bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher Plasma Cystatin C is associated with Mortality after Acute Respiratory Distress Syndrome: Findings from a Fluid and Catheter Treatment Trial (FACTT) Substudy
Authors: Hendrickson Carolyn M. , Kwong Yuenting Diana , Belzer Annika G , Shlipak Michael G , Matthay Michael A , Liu Kathleen Dori 
Published: June 2020

Abstract
Background: Cystatin C is a well validated marker of glomerular filtration rate in chronic kidney disease. Higher plasma concentrations of cystatin C are associated with worse clinical outcomes in heterogenous critically-ill populations and may be superior to creatinine in identifying kidney injury in critically-ill patients. We hypothesized that elevated levels of plasma cystatin C in patients with Acute Respiratory Distress Syndrome (ARDS) would be associated with mortality. Methods: In a retrospective study, cystatin C was measured by nephelometry on plasma obtained at enrollment from 919 patients in the Fluid and Catheter Treatment Trial. Multivariable logistic regression was performed testing the association between quartiles of cystatin C and 60-day mortality. Analyses were stratified by Acute kidney injury (AKI) status identified in the first 7 days after enrollment by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results : Cystatin C was significantly higher among those patients who died compared to those who survived to 60 days [1.2 (0.9 – 1.9) mg/L vs. 0.8 (0.6 – 1.2) mg/L, p <0.001]. Compared to the lower three quartiles, subjects in the highest quartile of cystatin C had a significantly higher odds of death at 60 days [OR 1.8 (1.2-2.6), p =0.003 in adjusted analyses]; the odds of death incrementally rose in higher cystatin C quartiles compared to the lowest quartile (OR 1.1, 1.8, and 2.5). In adjusted analyses stratified by AKI status, compared to subjects in the lower three quartiles, subjects in the highest quartile of cystatin C with AKI had a significantly higher odds of death at 60 days both in participants with AKI [OR 1.6 (1.0-2.4), p =0.048] and those without AKI [OR 2.4 (1.2-5.0), p =0.017]. In adjusted analyses, there was no significant association between sex-stratified baseline creatinine quartiles and mortality. Conclusions : Higher plasma levels of cystatin C on enrollment were strongly associated with mortality at 60-days in patients with ARDS with and without AKI identified by creatinine-based definitions . Compared to creatinine, cystatin C may be a better biomarker of kidney function in patients with ARDS and therefore identify patients with multiple organ failure at higher risk of death.
Relationship between level of empathy during residency training and perception of professionalism climate
Authors: Aziz Aliya B , Ali Syeda Kauser 
Published: June 2020

Abstract
Background Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients.Unfortunately, there is evidence for the decline of physician’s empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.Objective This study examines the relationship between empathy level and perception of climate of professionalism among the residents.Method The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson scale of Physician empathy (JSPE) and “professionalism climate instrument”(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.Results The overall response rate was 81.4% with mean empathy level of 103±13. The internal consistency of each scale measured by Cronbach’s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106+8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs= 0.56, p = 0.64).Conclusion The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.
Exercise training improves adipocyte accumulation and muscle fibrosis by TGF-β1 and α-SMA reduction after botulinum toxin type A administration in mice
Authors: Na Jungtae , Lee Esther , Im Song I , Kim Yu-jin , Kim Su Young , Kim Beom Joon 
Published: June 2020

Abstract
Background: We aimed to investigate the effect of treadmill exercise on functional recovery of the murine gastrocnemius muscle and nerve after botulinum toxin type A (BoNT-A) administration. Methods: After the injection of 0.5 units of BoNT-A into the gastrocnemius muscle of ICR mice, treadmill exercise was conducted for a 6-week period, after which the muscle volume, weight, and sciatic functional index (SFI) was determined and a nerve conduction study (NCS) and histological evaluation were performed. Results: After exercise, there was no change in the gastrocnemius weight and volume, but NCS and SFI increased. Exercise prevented induced adipocyte accumulation and muscle fibrosis. Moreover, transforming growth factor-β1 and α-smooth muscle actin expressions decreased and CD34, brain-derived neurotrophic factor, and synaptosomal nerve-associated protein 25 expressions increased when treadmill exercise was performed after BoNT-A administration. Conclusions: Exercise can effectively recover the nerve function and would aid in muscle function recovery by preventing fat cell accumulation and muscle fibrosis after BoNT-A administration.
Exosomes derived from mesenchymal stem cells improved core symptoms of genetically modified mice model of autism Shank3B
Authors: Perets Nisim , Oron Oded , Herman Shay , Elliott Evan , Offen Daniel 
Published: June 2020

Abstract
Background: Partial or an entire deletion of SHANK3 are considered as major drivers in the Phelan McDermid syndrome, in which 75% of patients are diagnosed with autism spectrum disorder (ASD). During the recent years, there was an increasing interest in stem cell therapy in ASD, and specifically, mesenchymal stem cells (MSC). Moreover, it has been suggested that the therapeutic effect of the MSC is mediated mainly via the secretion of small extracellular-vesicle that contain important molecular information of the cell and are used for cell-to cell communication. Within the fraction of the extracellular-vesicles, exosomes were highlighted as the most effective ones to convey the therapeutic effect.Methods: Exosomes derived from MSC (MSC-exo) were purified, characterized and given via intranasal administration to Shank3B KO mice (in concentration of 107 particals/ml). Three weeks post treatment the mice were tested for behavioral scoring and their results were compared to control saline treated and to their wild type littermates. Results: Intranasal treatment with MSC-exo improves the social behavior deficit in multiple paradigms, increases vocalization and reduces repetitive behaviors. We also observed an increase of GABARB1 in the prefrontal cortex.Conclusions: Herein, we hypothesized that MSC-exo would have a direct beneficial effect on the behavioral autistic-like phenotype of the genetically modified Shank3B KO mice model of autism. Taken together, our data indicate that intranasal treatment with MSC-exo improves the core ASD-like deficits of this mouse model autism and therefore has the potential to treat ASD patients carrying the Shank3 mutation.Limitations: Although the behavioral scoring of the MSC-exo treated group was significantly improved compared to their saline treated littermates, there is much more to learn regarding the mechanism of action of the MSC-exo.
Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City
Authors: Unger-Saldaña Karla , Saldaña-Tellez Minerva , Potter Michael B. , Loon Katherine Van , Allen-Leigh Betania , Lajous Martin 
Published: June 2020

Abstract
Background. Colorectal cancer (CRC) incidence and mortality are increasing in many low- and middle-income countries (LMICs), possibly due to a combination of changing lifestyles and improved healthcare infrastructure to facilitate diagnosis. Unfortunately, a large proportion of CRC cases in these countries remain undiagnosed or are diagnosed at advanced stages, resulting in poor outcomes. Decreasing mortality trends in HICs are likely due to evidence-based screening and treatment approaches that are not widely available in LMICs. Formative research to identify emerging opportunities to implement appropriate screening and treatment programs in LMICs is, therefore, of growing importance. We sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. Methods. We performed a qualitative study with semi-structured individual and focus group interviews with different CRC screening stakeholders, including: 30 lay people at average risk for CRC; 13 health care personnel from a local public clinic; and 7 endoscopy personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data were analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We identified barriers and facilitators for implementation of a FIT-based CRC screening program at several levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: a lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest that multi-level CRC screening programs in middle income countries such as Mexico should incorporate complementary strategies to address barriers and facilitators, such as: 1) provision of free screening tests, 2) education of primary healthcare personnel, and 3) promotion of non fear-based CRC screening messages to the target population, tailored to address common lay beliefs.
“The right time is just after birth”: Acceptability of point-of-care birth testing in Eswatini: qualitative results from infant caregivers, health care workers, and policymakers
Authors: Sacks Emma , Khumalo Philisiwe , Tsabedze Bhekisisa , Montgomery William , Mthethwa Nobuhle , Nhlabatsi Bonisile , Masuku Thembie , Cohn Jennifer , Chouraya Caspian 
Published: June 2020

Abstract
Background: Testing for HIV at birth has the potential to identify infants infected in utero, and allows for the possibility of beginning treatment immediately after birth; point of care (POC) testing allows rapid return of results and faster initiation on treatment for positive infants. Eswatini piloted birth testing in three public maternities for over two years. Methods: In order to assess the acceptability of POC birth testing in the pilot sites in Eswatini, interviews were held with caregivers of HIV-exposed infants who were offered birth testing (N=28), health care workers (N=14), and policymakers (N=10). Participants were purposively sampled. Interviews were held in English or SiSwati, and transcribed in English. Transcripts were coded by line, and content analysis and constant comparison were used to identify key themes for each respondent type. Results: Responses were categorized into: knowledge, experience, opinions, barriers and challenges, facilitators, and suggestions to improve POC birth testing. Preliminary findings reveal that point of care birth testing has been very well received but challenges were raised. Most caregivers appreciated testing the newborns at birth and getting results quickly, since it reduced anxiety of waiting for several weeks. However, having a favorable experience with testing was linked to having supportive and informed family members and receiving a negative result. Caregivers did not fully understand the need for blood draws as opposed to tests with saliva, and expressed the fears of seeing their newborns in pain. They were specifically grateful for supportive nursing staff who respected their confidentiality. Health care workers expressed strong support for the program but commented on the high demand for testing, increased workload, difficulty with errors in the testing machine itself, and struggles to implement the program without sufficient staffing, especially on evenings and weekends when phlebotomists were not available. Policymakers noted that there have been challenges within the program of losing mothers to follow up after they leave hospital, and recommended stronger linkages to community groups. Conclusions: There is strong support for scale-up of POC birth testing, but countries should consider ways to optimize staffing and manage demand.
Differences in trochlear groove based on morphometric measurements of three-dimensional reconstruction models between native knees and five different femoral component designs in Chinese subjects
Authors: chen shi chang , Xu Hua , Gong Shaohua 
Published: June 2020

Abstract
Background: The p rosthetic trochlear design is important in postoperative patellofemoral kinematics and knee function. However, little research has been conducted on the differences in trochlear groove between native and prosthetic knees. We aimed to investigate the differences between Chinese native knees and prosthetic knees of five different femoral component designs using three-dimensional computerized quantification Of the entire trochlear length. Methods: Virtual total knee arthroplasty was performed using three-dimensional models of 42 healthy Chinese knees matched to the femoral components of five different prosthe tic systems by mechanical alignment . T he deepest points of the trochlear groove were marked in multiple cross sections for both the native and prosthetic knees . Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the trochlear groove were analyzed between the native and prosthetic knees. Results: From the proximal to the distal end, the native trochlear groove started from 0° cross section and extended laterally and then medially , with its turning point located at 69° cross section . T he prosthetic trochlear groove showed a similar medial orientation and extended more proximally, but varied in mediolateral location and the length extending to the intercondylar notch . Compared with the proximal portion of the native trochlear groove , the prosthetic knee s extended along a paradoxical orientation and started from a more proximal and lateral position to 3.2 mm in the 0° cross section , with maximal discrepancy. Distally, the prosthetic trochlear groove s were located significantly medial to 2.4 mm in the 69° cross section , with maximal discrepancy. Conclusion: The prosthetic trochlear design varie d among the different types and did not conform to the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may provide useful information for creating prosthetic trochlear design s that conform with the native knee anatomy to optimize patellofemoral biomechanics and reduce the risk of patellofemoral complications.
Identification and co-expression analysis of long noncoding RNAs and mRNAs involved in the deposition of intramuscular fat in Aohan fine-wool sheep
Authors: Han Fuhui , Li Jing , Liu Nan , Zhao Ranran , Liu Lirong , Li Lanlan , Li Qian , He Jianning 
Published: June 2020

Abstract
Background: Intramuscular fat (IMF) content has become one of the most important indicators for measuring meat quality, and levels of IMF are affected by various genes. Long non-coding RNAs (lncRNAs) are widely expressed non-coding RNAs that play an important regulatory role in a variety of biological processes; however, research on the lncRNAs involved in sheep IMF deposition is still in its infancy. Aohan fine-wool sheep (AFWS), one of China's most important meat-hair, dual-purpose sheep breed, provides a great model for studying the role of lncRNAs in the regulation of IMF deposition. We identified lncRNAs by RNA sequencing in longissimus dorsi muscle (LDM) samples of sheep at two ages: 2 months (Mth-2) and 12 months (Mth-12). Results: We identified a total of 26,247 genes and 6,935 novel lncRNAs in LDM samples of sheep. Among these, 606 mRNAs and 408 lncRNAs were differentially expressed. We then compared the structural characteristics of lncRNAs and mRNAs. We obtained target genes of differentially expressed lncRNAs (DELs) and performed enrichment analyses using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). We found that target mRNAs were primarily enriched in lipid metabolism, lipid transport, regulation of primary metabolic processes and developmental pathways. Based on the results of important KEGG pathways, we obtained six candidate lncRNAs that potentially regulate lipid deposition and constructed an lncRNA-mRNA co-expression network that included MSTRG.792.1- SCD , MSTRG.8227.1- ACAA2 , MSTRG.10679.1- FADS2 , MSTRG.21942.1- PLA2G4E , MSTRG.21380.1- FZD4 and MSTRG.9270.1- ULK1 . We speculated that these candidate lncRNAs might play a role by regulating the expression of target genes. We randomly selected five mRNAs and five lncRNAs to verify the accuracy of the sequencing data by qRT-PCR. Conclusions: Our study provided a list of the lncRNAs and mRNAs related to intramuscular lipid deposition in sheep and laid a foundation for future research on regulatory mechanisms.
Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study
Authors: Yue Jieya , Liu Jun , Williams Sarah , Zhang Bo , Zhao Yingxi , Zhang Qiannan , Zhang Lin , Liu Xin , Wall Stephen , Wetzel Greta , Zhao Gengli , Bouey Jennifer 
Published: June 2020

Abstract
Background
Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn’t adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China.

Methods
We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context.

Results
Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents’ resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals.

Conclusions
We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.
Resistance to Antihypertensive Drugs Targeting Renin Angiotensin Aldosterone System in Cancer patients: A Case Series
Authors: GOEL Mishita , Varandani Rajiv , Okwuosa Tochukwu 
Published: June 2020

Abstract
Hypertension impacts overall prognosis in cancer patients. There are no specific recommendations for its management in these patients. We report a case series of 5 cancer patients with suboptimal BP lowering and even worsening BP with ACEi or ARBs that improved to normal upon discontinuation of these drugs.
Tissue alkaline phosphatase activity and expression in an experimental infant swine model of cardiopulmonary bypass with deep hypothermic circulatory arrest
Authors: Khailova Ludmila , Robison Justin , Jaggers James , Ing Richard , Lawson Scott , Treece Amy , Soranno Danielle , Lujan Suzanne Osorio , Davidson Jesse 
Published: June 2020

Abstract
Background: Infant cardiac surgery with cardiopulmonary bypass results in decreased circulating alkaline phosphatase that is associated with poor postoperative outcomes. Bovine intestinal alkaline phosphatase infusion represents a novel therapy for post-cardiac surgery organ injury. However, the effects of cardiopulmonary bypass and bovine-intestinal alkaline phosphatase infusion on tissue-level alkaline phosphatase activity/expression are unknown.Methods: Infant pigs (n=20) underwent cardiopulmonary bypass with deep hypothermic circulatory arrest followed by four hours of intensive care. Seven control animals underwent mechanical ventilation only. Cardiopulmonary bypass/deep hypothermic circulatory arrest animals were given escalating doses of bovine intestinal alkaline phosphatase infusion (0-25U/kg/hr; n=5/dose). Kidney, liver, ileum, jejunum, colon, heart and lung were collected for measurement of tissue alkaline phosphatase activity and mRNA.Results: Tissue alkaline phosphatase activity varied significantly across organs with the highest levels found in the kidney and small intestine. Cardiopulmonary bypass with deep hypothermic circulatory arrest resulted in decreased kidney alkaline phosphatase activity and increased lung alkaline phosphatase activity, with no significant changes in the other organs. Alkaline phosphatase mRNA expression was increased in both the lung and the ileum. The highest dose of bovine intestinal alkaline phosphatase resulted in increased kidney and liver tissue alkaline phosphatase activity.Conclusions: Changes in alkaline phosphatase activity after cardiopulmonary bypass with deep hypothermic circulatory arrest and bovine intestinal alkaline phosphatase delivery are tissue specific. Kidneys, lung, and ileal alkaline phosphatase appear most affected by cardiopulmonary bypass with deep hypothermic circulatory arrest and further research is warranted to determine the mechanism and biologic importance of these changes.