Nevin Manimala

Obstet Gynecol. 2021 Mar 22. doi: 10.1097/AOG.0000000000004382. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening in the outpatient setting alone.

DATA SOURCES: Searches for articles in English included MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and reference lists (up to August 2020).

METHODS OF STUDY SELECTION: Using predefined criteria and DistillerSR software, 10,853 citations were dual-reviewed for randomized controlled trials (RCTs) and cohort studies of outpatient cervical ripening using prostaglandins and mechanical methods in pregnant women at or beyond 37 weeks of gestation.

TABULATION, INTEGRATION, AND RESULTS: Using prespecified criteria, study data abstraction and risk of bias assessment were conducted by two reviewers, random-effects meta-analyses were conducted and strength of evidence was assessed. We included 30 RCTs and 10 cohort studies (N=9,618) most generalizable to women aged 25-30 years with low-risk pregnancies. All findings were low or insufficient strength of evidence and not statistically significant. Incidence of cesarean delivery was not different for any comparison of inpatient and outpatient settings, or comparisons of different methods in the outpatient setting (most evidence available for single-balloon catheters and dinoprostone). Harms were inconsistently reported or inadequately defined. Differences were not found for neonatal infection (eg, sepsis) with outpatient compared with inpatient dinoprostone, birth trauma (eg, cephalohematoma) with outpatient compared with inpatient single-balloon catheter, shoulder dystocia with outpatient dinoprostone compared with placebo, maternal infection (eg, chorioamnionitis) with outpatient compared with inpatient single-balloon catheters or outpatient prostaglandins compared with placebo, and postpartum hemorrhage with outpatient catheter compared with inpatient dinoprostone. Evidence on misoprostol, hygroscopic dilators, and other outcomes (eg, perinatal mortality and time to vaginal birth) was insufficient.

CONCLUSION: In women with low-risk pregnancies, outpatient cervical ripening with dinoprostone or single-balloon catheters did not increase cesarean deliveries. Although there were no clear differences in harms when comparing outpatient with inpatient cervical ripening, the certainty of evidence is low or insufficient to draw definitive conclusions.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020167406.

PMID:33752219 | DOI:10.1097/AOG.0000000000004382

Hum Hered. 2021 Mar 22:1-3. doi: 10.1159/000515200. Online ahead of print.

ABSTRACT

It is plausible that variants in the ACE2 and TMPRSS2 genes might contribute to variation in COVID-19 severity and that these could explain why some people become very unwell whereas most do not. Exome sequence data was obtained for 49,953 UK Biobank subjects, of whom 82 had tested positive for SARS-CoV-2 and could be presumed to have severe disease. A weighted burden analysis was carried out using SCOREASSOC to determine whether there were differences between these cases and the other sequenced subjects in the overall burden of rare, damaging variants in ACE2 or TMPRSS2. There were no statistically significant differences in weighted burden scores between cases and controls for either gene. There were no individual DNA sequence variants with a markedly different frequency between cases and controls. Whether there are small effects on severity, or whether there might be rare variants with major effect sizes, would require studies in much larger samples. Genetic variants affecting the structure and function of the ACE2 and TMPRSS2 proteins are not the main explanation for why some people develop severe symptoms in response to infection with SARS-CoV-2. This research was conducted using the UK Biobank Resource.

PMID:33752217 | DOI:10.1159/000515200

Dig Dis. 2021 Mar 22. doi: 10.1159/000516021. Online ahead of print.

ABSTRACT

BACKGROUND: Although esophageal squamous cell carcinoma is more likely to develop in patients with any risk factor (male, drinking, or smoking), it is sometimes detected in patients with very low risk factors (female, non-drinking, and non-smoking). We examined the endoscopic features of superficial esophageal squamous carcinoma in patients with very low risk factors.

METHODS: In this single-center case-control study, 666 patients with 666 superficial esophageal squamous carcinoma lesions were divided into 2 groups: those with very low risk factors (very-low-risk group, n = 34) and those with any risk factors (any-risk group, n = 632). After case-control selection at a 1:5 ratio, the very-low-risk group comprised 34 patients and the any-risk group comprised 170 patients. We compared the baseline characteristics, endoscopic findings, and treatment results (including pathological diagnosis) between the two groups.

RESULTS: There were no statistically significant differences between the two groups in age, tumor size, tumor location, tumor morphology, or treatment results (including tumor depth and lymphovascular invasion). A longitudinal lesion with an attachment of white keratinized epithelium was more likely to be detected in the very-low-risk group than any-risk group (61.8% versus 17.6%, respectively; P < 0.001).

CONCLUSIONS: Esophageal squamous cell carcinoma in patients with very low risk factors is rare but can be encountered in daily practice. A longitudinal lesion with an attachment of white keratinized epithelium is its main characteristic, which is slightly different from that of patients with any risk factors.

PMID:33752198 | DOI:10.1159/000516021

Int J Hyg Environ Health. 2021 Mar 19;234:113738. doi: 10.1016/j.ijheh.2021.113738. Online ahead of print.

ABSTRACT

AIM: Living in areas with neighborhood greenness may be associated with the incidence of cardiovascular diseases (CVDs). However, little evidence in this regard has emerged from developing countries. In the present study, we examined neighborhood greenness associated with CVDs and the lipid accumulation product (LAP) and pulse pressure (PP) in China.

METHODS: We undertook our analysis using a community cross-sectional survey conducted in Longzihu District of Bengbu from July to August 2015. We measured triglyceride levels, waist circumference, and blood pressure. To assess exposure to neighborhood greenness, we used the average normalized difference vegetation index (NDVI) at 1,000-, 1,500-, and 2,000-m buffers in the participant community. We employed generalized mixed models to determine the association among neighborhood greenness, CVDs, LAP, and PP. We conducted stratified analysis by age, gender, income, and education. We assessed the potential mediating effects of road proximity and physical activity on greenness and CVDs, PP, and LAP.

RESULTS: The highest tertiles of NDVI_1500-m were steadily and significantly associated with lower odds of CVDs prevalence: the adjusted OR of such prevalence was 0.612 (95% CI, 0.462-0.811); higher NDVI was significantly associated with lower PP levels. The NDVI was strongly associated with CVDs prevalence among participants who were male and had high income. Ambient road proximity significantly mediated 9.7% of the estimated association between greenness and PP, there was no evidence of mediation effects for physical activity.

CONCLUSIONS: Higher neighborhood greenness could have a beneficial effect on CVDs and biomarkers. There were higher associations between residential greenness and CVDs among male and higher-income individuals; road proximity partially mediated the observed association between greenness and PP.

PMID:33752171 | DOI:10.1016/j.ijheh.2021.113738

Addict Behav. 2021 Mar 10;118:106905. doi: 10.1016/j.addbeh.2021.106905. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual minority status (SMS) is a known risk factor for marijuana use among youth in the United States (US). Limited research has examined the differing relationship between SMS and marijuana use across males and females. This study examined the modifying effect of sex on the relationship between sexual minority status (SMS) and past 30-day marijuana use among youth.

METHODS: Data were pooled from the 2015, 2017, and 2019 Youth Risk Behavior Surveillance survey. Participants were 9th through 12th grade students in the US (n = 37,870). An interaction model (SMS*sex) and models stratified by sex tested effect modification. Covariates included race/ethnicity, grade, tobacco use, illicit drug use, and survey year.

RESULTS: The association between SMS and past 30-day marijuana use differed statistically by sex assigned at birth. Among females, SMS was associated with 1.33 greater odds of past 30-day marijuana use. Conversely, among males, SMS was associated with 0.70 lower odds of past 30-day marijuana. Interaction model was statistically significant.

CONCLUSION: SMS is associated with greater odds of being a past 30-day marijuana user among females but lower odds among males. Prevention and education programs aimed at youth should consider these factors during development and implementation. Longitudinal research is needed to further examine the nuances of the relationship observed in this analysis.

PMID:33752162 | DOI:10.1016/j.addbeh.2021.106905

Mar Pollut Bull. 2021 Mar 19;166:112269. doi: 10.1016/j.marpolbul.2021.112269. Online ahead of print.

ABSTRACT

The present study aimed to document dinocyst ecological preferences in Ambon Bay, Eastern Indonesia, and to investigate if the bay sediments serve as a seedbank for toxic bloom events. To this end, dinocyst and geochemical analyses of surface sediment samples were performed, along with physicochemical water column parameters. Twentythree dinocyst species were identified, and high dinocyst concentrations (up to ~12,000 cysts g^-1 dry sediment) were found in the inner bay. Environmental factors such as surface water temperature and salinity generally played an important role in dinocyst distribution. The concentration of Polysphaeridium zoharyi cysts showed a strong positive correlation with phosphorus. A statistically significant correlation was also found with the concentration of other autotrophic dinocysts in the sediments, and an inverse correlation was observed with the sediment C/N ratio. Cysts may serve as seedbanks for Pyrodinium bahamense blooms in the area.

PMID:33752158 | DOI:10.1016/j.marpolbul.2021.112269

Clin Nutr. 2021 Mar 7;40(4):1621-1627. doi: 10.1016/j.clnu.2021.02.043. Online ahead of print.

ABSTRACT

AIMS: The aim of this study was to analyse the association between specific bioelectric impedance vector analysis (BIVA) and dual-energy X-ray absorptiometry (DXA) to assess segmental body composition using DXA as the reference technique.

METHODS: The sample comprised 50 young active students who practised or played different sports (25 men, age: 24.37 ± 4.79 y; 25 women, age: 24.32 ± 4.43 y) from the National Institute of Physical Education of Catalonia (INEFC). Anthropometric data (height, weight, arm, waist, and calf circumferences) and bioelectrical measurements (R, ohm; Xc, ohm) were recorded. Body composition was analysed with specific BIVA. DXA was used as the reference method to assess body composition of the whole-body, the trunk, and the limbs. The percentage of fat mass (%FM_DXA) and fat-free mass index (FFMI_DXA = FFM/length²) were calculated. The agreement between specific BIVA and DXA was evaluated by a depth-depth analysis, two-way ANOVA, and Pearson’s correlations.

RESULTS: The depth-depth analysis showed a good agreement between DXA and BIVA (F = 14.89, p < 0.001) in both sexes and all body segments. Specific vector length (Zsp; i.e. indicative of %FM) was correlated with %FM_DXA in the whole body and all body segments, and the phase angle was correlated with FFMI_DXA, with he trunk in women as the only exception. Specific BIVA demonstrated to balance the effect of body size on bioelectrical measurements in both whole and segmental approaches.

CONCLUSIONS: Segmental specific BIVA and DXA provided a consistent evaluation of body composition in both sexes, of the whole body and each body segment. The indices %FM and FFMI obtained with DXA were correlated to vector length and phase angle in each segment, respectively. Specific BIVA represents a promising technique for monitoring segmental body composition changes in sport science and clinical applications.

PMID:33752150 | DOI:10.1016/j.clnu.2021.02.043

Nurse Educ Pract. 2020 Dec 31;52:102964. doi: 10.1016/j.nepr.2020.102964. Online ahead of print.

ABSTRACT

Improving outcomes and quality of care through evidence-based practice (EBP) is a priority globally. But most nurses have insufficient competence in EBP. How to conduct Educational interventions to enhance clinical nurses’ EBP competencies and critical thinking disposition (CTD) requires more evidence. One hundred eleven clinical nurses from a Chinese four-campus hospital were enrolled in our EBP education program. The Johns Hopkins Nursing Evidence-Based Practice Model was used to develop and guide the educational and practical sessions. Multi-dimensional learning strategies -including online self-learning, on-site lectures, workshops, and social media-facilitated group discussions-were used to facilitate the implementation of the education sessions. After education, nurses embedded evidence into practice. The Chinese versions of the EBP Believe scale (EBPB), EBP Implementation scale (EBPI), and the Simplified Chinese Version of the Critical Thinking Disposition Inventory (CTDI-SCV) were applied to assess the relevant competencies among clinical nurses before and after the education program. Clinical nurses’ EBPB, EBPI, and CTDI-SCV scores improved. But only EBPB and EBP skills and attitudes were enhanced with a statistical difference (t = -2.980, -4.141, and -2.695, with all p < 0.01). There was a small positive association between EBPB and CTDI-SCV (r = 0.396, p < 0.01). Fifteen EBP programs were successfully accomplished.

PMID:33752147 | DOI:10.1016/j.nepr.2020.102964

Eur J Cancer. 2021 Mar 19;148:230-238. doi: 10.1016/j.ejca.2021.01.044. Online ahead of print.

ABSTRACT

BACKGROUND: Complete remission is observed in less than half of hypermutated (HM) tumours after immune checkpoint blockade therapy, indicating that HM tumours are very heterogeneous. Thus, there is an urgent requirement to decipher the unknown intrinsic HM tumour subtypes.

METHODS: Statistical analysis was performed on somatic mutation data from 5519 tumours across 11 cancer types obtained from The Cancer Genome Atlas and 338 colorectal cancer (CRC) samples obtained from an Asian cohort. Samples with a tumour mutation burden >10 mut/Mb were classified as HM. A total of 1040 HM samples harbouring corresponding transcriptomes were used for non-negative matrix factorisation clustering. Tumour mutational burden, neoantigens, T cell receptor (TCR) diversity, stromal score and immune score were compared between the subtypes.

RESULTS: HM tumours fell into three distinct immune subtypes: HM1, HM2 and HM3. HM3 tumours were correlated with increased CD8 T cell infiltration, high TCR diversity, a high immune score and prolonged survival. HM2 tumours were correlated with an abundant stromal component, epithelial-mesenchymal transition, TGFβ, angiogenesis hallmarks and poor outcomes. The infiltration of more CD8 T cells and increased chemokine expression in HM3 were validated in CRC by immunofluorescence.

CONCLUSIONS: These findings will facilitate the development of a subtype-oriented therapy strategy to enhance the treatment effect in the near future.

PMID:33752133 | DOI:10.1016/j.ejca.2021.01.044

Redox Biol. 2021 Mar 2;41:101926. doi: 10.1016/j.redox.2021.101926. Online ahead of print.

ABSTRACT

Chemosensitivity to cisplatin derivatives varies among individual patients with intractable malignancies including ovarian cancer, while how to unlock the resistance remain unknown. Ovarian cancer tissues were collected the debulking surgery in discovery- (n = 135) and validation- (n = 47) cohorts, to be analyzed with high-throughput automated immunohistochemistry which identified cystathionine γ-lyase (CSE) as an independent marker distinguishing non-responders from responders to post-operative platinum-based chemotherapy. We aimed to identify CSE-derived metabolites responsible for chemoresistant mechanisms: gold-nanoparticle (AuN)-based surface-enhanced Raman spectroscopy (SERS) was used to enhance electromagnetic fields which enabled to visualize multiple sulfur-containing metabolites through detecting scattering light from Au-S vibration two-dimensionally. Clear cell carcinoma (CCC) who turned out less sensitive to cisplatin than serous adenocarcinoma was classified into two groups by the intensities of SERS intensities at 480 cm^-1; patients with greater intensities displayed the shorter overall survival after the debulking surgery. The SERS signals were eliminated by topically applied monobromobimane that breaks sulfane-sulfur bonds of polysulfides to result in formation of sulfodibimane which was detected at 580 cm^-1, manifesting the presence of polysulfides in cancer tissues. CCC-derived cancer cell lines in culture were resistant against cisplatin, but treatment with ambroxol, an expectorant degrading polysulfides, renders the cells CDDP-susceptible. Co-administration of ambroxol with cisplatin significantly suppressed growth of cancer xenografts in nude mice. Furthermore, polysulfides, but neither glutathione nor hypotaurine, attenuated cisplatin-induced disturbance of DNA supercoiling. Polysulfide detection by on-tissue SERS thus enables to predict prognosis of cisplatin-based chemotherapy. The current findings suggest polysulfide degradation as a stratagem unlocking cisplatin chemoresistance.

PMID:33752108 | DOI:10.1016/j.redox.2021.101926