bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late Reinfection With a Different SARS-CoV-2&nbsp;Clade in a Patient With Refractory Arterial Hypertension: a Case Report.
Authors: Galiana Antonio , García-Abellán Javier , Fernández-González Marta , Gonzalo-Jiménez Nieves , Ruiz-García Montserrat , Andreo María , Falcón Selene , Masiá Mar , Gutiérrez Félix 
Published: April 2021

Abstract
Background: Differentiating between persistent infection with intermittent viral shedding and reinfection with SARS-CoV-2 remains challenging. Although a small number of cases with genomic evidence of second infection have been reported, limited information exists on frequency and determinants of reinfection, time between infections, and duration of immunity after the primary infection. Case presentation: We report a reinfection with SARS-CoV-2 in a 52-year old male whose primary infection was diagnosed in May 2020, during the first wave of the pandemic in Spain, and the second occurred eight months later, in January 2021. We present a complete data set including results from real-time polymerase chain reaction, serology and genome sequencing confirming reinfection with a different clade. Noteworthy was that the patient was immunocompetent but had multiple cardiometabolic comorbidities, including refractory arterial hypertension, that might increase the individual risk in COVID-19.Conclusions: This case of reinfection with SARS CoV-2 occurring several months after the primary infection reports the longest time interval between reinfection and initial infection described to date. It raises concerns on the duration of protective immunity, suggesting that it may begin to wane in patients who acquired the initial infection during the first wave of the pandemic. The potential contributing role of arterial hypertension and cardiometabolic comorbidities as risk factors for reinfection deserves investigation.
Performance Evaluation of The District's Primary Health Care System (DPHCS); Case Study Of Southeastern Iran
Authors: Rahimi Hamed , Goudarzi Reza , Noorihekmat Somayeh , Haghdoost Aliakbar 
Published: April 2021

Abstract
Background: Managers need to measure and evaluate the performance of their subordinates in order to plan, organize, and improve the performance of their organizations. In this study, the performance and efficiency of the district's primary health care system in the southeast of Iran were evaluated using the data envelopment analysis (DEA) model.Methods: The quantitative non-parametric data envelopment analysis was used to evaluate the performance of the primary care system in the districts. On the hand, human forcess, physical facilities, and vehicles were the variables used as the inputs, and the number of services and service recipients was considered as the outputs to measure efficiency. The data were analyzed using the DEAP software, and performance and efficiency were calculated with the output maximization approach and the assumption of variable returns to scale. It was carried out as linear programming with nine scenarios for nine districts in 2018.Results: The mean efficiency of the studied districts with the assumption of variable returns to scale was 0.76, indicating at least 24% capacity to increase efficiency in the primary care system of Kerman University of Medical Sciences without any increase in production factors. According to the mean values, Kerman and Kuhbanan were efficient while the other 7 districts were inefficient. The districts were divided into three groups: efficient, moderately efficient, and inefficient. Accordingly, the most inefficient primary health care systems were those of Shahr-e Babak, Baft, and Orzooieh.Conclusion: The results of this study showed inefficiency in most primary health care systems of the studied districts, indicating that primary care managers can provide more health services to the community through proper management of available resources. Inefficient districts can compare themselves with successful and reference districts and eliminate their shortcomings in order to improve their performance.
Research on Breakage Characteristics in Side Milling of Titanium Alloy with C emented Carbide End Mill
Authors: Du Yanjie , Yue Caixu , Li Xiaochen , Liu Xianli , Liang Steven Y. 
Published: April 2021

Abstract
Aiming at the breakage of tool and low precision of the machined surface in the high-speed milling process of titanium alloy, damage mechanics is used to reveal the formation mechanism of tool fatigue breakage during the milling and determine the critical condition of tool breakage. Cutting edge chipping caused by random impact fracture during the evolution of tool damage is the main failure form of tool fatigue breakage. Based on continuous damage mechanics, fatigue crack growth theory and sliding crack energy balance equation, the crack growth law of tool material is studied under different cutting impact, and the initial damage value and critical damage value of tool material fracture based on the interval method are obtained. And the impact fracture limit conditions of the end mill edge are established including cutting parameters, material hardness, tool damage, tool wear, and cutting impact, which provide a theoretical basis for determining the cutting parameters. A titanium alloy milling experiment is carried out to define the impact damage morphology of the tool in different states after the tool is damaged. The obtained tool safety area range is verified, and the research results provide parameter optimization for the high-speed and high-efficiency milling titanium alloy process.
DAP Inhibits&nbsp;the&nbsp;TNF-α-Induced Inflammatory Response by Modulating the MAPK Signaling Pathway in Synovial&nbsp;Cells
Authors: Wang Jieying , Kuang Nanzhen , zheng Mao , Dai Chan , Deng Huimin , Zeng Xiaoping , Fu yingyuan 
Published: April 2021

Abstract
Daphnetin(DAP) is extracted from Daphne odora var. marginata and contains coumarin compounds, which have a good anti-inflammatory analgesic effect. In this study, we investigated whether daphnetin can reduce the TNF-α-induced inflammatory response by inhibiting the MAPK signaling pathway in the synovial cells of CIA rats. A model of synovial cells was constructed using CIA rats induced by TNF-α. The expression of inflammatory cytokines in the synovial cells of CIA rats was observed by real-time PCR and ELISA. The expression and nuclear translocation of MAPK signaling pathway proteins were detected by Western blot and immunofluorescence assays. The results show that the mRNA and protein levels of IL-6, TGF-β, MMP-3 and MMP-13 were significantly lower than those in the culture supernatant of the model control group. The synovial cells of CIA rats induced by TNF-α exhibited decreased expression of p-p38, p-ERK1/2 and p-JNK in the nucleus. In conclusion, daphnetin can affect the activation of the MAPK signaling pathway and reduce the expression of inflammatory factors by inhibiting the MAPK signaling pathway, which plays a role in anti-rheumatic inflammation.
The current state of benzodiazepines and Z-drugs use and their influences on bipolar disorder outcomes-A small sample analysis
Authors: Chen Yiming , Wang Fan , Cui Lvchun , Huang Haijing , Kong Shuqi , Qian Nuoshi , Zhang Mengke , Lyu Dongbin , Wang Meiti , Liu Xiaohua , Cao Lan , Fang Yiru , Hong Wu 
Published: April 2021

Abstract
Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patients with bipolar disorder during affective episodes. We evaluated the difference of characteristics between bipolar patients with sleep disturbance who chose BZDs/Z-drugs, and those who did not chose the drugs during and after affective disorder. The influences of BZDs/Z-drugs use on suicide attempt and psychotic symptoms during affective disorder were also investigated. Results: Seventy patients with current affective episodes were studied. Among them, 61 had sleep disturbances. The amount of mood stabilizers use in the BZDs/Z-drugs group was significantly greater than that in the no BZDs/Z-drugs group (p=0.038) during affective episodes. After affective episode, sleep disturbances, especially midnight wakes, became more improved in BZDs/Z-drugs group compared to the no BZDs/Z-drugs group. By contrast, attention and decisiveness became more improved in the no BZDs/Z-drugs group than in the BZDs/Z-drugs group. Furthermore, we observed that BZDs/Z-drugs had an OR of 4.338 (95% CI 1.068-17.623, p=0.040), and other psychiatric drugs had an OR of 1.835 (95% CI 1.105-3.047, p=0.019) in relation to suicide attempt. After nine months, we found that BZDs/Z-drugs use was of no significant effect to depressive or manic severity, or to recurrence rate.Conclusion: BZDs/Z-drugs use have no significant influence on variations in depressive or manic severity during the course of an affective episode. Nevertheless, BZDs/Z-drugs users took a greater amount of mood stabilizers than no BZDs/Z-drugs users. Finally, BZDs/Z-drugs or other psychiatric drugs polytherapy was regarded as a risk factor of suicide attempt during an affective episode.
A theoretically informed, mixed-methods study of pharmacists’ aspirations and readiness to implement pharmacist prescribing
Authors: Stewart Derek , Pallivalapila Abdulrouf , Thomas Binny , Hanssens Yolande , Kassem Wessam El , Nazar Zachariah , Hail Moza Al 
Published: April 2021

Abstract
Background Studies have highlighted advancing clinical pharmacy practice in Qatar. Objective To explore pharmacists’ aspirations and readiness to implement pharmacist prescribing. Setting Hamad Medical Corporation (HMC), the main provider of secondary and tertiary care.Method A sequential explanatory mixed-methods design. Questionnaire items were derived from the Consolidated Framework of Implementation Research (CFIR), in domains of: awareness/support; readiness; implementation; and facilitators and barriers. Following piloting, all pharmacists (n=554) were invited to participate. Questionnaire data were analysed using descriptive and inferential statistics with principal component analysis (PCA) of attitudinal items. Focus groups were recorded, transcribed and analysed using the Framework Approach. Main outcome measure Aspirations and readiness to implement pharmacist prescribing. Results The response rate was 62.8% (n=348), with respondents highly supportive of implementation in Qatar (median 4, scale 0-5, extremely supportive). The majority (64.9%, n=226) considered themselves ready, particularly those more senior (p<0.05) and classifying themselves innovative (p<0.01). Outpatient (72.9%, n=221 agreeing) and inpatient (71.1%, n=218 agreeing) HMC settings were those perceived as being most ready. PCA identified 2 components, with ‘personal attributes’ being more positive than ‘prescribing support’. Facilitators were access to records, organizational/management support and the practice environment, with physician resistance and scope of practice as barriers. Focus groups provided explanation, with themes in CFIR domains of innovation characteristics, characteristics of individuals and the inner setting. Conclusion HMC pharmacists largely aspire, and consider themselves ready, to be prescribers with inpatient and outpatient settings most ready. CFIR domains and constructs identified as facilitators and barriers should be focus for implementation.
Oral administration of polystyrene microplastics for 2 weeks induces chronic constipation in ICR mice
Authors: Choi Yun Ju , Park Jun Woo , Kim Ji Eun , Lee Su Jin , Gong Jeong Eun , Jung Young Suk , Seo Sungbaek , Hwang Dae Youn 
Published: April 2021

Abstract
Objective: Indirect evidence has determined the possibility that microplastics (MP) induce constipation, although direct scientific proof for constipation induction in animals remains unclear. Thus, this study is aimed to investigate whether oral administration of polystyrene MP causes constipation.Methods: An alteration in the constipation parameters and their molecular mechanisms was analyzed in ICR mice treated with 0.5 μm polystyrene (PS)-MP for 2 weeks. Results: Significant alterations in water consumption, stool weight, stool water contents, and stool morphology were detected in MP treated ICR mice, as compared to Vehicle treated group. Also, the gastrointestinal (GI) motility and intestinal length were decreased, while the histopathological structure and cytological structure of the transverse colon were remarkably altered in treated mice. Mice exposed to MP also showed a significant decrease in the GI hormone concentration, muscarinic acetylcholine receptors (mAChRs) expression and their downstream signaling pathway, as well as mucin secretion and transcription of the MUC1, MUC2 and Klf4 genes. Subsequent to MP treatment, concentrations of chloride ion and expressions of its channel (CFTR and CIC-2) were decreased, whereas expressions of AQP3 and 8 for water transportation were downregulated by activation of the MAPK/NF-kB signaling pathway. These regulation on water and chloride transportation were verified in intestinal epithelioid cell line (IEC18) after MP treatment. Conclusion: These results are the first to suggest that oral administration of PS-MP induces chronic constipation through the dysregulation of GI motility, mucin secretion, and chloride ion and water transportation in the transverse colon.
Safety and preliminary efficacy of sequential multiple ascending doses of solnatide to treat pulmonary permeability edema in patients with moderate-to-severe ARDS - a randomized, placebo-controlled, double-blind trial
Authors: Schmid Benedikt , Kredel Markus , Ullrich Roman , Krenn Katharina , Lucas Rudolf , Markstaller Klaus , Fischer Bernhard , Kranke Peter , Meybohm Patrick , Zwißler Bernhard , Frank Sandra 
Published: April 2021

Abstract
Background Acute respiratory distress syndrome (ARDS) is a complex clinical diagnosis with various possible etiologies. One common feature, however, is pulmonary permeability edema, which leads to an increased alveolar diffusion pathway and, subsequently, impaired oxygenation and decarboxylation. A novel inhaled peptide agent (AP301, solnatide) was shown to markedly reduce pulmonary edema in animal models of ARDS and to be safe to administer to healthy humans in a phase-I clinical trial. Here, we present the protocol for a phase-IIB clinical trial investigating the safety and possible future efficacy endpoints in ARDS patients.Methods This is a randomized, placebo-controlled, double-blind intervention study. Patients with moderate to severe ARDS in need of mechanical ventilation will be randomized to parallel groups receiving escalating doses of solnatide or placebo, respectively. Before advancing to a higher dose, a data safety monitoring board will investigate the data from previous patients for any indication of patient safety violations. The intervention (application of the investigational drug) takes places twice daily over the course of seven days, ensued by a follow-up period of another 21 days.Discussion The patients to be included in this trial will be severely sick and in need of mechanical ventilation. The amount of data to be collected upon screening and during the course of the intervention phase is substantial and the potential timeframe for inclusion of any given patient is short. However, when prepared properly, adherence to this protocol will make for the acquisition of reliable data. Particular diligence needs to be exercised with respect to informed consent, because eligible patients will most likely be comatose and/or deeply sedated at the time of inclusion.Trial registration: This trial was prospectively registered with the EU Clinical trials register (clinicaltrialsregister.eu). EudraCT Number: 2017-003855-47.
Diploid Genomic Architecture of Nitzschia Hildebrandi, An Elite Biomass Production Diatom
Authors: Oliver Aaron , Podell Sheila , Pinowska Agnieszka , Traller Jesse C. , Smith Sarah R. , McClure Ryan S , Beliaev Alexander S , Bohutskyi Pavlo , Hill Eric A. , Rabines Ariel , Zheng Hong , Allen Lisa Zeigler , Kuo Alan , Grigoriev Igor V. , Allen Andrew E. , Hazlebeck David , Allen Eric E. 
Published: April 2021

Abstract
A near-complete diploid nuclear genome and accompanying circular mitochondrial and chloroplast genomes have been assembled from the elite commercial diatom species Nitzschia hildebrandi. The 50 Mbp haploid size of the nuclear genome is nearly double that of model diatom Phaeodactylum tricornutum, but 30% smaller than closer relative Fragilariopsis cylindrus. Diploid assembly, which was facilitated by low levels of allelic heterozygosity (2.7%), included 14 candidate chromosome pairs composed of long, syntenic contigs, covering 93% of the total assembly. Telomeric ends were capped with an unusual 12-mer, G-rich, degenerate repeat sequence. Predicted proteins were highly enriched in strain-specific marker domains associated with cell-surface adhesion, biofilm formation, and raphe system gliding motility. Expanded species-specific families of carbonic anhydrases suggest potential enhancement of carbon concentration efficiency, and duplicated glycolysis and fatty acid synthesis pathways across cytosolic and organellar compartments may enhance peak metabolic output, contributing to competitive success over other organisms in mixed cultures. The N. hildebrandi genome delivers a robust new reference for future functional and transcriptomic studies to illuminate the physiology of benthic pennate diatoms and harness their unique adaptations to support commercial algae biomass and bioproduct production.
Convolutional Neural Network for Classification of Eight types of Arrhythmia using 2D Time-Frequency Feature Map from Standard 12-Lead Electrocardiogram
Authors: Jeong Da Un , Lim Ki Moo 
Published: April 2021

Abstract
Electrocardiograms (ECGs) are widely used for diagnosing cardiac arrhythmia based on the deformation of signal shapes due to changes in various heart diseases. However, these abnormal signs may not be observed in some of the 12 ECG channels, depending on the location or shape of the heart and the type of cardiac arrhythmia. Therefore, to accurately diagnose cardiac arrhythmias, it is necessary to closely and comprehensively observe ECG signals acquired from 12 channel electrodes. In this study, we proposed a clustering algorithm that can classify persistent cardiac arrhythmia as well as episodic cardiac arrhythmias using the standard 12-lead ECG signals and the 2D CNN model using the time-frequency feature maps to classify the eight types of arrhythmias including normal sinus rhythm. The standard 12-lead ECG dataset was provided by Computing in Cardiology 2020 Physionet Challenge and consisted of 6,877 patients. The proposed algorithm showed excellent performance in the classification of persistent cardiac arrhythmias; however, its accuracy was somewhat low in the classification of episodic arrhythmias. If our proposed model is trained and verified using more clinical data, we believe it can be used as an auxiliary device for diagnosing cardiac arrhythmias.
Endoscopic Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in 1-Segment Lumbar Spondylolisthesis: A Prospective Randomised Pilot Study
Authors: Lv You , Chen Ming , Qin Ru-Jie , Ma Cheng , Ding Qi-Rui , Qin Hao-Nan , Chen Jing-Yang , Wang Shou-Lin , Ren Yongxin 
Published: April 2021

Abstract
BackgroundThere are currently several minimally invasive techniques for lumbar spine interbody fusion that have been shown to minimize surgical and perioperative morbidity. We aimed to evaluate the curative efficacy of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) by comparing perioperative characteristics and 1.5-year observational outcomes in 1-segment lumbar spondylolisthesis between the minimally invasive TLIF (MIS-TLIF) technique and the optimized Endo-TLIF technique. MethodsOne hundred and two patients treated by MIS-TLIF (48 cases) or Endo-TLIF (54 cases) were included from January 2017 to January 2019. Perioperative parameters and clinical outcomes were evaluated. Inflammatory biomarkers were measured for postoperative traumatic stress and muscle injury. Fusion rates were determined at 18 months after surgery by CT and the necessity of recombinant human bone morphogenetic protein-2 (rhBMP-2) application in Endo-TLIF was also observed. ResultsThe Endo-TLIF group had similar incision length, return to work time and rate (p>0.05). Blood loss, left bed time and analgesic ratio were significantly less in Endo-TLIF group (p<0.05). The Endo-TLIF group had a significantly longer operative and radiation exposure time compared with MIS-TLIF group (p<0.05). The CRP and ESR levels were lower in the Endo-TLIF group compared with the MIS-TLIF group (p<0.05). The VAS and ODI improved significantly in both groups after surgery. Significant decreases in low back VAS in the Endo-TLIF group were found at postoperative day 1 and 3 months after surgery (p<0.05). The fusion rate in the Endo-TLIF/rhBMP-2 group (75%) was lower than that in the MIS-TLIF group (95.8%)，but it was similar to that in the Endo-TLIF/rhBMP-2 group (90%).Conclusions﻿Endo-TLIF has comparable perioperative analysis and clinical outcomes in comparison to MIS-TLIF and manifests a greater improvement in less multifidus muscle damage, inflammation and faster patient recovery. Thus, Endo-TLIF should be considered as a feasible and effective technique for 1-segment lumbar spondylolisthesis patients.Trial registration: ChiCTR1800015197, 13 March 2018. Trial registry: Chinese Clinical Trial Registry.
Assessment of mortality-related risk factors and effective antimicrobial regimens for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacterales
Authors: Chen Liang , Han Xiudi , Li YanLi 
Published: April 2021

Abstract
Background
Bloodstream infections (BSIs) attributable to carbapenem-resistant Enterobacterales (CRE-BSIs) are dangerous and a major cause of mortality in clinical settings. This study was therefore designed to define risk factors linked to 30-day mortality in CRE-BSI patients and to examine the relative efficacy of different antimicrobial treatment regimens in affected individuals.
Methods
Data pertaining to 187 CRE-BSI cases from three teaching hospitals in China collected between January 2018 and June 2020 were retrospectively analyzed.
Results
For the 187 analyzed patients in this study, the 30-day mortality of CRE-BSI was 41.7% (78/187). Multivariate logistic regression analyses revealed that Pitt score [odd ratio (OR) 5.313, 95% confidence interval (CI) 3.209–8.797, P < 0.001], immunocompromised status (OR 4.605, 95% CI 1.629–13.020, P = 0.004), meropenem minimum inhibitory concentration (MIC) ≥ 8 mg/L (OR 3.736, 95% CI 1.091–12.795, P = 0.036), source control of infection (OR 0.316, 95% CI 0.117–0.854, P = 0.023), and appropriate empirical therapy (OR 0.129, 95% CI 0.027–0.625, P = 0.011) were independent predictors of CRE-BSI patient 30-day mortality. After controlling for potential confounding factors, relative to ceftazidime-avibactam (CAZ-AVI) treatment, combination therapies including CAZ-AVI (OR 1.287, 95% CI 0.124–13.403, P = 0.833) were not related to any significant change in patient mortality risk, whereas 30-day mortality risk was higher for patients administered other antimicrobial regimens (OR 12.407, 95% CI 1.684–31.430, P = 0.011). When patients were treated with antimicrobial regimens not containing CAZ-AVI, combination therapy (OR 0.239, 95% CI 0.077–0.741, P = 0.013) was related to a decreased 30-day mortality risk relative to monotherapy treatment.
Conclusion
The mortality-related risk factors and relative antimicrobial regimen efficacy data demonstrated in this study may guide the management of CRE-BSI patients.