bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of China’s new medical licensing examination for rural general practice
Authors: Han Xinxin , Li Xiaotong , Cheng Liang , Wu Zhuoqing , Zhu Jiming 
Published: September 2020

Abstract
Background
To evaluate the performance of China’s new medical licensing examination (MLE) for rural general practice, which determines the number of qualified doctors who can provide primary care for China’s rural residents, and to identify associated factors.

Methods
Data came from all 547 examinees of the 2017 MLE for rural general practice in Hainan province, China. Overall pass rates of the MLE and pass rates of the MLE Step 1 practical skills examination and Step 2 written exam were examined. Chi-square tests and multivariable logistic regression were used to identify examinee characteristics associated with passing Step 1 and Step 2, respectively.

Results
Of the 547 examinees, 68% passed Step 1, while only 23% of Step 1 passers passed Step 2, yielding an 15% (82 of 547) overall pass rate of the whole examination. Junior college medical graduates were 2.236 (95% CI, 1.127–4.435) times more likely to pass Step 1 than secondary school medical graduates. Other characteristics, including age, gender, forms of study and years of graduation, were also significantly associated with passing Step 1. In contrast, examinees’ vocational school major and Step 1 score were the only two significant predictors of passing Step 2.

Conclusions
Our study reveals a low pass rate of China’s new MLE for rural general practice in Hainan province, indicating a relatively weak competency of graduates from China’s alternative medical education. An effective long-term solution might be to improve examinees’ clinical competency through mandating residency training for graduates of China’s alternative medical education.
Health-care access and utilization among individuals with low back pain in Iran: a WHO-ILAR COPCORD study
Authors: Faezi Seyedeh Tahereh , Baghdadi Azarakhsh , Nejadhosseinian Mohammad , Moradi-Lakeh Maziar , Yekaninejad Mir Saeed , Holakoui Kourosh , Moghimi Nasrin , Sandoughi Mahnaz , Dehghan Ali , Banihashemi Arash Tehrani , Ghadimi Maryam , Davatchi Fereydoun 
Published: September 2020

AbstractBackgroundLow back pain (LBP) is a major contributor to chronic pain and disability. The purpose of this study was to evaluate health-care access and utilization among patients with LBP in Iran. We also sought to study the pattern and characteristics of care-utilization behavior in these patients.MethodsData from the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) were used for this study. Three cities (Zahedan, Sanandaj, Yazd) were selected to represent the Iranian population, with different socioeconomic status and ethnic, cultural, and religious background. Demographic data, acute or chronic LBP, disability index, and utilizing care from conventional medicine (CM), allied health providers (AHP), and complementary and alternative medicine (CAM) providers were recorded.ResultsOf 9101 patients, 38.6% reported LBP. Only 3.3% did not utilize care of any kind, 66.7% referred to CM providers, 20.8% to AHP, and 9.2% to CAM care. Health-care utilization was higher in female patients, older age, higher education, and higher disability index.ConclusionsThe findings of this study indicate a high rate of health-care utilization among patients with LBP in Iran. CM is the most prevalent health-care resource sought by patients. These findings could be used as a framework in developing more efficient health-care programs according to the needs of specific populations.
Uptake of HIV testing among adolescents and associated adolescent-friendly services
Authors: Kidman Rachel , Waidler Jennifer , Palermo Tia ,   On Behalf of the Tanzania Adolescent Cash Plus Evaluation Team, Palermo Tia , Groppo Valeria , Kajula Lusajo , de Hoop Jacobus , Prencipe Leah , Nkolo Jennifer Waidler Johanna Choumert , Mitti Respichius , Munanka Bhoke , Luchemba Paul , Lukongo Tumpe Mnyawami , Mulokozi Aroldia , Gilbert Ulrike , van Ufford Paul Quarles , Le Kirkegaard Rikke , Eetaama Frank 
Published: September 2020

Abstract
Background
HIV testing remains low among adolescents. Making public health services more adolescent-friendly is one strategy used to encourage testing. However, it remains unclear whether government-led initiatives have a meaningfully impact.

Methods
The current study is observational and utilizes two sources of data (health-facility and adolescent-level) from one round of data collection of an on-going, longitudinal impact evaluation of a pilot cash plus program targeting adolescents. This study linked data from adolescent surveys (n = 2191) to data collected from nearby government-run health facilities (n = 91) in two rural regions of Tanzania. We used log binomial regression models to estimate the association between specific adolescent-friendly health service (AFHS) characteristics and adolescents’ uptake of 1) HIV testing and 2) visiting a health care facility in the past year for sexual and reproductive health (SRH) services.

Results
Most adolescents (67%) lived in a village with a health facility, and all offered HIV services. We find, however, that AFHS have not been fully implemented. For example, less than 40% of facilities reported that they had guidelines for adolescent care. Only 12% of facilities had a system in place for referral and follow-up with adolescent clients, yet this was an important predictor of both past-year HIV testing (RR = 1.28, p < 0.1) and SRH visits (RR = 1.44, p < 0.05). Less than half (44%) offered services for survivors of gender-based violence (GBV), a significant predictor of past-year HIV testing (RR = 1.20, p < 0.05) and SRH visits (RR = 1.41, p < 0.01) among sexually-active adolescents.

Conclusions
We find that national guidelines on AFHS have not been fully translated into practice at the local level. We highlight particular gaps in adolescent referral systems and GBV services. Scaling up these two essential services could encourage greater HIV testing among a high-risk population, in addition to providing much needed support for survivors of violence.
Lysophosphatidic acid as a regulator of endometrial connective tissue growth factor and prostaglandin secretion during estrous cycle and endometrosis in the mare
Authors: Szóstek-Mioduchowska Anna , Leciejewska Natalia , Zelmańska Beata , Staszkiewicz-Chodor Joanna , Ferreira-Dias Graça , Skarzynski Dariusz 
Published: September 2020

Abstract
Background
Equine endometrosis is a chronic degenerative condition, described as endometrial fibrosis that forms in the stroma, under the basement membrane and around the endometrial glands. The role of lysophosphatidic acid (LPA) in the development of tissue fibrosis varies depending on the organ, and its profibrotic role in mare endometrosis remains unclear. The study aimed to establish the endometrial presence of LPA and its receptors (LPAR1–4), together with its effects on connective tissue growth factor (CTGF) and prostaglandins (PG) secretion from equine endometrium under physiological (estrous cycle), or pathological conditions (endometrosis). Mare endometria in the mid-luteal phase (n = 5 for each category I, IIA, IIB, III of Kenney and Doig) and in the follicular phase (n = 5 for each category I, IIA, III and n = 4 for IIB) were used. In experiment 1, the levels of LPA, LPAR1–4 mRNA level and protein abundance were investigated in endometria at different stages of endometrosis. In experiment 2, the in vitro effect of LPA (10− 9 M) on the secretion of CTGF and PGs from endometrial tissue explants at different stages of endometrosis were determined.

Results
Endometrial LPA concentration was higher in the mid-luteal phase compared to the follicular phase in category I endometrium (P < 0.01). There was an alteration in endometrial concentrations of LPA and LPAR1–4 protein abundance in the follicular phase at different stages of endometrosis (P < 0.05). Additionally, LPA increased the secretion of PGE2 from category I endometrium in both phases of the estrous cycle (P < 0.05). The effect of LPA on the secretion of CTGF and PGF2α from endometrial tissue was altered depending on different stages of endometrosis (P < 0.05).

Conclusion
Our data indicate that endometrosis disturbs proper endometrial function and is associated with altered endometrial LPA concentration, its receptor expression and protein abundance, PGE2/PGF2α ratio, and CTGF secretion in response to LPA. These changes could influence several physiological events occurring in endometrium in mare during estrous cycle and early pregnancy.
Validation of the Dutch version of the Multidimensional Adolescent Functioning Scale (MAFS)
Authors: Mayle Sally A. , de Klerk-Sluis Jessica M. , Lin Ashleigh , Yung Alison R. , Wardenaar Klaas J. , Broekman Sanne R J , Pluim W Heleen , Wigman Johanna T. W. 
Published: September 2020

Abstract
Background
The Multidimensional Adolescent Functioning Scale (MAFS) is a 23-item, self-report questionnaire assessing psychosocial functioning in adolescents aged 12–17 years. It captures three domains of functioning: ‘general functioning’, ‘family-related functioning’, and ‘peer-related functioning’. The original English version has good psychometric properties. The aim of the current paper was to translate the MAFS to Dutch and to investigate the psychometric properties of this translation.

Methods
After translation, the Dutch MAFS was assessed in 397 adolescents aged 12–17 years, assessed at schools. Internal consistency, factor structure and correlations with other questionnaires assessing functioning, psychopathology and well-being were investigated.

Results
A hierarchical/bifactor model with a general factor that loads on all items (MAFS-general) and three group factors, loading respectively on the GF, FF and PF items, was found to describe the data best. Internal consistency of the MAFS total score (α = 0.87) was good and of the subscales (α = 0.74–0.80) acceptable. Comparable alphas were found in males and females. Correlations between MAFS subscales ranged from 0.33 to 0.43, indicating sufficient differentiation. The MAFS general factor score and group factor scores showed positive correlations with other measures of good functioning and well-being, and negative correlations with measures of psychopathology, supporting convergent and divergent validity.

Conclusions
The Dutch translation of the MAFS has adequate psychometric properties to assess three domains of functioning in adolescents from the general population aged 12–17 years. The MAFS is freely accessible in the Appendix and easy to administer.
Health research capacity of professional and technical personnel in a first-class tertiary hospital in northwest China: multilevel repeated measurement, 2013–2017, a pilot study
Authors: Yan Peijing , Lao Yongfeng , Lu Zhenxing , Hui Xu , Zhou Biao , Zhu Xinyu , Chen Xiaojie , Li Li , Wang Zixuan , Zhang Min , Yang Kehu 
Published: September 2020

AbstractObjectivesTo explore the health research capacity (HRC) and factors associated with professional and technical personnel (PTP) in a first-class tertiary hospital in northwest China.MethodsWe collected the repeated measurement data from a first-class tertiary hospital in northwest China between 2013 and 2017. HRC of PTP was assessed by a comprehensive evaluation system and measured by research capacity score (RCS). The participants were divided into research group (RCS >0) and comparison group (RCS = 0); participants of the comparison group were selected by two-stage stratified random sampling. Multilevel model for repeated measures was used to investigate the potential factors associated with HRC.ResultsA total of 924 PTP were included (308 in the research group and 616 in the comparison group). This study found consistent growth in RCS and associated 95% CIs for the hospital during 2013 and 2017. The linear multilevel model showed PTP with a doctorate degree had higher RCS than those with a master’s degree (β, 1.74;P<0.001), bachelor’s degree (β, 2.02;P <0.001) and others without a degree (β, 2.32;P<0.001). Furthermore, the PTP with intermediate (β, 0.13;P = 0.015), vice-high (β, 0.27;P= 0.001) and senior (β, 0.63;P<0.001) professional titles had higher RCS than those with junior positions. Compared with PTP in the administration, those in paediatrics had higher RCS (β, 0.28;P= 0.047) though similar to PTP in other departments. PTP with an administrative position had a higher RCS than those in non-administrative positions (β, 0.26;P<0.001). The RCS increased with the research fund (β, 0.15;P<0.001). However, no associations were found between RCS and sex, age, ethnic, graduate school or technical type.ConclusionsHRC with associated variation of PTP for the hospital in northwest China increasingly improved and degree, professional title, administrative position, and research fund were related to HRC of PTP. Multi-central prospective studies are needed to clarify the potential relationship of related factors and HRC of PTP.
Immunoregulation of microglial polarization: an unrecognized physiological function of α-synuclein
Authors: Li Na , Stewart Tessandra , Sheng Lifu , Shi Min , Cilento Eugene M. , Wu Yufeng , Hong Jau-Syong , Zhang Jing 
Published: September 2020

Abstract
Background
Microglial function is vital for maintaining the health of the brain, and their activation is an essential component of neurodegeneration. There is significant research on factors that provoke “reactive” or “inflammatory” phenotypes in conditions of injury or disease. One such factor, exposure to the aggregated or oligomeric forms of α-synuclein, an abundant brain protein, plays an essential role in driving microglial activation; including chemotactic migration and production of inflammatory mediators in Lewy body (LB) diseases such as Parkinson’s disease. On the other hand, it is increasingly recognized that microglia also undergo changes, dependent on the cellular environment, that promote mainly reconstructive and anti-inflammatory functions, i.e., mostly desirable functions of microglia in a physiological state. What maintains microglia in this physiological state is essentially unknown.

Methods
In this study, using in vitro and in vivo models, we challenged primary microglia or BV2 microglia with LPS + IFN-γ, IL-4 + IL-13, α-synuclein monomer, and α-synuclein oligomer, and examined microglia phenotype and the underlying mechanism by RT-PCR, Western blot, ELISA, IF, IHC, Co-IP.

Results
We described a novel physiological function of α-synuclein, in which it modulates microglia toward an anti-inflammatory phenotype by interaction with extracellular signal-regulated kinase (ERK) and recruitment of the ERK, nuclear factor kappa B (NF-κB), and peroxisome proliferator-activated receptor γ (PPARγ) pathways.

Conclusions
These findings suggest a previously unrecognized function of monomeric α-synuclein that likely gives new insights into the pathogenesis and potential therapies for Lewy body-related diseases and beyond, given the abundance and multiple functions of α-synuclein in brain tissue.
HIV/AIDS research in Africa and the Middle East: participation and equity in North-South collaborations and relationships
Authors: González-Alcaide Gregorio , Menchi-Elanzi Marouane , Nacarapa Edy , Ramos-Rincón José-Manuel 
Published: September 2020

Abstract
Background
HIV/AIDS has attracted considerable research attention since the 1980s. In the current context of globalization and the predominance of cooperative work, it is crucial to analyze the participation of the countries and regions where the infection is most prevalent. This study assesses the participation of African countries in publications on the topic, as well as the degree of equity or influence existing in North-South relations.

Methods
We identified all articles and reviews of HIV/AIDS indexed in the Web of Science Core Collection. We analyzed the scientific production, collaboration, and contributions from African and Middle Eastern countries to scientific activity in the region. The concept of leadership, measured through the participation as the first author of documents in collaboration was used to determine the equity in research produced through international collaboration.

Results
A total of 68,808 documents published from 2010 to 2017 were analyzed. Researchers from North America and Europe participated in 82.14% of the global scientific production on HIV/AIDS, compared to just 21.61% from Africa and the Middle East. Furthermore, the publications that did come out of these regions was concentrated in a small number of countries, led by South Africa (41% of the documents). Other features associated with HIV/AIDS publications from Africa include the importance of international collaboration from the USA, the UK, and other European countries (75–93% of the documents) and the limited participation as first authors that is evident (30 to 36% of the documents). Finally, the publications to which African countries contributed had a notably different disciplinary orientation, with a predominance of research on public health, epidemiology, and drug therapy.

Conclusions
It is essential to foster more balance in research output, avoid the concentration of resources that reproduces the global North-South model on the African continent, and focus the research agenda on local priorities. To accomplish this, the global North should strengthen the transfer of research skills and seek equity in cooperative ties, favoring the empowerment of African countries. These efforts should be concentrated in countries with low scientific activity and high incidence and prevalence of the disease. It is also essential to foster intraregional collaborations between African countries.
Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome
Authors: Yuan Quanwen , Guo Zhixiong , Wang Xiaodong , Dai Jin , Zhang Fuyong , Fang Jianfeng , Yin Chunhua , Yu Wentao , Zhen Yunfang 
Published: September 2020

Abstract
Background
The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern.

Methods
The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores.

Results
The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7.

Conclusions
Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.
The functional limits of the aneurysmal aortic root. A unique pressure testing apparatus
Authors: Surman Timothy Luke , Abrahams John Matthew , O’Rourke Dermot , Reynolds Karen Jane , Edwards James , Worthington Michael George , Beltrame John 
Published: September 2020

Abstract
Background
The aortic root has unique embryological development and is a highly sophisticated and complex structure. In studies that report on the biomechanical characteristics of the thoracic aorta, distinction between the aortic root and ascending aorta regions is nonexistent. Our objective is to determine the maximal pressures at which dissection occurs or tissue failure occurs in the aortic root compared to that of the ascending aorta in the presence of aortic aneurysms. This may help guide preoperative monitoring, diagnosis and the decision for operative intervention for aortic root aneurysms in the normal and susceptible populations.

Methods
We developed a simple aortic root and ascending aorta pressure testing unit in series. Ten fresh porcine hearts were obtained from the local abattoir (n = 5 aortic root and n = 5 ascending aorta for comparison). Using a saline filled needle and syringe, artificial fluid-filled aneurysms were created between the intima and medial layers of the aortic root. The aorta lumen was then progressively filled with saline solution. Pressure measurement was taken at time of loss of tissue integrity, obvious tissue dissection or aneurysm rupture, and the tissue structure was then visually examined.

Results
In the aortic root, mean maximal pressure (mmHg) at tissue failure was 208 mmHg. Macroscopic examination revealed luminal tears around the coronary ostia in 2/5 specimens, and in all specimens, there was propagation of the dissection in the aortic root in a circumferential direction. In all ascending aorta specimens, the maximal aortic pressures exceeded 300 mmHg without tissue failure or dissection, and eventual apparatus failure.

Conclusion
Our results indicate that the aneurysmal aortic root tissues are at greater risk of rupture and dissection propagation at lower aortic pressure. With further analysis, this could guide clinical and surgical management.
BCMA-targeted immunotherapy for multiple myeloma
Authors: Yu Bo , Jiang Tianbo , Liu Delong 
Published: September 2020

AbstractB cell maturation antigen (BCMA) is a novel treatment target for multiple myeloma (MM) due to its highly selective expression in malignant plasma cells (PCs). Multiple BCMA-targeted therapeutics, including antibody-drug conjugates (ADC), chimeric antigen receptor (CAR)-T cells, and bispecific T cell engagers (BiTE), have achieved remarkable clinical response in patients with relapsed and refractory MM. Belantamab mafodotin-blmf (GSK2857916), a BCMA-targeted ADC, has just been approved for highly refractory MM. In this article, we summarized the molecular and physiological properties of BCMA as well as BCMA-targeted immunotherapeutic agents in different stages of clinical development.