bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Occurred Probability and Influencing Factors of Stroke in Followed-Up Hypertension Patients
Authors: Li An-le , Qi Ying , Zhu Shuai , Hu Zhi-hao , Xu Xue-jin , Wang Ya-wei , Qian Xin-zhi 
Published: August 2021

Abstract
Objective

To explore the risk occurred probability and influencing factors of stroke in followed-up hypertension (HP) patients through the analysis of long-term followed-up cohort data.
Methods

The method of followed-up observation cohort was used to collect the information of 168417 followed-up hypertension patients from 2002 to 2020 in Jiading district in Shanghai. Kaplan-Meier method was used to analyze the risk occurred probability of stroke complications in long-term followed-up HP patients, and the influencing factors were analyzed by Cox proportional risk model.
Results

Among 168417 followed-up hypertension patients, 11143 cases had occurred stroke, and the cumulative occurrence rate of stroke was 6.62% (male was 6.87%, female was 6.37%). With the extension of the years of hypertension, the cumulative risk occurred probability of stroke in HP patients would continue to increasing, and the interval was not equidistant. The total cumulative risk probability of stroke in HP patients was 78.9% (male was 91.0%, female was 70.7%). During the period of hypertension, the risk occurred probability of stroke was not fixed, but fluctuates. There were 4 onset peaks, which were in 8 years (peak value 4.2%), 15 years (peak value 14.0%), 22 years (peak value 6.0%) and 26 years (peak value 13.9%). The highest risk probability of male patients was in 26 years (peak value 23.1%), and the second peak was in 15 years (peak value 15.6%). The highest risk probability of female patients was in 15 years (peak value 12.9%), and the second peak was in 26 years (peak value 8.7%). The risk probability of different sex, BP grad and BMI was different, male was higher than female, grade 3 HP higher than grade 1 and grad 2 HP, thin higher than normal weight. The major influencing factors of stroke complications were age (RR = 2.917, p < 0.001), body mass index (RR = 1.450, p < 0.001), family history of stroke (RR = 1.386, p < 0.001), blood pressure grad (RR = 1.148, p < 0.001), registry age (RR = 1.071, P < 0.001 and family history of hypertension (RR = 1.051, P < 0.001).
Conclusion

The risk occurred probability of stroke among hypertension would continue to increase disproportionately during period of hypertension, and the total cumulative risk probability could finally reach 78.9%. Male was higher than female. Age, BMI, family history (stroke and HP), blood pressure grad and duration of HP were related to the occurrence of stroke complications.
First Metatarsal Pronation Stratified by Tibial Sesamoid Position on Coronal Plane: A Study Based on Weight-Bearing Computed Tomography
Authors: Wang Zhi , huijing HE , Shu ZHANG , Chao SUN , Xianjun WANG , Jianzhong ZHANG , Mingzhu Zhang 
Published: August 2021

Abstract
Backgrounds: Few studies analyzed the coronal rotation of first metatarsal in hallux valgus patients with weightbearing computed tomography (WBCT). The purpose of this study is to investigate the association between hallux valgus parameters and first metatarsal head rotation in the coronal plane.Methods: Retrospective review of full standing WBCT scans were taken by PedCAT. A group of 123 patients with 216 feet, that intermetatarsal angle (IMA) >9 degrees and hallux valgus angle (HVA) >15 degrees, were included. 27 feet of 17 female included in control group. Measurements of forefoot hallux valgus parameters included IMA, HVA, distal metatarsal abduction angle (DMAA), metatarsal adduction angle (MAA), first metatarsal coronal rotation angle (α-angle), tibial sesamoid position (TSP) on dorsoplantar view, and sesamoid grading in the coronal plane. The differences of HVA, IMA, MAA, DMAA and α-angle in control and study group were compared by Wilcoxon rank test and student t test. Spearman correlation test was performed between α-angle and other parameters. General linear regression analysis was used to predict relationship parameters and α-angle.Results: The mean α-angle in the control group was 11.33±6.16 (range ,0-20) degrees, with the 95% confidence interval (CI) for the mean from 8.90 degrees to 13.77 degrees. The mean of α-angle in the study group was 23.75±6.32 (range,9-39) degrees, with the 95% CI from 22.90 degrees to 24.59 degrees. In the hallux valgus group, there were positive correlations between α-angle and IMA (Spearman’s correlation coefficient (rs) 0.137, P=0.044), DMAA (rs=0.176, P=.010) and TSP (rs=0.218, P=0.001). General linear regression analysis showed that α-angle was correlated with TSP (P<0.001). 208 hallux valgus feet (96.3%) had more pronation than the control group, whereas 8 feet (3.7%) had no or less pronation. Comparing the control and study subjects with the same TSP, means of α-angle showed significant difference, P=0.005.Conclusion: A large portion of hallux valgus patients had the first metatarsal pronation, which was positive correlated to TSP, IMA, and DMAA, and did not correlated to HVA and Smith grading. TSP is a useful predicting factor to α-angle changing. Level of Evidence: Level Ⅲ，Retrospective Cohort study
Assessing Factors Affecting Drought, Earthquake, and Flood Risk Perception: Empirical Evidence From Bangladesh
Authors: Mallick Javed , Salam Roquia , Amin Ruhul , Islam A R M Towfiqul , Islam Aznarul , Siddik Md. Nur Alam , Alam GM Monirul 
Published: August 2021

Abstract
Understanding household disaster risk perception is crucial to formulate and apply disaster risk reduction strategies. Using survey data from 300 households from three highly disaster-prone areas of the lower Teesta River basin in Bangladesh, this study explores households’ risk perception of drought, earthquake, and flood at the local-level. The ordered probit regression model was applied to identify the factors influencing household disaster risk perception. Most of the respondents perceived the likelihood of occurring drought, earthquake, and flood hazards on large-scale in the selected areas which cause negative impacts on their quality of life and financial losses. They lacked knowledge on mitigation actions which makes them unable to control the devastating impacts of disasters. Econometric results show that households’ age, gender, education, and income-generating sources had significantly influenced the respondent's drought, earthquake, and flood risk perception (p < 0.01). Female participants perceived more risks, less knowledge on mitigations actions, and are less capable of controlling the hazards than their counterparts making them vulnerable group to the impacts of hazards. Urgent action is required to improve their socioeconomic conditions, to reduce the knowledge gap between male and female, as well as to improve the household’s understanding of mitigation and preparedness for mitigating disaster risk.
SIRT5 Functions as a Tumor Suppressor via Reversing Warburg Effect in Renal Cell Carcinoma
Authors: Yihan Liu , Xiaojing Wang , Ao Liu , Chuanjie Zhang , Haofei Wang , Yan Shen , HE Hongchao 
Published: August 2021

Abstract
Background: The aim of this study is to investigate the biological functions and the underlying mechanisms of SIRT5 in clear cell renal cell carcinoma (ccRCC).Methods: The datasets of SIRT5 expression in The Cancer Genome Atlas Kidney Clear Cell Carcinoma (TCGA-KIRC) was selected and the correlation between SIRT5 and various clinicopathological parameters was analyzed. The SIRT5 expression in RCC tissues was examined by immunohistochemistry. The SIRT5 knockdown cell lines were constructed. In vitro and in vivo experiments were carried out to investigate the function of SIRT5 on cellular biology of RCC, including cell viability assay, wound-healing assay, soft agar colony formation assay, Transwell invasion assay, qRT-PCR, Western blot, etc. Besides, microarray, rescue experiment and Western blot were used to investigate the molecular mechanisms underlying the functions of SIRT5.Results: SIRT5 expression was downregulated in RCC tissues, and low expression of SIRT5 was correlated with poor prognosis of RCC. Knockdown of SIRT5 significantly prompted cell proliferation, migration, and facilitated invasion in vitro. In vivo experiments revealed that knocking down SIRT5 prompted ccRCC tumorigenesis and metastasis. SIRT5 deglycosylated PDHA1 at K351 and increased the activity of PDC, thus changing the metabolic pathway to the TCA cycle and inhibiting the Warburg effect. The overexpression of SIRT5 was related to the low succinylation of PDHA1.Conclusion: SIRT5 correlated with PDHA1 hyposuccinylation and progression in ccRCC, which suggested that SIRT5 might become a potential target for ccRCC therapy.
An Undergraduate Medical Education Framework for Refugee and Migrant Health: Curriculum Development and Conceptual Approaches
Authors: Gruner Douglas , Feinberg Yael , Venables Maddie J. , Hashmi Syeda Shanza , Saad Ammar , Archibald Douglas , Pottie Kevin 
Published: August 2021

Abstract
Background: International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a ‘trauma informed’ refugee health curriculum framework from medical students and global health faculty. Methods: We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant faculty interviews and e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation. Results: The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We report competency-based learning objectives and primary and secondary topics. We also discuss curriculum delivery and evaluation methods such as community service learning with reflection exercises. Conclusions: This guiding undergraduate medical education curriculum suggests integrating cross-cultural communication skills, exploration of access to care barriers for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.
Ovarian Gonadoblastoma with the Karyotype of 46, XX: A Case Report
Authors: Zhao Fengju , Zhao Yingchao , Xing Biyuan , Liu Zhao 
Published: August 2021

Abstract
Gonadoblastoma is a rare tumor comprised of sex cord derivatives and germ cells. The risk for developing gonadoblastoma increases significantly in patients who possess a Y chromosome or Y chromosome material. A 49-year-old Chinese woman found a pelvic mass during a routine physical examination. Pathological analysis after surgery indicated that the tumor was unilateral ovarian gonadoblastoma with dysgerminoma. Compared with other cases in the literature, our patient was the oldest, and the tumor mass was smaller. Karyotype analysis of peripheral blood lymphocytes revealed that the woman had a 46, XX female karyotype. Whole-exon sequencing revealed that some mutations, such as altered somatic genes in the Forkhead box protein O (FoxO) signaling pathway and KIT, might cause the disease. In conclusion, we described a rare case of gonadoblastoma in a woman who had normal routine menstruation, sexual development, and successful pregnancies and possessed a normal female 46, XX karyotype.
Does Blastocyst Morphology Affect Live Birth Rate After Transfer of Single Euploid Embryo?
Authors: Li Na , Guan Yichun , Ren Bingnan , Zhang Yuchao , Du Yulin , Kong Hongjiao , Zhang Yongjie , Lou Hua 
Published: August 2021

Abstract
Background

The aim of this study was to investigate whether the morphologic parameters of blastocyst influence the live birth rate (LBR) of euploid embryos transferred in subsequent single frozen-thawed embryo transfer (FET) cycles?
Methods

Women who received first preimplantation genetic testing for aneuploidy (PGT-A) and following underwent frozen-thawed single euploid blastocyst transfer cycles from June 2017 to May 2020 were divided into three age groups (< 30, 30–34 and ≥ 35 years). The primary outcome measure was LBR. Outcomes were compared between different blastocyst quality, inner cell mass (ICM) grade, trophectoderm (TE) grade and day of TE biopsy within the same age group.
Results

In the youngest group (< 30 years, n = 100), LBR were compared between cycles with various blastocyst quality (66.67% for good quality, 65.52% for average quality and 36.36% for poor quality; P = 0.013), ICM grade (61.11% for grade A and 51.22% for grade B; P = 0.466), TE grade (68.75% for grade A,65.00% for grade B and 36.30% for grade C; P = 0.012) and day of TE biopsy (65.38% for Day 5 and 39.58% for Day 6; P = 0.010). Similarly, in the 30–34 years group(n = 121) and the oldest group (≥ 35years, n = 58), LBR were also comparable between these subgroups, but no significant differences were seen between blastocyst morphologic grading and LBR (P > 0.05). Moreover, good quality (adjusted odds ratio [aOR] 3.30; 95% confidence interval [CI], 1.09 ~ 9.99; P = 0.035) and average quality (aOR 3.71; 95%CI, 1.25 ~ 11.01; P = 0.018) embryos were still yielded a significantly higher LBR than poor-quality embryos, TE grade B embryos were also associated with a statistically significantly higher LBR compared with TE grade C embryos (aOR 3.69;95%CI, 1.37 ~ 9.95; P = 0.010) after adjusting for the potential confounding factors.
Conclusion

Blastocyst quality and trophectoderm grading is a useful predictor of LBR in single frozen-thawed euploid embryo transfer cycles among women < 30 years old. However, these differences were not found in women older than 30 years.
Problem Based Learning: Aspects and Perspectives of Students of a Medical College of Kathmandu Valley, Nepal
Authors: Mainali Gaurab , Jha Pinky , Karki Pearlbiga , Khadka Manoj , Karki Prabesh , Khadka Anjan 
Published: August 2021

Abstract
Background: Problem-based learning focuses on self-directed learning through problem-based approaches. This study was conducted to know the perspectives of medical students towards problem-based learning, along with its advantages and disadvantages, the role of facilitators and participants, and the scenario of problem-based learning in Tribhuvan University (TU) based medical colleges. Methods: This descriptive cross-sectional study was conducted among the first to third-year medical students at Nepalese Army Institute of Health Sciences, Kathmandu via a self-administered questionnaire. Convenience sampling method was used. The collected data was extracted to Microsoft Excel-13 and analyzed with a statistical package for social sciences (SPSS) version-22.Results: Out of 234 study participants, the majority found problem-based learning course interesting and informative (97.5%). More than three-fourths of respondents study more regularly in problem-based learning than lectures (82.5%) and understood applied aspects of course better than that taught via lectures because of problem-based learning (80.8%). Conclusions: The majority of the study participants have found problem-based learning fruitful than traditional lecture learning. Since problem-based learning integrates the basic and clinical knowledge and enhances collaborative learning skills, we strongly recommend frequent problem-based learning sessions in the medical schools of Nepal.
Natural ACTH Relieves Acute Inflammation of Gout by Changing the Function of Macrophages
Authors: Xu Rui , Zhao Li , Liu Jiyu , Cao Lin , Zhao Tianyi , Yu Yiyun , Xuan Dandan , Wan Weiguo , Zou Hejian , Xue Yu 
Published: August 2021

Abstract
Objective: Gout is a common arthritis caused by deposition of monosodium urate crystals. Macrophage is crucial in the process of monosodium urate (MSU) -induced inflammation. Although it has been reported that adrenocorticotropic hormone (ACTH) in nature can be used to cure urarthritis, the mechanism concerning macrophage is still not clear. This study aims to explore how natural ACTH can alleviate urarthritis through functional changes in macrophage. Methods: We analysed the variations in VAS pain scores of five patients, knowing the time of action, and detecting the level of cortisol and ACTH in patients 24 hours after the application of ACTH. The effect of natural ACTH on joint inflammation and the level of cortisol in blood in mouse model was evaluated by studies in vivo. In vitro studies we evaluated the effect of natural ACTH on macrophage and revealed different functions of ACTH and dexamethasone on macrophage in the transcriptional level. Results: In patients with acute gout, natural ACTH can quickly alleviate pain and has no effect on the level of cortisol and ACTH. Natural ACTH is able to ease the swelling and inflammatory cell infiltration caused by arthritis, without changing the level of cortisol. Besides, natural ACTH in vitro can alleviate acute gouty inflammation by regulating phagocytosis and polarization of macrophage, which also exert different effects on the transcription of some related genes.Conclusion: Natural ACTH is able to alleviate acute gouty inflammation by regulating macrophage, and this effect differs from that of dexamethasone in the transcriptional level.
Validation of the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale (A- DEAPS) among Lebanese pregnant women: A step closer to Pregorexia Awareness
Authors: Gerges Sarah , Obeid Sahar , Hallit Souheil 
Published: August 2021

Abstract
Background

Lately, there has been an upsurge in the prevalence of eating disorders (including anorexia, bulimia, orthorexia and recently, pregorexia), mainly due to changes in sociocultural factors. Pregnancy may serve as a propitious basis for the flourishing of “Pregorexia”: a notion of popular psychology designating a newly emerging eating disorder. Bannatyne et al. generated a brief pregnancy-specific instrument in furtherance of screening for antenatal eating disorders: the DEAPS (Disordered Eating Attitudes in Pregnancy Scale), which demonstrated a high level of internal consistency and good validity. Our study's objective was to linguistically validate and examine the reliability and psychometric properties of the Arabic version of this previously established pregnancy-specific scale among Lebanese pregnant women.
Methods

We conceived and implemented a cross-sectional survey between June and July 2021 (N = 433). The sample was randomly divided in two as per the SPSS data selection option; the first was used to conduct the DEAPS items factor analysis, whereas the second was used for the confirmatory analysis. Multiple indices of goodness-of-fit were described: the Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Tucker Lewis Index (TLI) and Comparative Fit Index (CFI).
Results

A factor analysis was conducted on Sample 1 (N = 207) chosen randomly from the original sample. With the exception of item 8, all other items converged over a two-factor solution (Factor 1: Self-Objectification (Body Control, Body Shame and Esteem) and Factor 2: Pregorexia), explaining a total variance of 39.3%. In sample 2 (N = 226), the one-factor model (Factor 2) that derived from the factor analysis conducted on sample 1, fitted well accordingly to CFI, TLI and χ2/df values, but fitted modestly according to RMSEA. The estimates obtained for Models 1 (original scale) and 2 (according to the two-factor solution obtained from the FA in sample 1) fitted less than the third model. The results showed that 28 (6.6%) of the participants were at risk of having disordered eating during pregnancy, whereas 25 (5.8%) had possible presence of disordered eating.
Conclusion

This study was able to show that the A-DEAPS seems to be a good and reliable tool for the assessment of disordered eating among Lebanese pregnant women.
The Mitochondrial Genome and Epigenome of the Golden Lion Tamarin from Fecal DNA using Nanopore Adaptive Sequencing
Authors: Wanner Nicole , Larsen Peter A. , McLain Adam T. , Faulk Christopher 
Published: August 2021

Abstract
The golden lion tamarin (Leontopithecus rosalia) is an endangered Platyrrhine primate endemic to the Atlantic coastal forests of Brazil. Despite ongoing conservation efforts, genetic data on this species remains scarce. Complicating factors include limitations on sample collection and a lack of high-quality reference sequences. Here, we used nanopore adaptive sampling to resequence the L. rosalia mitogenome from feces, a sample which can be collected non-invasively. Adaptive sampling doubled the fraction of both host-derived and mitochondrial sequences compared to sequencing without enrichment. 258x coverage of the L. rosalia mitogenome was achieved in a single flow cell by targeting the unfinished genome of the distantly related emperor tamarin (Saguinus imperator) and the mitogenome of the closely related black lion tamarin (Leontopithecus chrysopygus). The L. rosalia mitogenome has a length of 16,597 bp, sharing 99.68% sequence identity with the L. chrysopygus mitogenome. A total of 38 SNPs between them were identified, with the majority being found in the non-coding D-loop region. DNA methylation and hydroxymethylation were directly detected using a neural network model applied to the raw signal from the MinION sequencer. In contrast to prior reports, DNA methylation was negligible in mitochondria in both CpG and non-CpG contexts. Surprisingly, a quarter of the 642 CpG sites exhibited DNA hydroxymethylation greater than 1% and 44 sites were above 5%, with concentration in the 3’ side of several coding regions. Overall, we report a robust new mitogenome assembly for L. rosalia and direct detection of cytosine base modifications in all contexts.
Civil-Military Engagement During Public Health Emergencies: A Comparative Analysis of Domestic Responses to COVID-19
Authors: Boland Samuel T. , Grace Rob , Kaplan Josiah 
Published: August 2021

Abstract
Background

Despite the central role that domestic militaries regularly play in supporting civilian disease outbreak responses, the dynamics of domestic civil-military engagement (CME) during major health emergencies remain largely under-explored in public health, humanitarian, and security literatures. Previous research has found, furthermore, that existing international and domestic civil-military guidelines hold limited relevance during public health emergencies, including epidemics and pandemics, currently evidenced by the observable lack of coherence and high variance in both international and domestic military approaches to supporting COVID-19 responses worldwide.
Methods

This article presents a comparative analysis of three of these approaches—in China, the United Kingdom, and the Philippines—and maps these countries’ military contributions to the COVID-19 response across a number of domains.
Results

Analysis of these case studies provides important insights into the ways that CME exists in unacknowledged contexts and forms; how militaries, particularly domestic forces acting as first responders, play an important role in major health crisis contexts; the confusion surrounding how to understand various non-military armed and security actors; and how pandemics, in particular—and other types of largescale health emergencies more broadly—represent a unique domain for CME that tests both the international system and international norms.
Conclusion

This paper concludes with policy, guidance development, and research recommendations for improved practice for localised CME during public health emergencies.