bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Study of the C5-C8 Cervical Extraforaminal Ligaments
Authors: Zhao Qinghao , Yang Yemei , Wu Penghuan , Huang Chengyan , Zhang Rusen , Li Qingchu , Shi Benchao 
Published: September 2020

Abstract
Background:The anatomical distribution of the extraforaminal ligaments in the cervical intervertebral foramina has been well studied. However, detailed descriptions of the biomechanical characteristics of these ligaments are lacking.Methods: The paravertebral muscles were dissected, and the extraforaminal ligaments and nerve roots were identified. The C5 and C7 or C6 and C8 cervical nerve roots on both sides were randomly selected, and a window was opened on the vertebral lamina to expose the posterior spinal nerve root segments. Five needles were placed on the nerve root and the bone structure around the intervertebral foramen; the distal end of the nerve root was then tied with silk thread, and the weights were connected across the pulley. A weight load was gradually applied to the nerve root (50 g/ time, 60 times in total). At the end of the experiment, segments of the extraforaminal ligaments were selectively cut off to compare the changes in nerve root displacement.Results: The displacement of the C5, C6, C7, C8 nerve roots increases with an increasing traction load, and the rate of change of nerve root displacement in the intervertebral foramen is smaller than that in the nerve root on the outside area (p <0.05). Extraforaminal ligaments can absorb part of the pulling load of the nerve root; the C5 nerve root has the largest load range.Conclusions: Cervical extraforaminal ligaments can disperse the tension load on the nerve root and play a role in protecting the nerve root. The protective effect of the C5 nerve root was the strongest, and this may anatomically explain why the C5 nerve roots are less prone to simple avulsion.
Implementation of An Outdoor Smoke-Free Policy at Sports Clubs: Critical Situations and Factors Influencing Implementation
Authors: Garritsen Heike H , Rozema Andrea D , Goor Ien AM van de , Kunst Anton E 
Published: September 2020

Abstract
Background: Outdoor smoke-free policies (SFPs) at sports clubs have significant potential in reducing adolescent smoking. However, the actual occurrence of such effects may be strongly dependent on how these policies are implemented in practice. The aim of this study is to identify to what extent outdoor SFPs at sports clubs are implemented in practice and which factors contribute to successful implementation.Methods: Semi-structured interviews were held with 46 key stakeholders at 8 Dutch sports clubs (i.e., field hockey, soccer, tennis, korfball) with an outdoor SFP. A thematic approach was used for analysis of the transcripts. Results: Overall, the implementation of an outdoor SFP at sports clubs appears to be successful. The SFP is often enforced, smokers react positively when they are approached, the SFP has led to less (visible) smokers at the venue, and a nonsmoking norm is reinforced. However, we identified three ‘critical situations’ in which implementation is less than optimal: 1) when children are not present at the sports club, 2) when alcohol is involved, and 3) when smokers relocate at the entrance of the sports club. Several factors influenced implementation in those critical situations: 1) factors related to individual smokers and club members (i.e., support, communication towards smokers), 2) factors related to the SFP itself (i.e., clarity of the policy), 3) factors related to the sports club (i.e., communication of the policy, characteristics of the sports club), and 4) factors related to the wider community (i.e., change of social norm with regard to smoking, support from local and national organizations).Conclusions: Successful implementation of an outdoor SFP at sports clubs is feasible since support is high and experiences are mainly positive. Nevertheless, some situations represent challenges to compliance and enforcement. We identified a number of factors through which sports clubs may foster effectively implementation of an outdoor SFP at their clubs.
Metabolic Syndrome Among Children and Adolescents in Low and Middle Income Countries: A Systematic Review and Meta-analysis
Authors: Bitew Zebenay Workneh , Alemu Ayinalem , Ayele Ermias Getaneh , Tenaw Zelalem , Alebel Anmut , Worku Teshager 
Published: September 2020

Abstract
Background: Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is raising the low and middle income countries (LMICs). There are various studies with inconsistent findings, but they are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs. Methods: Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger’s regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies. Result: In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among the overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females. Conclusion: This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem.
Intestinal Absorption Mechanisms of Five Flavonoids from Malus hupehensis (Pamp.) Rehd. Extracts in Situ Single-Pass Intestinal Perfusion and in Vitro Caco-2 Cell Model
Authors: Yang Hui , Tang Zhishu , Cheng Jiangxue , Wang Jing , Zou Junbo , Zhang Xiaofei , Shi Yajun , Guo Dongyan 
Published: September 2020

Abstract
Background: Previous studies have shown that Malus hupehensis (Pamp.) Rehd. extracts have anti-oxidant, anti-aging and other effects, its bioavailability is low, however its absorption mechanism is still unclear. To investigate the absorption properties of hyperin, quercitrin, phloridzin, quercetin, and phloretin in total flavonoids of Malus hupehensis (Pamp.) Rehd. Extracts. Methods: In situ single-pass intestinal perfusion model and in vitro Caco-2 cell model were used in this study. The effects of concentration of the extract, administration time, temperature, different intestinal segments, paracellular pathway were analyzed, and the effect of efflux inhibitors, such as the P-gp inhibitor verapamil, the multidrug resistance protein2 (MRP2) inhibitor indomethacin, the breast cancer resistance protein (BCRP) inhibitor reserpine, on the transport were evaluated. As well as EDTA, a tight junction regulator, was studied.Results: The results indicated that the jejunum was the optimal absorption intestine segment of quercitrin, phloridzin, and phloretin. And the greatest absorption intestine segment of quercetin was ileum. Furthermore, it was found that the absorption mechanisms of phloridzin in extract was involved in passive diffusion and the mediation of P-gp and MRP2 should not be neglected. The absorption mechanisms of quercetin and phloretin from extract involved active transport and were accompanied by the participation of efflux transporters, such as P-gp, MRP2 and BCRP. And also the paracellular pathway was involved in hyperin and quercitrin. Conclusion: The absorption mechanisms of five flavonoids from Malus hupehensis (Pamp.) Rehd. extract are related to the concentration of the drugs, intestinal segments, and efflux protein.
Preoperative Plasma Fibrinogen: An Independent Predictor for Survival in Adult Patients with Xp11.2 Translocation Renal Cell Carcinoma
Authors: Dong Jie , Xu Weifeng , Ji Zhigang , Pan Boju 
Published: September 2020

Abstract
Background. Xp11.2 translocation renal cell carcinoma, a rare malignancy, is more common in children than in adults. It manifests with an aggressive course in adults and relatively indolent in children. Prognostic studies for adult patients are scare for the rarity of the disease; and the prognostic value of preoperative plasma fibrinogen awaits further illumination.Methods. This retrospective single-center study enrolled 24 consecutive newly diagnosed Xp11.2 translocation RCC adult patients. Clinical presentations, baseline laboratory results and follow-up data were collected. Possible risk factors for progression free survival and overall survival were first scanned with chi-square tests and t-tests to compare patients who suffered from progression or death and who did not. Multivariate Cox regression was further utilized to identify independent risk factors.Results. Twenty-four adult patients (median age 32, range 16-73), with a male-to-female ratio of 1:1, was included from 2010.4 to 2020.3. After a mean follow-up of 35.7months, seven patients died. With univariate analysis, higher C-reactive protein-to-albumin ratio (p=0.028), higher baseline fibrinogen (p=0.006), and presence of distant metastasis (p=0.007) were associated with progression of disease; higher preoperative fibrinogen (p=0.014) and distant metastasis (p=0.020) were associated with death. With multivariate Cox regression, only baseline fibrinogen level (p=0.001) was identified as an independent risk factor for progression free survival; meanwhile, fibrinogen level (p=0.048) and distant metastasis (p=0.043) were identified as independent risk factors for survival.Conclusions. Preoperative plasma fibrinogen, a routinely tested parameter before surgery, is a promising tool for risk stratification in adult patients with Xp11.2 translocation renal cell carcinoma.JIE et al: Preoperative plasma fibrinogen predicts outcome in Xp11.2 translocation RCC
The Prognostic Value of the SOFA Score in Patients with COVID-19: A Retrospective, Observational Study
Authors: Yang Zheng , Hu Qinming , Huang Fei , Xiong Shouxin , Sun Yi 
Published: September 2020

Abstract
Background: Patients with Coronavirus disease 2019 (COVID-19) have a high mortality rate, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients.Methods: Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan-Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated.Results: The median SOFA score of all patients was 2 (IQR, 1-3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 [3 (IQR, 2-4) vs 1 (IQR, 0-1); P<0.001]. The SOFA score increased the risk of severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044-11.245; P<0.001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 [cutoff value = 2; AUC = 0.908 (95% CI: 0.857-0.960); sensitivity: 85.20%; specificity: 80.40%] and the risk of death in COVID-19 patients [cutoff value = 5; AUC = 0.995 (95% CI: 0.985-1.000); sensitivity: 100.00%; specificity: 95.40%]. Regarding the 60-day mortality rates of patients in the two groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score <5).Conclusion: The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.
Acceptability and Appropriateness of a Novel Parent-Staff Co-Leadership Model for Childhood Obesity Prevention in Head Start: A Qualitative Interview Study
Authors: Beckerman-Hsu Jacob Philip , Gago Cristina , Aftosmes-Tobio Alyssa , Jurkowski Janine M , Lansburg Kindra , Leonard Jessie , Torrico Merieka , Haneuse Sebastien , Subramanian SV , Kenney Erika L , Davison Kirsten K 
Published: September 2020

Abstract
Background: Peer leadership can be an effective strategy for implementing health programs, benefiting both program participants and peer leaders. To realize such benefits, the peer leader role must be appropriate for the community context. Also, peer leaders must find their role acceptable (i.e., satisfactory) to ensure their successful recruitment and retention. To date, parent peer leaders have seldom been part of early childhood obesity prevention efforts. Moreover, parents at Head Start preschools have rarely been engaged as peer leaders. The aim of this study is to evaluate the appropriateness and acceptability of an innovative model for engaging parents as peer leaders for this novel content area (early childhood obesity prevention) and setting (Head Start).Methods: Parents Connect for Healthy Living (PConnect) is a 10-session parent program being implemented in Head Start preschools as part of the Communities for Healthy Living early childhood obesity prevention trial. PConnect is co-led by a parent peer facilitator who is paired with a Head Start staff facilitator. In the spring of 2019, 10 PConnect facilitators participated in a semi-structured interview about their experience. Interview transcripts were analyzed by two coders using an inductive-deductive hybrid analysis. Themes were identified and member-checked with two interviewees.Results: Acceptability was high because PConnect facilitators were able to learn and teach, establish meaningful relationships, and positively impact the parents participating in their groups, although facilitators did express frustration when low attendance limited their reach. Appropriateness was also high, as PConnect provided adequate structure and support without being overly rigid, and facilitators were able to overcome most challenges they encountered.Conclusions: The PConnect co-facilitation model was highly acceptable and appropriate for both the parent facilitators (peer leaders) and the staff facilitators. Including parents as peer leaders aligns to Head Start’s emphasis on parent engagement, making it a strong candidate for sustained implementation in Head Start. The insights gained about the drivers of peer leadership appropriateness and acceptability in this particular context may be used to inform the design and implementation of peer-led health programs elsewhere.
Evaluation of carbapenem-resistant Enterobacteriaceae (CRE) Guideline Implementation in the Veteran’s Affairs Medical Centers Using the Consolidated Framework for Implementation Research
Authors: Goedken Cassie Cunningham , Guihan Marylou , Brown Charnetta R. , Ramanathan Swetha , Vivo Amanda , Suda Katie J. , Fitzpatrick Margaret A. , Poggensee Linda , Perencevich Eli N. , Rubin Michael , Reisinger Heather Schacht , Evans Martin , Evans Charlesnika T. 
Published: September 2020

Abstract
Background: Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing (CP) CRE are difficult to treat, resulting in high mortality in healthcare settings every year. The Veteran’s Health Administration (VHA) disseminated guidelines in 2015 and an updated directive in 2017 for control of CRE focused on laboratory testing, prevention, and management. The Consolidated Framework for Implementation Research (CFIR) framework was used to examine contextual factors and identify best practices influencing implementation of the 2015 guidelines/2017 directive in VA Medical Centers (VAMCs).Methods: Qualitative interviews were conducted at 29 VAMCs with staff involved in implementing CRE guidelines at their facility. Survey and VHA administrative data were used to identify geographically representative large and small VAMCs with varying levels of CRE incidence. Interviews addressed perceptions of guideline dissemination, laboratory testing, staff attitudes and training, patient education, and technology support. Participant responses were coded using a consensus-based mixed deductive-inductive approach guided by CFIR. A quantitative analysis comparing CFIR constructs and emergent codes to sites actively screening for CRE (vs. non-screening) and any (vs. no) CRE positive cultures was conducted with a Fisher’s exact test.Results: Forty-three semi-structured interviews were conducted between 10/2017-8/2018 with laboratory staff (47%), Multi-Drug Resistant Organism Program Coordinators (MPCs, 35%), infection preventionists (12%), and physicians (6%). Participants cited the need for more standardized tools to promote effective communication (e.g., electronic screening). Participants also indicated that CRE-specific educational materials were needed for staff, patient, and family members. Quantitative analysis identified the following CFIR constructs as being significantly associated with CRE screening or presence of CRE: Leadership Engagement, Relative Priority Available Resources, Team Communication, and Access to Knowledge & Information. Conclusions: Effective CRE identification, prevention and treatment requires ongoing collaboration between clinical, microbiology, infection prevention, antimicrobial stewardship, and infectious diseases specialists. Our results emphasize the importance of leadership’s role in promoting positive facility culture, including increasing healthcare worker’s awareness of infection control and prevention for emerging pathogens, access to resources, improving communication and facilitating successful implementation of the CRE guidelines.
Aptamer-Functionalized Dendrimer Delivery lncRNA MEG3 Enhances Castration-Resistant Prostate Cancer Gene Therapy
Authors: Tai Zongguang , Ma Jinyuan , Ding Jianing , Pan Huijun , Chai Rongrong , Zhu Congcong , Cui Zhen , Chen Zhongjian , Zhu Quangang 
Published: September 2020

Abstract
Androgen castration therapy is an effective treatment method for prostate cancer patients who cannot be completely cured by surgery. However, drug resistance often leads to treatment failure and poor prognosis. For castration-resistant prostate cancer (CRPC), some new treatment methods have been gradually put into clinical validation or use. Considering the side effects of traditional treatment, gene therapy has been applied in recent studies to combat prostate cancer (PCa). A 19-nt RNA aptamer, termed as EpDT3, is endocytosed when bound to epithelial cell adhesion molecule EpCAM-overexpressing cells, including various types of prostate cancer cells. Therefore, poly (amidoamine) dendrimer (PAMAM) conjugated with EpDT3 on the surface was developed for gene delivery targeting the CRPC. Moreover, the PAMAM-PEG-EpDT3 vehicles were accumulated in CRPC cells. The CRPC-inhibitory effect of PAMAM modified with EpDT3 was significantly higher than that of the unmodified construct when loading the plasmid that encodes long noncoding (lnc) RNA MEG3 (pMEG3). In summary, the above results suggested that PAMAM-PEG-EpDT3/pMEG3 nanoparticles (NPs) have great potential for enhancing CRPC gene therapy.
Comparison of Characteristics and Outcome in Asymptomatic COVID-19 Patients Before and After Hospitalization in Korea
Authors: Hyun Miri , Lee Ji Yeon , Park Jae Suck , Kim Hyun Ah 
Published: September 2020

Abstract
Background: The progression of coronavirus disease-2019 (COVID-19) is less well-studied in asymptomatic patients. The study aimed to understand the clinical characteristics of asymptomatic COVID-19 patients at the time of admission and follow-up their occurrence of symptoms during hospitalization.Methods: Patients were divided into two groups—those with no symptoms until discharge (group A) and those who had symptoms that developed during hospitalization (group B). Baseline and clinical characteristics were retrospectively measured, and logistic regression analysis was performed to identify risk factors for deterioration during hospital stay.Results: Overall, 223 patients were enrolled in the study, including 42 and 181 patients in groups A and B, respectively. Patients were older in group B than in group A. They developed cough as the most common symptom. Abnormal initial chest X-ray (CXR) and higher levels of C-reactive protein were frequently observed in group B than in group A. Moreover, 5 patients required mechanical support, including hi-flow nasal cannular and mechanical ventilation in group B. Five patients were transferred to tertiary hospitals owing to deterioration, and 4 patients succumbed to COVID-19. The risk factors for deterioration were age over 75 years, diabetes mellitus, and C-reactive protein > 1.Conclusions: Even when the patients have no symptoms at admission, we recommend close monitoring of symptoms during hospital stay in patients who present with risk factors at the time of admission.