bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mesenchymal stem and non-stem cell surgery, rescue, and regeneration in glaucomatous optic neuropathy
Authors: Limoli Paolo Giuseppe , Limoli Celeste , Vingolo Enzo Maria , Franzone Federica , Nebbioso Marcella 
Published: May 2021

Abstract
Background
Glaucomatous optic neuropathy (GON) is an anatomofunctional impairment of the optic nerve triggered by glaucoma. Recently, growth factors (GFs) have been shown to produce retinal neuroenhancement. The suprachoroidal autograft of mesenchymal stem cells (MSCs) by the Limoli retinal restoration technique (LRRT) has proven to achieve retinal neuroenhancement by producing GF directly into the choroidal space. This retrospectively registered clinical study investigated the visual function changes in patients with GON treated with LRRT.

Methods
Twenty-five patients (35 eyes) with GON in progressive disease conditions were included in the study. Each patient underwent a comprehensive ocular examination, including the analysis of best corrected visual acuity (BCVA) for far and near visus, sensitivity by Maia microperimetry, and the study of the spectral domain-optical coherence tomography (SD-OCT). The patients were divided into two groups: a control group, consisting of 21 eyes (average age 72.2 years, range 50–83), and an LRRT group, consisting of 14 eyes (average age 67.4, range 50–84).

Results
After 6 months, the BCVA, close-up visus, and microperimetric sensitivity significantly improved in the LRRT-treated group (p<0.05), whereas the mean increases were not statistically significant in controls (p>0.5).

Conclusions
Patients with GON treated with LRRT showed a significant increase in visual performance (VP) both in BCVA and sensitivity and an improvement of residual close-up visus, in the comparison between the LRRT results and the control group. Further studies will be needed to establish the actual significance of the reported findings.
Umbilical mesenchymal stem cell-derived extracellular vesicles as enzyme delivery vehicle to treat Morquio A fibroblasts
Authors: Flanagan Michael , Pathak Isha , Gan Qi , Winter Linda , Emnet Ryan , Akel Salem , Montaño Adriana M. 
Published: May 2021

AbstractBackgroundMucopolysaccharidosis IVA (Morquio A syndrome) is a lysosomal storage disease caused by the deficiency of enzymeN-acetylgalactosamine-6-sulfate sulfatase (GALNS), which results in the accumulation of the glycosaminoglycans (GAGs), keratan sulfate, and chondroitin-6-sulfate in the lysosomes of all tissues causing systemic dysfunction. Current treatments include enzyme replacement therapy (ERT) which can treat only certain aspects of the disease such as endurance-related biological endpoints. A key challenge in ERT is ineffective enzyme uptake in avascular tissues, which makes the treatment of the corneal, cartilage, and heart valvular tissue difficult. The aim of this study was to culture human umbilical mesenchymal stem cells (UMSC), demonstrate presence of GALNS enzyme activity within the extracellular vesicles (EVs) derived from these UMSC, and study how these secreted EVs are taken up by GALNS-deficient cells and used by the deficient cell’s lysosomes.MethodsWe obtained and cultured UMSC from the umbilical cord tissue from anonymous donors from the Saint Louis Cord Blood Bank. We characterized UMSC cell surface markers to confirm phenotype by cell sorting analyses. In addition, we confirmed that UMSC secrete GALNS enzyme creating conditioned media for co-culture experiments with GALNS deficient cells. Lastly, we isolated EVs derived from UMSC by ultracentrifugation to confirm source of GALNS enzyme.ResultsCo-culture and confocal microscopy experiments indicated that the lysosomal content from UMSC migrated to deficient cells as evidenced by the peak signal intensity occurring at 15 min. EVs released by UMSC were characterized indicating that the EVs contained the active GALNS enzyme. Uptake of GALNS within EVs by deficient fibroblasts was not affected by mannose-6-phosphate (M6P) inhibition, suggesting that EV uptake by these fibroblasts is gradual and might be mediated by a different means than the M6P receptor.ConclusionsUMSC can deliver EVs containing functional GALNS enzyme to deficient cells. This enzyme delivery method, which was unaffected by M6P inhibition, can function as a novel technique for reducing GAG accumulation in cells in avascular tissues, thereby providing a potential treatment option for Morquio A syndrome.
Complex PTSD and borderline personality disorder
Authors: Ford Julian D. , Courtois Christine A. 
Published: May 2021

Abstract
Background
This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD.

Main body
The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment.

Conclusion
The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.
The cultural and heritage tourist, SEM analysis: the case of The Citadel of the Catholic King
Authors: Hernández-Rojas Ricardo David , del Río Juan Antonio Jimber , Fernández Alberto Ibáñez , Vergara-Romero Arnaldo 
Published: May 2021

Abstract
This study researches the loyalty of travelers to destinations which include material cultural heritage. It analyzes the loyalty of visitors to a destination with cultural heritage sites in order to provide results which can be used to improve the management of the destination. This research used Warp-PLS 7.0 software with a structural equations model to evaluate the 8 proposed and validated hypotheses. A questionnaire was given to a sample of 499 tourists who visited The Citadel of the Catholic King in Córdoba and the statistical study of the replies gave results about the loyalty of visitors to a destination which includes cultural heritage. This study adds an innovative component by analyzing the moderating effect of perceived heritage quality and perceived cultural quality on the relationship of perceived value and visitor satisfaction. This study shows that visitor loyalty to The Citadel of the Catholic King depends on the visitor satisfaction with the cultural heritage, it also analyses how the quality perceived by the tourist modulates to varying degrees the relationship between perceived value and tourist satisfaction. Areas which can be improved at cultural heritage sites have been identified and these include the professionalization of tour guides specialized in cultural heritage sites, improving and showing the cultural importance of the heritage, the information available about the heritage and the access to the heritage. These findings are important for city managers when preparing projects to increase the loyalty and competitiveness of the city compared to other similar destinations with cultural heritage.
Feasibility, safety and acceptability of select outcome measures in a physiotherapy study protocol for boys with haemophilia
Authors: Thorpe Nicola , Harniess Phillip , Main Eleanor , Hubert Nicola , Rand Sarah , Stephensen David , Liesner Ri , Bladen Melanie 
Published: May 2021

Abstract
Background
There is a lack of functional performance measures for children and young people with haemophilia (CYPwH) with associated control data from typically developing boys (TDB). The literature advocates development of a core set of outcome measures for different chronic conditions. As medical treatment improves, CYPwH are experiencing better outcomes; therefore, more challenging measures are required to monitor physical performance. Such testing is not performed routinely, due to practical and safety concerns.

Aim
Evaluate the feasibility, safety and acceptability of select outcome measures as part of a study protocol testing CYPwH; including myometry, 10 metre incremental shuttle walk test (10-m ISWT), iSTEP (an incremental step test, with data from TDB), and 1 week of accelerometry-wear at home.

Methods
Sixty-six boys aged 6–15 years with mild, moderate or severe haemophilia A or B (including inhibitors) attending routine clinics at Great Ormond Street Hospital were approached to participate. Descriptive statistics and content analysis were used to assess outcomes of feasibility, safety and acceptability, which included recruitment/retention rates, protocol completion within routine appointment timeframes, performance testing without serious adverse events/reactions (SAE/SARs), and acceptability to CYPwH of high-level performance measures.

Results
Outcomes were met: 43 boys completed testing at clinic review (Jan–Nov 2018) within a 10-month timeframe, retention was 95% at completion of protocol and no SAE/SARs were reported throughout testing.

Conclusion
Feasibility, safety and acceptability of the study protocol have been established in this population. Both high-level performance tests, iSTEP and 10-m ISWT, were an acceptable addition to boys’ routine clinic appointments and could be safe, acceptable choices of outcome measure as part of a core set of tests for CYPwH. Further investigation of the psychometric properties for the iSTEP is now justified, in order for it to be used as a standardised, validated, reliable outcome measure in clinical or research settings.

Trial registration
Retrospectively registered on September 3, 2019, on ClinicalTrials.gov (ID: NCT04076306).
Development and implementation of a novel, mandatory competency-based medical education simulation program for pediatric emergency medicine faculty
Authors: Pirie Jonathan , Fayyaz Jabeen , Gharib Mireille , Simone Laura , Glanfield Carrie , Kempinska Anna 
Published: May 2021

Abstract
Background
Maintaining acute care physician competence is critically important. Current maintenance of certification (MOC) programs has started to incorporate simulation-based education (SBE). However, competency expectations have not been defined. This article describes the development of a mandatory annual SBE, competency-based simulation program for technical and resuscitation skills for pediatric emergency medicine (PEM) physicians.

Methods
The competency-based medical education (CBME) program was introduced in 2016. Procedural skill requirements were based on a needs assessment derived from Royal College PEM training guidelines. Resuscitation scenarios were modified versions of pre-existing in-situ mock codes or critical incident cases. All full-time faculty were required to participate annually in both sessions. Delivery of educational content included a flipped classroom website, deliberate practice, and stop-pause debriefing. All stations required competency checklists and global rating scales.

Results
Between 2016 and 2018, 40 physicians and 48 registered nurses attended these courses. Overall course evaluations in 2018 were 4.92/5 and 4.93/5. Barriers to implementation include the need for many simulation education experts, time commitment, and clinical scheduling during course events.

Conclusion
We have developed a mandatory simulation-based, technical, and resuscitation CBME program for PEM faculty. This simulation-based CBME program could be adapted to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes.
Do foreign aid triggers economic growth in Chad? A time series analysis
Authors: Kirikkaleli Dervis , Adeshola Ibrahim , Adebayo Tomiwa Sunday , Awosusi Abraham Ayobamiji 
Published: May 2021

AbstractThis study explores the nexus between foreign aid and Chad's economic growth. Empirical evidence is based on annual data from 1982 to 2018. The study used ARDL, FMOLS, and DOLS techniques to establish interconnection among the economic indicators. Subsequently, the study utilized the wavelet coherence technique to capture causality and correlation between economic growth and the independent variables. One of the wavelet approach's uniqueness is that it shows the pattern and behavior of the variables used, including the different time horizons. Thus, we explore the dynamic influence of gross capital formation, foreign aid, import, and export on Chad's economic growth. The result of the ARDL long-run estimates reveals that gross capital formation and foreign aid exert insignificant impact on GDP growth. However, exports and imports exert a positive and significant impact on GDP growth. Furthermore, the global financial crisis has a negative and significant impact on the economy of Chad. The outcomes of the wavelet coherence test provide supportive evidence for the ARDL long-run outcomes. Hence, we suggested that substantial macroeconomic reforms and economic liberalization initiatives will help in the dissemination of information and promote domestic investment and importation of high-tech goods.
Effect of intradialytic exercise on bone profile in hemodialysis patients
Authors: Elshinnawy Howaida Abdelhameed , Mohamed Ahmed Mohamed Bakr Bakr , Farrag Dina Abou Bakr , AbdElgawad Moustafa Abd Elnassier 
Published: May 2021

Abstract
Background
Chronic kidney disease increases the risk of fractures and altered bone and mineral metabolism. Exercise training could be a non-pharmacological therapeutic intervention. The aim of this work is to evaluate the effect of intradialytic exercise training on bone markers in hemodialysis (HD) patients.

Results
Forty adult patients on regular HD participated in the study. Twenty of which completed 3 months supervised intradialytic cycling exercise program and 20 served as controls. At baseline, there was no difference between both groups regarding age, sex, physical performance, and laboratory studies performed. After 3 months, the exercise group showed significant improvement in short performance battery test (SPBT) total score (P<0.001) associated with significant decrease in serum parathormone (PTH) (P=0.01) and increase in serum alkaline phosphatase (ALP) and bone specific alkaline phosphatase (BALP) (P<0.05 and P<0.001 respectively). Controls did not show similar change in SPBT or laboratory studies. There was no significant change in serum calcium or phosphorus in both groups. A significant positive correlation was observed between SPBT scores post-exercise and both BALP and ALP levels (r=0.432, P=0.01 and r=0.645, P<0.01 respectively). Also, an inverse relation was observed between SPBT and PTH (r=−0.503, P=0.01).

Conclusion
Intradialytic cycling exercise program resulted in significant increase in physical performance associated with decrease in serum PTH and increase in BALP and ALP in HD patients. This indicates the positive influence of exercise not only on physical performance in dialysis patients but also on bone metabolism.
FGF21 Normalizes Plasma Glucose in Mouse Models of Type 1 Diabetes and Insulin Receptor Dysfunction
Authors: Diener John L , Mowbray Sarah , Huang Waan-Jeng , Yowe David , Xu Jian , Caplan Shari , Misra Abhay , Kapur Ankur , Shapiro Jeffrey , Ke Xiaoling , Wu Xiaoping , Bose Avirup , Panza Darrell , Chen Min , Beaulieu Valerie , Gao Jiaping 
Published: May 2021

Abstract
Fibroblast growth factor (FGF) 21 is a member of the FGF family of proteins. The biological activity of FGF21 was first shown to induce insulin-independent glucose uptake in adipocytes through the GLUT1 transporter. Subsequently, it was shown to have effects on the liver to increase fatty acid oxidation. FGF21 treatment provides beneficial metabolic effects in both animal models and patients with obesity, type 2 diabetes mellitus (T2D) and/or fatty liver disease. In this paper, we revisited the original finding and found that insulin-independent glucose uptake in adipocytes is preserved in the presence of an insulin receptor antagonist. Using a 40-kDa PEGylated (PEG) and half-life extended form of FGF21 (FGF21-PEG), we extended these in vitro results to 2 different mouse models of diabetes. FGF21-PEG normalized plasma glucose in streptozotocin-treated mice, a model of type 1 diabetes (T1D), without restoring pancreatic β-cell function. FGF21-PEG also normalized plasma glucose levels and improved glucose tolerance in mice chronically treated with an insulin competitive insulin receptor antagonist, a model of autoimmune/type-B insulin resistance. These data extend the pharmacological potential of FGF21 beyond the settings of T2D, fatty liver, and obesity.
The Relationship between Lifestyle and Hypertension Cases at UPT Cibiru Public Health Center Bandung City
Authors: Sutriyawan Agung , Apriyani Reni , Miranda Tenike Gita 
Published: May 2021

Background: Hypertension is one of the non-communicable diseases which is the main cause of death in Indonesia (25.8%). Hypertension is also often called a silent killer because most of the hypertension cases do not cause symptoms. Hypertension is closely related to behavior and lifestyle. Hypertension control is done with behavioral changes, such as conducting adequate physical activity, healthy diet with dietary and quitting smoking. This research aims to determine the relationship between lifestyle, which includes physical activity, diet, and smoking behavior, and hypertension cases. Method: This study used quantitative analytic method with cross sectional research design. The population in this study was all patients who visited and were treated at the public clinic as recorded in the registration report at Cibiru Community Health Center (Puskesmas) in June 2019. The samples were 74 respondents, taken by using purposive sampling technique. The data were analyzed by using the chi square test. Results: The results showed that the lifestyles associated with the hypertension cases were physical activity (p value = 0.022) and smoking behavior (p value = 0.003). Meanwhile, the diet was not related to the incidence of hypertension (p value = 0.326). Conclusion: Based on the research result, it can be concluded that physical activity and smoking behavior were proven to be associated with hypertension, while the diet was not proven related to hypertension. It is suggested that the community health center should maximize the NCD Integrated Guidance Post (Posbindu-PTM) and conduct counseling on the importance of physical activities and the danger of smoking in order to improve the health efforts in the work area of Puskesmas Cibiru.
Occupational Safety Practice of Hazardous Health-care Waste Management in Bengkulu City
Authors: Suyanto Jipri , Rahmadhani Wulan , Hilinti Yatri , Nobnorb Nipaporn , Phu MD Phan Trieu 
Published: May 2021

Background: Facing many patients while the workers were limited prompted health workers to make a quick decision regarding health-care waste. High workload pressured health workers and put them at risk of getting diseases than others, especially diseases from medical waste that they took care. Besides, as health workers, they should be clean from bacteria or viruses that can transmit diseases to their patients. This research aimed to investigate the factors associated with occupational safety practice of hazardous health-care waste management in Bengkulu City. Method: This cross-sectional study used a stratified random sampling technique to select 230 respondents who work as health workers to respond to a questionnaire interview. The data were analyzed using multivariate logistic regression to find the association between the outcomes and the independent variables. Results: The prevalence of poor occupational safety practice of hazardous health-carewaste management was 35.21 % (95% CI = 29.27-41.66). The factors significantly associated with occupational safety practice of hazardous health-care waste management were; gender (p-value < 0.001), department/unit (p-value < 0.001), knowledge (p-value < 0.001), and spirituality (p-value < 0.001). Conclusion: gGnder, department/unit, knowledge, and spirituality were associated with occupational safety practice of hazardous health-carewaste management in Bengkulu City.
Leste da República Democrática do Congo: (re)estruturação do Estado a partir de relações entre atores estatais e não-estatais
Authors: Bessa Marcelle Christine 
Published: May 2021

Muitas discussões acerca da governança de recursos naturais nos Estados pós-coloniais têm ocorrido, recentemente, na literatura de Relações Internacionais. No entanto, a maior parte dessas discussões busca focar no papel do Estado. Esse paper buscará mudar esta abordagem, deslocando seu foco para a atuação dos atores não-estatais, sobretudo, warlords e grupos armados regionais. Assim, serão apontadas discussões sobre as relações existentes entre esses atores e os atores estatais, apresentando as (re)articulações existentes a partir do conceito de “global assemblage”. Analisando a atuação dos grupos armados e warlords na região leste da República Democrática do Congo (RDC), mostraremos as diferentes interações entre atores estatais e não-estatais, em relações de competição e cooperação, produzindo novas práticas, instituições e formas de governança.Palavras-chave: Assemblage; República Democrática do Congo (RDC); warlord. ABSTRACTMany discussions about the governance of natural resources in post-colonial states have recently occurred in the literature on International Relations. However, most of these discussions seek to focus on the role of the State. This paper will seek to change this approach, shifting its focus to the role of non-state actors, above all, warlords and regional armed groups. Thus, discussions on the existing relationships between these actors and state actors will be pointed out, presenting the existing (re)articulations based on the concept of “global assemblage”. Analyzing the role of armed groups and warlords in the eastern region of the Democratic Republic of Congo (DRC), we will show the different interactions between state, and non-state actors, in competitive and cooperative relationships, producing new practices, institutions and forms of governance.Keywords: Assemblage; Democratic Republic of Congo (DRC); warlord. Recebido em 30 dez. 2020 | Aceito em 29 abr. 2021.
A ESPERANÇA ILUSÓRIA E A EXISTÊNCIA DIFICIL DAS MULHERES EM "CELLES QUI ATTENDENT" DE FATOU DIOME
Authors: Fatime Samb 
Published: May 2021

A emigração, especialmente a chamada clandestina, é um tema recorrente na atualidade e na literatura francofona. Foi neste âmbito que Fatou Diome, através de seu romance "Celles qui attendent" se interessou muito por este fenômeno e especialmente pela vida das mulheres, mães e esposas, daqueles que foram para o fascínio enganador, a Europa. O objetivo deste artigo é analisar e interpretar como Fatou Diome revela o cotidiano dessas mulheres que permanecem no país e que esperam o retorno do filho ou do cônjuge acompanhado do sucesso social e financeiro que a emigração pode lhe trazer. O romance destaca a miséria, o sofrimento, a poligamia, a solidão, a tristeza e o peso da cultura na vida dessas mulheres corajosas. Nosso trabalho será baseado em estudos literários, etnológicos e históricos realizados sobre os mesmos temas. PALAVRAS CHAVES: Emigração clandestina-mulheres-sofrimento-poligamia-solidão