bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Health Policy Priorities in Pakistan: A Content Analysis of Policy Documents
Authors: Sadaat Pakeezah , Zain Shahzadi , Jameel Bismah , Shaikh Rida , Bowen Brittany , Majid Umair 
Published: November 2020

Abstract
Background: Despite numerous improvements in the health care system of Pakistan in the past few decades, many disparities continue to persist between health care policies and practices in comparison to developed nations, particularly in the area of maternal health. Despite a 181% increase in expenditure, Pakistan did not meet its target to reduce child mortality and improve maternal health by 2015, causing these disparities to further widen. Methods: We sought to investigate the policymaking process of Pakistan by conducting a content analysis of 34 policy documents pertaining to maternal health service delivery. Results: We found a number of gaps, priorities, and determinants for health policymaking. The most commonly discussed themes were the following: Measures of Burden, System and Organizational Capacity, Access and Availability of Health Services, Policy and Planning, Gaps and Needs, and Socioeconomic Factors. Integrated care and opioid use were seldom mentioned in included policy documents. Conclusions: We discuss the reasons that might explain why Pakistan has not observed an improvement in maternal health outcomes despite significant investment. We use path dependency to explain that drawbacks of health care priority-setting processes in Pakistan. We suggest a refocus on identifying and improving health disparities between communities. We also suggest research and policy attention on integrated care and opioid use in Pakistan.
Genomic Differences Between Carbapenem-susceptible and Carbapenem-resistant Escherichia Coli Analyzed by Whole-genome Sequencing
Authors: Wu Qiong , Hu Jun , Wang Jianqiang , Li Yungai , Pan Yunqi , Chen Rong , Tang Jin 
Published: November 2020

Abstract
Background The widespread resistance to carbapenem via Enterobacteriaceae is a major public health concern. To investigate the reason for the change of Escherichia coli from carbapenem-susceptible to carbapenem-resistant status after antibiotic therapy, whole-genome sequencing was applied for the analysis of genetic difference between the two isolates. The genome of the two isolates of Escherichia coli with distinct resistant phenotypes recovered from one patient was sequenced and compared. Single-nucleotide polymorphisms and insertions/deletions were analyzed using software MUMmer (http://mummer.sourceforge.net/). Results The homology of chromosomes, plasmid 1, and plasmid 2 between the two isolates was very high (>99.5%). However, the coverage ratio of plasmid 3 was only 7.13%. This plasmid harbored the IMP-4 carbapenemase-coding gene. The upstream of blaIMP-4 was the plasmid mobilization relaxosome protein Mobe gene and the downstream were class 1 integrom integrase IntI1 and IS6 family transposase IS15DIV, which may be related to carbapenemase gene capture. Conclusions Single-nucleotide mutation, insertion, and deletion could not result in the development of resistance to carbapenem, whereas acquisition of the IMP-4-encoding gene may be the reason for changes in resistance to carbapenem.
Seasonal Changes of the Airborne Microbiome in a Large Urban Area
Authors: Núñez Andrés , Moreno Diego A , García Ana M , Guantes Raul 
Published: November 2020

Abstract
Background Compared to soil or aquatic ecosystems, the atmosphere is still an underexplored environment for microbial diversity. Besides its ecological importance, the spatial and temporal characterization of aerosolized microorganisms is relevant for understanding allergy and disease outbreaks, especially in highly populated cities. Results In this study, we surveyed the composition, variability and sources of microbes (bacteria and fungi) in the near surface atmosphere of a highly populated area, spanning ~ 4,000 Km 2 around the city center of Madrid (Spain), in different seasonal periods along two years. We found a core of abundant bacterial genera robust across space and time, most of soil origin, while fungi were more sensitive to environmental conditions. Microbial communities showed clear seasonal patterns driven by variability of environmental factors, mainly temperature and accumulated rain, while local sources played a minor role. We also identified taxa in both kingdoms characteristic of seasonal periods, but not of specific sampling sites or plant coverage. Conclusions The present study suggests that the near surface atmosphere of urban environments constitutes a stable ecosystem, with a relatively homogenous composition, modulated by climatic variations. As such, it contributes to our understanding of the long-term changes associated to the human exposome in the air of highly populated areas.
Efficacy of Pediatric Integrative Manual Therapy in Positional Plagiocephaly: A Randomized Controlled Trial.
Authors: Pastor-Pons Iñaki , López María Orosia Lucha , Barrau-Lalmolda Marta , Rodes-Pastor Iñaki , Rodríguez-Fernández Ángel Luis , Hidalgo-García César , Tricás-Moreno José Miguel 
Published: November 2020

Abstract
Background: positional plagiocephaly frequently affects healthy babies. It is hypothesized that manual therapy tailored to pediatrics is more effective in improving plagiocephalic cranial asymmetry than just repositioning and sensory and motor stimulation. Methods: 34 neurologically healthy subjects aged less than 28 weeks old with a difference of at least 5 mm between cranial diagonal diameters were randomly distributed into 2 groups. For 10 weeks, the pediatric integrative manual therapy (PIMT) group received manual therapy plus a caregiver education program, while the controls received the same education program exclusively. Cranial shape was evaluated using anthropometry; cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Parental perception of change was assessed using a visual analogue scale (-10 cm to +10 cm). Results: CVAI presented a greater decrease in PIMT group: 3.72 ± 1.40 % compared with 0.34 ± 1.72% in the controls (p=0.000). CI changes did not present any significant differences between the 2 groups. Manual therapy increased positive parental perception of cranial changes (manual therapy: 6.66 ± 2.07 cm; control: 4.25 ± 2.31 cm; p= 0.004). Conclusion: manual therapy plus caregiver education program improved cranial symmetry and parents’ satisfaction more effectively than solely caregiver education program.Trial registration: trial registration number: NCT03659032; registration date: September 1, 2018. Retrospectively registered.https://clinicaltrials.gov/ct2/show/NCT03659032?term=NCT03659032&cond=Plagiocephaly&draw=2&rank=1
ADHD Symptoms and School Impairment History in Parents of ADHD Children are a Fundamental Diagnostic and Therapeutic Clue.
Authors: Wiel Luisa Cortellazzo , Rispoli Francesco , Peccolo Giulia , Rosolen Valentina , Barbi Egidio , Skabar Aldo 
Published: November 2020

Abstract
Background: Attention Deficit and Hyperactivity Disorder (ADHD) is a multi-factorial condition, with inheritance playing a major role. Recognizing parents’ ADHD represents a clue not only for an earlier diagnosis of the disease in their children, but also to optimize psycho-educational therapy outcome, by addressing the impairment of parenting related to untreated ADHD. This study aimed to assess the frequency of features suggestive of ADHD during childhood among parents of affected children, and the presence of school and emotional impairment.Methods: We administered the Wender Utah Rating Scale-25, a self-assessment tool for the retrospective identification of symptoms consistent with ADHD during childhood, to a cohort of 120 parents of 60 children diagnosed with ADHD, and to a consistent number of “controls”.Results: The WURS-25 proved positive in 49.1% of fathers and 30.0% of mothers of ADHD patients, compared to 1.7% of fathers and 1.7% of mothers of non-ADHD patients (p < 0.0001). The questions addressing learning and emotional impairment provided significantly higher scores in parents with an overall positive test compared to those with negative test (p < 0.0001).Conclusions: This study demonstrates a remarkably high rate of symptoms consistent with ADHD during childhood in parents of affected children. Physicians should be aware that this is a relevant anamnestic clue and, given the relevance of parents’ role in the management of children with ADHD, an important issue in order to improve patients’ treatment.
Case Report of Severe Lactic Acidosis and Persistent Diastolic Hypotension After Standard Dose Intermittent Salbutamol Nebulization in a Child: Rare Adverse Effects for Common Treatment.
Authors: Colombo Marco , Plebani Anna , Bosco Annalisa , Agosti Massimo 
Published: November 2020

Abstract
BackgroundSalbutamol is a selective β2 receptor agonist widely used to treat asthma and other conditions and it often represents the treatment of choice for reversing airflow obstruction both in emergency and domiciliary settings. However, it can be associated to a broad spectrum of side effects and even paradox effects, if administered intravenously, at high doses continuous nebulized treatment and even at standard doses intermittent nebulized treatment, the latter being the most hazardous due to its infrequency. Lactic acidosis and persistent diastolic hypotension secondary to intermittent salbutamol nebulization are rare in children, moreover at standard therapeutic doses during asthma exacerbations.Case presentation We present a case of a 12 year-old boy, 34 Kg, who experienced a serious drug reaction during a moderate asthma attack, after intermittent inhaled (0.2 mg in 3 hours interval – overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg in 20 minutes interval in 60 minutes, overall 11.25 mg in our ED). He began experiencing symptoms of toxicity (tremor) in the emergency department few minutes after administration of the second dose of nebulized salbutamol, without reporting that to health care providers. Few minutes after the end of the third nebulized dose, clinical conditions worsened showing hyperglycemia (highest value 222 mg/dl), hypokalemia (lowest value 2.6 mEq/L), electrocardiogram alterations, decreased blood pressure (lowest value 87/33 mm/Hg), increased lactate serum level (highest value 8.1 mmol/L). The patient fully recovered after discontinuation of salbutamol and was discharged after 24 hours of staying in the intensive brief observation unit of our pediatric emergency department.ConclusionsWe reinforce the message that not only intravenous administration or continuous nebulization of salbutamol can lead to severe complication in children, but also intermittent therapy given at standard doses. Then, health care providers should pay attention not only in emergency settings in order to achieve prompt recognition and proper management of this adverse reaction.
Breast Adipose Tissue Macrophages (BATMs) have a Stronger Correlation with Breast Cancer Survival than Breast Tumor Stroma Macrophages (BTSMs)
Authors: Lin Lili , Kuhn Christina , Ditsch Nina , Kolben Thomas , Czogalla Bastian , Beyer Susanne , Trillsch Fabian , Schmoeckel Elisa , Mayr Doris , Mahner Sven , Jeschke Udo , Hester Anna 
Published: November 2020

Abstract
Background: An abundance of tumor-associated macrophages has been shown to be an independent prognostic factor for a poor prognosis of human breast cancer (BC). Adipose tissue accounts for the largest proportion of the breast and has also been identified as an independent indicator of poor survival in BC. This study aims to elucidate, if the influence of adipose tissue in BC might be mediated by macrophages. The roles of macrophages in the breast tumor-stroma (breast tumor stroma macrophages, BTSM) and macrophages in the surrounding adipose tissue (breast adipose tissue macrophages, BATM) were explored separately.Methods: 298 BC tissue samples were analyzed immunohistochemically. The number of macrophages was detected by CD68+ staining. The quantity of BATMs and BTSMs was correlated to clinical and pathological parameters as well as to disease free survival (DFS) and overall survival (OS). Results: The amounts of BATMs and BTSMs strongly correlated with each other (r = 0.5, p < 0.001). The quantity of BTSMs, but not of BATMs, was significantly associated with the BC molecular subtype (p < 0.001) and all triple negative BC tumors contained high amounts of BTSMs. BATMs were negatively associated with DFS (p = 0.0332). Both BATMs (p < 0.001) and BTSMs (p = 0.021) were negatively associated with OS in the Kaplan-Meier analysis, but only BATMs remained an independent factor in the multivariate Cox-regression analysis (HR = 4.464, p = 0.004). Combining prostaglandin E2 receptor 3 (EP3)-expression and the quantity of BATMs, a subgroup with an extremely poor prognosis could be identified (median OS 2.31 years in the “high BATMs/low EP3” subgroup compared to 11.42 years in the most favorable “low BATMs/high EP3” subgroup, p < 0.001).Conclusion: Our findings suggest that BTSMs and BATMs seem to be involved differently in BC. Breast adipose tissue might contribute to the aggressiveness of BC via BATMs, which were independently associated with BC survival. BATMs’ role and occurrence might be functionally dependent on EP3, as a combination of both factors was strongly associated with survival. Targeting BATMs – eventually in combination with targeting the EP3-pathway – might be promising for future therapies.
Effects of Combining Diaphragm Training with Electrical Stimulation on Balance, Pain, and Function in Athletes with Chronic Low Back Pain : A Randomized Clinical Trial
Authors: Otadi Khadijeh , Ansari Noureddin Nakhostin , Sharify Shahriar , Fakhari Zahra , Sarafraz Hadi , Aria Amir , Rasouli Omid 
Published: November 2020

Abstract
Background: It is unknown how diaphragm training combined with electrical stimulation affect balance, core stability, pain, and function in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on core stability, dynamic balance, pain, and function in young athletes with nonspecific CLBP.Methods: The design was a randomized clinical trial A total of 24 young adult athletes (12 women, 12 men) with non-specific CLBP were randomly allocated into experimental and control group. The experimental group received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group received only TENS. Both groups underwent 12 sessions over a 4-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention.Results: Significant improvements in pain and function scores were found in both groups after completing the interventions. However, only the experimental group showed significant improvements in the static stability and dynamic balance post-intervention. The experimental group showed greater improvements in pain and static stability. No significant differences in function or dynamic balance were observed between the groups. Conclusions: The present study indicates that diaphragm training plus TENS can improve static stability, dynamic balance, function, and pain in young athletes with non-specific CLBP. It seems beneficial to add diaphragm training to rehabilitation programs for athletes with CLBP.Trial registration: The trial was retrospectively registered at the Iranian Registry of Clinical Trials on www.irct.ir (Identification number: IRCT20090228001719N8).
The Role of Pruriceptors in Enhancing Sensitivity to Pruritogens in a Murine Chronic Compression Model of Dorsal Root Ganglion
Authors: Wang Tao , Tao Jin , Fang Yehong , Ma Chao 
Published: November 2020

Abstract
Chronic pruritus is a symptom that commonly observed in neurological diseases. It has been hypothesized that the chronic pruritus may result from sensitization of itch-signaling pathways but the mechanisms remain obscure. In this study, we established a mouse model of chronic compression of dorsal root ganglion (CCD) and injected various pruritogenic and algogenic agents intradermally to the calf skin ipsilateral to the compressed dorsal root ganglion (DRG). Compared to the naïve mice, a significant increase in itch-related behaviors was observed in the CCD mice after the injection of pruritogens including histamine and BAM8-22, but not after the injection of capsaicin, although all the above agents evoked enhanced pain-related behaviors toward the injected site. In addition, we investigated if pruritogen-evoked activities of DRG neurons are enhanced in this model. In vivo calcium imaging revealed that compressed DRG neurons exhibited significant enhanced responses to histamine and BAM8-22. Immunoflorescent staining also showed that the histamine receptor H1 and the capsaicin receptor TRPV1 were significantly upregulated in DRG neurons. Our findings indicated that in mice modeling the sensitization of primary pruriceptive neurons may underlie the enhanced itch sensation after chronic compression of DRG neurons, and may play a role in chronic pruritus in neurological diseases.
High Lymphocyte Population-related Predictive Factors for a Long-term Response in Non-small Cell Lung Cancer Patients Treated with Pemetrexed: A Retrospective Observational Study
Authors: Sumiyoshi Issei , Okabe Takahiro , Togo Shinsaku , Takagi Haruhi , Motomura Hiroaki , Ochi Yusuke , Shimada Naoko , Haraguchi Mizuki , Shibayama Rina , Fujimoto Yuichi , Watanabe Junko , Iwai Moe , Kadoya Kotaro , Iwakami Shin-ichiro , Takahashi Kazuhisa 
Published: November 2020

Abstract
BackgroundRegimens combining pemetrexed (PEM) and immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1) or programmed death-ligand 1 (PD-L1) are widely used for the treatment of advanced non-squamous non-small-cell lung cancer (NSq-NSCLC). Recently, PEM was shown to induce immunogenic cell death (ICD) and to enhance immune-regulatory genes. Some patients demonstrate an extremely long-term response to PEM. It is possible that the continued response in these patients is dependent on not only the pharmacological induction of cytotoxic cell death but also antitumor immunity. However, factors that can predict outcomes associated with long-term PEM administration using blood test results have not yet been elucidated. We investigated the clinical characteristics and predictive factors in patients with advanced NSq-NSCLC who underwent long-term PEM maintenance therapy.MethodsIn total, 504 patients with advanced NSq-NSCLC who received PEM combination therapy/monotherapy (n=414) or paclitaxel (PTX) combination therapy (n=90) between January 2010 and November 2019 were recruited; 381 patients were retained for the final analysis. Patients treated with PEM (n=301) were divided into subgroups according to the total cycles of PEM (≥17 [n=25] for the long-term administration group and ≤16 [n=276] for the intermediate/short-term group) and compared with another population (n=80) treated with PTX combination regimen. We investigated clinical features and predictive biomarkers, focusing on immune-regulatory factors, absolute lymphocyte count (ALC), neutrophil-to-lymphocyte ratio (NLR), and PD-1 and PD-L1 expression, to predict long-term response to PEM. ResultsThe long-term PEM administration group exhibited a higher ALC and a lower NLR than the shorter-term group did. Both these markers displayed greater association with progression-free survival and overall survival in the PEM combination therapy group than in the PTX combination therapy group. Increased PD-1 lymphocytes were associated with the long-term PEM response group, as PD-L1 expression in tumors was associated with a high incidence of immune-related adverse effects following ICI administration.ConclusionsALC, NLR, and PD-1 expression are PEM-mediated predictive biomarkers that are indirectly related to tumor immunity and can provide useful predictive information on the long-term response to PEM in patients with NSq-NSCLC.
Identification of Robust Immune‐Associated lncRNAs Signature for Immune Checkpoint Blockade and Prognosis in Pancreatic Ductal Adenocarcinoma
Authors: Xu Qianhui , Wang Yuxin , Huang Wen 
Published: November 2020

Abstract
Background: An increasing body of evidence has suggested that long non-coding RNAs (lncRNAs) can serve as essential regulators in cancer immunity. We aimed to establish a robust immune-associated lncRNA signature for pancreatic ductal adenocarcinoma (PDAC) outcome prediction to enhance prognostic accuracy.Methods: Pancreatic cancer samples were obtained from the The Cancer Genome Atlas (TCGA) project. Immune‐related lncRNAs displaying significant association with overall survival (OS) were screened through univariate Cox regression analysis and the least absolute shrinkage and selection operator (LASSO) algorithm. The prediction reliability was further estimated in the internal validation set and combination set. Gene set enrichment analysis (GSEA) of the lncRNA model risk score was performed for functional annotation. The correlation between immune checkpoint inhibitors and this signature was examined. Results: 5 immune-related lncRNAs were confirmed to establish five‐immune-related lncRNAs prognostic signature. The constructed risk model showed significant correlation with PDAC OS. The area under the curve (AUC) for this lncRNA model was up to 0.747. This immune‐related lncRNA signature was correlated with disease progression and worse survival and was an independent prognostic biomarker. Our signature mediated chondrocyte development, laminin binding and so forth. This risk score model was associated with immune cell infiltration (i.e., CD4 T cells, etc.,) and immune checkpoint blockade (ICB) immunotherapy‐related molecules (i.e., PDCD1 and CTLA4).Conclusion: The immune‐related lncRNA signature we established possesses latent prognostic value for patients with PDAC and may have the potential to measure the response to ICB immunotherapy, which could guide for immunological treatment in PDAC.