bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury
Authors: Azami-Aghdash Saber , Moosavi Ahmad , Gharaee Hojatolah , Sadeghi Ghader , Mousavi Isfahani Haleh , Ghasemi Dastgerdi Alireza , Mohseni Mohammad
Published: March 2021

Abstracts

Background

Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs.

Methods

Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique.

Results

Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi’s technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized.

Conclusion

Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC.
Artificial intelligence-assisted reduction in patients’ waiting time for outpatient process: a retrospective cohort study
Authors: Li Xiaoqing , Tian Dan , Li Weihua , Dong Bin , Wang Hansong , Yuan Jiajun , Li Biru , Shi Lei , Lin Xulin , Zhao Liebin , Liu Shijian
Published: March 2021

Background

Many studies suggest that patient satisfaction is significantly negatively correlated with the waiting time. A well-designed healthcare system should not keep patients waiting too long for an appointment and consultation. However, in China, patients spend notable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.

Methods

We developed an artificial intelligence (AI)-assisted module and name it XIAO YI. It could help outpatients automatically order imaging examinations or laboratory tests based on their chief complaints. Thus, outpatients could get examined or tested before they went to see the doctor. People who saw the doctor in the traditional way were allocated to the conventional group, and those who used XIAO YI were assigned to the AI-assisted group. We conducted a retrospective cohort study from August 1, 2019 to January 31, 2020. Propensity score matching was used to balance the confounding factor between the two groups. And waiting time was defined as the time from registration to preparation for laboratory tests or imaging examinations. The total cost included the registration fee, test fee, examination fee, and drug fee. We used Wilcoxon rank-sum test to compare the differences in time and cost. The statistical significance level was set at 0.05 for two sides.

Results

Twelve thousand and three hundred forty-two visits were recruited, consisting of 6171 visits in the conventional group and 6171 visits in the AI-assisted group. The median waiting time was 0.38 (interquartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05). The total cost was 335.97 (interquartile range: 244.80, 437.60) CNY (Chinese Yuan) for the AI-assisted group and 364.58 (249.70, 497.76) CNY for the conventional group (p < 0.05).

Conclusions

Using XIAO YI can significantly reduce the waiting time of patients, and thus, improve the outpatient service process of hospitals.
Cochlear activity in silent cue-target intervals shows a theta-rhythmic pattern and is correlated to attentional alpha and theta modulations
Authors: Köhler Moritz Herbert Albrecht , Demarchi Gianpaolo , Weisz Nathan
Published: March 2021

Background

A long-standing debate concerns where in the processing hierarchy of the central nervous system (CNS) selective attention takes effect. In the auditory system, cochlear processes can be influenced via direct and mediated (by the inferior colliculus) projections from the auditory cortex to the superior olivary complex (SOC). Studies illustrating attentional modulations of cochlear responses have so far been limited to sound-evoked responses. The aim of the present study is to investigate intermodal (audiovisual) selective attention in humans simultaneously at the cortical and cochlear level during a stimulus-free cue-target interval.

Results

We found that cochlear activity in the silent cue-target intervals was modulated by a theta-rhythmic pattern (~ 6 Hz). While this pattern was present independently of attentional focus, cochlear theta activity was clearly enhanced when attending to the upcoming auditory input. On a cortical level, classical posterior alpha and beta power enhancements were found during auditory selective attention. Interestingly, participants with a stronger release of inhibition in auditory brain regions show a stronger attentional modulation of cochlear theta activity.

Conclusions

These results hint at a putative theta-rhythmic sampling of auditory input at the cochlear level. Furthermore, our results point to an interindividual variable engagement of efferent pathways in an attentional context that are linked to processes within and beyond processes in auditory cortical regions.
The loss of DLG2 isoform 7/8, but not isoform 2, is critical in advanced staged neuroblastoma
Authors: Keane Simon , Martinsson Tommy , Kogner Per , Ejeskär Katarina
Published: March 2021

Background

Neuroblastoma is a childhood neural crest tumor showing large clinical and genetic heterogeneity, one form displaying 11q-deletion is very aggressive. It has been shown that 11q-deletion results in decreased expression of DLG2, a gene residing in the deleted region. DLG2 has a number of different isoforms with the main difference is the presence or absence of a L27 domain. The L27 domain containing DLG proteins can form complexes with CASK/MPP and LIN7 protein family members, which will control cell polarity and signaling.

Methods

We evaluated the DLG gene family and the LIN7 gene family for their expression in differently INSS staged neuroblastoma from publically available data and primary tumors, we included two distinct DLG1 and DLG2 N-terminal transcript isoforms encoding L27 domains for their expression. Functionality of DLG2 isoforms and of LIN7A were evaluated in the 11q-deleted neuroblastoma cell line SKNAS.

Results

In neuroblastoma only two DLG2 isoforms were expressed: isoform 2 and isoform 7/8. Using the array data we could determine that higher expression of DLG members that contain L27 domains correlated to better survival and prognosis. Whilst DLG1 showed a decrease in both isoforms with increased INSS stage, only the full length L27 containing DLG2 transcripts DLG2-isoform 7/8 showed a decrease in expression in high stage neuroblastoma. We could show that the protein encoded by DLG2-isoform 7 could bind to LIN7A, and increased DLG2-isoform 7 gene expression increased the expression of LIN7A, this reduced neuroblastoma cell proliferation and viability, with increased BAX/BCL2 ratio indicating increased apoptosis.

Conclusion

We have provided evidence that gene expression of the L27 domain containing DLG2-isoform 7/8 but not L27 domain lacking DLG2-isoform 2 is disrupted in neuroblastoma, in particular in the aggressive subsets of tumors. The presence of the complete L27 domain allows for the binding to LIN7A, which will control cell polarity and signaling, thus affecting cancer cell viability.
Systemic lupus Erythematosus and geomagnetic disturbances: a time series analysis
Authors: Stojan George , Giammarino Flavia , Petri Michelle
Published: March 2021

Background

To examine the influence of solar cycle and geomagnetic effects on SLE disease activity.

Methods

The data used for the analysis consisted of 327 observations of 27-day Physician Global Assessment (PGA) averages from January 1996 to February 2020. The considered geomagnetic indices were the AP index (a daily average level for geomagnetic activity), sunspot number index R (measure of the area of solar surface covered by spots), the F10.7 index (measure of the noise level generated by the sun at a wavelength of 10.7 cm at the earth’s orbit), the AU index (upper auroral electrojet index), and high energy (> 60 Mev) proton flux events. Geomagnetic data were obtained from the Goddard Space Flight Center Space Physics Data Facility. A time series decomposition of the PGA averages was performed as the first step. The linear relationships between the PGA and the geomagnetic indices were examined using parametric statistical methods such as Pearson correlation and linear regression, while the nonlinear relationships were examined using nonparametric statistical methods such as Spearman’s rho and Kernel regression.

Results

After time series deconstruction of PGA averages, the seasonality explained a significant fraction of the variance of the time series (R2 = 38.7%) with one cycle completed every 16 years. The analysis of the short-term (27-day) relationships indicated that increases in geomagnetic activity Ap index (p < 0.1) and high energy proton fluxes (> 60 Mev) (p < 0.05) were associated with decreases in SLE disease activity, while increases in the sunspot number index R anticipated decreases in the SLE disease activity expressed as PGA (p < 0.05). The short-term correlations became statistically insignificant after adjusting for multiple comparisons using Bonferroni correction. The analysis of the long-term (297 day) relationships indicated stronger negative association between changes in the PGA and changes in the sunspot number index R (p < 0.01), AP index (p < 0.01), and the F10.7 index (p < 0.01). The long-term correlations remained statistically significant after adjusting for multiple comparisons using Bonferroni correction.

Conclusion

The seasonality of the PGA averages (one cycle every 16 years) explains a significant fraction of the variance of the time series. Geomagnetic disturbances, including the level of geomagnetic activity, sunspot numbers, and high proton flux events may influence SLE disease activity. Studies of other geographic locales are needed to validate these findings.
“Drugs are a taboo”: a qualitative and retrospective study on the role of education and harm reduction strategies associated with the use of psychoactive substances under the age of 18
Authors: da Silva Gabriela Almeida Pinto , Pereira Catarina Pinto , Pinto Marta Sofia de Sousa
Published: March 2021

Background

The use of psychoactive substances frequently starts at a younger age than adulthood. Considering the perspective of young people, this retrospective study tried to provide them with a role in identifying their own needs regarding drug use and interventions focused on it; the obstacles in accessing both general health and harm reduction services; the changes needed for a more effective, congruent and empowering response to the use of psychoactive substances before the age of 18.

Methods

The study was divided into two parts having both parts a qualitative focus. In the first part of the study, an online questionnaire was sent to all harm reduction teams and two focus groups were carried out with eight harm reduction professionals and six people who use(d) drugs. The second part used an online questionnaire applied to 143 participants aged between the age of 18 and 25 complemented by two semi-structured interviews.

Results

The need for education about psychoactive substances, namely in the educational context; the lack of information about available services; and the need for confidentiality were the most mentioned issues by the young people. Also, the informal network played a significant role in the participants relationship with psychoactive substances.

Conclusions

The lack of information was the most highlighted obstacle. Also, there is a confluence of various vulnerabilities such as being under 18, using drugs and the different social situations that they live in. To improve policy and practice regarding drug use among young people, harm reduction interventions must be scaled-up as well as intentionally driven to empower youth to deal with. School environment was chosen by participants as one of the elected environments to implement harm reduction services.
A study protocol for a quasi-experimental community trial evaluating the integration of indigenous healing practices and a harm reduction approach with principles of seeking safety in an indigenous residential treatment program in Northern Ontario
Authors: Marsh T. N. , Eshakakogan C. , Eibl J. K. , Spence M. , Morin K. A. , Gauthier G. J. , Marsh D. C.
Published: March 2021

Background

Indigenous communities in Canada face significant challenges with intergenerational trauma, which manifests in substance use disorders. There is consensus that connecting treatment approaches to culture, land, community, and spiritual practices is a pathway to healing trauma and substance use disorders for Indigenous peoples. Indigenous residential addiction treatment programs have been established as the primary intervention to provide healing for Indigenous peoples with substance use disorders and intergenerational trauma. However, there is limited evidence demonstrating the effectiveness of these programs. In collaboration with the Benbowopka Treatment Centre, this paper describes a study protocol which aims to evaluate the effectiveness of blending Indigenous Healing Practices and Seeking Safety for the treatment of Indigenous patients with intergenerational trauma and substance use disorders.

Methods

We will conduct a pre/post Quasi Experimental Community trial, to compare historical treatment outcomes for patients following the implementation of Indigenous Healing and Seeking Safety. We will conduct quantitative and qualitative analyses to understand the differences before and after the intervention is implemented. The pre- Indigenous Healing and Seeking Safety intervention study window will span from 2013 to 2016;n = 343, and the post-Indigenous Healing and Seeking Safety intervention study window from 2018 to 2020;n > 300. All participants will be enrolled in the Benbowopka residential treatment for the first time during the study periods. All data will be anonymized at the time of data entry. Propensity matching will be undertaken for patient characteristics, including sex/gender, age, and substance use type.

Results and conclusions

The study findings could be used to inform intergenerational trauma and substance use disorders residential treatment programming for Indigenous communities across Canada. Our work will contribute to the field of community-based intergenerational trauma and substance use disorders programming by addressing objectives that consider: (a) the patient perspective, (b) the program perspective, and (c) the community perspective. The study findings may validate an innovative approach for evaluating the effectiveness of residential addiction treatment and particularly the effective and appropriate care for Indigenous patients with intergenerational trauma and substance use disorders.
Detecting response shift in health-related quality of life measurement among patients with hypertension using structural equation modeling
Authors: Chen Hao , Zhu Lin , Zhou Rui , Liu Panpan , Lu Xiaoyang , Patrick Donald L. , Edwards Todd C. , Wang Hongmei
Published: March 2021

Background

Outcomes derived from longitudinal self-reported health-related quality of life measures can be confounded by response shift. This study was aimed to detect response shift among patients with hypertension attending a community-based disease management program.

Methods

240 consecutive consulting or follow-up patients with diagnosed hypertension were recruited. The Short Form 36-item Health Survey was self-administered at 12 community health service stations at baseline and four weeks after attending the program. The 4-step structural equation modeling approach assessed response shift.

Results

Data from 203 (84.6%) patients were eligible for analyses (mean age 65.9 ± 10.8 years, 46.3% female). The results showed uniform recalibration of social functioning ($${\upchi}_{\mathrm{SBdiff}}^{2}$$

χ

SBdiff

2

(1) = 22.98, P < 0.001), and non-uniform recalibration of role limitations due to physical problems ($${\upchi}_{\mathrm{SBdiff}}^{2}$$

χ

SBdiff

2

(1) = 8.84, P = 0.003), and bodily pain ($${\upchi}_{\mathrm{SBdiff}}^{2}$$

χ

SBdiff

2

(1) = 17.41, P < 0.001). The effects of response shift on social functioning were calculated as “small” (effect-size = 0.35), but changed the observed changes from improvement (effect-size = 0.25) to slight deterioration (effect-size = -0.10). After accounting for the response shift effect, the general physical health of participants was improved (effect-size = 0.37), while deterioration (effect-size = -0.21) in the general mental health was also found.

Conclusions

Recalibration existed among patients with hypertension attending the disease management program. The interventions in the program might act as a catalyst that induced the response shift. We conclude that response shift should be considered in hypertension research with longitudinal health-related quality of life data.
Psycho-sexual influence of sterilization on women’s quality of life: a path model
Authors: Youseflu Samaneh , Jahanian Sadatmahalleh Shahideh
Published: March 2021

Background

Tubal ligation, as a permanent contraception method, have a negative and positive impact on women’s life. This study aimed to test a conceptual model considering the interrelated role of menorrhagia, body image concern, self-esteem, sexual function, anxiety and depression on quality of life (QOL) of sterilized women.

Methods

The current study was conducted as a cross-sectional study on 200 sterilized women. Data were collected using a socio-demographic checklist, Short Form Health Survey (SF-12), pictorial blood loss assessment chart, female sexual function index, hospital anxiety and depression scale, body image concern inventory, and Rosenberg Self-esteem Scale. Data were analyzed using Pearson correlation coefficient and path analysis.

Results

Results show that anxiety, sexual function, self-esteem, and body image dissatisfaction have a direct effect on women’s QOL. Higher level of anxiety, and body dissatisfaction directly reduce QOL. Sexual function, and menorrhagia, with an indirect effect through anxiety, reduces QOL. Higher level of anxiety with indirect effect thorough self-esteem can worsen QOL. Also, sexual function indirectly affects QOL through anxiety.

Conclusion

It looks that the proposed predictors of this model are greatly important. These findings give support for a hypothetical model in which betterment in SF, body image satisfaction, self-esteem, anxiety, and menorrhagia led to a good QOL of sterilized women. Hence, in designing care for sterilized women, these factors should be considered.
A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients
Authors: Rios Tatiane Correia , de Oliveira Lucivalda Pereira Magalhães , da Costa Maria Lúcia Varjão , da Silva Baqueiro Boulhosa Ramona Souza , Roriz Anna Karla Carneiro , Ramos Lilian Barbosa , Bueno Allain Amador
Published: March 2021

Rationale

Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients.

Method

432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann–Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL.

Results

37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (βo =  − 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship.

Conclusion

Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.
Lupus anticoagulant hypoprothrombinemia syndrome associated with bilateral adrenal haemorrhage in a child: early diagnosis and intervention
Authors: Sakamoto Atsushi , Ogura Masao , Hattori Atsushi , Tada Kinji , Horikawa Reiko , Nakadate Hisaya , Matsumoto Kimikazu , Nogami Keiji , Ieko Masahiro , Ishiguro Akira
Published: March 2021

Background

Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is characterized by bleeding and thrombosis in patients with autoimmune diseases or infections. Paediatric LAHPS exhibits various degrees of bleeding, ranging from mild to severe; however, adrenal haemorrhage due to LAHPS and its long-term clinical course have not been sufficiently described.

Case presentation

A 9-year-old boy presented with prolonged abdominal pain and abnormal coagulation screening tests. The laboratory tests showed prolonged activated partial thromboplastin time and subsequently revealed the presence of lupus anticoagulant, anti-nuclear antibodies, and hypoprothrombinemia, leading to diagnosis of LAHPS. An enhanced computed tomogram demonstrated nodular lesions in the adrenal glands bilaterally, suggestive of adrenal haemorrhage. Laboratory and clinical manifestations exhibited life-threatening adrenal insufficiency that required hydrocortisone administration. The patient developed systemic lupus erythematosus, diagnosed 12 months later.

Conclusions

This patient with LAHPS developed rare adrenal failure due to adrenal haemorrhage, a life-threatening event that should be recognized and treated early. In our case, renal dysfunction was also observed when systemic lupus erythematosus was diagnosed 1 year after LAHPS. Our case emphasizes that early recognition of adrenal failure and careful long-term observation is required in patients with autoantibodies.
Cyclophosphamide use in treatment of refractory Kawasaki disease with coronary artery aneurysms
Authors: Halyabar Olha , Friedman Kevin G. , Sundel Robert P. , Baker Annette L. , Chang Margaret H. , Gould Patrick W. , Newburger Jane W. , Son Mary Beth F.
Published: March 2021

Background

Despite timely administration of IVIG, some patients with Kawasaki disease (KD) develop rapidly progressive or giant coronary artery aneurysms (CAA).

Case presentation

We describe our experience using cyclophosphamide (CYC) for the treatment of such cases as well as a review of the literature on the use of CYC in KD. Through a retrospective chart review of our KD population, we identified ten children treated for KD with intravenous CYC (10 mg/kg/dose) for one or two doses. Seven patients were male, the median age was 2.0 years (range 4 months − 5 years). All patients received initial IVIG between day 4–10 of illness. Other anti-inflammatory treatments administered before CYC included second IVIG (n = 9), corticosteroids (n = 10), infliximab (n = 4), cyclosporine (n = 2), and anakinra (n = 1). Median illness day at administration of the first CYC dose was 22.5 days (range:10–36 days). The primary indication for treatment with CYC for all patients was large or giant CAA and/or rapid progression of CAA. Three patients received a second dose of CYC (10 mg/kg) for progressively enlarging CAA. CAA did not progress after final CYC treatment. One patient with a history of neutropenia in infancy developed severe neutropenia 9 days after treatment with CYC, which recovered without intervention or complications. No patient developed infections or other serious toxicity from CYC.

Conclusion

In KD patients with severe and progressive enlargement of CAA despite anti-inflammatory therapy, CYC seemed to arrest further dilation and was well-tolerated. Future multicenter studies are needed to confirm our findings in this subgroup of KD patients.
A systemic immune challenge to model hospital-acquired infections independently regulates immune responses after pediatric traumatic brain injury
Authors: Sharma Rishabh , Zamani Akram , Dill Larissa K. , Sun Mujun , Chu Erskine , Robinson Marcus J. , O’Brien Terence J. , Shultz Sandy R. , Semple Bridgette D.
Published: March 2021

Background

Traumatic brain injury (TBI) is a major cause of disability in young children, yet the factors contributing to poor outcomes in this population are not well understood. TBI patients are highly susceptible to nosocomial infections, which are mostly acquired within the first week of hospitalization, and such infections may modify TBI pathobiology and recovery. In this study, we hypothesized that a peripheral immune challenge such as lipopolysaccharide (LPS)—mimicking a hospital-acquired infection—would worsen outcomes after experimental pediatric TBI, by perpetuating the inflammatory immune response.

Methods

Three-week-old male mice received either a moderate controlled cortical impact or sham surgery, followed by a single LPS dose (1 mg/kg i.p.) or vehicle (0.9% saline) at 4 days post-surgery, then analysis at 5 or 8 days post-injury (i.e., 1 or 4 days post-LPS).

Results

LPS-treated mice exhibited a time-dependent reduction in general activity and social investigation, and increased anxiety, alongside substantial body weight loss, indicating transient sickness behaviors. Spleen-to-body weight ratios were also increased in LPS-treated mice, indicative of persistent activation of adaptive immunity at 4 days post-LPS. TBI + LPS mice showed an impaired trajectory of weight gain post-LPS, reflecting a synergistic effect of TBI and the LPS-induced immune challenge. Flow cytometry analysis demonstrated innate immune cell activation in blood, brain, and spleen post-LPS; however, this was not potentiated by TBI. Cytokine protein levels in serum, and gene expression levels in the brain, were altered in response to LPS but not TBI across the time course. Immunofluorescence analysis of brain sections revealed increased glia reactivity due to injury, but no additive effect of LPS was observed.

Conclusions

Together, we found that a transient, infection-like systemic challenge had widespread effects on the brain and immune system, but these were not synergistic with prior TBI in pediatric mice. These findings provide novel insight into the potential influence of a secondary immune challenge to the injured pediatric brain, with future studies needed to elucidate the chronic effects of this two-hit insult.
HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke
Authors: Rozevink Samantha G. , van der Sluis Corry K. , Garzo Ainara , Keller Thierry , Hijmans Juha M.
Published: March 2021

Background

HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke).

Methods

Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.

Results

Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements.

Conclusion

Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home.

Trial registrationThis study is registered at the Netherlands Trial Register (NL7535). Registered 18–02-2019,https://www.trialregister.nl/trial/7535.
Evaluation of patients with COVID-19 diagnosis for chronic diseases
Authors: Altuntas Murat , Yilmaz Habip , Guner Abdullah Emre
Published: March 2021

Aim

COVID-19 is one of the most consequential pandemic in world history. Chronic diseases, which are risk factors that increase the case fatality rates, have been the leading cause of death all over the world. This study was aimed at detecting coexisting chronic diseases in patients hospitalized with a diagnosis of COVID-19.

Material and method

The study was carried out with data from 229 patients in an intensive care unit, from June 1st through June 30th. 2020. The inclusion criteria of the study was as follows: (1) having a COVID-19 diagnosis confirmed by PCR test; (2) being hospitalized in the relevant intensive care unit within the dates of the study; and (3) having their data accessible through the hospital automation system. Through literature; chronic diseases of the patients and their effects on the COVID-19 process were evaluated. Statistical analyzes were performed using the Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp.; Armonk, NY, USA).

Results

The average age of the patients studied were 61.4 years. While the average symptom duration was 8.2 days; total hospitalization period was 13.1 days. The average length of stay of patients (n = 75) who were sent to intensive care unit was 10.1. The most common chronic disease among patients was hypertension with 47.2%. This was followed by diabetes mellitus (32.8%) and heart disease (27.5%), respectively. In the population studied, cough (59.4%), fever (58.5%) and shortness of breath (45.9%) were found to be the most common symptoms. Leukopenia, impairments in liver and muscle enzymes, abnormal C-reactive protein, ferritin and d-dimer levels were the important biochemical tests.

Conclusion

Particular attention should be paid to the elderly COVID-19 patients with chronic diseases, especially DM, HT and cancer.
Low post-arthroplasty infection rate is possible in developing countries: long-term experience of local vancomycin use in Iran
Authors: Tahmasebi Mohammad Naghi , Vaziri Arash Sharafat , Vosoughi Fardis , Tahami Mohamad , Khalilizad Majid , Rabie Hamid
Published: March 2021

Background

Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections.

Methods

This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011).

Results

Altogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002).

Conclusions

Our experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.
Relationships between above- and below-ground carbon stocks in mangrove forests facilitate better estimation of total mangrove blue carbon
Authors: Meng Yuchen , Bai Jiankun , Gou Ruikun , Cui Xiaowei , Feng Jianxiang , Dai Zheng , Diao Xiaoping , Zhu Xiaoshan , Lin Guanghui
Published: March 2021

Background

Although great efforts have been made to quantify mangrove carbon stocks, accurate estimations of below-ground carbon stocks remain unreliable. In this study, we examined the distribution patterns of mangrove carbon stocks in China and other countries using our own field survey data and datasets from published literature. Based on these data, we investigated the possible relationships between above-ground carbon stock (AGC) and below-ground carbon stock (BGC) for mangrove forests, aiming to provide a scientific basis for estimation of total mangrove carbon stocks.

Results

The average above-ground carbon stock in each region was sizeable (ranging from 12.0 to 150.2 Mg/ha), but average below-ground carbon stock was dominant (ranging from 46.6 to 388.6 Mg/ha), accounting for 69–91% of total carbon stock at the sites studied in China. Significant positive relationships were found between above-ground and below-ground mangrove carbon stocks, with the best fitting equation as BGC = 1.58 * AGC + 81.06 (Mg/ha, R2 = 0.62, p < 0.01, n = 122) for China. Such linear relationships vary for mangrove forests of different types and locations, from different geographical regions in China to other countries worldwide.

Conclusion

The positive relationship we found between above- and below-ground carbon stocks of mangrove forests in China and worldwide can facilitate more accurate assessments of mangrove blue carbon stocks at regional or global scales using modern techniques including remote sensing.
Cirsiliol targets tyrosine kinase 2 to inhibit esophageal squamous cell carcinoma growth in vitro and in vivo
Authors: Jia Xuechao , Huang Chuntian , Hu Yamei , Wu Qiong , Liu Fangfang , Nie Wenna , Chen Hanyong , Li Xiang , Dong Zigang , Liu Kangdong
Published: March 2021

Background

Esophageal squamous cell carcinoma (ESCC) is an aggressive and lethal cancer with a low 5 year survival rate. Identification of new therapeutic targets and its inhibitors remain essential for ESCC prevention and treatment.

Methods

TYK2 protein levels were checked by immunohistochemistry. The function of TYK2 in cell proliferation was investigated by MTT [(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] and anchorage-independent cell growth. Computer docking, pull-down assay, surface plasmon resonance, and kinase assay were used to confirm the binding and inhibition of TYK2 by cirsiliol. Cell proliferation, western blot and patient-derived xenograft tumor model were used to determine the inhibitory effects and mechanism of cirsiliol in ESCC.

Results

TYK2 was overexpressed and served as an oncogene in ESCC. Cirsiliol could bind with TYK2 and inhibit its activity, thereby decreasing dimer formation and nucleus localization of signal transducer and activator of transcription 3 (STAT3). Cirsiliol could inhibit ESCC growth in vitro and in vivo.

Conclusions

TYK2 is a potential target in ESCC, and cirsiliol could inhibit ESCC by suppression of TYK2.
Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy
Authors: Knapp Jürgen , Eberle Bettina , Bernhard Michael , Theiler Lorenz , Pietsch Urs , Albrecht Roland
Published: March 2021

Background

Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative.

Methods

We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.

Results

FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.

Conclusion

Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.
Neurological complications during veno-venous extracorporeal membrane oxygenation: Does the configuration matter? A retrospective analysis of the ELSO database
Authors: Lorusso Roberto , Belliato Mirko , Mazzeffi Michael , Di Mauro Michele , Taccone Fabio Silvio , Parise Orlando , Albanawi Ayat , Nandwani Veena , McCarthy Paul , Kon Zachary , Menaker Jay , Johnson Daniel M. , Gelsomino Sandro , Herr Daniel
Published: March 2021

Background

Single- (SL) and double-lumen (DL) catheters are used in clinical practice for veno-venous extracorporeal membrane oxygenation (V-V ECMO) therapy. However, information is lacking regarding the effects of the cannulation on neurological complications.

Methods

A retrospective observational study based on data from the Extracorporeal Life Support Organization (ELSO) registry. All adult patients included in the ELSO registry from 2011 to 2018 submitted to a single run of V-V ECMO were analyzed. Propensity score (PS) inverse probability of treatment weighting estimation for multiple treatments was used. The average treatment effect (ATE) was chosen as the causal effect estimate of outcome. The aim of the study was to evaluate differences in the occurrence and the type of neurological complications in adult patients undergoing V-V ECMO when treated with SL or DL cannulas.

Results

From a population of 6834 patients, the weighted propensity score matching included 6245 patients (i.e., 91% of the total cohort; 4175 with SL and 20,270 with DL cannulation). The proportion of patients with at least one neurological complication was similar in the SL (306, 7.2%) and DL (189, 7.7%; odds ratio 1.10 [95% confidence intervals 0.91–1.32]; p = 0.33). After weighted propensity score, the ATE for the occurrence of least one neurological complication was 0.005 (95% CI − 0.009 to 0.018; p = 0.50). Also, the occurrence of specific neurological complications, including intracerebral hemorrhage, acute ischemic stroke, seizures or brain death, was similar between groups. Overall mortality was similar between patients with neurological complications in the two groups.

Conclusions

In this large registry, the occurrence of neurological complications was not related to the type of cannulation in patients undergoing V-V ECMO.
Combination of first-line chemotherapy with Kanglaite injections versus first-line chemotherapy alone for advanced non-small-cell lung cancer: study protocol for an investigator-initiated, multicenter, open-label, randomized controlled trial
Authors: Gao Ruike , Zhang Ying , Hou Wei , Li Jie , Zhu Guanghui , Zhang Xiaoxiao , Xu Bowen , Wu Zhe , Wang Heping
Published: March 2021

Background

Non-small-cell lung cancer (NSCLC) is usually diagnosed at an advanced stage, and chemotherapy is the main treatment for this disease. Kanglaite injections (KLTi) have been widely used for the treatment of cancer in China. KLTi combined with chemotherapy could improve the short-term efficacy, quality of life, and performance status for NSCLC compared with chemotherapy alone. This trial aims to assess the long-term efficacy and safety of KLTi in combination with chemotherapy for the treatment of advanced NSCLC.

Methods

This will be an investigator-initiated multicenter open-label randomized controlled trial. We will randomly assign 334 eligible participants with stage IIIA-IV NSCLC to the treatment or control groups in a 1:1 ratio. Patients in both groups will be administered 4–6 cycles of first-line platinum-based double chemotherapy regimens. Patients with complete response, partial response, or stable disease after 4–6 cycles will receive non-platinum single-agent chemotherapy. Patients in the treatment group are to receive intravenous KLTi 200 ml per day continuously for 14 days, commencing on the first day of chemotherapy. The treatment will be discontinued at the time of disease progression or until unacceptable toxicity is noted. The follow-up will be conducted every 2 months until death, loss of follow-up, or 12 months from randomized enrollment. The primary outcome will be progression-free survival (PFS). The secondary outcomes will be the objective response rate, 1-year survival rate, quality of life, living ability, and blood lipids. The safety outcome will be the rate of adverse events.

Discussion

This study will be the first randomized controlled trial in which PFS is used as the primary outcome to test whether KLTi combined with first-line chemotherapy has superior efficacy and reduced toxicity compared to chemotherapy alone in advanced NSCLC. This will also be the first clinical study to observe the effects of KLTi on blood lipids.

Trial registration

ClinicalTrials.gov NCT03986528. Prospectively registered on 30 May 2019.
Isolation, structure characteristics and antioxidant activity of two water-soluble polysaccharides from Lenzites betulina
Authors: Guo Lei , Dai Hongwei , Ma Jiayu , Wang Junmin , Hua Yan , Zhou Lingyun
Published: March 2021

Background

Fungal polysaccharides belong to a very important class of biological macromolecules in nature, and have complex monosaccharide composition and structure. These studies on structure and biological activity of fungal polysaccharides have become one of the research hotspots of scholars at home and abroad.

Results

This study was performed in order to understand the structural characteristics and antioxidant activity of polysaccharides from Lenzites betulina (LBPs). The LBPs were deproteinized using sevag method, and further purified by DEAE cellulose-52 column and Sephadex G-100 column chromatographies, then the two refined polysaccharides were obtained and named LBPs-5 and LBPs-6. Fourier transform infrared spectrometry (FT-IR) showed that LBPs-5 and LBPs-6 are typical β-pyranose with characteristic peaks of polysaccharides. The molecular weight of the two water-soluble polysaccharides were estimated to be 3.235 × 103 Da and 6.196 × 103 Da by HPGPC, respectively. HPLC with PMP derivatization analysis indicated that the monosaccharide compositions of LBPs-5 were mannose, glucuronic acid, glucose, and galactose in a molar ratio of 0.05:0.15:0.76:0.04. The monosaccharide compositions of LBPs-6 were mannose, glucuronic acid, and glucose, in a molar ratio of 0.04:0.17:0.79. Furthermore, the two water-soluble polysaccharides demonstrated strong scavenging effects on DPPH·, ABTS·+, ·OH and weak total reducing power, especially LBPs-6 was significantly stronger in scavenging rate than that of LBPs-5.

Conclusions

The outcome of the study indicated that LBPs had good potential as medicine and food.
A randomized, placebo-controlled experimental medicine study of RIPK1 inhibitor GSK2982772 in patients with moderate to severe rheumatoid arthritis
Authors: Weisel Kathleen , Berger Scott , Thorn Katie , Taylor Peter C. , Peterfy Charles , Siddall Hilary , Tompson Debra , Wang Susanne , Quattrocchi Emilia , Burriss Susan W. , Walter Jochen , Tak Paul Peter
Published: March 2021

Background

Receptor-interacting protein kinase 1 (RIPK1) is a key mediator of inflammation through cell death and proinflammatory cytokine production. This multicenter, randomized, double-blind (sponsor-unblinded), placebo-controlled, experimental medicine study evaluated the safety, pharmacokinetics (PK), and preliminary efficacy of GSK2982772, a RIPK1 inhibitor, in moderate to severe rheumatoid arthritis (RA).

Methods

Patients with moderate to severe RA who had received ≥12 weeks’ stable-dose conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy were randomized (2:1) to GSK2982772 60 mg or placebo orally 2 or 3 times daily for 84 days. Safety, PK, disease activity, joint damage, and pharmacodynamic (PD) biomarkers were assessed at days 43 and 85.

Results

A total of 52 patients were randomized (placebo, 18; GSK2982772, 34). Adverse events (AEs) were reported in 13 (72%) in patients in the placebo group (n = 3 b.i.d; n = 10 t.i.d.) and 20 (61%) in the GSK2982772 group (n = 3 b.i.d; n = 17 t.i.d.). All treatment-related AEs were mild/moderate, except one severe case of alopecia areata at day 49 and retinal vein thrombosis at day 66 (which led to withdrawal from the study) in patients receiving GSK2982772 t.i.d. Disease Activity Score in 28 Joints–C-reactive protein (DAS28-CRP) scores, ACR20/50/70 response, and rates of low disease activity and remission were similar between placebo and GSK2982772 arms.

Conclusions

These results suggest that inhibition of RIPK1 activity at the GSK2982772 exposure levels evaluated do not translate into meaningful clinical improvement of RA.

Trial registration

ClinicalTrials.gov Identifier: NCT02858492. Registered 8 August 2016.