bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining the effector mechanisms of Xuebijing Injection on COVID-19 based on network pharmacology
Authors: Zheng Wenjiang , Yan Qian , Ni Yongshi , Zhan Shaofeng , Yang Liuliu , Zhuang Hongfa , Liu Xiaohong , Jiang Yong 
Published: May 2020

Abstract
Objective To examine the potential effector mechanisms of Xuebijing (XBJ) on coronavirus disease 2019 (COVID-19) based on network pharmacology.Methods We searched Chinese and international papers to obtain the active ingredients of XBJ. Then, we compiled COVID-19 disease targets from the GeneCards gene database and via literature searches. Next, we used the SwissTargetPrediction database to predict XBJ’s effector targets and map them to the abovementioned COVID-19 disease targets in order to obtain potential therapeutic targets of XBJ. Cytoscape software version 3.7.0 was used to construct a “XBJ active-compound–potential-effector target” network and protein–protein interaction (PPI) network, and then to carry out network topology analysis of potential targets. We used the ClueGO and CluePedia plugins in Cytoscape to conduct gene ontology (GO) Biological Process (BP) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis of XBJ’s effector targets.Results We obtained 147 potential COVID-19 effector targets of XBJ. Fourteen of these targets—glyceraldehyde 3-phosphate dehydrogenase (GAPDH), albumin (ALB), tumor necrosis factor (TNF), epidermal growth factor receptor (EGFR), mitogen-activated protein kinase 1 (MAPK1), Caspase-3 (CASP3), signal transducer and activator of transcription 3 (STAT3), MAPK8, prostaglandin-endoperoxide synthase 2 (PTGS2), JUN, interleukin-2 (IL-2), Estrogen Receptor 1 (ESR1), and MAPK14—had degree values > 40 and therefore could be considered key targets. They participated in extracellular signal–regulated kinase 1 and 2 (ERK1, ERK2) cascade, the T-cell receptor signaling pathway, activation of MAPK activity, cellular response to lipopolysaccharide (LPS), and other inflammation- and immune-related BPs. XBJ exerted its therapeutic effects through the renin–angiotensin system (RAS), nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), MAPK, phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)–protein kinase B (Akt)–vascular endothelial growth factor (VEGF), toll-like receptor (TLR), TNF, and inflammatory-mediator regulation of transient receptor potential (TRP) signaling pathways to ultimately construct a “ingredient–target–pathway” effector network. Conclusion: The active ingredients of XBJ regulated different genes, acted on different pathways, and synergistically produced anti-inflammatory and immune-regulatory effects, which fully demonstrated the synergistic effects of different components on multiple targets and pathways. The results of this study validated current pharmacological mechanistic studies of XBJ in the treatment of sepsis and severe pneumonia and could better explain XBJ’s effector mechanisms in the clinical treatment of COVID-19.
Enhanced therapeutic effects of umbilical cord mesenchymal stem cells after prolonged treatment for HBV- related liver failure and liver cirrhosis
Authors: Jia Yifan , Shu Xin , Yang Xiaoan , sun Haixia , Cao Huijuan , Cao Hong , Zhang Ka , Xu Qihuan , Li Gang , Yang Yang 
Published: May 2020

Abstract
Background: This study aimed to investigate the therapeutic effect of umbilical cord mesenchymal stem cells (UCMSCs) on HBV-related liver failure and liver cirrhosis and to compare the different efficacies of UCMSCs after different treatment courses.Methods: This was an observational study that retrospectively considered a three-year period during which 513 patients who received stem cell infusion met the criteria of hepatic failure and liver cirrhosis were identified from databases of the Third Affiliated Hospital of Sun Yat-sen University. Eligible patients were categorized into the liver failure group and liver cirrhosis group. The two groups were divided into different subgroups according to the times of stem cell therapy. In the liver failure group, group A received more than 4 weeks and group B received less than 4 weeks. In the liver cirrhosis group, patients who received more than 4 weeks of stem cell therapy belonged to group C, and group D received less than 4 weeks. The patients were followed up for 24 weeks. The demographics, clinical characteristics, biochemical factors, and MELD scores were recorded and compared among different groups.Results: A total of 64 patients met the criteria of liver failure, and 59 patients met the criteria of liver cirrhosis. After UCMSC treatments, the levels of ALT, AST, and TBIL at all postbaseline time points were significantly lower than those at baseline in the liver failure group and liver cirrhosis group; the PTA and MELD scores only gradually improved in the liver failure group. Four weeks after UCMSC treatment, patients with prolonged treatment with UCMSCs had higher TBIL decline levels than patients who terminated treatment with UCMSCs. After more than 4 weeks of UCMSC treatment, there was no statistically significant difference in the levels of change for ALT, AST, TBIL, PTA value and the MELD score between patients with liver failure with prolonged treatment with UCMSCs and patients with liver cirrhosis with prolonged treatment with UCMSCs at all observation weeks. However, the median decline and cumulative decline in the TBIL level of patients with liver failure with a standard 4-week treatment course were higher than those of patients with liver cirrhosis with a standard 4-week treatment course.Conclusion: Peripheral infusion of UCMSCs showed good therapeutic effects for HBV-related liver failure and liver cirrhosis. Prolonging the treatment course can increase the curative effect of UCMSCs for end-stage liver disease, especially for patients with cirrhosis.
Quantification of Epicardial Fat using 3D Cine Dixon MRI
Authors: Henningsson Markus , Brundin Martin , Scheffel Tobias , Edin Carl , Viola Federica , Carlhäll Carl-Johan 
Published: May 2020

Abstract
Background There is an increased interest in quantifying and characterizing epicardial fat which has been linked to various cardiovascular diseases such as coronary artery disease and atrial fibrillation. Recently, three-dimensional single-phase Dixon techniques has been used to depict the heart and to quantify the surrounding fat. The purpose of this study was to investigate the merits of a new high-resolution cine 3D Dixon technique for quantification of epicardial adipose tissue and compare it to single-phase 3D Dixon in patients with cardiovascular disease.Methods Fifteen patients referred for clinical CMR examination of known or suspected heart disease were scanned on a 1.5T scanner using single-phase Dixon and cine Dixon. Epicardial fat was segmented by three readers and intra- and inter-observer variability was calculated per slice. Cine Dixon segmentation was performed in the same cardiac phase as single-phase Dixon. Subjective image quality assessment of water and fat images were performed by three readers using a 4-point Likert scale (1 = severe; 2 = significant; 3 = mild; 4 = no blurring of cardiac structures).Results Intra-observer variability was excellent for cine Dixon images (ICC = 0.96), and higher than single-phase Dixon (ICC = 0.92). Inter-observer variability was good for cine Dixon (ICC = 0.76) and moderate for single-phase Dixon (ICC = 0.63). The intra-observer measurement error (mean ± standard deviation) per slice for cine was − 0.02 ± 0.51 ml (-0.08 ± 0.4%), and for single-phase 0.39 ± 0.72 ml (0.18 ± 0.41%). Inter-observer measurement error for cine was 0.46 ± 0.98 ml (0.11 ± 0.46%) and for single-phase 0.42 ± 1.53 ml (0.17 ± 0.47%). Visual scoring of the water image yielded median of 2 (interquartile range = [Q3-Q1] 2–2) for cine and median of 3 (interquartile range = 3 − 2) for single-phase (P < 0.05) while no significant difference was found for the fat images, both techniques yielding a median of 3 and interquartile range of 3 − 2.Conclusion Cine Dixon can be used to quantify epicardial fat with lower intra- and inter-observer variability compared to standard single-phase Dixon. The time-resolved information provided by the cine acquisition appears to support the delineation of the epicardial adipose tissue depot.
Perceptions of Education Quality and Influence of Language Barrier: Graduation Survey of International Medical Students at Four Universities in China
Authors: Li Wen , Liu Chang , Liu Shenjun , Zhang Xin , Shi Rong-gen , Jiang Hailan , Ling Yi , Sun Hong 
Published: May 2020

Abstract
Background: As an increasing number of Asian and African students are studying medicine in China, it is imperative to assess the training quality of these international medical students (IMSs). The study was to gain insight into the attitudes from China-educated IMSs towards the medical curriculum and the influence of Chinese language abilities on their clinical studies. Methods: A modified Association of American Medical Colleges Graduation Questionnaire was applied among the final-year IMSs during the graduation season from May 2019 to July 2019 at four universities in China. The questionnaire asked IMSs to evaluate medical education quality and assess their Chinese language capacity. One-way ANOVA was used to determine whether participants' Chinese language capacity was associated with their clinical experience and clinical competence. Results: Overall, 209 valid responses were received and 76.1% were satisfied with the quality of the medical education. Genetics, physics, and mathematics were seen as the least helpful basic courses for practice, and 21.5% thought community-oriented medicine was a topic that lacked instruction. 58.9% were positive that discussions surrounding ethical topics were involved during their clerkships, and 71.3% believed they had acquired sufficient clinical skills to begin a residency program. Chinese speaking skill and communication manner were significant factors to influence students' clinical experience and competence. Conclusion: The study demonstrates China-educated IMSs' perceptions of the contemporary education policy from various aspects and language influence on their education experiences. The curriculum for IMSs in China should be more problem-based to enhance course interaction and more community-engaged to meet people's needs for health and medical care. Besides, the oral Chinese teaching and the initiative to speak need to be emphasized to facilitate the clinical training for IMSs. Our findings can be used as a source of evidence to benchmark medical curricular codifications catering for Asian and African students.
Grit protects medical students from burnout: a longitudinal study
Authors: Jumat Raihan , Chow Pierce Kah-Hoe , Allen John , Lai Siang-Hui , Hwang Nian-Chih , Iqbal Jabed , Mok May Un Sam , Rapisarda Attilio , Velkey John Matthew , Engle Deborah , Compton Scott 
Published: May 2020

Abstract
BackgroundBurnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year.MethodsThe specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis. ResultsOut of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89).ConclusionsGrit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.
Knowledge, attitudes, social responsibilities and career plans toward Corona Virus Disease 2019 (Covid-19) among Chinese clinical medical students
Authors: Yang Haojun , Zheng Yue , Yu Fang , Cheng Bohao , Zhu Ziqing , Liao Sheng , Chen Yu , Wang Fang 
Published: May 2020

Abstract
Purpose: To assess knowledge, attitudes and social responsibilities toward Covid-19 among Chinese clinical medical students. Method: Self-administered questionnaires were used to collect data for 889 clinical medical students from 3 well-known Chinese medical universities. The questionnaire was comprised of three domains which consisted of 7 items for knowledge, 5 items for attitudes and social responsibilities and 4 items for career planning. Results: It was found that 47.2%, 46.9% of the clinical medical students were willing to be volunteers in Hubei Province or stick to their own hospitals if they had been back to work, mainly because of responsibilities of doctors(92.7%). About 74.1% of the participants had a clear career plan for the future. 12.5% of the participants preferred several departments with the heaviest workload during the outbreak(Department of infectious disease, 1.2%; Department of respiration, 3.6%; ICU or emergency, 7.7%). Besides, students at clinical learning stage mastered better than basic learning students in the knowledge of Covid-19 especially in clinical manifestations(p < 0.001). There were significant differences between graduated and new-enrolled medical students in the attitudes of becoming a front-line doctor of Wuhan and the professional happiness of doctors(p < 0.001). Conclusions: Students at clinical learning stage mastered better than basic learning students in the knowledge of Covid-19 especially in clinical manifestations. The expectations of professional happiness and social responsibilities in new-enrolled clinical medical students were higher than those in graduated medical students which could be easily influenced and had no relation with different clinical major. Therefore, future strategies for medical education reform in China should focus on keeping the professional identity and sense of belonging of medical students.
Extracellular vesicular Wnt7b mediates HPV E6-induced cervical cancer angiogenesis by activating the β-catenin signaling pathway
Authors: Qiu Jun-Jun , Sun Shu-Gen , Tang Xiao-Yan , Lin Ying-Ying , Hua Keqin 
Published: May 2020

Abstract
Background

The E6 oncoproteins of human papillomavirus (HPV) 16/18 are the critical drivers of cervical cancer (CC) progression. Extracellular vesicles (EVs) are emerging as critical mediators of cancer-tumor microenvironment (TME) communication. However, whether EVs contribute to HPV 16/18 E6-mediated impacts on CC progression remains unclear.

Methods

A series of in vitro and in vivo assays were performed to elucidate the roles and mechanism of EV-Wnt7b in HPV E6-induced CC angiogenesis. The prognostic value of serum EV-Wnt7b was determined and a predictive nomogram model was established.

Results

HPV 16/18 E6 upregulated Wnt7b expression in four HPV 16/18-positive CC cell lines and their EVs. In vitro and in vivo experiments demonstrated that EV-Wnt7b was transferred to and modulated human umbilical vein endothelial cells (HUVECs) toward more proliferative and proangiogenic behaviors by impacting β-catenin signaling. Clinically, serum EV-Wnt7b levels were elevated in CC patients and significantly correlated with an aggressive phenotype. Serum EV-Wnt7b was determined to be an independent prognostic factor for CC overall survival (OS) and recurrence-free survival (RFS). Notably, we successfully established a novel predictive nomogram model using serum EV-Wnt7b, which showed good prediction of 1- and 3-year OS and RFS.

Conclusions

Our results illustrate a potential crosstalk between HPV 16/18-positive CC cells and HUVECs via EVs in the TME and highlight the potential of circulating EV-Wnt7b as a novel predictive biomarker for CC prognosis.
Nelfinavir for COVID19: Summary of basic science data and initial clinical experience
Authors: Lee Paul C 
Published: May 2020

Abstract
Based on in vitro and computational model data that nelfinavir is highly active again SARS-CoV-2, we administered nelfinavir to six COVID-19 outpatients. Three of four acute outpatient COVID-19 patients became afebrile within 48 hours. In contrast, the two subacute COVID-19 patients with predominant GI symptoms responded only partially to nelfinavir.
Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department
Authors: Chen Wei-Lung , Hsu Chan-Peng , Wu Po-Han , Chen Jiann-Hwa , Huang Chien-Cheng , Chung Jui-Yuan 
Published: May 2020

Abstract
Background: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). It has contributed to improvements in patient treatment quality, procedural safety, timeliness of care, diagnostic accuracy, and cost reduction. We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center, evaluating a centralized residency-based POCUS training course from July 2017 to June 2018 for ED residents that included 12 core ultrasound applications: trauma, intrauterine pregnancy, abdominal aortic aneurysm, echocardiography and hemodynamic assessment, hepatobiliary system, urinary tract, deep vein thrombosis, soft tissue and musculoskeletal, thoracic-airway, ocular, bowel, and procedural guidance. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. Utilization of POCUS among ED residents before and after the POCUS training course (July 2016–June 2017 and July 2018–June 2019) was calculated and analyzed using the Wilcoxon signed-rank test.Results: In total, 16 residents participated and completed the entire training course. The post-test score improved significantly compared to the pre-test score by a median of 12 points (p = 0.04). Utilization of POCUS among the ED residents increased significantly from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (p < 0.01) after completion of the entire training course. Increased POCUS scanning percentages over the cardiac, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conclusions: There was a significant increase in POCUS utilization among ED residents after a comprehensive residency-based POCUS training program.
Factors Affecting the Acceptance of Blended Learning in Medical Education: Application of UTAUT2 Model
Authors: Azizi Seyyed Mohsen , Roozbahani Nasrin , Khatony Alireza 
Published: May 2020

Abstract
Background: Blended learning is a new approach toward improving the quality of medical education. Acceptance of blended learning plays an important role in its effective implementation. Therefore, the purpose of this study was to investigate and determine the factors that may influence the behavioral intention to use of blended learning in medical education.Methods: In this cross-sectional, correlational study, the sample consisted of 225 Iranian medical sciences students. The theoretical framework for designing the conceptual model was UTAUT2. Data were analyzed using SPSS-18 and AMOS-23 software. Structural equation modeling technique was used to test the hypothesis.Results: The validity and reliability of the model constructs were acceptable. Performance expectance, effort expectance, social influence, facilitating conditions, hedonic motivation, price value and habit had a significant effect on students’ behavioral intention to use of blended learning. Additionally, Behavioral intention to use of blended learning also had a significant effect on students’ actual usage of blended learning (β=0.645, P≤0.01).Conclusion: The study revealed that the proposed framework based on UTAUT2 has good potential to identify factors influencing students' behavioral intention to using of blended learning. Universities can use the results of this study to design and implementation successful blended learning courses in medical education.
Limited effects from professional identity formation-oriented education on self-regulated learning in a hybrid problem-based learning curriculum: a mixed-method study in Japan
Authors: Matsuyama Yasushi , Nakaya Motoyuki , Leppink Jimmie , Vleuten Cees van der , Asada Yoshikazu , Lebowitz Adam Jon , Sasahara Teppei , Yamamoto Yu , Matsumura Masami , Gomi Akira , Ishikawa Shizukiyo , Okazaki Hitoaki 
Published: May 2020

Abstract
Background: Developing self-regulated learning (SRL) in a teacher-centered curriculum is challenging. Previous studies indicate professional identity formation (PIF), or the formation of self-identity with internalized values and norms of professionalism, might improve SRL．We designed a PIF-oriented education format for hybrid problem-based learning (PBL) and tested its effectiveness on SRL in a mixed research method.Methods: A randomized controlled crossover trial was conducted using 112 pre-clinical year students at Jichi Medical University. In the six one-day PBL sessions, Groups A (n = 56, female 18, mean age 21.5y ± 0.7) and B (n = 56, female 11, mean age 21.7y ± 1.0) experienced PIF-oriented pre-PBL learning: Group A had three sessions in the first half, B in the second half. Between-group PIF and SRL levels were compared using Professional Identity Essay (PIE) and Motivated Strategies for Learning Questionnaire (MSLQ). A qualitative thematic analysis of potential reasons for PIF improvement was performed using the PIE description.Results: Two-level regression analyses showed moderate improvement of PIF stages over time (R2 = 0.069), regardless of intervention. PIF-oriented pre-PBL learning alone did not significantly improve PIE stages or MSLQ scores. Thematic analysis indicated that PIF-oriented pre-PBL learning helped students recognize realistic difficulties in clinical practice, and articulate professional image and values. However, encounters in extracurricular clinical settings had diverse and meaningful impacts on PIF.Conclusions: Limited effect of PIF-oriented pre-PBL learning on PIF and SRL indicate challenges in SRL-oriented education for pre-clinical year students within a teacher-centered hybrid PBL curriculum.