bluuebunny/crossref_metadata_2025_split huggingface dataset:
Documenting plans for care: advance care directives and the 7-step pathway in the acute care context
Authors: Crawford Gregory Brian , Hodgetts Katherine , Burgess Teresa , Eliott Jaklin 
Published: September 2021

Abstract
Background
Advance care planning involves the discussion and documentation of an individual’s values and preferences to guide their future healthcare should they lose capacity to make or communicate treatment decisions. Advance care planning can involve the individual’s completion of an Advance Care Directive (ACD), a legislated and common-law instrument which may include appointment of a substitute decision-maker and binding refusals of treatment. In South Australia, ACDs intersect in the acute-care context with the Resuscitation Plan 7-Step Pathway (7-SP), an integrated care plan written for and by clinicians, designed to organise and improve patients’ end-of-life care through the use of structured documentation. Here, we examine the perspectives of healthcare professionals (HCPs) within a hospital setting on the practical integration of ACDs and the 7-SP, exploring the perceived role, function, and value of each as they intersect to guide end-of-life care in an Australian hospital setting.

Methods
Qualitative data were collected via eight focus groups with a total of 74 HCPs (acute care, and oncology specialists; medical intern; general and emergency nurses; social workers) across two hospitals. Audio recordings were transcribed and thematically analysed.

Results
HCPs viewed ACDs as a potentially valuable means of promoting patient autonomy, but as rarely completed and poorly integrated into hospital systems. Conversely, the process and documentation of the 7-SP was perceived as providing clarity about clinicians’ responsibilities, and as a well-understood, integrated resource. Participants sometimes exhibited uncertainty around which document takes precedence if both were present. Sometimes, the routinisation of the 7-SP meant it was understood as the ‘only way’ to determine patient wishes and provide optimal end-of-life care. When this occurs, the perceived authority of ACDs, or of patients’ choice not to participate in end-of-life discussions, may be undermined.

Conclusions
The intersection of ACDs and the 7-SP appears problematic within acute care. Clinicians’ uncertainty as to whether an ACD or 7-SP takes precedence, and when it should do so, suggests a need for further clarity and training on the roles of these documents in guiding clinical practice, the legislative context within which specific documentation is embedded, and the dynamics associated with collaborative decision-making in end-of-life care.
A qualitative analysis of third-year medical students’ reflection essays regarding the impact of COVID-19 on their education
Authors: Kelly Erin L. , Casola Allison R. , Smith Kelsey , Kelly Samantha , de la Cruz Maria Syl D. 
Published: September 2021

Abstract
Background
The COVID-19 pandemic fundamentally changed every aspect of healthcare delivery and training. Few studies have reported on the impact of these changes on the experiences, skill development, and career expectations of medical students.

Method
Using 59 responses to a short reflection essay prompt, 3rd year medical students in Philadelphia described how the COVID-19 pandemic affected their education in mid-2020. Using conventional content analysis, six main themes were identified across 14 codes.

Results
Students reported concerns regarding their decreased clinical skill training and specialty exposure on their career development due to the loss of in-person experience during their family medicine clerkship. A small number felt very let down and exploited by the continued high cost of tuition while missing clinical interactions. However, many students also expressed professional pride and derived meaning from limited patient and mentorship opportunities. Many students developed a new sense of purpose and a call to become stronger public health and patient advocates.

Conclusions
The medical field will need to adapt to support medical students adversely impacted by the COVID-19 pandemic, from an educational and mental health standpoint. However, there are encouraging signs that this may also galvanize many students to engage in leadership roles in their communities, to become more empathetic and thoughtful physicians, and to redesign healthcare in the future to better meet the needs of their most vulnerable patients.
Impact of COVID-19 pandemic on the professional intention of medical and related students
Authors: Gong Zheng , Li Wen , Bu Huimin , He Mingyu , Hou Hongjian , Ma Tongtong , Hu Xide , Fu Lu , Adu-Amankwaah Joseph , Sun Hong 
Published: September 2021

Abstract
Background
The outbreak of COVID-19 has led to increased workload and infection risks among medical staff. This situation may influence current medical and health-related students’ decision on the choices of their future careers. Hence, this study investigated the impact of COVID-19 on their future career intentions.

Methods
This is a cross-sectional observational study that included medical and health-related students from three universities between October 2020 and January 2021. The study questionnaire was divided into two main sections: Section 1, which comprised students’ basic information. And section 2 focused mainly on the impact of COVID-19 pandemic on students’ professional intentions. The chi-squared χ2 test was used to compare the responses before and after the pandemic outbreak among Chinese and non-Chinese students.

Results
In overall, 1253 students completed the questionnaires. The responses showed that the number of students who preferred clinical medicine, public health, pharmacy and oral medicine increased significantly after the pandemic outbreak. In contrast, the number of students who chose nursing and medical technology decreased significantly. The change mainly occurred in Chinese students, predominantly females. Half of students (50.35%) were more willing to engage in medical and health work after completing their current program. Also, 36.39% of students felt that knowledge was too limited in the pandemic’s face and would like to continue studying after graduation to gain more knowledge. Due to the pandemic, 34.18% of students would like a future workplace near their hometown, and 19.63% preferred to work in urban areas.

Conclusion
The COVID-19 outbreak impacted current medical and health-related students’ career planning on their future workplaces and employment time choices. Additionally, the pandemic influenced the intention of Chinese students in choosing their future careers. This study provided the basis for the policymaking, specialty setting of colleges and supplied the medical health department’s talent reserve information.
Prediction of lung emphysema in COPD by spirometry and clinical symptoms: results from COSYCONET
Authors: Kellerer Christina , Jörres Rudolf A. , Schneider Antonius , Alter Peter , Kauczor Hans-Ulrich , Jobst Bertram , Biederer Jürgen , Bals Robert , Watz Henrik , Behr Jürgen , Kauffmann-Guerrero Diego , Lutter Johanna , Hapfelmeier Alexander , Magnussen Helgo , Trudzinski Franziska C. , Welte Tobias , Vogelmeier Claus F. , Kahnert Kathrin 
Published: September 2021

Abstract
Background
Lung emphysema is an important phenotype of chronic obstructive pulmonary disease (COPD), and CT scanning is strongly recommended to establish the diagnosis. This study aimed to identify criteria by which physicians with limited technical resources can improve the diagnosis of emphysema.

Methods
We studied 436 COPD patients with prospective CT scans from the COSYCONET cohort. All items of the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale, as well as data from spirometry and CO diffusing capacity, were used to construct binary decision trees. The importance of parameters was checked by the Random Forest and AdaBoost machine learning algorithms.

Results
When relying on questionnaires only, items CAT 1 & 7 and SGRQ 8 & 12 sub-item 3 were most important for the emphysema- versus airway-dominated phenotype, and among the spirometric measures FEV1/FVC. The combination of CAT item 1 (≤ 2) with mMRC (> 1) and FEV1/FVC, could raise the odds for emphysema by factor 7.7. About 50% of patients showed combinations of values that did not markedly alter the likelihood for the phenotypes, and these could be easily identified in the trees. Inclusion of CO diffusing capacity revealed the transfer coefficient as dominant measure. The results of machine learning were consistent with those of the single trees.

Conclusions
Selected items (cough, sleep, breathlessness, chest condition, slow walking) from comprehensive COPD questionnaires in combination with FEV1/FVC could raise or lower the likelihood for lung emphysema in patients with COPD. The simple, parsimonious approach proposed by us might help if diagnostic resources regarding respiratory diseases are limited.
Trial registration ClinicalTrials.gov, Identifier: NCT01245933, registered 18 November 2010, https://clinicaltrials.gov/ct2/show/record/NCT01245933.
Optimizing operational parameters for the enzymatic production of furandicarboxylic acid building block
Authors: Sánchez-Ruiz María Isabel , Martínez Angel T. , Serrano Ana 
Published: September 2021

Abstract
Background
2,5-Furandicarboxylic acid (FDCA) is a precursor for green plastics due to its structural similarity to terephthalic acid, a common precursor of oil-derived polymers, and its potential production from sugars obtained from plant biomass. Hydroxymethylfurfural oxidase (HMFO) has been reported as a promising biocatalyst for FDCA production since it can convert bio-based 5-hydroxymethylfurfural (HMF) into FDCA building block. This three-step oxidation reaction occurs through the diformylfuran and 2,5-formylfurancarboxylic acid (FFCA) intermediates. Several efforts have been made for the development of HMFO variants that increase FDCA yields by improving their activities over the reaction intermediates. However, there is still limited insight into how operational conditions can influence these enzymatic reactions. The setup of optimal reaction conditions would enable to understand potential problems hampering the effective industrial production of this bioplastic precursor using HMFO as biocatalyst.

Results
In this work, several parameters affecting the performance of Methylovorus sp HMFO oxidizing HMF have been analyzed for the wild-type enzyme, and its V367R and W466F single variants, V367R/W466F double variant, and I73V/H74Y/G356H/V367R/T414K/A419Y/A435E/W466F (8BxHMFO) octuple variant. Our results show how the oxidation of HMF by HMFO enzymes is highly influenced by pH, with different optimal pH values for the different improved variants. Moreover, the enzymes are not stable at high hydrogen peroxide concentrations and their activity is inhibited by the FFCA intermediate in a pH-dependent way. These limitations can be efficiently overcome with the addition of catalase to the reaction medium, which removes the hydrogen peroxide formed during the oxidations, and the controlled dosage of the substrate to limit the amount of FFCA accumulated in the reaction. The different behavior of wild-type HMFO and its variants against pH, hydrogen peroxide and FFCA highlights the importance of considering each variant as an individual enzyme with its own operational conditions for an eventual industrial FDCA production.

Conclusions
This work provides information of those parameters that condition a high production of FDCA by HMFO. Unraveling these factors allowed to increase the FDCA yields by using the most stable enzymes at their optimal pH for HMF oxidation, removing the peroxide with catalase, and avoiding FFCA accumulation by controlling substrate and/or enzyme concentration. These above findings will be useful when planning a future scale-up of these conversions and will provide new viewpoints for the design of HMFO variants that render a more effective performance during HMF conversion into FDCA.
Role of glutamine and its metabolite ammonia in crosstalk of cancer-associated fibroblasts and cancer cells
Authors: Li Xiao , Zhu Hongming , Sun Weixuan , Yang Xingru , Nie Qing , Fang Xuedong 
Published: September 2021

AbstractCancer-associated fibroblasts (CAFs), the most abundant cells in the tumor microenvironment, play an indispensable role in cancer initiation, progression, metastasis, and metabolism. The limitations of traditional treatments can be partly attributed to the lack of understanding of the role of the tumor stroma. For this reason, CAF targeting is gradually gaining attention, and many studies are trying to overcome the limitations of tumor treatment with CAF as a breakthrough. Glutamine (GLN) has been called a “nitrogen reservoir” for cancer cells because of its role in supporting anabolic processes such as fuel proliferation and nucleotide synthesis, but ammonia is a byproduct of the metabolism of GLN and other nitrogenous compounds. Moreover, in some studies, GLN has been reported as a fundamental nitrogen source that can support tumor biomass. In this review, we discuss the latest findings on the role of GLN and ammonia in the crosstalk between CAFs and cancer cells as well as the potential therapeutic implications of nitrogen metabolism.
Association between abnormal body mass index and pregnancy outcomes in patients following frozen embryo transfer: a systematic review and meta-analysis
Authors: Yang Jiaqi , He Yichen , Wu Yiqing , Zhang Dan , Huang Hefeng 
Published: September 2021

Abstract
Background
There has been increasing interest in the relationship between body mass index(BMI) and pregnancy outcomes, especially in women undergoing frozen embryo transfer(FET). Several observational studies have been published, but so far with conflicting results.

Methods
A systematic review and meta-analysis was conducted according to PRISMA guidelines. Pubmed, Embase, Cochrane Library, Clinicaltrails.gov and Web of Science databases were searched based on established search strategy from inception through January 2021.

Results
Twelve studies were eligible. In women following FET, high BMI (BMI ≥ 23 kg/m2) was associated with an impaired live birth rate (LBR, OR: 0.89, 95% CI: 0.82–0.96, P = 0.002), but wasn’t associated with the implantation rate or the clinical pregnancy rate. Subgroup analysis revealed higher LBR for women didn’t complicated by polycystic ovary syndrome (PCOS, OR: 0.96, 95% CI: 0.85–1.08, P = 0.46) and women with blastocyst transferred (OR: 0.89, 95% CI: 0.68–1.16, P = 0.40). LBR did not differ between the low BMI group (BMI < 18.5 kg/m2) and the normal weight group.

Conclusions
Our study showed that high BMI in women is negatively associated with LBR in FET cycles, whereas low BMI isn’t. The results of subgroup analysis implied a need for women with a high BMI to get individualized weight management and treatment. Further evidence is still required to optimize preconception health and develop Nutritional and exercise guidelines.
RETRACTED ARTICLE: microRNA-193-3p attenuates
myocardial injury of mice with sepsis via STAT3/HMGB1 axis
Authors: Pan Jianyuan , Alexan Buse , Dennis Dorn , Bettina Chiristine , Christoph Laeuf Ilona Mariya , Tang Yongqin 
Published: September 2021

Abstract
Objective
Little is known regarding the functional role of microRNA-193-3p
(miR-193-3p) in sepsis. Hence, the aim of the present study was to investigate the
effect of miR-193-3p on myocardial injury in mice with sepsis and its mechanism
through the regulation of signal transducers and activators of transcription 3
(STAT3).

Methods
The mice model of sepsis was established by cecal ligation and puncture
(CLP), septic mice were injected with miR-193-3p agomir, miR-193-3p antagomir or
siRNA-STAT3. The expression of miR-193-3p, STAT3 and HMGB1 in the myocardial tissue
of septic mice were detected. Cardiac ultrasound, hemodynamics, myocardial injury
markers, inflammatory factors and cardiomyocyte apoptosis in septic mice were
measured.

Results
MiR-193-3p expression was reduced while STAT3 expression was increased
in septic mice. Down-regulated STAT3 or up-regulated miR-193-3p improved cardiac
function, attenuated myocardial injury, inflammation and cardiomyocyte apoptosis in
septic mice. Knockdown STAT3 reversed the role of inhibited miR-193-3p for mice with
sepsis. miR-193-3p targeted STAT3, thereby inhibiting HMGB1 expression.

Conclusion
This study provides evidence that miR-193-3p targets STAT3 expression to
reduce HMGB1 expression, thereby reducing septic myocardial damage. MiR-193-3p might
be a potential candidate marker and therapeutic target for sepsis.
Genome-wide identification of endogenous viral sequences in alfalfa (Medicago sativa L.)
Authors: Boutanaev Alexander M. , Nemchinov Lev G. 
Published: September 2021

AbstractEndogenous viral elements (EVEs) have been for the most part described in animals and to a less extent in plants. The endogenization was proposed to contribute toward evolution of living organisms via horizontal gene transfer of novel genetic material and resultant genetic diversity. During the last two decades, several full-length and fragmented EVEs of pararetroviral and non-retroviral nature have been identified in different plant genomes, both monocots and eudicots. Prior to this work, no EVEs have been reported in alfalfa (Medicago sativa L.), the most cultivated forage legume in the world. In this study, taking advantage of the most recent developments in the field of alfalfa research, we have assessed alfalfa genome on the presence of viral-related sequences. Our analysis revealed segmented EVEs resembling two dsDNA reverse-transcribing virus species: Soybean chlorotic mottle virus (family Caulimoviridae, genus Soymovirus) and Figwort mosaic virus (family Caulimoviridae, genus Caulimovirus). The EVEs appear to be stable constituents of the host genome and in that capacity could potentially acquire functional roles in alfalfa’s development and response to environmental stresses.
Stable transfection system for Babesia sp. Xinjiang
Authors: Wang Jinming , Wang Xiaoxing , Guan Guiquan , Yang Jifei , Liu Junlong , Liu Aihong , Li Youquan , Luo Jianxun , Yin Hong 
Published: September 2021

Abstract
Background
Stable transfection systems have been described in many protozoan parasites, including Plasmodium falciparum, Cryptosporidium parvum, Babesia bovis, Babesia ovata, and Babesia gibsoni. For Babesia sp. Xinjiang (Bxj), which is the causative pathogen of ovine babesiosis and mainly prevails across China, the platform of those techniques remains absent. Genetic manipulation techniques are powerful tools to enhance our knowledge on parasite biology, which may provide potential drug targets and diagnostic markers.

Methods
We evaluated the inhibition efficiency of blasticidin (BSD) and WR99210 to Bxj. Then, a plasmid was constructed bearing selectable marker BSD, green fluorescent protein (GFP) gene, and rhoptry-associated protein-1 3′ terminator region (rap 3′ TR). The plasmid was integrated into the elongation factor-1 alpha (ef-1α) site of Bxj genome by cross-over homologous recombination technique. Twenty μg of plasmid was transfected into Bxj merozoites. Subsequently, drug selection was performed 24 h after transfection to generate transfected parasites.

Results
Transfected parasite lines, Bxj-c1, Bxj-c2, and Bxj-c3, were successfully obtained after transfection, drug selection, and colonization. Exogenous genes were integrated into the Bxj genome, which were confirmed by PCR amplification and sequencing. In addition, results of western blot (WB) and indirect immunofluorescence assay (IFA) revealed that GFP-BSD had expressed for 11 months.

Conclusions
In our present study, stable transfection system for Bxj was successfully developed. We anticipate that this platform will greatly facilitate basic research of Bxj.

Graphical abstract
Non-cancer-related pathogenic germline variants and expression consequences in ten-thousand cancer genomes
Authors: Wang Zishan , Fan Xiao , Shen Yufeng , Pagadala Meghana S , Signer Rebecca , Cygan Kamil J. , Fairbrother William G. , Carter Hannah , Chung Wendy K. , Huang Kuan-lin 
Published: September 2021

Abstract
Background
DNA sequencing is increasingly incorporated into the routine care of cancer patients, many of whom also carry inherited, moderate/high-penetrance variants associated with other diseases. Yet, the prevalence and consequence of such variants remain unclear.

Methods
We analyzed the germline genomes of 10,389 adult cancer cases in the TCGA cohort, identifying pathogenic/likely pathogenic variants in autosomal-dominant genes, autosomal-recessive genes, and 59 medically actionable genes curated by the American College of Molecular Genetics (i.e., the ACMG 59 genes). We also analyzed variant- and gene-level expression consequences in carriers.

Results
The affected genes exhibited varying pan-ancestry and population-specific patterns, and overall, the European population showed the highest frequency of pathogenic/likely pathogenic variants. We further identified genes showing expression consequence supporting variant functionality, including altered gene expression, allelic specific expression, and mis-splicing determined by a massively parallel splicing assay.

Conclusions
Our results demonstrate that expression-altering variants are found in a substantial fraction of cases and illustrate the yield of genomic risk assessments for a wide range of diseases across diverse populations.
Quantitative ultrasound imaging of soft biological tissues: a primer for radiologists and medical physicists
Authors: Cloutier Guy , Destrempes François , Yu François , Tang An 
Published: September 2021

AbstractQuantitative ultrasound (QUS) aims at quantifying interactions between ultrasound and biological tissues. QUS techniques extract fundamental physical properties of tissues based on interactions between ultrasound waves and tissue microstructure. These techniques provide quantitative information on sub-resolution properties that are not visible on grayscale (B-mode) imaging. Quantitative data may be represented either as a global measurement or as parametric maps overlaid on B-mode images. Recently, major ultrasound manufacturers have released speed of sound, attenuation, and backscatter packages for tissue characterization and imaging. Established and emerging clinical applications are currently limited and include liver fibrosis staging, liver steatosis grading, and breast cancer characterization. On the other hand, most biological tissues have been studied using experimental QUS methods, and quantitative datasets are available in the literature. This educational review addresses the general topic of biological soft tissue characterization using QUS, with a focus on disseminating technical concepts for clinicians and specialized QUS materials for medical physicists. Advanced but simplified technical descriptions are also provided in separate subsections identified as such. To understand QUS methods, this article reviews types of ultrasound waves, basic concepts of ultrasound wave propagation, ultrasound image formation, point spread function, constructive and destructive wave interferences, radiofrequency data processing, and a summary of different imaging modes. For each major QUS technique, topics include: concept, illustrations, clinical examples, pitfalls, and future directions.