bluuebunny/crossref_metadata_2025 huggingface dataset:
Single high-sensitivity troponin levels to assess patients with potential acute coronary syndromes
Authors: Barnes Cara , Fatovich Daniel M , Macdonald Stephen P J , Alcock Richard F , Spiro Jon R , Briffa Tom G , Schultz Carl J , Hillis Graham S
Published: January 2021

Objective

We tested the hypothesis that patients with a potential acute coronary syndrome (ACS) and very low levels of high-sensitivity cardiac troponin I can be efficiently and safely discharged from the emergency department after a single troponin measurement.

Methods

This prospective cohort study recruited 2255 consecutive patients aged ≥18 years presenting to the Emergency Department, Royal Perth Hospital, Western Australia, with chest pain without high-risk features but requiring the exclusion of ACS. Patients were managed using a guideline-recommended pathway or our novel Single Troponin Accelerated Triage (STAT) pathway. The primary outcome was the percentage of patients discharged in <3 hours. Secondary outcomes included the duration of observation and death or acute myocardial infarction in the next 30 days.

Results

The study enrolled 1131 patients to the standard cohort and 1124 to the STAT cohort. Thirty-eight per cent of the standard cohort were discharged directly from emergency department compared with 63% of the STAT cohort (p<0.001). The median duration of observation was 4.3 (IQR 3.3–7.1) hours in the standard cohort and 3.6 (2.6–5.4) hours in the STAT cohort (p<0.001), with 21% and 38% discharged in <3 hours, respectively (p<0.001). No patients discharged directly from the emergency department died or suffered an acute myocardial infarction within 30 days in either cohort.

Conclusions

Among low-risk patients with a potential ACS, a pathway which incorporates early discharge based on a single very low level of high-sensitivity cardiac troponin increases the proportion of patients discharged directly from the emergency department, reduces length of stay and is safe.

Trial registration number

ACTRN12618000797279.
Therapy of lymphoma by immune checkpoint inhibitors: the role of T cells, NK cells and cytokine-induced tumor senescence
Authors: Ahmetlic Fatima , Fauser Josia , Riedel Tanja , Bauer Vera , Flessner Carolin , Hömberg Nadine , Hennel Roman , Brenner Ellen , Lauber Kirsten , Röcken Martin , Mocikat Ralph
Published: January 2021

Background

Although antibodies blocking immune checkpoints have already been approved for clinical cancer treatment, the mechanisms involved are not yet completely elucidated. Here we used a λ-MYC transgenic model of endogenously growing B-cell lymphoma to analyze the requirements for effective therapy with immune checkpoint inhibitors.

Methods

Growth of spontaneous lymphoma was monitored in mice that received antibodies targeting programmed cell death protein 1 and cytotoxic T lymphocyte-associated protein-4, and the role of different immune cell compartments and cytokines was studied by in vivo depletion experiments. Activation of T and natural killer cells and the induction of tumor senescence were analyzed by flow cytometry.

Results

On immune checkpoint blockade, visible lymphomas developed at later time points than in untreated controls, indicating an enhanced tumor control. Importantly, 20% to 30% of mice were even long-term protected and did never develop clinical signs of tumor growth. The therapeutic effect was dependent on cytokine-induced senescence in malignant B cells. The proinflammatory cytokines interferon-γ (IFN-γ) and tumor necrosis factor (TNF) were necessary for the survival benefit as well as for senescence induction in the λ-MYC model. Antibody therapy improved T-cell functions such as cytokine production, and long-time survivors were only observed in the presence of T cells. Yet, NK cells also had a pronounced effect on therapy-induced delay of tumor growth. Antibody treatment enhanced numbers, proliferation and IFN-γ expression of NK cells in developing tumors. The therapeutic effect was fully abrogated only after depletion of both, T cells and NK cells, or after ablation of either IFN-γ or TNF.

Conclusions

Tumor cell senescence may explain why patients responding to immune checkpoint blockade frequently show stable growth arrest of tumors rather than complete tumor regression. In the lymphoma model studied, successful therapy required both, tumor-directed T-cell responses and NK cells, which control, at least partly, tumor development through cytokine-induced tumor senescence.
Incidence of thromboembolism in patients with melanoma on immune checkpoint inhibitor therapy and its adverse association with survival
Authors: Sussman Tamara A , Li Hong , Hobbs Brian , Funchain Pauline , McCrae Keith R , Khorana Alok A
Published: January 2021

Background

Thromboembolism (TE) in cancer significantly contributes to morbidity and mortality. Little is known about the incidence of arterial TE (ATE) and venous TE (VTE) in patients with melanoma on immune checkpoint inhibitor (ICI) therapy.

Methods

We conducted a retrospective cohort study of patients with melanoma receiving ICI from July 2015 through December 2017 at the Cleveland Clinic. TE, including VTE events of deep venous thrombosis, pulmonary embolism, visceral vein thrombosis, and ATE events of myocardial infarction, stroke, peripheral arterial embolism, or transient ischemic attack after ICI initiation were identified. Overall survival (OS) from ICI initiation was estimated by Kaplan-Meier and Cox hazard models; associations between TE, ICI regimen, and clinical risk factors were evaluated using log-rank test.

Results

The study population comprised 228 patients with median age of 65 years (23–91 years), 67% male, and median follow-up of 27.3 months. Pembrolizumab was most commonly used (38.7%), followed by combination of ipilimumab plus nivolumab (29.4%), ipilimumab (20%), and nivolumab (12.3%). Most had stage IV disease (81.1%) and 11% had brain metastases (BM) at treatment initiation. Fifty-one TE events occurred in 47 patients (20.6%), including 37 (16.2%) VTE and 14 (6.1%) ATE. Cumulative incidence of TE after ICI initiation was 9.3% (95% CI: 6.0% to 13.6%) at 6 months, and 16.0% (95% CI: 11.6% to 21.2%) at 12 months. The 6-month and 12-month VTE cumulative incidence rates were higher with combination ICI than single agent (16.7% vs 5.0% and 21.3% vs 9.5%, respectively; p=0.02). Risk factors significantly associated with VTE in multivariate analysis included combination ICI (HR 2.70; 95% CI: 1.28 to 5.70; p=0.009), Khorana Score ≥1 (HR 2.24; 95% CI: 1.06 to 4.74; p=0.03), history of coronary artery disease (HR 2.71; 95% CI: 1.16 to 6.29); p=0.02), and anticoagulation at treatment start (HR 4.14; 95% CI: 1.60 to 10.7; p=0.003). Of patients without BM, OS was worse in patients with TE compared with those without (2-year OS 50.8% vs 71.3%; HR 2.27; 95% CI: 1.36 to 3.79; p=0.002), when adjusted for age and stage.

Conclusions

ICI is associated with a high incidence of TE in patients with melanoma, with higher rates with combination therapy; TE is associated with substantial worsening of survival. Further studies are needed to identify pathophysiology, biomarkers, and preventive approaches.
Olfactory impairment as an early marker of Parkinson’s disease in REM sleep behaviour disorder: a systematic review and meta-analysis
Authors: Lyu Zhihong , Zheng Shuxin , Zhang Xiaoyuan , Mai Yiling , Pan Jiyang , Hummel Thomas , Hähner Antje , Zou Laiquan
Published: January 2021

Olfactory impairment and rapid eye movement sleep behaviour disorder (RBD) are prodromal symptoms of Parkinson’s disease (PD) that may be associated with each other. This review aims to investigate the significance of olfaction in the diagnosis and prognosis of patients with RBD and to assess moderating factors affecting olfactory performance. We searched articles on olfaction in RBD and PD in five electronic databases. We identified 32 studies for the systematic review and used 28 of those, including 2858 participants for meta-analysis. Results revealed significant deficits in odour identification (g=−1.80; 95% CI: −2.17 to −1.43), threshold (g=−1.29; 95% CI: −1.67 to −0.91), discrimination (g=−1.08; 95% CI: −1.28 to −0.87) and overall olfactory function (g=−1.64; 95% CI: −1.94 to −1.35) in patients with RBD. Except for the Unified Parkinson's Disease Rating Scale Part III scores, none of the known moderating variables (including age, sex, disease duration and years of education) accounted for the olfactory function heterogeneity in patients with RBD. We identified similar olfactory impairments in patients with RBD and patients with PD (either with or without underlying RBD). These findings suggest that olfactory impairment may be a sensitive and stable diagnostic biomarker of RBD and appears to be useful for identifying patients with idiopathic RBD at high risk for early conversion to PD.
How can we decide a fair allocation of healthcare resources during a pandemic?
Authors: Roadevin Cristina , Hill Harry
Published: January 2021

Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources during the COVID-19 pandemic that may have been warranted given the urgency of the situation. However, these actions do not bypass the opportunity cost principle although they can appear to in the short term, since spending increases cannot continue indefinitely and there are patient groups who lose out when resources are redirected to pandemic services. Therefore, policy-makers must consider who bears the cost of the displaced healthcare resources. Failure to do so runs a risk of reducing overall population health while disproportionally worsening health in socially disadvantaged groups. We give the example of ethnic minorities in England who already had the worst health and, due to structural injustices, were hardest hit by the pandemic and may stand to lose the most when services are reallocated to meet the resource demands of the crisis. How can we prevent this form of health inequity? Our proposal is forward-looking: we suggest that the government should invest our resources wisely while taking issues of equity into account–that is, introduce cost–equity analysis.
Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes
Authors: Abbasi Mehdi , Liu Yang , Fitzgerald Seán , Mereuta Oana Madalina , Arturo Larco Jorge L , Rizvi Asim , Kadirvel Ramanathan , Savastano Luis , Brinjikji Waleed , Kallmes David F
Published: January 2021

Background

First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes.

Objective

To determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE.

Methods

In July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c–3 after a single pass) and modified FPE (mFPE, defined as TICI 2b–3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate.

Results

Sixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE).

Conclusions

Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.
Berth Allocation in a Bulk Terminal with Overall Quay Length Constraint
Authors: Yao Jiangbo , Wu Junfang
Published: January 2021

Motivated by the operation of bulk terminal in the Pearl River Delta, we study a berth allocation problem (BAP) with 2 berths and overall quay length constraint. The quay length occupied by a vessel depends on its berthing directions. The feasible berthing direction changes in a tide cycle. The objective is to minimize the total service of all vessels. We develop a mixed integer programming (MIP) model for the problem. We also propose an efficient genetic algorithm to tackle the problem. Our computational experiments show that the mixed integral programming model can only be solved by CPLEX for small-size instances, the genetic algorithm obtains good approximation solutions for large-size instances.
COMPLEX FRACTIONAL-ORDER HIV DIFFUSION MODEL BASED ON AMPLITUDE EQUATIONS WITH TURING PATTERNS AND TURING INSTABILITY
Authors: IQBAL NAVEED , KARACA YELIZ
Published: January 2021

A weakly nonlinear analysis provides a system constituting amplitude equations and its related analysis is capable of predicting parameter regimes with different patterns expected to co-exist in dynamical circumstances that exhibit complex fractional-order system characteristics. The Turing mechanism of pattern formation as a result of diffusion-induced instability of the homogeneous steady state is concerned with unpredictable conditions. The Turing instability caused by fractional diffusion in a Human Immunodeficiency Virus model has been addressed in this study. It is important that the effect of the Human Immunodeficiency Virus to the immune system can be modeled by the interaction of uninfected cells, unhealthy cells, virus particles and antigen-specific. Initially, all potential equilibrium points are defined and the stability of the interior equilibrium point is then evaluated using the Routh–Hurwitz criteria. The conditions for Turing instability are obtained by local equilibrium points with stability analysis. In the neighborhood of the Turing bifurcation point, weakly nonlinear analysis is employed to deduce the amplitude equations. After applying amplitude equations, it is observed that this system has a very rich dynamical behavior. The constraints for the formation of the patterns like a hexagon, spot, mixed and stripe patterns are identified for the amplitude equations by dynamic analysis. Furthermore, by using the numerical simulations, the theoretical results are verified. Within this framework, this study through the dynamical behavior of the complex system perspective and bifurcation point based on the viral death rate can provide the basis for several researchers working on Human Immunodeficiency Virus model through various aspects. Accordingly, the Turing bifurcation point and weakly nonlinear analysis employed within the complex fractional-order dynamics addressed herein are highly relevant experimentally since the related effects can be studied and applied concerning different mathematical, physical, engineering and biological models.
EXISTENCE RESULTS FOR ABC-FRACTIONAL DIFFERENTIAL EQUATIONS WITH NON-SEPARATED AND INTEGRAL TYPE OF BOUNDARY CONDITIONS
Authors: MEHMOOD NAYYAR , ABBAS AHSAN , ABDELJAWAD THABET , AKGÜL ALI
Published: January 2021

This paper presents a study on the existence theory of fractional differential equations involving Atangana–Baleanu (AB) derivative of order [Formula: see text], with non-separated and integral type boundary conditions. An existence result for the solutions of given AB-fractional differential equation is proved using Krasnoselskii’s fixed point theorem, while the uniqueness of the solution is obtained using Banach contraction principle. Some conditions are proposed under which the given boundary value problem is Hyers–Ulam stable. Examples are given to validate our results.
RHUPS
Authors: Baek Yoonji , Yun Unil , Kim Heonho , Nam Hyoju , Kim Hyunsoo , Lin Jerry Chun-Wei , Vo Bay , Pedrycz Witold
Published: January 2021

Databases that deal with the real world have various characteristics. New data is continuously inserted over time without limiting the length of the database, and a variety of information about the items constituting the database is contained. Recently generated data has a greater influence than the previously generated data. These are called the time-sensitive non-binary stream databases, and they include databases such as web-server click data, market sales data, data from sensor networks, and network traffic measurement. Many high utility pattern mining and stream pattern mining methods have been proposed so far. However, they have a limitation that they are not suitable to analyze these databases, because they find valid patterns by analyzing a database with only some of the features described above. Therefore, knowledge-based software about how to find meaningful information efficiently by analyzing databases with these characteristics is required. In this article, we propose an intelligent information system that calculates the influence of the insertion time of each batch in a large-scale stream database by applying the sliding window model and mines recent high utility patterns without generating candidate patterns. In addition, a novel list-based data structure is suggested for a fast and efficient management of the time-sensitive stream databases. Moreover, our technique is compared with state-of-the-art algorithms through various experiments using real datasets and synthetic datasets. The experimental results show that our approach outperforms the previously proposed methods in terms of runtime, memory usage, and scalability.
Acupoint Massage Therapy Alters the Composition of Gut Microbiome in Functional Constipation Patients
Authors: Chen Hui , Tan Pei-Shan , Li Chun-Ping , Chen Bi-Zhen , Xu Yu-Qin , He Yan-Qin , Ke Xiao
Published: January 2021

Objective and Background. Constipation is under high incidence globally. Current drug treatment on constipation, especially chronic functional constipation (CFC), lacks of efficiency and has an adverse reaction. Acupoint Massage Therapy (AMT) is traditionally applied to CFC with a good success rate and without unfavorable reaction in China. The underline mechanism of AMT remains unclear. Recent studies revealed that gut microbiome is involved in constipation development and treatment. Our aim is to evaluate the composition of gut microbiome of CFC patients after AMT. Patients and Methods. 104 CFC patients were enrolled in the study, including 49 males and 55 females. We investigated the gut microbiome of CFC patients after AMT through 16SrDNA sequencing. Results. Results showed the overall structure of gut microbiome has no significant difference between experimental and control groups. In the genus level, the abundance of Pseudobutyrivibrio and Ruminiclostridium is higher in the experiment group than in the control, whereas that of Fusicatenibacter is less. The 16S KEGG function prediction suggested that Parkinson disease, retinol metabolism, and arachidonic acid metabolism could explain the biological function of different gut microbiome. Furthermore, cytokines in the serum showed a correlation with the abundance of Pseudobutyrivibrio in CFC. Conclusion. AMT could change the composition of gut microbiome which is associated with cytokines in CFC patients.
Evaluation of Water Retention Capacity of Bulkheads in Underground Coal Mines
Authors: Hang Yuan , Jin Lichuang , Yang Binbin , Li Ning , Yuan Shichong , Gao Zhilin , Sun Linxuan , Zheng Sen , Hu Mingming
Published: January 2021

The mechanism of water flow in and around the bulkheads and the surrounding rock is studied for Panel No. 21102 in the Sanhejian coal mine in Xuzhou, China. Based on an analysis of the properties of the bulkheads and the surrounding rock, three types of water conducting pathways are identified: (1) a water conducting pathway at the interface between the bulkhead and the surrounding rock; (2) a water conducting pathway in the faults of the rock; and (3) a water conducting pathway in the fractures of the rock. The possibility of these three pathways for water flow at Panel No. 21102 is analyzed, and the connectivity coefficient of the water conducting pathway is determined. The expression for calculating the critical hydraulic gradient of the rock by using the connectivity coefficient in the water conducting pathways is presented which is based on the permeability and integrity of the rock. The ratios of the critical hydraulic gradient to the steady state hydraulic gradient are calculated for 13 mines in China. An acceptable safety factor in controlling the water flow for the bulkhead is found to be 1.68. When the safety factor is less than 1.68, water leakage has occurred in a number of cases. Finally, changes in the water pressure in the bulkheads with time and changes in the seepage flow with time in the surrounding rock are analyzed. It is found that there is a good correlation between the rate of water flow and water pressure which confirms that water pressure plays a decisive role in controlling seepage from the rock in and around the bulkheads.
Effect of Rainfall Pattern and Crack on the Stability of a Red Bed Slope: A Case Study in Yunnan Province
Authors: Zhang Zhenping , Fu Xiaodong , Sheng Qian , Yin Dawei , Zhou Yongqiang , Huang Juehao
Published: January 2021

Red bed slopes in the southwest of China are associated with a grant number of geological hazards, such as landslides, mud‐rock flows, and rock blocks falling, which are vital problems in geotechnical engineering. The damage can be induced or triggered due to a series of human and environmental activities, such as excavation, concentrated or long‐term rainfall, earthquake, and fluctuation of groundwater level. According to the field observations and geological exploration results, a small‐scale landslide was observed on January 10, 2016, after excavation along XiaoMo highway in Yunnan Province. A numerical model in actual size using GeoStudio software based on this typical red bed engineering slope was established in this study. Back analyses and laboratory tests were used to obtain the mechanical parameters of the geomaterial inside the slope. The historic rainfall data of Mengla County from July to September in 2016 was utilized as the flux boundary in analyzing the seepage variation features and the stability of the engineering slope in the rainy season. One major tension crack was set in the shallow region of the silty clay according to the geology survey to perform the disturbance of excavation on the geomorphology of the slope. Attempts were made to establish the anisotropic permeability of the crack induced by the complex fillings, and differences in the hydraulic response between the cracking and completed slope during the rainfall process were discussed. The result shows that the factor of safety of the slope without crack before the rainfall is 1.076, and the slope is considered in the state of the critical limit equilibrium, which is in accordance with the previous state of the slope under real conditions. The pore water pressure variations of the monitor points in the shallow region of the completed slope present close compliance with the rainfall intensity subjected to different rainfall patterns, which also controls the distribution of the plastic zone in the slope after rainfall. The comparisons in the seepage field and plastic zone between the cracking and completed slope reveal that the crack can shorten the infiltration path effectively, and the higher the permeability coefficient in the vertical direction is, the larger the pore water pressure increasing zone is and the higher the underground water level is, which should be paid more attention in highway constructions.
Effect of Training Eye Care Clinical Guideline for ICU Patients on Clinical Competence of Eye Care in Nurses
Authors: Momeni Mehrjardi Zakieh , Mirzaei Samaneh , Gohari Mohsen , Hafezieh Abbass , Nasiriani Khadijeh
Published: January 2021

Introduction. Sight is one of the most important and vital human senses. Lack of proper eye care (EC) in anesthetized patients can lead to serious ocular complications and even vision loss. Insufficient knowledge, attitude, and skills of nurses are considered as a barrier to providing EC in the intensive care unit (ICU). The aim of the present study was to determine the effect of training EC clinical practice guidelines for ICU patients on nurses’ knowledge, attitude, and practice of EC. Methods. This was an interventional study with a pre-post design performed on 60 ICU nurses. For the experimental group, EC clinical guideline training was performed for anesthetized patients in three sessions. The data collection tool included nurses’ clinical competence of the EC questionnaire with a possible score range of 0–86. This tool consists of three domains, including knowledge (0–18), attitude (0–28), and practice (0–40), which was completed in a self-assessment manner before and three months after the training program. Data analysis was carried out using SPSS16. Findings. The mean scores of knowledge, attitude, and practice after the intervention in the experimental and control groups were 15.03 ± 2.72 and 11.11 ± 3.50, 25.65 ± 3.47 and 22.07 ± 3.08, and 33.88 ± 4.14 and 28.5 ± 55.08, respectively, which were statistically significant (

P
≤
0.001

). Also, the total score of clinical competence of EC after the intervention in the experimental and control groups was 74.56 ± 7.93 and 61.74 ± 9.66, which showed a significant difference (

P
≤
0.001

). Conclusion. Training nurses based on EC clinical guidelines for anesthetized patients can improve the knowledge, attitude, and practice of ICU nurses. Evidence-based EC practice requires continuous training based on clinical guidelines and EC practice monitoring by nursing managers according to EC clinical guideline for an anesthetized patient.
Compressive Capacity of Vortex‐Compression Nodular Piles
Authors: Li Chunbao , Ma Xiaosong , Xue Shifeng , Chen Haiyang , Qin Pengju , Li Gaojie
Published: January 2021

Compared with traditional equal‐section pile, the nodular parts of nodular pile expand the contact area between the pile and foundation soil, which can greatly improve the bearing capacity of pile foundation and increase the stability of pile body structure. In this paper, the mechanism of pile‐soil interaction in the construction of vortex‐compression nodular pile is studied with the purpose of evaluating the compressive capacity of nodular piles. Through the indoor model test and ABAQUS numerical simulation analysis, the compressive characteristics of 12 types of vortex‐compression nodular pile are obtained, and the variation rules of the parameters of the compressive characteristics of vortex‐compression nodular piles are quantitatively analyzed, including the failure pattern of foundation soil, load‐settlement relationship, and load transfer law of vortex‐compression nodular piles. The results showed that the compressive capacity of vortex‐compression nodular piles has significant advantages over that of traditional equal‐section piles. Based on the results of the indoor model test and numerical simulation, the calculation method and formula of the compressive capacity of vortex‐compression nodular piles are given by modifying the corresponding calculation formula of traditional nodular piles. The new method and formula are more in line with the actual working conditions and provide theoretical and data support for the further engineering application of vortex‐compression nodular piles.
LAPTM5 Plays a Key Role in the Diagnosis and Prognosis of Testicular Germ Cell Tumors
Authors: Li Xiunan , Su Yu , Zhang Jiayao , Zhu Ye , Xu Yingkun , Wu Guangzhen
Published: January 2021

Objective. Testicular germ cell tumors (TGCT) are a serious malignant tumor with low early diagnosis rates and high mortality. Methods. To investigate novel biomarkers to predict the diagnosis and prognosis of this cancer, bioinformatics analysis was used as an accurate, efficient, and economical method. Results. Our study detected 39 upregulated and 589 downregulated differentially expressed genes (DEGs) using the GEO and TCGA databases. To identify the function of DEGs, GO functional analysis, three pathway analysis (KEGG, REACTOME, and PANTHER), and protein-protein interaction network were performed using the KOBAS website, as well as the String database. After a series of analyses in GEPIA and TIMER, including differential expression, we found one candidate gene related to the prognosis and diagnosis of TGCT. LAPTM5 was also associated with CD8+ T cell and PDCD1 expression, which suggests that it may affect immune infiltration. Conclusions. LAPTM5 was identified as a hub gene, which could be used as a potential biomarker for TGCT diagnosis and prognosis.
Iodine Deficiency Disorder and Knowledge about Benefit and Food Source of Iodine among Adolescent Girls in the North Shewa Zone of Amhara Region
Authors: Zeru Abayneh Birlie , Muluneh Mikyas Arega , H Giorgis Kassa Ketsela , Menalu Mulat Mossie , Tizazu Michael Amera
Published: January 2021

Background. As the dietary iodine content depends on the iodine contents of the soil where the crop is harvested, in highland areas where the iodine content of topsoil was washed away due to erosion, iodized salt is the main source of iodine. This study assessed the magnitude of iodine deficiency disorder and knowledge about the benefit and food sources of iodine among adolescent girls in the highland areas of the North Shewa Zone, Amhara Region, central Ethiopia. Methods. An institutional cross-sectional study was conducted from October 5, 2018, to December 30, 2019. Through a multistage sampling technique, 625 adolescent school girls were selected from 9 schools. A pretested semistructured self-administered questionnaire was used for data collection. Anthropometric measures and thyroid gland physical examinations were performed by trained nurses. The collected data were entered into the computer through Epi Data 3.1 software, and analysis was performed using Anthro plus and SPSS software. Results. The total goiter rate was 317 (50.7%) with 95%CI of 46.9% to 54.6%. Grade-one and grade-two goiter accounts 226 (36.2%) and 91 (14.6%), respectively. About one-third, 428 (68.5%), had knowledge about locally available iodine source foods and 309 (72.2%) of them mentioned salt as a source of iodine. Over half, 216 (55.1%), of 392 (62.7%) participants who had knowledge about the benefit of iodine knew it prevents goiter. Diet diversity score of <5 food groups [AOR 1.487, 95%CI 1.061–2.083], stunting [AOR 1.876, 95%CI 1.079–3.257], menstruation [AOR 1.615, 95%CI 1.110–2.349], rural residence [AOR 1.412, 95%CI 1.005–1.984], and open salt storage container [AOR 2.001, 95%CI 1.044–3.833] were significantly associated with goiter. Conclusions. Total goiter rate of adolescent school girls is high in the area. Low diet diversity score, stunting, menstruation, rural residence, and using an open container for salt storage increased the risk of goiter. In addition to universal salt iodization, the emphasis has to be given on proper handling and utilization of iodized salts at the household level to avoid iodine deficiency disorder in adolescent girls.
Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability
Authors: Cain Nicole M. , Jowers Callie , Blanchard Mark , Nelson Sharon , Huprich Steven K.
Published: January 2021

Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.
Objective Physical Activity Assessment in Clinical Congenital Heart Disease Research: A Systematic Review on Study Quality, Methodology, and Outcomes
Authors: Brudy Leon , Meyer Michael , Garcia-Cuenllas Luisa , Oberhoffer Renate , Hager Alfred , Ewert Peter , Müller Jan
Published: January 2021

Background: The shift toward a preventative approach in medical aftercare of congenital heart disease (CHD) patients has led to encouragement of regular physical activity (PA) in this patient population. Objective measures are crucial in accurately displaying PA levels and have increasingly found their way into clinical research. This review aims to give an overview about quality, methodology, and outcomes of current scientific work on accelerometers objectively assessing PA in patients with CHD. Methods: Systematically researched literature in all relevant databases (PubMed, Cochrane, and Scopus) over the past decade (2009–2019) with history of CHD and accelerometer-based PA assessment was evaluated by 2 independent reviewers according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. Results: Eight articles with 664 pediatric patients with CHD aged 3–18 years (range 10–162 patients), 5 studies with 574 adults with CHD aged 18–63 years (range 28–330 patients), and 3 studies with 177 pediatric patients and adults with CHD aged 8–52 years were included. Two studies were rated “good”; 9, “fair”; and 5, “poor.” Methodologies and devices differed substantially across all studies. Conclusions: Overall study quality was fair at best, and due to difficult methodological comparability of the studies, no clear answer on how active patients with CHD really are can currently be given. Larger studies carefully considering collection and processing criteria, and correct reporting standards exploring PA in patients with CHD from different angles are needed.
Storytelling to Inspire Dialysis Patients to Learn about Living Donor Kidney Transplant
Authors: Wood Emily H. , Waterman Amy D. , Pines Rachyl
Published: January 2021

Background: Policy changes including the Advancing American Kidney Health initiative and CMS’s ESRD Quality Incentive Program recommend increasing educational initiatives within dialysis centers to increase living kidney donor transplant (LDKT) rates. LDKT education can be challenging in dialysis centers due to limited provider time to educate, patient fears or reluctance to learn about LDKT, and difficulty educating potential living donors. New educational innovations that increase dialysis patient curiosity about pursuing LDKT are needed. Summary: Digital first-person storytelling, or the sharing of narratives by individuals in their own words, is a culturally competent, health literate, patient-driven approach to expanding patient understanding about LDKT that can supplement traditional educational strategies without additional burden for dialysis providers. The Living Donation Storytelling Project is an online digital library of over 150 video stories told by diverse kidney recipients, donors, those in search of a donor, and their family/friends. By honestly discussing how they overcame fears and challenges related to LDKT, these stories address sensitive topics that can be hard for providers to introduce by using easily accessible learning methodology that may better connect with racial/ethnic minorities, scared patients, and patients facing health literacy challenges. Key Messages: Supplementing traditional educational approaches with digital storytelling may help overcome time limitations in educating for busy providers, boost providers’ own knowledge about LDKT, serve as a free supplemental resource for patients, reduce fears and increase self-efficacy about transplant, help more patients to share about transplant with their social networks, and ultimately increase LDKT rates.
Contralateral Axillary Lymph Node Metastasis in a Patient with Relapsed Breast Cancer: Locoregional Event or Distant Metastasis Disease?
Authors: Herrera-Martínez Yiraldine , Acevedo-Bañez Irene , De-Bonilla-Damiá Álvaro , Fernández-Rodríguez Paula , Sousa José María , Jiménez-Hoyuela García José M.
Published: January 2021

Introduction: Contralateral axillary lymph node metastasis (CAM) is a rare clinical condition in patients with breast cancer. It can be explained from hematogenous spread from the original primary tumor (stage IV) to aberrant regional lymphatic drainage to the contralateral axilla. However, according to the current clinical guidelines, regardless of its origin, CAM is considered as metastatic disease. Case Presentation: A 68-year-old woman presented with relapsed right breast cancer; lymphoscintigraphy showed only one sentinel lymph node (SLN) in the contralateral axilla (left region). Twenty-four hours later, the patient underwent upper internal quadrantectomy and bilateral selective lymph node biopsy. The final pathological analysis revealed one contralateral macrometastasis (>4 mm) in one left SLN. Subsequently, second-level left lymphadenectomy was performed. Currently the patient is being treated with chemotherapy, with appropriate clinical response. Discussion: Our patient was considered to be node-positive rather than having metastatic disease since the preoperative lymphoscintigraphy demonstrated contralateral lymphatic drainage. Through preoperative scan in patients with relapsed breast cancer with clinically negative lymph nodes and CAM, it is possible to identify those cases that would benefit from therapy with curative intention.
ВИКОРИСТАННЯ СИМУЛЯЦІЙНОГО НАВЧАННЯ З МЕТОЮ ФОРМУВАННЯ КОМПЕТЕНТНОСТІ СПЕЦІАЛІСТІВ
Authors: Vavryshchuk A. E.
Published: January 2021

Одним із методів формування високого рівня компетентності у майбутнього молодшого спеціаліста є використання симуляційного навчання на практичних заняттях із клінічних дисциплін. Завдяки сталій системі застосування даного методу навчання на кожному практичному занятті, яке потребує відтворення маніпуляцій, можна досягти високих результатів.
ТОВАРОЗНАВЧИЙ АНАЛІЗ РИНКУ ПОЛЬЩІ ЗАСОБІВ ДЛЯ ВИМІРЮВАННЯ АРТЕРІАЛЬНОГО ТИСКУ
Authors: Ravliv Yu. A. , Mach V. R.
Published: January 2021

Гіпертонічна хвороба – це захворювання серцево-судинної системи, яке проявляється систематичним підвищенням артеріального тиску. Своєчасне виявлення артеріальної гіпертензії, проведення заходів первинної та вторинної профілактики та призначення адекватної медикаментозної терапії затримує прогресування захворювання, знижує ризик виникнення ускладнень, сприяє поліпшенню якості життя та збереженню працездатності. Актуальним є дослідження фармацевтичного ринку щодо засобів вимірювання артеріального тиску для своєчасної діагностики артеріальної гіпертензії.
IMPLEMENTATION OF ECOLOGICAL EDUCATION TO THE TEACHING PROCESS ON DISCIPLINE “HYGIENE AND ECOLOGY” FOR ENGLISH-SPEAKING SIX YEAR STUDENTS
Authors: Hryhorenko L. V. , Baibakov V. M.
Published: January 2021

The article adduces the features of training English-speaking students of graduate courses in the departments of hygienic profile at the medical schools. It was established that the following issues remain difficult at the implementation of ecological education for English-speaking students in the departments of hygienic profile: adaptation of current national normative documents to the educational process;  application of international regulatory standards and recommendations of US EPA and WHO international organizations, if compared with domestic counterparts; at the teaching of lectures and practical classes, especially on ecological-dependent pathology, should be taking into account deontological, national and religious peculiarities of foreign students.  The results of the survey conducted among English-speaking six year students (36 students in total) showed that 40 to 60 % from total number of academic hours in the discipline should be assigned to independent work in a medical university, according to (25 and 19.4 %) respondents.  At the same time, the time budget for IWS preparation differs: for theoretical subjects, on average, a foreign student spends 1–2 hours (30.5 %), while less than 1 hour (22.2 %) preparation for clinical disciplines. Majority of English-speaking students (53 %) believe that the amount of time they spend preparing for classes depends on their interest in learning a particular discipline.  This is due to the complexity of this or that topic, as 55.5 % of respondents noted.  The other 30.8 % of foreigners do not think so, which indicates about low motivation this quota of senior students to study in Medical Higher Education Institutions, and requires more careful attention of teachers in creating interest in the study of hygiene disciplines.
ВИКОРИСТАННЯ МІЖДИСЦИПЛІНАРНИХ ЗВ’ЯЗКІВ ЯК УМОВА ЯКІСНОЇ ПІДГОТОВКИ СТУДЕНТІВ ДО ЛІЦЕНЗІЙНОГО ІСПИТУ «КРОК 1. ЗАГАЛЬНА ЛІКАРСЬКА ПІДГОТОВКА»
Authors: Ivanchenko O. Z. , Melnikovа O. Z. , Sergeeva L. N.
Published: January 2021

У статті проаналізовано роль міждисциплінарних звʼязків між медичною і біологічною фізикою та нормальною фізіологією людини для підготовки студентів до ліцензійного іспиту «Крок 1. Загальна лікарська підготовка», знайдених шляхом порівняння навчальних програм з обох дисциплін. Розглянуто тестові питання з нормальної фізіології у базі тестів для підготовки й у буклетах для складання іспиту, і визначено завдання, які студенти виконують вже на першому курсі в процесі вивчення медичної і біологічної фізики. Показано, що у базі тестів число таких завдань складає в середньому 8,7 % загальної кількості питань з нормальної фізіології людини, тоді як у буклетах іспиту – в середньому 22 %. Такі дані свідчать про необхідність широкого залучення міждисциплінарних звʼязків у вивченні обох наук, що дозволить уникнути дублювання навчального матеріалу в процесі навчання, відкриваючи перспективи для ретельнішого освоєння студентами програми з нормальної фізіології.
ДОСВІД ПРОВЕДЕННЯ КЛІНІЧНОЇ ПРАКТИКИ ДЛЯ ФІЗИЧНИХ ТЕРАПЕВТІВ НА БАЗІ ГЕРІАТРИЧНОГО ПАНСІОНАТУ
Authors: Mysula I. R. , Bakaliuk T. H. , Stelmakh H. O.
Published: January 2021

У статті здійснено аналіз ролі клінічної практики для бакалаврів та магістрів зі спеціальності «Фізична терапія. Ерготерапія» на базі геріатричного пансіонату у професійному становленні майбутніх фахівців. Показано, що важливу роль у підготовці фізичного терапевта відіграє клінічна практика, мета якої полягає у перевірці й закріпленні знань, отриманих студентами при вивченні основних клінічних та інших дисциплін, подальшому вдосконаленні практичних навичок, набутих упродовж навчального року, ознайомленні з організацією та умовами роботи фізичного терапевта в медичних закладах.

Під час практики студенти навчаються проводити оцінку функціонального стану серцево-судинної і дихальної систем у хворих похилого віку, що є дуже важливим фактором перед початком курсу реабілітації. Це дає можливість проведення раціонального відновного лікування з адекватним дозуванням фізичних навантажень кожному хворому під час перебування в геріатричному пансіонаті, а також моніторингу ефективності проведених процедур та підбору для кожного пацієнта індивідуального комплексу вправ для подальших занять, оскільки люди похилого віку потребують у програмах реабілітації вправ, що відповідають віковим змінам. Практична орієнтованість викладання клінічної практики для бакалаврів та магістрів зі спеціальності «Фізична терапія. Ерготерапія» на базі геріатричного пансіонату розширює світогляд майбутнього фізичного терапевта і дає можливість індивідуально підібрати реабілітаційне втручання та провести його контроль. Якісна організація клінічної практики для фізичних терапевтів дає можливість закріпити практичні навички у реальних професійних умовах. Формування клінічного мислення, відпрацювання практичних навичок, засвоєння культури спілкування з пацієнтами є основними напрямками навчання з клінічної практики для бакалаврів та магістрів зі спеціальності «Фізична терапія. Ерготерапія».
Comparability of Event Adjudication Versus Administrative Billing Claims for Outcome Ascertainment in the DAPT Study
Authors: Faridi Kamil F. , Tamez Hector , Butala Neel M. , Song Yang , Shen Changyu , Secemsky Eric A. , Mauri Laura , Curtis Jeptha P. , Strom Jordan B. , Yeh Robert W.
Published: January 2021

Background:

Data from administrative claims may provide an efficient alternative for end point ascertainment in clinical trials. However, it is uncertain how well claims data compare to adjudication by a clinical events committee in trials of patients with cardiovascular disease.

Methods:

We matched 1336 patients ≥65 years old who received percutaneous coronary intervention in the DAPT (Dual Antiplatelet Therapy) Study with the National Cardiovascular Data Registry CathPCI Registry linked to Medicare claims as part of the EXTEND (Extending Trial-Based Evaluations of Medical Therapies Using Novel Sources of Data) Study. Adjudicated trial end points were compared with Medicare claims data with
International Classification of Diseases, Ninth Revision
codes from inpatient hospitalizations using time-to-event analyses, sensitivity, specificity, positive predictive value, negative predictive value, and kappa statistics.

Results:

At 21-month follow-up, the cumulative incidence of major adverse cardiovascular and cerebrovascular events (combined mortality, myocardial infarction, and stroke) was similar between trial-adjudicated events and claims data (7.9% versus 7.2%, respectively;
P
=0.50). Bleeding rates were lower using adjudicated events compared with claims (5.0% versus 8.6%, respectively;
P
<0.001). The sensitivity and positive predictive value of comprehensive billing codes for identifying adjudicated events were 65.6% and 85.7% for myocardial infarction, 61.5% and 47.1% for stroke, and 76.8% and 39.3% for bleeding, respectively. Specificity and negative predictive value for all outcomes ranged from 93.7% to 99.5%. All 39 adjudicated deaths were identified using Medicare data. Kappa statistics assessing agreement between events for myocardial infarction, stroke, and bleeding were 0.73, 0.52, and 0.49, respectively.

Conclusions:

Claims data had moderate agreement with adjudication for myocardial infarction and poor agreement but high specificity for bleeding and stroke in the DAPT Study. Deaths were identified equivalently. Using claims data in clinical trials could be an efficient way to assess mortality among Medicare patients and may help detect other outcomes, although additional monitoring is likely needed to ensure accurate assessment of events.