bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nationwide study of six-month readmissions in critical limb ischemia: Predictors and impact of revascularization strategies
Authors: Acharya Prakash , Sethi Prince , Ranka Sagar , Alli Adam , Hance Kirk , Prasad Anand , Shah Zubair , Gupta Kamal 
Published: April 2021

Objective There is a paucity of data regarding six-month readmissions in critical limb ischemia patients and the influence of management strategy during index-admission [endovascular, surgical, hybrid procedure, medical therapy, and amputation]. We aimed to investigate the incidence, predictors, and impact of management strategies on six-month readmission in patients with critical limb ischemia. Methods A secondary analysis of the Nationwide Readmissions Database (2016–2017) was conducted. Propensity score matching was performed for subgroup analysis. Results We identified 50,058 patients with primary diagnosis of critical limb ischemia. Six-month all-cause and critical limb ischemia-related readmission rate was 52.36% and 10.86%, respectively. The risk of all-cause readmission was lower with amputation but was similar among other subgroups. Patients receiving surgical [HR 0.62, CI(0.48–0.79), p < 0.001] and hybrid procedure [HR 0.65 (0.46–0.93), p = 0.02] had lower risk of unplanned critical limb ischemia-related readmission compared to endovascular, though the risk of unplanned revascularization/amputation during readmission was similar between the three strategies. The risk of non-critical limb ischemia-related readmission was higher with surgical [HR 1.13, CI(1.04–1.23), p = 0.003] and hybrid procedure [HR 1.17, CI(1.08–1.28), p < 0.001], driven by increased procedure-related/wound complications. Eventhough endovascular patients were older with more severe critical limb ischemia presentation, a lower proportion received home-health or placement upon discharge from index-admission. This could account for higher readmission without higher repeat revascularization in endovascular group. Conclusion The risk of critical limb ischemia and non-critical limb ischemia-related readmission differ according to the management strategy. Significant differences in discharge disposition exist depending on revascularization strategy. Study findings identify opportunities for reducing readmissions by focusing on nonprocedural aspects like wound-care, discharge planning and placement.
Factors affecting adherence to lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019
Authors: Aynalem Getasew Amogne , Bekele Tadesse Alemu , Berhe Tirhas Tadesse , Endazenew Getabalew 
Published: April 2021

Introduction: Adherence to lifestyle modification in addition to medication adherence is very important in preventing complications. Nevertheless, lifestyle modification guidelines are not widely followed by patients with hypertension. The objective of the study was to explore the predictors of compliance with lifestyle modification among patients with hypertension at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, 2019. Method: A descriptive cross-sectional study design was used. A total of 384 patients with hypertension were included in this study. A systematic sampling method was used to select study participants. The data were collected through an interview method by using a structured questionnaire. The data were entered and analyzed using SPSS. Each variable was summarized using summary statistics. To measure the association between lifestyle modification and its predictors, a bivariate and multivariate logistic regression model was used. P-value < 0.05, odds ratio (OR), and 95% confidence interval (CI) were used to determine statistical significance, direction, and strength of association. Results: Two hundred six (53.6%) patients with hypertension had poor adherence to the recommended lifestyle modification. Male patients with hypertension were more adherent to lifestyle modification compared with female patients (adjusted OR (AOR) = 0.60, 95% CI: 0.39–0.92). The rate of poor adherence was 1.86 times higher among patients with hypertension diagnosis of <5 years compared with patients with hypertension diagnosis of ⩾5 years(AOR = 1.86, 95% CI: 1.19–2.89). Patients who were adherent to their medication were 2.13 times to have poor adherence to lifestyle modification compared with medication non-adherent patients (AOR = 2.13, 95% CI: 1.38–3.27). Conclusion: High proportions of patients with hypertension were non-adherent to lifestyle modification. Sex, age, duration of the disease, and medication adherence were significantly associated with lifestyle modification adherence. Close follow-up of female patients, the elderly, and patients with a short duration of hypertension is recommended.
Which Type of Interpersonal Interaction Better Facilitates College Student Learning and Development in China: Face-to-Face or Online?
Authors: Yin (尹弘飚) Hongbiao , Shi (史练) Lian 
Published: April 2021

Purpose: This study attempts to explore how Chinese college students engage in face-to-face synchronous and online asynchronous interactions and examine how the two different interaction types are associated with their academic learning (learning achievement and the development of research skills), satisfaction, and their perceptions of learning environments. Design/Approach/Methods: A sample of 3,999 undergraduate students from a research university in Northern China participated in the survey. A series of cluster analysis, one-way analysis of variance, and hierarchical multiple regression were conducted. Findings: The cluster analysis results revealed that there were four types of learners among these students and that a large percentage of Chinese undergraduates were classified into either digital communicators (36.16%) or passive interactors (32.71%). In general, the face-to-face synchronous interaction generated more desirable academic learning, perceptions of the learning environment, and higher satisfaction than the online asynchronous interaction in most aspects. However, the asynchronous online interaction fostered student autonomy and contributed to students’ completion of an in-depth thesis. Originality/Value: By distinguishing face-to-face synchronous versus online asynchronous interactions, this study led to an enhanced knowledge of the interactive patterns of Chinese college students and uncovered the specific effects of the two types of interpersonal interactions in Chinese research universities.
Context-dependent and -independent selection on synonymous mutations revealed by 1,135 genomes of Arabidopsis thaliana
Authors: Chu Duan , Wei Lai 
Published: April 2021

AbstractBackgroundSynonymous mutations do not alter the amino acids and therefore are regarded as neutral for a long time. However, they do change the tRNA adaptation index (tAI) of a particular codon (independent of its context), affecting the tRNA availability during translation. They could also change the isoaccepting relationship with its neighboring synonymous codons in particular context, which again affects the local translation process. Evidence of selection pressure on synonymous mutations has emerged.ResultsThe proposed selection patterns on synonymous mutations are never formally and systematically tested in plant species. We fully take advantage of the SNP data from 1,135A. thalianalines, and found that the synonymous mutations that increase tAI or the isoaccepting mutations in isoaccepting codon context tend to have higher derived allele frequencies (DAF) compared to other synonymous mutations of the opposite effects.ConclusionsSynonymous mutations are not strictly neutral. The synonymous mutations that increase tAI or the isoaccepting mutations in isoaccepting codon context are likely to be positively selected. We propose the concept of context-dependent and -independent selection on synonymous mutations. These concepts broaden our knowledge of the functional consequences of synonymous mutations, and should be appealing to phytologists and evolutionary biologists.
Towards elimination of mother‐to‐child transmission of HIV in Rwanda: a nested case‐control study of risk factors for transmission
Authors: Remera Eric , Mugwaneza Placidie , Chammartin Frédérique , Mulindabigwi Augustin , Musengimana Gentille , Forrest Jamie I. , Mwanyumba Fabian , Kondwani Ng’oma , Condo Jeanine U. , Riedel David J. , Mills Edward J. , Nsanzimana Sabin , Bucher Heiner C. 
Published: April 2021

Abstract
Background
Mother-to-child HIV transmission (MTCT) has substantially declined since the scale-up of prevention programs around the world, including Rwanda. To achieve full elimination of MTCT, it is important to understand the risk factors associated with residual HIV transmission, defined as MTCT at the population-level that still occurs despite universal access to PMTCT.

Methods
We performed a case control study of children born from mothers with HIV with known vital status at 18 months from birth, who were followed in three national cohorts between October and December 2013, 2014, and 2015 in Rwanda. Children with HIV were matched in a ratio of 1:2 with HIV-uninfected children and a conditional logistic regression model was used to investigate risk factors for MTCT.

Results
In total, 84 children with HIV were identified and matched with 164 non-infected children. The median age of mothers from both groups was 29 years (interquartile range (IQR): 24–33). Of these mothers, 126 (51.4 %) initiated antiretroviral therapy (ART) before their pregnancy on record. In a multivariable regression analysis, initiation of ART in the third trimester (Adjusted Odds Ratio [aOR]: 9.25; 95 % Confidence Interval [95 % CI]: 2.12–40.38) and during labour or post-partum (aOR: 8.87; 95 % CI: 1.92–40.88), compared to initiation of ART before pregnancy, increased the risk of MTCT. Similarly, offspring of single mothers (aOR: 7.15; 95 % CI: 1.15–44.21), and absence of postpartum neonatal ART prophylaxis (aOR: 7.26; 95 % CI: 1.66–31.59) were factors significantly associated with MTCT.

Conclusions
Late ART initiation for PMTCT and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda.
Longitudinal association of dietary sources of animal and plant protein throughout childhood with menarche
Authors: Moslehi Nazanin , Asghari Golaleh , Mirmiran Parvin , Azizi Fereidoun 
Published: April 2021

Abstract
Background
Inconsistent findings have been reported for associations between protein intake and age at menarche. We aimed to investigate the association between intake of protein and protein-containing food groups during childhood with menarche among Iranian girls.

Methods
Girls aged 6–18 years who did not experience menarche in the third or fourth examination cycles of the Tehran Lipid and Glucose Study were selected and were followed to the fifth examination cycle. Daily intakes of protein from different animal/plant sources and ten protein-containing food groups were assessed using a food frequency questionnaire at baseline (the third or fourth examination cycles). Occurrence of menarche and its onset age were asked during each examination cycle. Cox proportional hazards regression was used to estimating hazard ratios (HRs) and 95% confidence interval (95%CI) for the occurrence of menarche per one standard deviation (SD) of dietary intakes. Logistic regression was also used to estimate the odds of reaching menarche ≤12 years.

Results
During the study, 147(61%) of girls reached menarche, the median age at menarche was 12 years. The adjusted HRs (95% CI) for the occurrence of menarche per one-SD of dietary intakes were 0.68 (0.48, 0.98; p = 0.040) for plant protein and 1.36 (1.01, 1.84; p = 0.042) for animal protein after adjusting for baseline age, BMI Z-score, energy intake, and mother’s early menarche and education. Substituting 10-g animal protein with plant protein was associated with a 16% (95%CI: 5–25%; p = 0.006) lower risk of menarche. Dietary intakes of poultry (adjusted HR: 1.35; 95% CIs: 1.00–1.82; p = 0.049) and low-fat dairy (adjusted HR: 1.20; 95%CIs: 0.99–1.46; p = 0.064) were marginally associated with the increased risk of menarche. However, the odds of early menarche was significant only for plant protein (adjusted odds ratio = 0.39; 95% CI: 0.16–0.96; p = 0.040).

Conclusions
Our findings indicate that the risk of menarche increases by higher intakes of animal protein and decreases by plant protein. Intakes of poultry and low-fat dairy associate with a higher risk of menarche. The odds of menarche occurrence ≤12 years reduces by higher intakes of plant protein.
Risk factors for Pseudomonas aeruginosa colonization in non-cystic fibrosis bronchiectasis and clinical implications
Authors: Kwok Wang Chun , Ho James Chung Man , Tam Terence Chi Chun , Ip Mary Sau Man , Lam David Chi Leung 
Published: April 2021

Abstract
Background
Pseudomonas aeruginosa is one of the commonest bacteria colonizing the airway in patients with non-cystic fibrosis bronchiectasis. Pseudomonas aeruginosa colonization is associated with poor outcomes in patients with bronchiectasis, including rapid decline in lung function, exacerbation frequency and hospitalization.

Methods
A cross-sectional study in Queen Mary Hospital, Hong Kong that included 350 Chinese patients with non-cystic fibrosis bronchiectasis to investigate the risk factors for Pseudomonas aeruginosa colonization and clinical implications on disease outcomes.

Discussions
Pseudomonas aeruginosa colonization was more commonly found in patients with longer duration of bronchiectasis and those on proton pump inhibitors (PPIs) with adjusted ORs of 1.066 (95% CI = 1.036–1.096, p < 0.001) and 2.815 (95% CI = 1.307–6.064, p = 0.008) respectively. Patients with Pseudomonas aeruginosa colonization have more extensive lung involvement and higher risks of exacerbation requiring hospitalization with adjusted ORs of 2.445 (95% CI = 1.283–4.657, p = 0.007) and 2.745 (95% CI = 1.012–7.449, p = 0.047) respectively. Pseudomonas aeruginosa colonization is more common among patients with longer duration of bronchiectasis and those on PPI. Pseudomonas aeruginosa colonization is associated with more extensive lung involvement and higher risks of exacerbation requiring hospitalization.
Tropomyosin 2.1 collaborates with fibronectin to promote TGF-β1-induced contraction of human lung fibroblasts
Authors: Bradbury Peta , Nader Cassandra P. , Cidem Aylin , Rutting Sandra , Sylvester Dianne , He Patrick , Rezcallah Maria C. , O’Neill Geraldine M. , Ammit Alaina J. 
Published: April 2021

AbstractMany lung diseases are characterized by fibrosis, leading to impaired tissue patency and reduced lung function. Development of fibrotic tissue depends on two-way interaction between the cells and the extra-cellular matrix (ECM). Concentration-dependent increased stiffening of the ECM is sensed by the cells, which in turn increases intracellular contraction and pulling on the matrix causing matrix reorganization and further stiffening. It is generally accepted that the inflammatory cytokine growth factor β1 (TGF-β1) is a major driver of lung fibrosis through the stimulation of ECM production. However, TGF-β1 also regulates the expression of members of the tropomyosin (Tm) family of actin associating proteins that mediate ECM reorganization through intracellular-generated forces. Thus, TGF-β1 may mediate the bi-directional signaling between cells and the ECM that promotes tissue fibrosis. Using combinations of cytokine stimulation, mRNA, protein profiling and cellular contractility assays with human lung fibroblasts, we show that concomitant induction of key Tm isoforms and ECM by TGF-β1, significantly accelerates fibrotic phenotypes. Knocking down Tpm2.1 reduces fibroblast-mediated collagen gel contraction. Collectively, the data suggest combined ECM secretion and actin cytoskeleton contractility primes the tissue for enhanced fibrosis. Our study suggests that Tms are at the nexus of inflammation and tissue stiffening. Small molecules targeting specific Tm isoforms have recently been designed; thus targeting Tpm2.1 may represent a novel therapeutic target in lung fibrosis.
Impact of immediate cryopreservation on the establishment of patient derived xenografts from head and neck cancer patients
Authors: Abel Lindsey , Durmaz Arda , Hu Rong , Longhurst Colin , Baschnagel Andrew M. , Wheeler Deric , Scott Jacob G. , Kimple Randall J. 
Published: April 2021

Abstract
Background
Patient-derived xenografts established from human cancers are important tools for investigating novel anti-cancer therapies. Establishing PDXs requires a significant investment and many PDXs may be used infrequently due to their similarity to existing models, their growth rate, or the lack of relevant mutations. We performed this study to determine whether we could efficiently establish PDXs after cryopreservation to allow molecular profiling to be completed prior to implanting the human cancer.

Methods
Fresh tumor was split with half used to establish a PDX immediately and half cryopreserved for later implantation. Resulting tumors were assessed histologically and tumors established from fresh or cryopreserved tissues compared as to the growth rate, extent of tumor necrosis, mitotic activity, keratinization, and grade. All PDXs were subjected to short tandem repeat testing to confirm identity and assess similarity between methods.

Results
Tumor growth was seen in 70% of implanted cases. No growth in either condition was seen in 30% of tumors. One developed a SCC from the immediate implant but a lymphoproliferative mass without SCC from the cryopreserved specimen. No difference in growth rate was seen. No difference between histologic parameters was seen between the two approaches.

Conclusions
Fresh human cancer tissue can be immediately cryopreserved and later thawed and implanted to establish PDXs. This resource saving approach allows for tumor profiling prior to implantation into animals thus maximizing the probability that the tumor will be utilized for future research.
Genotype characterization and delayed loss of ambulation by glucocorticoids in a large cohort of patients with Duchenne muscular dystrophy
Authors:   National DMD Research Network of “One City, One Doctor”, Zhang Shu , Qin Dongdong , Wu Liwen , Li Man , Song Lifang , Wei Cuijie , Lu Chunling , Zhang Xiaoli , Hong Siqi , Ma Mingming , Wu Shiwen 
Published: April 2021

Abstract
Background
Duchenne muscular dystrophy (DMD) is the most common genetic muscle disease in human. We aimed to describe the genotype distribution in a large cohort of Chinese DMD patients and their delayed loss of ambulation by glucocorticoid (GC) treatments. This is to facilitate protocol designs and outcome measures for the emerging DMD clinical trials.

Results
A total of 1163 patients with DMD were recruited and genotyped. Genotype variations were categorized as large deletions, large duplications, and small mutations. Large deletions were further analyzed for those amenable to exon-skipping therapies. Participants aged 5 years or older were grouped into GC-treated and GC-naïve groups. Clinical progression among different genotypes and their responses to GC treatments were measured by age at loss of ambulation (LOA). Among the mutation genotypes, large deletions, large duplications, and small mutations accounted for 68.79%, 7.14%, and 24.07%, respectively. The mean age at diagnosis was 4.59 years; the median ages at LOA for the GC-naïve, prednisone/prednisolone-treated, and deflazacort-treated groups were 10.23, 12.02, and 13.95 years, respectively. The “deletion amenable to skipping exon 44” subgroup and the nonsense-mutation subgroup had older ages at LOA than the “other deletions” subgroup. Subgroups were further analyzed by both genotypes and GC status. All genotypes showed significant beneficial responses to GC treatment. Deletions amenable to skipping exon 44 showed a lower hazard ratio (0.155). The mean age at death was 18.57 years in this DMD group.

Conclusion
Genotype variation influences clinical progression in certain DMD groups. Beneficial responses to GC treatment were observed among all DMD genotypes. Compared with other genotypes, deletions amenable to skipping exon 44 had a lower hazard ratio, which may indicate a stronger protective effect of GC treatments on this subgroup. These data are valuable for designing future clinical trials, as clinical outcomes may be influenced by the genotypes.
Knowledge of mental health symptoms and help seeking attitude in a population-based sample in Hong Kong
Authors: Fung Ada Wai Tung , Lam Linda Chiu Wa , Chan Sandra Sau Man , Lee Sing 
Published: April 2021

AbstractBackgroundMental health symptoms can be subtle, resulting in delaying treatment. A prompt identification of mental signs and symptoms is important for preventing mental disorders in the public. This study examined whether local public have adequate knowledge to identify mental health symptoms and the need to get timely professional help.MethodsThe population-based telephone surveys were conducted in 2015 and 2018. It involved a random sample of 4033 respondents aged 12–75 years. Mental health knowledge and help seeking attitude were assessed using six vignettes depicting subtle and obvious symptoms of anxiety disorders, mixed anxiety and depressive disorders, and dementia. Logistic regression models were performed to examine association between mental health knowledge and help-seeking attitude.ResultsIndividuals with poor knowledge in subtle symptoms were more likely to be males (t =  − 5.0, p < .001), younger (F = 15.0, p < .001), have tertiary education (F = 15.0, p < .001), and employed (t =  − 2.1, p = .037). The knowledge scores of subtle and obvious symptoms were 1.5 and 2.3 respectively. Binary logistic regression found that poor knowledge of subtle symptoms was associated with reluctance to professional help seeking.ConclusionsPoorly identified subtle mental health symptoms is a major barrier to early professional help in highly educated working males. Future research should explore specific interventions to increase knowledge and professional help seeking in this group.