bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock
Authors: Awad Wedad B. , Nazer Lama , Elfarr Salam , Abdullah Maha , Hawari Feras 
Published: June 2021

Abstract
Background
Though sepsis is common in patients with cancer, there are limited studies that evaluated sepsis and septic shock in this patient population. The objective of this study was to evaluate the outcomes and to identify predictors of mortality in cancer patients admitted to the intensive care unit (ICU) with septic shock.

Methods
This was a retrospective study conducted at a medical-surgical oncologic ICU of a comprehensive cancer center. Adult cancer patients admitted with septic shock between January 1, 2008 and December 31, 2019 were enrolled. Septic shock was defined as an ICU admission diagnosis of sepsis that required initiating vasopressors within 24 h of admission. Patient baseline characteristics, ICU length of stay and ICU and hospital mortality were recorded. Univariate analysis and logistic regression were performed to identify predictors associated with ICU and hospital mortality.

Results
During the study period, 1408 patients met the inclusion criteria. The mean age was 56.8 ± 16.1 (SD) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 23.0 ± 7.91 (SD). Among the enrolled patients, 67.8% had solid tumors while the remaining had hematological malignancies. Neutropenia and thrombocytopenia were reported in 19.3 and 39.5% of the patients, respectively, and mechanical ventilation was required for 42% of the patients. Positive cultures were reported in 836 (59.4%) patients, most commonly blood (33%) and respiratory (26.6%). Upon admission, about half the patients had acute kidney injury, while elevated total bilirubin and lactic acid levels were reported in 13.8 and 65.2% of the patients, respectively. The median ICU length of stay was 4 days (IQR 3–8), and ICU and hospital mortality were reported in 688 (48.9%) and 914 (64.9%) patients, respectively. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significantly associated with both ICU and hospital mortality.

Conclusions
In a relatively large cohort of patients with solid and hematological malignancies admitted to the ICU with septic shock, hospital mortality was reported in about two-third of the patients. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significant predictors of mortality.
Alternative duty work as workplace-initiated procedure to reduce sickness absence
Authors: Mattila-Holappa Pauliina , Kausto Johanna , Aalto Ville , Kaila-Kangas Leena , Kivimäki Mika , Oksanen Tuula , Ervasti Jenni 
Published: June 2021

Abstract
Purpose
Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector.

Methods
Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class).

Results
During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09–1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14–1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days.

Conclusions
This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees’ sickness absences.
Health seeking behavior and associated factors among individuals with cough in Yiwu, China: a population-based study
Authors: Sun Xiaoyan , Luo Shuying , Lou Lingqiao , Cheng Hang , Ye Zhen , Jia Jianwei , Wei Yina , Tao Jingbo , He Hanqing 
Published: June 2021

Abstract
Background
Previous studies have shown that a certain proportion of the population did not seek medical treatment after coughing, and understanding the potential reasons is crucial for disease prevention and control.

Method
A population-based study was conducted with the probability proportional to population size sampling in Yiwu, Zhejiang, China. A total of 5855 individuals aged ≥15 years lived in Yiwu for more than 6 months were included. All participants completed a laptop-based questionnaire to collect detailed information by a face-to-face interview. Characteristics of individuals were described by categories of health seeking behavior using frequency and percentage. Univariate and multivariate logistic regression analyses were performed to estimate the associations of social-demographic and cough characteristics with health seeking behavior.

Results
19.3% (1129/5855) of participants had a cough in the past month, 40% (452/1129) had sought medical treatment. Of these, 26.5% (120/452) chose hospitals at county level or above. Individuals aged ≥65 years old (OR = 2.25, 95% CI: 1.23, 4.12), female (OR = 1.57, 95% CI: 1.21, 2.06), living in rural areas (OR = 1.30, 95% CI: 1.003, 1.69), persistent cough for 3–8 weeks (OR = 2.91, 95% CI: 1.72, 4.92) and with more accompanying symptoms (P trend < 0.001) were more likely to seek medical treatment, but those coughed for > 8 weeks were not (p > 0.5). Female (OR = 0.33, 95% CI: 0.21, 0.54) and people living in rural areas (OR = 0.57, 95% CI: 0.36, 0.92) were less likely to choose hospitals at county level or above while the higher educated were more likely to (OR = 3.29, 95% CI: 1.35, 8.02). Those who coughed for more than 2 weeks were more likely to choose hospitals at or above the county level. But the number of accompanying symptoms does not show any significant relationship with the choice of medical facility.

Conclusion
The present study found that age, sex, living areas and features of cough were associated with health seeking behavior. It is worth noting that those who coughed for too long (e.g. > 8 weeks) were less likely to seek medical treatment. Targeted measures should be developed based on the key factors found in this study to guide persons to seek medical treatment more scientifically.
Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis
Authors: McLarnon Michael , Heron Neil 
Published: June 2021

Abstract
Background
Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA.

Methods
All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies.

Results
Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (− 0.78 (− 1.34 to − 0.23) standard mean deviations (SMD) and − 1.63 (− 2.14 to − 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (− 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01).

Conclusions
IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection.

Prospero trial registration number
CRD42020181928.
Oral health-related quality of life in patients infected with HIV, Iran: a cross-sectional study
Authors: Shaghaghian S. , Saranjam E. , Homayooni M. 
Published: June 2021

Abstract
Background
The life expectancy of patients with Human Immunodeficiency Virus (HIV) has increased, but its oral manifestations can affect the Oral Health-Related Quality of Life (OHRQoL) of these patients. This study aimed to evaluate OHRQoL in HIV-infected patients and determine its related factors.

Methods
In this cross-sectional study, 250 HIV-infected patients were randomly selected from Shiraz Voluntary Counseling and Testing center in 2019. OHRQoL was measured using the revised Geriatric Oral Health Assessment Index for HIV patients. The associations between patients’ OHRQoL and demographic characteristics were examined.

Results
The mean score of the patients' OHRQoL was 24.55 ± 6.27. The lowest and highest scores belonged to the psychosocial and pain categories, respectively. In the univariate analysis, the OHRQoL was significantly associated with patients' age (p = 0.012), duration of the disease (p = 0.009), job (p = 0.006), edentulous status (p = 0.003), and wearing denture (p < 0.001). However, in the multiple linear regression analysis, a significant difference was found only between denture wearing and non-denture wearing patients (p ≤ 0.001).

Conclusions
The OHRQoL of HIV-infected patients was not optimal since most of the patients were worried about their oral and dental health problems. The OHRQoL was significantly better in denture-wearing patients. This finding highlights the impact of unmet dental needs on OHRQoL in HIV-infected patients. Therefore, dental services coverage for patients with HIV is essential, so that they can have timely access to oral health care. Furthermore, dentures should be considered as an unmet healthcare need among HIV patients in public health policies.
Evaluating the effectiveness of a single-day simulation-based program in psychiatry for medical students: a controlled study
Authors: Younes Nadia , Delaunay Anne Laure , Roger M. , Serra Pierre , Hirot France , Urbain Frédéric , Godart Nathalie , Speranza Mario , Passerieux Christine , Roux Paul 
Published: June 2021

AbstractBackgroundTraining in psychiatry requires specific knowledge, attitudes, and skills that are obtainable by simulation, of which the use is only recent and still needs further development. Evidence is accumulating on its effectiveness but requires further validation for medical students. We aimed to evaluate the effectiveness of a single-day optional teaching program in psychiatry by simulation for medical students and validate a scale measuring Confidence in Psychiatric Clinical Skills (CPCQ), as part of the assessment.MethodsThis was a controlled study in a French University that compared (using paired-sample Student t-tests) knowledge and attitudes (university grades and CPCQ scores) before, just after teaching with simulated patients, and 2 months later. Satisfaction with the program (including the quality of the debriefing) was also investigated. The CPCQ scale was validated by assessing the factor structure, internal consistency, and test-retest reliability. Finally, a comparison was run with a control group who received the usual psychiatric instruction using covariance analyses.ResultsTwenty-four medical students were included in the simulation group and 76 in the control group. Just after the simulation, knowledge and attitudes increased significantly in the simulation group. Satisfaction with the training and debriefing was very high. The CPCQ scale showed good psychometric properties: a single-factor structure, acceptable internal consistency (α = 0.73 [0.65–0.85]), and good test-retest reliability (ICC = 0.71 [0.35–0.88]). Two months after the simulation, knowledge and attitudes were significantly higher in the simulation group than the control group, despite a lack of difference in knowledge before the simulation.ConclusionsAdding a simulation program in psychiatry to the usual teaching improved the knowledge and confidence of medical students. The CPCQ scale could be used for the evaluation of educational programs.
Divergent camptothecin biosynthetic pathway in Ophiorrhiza pumila
Authors: Yang Mengquan , Wang Qiang , Liu Yining , Hao Xiaolong , Wang Can , Liang Yuchen , Chen Jianbo , Xiao Youli , Kai Guoyin 
Published: June 2021

AbstractBackgroundThe anticancer drug camptothecin (CPT), first isolated fromCamptotheca acuminata, was subsequently discovered in unrelated plants, includingOphiorrhiza pumila. Unlike known monoterpene indole alkaloids, CPT inC. acuminatais biosynthesized via the key intermediate strictosidinic acid, but howO. pumilasynthesizes CPT has not been determined.ResultsIn this study, we used nontargeted metabolite profiling to show that 3α-(S)-strictosidine and 3-(S), 21-(S)-strictosidinic acid coexist inO. pumila. After identifying the enzymesOpLAMT,OpSLS, andOpSTR as participants in CPT biosynthesis, we compared these enzymes to their homologues from two other representative CPT-producing plants,C. acuminataandNothapodytes nimmoniana, to elucidate their phylogenetic relationship. Finally, using labelled intermediates to resolve the CPT biosynthesis pathway inO. pumila, we showed that 3α-(S)-strictosidine, not 3-(S), 21-(S)-strictosidinic acid, is the exclusive intermediate in CPT biosynthesis.ConclusionsIn our study, we found thatO. pumila, another representative CPT-producing plant, exhibits metabolite diversity in its central intermediates consisting of both 3-(S), 21-(S)-strictosidinic acid and 3α-(S)-strictosidine and utilizes 3α-(S)-strictosidine as the exclusive intermediate in the CPT biosynthetic pathway, which differs fromC. acuminata. Our results show that enzymes likely to be involved in CPT biosynthesis inO. pumila,C. acuminata, andN. nimmonianahave evolved divergently. Overall, our new data regarding CPT biosynthesis inO. pumilasuggest evolutionary divergence in CPT-producing plants. These results shed new light on CPT biosynthesis and pave the way towards its industrial production through enzymatic or metabolic engineering approaches.
Serum urate and lung cancer: a cohort study and Mendelian randomization using UK Biobank
Authors: Horsfall Laura J. , Hall Ian P. , Nazareth Irwin 
Published: June 2021

Abstract
Background
Serum urate is the most abundant small molecule with antioxidant properties found in blood and the epithelial lining fluid of the respiratory system. Moderately raised serum urate is associated with lower rates of lung cancer and COPD in smokers but whether these relationships reflect antioxidant properties or residual confounding is unknown.

Methods
We investigated the observational and potentially causal associations of serum urate with lung cancer incidence and FEV1 using one-sample Mendelian randomization (MR) and the UK Biobank resource. Incident lung cancer events were identified from national cancer registries as FEV1 was measured at baseline. Observational and genetically instrumented incidence rate ratios (IRRs) and risk differences per 10,000 person-years (PYs) by smoking status were estimated.

Results
The analysis included 359,192 participants and 1,924 lung cancer events. The associations between measured urate levels and lung cancer were broadly U-shaped but varied by sex at birth with the strongest associations in current smoking men. After adjustment for confounding variables, current smoking men with low serum urate (100 µmol/L) had the highest predicted lung cancer incidence at 125/10,000 PY (95%CI 56–170/10,000 PY) compared with 45/10,000 PY (95%CI 38–47/10,000 PY) for those with the median level (300 µmol/L). Raised measured urate was associated with a lower baseline FEV1. The MR results did not support a causal relationship between serum urate and lung cancer or FEV1.

Conclusions
We found no evidence that serum urate is a modifiable risk factor for respiratory health or lung cancer.
Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes
Authors: Groenewegen Amy , Zwartkruis Victor W. , Cekic Betül , de Boer Rudolf. A. , Rienstra Michiel , Hoes Arno W. , Rutten Frans H. , Hollander Monika 
Published: June 2021

Abstract
Background
Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed.

Methods
A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated.

Results
Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter.

Conclusion
There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.
Clinical verification of vimentin/EpCAM immunolipid magnetic sorting system in monitoring CTCs in arterial and venous blood of advanced tumor
Authors: Liu Yan , Li Qiuying , Chen Tingsong , Shen Tianhao , Zhang Xufeng , Song Ping , Liu Lantao , Liu Jianming , Jiang Tinghui , Liang Xiaofei 
Published: June 2021

Abstract
Background
Circulating tumor cells (CTCs) are the dominant factor leading to tumor metastasis. This study aims to investigate the effect of disparate sources of CTCs on the treatment and prognosis of patients with advanced tumors by analyzing the number and gene mutations change of CTCs in arterial and venous blood in patients with advanced tumors.

Results
A CTCs sorting system was constructed based on Vimentin-immunolipid magnetic balls (Vi-IMB) and EpCAM immunolipid magnetic balls (Ep-IMB). Results showed that the prepared Ep-IMB and Vi-IMB had lower cytotoxicity, better specificity and sensitivity. The number of arterial CTCs was higher than that of venous CTCs, with a statistically significant difference (P < 0.05). Moreover, the prognosis of the low positive group of total CTCs in arterial blood and venous blood was higher than that of the high positive group, with a statistical significance (P < 0.05). The genetic testing results showed that the targeted drug gene mutations in tissues, arterial CTCs and venous CTCs showed a complementary trend, indicating that there was heterogeneity among different tumor samples.

Conclusions
CTCs in blood can be efficiently captured by the CTCs sorting system based on Vi-LMB/Ep-LMB, and CTCs detection in arterial blood can be utilized to more accurately evaluate the prognosis and predict postoperative progress. It is further confirmed that tumor samples from disparate sources are heterogeneous, providing a reference basis for gene mutation detection before clinical targeted drug treatment, and the detection of CTCs in arterial blood has more potential clinical application value.
Trial registration: The Ethics Committee of Putuo Hospital, PTEC-A-2019-18-1. Registered 24 September 2019.

Graphic abstract
Telemedicine use by pediatric rheumatologists during the COVID-19 pandemic
Authors: Pooni Rajdeep , Ronis Tova , Lee Tzielan ,   the CARRA Investigators
Published: June 2021

Abstract
Background
To characterize various aspects of telemedicine use by pediatric rheumatology providers during the recent pandemic including provider acceptability of telehealth practices, clinical reliability, and clinical appropriateness.

Methods
An electronic survey was generated and disseminated amongst the Childhood Arthritis and Rheumatology Research Alliance (CARRA) listserv (n = 547). Survey items were analyzed via descriptive statistics by question.

Results
The survey response rate was 40.8% (n = 223) with the majority of respondents in an attending-level role. We observed that musculoskeletal components of the exam were rated as the most reliable components of a telemedicine exam and 86.5% of survey respondents reported engaging the patient or patient caregiver to help conduct the virtual exam. However, 65.7% of providers reported not being able to elicit the information needed from a telemedicine visit to make a complete clinical assessment. We also noted areas of disagreement regarding areas of patient engagement and confidentiality. We found that approximately one-third (35.8%) of those surveyed felt that their level of burnout was increased due to telemedicine.

Conclusion
In general, providers found exam reliability (specifically around focused musculoskeletal elements) in telemedicine visits but overall felt that they were unable to generate the information needed to generate a complete clinical assessment. Additionally, there were suggestions that patient engagement and confidentiality varied during telemedicine visits when compared to in-person clinical visits. Further qualitative work is needed to fully explore telemedicine use in pediatric rheumatology.