bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial
Authors: Esmaeili Vahid , Juneau Andréanne , Dyer Joseph-Omer , Lamontagne Anouk , Kairy Dahlia , Bouyer Laurent , Duclos Cyril 
Published: June 2020

Abstract
Background: Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective: To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods: Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 minute were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over three weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results: With no baseline differences between groups (p>0.075), perturbation training yielded large improvements in most variables in the Perturb (p<0.05, Effect Size: ES>.46) group (n=10) and the NonPerturb (p≤.089, ES>.45) group (n=7 post-crossing), except for maximal strength (p>.23) in the NonPerturb group. Walking-only training in the NonPerturb group (n=8, pre-crossing) mostly had no effect (p>.292, ES<.26), except on balance confidence (p=.063, ES=.46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion: Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830 (https://clinicaltrials.gov/ct2/show/NCT04314830?term=NCT04314830&draw=2&rank=1).
Identification of key biomarkers associated with cell adhesion in multiple myeloma by integrated bioinformatics analysis
Authors: Peng Yue , Wu Dong , Li Fangmei , Zhang Peihua , Feng Yuandong , He Aili 
Published: June 2020

Abstract
Background: Multiple Myeloma (MM) is a hematologic malignant disease whose underlying molecular mechanism has not yet fully understood. Generally, cell adhesion plays an important role in MM progression. In our work, we intended to identify key genes involved in cell adhesion in MM. Methods: First, we identified differentially expressed genes (DEGs) from the mRNA expression profiles of GSE6477 dataset using GEO2R with cut-off criterion of p < 0.05 and [logFC] ≥ 1. Then, GO and KEGG analysis were performed to explore the main function of DEGs. Moreover, we screened hub genes from the protein-protein interaction (PPI) network analysis and evaluated their prognostic and diagnostic values by the PrognoScan database and ROC curves. Additionally, a comprehensive analysis including clinical correlation analysis, GSEA and transcription factor (TF) prediction, pan-cancer analysis of candidate genes was performed using both clinical data and mRNA expression data. Results: First of all, 1383 DEGs were identified. Functional and pathway enrichment analysis suggested that many DEGs were enriched in cell adhesion. 180 overlapped genes were screened out between the DEGs and genes in GO terms of cell adhesion. Furthermore, 12 genes were identified as hub genes based on a PPI network analysis. ROC curve analysis demonstrated that ITGAM, ITGB2, ITGA5, ITGB5, CDH1, IL4, ITGA9, and LAMB1 were valuable biomarkers for the diagnosis of MM. Further study demonstrated that ITGA9 and LAMB1 revealed prognostic values and clinical correlation in MM patients. GSEA and transcription factor (TF) prediction suggested that MYC may bind to ITGA9 and repress its expression and HIF-1 may bind to LAMB1 to promote its expression in MM. Additionally, pan-cancer analysis showed abnormal expression and clinical outcome associations of LAMB1 and ITGA9 in multiple cancers. Conclusion: In conclusion, ITGA9 and LAMB1 were identified as potent biomarkers associated with cell adhesion in MM.
DNA methylation-based classification and identification of bladder cancer prognosis-associated subgroups
Authors: Tian Zijian , Meng lingfeng , Long Xingbo , Diao Tongxiang , Hu Maolin , Wang Miao , Liu Ming , Wang Jianye 
Published: June 2020

Abstract
Background: Bladder cancer (BCA) is the most common urinary tumor, but its pathogenesis is unclear, and the associated treatment strategy has rarely been updated. In recent years, a deeper understanding of tumor epigenetics has been gained, providing new opportunities for cancer detection and treatment.Methods: We identified prognostic methylation sites based on DNA methylation profiles of BCA in the TCGA database and constructed a specific prognostic subgroup. Results: Based on the consistent clustering of 402 CpGs, we identified seven subgroups that had a significant association with survival. The difference in DNA methylation levels was related to T stage, N stage, M stage, grade, sex, age, stage and prognosis. Finally, the prediction model was constructed using a Cox regression model and verified using the test dataset; the prognosis was consistent with that of the training set. Conclusions: The classification based on DNA methylation is closely related to the clinicopathological characteristics of BCA and determines the prognostic value of each epigenetic subtype. Therefore, our findings provide a basis for the development of DNA methylation subtype-specific therapeutic strategies for human bladder cancer.
Validation of Igbo Version of the Modified Fall Efficacy Scale Among Community-Dwelling Older Adults: A Validation Study
Authors: Okoye Emmanuel Chiebuka , Akosile Christopher Olusanjo , Maruf Fatai Adesina , Onwuakagba Ifeoma Uchenna , Urama Sunday Tobias 
Published: June 2020

Abstract
Background: Fear of falling (FOF) is a very pervasive problem among older adults. Consequently, many scales have been developed for its assessment. The Modified Fall Efficacy Scale (MFES) is one of the most popular FOF scales. The MFES was originally developed for use in developed countries, and thus may not be entirely suitable for use in developing countries due to cultural and environmental differences between the two country categories. This study was therefore designed to cross-culturally adapt and validate the MFES to Igbo culture and environment among community-dwelling older adults in Nnewi community using established guidelines. Methods: The original English version of the MFES (E-MFES) was translated, synthesized, back-translated, subjected to expert panel review, and pretested before producing the final Igbo version of the MFES (I-MFES). The E-MFES, the I-MFES and the Short Falls Efficacy International were randomly administered to consecutively recruited 109 consenting older adult residents of Nnewi (43.1% males; mean age=74.45±8.78 years). Concurrent, convergent and structural validities and internal consistency of the I-MFES were assessed at 0.05 level of significance. Results: All the 14 items on the E-MFES were retained on the I-MFES. The I-MFES exhibited the same structure as the E-MFES. The correlations between the corresponding scores on the I-MFES and the M-FES were all excellent (r=0.97-1.00) indicating evidence of concurrent validity of the I-MFES. The correlation between the total scores on the I-MFES and the Short Falls Efficacy International was excellent (r=9.3) indicating evidence of convergent validity. The Cronbach’s alpha value of the I-MFES is 0.97 showing evidence of excellent internal consistency. Conclusion: This study provides evidence of some aspects of validity and reliability of the I-MFES.
Changes in D-Dimer after initiation of antiretroviral therapy in adults living with HIV in Kenya
Authors: Teasdale Chloe A , Hernandez Cecilia , Zerbe Allison , Chege Duncan , Hawken Mark , El-Sadr Wafaa M 
Published: June 2020

Abstract
Background: Increased coagulation biomarkers are associated with poor outcomes among people living with HIV(PLHIV). There are few data available from African cohorts demonstrating the effect of antiretroviral therapy (ART) on coagulation biomarkers. Methods: From March 2014 to October 2014, ART-naïve PLHIV initiating non-nucleoside reverse transcriptase inhibitor-based ART were recruited from seven clinics in western Kenya and followed for up to 12 months. Demographics, clinical history and blood specimens were collected. Logistic regression models adjusted for intrasite clustering examined associations between viral load and D-Dimer at baseline. Mixed linear effects models were used to estimate mean change from baseline to six months overall, and by baseline viral load, sex and TB status at enrollment. Mean change in D-dimer at six months is reported on the log10 scale and as percentage change from baseline. Results: Among 611 PLHIV enrolled, 66% were female, median age was 34 years (interquartile range (IQR) 29-43 years), 31 (5%) participants had tuberculosis and median viral load was 113,500 copies/mL (IQR: 23,600-399,000). At baseline, 311 (50.9%) PLHIV had elevated D-dimer (>500 ng/mL) and median D-dimer was 516.4 ng/mL (IQR: 302.7-926.6) (log baseline D-dimer: 2.7, IQR: 2.5-3.0). Higher baseline D-dimer was significantly associated with higher viral load (p<0.0001), female sex (p=0.02) and tuberculosis (p=-0.02). After six months on ART, 518 (84.8%) PLHIV had achieved viral load <1,000 copies/mL and median D-dimer was 390.0 (IQR: 236.6-656.9) (log D-dimer: 2.6, IQR: 2.4-2.8). Mean change in log D-dimer from baseline to six months was -0.12 (95%CI -0.15, - 0.09) (p<0.0001) indicating at 31.3% decline (95%CI -40.0, -23.0) in D-dimer levels over the first six months on ART. D-dimer decline after ART initiation was significantly greater among PLHIV with tuberculosis at treatment initiation (-172.1%, 95%CI -259.0, -106.3; p<0.0001) and those with log viral load >6.0 copies/mL (-91.1%, 95%CI -136.7, -54.2; p<0.01). Conclusions: In this large Kenyan cohort of PLHIV, women, those with tuberculosis and higher viral load had elevated baseline D-dimer. ART initiation and viral load suppression among ART-naïve PLHIV in Kenya were associated with significant decrease in D-dimer at six months in this large African cohort.
The value of the atherogenic index of plasma in non-obese people with non-alcoholic fatty liver disease: a secondary analysis based on a cross-sectional study
Authors: Dong Buyuan , Mao Yuqing , Li Zhengyang , Yu Fujun 
Published: June 2020

Abstract
Background and objectives: The atherogenic index of plasma (AIP) is elevated in fatty liver disease, but its value in non-obese people with non-alcoholic fatty liver disease (NAFLD) is unclear. This study aimed to investigate the relationship between AIP and NAFLD as well as to determine whether AIP might be used as an indicator of NAFLD in non-obese individuals. Methods : The present study involved non-obese Chinese and Japanese participants. Univariate and multivariate logistic regression models were used to determine risk factors. The performance of risk factors was compared according to the area under the receiver operating characteristic curve. Results : In the unadjusted model, the odds ratio (OR) for every 1 standard deviation (SD) increase in AIP was 52.30. In adjusted models I and II, the OR for every 1 SD increase in AIP was 36.57 and 50.84, respectively. The area under the receiver operating characteristic curve for AIP was 0.803 and 0.802 in the development and validation groups, respectively. The best cut-off value of AIP for discrimination between NAFLD and non-NAFLD was 0.005 in the Chinese group and -0.220 in the Japanese group. Conclusions : AIP and NAFLD are positively correlated in Chinese and Japanese populations. Therefore, AIP can be used as a new screening indicator for non-obese people with NAFLD in different nations.
A study on the protective mechanism of mTOR inhibitor Everolimus on brain injury after epilepsy
Authors: Huang Xiang-yi , Hu Qing-peng , Zheng Ya-yu , Hu Rong-rong 
Published: June 2020

Abstract
Background: Epilepsy is a common acute and severe disease in infants and children. Recurrent seizures or status epilepticus can cause irreversible brain damage. While the PI3K/Akt/mTOR pathway regulates various physiological processes of neurons and glia, it may also lead to abnormal neuronal signal transduction under pathological conditions, including that of epilepsy. Everolimus (Eve) is an mammalian target of repamycin (mTOR) inhibitor that may affect neuronal excitability and have a therapeutic effect on epilepsy. Therefore, this study aimed to investigate the protective effect of Everolimus on post-epileptic brain injury and the regulation mechanism of the PI3K/Akt/mTOR and NF-kB/IL-6 signaling pathway. Intraperitoneal administration of kanic acid (KA) 15mg/kg was used to induce epilepsy in the developing rat and Everolimus (1, 2, 5mg/kg) was injected intraperitoneally 2 hours before KA injection. Cerebral cortex tissue was sampled at 24 hours post-epilepsy.Results: The protein and mRNA levels of PI3K、AKt、mTOR、NF-kB and IL-6 as well as microglia activation significantly increased after KA-induced epilepsy, however these effects were inhibited by Everolimus treatment. Furthermore, pretreatment with Everolimus decreased seizure scores and increased seizure latency. This study demonstrates that mTOR inhibitor.Conclusions: Everolimus can decrease the PI3K/Akt/mTOR and NF-kB/IL-6 signaling pathway, reduce microglia activation, and attenuate seizure susceptibility and intensity, thus having a protective effect on post-epileptic brain damage.
The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms
Authors: Fang Youhong , Peng Kerong , Zhao Hong , Chen Jie 
Published: June 2020

Abstract
Background Henoch–Schönlein purpura (HSP) is a systemic small-vessel vasculitis that commonly affects gastrointestinal tract. The video capsule endoscopy (VCE) characteristics of pediatric HSP patients were rarely investigated. Methods Patients diagnosed with HSP by VCE examination at our hospital from February 2010 to January 2019 are analyzed. The clinical features, laboratory findings, and the characteristics of VCE findings are studied. Results There are 30 patients enrolled in this investigation from February 2010 to January 2020. The mean age of these patients is 96.9±35.8 months, and the most frequent finding of VCE is mucosal erosion, which account for 69 % of the patients, and followed by mucosal erythema or petechia accounted for 79.3 % of the patients. Regarding to the disease location detected by endoscopy, jejunum is the most common involved part of the gastrointestinal tract in pediatric HSP patients. All the patients had jejunum involved except in one patient the VCE did not pass through the pylorus. One third of the patients involved the descent part of duodenum. No side effects are observed in this study. Conclusions VCE is safe and effective in the diagnosis of gastrointestinal involved HSP patients with or without typical skin purpura. Jejunum is the most common involve location in gastrointestinal.
The protective effect of 3% diquafosol on meibomian gland morphology in glaucoma patients treated with prostaglandin analogs: a 12-month follow-up study
Authors: Guo Yue , Ha Jun Young , Piao Helong , Sung Mi Sun , Park Sang Woo 
Published: June 2020

Abstract
Background
To determine if 3% diquafosol (DQS) can preserve the meibomian gland morphology in glaucoma patients treated with prostaglandin analogs (PGA) for a 12-month follow-up period.
Methods
This study included 84 eyes of 46 normal tension glaucoma (NTG) patients who were treated with either preservative-containing PGA (PC-PGA; 16 patients, 28 eyes), preservative-free PGA (PF-PGA; 21 patients, 39 eyes), or a combination of PC-PGA and 3% DQS (PC-PGA + DQS; 9 patients, 17 eyes). The meibography of the upper eyelid was acquired using Keratograph® 5M at baseline and at each follow-up (1, 3, 6, 9, and 12 months). Meibomian gland loss (MGL) was quantitatively analyzed by using ImageJ software.
Results
In the PC-PGA group, MGL increased significantly from baseline to month 9 and month 12, whereas no significant changes were observed in the PF-PGA and PC-PGA + DQS groups during the entire 12 months. All groups showed similar MGL at each follow-up time from baseline to six months. However, MGL in the PC-PGA group was significantly higher than those in the PF-PGA and PC-PGA + DQS groups at the 9 and 12 months.
Conclusions
Combining 3% DQS with PC-PGA was as effective as PF-PGA in preserving the meibomian gland morphology for at least 12 months. Our results suggest that 3% DQS may be a promising strategy for managing glaucoma patients with a high risk of developing meibomian gland dysfunction due to preservative-containing topical medications.
Prevalence, predictors and outcome of carotid stenosis. A sub study in the Preventive Antibiotics in Stroke Study (PASS)
Authors: Velzen Twan van , Kuhrij Laurien , Westendorp Willeke , de Beek Diederik van , Nederkoorn Paul 
Published: June 2020

Abstract
Background:The prevalence of carotid artery stenosis (CAS) in acute ischaemic stroke (AIS) patients is historically reported at 15-20%, but an up-to-date estimate is lacking. We hypothesise it is lower than historically reported, due to better risk management to date. The study aims to study prevalence, predictors and survival of CAS in AIS patients. Methods:We included patients with AIS from the Preventive Antibiotics in Stroke Study (PASS), a large Dutch randomized, multicentre, open-label phase III trial that included 2538 patients with acute stroke and randomised between standard care or preventive ceftriaxone. Patients with stroke in the anterior circulation that underwent diagnostic testing of the internal carotid artery (ICA) were eligible for this sub study and used in these secondary analyses. Logistic regression analyses were performed to identify predictors for CAS ≥50%. Additionally, an ordinal regression was performed to assess the association between presence of CAS at baseline and functional outcome at three months on the modified Rankin scale (mRS). Results:1480 patients with AIS were included; 277 had CAS (18.7%; 95%CI:17.7-19.7). Age, hypertension, smoking and male gender were found as best-fit predictors for presence of CAS. Significant shift in mRS score after 90 days for CAS ≥50% towards a higher mRS score with an OR of 1.66 (95% CI 1.30-2.10) was found.Conclusions:Current prevalence of CAS is 18.7%, which is higher than we expected. Gender, smoking and hypertension are important factors associated with CAS. Patients with CAS had a significantly higher mRs score after 90 days. Clinical Trial Registration-URL: https://doi.org/10.1186/ISRCTN66140176 Unique identifier: ISRCTN66140176
Biased Technical Change in Hospital Care and the Demand for Physicians
Authors: Blank Jos L.T. , Niaounakis Thomas K. , Valdmanis Vivian G. 
Published: June 2020

Abstract
Background The development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007-2017) and discusses its implications for workforce planning, also in relation to the existing literature. Methods A regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007-2017 across 24 different specialties using regression methods. Results The results indicate that the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms. Conclusions The results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians’ productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed and some consensus has been reached.
Echocardiography Evaluation of the Effects of Midazolam on Passive Leg Raising Test in Critically ill Patients in the Intensive Care Unit, diagnosed with Sepsis, determined to be hypovolemic and responding to fluid treatment
Authors: Yektaş Abdulkadir 
Published: June 2020

Abstract
Background
This study used echocardiography parameters to investigate the effects of midazolam sedation on intravascular volume in intubated patients who are diagnosed with sepsis and treated with invasive mechanical ventilation in continuous positive airway pressure mode.
Methods
This study included 152 intensive care unit patients aged 30–50 years with spontaneous breathing; all were intubated, had their lungs ventilated with a positive end-expiratory pressure of 5 cmH2O in continuous positive airway pressure mode via invasive mechanical ventilation, had a Ramsey sedation scale score of 5–6 at 5 min after midazolam administration, and exhibited a fluid deficit (i.e., inferior vena cava collapsibility index > 42% and > 12% systolic arterial pressure increase in the passive leg raising test). Cardiac index, cardiac output, and velocity time integral measurements were taken after the passive leg raising test, before and after midazolam sedation, in patients with hypovolaemia who responded to fluid treatment. Changes in passive leg raising test results were compared before and after administration of midazolam.
Results
Cardiac output > 15%, cardiac index > 10%, and > 15% increase in velocity time integral during the passive leg raising test before midazolam administration indicated that patients exhibited hypovolaemia and responded to fluid therapy. Cardiac output < 15%, cardiac index < 10%, and < 15% increase in velocity time integral during the passive leg raising test after midazolam administration indicated that patients did not exhibit hypovolaemia.
Conclusions
We recommend that the passive leg raising test, which is used to determine intravascular volume status of critically ill intensive care unit patients who exhibit hypovolaemia and respond to fluid therapy, should be performed before midazolam sedation.