bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Chloride Burden and Clinical Outcomes in Critically Ill Patients With Large Hemispheric Infarction
Authors: Gwak Dong-Seok , Chung Inyoung , Kim Baik-Kyun , Lee Sukyoon , Jeong Han-Gil , Kim Yong Soo , Chae Heeyun , Park Chan-Young , Han Moon-Ku 
Published: May 2021

Background: In general, disease severity has been found to be associated with abnormal chloride levels in critically ill patients, but hyperchloremia is associated with mixed results regarding patient-centered clinical outcomes. We aimed to investigate the impact of maximum serum chloride concentration on the clinical outcomes of critically ill patients with large hemispheric infarction (LHI).Methods: We conducted a retrospective observational cohort study using prospective institutional neurocritical care registry data from 2013 to 2018. Patients with LHIs involving over two-thirds of middle cerebral artery territory, with or without infarction of other vascular territories, and a baseline National Institutes of Health Stroke Scale score of ≥13 were assessed. Those with a baseline creatinine clearance of &lt;15 mL/min and required neurocritical care for &lt;72 h were excluded. Primary outcome was in-hospital mortality. Secondary outcomes included 3-month mortality and acute kidney injury (AKI) occurrence. Outcomes were compared to different maximum serum chloride levels (5 mmol/L increases) during the entire hospitalization period using multivariable logistic regression analyses.Results: Of 90 patients, 20 (22.2%) died in-hospital. Patients who died in-hospital had significantly higher maximum serum chloride levels than did those who survived up to hospital discharge (139.7 ± 8.1 vs. 119.1 ± 10.4 mmol/L; p &lt; 0.001). After adjusting for age, sex, and Glasgow coma scale score, each 5-mmol/L increase in maximum serum chloride concentration was independently associated with an increased risk of in-hospital mortality (adjusted odds ratio (aOR), 4.34; 95% confidence interval [CI], 1.98–9.50; p &lt; 0.001). Maximum serum chloride level was also an independent risk factor for 3-month mortality (aOR, 1.99 [per 5 mmol/L increase]; 95% CI, 1.42–2.79; p &lt; 0.001) and AKI occurrence (aOR, 1.57 [per 5 mmol/L increase]; 95% CI, 1.18–2.08; p = 0.002).Conclusions: High maximum serum chloride concentrations were associated with poor clinical outcomes in critically ill patients with LHI. This study highlights the importance of monitoring serum chloride levels and avoiding hyperchloremia in this patient population.
Physical Activity as a Predictor of Cognitive Decline in an Elderly Essential Tremor Cohort: A Prospective, Longitudinal Study
Authors: Radler Keith H. , Chapman Silvia , Zdrodowska Maria Anna , Dowd Hollie N. , Liu Xinhua , Huey Edward D. , Cosentino Stephanie , Louis Elan D. 
Published: May 2021

Background:Essential tremor (ET), one of the most common neurological diseases, is associated with cognitive impairment. Surprisingly, predictors of cognitive decline in ET remain largely unidentified, as longitudinal studies are rare. In the general population, however, lower physical activity has been linked to cognitive decline.Objectives:To determine whether baseline physical activity level is a predictor of cognitive decline in ET.Methods:One hundred and twenty-seven ET cases (78.1 ± 9.5 years, range = 55–95), enrolled in a prospective, longitudinal study of cognition. At baseline, each completed the Physical Activity Scale for the Elderly (PASE), a validated, self-rated assessment of physical activity. Cases underwent an extensive battery of motor-free neuropsychological testing at baseline, 1.5 years, and 3 years, which incorporated assessments of cognitive subdomains. Generalized estimating equations (GEEs) were used to assess the predictive utility of baseline physical activity for cognitive change.Results:Mean follow-up was 2.9 ± 0.4 years (range = 1.3–3.5). In cross-sectional analyses using baseline data, lower physical activity was associated with lower overall cognitive function as well as lower cognitive scores in numerous cognitive domains (memory, language, executive function, visuospatial function and attention, allp&lt; 0.05). In adjusted GEE models, lower baseline physical activity level significantly predicted overall cognitive decline over time (p=0.047), and declines in the subdomains of memory (p= 0.001) and executive function (p= 0.03).Conclusions:We identified reduced physical activity as a predictor of greater cognitive decline in ET. The identification of risk factors often assists clinicians in determining which patients are at higher risk of cognitive decline over time. Interventional studies, to determine whether increasing physical activity could modify the risk of developing cognitive decline in ET, may be warranted.
Satisfaction of Telehealth in Patients With Established Neuromuscular Disorders
Authors: Hooshmand Sara , Cho Junsang , Singh Shivangi , Govindarajan Raghav 
Published: May 2021

Introduction/aims: Determine established neuromuscular disease patients' satisfaction with telehealth during the COVID-19 pandemic.Methods: We received 50 completed Utah telehealth satisfaction surveys from a cohort of 90 from April 2020 to June 2020. Returning neuromuscular disease patients rated seven aspects from 1 (strongly disagree) to 5 (strongly agree): Communication, timeliness of physician, picture quality, sound quality, protection of privacy, the comfort of the physical exam, the ease of healthcare, and whether patients would prefer “in-person” visits despite safety precaution. A favorable response was defined as a response of “Agree” or “Strongly Agree” to the survey questions. An independent t-test, Fisher's or chi-square test were used to compare demographic factors on outcomes for each survey question.Results: The average age was 47.54 ± 20.63, 54% were female, 70% from rural areas, 60% had family present “webside,” and 14% had family present remotely. The majority of patients reported “Agree” or “Strongly Agree” to each survey question assessing their telehealth satisfaction, except for whether patients preferred in-person appointments. Demographic factors, including location and clinical diagnosis, did not influence survey responses.Discussion: The vast majority of established neuromuscular disease patients responded favorably to their telehealth experience during the COVID-19 pandemic.
Results From an Italian Expanded Access Program on Cannabidiol Treatment in Highly Refractory Dravet Syndrome and Lennox–Gastaut Syndrome
Authors: Iannone Luigi Francesco , Arena Gabriele , Battaglia Domenica , Bisulli Francesca , Bonanni Paolo , Boni Antonella , Canevini Maria Paola , Cantalupo Gaetano , Cesaroni Elisabetta , Contin Manuela , Coppola Antonietta , Cordelli Duccio Maria , Cricchiuti Giovanni , De Giorgis Valentina , De Leva Maria Fulvia , De Rinaldis Marta , d'Orsi Giuseppe , Elia Maurizio , Galimberti Carlo Andrea , Morano Alessandra , Granata Tiziana , Guerrini Renzo , Lodi Monica A. M. , La Neve Angela , Marchese Francesca , Masnada Silvia , Michelucci Roberto , Nosadini Margherita , Pilolli Nicola , Pruna Dario , Ragona Francesca , Rosati Anna , Santucci Margherita , Spalice Alberto , Pietrafusa Nicola , Striano Pasquale , Tartara Elena , Tassi Laura , Papa Amanda , Zucca Claudio , Russo Emilio , Mecarelli Oriano ,   The CBD LICE Italy Study Group
Published: May 2021

Background: Purified cannabidiol (CBD) was administered to highly refractory patients with Dravet (DS) or Lennox–Gastaut (LGS) syndromes in an ongoing expanded access program (EAP). Herein, we report interim results on CBD safety and seizure outcomes in patients treated for a 12-month period.Material and Methods: Thirty centers were enrolled from December 2018 to December 2019 within the open-label prospective EAP up to a maximum of 25 mg/kg per day. Adverse effects and liver function tests were assessed after 2 weeks; 1, 3, and 6 months of treatment; and periodically thereafter. Seizure endpoints were the percentage of patients with ≥50 and 100% reduction in seizures compared to baseline.Results: A total of 93 patients were enrolled and included in the safety analysis. Eighty-two patients [27 (32.9%) DS, 55 (67.1%) LGS] with at least 3 months of treatment have been included in the effectiveness analysis; median previously failed antiseizure medications was eight. Pediatric and adult patients were uniformly represented in the cohort. At 3-month follow-up, compared to the 28-day baseline period, the percentage of patients with at least a 50% reduction in seizure frequency was 40.2% (plus 1.2% seizure-free). Retention rate was similar according to diagnosis, while we found an increased number of patients remaining under treatment in the adult group. CBD was mostly coadministered with valproic acid (62.2%) and clobazam (41.5%). In the safety dataset, 29 (31.2%) dropped out: reasons were lack of efficacy [16 (17.2%)] and adverse events (AEs) [12 (12.9%)], and one met withdrawal criteria (1.1%). Most reported AEs were somnolence (22.6%) and diarrhea (11.9%), followed by transaminase elevation and loss of appetite.Conclusions: CBD is associated with improved seizure control also in a considerable proportion of highly refractory patients with DS and LGS independently from clobazam use. Overall, CBD safety and effectiveness are not dose-related in this cohort.
Risk Models for Advanced Melanoma Patients Under Anti-PD-1 Monotherapy—Ad hoc Analyses of Pooled Data From Two Clinical Trials
Authors: Bai Xue , Dai Jie , Li Caili , Cui Chuanliang , Mao Lili , Wei Xiaoting , Sheng Xinan , Chi Zhihong , Yan Xieqiao , Tang Bixia , Lian Bin , Wang Xuan , Zhou Li , Li Siming , Kong Yan , Qi Zhonghui , Xu Huayan , Duan Rong , Guo Jun , Si Lu 
Published: May 2021

Background: The best response and survival outcomes between advanced melanoma patients treated with the anti-PD-1 monotherapy vary greatly, rendering a risk model in need to optimally stratify patients based on their likelihood to benefit from the said treatment.Methods: We performed an ad hoc analysis of 89 advanced melanoma patients treated with the anti-PD-1 monotherapy from two prospective clinical trials at the Peking University Cancer Hospital from April 2016 to May 2018. Clinicodemographical characteristics, baseline and early-on-treatment (median 0.6 months after anti-PD-1 monotherapy initiation) routine laboratory variables, including complete blood count and general chemistry, and best response/survival data were extracted and analyzed in both univariate and multivariate logistic and Cox proportional hazard models.Results: After three rounds of screening, risk factors associated with a poorer PFS included a high pre-treatment neutrophil, derived neutrophil-lymphocyte ratio (dNLR), low pre-treatment hemoglobin, and low early-on-/pre-treatment fold change of eosinophil; those with a poorer OS included a high pre-treatment neutrophil, eosinophil, PLT, early-on/pre-treatment fold change of LDH and neutrophil; and those with a poorer best response included a high pre-treatment NLR and early-on-/pre-treatment LDH fold change. Risk models (scale: low, median-low, median high, and high risk) were established based on these risk factors as dichotomous variables and M stage (with vs. without distant metastasis) for PFS (HR 1.976, 95% CI, 1.507–2.592, P &lt; 0.001), OS (HR 2.348, 95% CI, 1.688–3.266), and non-responder (OR 3.586, 95% CI, 1.668–7.713, P = 0.001), respectively. For patients with low, median-low, median-high, and high risks of developing disease progression (PD), six-month PFS rates were 64.3% (95% CI, 43.5–95.0%), 37.5% (95% CI, 22.4–62.9%), 9.1% (95% CI, 3.1–26.7%), and 0%, respectively. For patients with OS risks of low, median-low, median-high, and high, OS rates at 12 months were 82.5% (95% CI, 63.1–100%), 76.6% (95% CI, 58.4–100%), 42.1% (95% CI, 26.3–67.3%), and 23.9% (95% CI, 11.1–51.3%), respectively. For patients with risks of low, median-low, median-high, and high of being a non-responder, objective response rates were 50.0% (95% CI, 15.7–84.3%), 27.8% (95% CI, 9.7–53.5%), 10.3% (95% CI, 2.9–24.2%), and 0%, respectively.Conclusion: A risk scoring model based on the clinicodemographical characteristics and easily obtainable routinely tested laboratory biomarkers may facilitate the best response and survival outcome prediction and personalized therapeutic decision making for the anti-PD-1 monotherapy treated advanced melanoma patients in Asia.
Turbina oblongata Protects Against Oxidative Cardiotoxicity by Suppressing Lipid Dysmetabolism and Modulating Cardiometabolic Activities Linked to Cardiac Dysfunctions
Authors: Erukainure Ochuko L. , Chukwuma Chika I. , Matsabisa Motlalepula G. , Javu Mirranda T. , Salau Veronica F. , Koorbanally Neil A. , Islam Md. Shahidul 
Published: May 2021

Cardiotoxicity leading to cardiovascular dysfunction and ultimately cardiac failure remains a major global health issue irrespective of race, age and country. Several factors including lipotoxicity, oxidative imbalance, exacerbated angiotensin-converting enzyme (ACE) activity and altered bioenergetics have been implicated in the pathophysiology of cardiovascular diseases. Turbina oblongata (E. Mey. ex Choisy) A. Meeuse is among the medicinal plants commonly used traditionally in the treatment and management of various ailments including cardiovascular dysfunctions in South Africa. In the present study, T. oblongata was investigated for its cardioprotective mechanism on oxidative-mediated cardiotoxicity by determining its effect on redox imbalance, purinergic and cholinergic dysfunction, and ACE activity as well as lipid dysmetabolism and pathways in iron-induced oxidative cardiac injury. Oxidative injury was induced ex vivo in freshly isolated heart by incubating with 0.1 mM FeSO4. Treatment was done by co-incubating with T. oblongata extract or gallic acid which served as the standard antioxidant. Induction of oxidative cardiac injury led to significant depleted levels of glutathione, triglyceride, HDL-cholesterol, superoxide, catalase and ENTPDase activities, with concomitant elevated levels of malondialdehyde, cholesterol, LDL-cholesterol, ACE, acetylcholinesterase, ATPase and lipase activities. These levels and activities were significantly reversed following treatment with T. oblongata. Induction of oxidative injury also caused alterations in lipid metabolites, with concomitant activation of beta oxidation of very long chain fatty acids, plasmalogen synthesis and mitochondrial beta-oxidation of long chain saturated fatty acids pathways. Some of the altered metabolites were restored following treatment with T. oblongata, with concomitant inactivation of beta oxidation of very long chain fatty acid pathway. These results indicate the cardioprotective effect of T. oblongata against oxidative-mediated cardiotoxicity. This is evidenced by its ability to mitigate lipotoxicity and modulate dysregulated cardiometabolic activities as portrayed by its antioxidative activity and suppressive effects on ACE, acetylcholinesterase and lipase activities, while modulating cardiac lipid dysmetabolism.
Glucocappasalin Induces G2/M-Phase Arrest, Apoptosis, and Autophagy Pathways by Targeting CDK1 and PLK1 in Cervical Carcinoma Cells
Authors: Xu Guangya , Yan Xueling , Hu Zhongjia , Zheng Lulu , Ding Ke , Zhang Yamei , Qing Yi , Liu Tao , Cheng Lijia , Shi Zheng 
Published: May 2021

Glucocappasalin (GCP), a natural product derived from the seeds of Descurainia sophia (L.) Webb. ex Prantl, exhibits potential antitumor activity in HeLa cervical carcinoma cells. In this study, we investigated the anti-cervical cancer property of GCP through the induction of cell cycle arrest, apoptosis, and autophagy in vitro and in vivo, and elucidated the underlying molecular mechanisms. We demonstrated that treatment with GCP inhibited the growth of HeLa, Siha, and Ca Ski cell lines in a dose-dependent manner, with HeLa cells displaying particular sensitivity to the GCP treatment. Subsequently, the expression of cyclin-dependent kinase 1 (CDK1) and polo like kinase 1 (PLK1) were evaluated in HeLa cells using the CDK1 kinase assay kit, the fluorescence polarization assay, real-time quantitative PCR, and western blotting. Our results demonstrate that GCP could be employed to attenuate the expression of CDK1 and PLK1 in a dose- and time-dependent manner. The complementary results obtained by flow cytometry and western blotting allowed us to postulate that GCP may exhibit its antitumor effects by inducing G2/M cell cycle arrest. Moreover, HeLa cells treated with GCP exhibited a loss in mitochondrial membrane potential, together with the activation of caspases 3 and 9, and poly ADP-ribose polymerase (PARP). Additionally, we found that GCP could increase the formation of acidic vesicular organelles (AVOs), as well as the levels of Beclin1, LC3-II, p62, and Atg5 proteins in HeLa cells. Further studies indicated that GCP triggered autophagy via the suppression of the PI3K/AKT/mTOR signaling pathways. The autophagy inhibitor 3-methyladenine (3-MA) was used to determine whether autophagy affects the apoptosis induced by GCP. Interestingly, the inhibition of autophagy attenuated apoptosis. In vivo anti-tumor experiments indicated that GCP (60 mg/kg, i.p.) markedly reduced the growth of HeLa xenografts in nude mice without apparent toxicity. Taken together, we demonstrate that GCP induces cell cycle G2/M-phase arrest, apoptosis, and autophagy by acting on the PI3K/AKT/mTOR signaling pathways in cervical carcinoma cells. Thus, GCP may represent a promising agent in the eradication of cervical cancer.
Optimal Implantation Site of Orthodontic Micro-Screws in the Mandibular Anterior Region Based on CBCT
Authors: Wang Yannan , Shi Quan , Wang Feng 
Published: May 2021

Background: To determine the optimal implantation site of orthodontic micro-screws based on cone beam computed tomography (CBCT) analysis in the mandibular anterior tooth region, provide a theoretical basis for orthodontic implant placement and improve post-implantation stability.Methods: Forty patients who underwent CBCT scanning were selected for this study. CBCT scanning was applied to measure the interradicular distance, buccolingual dimension, labial cortical bone thickness and lingual cortical bone thickness between mandibular anterior teeth at planes 2, 4, 6, and 8 mm below the alveolar ridge crest. The data were measured and collected to obtain a comprehensive evaluation of the specific site conditions of the alveolar bone.Results: The interradicular distance, buccolingual dimension and labial cortical bone thickness between the mandibular anterior teeth were positively correlated with the distance below the alveolar ridge crest (below 8 mm). The interradicular distance, buccolingual dimension, labial cortical bone thickness, and lingual cortical bone thickness were all greater than those in other areas between the lateral incisor root and canine incisor root 4, 6, and 8 mm below the alveolar ridge crest.Conclusion: The area between the lateral incisor root and the canine incisor root in planes 4, 6, and 8 mm from the alveolar ridge crest can be used as safe sites for implantation, while 8 mm below the alveolar ridge crest can be the optimal implantation site. An optimal implantation site can be 8 mm below the alveolar ridge crest between the lateral incisor root and the canine incisor root.
Financial Strain and Health Status Among European Workers: Gender and Welfare State Inequalities
Authors: Artazcoz Lucía , Cortès-Franch Imma , Escribà-Agüir Vicenta , Benavides Fernando G. 
Published: May 2021

Objectives: Although in-work poverty has been increasing, in Europe policy about poverty and social exclusion tends to focus on labor market participation, independently of the level of remuneration and the quality of work, and studies about financial strain among workers, as well as on its relationship with health status, are still scarce. The objectives of this study were: (1) to compare the prevalence of financial strain among workers among different welfare state typologies, and (2) to examine whether the relationship between financial strain and health status differs by welfare state regime. For both objectives we examined whether there were gender differences.Methods: We conducted a cross-sectional study using data from the 6th European Working Conditions Survey of 2015 and selected a subsample of all employees from the EU28 aged 16–64 years (13,156 men and 13,225 women).Results: There were large differences in the prevalence of financial strain between welfare state typologies, which were not explained by individual factors. Additionally, differences across welfare regimes were greater among women. Nordic countries had the lowest prevalence (12.1% among men and 12.3% among women) whereas Southern European countries had the highest (49.5% among men and 47.9% among women). In both sexes and in all welfare state typologies, financial strain was associated with poor self-perceived health status and poor psychological well-being. Whereas, Southern European countries had the highest prevalence of financial strain, the magnitude of the association with health status was smaller than in other country typologies.Conclusion: In Europe, policies are needed to address the specific structural factors leading to financial strain as well as its relationship with health status among workers.
Will Healthcare Workers Accept a COVID-19 Vaccine When It Becomes Available? A Cross-Sectional Study in China
Authors: Sun Yufang , Chen Xiaohong , Cao Min , Xiang Tao , Zhang Jimei , Wang Ping , Dai Hang 
Published: May 2021

Objective: The Coronavirus disease 2019 (COVID-19) vaccine is currently available. This timely survey was conducted to provide insight into on the willingness of healthcare workers (HCWs)to receive the vaccine and determine the influencing factors.Methods: This was a cross-sectional online survey. An online questionnaire was provided to all participants and they were asked if they would accept a free vaccine. The questionnaire gathered general demographic information, and included the General Health Questionnaire (GHQ-12); Myers-Briggs Type Indicator questionnaire (MBTI); Depression, Anxiety, and Stress Scales (DASS-21); and the 12-item Short Form Health Survey (SF-12). The data were collected automatically and electronically. Univariate analysis was done between all the variables and our dependent variable. Multivariable logistic regression models were employed to examine and identify the associations between the acceptance of the COVID-19 vaccine with the associated variables.Results: We collected 505 complete answers. The participants included 269 nurses (53.27%), 206 clinicians (40.79%), 15 administrative staff (2.97%), and 15 other staff (2.97%). Of these, 76.63% declared they would accept the vaccine. The major barriers were concerns about safety, effectiveness, and the rapid mutation in the virus. Moreover, four factors were significantly associated with the willingness to receive the vaccine: (a) “understanding of the vaccine” (odds ratio (OR):2.322; 95% confidence interval [CI]: 1.355 to 3.979); (b) “worried about experiencing COVID-19” (OR 1.987; 95% CI: 1.197–3.298); (c) “flu vaccination in 2020” (OR 4.730; 95% CI: 2.285 to 9.794); and (d) “living with elderly individuals” (OR 1.928; 95% CI: 1.074–3.462).Conclusions: During the vaccination period, there was still hesitation in receiving the vaccine. The results will provide a rationale for the design of future vaccination campaigns and education efforts concerning the vaccine.