bluuebunny/crossref_metadata_2025_split huggingface dataset:
Type 2 diabetes mellitus and cognitive decline in older adults in Germany – results from a population-based cohort
Authors: Xie Kun , Perna Laura , Schöttker Ben , Kliegel Matthias , Brenner Hermann , Mons Ute 
Published: May 2022

Abstract
Background
A large body of evidence supports a link between type 2 diabetes mellitus (T2DM) and cognitive function, including dementia. However, longitudinal studies on the association between T2DM and decline of cognitive function are scarce and reported mixed results, and we hence set out to investigate the cross-sectional and longitudinal association between T2DM and global as well as domain-specific cognitive performance.

Methods
We used multivariable regression models to assess associations of T2DM with cognitive performance and cognitive decline in a subsample of a population-based prospective cohort study (ESTHER). This subsample (n = 732) was aged 70 years and older and had participated in telephone-based cognitive function assessment (COGTEL) measuring global and domain-specific cognitive performance during the 5- and 8-year follow-up.

Results
Total COGTEL scores of patients with prevalent T2DM were 27.4 ± 8.3 and 29.4 ± 8.7 at the 5- and 8-year measurements, respectively, and were roughly two points lower than those of T2DM-free participants after adjustment for age and sex. In cross-sectional models, after adjustment for several potential confounders, performance in verbal short-term and long-term memory tasks was statistically significantly lower in participants with T2DM, but the association was attenuated after further adjustment for vascular risk factors. The difference in total COGTEL scores reflecting global cognitive function by T2DM status after full adjustment for confounders and vascular risk factors was equivalent to a decrement in global cognitive function associated with a four-year age difference. In longitudinal models, a statistically significantly stronger cognitive decline in patients with T2DM was observed for working memory.

Conclusions
In this sample of older individuals, T2DM was associated with worse performance and stronger decline in a cognitive function test. Memory-related domains were found to be particularly sensitive to T2DM. Further large-scale prospective studies are needed to clarify potential T2DM-related predictors of cognitive decline and possible consequences on the abilities to perform patient self-management tasks in diabetes care.
The first case of cholecytitis caused by Aggregatibacter kilianii in Korea
Authors: Yang Dahae , Kim Chang-Ki , Park Junja , Song Na Yeong , Lee Yunna , Lee Woonhyoung 
Published: May 2022

Abstract
Background
The bacterial genus Aggregatibacter was categorized in 2006 to accommodate the former Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and H. segnis species. Aggregatibacter kilianii is a normal resident of the human upper respiratory tract but can also cause serious infections. A. kilianii is relatively newly identified and has been isolated from conjunctivitis, wounds, abdominal abscesses, and blood.

Case presentation
An 80-year-old female patient with distal common bile duct cancer was admitted to our hospital with sudden loss of consciousness and general weakness, fever, and abdominal pain for 3 days. Two colonial morphologies were isolated from both the blood and bile cultures; one was identified as Streptococcus constellatus subsp. pharyngis, but the other was not recognized by Vitek2 and MALDI-TOF. The 16 S rRNA sequences showed 99.73% similarity with the sequence of A. kilianii strains.

Conclusion and discussion
This article presents the first case of a clinical isolate of A.kilianii outside Europe. This case is also the first of the antimicrobial profile of this strain. This report highlights the importance of proper molecular identification for timely diagnosis and treatment of disease.
Deep learning-based automated segmentation of eight brain anatomical regions using head CT images in PET/CT
Authors: Wang Tong , Xing Haiqun , Li Yige , Wang Sicong , Liu Ling , Li Fang , Jing Hongli 
Published: May 2022

Abstract
Objective
We aim to propose a deep learning-based method of automated segmentation of eight brain anatomical regions in head computed tomography (CT) images obtained during positron emission tomography/computed tomography (PET/CT) scans. The brain regions include basal ganglia, cerebellum, hemisphere, and hippocampus, all split into left and right.

Materials and methods
We enrolled patients who underwent both PET/CT imaging (with an extra head CT scan) and magnetic resonance imaging (MRI). The segmentation of eight brain regions in CT was achieved by using convolutional neural networks (CNNs): DenseVNet and 3D U-Net. The same segmentation task in MRI was performed by using BrainSuite13, which was a public atlas label method. The mean Dice scores were used to assess the performance of the CNNs. Then, the agreement and correlation of the volumes of the eight segmented brain regions between CT and MRI methods were analyzed.

Results
18 patients were enrolled. Four of the eight brain regions obtained high mean Dice scores (> 0.90): left (0.978) and right (0.912) basal ganglia and left (0.945) and right (0.960) hemisphere. Regarding the agreement and correlation of the brain region volumes between two methods, moderate agreements were observed on the left (ICC: 0.618, 95% CI 0.242, 0.835) and right (ICC: 0.654, 95% CI 0.298, 0.853) hemisphere. Poor agreements were observed on the other regions. A moderate correlation was observed on the right hemisphere (Spearman’s rho 0.68, p = 0.0019). Lower correlations were observed on the other regions.

Conclusions
The proposed deep learning-based method performed automated segmentation of eight brain anatomical regions on head CT imaging in PET/CT. Some regions obtained high mean Dice scores and the agreement and correlation results of the segmented region volumes between two methods were moderate to poor.
Motivation for protection in sexual relationship during the COVID-19 quarantine: analysis of the sociodemographic variables of the Iranian population
Authors: Maasoumi Raziyeh , Kazemi Sara , Haghani Shima , Zarei Fatemeh 
Published: May 2022

Abstract
Background
Coronavirus is an infectious disease that has affected sexual life. Sexual activity has decreased for many people, and couples' physical contact has reduced. The present study aimed to determine the sexual relationship of Iranian people and related factors during the Corona home quarantine by focusing on all constructs of the protective motivation theory.

Methods
This cross-sectional online survey was conducted on Iranian people under in-home quarantine from July to December 2020 during the Covid-19 pandemic. Seven hundred sixteen people were selected by the convenience sampling method. The data was gathered by an ad-hoc tool consisting of demographic information and sexual relationship regarding protection motivation behavior in the Covid-19 pandemic. Participants should be able to complete the online questionnaire because the questionnaires were completed online. One-way ANOVA, independent T, and Pearson correlation tests were used to analyze the data in SPSS 16 software.

Results
Findings indicate the average age of the participants was 37.78 + 8.34 years. Most of them were women (%85.1), married (%91.3) and had a university education (%90.2). In addition, %42.5% of participants had Full-time jobs and %34.2 lived in Tehran. 49.9% obtained information about corona from TV. 63.3% of the participants and their spouses did not catch Covid-19. Employment status was the only variable that was significantly different from sexual relationships regarding protection motivation (p = 0.031). Perceived response efficiency with an average of 79.12 had the highest, and perceived self-efficacy with an average of 69.92 had the lowest mean score among the areas of sexual relationship. Among the protection motivation domains of sexual behavior that all had significant correlations, there was no significant correlation between perceived severity and perceived self-efficacy (p = 0.067).

Conclusion and implication
Perceived vulnerability is associated with employment status, place of residence, and age. Sexual relationships regarding protection motivations are only associated with employment status. Overall, participants in the present study reported high levels of perceived severity, perceived vulnerability, perceived response efficiency, and perceived costs Therefore, they reported a high level of motivation for protective and preventive behaviors in their sexual relationship. Our findings suggest that future interventions should focus on general cognition by developing appropriate knowledge about the severity and vulnerability of Covid-19 and sexual behaviors, improving perceived response efficiency, and self-efficacy of protective behavior through skills training.
Simple tuberculosis screening tool using signs, symptoms, and risk factors to reduce the missed opportunity in the older population
Authors: Hidayat Agus , Murti Bhisma , Soedarsono Soedarsono , Harsini  , Wahyuni Chatarina Umbul , Qodrijati Isna 
Published: May 2022

Abstract
Background
There is a growing concern on how to increase tuberculosis (TB) case detection in resource-poor settings. The healthcare facilities routinely providing services to the elderly for chronic diseases often failed to detect TB cases, causing a missed opportunity. This study aimed to develop a simple and sensitive screening tool using signs, symptoms, and risk factors for TB case detection in the elderly.

Methods
This was a cross-sectional study conducted from August to December 2020. A random sample of 302 subjects was taken from the elderly aged ≥ 60 years attending the outpatient polyclinic at Mangunharjo hospital, Madiun, East Java, Indonesia, for a chronic disease problem. The test was developed using 16 TB signs, symptoms, and risk factors. Test performance was assessed by comparing it against the GeneXpert MTB/RIF.

Results
Marginal analysis resulted in the optimal cut-point of ≥ 7 for the test, which gave an area under the curve (AUC) of 0.62, with the maximum marginal AUC of 0.04 (p < 0.001). The sensitivity and specificity were 60.26% and 64.29%, meaning 60 TB cases for every 100 elderly with TB would be otherwise left undetected if this screening test did not take place.

Conclusion
A simple TB screening tool with moderate sensitivity and AUC has been developed using TB signs, symptoms, and risk factors. It can be used as an initial step of the systematic TB screening in the elderly visiting healthcare facilities for routine chronic disease examination, with the additional utility of reducing the missed opportunity.
Upregulation of TGF-β-induced HSP27 by HSP90 inhibitors in osteoblasts
Authors: Kuroyanagi Gen , Tokuda Haruhiko , Fujita Kazuhiko , Kawabata Tetsu , Sakai Go , Kim Woo , Hioki Tomoyuki , Tachi Junko , Matsushima-Nishiwaki Rie , Otsuka Takanobu , Iida Hiroki , Kozawa Osamu 
Published: May 2022

Abstract
Background
Heat shock protein (HSP) 90 functions as a molecular chaperone and is constitutively expressed and induced in response to stress in many cell types. We have previously demonstrated that transforming growth factor-β (TGF-β), the most abundant cytokine in bone cells, induces the expression of HSP27 through Smad2, p44/p42 mitogen-activated protein kinase (MAPK), p38 MAPK, and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) in mouse osteoblastic MC3T3-E1 cells. This study investigated the effects of HSP90 on the TGF-β-induced HSP27 expression and the underlying mechanism in mouse osteoblastic MC3T3-E1 cells.

Methods
Clonal osteoblastic MC3T3-E1 cells were treated with the HSP90 inhibitors and then stimulated with TGF-β. HSP27 expression and the phosphorylation of Smad2, p44/p42 MAPK, p38 MAPK, and SAPK/JNK were evaluated by western blot analysis.

Result
HSP90 inhibitors 17-dimethylaminoethylamino-17-demethoxy-geldanamycin (17-DMAG) and onalespib significantly enhanced the TGF-β-induced HSP27 expression. TGF-β inhibitor SB431542 reduced the enhancement by 17-DMAG or onalespib of the TGF-β-induced HSP27 expression levels. HSP90 inhibitors, geldanamycin, onalespib, and 17-DMAG did not affect the TGF-β-stimulated phosphorylation of Smad2. Geldanamycin did not affect the TGF-β-stimulated phosphorylation of p44/p42 MAPK or p38 MAPK but significantly enhanced the TGF-β-stimulated phosphorylation of SAPK/JNK. Onalespib also increased the TGF-β-stimulated phosphorylation of SAPK/JNK. Furthermore, SP600125, a specific inhibitor for SAPK/JNK, significantly suppressed onalespib or geldanamycin’s enhancing effect of the TGF-β-induced HSP27 expression levels.

Conclusion
Our results strongly suggest that HSP90 inhibitors upregulated the TGF-β-induced HSP27 expression and that these effects of HSP90 inhibitors were mediated through SAPK/JNK pathway in osteoblasts.
Surgical planning of osteotomies around the knee differs between preoperative standing and supine radiographs in nearly half of cases
Authors: Nejima Shuntaro , Kumagai Ken , Yamada Shunsuke , Sotozawa Masaichi , Kumagai Dan , Yamane Hironori , Inaba Yutaka 
Published: May 2022

Abstract
Background
To evaluate the difference in surgical planning of osteotomies around the knee between preoperative standing and supine radiographs and to identify risk factors for discrepancies in surgical planning.

Methods
This study included 117 knees of 100 patients who underwent osteotomies around the knee for knee osteoarthritis with genu varum. Surgical planning was performed so that the target point of the postoperative weight-bearing line (WBL) ratio was 62.5% in preoperative standing and supine radiographs. If the opening gap would be > 13 mm in open-wedge high tibial osteotomy (OWHTO), closed-wedge HTO (CWHTO) was planned. If the postoperative mMPTA would be > 95° in isolated HTO, double-level osteotomy (DLO) was planned. In DLO, lateral closed-wedge distal femoral osteotomy was performed so that the postoperative mechanical lateral distal femoral angle (mLDFA) was 85°, and any residual varus deformity was corrected with HTO.

Results
Surgical planning differed between standing and supine radiographs in 43.6% of cases. In all knees for which surgical planning differed between standing and supine radiographs, a more invasive type of osteotomy was suggested by standing radiographs than by supine radiographs. The risk factors for discrepancies in surgical planning were a lower WBL ratio in standing radiographs and a lower joint line convergence angle in supine radiographs.

Conclusions
Surgical planning of DLO, CWHTO and OWHTO, in standing radiographs differed from that in supine radiographs in nearly half of the cases. Surgical planning based on standing radiographs leads to more invasive surgical procedures compared to supine radiographs.
Factors related to implementation of an interprofessional communication concept in thoracic oncology: a mixed-methods study
Authors: Krug Katja , Bossert Jasmin , Möllinger Sophia , Deis Nicole , Unsöld Laura , Siegle Anja , Villalobos Matthias , Hagelskamp Laura , Jung Corinna , Thomas Michael , Wensing Michel 
Published: May 2022

Abstract
Background
An innovative patient-centred interprofessional communication concept with advanced lung cancer patients (Heidelberg Milestone Communication Approach, MCA) has been developed and implemented. Role changes and interprofessional communication are challenging in a busy outpatient oncology service. The aim of the study was to present attitudes to interprofessional collaboration of professions in thoracic oncology during the implementation of MCA and to explore factors and experiences healthcare team members associate with its implementation.

Methods
In a longitudinal study, 3 of the 4 subscales of the validated German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D) were collected prior to implementation of MCA (t0) with follow-up data collections at 4 months (t1), 10 months (t2) and 17 months (t3). Descriptive analysis included calculating subscale sum scores and categorizing each subscale into positive, neutral and negative attitudes. Interviews and focus groups on implementation and interprofessional collaboration in the context of MCA were conducted with healthcare staff. The topics were analysed deductively, guided by the Professional Interactions factor of the Tailored Implementation for Chronic Diseases (TICD) framework.

Results
The survey with 87 staff (44 nurses, 13 physicians, 12 psycho-social staff, 7 therapists, and 11 others) participating at least once found heterogeneous attitudes. ‘Communication and Teamwork’ and ‘Interprofessional Relationships’ were characterized by primarily positive attitudes. Neutral attitudes to ‘Interprofessional Interaction’ were indicated by the majority of respondents. There were no differences between collection times. Fifteen staff members participated in the interviews and focus groups. The main interprofessional interaction factors associated with implementation concerned the knowledge of the MCA and the impact of the intervention on team roles, on information sharing and on transfer processes between wards. Adaptive processes led to a shift in the perception of responsibilities and interprofessional collaboration.

Conclusions
Positive experiences and potential shortfalls in the implementation were observed. Future introductions of interprofessional communication concepts require further activities which should address the attitudes of healthcare professionals towards interprofessional care.

Trial registration
DRKS00013469 / Date of registration: 22/12/2017.
A phenomenographic study exploring the conceptions of stakeholders on their teaching and learning roles in nursing education
Authors: Munangatire Takaedza , McInerney Patricia 
Published: May 2022

Abstract
Background
Nursing education involves a number of stakeholders in the teaching and learning process, and these are student nurses, lecturers, clinical instructors and nurses. The role that each of these parties play in the teaching and learning process is dependent on each other and is key to the development of competence among student nurses. However, there is scanty literature on the discourse of how these stakeholders conceptualise their roles to maximise student learning. The objective of this study was to explore the conceptions of stakeholders on their teaching and learning roles in nursing education.

Methods
Thirty-eight semi-structured interviews and three focus group discussions were conducted with nursing students, lecturers, clinical educators at a Namibian nursing college and nurses at teaching hospitals. Phenomenographic data analysis approach was applied.

Results
Four conceptions were constructed that described the level of involvement of the different parties in teaching and learning. These were initiating, supporting, becoming part of and owning the teaching and learning role. Three dimensions of variation marked the differences among the conceptions: responsibility and accountability, priorities and level of collaboration.

Conclusions
The parties involved in the teaching and learning in nursing education have qualitatively different understating of their roles and those of others. There is a pattern transcending from being at the periphery of teaching and learning to taking ownership of teaching and learning. And a movement from limited responsibility and collaboration to that of being responsible, accountable and high level of collaboration in the teaching and learning of nursing students. The conceptions in this study add more ways of enhancing collaboration between theoretical and clinical sites in nursing education, by ensuring that those involved are aware of their role and that of others and work collaboratively at the micro-level.
Mind your language: the importance of english language skills in an International Medical Programme (IMP)
Authors: Chan Sharon Min Hui , Mamat Norul Hidayah , Nadarajah Vishna Devi 
Published: May 2022

Abstract
Background
Language proficiency is crucial for doctors as they communicate with patients, peers and other healthcare professionals. Although proficiency in English is part of admission requirements, there is a gap in the knowledge of medical students’ perception of factors enhancing English language (EL) skills during training in international medical programmes (IMPs). The gap prevents educators and policy makers from helping students who struggle with communication skills during medical training. This study therefore explores the importance of English language skills from medical students’ perspectives.

Methods
Six focus group interviews with 24 medical students were conducted in an IMP. Data were analysed using Braun and Clarke’s framework of thematic analysis.

Results
Results established three themes that constitute the importance of EL skills, namely the use of EL in medical training and practice, influence of university culture in EL mastery and individual EL proficiency as perceived by medical students.

Conclusions
Findings of this study demonstrate how students perceived the importance of EL skills as a professional and social requirement during medical training and for future practice. It also informs that setting English language admission pre requisites needs to be complemented with opportunities to practice context specific communication skills. Thus, international medical programmes should embed diverse and inclusive strategies to support and develop medical students’ English language skills.