bluuebunny/crossref_metadata_2025 huggingface dataset:
Aesthetics, Medium, and Method: An Introduction to the Differences and Similarities Between Arts and Non-arts Entrepreneurs
Authors: Hart James D. , Beckman Gary D.
Published: November 2021

A topic not often addressed in entrepreneurship literature is the broader similarities and differences between arts and non-arts entrepreneurs and the implications these analogous distinctions have in the classroom. This article is an initial exploration of the topic and outlines a minimal, broad-based hierarchy of the artistic process. Further, we attempt to identify the fundamental similarities of the two entrepreneurs and suggest they both engage not only in an analogous process, they are somewhat distinct in the “meta” materials used. Through comparison, we posit that the “meta” process used by artists is also used by non-arts entrepreneurs. By drawing attention to these analogies, educators will likely discover components applicable to traditional entrepreneurship courses; the inverse is already occurring within the medium of creative and arts entrepreneurship.
The Relevance of Ineffective Esophageal Motility to Surgical Practice
Authors: Kohn Geoffrey P.
Published: November 2021

Foregut surgery is often complicated by postoperative dysphagia. Preoperative esophageal manometry has been used to counsel patients and to guide choice of operation to minimize dysphagia outcomes. Uncertainty surrounds the optimal surgical management of patients with disordered motility. While treatment protocols are generally accepted for the disorders of esophagogastric junction outflow, surgery choice in the presence of disorders of peristalsis, particularly ineffective esophageal motility (IEM), is less clear. With the diagnosis of IEM, provocation testing is being utilized to predict postoperative dysphagia and to guide management, though evidence is not yet sufficient to allow for strong recommendations.
Evolution of Esophageal Motility Testing: From Kronecker to Clouse
Authors: Grubic Andrew D. , Crookes Peter F.
Published: November 2021

Esophageal motility, the science of quantifying the mechanical function of the esophagus, was initiated by Hugo Kronecker in Germany in 1882. Little progress was made until after World War II, when motility studies began in the Mayo Clinic and Boston University. After 1960, several key figures promoted the science, including Lauran Harris, Don Castell, Jerry Dodds, Tom DeMeester, Peter Kahrilas, and Ray Clouse. All were inspirational teachers and mentors as well as scientists. The technical developments from balloons and perfused catheters to the current solid-state catheters and sophisticated software has provided insights which have helped physicians to treat patients with dysfunction of the esophagus with increasing success.
The Value of High-Resolution Manometry in Measurement of EGJ Competency and Manometric Outcomes of Antireflux Surgery
Authors: Mittal Sumeet K. , Baboli Komeil Mirzaei
Published: November 2021

The esophagogastric junction (EGJ) barrier plays an integral role in the prevention of gastroesophageal reflux; however, not much attention has been paid to competency parameters, especially in the era of high-resolution manometry (HRM). HRM provides a unique spatiotemporal pressure profile and measurements of the EGJ. Herein, we discuss the evidence for objective measures of EGJ competency, which should guide the clinical management of gastroesophageal reflux disease. Additionally, we will briefly discuss expected normal values after antireflux surgery.
The similarity of class II HLA genotypes defines patterns of autoreactivity in idiopathic bone marrow failure disorders
Authors: Pagliuca Simona , Gurnari Carmelo , Awada Hassan , Kishtagari Ashwin , Kongkiatkamon Sunisa , Terkawi Laila , Zawit Misam , Guan Yihong , LaFramboise Thomas , Jha Babal K. , Patel Bhumika J. , Hamilton Betty K. , Majhail Navneet S. , Lundgren Sofie , Mustjoki Satu , Saunthararajah Yogen , Visconte Valeria , Chan Timothy A. , Yang Chao-Yie , Lenz Tobias L. , Maciejewski Jaroslaw P.
Published: November 2021

Idiopathic aplastic anemia (IAA) is a rare autoimmune bone marrow failure (BMF) disorder initiated by a human leukocyte antigen (HLA)-restricted T-cell response to unknown antigens. As in other autoimmune disorders, the predilection for certain HLA profiles seems to represent an etiologic factor; however, the structure-function patterns involved in the self-presentation in this disease remain unclear. Herein, we analyzed the molecular landscape of HLA complexes of a cohort of 300 IAA patients and almost 3000 healthy and disease controls by deeply dissecting their genotypic configurations, functional divergence, self-antigen binding capabilities, and T-cell receptor (TCR) repertoire specificities. Specifically, analysis of the evolutionary divergence of HLA genotypes (HED) showed that IAA patients carried class II HLA molecules whose antigen-binding sites were characterized by a high level of structural homology, only partially explained by specific risk allele profiles. This pattern implies reduced HLA binding capabilities, confirmed by binding analysis of hematopoietic stem cell (HSC)-derived self-peptides. IAA phenotype was associated with the enrichment in a few amino acids at specific positions within the peptide-binding groove of DRB1 molecules, affecting the interface HLA-antigen-TCR β and potentially constituting the basis of T-cell dysfunction and autoreactivity. When analyzing associations with clinical outcomes, low HED was associated with risk of malignant progression and worse survival, underlying reduced tumor surveillance in clearing potential neoantigens derived from mechanisms of clonal hematopoiesis. Our data shed light on the immunogenetic risk associated with IAA etiology and clonal evolution and on general pathophysiological mechanisms potentially involved in other autoimmune disorders.
Pain sensitivity in men who have never experienced a headache: an observer blinded case control study
Authors: Olofsson Isa Amalie , Hvedstrup Jeppe , Falkenberg Katrine , Chalmer Mona Ameri , Schytz Henrik Winther , Pedersen Miguel Benjamin , Ullum Henrik , Pedersen Ole Birger , Olesen Jes , Hansen Thomas Folkmann
Published: November 2021

Background

Headache affects 90–99% of the population. Based on the question “Do you think that you never ever in your whole life have had a headache?” 4% of the population say that they have never experienced a headache. The rarity of never having had a headache suggests that distinct biological and environmental factors may be at play. We hypothesized that people who have never experienced a headache had a lower general pain sensitivity than controls.

Methods

We included 99 male participants, 47 headache free participants and 52 controls, in an observer blinded nested case-control study. We investigated cold pain threshold and heat pain threshold using a standardized quantitative sensory testing protocol, pericranial tenderness with total tenderness score and pain tolerance with the cold pressor test. Differences between the two groups were assessed with the unpaired Student’s t-test or Mann-Whitney U test as appropriate.

Results

There was no difference in age, weight or mean arterial pressure between headache free participants and controls. We found no difference in pain detection threshold, pericranial tenderness or pain tolerance between headache free participants and controls.

Conclusion

Our study clearly shows that freedom from headache is not caused by a lower general pain sensitivity. The results support the hypothesis that headache is caused by specific mechanisms, which are present in the primary headache disorders, rather than by a decreased general sensitivity to painful stimuli.

Trial registration

Registered at ClinicalTrials.gov (NCT04217616), 3rd January 2020, retrospectively registered.
Application of artificial intelligence ensemble learning model in early prediction of atrial fibrillation
Authors: Wu Cai , Hwang Maxwell , Huang Tian-Hsiang , Chen Yen-Ming J. , Chang Yiu-Jen , Ho Tsung-Han , Huang Jian , Hwang Kao-Shing , Ho Wen-Hsien
Published: November 2021

Background

Atrial fibrillation is a paroxysmal heart disease without any obvious symptoms for most people during the onset. The electrocardiogram (ECG) at the time other than the onset of this disease is not significantly different from that of normal people, which makes it difficult to detect and diagnose. However, if atrial fibrillation is not detected and treated early, it tends to worsen the condition and increase the possibility of stroke. In this paper, P-wave morphology parameters and heart rate variability feature parameters were simultaneously extracted from the ECG. A total of 31 parameters were used as input variables to perform the modeling of artificial intelligence ensemble learning model.

Results

This paper applied three artificial intelligence ensemble learning methods, namely Bagging ensemble learning method, AdaBoost ensemble learning method, and Stacking ensemble learning method. The prediction results of these three artificial intelligence ensemble learning methods were compared. As a result of the comparison, the Stacking ensemble learning method combined with various models finally obtained the best prediction effect with the accuracy of 92%, sensitivity of 88%, specificity of 96%, positive predictive value of 95.7%, negative predictive value of 88.9%, F1 score of 0.9231 and area under receiver operating characteristic curve value of 0.911.

Conclusion

In feature extraction, this paper combined P-wave morphology parameters and heart rate variability parameters as input parameters for model training, and validated the value of the proposed parameters combination for the improvement of the model’s predicting effect. In the calculation of the P-wave morphology parameters, the hybrid Taguchi-genetic algorithm was used to obtain more accurate Gaussian function fitting parameters. The prediction model was trained using the Stacking ensemble learning method, so that the model accuracy had better results, which can further improve the early prediction of atrial fibrillation.
Artificial intelligence classification model for macular degeneration images: a robust optimization framework for residual neural networks
Authors: Ho Wen-Hsien , Huang Tian-Hsiang , Yang Po-Yuan , Chou Jyh-Horng , Huang Hong-Siang , Chi Li-Chung , Chou Fu-I , Tsai Jinn-Tsong
Published: November 2021

Background

The prevalence of chronic disease is growing in aging societies, and artificial-intelligence–assisted interpretation of macular degeneration images is a topic that merits research. This study proposes a residual neural network (ResNet) model constructed using uniform design. The ResNet model is an artificial intelligence model that classifies macular degeneration images and can assist medical professionals in related tests and classification tasks, enhance confidence in making diagnoses, and reassure patients. However, the various hyperparameters in a ResNet lead to the problem of hyperparameter optimization in the model. This study employed uniform design—a systematic, scientific experimental design—to optimize the hyperparameters of the ResNet and establish a ResNet with optimal robustness.

Results

An open dataset of macular degeneration images (https://data.mendeley.com/datasets/rscbjbr9sj/3) was divided into training, validation, and test datasets. According to accuracy, false negative rate, and signal-to-noise ratio, this study used uniform design to determine the optimal combination of ResNet hyperparameters. The ResNet model was tested and the results compared with results obtained in a previous study using the same dataset. The ResNet model achieved higher optimal accuracy (0.9907), higher mean accuracy (0.9848), and a lower mean false negative rate (0.015) than did the model previously reported. The optimal ResNet hyperparameter combination identified using the uniform design method exhibited excellent performance.

Conclusion

The high stability of the ResNet model established using uniform design is attributable to the study’s strict focus on achieving both high accuracy and low standard deviation. This study optimized the hyperparameters of the ResNet model by using uniform design because the design features uniform distribution of experimental points and facilitates effective determination of the representative parameter combination, reducing the time required for parameter design and fulfilling the requirements of a systematic parameter design process.
Metaproteomics reveals insights into microbial structure, interactions, and dynamic regulation in defined communities as they respond to environmental disturbance
Authors: Shrestha Him K. , Appidi Manasa R. , Villalobos Solis Manuel I. , Wang Jia , Carper Dana L. , Burdick Leah , Pelletier Dale A. , Doktycz Mitchel J. , Hettich Robert L. , Abraham Paul E.
Published: November 2021

Background

Microbe-microbe interactions between members of the plant rhizosphere are important but remain poorly understood. A more comprehensive understanding of the molecular mechanisms used by microbes to cooperate, compete, and persist has been challenging because of the complexity of natural ecosystems and the limited control over environmental factors. One strategy to address this challenge relies on studying complexity in a progressive manner, by first building a detailed understanding of relatively simple subsets of the community and then achieving high predictive power through combining different building blocks (e.g., hosts, community members) for different environments. Herein, we coupled this reductionist approach with high-resolution mass spectrometry-based metaproteomics to study molecular mechanisms driving community assembly, adaptation, and functionality for a defined community of ten taxonomically diverse bacterial members of Populus deltoides rhizosphere co-cultured either in a complex or defined medium.

Results

Metaproteomics showed this defined community assembled into distinct microbiomes based on growth media that eventually exhibit composition and functional stability over time. The community grown in two different media showed variation in composition, yet both were dominated by only a few microbial strains. Proteome-wide interrogation provided detailed insights into the functional behavior of each dominant member as they adjust to changing community compositions and environments. The emergence and persistence of select microbes in these communities were driven by specialization in strategies including motility, antibiotic production, altered metabolism, and dormancy. Protein-level interrogation identified post-translational modifications that provided additional insights into regulatory mechanisms influencing microbial adaptation in the changing environments.

Conclusions

This study provides high-resolution proteome-level insights into our understanding of microbe-microbe interactions and highlights specialized biological processes carried out by specific members of assembled microbiomes to compete and persist in changing environmental conditions. Emergent properties observed in these lower complexity communities can then be re-evaluated as more complex systems are studied and, when a particular property becomes less relevant, higher-order interactions can be identified.
Transcriptome-wide N6-methyladenosine (m6A) methylation in watermelon under CGMMV infection
Authors: He Yanjun , Li Lili , Yao Yixiu , Li Yulin , Zhang Huiqing , Fan Min
Published: November 2021

Background

Cucumber green mottle mosaic virus (CGMMV) causes substantial global losses in cucurbit crops, especially watermelon. N6-methyladenosine (m6A) methylation in RNA is one of the most important post-transcriptional modification mechanisms in eukaryotes. It has been shown to have important regulatory functions in some model plants, but there has been no research regarding m6A modifications in watermelon.

Results

We measured the global m6A level in resistant watermelon after CGMMV infection using a colorimetric method. And the results found that the global m6A level significantly decreased in resistant watermelon after CGMMV infection. Specifically, m6A libraries were constructed for the resistant watermelon leaves collected 48 h after CGMMV infection and the whole-genome m6A-seq were carried out. Numerous m6A modified peaks were identified from CGMMV-infected and control (uninfected) samples. The modification distributions and motifs of these m6A peaks were highly conserved in watermelon transcripts but the modification was more abundant than in other reported crop plants. In early response to CGMMV infection, 422 differentially methylated genes (DMGs) were identified, most of which were hypomethylated, and probably associated with the increased expression of watermelon m6A demethylase gene ClALKBH4B. Gene Ontology (GO) analysis indicated quite a few DMGs were involved in RNA biology and stress responsive pathways. Combined with RNA-seq analysis, there was generally a negative correlation between m6A RNA methylation and transcript level in the watermelon transcriptome. Both the m6A methylation and transcript levels of 59 modified genes significantly changed in response to CGMMV infection and some were involved in plant immunity.

Conclusions

Our study represents the first comprehensive characterization of m6A patterns in the watermelon transcriptome and helps to clarify the roles and regulatory mechanisms of m6A modification in watermelon in early responses to CGMMV.
Right stellate ganglion block improves learning and memory dysfunction and hippocampal injury in rats with sleep deprivation
Authors: Dai Dongsheng , Zheng Biqiong , Yu Zenggui , Lin Shizhu , Tang Yijie , Chen Mengnan , Ke Peng , Zheng Chengjie , Chen Yanqing , Wu Xiaodan
Published: November 2021

Background

Sleep deprivation (SD) often leads to complex detrimental consequences, though the mechanisms underlying these dysfunctional effects remain largely unknown. We investigated whether the right stellate ganglion block in rats can improve the spatial learning and memory dysfunction induced by sleep deprivation by alleviating the damage of hippocampus in rats.

Methods

Sixty four male Sprague Dawley rats were randomly divided into four groups: Control, SD (sleep deprivation), SGB (stellate ganglion block) and SGB + SD (stellate ganglion block+ sleep deprivation) (n = 16). The SGB and SD + SGB groups were subjected to right stellate ganglion block through posterior approach method once per day. SD and SD + SGB groups were treated with modified multi-platform water environment method for 96 h sleep deprivation in rats and their body weights were analyzed. Histopathological changes of hippocampal neurons in rats and the expression of Caspase-3 in hippocampus of rats was detected by western blotting. ELISA was used to detect the content of IL-6, IL-1 in hippocampus and serum melatonin levels.

Results

Compared with the group SD, the spatial learning and memory function of the group SD + SGB was improved, the weight loss was alleviated, the pathological damage of the hippocampus was reduced and the expression of IL-6, IL-1β and Caspase-3 in the hippocampus was decreased. The content of rat serum melatonin was also increased.

Conclusions

The right stellate ganglion block can improve the spatial learning and memory dysfunction of rats with sleep deprivation, and the underlying mechanism may be related to alleviating the apoptosis and inflammation of hippocampus of rats with sleep deprivation.
Effect of fasting blood glucose on risk of new‐onset hypertension in rural Chinese population: a 15-year follow-up cohort
Authors: Liu Jing , Cheng Nan N. , Zhou Zi Y. , Zhang Yue , Yang Jie , Liu Li S. , Song Yun , Huang Xiao , Tang Gen F. , Wang Bin Y. , Qin Xian H. , Xu Xi P. , Kong Xiang Q.
Published: November 2021

Background

The purpose of this study was to examine the correlation between fasting blood glucose and new-onset hypertension and examine any synergistically effect modification with multiple risk factors.

Methods

We conducted post-hoc analyses of repeated-measures data in the original Dongzhi osteoporosis cohort study. In total, 3985 participants without hypertension aged 25–64 years were included in the current analyses. Generalized estimating equation models were used to assess the relationship between fasting blood glucose and risk of new-onset hypertension after adjusting for pertinent covariates and autocorrelations among siblings.

Results

393 men (19.4%) and 398 women (20.3%) without hypertension at the baseline developed hypertension by the end of the study period. Compared to lower baseline fasting blood glucose levels (Q1–Q3: < 5.74 mmol/L; clinical cut points: < 5.6 mmol/L), higher baseline fasting blood glucose levels (Q4: ≥ 5.74 mmol/L; clinical cut points: ≥ 5.6 mmol/L and < 7.0 mmol/L) increased the risk of new-onset hypertension significantly [(OR: 1.54, 95% CI 1.19–1.98, P < 0.001); (OR: 1.38, 95% CI 1.09–1.75, P = 0.008)] in women. Additionally, a stronger significant association was found in women with elevated fasting blood glucose on risk of new-onset of hypertension with higher total cholesterol (≥ 5.2 mmol/L) [(OR: 2.76; 95% CI: (1.54, 4.96), P < 0.001)]. However, no association was found between fasting blood glucose and risk of new-onset hypertension in men.

Conclusions

High fasting blood glucose may be significantly associated with risk of new-onset hypertension in Chinese women, especially in women with higher total cholesterol. Further randomized studies are needed to confirm our findings.
Cardiogenic shock with highly complicated course after influenza A virus infection treated with vva-ECMO and Impella CP (ECMELLA): a case report
Authors: Ebert Daniel , Mungard Nils , Mensch Alexander , Homeister Lorenz , Willsch Jan , Ibe Richard , Baust Henning , Stiller Markus , Rebelo Artur , Ukkat Joerg , Rigopoulos Angelos G. , Weber Elke , Bucher Michael , Noutsias Michel
Published: November 2021

Background

The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial.

Case presentation

A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2: 22 kPa) with severe respiratory acidosis (pH: 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission.

Conclusions

This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.
The relationship between arterial stiffness index and coronary heart disease and its severity
Authors: Gao Longjian , Lu Dasheng , Xia Guangwei , Zhang Hao
Published: November 2021

Background

Arterial stiffness index (ASI) is closely related to coronary atherosclerosis. This study aims to explore whether ASI can predict coronary heart disease (CHD) and its severity.

Methods

In this study, a total of 726 patients with suspected CHD were recruited. Based on coronary angiography results, the subjects were assigned into three groups: the control group (without obvious coronary artery disease), single-vessel disease group, and multi-vessel disease group (the number of vessels diseased ≥ 2). At the same time, according to the results of angiography, myocardial enzyme spectrum, electrocardiogram, color Doppler echocardiography and clinical manifestations, these patients were divided into four groups: the control group, stable angina (SA) Group, unstable angina (UA) group, and acute myocardial infarction (AMI) group. We have compared whether there were differences in ASI and related baseline data between groups. Receiver operating curve (ROC) analysis was conducted to determine whether ASI could predict CHD and evaluate the severity.

Results

ASI was positively correlated with the number of diseased branches of coronary artery. The value of ASI was increased as the number of the diseased branches increased. The ASI value in the SA group was significantly higher compared with the control group. Furthermore, the ASI value in the UA and AMI groups was remarkably increased compared with the control and SA groups. The results of ROC analysis indicated that the sensitivity and specificity of ASI was 71.0% and 85.4% in diagnosing CHD, respectively. While ASI was used in predicting the severity of CHD, the sensitivity was 72.1% and specificity 57.9%.

Conclusion

ASI is of great value in the diagnosis of coronary heart disease and the prediction of its severity.
Risk prediction of biomarkers for early multiple organ dysfunction in critically ill patients
Authors: Ishikawa Shigeto , Teshima Yuto , Otsubo Hiroki , Shimazui Takashi , Nakada Taka-aki , Takasu Osamu , Matsuda Kenichi , Sasaki Junichi , Nabeta Masakazu , Moriguchi Takeshi , Shibusawa Takayuki , Mayumi Toshihiko , Oda Shigeto
Published: November 2021

Background

Shock and organ damage occur in critically ill patients in the emergency department because of biological responses to invasion, and cytokines play an important role in their development. It is important to predict early multiple organ dysfunction (MOD) because it is useful in predicting patient outcomes and selecting treatment strategies. This study examined the accuracy of biomarkers, including interleukin (IL)-6, in predicting early MOD in critically ill patients compared with that of quick sequential organ failure assessment (qSOFA).

Methods

This was a multicenter observational sub-study. Five universities from 2016 to 2018. Data of adult patients with systemic inflammatory response syndrome who presented to the emergency department or were admitted to the intensive care unit were prospectively evaluated. qSOFA score and each biomarker (IL-6, IL-8, IL-10, tumor necrosis factor-α, C-reactive protein, and procalcitonin [PCT]) level were assessed on Days 0, 1, and 2. The primary outcome was set as MOD on Day 2, and the area under the curve (AUC) was analyzed to evaluate qSOFA scores and biomarker levels.

Results

Of 199 patients, 38 were excluded and 161 were included. Patients with MOD on Day 2 had significantly higher qSOFA, SOFA, and Acute Physiology and Chronic Health Evaluation II scores and a trend toward worse prognosis, including mortality. The AUC for qSOFA score (Day 0) that predicted MOD (Day 2) was 0.728 (95% confidence interval [CI]: 0.651–0.794). IL-6 (Day 1) showed the highest AUC among all biomarkers (0.790 [95% CI: 0.711–852]). The combination of qSOFA (Day 0) and IL-6 (Day 1) showed improved prediction accuracy (0.842 [95% CI: 0.771–0.893]). The combination model using qSOFA (Day 1) and IL-6 (Day 1) also showed a higher AUC (0.868 [95% CI: 0.799–0.915]). The combination model of IL-8 and PCT also showed a significant improvement in AUC.

Conclusions

The addition of IL-6, IL-8 and PCT to qSOFA scores improved the accuracy of early MOD prediction.
Visualizing adverse events in clinical trials using correspondence analysis with R-package visae
Authors: Diniz Márcio A. , Gresham Gillian , Kim Sungjin , Luu Michael , Henry N. Lynn , Tighiouart Mourad , Yothers Greg , Ganz Patricia A. , Rogatko André
Published: November 2021

Background

Graphical displays and data visualization are essential components of statistical analysis that can lead to improved understanding of clinical trial adverse event (AE) data. Correspondence analysis (CA) has been introduced decades ago as a multivariate technique that can communicate AE contingency tables using two-dimensional plots, while quantifying the loss of information as other dimension reduction techniques such as principal components and factor analysis.

Methods

We propose the application of stacked CA using contribution biplots as a tool to explore differences in AE data among treatments in clinical trials. We defined five levels of refinement for the analysis based on data derived from the Common Terminology Criteria for Adverse Events (CTCAE) grades, domains, terms and their combinations. In addition, we developed a Shiny app built in an R-package, visae, publicly available on Comprehensive R Archive Network (CRAN), to interactively investigate CA configurations based on the contribution to the explained variance and relative frequency of AEs. Data from two randomized controlled trials (RCT) were used to illustrate the proposed methods: NSABP R-04, a neoadjuvant rectal 2 × 2 factorial trial comparing radiation therapy with either capecitabine (Cape) or 5-fluorouracil (5-FU) alone with or without oxaliplatin (Oxa), and NSABP B-35, a double-blind RCT comparing tamoxifen to anastrozole in postmenopausal women with hormone-positive ductal carcinoma in situ.

Results

In the R04 trial (n = 1308), CA biplots displayed the discrepancies between single agent treatments and their combinations with Oxa at all levels of AE classes, such that these discrepancies were responsible for the largest portion of the explained variability among treatments. In addition, an interaction effect when adding Oxa to Cape/5-FU was identified when the distance between Cape+Oxa and 5-FU + Oxa was observed to be larger than the distance between 5-FU and Cape, with Cape+Oxa and 5-FU + Oxa in different quadrants of the CA biplots. In the B35 trial (n = 3009), CA biplots showed different patterns for non-adherent Anastrozole and Tamoxifen compared with their adherent counterparts.

Conclusion

CA with contribution biplot is an effective tool that can be used to summarize AE data in a two-dimensional display while minimizing the loss of information and interpretation.
Clinical outcomes of surgical resection versus radiofrequency ablation in very-early‐stage hepatocellular carcinoma: a propensity score matching analysis
Authors: Li Yuan-Chen , Chen Ping-Hung , Yeh Jen-Hao , Hsiao Pojen , Lo Gin-Ho , Tan TaoQian , Cheng Pin-Nan , Lin Hung-Yu , Chen Yaw-Sen , Hsieh Kun-Chou , Hsieh Pei-Min , Lin Chih-Wen
Published: November 2021

Background

The detection rate of Barcelona Clinic Liver Cancer (BCLC) very-early-stage hepatocellular carcinoma (HCC) is increasing because of advances in surveillance and improved imaging technologies for high-risk populations. Surgical resection (SR) and radiofrequency ablation (RFA) are both first‐line treatments for very-early-stage HCC, but the differences in clinical outcomes between patients treated with SR and RFA remain unclear. This study investigated the prognosis of SR and RFA for very-early‐stage HCC patients with long‐term follow‐up.

Methods

This study was retrospectively collected data on the clinicopathological characteristics, overall survival (OS), and disease-free survival (DFS) of 188 very-early-stage HCC patients (≤ 2 cm single HCC). OS and DFS were analyzed using the Kaplan–Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.

Results

Of the 188 HCC patients, 103 received SR and 85 received RFA. The median follow‐up time was 56 months. The SR group had significantly higher OS than the RFA group (10-year cumulative OS: 55.2% and 31.3% in the SR and RFA groups, respectively). No statistically significant difference was observed in DFS between the SR and RFA groups (10-year cumulative DFS: 45.9% and 32.6% in the SR and RFA groups, respectively). After PSM, the OS in the SR group remained significantly higher than that in the RFA group (10-year cumulative OS: 54.7% and 42.2% in the SR and RFA groups, respectively). No significant difference was observed in DFS between the SR and RFA groups (10-year cumulative DFS: 43.0% and 35.4% in the SR and RFA groups, respectively). Furthermore, in the multivariate Cox regression analysis, treatment type (hazard ratio (HR): 0.54, 95% confidence interval (CI): 0.31–0.95; P = 0.032) and total bilirubin (HR: 1.92; 95% CI: 1.09–3.41; P = 0.025) were highly associated with OS. In addition, age (HR: 2.14, 95% CI: 1.36–3.36; P = 0.001) and cirrhosis (HR: 1.79; 95% CI: 1.11–2.89; P = 0.018) were strongly associated with DFS.

Conclusion

For patients with very-early-stage HCC, SR was associated with significantly higher OS rates than RFA. However, no significant difference was observed in DFS between the SR and RFA groups.
Role of health extension workers in the relationship between vector control interventions and malaria in Ethiopia
Authors: Aliye Mohammed , Hong Tao
Published: November 2021

Background

Despite a tremendous decline in the burden of malaria through public health interventions, it is yet remains a critical parasitic health problem in Ethiopia. Insecticide-treated nets and indoor residual spray are considered as the most effective preventive interventions against malaria. This study intended to determine the role of health extension workers in influencing the relationship between vector control strategies and malaria prevalence in Ethiopia.

Methods

The study adopted a descriptive study based on panel data collected from 10 regions of Ethiopia from 2010 to 2018. The data collected were analyzed using STATA version 13.0. Structural equation modelling was used to assess the mediating effect of health extension workers in the relationship. Further, the random effect model was employed to investigate the direct relationship among the study variables.

Results

We observed a strong mediating role of health extension workers to the relationship between strategic interventions and malaria prevalence, where the direct path is (β = 0.64, p < 0.05), and the indirect path (β = 0.72, p < 0.001) and (β = 0.98, p < 0.001) confirming the mediation condition to appear. Our analysis revealed that, insecticide-treated nets and indoor residual spray significantly impacts the malaria prevalence (β = 0.20, p < 0.05) and (β = 0.70, p < 0.001) respectively. Further, our analysis suggests that the cumulative effect of indoor residual spray and insecticide-treated mosquito nets have helped better avert malaria prevalence (β = 81.3%, P < 0.05). Moreover, the finding demonstrates the incremental rate of 30.2%, which is the indirect effect of the research [(β = 0.813) - (β1 = 0.511)].

Conclusion

The findings are potentially useful for the health sector in charge of infectious disease prevention and control, particularly in developing countries explaining how these group provided support to reduce malaria ensuring the provision of proper health message about the program.
Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy
Authors: Bendala Estrada Alejandro David , Calderón Parra Jorge , Fernández Carracedo Eduardo , Muiño Míguez Antonio , Ramos Martínez Antonio , Muñez Rubio Elena , Rubio-Rivas Manuel , Agudo Paloma , Arnalich Fernández Francisco , Estrada Perez Vicente , Taboada Martínez María Luisa , Crestelo Vieitez Anxela , Pesqueira Fontan Paula Maria , Bustamante Marta , Freire Santiago J. , Oriol-Bermúdez Isabel , Artero Arturo , Olalla Sierra Julián , Areses Manrique María , Carrasco-Sánchez H. Francisco Javier , Vento Vanessa Carolina , García García Gema María , Cubero-Morais Pablo , Casas-Rojo José-Manuel , Núñez-Cortés Jesús Millán
Published: November 2021

Background

Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection.

Methods

This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality.

Results

Of 13,932 patients, antibiotics were used in 12,238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21–1.62;p < .001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64–0.76;p < .001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often.

Conclusions

Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment.
Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study
Authors: Okemo J. K. , Kamya D. , Mwaniki A. M. , Temmerman M.
Published: November 2021

Background

Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya.

Methods

A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically.

Findings

A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH).

Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy.

The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC.

Conclusion

From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later.
Intimate partner violence as a predictor of antenatal care services utilization in Rwanda
Authors: Bahati Claire , Izabayo Josias , Niyonsenga Japhet , Sezibera Vincent , Mutesa Léon
Published: November 2021

Background

Although compelling evidence shows that exposure to intimate partner violence (IPV) during pregnancy is detrimental to both physical and mental health of the victims and their fetuses, studies on negative impact of IPV on antenatal care (ANC) services utilization are scarce.

Methods

The aim of the current study was to determine the impact of IPV exposure on ANC services utilization indicators such as (i) initiation of care within the first 3 months of pregnancy, (ii) receipt of at least four ANC visits and (iii) receipt of care from skilled providers among reproductive age women in Rwanda. This study used the data from the 2014–15 Rwanda Demographic and Health Survey. Multiple logistic regression was used to estimate the effects of physical and sexual IPV on the ANC services utilization indicators.

Results

Among married women living with their partners with at least one child aged 5 years or under (N = 5116), 17% of them reported physical violence, 22.8% reported psychological violence and 9.2% reported sexual violence. We found that there was a significant negative relationship between physical IPV and both early ANC and sufficient ANC. Women who had experienced physical violence by their partners during the preceding 12 months were less likely to receive more than four ANC visits, (O.R = 0.61, CI = 0.417–0.908) and they were less likely to attend the first ANC visits within the first 3 months (O.R = 0.656, CI = 0.445–0.967).

Conclusion

In this study, the prevalence of IPV still remains high and there is evidence that it does have significant impact on ANC. Therefore, the results provide support for continued efforts to reduce intimate partner violence, through the improvement of screening for IPV during ANC visits.
Incidence, mortality and survival in malignant pleural mesothelioma before and after asbestos in Denmark, Finland, Norway and Sweden
Authors: Hemminki Kari , Försti Asta , Chen Tianhui , Hemminki Akseli
Published: November 2021

Background

Malignant pleural mesothelioma (MPM) is a rare but fatal cancer, which is largely caused by exposure to asbestos. Reliable information about the incidence of MPM prior the influence of asbestos is lacking. The nationwide regional incidence trends for MPM remain poorly characterized. We use nationwide MPM data for Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE) to assess incidence, mortality and survival trends for MPM in these countries.

Methods

We use the NORDCAN database for the analyses: incidence data were available from 1943 in DK, 1953 in FI and NO and 1958 in SE, through 2016. Survival data were available from 1967 through 2016. World standard population was used in age standardization.

Results

The lowest incidence that we recorded for MPM was 0.02/100,000 for NO women and 0.05/100,000 for FI men in 1953–57, marking the incidence before the influence of asbestos. The highest rate of 1.9/100,000 was recorded for DK in 1997. Female incidence was much lower than male incidence. In each country, the male incidence trend for MPM culminated, first in SE around 1990. The regional incidence trends matched with earlier asbestos-related industrial activity, shipbuilding in FI and SE, cement manufacturing and shipbuilding in DK and seafaring in NO. Relative 1-year survival increased from about 20 to 50% but 5-year survival remained at or below 10%.

Conclusion

In the Nordic countries, the male incidence trends for MPM climaxed and started to decrease, indicating that the prevention of exposure was beneficial. Survival in MPM has improved for both sexes but long-term survival remains dismal.
Rural Latino parent and child physical activity patterns: family environment matters
Authors: Domogalla Benjamin , Ko Linda K. , Jones Reo , Ali Wafaa Bin , Rodriguez Edgar , Duggan Catherine , Perry Cynthia K.
Published: November 2021

Background

Rural Latino children and adults are less active than urban and non-Latino counterparts. We examined physical activity (PA) patterns of rural Latino children and their parents, and explored parental beliefs about and reported barriers of Latino family physical activity. Latino families in a rural area in eastern Washington state, with children in grades 3–5 were included.

Methods

We used mixed methods. Children (n = 27) and parents (n = 25) wore an accelerometer for 5 days; parents (n = 31) participated in a semi-structured interview and completed a demographic survey. Parent and child activity levels were compared using paired t-tests; interviews were analyzed with qualitative content analysis.

Results

Although 100% children and 46% parents met physical activity guidelines, parents and children spent most of the day in sedentary behaviors. Parent-reported PA barriers included their long work hours, lack of transportation, and their child’s screen-time.

Conclusion

Addressing barriers and reducing sedentary time could increase PA of rural Latino families.
Electrical impedance tomography in pediatric patients with COVID-19, the first reports
Authors: Nascimento Milena S. , Alcala Glasiele C. , Guzman Ana I. A. , Corrêa Leticia C. , Baggio Diana M. , Rossi Felipe S. , Fascina Linus P. , Amato Marcelo B. P. , do Prado Cristiane
Published: November 2021

Introduction

Electrical impedance tomography (EIT) is a noninvasive, radiation-free, bedside tool to monitor ventilation distribution in real time.

Objective

To evaluate, in pediatric COVID-19 patients, the ventilation distribution using EIT and compare it to thoracic computed tomography (TCT) or chest radiograph results obtained in these patients.

Methods

This was a prospective, observational clinical study including pediatric patients admitted to the intensive care unit of a private hospital. The patients monitored with EIT tested positive for COVID-19 and were submitted to the previously mentioned radiation exams. EIT monitoring lasted 15 min and no sedation was used.

Results

Six patients were included in this study. The main differences observed in the EIT were in the right-left distribution and were compatible with the morphological changes found in the TCT or radiograph images due to COVID-19 infection.

Conclusion

We conclude that EIT is ready to investigate the ventilatory profile present at different lung diseases, including COVID-19, and might postpone or mitigate the need of repeated ionizing radiation exams in the pediatric population, although larger pediatric cohorts comparing to standard radiological imaging are needed.