bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of dementia treatment in older adults with Parkinson’s disease using nationwide medical claims data
Authors: Yoon Bora , Kim Hwa-Jung
Published: April 2022

Background

Dementia is a common feature in Parkinson’s disease (PD); however, data on dementia treatment patterns in patients with PD are scarce. This study aimed to evaluate the incidence of dementia in individuals with PD and to describe the dementia treatment patterns in the Korean elderly population.

Methods

We conducted a retrospective population-based cohort study using data obtained from the Korean National Health Insurance Service-Senior Cohort (NHIS-SC) database. The dataset comprised more than 500,000 health insurance beneficiaries from January 1, 2002 to December 31, 2015. We estimated the incidence of patients newly diagnosed with dementia during this observational period, compared patient demographics, and analyzed the exposure to anticholinergic drugs among PD patients with (PD + D) and without (PD-D) dementia. Furthermore, the duration to dementia diagnosis and patterns of dementia treatment were evaluated.

Results

A cohort of 28,537 patients aged 60 years or older who were diagnosed with PD by the NHIS was established. Within this cohort, 8620 patients were eligible study participants according to strict inclusion/exclusion criteria. Of these individuals, 3879 (45.0%) patients were newly diagnosed with dementia; the incidence of dementia in PD was 15.2 per 1000 person-years. The proportion of women was higher in the PD + D (64.6%) than the PD-D group (58.2%) (P < 0.001); furthermore, the use of anticholinergic medication was greater in PD + D (37.6%) than in PD-D (24.0%) patients. The incidence curves for dementia over time were the steepest during the first year and decreased every year thereafter. Approximately 60% of PD patients were diagnosed with dementia during the first 3 years. Regarding the use of anti-dementia drugs, 2539 (65.5%) of 3879 PD + D were prescribed medication. During the observation period, 1799 (70.9%) patients were prescribed only one type of anti-dementia drug. In this monotherapy group, the most commonly prescribed medication was donepezil (1313[73.0%]), followed by rivastigmine (capsule and patch; 246[13.7%]), memantine (187[10.4%]), and galantamine (53[2.9%]).

Conclusions

In Korea, dementia was observed to occur relatively soon after the diagnosis of PD. Anti-dementia medication was prescribed to approximately 66% of PD + D patients, with the majority receiving donepezil as monotherapy.
“You have a self-testing method that preserves privacy so how come you cannot give us treatment that does too?” Exploring the reasoning among young people about linkage to prevention, care and treatment after HIV self-testing in Southern Malawi
Authors: Harrison Lisa , Kumwenda Moses , Nyirenda Lot , Chilongosi Richard , Corbett Elizabeth , Hatzold Karin , Johnson Cheryl , Simwinga Musonda , Desmond Nicola , Taegtmeyer Miriam
Published: April 2022

Background

Young people, aged 16–24, in southern Malawi have high uptake of HIV self-testing (HIVST) but low rates of linking to services following HIVST, especially in comparison, to older generations. The study aim is to explore the barriers and facilitators to linkage for HIV prevention and care following uptake of HIV self-testing among young Malawians.

Methods

We used qualitative methods. Young people aged 16–24 who had received HIVST; community-based distribution agents (CBDAs) and health care workers from the linked facilities were purposively sampled from two villages in rural southern Malawi.

Results

We conducted in-depth interviews with thirteen young people (9 female) and held four focus groups with 28 healthcare workers and CBDAs. Young people strongly felt the social consequences associated with inadvertent disclosure of HIV sero-status were a significant deterrent to linkage at their stage in life. They also felt communication on testing benefits and the referral process after testing was poor. In contrast, they valued encouragement from those they trusted, other’s positive treatment experiences and having a “strength of mind”. CBDAs were important facilitators for young people as they are able to foster a trusting relationship and had more understanding of the factors which prevented young people from linking following HIVST than the healthcare workers. Young people noted contextual barriers to linkage, for example, being seen on the road to the healthcare centre, but also societal gendered barriers. For example, young females and younger adolescents were less likely to have the financial independence to link to services whilst young males (aged 19–24) had the finances but lacked a supportive network to encourage linkage following testing. Overall, it was felt that the primary “responsibility” for linking to formal healthcare following self-testing is shouldered by the young person and not the healthcare system.

Conclusions

Young people are happy to self-test for HIV but faced barriers to link to services following a self-test. Potential interventions for improving linkage suggested by this analysis include the establishment of youth-friendly linkage services, enhanced lines of communication between young people and healthcare providers and prioritising linkage for future interventions when targeting young people following HIVST.
Altered retinal nerve fiber layer thickness in children with allergic conjunctivitis: the Nanjing eye study
Authors: Chen Danni , Li Rui , Huang Dan , Tong Haohai , Zhao Xiaoyan , Yan Wen , Shen Shiya , Liu Hu , Zhu Hui
Published: April 2022

Background

So far, few data are available on the relationship between allergic conjunctivitis (AC) and ocular fundus. Whether retinal parameters change in patients with AC remains unknown. In this study, we investigated the influence of AC on retinal thickness and vessel density among 7-years-old school-age children.

Methods

This large population-based study is part of the Nanjing Eye Study (NES). Comprehensive examinations including anthropometric parameters, refraction, ocular biometric parameters, intraocular pressure and retinal parameters were conducted on each child. Retinal thickness and vessel density were assessed using the optical coherence tomography angiography. Information on AC was obtained from a comprehensive questionnaire.

Results

A total of 739 children (mean age ± SD: 7.40 ± 0.29 years) had complete eye examination and questionnaire data we needed. Ninety-four children (12.7%) had AC, among which, 5 children had the history of corticosteroid use and were excluded from the final analysis. Spherical equivalent, axial length, body mass index and birth weight were correlated with retinal parameters. After adjusting for sex, age, spherical equivalent, axial length, body mass index, birth weight and premature history, children with AC had thinner retinal nerve fiber layer thickness for average (117.39 versus 120.97 μm, p = 0.007), temporal (80.73 versus 84.34 μm, p = 0.001), nasal (98.82 versus 102.18 μm, p = 0.049) and inferior (152.68 versus 157.06 μm, p = 0.034) quadrants than the control group.

Conclusions

Children with AC tended to have thinner retinal nerve fiber layer thickness. More attention is needed to fundus condition of children with AC.
Breastfed and mixed fed infants who do not consume infant cereal are at risk for inadequate iron intake:data from the feeding infants and toddlers study 2016, a cross-sectional survey
Authors: Finn Kristen , Quick Sarah , Anater Andrea , Hampton Joel , Kineman Brian , Klish William
Published: April 2022

Background

According to the Feeding Infants and Toddlers Study (FITS), the percentage of older infants consuming infant cereal has declined from 72% of 6–11.9 month old infants in 2002 to 52% in 2016. This is especially concerning for breastfed and mixed fed infants because of their increased need for dietary sources of iron. This study explored the association between infant cereal consumption and nutrient intakes among breastfed and mixed fed infants.

Methods

FITS 2016 is the largest cross-sectional survey of food and nutrient intakes among caregivers of children less than 4 years old in the United States. For this analysis, we evaluated 24 h dietary recalls for infants 6–11.9 months who were either breastfed (no infant formula provided,n = 296) or mixed fed (breastmilk and infant formula provided,n = 102). Infants were further categorized as infant cereal consumers or non-consumers. Nutrient intakes were compared with Adequate Intakes or Estimated Average Requirements when available. Differences between cereal consumers and non-consumers were calculated using unpaired T-tests.

Results

Significantly fewer breastfed cereal consumers had intakes below the Estimated Average Requirement for iron (19% vs. 96%) and zinc (61% vs. 16%,p < 0.0001). Additionally, significantly more breastfed cereal consumers had intakes above the Adequate Intake level for 12 other nutrients compared to non-consumers. Among mixed fed infants, significantly fewer cereal consumers had intakes below the Estimated Average Requirement for iron compared to non-consumers (5% vs. 70%), but differences in other nutrients were not observed.

Conclusions

Almost all (96%) of the breastfed infants who did not consume infant cereal had inadequate iron intakes. Even among mixed fed infants, significantly fewer infant cereal consumers had inadequate iron intakes compared to non-cereal consumers. Infant cereal is an important source of iron and other key nutrients, especially for infants receiving breastmilk.
Factors associated with the mental health of back-to-Wuhan university students based on quantile regression model during the COVID-19 period
Authors: Wu Qian , Zhuo Lijun , Li Hao , Zheng Ling , Ma Guoqing , Tao Hongbing
Published: April 2022

Background

The COVID-19 pandemic had brought the increased levels of depression and anxiety on people. Our study investigated the levels of mental health and influencing factors among back-to-Wuhan university students.

Methods

A cross-sectional questionnaire survey was conducted from 31 August 2020, to 14 September 2020 by convenience sampling on the back-to-Wuhan university students, which included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index-7 (ISI-7), the revised Impact of Event Scale (IES-R) scales, and the basic demographic characteristics. Moreover, quantile regression analysis was used to identify the key factors related to the mental health variables of the back-to-Wuhan university students during the COVID-19 period.

Results

The results from 1017 participants suggested that the prevalence rates of the anxiety, depression, insomnia, and distress were 44%, 47.5%, 37.7%, 57.7%, respectively. Quantile regression showed that mental health scores were negatively associated to age, years from graduation, being discriminated against owing to the experience in Wuhan, and the attitude on the future of COVID-19, while was positively related to the education level (P < 0.05). Especially, the education level was highly related with anxiety (25th = 1.64, 50th = 2.54).

Conclusion

The finding showed that the respondents who were near graduation, discriminated owing to the experience in Wuhan, and worried about the future trend of COVID-19 had a higher risk of negative psychologic status, especially in the bottom and median quantile, and might require more psycho-social interventions or support.
ASD with ADHD vs. ASD and ADHD alone: a study of the QbTest performance and single-dose methylphenidate responding in children and adolescents
Authors: Stevanovic Dejan , Wentz Elisabet , Nasic Salmir , Knez Rajna
Published: April 2022

Background

The continuous performance task (CPT) may help identify coexistent attention deficit hyperactivity disorder (ADHD) in autism spectrum disorder (ASD). The Quantified behavior Test (QbTest) combines a CPT and motion-tracking data to assess ADHD symptoms. This study aimed to evaluate the QbTest performance of children and adolescents with ASD plus ADHD, including estimating the effects of single-dose methylphenidate (MPH). To achieve these aims, (1) the QbTest performances were evaluated in ASD alone, ASD plus ADHD, and ADHD alone, and (2) the effects on the QbTest performance of single-dose MPH before and after intake were estimated across the groups. It was assumed that the ASD plus ADHD performance, including the MPH response, would preferably resemble the performance in ADHD alone, rather than ASD alone.

Methods

Retrospective data were analyzed for 482 children and adolescents: 69 with ASD alone, 142 with ASD plus ADHD (ASD/ADHD), and 271 with ADHD alone. For 343 subjects, the QbTest was performed before and up to four hours after a single-dose MPH intake. A summary index of the CPT and motion-capture data was provided for QbTest cardinal parameters.

Results

Of 12 QbTest parameters assessed before given MPH, the ASD/ADHD group had scores in line with the ASD group regarding four parameters and the ADHD group regarding nine parameters. Significant differences between groups were seen with respect to QbInattention (p > 0.05); the lowest scores in ASD and the highest in ADHD. Those with ASD/ADHD and ADHD had similar QbActivity and QbImpulsivity scores, but significantly higher than those with ASD. After MPH intake, scores for QbActivity decreased similarly in ASD/ADHD and ADHD, as well as scores for QbImpulsivity. QbImpulsivity increased in ASD. QbInattention scores decreased similarly in all groups after MPH intake.

Conclusions

Children and adolescents with ASD plus ADHD exhibited more atypical QbTest performances than those with ASD alone, while most of their performances were similar to those observed in ADHD alone. In addition, a single dose of MPH mitigated attention deficits and decreased hyperactivity while improved impulsivity in these children. Prospective studies should further clarify the role of the QbTest in the diagnostic and therapeutic interventions in ASD with ADHD.
University students with attention deficit hyperactivity disorder (ADHD): a consensus statement from the UK Adult ADHD Network (UKAAN)
Authors: Sedgwick-Müller Jane A. , Müller-Sedgwick Ulrich , Adamou Marios , Catani Marco , Champ Rebecca , Gudjónsson Gísli , Hank Dietmar , Pitts Mark , Young Susan , Asherson Philip
Published: April 2022

Background

Attention deficit hyperactivity disorder (ADHD) is associated with poor educational outcomes that can have long-term negative effects on the mental health, wellbeing, and socio-economic outcomes of university students. Mental health provision for university students with ADHD is often inadequate due to long waiting times for access to diagnosis and treatment in specialist National Health Service (NHS) clinics. ADHD is a hidden and marginalised disability, and within higher education in the UK, the categorisation of ADHD as a specific learning difference (or difficulty) may be contributing to this.

Aims

This consensus aims to provide an informed understanding of the impact of ADHD on the educational (or academic) outcomes of university students and highlight an urgent need for timely access to treatment and management.

Methods

The UK Adult ADHD Network (UKAAN) convened a meeting of practitioners and experts from England, Wales, and Scotland, to discuss issues that university students with ADHD can experience or present with during their programme of studies and how best to address them. A report on the collective analysis, evaluation, and opinions of the expert panel and published literature about the impact of ADHD on the educational outcomes of university students is presented.

Results

A consensus was reached that offers expert advice, practical guidance, and recommendations to support the medical, education, and disability practitioners working with university students with ADHD.

Conclusions

Practical advice, guidance, and recommendations based on expert consensus can inform the identification of ADHD in university students, personalised interventions, and educational support, as well as contribute to existing research in this topic area. There is a need to move away from prevailing notions within higher education about ADHD being a specific learning difference (or difficulty) and attend to the urgent need for university students with ADHD to have timely access to treatment and support. A multimodal approach can be adapted to support university students with ADHD. This approach would view timely access to treatment, including reasonable adjustments and educational support, as having a positive impact on the academic performance and achievement of university students with ADHD.
Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self‐Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing
Authors: Nicholls Emily Jay , Samba Phil , McCabe Leanne , Gafos Mitzy , Philips Andrew N. , Trevelion Roy , Rodger Alison J. , Burns Fiona M. , Weatherburn Peter , Witzel T. Charles
Published: April 2022

Background

HIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations.

Methods

Twenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework.

Results

The gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of ‘whiteness’ on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options.

Conclusions

HIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services.

Trial Registration

SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003).
Evaluating the effectiveness of Hong Kong’s border restriction policy in reducing COVID-19 infections
Authors: ZHU Pengyu , TAN Xinying
Published: April 2022

This study evaluates the effectiveness of Hong Kong’s strict border restrictions with mainland China in curbing the transmission of COVID-19. Combining big data from Baidu Population Migration with traditional meteorological data and census data for over 200 Chinese cities, we utilize an advanced quantitative approach, namely synthetic control modeling, to produce a counterfactual “synthetic Hong Kong” without a strict border restriction policy. We then simulate infection trends under the hypothetical scenarios and compare them to actual infection numbers. Our counterfactual synthetic control model demonstrates a lower number of COVID-19 infections than the actual scenario, where strict border restrictions with mainland China were implemented from February 8 to March 6, 2020. Moreover, the second synthetic control model, which assumes a border reopen on 7 May 2020 demonstrates nonpositive effects of extending the border restriction policy on preventing and controlling infections. We conclude that the border restriction policy and its further extension may not be useful in containing the spread of COVID-19 when the virus is already circulating in the local community. Given the substantial economic and social costs, and as precautionary measures against COVID-19 becomes the new normal, countries can consider reopening borders with neighbors who have COVID-19 under control. Governments also need to closely monitor the changing epidemic situations in other countries in order to make prompt and sensible amendments to their border restriction policies.
Prescreening for osteoporosis with forearm bone densitometry in health examination population
Authors: Yue Chun , Ding Na , Xu Lu-Lu , Fu Ya-Qian , Guo Yuan-Wei , Yang Yan-Yi , Zhao Xian-Mei , Sheng Zhi-Feng
Published: April 2022

Background

Early detection and timely prophylaxis can retard the progression of osteoporosis. The purpose of this study was to determine the validity of peripheral Dual Energy X-ray Absorptiometry (DXA) test for osteoporosis screening. We examined peripheral bone mineral density (BMD) using AKDX-09 W-I DXA densitometer. Firstly, we acquired BMD data from manufacturer-supplied density-gradient phantoms and 30 volunteers to investigate its accuracy and precision, then we measured BMD for 150 volunteers using both AKDX (left forearm) and Hologic Discovery Wi (left forearm, left hip and L1 - L4 vertebrae) simultaneously. Correlation relationship of BMD results acquired from two instruments was assessed by simple linear regression analysis, the Receiver Operating Characteristic (ROC) curves and Areas Under the Curves (AUCs) were evaluated for the diagnostic value of left forearm BMD measured by AKDX in detecting osteoporosis.

Results

In vitro precision errors of AKDX BMD were 0.40, 0.20, 0.19%, respectively, on low-, medium-, and high-density phantom; in vivo precision was 1.65%. Positive correlation was observed between BMD measured by AKDX and Hologic at the forearm (r = 0.670), L1–L4 (r = 0.430, femoral neck (r = 0.449), and total hip (r = 0.559). With Hologic measured T-score as the gold standard, the sensitivity of AKDX T-score < − 1 for identifying suboptimal bone health was 63.0 and 76.1%, respectively, at the distal one-third radius and at any site, and the specificity was 73.9 and 90.0%, respectively; the AUCs were 0.708 and 0.879. The sensitivity of AKDX T-score ≤ − 2.5 for identifying osteoporosis at the distal one-third radius and at any site was 76.9 and70.4%, respectively, and the specificity was 80.4 and 78.0%, respectively; the AUCs were 0.823 and 0.778.

Conclusions

Peripheral DXA appears to be a reliable tool for prescreening for osteoporosis.
Postoperative outcomes after degenerative lumbar spine surgery in rheumatoid arthritis patients -a propensity score-matched analysis
Authors: Kato So , Nakamoto Hideki , Matsubayashi Yoshitaka , Taniguchi Yuki , Doi Toru , Yoshida Yuichi , Higashikawa Akiro , Takeshita Yujiro , Fukushima Masayoshi , Ono Takashi , Hara Nobuhiro , Okazaki Rentaro , Iwai Hiroki , Oshina Masahito , Sugita Shurei , Hirai Shima , Masuda Kazuhiro , Tanaka Sakae , Oshima Yasushi ,   University of Tokyo Spine Group, Oshima Yasushi , Kawamura Naohiro , Higashikawa Akiro , Hara Nobuhiro , Ono Takashi , Takeshita Yujiro , Taniguchi Yuki , Matsubayashi Yoshitaka , Kato So
Published: April 2022

Background

Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis.

Methods

Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups.

Results

Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids.

Conclusions

RA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.
Non-ossifying fibromas and fibrous cortical defects around the knee - an epidemiologic survey in a Japanese pediatric population
Authors: Emori Makoto , Tsuchie Hiroyuki , Teramoto Atsushi , Shimizu Junya , Mizushima Emi , Murahashi Yasutaka , Nagasawa Hiroyuki , Miyakoshi Naohisa , Yamashita Toshihiko
Published: April 2022

Background

The aim of the present study was to evaluate the prevalence of non-ossifying fibroma (NOF) and fibrous cortical defect (FCD) in a Japanese pediatric population and the association between the lesion size and pain.

Methods

This retrospective study, conducted across 10 Japanese institutions, included patients aged 5–15 years who had undergone standard antero-posterior and lateral view radiography of the knee. Using these radiographs, we diagnosed the lesion as a NOF or FCD. Patient demographics, including age, sex, the size and location of the NOF, and chief complaint were recorded. The lesion size was determined using radiographs. Student’s t-test was used to compare the associations between the lesion size and spontaneous pain.

Results

A total of 6222 subjects (3567 boys and 2455 girls) were included in this study. The number of NOF and FCD cases was 143 and 437, respectively, and the prevalence of NOF and FCD was 2.3% and 7.0%, respectively. The average size of NOF and FCD was 22.1 mm (range: 4–102 mm) and 13.2 mm (range: 5–21 mm), respectively. Three patients (2.1%) had pathological fractures due to NOF. Of the 140 NOFs and 437 FCDs, we obtained complaints from the medical records of 126 and 393 patients, respectively. The number of patients with spontaneous pain or other problems with NOF was 68 (54%) and 58 (46%), respectively, that of patients with FCD was 195 (50%) and 198 (50%) patients, respectively. The lesion size was not associated with spontaneous pain in either lesion (p = 0.67 andp = 0.27, respectively).

Conclusion

The prevalence of NOF and FCD around the knee was lower than that reported in previous studies. The prevalence of NOF increased and that of FCD decreased with advancing age. In both lesions, the lesion size may not be associated with pain.
Chief complaints of patients with cancer who visit the emergency department over their oncologist’s outpatient clinic in South Korea
Authors: Son Min Hyun , Chung Han Sol
Published: April 2022

Background

There have been several reports of patients with cancer visiting the Emergency Department (ED) rather than the outpatient department of their oncologist. In this study, we aimed to analyze the chief complaints, visit time, and time spent in the ED between study groups of patients with cancer visiting the ED. This finding will help medical staff provide better care for patients with cancer and reduce time spent in the ED.

Methods

A total of 787 patients with cancer visited the Regional Emergency Medical Center between January 1, 2020, and December 31, 2020. After the exclusion criterion such as patients who were transferred to the ED with a referral issued slip, patients who were pregnant women or minors under the age of 18 were applied, data from 607 patients with cancer were collected retrospectively from electronic medical records at the hospital. The participating patients with cancer were divided into two groups: 1) ED group—those who were cared for by the ED physician and 2) Referral group—those who were referred to their oncologist for hospitalization.

Results

We found that 40% of the total patients with cancer included in the study visited the ED with a chief complaint of pain. It was observed that the highest frequency of visits to the ED was around noon during clinic hours. The length of ED stay was 169 and 566 min for the ED and referral groups, respectively.

Conclusion

It would be more beneficial for patients with cancer visiting the ED to be quickly discharged from the ED physician’s active care for their symptoms. This usage of ED services will reduce unnecessary waiting time.
Proangiogenesis effects of compound danshen dripping pills in zebrafish
Authors: Hu Yang-Xi , You Hong-Min , Ren Chang-Zhen , Hu Bo-Wen , Zhang Lu-Jun , Zhang Yan-Da , He Zhi-Qing , Ding Ru , Guo Zhi-Fu , Liang Chun
Published: April 2022

Background

The compound Danshen Dripping Pill (CDDP), which is a mixture of extracts from Radix Salviae and Panax notoginseng, is a patented traditional Chinese medicine that is widely used in multiple countries for relieving coronary heart disease (CHD), but its pharmacological mechanism has not been fully elucidated. In this study, we screened the key pharmacological pathways and targets of CDDP that act on CHD using a network pharmacology-based strategy, and the angiogenic activity of CDDP was directly visually investigated in zebrafish embryos in vivo.

Methods

The potential therapeutic targets and pathways were predicted through a bioinformatics analysis. The proangiogenic effects of CDDP were examined using vascular sprouting assays on subintestinal vessels (SIVs) and optic arteries (OAs) as well as injury assays on intersegmental vessels (ISVs). Pharmacological experiments were applied to confirm the pathway involved.

Results

Sixty-five potential therapeutic targets of CDDP on CHD were identified and enriched in the PI3K/AKT and VEGF/VEGFR pathways. An in vivo study revealed that CDDP promoted angiogenesis in SIVs and OAs in a dose-dependent manner and relieved the impairments in ISVs induced by lenvatinib, a VEGF receptor kinase inhibitor (VRI). In addition, Vegfaa and Kdrl expression were significantly upregulated after CDDP treatment. Furthermore, the proangiogenic effect of CDDP could be abolished by PI3K/AKT pathway inhibitors.

Conclusions

CDDP has a proangiogenic effect, the mechanism of which involves the VEGF/VEGFR and PI3K/AKT signaling pathways. These results suggest a new insight into the cardiovascular protective effect of CDDP.
PEDF is an antifibrosis factor that inhibits the activation of fibroblasts in a bleomycin-induced pulmonary fibrosis rat model
Authors: Qin Xichun , Jia Caili , Liang Jingtian , Chen Jiali , Liu Xiucheng , Chao Zhixiang , Qin Hao , Yuan Yanliang , Liu Zhiwei , Zhang Zhongming , Dong Hongyan , Zhang Hao
Published: April 2022

Background

Idiopathic pulmonary fibrosis (IPF) is a highly heterogeneous and fatal lung disease. In addition to dense fibrous tissue, abnormal angiogenesis is also an important feature of IPF. Pigment epithelium-derived factor (PEDF) is an angiogenesis inhibitor and a potential anti-fibrous factor. The purpose of this experiment is to observe the effect of PEDF on bleomycin (BLM)-induced pulmonary fibrosis in rats.

Methods

In vivo, pathological examination and detection of related factors were performed on pulmonary fibrosis induced by BLM in rats, and the temporal and spatial distribution of PEDF was investigated. Furthermore, lung gene delivery (PEDF-adeno-associated virus) was performed to investigate the effect of PEDF on pulmonary fibrosis. In vitro, lentiviral vectors were used to construct PEDF over-expression or knock out primary rat lung (PRL) fibroblasts. The effect of PEDF on fibroblast activation under TGF-β1 stimulation was evaluated, and the activation of TGF-β1/smad pathway and PPAR-γ expression (in the presence or absence of PPAR-γ inhibitors) were analyzed.

Results

In vivo results showed that PEDF expression decreased during the inflammatory phase and increased during the fibrotic phase. PEDF could inhibit the progression of pulmonary fibrosis in rats. In vitro results showed that PEDF could effectively inhibit TGF-β1-stimulated fibroblast activation and reduce the production of α-SMA and collagen-I. PEDF could inhibit the TGF-β1/smad pathway by up-regulating the activity of PPAR-γ.

Conclusions

PEDF can act as an anti-fibrotic factor, inhibit fibroblast activation by upregulating PPAR-γ activity and reduce BLM-induced pulmonary fibrosis in rats.
Is energy excess the initial trigger of carbon overflow metabolism? Transcriptional network response of carbon-limited Escherichia coli to transient carbon excess
Authors: Li Zhaopeng , Nees Markus , Bettenbrock Katja , Rinas Ursula
Published: April 2022

Background

Escherichia coli adapted to carbon-limiting conditions is generally geared for energy-efficient carbon utilization. This includes also the efficient utilization of glucose, which serves as a source for cellular building blocks as well as energy. Thus, catabolic and anabolic functions are balanced under these conditions to minimize wasteful carbon utilization. Exposure to glucose excess interferes with the fine-tuned coupling of anabolism and catabolism leading to the so-called carbon overflow metabolism noticeable through acetate formation and eventually growth inhibition.

Results

Cellular adaptations towards sudden but timely limited carbon excess conditions were analyzed by exposing slow-growing cells in steady state glucose-limited continuous culture to a single glucose pulse. Concentrations of metabolites as well as time-dependent transcriptome alterations were analyzed and a transcriptional network analysis performed to determine the most relevant transcription and sigma factor combinations which govern these adaptations. Down-regulation of genes related to carbon catabolism is observed mainly at the level of substrate uptake and downstream of pyruvate and not in between in the glycolytic pathway. It is mainly accomplished through the reduced activity of CRP-cAMP and through an increased influence of phosphorylated ArcA. The initiated transcriptomic change is directed towards down-regulation of genes, which contribute to active movement, carbon uptake and catabolic carbon processing, in particular to down-regulation of genes which contribute to efficient energy generation. Long-term changes persisting after glucose depletion and consumption of acetete encompassed reduced expression of genes related to active cell movement and enhanced expression of genes related to acid resistance, in particular acid resistance system 2 (GABA shunt) which can be also considered as an inefficient bypass of the TCA cycle.

Conclusions

Our analysis revealed that the major part of the trancriptomic response towards the glucose pulse is not directed towards enhanced cell proliferation but towards protection against excessive intracellular accumulation of potentially harmful concentration of metabolites including among others energy rich compounds such as ATP. Thus, resources are mainly utilized to cope with “overfeeding” and not for growth including long-lasting changes which may compromise the cells future ability to perform optimally under carbon-limiting conditions (reduced motility and ineffective substrate utilization).
The changing malaria trend and control efforts in Oromia Special zone, Amhara Regional State, North-East Ethiopia
Authors: Tefera Selomon , Bekele Temesgen , Getahun Kefelegn , Negash Abiyot , Ketema Tsige
Published: April 2022

Background

Countries in malaria endemic regions are determinedly making an effort to achieve the global malaria elimination goals. In Ethiopia, too, all concerned bodies have given attention to this mission as one of their priority areas so that malaria would be eradicated from the country. Despite the success stories from some areas in the country, however, malaria is still a major public health concern in most parts of Ethiopia. Therefore, this study is aimed at analysing the changing malaria trend and assessing the impact of malaria control efforts in one of the malaria endemic regions of Ethiopia.

Methods

Five years data on clinical malaria cases diagnosed and treated at all health facilities (including 28 Health Centres, 105 Health Posts and 2 Hospitals) in Oromia Special zone, Amhara Regional State, Ethiopia, were reviewed for the period from June 2014 to June 2019. Data on different interventional activities undertaken in the zone during the specified period were obtained from the Regional Health Bureau.

Results

The cumulative malaria positivity rate documented in the zone was 12.5% (n = 65,463/524,722). Plasmodium falciparum infection was the dominant malaria aetiology and accounted for 78.9% (n = 51,679). The age group with the highest malaria burden was found to be those aged above 15 years (54.14%, n = 35,443/65,463). The malaria trend showed a sharp decreasing pattern from 19.33% (in 2015) to 5.65% (in 2018), although insignificant increment was recorded in 2019 (8.53%). Distribution of long-lasting insecticidal nets (LLIN) and indoor residual spraying (IRS) were undertaken in the zone once a year only for two years, specifically in 2014 and 2017. In 2014, a single LLIN was distributed per head of households, which was not sufficient for a family size of more than one family member. Number of houses sprayed with indoor residual spray in 2014 and 2017 were 33,314 and 32,184 houses, respectively, leading to the assumption that, 151,444 (25.9%) and 141,641 (24.2%) population were protected in year 2014 and 2017, respectively. The analysis has shown that P. falciparum positivity rate was significantly decreased following the interventional activities by 3.3% (p = 0.009), but interventional efforts did not appear to have significant effect on vivax malaria, as positivity rate of this parasite increased by 1.49% (p = 0.0218).

Conclusion

Malaria burden has shown a decreasing pattern in the study area, although the pattern was not consistent throughout all the years and across the districts in the study area. Therefore, unremitting surveillance along implementation of interventional efforts should be considered taking into account the unique features of Plasmodium species, population dynamics in the zone, seasonality, and malaria history at different districts of the zone should be in place to achieve the envisaged national malaria elimination goal by 2030.
The clinical outcomes of selective and spontaneous fetal reduction of twins to a singleton pregnancy in the first trimester: a retrospective study of 10 years
Authors: Wang Chao , Tang Fei , Song Bing , Li Guanjian , Xing Qiong , Cao Yunxia
Published: April 2022

Background

Singleton pregnancy is encouraged to reduce pregnancy complications. In addition to single embryo transfer (SET), selective and spontaneous fetal reduction (SEFR and SPFR) can also achieve singleton pregnancies. After SEFR or SPFR, an inanimate fetus remains in the uterus. It is unclear whether the inanimate fetus would adversely affect another fetus or the mother. Previous studies have focused on the differences between pre- and post-reduction. However, studies focusing on the influence of SEFR and SPFR on the remaining fetal development and maintenance of pregnancy are rare.

Methods

Materials from 5922 patients whose embryo transfer dates ranged from March 2011 to January 2021 were collected. Both the SEFR group (n = 390) and SPFR group (n = 865) had double embryos transferred (DET) and got twin pregnancies, but subsequent selective or spontaneous fetal reduction occurred. The SET group (n = 4667) had only one embryo transferred. All were singleton pregnancies on the 65th day after embryo transfer. Clinical outcomes, including pregnancy outcomes, pregnancy complications, and newborn outcomes, were compared among the three groups.

Results

After adjusting for age, infertility duration, types of infertility, states of embryos, body mass index, and factors affecting SET or DET decisions, multivariate regression analysis revealed that SEFR increased the risk of miscarriage (OR 2.368, 95% CI 1.423–3.939) and preterm birth (OR 1.515, 95% CI 1.114–2.060), and reduced the gestational age (βeta -0.342, 95% CI -0.544– -0.140). SPFR increased the risk of gestational diabetes mellitus (GDM) (OR 1.657, 95% CI 1.215–2.261), preterm premature rupture of membranes (PPROM) (OR 1.649, 95% CI 1.057–2.574), and abnormal amniotic fluid volume (OR 1.687, 95% CI 1.075–2.648). Both SEFR and SPFR were associated with reduced live birth rate (OR 0.522, 95% CI 0.330–0.825; OR 0.671, 95% CI 0.459–0.981), newborn birth weight (βeta -177.412, 95% CI -235.115–-119.709; βeta -42.165, 95% CI -83.104–-1.226) as well as an increased risk of low-birth-weight newborns (OR 2.222, 95% CI 1.490–3.313; OR 1.510, 95% CI 1.092–2.087).

Conclusions

DET with subsequent fetal reduction was related to poor clinical outcomes. We recommend that DET with subsequent fetal reduction should only be considered as a rescue method for multiple pregnancy patients with potential complications, and SET is more advisable.
International medical electives during and after the COVID-19 pandemic - current state and future scenarios: a narrative review
Authors: Storz Maximilian Andreas
Published: April 2022

Background

International medical electives are an important and popular component of the academic curriculum in many medical schools and universities worldwide. The purpose of abroad electives is to provide medical students with an opportunity to gain a better understanding of education and healthcare in an international context. The COVID-19 pandemic, however, has substantially changed the international elective landscape. Travel restrictions, closures of international elective programs and the expansion of virtual methods for education caused a widespread disruption to abroad electives. A comprehensive analysis with regard to other consequences for abroad electives, however, has not been done before. Thus, we sought to a) summarize the current transformation of the international medical elective and b) to address potential challenges for post-pandemic international medical electives.

Methods

The methodology employed is a multidisciplinary narrative review of the published and grey literature on international electives during the last two years of the COVID-19 pandemic.

Results

Students worldwide had electives postponed or canceled. Apart from evident immediate pandemic-related consequences (such as the substantial decline in global electives and impaired elective research opportunities for educators), there are other several problems that have received little attention during the last two years. These include challenges in the elective application process, poorly-understood consequences for host institutions, and growing global (ethical) disparities that are likely to increase once elective programs will gradually re-open. There is ample evidence that the post-pandemic elective landscape will be characterized by increasing elective fees, and a more competitive seat-to-applicant ratio. Ethical problems for international electives arising from an unequal global vaccine distribution will pose an additional challenge to students and elective coordinators alike.

Conclusion

The COVID-19 pandemic transformed the international medical elective landscape in an unprecedented way, and future generations of medical students will face a series of additional challenges when applying for global medical electives.
Ultrasound localization of central vein catheter tip by contrast-enhanced transthoracic ultrasonography: a comparison study with trans-esophageal echocardiography
Authors: Corradi Francesco , Guarracino Fabio , Santori Gregorio , Brusasco Claudia , Tavazzi Guido , Via Gabriele , Mongodi Silvia , Mojoli Francesco , Biagini Raffaello Umberto Dario , Isirdi Alessandro , Dazzi Federico , Robba Chiara , Vetrugno Luigi , Forfori Francesco ,   UCARE research group, Bologna Maria Lidia , Cardu Alessandro , Crocetti Laura , Cundari Francesco , Del Frate Elisa , Ferrari Samuele , Laffi Alberto , Marrucci Elena , Monfroni Marco , Piagnani Chiara , Taddei Erika , Tecchi Ludovica , Tempini Sara , Tognarelli Debora , Vullo Carmelo
Published: April 2022

Background

To assess the usefulness of pre-operative contrast-enhanced transthoracic echocardiography (CE-TTE) and post-operative chest-x-ray (CXR) for evaluating central venous catheter (CVC) tip placements, with trans-esophageal echocardiography (TEE) as gold standard.

Methods

A prospective single-center, observational study was performed in 111 patients requiring CVC positioning into the internal jugular vein for elective cardiac surgery. At the end of CVC insertion by landmark technique, a contrast-enhanced TTE was performed by both the apical four-chambers and epigastric bicaval acoustic view to assess catheter tip position; then, a TEE was performed and considered as a reference technique. A postoperative CXR was obtained for all patients.

Results

As per TEE, 74 (67%) catheter tips were correctly placed and 37 (33%) misplaced. Considering intravascular and intracardiac misplacements together, they were detected in 8 patients by CE-TTE via apical four-chamber view, 36 patients by CE-TTE via epigastric bicaval acoustic view, and 12 patients by CXR. For the detection of catheter tip misplacement, CE-TTE via epigastric bicaval acoustic view was the most accurate method providing 97% sensitivity, 90% specificity, and 92% diagnostic accuracy if compared with either CE-TTE via apical four-chamber view or CXR. Concordance with TEE was 79% (p < 0.001) for CE-TTE via epigastric bicaval acoustic view.

Conclusions

The concordance between CE-TTE via epigastric bicaval acoustic view and TEE suggests the use of the former as a standard technique to ensure the correct positioning of catheter tip after central venous cannulation to optimize the use of hospital resources and minimize radiation exposure.