bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of sodium-glucose co-transporter-2 inhibitors on arterial stiffness: A systematic review and meta-analysis of randomized controlled trials
Authors: Patoulias Dimitrios , Papadopoulos Christodoulos , Kassimis George , Fragakis Nikolaos , Vassilikos Vassilios , Karagiannis Asterios , Doumas Michael
Published: June 2022

Background:

Arterial stiffness represents an established cardiovascular risk marker. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have significant cardio-protective effects. Herein we sought to determine the effect of SGLT-2 inhibitors on pulse wave velocity (PWV).

Methods:

We searched PubMed, Cochrane Library, and grey literature from inception to 7th February 2022 for randomized controlled trials (RCTs) enrolling adult subjects with or without type 2 diabetes mellitus (T2DM), assigned to a SGLT-2 inhibitor versus control and addressing their effect on PWV. We set as primary efficacy outcome the change in PWV with SGLT-2 inhibitors versus placebo or control.

Results:

We pooled data from six trials in a total of 452 enrolled participants assigned either to SGLT-2 inhibitor or control. Overall, SGLT-2 inhibitor treatment compared to control resulted in a nonsignificant decrease in PWV. Exclusion of a trial utilizing cardiac magnetic resonance imaging for the assessment of PWV demonstrated that SGLT-2 inhibitors induce a significant reduction in PWV by 0.21 m/s. When we restricted our analysis to RCTs enrolling subjects with T2DM, we observed that SGLT-2 inhibitor compared to control resulted in a significant decrease in PWV by 0.17 m/s.

Conclusion:

SGLT-2 inhibitors do not decrease PWV in patients with established cardiovascular disease or cardiovascular risk factors. However, we have shown that SGLT-2 inhibitors lead to a slight, but significant decrease in PWV in patients with T2DM. The latter finding is of great value, based on the significant correlation between PWV and micro- and macro-vascular complications of T2DM.
Slow scholarship? Cultural studies and television historiography
Authors: Levine Elana
Published: June 2022

Levine discusses the research and writing of her 2020 book, Her Stories: Daytime Soap Opera and US Television History, considering whether the long duration of the project qualifies it as “slow scholarship.” Within this context, she examines the slow scholarship movement and the ways that slowness may function as an interventionist practice. As well, she considers the ways that cultural studies benefits from an embrace of slowness, in particular in terms of the move toward radical contextualization inherent in cultural studies models of inquiry.
Hybrid Approach of a Complex Aneurysm of the Subclavian-Axillary-Brachial Axis: A Case Report
Authors: Mendes Daniel , Vaz Carolina , Machado Rui , Almeida Rui
Published: June 2022

Background

Upper extremity arterial aneurysms are a rare, potentially limb-threatening disorder. Due to its rarity, the best treatment modality and outcomes are not entirely established; however, there is a consensus that open surgery is the first-line treatment. We present a complex case of an arterial aneurysm of the subclavian-axillary-brachial axis adequately treated using a hybrid surgical and endovascular treatment.

Case Presentation

A 59-year-old man presented to the emergency department with acute ischemia of the right upper limb. An extensive thrombosed aneurysm of the subclavian-axillary-brachial axis was identified. The treatment was carried out in two stages. In the first phase, urgent limb revascularization was performed using the great saphenous vein to perform a subclavian-brachial artery bypass. Later, the aneurysm was excluded using a vascular plug and multiple coils. Successful treatment was achieved with no morbidity for the patient.

Conclusions

Although the gold standard for treating upper limb aneurysms is open surgery, endovascular techniques can be a significant adjunct, reducing treatment morbidity and even mortality.
A straightforward coupling of 4-sulfonylpyridines with Grignard reagents
Authors: Song Liu-Yi , Chen Meng-Ke , Wang Jian , Li Jing-Hua
Published: June 2022

A straightforward synthesis of alkyl-sulfonylpyridines and aryl-sulfonylpyridines is developed by coupling of sulfonylpyridines with the Grignard reagents. The protocol proceeds through a catalyst- and oxidant-free coupling of sulfonylpyridines as substrates via a Chichibabin-type reaction mechanism.
Disrupting Agamben: Beyond undocumented children as “Homo Sacer”
Authors: Gonzalez-Gorman Sylvia
Published: June 2022

Migrant and refugee studies have received much attention grounded in Agamben’s state of exception and homo sacer theory. Much scholarship draws from Agamben’s work and the relationship between the sovereign state and biopolitical subjects in a permanent state of exception. Absent from Agamben’s homo sacer theoretical argument is a discussion on the political influence of undocumented youth. Now more than ever, unaccompanied children have an innocuous ability to transform and influence bidirectional immigration policy. The present research contributes to the literature by repositioning unaccompanied children away from the presupposition of bare life and the state of exception to an active role in the political sphere. This analysis maintains that in the United States, undocumented youth act as nonstate geopolitical actors who influence federal policy and are not necessarily in a complete state of exception or homo sacer an area not fully considered by Agamben.
Shadow education: Shapes of private tutoring in e-learning environment
Authors: Glotova Alexandra , Samoylenko Nataliya , Zharko Ludmila , Georgiadi Alexandra , Shevchenko Maria
Published: June 2022

Modern technologies and World Wide Web open new opportunities for smooth learning process making education more accessible and flexible. Digitalization of modern society has resulted in the transformation of all levels of education leading to the transition from mass education to high quality individual training. In modern context the quality of education is viewed as the most important indicator of the institutions’ competitiveness on the market of educational services. The quality of education is the priority of states’ policy agenda around the world. The paper considers “shadow education” and private tutoring, as one of its forms. The term “private tutoring” is defined in the article based on the analysis of legislative and regulatory sources that allow to provide tutoring services using e-learning tools and technologies in compliance with the legal framework of the Russian Federation. The legitimacy of the notion of “private tutoring” in the legislation of Russia is justified in the research. An overview of sites offering tutoring services is given with the comparison of price range, depending on the academic subject and regions of Russia. Besides, the advantages and disadvantages of private tutoring are outlined. The results of the study showed that private tutoring services are in high demand due to two main factors: the insufficient level of public/private education received and the inconsistency in knowledge obtained and the requirements of national and international labor markets. The paper also contains the review of popular educational platforms and online learning tools used by private tutors as well as pros and cons of their application. The results of the questionnaire offered to the academic staff of the V.I. Vernadsky Crimean Federal University, the Sevastopol State University, and the Crimean Fevzi Yakubov Engineering and Pedagogical University show that most of educators practice online tutoring and consider it to be their additional professional activity.
Determinants of knowledge and attitude toward first aid among final year students at technical and vocational schools in Addis Ababa, Ethiopia
Authors: Adere Abera Lemma , Abicho Temesgen Beyene , Seid Heyria Hussien , Workneh Belayneh Shetie , Getaneh Mekonen Enyew
Published: June 2022

Introduction:

Injuries among technical and vocational school students are considered one of the most serious health problems worldwide today. Getting injuries in a technical and vocational school are high as different machines are used. Therefore, this study aimed to assess knowledge, attitude, and associated factors toward first aid among graduating students at technical and vocational schools in Addis Ababa, Ethiopia.

Methods:

School-based cross-sectional study was conducted from April to June 2019. A simple random sampling technique was employed. Data were entered in Epi-info version 7 and analyzed using SPSS version 24. Bivariable and multivariable analyses were employed using a binary logistic regression model. Variables with a p-value of <0.05 are considered as factors significantly associated.

Results:

The result of this study reveals 53.2% and 60.3% of the respondents had good knowledge and favorable attitude, respectively. Training (adjusted odds ratio: 5.14; 95% confidence interval = (2.82, 9.38)), participating in school first aid club (adjusted odds ratio: 3.66; 95% confidence interval = (2.23, 6.00)), and mother’s level of education (adjusted odds ratio: 1.90; 95% confidence interval = (1.02, 3.55)) were significantly associated with knowledge. Being female (adjusted odds ratio = 2.10; 95% confidence interval = (1.24, 3.39)), training (adjusted odds ratio: 3.18; 95% confidence interval = (1.73, 5.82)), and participating in school first aid club (adjusted odds ratio: 4.82; 95% confidence interval = (2.98, 7.81)) were significantly associated with attitude.

Conclusion:

Only half and nearly two-thirds of the participants have good knowledge and favorable attitude, respectively. Training, participating in school first aid club, and having an educated mother increase the odds of having good knowledge. Being female, training, and participating in school first aid clubs increase the odds of a favorable attitude. Since first aid is a frontline and lifesaving intervention during life-threatening situations, it is better to give attention to enhance students’ knowledge and attitude toward first aid by giving training, establishing first aid clubs, and considering first aid courses to be included in the curriculum.
Epidemiological and clinical characteristics of SARS-CoV-2 reinfections in a Spanish region
Authors: Yuguero Oriol , Companys Maria , Guzmán Marianela , Maciel Rita , Llobet Cecília , López Aurora , Olles Rebeca , Pujol Violant , Ruiz Maria José , Saura Mireia , Vidal Carmel , Godoy Pere
Published: June 2022

Objective:

We aimed to assess the prevalence and clinical characteristics of SARS-CoV-2 reinfections in a Spanish region.

Methods:

This is a retrospective observational study in all patients with SARS-CoV-2 infections in the Lleida health region from 1 March to 30 November 2020. Reinfections were classified as patients with positive SARS-CoV-2 PCR tests separated by at least 90 days plus a negative test result between both infection episodes. Primary and secondary outcomes: The primary outcome was the percentage of SARS-CoV-2 reinfections among all SARS-CoV-2 infections detected during our study period. Secondary outcomes were the clinical and sociodemographic characteristics of patients with SARS-CoV-2 reinfections.

Results:

Of the 27,758 patients diagnosed with SARS-CoV-2 infection in the study period, 14 were identified as coronavirus reinfection (0.050%). Of the reinfected sample, 12 patients (85.7%) were women. The median age was 41.5 years. Two patients died in the second coronavirus episode.

Conclusion:

The reinfection rate of SARS-CoV-2 in the Spanish region Lleida was relatively low during the observational period in 2020 (less than 1%). These data are in line with the notion that previous SARS-CoV-2 infections may offer a significant protection by so called natural immunity.
Preparing infection detection technology for hospital at home after lower limb external fixation
Authors: Annadatha Sowmya , Hua Qirui , Fridberg Marie , Lindstrøm Jensen Tobias , Liu Jianan , Kold Søren , Rahbek Ole , Shen Ming
Published: June 2022

Background

Patients with severe bone fractures and complex bone deformities are treated by orthopedic surgeons with external fixation for several months. During this long treatment period, there is a high risk of inflammation and infection at the superficial skin area (pin site). This can develop into a devastating, sometimes fatal, and always costly condition of deep bone infection.

Objective

For pin site infection surveillance, thermography technology could be the solution to build an objective and continuous home-based remote monitoring tool to avoid frequent nursing care and hospital visits. However, future studies of infection monitoring require a preliminary step to automate the process of locating and detecting the pin sites in thermal images reliably for temperature measurement, and this step is the aim of this study.

Methods

This study presents an automatic approach for identifying and annotating pin sites on visible images using bounding boxes and transferring them to the corresponding thermal images for temperature measurement. The pin site is detected by applying deep learning-based object detection architecture YOLOv5 with a novel loss evaluation and regression method, control distance intersection over union. Furthermore, we address detecting pin sites in a practical environment (home setting) accurately through transfer learning.

Results and conclusion

The proposed model offers the pin site detection in 1.8 ms with a high precision of 0.98 and enables temperature information extraction. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment on thermography.
Values in Early Childhood Education (ECE): A Cross-Cultural Comparative Study of Values for ECE Expressed in Policy Documents
Authors: Gunnestad Arve , Mørreaunet Sissel , Chahboun (صبح شهبون) Sobh , Pearson Jolene
Published: June 2022

Purpose

This comparative study identifies core values expressed in Early Childhood Education (ECE) official policy documents from a sample of thirteen countries.

Design/Approach/Methods

This study employs document analysis as well as content and thematic analysis. ECE values identified in the policy documents are categorized into three groups: political and society-related values, educational values, and individual and relational values.

Findings

Document analysis reveals the values that are common across countries and those that are more specific to just one or a few countries at most. This study discusses the characteristics of these values from the perspective of globalization. In doing so, this comparative study illustrates and discusses the tendencies for both convergence and divergence in ECE values in policymaking worldwide.

Originality/Value

The findings of this study expand our understanding of the values in ECE policy documents in the sampled countries, offering insights into ECE objectives and policymaking in various countries.
Hierarchical Education Investment and Economic Growth in China
Authors: Li Zhao , Chu Yujing , Fang Hang
Published: June 2022

There is a difference between the ways investment in general and advanced education affects human capital accumulation. Based on the endogenous economic growth model, this study considered the impact of hierarchical education investment on human capital accumulation and economic growth. Using Provincial Panel Data, the empirical analysis found that only investment in general education had a significant effect on economic output per capita, while the effect of investment in advanced education was insignificant. Increasing investment in general education could promote technological progress. However, increasing investment in advanced education does not, which means that the human capital accumulated as a result of advanced education does not have the expected benefit. Furthermore, the expansion of enrolment in colleges and universities promoted the effect of advanced education on economic output and technological progress.
Patient Perceptions of Cancer and Reconstructive Care During the COVID-19 Pandemic
Authors: Sorice-Virk Sarah , Patel Viren , Christopher Adrienne N. , Morris Martin P. , Broach Robyn B. , Rothman Jami D. , Serletti Joseph M.
Published: June 2022

Background: The Coronavirus-2019 (COVID-19) pandemic profoundly impacted care for breast cancer patients. Oncologic and reconstructive surgeries were delayed as hospitals attempted to preserve personal protective equipment and bed capacity. Little is known about how this unprecedented time has affected breast cancer patients’ mental health and perceptions regarding their care. Methods: A survey was sent to surgical oncology and plastic surgery patients who received breast cancer care between March and May 2020, during which our institution suspended elective surgery. The survey questions included patient demographics, as well as questions focused on worries related to COVID-19, individualized cancer and reconstructive care, and patient satisfaction with telemedicine. Descriptive statistics were used to assess patient responses. Results: 56 breast cancer patients completed the survey, which reflected a 25% response rate. A majority of patients expressed moderate concern about contracting COVID-19, accessing high-quality cancer care (78%), and receiving timely surgical care (68%). Only 43% of patients reported delays in their surgical cancer and reconstructive care, when in actuality 57% of patients experienced surgical delays. Overall, patients were satisfied with telemedicine and did not feel it negatively impacted their care (69%). Conclusions: The COVID-19 pandemic has led to disruptions of routine oncologic and reconstructive care for breast cancer patients. Patients were concerned about receiving high-quality cancer and reconstructive care, and the results of this study uncovered gaps in patient–physician communication. The implementation of telemedicine was received positively. These data can be used to improve future health system practices as the medical community faces new potential shutdowns of surgical services.
Resident Exposure and Involvement in Core Procedural Competencies within Pediatric Plastic Surgery
Authors: D’Abbondanza Josephine A. , Shih Jessica G. , Knox Aaron D. C. , Zhygan Nick , Brown Mitchell H. , Fish Joel S. , Courtemanche Douglas J.
Published: June 2022

Introduction: The implementation of competency-based residency training in plastic surgery is underway. Key competencies in plastic surgery have been previously identified, however, within the domain of pediatrics, data suggest limited exposure throughout training for Canadian graduates. This study aims to identify the exposure and involvement of residents in core pediatric cases. Methods: We performed a retrospective, multicenter review of plastic surgery resident case logs (T-Res, POWER, New Innovations) across 10 Canadian, English-speaking training programs between 2004 and 2014. Case logs were coded according to the 8 core pediatric competencies previously identified by a modified Delphi technique. Results: A total of 3061 of 59 405 cases (5.2%) logged by 55 graduating residents were core pediatric procedures with an average of 55.6 ± 23.0 cases logged per resident. The top 3 most commonly logged procedures were cleft lip repair, cleft palate repair, and setback otoplasty. The number of cases per program varied widely with the most at 731 and least at 85 logged cases. Roles across procedures have wide variation and residents are most commonly identified as the assistant rather than surgeon or co-surgeon. Conclusion: These findings highlight variability both within and across residency programs with a paucity of exposure and involvement in pediatric plastic surgery cases. This may present a conflict between current recommendations for residency-specific procedural competencies and true clinical exposure. Further curriculum development and simulation may be of benefit.
A Case Study in Indigeneity in the Philippines: Looking Back at a 1930s Effort to Do Missions Using Indigenous Church Principles
Authors: Dean Marcus W.
Published: June 2022

This article focuses on the missions efforts of a small denomination from the framework of indigeneity. Within the 1930s missions structure of the Pilgrim Holiness Church, one person was instrumental in the implementation of a mission policy focused on indigeneity. A part of this study is an overview of the concepts of indigeneity available in 1930 to place the policy in its missiological context. The work in the Philippines is examined, as there were clear efforts to carry out the policy in that field. Finally, lessons are developed from the case study.
Deep learning-based investigation of the impact of urban form on the particulate matter concentration on a neighborhood scale
Authors: Kim Moon-Hyun , Gim Tae-Hyoung Tommy
Published: June 2022

Despite the importance of urban forms to the dispersion of particulate matter (PM), only a few studies exist on the relationship between them due to the limitations of the data and methodology. Thus, this study used a deep learning-based investigation of the impact of urban form on PM2.5 concentration. Autoencoder, long short-term memory (LSTM), and the random forest model were used to analyze their relationship. The random forest model showed that urban form variables predict PM2.5 concentration with a 95.66% accuracy, confirming that urban form characteristics significantly impact PM2.5 concentrations. Among the urban form variables, floor area ratio turned out to be the most important, suggesting the need for more detailed efforts to reduce PM2.5 in locations with high floor areas. The effect on PM2.5 prediction accuracy was evaluated with root mean square error. It was difficult to accurately predict PM2.5 in areas with large building coverage areas and low-rise residential areas. This study improved the accuracy of results on the influence of urban form by using PM2.5 non-aggregated data measured hourly over 4 years, which expanded the applicability of deep learning-based urban analysis.
That’s a Lot to Process! Pitfalls of Popular Path Models
Authors: Rohrer Julia M. , Hünermund Paul , Arslan Ruben C. , Elson Malte
Published: June 2022

Path models to test claims about mediation and moderation are a staple of psychology. But applied researchers may sometimes not understand the underlying causal inference problems and thus endorse conclusions that rest on unrealistic assumptions. In this article, we aim to provide a clear explanation for the limited conditions under which standard procedures for mediation and moderation analysis can succeed. We discuss why reversing arrows or comparing model fit indices cannot tell us which model is the right one and how tests of conditional independence can at least tell us where our model goes wrong. Causal modeling practices in psychology are far from optimal but may be kept alive by domain norms that demand every article makes some novel claim about processes and boundary conditions. We end with a vision for a different research culture in which causal inference is pursued in a much slower, more deliberate, and collaborative manner.
Hypoperfusion in nucleus accumbens in chronic migraine using 3D pseudo-continuous arterial spin labeling imaging MRI
Authors: Liu Mengqi , Sun Yijie , Li Xin , Chen Zhiye
Published: June 2022

Background

Nucleus accumbens (NAcc) played an important role in pain mediation, and presents changes of neuronal plasticity and functional connectivity. However, less is known about altered perfusion of NAcc in chronic migraine (CM). The aim of this study is to investigate the altered perfusion of the NAcc in CM using a MR three-dimensional pseudo-continuous arterial spin labeling (3D PCASL) imaging.

Methods

Thirteen CM patients and 15 normal controls (NC) were enrolled and underwent 3D PCASL and brain structural imaging. The cerebral blood flow (CBF) images were co-registered with the brain structural images, and the volume and CBF value of NAcc were extracted from the raw brain structural images and co-registered CBF images using an individual NAcc mask, which was obtained from the AAL3 template under transformation by the inverse deformation field generated from the segmentation of the brain structural images. The independent sample t test and receiver operating characteristic (ROC) curve was used to investigate the altered volume and perfusion of the NAcc in CM patients.

Results

There was no significant difference for the volume of bilateral NAccs between CM and NC (p > 0.05). CM presented a lower CBF value (49.34 ± 6.09 ml/100 mg/min) compared with that of NC (55.83 ± 6.55 ml/100 mg/min) in left NAcc (p = 0.01), while right NAcc showed no significant difference between CM and NC (p = 0.11). ROC analysis identified that the area under the curve was 0.73 (95CI% 0.53–0.88) with cut-off value 48.63 ml/100 mg/min with sensitivity 50.00% and specificity 93.33%. The correlation analysis found a negative correlation between the CBF value of the left NAcc and VAS score (r = -0.61, p = 0.04).

Conclusion

Hypoperfusion of the left NAcc was observed in CM, which could be considered as a potential diagnostic imaging biomarker in CM.
Variation in haplotypes in single cysts of assemblages C and D, but not of assemblage E of Giardia duodenalis
Authors: Veldhuis Floor L. , Nijsse Rolf , Wagenaar Jaap A. , Arkesteijn Ger , Kooyman Frans N. J.
Published: June 2022

Background

Giardia duodenalis, a single-celled intestinal parasite, is divided into eight assemblages (A-H), with differences in host specificity. Giardia duodenalis reproduces asexually and cycles between the binucleated trophozoite (4 N) and the infectious cyst with four nuclei (16 N). Interaction between the nuclei is limited. Therefore, genetic drift causes differences in genetic make-up between the non-daughter nuclei; the allelic sequence heterozygosity (ASH). The ASH is low (0.01%—0.0023%) for the related assemblages A and E, higher (0.43–0.53) for assemblage B and much higher (0.74% -0.89%) for the assemblage C and D at the root of the phylogenetic tree. The heterozygosity in assemblage F, in the same clade as assemblage A and E, was unknown. The heterozygosity in the sequences of the gdh and dis3 genes was used as proxy for the ASH and whole genome amplification of single cysts followed by cloning and Sanger sequencing of dis3 fragment could reveal the genetic variation within the cyst. The aim of the study was to determine the level of heterozygosity within pooled and single cysts of different assemblages.

Results

The heterozygosity in gdh and dis3 was determined in pooled cysts of the assemblages A to F. Heterozygosity in the isolates of the assemblages C (n = 2) and D (n = 1) ranged from 0.41% to 0.82% for gdh and dis3 and no heterozygosity was found in the isolates of the assemblages A (n = 4), E (n = 3) and F (n = 3). The heterozygosity in assemblage B (n = 7) was intermediate (0% to 0.62%). Next, the number of haplotypes of dis3 was determined for single cysts of assemblages C, D and E. In the assemblages C and D, two to four haplotypes were found per cyst, while in assemblage E only one haplotype was identified.

Conclusions

Having high heterozygosity is characteristic for the assemblages C and D, while having a low heterozygosity is characteristic for the clade with the assemblages A, E and F.

Presence of more than 1 haplotype per cyst in assemblage C and D suggests differences between the non-daughter nuclei, in contrast to the one haplotype in assemblage E.
Educational approaches for patients with heart surgery: a systematic review of main features and effects
Authors: Shahmoradi Leila , Rezaei Nafiseh , Rezayi Sorayya , Zolfaghari Mitra , Manafi Babak
Published: June 2022

Introduction

Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery.

Method and materiel

A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Results

A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong.

Conclusion

The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.
Screen time increases overweight and obesity risk among adolescents: a systematic review and dose-response meta-analysis
Authors: Haghjoo Purya , Siri Goli , Soleimani Ensiye , Farhangi Mahdieh Abbasalizad , Alesaeidi Samira
Published: June 2022

Background

Adolescence is a critical period in human life, associated with reduced physical activity and increased sedentary behaviors. In this systematic review and dose-response meta-analysis, we evaluated the association between screen time and risk of overweight/obesity among adolescents.

Methods

A systematic search in electronic databases, including PubMed, Embase, and Scopus was performed up to September 2021. All published studies evaluating the association between screen time and risk of overweight/obesity among adolescents were retrieved. Finally, a total of 44 eligible studies were included in the meta-analysis.

Results

The results of the two-class meta-analysis showed that adolescents at the highest category of screen time were 1.27 times more likely to develop overweight/obesity (OR = 1.273; 95% CI = 1.166–1.390; P < 0.001; I-squared (variation in ES attributable to heterogeneity) = 82.1%). The results of subgrouping showed that continent and setting were the possible sources of heterogeneity. Moreover, no evidence of non-linear association between increased screen time and risk of overweight/obesity among adolescents was observed (P-nonlinearity = 0.311).

Conclusion

For the first time, the current systematic review and meta-analysis revealed a positive association between screen time and overweight/obesity among adolescents without any dose-response evidence.

Trial registration

The protocol of the current work has been registered in the PROSPERO system (Registration number: CRD42021233899).
The prognostic utility of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) biomarkers for predicting preeclampsia: a secondary analysis of data from the INSPIRE trial
Authors: Kifle Meron M. , Dahal Prabin , Vatish Manu , Cerdeira Ana Sofia , Ohuma Eric O.
Published: June 2022

Objective

To compare the prognostic performance of biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1), Placental Growth Factor (PIGF), and sFlt-1/PIGF ratio as continuous values or as a binary cut-off of 38 for predicting preeclampsia (PE) within 7 days.

Design

Secondary analysis of a randomised clinical trial.

Setting

Oxford University Hospitals, Oxford, United Kingdom (UK).

Population

Pregnant women between 24+0 to 37+0 weeks of gestation with a clinical suspicion of preeclampsia.

Main outcome

Onset of preeclampsia within 7 days of the initial biomarker test.

Methods

Logistic regression model for onset of preeclampsia using: (i) sFlt-1 (ii) PIGF, (iii) sFlt-1/PIGF ratio (continuous), and (iv) sFlt-1/PIGF ratio as a cut-off above or below 38.

Results

Of the total 370 women, 42 (11.3%) developed PE within 7 days of screening. Models with sFlt-1 and sFlt-1/PIGF ratio (continuous) had greater overall performance than models with PIGF or with sFlt-1/PIGF ratio as a cut-off at 38 (R2: sFlt-1 = 55%, PIGF = 38%, sFlt-1/PIGF ratio = 57%, sFlt-1/PIGF ratio as cut-off at 38 model = 46%). The discrimination performance was the highest in sFlt-1 and sFlt-1/PIGF ratio (continuous) (c-statistic, sFlt-1 = 0.94, sFlt-1/PIGF ratio (continuous) = 0.94) models compared to PIGF or sFlt-1/PIGF cut-off models (c-statistic, PIGF = 0.87, sFlt-1/PIGF cut-off = 0.89).

Conclusion

Models using continuous values of sFlt-1 only or sFlt-1/PIGF ratio had better predictive performance compared to a PIGF only or the model with sFlt-1/PIGF ratio as a cut-off at 38. Further studies based on a larger sample size are warranted to substantiate this finding.
Polygenic risk scores indicate extreme ages at onset of breast cancer in female BRCA1/2 pathogenic variant carriers
Authors: Borde Julika , Laitman Yael , Blümcke Britta , Niederacher Dieter , Weber-Lassalle Konstantin , Sutter Christian , Rump Andreas , Arnold Norbert , Wang-Gohrke Shan , Horváth Judit , Gehrig Andrea , Schmidt Gunnar , Dutrannoy Véronique , Ramser Juliane , Hentschel Julia , Meindl Alfons , Schroeder Christopher , Wappenschmidt Barbara , Engel Christoph , Kuchenbaecker Karoline , Schmutzler Rita K. , Friedman Eitan , Hahnen Eric , Ernst Corinna
Published: June 2022

Background

Clinical management of women carrying a germline pathogenic variant (PV) in the BRCA1/2 genes demands for accurate age-dependent estimators of breast cancer (BC) risks, which were found to be affected by a variety of intrinsic and extrinsic factors. Here we assess the contribution of polygenic risk scores (PRSs) to the occurrence of extreme phenotypes with respect to age at onset, namely, primary BC diagnosis before the age of 35 years (early diagnosis, ED) and cancer-free survival until the age of 60 years (late/no diagnosis, LD) in female BRCA1/2 PV carriers.

Methods

Overall, estrogen receptor (ER)-positive, and ER-negative BC PRSs as developed by Kuchenbaecker et al. for BC risk discrimination in female BRCA1/2 PV carriers were employed for PRS computation in a curated sample of 295 women of European descent carrying PVs in the BRCA1 (n=183) or the BRCA2 gene (n=112), and did either fulfill the ED criteria (n=162, mean age at diagnosis: 28.3 years, range: 20 to 34 years) or the LD criteria (n=133). Binomial logistic regression was applied to assess the association of standardized PRSs with either ED or LD under adjustment for patient recruitment criteria for germline testing and localization of BRCA1/2 PVs in the corresponding BC or ovarian cancer (OC) cluster regions.

Results

For BRCA1 PV carriers, the standardized overall BC PRS displayed the strongest association with ED (odds ratio (OR) = 1.62; 95% confidence interval (CI): 1.16–2.31, p<0.01). Additionally, statistically significant associations of selection for the patient recruitment criteria for germline testing and localization of pathogenic PVs outside the BRCA1 OC cluster region with ED were observed. For BRCA2 PV carriers, the standardized PRS for ER-negative BC displayed the strongest association (OR = 2.27, 95% CI: 1.45–3.78, p<0.001).

Conclusions

PRSs contribute to the development of extreme phenotypes of female BRCA1/2 PV carriers with respect to age at primary BC diagnosis. Construction of optimized PRS SNP sets for BC risk stratification in BRCA1/2 PV carriers should be the task of future studies with larger, well-defined study samples. Furthermore, our results provide further evidence, that localization of PVs in BC/OC cluster regions might be considered in BC risk calculations for unaffected BRCA1/2 PV carriers.
Autoamputation of the appendix and survival of the amputated part: a rare case report and literature review
Authors: Wang Mingxiang , Ning Shili , Liu Yaqing , Chen Zhao , Jiang Haodong , Faiz Shabnam , Luo Fuwen
Published: June 2022

Background

Autoamputation of the appendix, i.e., complete separation of a part of the appendix without any surgical intervention, has been rarely documented in the literature in recent years. Herein, we report a case where the amputated part of the appendix was viable after autoamputation and reviewed the related literature.

Case presentation

A 39-year-old female patient was admitted to our hospital complaining of abdominal pain and subsequently underwent an emergency laparoscopic appendectomy (LA). Intraoperatively, we found an abnormally short appendix protruding from the cecum and a strip-like tissue attached to the mesoappendix, considered a duplex appendix, was resected. Finally, in conjunction with the histopathology findings and the past medical history, the patient was diagnosed with “Pseudo-duplication of the Appendix”.

Conclusions

Autoamputation of the appendix resulting in preserved tissue viability and absence of necrosis at both ends, can be termed as “Pseudo-duplication of the Appendix”. This condition is very rare in clinical practice and has not been reported in China, to the best of our knowledge. It has been established that the autoamputated appendix can produce chronic inflammation, intestinal fistulae and even cancer, affecting the patient’s quality of life. Accordingly, a clear diagnosis and timely management are essential. In this report, we established a novel classification for “Pseudo-duplication of the Appendix”, hoping that our report will help surgeons better understand this anatomical anomaly of the appendix, to help during the differential diagnosis process and avoid confusion.
Discrimination in an “equal country”—a survey amongst Swedish final-year medical students
Authors: Velin Lotta , Chew Michelle S. , Pompermaier Laura
Published: June 2022

Background

Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden.

Methods

A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher’s exact test, and logistic regression. Free-text answers were analyzed thematically using the “Master Suppression techniques” conceptual framework.

Results

Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41–4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69–24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39–5.27]), and disability (p = 0.02, OR 13.8 [1.58–12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported “large” or “extreme” impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001).

Conclusions

Discrimination appears to be frequent in medical school, even in one of the world’s “most equal countries”. Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.
Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review
Authors: Walraven Janneke E. W. , van der Hel Olga L. , van der Hoeven J. J. M. , Lemmens Valery E. P. P. , Verhoeven Rob H. A. , Desar Ingrid M. E.
Published: June 2022

Background

Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement.

Methods

Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author.

Results

Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs.

Conclusions

MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
Physiological constraints dictate toxin spatial heterogeneity in snake venom glands
Authors: Kazandjian Taline D. , Hamilton Brett R. , Robinson Samuel D. , Hall Steven R. , Bartlett Keirah E. , Rowley Paul , Wilkinson Mark C. , Casewell Nicholas R. , Undheim Eivind A. B.
Published: June 2022

Background

Venoms are ecological innovations that have evolved numerous times, on each occasion accompanied by the co-evolution of specialised morphological and behavioural characters for venom production and delivery. The close evolutionary interdependence between these characters is exemplified by animals that control the composition of their secreted venom. This ability depends in part on the production of different toxins in different locations of the venom gland, which was recently documented in venomous snakes. Here, we test the hypothesis that the distinct spatial distributions of toxins in snake venom glands are an adaptation that enables the secretion of venoms with distinct ecological functions.

Results

We show that the main defensive and predatory peptide toxins are produced in distinct regions of the venom glands of the black-necked spitting cobra (Naja nigricollis), but these distributions likely reflect developmental effects. Indeed, we detected no significant differences in venom collected via defensive ‘spitting’ or predatory ‘biting’ events from the same specimens representing multiple lineages of spitting cobra. We also found the same spatial distribution of toxins in a non-spitting cobra and show that heterogeneous toxin distribution is a feature shared with a viper with primarily predatory venom.

Conclusions

Our findings suggest that heterogeneous distributions of toxins are not an adaptation to controlling venom composition in snakes. Instead, it likely reflects physiological constraints on toxin production by the venom glands, opening avenues for future research on the mechanisms of functional differentiation of populations of protein-secreting cells within adaptive contexts.
The host micro-RNA cfa-miR-346 is induced in canine leishmaniasis
Authors: Buffi Gloria , Diotallevi Aurora , Ceccarelli Marcello , Bruno Federica , Castelli Germano , Vitale Fabrizio , Magnani Mauro , Galluzzi Luca
Published: June 2022

Background

Leishmaniases are a group of anthropo-zoonotic parasitic diseases caused by a protozoan of the Leishmania genus, affecting both humans and other vertebrates, including dogs. L. infantum is responsible for the visceral and occasionally cutaneous form of the disease in humans and canine leishmaniasis. Previously, we have shown that L. infantum induces a mild but significant increase in endoplasmic reticulum (ER) stress expression markers to promote parasites survival in human and murine infected macrophages. Moreover, we demonstrated that the miRNA hsa-miR-346, induced by the UPR-activated transcription factor sXBP1, was significantly upregulated in human macrophages infected with different L. infantum strains. However, the ER stress response in infected dogs, which represent an important reservoir for Leishmania parasite, was described once recently, whereas the miR-346 expression was not reported before. Therefore, this study aimed to investigate these pathways in the canine macrophage-like cell line DH82 infected by Leishmania spp. and to evaluate the presence of cfa-miR-346 in plasma of non-infected and infected dogs. 

The DH82 cells were infected with L. infantum and L. braziliensis parasites and the expression of cfa-mir-346 and several ER stress markers was evaluated by quantitative PCR (qPCR) at different time points. Furthermore, the cfa-miR-346 was monitored in plasma collected from non-infected dogs (n = 11) and dogs naturally infected by L. infantum (n = 18).

Results

The results in DH82 cells showed that cfa-mir-346 was induced at both 24 h and 48 h post-infection with all Leishmania strains but not with tunicamycin, accounting for a mechanism of induction independent from sXBP1, unlike what was previously observed in human cell lines. Moreover, the cfa-miR-346 expression analysis on plasma revealed a significant increase in infected dogs compared to non-infected dogs.

Conclusions

Here for the first time, we report the upregulation of cfa-miR-346 induced by Leishmania infection in canine macrophage-like cells and plasma samples of naturally infected dogs. According to our results, the cfa-miR-346 appears to be linked to infection, and understanding its role and identifying its target genes could contribute to elucidate the mechanisms underlying the host–pathogen interaction in leishmaniasis.