bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients
Authors: Lin Chun-Yu , Tung Tao-Hsin , Wu Meng-Yu , Tseng Chi-Nan , Tsai Feng-Chun 
Published: July 2021

AbstractBackgroundThe DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis.MethodsBetween January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared.ResultsIn the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%;P = 0.036) and matched cohorts (19.6% vs 5.4%;P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%;P = 0.378) and matched cohorts (79.1% vs 85.2%;P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively.ConclusionsPatients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.
Setting the forest reference levels in the European Union: overview and challenges
Authors: Vizzarri Matteo , Pilli Roberto , Korosuo Anu , Blujdea Viorel N. B. , Rossi Simone , Fiorese Giulia , Abad-Viñas Raul , Colditz Rene R. , Grassi Giacomo 
Published: July 2021

AbstractBackgroundThe contribution of EU forests to climate change mitigation in 2021–2025 is assessed through the Forest Reference Levels (FRLs). The FRL is a projected country-level benchmark of net greenhouse gas emissions against which the future net emissions will be compared. The FRL models the hypothetical development of EU forest carbon sink if the historical management practices were continued, taking into account age dynamics. The Member States’ FRLs have been recently adopted by the European Commission with the delegated Regulation (EU) 2021/268 amending the Regulation (EU) 2018/841. Considering the complexity of interactions between forest growth, management and carbon fluxes, there is a need to understand uncertainties linked to the FRL determination.ResultsWe assessed the methodologies behind the modelled FRLs and evaluated the foreseen impact of continuation of management practices and age dynamics on the near-future EU27 + UK forest carbon sink. Most of the countries implemented robust modelling approaches for simulating management practices and age dynamics within the FRL framework, but faced several challenges in ensuring consistency with historical estimates. We discuss that the projected 16% increase in harvest in 2021–2025 compared to 2000–2009, mostly attributed to age dynamics, is associated to a decline of 18% of forest sink (26% for living biomass only).ConclusionsWe conclude that the FRL exercise was challenging but improved the modelling capacity and data availability at country scale. The present study contributes to increase the transparency of the implementation of forest-related EU policies and provides evidence-based support to future policy development.
Variants in a cis-regulatory element of TBX1 in conotruncal heart defect patients impair GATA6-mediated transactivation
Authors: Jiang Xuechao , Li Tingting , Liu Sijie , Fu Qihua , Li Fen , Chen Sun , Sun Kun , Xu Rang , Xu Yuejuan 
Published: July 2021

Abstract
Background
TBX1 (T-box transcription factor 1) is a major candidate gene that likely contributes to the etiology of velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS). Although the haploinsufficiency of TBX1 in both mice and humans results in congenital cardiac malformations, little has been elucidated about its upstream regulation. We aimed to explore the transcriptional regulation and dysregulation of TBX1.

Methods
Different TBX1 promoter reporters were constructed. Luciferase assays and electrophoretic mobility shift assays (EMSAs) were used to identify a cis-regulatory element within the TBX1 promoter region and its trans-acting factor. The expression of proteins was identified by immunohistochemistry and immunofluorescence. Variants in the cis-regulatory element were screened in conotruncal defect (CTD) patients. In vitro functional assays were performed to show the effects of the variants found in CTD patients on the transactivation of TBX1.

Results
We identified a cis-regulatory element within intron 1 of TBX1 that was found to be responsive to GATA6 (GATA binding protein 6), a transcription factor crucial for cardiogenesis. The expression patterns of GATA6 and TBX1 overlapped in the pharyngeal arches of human embryos. Transfection experiments and EMSA indicated that GATA6 could activate the transcription of TBX1 by directly binding with its GATA cis-regulatory element in vitro. Furthermore, sequencing analyses of 195 sporadic CTD patients without the 22q11.2 deletion or duplication identified 3 variants (NC_000022.11:g.19756832C > G, NC_000022.11:g.19756845C > T, and NC_000022.11:g. 19756902G > T) in the non-coding cis-regulatory element of TBX1. Luciferase assays showed that all 3 variants led to reduced transcription of TBX1 when incubated with GATA6.

Conclusions
Our findings showed that TBX1 might be a direct transcriptional target of GATA6, and variants in the non-coding cis-regulatory element of TBX1 disrupted GATA6-mediated transactivation.
Health-related risky behaviors in Chinese adolescents with autism: a cross-sectional study
Authors: Sun Yajing , Li Xue , Xu Lingzi , Ma Zenghui , Yang Yulu , Yin Tingni , Gao Zilin , Gong Xiaoyun , Li Lei , Liu Qinyi , Tang Xinzhou , Liu Jing 
Published: July 2021

Abstract
Background
Health-related risky behaviors (HRB) generally refer to behaviors that have a negative influence on health and quality of life. HRB in adolescents with autism have not been well understood so far. We aim to explore health-related risky behaviors and their risk factors with autistic adolescents.

Methods
In this study, 150 adolescents with autism and 150 neurotypical adolescents were enrolled. Participants in both groups completed the Adolescent Health-Related Risky Behavior Inventory (AHRBI). Autism Spectrum Screening Questionnaire (ASSQ), Wechsler Intelligence Scale, Theory of Mind (ToM) Test, Zung Self-rating Anxiety Scale (SAS), Zung Self-rating Depression Scale (SDS), and Self-Esteem Scale (SES) were also assessed in the autism group to explore risk factors.

Results
The results showed that the total score of AHRBI and scores of "aggression and violence (AV)", "suicide or self-injury (SS)", "health-compromising behavior (HCB)", and "unprotected sex (US)" subscales in the autism group were significantly higher than those in the control group (Z value = − 4.58 ~ − 2.26, all P < 0.05). Anxiety, depression, low self-esteem, low IQ score, low ToM test score, increasing age, and communication disorder were found as risk factors for health-related risky behaviors in autistic adolescents.

Conclusions
Adolescents with autism have more health-related risky behaviors than neurotypical adolescents. We should pay attention to the emotional state, self-esteem, cognitive function, and verbal communication levels of autistic adolescent with health-related risky behaviors.
LncRNA TMPO-AS1 suppresses the maturation of miR-335-5p to participate in polycystic ovary syndrome
Authors: Hou Fang , Li Jie , Peng Jie , Teng Zhenghua , Feng Jun , Xia Weiwei 
Published: July 2021

Abstract
Background
TMPO-AS1 is a recently characterized oncogenic lncRNA in ovarian cancer. Its role in other ovary diseases is unknown. This study explored its role in polycystic ovary syndrome (PCOS).

Methods
Follicular fluid was extracted from both PCOS patients and controls. The levels of TMPO-AS1 and mature and premature miR-335-5p were analyzed by RT-qPCR. The role of TMPO-AS1 in regulating miR-355-5p maturation in granulosa-like tumor (KGN) cells was analyzed by overexpression experiments. The interaction between TMPO-AS1 and premature miR-335-5p was analyzed by RNA pull-down assay. The subcellular location of TMPO-AS1 in KGN cells was analyzed by nuclear fractionation assay. The role of TMPO-AS1 and miR-335-5p in KGN cell proliferation was analyzed by BrdU assay.

Results
TMPO-AS1 was increased in PCOS, while mature miR-355-5p was decreased in PCOS. TMPO-AS1 overexpression decreased mature miR-355-5p level but increased premature miR-355-5p. TMPO-AS1 was localized in both nucleus and cytoplasm. TMPO-AS1 directly interacted with premature miR-355-5p in KGN cells. TMPO-AS1 increased KGN cell proliferation while miR-355-5p decreased cell proliferation. The co-transfection assay showed that TMPO-AS1 reduced the suppressive effects of miR-355-5p on cell proliferation.

Conclusions
TMPO-AS1 might suppress miR-335-5p maturation to participate in PCOS.
The way to a man’s heart is through his stomach: a case of myocardial infarction mimic and pseudo-tamponade in a polytrauma patient
Authors: Brun Mathew , Brun Shane , Pearson David , Wullschleger Martin 
Published: July 2021

Abstract
Background
There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma.

Case presentation
We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms.

Conclusions
This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.
Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: a pilot study of communication behaviours
Authors: Gerwing Jennifer , Steen-Hansen Jon Erik , Mjaaland Trond , Jensen Bård Fossli , Eielsen Olav , Thomas Owen Matthew Truscott , Gulbrandsen Pål 
Published: July 2021

Abstract
Background
Calls to emergency medical lines are an essential component in the chain of survival. Operators make critical decisions based on information they elicit from callers. Although smooth cooperation is necessary, the field lacks evidence-based guidelines for how to achieve it while adhering to strict parameters of index-driven questioning. We aimed to evaluate the effect of a training intervention for emergency medical operators at a call centre in Tønsberg, Norway. The course was designed to enhance operators’ communication skills for smoothing cooperation with callers.

Methods
Calls were analyzed using inductively developed coding based on the course rationale and content. To evaluate whether the course generated consolidated behavioral change in everyday practice, the independent analyst evaluated 32 calls, selected randomly from eight operators, two calls before and two after course completion. To measure whether skill attainment delayed decision making, we compared the time to the first decision logged by intervention operators to eight control operators. Analysis included 3034 calls: 1375 to intervention operators (T1 = 815; T2 = 560) and 1659 to control operators (T1 = 683; T2 = 976).

Results
Operators demonstrated improved behaviours on how they greeted the caller (p < .001), acknowledged the caller (p < .001), and displayed empathy (p = 0.015). No change was found in the use of open-ended questions and agreeing with the caller. Contrary to expectations, operators who took the course logged first decisions more quickly than the control group (p < .001).

Conclusions
This pilot study demonstrated that the training intervention generated behavioural change in these operators, providing justification for scaling up the intervention.
The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision - a biomechanical study using healthy volunteers
Authors: Nutbeam Tim , Fenwick Rob , May Barbara , Stassen Willem , Smith Jason E. , Wallis Lee , Dayson Mike , Shippen James 
Published: July 2021

Abstract
Background
Motor vehicle collisions account for 1.3 million deaths and 50 million serious injuries worldwide each year. However, the majority of people involved in such incidents are uninjured or have injuries which do not prevent them exiting the vehicle. Self-extrication is the process by which a casualty is instructed to leave their vehicle and completes this with minimal or no assistance. Self-extrication may offer a number of patient and system-wide benefits. The efficacy of routine cervical collar application for this group is unclear and previous studies have demonstrated inconsistent results. It is unknown whether scripted instructions given to casualties on how to exit the vehicle would offer any additional utility.
The aim of this study was to evaluate the effect of cervical collars and instructions on spinal movements during self-extrication from a vehicle, using novel motion tracking technology.

Methods
Biomechanical data on extrications were collected using Inertial Measurement Units on 10 healthy volunteers. The different extrication types examined were: i) No instructions and no cervical collar, ii) No instructions, with cervical collar, iii) With instructions and no collar, and iv) With instructions and with collar. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement, mean, standard deviation and confidence intervals are reported for each extrication type.

Results
Data were recorded for 392 extrications. The smallest cervical spine movements were recorded when a collar was applied and no instructions were given: mean 6.9 mm AP and 4.4 mm LAT. This also produced the smallest movements at the lumbar spine with a mean of 122 mm AP and 72.5 mm LAT.
The largest overall movements were seen in the cervical spine AP when no instructions and no collar were used (28.3 mm). For cervical spine lateral movements, no collar but with instructions produced the greatest movement (18.5 mm). For the lumbar spine, the greatest movement was recorded when instructions were given and no collar was used (153.5 mm AP, 101.1 mm LAT).

Conclusions
Across all participants, the most frequently occurring extrication method associated with the least movement was no instructions, with a cervical collar in situ.
Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis
Authors: Cammarota Gianmaria , Esposito Teresa , Azzolina Danila , Cosentini Roberto , Menzella Francesco , Aliberti Stefano , Coppadoro Andrea , Bellani Giacomo , Foti Giuseppe , Grasselli Giacomo , Cecconi Maurizio , Pesenti Antonio , Vitacca Michele , Lawton Tom , Ranieri V. Marco , Di Domenico Sandro Luigi , Resta Onofrio , Gidaro Antonio , Potalivo Antonella , Nardi Giuseppe , Brusasco Claudia , Tesoro Simonetta , Navalesi Paolo , Vaschetto Rosanna , De Robertis Edoardo 
Published: July 2021

AbstractBackgroundNoninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU.MethodsWe searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with ‘do-not-intubate’ (DNI) orders.ResultsSeventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30–41%]. 26% [21–30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36–54%]. 23% [15–32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65–78%]. Oxygenation on admission was the main source of between-study heterogeneity.ConclusionsDuring COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance.RegistrationPROSPERO,https://www.crd.york.ac.uk/prospero/, CRD42020224788, December 11, 2020.
Body fatness and breast cancer risk in relation to phosphorylated mTOR expression in a sample of predominately Black women
Authors: Cheng Ting-Yuan David , Omilian Angela R. , Yao Song , Zhang Weizhou , Datta Susmita , Bshara Wiam , Ondracek Rochelle Payne , Davis Warren , Liu Song , Hong Chi-Chen , Bandera Elisa V. , Khoury Thaer , Ambrosone Christine B. 
Published: July 2021

Abstract
Background
The mechanistic target of rapamycin (mTOR) pathway promoted by positive energy imbalance and insulin-like growth factors can be a mechanism by which obesity influences breast cancer risk. We evaluated the associations of body fatness with the risk of breast cancer varied with phosphorylated (p)-mTOR protein expression, an indication of the pathway activation.

Methods
Women with newly diagnosed breast cancer (n = 715; 574 [80%] Black and 141 [20%] White) and non-cancer controls (n = 1983; 1280 [64%] Black and 713 [36%] White) were selected from the Women’s Circle of Health Study. Surgical tumor samples among the cases were immunostained for p-mTOR (Ser2448) and classified as p-mTOR-overexpressed, if the expression level ≥ 75th percentile, or p-mTOR-negative/low otherwise. Anthropometrics were measured by trained staff, and body composition was determined by bioelectrical impedance analysis. Odds ratios (ORs) of p-mTOR-overexpressed tumors and p-mTOR-negative/low tumors compared to controls were estimated using polytomous logistic regression. The differences in the associations by the p-mTOR expression status were assessed by tests for heterogeneity.

Results
Cases with p-mTOR-overexpressed tumors, but not cases with p-mTOR-negative/low tumors, compared to controls were more likely to have higher body mass index (BMI), percent body fat, and fat mass index (P-heterogeneity < 0.05), although the OR estimates were not significant. For the measurement of central adiposity, cases with p-mTOR overexpressed tumors had a higher odds of being at the Q3 (OR = 2.52, 95% CI = 1.46 to 4.34) and Q4 (OR = 1.99, 95% CI = 1.12 to 3.50) of waist circumference (WC) compared to controls. Similarly, cases with p-mTOR overexpressed tumors had a higher odds of being at the Q3 (OR = 1.82, 95% CI = 1.11 to 2.98) and Q4 (OR = 1.81, 95% CI = 1.11 to 2.98) of WHR compared to controls. These associations of WC and waist-to-hip ratio (WHR) did not differ by tumor p-mTOR status (P-heterogeneity = 0.27 and 0.48, respectively).

Conclusions
Our findings suggest that in this population composed of predominately Black women, body fatness is associated with breast cancer differently for p-mTOR overexpression and p-mTOR negative/low expression. Whether mTOR plays a role in the obesity and breast cancer association warrants confirmation by prospective studies.
‘Relearning how to think’: A brief online intervention to modify biased interpretations in emotional disorders—study protocol for a randomised controlled trial
Authors: Nieto Inés , Vazquez Carmelo 
Published: July 2021

Abstract
Background
Cognitive biases play an important role in the development and maintenance of emotional disorders, such as depression and anxiety. Novel procedures, known as Cognitive Bias Modification (CBM), aim to reduce these dysfunctional information processing modes. This study develops a brief clinically based online intervention programme to modify biased interpretations in depression and anxiety (CBM-IClin), overcoming some methodological issues that have been addressed in previous literature.

Methods
Volunteer participants will be recruited via social media and posters at the university. They will be randomly assigned to an experimental group or a waiting list control group. Both groups will complete two assessment sessions (before and after the intervention) consisting of questionnaires measuring cognitive and emotional variables as well as experimental tasks measuring cognitive biases (i.e. attention, memory, and interpretation). After the first assessment session, only participants in the experimental group will receive a link to follow the four CBM-IClin sessions at home. All participants will receive, via email, follow-up questionnaires 2 weeks and 3 months after the second assessment.

Discussion
This study will test the 'Relearning how to think', an online programme potentially beneficial to modify cognitive biases in emotional disorders. Several limitations of previous CBM procedures are addressed, and the impact of the programme both on objective cognitive bias tasks and clinical symptoms will be explored.

Trial registration
ClinicalTrials.gov NCT03987477. Prospectively registered on June 17, 2019