bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of the combination of preoperative red cell distribution width and platelet distribution width in patients with gastric cancer
Authors: Saito Hiroaki , Shimizu Shota , Shishido Yuji , Miyatani Kozo , Matsunaga Tomoyuki , Fujiwara Yoshiyuki 
Published: December 2021

Abstract
Background
Platelet distribution width (PDW) and red cell distribution width (RDW) are readily obtainable data, and are reportedly useful as prognostic indicators in some cancers. However, their prognostic significance is unclear in gastric cancer (GC).

Methods
We enrolled 445 patients with histopathological diagnoses of gastric adenocarcinoma who had undergone curative surgeries.

Results
According to the optimal cut-off value of PDW and RDW by receiver operating characteristic (ROC) analysis, we divided patients into PDWHigh (≥ 16.75%), PDWLow (< 16.75%), RDWHigh (≥ 14.25%), and RDWLow (< 14.25%) subgroups. Overall survival (OS) was significantly worse in patients with PDWHigh than in those with PDWLow (P = 0.0015), as was disease specific survival (P = 0.043). OS was also significantly worse in patients with RDWHigh than in those with RDWLow (P <  0.0001), as was disease specific survival (P = 0.0002). Multivariate analysis for OS revealed that both PDW and RDW were independent prognostic indicators. Patients were then given PDW-RDW score by adding points for their different subgroups (1 point each for PDWHigh and RDWHigh; 0 points for PDWLow and RDWLow). OS significantly differed by PDW-RDW score (P <  0.0001), as did disease specific survival (P = 0.0005). In multivariate analysis for OS, PDW-RDW score was found to be an independent prognostic indicator.

Conclusions
The prognosis of GC patients can be precisely predictable by using both PDW and RDW.
Refractive outcomes of table-mounted and hand-held auto-refractometers in children: an observational cross-sectional study
Authors: Karabulut Müjdat , Karabulut Sinem , Karalezli Aylin 
Published: December 2021

Abstract
Background
To compare the refractive results of hand-held and table-mounted autorefractors.

Methods
We designed this study as an observational, cross-sectional study. We compared the mean spheric and cylinder power, spherical equivalent, Jackson cross-cylinder values, determined the limits of agreement (LoA), and evaluated the reliability of two autorefractors.

Results
We evaluated 256 eyes of 256 pediatric patients (mean age, 9.12 ± 2.26 years; range, 5–16 years). 49% of the patients were female, and 51% were male. The Nidek HandyRef-K autorefractor measured relatively more astigmatism (P < 0.001) and less hyperopia (P = 0.024). The mean differences and 95% LoA were 0.06 D ± 0.47 D (− 0.82 D to 0.98 D) in spherical power, 0.08 D ± 0.28 D (− 0.47 D to 0.64 D) in cylindrical power, 0.11 D ± 0.47 D (− 0.81 D to 1.01 D) in spherical equivalent, 0.02 D ± 0.36 D (− 0.73 D to 0.69 D) in Jackson cross-cylinder power at 0°, 0.005 D ± 0.54 D (− 1.07 D to 1.06 D) in Jackson cross-cylinder power at 45°. We found the difference within 0.50 D in 244 (95%) eyes for spherical power, in 245 (96%) eyes for cylindrical power, 228 (89%) eyes for spherical equivalent, 224 (87%) eyes for Jackson cross-cylinder power at 0°, 213 (83%) eyes for Jackson cross-cylinder power at 45°. When comparing devices, there were strong correlations for spherical power (Spearman’s rho = 0.99, P < 0.001), cylindrical power (Spearman’s rho = 0.88, P < 0.001), and spherical equivalent (Spearman’s rho = 0.98, P < 0.001).

Conclusion
Two autorefractors showed clinically applicable agreement limits; excellent reliability for spherical power and spherical equivalent and good reliability for cylindrical power; high positive percent agreement for spherical and cylindrical power, spherical equivalent, Jackson cross-cylinder power at 0°and 45°. These results showed that both devices might be used interchangeably for screening of refractive error in children.
Case report : a novel ASXL3 gene variant in a Sudanese boy
Authors: Wu Ke , Cong Yan 
Published: December 2021

Abstract
Background
Bainbridge-Ropers syndrome (BRPS) [OMIM#615485] is a neurodevelopmental disorder, characterized by delayed psychomotor development with generalized hypotonia, moderate to severe intellectual disability, poor or absent speech, feeding difficulties, growth failure, dysmorphic craniofacial features and minor skeletal features. The aim of this study was to investigate the genetic etiology of a Sudanese boy with severe developmental delay, intellectual disability, and craniofacial phenotype using trio-based whole-exome sequencing. To our knowledge, no patients with ASXL3 gene variant c.3043C>T have been reported detailedly in literature.

Case presentation
The patient (male, 3 years 6 months) was the first born of a healthy non-consanguineous couple originating from Sudan, treated for “psychomotor retardation” for more than 8 months in Yiwu. The patient exhibited severely delayed milestones in physiological and intellectual developmental stages, language impairment, poor eye-contact, lack of subtle motions of fingers, fear of claustrophobic space, hypotonia, clinodactyly, autistic features. Peripheral blood samples were collected from the patient and his parents. Trio-based whole-exome sequencing(Trio-WES) identified a de novo heterozygous ASXL3 gene variant c.3043C>T;p.Q1015X. Sanger sequencing verified variants of this family.

Conclusion
Trio-WES analysis identified a de novo nonsense variant (c.3043C>T) of ASXL3 gene in a Sudanese boy. To our knowledge, the patient with this variant has not been reported previously in literature. This study presents a new case for ASXL3 gene variants, which expanded the mutational and phenotypic spectrum.
Clinical features of respiratory syncytial virus bronchiolitis in an infant: rapid and fatal brain involvement
Authors: Bottino Paolo , Miglino Rebecca , Pastrone Lisa , Barbui Anna Maria , Botta Giovanni , Zanotto Elisa , Sidoti Francesca , Costa Cristina , Cavallo Rossana 
Published: December 2021

Abstract
Background
Respiratory Syncytial Virus (RSV) infection is a significant cause of bronchiolitis and pneumonia, mostly responsible for hospitalization and infant death worldwide. However, in recent years the importance of extrapulmonary RSV manifestations, especially at neurological level, have become evident. Seizures, lethargy, ataxia and status epilepticus are suggestive of brain involvement, but also in their absence a direct neurological damage RSV-related need to be evaluated.

Case presentation
A 40-day old male infant was admitted to the Emergency Department with severe bronchiolitis and dyspnea. The patient was reported to be coughing for a week with a vomiting episode in the previous two days. The nasopharyngeal swab confirmed the diagnosis of RSV infection and blood gas test showed hypoxemia and respiratory acidosis. For these reasons, the patient was provided with oxygen therapy. A few hours later, after an initial improvement in clinical parameters, a worsening of respiratory dynamics occurred and the patient was prepared for endotracheal intubation, but in the meantime death occurred. During all the observation period in the Emergency Room, no signs of neuropathological damage were evident. Post mortem examination showed lungs congestion with alveolar atelectasis and white matter degradation with severe edema at brain level. Microbiological analysis performed on autoptic samples confirmed the presence of RSV genome in tracheobronchial aspirate, meningeal swabs, pericardic and abdominal fluids, lung and brain biopsies.

Conclusions
RSV is usually associated with respiratory diseases, however, as reported by an increasingly number of studies, the systemic dissemination of virus during severe disease can lead to a sudden infant death. The clinical picture herein reported showed a severe bronchiolitis resulting in a fatal and underestimated cerebral involvement due to RSV neurotropic behaviour and underline the need for clinicians to pay more attention to neurological involvement of RSV infection, even in absence of cerebral damage evidence.
Epidemiological features of COVID-19 patients with prolonged incubation period and its implications for controlling the epidemics in China
Authors: Zhang Zhi-Jie , Che Tian-Le , Wang Tao , Zhao Han , Hong Jie , Su Qing , Zhang Hai-Yang , Zhou Shi-Xia , Teng Ai-Ying , Zhang Yuan-Yuan , Yang Yang , Fang Li-Qun , Liu Wei 
Published: December 2021

Abstract
Background
COVID-19 patients with long incubation period were reported in clinical practice and tracing of close contacts, but their epidemiological or clinical features remained vague.

Methods
We analyzed 11,425 COVID-19 cases reported between January–August, 2020 in China. The accelerated failure time model, Logistic and modified Poisson regression models were used to investigate the determinants of prolonged incubation period, as well as their association with clinical severity and transmissibility, respectively.

Result
Among local cases, 268 (10.2%) had a prolonged incubation period of > 14 days, which was more frequently seen among elderly patients, those residing in South China, with disease onset after Level I response measures administration, or being exposed in public places. Patients with prolonged incubation period had lower risk of severe illness (ORadjusted = 0.386, 95% CI: 0.203–0.677). A reduced transmissibility was observed for the primary patients with prolonged incubation period (50.4, 95% CI: 32.3–78.6%) than those with an incubation period of ≤14 days.

Conclusions
The study provides evidence supporting a prolonged incubation period that exceeded 2 weeks in over 10% for COVID-19. Longer monitoring periods than 14 days for quarantine or persons potentially exposed to SARS-CoV-2 should be justified in extreme cases, especially for those elderly.
COVID-19 and medical education in Africa: a cross sectional analysis of the impact on medical students
Authors: Bernard Alec , Indig Gnendy , Byl Nicole , Abdu Amani Nureddin , Mengesha Dawit Tesfagiorgis , Admasu Bereket Alemayehu , Holman Elizabeth 
Published: December 2021

Abstract
Background
The African continent currently experiences 25% of the global burden of disease with only 1.3% of the world’s healthcare workers. The COVID-19 pandemic has caused unprecedented disruption to medical education systems, increasing the strain on already-vulnerable regions. Our study examines the impact of COVID-19 on medical students across 33 countries in the African continent.

Methods
A 39-item anonymous electronic survey was developed and distributed to medical students across Africa through social networks to assess the impact of the COVID-19 pandemic on medical education. The survey assessed the domains of: class structure changes and timing, patient interactions, exam administration, learning environment satisfaction, mental health impacts, and volunteer opportunities/engagement.

Results
694 students across 33 countries participated. 80% of respondents had their classes suspended for varied lengths of time during the pandemic, and from these students 59% of them resumed their classes. 83% of students felt they were in a supportive learning environment before the pandemic, which dropped to 32% since the start. The proportion of students taking exams online increased (6–26%, p<0.001) and there was a decrease in the proportion of students seeing patients as a part of their education (72–19%, p<0.001).

Conclusions
COVID-19 is harming medical students in Africa and is likely to worsen the shortage of the future’s healthcare workforce in the region. Pandemic-related impacts have led to a degradation of the learning environment of medical students. Medical schools have shifted online to differing degrees and direct patient-care in training of students has decreased. This study highlights the urgent need for flexible and innovative approaches to medical education in Africa.
A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana
Authors: Amoah Padmore Adusei , Nyamekye Kingsley Atta , Owusu-Addo Ebenezer 
Published: December 2021

AbstractBackgroundMany governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective.MethodData were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data.ResultsSatisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system.ConclusionStrategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.
Ketone bodies: from enemy to friend and guardian angel
Authors: Kolb Hubert , Kempf Kerstin , Röhling Martin , Lenzen-Schulte Martina , Schloot Nanette C. , Martin Stephan 
Published: December 2021

Abstract
During starvation, fasting, or a diet containing little digestible carbohydrates, the circulating insulin levels are decreased. This promotes lipolysis, and the breakdown of fat becomes the major source of energy. The hepatic energy metabolism is regulated so that under these circumstances, ketone bodies are generated from β-oxidation of fatty acids and secreted as ancillary fuel, in addition to gluconeogenesis. Increased plasma levels of ketone bodies thus indicate a dietary shortage of carbohydrates. Ketone bodies not only serve as fuel but also promote resistance to oxidative and inflammatory stress, and there is a decrease in anabolic insulin-dependent energy expenditure. It has been suggested that the beneficial non-metabolic actions of ketone bodies on organ functions are mediated by them acting as a ligand to specific cellular targets. We propose here a major role of a different pathway initiated by the induction of oxidative stress in the mitochondria during increased ketolysis. Oxidative stress induced by ketone body metabolism is beneficial in the long term because it initiates an adaptive (hormetic) response characterized by the activation of the master regulators of cell-protective mechanism, nuclear factor erythroid 2-related factor 2 (Nrf2), sirtuins, and AMP-activated kinase. This results in resolving oxidative stress, by the upregulation of anti-oxidative and anti-inflammatory activities, improved mitochondrial function and growth, DNA repair, and autophagy. In the heart, the adaptive response to enhanced ketolysis improves resistance to damage after ischemic insults or to cardiotoxic actions of doxorubicin. Sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors may also exert their cardioprotective action via increasing ketone body levels and ketolysis. We conclude that the increased synthesis and use of ketone bodies as ancillary fuel during periods of deficient food supply and low insulin levels causes oxidative stress in the mitochondria and that the latter initiates a protective (hormetic) response which allows cells to cope with increased oxidative stress and lower energy availability.

Keywords
Ketogenic diet, Ketone bodies, Beta hydroxybutyrate, Insulin, Obesity, Type 2 diabetes, Inflammation, Oxidative stress, Cardiovascular disease, SGLT2, Hormesis
Pak2 reduction induces a failure of early embryonic development in mice
Authors: Zeng Juan , Liu Nengqing , Yang Yinghong , Cheng Yi , Li Yuanshuai , Guo Xiaoxia , Luo Qian , Zhu Lifen , Guan Hongmei , Song Bing , Sun Xiaofang 
Published: December 2021

Abstract
Background
The quality of the early embryo is vital to embryonic development and implantation. As a highly conserved serine/threonine kinase, p21-activated kinase 2 (Pak2) participates in diverse biologic processes, especially in cytoskeleton remodeling and cell apoptosis. In mice, Pak2 knock out and endothelial depletion of Pak2 showed embryonic lethality. However, the role of Pak2 in preimplantation embryos remains unelucidated.

Methods
In the present work, Pak2 was reduced using a specific small interfering RNA in early mouse embryos, validating the unique roles of Pak2 in spindle assembly and DNA repair during mice early embryonic development. We also employed immunoblotting, immunostaining, in vitro fertilization (IVF) and image quantification analyses to test the Pak2 knockdown on the embryonic development progression, spindle assembly, chromosome alignment, oxidative stress, DNA lesions and blastocyst cell apoptosis. Areas in chromatin with γH2AX were detected by immunofluorescence microscopy and serve as a biomarker of DNA damages.

Results
We found that Pak2 knockdown significantly reduced blastocyst formation of early embryos. In addition, Pak2 reduction led to dramatically increased abnormal spindle assembly and chromosomal aberrations in the embryos. We noted the overproduction of reactive oxygen species (ROS) with Pak2 knockdown in embryos. In response to DNA double strand breaks (DSBs), the histone protein H2AX is specifically phosphorylated at serine139 to generate γH2AX, which is used to quantitative DSBs. In this research, Pak2 knockdown also resulted in the accumulation of phosphorylated γH2AX, indicative of increased embryonic DNA damage. Commensurate with this, a significantly augmented rate of blastocyst cell apoptosis was detected in Pak2-KD embryos compared to their controls.

Conclusions
Collectively, our data suggest that Pak2 may serve as an important regulator of spindle assembly and DNA repair, and thus participate in the development of early mouse embryos.
The Selah study protocol of three interventions to manage stress among clergy: a preference-based randomized waitlist control trial
Authors: Tice Logan C. , Eagle David E. , Rash Joshua A. , Larkins Jessie S. , Labrecque Sofia M. , Platt Alyssa , Yao Jia , Proeschold-Bell Rae Jean 
Published: December 2021

Abstract
Introduction
Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms.

Methods and analysis
The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control.

Ethics and dissemination
Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community.

Strengths and limitations of this study

While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals.

Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training.

If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day.

This study is limited by the inclusion of Christian clergy of only one denomination.

Trial registration
ClinicalTrials.gov NCT04625777. November 12, 2020.
Study on Deterioration Characteristics and Fracturing Mechanism of Concrete Under Liquid Nitrogen Cold Shock
Authors: Liu Jialiang , Jin Yu , Zhu Yujie , Li Jinyang , Zhang Xuguang , Tao Chao 
Published: December 2021

AbstractHigh-pressure water jet crushing concrete has significant advantages in safety, quality and environmental protection, which has a broad application prospect in the maintenance and reconstruction of concrete building. Nevertheless, it still has some problems such as high threshold pump pressure and large specific energy consumption. Water jet breaking concrete with liquid nitrogen (LN2) cold shock assistance combined with the low-temperature-induced fracturing and hydraulic impact can effectively reduce the working pressure of water jet and improve the energy utilization rate. On account of the unclear cracking characteristics and mechanism of concrete under the LN2 cold shock, this research carried out the following systematic research focusing on the key scientific issues above based on mechanical tests, scanning electron microscopy (SEM), and nuclear magnetic resonance (NMR). Results indicate that the total mass of concrete exfoliated blocks after compression failure increases as the LN2 cold shock time and the number of shock cycles goes up, and the uniaxial compressive strength decreases from 8.27 to 21.96%. Through SEM and NMR analysis, it is found that LN2 cold shock can cause more micro-cracks to develop inside the concrete, and the pore development increases as the cold shock time and the cycle number increase. Additionally, under the condition of water jet pump pressure of 150 MPa, the maximum width and depth of crater for cold shock of 5 min increase by 41.79% and 20.48%, respectively, and those for cold shock of 10 min increase by 76.72% and 40.43%, respectively, compared with the original sample.