bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement in circulating endothelial progenitor cells pool after cardiac resynchronization therapy: increasing the list of benefits
Authors: Cristóvão Gonçalo , Milner James , Sousa Pedro , Ventura Miguel , Cristóvão João , Elvas Luís , Paiva Artur , Gonçalves Lino , Ribeiro Carlos Fontes , António Natália 
Published: March 2020

Abstract
Background Recent studies suggest that circulating endothelial progenitor cells (EPCs) may influence the response to cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the effect of CRT on EPCs levels and to assess the impact of EPCs on long-term clinical outcomes. Population and methods Prospective study of 50 patients submitted to CRT. Two populations of circulating EPCs were quantified previously to CRT implantation: CD34 + KDR + and CD133 + KDR + cells. EPCs levels were reassessed 6 months after CRT. Endpoints during the long-term follow-up were all-cause mortality, heart transplantation and hospitalization for heart failure (HF) management. Results The proportion of non-responders to CRT was 42% and tended to be higher in patients with an ischemic vs non-ischemic etiology (64% vs 35%, p=0.098). Patients with ischemic cardiomyopathy (ICM) showed significantly lower CD34+KDR+ EPCs levels when compared to non-ischemic dilated cardiomyopathy patients (DCM) (0.0010 ± 0.0007 vs 0.0030 ± 0.0024 cells/100 leukocytes, p=0.032). There were no significant differences in baseline EPCs levels between survivors and non-survivors nor between patients who were rehospitalized for HF management during follow-up or not. At 6-month follow-up, circulating EPCs levels were significantly higher than baseline levels (0.0024 ± 0.0023 vs 0.0047 ± 0.0041 CD34 + KDR + cells/100 leukocytes, p=0.010 and 0.0007 ± 0.0004 vs 0.0016 vs 0.0013 CD133 + /KDR + cells/100 leukocytes, p=0.007). Conclusions Patients with ICM showed significantly lower levels of circulating EPCs when compared to their counterparts. CRT seems to improve the pool of endogenously circulating EPCs and reduced baseline EPCs levels seem not influence long-term outcomes after CRT.
Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana
Authors: Krumkamp Ralf , Oppong Kwabena , Hogan Benedikt , Strauss Ricardo , Frickmann Hagen , Wiafe-Akenten Charity , Boahen Kennedy , Rickerts Volker , McCormick Ilka , Groß Uwe , Schulze Marco , Jaeger Anna , Loderstädt Ulrike , Sarpong Nimako , Owusu-Dabo Ellis , May Jürgen , Dekker Denise 
Published: March 2020

Abstract
Background: Chronic infected wounds are generally difficult to manage and treatment can be particularly challenging in resource-limited settings where diagnostic testing is not readily available. In this study, the epidemiology of microbial pathogens in chronically infected wounds in rural Ghana was assessed to support therapeutic choices for physicians.Methods. Culture-based bacterial diagnostics including antimicrobial resistance testing were performed on samples collected from patients with chronic wounds at a hospital in Asante Akim North Municipality, Ghana. Fungal detection was performed by broad-range fungal PCR and sequencing of amplicons. Results: In total, 105 patients were enrolled in the study, from which 207 potential bacterial pathogens were isolated. Enterobacteriaceae (n=84, 41%) constituted the most frequently isolated group of pathogens. On species level, Pseudomonas aeruginosa (n=50, 24%) and Staphylococcus aureus (n=28, 14%) were predominant. High resistance rates were documented, comprising 29% methicillin resistance in Staphylococcus aureus as well as resistance to 3rd generation cephalosporins and fluoroquinolones in 33% and 58% of Enterobacteriaceae, respectively. One Pseudomonas aeruginosa strain with carbapenem resistance was identified. The most frequently detected fungi were Candida tropicalis.Conclusions: The pathogen distribution in chronic wounds in rural Ghana matched the internationally observed patterns with a predominance of Pseudomonas aeruginosa and Staphylococcus aureus. Very high resistance rates discourage antibiotic therapy but suggest an urgent need for microbiological diagnostic approaches, including antimicrobial resistance testing to guide the management of patients with chronic wounds in Ghana.
Ocular lesions in hereditary hemorrhagic telangiectasia: genetics and clinical characteristics
Authors: Gómez-Acebo Ines , Prado Sara Rodríguez , Mora Angel De la , Puente Roberto Zarrabeitia , Varela Beatriz de la Roza , Dierssen-Sotos Trinidad , Llorca Javier 
Published: March 2020

Abstract
Background The aim of our study is to study the association between eye lesions in Hereditary Hemorrhagic Telangiectasia (HHT) and other signs of the disease, as well as to characterize its genetics.Methods A cross-sectional study was conducted of a cohort of 206 patients studied in the HHT Unit of Hospital de Sierrallana, a reference centre for Spanish patients with HHT. Odds ratios for several symptoms or characteristics of HHT and ocular lesions were estimated using logistic regression adjusting for age and sex.Results The ocular involvement was associated with being a carrier of a mutation for the ENG gene, that is, suffering from a type 1 HHT involvement (OR = 2.09; 95% CI [1.17-3.72]). p = 0.012). In contrast, patients with ocular lesions have less frequently mutated ACVRL1/ALK1 gene (OR = 0.52; 95% CI [0.30- 3.88], p = 0.022).Conclusions In conclusion, half of the patients with HHT in our study have ocular involvement. These eye lesions are associated with mutations in the ENG gene and ACVRL1/ALK1 gene. Thus, the ENG gene increases the risk of ocular lesions, while being a carrier of the mutated ACVRL1/ALK1 gene decreases said risk.
Chinese public’s knowledge, perceived severity, and perceived controllability of the COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: A national survey
Authors: Li Jian-Bin , Yang An , Dou Kai , Wang Lin-Xin , Zhang Ming-Chen , Lin Xiao-Qi 
Published: March 2020

Abstract
Background The outbreak of the coronavirus disease-19 (COVID-19) has caused enormous stress among the public in China. Intellectual input from various aspects is needed to control the COVID-19, including the understanding of the public’s emotion and behaviour and their antecedents from the psychological perspectives. Drawing upon the cognitive appraisal theory, this study examined three cognitive appraisals (i.e., knowledge, perceived severity and perceived controllability of the COVID-19) and their associations with a wide range of emotional and behavioural outcomes among the Chinese public. Methods Participants were 4607 citizens (age range: 17–90 years, Mage=23.71 years) from 31 provinces in China and they took part in an online survey. Results The results showed that the public’s emotional and behavioural reactions were slightly affected by the outbreak of the COVID-19. Moreover, the public had limited participation in the events regarding the COVID-19 but actively engaged in precautionary behaviour. In addition, results of hierarchical regression analysis revealed that the three appraisals were differentially related to the outcome variables. Conclusions The findings highlight the utility of cognitive appraisal, as a core process of coping stress, in explaining the public’s emotion and behaviour in the encounter of public health concern. Practically, the findings facilitate the government and practitioners to design and deliver targeted intervention programs to the public affected by the COVID-19.
Evaluation of fractional exhaled nitric oxide in interstitial lung disease
Authors: Lin Geng-peng , Guo Yu-biao , Shi Jia , Hui Yi , Liu Yang-li , Xie Can-mao , Luo Yi-feng , CHEN FENG JIA 
Published: March 2020

Abstract
Background No established biomarkers are available to guide the treatment of chronic interstitial lung diseases (ILDs). Nitric oxide reflects the inflammation in the airway, and fractional exhaled nitric oxide (FeNO) is a non-invasive and reproducible biomarker in lung-disease diagnosis and treatment. Whether FeNO can help manage ILDs remains uncertain. This study aimed to determine the role of FeNO in ILDs and the association between FeNO and ILD subtype. Methods 53 patients with ILDs were retrospectively recruited. Patient characteristics, FeNO values, blood tests for inflammatory markers, and pulmonary function test data were obtained. ResultsThis group of patients with ILDs had decreased vital capacity(VC)and total lung capacity(TLC) of 71.75 ± 17.58% and 75.27 ± 14.07%, respectively. The diffusion capacity of the lung for carbon monoxide(DLCO) also declined, with an average level of 38.15 ± 11.10%. The average FeNO value was 20.34 ± 9.97 ppb. According to the characteristics of chest computed tomography, patients were divided into usual interstitial pneumonia (UIP)-ILD (n = 24) and non-UIP-ILD (n = 29). The FeNO value in the UIP-ILD group was 12.58 ± 3.63 ppb. This value was significantly lower than that of the non-UIP-ILD group (26.62 ± 8.61 ppb, P<0.0001).According to the etiology, all patients with ILDs were divided into connective tissue diseases associated with interstitial lung disease (CTD-ILD) (n = 30) and non-CTD-ILD (n = 23). There were more female patients in CTD-ILD group compared to non-CTD ILD group and patients in CTD-ILD group were younger. With regard to the FeNO, PFT values, and systemic inﬂammatory markers, no signiﬁcant differences were observed between groups. In the overall ILD population, FeNO level correlated with blood eosinophil (r = 0.3066, P=0.0333), but no statistical significant correlations were observed between the FeNO and blood eosinophil percentage, IgE or systemic inﬂammatory markers. The FeNO cut-off value of 18.5 ppb showed a sensibility of 83.3% and a speciﬁcity of 95.8% in discriminating non-UIP-ILDs from UIP ILDs. Conclusions Our study suggested the importance of FeNO test in patients with ILDs. High FeNO levels may indicate the need of systemic treatment, and FeNO can be a helpful biomarker for ILD management.
Prognostic value of the site of distant metastasis and of surgical interventions in metastatic gastric cancer: a population-based study
Authors: Li Yinghua , Xie Danna , Chen Xiaojing , Hu Teng , Lu Simin , Han Yunwei 
Published: March 2020

Abstract
Background: The studies on the prognostic significance of site-specific distant metastasis, multiple-site metastases, and the impact of surgery of the primary tumor and metastatic lesion on survival outcomes of patients with metastatic gastric cancer (GC) remain elusive. Therefore, the present study aimed to investigate the prognostic significance of the site of distant metastasis among patients with metastatic GC. Furthermore, the effect of surgery of the primary tumor and metastatic lesion on the prognosis of metastatic GC was also analyzed.Methods: The data of 4,221 eligible patients, who were diagnosed with metastatic GC between 2010 and 2015, were identified from the Surveillance Epidemiology and End Results (SEER) database. Multivariate logistic regression analysis was performed to assess the association between potential prognostic factors, including the site of metastasis and surgery, and survival of patients with metastatic GC. Overall survival (OS) and cause-specific survival (CSS) were determined using the Kaplan-Meier survival curves and differences were assessed using the Log-rank test.Results: A total of 4,221 eligible GC patients with definite organ metastases were identified. Of these, 3312 GC patients had single-site metastasis while 909 patients had multiple-site metastases. GC Patients with single-site metastasis of liver or lung exhibited better CSS and OS compared to GC patients with bone metastasis. Furthermore, GC patients with liver metastasis were benefitted from surgery of both the primary and metastatic lesions, while GC patients with lung metastasis were benefited from surgery of metastasis resection only. Multivariate Cox regression analysis revealed that GC patients with single-site metastasis, well-differentiated tumors, and GC patients who underwent surgery of the primary tumor and those who received chemotherapy exhibited favorable prognosis.Conclusions: The site of metastasis was an independent prognostic factor for metastatic GC. Surgery had survival benefits in certain cases of metastatic GC; however, further studies are warranted to clarify these benefits in carefully selected patients.
Psychometric Properties of the Critical Thinking Disposition Assessment Test Amongst Medical Students in China: A Cross-Sectional Study
Authors: Cui Liyuan , Zhu Yaxin , Qu Jinglou , Tie Liming , Wang Ziqi , Qu Bo 
Published: March 2020

Abstract
Background: Critical thinking helps medical students and professionals overcome the effects of personal values and beliefs when exercising clinical judgment. The lack of effective instruments to measure critical thinking disposition in medical students has become an obstacle for training and evaluating students in undergraduate programs in China. The aim of this study was to evaluate the psychometric properties of the CTDA test.Methods: A total of 278 students participated in this study and responded the CTDA test. Cronbach’s a coefficient, internal consistency, test-retest reliability, floor effects and ceiling effects were measured to assess the reliability of the questionnaire. Construct validity of the pre-specified three-domain structure of the CTDA was evaluated by the confirmatory factor analysis (CFA). The concurrent validity, convergent validity and discriminant validity were also analyzed.Results: Cronbach’s alpha coefficient for the entire questionnaire was 0.923, all of the domains showed excellent internal consistency (0.814-0.861), and the test-retest reliability indicated acceptable intra-class correlation coefficients (ICCs) (0.710-0.795, p<0.01). The CFA demonstrated that the three-domain model fitted the data adequately. All dimensions were significantly correlated with the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and subscales (p<0.01), and the instrument showed satisfactory convergent and discriminant validity.Conclusions: The CTDA has acceptable psychometric characteristics and is a reliable and valid questionnaire to evaluate medical students’ disposition towards critical thinking in China. The CTDA could be applied in critical thinking programs and medical education research.
Relationship between level of empathy during residency training and perception of professionalism climate
Authors: Aziz Aliya B , Ali Syeda Kauser 
Published: March 2020

Abstract
Background

Empathy is one of the vital personality attributes for all physicians. It is essential for establishing genenal interpersonal relationships among doctors and patients.Unfortunately, there is evidence for the decline of physician’s empathy during the clinial training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

Objective

This study examines the relationship between empathy level and perception of climate of professionalism among the residents.

Method

The study participants included residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital. Two self-administered internet based surveys - Jefferson scale of Physician empathy (JSPE) and “professionalism climate instrument”(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

Results

The overall response rate was 81.4% with mean empathy level of 103±13. The internal consistency of each scale measured by Cronbach’s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (r s = 0.56, p = 0.64).

Conclusion

The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.
Low Cost Simulator For Cardiopulmonary Resuscitation In Infants
Authors: Targino Ailton do Nascimento , Patricio Alan , de Oliveira Adriana Gonçalves , Echeimberg Jorge de Oliveira , de Abreu Luiz Carlos , Raimundo Rodrigo Daminello 
Published: March 2020

Abstract
Background The use of realistic simulation methodology is used in several learning scenarios, allowing students to participate directly in the problematization of situations that require immediate professional action. Objective Develop, enable and validate a low-cost simulator for cardiopulmonary resuscitation procedures in infants. Methods An experimental study with undergraduate students of the 1st year of the Nursing course at a higher education institution in the State of Paraíba, Brazil, developed a simulator model with dimensions similar to an infant with low cost materials and enabled the use as a prototype for training Basic Life Support. The prototype was developed with the accessories for stop chocking and cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the American Hearth Association Basic Life Support guideline to enable and validate the Basic Life Support training instrument. Results The low-cost prototype for Basic Life Support training was used as an appropriate learning object and enabled the teaching-learning process as a low-cost resource accessible. Based on the questionnaire applied, we observed that there was an increase in the median number of correct answers and a reduction in the median of errors, which indicated an improvement in the acquisition of information and improvement in learning, observed through the Signal Sampling of Related Samples and the Wilcoxon Signal Test of hits (M A ) and errors (M E ), before and after training where it was found that there was an increase in M A and a reduction in M E with 5% significance (p <0.001). The frequencies of response modifications after training with the simulator were also studied by means of the two-tailed McNemar test where Q 1 , Q 2 , Q 3 , Q 4 , Q 8 , Q 9 , Q 13 and Q 15 questions showed significant changes (p <0, 05). Conclusion It was developed a prototype that obtained its application in simulation of training activity in Basic Life Support, which made possible the accomplishment of the procedures in the proper way in positioning and simulation of cardiac resuscitation, mouth / nose ventilation and tapping in the scapular region, which allowed to validate stop chocking and resuscitation training as a low-cost alternative to health education.
Development and evaluation of an online education tool on Attention Deficit Hyperactivity Disorder for General Practitioners: the important contribution of co-production
Authors: French Blandine , Daley David , Perez-Vallejos Elvira , Sayal Kapil , Hall Charlotte 
Published: March 2020

Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is underdiagnosed in the UK and the assessment and diagnosis pathway often involves a general practitioner (GP) referral to secondary care services. GPs’ levels of knowledge and understanding about ADHD is often a significant barrier in patients accessing care. The development of an online education ressource could improve GPs knowledge of ADHD and optimise appropriate referrals. Involving end-users in co-creating interventions may enhance their clinical utility and impact in routine clinical practice. However, there is limited published evidence describing how to meaningfully involve stakeholders in both the design and development components of co-production.Method: We report a step wise, co-production approach towards developing an online ADHD education intervention for GPs. Preparatory work highlighted the relevant topics to be included in the intervention, from which educational videos were then developed. Workshops were then conducted with GPs, leading to further refinement of the video content and subsequently the final intervention. A pilot usability study (n=10 GPs) was then conducted to assess the intervention’s acceptability, feasibility and accessibility.Results: The development of the online intervention was greatly facilitated by the involvement of GPs. Having a co-production development process ensured the consistent adaptation of the intervention to meet GPs’ needs. The usability study showed that the content of the intervention was suitable, easily accessible, engaging and delivered at an acceptable level of intensity, validating the development approach taken.Conclusion: While further studies are needed to evaluate the efficacy of the developed intervention, preliminary findings demonstrated that it was acceptable and well received. The importance of co-development was highlighted in developing an intervention that addresses specific needs for GPs. This development approach may be useful for other researchers and developers of clinical interventions.
Long non-coding RNA HOXA-AS2 may serve as a new therapeutic target and promising prognostic market for most of cancers
Authors: Guo Qiang , Fang ShiXu , Gao WeiLong , Ke XiXian , Chen Cheng , Li Dan , Lu HongLing , Xu Gang 
Published: March 2020

Abstract
Backgroud: To elucidate the relationship between the expression level of HOXA-AS2 and it’s prognostic value of cancer by meta-analysis. Methods: Databases of PubMed, Cochrane Library, Embase, Web of Science, Google Scholar, CNKI and some others were searched systematically. Comprehensively screen according to the inclusion criteria and the exclusion criteria was conducted. The connection between HOXA-AS2 and the prognosis characteristics of patients with various types of cancer was screened by combining odds ratio (OR), Hazard ratios (HR) and 95% confidence interval (CI) for the studies collected in this meta-analysis. In addition, we further analyzed the expression of the gene and its potential clinical value in Gene Expression Profiling Interactive Analysis (GEPIA) and the lnCAR database. Results: A total of 12 studies consisting 796 patients were included in this research. Compared low HOXA-AS2 expression group, patients with high HOXA-AS2 expression were more likely to get poor overall survival (OS). Moreover, high HOXA-AS2 expression demonstrates advanced TNM stage, earlier lymph node metastasis, distant metastasis and bigger tumor size. But there was no correlation or the correlation was not statistically significant between the expression and the age, sex or the pathological differentiation. In addition, data from the GEPIA and LnCAR databases revealed that increasing HOXA-AS2 expression means bad prognosis in most of cancers. Conclusions: High HOXA-AS2 expression shows worse cancer prognosis in cancer patients, and HOXA-AS2 may be acted as therapeutic target and promising prognostic marker.