bluuebunny/crossref_metadata_2025 huggingface dataset:
Sport policy and practice: Why a focus on retention of sport participants is required for both health and performance
Authors: Eime Rochelle , Charity Melanie , Westerbeek Hans
Published: August 2020

Background: Australia like many developed countries is largely an inactive nation. Participation in sport, a form of leisure-time physical activity, can contribute to a range of individual and community health benefits. National sport policy often has a dual focus on population-based participation, and elite performance. Whist there are various sport models depicting the pathway to elite, there has been no strategic population-level sport participation pathway model developed as a guide towards increasing sport participation. The aim of this study is to explore sport participation across age groups and develop a neutral (conceptual) model that does not favour community or elite sport and that highlights the critical participation transition points including drop-out, and specifically for children and youth. Methods: We conducted a longitudinal analysis of sport participation records for 8 major sports from 2015-2017 for children and young people aged 4-29 years. Individual participation within sports was tracked from 2015 and subsequent years 2016 and 2017. Results: The total number of participants was 579,696. Only half 50.8% played continuously for the three years, 44.7% dropped out, and 4.5 played discontinuously. Drop-out was highest for those aged 4 (57.0%), and lowest for those aged 10-14 years (39.3%). From the retention and drop-out participation patterns across the lifespan, in conjunction with the published literature on sport policy and participation, we developed the Sport Participation Pathway Model (SPPM). The SPPM conceptually depicts sport participation and in doing so emphasises the significant drop-out of sport. Conclusion: The retention data and the SPPM, demonstrates the trends in participation in sport and the high drop-out of competitive club-based sport. Those who manage and govern sport need to better recognise that club-based sport is merely one component of a range of leisure-time physical activities. If sport is to have an increased impact on making populations more active, then the evidence about the participation patterns and significant drop-out should be used to justify a re-focus on retention. We also recommend that the collection, analysis and reporting of longitudinal physical activity and sport participation data is expanded, to better serve policy evaluation and redirection.
Patterns of food parenting practices regarding junk food and sugary drinks among parent-child dyads
Authors: Thomson Jessica , Hennessy Erin , Landry Alicia , Goodman Melissa
Published: August 2020

Background: Children’s food preference and intake patterns are affected by parental child feeding practices. The objective was to determine patterns of food parenting practices regarding junk food and sugary drinks (JS) and investigate their associations with demographic characteristics and dietary intake in a large cohort of parents and their children (12-17 years).Methods: Dyadic survey data from the cross-sectional, internet-based Family Life, Activity, Sun, Health, and Eating Study, conducted in 2014, were analyzed using latent class analysis to identify patterns of use for six JS parenting practices – negative emotions, restriction, monitoring, availability, modeling, and child involvement – based on parent and child report. Model covariates included self-reported parent and child sex, age (child only), body mass index category (based on height and weight), added sugars intake, and legitimacy of parental authority. Results: Based on 1,657 parent-child dyads, five parenting practice patterns were identified representing different levels of practice use – Complete Influencers (28%; reference class), Indifferent Influencers (21%), Negative Influencers (20%), Minimal Influencers (18%), and Disagreeing Influencers (13%). Compared to older child dyads, younger child dyads were less likely to belong to Indifferent and Minimal Influencers (79% and 63% lower odds, respectively). Greater parent added sugars intake increased the odds of belonging to Indifferent and Negative Influencers (4% and 5% higher for every teaspoon increase, respectively) while greater child added sugars intake decreased the odds of belonging to Minimal Influencers (6% lower for every teaspoon increase). Compared to dyads with high scores, dyads with low child scores for legitimacy of parental authority regarding JS were 18 times as likely to belong to Disagreeing Influencers. Conclusions: The study findings suggest that parents utilize distinct patterns of feeding practices regarding JS ranging from use of many practices, use of some practices, to low use of any practice, with differential associations with parent and child intakes of added sugars. Counseling or intervening with parents to use a mix of structure practices, such as availability and modeling, to positively influence their child’s and possibly their own intake of sugary snacks and drinks may prove more efficacious than use of coercive control practices, such as negative emotions.
A unique radioprotective effect of resolvin E1 reduces irradiation-induced damage to the inner ear by inhibiting the inflammatory response
Authors: Zhang Jie , Xu Anting , Niu Tingting , Liu Chengcheng , Zhang Yongju , Li Tao , Wang Jihua , Wang Yongjing , Sun Dianshui
Published: August 2020

Background: In addition to the direct effects of irradiation, the induced inflammatory response may play an important role in the damage to the inner ear caused by radiotherapy for the treatment of head and neck cancers. Resolvin E1 (RvE1) has anti-inflammatory activity, acting by reducing neutrophil infiltration and proinflammatory cytokine expression. Therefore, in this study we sought to confirm whether the inflammation induced by irradiation was involved in damage to the inner ear after radiotherapy and to investigate the protective effect and underlying mechanism of RvE1 using mouse models. Methods: A dose of RvE1 was delivered by intraperitoneal injection to mice before irradiation. Changes in the auditory brainstem response (ABR), relative balance ability, inner ear morphology and the expression levels of inflammatory factors in the inner ear were analyzed on days 7 and 14 after irradiation and compared among different experimental groups. Results: Changes of ABR and relative balance ability showed the inner functions of experimental mice presented severe damage after irradiation, but the damage was significantly alleviated after RvE1 pretreatment compared to irradiation alone. Morphological analysis of the inner ear showed severe damage to the cochlea and vestibule after irradiation. In contrast, damage to the cochlea and vestibule was significantly reduced in the RvE1-pretreated group compared to that in the irradiation alone group. Along with these functional and morphological changes, the mRNA expression level of anti-inflammatory factors interleukin-2 was significantly increased, while those of proinflammatory factors interleukin-6 and tumor necrosis factor-α were significantly decreased in the inner ear of mice after RvE1 pretreatment compared to irradiation alone. Conclusions: We believe that inflammation induced by irradiation is involved in the damage to the inner ear caused by radiotherapy, and that RvE1 reduces the damage caused by irradiation to the inner ear by regulating the induced inflammatory response.
A retrospective analysis of usefulness of impulse oscillometry system in the treatment of asthma
Authors: Sugawara Hiroyuki , Saito Atsushi , Yokoyama Saori , Tsunematsu Kazunori , Chiba Hirofumi , Takahashi Hiroki
Published: August 2020

Background: Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is an emerging technique device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS.Methods: Of the 245 patients with bronchial asthma who were screened, 108 were enrolled in this study. These patients were divided based on three subtypes according to the IOS result as follows: central predominant type (n = 34), peripheral predominant type (n = 58), and resistless type (n = 16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT) and were compared among the three subtypes.Results: In the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p < 0.01) and the BUD group (15.4 vs. 8.8, p < 0.05); the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs. 21.7, 22.3, respectively, p < 0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p < 0.05); the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs. 24.6, 24.4, respectively, p < 0.01) at 4 weeks after treatment. Conclusions: An association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficacy in BA. This result indicates that the IOS could be an effective tool in the selection of ICS and the evaluation of the BA phenotype.
The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998
Authors: Quattrochi John Paul , Hill Kenneth , Salomon Joshua A , Castro Marcia C
Published: August 2020

BackgroundDespite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates.MethodsWe combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach.FindingsWe found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8pp decrease in at least three antenatal visits [95% CI -1.4 to -0.2]; 1.2pp decrease in skilled assistance during delivery [95%CI -1.6 to -0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4pp decrease for a one kilometer decrease [95%CI 0.004 to 0.044]).ConclusionReducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.
The accelerator, the brake, and the terrain: associations of reward-related eating, self-control, and the home food environment with diet quality assessed by 24-hour recalls during pregnancy and postpartum in the Pregnancy Eating Attributes Study (PEAS) cohort
Authors: Nansel Tonja R. , Lipsky Leah M. , Faith Myles , Liu Aiyi , Siega-Riz Anna Maria
Published: August 2020

Background. Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality.Methods. Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-hour diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics.Results. Pregnancy HEI-total was inversely associated with PFS (β=-0.14± 0.05, p=0.009), mYFAS(β=-0.14± 0.06, p=0.02), 2 of the 5 RVFQ indices, MCP (β=-0.14± 0.05, p=0.01), and DGI food subscale (β=0.23± 0.05, p<0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β=-0.17± 0.06, p=0.004 and β=-0.19± 0.07, p=0.006, respectively), and positively with HFI-FV (β=0.21±0.05, p<0.001 and β=0.17± 0.06, p=0.009, respectively).Conclusions. Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period.Trial Registration. Clinicaltrials.govURL – https://clinicaltrials.gov/ct2/show/NCT02217462Registration ID – NCT02217462Date of registration – August 13, 2014
Identification and Characterization of the Bacteriocin Carocin S3 from the Multiple Bacteriocin Producing Strain of Pectobacterium carotovorum subsp. carotovorum
Authors: Wang Jyun-Wei , Derilo Reymund Callanga , Lagitnay Ruchi Briam James , Wu Huang-Pin , Chen Kai-In , Chuang Duen-Yau
Published: August 2020

Background: Pectobacterium carotovorum subsp. carotovorum belongs to the Enterobacteriaceae family, which causes soft-rot disease in numerous plants worldwide resulting in significant economic losses. Results from our previous studies showed that the strain H-rif-8-6 produces low-molecular-weight bacteriocin (LMWB) Carocin S1. Interestingly, TH22-10, the caroS1K:Tn5 insertional mutant in H-rif-8-6, loses Carocin S1 producing ability, but still produces other LMWBs which the indicator strain SP33 can detect. The SP33 is one of the many strains that are sensitive toward the cytotoxic effects of Carocin S3K, but not Carocin S1. The result revealed that H-rif-8-6 is a multiple-bacteriocin producing strain.Results: In this study, a 4.1-kb DNA fragment was isolated from the chromosomal DNA of Pcc strain, H-rif-8-6, by a DNA probe using the caroS1K gene as the template. DNA sequencing and analysis by GenBank revealed two complete open reading frames (ORFs), designated ORF1 and ORF2, which were identified within the sequence fragment. ORF1 and ORF2, similar to the identified carocin S2 genes, encode the killer (Carocin S3K) and the immunity (Carocin S3I) proteins, respectively, which were homologous to the colicin E3 gene. Carocin S3K and Carocin S3I were expressed, isolated, and purified in Escherichia coli BL21 after subcloning of the expression plasmid pGS3KI or pGSK3I. SDS-PAGE analysis showed that the relative masses of Carocin S3K and Carocin S3I were 95.6 kDa and 10.2 kDa, respectively. The results reveal that Carocin S3K has higher antimicrobial and specific antimicrobial activities for Pcc along with a nuclease activity than Carocin S3I. However, Carocin S3I inhibits the activity of Carocin S3K. Interestingly, a high concentration of Carocin S3I protein is also a DNA nuclease, and Carocin S3K also inhibits its activity.Conclusion: This study showed that another type of bacteriocin was found in Pectobacterium carotovorum. This new type of bacteriocin, Carocin S3, has the killer protein, Carocin S3K, and the immunity protein, Carocin S3I.
Middle-aged Lebanese women interpretation of sexual difficulties: A qualitative inquiry
Authors: Azar Mathilde , Bradbury-Jones Caroline , Kroll Thilo
Published: August 2020

Background: The study explores women’s perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women’s subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.Methods: Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. In respect to ethical principles, women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analyzed about the framework analysis. Many strategies were adopted to ensure rigour.Results: Women’s narratives led to four themes: women's inability to communicate sexual desires and concerns; male-related sexual difficulties; marital conflicts; and sexual difficulties as context bound. Women’s sexual difficulties are driven by double standards and inhibiting sexual socialization. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands’ poor sexual performance to protect their masculinity and thus their social image and identity. Women’s narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties. Conclusion: The study makes a unique contribution to voicing women’s views and concerns as sexuality is underreported and poorly researched in Lebanon. It corroborates the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.
A Urine-Based Exosomal Gene Expression Test Stratifies Risk of High-Grade Prostate Cancer in Men with Prior Negative Prostate Biopsy Undergoing Repeat Biopsy
Authors: McKiernan James , Noerholm Mikkel , Tadigotla Vasisht , Kumar Sonia , Torkler Phillipp , Sant Grannum , Alter Jason , Donovan Michael J , Skog Johan
Published: August 2020

BACKGROUND: Initial prostate biopsy often fails to identify prostate cancer resulting in patient anxiety, especially when clinical features such as prostate specific antigen (PSA) remain elevated, leading to the need for repeat biopsies. Prostate biomarker tests, such as the ExoDx™ Prostate(IntelliScore), or EPI test, have been shown to provide individualized risk assessment of clinically significant prostate cancer at initial biopsy; however, the performance in the repeat biopsy setting is not well established. Methods: As part of a previous prospective clinical validation study evaluating the performance of the EPI test, we collected first-catch, non-DRE urine samples across 22 sites from men with at least one prior negative biopsy scheduled to undergo a repeat prostate biopsy to rule out prostate cancer. All men were 50 years or older with a PSA 2-10ng/mL. Exosomal mRNA was extracted and expression of three genomic markers, PCA3, ERG and SPDEF was measured. The resulting EPI score was correlated with biopsy results. Results: 229 men with a prior negative biopsy underwent repeat biopsies. ExoDx Prostate demonstrated good performance ruling out high-grade (Grade group 2, GG2, or higher) prostate cancer (HGPCa) using the previously validated 15.6 cut point in the initial biopsy setting. The EPI test yielded an NPV of 92% independent of other clinical features and would have avoided 26% of unnecessary biopsies while missing only five patients with HGPCa (2.1%). Furthermore, the EPI test provided additional information at a cut-point of 20 and 29.6 with an NPV of 94%, potentially delaying 35% and 61% of unnecessary biopsies, respectively. AUC curves and Net Health Benefit Analyses demonstrated superior performance of ExoDx Prostate over PSA and clinical only risk calculators, i.e. ERSPC.Conclusions: The EPI test provided good performance using the 15.6 cut-point for ruling out HGPCa / GG2 or higher in men undergoing a repeat prostate biopsy with a PSA of 2-10ng/ml. Furthermore, the test utilizes gene expression data independent of clinical features to predict the likelihood of HGPCa / GG2 on a subsequent needle biopsy.
Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function
Authors: Kurniawan Adi Lukas , Hsu Chien-Yeh , Lee Hsiu-An , Rau Hsiao-Hsien , Paramastri Rathi , Syauqy Ahmad , Chao Jane C-J
Published: August 2020

Background: Dietary patterns were associated with the risk of chronic disease development and outcome-related diseases. In this study, we aimed to compare the correlation between dietary patterns and metabolic syndrome (MetS) using two methods for identifying dietary patterns.Methods: The participants (n = 25,569) aged ≥ 40 years with impaired kidney function were retrieved from Mei Jau (MJ) Health Screening database from 2008 to 2010. Dietary patterns were identified by principal component analysis (PCA) and reduced rank regression (RRR) from twenty-two food groups using PROC FACTOR and PROC PLS functions.Results: We identified two similar dietary pattern characteristics (high intakes of deep fried foods, preserved or processed foods, dipping sauce, meat, sugary drinks, organ meats, jam/honey, fried rice/flour products, instant noodles and eggs) derived by PCA and RRR. Logistic regression analysis revealed that RRR-derived dietary pattern scores were positively associated with an odds ratio (OR = 1.70, 95% CI: 1.56, 1.86) of having MetS than PCA-derived dietary pattern scores (OR = 1.38, 95% CI: 1.27, 1.51). The correlations between RRR-derived dietary pattern scores and elevated systolic and diastolic blood pressure (OR = 1.30 for both) or low high density lipoprotein cholesterol in women (OR = 1.32) were statistically significant but not significant in PCA-derived dietary pattern scores.Conclusions: Our findings suggest that RRR gives better results when studying behavior related dietary patterns in association with MetS. RRR may be more preferable to provide dietary information for developing dietary guidelines among people with MetS. Further studies with prospective measurements are needed to verify whether RRR is a useful analytic tool for the association between dietary patterns and other chronic diseases.
Cervical Spine Osteoradionecrosis or Bone Metastasis after Radiotherapy for Nasopharyngeal Carcinoma? The MRI-Based Radiomics for Characterization
Authors: Zhong Xi , Li Li , Jiang Huali , Yin Jinxue , Lu Bingui , Han Wen , Li Jiansheng , Zhang Jian
Published: August 2020

Background: To develop and validate an MRI-based radiomics nomogram for differentiation of cervical spine ORN from metastasis after radiotherapy (RT) in nasopharyngeal carcinoma (NPC).Methods: A radiomics nomogram was developed in a training set that comprised 46 NPC patients after RT with 95 cervical spine lesions (ORN, n = 51; metastasis, n = 44), and data were gathered from January 2008 to December 2012. 279 radiomics features were extracted from the axial contrast-enhanced T1-weighted image (CE-T1WI). A radiomics signature was created by using the least absolute shrinkage and selection operator (LASSO) algorithm. A nomogram model was developed based on the radiomics scores. The performance of the nomogram was determined in terms of its discrimination, calibration, and clinical utility. An independent validation set contained 25 consecutive patients with 47 lesions (ORN, n = 25; metastasis, n = 22) from January 2013 to December 2015.Results: The radiomics signature that comprised eight selected features was significantly associated with the differentiation of cervical spine ORN and metastasis. The nomogram model demonstrated good calibration and discrimination in the training set [AUC, 0.725; 95% confidence interval (CI), 0.622–0.828] and the validation set (AUC, 0.720; 95% CI, 0.573–0.867). The decision curve analysis indicated that the radiomics nomogram was clinically useful.Conclusions: MRI-based radiomics nomogram shows potential value to differentiate cervical spine ORN from metastasis after RT in NPC.
Evaluation of [68Ga]Ga-PSMA PET/CT Images Acquired with a Reduced Scan Time Duration in Prostate Cancer Patients using the Digital Biograph Vision
Authors: Weber Manuel , Jentzen Walter , Hofferber Regina , Herrmann Ken , Fendler Wolfgang Peter , Conti Maurizio , Wetter Axel , Kersting David , Rischpler Christoph , Costa Pedro Fragoso
Published: August 2020

Aim: [68Ga]Ga-PSMA-11 PET/CT allows for a superior detection of prostate cancer tissue, especially in the context of a low tumor burden. Digital PET/CT bears the potential of reducing scan time duration / administered tracer activity due to, for instance, its higher sensitivity and improved time coincidence resolution. It might thereby expand [68Ga]Ga-PSMA-11 PET/CT that is currently limited by 68Ge/68Ga-generator yield. Our aim was to clinically evaluate the influence of a reduced scan time duration in combination with different image reconstruction algorithms on the diagnostic performance.Methods: Twenty prostate cancer patients (11 for biochemical recurrence, 5 for initial staging, 4 for metastatic disease) sequentially underwent [68Ga]Ga-PSMA-11 PET/CT on a digital Siemens Biograph Vision. PET data were collected in continuous-bed-motion mode with a mean scan time duration of 16.7 min (reference acquisition protocol) and 4.6 min (reduced acquisition protocol). 4 iterative reconstruction algorithms were applied using a time-of-flight (TOF) approach alone or combined with point-spread-function (PSF) correction, each with 2 or 4 iterations. To evaluate the diagnostic performance, the following metrics were chosen: (a) per-region detectability, (b) the tumor maximum and peak standardized uptake values (SUVmax and SUVpeak) and (c) image noise using the liver’s activity distribution.Results: Overall, 98% of regions (91% of affected regions) were correctly classified in the reduced acquisition protocol independent of the image reconstruction algorithm. Two nodal lesions (each ≤4 mm) were not identified (leading to downstaging in 1/20 cases). Mean absolute percentage deviation of SUVmax (SUVpeak) was approximately 9% (6%) for each reconstruction algorithm. The mean image noise increased from 13% to 21% (4 iterations) and from 10% to 15% (2 iterations) for PSF+TOF and TOF images.Conclusions: High agreement at 3.5-fold reduction of scan time in terms of per-region detection (98 % of regions) and image quantification (mean deviation ≤ 10 %) was demonstrated; however, small lesions can be missed in about 10% of patients leading to downstaging (T1N0M0 instead of T1N1M0) in 5 % of patients. Our results suggest that a reduction of scan time duration or administered [68Ga]Ga-PSMA-11 activities can be considered in metastatic patients, where missing small lesions would not impact patient management. Limitations include the small and heterogeneous sample size and the lack of follow-up.
Time Spent Abroad Predicts Late Presentation for HIV among HIV-positive Tajikistani Migrants to the Russian Federation
Authors: Bromberg Daniel J , Tate Mary M , Alaei Kamiar , Karimov Saifuddin , Saidi Dilshod , Alaei Arash
Published: August 2020

Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan.Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, are more likely to have purchased the services of sex workers, and have more sexual partners on average. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis.
Changes in Serum Markers Failed to Predict Persistent Infection after Two-stage Exchange Arthroplasty
Authors: Jiang Qiao , Fu Jun , Chai Wei , Hao Li-bo , Zhou Yong-Gang , Xu Chi , CHEN Ji-Ying
Published: August 2020

Background The proper timing of reimplantation is importation to treatment success in two-stage exchange revision. The 2018 International Consensus Meeting suggested that a variation trend toward normalization in serum markers was useful for determining the proper timing of reimplantation. However, the opposite results were found that by previous studies, and the normalization of serum markers was reported to fail to predict infection control. We investigated whether value changes and percent changes in four common serum markers (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen) can predict persistent infection?Methods A retrospective review of 141 patients treated with two-stage revision from 2014 to 2018 was conducted. The variation trend in serum indicators was evaluated by the percent changes (using values of serum markers prereimplantation divided by values preresection) and value changes (using values of serum markers preresection minus values prereimplantation). Treatment success was defined according to the Delphi-based consensus criteria with a minimum follow-up of 1 year, and the receiver operator characteristic (ROC) was used to examine the usefulness of changes in serum markers.Results 22 patients (15.60%) were persistently infected. No significant difference was found in either the value change or percent change in serum markers between reinfection and non-reinfection patients. When predicting persistent infection, the area under the curves (AUC) demonstrated that both percent changes and value changes in serum markers were poor indicators. The AUC of value changes was 0.533 for the CRP, 0.504 for the IL-6, 0.508 for the ESR and 0.586 for fibrinogen when predicted persistent PJI. In addition, the AUC indicated that percent changes in the CRP (0.464), the IL-6 (0.534), the ESR (0.527) and fibrinogen (0.586) were all poor markers.Conclusions We have shown that both value changes and percent changes in serum markers were not sufficiently rigorous to aid in persistent infection diagnosis. The proper timing of reimplantation must therefore take into account various clinical tests rather than the downward trend of serum markers only.
A modelling study highlights the power of detecting and isolating asymptomatic or very mildly affected individuals for COVID-19 epidemic management.
Authors: Mayorga Lia , Samartino Clara García , Flores Gabriel , Masuelli Sofía , Sánchez María V. , Mayorga Luis S. , Sánchez Cristián G.
Published: August 2020

Background: Mathematical modelling of infectious diseases is a powerful tool for the design of management policies and a fundamental part of the arsenal currently deployed to deal with the COVID-19 pandemic. Methods: We present a compartmental model for the disease where symptomatic and asymptomatic individuals move separately. We introduced healthcare burden parameters allowing to infer possible containment and suppression strategies. In addition, the model was scaled up to describe different interconnected areas, giving the possibility to trigger regionalized measures. It was specially adjusted to Mendoza-Argentina’s parameters, but is easily adaptable for elsewhere. Results: Overall, the simulations we carried out were notably more effective when mitigation measures were not relaxed in between the suppressive actions. Since asymptomatics or very mildly affected patients are the vast majority, we studied the impact of detecting and isolating them. The removal of asymptomatics from the infectious pool remarkably lowered the effective reproduction number, healthcare burden and overall fatality. Furthermore, different suppression triggers regarding ICU occupancy were attempted. The best scenario was found to be the combination of ICU occupancy triggers (on: 50%, off: 30%) with the detection and isolation of asymptomatic individuals. In the ideal assumption that 45% of the asymptomatics could be detected and isolated, there would be no need for complete lockdown, and Mendoza’s healthcare system would not collapse. Conclusions: Our model and its analysis inform that the detection and isolation of all infected individuals, without leaving aside the asymptomatic group is the key to surpass this pandemic.
Exploring the experiences of stroke patients treated with transcranial magnetic stimulation for upper limb recovery: a qualitative study
Authors: Lieshout Eline CC van , Jacobs Lilliane D , Pelsma Maaike , Dijkhuizen Rick M , Visser-Meily Johanna MA
Published: August 2020

Background: Transcranial magnetic stimulation (TMS) treatments have shown promise in improving arm recovery in stroke patients. Currently, little is known about patients’ experiences with TMS treatment, and this lack of knowledge may affect optimal implementation in clinical practice. The aim of this explorative study was to gain insight in the perceived effects and experiences of the design and delivery of a TMS treatment for upper limb recovery from the perspectives of stroke patients. Methods: This qualitative study was conducted as part of a randomized controlled trial (RCT) in a specialized rehabilitation center. Data were collected through face-to-face semi-structured interviews with 13 stroke patients who completed a 10-day TMS intervention for upper limb recovery. The interviews were recorded, transcribed verbatim and analyzed using thematic analysis. Results: The major themes that emerged from the patients’ feedback were the following: positive experiences of the treatment (experienced physical effects, comfort, therapeutic relationship, receiving information, learning about the brain, no burden of added rTMS treatment session, no unpleasant aspects), concerns (effects of stimulation of the brain, equipment, logistics), general experience of recovery, experienced psychological effects (grateful, sense of purpose, recovery as extra motivation to exercise, disappointment and hope of group allocation), and motivation to participate (personal benefit and cognitions, altruism). Important components related to the positive experience of the design and delivery of the treatment included comfort (i.e. moment of relaxation) and the sensation of a painless treatment without side-effects. Key concerns included uncertainty and anxiety about possible negative consequences and group allocation. Conclusions: This study demonstrates that TMS is well accepted by stroke patients with an upper limb paresis. Besides the expectation of a therapeutic benefit, the patients reported various psychological effects. Positive experiences, such as the provision of a short moment of relaxation each day, could have practical implications for clinical stroke rehabilitation settings aimed at improving patient satisfaction. Explanation about and feedback from routine motor recovery progression monitoring at fixed times post-stroke is also valued by patients. Negative emotions may be limited or avoided by transparent and recurrent information delivery in future trials. Trial registration: NL5952 Registered November 28, 2016.
Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs
Authors: wei shuai , Wang Wei , Li Li , Meng Haoye , Feng Chunzhen , Dong Yuying , Fang Xichi , Dong Qiqiang , Jiang Wen , Li Zhanzhen , Wang Xin
Published: August 2020

Background: Vacuum sealing drainage (VSD) and epidermal growth factor (EGF) both play an important role in the treatment of wounds. This study aims to explore the effect of the combination of VSD and EGF on wound healing and the optimal concentration and time of EGF.Methods: In this study, we tested the proliferation and migration capacity of HaCaT and L929 cells at different EGF concentrations (0, 1, 5, 10, and 100 ng/ml) and different EGF action times (2, 10, and 30min). A full-thickness skin defect model was established using male, 30-week-old Bama pigs. The skin defects were randomly divided follows: routine dressing change after covering with sterile auxiliary material (Control), continuous negative pressure drainage of the wound (VSD), continuous negative pressure drainage of the wound and injection of epidermal growth factor 10 minutes followed by removal by continuous lavage (V+E 10 min), and continuous negative pressure drainage of the wound and injection of epidermal growth factor 30 minutes followed by removal by continuous lavage (V+E 30 min). The wound healing rate, histological repair effect and collagen deposition were compared among the four groups.Results: An EGF concentration of 10 ng/ml and an action time of 10 minutes had optimal effects on the proliferation and migration capacities of HaCaT and L929 cells. The drug dispersion effect was better than drug infusion after bolus injection effect, and the contact surface was wider. Compared with other groups, the V+E 10min group promoted wound healing to the greatest extent and obtained the best histological score. Conclusions: A rhEGF concentration of 10 ng/ml can promote the proliferation and migration of epithelial cells and fibroblasts to the greatest extent in vitro. VSD combined with rhEGF kept in place for 10 minutes and then washed, can promote wound healing better than the other treatments in vivo.
Impact of investigator initiated trials and industry sponsored trials on medical practice (IMPACT): Rationale and study design
Authors: Nury Edris , Bischoff Karin , Wollmann Katharina , Nitschke Kai , Lohner Szimonetta , Schumacher Martin , Rücker Gerta , Blümle Anette
Published: August 2020

Background: The German Research Foundation (DFG) and the Federal Ministry of Education and Research (BMBF) initiated large research programs to foster high quality clinical research in the academic area. These investigator initiated trials (IITs) cover important areas of medical research and often go beyond the scope of industry sponsored trials (ISTs). The purpose of this project was to understand to what extent results of randomized controlled IITs and ISTs have an impact on medical practice, measured by their availability for decisions in healthcare and their implementation in clinical practice. We aimed to determine study characteristics influencing a trial’s impact such as type of sponsor and place of conduct. In this article, we describe the rationale and design of this project and present the characteristics of the trials included in our study cohort. Methods: The research impact of the following sub-cohorts was compared: German IITs (funded by DFG and BMBF or by other German non-commercial organizations), international IITs (without German contribution), German ISTs, and international ISTs. Trials included were drawn from the DFG-/BMBF-Websites, the German Clinical Trials Register, and from ClinicalTrials.gov. Research impact was measured as follows: 1) proportion of published trials, 2) time to publication, 3) proportion of publications appropriately indexed in biomedical databases, 4) proportion of openly accessible publications, 5) broadness of publication’s target group, 6) citation of publications by systematic reviews or meta-analyses, and 7) appearance of publications or citing systematic reviews or meta-analyses in clinical practice guidelines. We also aimed to identify study characteristics associated with the impact of trials.Results: We included 691 trials: 120 German IITs, 200 International IITs, 171 German ISTs and 200 International ISTs. The median number of participants was 150, 30% were international trials and 70% national trials, 48% drug-trials and 52% non-drug trials. Overall, 72% of the trials had one pre-defined primary endpoint, 28% two or more (max. 36).Conclusions: The results of this project deepen our understanding of the impact of biomedical research on clinical practice and healthcare policy, add important insights for the efficient allocation of scarce research resources and may facilitate providing accountability to the different stakeholders involved.
Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions
Authors: Zhang Huan , Li Xiangtao , Niu Luyuan , Feng Yaping , Luo Xiaoyun , Zhang Changming , Zhang Fuxian
Published: August 2020

Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.
Synthesis and characterization of conductive flexible cellulose carbon nanohorn sheets for human tissue applications
Authors: Selvam Karthik Paneer , Nagahata Taichi , Kato Kosuke , Koreishi Mayuko , Nakamura Toshiyuki , Nakamura Yoshimasa , Nishikawa Takeshi , Satoh Ayano , HAYASHI Yasuhiko
Published: August 2020

Background: Conductive sheets of cellulose and carbon nanomaterials and its human skin applications are an interesting research aspect as they have potential for applications for skin compatibility. Hence it is needed to explore the effects and shed light on these applications.Method: To fabricate wearable, portable, flexible, lightweight, inexpensive, and biocompatible composite materials, carbon nanohorns (CNHs) and hydroxyethylcellulose (HEC) were used as precursors to prepare CNH-HEC (Cnh-cel) composite sheets. Cnh-cel sheets were prepared with different loading concentrations of CNHs (10, 20 50,100 mg) in 200 mg cellulose. To fabricate the bio-compatible sheets, a pristine composite of CNHs and HEC was prepared without any pretreatment of the materials. Results: The obtained sheets possess a conductivity of 1.83×10-10 S/m and bio-compatible with human skin. Analysis for skin-compatibility was performed for Cnh-cel sheets by h-CLAT in vitro skin sensitization tests to evaluate the activation of THP-1 cells. It was found that THP-1 cells were not activated by Cnh-cel; hence Cnh-cel is a safe biomaterial for human skin. It was also found that the composite allowed only a maximum loading of 100 mg to retain the consistent geometry of free-standing sheets of < 100 µm thickness. Since CNHs have a unique arrangement of aggregates (dahlia structure), the composite is homogeneous, as verified by transmission electron microscopy (TEM) and, scanning electron microscopy (SEM), and other functional properties investigated by Raman spectroscopy, Fourier transform infrared spectroscopy (FT-IR), conductivity measurement, tensile strength measurement, and skin sensitization.Conclusion: It can be concluded that cellulose and CNHs sheets are conductive and compatible to human skin applications.