bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thromboembolic, cardiovascular and overall mortality risks of aromatase inhibitors, compared with tamoxifen treatment: an outpatient-register-based retrospective cohort study
Authors: Pineda-Moncusí Marta , Garcia-Giralt Natalia , Diez-Perez Adolfo , Tusquets Ignasi , Servitja Sonia , Albanell Joan , Prieto-Alhambra Daniel , Nogués Xavier 
Published: March 2020

Background: Tamoxifen (TAM) and aromatase inhibitor (AI) therapies have been associated with increased risk of thromboembolic and cardiovascular events, respectively, in addition to other side effects. This study analysed the risk of these events and the overall survival (OS) benefit in breast cancer patients treated with AI, compared with TAM-treated patients, in a large population-based cohort. Methods: This observational cohort study included women diagnosed with breast cancer and treated with TAM or AI. Data were extracted from primary care records in a population database (SIDIAP, System for the Development of Research in Primary Care). Incidence rates of study outcomes are reported. Survival analyses included Kaplan–Meier estimation and Cox proportional hazards models. Sensitivity analysis was carried out, using Fine and Gray models to account for competing risk of death. Confounding was minimized using propensity score adjustment and inverse probability weighting (IPW) adjustment. Results: Data from 3082 postmenopausal women treated with TAM, and 18,455 treated with AI, were available. Adjusted hazard ratios (HRs) [95% confidence interval (CI)] for AI users, compared with TAM group, were 0.93 (95%CI 0.69–1.26) for thromboembolic events (TEEs); 1.13 (95%CI 0.79–1.63) for cardiovascular events, and 0.76 (95%CI 0.70–0.82) for mortality. Additional analyses using competing risk analysis had similar results, while IPW adjustment showed a potential risk of pulmonary embolism (PE) [2.26 (95%CI 1.02–4.97)] in AI-treated patients. Conclusions: AI users had >20% lower all-cause mortality compared with TAM users, without increasing risk to experience cardiovascular and TEEs. This would locate AI therapy on the first line in clinical practice. Thus, AI might be the most preferable option in adjuvant hormonal therapy choice.
Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders
Authors: Ransby Thea Birch , Hansen Alice Ørts , Rolving Nanna 
Published: March 2020

Introduction Assessment of Motor and Process Skills (AMPS) has been proven to be a suitable measurement tool for assessing performance-based ADL ability; however, its reliability and validity have not been tested on patients with hand-related disorders. Methods Patients referred for outpatient hand rehabilitation were assessed with AMPS, The Canadian Occupational Performance Measure (COPM), dynamometer and goniometer at baseline and after eight weeks of hand therapy. Construct validity and responsiveness of AMPS were assessed by hypothesis testing. Construct validity was assessed by correlating the baseline score of AMPS with the baseline score of the other measurement tools. Responsiveness was assessed by correlating the change scores of each measurement tool with a Global Rating Scale. Results Fifty-one patients were recruited. The construct validity of AMPS indicated that the various measurement tools captured different aspects to functioning from the AMPS, as the correlations between AMPS and the other measurement tools were generally weak to low (r < 0.25 to 0.49). AMPS was less responsive than COPM when correlated with the GRS. The correlation between COPM and GRS was r = 0.62 compared with the AMPS motor, r = 0.45 and AMPS process, r = 0.33. Relative responsiveness of AMPS is similar to that of the dynamometer (r = 0.39) and goniometer (r = –0.34). Discussion In a sample of 51 patients, this study found that the construct validity of AMPS seemed to be moderate, while the responsiveness of AMPS seemed to be poor. However, due to the small sample size no conclusions can be made, and should be further assessed in larger studies.
Quality Indicators for the Diagnosis and Management of Acute Bacterial Rhinosinusitis
Authors: Cottrell Justin , Yip Jonathan , Chan Yvonne , Chin Christopher J , Damji Ali , de Almeida John R. , Desrosiers Martin , Eskander Antoine , Janjua Arif , Kilty Shaun , Lee John M. , Macdonald Kristian I. , Meen Eric K. , Rudmik Luke , Sommer Doron D. , Sowerby Leigh , Tewfik Marc A. , Thamboo Andrew , Vescan Allan D. , Witterick Ian J. , Wright Erin , Monteiro Eric 
Published: March 2020

Background Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease that is treated by a variety of specialties, including but not limited to, family physicians, emergency physicians, otolaryngology—head and neck surgeons, infectious disease specialists, and allergy and immunologists. Unfortunately, despite high-quality guidelines, variable and substandard care continues to be demonstrated in the treatment of ABRS. Objective This study aimed to develop ABRS-specific quality indicators (QIs) to evaluate the diagnosis and management that reduces symptoms, improves quality of life, and prevents complications. Methods A guideline-based approach, proposed by Kötter et al., was used to develop QIs for ABRS. Candidate indicators (CIs) were extracted from 4 guiding documents and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND/University of California at Los Angeles appropriateness methodology. Results Twenty-nine CIs were identified after literature review and evaluated by our panel. Of these, 5 CIs reached consensus as being appropriate QIs, with 1 requiring additional discussion. After a second round of evaluations, the panel selected 7 QIs as appropriate measures of high-quality care. Conclusion This study proposes 7 QIs for the diagnosis and management of patients with ABRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay for performance initiatives.
Effects of Ursolic Acid on the Expression of Th1–Th2-related Cytokines in a Rat Model of Allergic Rhinitis After PM2.5 Exposure
Authors: Sun Na , Han Zhijin , Wang Hong , Guo Zhiqiang , Deng Congrui , Dong Weiyang , Zhuang Guoshun , Zhang Ruxin 
Published: March 2020

Background Allergic rhinitis (AR) is a global health problem and closely related to environmental factors. Ursolic acid (UA) has potential in the treatment of allergic inflammation. The effects of UA intervention on PM2.5-induced AR remain uncertain. Objective To assess the effects of UA on nasal symptoms and the expression of T-helper (Th)1–Th2-related cytokines in a rat model of AR after fine particulate matter (particulate matter ≤ 2.5 µm [PM2.5]) exposure. Methods A total of 40 healthy female Sprague-Dawley rats were randomly divided into 4 groups: normal control group (NC group), ovalbumin (OVA)- induced AR model (AR group), PM2.5-exposed AR group exposed to 200 g/m3 PM2.5 for 30 days via inhalation (ARE group), and a group with UA intervention to the AR model after PM2.5 exposure (UA group). UA intervention was adopted after PM2.5 exposure in the UA group. Nasal symptoms and levels of Th1–Th2 cytokines in the serum were detected in each individual rat. The pathological changes and expression of Eotaxin in the nasal mucosa of each individual rat were examined by histology. Results PM2.5 significantly increased the number of sneezes and nasal rubs in the rats with AR, and UA alleviated these symptoms. UA decreased interleukin (IL)-4, IL-5, IL-13, Eotaxin-1, and OVA Immunoglobulin E (IgE) protein levels. In the AR group, hematoxylin and eosin staining showed disordered arrangement of the nasal mucosa epithelium, cell shedding, eosinophilic infiltration, swelling of the glands, and submucosal vascular congestion. UA group showed reduced eosinophilic infiltration and orderly arrangement of the mucosal epithelium when compared with the ARE group. Immunohistochemical results showed that the expression of Eotaxin in the UA group was lower than that in the ARE group. Conclusion UA could relieve nasal symptoms caused by PM2.5 exposure, the possible mechanism of which is to inhibit the expression of Th2 cytokines, eosinophilic infiltration, and specific IgE production.
Investigating Equity-Minded Migrant Education Policies in Shanghai From Migrant Parents’ Perspectives
Authors: Li Dongmei 
Published: March 2020

Purpose: This article aims to explore how suburban public schools in Shanghai of China have implemented the top-down equity-minded migrant policies of free compulsory education and equal access to public education. Design/Approach/Methods: This qualitative study focuses on public schools in the suburb of Shanghai, one of the top migrant-receiving metropolitan cities in China. Using personal network, referral, snowballing, and “guerrilla interviewing,” the researcher recruited 13 migrant parents that represent 11 cities of 9 provinces and collected interview data between early January and late June of 2015. Data sources include 10 face-to-face interviews, 3 telephone interviews, 6 follow-up interviews, and supplementary policy documents. Findings: It finds that local public schools have fully implemented free compulsory education, but have not supported equal access, revealing an inconsistent and arbitrary policy enactment pattern. Although all the interviewees have worked and lived in Shanghai for an average of 10 years, only those that afford a real property, receive exceptions, or have personal connections can have children enrolled in public schools. Further, parents’ perceptions of the policy implementation vary across cases with most of them not demonstrating an awareness of education equality. Originality/Value: This study synthesizes stories shared by migrant parents and reports an interesting policy implementation pattern. It contributes to the field of migrant education study and confirms that top-down equity-minded reform is likely to encounter challenges.
Are Confucius Institutes Building Blocks or Stumbling Blocks for Foreign Students in China: An Empirical Study of 190 Countries (1999–2015)
Authors: Chen Dongyang , Ha Wei 
Published: March 2020

Purpose: This study investigates the impact of Confucius Institutes on China’s international education initiatives. First, it examines whether the establishment of Confucius Institutes has a gravitational effect on the scale of foreign students coming to China. Second, it discerns whether there are any association between the establishment of Confucius Institutes and the attributes of foreign students based on the type of program they select. Third, it identifies whether there are any differences in the impact of Confucius Institutes based on constraints such as the number of foreign students, income levels, cultural distance, and geographical endowment. Design/Approach/Methods: Based on the trade gravity model and the push–pull theory, we estimated a two-way fixed-effects model using panel data of all source countries from 1999 to 2015. Findings: Results show that Confucius Institutes have helped China attract more foreign students on Chinese government scholarships, with each Institute increasing such enrolment by 1.3%. However, Confucius Institutes have resulted in a drop in the total number of foreign students studying in China, especially nondegree students. This substitution effect means that the Institutes actually help China improve the composition of its foreign students. Further heterogeneity analysis shows that the substitution effect is primarily driven by the main source countries. Accordingly, this study suggests that China should establish more Confucius Institutes in Africa and Eastern Europe to maximize the catalyzing effect of Confucius Institutes. Originality/Value: In contrast to previous studies on foreign scholarship in China, this study examines all 190 source countries from 1999 to 2015. This comprehensive study also explores the heterogeneous effects of foreign students on trade across economic, cultural, and geographical domains.
Intravenous Iron May Improve Outcomes in Elderly Patients With Operative Hip Fractures
Authors: Engel Jamie L. , Gabra Joseph N. , Kane Patrick , Kurtz William J. 
Published: March 2020

Introduction: Hip fractures are common injuries with high morbidity and mortality rates. These patients often become anemic and require allogenic blood transfusion. Transfusions are costly with potential complications. This study examines the effect of intravenous (IV) iron on patients with hip fractures, undergoing surgery within 48 hours, and being treated with a highly restrictive transfusion protocol. Materials and Methods: A retrospective chart review performed on patients admitted to a level 1 tertiary care center with fractures of the proximal femur from December 2015 to December 2017 included 239 patients. Patients who received 300 mg of IV iron when their hemoglobin fell below 11 g/dL were compared to a control group of patients who never received IV iron with respect to transfusion rate, 30-day readmission rate, nosocomial infections, length of stay, and hospital costs. Results: There were no significant differences in transfusion rates ( P = .118). There was a trend toward decreased length of stay ( P = .063) and 30-day readmission rates ( P = .051) with a 59% reduction in the odds of 30-day readmission when a patient received IV iron. There were no differences in nosocomial infection rates or cost of hospitalization. Discussion: This study presents a compelling argument for further research regarding the use of IV iron in elderly patients undergoing surgery for a hip fracture. Length of stay and transfusion rates are increased in patients with intertrochanteric fractures and undergoing intramedullary nailing. A higher number of these patients in the IV iron group may have falsely increased these rates. A prospective, randomized, controlled trial is needed to assess the true effects of perioperative IV iron. Conclusions: This study showed no significant benefit to IV iron use in elderly patients undergoing surgical treatment of hip fracture. The decrease in 30-day readmission rate should be further examined with a prospective randomized controlled trial.
Perioperative Blood Flow Restriction Rehabilitation in Patients Undergoing ACL Reconstruction: A Systematic Review
Authors: Lu Yining , Patel Bhavik H. , Kym Craig , Nwachukwu Benedict U. , Beletksy Alexander , Forsythe Brian , Chahla Jorge 
Published: March 2020

Background: Low-load blood flow restriction (BFR) training has attracted attention as a potentially effective method of perioperative clinical rehabilitation for patients undergoing orthopaedic procedures. Purpose: To (1) compare the effectiveness of low-load BFR training in conjunction with a standard rehabilitation protocol, pre- and postoperatively, and non-BFR interventions in patients undergoing anterior cruciate ligament reconstruction (ACLR) and (2) evaluate protocols for implementing BFR perioperatively for patients undergoing ACLR. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review of the 3 medical literature databases was conducted to identify all level 1 and 2 clinical trials published since 1990 on BFR in patients undergoing ACLR. Patient demographics from included studies were pooled. Outcome data were documented, including muscle strength and size, and perceived pain and exertion. A descriptive analysis of outcomes from BFR and non-BFR interventions was performed. Results: A total of 6 studies (154 patients; 66.2% male; mean ± SD age, 24.2 ± 3.68 years) were included. Of these, 2 studies examined low-load BFR as a preoperative intervention, 1 of which observed a significant increase in muscle isometric endurance ( P = .014), surface electromyography of the vastus medialis ( P < .001), and muscle blood flow to the vastus lateralis at final follow-up ( P < .001) as compared with patients undergoing sham BFR. Four studies investigated low-load BFR as a postoperative intervention, and they observed significant benefits in muscle hypertrophy, as measured by cross-sectional area; strength, as measured by extensor torque; and subjective outcomes, as measured by subjective knee pain during session, over traditional low-load resistance training (all P < .05). BFR occlusion periods ranged from 3 to 5 minutes, with rest periods ranging from 45 seconds to 3 minutes. Conclusion: This systematic review found evidence on the topic of BFR rehabilitation after ACLR to be sparse and heterogeneous likely because of the relatively recent onset of its popularity. While a few authors have demonstrated the potential strength and hypertrophy benefits of perioperative BFR, future investigations with standardized outcomes, long-term follow-up, and more robust sample sizes are required to draw more definitive conclusions.
Dimorphism in the TCRγ-chain repertoire defines 2 types of human immunity to Epstein-Barr virus
Authors: Djaoud Zakia , Parham Peter 
Published: March 2020

AbstractHumans form 2 groups based on their innate immunity to Epstein-Barr virus (EBV). Group 1 makes a strong natural killer (NK)–cell and γδ T-cell response, whereas group 2 makes a strong NK-cell response, but a weak γδ T-cell response. To investigate the underlying basis for this difference in γδ T-cell immunity to EBV, we used next-generation sequencing to compare the γδ T-cell receptor (TCR) repertoires of groups 1 and 2. In the absence of EBV, group 1 TCRγ chains are enriched for complementarity determining region 3 (CDR3s) containing JγP, whereas group 2 TCRγ chains are enriched for CDR3s containing Jγ2. In group 1 donors, EBV activates many γδ T cells expressing Vγ9JγP, inducing proliferation that produces a large population of activated effector cells. The TCRs using Vγ9JγP are closely related to the TCRs of γδ T cells that respond to phosphoantigens. In group 2 donors, EBV activates a small subpopulation of γδ T cells, most expressing Vγ9JγP. In conclusion, we find that differences in the TCRγ-chain repertoire underlie the differential response of group 1 and group 2 to EBV.
Cerebrospinal fluid of chronic osteoarthritic patients induced interleukin-6 release in human glial cell-line T98G
Authors: Liu Weiling , Li Chunmei , Tan Francis Chee Kuan , Neo Hong Jye , Chan Yiong Huak , Low Chian-Ming , Lee Tat Leang 
Published: March 2020

Abstract
Background
Chronic osteoarthritic pain is not well understood in terms of its pathophysiological mechanism. Activated glial cells are thought to play a role in the maintenance of chronic pain. T98G glioblastoma cell line was previously observed to release higher amounts of interleukin-6 (IL-6) when treated with cerebrospinal fluid (CSF) from patients with another chronic pain condition, post-herpetic neuralgia. In this study, we investigated the ability of CSF from patients diagnosed with knee osteoarthritis suffering from chronic pain, to trigger the release of pro-inflammatory cytokines, IL-6, IL-1beta and tumour necrosis factor alpha (TNF-α) from T98G. Characterization of upstream signalling was also explored.

Methods
Fifteen osteoarthritis patients undergoing total knee replacement due to chronic knee pain and 15 patients without pain undergoing other surgeries with spinal anaesthesia were prospectively recruited. CSF was collected during anaesthesia. CSF were added to cultured T98G cells in the presence of lipopolysaccharide. IL-6, IL-1β and TNF-α release from T98G cells were measured using enzyme immunoassay. Antibody array and western blotting were performed using CSF-triggered T98G cell lysates to identify possible signalling targets. Age, gender and pain scores were recorded. Mann-Whitney U test was used to compare IL-6 release and protein expression between groups. Association between IL-6 and pain score was analysed using linear regression.

Results
Significant higher levels of IL-6 were released by T98G cells when induced by osteoarthritis patients’ CSF in the presence of LPS. The IL-6 levels showed positive association with pain score (adjusted B estimate = 10.1 (95% Confidence Interval 4.3–15.9); p = 0.001). Antibody array conducted with 6 pooled T98G cell lysate induced with osteoarthritis pain patient CSF identified greater than 2-fold proteins including STE20-related kinase adaptor protein and spleen tyrosine kinase. Further validation done using western blotting of individual CSF-triggered T98G cell lysate showed non-significant increase.

Conclusion
Higher IL-6 release from T98G when triggered by OA-CSF, in the presence of LPS, suggest the presence of “unknown molecule” in CSF that may be crucial in the maintenance phase of chronic pain in our osteoarthritis population. Further studies on the signalling pathways involved in pain and relevance of IL-6 release from T98G cells in other pain models are needed.
Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia
Authors: Schliemann Désirée , Paramasivam Darishiani , Dahlui Maznah , Cardwell Christopher R. , Somasundaram Saunthari , Ibrahim Tamin Nor Saleha Binti , Donnelly Conan , Su Tin Tin , Donnelly Michael 
Published: March 2020

Abstract
Background
Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use.

Methods
Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials.

Results
Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of self-efficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months.

Conclusion
Overall, the findings of the evaluation indicated that the culturally adapted, evidence-based mass media intervention improved CRC symptom awareness among the Malaysian population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and social diversity in a population.