Nevin Manimala

Nurs Forum. 2022 Jun 21. doi: 10.1111/nuf.12770. Online ahead of print.

ABSTRACT

BACKGROUND: Oral anticoagulation is the most common method to decrease the risk of stroke in people with atrial fibrillation.

PURPOSE: To assess the knowledge of Jordanian nurses about anticoagulation therapy, the effectiveness of educational courses in increasing their knowledge, and the factors that affect nurses’ changing knowledge following completion of an educational course.

METHOD: A pre/posttest quasi-experimental design was used. A total of 123 nurses participated in the study, identified by convenience sampling and recruited from five governmental hospitals in Jordan. To assess changes in knowledge between pre-and posttest, a questionnaire based on European cardiovascular nurses’ knowledge of anticoagulation therapy was used. An educational course was given to improve participants’ knowledge of anticoagulation therapy. The participants’ knowledge was assessed before and after the educational course. For data analysis, Statistical Package for the Social Sciences version 23 was used.

RESULTS: Nurses’ knowledge of anticoagulants was poor; however, a significant improvement was achieved following the educational course (M = 25.5, SD = 3.41), as compared to before conducting it (M = 12.2, SD = 5.3, t = 42.54, p < 0.001). Having an academic degree was found to affect the change in knowledge scores among participants (t = -3.52, p = 0.001).

CONCLUSION: The educational course was effective in improving the nurses’ knowledge. Baccalaureate degree holders achieved more improvement in their knowledge scores. Post-graduate education for nurses would help to improve their knowledge of anticoagulants. Revision of nursing curricula may be deemed necessary to improve the quality of education for nurses during their degree work, especially regarding anticoagulants.

PMID:35726697 | DOI:10.1111/nuf.12770

J Diabetes Investig. 2022 Jun 21. doi: 10.1111/jdi.13862. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was conducted to assess the association of Dehydroepiandrosterone (DHEA) with diabetic nephropathy in patients with T2DM to better predict the progression of diabetic nephropathy.

METHODS: A total of 1082 patients with T2DM in the Department of Endocrinology and Metabolism of Tianjin Medical University General Hospital were inrolled in this study，and grouped for comparison.The effect of serum DHEA on DN was evaluated by multivariate Logistic regression analysis, and receiver operating characteristiccurves (ROC) were established to explore the optimal concentration of DHEA in patients with DN and non-DN.

RESULTS: DHEA was significantly decreased in patients with diabetic nephropathy (P < 0.001). The prevalence of diabetic nephropathy was significantly higher in the low DHEA quartile than in the other quartiles (P < 0.001).Spearman-related analysis showed that DHEA levels were negatively correlated with patient age, course of diabetes, systolic blood pressure, blood creatinine(Cr), uric acid(Ur), urine albumin-to-creatinine ratio (ACR), 24-hour urine microalbumin(24 h UMA), 24-hour urine protein quantification(24hUAER), and glomerular fltration rate(GFR), positively correlated with Body mass index (BMI) , total cholesterol(TC), and low density lipoprotein (LDL).Logistic regression analysis showed that the effect of DHEA on diabetic nephropathy was statistically significant (P< 0.001).The ROC curve showed that the sensitivity was 81.4%, the specificity was 70%, and the area under the curve was 0.812 when the optimal cut-off value was 1640 (pg/mL).

CONCLUSION: DHEA is significantly associated with DN and may be a protective factor for DN and is important for the prediction of DN.

PMID:35726691 | DOI:10.1111/jdi.13862

J Card Surg. 2022 Jun 21. doi: 10.1111/jocs.16699. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study was to analyze the surgical outcome of patients with total anomalous pulmonary venous connection (TAPVC) who underwent cardiac surgery.

METHODS: A retrospective study was carried out. Patients with diagnosis of TAPVC undergoing cardiac surgery at the National Institute of Cardiology Ignacio Chávez, from January 1, 2003 and June 30, 2019 were included. Descriptive statistics were calculated, as well as a bivariate analysis of the variables associated with mortality. A logistic regression model was included to determine risk factors associated with the main outcome and survival was analyzed using the Kaplan-Meier method.

RESULTS: A total of 5314 patients diagnosed with congenital heart disease (CHD) underwent surgery, 414 (7.8%) were patients with TAPVC, with an average age of 17.1 ± 34.6 months, 58.2% were male. It was frequent in infants (61.6%) and preschool (19.6%). Predominant type was supracardiac TAPVC (47.4%). Pulmonary venous obstruction (PVO) occurred in 32.1%. Risk factors associated with mortality were infracardiac TAPVC (odds ratio [OR]: 3.26; 95% confidence interval [CI]: 1.17-9.03; p = .02), PVO (OR: 2.56; 95% CI: 1.05-6.22; p = .03) and postoperative mechanical ventilation (OR: 1.005; 95% CI: 1.002-1.008; p = .01). Overall survival was 87.2%, with better outcomes in adolescents (100%), children (94.1%), mixed TAPVC (96%), and cardiac TAPVC (91.9%; p < .001).

CONCLUSIONS: The survival of our institution after surgical correction of TAPVC is similar to that of other referral centers, where patients with infracardiac TAPVC and newborns worse outcomes. All patients must undergo a rigorous evaluation to determine an adequate repair strategy.

PMID:35726661 | DOI:10.1111/jocs.16699

J Magn Reson Imaging. 2022 Jun 21. doi: 10.1002/jmri.28315. Online ahead of print.

ABSTRACT

BACKGROUND: A typical stroke MRI protocol includes perfusion-weighted imaging (PWI) and MR angiography (MRA), requiring a second dose of contrast agent. A deep learning method to acquire both PWI and MRA with single dose can resolve this issue.

PURPOSE: To acquire both PWI and MRA simultaneously using deep learning approaches.

STUDY TYPE: Retrospective.

SUBJECTS: A total of 60 patients (30-73 years old, 31 females) with ischemic symptoms due to occlusion or ≥50% stenosis (measured relative to proximal artery diameter) of the internal carotid artery, middle cerebral artery, or anterior cerebral artery. The 51/1/8 patient data were used as training/validation/test.

FIELD STRENGTH/SEQUENCE: A 3 T, time-resolved angiography with stochastic trajectory (contrast-enhanced MRA) and echo planar imaging (dynamic susceptibility contrast MRI, DSC-MRI).

ASSESSMENT: We investigated eight different U-Net architectures with different encoder/decoder sizes and with/without an adversarial network to generate perfusion maps from contrast-enhanced MRA. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), mean transit time (MTT), and time-to-max (T_max ) were mapped from DSC-MRI and used as ground truth to train the networks and to generate the perfusion maps from the contrast-enhanced MRA input.

STATISTICAL TESTS: Normalized root mean square error, structural similarity (SSIM), peak signal-to-noise ratio (pSNR), DICE, and FID scores were calculated between the perfusion maps from DSC-MRI and contrast-enhanced MRA. One-tailed t-test was performed to check the significance of the improvements between networks. P values < 0.05 were considered significant.

RESULTS: The four perfusion maps were successfully extracted using the deep learning networks. U-net with multiple decoders and enhanced encoders showed the best performance (pSNR 24.7 ± 3.2 and SSIM 0.89 ± 0.08 for rCBV). DICE score in hypo-perfused area showed strong agreement between the generated perfusion maps and the ground truth (highest DICE: 0.95 ± 0.04).

DATA CONCLUSION: With the proposed approach, dynamic angiography MRI may provide vessel architecture and perfusion-relevant parameters simultaneously from a single scan.

EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 5.

PMID:35726646 | DOI:10.1002/jmri.28315

Int J Epidemiol. 2022 Jun 21:dyac124. doi: 10.1093/ije/dyac124. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies had limited power to assess the associations of circulating insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) with clinically relevant prostate cancer as a primary endpoint, and the association of genetically predicted IGF-I with aggressive prostate cancer is not known. We aimed to investigate the associations of IGF-I, IGF-II, IGFBP-1, IGFBP-2 and IGFBP-3 concentrations with overall, aggressive and early-onset prostate cancer.

METHODS: Prospective analysis of biomarkers using the Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group dataset (up to 20 studies, 17 009 prostate cancer cases, including 2332 aggressive cases). Odds ratios (OR) and 95% confidence intervals (CI) for prostate cancer were estimated using conditional logistic regression. For IGF-I, two-sample Mendelian randomization (MR) analysis was undertaken using instruments identified using UK Biobank (158 444 men) and outcome data from PRACTICAL (up to 85 554 cases, including 15 167 aggressive cases). Additionally, we used colocalization to rule out confounding by linkage disequilibrium.

RESULTS: In observational analyses, IGF-I was positively associated with risks of overall (OR per 1 SD = 1.09: 95% CI 1.07, 1.11), aggressive (1.09: 1.03, 1.16) and possibly early-onset disease (1.11: 1.00, 1.24); associations were similar in MR analyses (OR per 1 SD = 1.07: 1.00, 1.15; 1.10: 1.01, 1.20; and 1.13; 0.98, 1.30, respectively). Colocalization also indicated a shared signal for IGF-I and prostate cancer (PP4: 99%). Men with higher IGF-II (1.06: 1.02, 1.11) and IGFBP-3 (1.08: 1.04, 1.11) had higher risks of overall prostate cancer, whereas higher IGFBP-1 was associated with a lower risk (0.95: 0.91, 0.99); these associations were attenuated following adjustment for IGF-I.

CONCLUSIONS: These findings support the role of IGF-I in the development of prostate cancer, including for aggressive disease.

PMID:35726641 | DOI:10.1093/ije/dyac124

J Intellect Disabil Res. 2022 Jun 21. doi: 10.1111/jir.12957. Online ahead of print.

ABSTRACT

BACKGROUND: Adults with Down syndrome (DS) are at increased risk of developing Alzheimer’s disease (AD) due to genetic predisposition. Identification of patients with AD is difficult since intellectual disabilities (ID) may confound diagnosis. The objective of this study was to evaluate the ability of the French version of the modified cued recall test (mCRT) to distinguish between subjects with and without AD in the adult DS population.

METHODS: This was a retrospective, single-centre, medical records study including data between March 2014 and July 2020. Adults aged ≥30 years with DS who had at least one mCRT record available were eligible. Age, sex and ID level were extracted, and subjects were attributed to three groups: patients with AD, patients with co-occurring conditions that may impact cognitive function and subjects without AD. mCRT scores, adjusted by sex, age and ID level, were compared between groups. The optimal cut-off value to distinguish between patients with and without AD was determined using the receiver operating characteristic curve. The impact of age and ID level on mCRT scores was assessed.

RESULTS: Overall, 194 patients with DS were included: 12 patients with AD, 94 patients with co-occurring conditions and 88 healthy subjects. Total recall scores were significantly lower (P < 0.0001) in patients with AD compared with healthy subjects. The optimal cut-off value to discriminate between patients with AD and healthy subjects was 22, which compares well with the cut-off value of 23 originally reported for the English version of the mCRT. Patients aged 30-44 years had higher mCRT total recall scores compared with patients aged ≥45 years (P = 0.0221). Similarly, patients with mild ID had higher mCRT scores compared with patients with severe ID (P < 0.0001).

INTERPRETATION: The mCRT is a sensitive tool that may help in the clinical diagnosis of AD in subjects with DS. Early recognition of AD is paramount to deliver appropriate interventions to this vulnerable population.

PMID:35726628 | DOI:10.1111/jir.12957

Omega (Westport). 2022 Jun 21:302228221110328. doi: 10.1177/00302228221110328. Online ahead of print.

ABSTRACT

The aim of the study was to determine Covid-19 anxiety, obsession, perception of risk and self-care agency levels of pregnant women during the pandemic and investigate the association between Covid-19 anxiety, obsession, perception of risk and self-care agency levels and the fears of death and losing their baby in the pregnant women. The study was a cross-sectional and descriptive study. Five hundred thirty-eight pregnant women were included in the study. “COVID-19 Anxiety Scale,” “COVID-19 Obsession Scale,” “Risk Perception in Pregnancy Scale,” and “The Exercise of Self-Care Agency Scale” were used to collect data of the study. In this study, the total Cronbach’s alpha reliability coefficients of the COVID-19 Anxiety Scale, COVID-19 Obsession Scale, The Perception of Pregnancy Risk Questionnaire, The Exercise of Self-Care Agency Scale were found to be 0.73, 0.70, 0.86 and 0.95 respectively. Statistical analysis of data in the study was conducted using SPSS (22.0, IBM Corp. Armonk, NY) statistical program. Statistically significant differences were identified between the mean score from COVID-19 anxiety scale and the mean scores from COVID-19 obsession scale, the perception of pregnancy risk questionnaire and the exercise of self-care agency scale. These results suggest that education and health policies that focus on the health of pregnant women and their fetus should be developed for antenatal care services.

PMID:35726590 | DOI:10.1177/00302228221110328

Anat Histol Embryol. 2022 Jun 21. doi: 10.1111/ahe.12827. Online ahead of print.

ABSTRACT

The aim of the study is to protect and preserve the cross-sectional diagnostic characteristics of the anatomy samples by using silicone plastination method, to examine them both macroscopically and microscopically, and to use them as an educational material. After the dissection procedures of 10 total sheep heads obtained from the slaughterhouse were completed, they were freshly frozen and sliced to prepare cross-sectional samples. Then, statistical analysis was performed after the colorimetric measurements. For microscopic examination, 30 brain samples were divided into three groups (Fresh-F, plastination-P, plastination/deplastination-P/D). Of the total brain samples, 20 were subject to routine plastination protocol. After the plastination/deplastination procedure, the changes occurring in cerebral histology were compared. In terms of tissue preservation, the effect of plastination and deplastination was examined using a light microscope. Plastinates subject to silicone plastination under room temperature were very similar to their natural appearance, and it was observed that they preserved their morphological features. Colour changes in the tissues were statistically evaluated. Volumetric shrinkages were observed as qualitative, especially in the brain. As a result of the evaluation done, it was seen that deplastination with toluene is not possible for the brain tissues. In addition, it was not possible to take cross sections of the plastinated tissues that were not deplastinated. On the contrary, findings regarding that deplastination with 5% sodium methoxide dissolved in methanol can allow microscopic examination in long-term preserved plastinated brain tissues were obtained.

PMID:35726566 | DOI:10.1111/ahe.12827

Mol Carcinog. 2022 Jun 21. doi: 10.1002/mc.23437. Online ahead of print.

ABSTRACT

Research has shown extensive metabolic remodeling in clear cell renal cell carcinoma (ccRCC), with increased glutathione (GSH) levels. We hypothesized that activating transcription factor-4 (ATF4) and the integrated stress response (ISR) induce a metabolic shift, including increased GSH accumulation, and that Vitamin A deficiency (VAD), found in ccRCCs, can also activate ATF4 signaling in the kidney. To determine the role of ATF4, we used publicly available RNA sequencing (RNA-seq) data sets from The Cancer Genomics Atlas. Subsequently, we performed RNA-seq and liquid chromatography-mass spectrometry-based metabolomics analysis of the murine TRAnsgenic Cancer of the Kidney (TRACK) model for early-stage ccRCC. To validate our findings, we generated RCC4 cell lines with ATF4 gene edits (ATF4-knockout [KO]) and subjected these cells to metabolic isotope tracing. Analysis of variance, the two-sided Student’s t test, and gene set enrichment analysis were used (p < 0.05) to determine statistical significance. Here we show that most human ccRCC tumors exhibit activation of the transcription factor ATF4. Activation of ATF4 is concomitant with enrichment of the ATF4 gene set and elevated expression of ATF4 target genes ASNS, ALDH1L2, MTHFD2, DDIT3 (CHOP), DDIT4, TRIB3, EIF4EBP1, SLC7A11, and PPP1R15A (GADD34). Transcript profiling and metabolomics analyses show that activated hypoxia-inducible factor-1α (HIF1α) signaling in our TRACK ccRCC murine model also induces an ATF4-mediated ISR. Notably, both normoxic HIF1α signaling in TRACK kidneys and VAD in wild-type kidneys diminish amino acid levels, increase ASNS, TRIB3, and MTHFD2 messenger RNA levels, and increase levels of lipids and GSH. By metabolic isotope tracing in human RCC4 kidney cancer parental and ATF4 gene-edited (ATF4-KO) cell lines, we show that ATF4 increases GSH accumulation in part via activation of the mitochondrial one-carbon metabolism pathway. Our results demonstrate for the first time that activation of ATF4 enhances GSH accumulation, increases purine and pyrimidine biosynthesis, and contributes to transcriptional and metabolic remodeling in ccRCC. Moreover, constitutive HIF1α expressed only in murine kidney proximal tubules activates ATF4, leading to the metabolic changes associated with the ISR. Our data indicate that HIF1α can promote ccRCC via ATF4 activation. Moreover, lack of Vitamin A in the kidney recapitulates aspects of the ISR.

PMID:35726553 | DOI:10.1002/mc.23437

J Glob Health. 2022 Jun 20;12:11004. doi: 10.7189/jogh.12.11004.

ABSTRACT

BACKGROUND: Measuring infant and young child feeding (IYCF) indicators is important in evaluating child health programs and making evidence-based decisions. With Internet and new media rapidly developing, communication apps such as WeChat (the most popular mobile social media platform in China) are widely used and can potentially be used as an alternative way to collect infant and young child feeding information. This study compares data agreement between a WeChat-based self-administered and an interviewer-administered survey on infant and young child feeding information.

METHODS: We recruited 297 mothers of children aged 6-23 months in Fenxi County, Shanxi Province, China. Using the Test-Retest method, we first collected data through a self-administered survey using a WeChat-based electronic questionnaire and asked 36 questions on breastfeeding and complementary feeding knowledge, practices, and information sources. We then conducted an interviewer-administered survey using the same questionnaire and compared the data agreement between the two survey methods during the same day. Cohen’s kappa score (κ) and intraclass correlation coefficients (ICC) were used for data agreement analysis for all 36 questions and six key IYCF indicators. The McNemar test was used to identify differences between the two survey methods for the six key indicators.

RESULTS: There was substantial or almost perfect agreement for 33 questions (κ/ICC>0.60), and slight or fair agreement for the other 3 questions (κ/ICC<0.40). Agreement of all six key IYCF indicators was substantial or almost perfect (κ = 0.78-0.94), while two indicators showed statistical differences between the two survey methods (P = 0.03 for “Minimum meal frequency” and P = 0.001 for “Minimum accepted diet”). Analysis of reasons for inconsistencies showed that 43.6% of all the inconsistencies were not caused by the self-administered survey method. The cost of the interviewer-administered survey was much higher than that of the self-administered survey: ¥45.9 (US$6.8) vs ¥19.7 (US$2.9) per questionnaire.

CONCLUSIONS: The WeChat-based self-administered method can be used for future data collection of infant and young child feeding information in China. Most of the questions and key indicators showed very good agreement without statistical differences between the two methods.

PMID:35726544 | DOI:10.7189/jogh.12.11004