bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between health literacy, general psychological factors, and adherence to medical treatment among Danes aged 50–80 years
Authors: Thapa Subash , Nielsen Jesper B 
Published: June 2021

Abstract
Background
Understanding behavioral factors associated with low health literacy (HL) is relevant for health care providers to better support their patients’ health and adherence to preventive treatment. In this study, we aim to study associations between low HL and socio-demographic characteristics, medication-related perceptions and experience, as well as general psychological factors among patients aged 50–80 years.

Methods
We used a cross-sectional survey design based on a representative group of 6,871 Danish citizens aged 50–80 years returning a web-based questionnaire with socio-demographic data added from a national registry. Chi-square tests were conducted to analyze associations between low HL and daily use of medication and self-rated health. Chi-square tests and binary logistic regression were conducted for analyzing data from respondents using prescribed medicines daily (N = 4,091).

Results
Respondents with low HL were more often on daily medications (19 % [777/4,091] vs. 16 % [436/2,775]; P < 0.001) and were more likely to have poorer self-rated health (P < 0.001). Among patients on daily medications, low HL was significantly higher among men and those with lower educational attainment and lower family income. Low HL was independently and positively associated with perceptions that taking prescribed medicines daily is difficult and time-consuming, with forgetting to take prescribed medicines, and with lower satisfaction with life and poor self-assessed health.

Conclusions
Our study provides information that patients aged 50–80 years with low HL are challenged on their adherence to treatment plans which is not only related to traditional sociodemographic factors but also on perceptions related to taking medication per se.
Frosted branch angiitis due to cytomegalovirus-associated unmasking immune reconstitution inflammatory syndrome: a case report and literature review
Authors: Tang Shi , Zhao Ning , Wang Li Yang , Wen Ying 
Published: June 2021

Abstract
Background
Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with acquired immunodeficiency syndrome. The common funduscopic manifestations are haemorrhagic necrotising variety and granular variety. Frosted branch angiitis (FBA), as a special form, when it occurred after antiretroviral therapy(ART), could possibly be associated with immune reconstitution. We report a case of FBA secondary to CMV infection-associated unmasking immune reconstitution inflammatory syndrome (IRIS).

Case presentation
A 27-year-old man with human immunodeficiency virus infection developed FBA after 35 days of ART. The left Aqueous humour (AqH) tested positive for CMV DNA, and the patient was diagnosed with CMV retinitis. The degree of intraocular inflammation was reflected by increased levels of interleukin (IL)-6 and IL-8 in AqH. After anti-CMV treatment and continuous ART for several months, his FBA and vision significantly improved. CMV DNA became undetectable in the left AqH, and the IL-6 and IL-8 levels in AqH decreased.

Conclusion
FBA could be a sign of CMV-associated unmasking IRIS. Anti-CMV treatment alone or combination with steroid treatment may be administered, depending on the changes in CMV DNA load and immunologic profile of AqH.
Effect of Oral carnosine supplementation on urinary TGF-β in diabetic nephropathy: a randomized controlled trial
Authors: Siriwattanasit Narongrit , Satirapoj Bancha , Supasyndh Ouppatham 
Published: June 2021

Abstract
Background
Activation of the transforming growth factor beta (TGF-β) pathway is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a dipeptide that can inhibit TGF-β synthesis. We tested the hypothesis that carnosine supplement added to standard therapy will result in reduced urinary TGF-β levels among patients with diabetic nephropathy.

Methods
We randomly assigned 40 patients with diabetic nephropathy and albuminuria 30–299 mg/day to treatment with carnosine (2 g/day) or placebo for 12 weeks. Urinary TGF-β level was determined using ELISA, urine albumin was ascertained by immunonephelometric assay, and renal function and metabolic profiles were determined at baseline and during 12 weeks of active treatment. Primary outcome was decrease in urinary levels of TGF-β.

Results
The 2 groups were comparable for baseline characteristics, blood pressure, urine albumin, urine TGF-β and renal function measurements. Urinary TGF-β significantly decreased with carnosine supplement (− 17.8% of the baseline values), whereas it tended to increase with placebo (+ 16.9% of the baseline values) (between-group difference P < 0.05). However, blood urea nitrogen, serum creatinine, glomerular filtration rate and other biochemical parameters remained unchanged during the study period including urinary albuminuria. Both groups were well tolerated with no serious side-effects.

Conclusions
These data indicated an additional renoprotective effect of oral supplementation with carnosine to decrease urinary TGF-β level that serves as a marker of renal injury in diabetic nephropathy.

Trial registration
Thai Clinical Trials, TCTR20200724002. Retrospectively Registered 24 July 2020.
Innumerable cerebral microbleeds in hepatitis B virus-related decompensated liver cirrhosis: a case report
Authors: Oh Chi Hyuk , Lee Jin San 
Published: June 2021

Abstract
Background
Cerebral microbleeds (CMBs) are small, rounded, dark-signal lesions on brain MRI that represent cerebral hemosiderin deposits resulting from prior microhemorrhages and are neuroimaging biomarkers of cerebral amyloid angiopathy (CAA). Here, we report a case of innumerable CMBs in a patient with hepatic encephalopathy underlying decompensated liver cirrhosis.

Case presentation
An 83-year-old woman diagnosed with hepatitis B virus-related liver cirrhosis 40 years before was referred to our neurology clinic for progressive disorientation of time and place, personality changes, and confusion with somnolence over 2 weeks. Based on the laboratory, neuroimaging, and electrophysiological findings, we diagnosed the patient with hepatic encephalopathy, and her symptoms recovered within 12 h after proper medical management. Brain MRI showed innumerable CMBs in the bilateral frontal, parietal, temporal, and occipital lobes. Since the distribution of CMBs in the patient was mainly corticosubcortical and predominantly in the posterior cortical regions, and the apolipoprotein E genotype was ε4/ε4, we speculated that CAA and hepatic encephalopathy coexisted in this patient.

Conclusions
We suggest that severe liver dysfunction associated with long-term decompensated liver cirrhosis may be related to an increased number of CMBs in the brain. Our findings indicate that decompensated liver cirrhosis may be a risk factor for the development of CMBs and corroborate a link between the liver and the brain.
Infection risks in multiple myeloma: a systematic review and meta-analysis of randomized trials from 2015 to 2019
Authors: Balmaceda Nicole , Aziz Muhammad , Chandrasekar Viveksandeep Thoguluva , McClune Brian , Kambhampati Suman , Shune Leyla , Abdallah Al-Ola , Anwer Faiz , Majeed Aneela , Qazilbash Muzaffar , Ganguly Siddhartha , McGuirk Joseph , Mohyuddin Ghulam Rehman 
Published: June 2021

Abstract
Background
Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments.

Methods
We performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs).

Results
The risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection.

Conclusions
This is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.
Optimizing palliative chemotherapy for advanced invasive mucinous adenocarcinoma of the lung
Authors: Jang Yoon Jung , Hyun Dong-gon , Choi Chang-Min , Lee Dae Ho , Kim Sang-We , Yoon Shinkyo , Kim Woo Sung , Ji Wonjun , Lee Jae Cheol 
Published: June 2021

Abstract
Background
A primary pulmonary invasive mucinous adenocarcinoma (IMA) is a rare subtype of invasive adenocarcinoma of the lung. The prognosis of advanced IMA depending on chemotherapy regimen has not been fully investigated. Here, we compared the clinical outcomes of patients with advanced IMA treated with different palliative chemotherapies that included novel therapeutics.

Methods
This single-center retrospective study included a total of 79 patients diagnosed with IMA and treated with palliative chemotherapy. The primary outcome was the comparison of overall survival according to palliative chemotherapy type. Risk factors associated with death were evaluated as a secondary outcome.

Results
The study cohort of 79 patients comprised 27 progressive or recurrent cases and 52 initial metastatic patients. Thirteen patients (16.5%) received targeted therapy and 18 cases (22.8%) received immunotherapy. When we compared the survival outcomes of the different treatment regimens, patients with IMA treated by immunotherapy (undefined vs. non-immunotherapy 17.0 months, p < 0.001) had better overall survival rates. However, there was no difference in the prognosis between the cases treated with a targeted therapy (35.6 vs. non-targeted therapy 17.0 months, p = 0.211). None of the conventional regimens produced a better outcome. By multivariable analysis, immunotherapy (HR 0.28; 95% CI 0.11–0.74; P = 0.008) was found to be an independent prognostic factor for death.

Conclusions
This study suggests that immunotherapy for patients with advanced IMA may provide favorable outcomes than other chemotherapy options.
Distinct BTK inhibitors differentially induce apoptosis but similarly suppress chemotaxis and lipid accumulation in mantle cell lymphoma
Authors: Liu Zhuojun , Liu Jia , Zhang Tianming , Li Lin , Zhang Shuo , Jia Hao , Xia Yuanshi , Shi Mingxia , Zhang Jing , Yue Shuhua , Chen Xiaofang , Yu Jian 
Published: June 2021

Abstract
Background
The more selective second-generation BTK inhibitors (BTKi) Acalabrutinib and Zanubrutinib and the first-generation BTKi Ibrutinib are highlighted by their clinical effectiveness in mantle cell lymphoma (MCL), however, similarities and differences of their biological and molecular effects on anti-survival of MCL cells induced by these BTKi with distinct binding selectivity against BTK remain largely unknown.

Methods
AlamarBlue assays were performed to define cytotoxicity of BTKi against MCL cells, Jeko-1 and Mino. Cleaved PARP and caspase-3 levels were examined by immunoblot analysis to study BTKi-induced apoptotic effects. Biological effects of BTKi on MCL-cell chemotaxis and lipid droplet (LD) accumulation were examined in Jeko-1, Mino and primary MCL cells via Transwell and Stimulated Raman scattering imaging analysis respectively. Enzyme-linked immunoassays were used to determine CCL3 and CCL4 levels in MCL-cell culture supernatants. RNA-seq analyses identified BTKi targets which were validated by quantitative RT-PCR (qRT-PCR) and immunoblot analysis.

Results
Acalabrutinib and Zanubrutinib induced moderate apoptosis in Ibrutinib high-sensitive JeKo-1 cells and Ibrutinib low-sensitive Mino cells, which was accompanied by cleaved PARP and caspase-3. Such effects might be caused by the stronger ability of Ibrutinib to upregulate the expression of pro-apoptotic genes, such as HRK, GADD45A, and ATM, in JeKo-1 cells than in Mino cells, and the expression of such apoptotic genes was slightly changed by Acalabrutinib and Zanubrutinib in both JeKo-1 and Mino cells. Further, Acalabrutinib, Zanubrutinib and Ibrutinib reduced MCL-cell chemotaxis with similar efficiency, due to their similar abilities to downmodulate chemokines, such as CCL3 and CCL4. Also, these three BTKi similarly suppressed MCL-cell LD accumulation via downregulating lipogenic factors, DGAT2, SCD, ENPP2 and ACACA without significant differences.

Conclusion
BTKi demonstrated differential capacities to induce MCL-cell apoptosis due to their distinct capabilities to regulate the expression of apoptosis-related genes, and similar biological and molecular inhibitory effects on MCL-cell chemotaxis and LD accumulation.
Ovarian cycle stage critically affects 21-gene recurrence scores in Mmtv-Pymt mouse mammary tumours
Authors: Bernhardt Sarah M. , Dasari Pallave , Glynn Danielle J. , Woolford Lucy , Moldenhauer Lachlan M. , Walsh David , Townsend Amanda R. , Price Timothy J. , Ingman Wendy V. 
Published: June 2021

Abstract
Background
The Oncotype DX 21-gene Recurrence Score is predictive of adjuvant chemotherapy benefit for women with early-stage, estrogen receptor (ER)-positive, HER2-negative breast cancer. In premenopausal women, fluctuations in estrogen and progesterone during the menstrual cycle impact gene expression in hormone-responsive cancers. However, the extent to which menstrual cycling affects the Oncotype DX 21-gene signature remains unclear. Here, we investigate the impact of ovarian cycle stage on the 21-gene signature using a naturally cycling mouse model of breast cancer.

Methods
ER-positive mammary tumours were dissected from naturally cycling Mmtv-Pymt mice at either the estrus or diestrus phase of the ovarian cycle. The Oncotype DX 21-gene signature was assessed through quantitative real time-PCR, and a 21-gene experimental recurrence score analogous to the Oncotype DX Recurrence Score was calculated.

Results
Tumours collected at diestrus exhibited significant differences in expression of 6 Oncotype DX signature genes (Ki67, Ccnb1, Esr1, Erbb2, Grb7, Bag1; p ≤ 0.05) and a significant increase in 21-gene recurrence score (21.8 ± 2.4; mean ± SEM) compared to tumours dissected at estrus (15.5 ± 1.9; p = 0.03). Clustering analysis revealed a subgroup of tumours collected at diestrus characterised by increased expression of proliferation- (p < 0.001) and invasion-group (p = 0.01) genes, and increased 21-gene recurrence score (p = 0.01). No correlation between ER, PR, HER2, and KI67 protein abundance measured by Western blot and abundance of mRNA for the corresponding gene was observed, suggesting that gene expression is more susceptible to hormone-induced fluctuation compared to protein expression.

Conclusions
Ovarian cycle stage at the time of tissue collection critically affects the 21-gene signature in Mmtv-Pymt murine mammary tumours. Further studies are required to determine whether Oncotype DX Recurrence Scores in women are similarly affected by menstrual cycle stage.
A comparative assessment of dry eye disease among outdoor street sweepers and indoor office cleaners
Authors: Echieh Chigozie I. , Etim Bassey A. , Echieh Chidiebere Peter , Oyeniyi Taiwo , Ajewole Jeff 
Published: June 2021

Abstract
Background
Occupational predisposition to dry eye disease is known. Simultaneous exposure to multiple factors may pose more risk. Street sweepers are exposed to sunlight in addition to dust which all sweepers are exposed to. Tropical climate predisposes to significant exposure to sunlight. Combined exposure to dust and sunlight may lead to a synergy of factors. This study aims to assess the prevalence of dry eye disease (DED) amongst Street sweepers and Office cleaners in Calabar metropolis.

Methods
A cross-sectional study was conducted among street sweepers and office cleaners. A systematic random sampling and multi-stage sampling method were used to select street sweepers (n = 115) and office cleaners (n = 115) respectively for the study. A pretested semi-structured interviewer-administered questionnaire was used to obtain information after which the respondents had an ophthalmic examination. An assessment of DED was done with Ocular Surface Disease Index (OSDI) questionnaire, Schirmer’s test, and tear break up time (TBUT). OSDI scores of 33 and above; Schirmer’s test readings of < 10 mm wetting in 5 min and a TBUT of less than 10s in either eye were considered as positive dry eye disease.
Results
The majority of respondents were females 215(93.5%) compared to males 15 (6.5%). The overall mean age of respondents was 40.96 ± 9.8 years. The average OSDI score, Schirmer’s test as well as TBUT among participants was 26.4 ± 16.0, 16.44 ± 9.52 mm, and 12.38 ± 4.53 s respectively.
The prevalence of DED among Street sweepers was 35.7% compared to 20% among office cleaners using the OSDI questionnaire (p = 0.352).
The prevalence of DED among street sweepers was 32.2% compared to 30.4% among Office cleaners using the Schirmer’s test. (p = 0.73) The TBUT reported a prevalence of 38.3% of DED among Street sweepers compared to 32.2% in office cleaners. (p = 0.48) Overall; the prevalence of dry eye disease among Street sweepers and office cleaners using OSDI score, Schirmers test, as well as TBUT were not statistically significant (> 0.05) Street Sweepers had higher odds of developing dry eye disease compared to office cleaners (OR = 2.085; C.I. =1.106–3.929; p = 0.02). Negative correlation coefficient was observed between TBUT and OSDI (rs = − 0.102; p = 0.125). This was not statistically significant.

Conclusion
Street sweepers had a higher prevalence of dry eye disease compared to office cleaners due to a higher risk of increased exposure to environmental factors such as dust, smoke, and sunlight. This effect is possibly due to a synergy of factors. Studies on dose-response are warranted.
Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study
Authors: Ghisi Gabriela Lima de Melo , Seixas Mariana Balbi , Pereira Daniele Sirineu , Cisneros Ligia Loiola , Ezequiel Danielle Guedes Andrade , Aultman Crystal , Sandison Nicole , Oh Paul , da Silva Lilian Pinto 
Published: June 2021

AbstractBackgroundGlobally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes.MethodsThese steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading).ResultsFour of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients’ needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures.ConclusionsThis program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education.
Epidemiology of skeletal trauma and skull fractures in children younger than 1 year in Shenzhen: a retrospective study of 664 patients
Authors: Deng Hansheng , Qiu Xin , Su Qiru , Zeng Shuaidan , Han Shuai , Li Shicheng , Cui Zhiwen , Zhu Tianfeng , Xiong Zhu , Tang Gen , Tang Shengping 
Published: June 2021

AbstractBackgroundUnintentional injury is one of the top three causes of death for infants. However, the epidemiological studies of skeletal trauma and skull fractures in infants younger than 1 year were poorly understood in China. Therefore, our study aimed to examine accidental and emergency attendance in infants under 1 year. It also tried to determine the prevalence and severity of accident types in infants.MethodsA retrospective analysis was performed on the demographic characteristics of infants younger than 1 year with skeletal trauma and skull fractures who visited the Shenzhen Children’s Hospital from January 1, 2016 to December 31, 2019. Age, gender, fracture site and type, mechanism of injury, length of visit, length of hospital stay, hospitalization cost, and treatment methods were analyzed.ResultsA total number of 675 fractures in 664 infants were included, the median age was 187days (IQR,90-273days), including 394 males and 270 females. The top three fracture sites were the skull (430 sites, 63.70 %), long bones of the limbs (168 sites, 24.89 %), and clavicle (53 sites, 7.85 %). The top three causes of injury were locomotion injuries (256 cases, 38.55 %), falls or trips from low height (from beds, tables, chairs, etc.) (130 cases, 19.58 %), and birth injuries (97 cases, 14.61 %). The greatest amount of fractures occurred in children 1–28 days of life (d) reached a top of 101 cases, followed by 331–365 days, accounting for 15.21 and 10.24 %, respectively. The number of fractures reached a trough of 29 cases in the 29-60d group (4.37 %). And increased again to 65 cases in the 151-180d group (9.79 %). The proportion remained relatively constant at 9 % in the 181-210d group (9.19 %) and 211-240d group (9.64 %). The interval between injury and visiting our hospital was ≤ 72 h in 554 cases.ConclusionsSpecial attention should be given to the demographic characteristics of fractures in infants under 1 year of age, and appropriate outreach should be implemented. For example, health education should be provided to aid in the prevention especially for frequently occurring locomotion injuries, and prompt access to specialist medical care should be recommended for skull fractures, which are prone to delayed treatment. In addition, multidisciplinary collaboration should be implemented in trauma care, while also promoting the establishment of trauma centers in specialist children’s hospitals with a stronger capacity to treat pediatric trauma, and a regional system for pediatric trauma treatment.