bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-controlled intravenous analgesia with opioids after thoracoscopic lung surgery: a randomized clinical trial
Authors: Yu Hong , Tian Wei , Xu Zhao , Jiang Rongjuan , Jin Liang , Mao Wenjie , Chen Ying , Yu Hai
Published: August 2022

Background

Opioids remain the mainstream therapy for post-surgical pain. The choice of opioids administered by patient-controlled intravenous analgesia (PCIA) for thoracoscopic lung surgery is unclear. This study compared 3 opioid analgesics for achieving satisfactory analgesia with minimal emesis (SAME).

Methods

This randomized clinical trial enrolled patients scheduled for thoracoscopic lung surgery randomized to receive 1 of 3 opioids for PCIA: oxycodone (group O), hydromorphone (group H), and sufentanil (group S). The primary outcome was the proportion of subjects achieving SAME, i.e., no-to-mild pain (pain score < 4/10) with minimal nausea/vomiting (PONV score < 2/4) when coughing during the pulmonary rehabilitation exercise in the first 3 postoperative days.

Results

Of 555 enrolled patients, 184 patients in group O, 186 in group H and 184 in group S were included in the final analysis. The primary outcome of SAME was significantly different among group O, H and S (41.3% vs 40.3% vs 29.9%, P = 0.043), but no difference was observed between pairwise group comparisons. Patients in groups O and H had lower pain scores when coughing on the second day after surgery than those in group S, both with mean differences of 1 (3(3,4) and 3(3,4) vs 4(3,4), P = 0.009 and 0.039, respectively). The PONV scores were comparable between three groups (P > 0.05). There were no differences in other opioid-related side effects, patient satisfaction score, and QoR-15 score among three groups.

Conclusions

Given clinically relevant benefits detected, PCIA with oxycodone or hydromorphone is superior to sufentanil for achieving SAME as a supplement to multimodal analgesia in patients undergoing thoracoscopic lung surgery.

Trial registration

This study was registered at (ChiCTR2100045614, 19/04/2021).
Relationship between increased systemic immune-inflammation index and coronary slow flow phenomenon
Authors: Dai Xin-tong , Kong Tian-zhong , Zhang Xiao-jiao , Luan Bo , Wang Yong , Hou Ai-jie
Published: August 2022

Background

Systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio), a new marker of inflammation, is associated with adverse cardiovascular events, but its relationship with coronary slow flow phenomenon (CSFP) is unclear. Therefore, we aimed to investigate the relationship between SII and CSFP.

Methods

We enrolled consecutive patients who presented with chest pain, with normal/near-normal coronary angiography findings (n = 89 as CSFP group; n = 167 as control group). The baseline characteristics, laboratory parameters and angiographic characteristics of the two groups were compared.

Results

SII levels were significantly higher in the CSFP group than in the control group (409.7 ± 17.7 vs. 396.7 ± 12.7, p < 0.001). A significant positive correlation between SII and the mean thrombolysis in myocardial infarction frame count (mTFC) was found (r = 0.624, p < 0.001). SII increased with the number of coronary arteries involved in CSFP. In multivariate logistic regression analysis, SII/10 was an independent predictor of CSFP (odds ratio: 1.739, p < 0.001). In addition, the SII level > 404.29 was a predictor of CSFP with 67.4% sensitivity and 71.9% specificity.

Conclusions

SII can predict the occurrence of CSFP.
Two-stage matching-adjusted indirect comparison
Authors: Remiro-Azócar Antonio
Published: August 2022

Background

Anchored covariate-adjusted indirect comparisons inform reimbursement decisions where there are no head-to-head trials between the treatments of interest, there is a common comparator arm shared by the studies, and there are patient-level data limitations. Matching-adjusted indirect comparison (MAIC), based on propensity score weighting, is the most widely used covariate-adjusted indirect comparison method in health technology assessment. MAIC has poor precision and is inefficient when the effective sample size after weighting is small.

Methods

A modular extension to MAIC, termed two-stage matching-adjusted indirect comparison (2SMAIC), is proposed. This uses two parametric models. One estimates the treatment assignment mechanism in the study with individual patient data (IPD), the other estimates the trial assignment mechanism. The first model produces inverse probability weights that are combined with the odds weights produced by the second model. The resulting weights seek to balance covariates between treatment arms and across studies. A simulation study provides proof-of-principle in an indirect comparison performed across two randomized trials. Nevertheless, 2SMAIC can be applied in situations where the IPD trial is observational, by including potential confounders in the treatment assignment model. The simulation study also explores the use of weight truncation in combination with MAIC for the first time.

Results

Despite enforcing randomization and knowing the true treatment assignment mechanism in the IPD trial, 2SMAIC yields improved precision and efficiency with respect to MAIC in all scenarios, while maintaining similarly low levels of bias. The two-stage approach is effective when sample sizes in the IPD trial are low, as it controls for chance imbalances in prognostic baseline covariates between study arms. It is not as effective when overlap between the trials’ target populations is poor and the extremity of the weights is high. In these scenarios, truncation leads to substantial precision and efficiency gains but induces considerable bias. The combination of a two-stage approach with truncation produces the highest precision and efficiency improvements.

Conclusions

Two-stage approaches to MAIC can increase precision and efficiency with respect to the standard approach by adjusting for empirical imbalances in prognostic covariates in the IPD trial. Further modules could be incorporated for additional variance reduction or to account for missingness and non-compliance in the IPD trial.
Development and validation of a machine learning-derived radiomics model for diagnosis of osteoporosis and osteopenia using quantitative computed tomography
Authors: Xie Qianrong , Chen Yue , Hu Yimei , Zeng Fanwei , Wang Pingxi , Xu Lin , Wu Jianhong , Li Jie , Zhu Jing , Xiang Ming , Zeng Fanxin
Published: August 2022

Background

To develop and validate a quantitative computed tomography (QCT) based radiomics model for discriminating osteoporosis and osteopenia.

Methods

A total of 635 patients underwent QCT were retrospectively included from November 2016 to November 2019. The patients with osteopenia or osteoporosis (N = 590) were divided into a training cohort (N = 414) and a test cohort (N = 176). Radiomics features were extracted from the QCT images of the third lumbar vertebra. Minimum redundancy and maximum relevance and least absolute shrinkage and selection operator were used for data dimensional reduction, features selection and radiomics model building. Multivariable logistic regression was applied to construct the combined clinical-radiomic model that incorporated radiomics signatures and clinical characteristics. The performance of the combined clinical-radiomic model was evaluated by the area under the curve of receiver operator characteristic curve (ROC–AUC), accuracy, specificity, sensitivity, positive predictive value, and negative predictive value.

Results

The patients with osteopenia or osteoporosis were randomly divided into training and test cohort with a ratio of 7:3. Six more predictive radiomics signatures, age, alkaline phosphatase and homocysteine were selected to construct the combined clinical-radiomic model for diagnosis of osteoporosis and osteopenia. The AUC of the combined clinical-radiomic model was 0.96 (95% confidence interval (CI), 0.95 to 0.98) in the training cohort and 0.96 (95% CI 0.92 to 1.00) in the test cohort, which were superior to the clinical model alone (training-AUC = 0.81, test-AUC = 0.79). The calibration curve demonstrated that the radiomics nomogram had good agreement between prediction and observation and decision curve analysis confirmed clinically useful.

Conclusions

The combined clinical-radiomic model that incorporates the radiomics score and clinical risk factors, can serve as a reliable and powerful tool for discriminating osteoporosis and osteopenia.
Quality of intrapartum care at Public Health Institutions of North Achefer District, North West Ethiopia: a mixed method study
Authors: Asmare Yinebeb , Tilahun Tizta , Debela Yamrot , Eshetie Yeshiambew , Minuye Biniam , Yalew Zemen Mengesha , Tsegaye Dejen
Published: August 2022

Background

Ending preventable maternal, and neonatal morbidity and mortality cannot be achieved without quality care interventions during the intrapartum and postpartum period. Poor quality care during the intrapartum and postpartum period contributes high burden of maternal and neonatal morbidity. Therefore, the current study aimed to assess the quality of intrapartum care and its associated factors in public health facilities in North Achefer District, North West Ethiopia.

Method

A mixed-type institution-based cross-sectional study design was conducted from November 7 to December 6, 2019. Simple random sampling and purposive sampling were used to select study participants for quantitative and qualitative studies respectively. Data were coded and entered into Epi data version 4.4.2 software and exported to SPSS version 25 for analysis. Variables with a p-value of less than and equal to 0.25 were entered into multivariable regression analysis and variables with p values < 0.05 were considered statistically significant factors of the quality of intrapartum care. The qualitative data were analyzed by using thematic content analysis. Finally, qualitative findings were used to supplement the quantitative result.

Result

The finding showed that, 27.3% (95% CI: 26.6–28) of mothers received good quality intrapartum care. Presence of long-distance (AOR = 0.19; 95% CI = 0.06, 0.66), health care facility (AOR = 0.07; 95% CI = 0.02, 0.20), and partograph utilization (AOR = 4.9; 95% CI = 1.82, 13.14) were factors associated with the quality of intrapartum care.

Conclusion

The proportion of intrapartum quality care was low. Distance, partograph utilization, and type of health facility were factors associated with quality of intrapartum care. The district, zonal health offices, and regional health bureau should provide capacity building and follow up on partograph utilization, and increase the accessibility of ambulances.
Factors influencing exclusive breastfeeding practice among under-six months infants in Ethiopia
Authors: Mekebo Gizachew Gobebo , Argawu Alemayehu Siffir , Likassa Habte Tadesse , Ayele Wondimu , Wake Senahara Korsa , Bedada Dechasa , Hailu Belema , Senbeto Temesgen , Bedane Ketema , Lulu Kebede , Daraje Sagni , Lemesa Reta , Aga Gudeta , Alemayehu Endale , Kefale Bizunesh , Bechera Terefa , Tadesse Getachew , Galdassa Agassa , Olani Jiregna , Hemba Geribe , Teferi Girma , Argaw Abebe , Irana Tariku , Tilahun Tsigereda , Diriba Gezahagn
Published: August 2022

Background

World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months of life. EBF has sustainable long-term health benefits for both infants and mothers. Despite its benefits, the practice of EBF in Ethiopia is lower than the internationally recommended one. This study aimed at identifying factors influencing EBF practice among under-6 month infants in Ethiopia.

Methods

This study used data drawn from the 2019 Ethiopian Mini Demographic and Health Survey (2019 EMDHS) data. A multivariable logistic regression model was employed to investigate factors significantly associated with EBF practice among under-6 month infants in Ethiopia. An adjusted odds ratio with 95% confidence interval was used to measure the association of factors with EBF practice.

Results

A total of 566 infants under the age of 6 months were included in the study. The prevalence of exclusive breastfeeding practice was 83% (95% CI: 79.70–86%). Urban residences (AOR: 0.40, 95% CI: 0.22–0.73), mothers having secondary education (AOR: 1.54, 95% CI: 1.29–1.84) and higher education (AOR: 3.18, 95% CI: 0.68–15.02), mothers having ANC visits of 1 to 3 times (AOR: 1.52, 95% CI: 1.24–1.88) and ANC visits of 4 and more times (AOR: 4.27, 95% CI: 1.06–17.25), family size of more than 5 (AOR: 0.45, 95% CI: 0.26–0.88), caesarean births (AOR: 0.63, 95% CI: 0.42–0.95), and deliveries at health facilities (AOR: 2.51, 95% CI: 1.12–5.63) were factors significantly associated with EBF practice among under-6 month infants.

Conclusion

In this study, EBF practice among under-6 month infants was significantly associated with place of residence, maternal educational level, ANC visits, family size, mode of delivery, and place of delivery. Therefore, encouraging ANC visit and promotion of institutional (health facility) delivery are recommended. Furthermore, special attention has to be given to mothers with no or less education to make them better aware of the EBF and its benefits to enhance exclusive breastfeeding practice.
Early prediction of noninvasive ventilation failure after extubation: development and validation of a machine-learning model
Authors: Wang Huan , Zhao Qin-Yu , Luo Jing-Chao , Liu Kai , Yu Shen-Ji , Ma Jie-Fei , Luo Ming-Hao , Hao Guang-Wei , Su Ying , Zhang Yi-Jie , Tu Guo-Wei , Luo Zhe
Published: August 2022

Background

Noninvasive ventilation (NIV) has been widely used in critically ill patients after extubation. However, NIV failure is associated with poor outcomes. This study aimed to determine early predictors of NIV failure and to construct an accurate machine-learning model to identify patients at risks of NIV failure after extubation in intensive care units (ICUs).

Methods

Patients who underwent NIV after extubation in the eICU Collaborative Research Database (eICU-CRD) were included. NIV failure was defined as need for invasive ventilatory support (reintubation or tracheotomy) or death after NIV initiation. A total of 93 clinical and laboratory variables were assessed, and the recursive feature elimination algorithm was used to select key features. Hyperparameter optimization was conducted with an automated machine-learning toolkit called Neural Network Intelligence. A machine-learning model called Categorical Boosting (CatBoost) was developed and compared with nine other models. The model was then prospectively validated among patients enrolled in the Cardiac Surgical ICU of Zhongshan Hospital, Fudan University.

Results

Of 929 patients included in the eICU-CRD cohort, 248 (26.7%) had NIV failure. The time from extubation to NIV, age, Glasgow Coma Scale (GCS) score, heart rate, respiratory rate, mean blood pressure (MBP), saturation of pulse oxygen (SpO2), temperature, glucose, pH, pressure of oxygen in blood (PaO2), urine output, input volume, ventilation duration, and mean airway pressure were selected. After hyperparameter optimization, our model showed the greatest accuracy in predicting NIV failure (AUROC: 0.872 [95% CI 0.82–0.92]) among all predictive methods in an internal validation. In the prospective validation cohort, our model was also superior (AUROC: 0.846 [95% CI 0.80–0.89]). The sensitivity and specificity in the prediction group is 89% and 75%, while in the validation group they are 90% and 70%. MV duration and respiratory rate were the most important features. Additionally, we developed a web-based tool to help clinicians use our model.

Conclusions

This study developed and prospectively validated the CatBoost model, which can be used to identify patients who are at risk of NIV failure. Thus, those patients might benefit from early triage and more intensive monitoring.

Trial registration: NCT03704324. Registered 1 September 2018, https://register.clinicaltrials.gov.
Ewing’s sarcoma of the male external genitalia: a case report and review of the literature
Authors: Rachapudi Sruti , Srinivasan Aditya , Gorman Brendan , Wilhelm Alyeesha B. , Eyzaguirre Eduardo , Orihuela Eduardo
Published: August 2022

Background

Ewing’s sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult.

Case presentation

We present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing’s sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia.

Conclusions

Rare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.
Factors associated with higher falling risk in elderly diabetic patients with lacunar stroke
Authors: Jin Jianlan , Wen Song , Li Yanyan , Zhou Mingyue , Duan Qingqing , Zhou Ligang
Published: August 2022

Purpose

The aim of this study is to explore the factors associated with the fall risk in type 2 diabetes (T2D) patients with a lacunar stroke.

Materials and methods

We compiled data of 146 T2D patients (mean age 68 years), including the Morse fall scale data (MFS), nutrition score, self-care scale, laboratory data, and data from continuous glucose monitoring system (CGMS) from 2019 to 2021 in Shanghai Pudong Hospital. Thereby, we evaluated the associations between MFS and other clinical parameters.

Results

The analyses showed that there were significantly increased size and numbers of lacunar infarction (p < 0.05). Furthermore, the greater risk group had an older mean age (p < 0.05), and significant decreased estimated glomerular filtration rate (eGFR), total triglyceride (TG), while increased microalbuminuria, magnesium, lipoprotein A (LP(a)), anti-thyroid peroxidase antibody (TPOAb) (p < 0.05). However, the time in range (TIR) was very comparable (p > 0.05). The correlational study revealed the higher score of MFS was associated with the age (r = 0.41), number of lacunar infarction (r = 0.18), nutrition score (r = 0.20), self-care score (r = − 0.43), serum creatine level (r = 0.19), eGFR (r = − 0.26) (p < 0.05). The total numbers of lacunar infarction were associated with age (r = 0.36), eGFR (r = − 0.40), homocysteine level (r = 0.33) (p < 0.05).

Conclusions

Age, nutrition, self-care ability, and renal function are all critical factors associated with the risk of fall in T2D with lacunar infarction. The age, eGFR, and homocysteine are closely associated with lacunar infarction, suggesting that in T2D, evaluation of kidney dysfunction, homocysteine level in the elderly can predict lacunar infarcts and falls.
Evaluation of associations between condylar morphology, ramus height, and mandibular plane angle in various vertical skeletal patterns: a digital radiographic study
Authors: Türker Gökhan , Öztürk Yaşar Meriç
Published: August 2022

Background

To evaluate condylar morphology, ramus height, and asymmetry indexes in patients with different vertical skeletal patterns and to determine the association between condylar and ramal measurements with the mandibular plane angle.

Methods

Dental panoramic radiographs of 60 patients with different skeletal patterns were evaluated. According to the cranial base (Sella-Nasion)-mandibular plane (SN-MP) angle, the patients were divided into three groups: normal angle (NA), low angle (LA), and high angle (HA). The condylar area, condylar perimeter, condylar heights, and ramus height were measured, and the asymmetry index value of each measurement was calculated. A one-way analysis of variance as well as a post hoc Tukey and Kruskall-Wallis tests were used to determine intergroup differences. Pearson’s correlation coefficient was used to determine the relationship between all measurements and SN-MP.

Results

The intergroup comparison of condylar area, condylar perimeter, condylar heights, and ramus height measurements showed that the patients in the LA group have statistically significantly greater values compared to those in the HA group. A statistically significant difference was detected between the NA and LA groups only in the condylar area measurements. There was no statistical difference only in the ramus height measurements between the NA and HA groups. Asymmetry index values of the groups were similar. The negative correlations were found between all measurements and the SN-MP angle.

Conclusion

HA individuals have lower ramus heights and smaller condylar morphologies than NA and LA individuals. In addition, as the SN-MP angle increases, the condyle dimensions and ramus height decrease, and this is a clinically important finding.
Investigation of three-rooted deciduous mandibular second molars in a Chinese population using cone-beam computed tomography
Authors: Jiang Chengfeng , Pei Fan , Wu Yihan , Shen Yifen , Tang Ying , Feng Xingmei , Gu Yongchun
Published: August 2022

Background

To investigate the anatomic features of three-rooted deciduous mandibular second molars (DMSMs) in Chinese children by using cone-beam computed tomography (CBCT).

Methods

A total of 247 CBCT scans of Chinese children were selected and retrospectively analyzed. The occurrence, gender and side predilection of three-rooted DMSMs were examined. The pattern of concurrence of bilateral three-rooted DMSMs, and concurrence of three-rooted DMSM and three-rooted permanent mandibular first molar (PMFM) was analyzed by the concurrence rate and Spearman’s rank correlation test. The geometric parameters of the disto-buccal (DB) and disto-lingual (DL) roots, including the vertical root length, level and angle of distal root furcation, angle of root curvature (by Schneider technique) and the spreading angle, were measured and compared to the three-rooted PMFMs (n = 42) from 100 randomly selected adult subjects.

Results

The occurrence of three-rooted DMSMs was 24.0% (54/225) calculated by individual, and 18.6% (88/472) by tooth. A significant right-side predilection was detected (23.0% vs 14.2%, p < 0.05), while gender predilection was not detected (p > 0.05). The bilateral concurrence rate was 49.0%, and Spearman’s correlation test indicated a significant relationship between the antimetric teeth (rho = 0.609, p < 0.01); whereas a weak but significant co-relationship was detected between the three-rooted DMSM and three-rooted PMFM (right side: concurrence rate = 31.6%, rho = 0.325, p < 0.01; left side: concurrence rate = 23.0%, rho = 0.260, p < 0.01). The length of DL roots in the DMSMs was 7.4 ± 1.5 mm, and the curvature angle was 16.4 ± 11.3 degrees, which was significantly (both p < 0.01) lower than that of the three-rooted PMFMs (root length = 11.0 ± 1.3 mm; degrees of curvature = 34.2 ± 16.1 degrees), whereas the spreading angle of the DL root in DMSMs (34.6 ± 8.4 degrees) was significantly (p < 0.01) greater than in the PMFMs (26.8 ± 6.5 degrees).

Conclusions

Three-rooted DMSMs have a high occurrence rate in the Chinese children with a right-side predilection, and they have a weak but statistically significant correlation with three-rooted PMFMs. The DL roots of DMSMs are shorter, less curved, and spreading more widely as compared with those in the three-rooted PMFMs.
Sociodemographic factors associated with HPV awareness/knowledge and cervical cancer screening behaviors among caregivers in the U.S
Authors: Kim Jiyeong , Dove Melanie S. , Dang Julie H. T.
Published: August 2022

Background

Family caregivers may be at a higher risk for several chronic diseases, including cancer. Cervical cancer is one of the most common causes of cancer death among women. Despite family caregivers’ vulnerability, the status of their HPV awareness, knowledge, and preventive health behaviors, including cervical cancer screening, has been understudied. Thus, this study aimed to examine the sociodemographic factors associated with HPV awareness and knowledge and adherence to the cervical cancer screening guidelines among caregivers in the U.S.

Methods

Nationally representative cross-sectional survey data were obtained from the Health Information National Trends Survey (HINTS 5, 2017–2020). Female caregivers aged 21–65 were included (N = 1190). Weighted multivariable logistic regression was performed to identify factors associated with HPV awareness (heard of HPV), knowledge (HPV can cause cervical cancer), and adherence to the United States Preventive Service Task Force 2018 cervical cancer screening guidelines by sociodemographic factors (age, race/ethnicity, education, household income, marital status,) and the intensity of caregiving.

Results

An estimated 79% of female caregivers were aware of HPV and 84% adhered to the cervical cancer screening guidelines. Caregivers who were older than 50 (OR = 3.62, 1.91–6.85, adherence of aged 21–50 vs. 51–65), Hispanics of race/ethnicity compared with Black/African Americans (OR = 3.14, 1.31–7.52, adherence of Black/African Americans vs. Hispanics), with a high school education or less (OR = 2.34, 1.14–4.82, adherence of Some college or more vs. High school education or less), and with intense caregiving duty (spending 35 h/week or more on caregiving) compared with light-duty (OR = 2.34, 1.10–5.00, adherence of 5–14 h vs. 35 h or more, weekly) had poor adherence to the cervical cancer screening guidelines. Caregivers who were older, racial minorities (Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, Multiple races), and less educated showed lower HPV awareness (Heard of HPV) than their counterparts.

Conclusions

There are caregiving populations whose HPV awareness and cervical cancer screening adherence are low. To improve their awareness and knowledge of HPV and support their cervical cancer screening behaviors, we need to consider interventions that target those specific populations.
Fertility decision and its associated factors in Sub-Saharan Africa: a multilevel multinomial logistic regression analysis
Authors: Teshale Achamyeleh Birhanu , Worku Misganaw Gebrie , Tesema Getayeneh Antehunegn
Published: August 2022

Background

Fertility desire is one of the predictors of contraceptive behavior and fertility-related outcomes. However, information is scarce on individual and community-level factors of women’s fertility decisions in sub-Saharan Africa.

Objective

To assess fertility decisions and their associated factors in Sub-Saharan Africa.

Methods

The 35 Sub-Saharan African country’s most recent demographic and health surveys (DHS) data conducted from 2008 to 2020 was used. A total of 284,744 (weighted) married women were used for analysis. The proportion of fertility decisions with their 95%CI was estimated. To assess the factors associated with fertility decisions, both random effect and fixed effect analyses were conducted. In the fixed analysis, particularly in the multivariable analysis, adjusted relative risk ratio (aRRR) with its 95% confidence interval (CI) was reported and variables with a p-value < 0.05 were considered significant predictors of fertility decisions.

Results

In this study, 64.35% (95%CI: 64.2%, 64.5%) of the study participants had fertility desire. However, 5.4% (95%CI: 5.3, 5.5) of the study participants had undecided fertility behavior. In the multivariable analysis, desire for more children and undecided fertility desire were relatively lower among older women, women with primary, secondary, and higher education, working women, women who currently use contraceptives, women with a higher number of living children, women with higher parity, women from eastern and southern Africa, and women from wealthy households. While, the ideal number of children, women who had decision-making autonomy, and women from the rural residence were all associated with a relatively higher desire for more children and undecided fertility desire. Furthermore, respondents' education and sex of household head were associated with the desire for more children while media exposure was associated with undecided fertility desire.

Conclusion

In this study, around two-thirds of women had a desire for more children and only 5.4% of women had undecided fertility desires. Both individual and community-level factors were associated with both desires for more children and undecided fertility desires. As a result, the aforementioned factors should be considered while developing reproductive health programs.
Continuing chronic care services during a pandemic: results of a mixed-method study
Authors: Sumner Jennifer , Bundele Anjali , Chong Lin Siew , Teng Gim Gee , Kowitlawakul Yanika , Mukhopadhyay Amartya
Published: August 2022

Background

Patients with chronic diseases have seen unprecedented changes to healthcare practices since the emergence of COVID-19. Traditional ‘on-site’ clinics have had to innovate to continue services. Whether these changes are acceptable to patients and are effective for care continuation are largely unreported.

Methods

We evaluated the effectiveness of care provision at a re-structured chronic care clinic and elicited the patient experiences of care and self-management. We conducted a convergent, parallel, mixed-methods study. Adult patients attending a chronic care clinic were included. We extracted data from 4,849 clinic visits before and during the COVID-19 pandemic, including operational metrics and attendee profile. We also conducted fifteen interviews with patients from the same clinic using a semi-structured interview guide.

Results

Re-structuring the chronic clinic, including the introduction of teleconsultations, home-delivery of prescriptions and use of community-based phlebotomy services, served to maintain continuity of care while adhering to COVID-19 containment measures. Qualitatively, five themes emerged. Patients were able to adjust to healthcare practice changes and adapt their own lifestyles, although poor self-management practices were adopted. While most were apprehensive about attending the clinic, they valued ongoing care access and were reassured by the on-site containment measures.

Conclusions

Continuation of routine services is desired by patients and can be achieved through the adoption of containment measures, by greater collaboration with community partners, and the use of technology. Patients adapted to service changes, but poor self-management was evident. To prevent chronic disease relapse, services must strive to innovate rather than suspend services during pandemics.
Long-haul COVID: healthcare utilization and medical expenditures 6 months post-diagnosis
Authors: Koumpias Antonios M. , Schwartzman David , Fleming Owen
Published: August 2022

Background

Despite extensive evidence that COVID-19 symptoms may persist for up to a year, their long-term implications for healthcare utilization and costs 6 months post-diagnosis remain relatively unexplored. We examine patient-level association of COVID-19 diagnosis association of COVID-19 diagnosis with average monthly healthcare utilization and medical expenditures for up to 6 months, explore heterogeneity across age groups and determine for how many months post-diagnosis healthcare utilization and costs of COVID-19 patients persist above pre-diagnosis levels.

Methods

This population-based retrospective cohort study followed COVID-19 patients’ healthcare utilization and costs from January 2019 through March 2021 using claims data provided by the COVID-19 Research Database. The patient population includes 250,514 individuals infected with COVID-19 during March-September 2020 and whose last recorded claim was not hospitalization with severe symptoms. We measure the monthly number and costs of total visits and by telemedicine, preventive, urgent care, emergency, immunization, cardiology, inpatient or surgical services and established patient or new patient visits.

Results

The mean (SD) total number of monthly visits and costs pre-diagnosis were .4783 (4.0839) and 128.06 (1182.78) dollars compared with 1.2078 (8.4962) visits and 351.67 (2473.63) dollars post-diagnosis. COVID-19 diagnosis associated with .7269 (95% CI, 0.7088 to 0.7449 visits; P < .001) more total healthcare visits and an additional $223.60 (95% CI, 218.34 to 228.85; P < .001) in monthly costs. Excess monthly utilization and costs for individuals 17 years old and under subside after 5 months to .070 visits and $2.77, persist at substantial levels for all other groups and most pronounced among individuals age 45–64 (.207 visits and $73.43) and 65 years or older (.133 visits and $60.49).

Conclusions

This study found that COVID-19 diagnosis was associated with increased healthcare utilization and costs over a six-month post-diagnosis period. These findings imply a prolonged burden to the US healthcare system from medical encounters of COVID-19 patients and increased spending.
Elucidating the picocyanobacteria salinity divide through ecogenomics of new freshwater isolates
Authors: Cabello-Yeves Pedro J. , Callieri Cristiana , Picazo Antonio , Schallenberg Lena , Huber Paula , Roda-Garcia Juan J. , Bartosiewicz Maciej , Belykh Olga I. , Tikhonova Irina V. , Torcello-Requena Alberto , De Prado Paula Martin , Puxty Richard J. , Millard Andrew D. , Camacho Antonio , Rodriguez-Valera Francisco , Scanlan David J.
Published: August 2022

Background

Cyanobacteria are the major prokaryotic primary producers occupying a range of aquatic habitats worldwide that differ in levels of salinity, making them a group of interest to study one of the major unresolved conundrums in aquatic microbiology which is what distinguishes a marine microbe from a freshwater one? We address this question using ecogenomics of a group of picocyanobacteria (cluster 5) that have recently evolved to inhabit geographically disparate salinity niches. Our analysis is made possible by the sequencing of 58 new genomes from freshwater representatives of this group that are presented here, representing a 6-fold increase in the available genomic data.

Results

Overall, freshwater strains had larger genomes (≈2.9 Mb) and %GC content (≈64%) compared to brackish (2.69 Mb and 64%) and marine (2.5 Mb and 58.5%) isolates. Genomic novelties/differences across the salinity divide highlighted acidic proteomes and specific salt adaptation pathways in marine isolates (e.g., osmolytes/compatible solutes - glycine betaine/ggp/gpg/gmgclusters and glycerolipidsglpK/glpA), while freshwater strains possessed distinct ion/potassium channels, permeases (aquaporin Z), fatty acid desaturases, and more neutral/basic proteomes. Sulfur, nitrogen, phosphorus, carbon (photosynthesis), or stress tolerance metabolism while showing distinct genomic footprints between habitats, e.g., different types of transporters, did not obviously translate into major functionality differences between environments. Brackish microbes show a mixture of marine (salt adaptation pathways) and freshwater features, highlighting their transitional nature.

Conclusions

The plethora of freshwater isolates provided here, in terms of trophic status preference and genetic diversity, exemplifies their ability to colonize ecologically diverse waters across the globe. Moreover, a trend towards larger and more flexible/adaptive genomes in freshwater picocyanobacteria may hint at a wider number of ecological niches in this environment compared to the relatively homogeneous marine system.
Cellular crosstalk during liver regeneration: unity in diversity
Authors: Shu Wenzhi , Yang Mengfan , Yang Jiayin , Lin Shengda , Wei Xuyong , Xu Xiao
Published: August 2022

The liver is unique in its ability to regenerate from a wide range of injuries and diseases. Liver regeneration centers around hepatocyte proliferation and requires the coordinated actions of nonparenchymal cells, including biliary epithelial cells, liver sinusoidal endothelial cells, hepatic stellate cells and kupffer cells. Interactions among various hepatocyte and nonparenchymal cells populations constitute a sophisticated regulatory network that restores liver mass and function. In addition, there are two different ways of liver regeneration, self-replication of liver epithelial cells and transdifferentiation between liver epithelial cells. The interactions among cell populations and regenerative microenvironment in the two modes are distinct. Herein, we first review recent advances in the interactions between hepatocytes and surrounding cells and among nonparenchymal cells in the context of liver epithelial cell self-replication. Next, we discuss the crosstalk of several cell types in the context of liver epithelial transdifferentiation, which is also crucial for liver regeneration.
Impact of a conserved N-terminal proline-rich region of the α-subunit of CAAX-prenyltransferases on their enzyme properties
Authors: Hagemann Anna , Tasillo Sandro , Aydin Aykut , Kehrenberg Miriam Caroline Alice , Bachmann Hagen Sjard
Published: August 2022

Background

The CAAX-prenyltransferases farnesyltransferase (FTase) and geranylgeranyltransferase I (GGTase I) are heterodimers with a common α- (FTα) and unique β-subunits. Recently, α-subunits of species (e.g., human) that harbour an N-terminal proline-rich region (PRR) showed different dimerization behaviours than α-subunits without PRR (e.g., yeast). However, the specific function of the PRR has not been elucidated so far.

Methods

To determine whether the PRR is a conserved motif throughout eukaryotes, we performed phylogenetics. Elucidating the impact of the PRR on enzyme properties, we cloned human as well as rat PRR deficient FTα, expressed them heterologously and compared protein–protein interaction by pull-down as well as crosslinking experiments. Substrate binding, enzyme activity and sensitivity towards common FTase inhibitors of full length and PRR-deletion α-subunits and their physiological partners was determined by continuous fluorescence assays.

Results

The PRR is highly conserved in mammals, with an exception for marsupials harbouring a poly-alanine region instead. The PRR shows similarities to canonical SH3-binding domains and to profilin-binding domains. Independent of the PRR, the α-subunits were able to dimerize with the different physiological β-subunits in in vitro as well as in yeast two-hybrid experiments. FTase and GGTase I with truncated FTα were active. The KM values for both substrates are in the single-digit µM range and show no significant differences between enzymes with full length and PRR deficient α-subunits within the species.

Conclusions

Our data demonstrate that an N-terminal PRR of FTα is highly conserved in mammals. We could show that the activity and inhibitability is not influenced by the truncation of the N-terminal region. Nevertheless, this region shows common binding motifs for other proteins involved in cell-signalling, trafficking and phosphorylation, suggesting that this PRR might have other or additional functions in mammals. Our results provide new starting points due to the relevant but only partly understood role of FTα in eukaryotic FTase and GGTase I.
Determining host factors contributing to the reactivation of JC virus in kidney transplant recipients
Authors: Keykhosravi Sajedeh , Khosravi Masoud , Shenagari Mohammad , Hasan-alizadeh Elham , Mosadegh Mehrdad , Noori Goodarzi Narjes , Monfared Ali , Ashrafkhani Babak , Hasandokht Tolou
Published: August 2022

Background and aims

The John Cunningham virus (JCV) is the established etiological agent of the polyomavirus-associated nephropathy among renal transplant recipients. In the present study, we aimed to determine the probable predictive factors leading to JCV replication in renal transplant patients.

Material and methods

Urine and plasma samples were collected from a total of 120 consecutive renal‐transplanted patients without preliminary screening from Jan 2018 to Mar 2019. After DNA extraction, the simultaneous detection and quantification of JCV and BK polyomavirus (BKV) were conducted using a Real-time quantitative PCR method. Moreover, statistical analyses were performed using the statistical software packages, SPSS version 21.

Results

The prevalence of JCV viruria and viremia among renal transplant recipients were 26 (21.67%) and 20 (16.67%), respectively. A significant association was observed between the JCV and two risk factors, diabetes mellitus (P = 0.002) and renal stones (P = 0.015). The prevalence of JCV viremia among recipients who were grafted near time to sampling was significantly higher (P = 0.02). There was a statistically significant coexistence between BK and JC viruses among our patients (P = 0.029). The frequency of JCV viruria in males was reported almost three times more than in females (P = 0.005). The JCV shedding in urine was significantly associated with the tropical steroids like prednisolone acetate, which have been the standard regimen (P = 0.039). Multivariable analysis revealed duration of post-transplantation (OR, 0.89; P = 0.038), diabetes mellitus (OR, 1.85; P = 0.034), and renal stone (OR 1.10; P = 0.04) as independent risk factors associated with JCV viremia post-renal transplantation.

Conclusion

It seems that the discovery of potential risk factors, including immunological and non-immunological elements, may offer a possible preventive or therapeutic approach in the JCV disease episodes. The results of this study may also help clarify the probable clinical risk factors involving in progressive multifocal leukoencephalopathy development.
Seroconversion following the first, second, and third dose of SARS-CoV-2 vaccines in immunocompromised population: a systematic review and meta-analysis
Authors: Mehrabi Nejad Mohammad-Mehdi , Shobeiri Parnian , Dehghanbanadaki Hojat , Tabary Mohammadreza , Aryannejad Armin , Haji Ghadery Abdolkarim , Shabani Mahya , Moosaie Fatemeh , SeyedAlinaghi SeyedAhmad , Rezaei Nima
Published: August 2022

Background

Immunocompromised (IC) patients are at higher risk of more severe COVID-19 infections than the general population. Special considerations should be dedicated to such patients. We aimed to investigate the efficacy of COVID-19 vaccines based on the vaccine type and etiology as well as the necessity of booster dose in this high-risk population.

Materials and methods

We searched PubMed, Web of Science, and Scopus databases for observational studies published between June 1st, 2020, and September 1st, 2021, which investigated the seroconversion after COVID-19 vaccine administration in adult patients with IC conditions. For investigation of sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. Statistical analysis was performed using R software.

Results

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 81 articles in the meta-analysis. The overall crude prevalence of seroconversion after the first (n: 7460), second (n: 13,181), and third (n: 909, all population were transplant patients with mRNA vaccine administration) dose administration was 26.17% (95% CI 19.01%, 33.99%, I2 = 97.1%), 57.11% (95% CI: 49.22%, 64.83%, I2 = 98.4%), and 48.65% (95% CI: 34.63%, 62.79%, I2 = 94.4%). Despite the relatively same immunogenicity of mRNA and vector-based vaccines after the first dose, the mRNA vaccines induced higher immunity after the second dose. Regarding the etiologic factor, transplant patients were less likely to develop immunity after both first and second dose rather than patients with malignancy (17.0% vs 37.0% after first dose, P = 0.02; 38.3% vs 72.1% after second dose, P < 0.001) or autoimmune disease (17.0% vs 36.4%, P = 0.04; 38.3% vs 80.2%, P < 0.001). To evaluate the efficacy of the third dose, we observed an increasing trend in transplant patients after the first (17.0%), second (38.3%), and third (48.6%) dose.

Conclusion

The rising pattern of seroconversion after boosting tends to be promising. In this case, more attention should be devoted to transplant patients who possess the lowest response rate.
Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty
Authors: Kazemi Seyyed-Morteza , Qoreishi Seyyed-Mohammad , Maleki Arash , Minaei-Noshahr Reza , Hosseininejad Seyyed-Mohsen
Published: August 2022

Background

Coronal alignment after total knee arthroplasty (TKA) would influence the implant survival. Coronal alignment could be measured on short and full-length X-rays. The goal of the current study was to assess the correlation of short and full-length X-rays to accurate prediction of the true Hip-Knee-Ankle alignment after TKA in the Iranian population.

Methods

Lateral distal femoral and medial proximal tibial angles, FTA, HKA, in 180 Iranian patients (243 knees without extra-articular deformities) were measured and compared on short and full-length standing X-rays of primary TKA pre/postoperatively.

Results

The correlation between the preoperative FTA-short and FTA-long, FTA-short and HKA, and FTA-long and HKA values in degrees were fair, good and good (r = 0.64) (r = 0.73), (r = 0.76), respectively. This correlation for postoperative aMPTA and mMPTA (r = 0.73), and FTA-short and HKA (r = 0.76) values were good and significant (P = 0.001). Also, assessing coronal alignment based on short and full-length measurements would result in varying pre/postoperative alignments (varus, neutral and valgus).

Conclusion

Full length X-rays could not be replaced by short knee X-rays to asses true coronal alignment in TKA; considerable portion of our cases were missorted as varus, neutral or valgus based on the FTA versus the HKA. Intraoperative fixed 5° valgus angle cut of distal femur did not result in postoperative favorable neutral alignment in all cases.

Level of evidence

IV.