bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rectal–vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele
Authors: Tan Cheng , Tan Man , Geng Jing , Tang Jun , Yang Xin 
Published: April 2021

AbstractObjectiveThe aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP).MethodPatients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient.ResultsA total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O,p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O,p < 0.001).ConclusionThe rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.
Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia
Authors: Adelson Pamela , Yates Rachael , Fleet Julie-Anne , McKellar Lois 
Published: April 2021

Abstract
Background
The sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.

Methods
A descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant’s commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.

Results
Overall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12–60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, “People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements “People who work here are determined to implement this change”, “People who work here want to implement this change”, and “People who work here are committed to implementing this change.

Conclusion
Results of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.
Validation of whole genome sequencing from dried blood spots
Authors: Agrawal Pooja , Katragadda Shanmukh , Hariharan Arun K. , Raghavendrachar Vijayashree Gauribidanur , Agarwal Arunika , Dayalu Rashmi , Awasthy Disha , Sharma Sanjay C. , Sivasamy Yasodha Kannan , Lakshmana P. , Shanmugam Ashwini , Veeramachaneni Vamsi , Gupta Vaijayanti , Vani B. P. , Subaiya Lekha , Syamala T. S. , Hariharan Ramesh , Chandru Vijay , Bloom David E. 
Published: April 2021

AbstractBackgroundDried blood spots (DBS) are a relatively inexpensive source of nucleic acids and are easy to collect, transport, and store in large-scale field surveys, especially in resource-limited settings. However, their performance in whole-genome sequencing (WGS) relative to that of venous blood DNA has not been analyzed for various downstream applications.MethodsThis study compares the WGS performance of DBS paired with venous blood samples collected from 12 subjects.ResultsResults of standard quality checks of coverage, base quality, and mapping quality were found to be near identical between DBS and venous blood. Concordance for single-nucleotide variants, insertions and deletions, and copy number variants was high between these two sample types. Additionally, downstream analyses typical of population-based studies were performed, such as mitochondrial heteroplasmy detection, haplotype analysis, mitochondrial copy number changes, and determination of telomere lengths. The absolute mitochondrial copy number values were higher for DBS than for venous blood, though the trend in sample-to-sample variation was similar between DBS and blood. Telomere length estimates in most DBS samples were on par with those from venous blood.ConclusionDBS samples can serve as a robust and feasible alternative to venous blood for studies requiring WGS analysis.
Associations of psychosocial factors, knowledge, attitudes and practices with hospitalizations in internal medicine divisions in different population groups in Israel
Authors: Sagie Shira , Na’amnih Wasef , Frej Juda , Alpert Gershon , Muhsen Khitam 
Published: April 2021

AbstractBackgroundInequalities in healthcare utilization exist across ethnic groups; however, the contributions of health-related knowledge and psychosocial factors to these inequalities remain unclear. We examined associations of social determinants of health, psychological factors, knowledge, attitudes and health practices, with hospitalizations in internal medicine divisions, among Israeli adults, Jews and Arabs, with non-communicable diseases, in a setting of universal health insurance.MethodsA retrospective study was undertaken among 520 Jews and Arabs aged 40 years or older with non-communicable diseases, members of a large health maintenance organization. Hospitalization (at least once during 2008) in an internal medicine division was determined based on documentation in electronic health records. Participants were randomly selected in strata of sex, population-group and hospitalization status (yes/no). Data were collected from medical records and via face-to-face interviews using a structured questionnaire. Main independent variables included comorbidity burden, health behaviors, mental health wellbeing and self-rated health. Scales measuring health knowledge and attitudes/beliefs were constructed using factor analysis.ResultsComorbidity burden (OR 1.41 [95% CI 1.24–1.61]) and self-rated health (not good vs. good) (OR 1.88 [95% CI 1.13–3.12]) were positively associated with hospitalizations in an internal medicine division, while an inverse association was found with better mental health wellbeing (OR 0.98 [95% CI 0.96–0.99, for each 1-point score increase). Among Jewish participants, positive associations were found of the number of offspring, comorbidity burden and perceived difficulty, with hospitalizations. No significant associations were found with hospitalizations of other sociodemographics, health behaviors, knowledge and attitudes/beliefs.ConclusionsComorbidity burden was the main risk factor of hospitalizations in internal medicine divisions. Psychosocial factors, such as self-rated health, a complex variable affected by social capital, mental wellbeing, the number of offspring, and perceived burden and difficulty, seem also to contribute. These findings suggest the involvement of broad family and social factors, beyond individual level characteristics and medical needs, in hospitalizations in internal medicine divisions. Interventions to reduce hospitalizations should be comprehensive and integrate aspects of mental health wellbeing; they should build on familial characteristics (e.g., number of offspring), factors related to social capital such as self-rated health, and perceived burden and difficulty.
Cost-utility analysis of imrecoxib compared with diclofenac for patients with osteoarthritis
Authors: Sun Xueshan , Zhen Xuemei , Hu Xiaoqian , Li Yuanyuan , Gu ShuYan , Gu Yuxuan , Zhao Zixuan , Yang Wei , Dong Hengjin 
Published: April 2021

Abstract
Background
To estimate the cost -utility of imrecoxib compared with diclofenac, as well as the addition of a proton pump inhibitor to both two treatment strategies, for patients with osteoarthritis, from a Chinese healthcare perspective.

Methods
A Markov model was built. Costs of managing osteoarthritis and initial adverse events were collected from a Medical Database which collected information from 170 hospitals. Other parameters were obtained from the literature. Subgroup analyses were conducted for people at high risk of gastrointestinal or cardiovascular adverse events. Deterministic and probabilistic sensitivity analyses were performed.

Results
Imrecoxib was highly cost-effective than diclofenac (the ICER was $401.58 and $492.77 in patients at low and high gastrointestinal and cardiovascular risk, respectively). The addition of a proton pump inhibitor was more cost -effective compared with single drug for both treatment strategies. Findings remained robust to sensitivity analyses. 59.04% and 57.16% probability for the co-prescription of imrecoxib and a proton pump inhibitor to be the most cost-effective strategy in all patients considered using the cost-effectiveness threshold of $30,000.

Conclusions
The addition of a proton pump inhibitor to both imrecoxib and diclofenac was advised. Imrecoxib provides a valuable option for patients with osteoarthritis. Uncertainties existed in the model, and the suggestions can be adopted with caution.
Inhibition of DKC1 induces telomere-related senescence and apoptosis in lung adenocarcinoma
Authors: Kan Guangyan , Wang Ziyang , Sheng Chunjie , Yao Chen , Mao Yizhi , Chen Shuai 
Published: April 2021

Abstract
Background
Lung cancer is one of the most widely spread cancers in the world and half of the non-small cell lung cancers are lung adenocarcinoma (LUAD). Although there were several drugs been approved for LUAD therapy, a large portion of LUAD still cannot be effectively treated due to lack of available therapeutic targets. Here, we investigated the oncogenic roles of DKC1 in LUAD and its potential mechanism and explored the possibility of targeting DKC1 for LUAD therapy.

Methods
The Gene Expression Omnibus (GEO) and The Cancer Genome Atlas Program (TCGA) databases were used to examine the DKC1 transcript levels. Gene expression with clinical information from tissue microarray of LUAD were analyzed for associations between DKC1 expression and LUAD prognosis. In addition, loss- and gain-of-function assays were used for oncogenic function of DKC1 both in vitro and in vivo.

Results
DKC1 is overexpressed in LUAD compared with adjacent normal tissues. High expression of DKC1 predicts the poor overall survival. DKC1 knockdown in LUAD cell lines induced G1 phase arrest and inhibited cell proliferation. Ectopic expression of DKC1 could rescue the growth of LUAD cell lines. In addition, the abundance of DKC1 is positively correlated with telomerase RNA component (TERC) and telomerase reverse transcriptase (TERT) levels in LUAD. DKC1 downregulation resulted in decreased TERC expression, reduced telomerase activity and shorten telomere, and thus eventually led to cell senescence and apoptosis.

Conclusions
Our results show that high DKC1 expression indicates poor prognosis of LUAD and DKC1 downregulation could induce telomere-related cell senescence and apoptosis. This study suggests that DKC1 could serve as a candidate diagnostic biomarker and therapeutic target for LUAD.
STEAP4 expression in CNS resident cells promotes Th17 cell-induced autoimmune encephalomyelitis
Authors: Zhao Junjie , Liao Yun , Miller-Little William , Xiao Jianxing , Liu Caini , Li Xiaoxia , Li Xiao , Kang Zizhen 
Published: April 2021

Abstract
Background
Multiple sclerosis (MS) is a debilitating neurological disease caused by autoimmune destruction of the myelin sheath. Experimental autoimmune encephalomyelitis (EAE) is a widely used animal model for the pathogenesis of MS. We and others have previously demonstrated that IL-17 is critical for the pathogenesis of EAE. The concentration of IL-17 is significantly higher in the sera of MS patients than in healthy controls and correlates with disease activity. Moreover, anti-IL-17 neutralizing antibody demonstrated promising efficacy in a phase II trial in MS patients, further substantiating a key pathogenic role for IL-17 in MS. While Th17 and IL-17 are emerging as a bona fide drivers for neuroinflammation, it remains unclear what effector molecule executes the inflammatory tissue destruction in Th17-driven EAE.

Methods
By microarray analysis, we found STEAP4 is a downstream molecule of IL-17 signaling in EAE. We then used STEAP4 global knockout mice and STEAP4 conditional knockout mice to test its role in the pathogenesis of EAE.

Results
Here, we report that the metalloreductase, STEAP4, is a key effector molecule that participates and contributes to the pathogenesis of Th17-mediated neuroinflammation in experimental autoimmune encephalomyelitis. STEAP4 knockout mice displayed delayed onset and reduced severity of EAE induced by active immunization. The reduced disease phenotype was not due to any impact of STEAP4 deficiency on myelin reactive T cells. In contrast, STEAP4 knockout mice were resistant to passively induced EAE, pointing to a role for STEAP4 in the effector stage of EAE. Notably, STEAP4 was only induced the spinal cord of EAE mice that received Th17 cells but not Th1 cells. Consistently, STEAP4 deficiency protected from only Th17 but not Th1-induced EAE. Finally, using Nestin-Cre STEAP4fl/fl mice, we showed that ablation of STEAP4 expression in the resident cells in the central nervous system attenuated disease severity in both active immunization and passive Th17 transfer-induced EAE.

Conclusion
In this study, we identified STEAP4 as a Th17-specific effector molecule that participates and contributes to the pathogenesis of neuroinflammation, thus potentially provide a novel target for MS therapy.
Falling fowl of the chicken reference genome: pitfalls of studying polymorphic endogenous retroviruses
Authors: Mason Andrew S. 
Published: April 2021

AbstractHigh quality reference genomes have facilitated the study of endogenous retroviruses (ERVs). However, there are an increasing number of published works which assume the ERVs in reference genomes are universal; even those of evolutionarily recent integrations. Consequently, these studies fail to properly characterise polymorphic ERVs, and even propose biological functions for ERVs that may not actually be present in the genomes of interest. Here, I outline the pitfalls of three studies of chicken endogenous Avian Leukosis Viruses (ALVEs or “ev genes”: the “original” ERVs), all confounded by the assumption that the reference genome provides a representative ALVE baseline.
Disclosure and health-related outcomes among children living with HIV and their caregivers
Authors: Amankwah-Poku Margaret , Klutsey Delight Abla , Asante Kwaku Oppong 
Published: April 2021

Abstract
Background
The prevalence of disclosure of status to children living with the Human Immunodeficiency Virus (HIV) is low in most sub-Saharan African countries, leading to poor compliance and adverse psychological outcomes in these children. This study examined the influence of disclosure on health outcomes in children living with HIV and their caregivers.

Methods
Using a cross-sectional design, 155 HIV-positive children between age 6–15 years and their caregivers were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health.

Results
Results indicated that only 33.5% of the children sampled knew their status. Disclosure of HIV status was significantly related to medication adherence, psychological wellbeing, the burden of caregiving, and the length of the disclosure. A child’s age and level of education were the only demographic variables that significantly predicted disclosure of HIV status. In a hierarchical analysis, after controlling for all demographic variables medication adherence, psychological well-being and burden of caregiving were found to be significant predictors of disclosure of status in children living with HIV.

Conclusions
Findings suggest the need for disclosure of status among children living with HIV for a positive impact on their medication adherence and psychological health. These findings underscore the need for the development of context-specific interventions that will guide and encourage disclosure of status by caregivers to children living with HIV.
When SEM becomes a deceptive tool of analysis: the unexpected discovery of epidermal glands with stalked ducts on the ultimate legs of geophilomorph centipedes
Authors: Sombke Andy , Müller Carsten H. G. 
Published: April 2021

AbstractBackgroundThe jointed appendage is a key novelty in arthropod evolution and arthropod legs are known to vary enormously in relation to function. Among centipedes, the ultimate legs always are distinctly different from locomotory legs, and different centipede taxa evolved different structural and functional modifications. In Geophilomorpha (soil centipedes), ultimate legs do not participate in locomotion and were interpret to serve a sensory function. They can be sexually dimorphic and in some species, male ultimate legs notably appear “hairy”. It can be assumed that the high abundance of sensilla indicates a pronounced sensory function. This study seeks for assessing the sensory diversity, however, documents the surprising and unique case of an extensive glandular epithelium in the ultimate legs of three phylogenetically distant species.ResultsThe tightly aggregated epidermal glands with stalked ducts – mistakenly thought to be sensilla – were scrutinized using a multimodal microscopic approach comprising histology as well as scanning and transmission electron microscopy inHaplophilus subterraneus. Hence, this is the first detailed account on centipede ultimate legs demonstrating an evolutionary transformation into a “secretory leg”. Additionally, we investigated sensory structures as well as anatomical features using microCT analysis. Contrary to its nomination as a tarsus, tarsus 1 possesses intrinsic musculature, which is an indication that this podomere might be a derivate of the tibia.DiscussionThe presence and identity of ultimate leg associated epidermal glands with stalked ducts is a new discovery for myriapods. A pronounced secretory as well as moderate sensory function inHaplophilus subterraneuscan be concluded. The set of characters will improve future taxonomic studies, to test the hypotheses whether the presence of these specialized glands is a common feature in Geophilomorpha, and that tarsus 1 may be a derivate of the tibia. As the number of epidermal glands with stalked ducts is sexually dimorphic, their function might be connected to reproduction or a sex-specific defensive role. Our results, in particular the unexpected discovery of ‘glandular hairs’, may account for a striking example for how deceptive morphological descriptions of epidermal organs may be, if based on non-invasive techniques alone.
Split-VMAT technique to control the deep inspiration breath hold time for breast cancer radiotherapy
Authors: Poeta Sara , Jourani Younes , De Caluwé Alex , Van den Begin Robbe , Van Gestel Dirk , Reynaert Nick 
Published: April 2021

Abstract
Background
To improve split-VMAT technique by optimizing treatment delivery time for deep-inspiration breath hold (DIBH) radiotherapy in left-sided breast cancer patients, when automatic beam-interruption devices are not available.

Methods
Ten consecutive patients were treated with an eight partial arcs (8paVMAT) plan, standard of care in our center. A four partial arcs (4paVMAT) plan was also created and actual LINAC outputs were measured, to evaluate whether there was a dosimetric difference between both techniques and potential impact on the delivered dose. Subsequently, ten other patients were consecutively treated with a 4paVMAT plan to compare the actual treatment delivery time between both techniques. The prescribed dose was 40.05 Gy/15 fractions on the PTV breast (breast or thoracic wall), lymph nodes (LN) and intramammary lymph node chain (IMN). Treatment delivery time, PTVs coverage, conformity index (CI), organs at risk (OAR) dose, monitor units (MU), and gamma index were compared.

Results
Both split-VMAT techniques resulted in similar dose coverage for the PTV Breast and LN, and similar CI. For PTV IMN we observed a 5% increased coverage for the volume receiving ≥ 36 Gy with 4paVMAT, with an identical volume receiving ≥ 32 Gy. There was no difference for the OAR sparing, with the exception of the contralateral organs: there was a 0.6 Gy decrease for contralateral breast mean (p ≤ 0.01) and 1% decrease for the volume of right lung receiving ≥ 5 Gy (p = 0.024). Overall, these results indicate a modest clinical benefit of using 4paVMAT in comparison to 8paVMAT. An increase in the number of MU per arc was observed for the 4paVMAT technique, as expected, while the total number of MU remained comparable for both techniques. All the plans were measured with the Delta4 phantom and passed the gamma index criteria with no significant differences. Finally, the main difference was seen for the treatment delivery time: there was a significant decrease from 8.9 to 5.4 min for the 4paVMAT plans (p < .05).

Conclusions
This study is mainly of interest for centers who are implementing the DIBH technique without automatic beam-holding devices and who therefore may require to manually switch the beam on and off during breast DIBH treatment. Split-VMAT technique with 4 partial arcs significantly reduces the treatment delivery time compared to 8 partial arcs, without compromising the target coverage and the OAR sparing. The technique decreases the number of breath holds per fraction, resulting in a shorter treatment session.