bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of antiviral treatment on long-term prognosis in non-immunocompromised patients with CMV reactivation
Authors: Park Ga Eun , Ki Hyun Kyun , Ko Jae-Hoon 
Published: May 2021

Abstract
Background
Reactivation of human cytomegalovirus (CMV) occurs in non-immunocompromised patients with or without specific organ involvement, but it is still unknown whether it has a clinical implication on long-term prognosis or not.

Methods
A retrospective cohort study evaluating non-immunocompromised adult patients with CMV reactivation was conducted during the period between January 2010 and February 2018. Patients were divided into ganciclovir-treated and non-treated groups. Patients who died within 30 days from CMV reactivation were excluded as they died from complex causes of conditions. Survivors were followed for 30-months to evaluate long-term prognosis.

Results
A total of 136 patients with CMV reactivation was included, consisting of 66 ganciclovir-treated (48.5%) and 70 non-treated (51.5%) patients. Overall, patients were old-aged (median 70 years old) and most were treated with pneumonia of any cause (91.2%). More patients in ganciclovir-treated group were treated at intensive care unit (43.9% vs 24.3%, respectively) and had higher viral load over 5000 copies/ml (48.5% vs 22.9%) than non-treated group (all P < 0.05). Primary and secondary endpoints including 30-months survival (28.0 vs 38.9%, respectively) and 12-months survival (40.3% vs 49.2%) were not statistically different between the ganciclovir-treated and non-treated groups. In the multivariate analyses, ganciclovir treatment was not associated with 30-months survival (HR 1.307, 95% CI 0.759–2.251) and 12-months survival (HR 1.533, 95% CI 0.895–2.624).

Conclusion
In a retrospective cohort study evaluating non-immunocompromised patients with CMV reactivation, ganciclovir treatment was not associated with long-term prognosis. Antiviral treatment in this condition would not be necessary unless organ involvement is suspected.
Influence of the second stage of labor on maternal and neonatal outcomes in vaginal births after caesarean section: a multicenter study in Germany
Authors: Gitas G. , Proppe L. , Ertan A. K. , Baum S. , Rody A. , Kocaer M. , Dinas K. , Allahqoli L. , Laganà A. S. , Sotiriadis A. , Sommer S. , Alkatout I. 
Published: May 2021

Abstract
Background
The American College of Obstetricians and Gynecologists (ACOG) introduced a new standard of care in 2014, extending the duration of the second stage of labor in order to reduce caesarean delivery (CD) rates and its severe complications. The aim of the present study is to evaluate success rates of trial of labor after caesarean section (TOLAC), as well as maternal and neonatal outcomes after the establishment of the recent guidelines.

Methods
A retrospective study was performed at two large departments in Germany from January 2008 to January 2018. Patients undergoing TOLAC were divided into two groups. Group I (958 patients) was constituted before the establishment of the current guidelines, and Group II (588 patients) after the establishment of the guidelines. A subgroup analysis was performed to compare neonatal outcomes after successful TOLAC and operative vaginal delivery with those after failed TOLAC and secondary CD.

Results
The success rate of vaginal births after cesarean section (VBAC) fell from 66.4% in Group I to 55.8% in Group II (p < 0.001). The median duration of the second stage of labor was statistically significantly longer in Group II than in Group I (79.3 ± 61.9 vs. 69.3 ± 58.2 min) for patients without previous vaginal birth. The incidence of operative vaginal delivery decreased from Group I to Group II (9.6% vs. 6.8%). The incidence of third- and fourth-degree perineal lacerations, blood loss and emergency CD were similar in the two groups. Concerning the neonatal outcome, our groups did not differ significantly in regard of rates of umbilical artery cord pH < 7.1 (p = 0.108), the 5-min Apgar scores below 7 (p = 0.224) and intubation (p = 0.547). However, the transfer rates to the neonatal care unit were significantly higher in Group II than in Group I (p < 0.001). Neonatal outcomes did not differ significantly in the subgroup analysis.

Conclusion
Extending the second stage of labor does not necessarily result in more vaginal births after TOLAC. Maternal and neonatal outcomes were similar in both groups. Further studies will be needed to evaluate the role of operative vaginal delivery and the duration of the second stage of labor in TOLAC.
Household chaos, family routines, and young child movement behaviors in the U.S. during the COVID-19 outbreak: a cross-sectional study
Authors: Kracht Chelsea L. , Katzmarzyk Peter T. , Staiano Amanda E. 
Published: May 2021

Abstract
Background
The home environment is an important facilitator of young child movement behaviors, including physical activity (PA), sleep, and screen-time. Household chaos, characterized by crowding, noise, and disorder in the home, may hinder efforts to obtain adequate amounts of movement behaviors. The COVID-19 outbreak impacted many families, and social distancing during this time may create conditions for more household chaos. Family routines can help establish order in the home and encourage an appropriate balance of movement behaviors, such as less screen-time and more sleep. The purpose of this study was to evaluate the association between household chaos and young child movement behaviors during the COVID-19 outbreak in the United States, and the role of family routines in this relationship.

Methods
A national online survey including 1836 mothers of preschoolers (3.0–5.9 years) was conducted during May 2020. Mothers reported demographic characteristics, household chaos, family routines, and the preschooler’s movement behaviors during the outbreak. Mothers completed a household chaos questionnaire and were grouped into chaos categories (low, moderate/low, moderate/high, and high) for analysis. Linear regression was used to assess the association between chaos category, family routines, and movement behaviors with adjustment for covariates.

Results
Mothers were 35.9 ± 4.1 years of age, middle income (47.8%), and preschoolers were 3.8 ± 0.8 years of age. Most mothers reported their preschooler was less physically active (38.9%), slept the same amount of time (52.1%), and increased their screen-time (74.0%) after the COVID-19 outbreak. Preschoolers in the high chaos households performed less total PA (β = − 0.36 days/week, 95% CI:-0.62 to − 0.09, p = 0.008), slept less (β = − 0.42 h, 95% CI:-0.59 to − 0.25, p = 0.001) and had more screen-time (β = 0.69 h, 95% CI:0.45 to 0.92, p = 0.001) compared to those in low chaos households. In most chaos categories, having a bed-time ritual was related to more child sleep, and mothers who viewed routines as “less/not important” reported more preschooler screen-time compared to mothers who viewed routines as “very important”.

Conclusion
Promoting bed-time rituals and prioritizing routines, even somewhat, may be related to an improved balance of child movement behaviors. Innovative measures are needed to support families during periods of disruption such as that experienced in the COVID-19 pandemic.
Ethnic inequalities in hospital admissions in England: an observational study
Authors: Petersen Jakob , Kandt Jens , Longley Paul A. 
Published: May 2021

Abstract
Background
Ethnic inequalities in health are well-known and partly explained by social determinants such as poorer living and working conditions, health behaviours, discrimination, social exclusion, and healthcare accessibility factors. Inequalities are known both for self-reported health and for diseases such as diabetes, cardiovascular diseases, respiratory diseases, and non-specific chest pains. Most studies however concern individual diseases or self-reported health and do not provide an overview that can detect gaps in existing knowledge. The aim of this study is thus to identify ethnic inequalities in inpatient hospital admission for all major disease categories in England.

Methods
Observational study of the inpatient hospital admission database in England enhanced with ethnicity coding of participants’ surnames. The primary diagnosis was coded to Level 1 of the Global Burden of Disease groups. For each year, only the first admission for each condition for each participant was included. If a participant was readmitted within two days only the first admission was counted. Admission risk for all major disease groups for each ethnic group relative to the White British group were calculated using logistic regression adjusting for age and area deprivation.

Results
40,928,105 admissions were identified between April 2009 and March 2014. Ethnic inequalities were found in cardiovascular diseases, respiratory diseases, chest pain, and diabetes in line with previous studies. Additional inequalities were found in nutritional deficiencies, endocrine disorders, and sense organ diseases.

Conclusions
The results of this study were consistent with known inequalities, but also found previously unreported disparities in nutritional deficiencies, endocrine disorders, and sense organ diseases. Further studies would be required to map out the relevant care pathways for ethnic minorities and establish whether preventive measures can be strengthened.
Feasibility and impact of laparoscopic sleeve gastrectomy after renal transplantation on comorbidities, graft function and quality of life
Authors: AlEnazi Naif A. , Ahmad Khaled S. , Elsamahy Ilham A. , Essa Mohamed S. 
Published: May 2021

Abstract
Background
The aim of this study is to clarify the feasibility and effect of laparoscopic sleeve gastrectomy (LSG) on comorbidities, graft function and quality of life in patients who underwent renal transplantation (RT).

Methods
This is a retrospective review of five patients who underwent LSG after RT. Demographic data, anthropometric parameters, the effect on comorbidities, postoperative course, immunosuppressive medications, causes of RT, renal function, the survival of graft, and quality of life after SG in obese patients with a history of RT were assessed using BAROS–Moorhead–Ardelt survey

Results
From September 2015 to September 2019, 5 renal transplant patients underwent LSG; three female, and two male. Median body mass index (BMI) decreased from 42.17 kg/m2 (range 36–55) before surgery to 28.16 kg/m2 (range 25–42) after surgery. Improvement in blood pressure, triglyceride, and cholesterol levels was observed, and all cases were able to decrease their medications. Insulin was stopped and replaced with linagliptin in all diabetic patients. Graft function improved, and proteinuria level decreased in all cases. All patients reported to have an excellent quality of life.

Conclusion
LSG showed excellent outcomes in this high-risk group of patients regarding comorbidities, graft function and quality of life
Survey analysis to determine the impact of evidence informed practice education upon East Asian medicine faculty clinical instruction and students’ skills, knowledge, attitudes and behaviors within a master’s degree program
Authors: Anderson Belinda J. , Dudla Saikaew , Marantz Paul R. , Kligler Benjamin E. , Leininger Brent D. , Evans Roni 
Published: May 2021

Abstract
Background
Between 2013 and 2018 Pacific College of Health and Science (formerly Pacific College of Oriental Medicine) trained faculty and developed curriculum in evidence informed practice (EIP), with support from a grant from the National Institutes of Health (NIH). A three-credit (45 h) Foundations of EIP course, and online EIP learning modules (developed as part of a previous NIH R25 award), were used for faculty and student training. In addition, EIP was incorporated into 73% of the East Asian medicine degree program. Clinical integration of EIP in the College clinic was enhanced by improving access to reference sources, including additional EIP-related questions to the patient intake forms, requiring the use of a patient-centered outcome instrument, and assessing students’ clinical EIP competencies.

Methods
Master’s degree students’ self-reported EIP skills, knowledge, attitudes and behaviors were assessed before and after taking the Foundations of EIP course using a 17-question paper-based survey with an additional open-ended comments section. The survey was administered in 29 courses across all three Pacific College campuses. Clinical faculty self-reported EIP instruction, focusing on the EIP content and instructional approaches that were utilized, was evaluated on the New York City campus using a paper-based survey before and after changes were made to enhance the clinical integration of EIP.

Results
A total of 1181 completed EIP-course surveys consisting of 657 pre-EIP course surveys and 524 post-EIP course surveys were analyzed. There was a statistically significant improvement in students’ EIP skills, knowledge and behaviors after completing the EIP course. Students’ perception of the importance of EIP was high before and after the EIP course. Little change in Faculty’s EIP-related clinical instruction was evident following the EIP-related changes that were made to the Clinic.

Conclusion
Our study suggests that the three-credit (45 h) EIP course was effective at improving the EIP skills, knowledge and behaviors of this group of East Asian medicine students who were undertaking a master’s degree that qualified them for licensure in acupuncture in the US. These students also demonstrated a high level of recognition for the importance of research and EIP both before and after the course. Training faculty clinical supervisors and providing greater access to evidence sources in the College clinic did not appear to increase EIP instructional activity.
Downregulation of testicular function in the goat by altrenogest
Authors: Mihsler-Kirsch Lisa , Wagner Henrik , Failing Klaus , Wehrend Axel 
Published: May 2021

Abstract
Background
The present study investigated whether the administration of the progestin altrenogest provides noninvasive, temporary, and reversible suppression of gonadal function in the goat as a potential alternative to chirurgical castration, which is related with irreversibility, risks of complications till death of the animal and welfare issues. Eight sexually mature Peacock goats were randomly divided into two groups. The experimental group was administered altrenogest (0.088 mg/kg) orally once daily for 7 weeks. The remaining four goats received an oral glucose solution and served as the control group. After completing the administration period, the reversibility of the medication was evaluated for another 7 weeks (observation phase). The treatment effects were assessed by clinical examination; ultrasound examination of the testes, including one-dimensional grayscale analysis, blood testosterone levels, analysis of semen parameters and libido. At the end of the observation period, the animals were castrated and the testicles were examined histologically.

Results
Altrenogest treatment had no significant effect on the physical development of the goats, the sonographic appearance of the testes, the gray values measured in the ultrasound images, or the blood testosterone levels. The effects of treatment on the testicular and semen parameters varied widely in the experimental animals; the testicle volume was significantly lower and the number of pathologically altered sperm in the ejaculate was significantly higher in treated animals.

Conclusion
These findings indicate that daily altrenogest administration at a dose of 0.088 mg/kg does not reliably suppress gonadal function in the goat.
The construction of recombinant Lactobacillus casei vaccine of PEDV and its immune responses in mice
Authors: Li Xiaowen , Zhang Bingzhou , Zhang Dasheng , Liu Sidang , Ren Jing 
Published: May 2021

AbstractBackgroundPorcine epidemic diarrhea (PED) is a contagious intestinal disease caused by porcine epidemic diarrhea virus (PEDV) characterized by vomiting, diarrhea, anorexia, and dehydration, which have caused huge economic losses around the world. At present, vaccine immunity is still the most effective method to control the spread of PED. In this study, we have constructed a novel recombinant L. casei-OMP16-PEDVS strain expressing PEDVS protein of PEDV and OMP16 protein ofBrucella abortusstrain. To know the immunogenicity of the recombinant L. casei-OMP16-PEDVS candidate vaccine, it was compared with BL21-OMP16-PEDVS-F, BL21-OMP16-PEDVS, and BL21-PEDVS recombinant protein.ResultsThe results showed that we could detect higher levels of IgG, neutralizing antibody, IL-4, IL-10, and INF-γ in serum and IgA in feces of L. casei-OMP16-PEDVS immunized mice, which indicated that L. casei-OMP16-PEDVS candidate vaccine could induce higher levels of humoral immunity, cellular immunity, and mucosal immunity.ConclusionTherefore, L. casei-OMP16-PEDVS is a promising candidate vaccine for prophylaxis of PEDV infection.
Plasma markers in pulmonary hypertension subgroups correlate with patient survival
Authors: Koudstaal T. , van Uden D. , van Hulst J. A. C. , Heukels P. , Bergen I. M. , Geenen L. W. , Baggen V. J. M. , van den Bosch A. E. , van den Toorn L. M. , Chandoesing P. P. , Kool M. , Boersma E. , Hendriks R. W. , Boomars K. A. 
Published: May 2021

Abstract
Background
Recent studies have provided evidence for an important contribution of the immune system in the pathophysiology of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). In this report, we investigated whether the inflammatory profile of pulmonary hypertension patients changes over time and correlates with patient WHO subgroups or survival.

Methods
50 PAH patients (16 idiopathic (I)PAH, 24 Connective Tissue Disease (CTD)-PAH and 10 Congenital Heart Disease (CHD)-PAH), 37 CTEPH patients and 18 healthy controls (HCs) were included in the study. Plasma inflammatory markers at baseline and after 1-year follow-up were measured using ELISAs. Subsequently, correlations with hemodynamic parameters and survival were explored and data sets were subjected to unbiased multivariate analyses.

Results
At diagnosis, we found that plasma levels of interleukin-6 (IL-6) and the chemokines (C-X3-C) motif legend CXCL9 and CXCL13 in CTD-PAH patients were significantly increased, compared with HCs. In idiopathic PAH patients the levels of tumor growth factor-β (TGFβ), IL-10 and CXCL9 were elevated, compared with HCs. The increased CXCL9 and IL-8 concentrations in CETPH patients correlated significantly with decreased survival, suggesting that CXCL9 and IL-8 may be prognostic markers. After one year of treatment, IL-10, CXCL13 and TGFβ levels changed significantly in the PAH subgroups and CTEPH patients. Unbiased multivariate analysis revealed clustering of PH patients based on inflammatory mediators and clinical parameters, but did not separate the WHO subgroups. Importantly, these multivariate analyses separated patients with < 3 years and > 3 years survival, in particular when inflammatory mediators were combined with clinical parameters.

Discussion
Our study revealed elevated plasma levels of inflammatory mediators in different PAH subgroups and CTEPH at baseline and at 1-year follow-up, whereby CXCL9 and IL-8 may prove to be prognostic markers for CTEPH patients. While this study is exploratory and hypothesis generating, our data indicate an important role for IL-8 and CXCL9 in CHD and CTEPH patients considering the increased plasma levels and the observed correlation with survival.

Conclusion
In conclusion, our studies identified an inflammatory signature that clustered PH patients into WHO classification-independent subgroups that correlated with patient survival.
“The devil is in the detail”: geographical inequalities of femicides in Ecuador
Authors: Fonseca-Rodríguez Osvaldo , San Sebastián Miguel 
Published: May 2021

Abstract
Background
Femicide is a very important public health problem in Ecuador. Since regional and country-level femicide rates can obscure significant variations at the sub-national level, it is important to provide information at the lowest relevant level of disaggregation to be able to develop targeted preventive policies. The aim of this study was to assess the spatial distribution of the femicide rate and to examine its spatial clustering at the canton level in Ecuador in the period 2018–2019.

Methods
Data on cases were collected by a national network of non-governmental organizations. Two age-disaggregated analyses were done, one for the 15 to 24 years-olds and the other for the female population of 15 and older. Age-specific population data were obtained from the National Institute of Statistics for the study period. Standardized mortality ratios for mapping the mortality were calculated using hierarchical Bayesian models and spatial scan statistics were applied to identify local clusters. Thematic maps of age-specific femicide rates were also constructed.

Results
During the two-year period, 61 and 183 women were killed in the age ranges 15–24 and 15 years and older, respectively. The annual rate of femicides in Ecuador was 1.0 and 0.8 per 100,000 in the female population aged 15–24 and 15+, respectively, with substantial variations among cantons. The spatial analysis contributed to visualize high risk cantons, which were mainly located in a small area in the central part of the country (for those 15+) but especially in the Amazon region, for both of the studied age groups.

Conclusions
This study has shown the usefulness of applying spatial analysis to the problem of femicides in Ecuador. The study has revealed important variations among cantons but also a spatial clustering, mainly in the Amazon region of the country. The results should help policymakers to focus on current prevention programmes for violence against women into these high-risk areas. Continuous monitoring of femicides at low-level geographical areas is highly recommended.