bluuebunny/crossref_metadata_2025 huggingface dataset:
REFLECT: prospective multicenter non-interventional study evaluating the effectiveness and safety of Sandoz rituximab (SDZ-RTX; Rixathon®) in combination with CHOP for the treatment of patients with previously untreated CD20-positive diffuse large B-cell lymphoma
Authors: Welslau Manfred , Kubuschok Boris , Topaly Julian , Otremba Burkhard , Wolff Thomas , Bryn Galyna
Published: July 2023

Background:

REFLECT is the first prospective study of Sandoz biosimilar rituximab (SDZ-RTX) in patients with diffuse large B-cell lymphoma (DLBCL).

Objective:

To evaluate the 2-year effectiveness and safety of SDZ-RTX as first-line treatment for DLBCL.

Design:

Real-world, multicenter, open-label, single-arm, non-interventional, post-approval study of SDZ-RTX in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with treatment-naïve CD20‑positive DLBCL.

Methods:

Treatment-naïve, CD20-positive adult patients (⩾18 years) with DLBCL eligible for therapy with R-CHOP were treated with SDZ-RTX-CHOP every 2 or 3 weeks for 6–8 cycles. The effectiveness of SDZ-RTX was measured by the complete response (CR) rate at the end of R-CHOP treatment, as assessed by the treating physician. Progression-free survival (PFS) was assessed at 24 months.

Results:

A total of 169 patients [52.1% female, median (range) age 70 (24−94) years] with DLBCL were included in the full analysis set. At baseline, 19.5% and 24.3% of patients had Ann Arbor disease stage III or IV, respectively, and most patients (80.5%) had Eastern Cooperative Oncology Group Performance Status of 0 or 1. A total of 100 (59.2%) patients completed the 24-month observation period. In total, 110 [65.1%; 95% confidence interval (CI): 57.4–72.3] patients achieved CR as best response and 50 (29.6%; 95% CI: 22.8–37.1) patients achieved partial response. Overall best response rate was 94.7% (95% CI: 90.1–97.5). One-year PFS was 84.9% (95% CI: 78.2–89.6), while 2-year PFS was 78.5% (95% CI: 70.9–84.4); median PFS was not reached within the observational period. A total of 143 (84.6%) patients experienced ⩾1 adverse event, 53 (31.4%) of which were suspected to be related to study drug.

Conclusion:

This real-world, 2-year study reconfirms that first-line treatment of CD20-positive DLBCL with R-CHOP using SDZ-RTX is effective and well tolerated.

Registration:

N/A
Tuberculosis-related knowledge, behaviors, stigmatizing attitude, and discrimination among refugees, migrants, and the general population in Jordan
Authors: Alsoukhni Majd A , Khader Yousef , Abaza Hiba , Wilson Nevin , Satyanarayana Srinath
Published: July 2023

Objective:

A better understanding of tuberculosis-related knowledge, attitude, practices in the community, and other issues can help in implementing evidence-driven activities to control tuberculosis in Jordan. This study aimed to assess tuberculosis-related knowledge, attitude, and behaviors among refugees, migrants, and general population, and assess their stigmatizing and discrimination attitudes toward tuberculosis patients, social behavior toward tuberculosis, and healthcare-seeking behaviors.

Methods:

A cross-sectional study was conducted among Jordanians, Syrian refugees, and migrants living in four governorates including Amman, Zarqa, Mafraq, and Irbid during the study period of June to September 2021. A structured questionnaire was developed to collect data via face-to-face interviews. Descriptive statistics, chi-square test, and general linear model procedure were used to analyze data.

Results:

A total of 2302 (27.7% Jordanians, 25.7% urban refugees, 22.1% camp refugees, and 24.5% migrants) participated in this study. Of the total, 90.1% of participants reported that they have heard of tuberculosis. However, 88.9% of Jordanians, 92.8% of urban refugees, 92% of camp refugees, and 90.5% of migrants had low level of tuberculosis-related knowledge. About 62.0% of urban refugees, 54.8% of Jordanians, 43.0% of camp refugees, and 55.4% of migrants had moderate to high stigmatizing attitude toward tuberculosis patients. About 15.1% of Jordanians, 10.6% of urban refugees, 23.7% of camp refugees, and 16.1% of migrants had moderate to high level of discriminating attitude toward tuberculosis patients. Camp refugees had a significantly higher level of discriminating attitude toward tuberculosis patients than the other groups.

Conclusion:

This study identified significant gaps in tuberculosis-related knowledge among the targeted groups. Moderate to high level of stigmatizing attitude was reported by a considerable proportion of the study participants. This suggests a need for public health education programs to educate people on tuberculosis causes, signs, symptoms, mode of transmission, and address related stigma, especially among the most disadvantaged and affected communities in Jordan.
“Our Pain Makes Us Family”: March For Our Lives and the constitutive role of gun violence trauma in youth publics
Authors: Jensen Kelly
Published: July 2023

This essay examines the dynamics of diverse youth public formation through analysis of the 20 student speeches delivered at the 2018 March For Our Lives rally. I argue that the collective identification as youth survivors of gun violence trauma functions to constitute this diverse youth public. I trace how the speakers’ shared gun violence trauma enabled them to form a racially integrated coalition while not discrediting their differently positioned identities and disparate gun violence experiences. In doing so, I forward a conceptualization of how youth publics negotiate gun violence trauma, asserting that youth publics are characterized by both present constraints and a future-oriented agency, members of youth publics must account for tensions across racial differences in their gun violence prevention advocacy, and gun violence trauma functions as a shared basis for political participation. My analysis of the students’ gun violence prevention discourse complicates this framework to reveal how gun violence trauma as a shared basis for youth public membership threatens their source of empowerment: ownership over their futures. Contributing to scholarship on the formation of publics, this essay demonstrates the significance of youth publics at the intersections of race, trauma, and gun violence.
Multi-Phenotypic Breast Cancer Post-Radiotherapy for Hodgkin Lymphoma: A Case of Secondary Malignancy
Authors: White Donnell , Sadough Shahmirzadi Maryam , Boulmay Brian
Published: July 2023

Morbidity and mortality associated with radiation-induced secondary malignancies (RISMs) have shifted treatment paradigms to minimize or eliminate radiation from treatment regimens. In this case, a 48-year-old woman was diagnosed with Hodgkin lymphoma (HL) and treated with radiotherapy in 2000. In 2018, she was diagnosed with ductal carcinoma in situ (DCIS) of the right breast and treated with a mastectomy. Soon after, she developed triple-negative invasive ductal carcinoma (IDC) in her reconstructed breast. The patient underwent a left lumpectomy, and pathology showed ER–/PR–/HER2+ IDC. This patient’s multi-phenotypic DCIS and IDC presentation are suspected to be RISM due to her previous HL treatment regimen.
‘Sick Guardians of Public Health’: A Qualitative Inquiry into Caste, Occupation and Health among Sanitation Workers of Solid Waste Management, Mumbai Municipal Corporation, India, from a Social Epidemiology Lens
Authors: Kadam Deeptesh H. , Gawde Nilesh , Darokar Shaileshkumar Sahebrao
Published: July 2023

Research studies conducted worldwide reveal the disadvantaged health conditions among sanitation workers. Higher disease burden is prominent among Mumbai municipal corporation sanitation workers who mainly belong to Scheduled Castes, the lowest point in the hierarchical social structure. Sanitary work is affixed to these caste groups. This study deciphered the mechanisms and pathways where caste, occupation and social environment affect and modulate workers’ health, imbibing the eco-social approach to health. We analysed in-depth interviews of 15 sanitation workers from three sanitation posts, one from three wards. Five volunteers with a contract-based non-governmental organisation and two supervisors as key informants were included in the sample ( N = 22). The findings explain mechanisms and pathways to embodiment through eco-social approach where the biology of workers is shaped by historical life trajectories of their castes and decent-based occupation, the ecology and the susceptibilities, cumulating and impacting their health and overall well-being.
A Biliary Stent in the Gallbladder Lumen: Misplacement or Migration?
Authors: Bhoil Rohit , Jhobta Anupam , Rana Nidhi
Published: July 2023

This case report describes a patient who presented with cholangitis gallbladder sludge, choledocolithiasis, and biliary dilatation. The patient’s magnetic resonance cholangiopancreatography demonstrated that the cystic duct had low and medial insertion on common bile duct. However, the patient presented with abdominal discomfort after the completion of an endoscopic retrograde cholangiopancreatography stenting. Subsequent imaging revealed the proximal stent lying in the gallbladder lumen. The case highlights the importance of having the endoscopists recheck and confirm the positioning of the stent, post-procedure. In addition, it is important to raise awareness among physicians/gastroenterologists regarding the possibility of presence of biliary stent in gallbladder lumen, especially in those patients with a history of endoscopic biliary intervention(s).
Melanoma cells induce dedifferentiation and metabolic changes in adipocytes present in the tumor niche
Authors: Simiczyjew Aleksandra , Wądzyńska Justyna , Pietraszek-Gremplewicz Katarzyna , Kot Magdalena , Ziętek Marcin , Matkowski Rafał , Nowak Dorota
Published: July 2023

Background

One of the factors that affect the progression of melanoma is the tumor microenvironment, which consists of cellular elements, extracellular matrix, acidification, and a hypoxic state. Adipocytes are one of the types of cell present in the niche and are localized in the deepest layer of the skin. However, the relationship between fat cells and melanoma remains unclear.

Methods

We assessed the influence of melanoma cells on adipocytes using an indirect coculture system. We estimated the level of cancer-associated adipocyte (CAA) markers through quantitative PCR analysis. The fibroblastic phenotype of CAAs was confirmed by cell staining and western blotting analysis. The lipid content was estimated by lipid detection in CAAs using LipidSpot and by quantitative analysis using Oil Red O. The expression of proteins involved in lipid synthesis, delipidation, and metabolic processes were assessed through quantitative PCR or western blotting analysis. Lactate secretion was established using a Lactate-Glo™ assay. Proteins secreted by CAAs were identified in cytokine and angiogenesis arrays. The proliferation of melanoma cells cocultured with CAAs was assessed using an XTT proliferation assay. Statistical analysis was performed using a one-way ANOVA followed by Tukey’s test in GraphPad Prism 7 software.

Results

Obtained CAAs were identified by decreased levels of leptin, adiponectin, resistin, and FABP4. Adipocytes cocultured with melanoma presented fibroblastic features, such as a similar proteolytic pattern to that of 3T3L1 fibroblasts and increased levels of vimentin and TGFβRIII. Melanoma cells led to a reduction of lipid content in CAAs, possibly by downregulation of lipid synthesis pathways (lower FADS, SC4MOL, FASN) or enhancement of lipolysis (higher level of phosphorylation of ERK and STAT3). Adipocytes cocultured with melanoma cells secreted higher IL6 and SerpinE1 levels and produced less CCL2, CXCL1, and angiogenic molecules. CAAs also showed metabolic changes comprising the increased secretion of lactate and enhanced production of glucose, lactate, and ion transporters. In addition, changes in adipocytes observed following melanoma coculture resulted in a higher proliferation rate of cancer cells.

Conclusions

Melanoma cells led to decreased lipid content in adipocytes, which might be related to enhanced delipidation or reduction of lipid synthesis. Fibroblast-like CAAs showed metabolic changes that may be the reason for accelerated proliferation of melanoma cells.
Study of the gut microbiome in Egyptian patients with Parkinson’s Disease
Authors: Mehanna Mohammad , AbuRaya Suzan , Ahmed Shwikar Mahmoud , Ashmawy Ghada , Ibrahim Ahmed , AbdelKhaliq Essameldin
Published: July 2023

Background

Recently, an important relationship between Parkinson’s disease and the gut microbiota, through the brain-gut axis interactions, has been established. Previous studies have declared that alterations in the gut microbiota have a great impact on the pathogenesis and clinical picture of Parkinson’s disease (PD). The present study aimed to identify the gut microbiome that is likely related to Parkinson’s disease as well as their possible relation to clinical phenotypes.

Methods

Thirty patients with Parkinson’s disease, who presented to the Parkinson’s disease Neurology Clinic of Alexandria University Hospital were enrolled in our study. A cross-matching control group of 35 healthy subjects of similar age and sex were included. Stool specimens were taken from each. Quantitative SYBR Green Real-Time PCR was done for the identification and quantitation of selected bacterial phyla, genera and/or species.

Results

There was a significant increase in Bacteroides and a significant decrease of Firmicutes and Firmicutes / Bacteroidetes ratio and Bifidobacteria in PD patients. Although Prevotella was decreased among PD patients relative to the healthy control, the difference was not statistically significant. Comparing the PD clinical phenotypes with the control group, the Mixed phenotype had significantly higher Bacteroides, Tremors predominant had lower Firmicutes and Firmicutes / Bacteroidetes ratio, and both tremors and postural instability and gait disability (PIGD) phenotypes had lower Bifidobacteria. However, there was no statistically significant difference between these phenotypes. Furthermore, when comparing tremors and non-tremors predominant phenotypes; Lactobacilli showed a significant decrease in non-tremors predominant phenotypes.

Conclusions

The current study showed evidence of changes in the gut microbiome of Parkinson’s disease patients compared to the healthy controls. These observations may highlight the importance of the identification of microbiome and specific bacterial changes that can be targeted for the treatment of Parkinson’s disease.
Propranolol restores susceptibility of XDR Gram-negative pathogens to meropenem and Meropenem combination has been evaluated with either tigecycline or amikacin
Authors: Mabrouk Samar S. , Abdellatif Ghada R. , Zaid Ahmed S. Abu , Aboshanab Khaled M.
Published: July 2023

Background

Infection with extensive-drug-resistant (XDR) carbapenem-resistant (CR) Gram-negative bacteria (GNB) are viewed as a serious threat to human health because of the limited therapeutic options. This imposes the urgent need to find agents that could be used as adjuvants or combined with carbapenems to enhance or restore the susceptibility of XDR CR- GNB. Therefore, this study aimed to examine the effect of propranolol (PR) in combination with Meropenem (MEM) on the susceptibility profile of XDR CR-GNB recovered from severely infected patients as well as to evaluate combining MEM with either tigecycline (TGC) or amikacin (AK).

Methods

A total of 59 non-duplicate CR- GNB were investigated for carbapenemase production by the major phenotypic methods. Molecular identification of five major carbapenemase-coding genes was carried out using polymerase chain reactions (PCR). Antimicrobial susceptibility tests were carried out using standard methods. Phenotypic and genotypic relatedness was carried out using the heatmap and ERIC PCR analysis. PR, 0.5 -1 mg/mL against the resulting non-clonal XDR CR-GNB pathogens were evaluated by calculating the MIC decrease factor (MDF). A combination of MEM with either AK or TGC was performed using the checkerboard assay.

Results

A total of 21 (35.6%) and 38 (64.4%) CR-GNB isolates were identified as enterobacterial isolates (including 16 (27.1%) Klebsiella Pneumoniae and 5 (8.5%) Escherichia coli) and non-fermentative bacilli (including, 23 (39%), Acinetobacter baumannii, and 15 (25.4%) Pseudomonas aeruginosa). The heatmap and ERIC PCR analysis resulted in non-clonal 28 XDR CR isolates. PR, at a concentration of 0.5 mg /ml, decreased MICs values of the tested XDR CR isolates (28; 100%) and restored susceptibility of only 4 (14.3%) isolates. However, PR (1 mg/mL) when combined with MEM has completely (28; 100%) restored the susceptibility of the tested XDR CR- GNB to MEM. The MEM + AK and MEM + TGC combination showed mostly additive effects (92.8% and 71.4%, respectively).

Conclusion

PR at a concentration of 1 mg/mL restored the susceptibility of XDR CR- GNB to MEM which is considered a promising result that should be clinically investigated to reveal its suitability for clinical use in patients suffering from these life-threatening pathogens.
Multi-omics quantitative data of tomato fruit unveils regulation modes of least variable metabolites
Authors: Moing Annick , Berton Thierry , Roch Léa , Diarrassouba Salimata , Bernillon Stéphane , Arrivault Stéphanie , Deborde Catherine , Maucourt Mickaël , Cabasson Cécile , Bénard Camille , Prigent Sylvain , Jacob Daniel , Gibon Yves , Lemaire-Chamley Martine
Published: July 2023

Background

The composition of ripe fruits depends on various metabolites which content evolves greatly throughout fruit development and may be influenced by the environment. The corresponding metabolism regulations have been widely described in tomato during fruit growth and ripening. However, the regulation of other metabolites that do not show large changes in content have scarcely been studied.

Results

We analysed the metabolites of tomato fruits collected on different trusses during fruit development, using complementary analytical strategies. We identified the 22 least variable metabolites, based on their coefficients of variation. We first verified that they had a limited functional link with the least variable proteins and transcripts. We then posited that metabolite contents could be stabilized through complex regulations and combined their data with the quantitative proteome or transcriptome data, using sparse partial-least-square analyses. This showed shared regulations between several metabolites, which interestingly remained linked to early fruit development. We also examined regulations in specific metabolites using correlations with individual proteins and transcripts, which revealed that a stable metabolite does not always correlate with proteins and transcripts of its known related pathways.

Conclusions

The regulation of the least variable metabolites was then interpreted regarding their roles as hubs in metabolic pathways or as signalling molecules.
Comprehensive transcriptomic analysis of three varieties with different brown planthopper-resistance identifies leaf sheath lncRNAs in rice
Authors: Liu Kai , Ma Xiaozhi , Zhao Luyao , Lai Xiaofeng , Chen Jie , Lang Xingxuan , Han Qunxin , Wan Xiaorong , Li Chunmei
Published: July 2023

Background

Long non-coding RNAs (lncRNAs) have been brought great attention for their crucial roles in diverse biological processes. However, systematic identification of lncRNAs associated with specialized rice pest, brown planthopper (BPH), defense in rice remains unexplored.

Results

In this study, a genome-wide high throughput sequencing analysis was performed using leaf sheaths of susceptible rice Taichung Native 1 (TN1) and resistant rice IR36 and R476 with and without BPH feeding. A total of 2283 lncRNAs were identified, of which 649 lncRNAs were differentially expressed. During BPH infestation, 84 (120 in total), 52 (70 in total) and 63 (94 in total) of differentially expressed lncRNAs were found only in TN1, IR36 and R476, respectively. Through analyzing their cis-, trans-, and target mimic-activities, not only the lncRNAs targeting resistance genes (NBS-LRR and RLKs) and transcription factors, but also the lncRNAs acting as the targets of the well-studied stress-related miRNAs (miR2118, miR528, and miR1320) in each variety were identified. Before the BPH feeding, 238 and 312 lncRNAs were found to be differentially expressed in TN1 vs. IR36 and TN1 vs. R476, respectively. Among their putative targets, the plant-pathogen interaction pathway was significantly enriched. It is speculated that the resistant rice was in a priming state by the regulation of lncRNAs. Furthermore, the lncRNAs extensively involved in response to BPH feeding were identified by Weighted Gene Co-expression Network Analysis (WGCNA), and the possible regulation networks of the key lncRNAs were constructed. These lncRNAs regulate different pathways that contribute to the basal defense and specific resistance of rice to the BPH.

Conclusion

In summary, we identified the specific lncRNAs targeting the well-studied stress-related miRNAs, resistance genes, and transcription factors in each variety during BPH infestation. Additionally, the possible regulating network of the lncRNAs extensively responding to BPH feeding revealed by WGCNA were constructed. These findings will provide further understanding of the regulatory roles of lncRNAs in BPH defense, and lay a foundation for functional research on the candidate lncRNAs.
Substitution of self-reported measures for objectively assessed grip strength and slow walk in the Physical Frailty Phenotype: ramifications for validity
Authors: Bandeen-Roche Karen , Tian Jing , Buta Brian , Walston Jeremy , Xue Qian-Li
Published: July 2023

Background

Frailty assessment promises to identify older adults at risk for adverse consequences following stressors and target interventions to improve health outcomes. The Physical Frailty Phenotype (PFP) is a widely-studied, well validated assessment but incorporates performance-based slow walk and grip strength criteria that challenge its use in some clinical settings. Variants replacing performance-based elements with self-reported proxies have been proposed. Our study evaluated whether commonly available disability self-reports could be substituted for the performance-based criteria in the PFP while still identifying as “frail” the same subpopulations of individuals.

Methods

Parallel analyses were conducted in 3393 female and 2495 male Cardiovascular Health Study, Round 2 participants assessed in 1989–90. Candidate self-reported proxies for the phenotype’s “slowness” and “weakness” criteria were evaluated for comparable prevalence and agreement by mode of measurement. For best-performing candidates: Frailty status (3 + positive criteria out of 5) was compared for prevalence and agreement between the PFP and mostly self-reported versions. Personal characteristics were compared between those adjudicated as frail by (a) only a self-reported version; (b) only the PFP; (c) both, using bivariable analyses and multinomial logistic regression.

Results

Self-reported difficulty walking ½ mile was selected as a proxy for the phenotype’s slowness criterion. Two self-reported weakness proxies were examined: difficulty transferring from a bed or chair or gripping with hands, and difficulty as just defined or in lifting a 10-pound bag. Prevalences matched to within 4% between self-reported and performance-based criteria in the whole sample, but in all cases the self-reported prevalence for women exceeded that for men by 11% or more. Cross-modal agreement was moderate, with by-criterion and frailty-wide Kappa statistics of 0.55–0.60 in all cases. Frail subgroups (a), (b), (c) were independently discriminated (p < 0.05) by race, BMI, and depression in women; by age in men; and by self-reported health for both.

Conclusions

Commonly used self-reported disability items cannot be assumed to stand in for performance-based criteria in the PFP. We found subpopulations identified as frail by resultant phenotypes versus the original phenotype to systematically differ. Work to develop self-reported proxies that more closely replicate their objective phenotypic counterparts than standard disability self-reports is needed.
Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies
Authors: Jung Yu-Seon , Suh David , Kim Eunyoung , Park Hee-Deok , Suh Dong-Churl , Jung Sun-Young
Published: July 2023

Background

Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case–control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to examine the consistency of the associations and the transient effects of the medications on FRIs.

Methods

This study was conducted using a national claims database (2002–2015) in Korea. Older adults (≥ 65 years) who had their first FRI between 2007 and 2015 were matched with non-cases in 1:2 ratio. Drug exposure was examined for 60 days prior to the date of the first FRI (index date) in the case–control design. The hazard period (1–60 days) and two control periods (121–180 and 181–240 days prior to the index date) were investigated in the case-crossover design. The risk of FRIs with 32 medications was examined using conditional logistic regression after adjusting for other medications that were significant in the univariate analysis. In the case-crossover study, the same conditional model was applied.

Results

In the case–control design, the five medications associated with the highest risk of FRIs were muscle relaxants (adjusted odd ratio(AOR) = 1.35, 95% confidence interval (CI) = 1.31–1.39), anti-Parkinson agents (AOR = 1.30, 95%CI = 1.19–1.40), opioids (AOR = 1.23, 95%CI = 1.19–1.27), antiepileptics (AOR = 1.19, 95%CI = 1.12–1.26), and antipsychotics (AOR = 1.16, 95%CI = 1.06–1.27). In the case-crossover design, the five medications associated with the highest risk of FRIs were angiotensin II antagonists (AOR = 1.87, 95%CI = 1.77–1.97), antipsychotics (AOR = 1.63, 95%CI = 1.42–1.83), anti-Parkinson agents (AOR = 1.58, 95%CI = 1.32–1.85), muscle relaxants (AOR = 1.42, 95%CI = 1.35–1.48), and opioids (AOR = 1.35, 95%CI = 1.30–1.39).

Conclusions

Anti-Parkinson agents, opioids, antiepileptics, antipsychotics, antidepressants, hypnotics and sedatives, anxiolytics, muscle relaxants, and NSAIDs/antirheumatic agents increased the risk of FRIs in both designs among older adults. Medications with a significant risk only in the case-crossover analysis, such as antithrombotic agents, calcium channel blockers, angiotensin II antagonists, lipid modifying agents, and benign prostatic hypertrophy agents, may have transient effects on FRIs at the time of initiation. Corticosteroids, which were only associated with risk of FRIs in the case–control analysis, had more of cumulative than transient effects on FRIs.
Comparison of placenta consumers’ and non-consumers’ postpartum depression screening results using EPDS in US community birth settings (n=6038): a propensity score analysis
Authors: Benyshek Daniel C. , Bovbjerg Marit L. , Cheyney Melissa
Published: July 2023

Background

Preventing postpartum depression (PPD) is the most common self-reported motivation for human maternal placentophagy, yet very little systematic research has assessed mental health following placenta consumption. Our aim was to compare PPD screening scores of placenta consumers and non-consumers in a community birth setting, using propensity score matching to address anticipated extensive confounding.

Methods

We used a medical records-based data set (n = 6038) containing pregnancy, birth, and postpartum information for US women who planned and completed community births. We first compared PPD screening scores as measured by the Edinburgh Postpartum Depression Scale (EPDS) of individuals who consumed their placenta to those who did not, with regard to demographics, pregnancy characteristics, and history of mental health challenges. Matching placentophagic (n = 1876) and non-placentophagic (n = 1876) groups were then created using propensity scores. The propensity score model included more than 90 variables describing medical and obstetric history, demographics, pregnancy characteristics, and intrapartum and postpartum complications, thus addressing confounding by all of these variables. We then used logistic regression to compare placentophagic to non-placentophagic groups based on commonly-cited EPDS cutoff values (≥ 11; ≥ 13) for likely PPD.

Results

In the unmatched and unadjusted analysis, placentophagy was associated with an increased risk of PPD. In the matched sample, 9.9% of women who ate their placentas reported EPDS ≥ 11, compared to 8.4% of women who did not (5.5% and 4.8%, respectively, EPDS ≥ 13 or greater). After controlling for over 90 variables (including prior mental health challenges) in the matched and adjusted analysis, placentophagy was associated with an increased risk of PPD between 15 and 20%, depending on the published EPDS cutoff point used. Numerous sensitivity analyses did not alter this general finding.

Conclusions

Placentophagic individuals in our study scored higher on an EPDS screening than carefully matched non-placentophagic controls. Why placentophagic women score higher on the EPDS remains unclear, but we suspect reverse causality plays an important role. Future research could assess psychosocial factors that may motivate some individuals to engage in placentophagy, and that may also indicate greater risk of PPD.
Hepatic arterial infusion in combination with systemic chemotherapy in patients with hepatic metastasis from colorectal cancer: a randomized phase II study – (NCT05103020) – study protocol
Authors: Kim Ji Su , Kim Hyunwook , Lee Seo Young , Han Yoon Dae , Han Kichang , Min Byung Soh , Kim Man-Deuk , Won Jong Yun , Beom Seung-Hoon , Shin Sang Joon , Kim Han Sang , Han Dai Hoon , Ahn Joong Bae
Published: July 2023

Background

Although 80% of patients with metastatic colorectal cancer (CRC) experience liver metastases, only 10–25% undergo resection at the time of diagnosis. Even in initially unresectable conditions, if appropriate treatment is provided, such as surgical conversion through a combination of hepatic arterial infusion (HAI) chemotherapy and systemic chemotherapy (sys-CT), better overall survival can be expected. Therefore, this study aims to evaluate the efficacy of HAI oxaliplatin in combination with sys-CT plus targeted therapy in patients with unresectable CRC with liver-only metastasis.

Methods

This is a single-center, randomized, open-label phase II trial (NCT05103020). Patients with untreated CRC, who have liver-only metastases and for whom liver resection is potentially possible but deemed infeasible at the time of initial diagnosis by a multidisciplinary team, will be eligible. Patients will be randomly assigned in a 1:1 ratio to either the combined HAI oxaliplatin and modified systemic 5-fluorouracil, folinic acid, and irinotecan (FOLFIRI) plus targeted therapy group or the systemic FOLFIRI plus targeted therapy group. Both regimens will be repeated every 2 weeks for a total of 12 cycles. The primary objective of this study is to compare the rate of conversion to liver resection. The surgical conversion rate is expected to increase by 25% with HAI oxaliplatin in combination with sys-CT plus targeted therapy (40% in the experimental arm versus 15% in the control arm) (power, 80%; two-sided alpha-risk, 5%). The secondary objectives include overall survival, progression-free survival, and objective response rate.

Discussion

This is the first randomized controlled trial to investigate the efficacy of HAI oxaliplatin in combination with sys-CT plus targeted therapy as first-line treatment from the initial diagnosis in patients with unresectable CRC with liver-only metastasis, aiming to significantly increase the surgical conversion rate.

Trial registration

ClinicalTrials.gov, (NCT05103020). Trial registration date: November 2, 2021.
RETRACTED ARTICLE: KRAS activation in gastric cancer stem-like cells promotes tumor angiogenesis and metastasis
Authors: Yoon Changhwan , Lu Jun , Jun Yukyung , Suh Yun-Suhk , Kim Bang-Jin , Till Jacob E. , Kim Jong Hyun , Keshavjee Sara H. , Ryeom Sandra , Yoon Sam S.
Published: July 2023

Our previous work showed that KRAS activation in gastric cancer cells leads to activation of an epithelial-to-mesenchymal transition (EMT) program and generation of cancer stem-like cells (CSCs). Here we analyze how this KRAS activation in gastric CSCs promotes tumor angiogenesis and metastasis. Gastric cancer CSCs were found to secrete pro-angiogenic factors such as vascular endothelial growth factor A (VEGF-A), and inhibition of KRAS markedly reduced secretion of these factors. In a genetically engineered mouse model, gastric tumorigenesis was markedly attenuated when both KRAS and VEGF-A signaling were blocked. In orthotropic implant and experimental metastasis models, silencing of KRAS and VEGF-A using shRNA in gastric CSCs abrogated primary tumor formation, lymph node metastasis, and lung metastasis far greater than individual silencing of KRAS or VEGF-A. Analysis of gastric cancer patient samples using RNA sequencing revealed a clear association between high expression of the gastric CSC marker CD44 and expression of both KRAS and VEGF-A, and high CD44 and VEGF-A expression predicted worse overall survival. In conclusion, KRAS activation in gastric CSCs enhances secretion of pro-angiogenic factors and promotes tumor progression and metastasis.
The crowding-out effect of sugar-sweetened beverages (SSBs) on household expenditure patterns in Bangladesh
Authors: Azad Abul Kalam , Huque Rumana
Published: July 2023

Background

Consumption of sugar-sweetened beverages (SSBs) or sugary drinks may reduce or even eliminate the household income allocation for other essential commodities. Reducing expenditure for consumption of other household commodities is known as the crowding-out effect of SSB. We aimed to determine the crowding-out effect of SSB expenditure on other household commodities. In addition, we also identified the factors influencing the household's decision to purchase of SSBs.

Methods

We used the logistic regression (logit and multinomial logit models) and the Seemingly Unrelated Regression (SUR) models. In order to find the probability of a given change in the socio-demographic variables, we also estimated the average marginal effects from the logistic regression. In addition, we regressed the SUR model by gender differences. We used Household Income and Expenditure Survey (HIES) 2016 data to estimate our chosen econometric models. HIES is nationally representative data on the household level across the country and is conducted using a multistage random sampling method by covering 46,075 households.

Results

The findings from the logit model describe that the greater proportion of male members, larger household size, household heads with higher education, profession, having a refrigerator, members living outside of the house, and households with higher income positively affect the decision of purchasing SSB. However, the determinants vary with the various types of SSB. The unadjusted crowding out effect shows that expenditure on SSB or sugar-added drinks crowds out the household expenditure on food, clothing, housing, and energy items. On the other hand, the adjusted crowding out effect crowds out the spending on housing, education, transportation, and social and state responsibilities.

Conclusion

Although the household expenditure on beverages and sugar-added drinks is still moderate (around 2% of monthly household expenditure), the increased spending on beverages and sugar-added drinks is a concern due to the displacement of household expenditure for basic commodities such as food, clothing, housing, education, and energy. Therefore, evidence-based policies to regulate the sale and consumption of SSB are required for a healthy nation.
COVID-19 victimization experience and university students’ smartphone addiction: the mediating role of emotional intelligence
Authors: Chen Hongxia , Zhang Hong-xin
Published: July 2023

Objectives

During the post-COVID-19 era, everyone has the risk of contracting the virus and becoming the victims of COVID-19. Examining the relationship between the COVID-19 victimization experience and its effects is more urgent. The aim of present study is to propose a mediation model to investigate the association between COVID-19 victimization experience and smartphone addiction, and the mediating role of emotional intelligence.

Methods

A online questionnaire including the COVID-19 Victimization Experience Scale, the Smartphone Addiction Scale, and the Emotional Intelligence Scale among Chinese university students, were employed in this study. Finally, 1154 valid questionnaires were collected. The reliability and confirmatory factor analysis results showed that all three scales had good reliability and validity.

Results

Structural Equation Model (SEM) demonstrated that COVID-19 victimization experience significantly predicted smartphone addiction in university students, and emotional intelligence partially mediated the association between COVID-19 victimization experience and smartphone addiction. Bootstrap results furthermore tested the rigor of the mediating effect.

Conclusion

COVID-19 victimization experience was a important variables in predicting university students’s martphone addiction, and emotional intelligence was a protective factor in decreasing the negative effect of COVID-19 victimization experience on addictive behaviors. It is suggested that instructors should integrate emotional intelligence training programs into mental health courses so as to improve students’ emotional intelligence ability.
Factors affecting the maxillary and mandibular incisors’ buccolingual inclinations and buccal and lingual cortical plate heights
Authors: Jafary Pour Seyed Mohammad , Gooran Morteza , Dabbaghi Arash , Parsi Farnoush , Rohani Ali , Moradinejad Mehrnaz , Mohagheghi Seyed Arman , Rakhshan Vahid
Published: July 2023

Introduction

Orthodontics is closely related to periodontics. The buccolingual inclination (BLI) of the incisors and deficiencies in their buccal (BHd) and lingual (LHd) cortical plate heights may affect orthodontic outcomes. Identifying risk factors that can compromise buccal or lingual bone heights may have clinical value. The literature on BLI/BHd/LHd is not only scarce but also limited to one jaw. We aimed to examine, for the first time, factors affecting BLI/BHd/LHd not evaluated before as well as other factors with scarce literature about them.

Methods

In this two-phase epidemiological and analytical study, inclinations and cortical heights of 248 incisors (bilateral centrals and laterals) were evaluated blindly on 62 randomly selected high-resolution pretreatment cone-beam computed tomography volumes (30 maxillae [13 men, 17 women], 32 mandibles [13 men, 19 women]). The sample was balanced in terms of sexes, jaws, and ages. The BLI/BHd/LHd of bilateral incisors were measured (intraobserver agreement > 95%). The effects of jaws, sexes, age, sides, and incisor types on each of the anatomical variables (BLI/BHd/LHd) were analyzed using a Mixed-Model Multiple Linear Regression analysis. Correlations among continuous variables were assessed using a Pearson coefficient (α = 0.05).

Results

For the maxillary centrals, BLI, BHd, and LHd were 106.79 ± 5.06, 1.94 ± 0.95, and 1.50 ± 0.76, respectively. These parameters were ‘110.56 ± 5.97, 1.81 ± 0.83, 1.23 ± 0.69’ for the maxillary laterals; ‘97.64 ± 8.26, 2.98 ± 1.48, 3.46 ± 1.45’ for the mandibular centrals; and ‘95.98 ± 6.80, 3.29 ± 1.72, and 2.73 ± 1.15’ for the mandibular laterals. BLI was greater in the maxilla compared to the mandible and in the lateral incisors compared to centrals (P < 0.05). BHd was greater (more deficient) in the mandible (P = 0.000). Age, sex, or side were not associated with BLI (P > 0.05). Age, sex, side, or incisor types were not associated with BHd (P > 0.05). LHd was greater in the mandible, older individuals, and centrals (P < 0.05). There were some significant but weak correlations between BLI with BHd and especially LHd (P < 0.05).

Conclusion

In the maxilla, but not in the mandible, incisors’ BLI may determine LHd. Maxillary incisors may have greater BLIs as well as greater buccal and lingual alveolar bone heights compared to mandibular incisors. BLI might be greater in the laterals compared to the centrals in both jaws combined.
Effects of self-perceived psychological stress on clinical symptoms, cortisol, and cortisol/ACTH ratio in patients with burning mouth syndrome
Authors: Lee Yeon-Hee , Suk Chon
Published: July 2023

Background

Psychological stress is a crucial parameter in defining the symptoms of burning mouth syndrome (BMS). We hypothesized that the level of psychological stress in patients with BMS would correlate with severity of clinical symptoms, cortisol levels, and cortisol/ adrenocorticotropic hormone (ACTH) ratio. We aimed to comprehensively investigate the influence of clinical and hematologic parameters on the hypothalamic–pituitary–adrenal axis, particularly concerning the presence or absence of self-perceived psychological stress in patients with BMS. In addition, we aimed to identify parameters predicting psychological stress in these patients.

Methods

One hundred and forty-one patients with BMS (117 women, 82.98%; 56.21 ± 13.92 years) were divided into psychological stress (n = 68; 55 females, 56.39 ± 12.89 years) and non-psychological stress groups (n = 73; 62 females, 56.03 ± 14.90 years), and inter- and intra-group statistical analyses were conducted. Significant predictors of psychological stress in patients with BMS were investigated through multiple logistic regression analysis.

Results

The prevalence of xerostomia was significantly higher (67.6% vs. 34.2%, p < 0.001), while unstimulated salivary flow rate was lower (0.66 ± 0.59 vs. 0.91 ± 0.53 mL/min, p < 0.01) in the psychological stress group than in the non-psychological stress group. SCL-90R subscale values for somatization, hostility, anxiety, and depression, as well as cortisol and ACTH levels and the cortisol/ACTH ratio, were also higher in the psychological stress group (all p < 0.05). Above-mean values for cortisol (AUC = 0.980, 95%CI: 0.959–1.000) and cortisol/ACTH (AUC = 0.779; 95%CI, 0.701–0.856) were excellent predictors of psychological stress, with cortisol (r = 0.831, p < 0.01) and cortisol/ACTH (r = 0.482, p < 0.01) demonstrating substantial correlations. Above-average values for cortisol (OR = 446.73) and cortisol/ACTH (OR = 6.159) significantly increased incidence of psychological stress in patients with BMS (all p < 0.001).

Conclusions

Among patients with BMS, xerostomia, decreased salivary flow rate, increased cortisol levels, and cortisol/ACTH ratio were associated with psychological stress, highlighting the psycho-neuro-endocrinological features of this condition. Cortisol and cortisol/ACTH ratio were strong predictors of psychological stress in patients with BMS.
Palliative care as a digital working world (PALLADiUM) - A mixed-method research protocol
Authors: Grimminger Sandra , Heckel Maria , Markgraf Moritz , Peuten Sarah , Wöhl Moritz , Gimpel Henner , Klein Carsten , Ostgathe Christoph , Steigleder Tobias , Schneider Werner
Published: July 2023

Background

In Palliative Care, actors from different professional backgrounds work together and exchange case-specific and expert knowledge and information. Since Palliative Care is traditionally distant from digitalization due to its holistically person-centered approach, there is a lack of suitable concepts enabling digitalization regarding multi-professional team processes. Yet, a digitalised information and collaboration environment geared to the requirements of palliative care and the needs of the members of the multi-professional team might facilitate communication and collaboration processes and improve information and knowledge flows. Taking this chance, the presented three-year project, PALLADiUM, aims to improve the effectiveness of Palliative Care teams by jointly sharing available inter-subjective knowledge and orientation-giving as well as action-guiding practical knowledge. Thus, PALLADiUM will explore the potentials and limitations of digitally supported communication and collaboration solutions.

Methods

PALLADiUM follows an open and iterative mixed methods approach. First, ethnographic methods – participant observations, interviews, and focus groups – aim to explore knowledge and information flow in investigating Palliative Care units as well as the requirements and barriers to digitalization. Second, to extend this body, the analysis of the historical hospital data provides quantitative insights. Condensing all findings results in a to-be work system. Adhering to the work systems transformation method, a technical prototype including artificial intelligence components will enhance the collaborative teamwork in the Palliative Care unit.

Discussion

PALLADiUM aims to deliver decisive new insights into the preconditions, processes, and success factors of the digitalization of a medical working environment as well as communication and collaboration processes in multi-professional teams.

Trial registration

The study was registered prospectively at DRKS (Deutsches Register Klinischer Studien) Registration-ID: DRKS0025356 Date of registration: 03.06.21.
Improving palliative care for people with intellectual disability: a self-assessment of policies, practices and competencies in care services
Authors: Voss Hille , Francke Anneke L. , de Veer Anke J.E.
Published: July 2023

Background

Providing care for ageing and vulnerable people with intellectual disability (ID) is challenging, and professionals working in ID care often have limited experience in palliative care. The current study provides insight into palliative care practices in ID care services and competencies of professionals and identifies ways to improve palliative care for people with ID.

Methods

For this study ten services in the Netherlands were recruited that provide care for people with mild to profound ID. Professionals in each of these services conducted a self-assessment of their palliative care policies and practices based on nine core element of palliative care described in the Dutch Quality Framework for Palliative Care. The self-assessment included a medical file review of a total of 100 people with ID who died non-suddenly. In addition, 424 professionals from the services returned a digital questionnaire on palliative care competencies and training needs.

Results

The self-assessments showed that individual care plans were recorded for people with ID and that multidisciplinary teams provided physical, psychological, social and spiritual care. However, other core elements of palliative care, such as cooperation with other organisations and expertise in palliative care, were less present in ID care services. Only half of the services collaborated with regional organisations in palliative care, and most services listed no requirements for the palliative care skills of their professionals. The questionnaire showed that almost 10% of the professionals reported that they were not at all competent in providing palliative care, and 74% felt that they needed training in palliative care. Reported areas for improvement in the provision of palliative care were increasing the quality of palliative care, improving the expertise of professionals and identifying palliative care needs earlier.

Conclusions

To improve palliative care in ID care services changes are required both in competencies of professionals, and organisational policies and practices. Services should enhance awareness about palliative care for people with ID, strengthen collaboration with palliative care services, and offer training or support for professionals in assessing and meeting the needs of people with ID at the end of life.