bluuebunny/crossref_metadata_2025 huggingface dataset:
Helmet noninvasive ventilation compared to facemask noninvasive ventilation and high-flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis
Authors: Chaudhuri Dipayan , Jinah Rehman , Burns Karen E.A. , Angriman Federico , Ferreyro Bruno L. , Munshi Laveena , Goligher Ewan , Scales Damon , Cook Deborah J. , Mauri Tommaso , Rochwerg Bram
Published: August 2021

Background

Although small randomised controlled trials (RCTs) and observational studies have examined helmet noninvasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high-flow nasal cannula (HFNC) in acute respiratory failure.

Methods

We searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, intensive care unit (ICU) length of stay, NIV duration, complications or comfort with NIV therapy. We assessed study risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Ottawa–Newcastle Scale for observational studies, and rated certainty of pooled evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) framework.

Results

We separately pooled data from 16 RCTs (n=949) and eight observational studies (n=396). Compared to facemask NIV, based on low certainty of evidence, helmet NIV may reduce mortality (relative risk 0.56, 95% CI 0.33–0.95) and intubation (relative risk 0.35, 95% CI 0.22–0.56) in both hypoxic and hypercapnic respiratory failure, but may have no effect on duration of NIV. There was an uncertain effect of helmet NIV on ICU length of stay and development of pressure sores. Data from observational studies were consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain.

Conclusions

Compared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet NIV compared to HFNC remains uncertain.
Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions
Authors: Walker Steven P. , Bintcliffe Oliver , Keenan Emma , Stadon Louise , Evison Matthew , Haris Mohammed , Nagarajan Thapas , West Alex , Ionescu Alina , Prudon Benjamin , Guhan Anur , Mustafa Rehan , Herre Jurgen , Arnold David , Bhatnagar Rahul , Kahan Brennan , Miller Robert F. , Rahman Najib M. , Maskell Nick A.
Published: August 2021

Objective

Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care.

Methods

A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation.

Results

220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sdbreathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sddrainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04).

Conclusion

We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.
Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease
Authors: Biblowitz Kathleen , Lee Cathryn , Zhu Daisy , Noth Imre , Vij Rekha , Strek Mary E. , Bellam Shashi K. , Adegunsoye Ayodeji
Published: August 2021

Background

Interstitial lung diseases (ILDs) are diffuse parenchymal lung disorders that cause substantial morbidity and mortality. In patients with ILD, elevated antinuclear antibody (ANA) titres may be a sign of an autoimmune process. Inhalational exposures contribute to ILD pathogenesis and affect prognosis and may trigger autoimmune disease. The association of inhalational exposures with ANA seropositivity in ILD patients is unknown.

Methods

This was a retrospective cohort study of adult ILD patients from five centres in the United States. Exposures to tobacco, inhaled organic antigens and inhaled inorganic particles were extracted from medical records. A multivariable logistic regression model was used to analyse the effects of confounders including age, ILD diagnosis, gender and exposure type on ANA seropositivity.

Results

Among 1265 patients with ILD, there were more ANA-seropositive (58.6%, n=741) than ANA-seronegative patients (41.4%, n=524). ANA-seropositive patients had lower total lung capacity (69%versus75%, p<0.001) and forced vital capacity (64%versus70%, p<0.001) than patients who were ANA-seronegative. Among patients with tobacco exposure, 61.4% (n=449) were ANA-positive compared to 54.7% (n=292) of those without tobacco exposure. In multivariable analysis, tobacco exposure remained independently associated with increased ANA seropositivity (OR 1.38, 95% CI 1.12–1.71). This significant difference was similarly demonstrated among patients with and without a history of inorganic exposures (OR 1.52, 95% CI 1.12–2.07).

Conclusion

Patients with ILD and inhalational exposure had significantly higher prevalence of ANA-seropositivity than those without reported exposures across ILD diagnoses. Environmental and occupational exposures should be systematically reviewed in patients with ILD, particularly those with ANA-seropositivity.
Evaluating the differences in the early laparoscopic donor nephrectomy learning curves of a Swiss high volume transplant program and a South African low volume transplant program after knowledge transfer
Authors: van der Merwe André , Ebinger Mundorf N. Nicole , van Heerden H. , Bonkat G. , van Deventer H. , Mantica G. , Keyser Z. , Bachmann A.
Published: August 2021

Background

To describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume (training) hospital in Basel, Switzerland, and a low volume (trainee) hospital in Cape Town, South Africa, after knowledge transfer. The South African hospital is resource constraint in hospital and training equipment. Techniques for performing the surgery were near identical.

Methods

Both units maintained prospective databases. Comparisons were made of the first 74 cases in each database: Basel’s series were from 19 January 2001 until 28 June 2004, while the Cape Town Hospital were from 8 April 2008 until 15 July 2008. Four surgeons operated in the Basel group, while only one surgeon operated in the Cape Town group. Variables compared include operating time (first skin incision until kidney was extracted), warm ischaemic time (renal arterial occlusion until cold bench reperfusion), blood loss, graft function, and hospital stay. We also analysed the first and last 25 cases of each series. Subgroup analysis of a single Basel surgeon was conducted.

Results

Donor age (means: Basel vs. Cape Town 54 vs. 33 p < 0.0001) and gender (males vs. females Cape Town 57% male and Basel 31% male) differed widely. The Basel group did more left-sided operations (72% vs. 58%). Operative times, blood loss and donor creatinine did not differ. Warm ischaemic time was significantly shorter in the Basel group (Cape Town mean 204 s Basel mean 130 s P = 0.0023). There was double the number of early graft failures in the South African group (six vs. three)—not related to donor surgery. Both groups showed a decline in operating times, plateauing at 30–34 cases.

Conclusions

There are statistically significant differences in some aspects of the learning curves of the Swiss (training) and South African (trainee) hospitals. These differences are clinically not pronounced, and the knowledge transfer was worth the effort.
Searchlight: automated bulk RNA-seq exploration and visualisation using dynamically generated R scripts
Authors: Cole John J. , Faydaci Bekir A. , McGuinness David , Shaw Robin , Maciewicz Rose A. , Robertson Neil A. , Goodyear Carl S.
Published: August 2021

Background

Once bulk RNA-seq data has been processed, i.e. aligned and then expression and differential tables generated, there remains the essential process where the biology is explored, visualized and interpreted. Without the use of a visualisation and interpretation pipeline this step can be time consuming and laborious, and is often completed using R. Though commercial visualisation and interpretation pipelines are comprehensive, freely available pipelines are currently more limited.

Results

Here we demonstrate Searchlight, a freely available bulk RNA-seq visualisation and interpretation pipeline. Searchlight provides: a comprehensive statistical and visual analysis, focusing on the global, pathway and single gene levels; compatibility with most differential experimental designs irrespective of organism or experimental complexity, via three workflows; reports; and support for downstream user modification of plots via user-friendly R-scripts and a Shiny app. We show that Searchlight offers greater automation than current best tools (VIPER and BioJupies). We demonstrate in a timed re-analysis study, that alongside a standard bulk RNA-seq processing pipeline, Searchlight can be used to complete bulk RNA-seq projects up to the point of manuscript quality figures, in under 3 h.

Conclusions

Compared to a manual R based analysis or current best freely available pipelines (VIPER and BioJupies), Searchlight can reduce the time and effort needed to complete bulk RNA-seq projects to manuscript level. Searchlight is suitable for bioinformaticians, service providers and bench scientists. https://github.com/Searchlight2/Searchlight2.
Intratumoral regulatory T cells from colon cancer patients comprise several activated effector populations
Authors: Szeponik Louis , Ahlmanner Filip , Sundström Patrik , Rodin William , Gustavsson Bengt , Bexe Lindskog Elinor , Wettergren Yvonne , Quiding-Järbrink Marianne
Published: August 2021

Background

Intratumoral regulatory T cells (Treg) in colon cancer are a heterogeneous cell population, with potential impact on patient outcome. Generally, a high Treg infiltration has been correlated to a worse patient outcome, but it is still unclear how the composition of different Treg subsets affects patient relapse and survival. In this study, we used mass and flow cytometry to characterize Treg in colon tumors and corresponding unaffected tissue, followed by a correlation to clinical parameters and patient outcome.

Results

Using mass cytometry, we defined 13 clusters of intestinal Treg, three of which were enriched in the tumors. The two most enriched clusters were defined by their expression of the proliferation marker Ki67 and CD56, respectively. The Treg accumulating in the tumors expressed inducible T-cell co-stimulator (ICOS), OX-40, and CD39, indicating that they were effector Treg (eTreg). Intratumoral CD39+Treg also had a higher expression of Foxp3, suggesting a higher suppressive activity, and we subsequently used CD39 as a marker for eTreg. Our further studies showed that colon tumors can be divided into two tumor groups, based on the proportion of CD39+putative eTreg in the tumors. This property was independent of both tumor microsatellite status and tumor stage, which are important factors in predicting cancer disease progression. In a prospective study of forty-four colon cancer patients, we also showed that patients with a high CD39 expression on tumor-infiltrating Treg have a tendency towards a less favorable patient outcome in terms of cumulative cancer-specific survival.

Conclusions

This study uncovers novel subsets of tumor-infiltrating Treg in colon cancer, and suggests that CD39 may be a potential therapeutic target in patients with microsatellite stable colon tumors, which are usually refractory to checkpoint blockade therapy.
A cysteine-rich receptor-like protein kinase CaCKR5 modulates immune response against Ralstonia solanacearum infection in pepper
Authors: Mou Shaoliang , Meng Qianqian , Gao Feng , Zhang Tingting , He Weihong , Guan Deyi , He Shuilin
Published: August 2021

Background

Cysteine-rich receptor-like kinases (CRKs) represent a large subfamily of receptor-like kinases and play vital roles in diverse physiological processes in regulating plant growth and development.

Results

CaCRK5 transcripts were induced in pepper upon the infection of Ralstonia solanacearum and treatment with salicylic acid. The fusions between CaCRK5 and green fluorescence protein were targeted to the plasma membrane. Suppression of CaCRK5 via virus-induced gene silencing (VIGS) made pepper plants significantly susceptible to R. solanacearum infection, which was accompanied with decreased expression of defense related genes CaPR1, CaSAR8.2, CaDEF1 and CaACO1. Overexpression of CaCRK5 increased resistance against R. solanacearum in Nicotiana benthamiana. Furthermore, electrophoretic mobility shift assay and chromatin immunoprecipitation coupled with quantitative real-time PCR analysis revealed that a homeodomain zipper I protein CaHDZ27 can active the expression of CaCRK5 through directly binding to its promoter. Yeast two-hybrid and bimolecular fluorescence complementation (BiFC) analyses suggested that CaCRK5 heterodimerized with the homologous member CaCRK6 on the plasma membrane.

Conclusions

Our data revealed that CaCRK5 played a positive role in regulating immune responses against R. solanacearum infection in pepper.
Plasma carbohydrate antigen-125 for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation
Authors: Wang Qingya , Dang Chengjing , Liu Haoyu , Hui Jie
Published: August 2021

Background

Elevated plasma carbohydrate antigen-125 (CA-125) levels are strongly associated with new-onset atrial fibrillation (AF) and heart failure, but the relationship between plasma CA-125 level and AF recurrence following radiofrequency catheter ablation (RFCA) remains poorly investigated. We aimed to assess whether elevated CA-125 levels are related to long-term AF recurrence following RFCA.

Methods

Preoperative CA-125 levels were determined in AF patients undergoing initial RFCA. Multivariate-adjusted Cox models were constructed to determine the relationship between CA-125 levels and AF recurrence. Multivariate logistic regression analyses were performed to determine predictors of AF recurrence.

Results

Of the 353 enrolled patients, 85 patients (24.1%) had AF recurrence at the 12-month follow-up. These patients had significantly higher baseline CA-125 levels than those without AF recurrence [(18.71 ± 12.63) vs. (11.27 ± 5.40) U/mL, P < 0.001]. The incidence of AF recurrence across quartiles 1–4 of CA-125 was 11.5%, 13.3%, 21.6% and 50.0%, respectively (P-trend < 0.001). The adjusted hazard ratios (aHRs) for AF recurrence across quartiles 1–4 of CA-125 were 1.00 (reference), 1.085 (95% CI, 0.468–2.520), 1.866 (95% CI, 0.867–4.019), and 4.246 (95% CI, 2.113–8.533), respectively (P-trend < 0.001). A similar effect was obtained when CA-125 was studied as continuous data (aHR per unit increase in LnCA-125, 3.225, 95% CI, 2.258–4.606; P < 0.001). When a predefined CA-125 cut-off of 13.75 U/mL was established, patients with CA-125 ≥ 13.75 U/mL had a higher risk of recurrent AF than those with CA-125 < 13.75 U/mL (aHR, 3.540, 95% CI, 2.268–5.525, P < 0.001). Multivariate analysis revealed CA-125, high-sensitivity C-reactive protein, and left atrium anteroposterior diameter as independent risk factors for AF recurrence.

Conclusions

Elevated preoperative CA-125 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following RFCA.
Isolation of Brucella abortus biovar 1 from human lumbar disc bulging: a case report of brucellar discitis
Authors: Alamian Saeed , Etemadi Afshar , Samiee Mohammad Reza , Dadar Maryam
Published: August 2021

Background

Brucellosis is an endemic zoonotic disease with rising health and economic concerns in many areas worldwide. Musculoskeletal pains are among the main complications of human brucellosis, which are often difficult to diagnose due to the variability of clinical symptoms. Brucellar discitis is a very disabling problem in some chronic forms of the disease which may lead to serious vertebral and neurological consequences.

Case presentation

In this case report, we reported the isolation of Brucella abortus from lumbar disc bulging in a woman who had rheumatoid arthritis and diabetes mellitus as underlying conditions. The patient had several negative brucellosis serological tests and dorsolumbar pains with urinary incontinence over a 2-month period. The diagnosis was confirmed by magnetic resonance imaging (MRI) examination of lumbar spine as well as disc culture. MRI examination was performed without intravenous contrast and revealed the presence of disc bulging, left foraminal narrowing at L5-S1, left foraminal narrowing, anterolisthesis grade II at L4-L5. The diagnosis was also confirmed by isolation of B. abortus biovar 1 from bulging disc culture. The isolate was characterized by AMOS PCR, Bruce-ladder PCR and biotyping, resulting in the identification of B. abortus from L4-L5 and L5-S1 disc bulging regions. The patient was treated with two drugs i.e. doxycycline and rifampin for 3 months. In the follow-up, in addition to improving the patient’s general condition, low-back pain was also significantly reduced.

Conclusions

MRI, serology, cultural and molecular test along with patient history are important to make a rapid diagnosis of brucellosis’ discitis, thereby decreasing the delay for the brucellosis treatment. The present report suggests that the infection by Brucella spp. should be fundamentally considered among the causative agents of back pain especially in the endemic areas of Brucella infections.
A case report of Nocardia spp. infective endocarditis in an injection drug user
Authors: Enwezor Chukwunyelu , Russ-Friedman Courtney L. , Gruss Zachary P. , Murphy Adam , Palavecino Elizabeth L. , Jakharia Niyati
Published: August 2021

Background

Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals.

Case presentation

A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice.

Conclusions

This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.
Quantitative CT for detecting COVID‑19 pneumonia in suspected cases
Authors: Lu Weiping , Wei Jianguo , Xu Tingting , Ding Miao , Li Xiaoyan , He Mengxue , Chen Kai , Yang Xiaodan , She Huiyuan , Huang Bingcang
Published: August 2021

Background

Corona Virus Disease 2019 (COVID-19) is currently a worldwide pandemic and has a huge impact on public health and socio-economic development. The purpose of this study is to explore the diagnostic value of the quantitative computed tomography (CT) method by using different threshold segmentation techniques to distinguish between patients with or without COVID-19 pneumonia.

Methods

A total of 47 patients with suspected COVID-19 were retrospectively analyzed, including nine patients with positive real-time fluorescence reverse transcription polymerase chain reaction (RT-PCR) test (confirmed case group) and 38 patients with negative RT-PCR test (excluded case group). An improved 3D convolutional neural network (VB-Net) was used to automatically extract lung lesions. Eight different threshold segmentation methods were used to define the ground glass opacity (GGO) and consolidation. The receiver operating characteristic (ROC) curves were used to compare the performance of various parameters with different thresholds for diagnosing COVID-19 pneumonia.

Results

The volume of GGO (VOGGO) and GGO percentage in the whole lung (GGOPITWL) were the most effective values for diagnosing COVID-19 at a threshold of − 300 HU, with areas under the curve (AUCs) of 0.769 and 0.769, sensitivity of 66.67 and 66.67%, specificity of 94.74 and 86.84%. Compared with VOGGO or GGOPITWL at a threshold of − 300 Hounsfield units (HU), the consolidation percentage in the whole lung (CPITWL) with thresholds at − 400 HU, − 350 HU, and − 250 HU were statistically different. There were statistical differences in the infection volume and percentage of the whole lung, right lung, and lobes between the two groups. VOGGO, GGOPITWL, and volume of consolidation (VOC) were also statistically different at the threshold of − 300 HU.

Conclusions

Quantitative CT provides an image quantification method for the auxiliary diagnosis of COVID-19 and is expected to assist in confirming patients with COVID-19 pneumonia in suspected cases.
Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia
Authors: Birindwa Archippe M. , Kasereka Jerry K. , Gonzales-Siles Lucia , Geravandi Shadi , Mwilo Mambo , Tudiakwile Léonard K. , Mwinja Néné L. , Muhigirwa Balthazar , Kashosi Théophile , Manegabe Jeanière T. , Bugashane Elie B. , Saili Stay M. , Mungo Clement , Nordén Rickard , Andersson Rune , Skovbjerg Susann
Published: August 2021

Background

Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia.

Methods

Between June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination.

Results

During the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/μL and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes.

Conclusions

The occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.
Childbirth violence-based negative health consequences: a qualitative study in Iranian women
Authors: Taghizadeh Ziba , Ebadi Abbas , Jaafarpour Molouk
Published: August 2021

Background

Violation of mothers' rights during childbirth is a global problem that often silently torments women in many parts of the world. The aim of this study was to explore negative health consequences due to childbirth violence based on mothers' perceptions and experiences.

Methods

To achieve rich data, an exploratory qualitative study was carried out in 2019 on 26 women with childbirth violence experience who had given birth in hospitals of Ilam, Iran. Data were collected using semi‑structure in‑depth interviews (IDIs) and a purposive sampling. Participants were asked about their experiences and perceptions of negative health consequences due to childbirth violence. Data were analyzed by conventional content analysis based on Graneheim and Lundman approach. MAXQDA (v.18) software was used for better data management.

Results

Final codes were classified into 9 sub-categories and 3 main categories including maternal and newborn injuries, weakening of family ties, sense of distrust and hatred. These findings emerged the theme: negative health consequences.

Conclusions

This study broke the silence of abused mothers during childbirth and expressed the perspective of mothers who suffered childbirth violence as a routine phenomenon in maternal care, and a serious threat to the health of mothers, newborns and families. Findings of this study can be a warning for maternity health system, monitoring and support structures as well as health policy-makers to seriously plan to prevent and eliminate this problem.
Thyroid-related ophthalmopathy development in concurrence with growth hormone administration
Authors: Iwata Shimpei , Tsumura Kenji , Ashida Kenji , Tokubuchi Ichiro , Demiya Mutsuyuki , Kitamura Miyuki , Ohshima Hiroyuki , Yano Mamiko , Nagayama Ayako , Yasuda Junichi , Tsuruta Munehisa , Motomura Seiichi , Yoshida Shigeo , Nomura Masatoshi
Published: August 2021

Background

Thyroid stimulating hormone (TSH) receptor and local infiltrate lymphocytes have been considered as major pathological factors for developing thyroid-related ophthalmopathy. Overexpression of insulin-like growth factor-I (IGF-I) receptor has emerged as a promising therapeutic target for refractory patients. However, the relationship between activation of growth hormone (GH)/IGF-I receptor signaling and development or exacerbation of thyroid ophthalmopathy has not been elucidated. Herein we describe a case that provides further clarification into the association between thyroid-related ophthalmopathy and GH/IGF-I receptor signaling.

Case presentation

A 62-year-old Japanese female diagnosed with thyroid-related ophthalmopathy was admitted to Kurume University Hospital. She had received daily administration of GH subcutaneously for severe GH deficiency; however, serum IGF-I levels were greater than + 2 standard deviation based on her age and sex. She exhibited mild thyrotoxicosis and elevation in levels of TSH-stimulating antibody. Discontinuation of GH administration attenuated the clinical activity scores of her thyroid-related ophthalmopathy. Additionally, concomitant use of glucocorticoid and radiation therapies resulted in further improvement of thyroid-related ophthalmopathy. The glucocorticoid administration was reduced sequentially, followed by successful termination. Thereafter, the patient did not undergo recurrence of thyroid-related ophthalmopathy and maintained serum IGF-I levels within normal physiological levels.

Conclusions

We describe here a case in which development of thyroid-related ophthalmopathy occurred upon initiation of GH administration. GH/IGF-I signaling was highlighted as a risk factor of developing thyroid-related ophthalmopathy. Additionally, aberrant TSH receptor expression was suggested to be a primary pathophysiological mechanism within the development of thyroid-related ophthalmopathy. Physicians should be aware of the risks incurred via GH administration, especially for patients of advanced age, for induction of thyroid-related ophthalmopathy.
In vitro assessment of the effect of probiotic lactobacillus reuteri on peri-implantitis microflora
Authors: Mulla Munaz , Mulla Mushir , Hegde Shashikanth , Koshy Ajit V.
Published: August 2021

Background

Probiotics affect both the development and stability of microbiota by altering the colonization of pathogens and thus helps in stimulating the immune system of the individual. The aim of the present study is to assess the effect of probiotics on peri-implantitis microflora, by determining the minimum inhibitory concentration (MIC) of Lactobacillus reuteri, that can be effectively administered as an antimicrobial agent on specific peri-implantitis pathogens. Hence, this study will be helpful in finding the MIC of L. Reuteri that can be effectively administered as an antimicrobial agent on specific peri-implantitis pathogens.

Methods

This experimental research was conducted on patients visiting the periodontology department in M. A. Rangoonwala college of dental sciences and research centre. Sub-gingival plaque samples were collected from peri-implantitis patients to identify various peri-implantitis microorganisms. The identified microorganisms were compared to each other and Chi-Square test was used to calculate statistical significance. The isolated microorganisms were subjected to the effect of probiotic Lactobacillus reuteri in-vitro. Minimum inhibitory concentration (MIC) was assessed using serial dilution method.

Results

The research results showed the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Streptococcus salivaris and Staphylococcus aureus in the subgingival samples from peri-implantitis patients. Statistically, significantly higher proportion of samples had Porphyromonas gingivalis. When subjected to the effect of L. reuteri, all the microorganisms were affected by L.reuteri except Aggregatibacter actinomycetemcomitans.

Conclusion

This study provides the various MIC value for each isolated pathogen against L.reuteri. The authors recommend to avoid using standard guidelines for probiotic dose in the treatment of peri-implant infections as the antimicrobial profile is different for each periodontal pathogen.
Automatic detection of image sharpening in maxillofacial radiology
Authors: Kats Lazar , Goldman Yuli , Kahn Adrian
Published: August 2021

Background

Improvement of image quality in radiology, including the maxillofacial region, is important for diagnosis by enhancing the visual perception of the original image. One of the most used modification methods is sharpening, in which simultaneously with the improvement, due to edge enhancement, several artifacts appear. These might lead to misdiagnosis and, as a consequence, to improper treatment. The purpose of this study was to prove the feasibility and effectiveness of automatic sharpening detection based on neural networks.

Methods

The in-house created dataset contained 4290 X-ray slices from different datasets of cone beam computed tomography images were taken on 2 different devices: Ortophos 3D SL (Sirona Dental Systems GmbH, Bensheim, Germany) and Planmeca ProMax 3D (Planmeca, Helsinki, Finland). The selected slices were modified using the sharpening filter available in the software RadiAnt Dicom Viewer software (Medixant, Poland), version 5.5. The neural network known as "ResNet-50" was used, which has been previously trained on the ImageNet dataset. The input images and their corresponding sharpening maps were used to train the network. For the implementation, Keras with Tensorflow backend was used. The model was trained using NVIDIA GeForce GTX 1080 Ti GPU. Receiver Operating Characteristic (ROC) analysis was performed to calculate the detection accuracy using MedCalc Statistical Software version 14.8.1 (MedCalc Software Ltd, Ostend, Belgium). The study was approved by the Ethical Committee.

Results

For the test, 1200 different images with the filter and without modification were used. An analysis of the detection of three different levels of sharpening (1, 2, 3) showed sensitivity of 53%, 93.33%, 93% and specificity of 72.33%, 84%, 85.33%, respectively with an accuracy of 62.17%, 88.67% and 89% (p < 0.0001). The ROC analysis in all tests showed an Area Under Curve (AUC) different from 0.5 (null hypothesis).

Conclusions

This study showed a high performance in automatic sharpening detection of radiological images based on neural network technology. Further investigation of these capabilities, including their application to different types of radiological images, will significantly improve the level of diagnosis and appropriate treatment.
Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory
Authors: Wang Ting-Cheng , Chen Wei-Ting , Kang Yi-No , Lin Che-Wei , Cheng Chung-Yi , Suk Fat-Moon , Chen Hao-Yu , Hsu Chin-Wang , Fong Tsorng-Harn , Huang Wen-Cheng
Published: August 2021

Background

In recent years, point-of-care ultrasound (POCUS) has become an essential field of medical education. Bedside ultrasound has become a necessary skill for clinical physicians. Previous studies have already discussed the importance of advancements in ultrasound education. However, learning motivations for ultrasound education have seldom been analyzed in the literature. For medical students, learning ultrasound could have a relevance for their future career. The Existence, Relatedness and Growth (ERG) theory extended Maslow’s hierarchy of needs through these three concepts. This theory has been widely used in the workplace to analyze employee job performance but has not yet been applied in medical education. In this study ERG theory was applied to analyze pre-clinical medical students’ learning motivation toward ultrasound education.

Method

This mixed method study used online questionnaires consisting of open-ended questions as a data collection tool, and based on these results, both qualitative and quantitative analysis were conducted. Participants answered a series of neutral and open-ended questions regarding their motivations to learn ultrasonography. After data collection, a three-step analysis was conducted based on the grounded theory approach. Finally, the results of the thematic coding were used to complete additional quantitative analysis.

Results

The study involved 140 pre-clinical medical students, and their responses fell into 13 specific categories. The analysis demonstrated that students’ motivations toward ultrasound education were unbalanced across the three ERG domains (F = 41.257, p < .001). Pairwise comparisons showed that students mentioned existence motivation (MD = 39.3%; p < .001) and growth motivation (MD = 40.7%; p < .001) more frequently than relatedness motivation. However, there was no significant difference between existence motivation and growth motivation (MD = − 1.4%; p = .830).

Conclusion

The results revealed that students placed a high value on existence and growth needs rather than relatedness based on the survey. In addition, the findings suggest that ERG theory can be a useful tool to conduct medical education motivation analysis.
The ethics of machine learning-based clinical decision support: an analysis through the lens of professionalisation theory
Authors: Heyen Nils B. , Salloch Sabine
Published: August 2021

Background

Machine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation theory as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS.

Main text

Professionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics.

Conclusions

Using ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making.
Comparing the average cost of outpatient care of public and for-profit private providers in India
Authors: Garg Samir , Tripathi Narayan , Ranjan Alok , Bebarta Kirtti Kumar
Published: August 2021

Introduction

Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India’s. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients.

Methods

The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode.

Results

The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others.

Conclusions and recommendations

The findings have implications for the desired mix of public and private providers in India’s health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.
Organizing work in local service implementation: an ethnographic study of nurses’ contributions and competencies in implementing a municipal acute ward
Authors: Krone-Hjertstrøm Helle , Norbye Bente , Abelsen Birgit , Obstfelder Aud
Published: August 2021

Background

The increased prevalence of chronic diseases and an ageing population challenge healthcare delivery, particularly hospital-based care. To address this issue, health policy aims to decentralize healthcare by transferring responsibility and introducing new services in primary healthcare. In-depth knowledge of associated implementation processes is crucial for health care managers, policymakers, and the health care personnel involved. In this article, we apply an ethnographic approach in a study of nurses’ contributions to the implementation of a new inpatient service in an outpatient primary care emergency clinic and explore the competencies involved. The approach allowed us to explore the unexpressed yet significant effort, knowledge and competence of nurses that shaped the new service.

Methods

The study combines observations (250 h) and several in situ interviews with healthcare personnel and individual in-depth interviews with nurses (n = 8) at the emergency clinic. In our analysis, we draw on a sociological perspective on healthcare work and organization that considers nursing a practice within the boundaries of clinical patient work, organizational structures, and managerial and professional requirements.

Results

We describe the following three aspects of nurses’ contributions to the implementation of the new service: (1) anticipating worst-case scenarios and taking responsibility for preventing them, (2) contributing coherence in patient care by ensuring that new and established procedures are interconnected, and (3) engaging in “invisible work”. The nurses draw on their own experiences from their work as emergency nurses and knowledge of the local and regional contexts. They utilize their knowledge, competence, and organizing skills to influence the implementation process and ensure high-quality healthcare delivery in the extended service.

Conclusions

Our study illustrates that nurses’ contributions are vital to coordinating and adjusting extended services. Organizing work, in addition to clinical work, is a crucial aspect of nursing work. It ‘glues’ the complex and varied components of the individual patient’s services into coherent and holistic care trajectories. It is this organizing competence that nurses utilize when coordinating and adjusting extended services. We believe that nurses’ organizing work is generally invaluable in implementing new services, although it has not been well emphasized in practice and research.
Autonomic nervous system activity changes in patients with hypertension and overweight: role and therapeutic implications
Authors: Valensi Paul
Published: August 2021

The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathophysiology of hypertension, and treatments targeting the sympathetic nervous system (SNS), a key component of the autonomic nervous system, have been developed; however, current recommendations provide little guidance on their use. This review discusses the etiology of hypertension, and more specifically the role of the SNS in the pathophysiology of hypertension and its associated disorders. In addition, the effects of current antihypertensive management strategies, including pharmacotherapies, on the SNS are examined, with a focus on imidazoline receptor agonists.
Saccharomyces cerevisiae as host for the recombinant production of polyketides and nonribosomal peptides
Authors: Tippelt Anna , Nett Markus
Published: August 2021

As a robust, fast growing and genetically tractable organism, the budding yeastSaccharomyces cerevisiaeis one of the most widely used hosts in biotechnology. Its applications range from the manufacturing of vaccines and hormones to bulk chemicals and biofuels. In recent years, major efforts have been undertaken to expand this portfolio to include structurally complex natural products, such as polyketides and nonribosomally synthesized peptides. These compounds often have useful pharmacological properties, which make them valuable drugs for the treatment of infectious diseases, cancer, or autoimmune disorders. In nature, polyketides and nonribosomal peptides are generated by consecutive condensation reactions of short chain acyl-CoAs or amino acids, respectively, with the substrates and reaction intermediates being bound to large, multidomain enzymes. For the reconstitution of these multistep catalytic processes, the enzymatic assembly lines need to be functionally expressed and the required substrates must be supplied in reasonable quantities. Furthermore, the production hosts need to be protected from the toxicity of the biosynthetic products. In this review, we will summarize and evaluate the status quo regarding the heterologous production of polyketides and nonribosomal peptides inS. cerevisiae. Based on a comprehensive literature analysis, prerequisites for a successful pathway reconstitution could be deduced, as well as recurring bottlenecks in this microbial host.
Cardiac MR images of thalassemia major patients with myocardial iron overload: a data note
Authors: Shiae Ali Emad , Bakhshali Mohamad Amin , Shoja Razavi Seyed Jafar , Poorzand Hoorak , Layegh Parvaneh
Published: August 2021

Objective

Patients with thalassemia major (TM) have the highest mortality rate due to heart failure induced by myocardial iron overload. However, T2* weighted MR imaging is currently a gold standard approach for measuring iron overload. Examining ventricular volumes with magnetic resonance imaging (MR imaging) and measuring myocardial iron overload in TM patients allows for an early prediction of heart failure. This dataset includes cardiac MR images of TM patients and the control group with clinical and echocardiographic data. This dataset may be useful to researchers investigating myocardial iron overload. This dataset can also be used for medical image processing applications, such as ventricle segmentation.

Data description

This study provides open-source cardiac MR images of 50 subjects and clinical and echocardiographic data. From February 2016 to January 2019, all images and clinical data were obtained from the MRI department of a general hospital in Mashhad, Iran. All the images are 16-bit gray-scale and stored in DICOM format. All patient-specific information is removed from image headers to preserve patient privacy. In addition, all images associated with each subject are compressed and saved in the RAR format.