bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Serum Uric Acid Levels with COVID-19 Severity
Authors: Hu Fang , Guo Yifan , Lin Jianghong , Zeng Yingjuan , Wang Juan , Li Man , Cong Li 
Published: January 2021

Abstract
Aims: Hyperuricemia has attracted increasing attention, however, limited attention has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in COVID-19 patients. Therefore, we aim to explore the SUA levels in COVID-19 patients and the relationship between SUA and the severity of COVID-19. Methods: A case-control study based on 91 cases with COVID-19 and 1:3 age- and sex-matched healthy control subjects (N=273) were included. We firstly compared the SUA levels and the uric acid/creatinine (UA/Cr) ratio between COVID-19 patients and the healthy controls. Then, we examined the association of the SUA levels and UA/Cr ratios with COVID-19 severity defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19. Results: SUA levels at admission were 2.59% lower, UA/Cr ratios 6.06% lower in COVID-19 patients compared to controls. In sex stratified analysis, SUA and UA/Cr were lower in male COVID-19 patients while only SUA was lower in female COVID-19 patient. Moreover, SUA and UA/Cr values were 4.27% and 8.23% lower in the severe group than in the moderate group among male COVID patients. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent factors associated with lower SUA levels. COVID-19 male patients with low SUA levels at had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11，14.72) at admission. After completion of the first follow-up of the COVID-19 patients within 1-3 weeks after discharge, we found that male patients experienced severe symptoms had significantly lower SUA and UA/Cr ratio levels comparing to moderate patients but no significant difference between different time points. In females, female patients have both SUA and UA/Cr ratio levels lower at discharge than that at admission, however these differences disappear at follow-up exam.Conclusion: COVID-19 patients had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher risk of developing severe symptoms than those with high SUA levels. During the aggravation course of the disease, the level of SUA gradually decreased until discharge. At follow-up exam, the level of SUA is similar to the levels at admission.
Assessing the potential for reducing violence against young children through an adapted parenting program embedded within the public health system: Findings from a pre-post trial in Thailand
Authors: McCoy Amalee , Lachman Jamie , Ward Catherine , Tapanya Sombat , Poomchaichote Tassawan , Kelly Jane , Mukaka Mavuto , Cheah Phaik Yeong , Gardner Frances 
Published: January 2021

Abstract
BackgroundThis pre-post trial of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators.Method:Sixty primary caregivers of children aged 2–9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman’s ANOVA, and thematic analysis.ResultsParticipants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d=-0.58, p < 0.001), as well as reductions in physical (d=-0.58, p < 0.001) and emotional abuse (d=-0.40, p < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting (d=-0.52, p < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress.ConclusionsThis study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results.Trial registration11/01/2019, ClinicalTrials.gov, ID# NCT03539341
Expansion of a National Differentiated Service Delivery Model Increases Access to Treatment for HIV and Other Chronic Conditions in South Africa
Authors: Liu Lingrui , Christie Sarah , Munsamy Maggie , Roberts Phil , Pillay Merlin , Shenoi Sheela , Desai Mayur , Linnander Erika 
Published: January 2021

Abstract
Background: South Africa is home to 7.7 million people living with HIV and supports the largest antiretroviral therapy (ART) program worldwide. Despite global investment in HIV service delivery and the parallel threat of non-communicable diseases (NCDs), there are few examples of integrated programs addressing both HIV and NCDs through differentiated service delivery. In 2014, the National Department of Health (NDoH) launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to provide patients with chronic disease, including HIV, with differentiated access to medications via community-based pick-up points. This study describes the expansion of CCMDD to national scale.Methods: Yale monitors CCMDD enrollment as part of its mixed methods evaluation of Project Last Mile (PLM), a national technical support partner for CCMDD since 2016. From March 2016 through October 2019, cumulative weekly data on CCMDD uptake [patients enrolled, facilities registered, pick-up points contracted], type of medication collected [ART only; NCD only; and ART-NCD] and of collection site used [external pick-up points; adherence/outreach clubs; or facility-based fast lanes], were extracted for descriptive, longitudinal analysis.Results: As of October 2019, 3,436 health facilities were registered with CCMDD across 46 health districts (88% national coverage), and 2,037 external pick-up points had been established. A total of 2,069,039 patients were active on CCMDD, a significant increase since 2018 (p<0.001), including 76% collecting ART [64% ART only, 12% ART plus NCD/comorbidities] and 479,120 [24%] collecting for chronic diseases only. Further, 734,005 (35%) of patients were collecting from external pick-up points, a 73% increase in patient volume from 2018.Discussion: This longitudinal description of CCMDD provides an example of a path to national scale for a differentiated service delivery model that integrates management of HIV and noncommunicable diseases. This study demonstrates the success of the program in engaging patients who are not living with HIV, which bodes well for the potential of the program to address the rising burden of NCDs in South Africa.Conclusion: The results signal potential for expansion in resource-limited settings, particularly in the context of private sector strategic support.
Mutations in Frizzled Class Receptor 4 Associated With Congenital Cavus Foot Deformity
Authors: Yan Wenjin , Mao Haijun , Xu Xingquan , Zheng Liming , Yu Pengjun , Dai Jin , Xu Guangyue , Jiang Qing , Yang Yannick 
Published: January 2021

Abstract
BackgroundCongenital cavus foot deformity (CFD) (congenital =present at birth) is a disease very disabling that could connected to the mobility, neurologic entities and the imbalance of synergistic intrinsic and extrinsic muscles of the patients, and the problem is even dynamic (often progressive). Here, we report the clinical and radiographic manifestations of one Chinese Han congenital CFD family and 23 congenital CFD patients. In the congenital CFD family, the proband’s mother and brother are also CFD patients. ResultsWe performed whole-exome sequencing for three patients and two healthy people in this family, and sequenced the Frizzled Class Receptor 4 (FZD4) for the other. One novel FZD4 mutation (exon2 c.1589G>A; p.G530E, NM_012193) was identiﬁed. Then mutations in FZD4 gene were further examined in 23 congenital CFD patients, and also find FZD4 mutation (FZD4:NM_012193:exon1:c.205C>T:p.H69Y) in one congenital CFD patient. ConclusionsOur study suggested that the congenital cavus foot deformity might be associated with the identified mutations in FZD4.
The Relationship between Chinese Outpatients’ Characteristics and Healthcare-Seeking Behavioral Decision-Making: Decision Tree and Linear Regression Analyses Based on Survey Data in Jiaxing
Authors: Yu Mingming , Yang Zan 
Published: January 2021

Abstract
Background Chinese patients generally experience difficulties and high costs when obtaining medical services. One consensus reason for these difficulties is imbalances in hospitals’ medical standards and resources, which cannot be changed in the short term. This article explores the most perplexing healthcare-seeking problems in China by considering the laws pertaining to how different patients may see a doctor. Methods Data mining and analysis can characterize a person and explore the heuristics underlying his or her decisions using a combination of comprehensive feature data. Accordingly, a questionnaire was designed that probed numerous variables of relevance to decision-making and we analyzed the survey data using a decision tree and linear regression. The decision tree facilitated observation of the healthcare-seeking decision-making routes of different patients. In addition, linear regression analysis revealed that patients tended to choose different hospitals with different features.Results This article primarily argues that in China, having medical insurance and a profession that represents economic strength and social class are the most important factors that guide the outpatient's patterns of seeing a doctor. Further, outpatients who live far from hospitals and recognize they have a serious disease would choose different hospitals than those on the contrary. Conclusion Using a decision tree and line regression, we drew the portraits and decision-making routes behind various outpatients’ characteristics when he or she saw a doctor. It provides direction about the type and location about future hospital construction in this area, and it addresses how to avoid overcrowding at large hospitals and how to provide enhanced possibilities for diversion to smaller hospitals.
Medium and High Fidelity Simulations in Training Undergraduate Nursing and Operating Room Students. Are They Effective?
Authors: Yazdanpanah Farideh , Dehghan Azizallah , Bazrafkan Leila 
Published: January 2021

Abstract
Background: Simulators-Based Education is any type of educational activity that uses simulation of clinical scenarios to increase students’ awareness and skills. Simulation environments are able to create a place for students to expand their competencies in specialized skills without posing a risk to patients. In simulation, an attempt is made to bring the learning conditions so close to the real conditions, so that the learned concepts can be transferred to the real world.Methods: This is a quasi-experimental study. The statistical populations of the study were nursing and operating room (OR) students of Larestan University of Medical Sciences who were selected using census method. A total of 192 students participated in this study, which 96 students were in the control group and 96 students were in the experimental group. At the beginning of the study, students of both groups participated in the pre-test. In this study low-fidelity simulation was used to train control group, and in the experimental group training, medium- and high-fidelity simulation were applied. The post-test was performed after completion of the training program of both groups. 4 instruments were used for data collection. The data were analyzed using SPSS software (version 20.0). Results: The results of this study showed that students in the experimental group scored significantly higher in knowledge domain compare to control group students, and also performed better in the objective structured clinical examination (OSCE) (P<0.001). Also, this study showed that the average total score of students’ attitudes towards the role of simulators in the experimental group is higher than the control group. Statistical relationship was significant in some factors such as “patients’ safety (P= 0.014)”, “increasing the student's self-confidence (P= 0.041)”, “connecting the topics taught in the theoretical units (P= 0.024)”. Also, statistical relationship was meaningful in training with low-fidelity models which stated “it was not a reliable learning experience (P= 0.004)”.Conclusions: Simulation is an effective method for better teaching­-learning that can increase knowledge, improve clinical competence, feel more confident and integrate knowledge in a safe and controlled environment.
Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial
Authors: Jiang Lulu , Wu Yujuan , Zhang Yang , Lu Dahao , Yan Keshi , Gao Ju 
Published: January 2021

Abstract
Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable. Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.
Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach
Authors: Ma Chao , Zhao Jiaju , Zhang Yong , Yi Nan , Zhou Jupu , Zuo Zhicheng , Jiang Bo 
Published: January 2021

Abstract
The purpose of this study was to assess the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) for the treatment of displaced intra-articular calcaneal fractures. In a retrospective design, 108 patients (117 feet) with Sanders II~IV calcaneal fractures were enrolled in this study, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The postoperative functional and radiological results showed that the average AOFAS scores and VAS scores of the MSTA group were higher than that of the ELA group (p<0.05). After surgery, the Bohler Angle, Gissane Angle, and the length, width, and height of the calcaneus were significantly improved in the MSTA group and the ELA group, but there were no statistically significant differences between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (p<0.000). In conclusion, the MSTA was able to achieve similar effects of anatomical reconstruction and function recovery as the ELA, while also effectively reducing the incidences of wound healing complications and postoperative sural nerve injury and shortening the length of hospital stay.
Comparative therapeutic effectiveness of probiotic and combinations of Probiotic with prebiotics and probiotic with rumenotorics in experimentally induced ruminal acidosis sheep
Authors: Fenta Melkie Dagnaw , Jemberu Wudu temesgen , G/mariam Ashenafi Assefa , Mebratu Atsede solomon 
Published: January 2021

Abstract
Backgroundrumen disorder is responsible for huge economic losses in ruminants due to decrease in production and increase in expenditure towards treatment. Acidosis is one of the most ruminal disorders, characterized by changes in the rumen environment and leds to systemic acidosis. To correct this disorder, recent alternative trends in sheep rearing have led to the use of prebiotics, rumenotorics and probiotics as feed additives or treatment.Context and purposethis study was to evaluate and compares the therapeutic effectiveness of probiotics, a combination of probiotics with prebiotics, probiotics with rumenotorics and with the standard treatment under experimentally induced acidosis.Methodsthe experimental study design was conducted from September to May 2019. For therapeutic study 25 sheep were randomly divided into 5 groups with deliberately imposed ruminal acidosis as a group comprising of 5 animals each.Resultsacidosis was induced by an oral dose of 50 g/kg with wheat flour after 24-hour fasting. Four therapeutic regimes and negative control group were employed, I-Probiotics, II-Probiotics with Prebiotics, III-Probiotics with Rumenotorics and IV-Standard treatment (sodium bicarbonate) was adopted. Then, laboratory analysis of rumen fluid, physical parameters and hematological changes before and after treatment was carried out. From a comparison of each treatment groups with the control group to correct ruminal pH, the combination of probiotics with rumenotorics, the mean ± SD before treatment (4.96 ± .837) increased to (5.92 ± .54), (6.30 ± .41), (6.75 ± 0.34) after treatment, was statistically significant (p < 0.05, 0.024, 0.047, 0.002), from day one-day three, respectively, and the therapeutic regimens of probiotics with rumenotorics was highly significance compare with control group (p < 0.05, p = 0.001 & p = 0.000) improved heart rate and respiratory rate at day three after treatment and the mean PCV value of treatment Group III was 38.00 ± 6.819 before treatment changed to 34.60 ± 5.367, 29.80 ± 6.261 and 24.80 ± 10.134 after treatment, were statistically significance (p < 0.05, p = 0.003, p = 0.02 &0.006) from day one-day three, respectively.Conclusionthe present study was concluded that probiotics with rumenotorics administered together were the most successful therapeutic regimen for improvement of ruminal acidosis. Therefore, in this experimental study for the treatment of acidosis, it has been recommended that use of probiotics with substrate is the promising alternative.
Gene Expression Profiles During Tissue Remodeling Following Bladder Outlet Obstruction
Authors: Ito Saya , Nomura Takeshi , Ueda Takashi , Inui Shogo , Morioka Yukako , Honjo Hisashi , Fukui Ayako , Fujihara Atsuko , Hongo Fumiya , Ukimura Osamu 
Published: January 2021

Abstract
Bladder outlet obstruction (BOO) often results in lower urinary tract symptoms (LUTSs) and negatively affects quality of life. Here, we evaluated gene expression patterns in the urinary bladder during tissue remodeling due to BOO. We divided BOO model rats into two groups according to the degree of hypertrophy of smooth muscle and hypoxia-inducible factor 1α (HIF1α) mRNA levels in the bladder. The strong muscular hypertrophy group, which exhibited markedly increased HIF1α mRNA levels and bladder smooth muscle proportion compared with the control group, was considered a model for the termination of hypertrophy, whereas the mild muscular hypertrophy group was considered a model of the initiation of hypertrophy. Some genes related to urinary function showed different expression patterns between the two groups. Furthermore, we found that several genes, including D-box binding PAR bZIP transcription factor (DBP), were upregulated only in the mild muscular hypertrophy group. DBP expression was increased in urinary bladder cells in response to hypoxic stress and induced the upregulation of some genes involved in urinary function. These findings suggested that the regulatory systems of gene expression were altered during tissue remodeling following BOO. Furthermore, circadian rhythms may be involved in urinary function via regulation of gene expression following hypoxic stress.
Dynamics of Contagion and Submerged Infections During the Second Wave of&nbsp;The SARS-CoV-2 Epidemic in the Italian Regions
Authors: Cereda Giulia , Viscardi Cecilia , Gherardini Luca , Mealli Fabrizia , Baccini Michela 
Published: January 2021

Abstract
After the SARS-CoV-2 outbreak in spring 2020, Italy faced a second epidemic wave in autumn. Using a SIRD model calibrated on COVID19-related deaths, we describe the regional epidemic dynamics from August to November 2020. We explore the time-varying reproductive number, R0(t), and quantify the number of infections, included their submerged portion, under different infection fatality rate scenarios. Results indicate that during the second epidemic wave, R0(t) changed over time heterogeneously across regions, with some important common elements including a mid-October peak and a decline during November, which suggest the possible role in inflating or deflating the contagion rate of specific events (e.g. schools reopening, regional elections) and of the restrictions imposed at the national and local level to reduce the infection spread. Despite the decline of R0(t) in most regions, the prevalence of circulating infections estimated at the end of the study period was not negligible, in particular in the North of the country. This suggests that even small increases of R0(t) in December may lead in a short time to unsustainable levels of contagion spread, depending on the regional supply of hospital and ICU beds and healthcare services throughout the territory.