokine secretion were observed after lactobacilli administration compared to saline solution, whereas IL-10 production was increased.

Conclusions

These results demonstrate that intranasal priming with lactobacilli acts as a prophylaxis, and avoids fatal complications caused byPseudomonas aeruginosapneumonia in mice. These results were independent of in vitro anti-Pseudomonas aeruginosaactivity on QS-dependent virulence factors. Further experiments are required to identify the immune mechanism before initiating clinical trials.
Effects of intraoperative lung-protective ventilation on clinical outcomes in patients with traumatic brain injury: a randomized controlled trial
Authors: Jiang Lulu , Wu Yujuan , Zhang Yang , Lu Dahao , Yan Keshi , Gao Ju
Published: June 2021

Background

Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.

Methods

Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10 mL/kg only]; Group B, small VT (8 mL/kg) + positive end-expiratory pressure (PEEP) (5 cmH2O); and Group C, small VT (8 mL/kg) + PEEP (5 cmH2O) + recruitment maneuvers (RMs). The primary outcome was the incidence of total postoperative pulmonary complications; Secondary outcomes were intraoperative respiratory mechanics parameters and serum levels of brain injury markers, and the incidence of each postoperative pulmonary and neurological complication.

Results

Seventy-nine patients completed the final analysis. The intraoperative PaO2 and dynamic pulmonary compliance of Groups B and C were higher than those of Group A (P = 0.028; P = 0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P = 0.004; P = 0.005). Compared to Group A, Groups B and C had decreased 30-day postoperative incidences of total pulmonary complications, hypoxemia, pulmonary infection, and atelectasis (84.0 % vs. 57.1 % vs. 53.8 %, P = 0.047; 52.0 % vs. 14.3 % vs. 19.2 %, P = 0.005; 84.0 % vs. 50.0 % vs. 42.3 %, P = 0.006; 24.0 % vs. 3.6 % vs. 0.0 %, P = 0.004). Moreover, intraoperative hypotension was more frequent in Group C than in Groups A and B (P = 0.007). At the end of surgery, the serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in Groups A and C (P = 0.002; P < 0.001). The postoperative incidences of neurological complications among the three groups were comparable.

Conclusions

Continuous intraoperative administration of small VT + PEEP is beneficial to TBI patients. Additional RMs can be performed with caution to prevent disturbances in the stability of cerebral hemodynamics.

Trial registration

Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge
Authors: Jachetti A. , Colombo G. , Brignolo-Ottolini B. , Franchi J. , Solbiati M. , Pecorino Meli M. , Bosco P. , Costantino G.
Published: June 2021

Background

In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic.

Methods

We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics.

Results

The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed.

Conclusions

We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.
Long-term complications after stent assist coiling dependent on clopidogrel response
Authors: Shoda Kenji , Enomoto Yukiko , Egashira Yusuke , Kinoshita Takamasa , Mizutani Daisuke , Iwama Toru
Published: June 2021

Background

Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications.

Methods

Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter).

Results

From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p <  0.01). Thrombotic events were not significantly different between the two groups.

Conclusion

Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.
Effects of immediate versus delayed frozen embryo transfer in high responder patients undergoing freeze-all cycles
Authors: Zuo Na , Gao Yingzhuo , Zhang Ningning , Li Da , Wang Xiuxia
Published: June 2021

Background

Frozen embryo transfer (FET) can greatly improve the pregnancy outcomes for high responder patients. However, it is not known whether the timing of FET is a risk factor on pregnancy outcomes in high responder patients undergoing freeze-all cycles.

Methods

A retrospective cohort study to compare the pregnancy outcomes of the immediate and delayed FET groups in high responder patients undergoing freeze-all cycles. The two groups were defined as that FET took place either within the first menstrual cycle following oocyte retrieval or afterwards. Propensity score matching was used to make the potential risk factors of the two groups comparable. Multivariable regression analysis was used to study the effect of the timing of FET on pregnancy outcomes in the entire cohort and propensity score-matched cohort, even in different controlled ovarian hyperstimulation protocol cohorts as subgroup analysis.

Results

We obtained 1130 patients in immediate FET group and 998 patients in delayed FET group, and the average age of the two groups were 30.30 and 30.63. We showed that the immediate FET group were equivalent to delayed FET group in the entire cohort [clinical pregnancy rate (CPR), 61.0% versus 63.4%, adjusted odd ratio (OR), 0.939, 95% confidence interval (CI), 0.781–1.129; spontaneous abortion rate (SAR), 10.1% versus 12.6%, adjusted OR, 0.831, 95% Cl (0.628–1.098); live birth rate (LBR), 49.9% versus 49.2%, adjusted OR, 1.056, 95% Cl (0.883–1.263)]. The same results were obtained by χ2 test in the propensity score-matched cohort (CPR, 60.5% versus 63.5%; SAR, 11.6% versus 12.3%; LBR, 48% versus 49.3%) (P > 0.05). Subgroup analysis indicated that pregnancy outcomes of immediate FET were no difference to delayed FET in gonadotropin-releasing hormone agonist (GnRH-a) protocol (P > 0.05). The SAR of the immediate FET group were lower than that of the delayed FET group in GnRH antagonist protocol (adjusted OR, 0.645, 95% CI, 0.430–0.966) (P < 0.05), no differences were observed in CPR and LBR (P > 0.05).

Conclusions

The pregnancy outcomes of immediate FET were no difference to delayed FET in high responder population undergoing freeze-all cycles.
Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake
Authors: Dong Jinju , Liu Shouyan , Wang Lingyun , Zhou Xingjian , Zhou Qinghong , Liu Congli , Zhu Jingrui , Yuan Weilan , Xu Wang-yang , Deng Jie
Published: June 2021

Background

Iodine plays an important role in pregnancy. How to maintain adequate iodine intake amongst pregnant women in each trimester of pregnancy to prevent adverse birth outcomes in central China is a challenge for clinical practice.

Methods

870 pregnant women and their infants were enrolled in the study. Urinary iodine concentration (UIC) was measured using an inductively coupled plasma mass spectrometry (ICP-MS). Maternal and newborn information were obtained during follow-up. Multinomial logistic regression models were established.

Results

Median UIC of pregnant women was 172 ± 135 μg/L which is currently considered to be sufficient. Multivitamin supplements containing iodine, iodized salt intake and frequent milk intake were significantly associated with higher UIC. Multivariate logistic regression analysis showed that multivitamin supplements containing iodine and milk consumption were risk factors for more than adequate iodine (UIC ≥ 250 μg/L). Iodine-rich diet was significantly related to heavier birthweight, larger head circumference and longer femur length of the newborns while more than adequate iodine intake (UIC ≥ 250 μg/L) was a risk factor for macrosomia. Logistic regression models based on potential risk factors involving iodine containing supplements and iodine-rich diet were established to predict and screen pregnant women with high risk of more than adequate iodine intake among local pregnant women in different trimesters and guide them to supplement iodine reasonably to prevent the risk.

Conclusions

Multivitamin supplements containing iodine and milk consumption were risk factors for maternal UIC ≥ 250 μg/L which was a risk factor for macrosomia. Iodine monitoring models were established to provide guidance for pregnant women to reduce the risk of more than adequate iodine intake, thereby contributing to reduce the risk of having a macrosomia.
Long non-coding RNA BRE-AS1 inhibits the proliferation, migration, and invasion of cancer cells in triple-negative breast cancer and predicts patients’ survival by downregulating miR-21
Authors: Gao Jianchao , Wang Sisi , Zhang Zhisheng , Li Jun
Published: June 2021

Background

BRE-AS1 is a recently identified tumor suppressor in non-small cell lung cancer. It role in other human diseases remains elusive.

Methods

Differential expression of BRE-AS1 in with triple-negative breast cancer (TNBC) patients (n = 74, patient group) and healthy volunteers (n = 58, control group) was studied with RT-qPCR. The direct interaction between BRE-AS1 and premature microRNA-21 (miR-21) was assessed by RNA pull-down assay. The interactions among BRE-AS1, miR-21 and PTEN were evaluated by overexpression assays. CCK-8 assay and Transwell assay were used to evaluate cell behaviors.

Results

BRE-AS1 was downregulated in TNBC, while miR-21 was highly expressed in TNBC. Low expression levels of lncRNA BRE-AS1 and high expression levels of miR-21 were significantly correlated with unfavorable survival outcomes. BRE-AS1 and miRNA-21 were inversely correlated across TNBC samples, not control samples. BRE-AS1 decreased miR-21 expression and increased PTEN expression while miR-21showed no role in BRE-AS1 expression. RNA pull-down assay illustrated that BRE-AS1 may sponge premature miR-21 to suppress it maturation. Overexpression of BRE-AS1 decreased cell behaviors, while overexpression of miR-21 promoted cell behaviors. MiR-21 suppressed the role of BRE-AS1 in cancer cell behaviors.

Conclusion

Therefore, BRE-AS1 may inhibit TNBC by downregulating miR-21.
“Inequalities in access to medicines for diabetes and hypertension across the capitals in different regions of Brazil: a population-based study”
Authors: Miranda Vanessa Iribarrem Avena , Schäfer Antônio Augusto , Tomasi Cristiane Damiani , Soratto Jacks , de Oliveira Meller Fernanda , Silveira Marysabel Pinto Telis
Published: June 2021

Background

To guarantee prevention and adequate treatment, as required for the population to have access to health services and technologies, including medicines. The purpose of this study is to analyse the economic and regional inequalities in access to medicines for diabetes and hypertension among the adult population in Brazil.

Methods

This was a cross-sectional study with adults aged 18 and over from the VIGITEL study conducted in 2019 in all Brazilian regions. Non-access to antidiabetic and antihypertensive drugs was assessed according to formal education and housing macro-region. The slope index of inequality (SII) was used to analyse absolute inequalities.

Results

The total number of individuals interviewed was 52,443. Approximately 10.0% of the people with diabetes and/or hypertension reported not having access to drug treatment. The major means for having access to antihypertensive drugs, in all regions, was private pharmacies; for antidiabetics, in the North region, people had greater access through private pharmacies, while in the Northeast, Southeast and South, they had greater access through the public sector. Inequalities were found in the lack of access to medicines according to the region of residence, especially in the North region.

Conclusion

The lack of access to medicines showed regional disparities, particularly in the most economically vulnerable regions.
SARS-Co-V2 infection in never, former, and current tobacco/nicotine users: a cohort study of 4040 Egyptian healthcare workers
Authors: Mostafa Aya , El-Sayed Manal H. , El-Meteini Mahmoud , Saleh Ayman , Omar Ashraf , Mansour Ossama , Girgis Samia , Hafez Hala , Kandil Sahar
Published: June 2021

Background

Smoking negatively impacts COVID-19 severity and adverse outcomes. Evidence on whether smoking is associated with SARS-Co-V2 infection and having a positive test is scarce, particularly from low-and middle-income countries, where most of the world’s billion smokers live. The inconsistency in relevant findings calls for study designs and analyses to account for possible confounders including background characteristics and pre-existing co-morbidities, to disentangle the specific effect of smoking. In healthcare workers (HCWs) the frequency of exposure to COVID-19 cases adds another layer of risk that was not factored in previous studies. We examined the association of HCWs’ tobacco/nicotine use (never, former, and current use) with having a positive SARS-Co-V2 test result and symptoms suggestive of infection, accounting for demographics, exposures, and co-morbidities.

Methods

A prospective cohort study of 4040 healthcare workers with baseline and follow-up screening took place during April–June 2020 in 12 healthcare facilities in Cairo, Egypt. Data on demographics, tobacco/nicotine use (manufactured or roll-your-own cigarettes, waterpipe tobacco, and electronic devices), co-morbidities, symptoms, exposures, and SARS-Co-V2 investigations were analyzed. Multinomial and multivariable logistic regression analyses were performed.

Results

Overall, 270/4040 (6.7, 95%CI: 5.9–7.5) had positive SARS-CoV-2 tests, 479 (11.9%) were current and 79 (2.0%) were former tobacco/nicotine users. The proportion of positive tests was 7.0% (243/3482, 95%CI: 6.1–7.8) among never, 5.1% (4/79, 95%CI: 0.1–10.0) among former, and 4.8% (23/479, 95%CI: 2.9–6.7) among current users. HCWs’ SARS-CoV-2 test results did not vary significantly by single/multiple or daily/non-daily tobacco/nicotine use. Compared to never users, former users were more likely to self-report a pre-existing medical condition (ORadjusted1.87, 95%CI: 1.05–3.33, p = 0.033), and to experience symptoms suggestive of COVID-19 (ORadjusted1.76, 95%CI: 1.07–2.90, p = 0.027). After adjustment, former (ORadjusted0.45, 95%CI: 0.11–1.89, p = 0.273) and current (ORadjusted0.65, 95%CI: 0.38–1.09, p = 0.101) tobacco/nicotine use was not associated with HCWs’ SARS-CoV-2 positive test results.

Conclusions

This is the first report on this association from low- and middle-income countries with high tobacco/nicotine use prevalence. In this HCW cohort, having a positive SARS-CoV-2 test was not associated with tobacco/nicotine use after accounting for demographics, exposures, and co-morbidities. Additional population-based studies could use such preliminary evidence to investigate this controversial association.