bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health research in the Syrian conflict: opportunities for equitable and multidisciplinary collaboration
Authors: Ekzayez Abdulkarim , Olabi Amina , Douedari Yazan , Meagher Kristen , Bowsher Gemma , Farhat Bashar , Patel Preeti 
Published: May 2021

Abstract
There is considerable global momentum from Syrian researchers, policy makers and diaspora to address health, security and development challenges posed by almost a decade of armed conflict and complex geopolitics that has resulted in different areas of political control. However, research funders have been so far reluctant to invest in large-scale research programmes in severely conflict-affected areas such as northern Syria. This paper presents examples of collaborations and programmes that could change this through equitable partnerships between academic and operational humanitarian organizations involving local Syrian researchers—a tremendous way forward to capitalize and accelerate this global momentum.
Several academic and humanitarian organizations have initiated collaborations to build new networks and partnerships for better research and policy engagement in Syria. The networks conducted two consecutive annual conferences in 2019 and 2020. Key messages from these conference include: (1) equitable partnerships between organizations and individual researchers must form the basis of conducting better research; (2) ensuring the inclusion of local Syrian researchers is crucial in the development of any viable partnership; (3) capacity strengthening in health research is urgently needed in Syria’s current phase of active conflict to inform, develop and implement strengthened and sustainable health systems in the post-conflict phase.
Geophilosophical exemption to mandatory vaccination
Authors: Kahambing Jan Gresil S 
Published: May 2021

Abstract
This correspondence introduces the ethics behind a specific exemption to mandatory vaccination. Public health acknowledges medical and non-medical reasons for vaccination exemption. Geophilosophical ones, which the author coined, can provide an option to remote populations with low density and are seeking more choices in confronting the dilemma of being vaccinated.
Mental health and legal education in the time of pandemic
Authors: Macaraan Maryrose C 
Published: May 2021

Abstract
In response to an article published in this journal where the authors systematically reviewed the impact of shifted norms and practices due to the COVID-19 pandemic on the mental health of people, this paper explores this aspect within a more specific set of the population—the law students. It addresses the impact of transition from physical face-to-face classes to a virtual online platform on their psychological wellness and coping mechanism. In the end, the paper mentions strategies that the law students may adopt amid the lack or absence of physical interaction with professors, classmates and friends.
Building vaccine confidence through public participation
Authors: Corpuz Jeff Clyde G 
Published: May 2021

Abstract
A recently published correspondence proposed the involvement of private-owned companies in Coronavirus Disease 2019 (COVID-19) vaccination program. This article raises awareness that vaccine hesitancy could undermine the effectiveness of COVID-19 vaccination programs. This article proposes the idea of public participation: dialog-based approach, incentive-based (non-financial) approach and reminder-recall approach based on the World Health Organization guidelines.
Can the ECG be used to estimate age-related survival?
Authors: Kellett J , Bogh S B , Ekelund U , Brabrand M 
Published: May 2021

Summary

Background
There are few reports of the relationship between electrocardiogram (ECG) findings and the age-related survival of acutely ill patients.

Aim
This study compared the 1-year survival curves of patients attending two Danish emergency departments (EDs) with normal and abnormal ECGs. Patients were divided into age groups from 20 to 90 years of age, and an abnormal ECG was defined as low QRS voltage (i.e. lead I + II &lt;1.4 mV) or QTc interval prolongation &gt;434 ms.

Methods
A retrospective register-based observational study on 35 496 patients attending two Danish EDs, with 100% follow-up for 1 year.

Results
ECG abnormality increases linearly with age, and between 30 and 70 years of age. Patients aged 20–29 years with ECG abnormalities are more than four times more likely to die within a year than patients of the same age with a normal ECG. An individual with an abnormal ECG has the same risk of dying within a year as an individual with a normal ECG who is 10 years older. After 70 years of age this tight relationship ends, but for younger individuals with an abnormal ECG the increase in mortality is even higher.

Conclusion
An ECG may be a simple practical estimate of age-related survival. For a patient under 70 years, an abnormal QRS voltage or a prolonged QTc interval may increase 1-year mortality to that of a patient ∼10 years older.
Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS)
Authors: Keramiotou Kyriaki , Anagnostou Christos , Konstantonis George , Kataxaki Evangelia , Sfikakis Petros P , Tektonidou Maria G 
Published: May 2021

Abstract

Objective
The aim was to examine hand function and performance in activities of daily living (ADL) in patients with SLE vs healthy controls, and any associations with demographic and disease-related characteristics.

Methods
Hand function (grip strength, pinch strength and dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and biological sex-matched healthy controls. Grip strength, pinch strength and dexterity were measured by Jamar dynamometer, pinch gauge and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by disabilities of the arm, shoulder and hand (DASH) and HAQ. Regression analysis was performed to assess the determinants of hand dysfunction.

Results
All hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS; n = 157) compared with healthy subjects (P &lt; 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ, and use of immunosuppressives with DASH, HAQ and grip strength. Likewise, in patients in LLDAS, painful joints were correlated with DASH and HAQ, age with grip strength and Purdue (P &lt; 0.001), gender with grip strength, and immunosuppressives with HAQ and grip strength.

Conclusion
Hand function and performance of daily activities are significantly impaired in SLE, even in patients who achieve LLDAS, suggesting the need for their evaluation and management in clinical practice.
Workplace volatility and gender inequality: a comparison of the Netherlands and South Korea
Authors: Jung Jiwook , Lippényi Zoltán , Mun Eunmi 
Published: May 2021

Abstract
Workplaces have become more unstable in recent decades, but how such instability shapes categorical inequalities remains little understood. This study explores how the rise of employment precarity, re-conceptualized as an attribute of workplaces, affects gender inequality. We argue that gender inequality increases in volatile workplaces where employee tenure is short and turnover is common. In such workplaces, gender stereotyping and opportunity hoarding by men may become prevalent, because members have little incentive to acquire individualized information about each other and those who are not satisfied with unequal distribution of rewards simply leave rather than raising their voice. To test our argument, we analyze the effect of workplace volatility on the gender-wage gap, using employer–employee linked data from two separate national contexts: South Korea and the Netherlands. Leveraging on the different institutional contexts of the two countries, we also examine the moderating roles of unionization and public sector employment. Our theory and empirical findings contribute to our understanding of the workplace-level mechanisms of inequality, especially in the context of recent structural changes in the labor market.
Propofol regulates miR-1-3p/IGF1 axis to inhibit the proliferation and accelerates apoptosis of colorectal cancer cells
Authors: Ye Ling-Ling , Cheng Zhong-Gui , Cheng Xiao-E , Huang Yuan-Lu 
Published: May 2021

Abstract
This study aimed to clarify the mechanism of propofol on proliferation and apoptosis of colorectal cancer (CRC) cell. SW620 and HCT15 cells were exposed to different concentrations of propofol, the proliferation and apoptotic rate, were measured by MTT, colony formation and flow cytometry assays, respectively. The expressions of miR-1-3p and insulin-like growth factors 1 (IGF1) were examined by real-time polymerase chain reaction (RT-qPCR). Western bolt was employed to quantify the protein levels of IGF1 and apoptotic proteins. The molecular interaction between miR-1-3p and IGF1 was validated using dual-luciferase reporter assay. A xenograft tumor model was established to further assess the effects of propofol on CRC in vivo. Propofol dramatically decreased the proliferation and elevated apoptotic rate of CRC cells. RT-qPCR assay demonstrated that miR-1-3p was downregulated in CRC cells, and could be strikingly increased by propofol. Importantly, miR-1-3p inhibited IGF-1 expression through interacting with its 3'-UTR region, thus inactivating AKT/mTOR signals. Gain or loss of functional study revealed that miR-1-3p downregulation remarkedly diminished the anti-tumor roles of propofol by directly inhibiting IGF1. In vivo study showed that propofol inhibited tumor growth by regulating miR-1-3p/IGF1 axis. Our data eventually elucidated that propofol suppressed CRC progression by promoting miR-1-3p which targeted IGF1. These results might provide a scientific basis for the application of propofol on the clinical surgery and the prognosis of patients with CRC.
Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial
Authors: Joosten Alexandre , Rinehart Joseph , Van der Linden Philippe , Alexander Brenton , Penna Christophe , De Montblanc Jacques , Cannesson Maxime , Vincent Jean-Louis , Vicaut Eric , Duranteau Jacques 
Published: May 2021

Background
Individualized hemodynamic management during surgery relies on accurate titration of vasopressors and fluids. In this context, computer systems have been developed to assist anesthesia providers in delivering these interventions. This study tested the hypothesis that computer-assisted individualized hemodynamic management could reduce intraoperative hypotension in patients undergoing intermediate- to high-risk surgery.

Methods
This single-center, parallel, two-arm, prospective randomized controlled single blinded superiority study included 38 patients undergoing abdominal or orthopedic surgery. All included patients had a radial arterial catheter inserted after anesthesia induction and connected to an uncalibrated pulse contour monitoring device. In the manually adjusted goal-directed therapy group (N = 19), the individualized hemodynamic management consisted of manual titration of norepinephrine infusion to maintain mean arterial pressure within 10% of the patient’s baseline value, and mini-fluid challenges to maximize the stroke volume index. In the computer-assisted group (N = 19), the same approach was applied using a closed-loop system for norepinephrine adjustments and a decision-support system for the infusion of mini-fluid challenges (100 ml). The primary outcome was intraoperative hypotension defined as the percentage of intraoperative case time patients spent with a mean arterial pressure of less than 90% of the patient’s baseline value, measured during the preoperative screening. Secondary outcome was the incidence of minor postoperative complications.

Results
All patients were included in the analysis. Intraoperative hypotension was 1.2% [0.4 to 2.0%] (median [25th to 75th] percentiles) in the computer-assisted group compared to 21.5% [14.5 to 31.8%] in the manually adjusted goal-directed therapy group (difference, −21.1 [95% CI, −15.9 to −27.6%]; P < 0.001). The incidence of minor postoperative complications was not different between groups (42 vs. 58%; P = 0.330). Mean stroke volume index and cardiac index were both significantly higher in the computer-assisted group than in the manually adjusted goal-directed therapy group (P < 0.001).

Conclusions
In patients having intermediate- to high-risk surgery, computer-assisted individualized hemodynamic management significantly reduces intraoperative hypotension compared to a manually controlled goal-directed approach.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Joint effects of ambient air pollution and maternal smoking on neonatal adiposity and childhood BMI trajectories in the Healthy Start study
Authors: Moore Brianna F. , Starling Anne P. , Martenies Sheena E. , Magzamen Sheryl , Dabelea Dana 
Published: May 2021

Background:
Coexposure to air pollution and tobacco smoke may influence early-life growth, but few studies have investigated their joint effects. We examined the interaction between fetal exposure to maternal smoking and ozone (O3) or fine particulate matter (PM2.5) on birth weight, neonatal adiposity, and body mass index (BMI) trajectories through age 3 years.

Methods:
Participants were 526 mother-child pairs, born ≥37 weeks. Cotinine was measured at ~27 weeks gestation. Whole pregnancy and trimester-specific O3 and PM2.5 were estimated via. inverse-distance weighted interpolation from stationary monitors. Neonatal adiposity (fat mass percentage) was measured via. air displacement plethysmography. Child weight and length/height were abstracted from medical records. Interaction was assessed by introducing cotinine (<31.5 vs. ≥31.5 ng/mL [indicating active smoking]), O3/PM2.5 (low [tertiles 1–2] vs. high [tertile 3]), and their product term in linear regression models for birth weight and neonatal adiposity and mixed-effects models for BMI trajectories.

Results:
The rate of BMI growth among offspring jointly exposed to maternal smoking and high PM2.5 (between 8.1 and 12.7 μg/m3) in the third trimester was more rapid than would be expected due to the individual exposures alone (0.8 kg/m2 per square root year; 95% CI = 0.1, 1.5; P for interaction = 0.03). We did not detect interactions between maternal smoking and O3 or PM2.5 at any other time on birth weight, neonatal adiposity, or BMI trajectories.

Conclusions:
Although PM2.5 was generally below the EPA annual air quality standards of 12.0 μg/m3, exposure during the third trimester may influence BMI trajectories when combined with maternal smoking.
Associations of childhood overweight and obesity with upper-extremity fracture characteristics
Authors: Nhan Derek T. , Leet Arabella I. , Lee R. Jay 
Published: May 2021

Abstract
Childhood obesity is a growing epidemic in the United States, and is associated with an increased risk of lower-extremity physeal fractures, and fractures requiring operative intervention. However, no study has assessed the risk upper extremity physeal fractures among overweight children. Our purpose was to compare the following upper-extremity fracture characteristics in overweight and obese children with those of normal-weight/underweight children (herein, “normal weight”): mechanism of injury, anatomical location, fracture pattern, physeal involvement, and treatment types. We hypothesized that overweight and obese children would be higher risk for physeal and complete fractures with low-energy mechanisms and would therefore more frequently require operative intervention compared with normal-weight children.
We performed a cross-sectional review of our database of 608 patients aged 2 to 16 years, and included patients who sustained isolated upper-extremity fractures at our level-1 pediatric tertiary care center from January 2014 to August 2017. Excluded were patients who sustained pathologic fractures and those without basic demographic or radiologic information. Using body mass index percentile for age and sex, we categorized patients as obese (≥95th percentile), overweight (85th to <95th percentile), normal weight (5th to <85th percentile), or underweight (<5th percentile). The obese and overweight groups were analyzed both separately and as a combined overweight/obese group. Demographic data included age, sex, height, and weight. Fractures were classified based on fracture location, fracture pattern (transverse, comminuted, buckle, greenstick, avulsion, or oblique), physeal involvement, and treatment type. Of the 608 patients, 58% were normal weight, 23% were overweight, and 19% were obese. There were no differences in the mean ages or sex distributions among the 3 groups.
Among patients with low-energy mechanisms of injury, overweight/obese patients had significantly greater proportions of complete fractures compared with normal-weight children (complete: 65% vs 55%, P = .001; transverse: 43% vs 27%, P = .006). In addition, the overweight/obese group sustained significantly more upper-extremity physeal fractures (37%) than did the normal-weight group (23%) (P = .007).
Compared with those in normal-weight children, upper-extremity fracture patterns differ in overweight and obese children, who have higher risk of physeal injuries and complete fractures caused by low-energy mechanisms.
Level of Evidence: Level III, retrospective comparative study.
Sedentary behavior is associated with chronic obstructive pulmonary disease
Authors: Lei Yalin , Zou Kun , Xin Junguo , Wang Zhuo , Liang Kaili , Zhao Li , Ma Xiao 
Published: May 2021

Abstract
Chronic obstructive pulmonary disease (COPD) is the fourth and third leading cause of death worldwide and in China, respectively. Sedentary behavior has been shown to increase the risk of respiratory disease, such as asthma. However, the relationship between sedentary behavior and COPD is unclear. This study aimed to investigate the association between sedentary behavior and COPD.
Data was extracted from the 2018 a large-scale cross-sectional study of Chronic Disease and Lifestyle Population Survey in Sichuan Province of China, in which sedentary behavior and chronic diseases were self-reported according to medical records. The association between sedentary behavior on risk of COPD was estimated using multivariable regression model in non-matching cohorts and generalized propensity score-weighted (GPSW)cohorts, respectively, controlling for potential confounders.
Individuals who remained sedentary for more than 7 hours per day were more likely to have COPD than the control group (<3 hours) both in conventional multivariate logistic regression analysis (OR = 2.020, 95%CI: 1.575–2.585, P < .001) and GPSW analysis (OR = 2.381, 95%CI: 1.778–3.188, P < .001). After GPSW and the sensitivity analysis using refined smoking variable further found a dose-effect between sedentary behavior and COPD, with 1.242 (95%CI: 1.006–1.532, P < .05) times risk of COPD in those sedentary behavior of more than 5 hours per day (GPSW) and 1.377 (95%CI: 1.092–1.736, P < .05) times risk in those sedentary behavior above 5 hours per day (sensitivity analysis), comparing with the control group.
Sedentary behavior is independently associated with increased risk of COPD, adjusting for other confounders. The findings of this study have important implications for future research and public health guidance. Reducing sedentary time may have a significant role in COPD prevention.
The efficacy and safety of silver needle in the treatment of rheumatoid arthritis
Authors: Yu Jinling , Wang Pingsheng , Nie Cui , Zheng Bo 
Published: May 2021

Abstract

Background:
Rheumatoid arthritis is a kind of chronic crippling disease, the condition is complex, the course of the disease is repeated, seriously affecting the quality of life of patients. Adverse reactions and drug resistance associated with conventional treatment can no longer meet the clinical need. Therefore, complementary and alternative therapies need to be explored. The evidence shows that silver needle therapy has advantages in the treatment of rheumatoid arthritis, but there is a lack of standard clinical studies to verify this conclusion.

Methods:
This is a prospective randomized controlled trial to study the efficacy and safety of silver needles in the treatment of rheumatoid arthritis. Approved by the Clinical Research Ethics Committee of our hospital. The patients are randomly divided into a treatment group (silver needle treatment group) or control group (routine western medicine treatment group). The patients are followed up for 2 months after 4 weeks of treatment. Observation indicators include: TCM symptom score, HAQDI score, DAS-28 score, laboratory indicators, adverse reactions and so on. Data will be analyzed using the statistical software package SPSS version 18.0 (Chicago, IL).

Discussion:
This study will evaluate the clinical efficacy of a silver needle in the treatment of rheumatoid arthritis. The results of this study will provide a reliable reference for the clinical use of a silver needle in the treatment of rheumatoid arthritis.

Trial registration:
OSF Registration number: DOI 10.17605/OSF.IO/4X5QB
Inhibition of the renin-angiotensin-aldosterone system prevents and cures atrial fibrillation
Authors: Yu Zhixiang , Zhang Dong , Ji Qiuhe , Yi Fu 
Published: May 2021

Abstract
Background: Atrial fibrillation (AF) is a type of arrhythmia that represents a severe health hazard. The current therapies for AF have achieved success in some conditions. However, because the mechanisms underlying the occurrence and development of this disease remain unclear, the current treatment for AF often does not achieve the desired outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), which exert robust effects on specific cardiovascular diseases, are widely used in the clinic. Several studies are focusing on the effect of ACEIs/ARBs on the prevention and cure of AF. Some systematic reviews have obtained different and even opposite results. An overview is required to obtain a conclusion and provide strong evidence to guide clinical work.
Methods: We searched 5 databases, including MEDLINE, EMBASE, Cochrane Library, Web of Science, and CNKI (Chinese), and selected relevant reviews that passed the assessment we performed. Then, we synthesized the data for each result from the included reviews and obtained conclusions.
Results: ACEIs/ARBs prevented new-onset AF and AF after heart failure. ACEIs/ARBs performed well in the prevention of secondary AF, especially postoperative AF. However, for patients suffering from hypertension and myocardial infarction, ACEIs/ARBs were not the right choices for preventing AF.
Conclusions: We suggest that physicians select ACEIs/ARBs as an anti-AF therapy for patients with heart failure due to their additional benefits. Moreover, for patients who have suffered AF, ACEIs/ARBs may be a routine drug for secondary prevention.