bluuebunny/crossref_metadata_2025 huggingface dataset:
Midbrain/pons area ratio and clinical features predict the prognosis of progressive Supranuclear palsy
Authors: Cui Shi-Shuang , Ling Hua-Wei , Du Juan-Juan , Lin Yi-Qi , Pan Jing , Zhou Hai-Yan , Wang Gang , Wang Ying , Xiao Qin , Liu Jun , Tan Yu-Yan , Chen Sheng-Di
Published: March 2020

Background

Progressive supranuclear palsy (PSP) is a rare movement disorder with poor prognosis. This retrospective study aimed to characterize the natural history of PSP and to find predictors of shorter survival and faster decline of activity of daily living.

Method

All patients recruited fulfilled the movement disorder society (MDS) clinical diagnostic criteria for PSP (MDS-PSP criteria) for probable and possible PSP with median 12 years. Data were obtained including age, sex, date of onset, age at onset (AAO), symptoms reported at first visit and follow-up, date of death and date of institutionalization. Magnetic resonance imaging was collected at the first visit. Endpoints were death and institutionalization. Kaplan-Meier method and Cox proportional hazard model were used to explore factors associated with early death and institutionalization.

Results

Fifty-nine patients fulfilling MDS-PSP criteria were enrolled in our study. Nineteen patients (32.2%) had died and 31 patients (52.5%) were institutionalized by the end of the follow-up. Predictors associated with poorer survival were late-onset PSP and decreased M/P area ratio. Predictors associated with earlier institutionalization were older AAO and decreased M/P area ratio.

Conclusion

Older AAO and decreased M/P area ratio were predictors for earlier dearth and institutionalization in PSP. The neuroimaging biomarker M/P area ratio was a predictor for prognosis in PSP.
Antenatal cervical length measurement as a predictor of successful vaginal birth
Authors: Taha Omima T. , Elprince Mohamed , Atwa Khaled A. , Elgedawy Asmaa M. , Ahmed Amal A. , Khamees Rasha E.
Published: March 2020

Background

Antenatal cervical length measurement has paramount importance in the prediction of labor. It was compared to the Bishop Score and incorporated in the modified Bishop score due to its relevance and convenience. It is a more accurate tool that imposes no harm or distress to the patients. The study aimed to evaluate the role of antenatal cervical length measurement in the prediction of a successful vaginal birth and its relation to the duration of labor.

Methods

This was a prospective cohort study, conducted at the emergency ward of obstetrics and gynecology department. We recruited 162 women over 1 year from January 2018 to January 2019. Women eligible for the study had a transvaginal ultrasound for the examination of the cervical length before the onset of labor. The success of vaginal delivery was evaluated.

Results

The mean cervical length (mm) was 43.3 ± 8.0. The majority of the patients labored spontaneously [102 (63.0%)] while the remaining ones required induction of labor due to different causes. One hundred and eight patients (66.7%) had a successful vaginal delivery. The cervical length was significantly shorter among patients who delivered vaginally than those delivered by CS (P-value < 0.001). Multiple factors had a significant role in the prediction of the mode of delivery (cervical length, BMI, the onset of labor, parity). Maternal body mass index and labor induction were associated with a prolonged duration of the active phase of labor.

Conclusion

Antenatal cervical length measurement predicted the mode of delivery as well as the gestational age at which delivery ensued. It can be used in patients’ counseling regarding the mode of delivery.
Predictors of institutional delivery service utilization among women of reproductive age in Gambia: a cross-sectional analysis
Authors: Yaya Sanni , Bishwajit Ghose
Published: March 2020

Background

Over the last two decades, Gambia has made noticeable progress in the reducing the high maternal mortality rates and improving child survival rates. Nonetheless, numerous infrastructural and financial constraints continue to restrict access to institutional delivery care, a key component of achieving the maternal and child health related Sustainable Development Goals (SDG 3.1). This study assesses factors that predict women’s choice of mode and place of delivery in urban and rural Gambia.

Methods

Cross-sectional data from the latest round of Gambia Demographic and Health Survey (2013) on women aged 15–49 years (n = 5351) were analyzed. The outcome measures were place (home vs health facility) and mode of delivery (caesarean vs normal) in urban and rural Gambia. Data were analyzed using descriptive and multivariate regression methods.

Results

About three-fifth (60.8%) of the participants had their last childbirth at a health facility and 39.2% at their home. There was a significant urban-rural difference in the prevalence of facility delivery with 86.9% of the urban women choosing health facility over home compared with 45.8% among the rural women. In the regression analysis, place of residence, education of participants and the husband, employment, parity and use of antenatal care were significantly associated with the use of health facility delivery services. For instance, having secondary [OR = 1.657, 95%CI = 1.337,2.053] and higher education [OR-2.451, 95%CI = 1.166,5.150] showed higher odds for using facility delivery services; and women from the richest wealth quintile had significantly higher [OR = 2.239, 95%CI = 1.525,3.289] odds of using facility delivery compared with those in the lowest quintile.

Conclusion

Our findings suggest a sub-optimal use of professional childbirth services among Gambian women which appears to be driven by various geographical, educational, wealth inequality, parity and low use of ANC services. Addressing the socioeconomic and demographic inequalities may lead to a more widespread usage of maternity services in Gambia.
Searching for novel multimodal treatments in oligometastatic pancreatic cancer
Authors: Filippini D. M. , Grassi E. , Palloni A. , Carloni R. , Casadei R. , Ricci C. , Serra C. , Ercolani G. , Brandi G. , Di Marco M.
Published: March 2020

Background

Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases.

Case presentation

We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach.

A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment.

The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis.

Conclusions

Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.
A key genomic signature associated with lymphovascular invasion in head and neck squamous cell carcinoma
Authors: Zhang Jian , Lin Huaming , Jiang Huali , Jiang Hualong , Xie Tao , Wang Baiyao , Huang Xiaoting , Lin Jie , Xu Anan , Li Rong , Zhang Jiexia , Yuan Yawei
Published: March 2020

Background

Lymphovascular invasion (LOI), a key pathological feature of head and neck squamous cell carcinoma (HNSCC), is predictive of poor survival; however, the associated clinical characteristics and underlying molecular mechanisms remain largely unknown.

Methods

We performed weighted gene co-expression network analysis to construct gene co-expression networks and investigate the relationship between key modules and the LOI clinical phenotype. Functional enrichment and KEGG pathway analyses were performed with differentially expressed genes. A protein–protein interaction network was constructed using Cytoscape, and module analysis was performed using MCODE. Prognostic value, expression analysis, and survival analysis were conducted using hub genes; GEPIA and the Human Protein Atlas database were used to determine the mRNA and protein expression levels of hub genes, respectively. Multivariable Cox regression analysis was used to establish a prognostic risk formula and the areas under the receiver operating characteristic curve (AUCs) were used to evaluate prediction efficiency. Finally, potential small molecular agents that could target LOI were identified with DrugBank.

Results

Ten co-expression modules in two key modules (turquoise and pink) associated with LOI were identified. Functional enrichment and KEGG pathway analysis revealed that turquoise and pink modules played significant roles in HNSCC progression. Seven hub genes (CNFN, KIF18B, KIF23, PRC1, CCNA2, DEPDC1, and TTK) in the two modules were identified and validated by survival and expression analyses, and the following prognostic risk formula was established: [risk score = EXPDEPDC1 * 0.32636 + EXPCNFN * (− 0.07544)]. The low-risk group showed better overall survival than the high-risk group (P < 0.0001), and the AUCs for 1-, 3-, and 5-year overall survival were 0.582, 0.634, and 0.636, respectively. Eight small molecular agents, namely XL844, AT7519, AT9283, alvocidib, nelarabine, benzamidine, L-glutamine, and zinc, were identified as novel candidates for controlling LOI in HNSCC (P < 0.05).

Conclusions

The two-mRNA signature (CNFN and DEPDC1) could serve as an independent biomarker to predict LOI risk and provide new insights into the mechanisms underlying LOI in HNSCC. In addition, the small molecular agents appear promising for LOI treatment.
Impact of individual background on the unmet needs of cancer survivors and caregivers – a mixed-methods analysis
Authors: Watanabe Kaname , Katayama Kayoko , Yoshioka Takashi , Narimatsu Hiroto
Published: March 2020

Background

Cancer survivors and their caregivers may have various unmet needs that are medically difficult to solve. Previous studies have suggested the relations between individuals’ backgrounds and their unmet needs. We conducted a large-scale analysis to clarify the influence of individuals’ backgrounds, primarily cancer type, on specific types of unmet needs.

Methods

Using a mixed-methods approach, we analyzed records of first-time callers to a cancer-focused telephone consultation service that was provided by the Kanagawa Cancer Clinical Research Information Organization from October 2006 to May 2014. The qualitative approach concerned extracting unmet needs mentioned in each consultation and classifying them into themes of specific needs, while the quantitative approach comprised multi-variated analysis of the relationships between the frequency by which the needs in each theme arose and the associated callers’ backgrounds.

Results

A total of 1938 consultation cases were analyzed. In the qualitative analysis, the needs were classified into 16 themes. The mean number of unmet needs for each caller was 1.58 (standard deviation = 0.86). In the multi-variated analysis, caregivers for colorectal cancer survivors had a lower frequency of “emotional/mental health” needs (OR: 0.31, 95%CI: 0.11–0.88, p = 0.028) than did caregivers for breast-cancer survivors. Nevertheless, this was the only significant difference in needs frequency among callers (including survivors and their caregivers) with specific cancer types. Meanwhile, there significant difference in the frequency of occurrence of each unmet need theme was found among items concerning other background elements. Among survivors, sex was related to the frequency of needs among “physical” and “resources” themes, and “emotions/mental health”; their age group with “employment”; treatment course with “physical” and “resources” themes and “cure”; residence with “physical” themes; presence of symptom with “physical,” “education/information,” “resources,” “emotions/mental health,” and “cure” themes.

Conclusions

This large-scale study suggests that cancer type is not a significant factor for specific unmet needs and that individuals’ backgrounds and presence of symptoms play a more important role. Through this study, it was found that instruments to predict people’s needs and a system to provide individualized cancer care across cancer types should be developed in the future.
The association of dry eye syndrome and psychiatric disorders: a nationwide population-based cohort study
Authors: Liang Chiao-Ying , Cheang Wai-Man , Wang Chun-Yuan , Lin Keng-Hung , Wei Li-Chen , Chen Yu-Yen , Shen Ying-Cheng
Published: March 2020

Background

Several previous studies reported a greater prevalence of dry eye syndrome (DES) among patients with psychiatric diseases. The aim of this study is to investigate the prevalence and risk factors of DES in patients with psychiatric disorders (PD) using nationwide population-based data in Taiwan.

Methods

This population-based cohort study retrospectively identified patients with PD from 1997 to 2011. Patients with both PD and DES served as the DES cohort, and PD patients without DES comprised the non-DES cohort. PD was defined as a diagnosis of PD (ICD-9-CM 290–319) made by psychiatrists only, with at least three consecutive outpatient visits or at least one inpatient visit. DES was defined as a diagnosis of DES (ICD-9-CM 375.15) and a prescription for an eye lubricant (anatomical therapeutic chemical code, ATC code: S01XA). The main outcome measures were the prevalence of DES in these patients and associated risk factors.

Results

A total of 75,650 patients with PD (3665 in the DES cohort and 71,985 in the non-DES cohort) were included in the final analysis. The majority of patients in the DES group were women (72.6%), compared the non-DES group (57.8%). The mean age of patients in the DES cohort was 62.2 ± 14.9, which was significantly older than those in the non-DES group (50.9 ± 17.5). The patients with DES had a significantly greater likelihood of having dementia, bipolar disorder, depression, and neurotic disorders. Conditional regression analyses revealed that patients with dry eye disease were more likely to have schizophrenia (OR = 1.34), bipolar disorder (OR = 1.9), depression (OR = 1.54), and neurotic disorders (OR = 1.62). In addition, patients with DES were more likely to use 1st generation anti-psychotics (OR = 1.28) and had a lower risk of using 2nd generation anti-psychotics (OR = 0.64).

Conclusion

The study demonstrated that among PD patients, DES is highly prevalence in certain subtypes of PD, such as depression, bipolar disorder, and neurotic disorders, after adjusting for the comorbidities.
Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data
Authors: Steffen Annika , Nübel Julia , Jacobi Frank , Bätzing Jörg , Holstiege Jakob
Published: March 2020

Background

Depression is frequently accompanied by other mental disorders and various somatic diseases; however, previous comorbidity studies often relied on self-reported data and have not simultaneously assessed the entire spectrum of mental and somatic diagnoses. The aim is to provide a complete picture of mental and somatic comorbidity of depression in routine outpatient care in a high income country with a relatively well equipped health care system.

Methods

Using ambulatory claims data covering 87% of the German population (age 15+), we designed a cross-sectional study by identifying persons diagnosed with mild, moderate and severe depression in 2017 (N = 6.3 million) and a control group matched 4:1 on sex, 5-year age group and region of residence (N = 25.2 million). Stratified by severity, we calculated the prevalence of 202 diagnosis groups included in the ICD-10 in persons with depression as compared to matched controls using prevalence ratios (PR).

Results

Nearly all mental disorders were at least twice as prevalent in persons with depression relative to controls, showing a dose-response relationship with depression severity. Irrespective of severity, the three most prevalent somatic comorbid diagnosis groups were ‘other dorsopathies’ (M50-M54), ‘hypertensive diseases’ (I10-I15) and ‘metabolic disorders’ (E70-E90), exhibiting PRs in moderate depression of 1.56, 1.23 and 1.33, respectively. Strong associations were revealed with diseases of the central nervous system (i.e. multiple sclerosis) and several neurological diseases, among them sleep disorders, migraine and epilepsy, most of them exhibiting at least 2- to 3-fold higher prevalences in depression relative to controls. Utilization of health care was higher among depression cases compared to controls.

Conclusions

The present study based on data from nearly the complete adolescent and adult population in Germany comprehensively illustrates the comorbidity status of persons diagnosed with depression as coded in routine health care. Our study should contribute to increasing the awareness of the strong interconnection of depression with all other mental and the vast majority of somatic diseases. Our findings underscore clinical and health-economic relevance and the necessity of systematically addressing the high comorbidity of depression and somatic as well as other mental diseases through prevention, early identification and adequate management of depressive symptoms.
Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV)
Authors: Breivik R. , Wilberg T. , Evensen J. , Røssberg J. I. , Dahl H. S. J. , Pedersen G.
Published: March 2020

Background

The Feeling Word Checklist (FWC) is a self-report questionnaire designed to assess therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief, 12-item version of the Feeling Word Checklist (FWC-BV). The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients’ personality pathology and therapeutic alliance (TA).

Methods

Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders participated, and the study includes therapies for a large sample of patients (N = 2425) with personality pathology. Over a period of 2.5 years, therapists completed the FWC-BV for each patient in therapy every 6 months. Statistical methods included exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald’s coefficient Omega (ωt). The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR).

Results

Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales.

Conclusions

The FWC-BV measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts.
Health behaviours associated with video gaming in adolescent men: a cross-sectional population-based MOPO study
Authors: Puolitaival Tuulia , Sieppi Mirjam , Pyky Riitta , Enwald Heidi , Korpelainen Raija , Nurkkala Marjukka
Published: March 2020

Background

Playing video games, a form of sedentary behaviour, is associated with poor well-being and increased risk of morbidity due to chronic disease. However, the association between health behaviours and video gaming is poorly understood. The purpose of this population-based study was to reveal the differences in dietary habits and physical activity for adolescent men with high amount of video games on weekdays, as compared to their peers who play less often.

Methods

Seven hundred ninety-six adolescent men (age: mean = 17.8, SD = 0.6) attended compulsory conscription for military service in 2013 and completed a questionnaire regarding the amount and frequency of their video gaming. They also participated in a medical examination and underwent physiological measurements. The participants who played video games more than 3 h/d on weekdays were compared with those who played 3h/d or less. The association between health behaviours and the amount of playing video gaming was analysed using multivariable logistic regression analysis.

Results

24.1% (n = 192) of the participants reported video gaming in excess of 3 h/d. This group had higher incidence of having low physical fitness, having poor eating habits, and being obese. No differences were found in smoking or alcohol drinking habits. Other factors, including low leisure-time physical activity (OR = 1.94; 95% CI, 1.29–2.91), low consumption of vegetables and fruits (OR = 0.83; 95% CI, 0.72–0.97), high consumption of sweetened soft drinks (OR = 1.28; 95% CI, 1.06–1.55) and high amount of sitting time (OR = 1.40; 95% CI, 1.28–1.52), explained one-fourth of the difference.

Conclusion

In this population-based study, adolescent men who played video games a lot on weekdays had lower physical fitness, were more often obese, and had poorer dietary habits, as compared to their peers who played less often. Because playing video games typically adds to a person’s total sedentary time, this activity may be associated with adverse health outcomes at a very young age— especially in combination with poor health behaviours. The results of this study can be utilized to promote health interventions targeted at adolescent men so as to raise their awareness of the disadvantages of excessive video gaming.
Modelling immune deterioration, immune recovery and state-specific duration of HIV-infected women with viral load adjustment: using parametric multistate model
Authors: Dessie Zelalem G. , Zewotir Temesgen , Mwambi Henry , North Delia
Published: March 2020

Background

CD4 cell and viral load count are highly correlated surrogate markers of human immunodeficiency virus (HIV) disease progression. In modelling the progression of HIV, previous studies mostly dealt with either CD4 cell counts or viral load alone. In this work, both biomarkers are in included one model, in order to study possible factors that affect the intensities of immune deterioration, immune recovery and state-specific duration of HIV-infected women.

Methods

The data is from an ongoing prospective cohort study conducted among antiretroviral treatment (ART) naïve HIV-infected women in the province of KwaZulu-Natal, South Africa. Participants were enrolled in the acute HIV infection phase, then followed-up during chronic infection up to ART initiation. Full-parametric and semi-parametric Markov models were applied. Furthermore, the effect of the inclusion and exclusion viral load in the model was assessed.

Results

Inclusion of a viral load component improves the efficiency of the model. The analysis results showed that patients who reported a stable sexual partner, having a higher educational level, higher physical health score and having a high mononuclear component score are more likely to spend more time in a good HIV state (particularly normal disease state). Patients with TB co-infection, withanemia,having a high liver abnormality score and patients who reported many sexual partners, had a significant increase in the intensities of immunological deterioration transitions. On the other hand, having high weight, higher education level, higher quality of life score, having high RBC parameters, high granulocyte component scores and high mononuclear component scores, significantly increased the intensities of immunological recovery transitions.

Conclusion

Inclusion of both CD4 cell count based disease progression states and viral load, in the time-homogeneous Markov model, assisted in modeling the complete disease progression of HIV/AIDS. Higher quality of life (QoL) domain scores, good clinical characteristics, stable sexual partner and higher educational level were found to be predictive factors for transition and length of stay in sequential adversity of HIV/AIDS.
Effects of a transtheoretical model - based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: a randomized controlled trial
Authors: Li Xiaoyun , Yang Silan , Wang Yishu , Yang Bingxiang , Zhang Jingping
Published: March 2020

Background

Depression is a major risk factor for the morbidity and mortality of cardiovascular disease. A transtheoretical model-based intervention and motivational interviewing have been used to change health risk behaviors and have demonstrated positive effects. To our knowledge, no studies of patients with coronary heart disease (CHD) have used a transtheoretical model-based intervention and motivational interviewing as an intervention to provide dynamic education. Therefore, this study aimed to determine the effects of the transtheoretical model-based intervention and motivational interviewing on the management of depression in hospitalized patients with CHD.

Method

A randomized controlled trial was designed. A total of 110 participants were randomly divided into an intervention group (n = 55) and a control group (n = 55). The Hamilton Rating Scale for Depression and the Depression Prevention & Management Survey items (stages of change, perceived benefits, perceived barriers, process of change and self-efficacy) were used to collect data at all time points. Analysis of covariance, chi-square test and repeated measures analysis of variance were used to analyze the data.

Results

After the intervention, there were more positive changes in stages of change, higher scores for the cognitive and behavioral levels, the perceived benefits, and self-efficacy, and lower perceived barriers and depression in the intervention group than in the control group. Finally, there were statistically significant differences in the depression scores at different time points in the intervention group (F = 17.814, p = 0.000 < 0.01).

Conclusions

The study showed that a transtheoretical model-based intervention and motivational interviewing exert positive effects on the management of depression in hospitalized patients with CHD.

Trial registration

Clinicaltrials.gov, NCT03953924 (Date assigned: 16/5/2019). Retrospectively registered.
Application of chimerical ALT perforator flap with vastus lateralis muscle mass for the reconstruction of oral and submandibular defects after radical resection of tongue carcinoma: a retrospective cohort study
Authors: Yang Rong , Wu Xiaoshan , Kumar Pathak Ajit , Xiong Yafei , Jiang Canhua , Jian Xinchun , Guo Feng
Published: March 2020

Background

Patients with tongue carcinoma who undergo combined tongue and neck radical resection often have simultaneous oral and submandibular defects. Due to its high flexibility, the anterolateral thigh (ALT) perforator flap is gradually being adopted by surgeons for oral reconstruction. However, the tissue volume of perforator flaps is insufficient for the reconstruction of both the oral and submandibular regions. In this retrospective cohort study, we compared the postoperative outcomes and complications between patients reconstructed with using the classical ALT perforator flap and patients reconstructed using the chimeric ALT perforator flap with vastus lateralis muscle mass.

Methods

From August 2017 to August 2019, 25 patients underwent reconstructive therapy using a classical ALT perforator flap (classical group), while 26 patients were reconstructed with the chimeric ALT perforator flap (chimeric group) after radical resection of tongue cancer in Xiangya Hospital, Central South University. The flap survival rate, incidence of submandibular infection, lateral appearance, lower extremity function, and quality of life were compared between the two groups.

Results

There were no differences in flap survival rate and postoperative lower extremity function between the two groups. The incidence of submandibular infection was 15.4 and 40% in the chimeric and classical group, respectively. The duration of recovery was 12.20 ± 2.69 and 15.67 ± 4.09 days in the chimeric and classical group, respectively. The submandibular region fullness was satisfactory in the chimeric group. The postoperative quality of life in the chimeric group was better than that in the classical group (P < 0.05).

Conclusions

The chimerical ALT perforator flap with muscle mass reconstructs both the oral and submandibular defects accurately. It maintains the profile and fullness of the submandibular region and may reduce the incidence of submandibular infection.
Associations between menopausal hormone therapy and sleep disturbance in women during the menopausal transition and post-menopause: data from the Norwegian prescription database and the HUNT study
Authors: Andenæs Randi , Småstuen Milada Cvancarova , Misvær Nina , Ribu Lis , Vistad Ingvild , Helseth Sølvi
Published: March 2020

Background

Impaired sleep is common in menopausal women. The aim was to examine associations between uses of systemic menopausal hormone therapy (MHT) and sleep disturbance in a large population sample.

Methods

Female participants aged 45 to 75 years were selected from the Norwegian Health Study in Nord-Trøndelag (HUNT3, 2006–2008) (N = 13,060). Data were linked to the Norwegian Prescription Database, identifying use of prescribed MHT and use of sleep medication. Data were analyzed using multiple linear regression.

Results

In total, 996 women used systemic MHT (7.6%), with the highest prevalence of 10.3% among women 55 to 64 years of age. Despite high reports of frequent nocturnal awakening (24.7%) and high reports of hot flashes, use of MHT was low in this large population based survey. Although MHT use was associated with more sleep disturbance in unadjusted analyses, the association was not significant after adjusting for relevant covariates. Using sleep medication, reporting poor health, tobacco and alcohol use, doing daily exercise, having higher levels of anxiety, and being less satisfied with life were factors showing the strongest associations with sleep disturbance.

Conclusion

The lack of association between MHT and sleep disturbance suggests that other factors, such as self-perceived good health, a healthy lifestyle and anxiety/depression, are more relevant to sleep than MHT.
The risk of coronary artery disease in patients with rheumatoid arthritis using Chinese herbal products and conventional medicine in parallel: a population-based cohort study
Authors: Yu Han-Hua , Hsiung Nai-Huan , Chiang Jen-Huai , Shen Hsuan-Shu
Published: March 2020

Background

Few studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA). This study investigated the risk of CAD among patients with RA using CHP in combination with conventional medicine.

Methods

A retrospective cohort study was conducted using the Taiwan National Insurance Research Database to assess 22,353 patients who had been newly diagnosed with RA between 1997 and 2010. Patients were assigned to the CHP group or non-CHP group according to their use or nonuse of CHP after being diagnosed with RA. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of CAD for a 1:1 matched sample.

Results

Both the CHP and non-CHP groups comprised 4889 patients after 1:1 matching. The risk of CAD was significantly reduced in the CHP group [adjusted HR (aHR): 0.59, 95% confidence interval (CI): 0.50–0.71] compard with the non-CHP group. Those who used CHP for > 180 days had an even lower risk of CAD than users with CHP usage less than 30 days (aHR: 0.64, 95% CI: 0.43–0.95). Additionally, frequently prescribed formulae, such as Kuei-Chih-Shao-Yao-Chih-Mu-Tang, Tang-Kuei-Nien-Tung-Tang, and Shu-Ching-Huo-Hsieh-Tang, were associated with a reduced risk of CAD.

Conclusion

The use of CHP was associated with a lower risk of CAD in patients with RA. Additional randomized controlled trials are required to assess any causal relationship between the effect of CHP usage and the risk of CAD.
Identifying the context, mechanisms and outcomes underlying collective leadership in teams: building a realist programme theory
Authors: De Brún Aoife , McAuliffe Eilish
Published: March 2020

Background

There is accumulating evidence for the value of collective and shared approaches to leadership. However, relatively little research has explored collective leadership in healthcare and thus, there is a lack understanding of the mechanisms that promote or inhibit the practice of collective leadership in healthcare teams. This study describes the development of an initial programme theory (IPT) to provide insight into the mechanisms underpinning the enactment of collective leadership.

Methods

This IPT was informed by a multiple-method data collection process. The first stage involved a realist synthesis of the literature on collective leadership interventions in healthcare settings (n = 21 studies). Next, we presented initial findings to receive feedback from a realist research peer support group. Interviews with members of teams identified as working collectively (n = 23) were then conducted and finally, we consulted with an expert panel (n = 5). Context-mechanism-outcome configurations (CMOCs) were extrapolated to build and iteratively refine the programme theory and finalise it for testing.

Results

Twelve CMOCs were extrapolated from these data to form the initial programme theory and seven were prioritised by the expert panel for focused testing. Contextual conditions that emerged included team training on-site, use of collaborative/co-design strategies, dedicated time for team reflection on performance, organisational and senior management support, inclusive communication and decision-making processes and strong supportive interpersonal relationships within teams. Mechanisms reported include motivation, empowerment, role clarity, feeling supported and valued and psychological safety which led to outcomes including improvements in quality and safety, staff and patient satisfaction, enhanced team working, and greater willingness to share and adopt leadership roles and responsibilities.

Conclusions

This study has identified preliminary support for the contexts, mechanisms and outcomes underpinning the practice of collective leadership. However, it must be noted that while they may appear linear in presentation, in reality they are independent and interlinked and generative of additional configurations. This paper contributes to the nascent literature through addressing an identified gap in knowledge by penetrating below the surface level inputs and outputs of an intervention to understand why it works or doesn’t work, and for whom it may work.
Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis
Authors: Richards Georgia C. , Mahtani Kamal R. , Muthee Tonny B. , DeVito Nicholas J. , Koshiaris Constantinos , Aronson Jeffrey K. , Goldacre Ben , Heneghan Carl J.
Published: March 2020

Background

The risks of harms from opioids increase substantially at high doses, and high-dose prescribing has increased in primary care. However, little is known about what leads to high-dose prescribing, and studies exploring this have not been synthesized. We, therefore, systematically synthesized factors associated with the prescribing of high-dose opioids in primary care.

Methods

We conducted a systematic review of observational studies in high-income countries that used patient-level primary care data and explored any factor(s) in people for whom opioids were prescribed, stratified by oral morphine equivalents (OME). We defined high doses as ≥ 90 OME mg/day. We searched MEDLINE, Embase, Web of Science, reference lists, forward citations, and conference proceedings from database inception to 5 April 2019. Two investigators independently screened studies, extracted data, and appraised the quality of included studies using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We pooled data on factors using random effects meta-analyses and reported relative risks (RR) or mean differences with 95% confidence intervals (CI) where appropriate. We also performed a number needed to harm (NNTH) calculation on factors when applicable.

Results

We included six studies with a total of 4,248,119 participants taking opioids, of whom 3.64% (n = 154,749) were taking high doses. The majority of included studies (n = 4) were conducted in the USA, one in Australia and one in the UK. The largest study (n = 4,046,275) was from the USA. Included studies were graded as having fair to good quality evidence. The co-prescription of benzodiazepines (RR 3.27, 95% CI 1.32 to 8.13, I2 = 99.9%), depression (RR 1.38, 95% CI 1.27 to 1.51, I2 = 0%), emergency department visits (RR 1.53, 95% CI 1.46 to 1.61, I2 = 0%, NNTH 15, 95% CI 12 to 20), unemployment (RR 1.44, 95% CI 1.27 to 1.63, I2 = 0%), and male gender (RR 1.21, 95% CI 1.14 to 1.28, I2 = 78.6%) were significantly associated with the prescribing of high-dose opioids in primary care.

Conclusions

High doses of opioids are associated with greater risks of harms. Associated factors such as the co-prescription of benzodiazepines and depression identify priority areas that should be considered when selecting, identifying, and managing people taking high-dose opioids in primary care. Coordinated strategies and services that promote the safe prescribing of opioids are needed.

Study registration

PROSPERO, CRD42018088057
Selected cardiac abnormalities in Trypanosoma cruzi serologically positive, discordant, and negative working dogs along the Texas-Mexico border
Authors: Meyers Alyssa C. , Ellis Megan M. , Purnell Julia C. , Auckland Lisa D. , Meinders Marvin , Saunders Ashley B. , Hamer Sarah A.
Published: March 2020

Background

Chagas disease is increasingly recognized in the southern U.S., where triatomine vectors transmitTrypanosoma cruziamong wildlife and domestic dogs with occasional vector spillover to humans. As in humans, clinical outcome in dogs is variable, ranging from acute death to asymptomatic infections or chronic heart disease. In order to characterize cardiac manifestations ofT. cruziinfections, we tracked a cohort of naturally-infected dogs and a matched cohort of uninfected dogs. We hypothesized that selected measures of cardiac disease (abnormal rate, abnormal rhythm, and elevated cardiac troponin I (cTnI; a biomarker of cardiac injury)) would occur more commonly in infected than uninfected dogs matched by age, breed, sex and location. In addition to the clearly positive and negative dogs, we specifically tracked dogs with discordant test results across three independent serological assays to gather clinical data that might elucidate the infection status of these animals and inform the utility of the different testing approaches.

Results

We placed an ambulatory ECG monitor (Holter) on 48 government working dogs and analyzed 39 successful recordings that met length and quality criteria from 17 T. cruzi-infected, 18 uninfected dogs and 4 dogs with discordant results. Overall, 76.5% of positive, 100.0% of discordant, and 11.1% of negative dogs showed> 1 ECG abnormality (p < 0.0001), and positive and discordant dogs had a higher mean number of different types of ECG abnormalities than negative dogs (p< 0.001–0.014). The most common cardiac abnormalities included supraventricular and ventricular arrhythmias and atrioventricular block. Positive dogs had higher serum concentrations of cTnI than both negative dogs (p= 0.044) and discordant dogs (p = 0.06). Based on dog handler reports, nearly all (4/5; 80%) dogs with reported performance decline or fatigue wereT. cruzi-infected dogs.

Conclusions

Further understanding cardiac manifestations in dogs naturally infected withT. cruziis critical for prognostication, establishing a baseline for drug and vaccine studies, and better understanding of zoonotic risk.
Compartmental fat distribution in the abdomen of dogs relative to overall body fat composition
Authors: Turner R. B. S. , Tyrrell D. , Hepworth G. , Dunshea F. R. , Mansfield C. S.
Published: March 2020

Background

Adipose tissue may have different metabolic and endocrine functions depending on the region of the body in which it is located. While visceral or intra-abdominal fat has been found to contribute to leptin concentrations, insulin resistance and obesity-related diseases, there are only a few imaging studies documenting the preferential distribution of body fat to either the intra-abdominal or subcutaneous compartments in dogs. This study aimed to determine if CT-measured abdominal fat distributed preferentially to the visceral space (V) relative to the subcutaneous space (SQ), with increasing DXA-determined total body fat percentage; and if ultrasound measurements of the ventral midline subcutaneous (SAT) and visceral adipose thickness (VAT) can be used to estimate the distribution of fat to the subcutaneous and visceral abdominal spaces, in a sample of 22 dogs with variable body condition.

Results

Multivariate analysis showed no statistically significant correlation between visceral to subcutaneous fat ratio (V/SQ) and increasing total body fat percentage (β = − 0.07, p = 0.733), but strong correlation with age (β = 0.71 p = 0.002). A substantial amount of variation for the ultrasound visceral adipose thickness to subcutaneous fat thickness (VAT/SAT) could be explained by both CT V/SQ and sex (R2Adjusted = 0.477, p = 0.001), with female dogs having significant lower VAT/SAT ratios compared to the male dogs (p = 0.047). The ultrasound fat measurements appeared moderately reliable, but a larger sample number is required to confirm this.

Conclusions

The findings suggest that dogs with a relatively healthy to slightly overweight body condition score, distribute fat relatively similarly between their peritoneal (visceral) and subcutaneous abdominal compartments with increasing total body fat percentage. However, there was increased fat distribution to the peritoneal space relative to the subcutaneous space with increasing age. Further, abdominal ultrasound may be useful in estimating the ratio of fat distribution to both the abdominal visceral and subcutaneous spaces.
Microbial burden and viral exacerbations in a longitudinal multicenter COPD cohort
Authors: Bouquet Jerome , Tabor David E. , Silver Jonathan S. , Nair Varsha , Tovchigrechko Andrey , Griffin M. Pamela , Esser Mark T. , Sellman Bret R. , Jin Hong
Published: March 2020

Background

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by frequent exacerbation phenotypes independent of disease stage. Increasing evidence shows that the microbiota plays a role in disease progression and severity, but long-term and international multicenter assessment of the variations in viral and bacterial communities as drivers of exacerbations are lacking.

Methods

Two-hundred severe COPD patients from Europe and North America were followed longitudinally for 3 years. We performed nucleic acid detection for 20 respiratory viruses and 16S ribosomal RNA gene sequencing to evaluate the bacterial microbiota in 1179 sputum samples collected at stable, acute exacerbation and follow-up visits.

Results

Similar viral and bacterial taxa were found in patients from the USA compared to Bulgaria and Czech Republic but their microbiome diversity was significantly different (P < 0.001) and did not impact exacerbation rates. Virus infection was strongly associated with exacerbation events (P < 5E-20). Human rhinovirus (13.1%), coronavirus (5.1%) and influenza virus (3.6%) constitute the top viral pathogens in triggering exacerbation. Moraxella and Haemophilus were 5-fold and 1.6-fold more likely to be the dominating microbiota during an exacerbation event. Presence of Proteobacteria such as Pseudomonas or Staphylococcus amongst others, were associated with exacerbation events (OR > 0.17; P < 0.02) but more strongly associated with exacerbation frequency (OR > 0.39; P < 4E-10), as confirmed by longitudinal variations and biotyping of the bacterial microbiota, and suggesting a role of the microbiota in sensitizing the lung.

Conclusions

This study highlights bacterial taxa in lung sensitization and viral triggers in COPD exacerbations. It provides a global overview of the diverse targets for drug development and explores new microbiome analysis methods to guide future patient management applications.
Constraining the carbonate system in soils via testing the internal consistency of pH, pCO2 and alkalinity measurements
Authors: Bargrizan Sima , Smernik Ronald J. , Mosley Luke M.
Published: March 2020

Inorganic carbon exists in various dissolved, gaseous and solid phase forms in natural waters and soils. It is important to accurately measure and model these forms to understand system responses to global climate change. The carbonate system can, in theory, be fully constrained and modelled by measuring at least two out of the following four parameters: partial pressure (pCO2), total alkalinity (TA), pH and dissolved inorganic carbon (DIC) but this has not been demonstrated in soils. In this study, this “internal consistency” of the soil carbonate system was examined by predicting pH of soil extracts from laboratory measurement of TA through alkalinity titration for solutions in which pCO2 was fixed through equilibrating the soil solution with air with a known pCO2. This predicted pH (pHCO2) was compared with pH measured on the same soil extracts using spectrophotometric and glass electrode methods (pHspec and pHelec). Discrepancy between measured and calculated pH was within 0.00–0.1 pH unit for most samples. However, more deviation was observed for those sample with low alkalinity (≤ 0.5 meq L−1). This is likely attributable to an effect of dissolved organic matter, which can contribute alkalinity not considered in the thermodynamic carbonate model calculations; further research is required to resolve this problem. The effects of increasing soil pCO2 was modelled to illustrate how internally consistent models can be used to predict risks of pH declines and carbonate mineral dissolution in some soils.