bluuebunny/crossref_metadata_2025_split huggingface dataset:
Micropulse laser in patients with refractory and treatment-naïve center–involved diabetic macular edema: short terms visual and anatomic outcomes
Authors: Valera-Cornejo Diego Alejandro , García-Roa Marlon , Quiroz-Mendoza Jaime , Arias-Gómez Alejandro , Ramírez-Neria Paulina , Villalpando-Gómez Yolanda , Romero-Morales Veronica , García-Franco Renata 
Published: January 2021

Purpose: The purpose of the study is to describe visual and anatomic outcomes of 5774nm micropulse laser photocoagulation in eyes with either treatment-naïve or refractory diabetic macular edema (DME) at 3 months. Methods: This was a prospective case series that recruited 23 consecutive patients (33 eyes) with center-involved DME that was either treatment-naïve or had not responded to prior treatment. Micropulse therapy was performed with the Easy Ret 577 (Quantel Medical, Cournon d’Auvergne, France) diode laser in a high-density manner in eyes with treatment-naïve or refractory DME. The primary outcome was the change of best-corrected visual acuity (BCVA; logMAR) at 1 and 3 months. Secondary outcomes were changes in the central macular thickness (CMT), thickness area, macular volume, and macular capillary leakage at 1 and 3 months. Results: There were no significant changes in BCVA at 3 months, with mean ± standard deviation (SD) of −0.08 ± 0.01 ( p = 0.228) and + 0.01 ± 0.01 ( p = 0.969) for treatment-naïve and refractory groups, respectively. The change in CMT at 3 months was statistically but not clinically significant in the treatment-naïve group only (mean ± SD; –30 ± 130 µm; p = 0.011). The macular volume and area thickness change were not statistically significant ( p = 0.173 and p = 0.148 for macular volume and area thickness, respectively) in the treatment-naïve group. There was no difference concerning the leakage area in both groups. No adverse events were reported. Conclusion: We concluded that micropulse 577nm laser therapy maintained the visual acuity and macular thickness at 3 months in both treatment-naïve and refractory DME.
Elevated levels of tissue factor pathway inhibitor in patients with mild to moderate bleeding tendency
Authors: Mehic Dino , Tolios Alexander , Hofer Stefanie , Ay Cihan , Haslacher Helmuth , Rejtö Judit , Ouwehand Willem H. , Downes Kate , Haimel Matthias , Pabinger Ingrid , Gebhart Johanna 
Published: January 2021

AbstractHigh levels of tissue factor pathway inhibitor (TFPI), caused by a longer TFPIα half-life after binding to a factor V splice variant and variants in the F5 gene, were recently identified in 2 families with an as-yet-unexplained bleeding tendency. This study aimed to investigate free TFPIα in a well-characterized cohort of 620 patients with mild to moderate bleeding tendencies and its association to genetic alterations in the F5 gene. TFPIα levels were higher in patients with bleeding compared with healthy controls (median [interquartile range], 8.2 [5.5-11.7] vs 7.8 [4.3-11.1]; P = .026). A higher proportion of patients had free TFPIα levels more than or equal to the 95th percentile compared with healthy controls (odds ratio [OR] [95% confidence interval (CI)], 2.82 [0.98-8.13]). This was pronounced in the subgroup of patients in whom no bleeding disorder could be identified (bleeding of unknown cause [BUC; n = 420]; OR [95% CI], 3.03 [1.02-8.98]) and in platelet function defects (PFDs) (n = 121; OR [95% CI], 3.47 [1.09-11.08]). An increase in free TFPIα was associated with a mild delay in thrombin generation (prolonged lag time and time to peak), but not with alterations in routinely used global clotting tests. We could neither identify new or known genetic variations in the F5 gene that are associated with free TFPIα levels, nor an influence of the single-nucleotide variant rs10800453 on free TFPIα levels in our patient cohort. An imbalance of natural coagulation inhibitors such as TFPIα could be an underlying cause or contributor for unexplained bleeding, which is most probably multifactorial in a majority of patients.
Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage
Authors: Su Chun Mei , Warren Andrew , Kraus Cassie , Macias-Konstantopoulos Wendy , Zachrison Kori S. , Viswanathan Anand , Anderson Christopher , Gurol M. Edip , Greenberg Steven M. , Goldstein Joshua N. 
Published: January 2021

Abstract
Background and aim
Early diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. We examined whether racial or ethnic disparities exist in acute care processes in the first hours after ICH.

Methods
We performed a retrospective review of a prospectively collected cohort of consecutive patients with spontaneous primary ICH presenting to a single urban tertiary care center. Acute care processes studied included time to computerized tomography (CT) scan, time from CT to inpatient bed request, and time from bed request to hospital admission. Clinical outcomes included mortality, Glasgow Outcome Scale, and modified Rankin Scale.

Results
Four hundred fifty-nine patients presented with ICH between 2006 and 2018 and met inclusion criteria (55% male; 75% non-Hispanic White [NHW]; mean age of 73). In minutes, median time to CT was 43 (interquartile range [IQR] 28, 83), time to bed request was 62 (IQR 33, 114), and time to admission was 142 (IQR 95, 232). In a multivariable analysis controlling for demographic factors, clinical factors, and disease severity, race/ethnicity had no effect on acute care processes. English language, however, was independently associated with slower times to CT (β = 30.7 min, 95% CI 9.9 to 51.4, p = 0.004) and to bed request (β = 32.8 min, 95% CI 5.5 to 60.0, p = 0.02). Race/ethnicity and English language were not independently associated with worse outcome.

Conclusions
We found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
An acute eccentric exercise increases circulating myomesin 3 fragments
Authors: Lee Minjung , Shin Jaehoon , Kato Tatsuya , Kanda Kazue , Oikawa Satoshi , Sakuma Jun , Sugama Kaoru , Kawakami Yasuo , Suzuki Katsuhiko , Akimoto Takayuki 
Published: January 2021

AbstractDiscovery of blood biomarkers to evaluate exercise-induced muscle damage have attracted many researchers and coaches. This study aimed to determine changes in circulating myomesin 3 fragments as a novel biomarker for exercise-induced muscle damage. Nine healthy males performed 10 sets of 40 repetitions of one-leg calf-raise exercise by the load corresponding to the half of their body weight. Muscle symptoms were evaluated by a visual analog scale (VAS). Blood samples were collected before and 2, 4, 24, 48, 72, and 96 h post-exercise. Plasma myomesin 3 fragments levels were significantly increased at 96 h after the eccentric exercise. The myomesin 3 fragments levels were correlated with other biomarkers of muscle damage and the muscle symptoms. These results suggest that the circulating myomesin 3 fragments levels are potential biomarkers reflecting eccentric exercise-induced muscle damage.
Comparative analysis of gene expression profiles in differentiated subcutaneous adipocytes between Jiaxing Black and Large White pigs
Authors: Zhang Dawei , Wu Wenjing , Huang Xin , Xu Ke , Zheng Cheng , Zhang Jin 
Published: January 2021

Abstract
Background
Chinese domestic pig breeds are reputed for pork quality, but their low ratio of lean-to-fat carcass weight decreases production efficiency. A better understanding of the genetic regulation network of subcutaneous fat tissue is necessary for the rational selection of Chinese domestic pig breeds. In the present study, subcutaneous adipocytes were isolated from Jiaxing Black pigs a Chinese indigenous pig breed with redundant subcutaneous fat deposition and Large White pigs a lean-type pig breed with relatively low subcutaneous fat deposition. The expression profiles of mRNAs and lncRNAs were compared by RNA-seq analysis to identify biomarkers correlated with the differences of subcutaneous fat deposition between the two breeds.

Results
A total of 1058 differentially expressed genes and 221 differentially expressed lncRNAs were identified in subcutaneous adipocytes between Jiaxing Black and Large White pigs, which included 275 up-regulated mRNAs, 783 down-regulated mRNAs, 118 up-regulated lncRNAs and 103 down-regulated lncRNAs. Gene Ontology and KEGG pathway enrichment analyses revealed that the differentially expressed genes and differentially expressed lncRNAs were mainly involved in the immune response, cell fate determination, PI3K-Akt signaling pathway and MAPK signaling pathway, which are known to be related to adipogenesis and lipid metabolism. The expression levels of differentially expressed genes and differentially expressed lncRNAs according to the RNA-seq data were verified by quantitative PCR, which showed 81.8% consistency. The differences in MAPK pathway activity between Jiaxing Black and Large White pigs was confirmed by western blot analysis, which revealed elevated p38 phosphorylation in Jiaxing Black pigs.

Conclusions
This study offers a detailed characterization of mRNAs and lncRNAs in fat- and lean-type pig breeds. The activity of the MAPK signaling pathway was found to be associated with subcutaneous adipogenesis. These results provide new targets for further investigation of the molecular mechanisms regulating subcutaneous fat deposition in pigs.
Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis
Authors: Bijani Mostafa , Abedi Saeed , Karimi Shahnaz , Tehranineshat Banafsheh 
Published: January 2021

Abstract
Background
Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel.

Methods
The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis.

Results
The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues.

Conclusion
The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel’s professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel’s clinical decision-making skill.
Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review
Authors: Albarqouni Loai , Moynihan Ray , Clark Justin , Scott Anna Mae , Duggan Anne , Del Mar Chris 
Published: January 2021

AbstractBackgroundOveruse of proton pump inhibitors (PPIs) – frequently used for relieving symptoms of gastroesophageal reflux disease (GORD) – raises long-term safety concerns, warranting evidence-based non-drug interventions. We conducted a systematic review to evaluate the effect of head-of-bed elevation on relieving symptoms of GORD in adults.MethodsWe included controlled trials comparing the effect of head-of-bed elevation interventions to control in adults with GORD. Two independent reviewers screened articles, extracted data, and assessed quality of included studies. Primary outcomes were changes in GORD symptoms and use of PPIs.ResultsWe screened 1206 records; and included five trials (four cross-over and one factorial) comprising 228 patients. All five included trials were judged to be at high-risk of performance bias and four of selection bias. Of five included trials, two used ‘bed blocks’ under the bed legs; one used ‘sleeping on a wedge’ pillow, and two used both. High heterogeneity in outcome measures and reported outcomes data precluded meta-analyses. The four studies that reported on GORD symptoms found an improvement among participants in the head-of-bed elevation; a high-quality crossover trial showed a clinical important reduction in symptom scores at 6 weeks (risk ratio of 2.1; 95% CI 1.2 to 3.6). These results are supported by the observed improvement in physiological intra-oesophageal pH measurements.ConclusionsMethodological and reporting limitations in available literature preclude definitive recommendations. However, head-of-bed elevation could be still considered as a cheap and safe alternative to drug interventions with unfavourable safety profiles.Protocol registrationOpen Science Framework:http://osf.io/2hz3j
Multiple non-polypoid mucosal Schwann cell hamartomas presenting as edematous and submucosal tumor-like lesions: a case report
Authors: Okamoto Takeshi , Yoshimoto Takaaki , Fukuda Katsuyuki 
Published: January 2021

Abstract
Background
Mucosal Schwann cell hamartomas are rare neurogenic tumors which present most commonly in the distal colon. They are usually discovered as small, single polyps in asymptomatic patients.

Case presentation
An asymptomatic 64-year-old man was referred to us after a 12 mm subepithelial lesion was discovered incidentally on screening colonoscopy. Follow-up colonoscopy conducted 2 months later revealed that the tumor had disappeared, leaving multiple edematous, submucosal tumor-like elevations presenting as skip lesions throughout the sigmoid colon. Lesions had elongated pits on magnifying endoscopy and were limited to the first layer on endoscopic ultrasound. Biopsies revealed unclearly delineated foci of spindle-shaped cells limited to the lamina propria. On immunohistochemistry, all lesions were positive for S-100 protein and negative for CD34, CD56, and neurofilament protein. The patient was diagnosed with multiple mucosal Schwann cell hamartomas of the sigmoid colon. He remains asymptomatic after 18 months of follow-up, but the lesions have also remained unchanged.

Conclusion
We report a case of multiple non-polypoid mucosal Schwann cell hamartomas. Endoscopic findings may assist in the differential diagnosis, particularly when presenting as non-polypoid, submucosal tumor-like lesions.
Critically ill patients with diabetes and Middle East respiratory syndrome: a multi-center observational study
Authors:   The Saudi Critical Care Trials Group, Jose Jesna , Al-Dorzi Hasan M. , Al-Omari Awad , Mandourah Yasser , Al-Hameed Fahad , Sadat Musharaf , Al Qasim Eman , Alraddadi Basem , Al Harthy Abdulrahman , Al Mekhlafi Ghaleb A. , Almotairi Abdullah , Al Khatib Kasim , Abdulmomen Ahmed , Qushmaq Ismael , Sindi Anees A. , Mady Ahmed , Solaiman Othman , Al-Raddadi Rajaa , Maghrabi Khalid , Ragab Ahmed , Kharaba Ayman , Shalhoub Sarah , Al-Aithan Abdulsalam M. , Vishwakarma Gajendra K. , Bhattacharjee Atanu , Arabi Yaseen M. 
Published: January 2021

AbstractBackgroundDiabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).MethodsThis retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms and signs, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine if diabetes was an independent predictor of 90-day mortality.ResultsOf the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely to present with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%,p < 0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality (odds ratio, 2.09; 95% confidence interval, 1.18–3.72).ConclusionsHalf of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS.
Tumor volume: a new prognostic factor of oncological outcome of localized clear cell renal cell carcinoma
Authors: Chen Shao-Hao , Xu Long-Yao , Wu Yu-Peng , Ke Zhi-Bin , Huang Peng , Lin Fei , Li Xiao-Dong , Xue Xue-Yi , Wei Yong , Zheng Qing-Shui , Xu Ning 
Published: January 2021

Abstract
Background
Clear cell renal cell carcinoma (ccRCC) is one of the most frequent malignancies; however, the present prognostic factors was deficient. This study aims to explore whether there is a relationship between tumor volume (TV) and oncological outcomes for localized ccRCC.

Methods
Seven hundred forty-nine localized ccRCC patients underwent surgery in our hospital. TV was outlined and calculated using a three-dimensional conformal radiotherapy planning system. We used receiver operating characteristic (ROC) curves to identified optimal cut-off value. Univariable and multivariable Cox regression models were performed to explore the association between TV and oncological outcomes. Kaplan-Meier method and log-rank test were used to estimate survival probabilities and determine the significance, respectively. Time-dependent ROC curve was utilized to assess the prognostic effect.

Results
Log rank test showed that higher Fuhrman grade, advanced pT classification and higher TV were associated with shortened OS, cancer-specific survival (CSS), freedom from metastasis (FFM) and freedom from local recurrence (FFLR). multivariable analysis showed higher Fuhrman grade and higher TV were predictors of adverse OS and CSS. The AUC of TV for FFLR was 0.822. The AUC of TV (0.864) for FFM was higher than that of pT classification (0.818) and Fuhrman grade (0.803). For OS and CSS, the AUC of TV was higher than that of Fuhrman grade (0.832 vs. 0.799; 0.829 vs 0.790).

Conclusions
High TV was an independent predictor of poor CSS, OS, FFLR and FFM of localized ccRCC. Compared with pT classification and Fuhrman grade, TV could be a new and better prognostic factor of oncological outcome of localized ccRCC, which might contribute to tailored follow-up or management strategies.
Comparison of early visual quality in patients with moderate myopia using different optical zones in small incision lenticule extraction (SMILE)
Authors: Wu Yan , Huang Zhenping 
Published: January 2021

Abstract
Background
The early visual qualities of patients with moderate myopia were evaluated after small incision lenticule extraction (SMILE) using different optical zones.

Methods
In this retrospective case study, 27 cases (51 eyes) were selected, including 10 cases in Group A (19 eyes), 6.6–6.8 mm in the optical zone, 10 cases in Group B (19 eyes), 6.4–6.5 mm in the optical zone, and 7 cases in Group C (13 eyes),6.1–6.3 mm in the optical zone. The following items were examined preoperatively and 1 month postoperatively: uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical, cylinder, central corneal thickness (CCT), corneal mean curvature (CMC), total ocular aberrations (TA), total low order aberrations (tLOAs), defocus, astigmatism and total high order aberrations (tHOAs), spherical, coma, trefoil, modulation transfer function (MTF), MTFcutoff, SR, objective scatter index (OSI), point scatter function at 50 and 10% (PSF50%, PSF10%), and contrast visual acuity of 100, 20, and 9% (VA100%, VA20%, and VA9%). We compared the three groups by Kruskal-Wallis test. Wilcoxon signed ranks test was used for each group before and 1 month after surgeries. P< 0.05 was considered statistically significant.

Results
There was no significant difference in UCVA, BCVA, CCT, cylinder, and CMC in three groups preoperatively and 1 month postoperatively (P> 0.05). Comparison of the aberrations of the three groups showed statistically significant difference only in TA, tLOA, defocus, astigmatism and SA preoperatively, and trefoil 1 month postoperatively(P< 0.05). The postoperative TA, tLOAs, defocus, astigmatism and trefoil of the three groups were lower than those before surgeries (P< 0.05). The postoperative tHOAs of Group B and C was lower than those before surgeries (P< 0.05). The MTF results showed that before surgeries, there were significant differences in three groups (P< 0.05) in spatial frequencies 5~15 cycles per degree (cpd), and no differences in 20~30 cpd(P> 0.05), while no difference were observed in all spatial frequencies postoperatively (P> 0.05). Comparing the preoperative and postoperative MTF values for each group, the results showed that there was a significant difference in Group C at 5~20 cpd after surgeries(P< 0.05). There was no significant difference in MTFcutoff, SR, OSI, PSF50%, PSF10%, VA100%, VA20%, and VA9% in the three groups preoperatively (P> 0.05). One month after surgeries, higher VA9% values were measured for Group C compared to Group A and B (P < 0.05). There was no significant difference in each group before and after surgeries (P> 0.05).

Conclusion
SMILE could improve the visual qualities of patients with moderate myopia. Reducing the surgical optical zone will only affect night vision slightly.