bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of RGOs&nbsp;on the Efficacy of Nkx2.5 Transfected Bone Marrow Mesenchymal Stem Cells Transplantation in Treatment Heart Failure in Rats
Authors: Wang Lin , Deng Bo , Zhang Ran , Hu Xingxing , Li Yang , Zhu Qinglei 
Published: December 2020

Abstract
Background: Heart failure (HF) is one of the major serious diseases to do harm to human health. Drugs, interventional treatment and heart transplantation are currently the main methods to treat HF. However, they fail to improve the patient's condition. Mesenchymal stem cells (MSCs) can regenerate functional cardiomyocytes and are promising to become a new therapeutic measure to treat heart failure. We assumed that Rehmannia glutinosa oligosaccharide (RGOs) has the synergistic effect with Nkx2.5 transfected MSCs (Nkx2.5) transplantation in treatment heart failure. Methods: MSCs and Nkx2.5 were preconditioned by RGOs. The apoptosis rate was detected by flow cytometry and the expressions of cardiac specific genes were analyzed with quantitative real-time PCR and Western blot in vitro. Heart failure models were duplicated by injecting doxorubicin (total dose of 15mg/kg) intraperitoneally in male SD rats. When the models were prepared, rats were randomly divided into 6 groups: Control (CON), HF, MSCs, Nkx2.5, RGOs and RGOs combined with Nkx2.5 (RGOs+Nkx2.5) group. Echocardiography was used to detect cardiac function in rats. HE staining was used to observe the pathological changes of myocardium, and Masson staining was used to calculate the collagen volume fraction to detect the degree of myocardial fibrosis. The total mRNA was extracted to detect the following genes including cTnI, CX43, TGF-β1, Collagen I, MEF2 and GATA4 by Q-PCR. Protein of myocardial tissue was extracted to detect the expression of cTnI, CX43, MEF2 and GATA4, by western blot. Results: RGOs could not enhance cardiac specific gene expressions including CK, α-MHC, however it improved the survival of Nkx2.5 induced by H2O2 in vitro. In rat heart failure models, RGOs alone improved the heart pumping function and decreased collagen volume fraction (CVF), TGF-β1 and collagen I expression, and increased MEF2 and GATA4 mRNA expression. Moreover, RGOs cooperated with Nkx2.5 in improving left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). Furthermore, RGOs and Nkx2.5 combination also increased CX43 expression, whereas decreased CVF and collagen I expression. Conclusion: RGOs has the synergistic effect with Nkx2.5 gene transfected MSCs transplantation in treatment with heart failure through decreasing myocardial fibrosis, inhibiting ventricular remodeling, and increasing the expressions of GATA4, MEF2.
Genetic Diversity and Antifungal Susceptibility of Candida Albicans Strains Isolated from Lranian HIV+ Patients With Oral Candidiasis
Authors: Tamai Iradj Ashrafi , Pakbin Babak , Fasaei Bahar Nayeri 
Published: December 2020

Abstract
Objective: The objectives of this study were to investigate the antifungal susceptibility and genetic diversity of oral Candida albicans strains isolated from HIV+ patients with oropharyngeal candidiasis. A total of 50 C. albicans isolates were cultured on Sabouraud glucose agar containing chloramohenicol. The antifungal susceptibility of C. albicans against fluconazole, clotrimazole, nystatin, amphotericin B, ketoconazole and flucytosine was assessed using disc diffusion method. The genetic diversity of different C. albicans strains was determined using random amplified polymorphic DNA technique. Results: The inhibition zones ranged from 4±1.8 to 40±3.8 mm for fluconazole, 7±1.0 to 37±1.8 mm for ketoconazole, 14±0.8 to24±0.8 mm for amphotericin B, 25±0.0 to 33±0.0 mm for nystatin and 7±4.2 to 40±0.0 mm for clotrimazole. At 90% similarity, three distinct groups were observed. The smallest cluster composed of 3 of 50 C. albicans isolates, whereas the largest cluster composed of 17 of 50 isolates. Of 50 C. albicans isolates, 32%, 28% and 14% were resistant to fluconazole, ketoconazole and clotrimazole, respectively. There were no significant differences among antifungal susceptibility of different C. albicans strains from three genotype clusters.
Impact of Age for Overall Survival in Head and Neck Sarcoma
Authors: Suzuki Hidenori , Takano Gaku , Tsukushi Satoshi , Ando Masashi , Yasushi Yatabe , Kodaira Takeshi , Nishikawa Daisuke , Beppu Shintaro , Hasegawa Yasuhisa , Hanai Nobuhiro 
Published: December 2020

Abstract
Background：The association between age and survival outcomes in head and neck sarcoma (HNS) has yet to be fully investigated due to rare tumor. To research the association between age at surgery and survival outcomes of patients with HNS. Methods: Twenty-six patients with HNS who underwent by surgery from 2003 to 2017 were retrospectively enrolled. The association between clinicopathological parameters and age was assessed by Mann-Whitney U test, and the optimal cut-off age at surgery for predicting death was determined by receiver operating curve analysis. Log-rank test and Cox proportional hazards model were used for survival analyses.Results: Patients who did not undergo chemotherapy were significantly older age at surgery. Fifty-five was the cut-off age that predicted death. Shorter survival rates of overall, disease-specific, local recurrence-free and disease-free were associated with older age. Age (≥ 55 years/< 55 years) was correlated with shorter overall survival by multivariate analysis adjusting with chemotherapy (absence/presence). Conclusion: Older age predicts worse overall survival in HNS.
Pathological Complete Response After Immune-Checkpoint Inhibitor Followed by Salvage Surgery for Clinical Stage IV Pulmonary Adenocarcinoma with Continuous Low Neutrophil-to-Lymphocyte Ratio: A Case Report
Authors: Higuchi Mitsunori , Kawamata Takahiro , Oshibe Ikuro , Soeta Nobutoshi , Saito Takuro , Hojo Hiroshi , Matsumura Yuki , Suzuki Hiroyuki 
Published: December 2020

Abstract
Background: Immune-checkpoint inhibitors (ICIs) play a crucial role in the treatment of advanced non-small cell lung cancer (NSCLC), however, most patients fail this treatment after a limited period. We here report a patient with a pathological complete response (CR) after treatment with ICI for stage IV pulmonary adenocarcinoma.Case presentation: A 73-year-old man was referred to our hospital because of hoarseness. A roentgenogram and chest CT scan revealed a huge (78-mm diameter) pulmonary tumor in the right upper lobe and a tumor with cavitation in the left lower lobe. A CT scan also showed enlarged upper mediastinal lymph nodes. Transbronchial lung biopsy (TBLB) of the tumors showed adenocarcinomas in both. The tumor in the right upper lobe was considered to be the primary with mediastinal lymph nodes metastasis and that in the left lower lobe a pulmonary metastasis. The disease was determined to be cT4N2M1a stage IVA after whole body evaluation . He was treated with first line chemotherapy comprising cisplatin, pemetrexed, and bevacizumab for six cycles, achieving a partial response. However, 6 months after initial treatment, the primary and metastatic tumors enlarged and he was treated with second line anti-PD-1 therapy for 7 months with a partial response. 18-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed weak accumulation of FDG in the primary tumor only with no accumulation in the left pulmonary metastasis or mediastinal lymph nodes, despite the lymph nodes still being enlarged. He was diagnosed as having ycT1bN0M0 stage IA2 disease and underwent right upper lobectomy. Postoperative pathological findings revealed that cancer tissues had been replaced by scar tissue and that CD4 positive T cells, rather than CD8 positive T cells, were predominant. It was also noted that he had a lower neutrophil-to-lymphocyte ratio (NLR) during immunotherapy than before immunotherapy and after surgery. He was diagnosed to be ypT0N0M0 stage 0 (Ef.3). His postoperative course was uneventful and he remained well for twelve months after surgery with no further treatment.Conclusions: Neoadjuvant chemotherapy with ICIs for advanced NSCLC may be a promising modality, even for clinical stage IV disease, in the near future. Furthermore, NLR during immunotherapy may be a promising biomarker of ICIs treatment.
Comprehensive Case Study Program of Ethics Course Based on the Blended Learning Model and its Impact on Active Learning Indicators
Authors: mosalanejad leili , karamzadeh Atefeh , Bazrafkan Leila 
Published: December 2020

Abstract
Background Now in training physicians, should be pay attention to medical education and clinical skills with respect to justice, dignity and human rights. This is the ultimate goal of medical ethics. The purpose of this study is a comprehensive case study educational program of ethics course based on blended learning model and its effect on indicators of active learning. MethodsThis quasi-experimental intervention study was performed on 70 physiopathology medical students who had taken medical ethics course. The students' educational program included teaching theoretical topics of medical ethics, discussing ethical issues and clinical reasoning on cases, discussing in forum environment and individual assignments in LMS system and completing portfolio. Student evaluation was associated with evaluating the effect of method on students' knowledge, attitude and ethical reasoning skills. The impact of intervention on self-directed learning and self-regulation was also investigated. Data collection tools were Gaglimino (1978) and Beauford (1995) self-directed readiness questionnaires that students answered before and after their intervention. . Data analysis was performed using SPSS software at two levels of descriptive and analytic statistics. Results The results showed that there was a significant difference between students 'self-direction after the intervention compared to before the intervention (p = 0.005). but, students' self-regulation was not significant despite the increase after the intervention (p = 0.149). Also, the total score of students in intervention group were significant compared to traditional group (p<.05).Conclusion According to research findings, it is suggested that while considering student-centered educational approaches based on case study, the use of blended learning in medical ethics course, can have a positive effects on improving students' learning and individual learning indicators (self-regulation and self-directed learning). Using those method suggest in other medical courses.
Acquiring University Teaching Competences with Clinical Simulation in Health Sciences Education
Authors: Castillo Rafael Fernandez , Gómez Francisco Jose Gómez , Perez Raquel Garcia , Gonzalez Antonio Liñan 
Published: December 2020

Abstract
Backgorund:Clinical simulation exercises provide students with the opportunity to engage in role-playing and to reenact a professional situation. They can thus practice treating patients in simulation labs that replicate real-life scenarios that can be complicated, stressful, or even conflictive. The aim of this study was to determine the degree of satisfaction of a group of postgraduate students enrolled in the Masters in Teaching at the University of Granada (Spain) with this teaching technique. Methods: We conducted a longitudinal study over the 4-year perio. To ascertain the students’ satisfaction with quality of the clinical simulation lab, they were asked to fill out a survey. The sample population of this study consisted of 108 students in the four groups of the Master’s program. During the 4-year study period, students were required to design and prepare a clinical case study, with a set of objectives and a topic related to their degree or specialization. The presentation, which had a duration of fifteen minutes, was given in a simulation lab. Results:The 100% of the Master’s students either agreed or strongly agreed that simulation was a useful teaching method and that the simulation scenarios envisaged were realistic. Of the sample, 77.8% affirmed that the simulation experience had improved their use of new technologies. All of the students agreed or strongly agreed that the simulation helped to develop their capacity for critical reasoning and decision-making.Conclusions. The results obtained confirmed that the students valued this technique and regarded it as an innovative strategy that fosters immersive learning, and which has great potential for the development of clinical competence. Not only did it boost their self-confidence, but they claimed that it also opened new professional doors for them and trained them for a possible future as a university lecturer.
Stakeholder Perspectives to Inform Adaptation of a Hypertension Treatment Program in Primary Healthcare Centers in the Federal Capital Territory, Nigeria: A Qualitative Study
Authors: Okoli Rosemary CB , Shedul Gabriel , Hirschhorn Lisa R , Orji Ikechukwu A , Ojo Tunde M , Egenti Nonye , Omitiran Kasarachi , Akor Blessing , Baldridge Abigail S. , Huffman Mark D , Ojji Dike , Kandula Namratha R 
Published: December 2020

Abstract
Background: Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods: Purposive sampling in 8 PHCs identified patients (n=8), non-physician health workers (n= 12), administrators (n=3), and primary care physicians (n=6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results: Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment; (2) expansion of team-based care with additional training; (3) information systems to track patients and medication supply chain; and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: first contact accessibility, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could limit effectiveness of the HTN Program. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to raise awareness about the HTN Program and to train community members in blood pressure measurement. Conclusions: These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria with the ultimate aim of scaling it to other parts of the country.
Evaluation of the Implementation Process of the Mobile Health Platform ‘WelTel’ in Six Sites in East Africa and Canada Using the Modified Consolidated Framework for Implementation Research (mCFIR)
Authors: Joueidi Samia El , Bardosh Kevin , Musoke Richard , Tilahun Binyam , Moslim Maryam Abo , Gourlay Katie , MacMullin Alissa , Cook Victoria J. , Murray Melanie , Mbaraga Gilbert , Nsanzimana Sabin , Lester Richard 
Published: December 2020

Abstract
Background: Health systems globally are investing in integrating secure messaging platforms for virtual care in clinical practice. Implementation science is essential for adoption, scale-up, spread and maintenance of complex evidence-based solutions in clinics with evolving priorities. In response, the mHealth Research Group modified the existing Consolidated Framework for Implementation Research (mCFIR) to evaluate implementation of virtual health tools in clinical settings. WelTel® is an evidence-based digital health platform widely deployed in various geographical and health contexts. Objectives: To identify the facilitators and barriers for implementing WelTel and to assess the application of the mCFIR tool in facilitating focus groups in different geographical and health settings. Methodology: Both qualitative and semi-quantitative approaches were employed. Six mCFIR sessions were held in three countries with 51 key stakeholders surveyed. The mCFIR tool consists of 5 Domains and 25 Constructs and was built and distributed through Qualtrics XM. “Performance ” and “Importance” scores were valued on a scale of 0 to 10 (Mean + SD). Descriptive analysis was conducted using R computing software. NVivo 12 Pro software was used to analyze mCFIR responses and to generate themes from the participants’ input. Semi-structured interviews were conducted with the focus group facilitators to understand their experience using the mCFIR tool. Results: We observed a parallel trend in the scores for Importance and Performance. Of the five Domains, Domain 4 (End-user Characteristics) and Domain 3 (Inner Settings) scored highest in Importance (8.9 + 0.5 and 8.6 + 0.6, respectively) and Performance (7.6 + 0.7 and 7.2 + 1.3, respectively) for all sites. Domain 2 (Outer Setting) scored the lowest in both Importance and Performance for all sites (7.6 + 0.4 and 5.6 + 1.8). Areas of strengths included timely diagnosis, immediate response, cost-effectiveness, user-friendliness, and simplicity. Areas for improvement included training, phone accessibility, health authority’s engagement, and literacy. Conclusion: The mCFIR tool allowed for a comprehensive understanding of the barriers and facilitators to the implementation, reach, and scale-up of digital health tools. Participants emphasized the importance of creating partnerships with external organizations and health authorities in order to achieve sustainability and scalability.Trial Registration: NCT02603536 – November 11, 2015NCT01549457 – March 9, 2012
Importance of the number emission factor of combustion-generated aerosols from nano-enabled products
Authors: Hammer Tobias , Bossa Nathan , Persson Michael , Wichser Adrian , Lehner Ken , Ruggiero Emmanuel , Fonseca Ana Sofia , Jovic Milijana , Gaan Sabyasachi , Wohlleben Wendel , Wang Jing 
Published: December 2020

Abstract
Accidental or open waste burning and incineration of nano-enabled products (NEPs) might lead to the release of incidental nanomaterials (NMs) into the environment resulting in harmful effects on humans. We have investigated combustion-generated NM release during accidental burning for several real-life NEPs such as paints with silica (SiO2) and spruce wood panels containing SiO2 and Fe2O3 NMs, paper with SiO2 and Fe2O3 NMs and polymeric composites with CuPhthtalocyanine NMs in poly lactic acid (PLA), polyamide 6 (PA6) and thermoplastic pol-urethane (TPU) matrices.Chemical compositions, aerosols number emission factors (nefs) and concentrations of the signature elements of the NMs of the combustion-generated aerosols were investigated. In addition, the residual ash was analyzed. The outcomes of this study shed light on how NM and matrix types influenced the properties of the released aerosols. Based on our results it was established that the combustion-generated aerosols were composed of transformed NMs with modified physical-chemical characteristics compared to the pristine NMs. In addition to the transformed NMs, there were also particles due to incomplete combustion of the matrix. Types of the pristine NMs and matrices affected the characteristics of the released aerosols. Since the hazard of the aerosols is related to the inhaled aerosol number concentration, the nef is an important parameter. Our results showed that the nefs in the size range of 5.6 to 560 nm depended strongly on the type of combusted NEP, which indicated that the NEPs could be categorized according to their potential to release aerosols in this size range when they were burnt. The generated release data facilitate the assessment of human and environmental exposure and the associated risk assessment of combustion-generated aerosols from NEPs.
Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn
Authors: Huang Ruo-Yi , Chen Szu-Jen , Hsiao Yen-Chang , Kuo Ling-Wei , Liao Chien-Hung , Hsieh Chi-Hsun , Bajani Francesco , Fu Chih-Yuan 
Published: December 2020

Abstract
BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.