bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomised Clinical Trial: Effect of Adding Branched Chain Amino Acids to Exercise and Standard-of-care on Muscle Mass in Cirrhotic Patients With Sarcopenia
Authors: Mohta Srikant , Anand Abhinav , Sharma Sanchit , Qamar Sumaira , Agarwal Samagra , Gunjan Deepak , Singh Namrata , Madhusudhan Kumble Seetarama , Pandey Ravindra Mohan , Saraya Anoop 
Published: September 2021

Abstract
BackgroundsThe role of branched chain amino acids (BCAA) in improving muscle mass in cirrhosis is presently debatable. AimsTo evaluate the role of BCAA in improving the muscle mass in a double-blind randomized placebo-controlled trial in patients with cirrhosis having sarcopenia.Methods Consecutive patients with cirrhosis with Child Pugh score<10 and sarcopenia were randomized to receive either 12g/day of BCAA orally or a placebo(1:1) for 6 months in addition to a home-based exercise program(30 minutes/day), dietary counselling and standard medical therapy. Sarcopenia was defined according to gender-specific axial skeletal muscle index(SMI) cut-offs. The primary end point was change in muscle mass based on CT scan(SMI) after 6 months of supplementation.ResultsSixty patients (mean age 41.6±9.9 years; males(66.6%) of predominantly viral(40%) and alcohol-related(31.7%) cirrhosis were randomized. Baseline clinical and demographic characters were similar except MELD score (10.2 ± 2.8 vs. 12.2 ± 3.5, p=0.02) and calorie intake (1838.1kcal ± 631.5 vs. 2217.5kcal ± 707.3, p=0.03), both being higher in the placebo arm. After adjusting for both baseline confounders, baseline SMI and protein intake, the change in SMI at 6 months was similar in both groups [mean adjusted difference(MAD) +0.84, CI -2.9; +1.2, p=0.42] by intention-to-treat analysis. The secondary outcomes including change in hand grip strength(p=0.65), 6-meter gait speed(p=0.20), 6-minute walk distance(p=0.39) were similar in both arms. Four patients had minor adverse events in each arm.ConclusionAddition of BCAA to exercise, dietary counselling and standard medical therapy did not improve muscle mass in patients with cirrhosis having sarcopenia. (CTRI/2019/05/019269).
Exosomal miR-301a-3p from Esophageal Squamous Cell Carcinoma Cells Promotes Angiogenesis by Inducing M2 Polarization of Macrophages via the PTEN/PI3K/AKT Signaling Pathway
Authors: Shou Yuwei , Wang Xiaoqian , Chen Chao , Liang Yinghao , Yang Chenbo , Xiao Qiankun , Li Hui , Wang Shuaiyuan , Shu Jiao , Tian Xiangyu , Chen Kuisheng 
Published: September 2021

Abstract
Background: Growing evidence has indicated that tumor-associated macrophages (TAMs) promote tumor angiogenesis. However, the mechanisms underlying the pro-angiogenic switch of TAMs remains unclear. Here, we examined how exosomal miR-301a-3p secreted by esophageal squamous cell carcinoma (ESCC) cells triggers the pro-angiogenic switch of TAMs.Methods: We quantified miR-301a-3p levels in ESCC tumors using qRT-PCR. Macrophage phenotypes were identified using flow cytometry and qRT-PCR. The pro-angiogenic ability of TAMs was measured using the CCK-8 assay, scratch assay, Transwell migration and invasion assay, and tube formation assay. The mechanism by which exosomal miR-301a-3p secreted by ESCC cells triggers the pro-angiogenic switch of TAMs was elucidated using western blots, qRT-PCR, and a dual-luciferase reporter assay.Results: We observed anomalous miR-301a-3p overexpression in ESCC tumor tissues and cell lines. Then, we verified that ESCC-derived exosomes promoted angiogenesis by inducing macrophage polarization into M2 type, and exosomal miR-301a-3p secreted by ESCC cells was responsible for this effect. Finally, we discovered that exosomal miR-301a-3p promoted M2 macrophage polarization via the inhibition of PTEN and activation of the PI3K/AKT signaling pathway, subsequently promoting angiogenesis via the secretion of VEGFA and MMP9.Conclusion: The pro-angiogenic switch of TAMs is triggered by exosomal miR-301a-3p secreted from ESCC cells via the PTEN/PI3K/AKT signaling pathway. Although tumor angiogenesis can be regulated by a wide range of factors, exosomal miR-301a-3p could hold promise as a novel anti-angiogenesis target for ESCC treatment.
Effect of Physiological Status And Parity On Metabolic And Trace Elements Profile of Crossbred Rambouillet Sheep of Himalayan Region
Authors: SINGH RAJIV , SINGH A , BEIGH S A , SHARMA N , SINGH V 
Published: September 2021

Abstract
The study was designed to evaluate the effect of physiological status and parity on metabolic profile in crossbred Rambouillet ewes of Himalyan region. The study was conducted on 20 ewes divided into two groups, primiparous (PP) and multiparous (MP) with 10 ewes in each group. Blood samples were collected on 4- and 1-week pre-lambing and 1- and 4-weeks post-lambing to measure metabolic parameters and minerals. The glucose(p<0.01), Total plasma protein (TPP) (p<0.05), albumin (p<0.05), BUN (p<0.05), cholesterol (p<0.05), triglyceride (p<0.01), HDL-C (P<0.05), Calcium (p<0.01), Phosphours (p<0.05), Magnesium (p<0.01), Cu (p<0.05), and Zn (p<0.01) levels revealed significant change along the time with the concentration decreasing 3 weeks pre lambing to immediate post lambing thereafter levels increased steadily. Significant increase (P<0.01) was observed in NEFA, AST, GGT, Iron(P<0.05), and bilirubin (P<0.05) concentrations along the sampling time. No group difference was observed in any of the parameters however, parity and time interaction was observed in Glucose, NEFA, GGT, calcium, and phosphorus. While NEFA levels were significantly high in pre-lambing in PP ewes compared to MP ewes, the post-lambing levels were significantly high in MP ewes. Pre-lambing levels of GGT were at par between the two groups; however, post-lambing levels were significantly high in MP ewes. Glucose, Ca and Pi were low during pre-lambing in PP ewes and post-lambing in MP ewes. The result showed that ewes shows a significant change in metabolic profile and trace minerals during late gestation and immediate post-partum, however these changes were more pronounced during late gestation in primiparous and post lambing in multiparous.
Improving Prioritisation Processes for Clinical Practice Guidelines: New Methods and an Evaluation From the National Heart Foundation of Australia.
Authors: Atkins Brooke , Briffa Tom , Connell Cia , Buttery Amanda , Jennings Garry 
Published: September 2021

Abstract
BackgroundReleasing timely and relevant clinical guidelines is challenging for organisations globally. Priority setting is crucial as guideline development is resource intensive. Our aim, as a national organisation responsible for developing cardiovascular clinical guidelines, was to develop a method of generating and prioritising topics for future clinical guideline development in areas where guidance was most needed.MethodsSeveral novel processes were developed, adopted and evaluated including: 1) initial public consultation for health professionals and the general public to generate topics; 2) thematic and qualitative analysis, according to the International Classification of Diseases (ICD-11), to aggregate topics; 3) adapting a criteria-based matrix tool to prioritise topics; 4) achieving consensus through modified-nominal group technique and voting on priorities; and 5) process evaluation via survey of end-users. The latter was comprised of the organisation’s Expert Committee of 12 members with expertise across cardiology and public health, including two citizen representatives.ResultsTopics (n=405; reduced to n=278 when duplicates removed) were identified from public consultation responses (n=107 respondents). Thematic analysis synthesised 127 topics that were then categorised into 37 themes using ICD-11 codes. Exclusion criteria were applied (n=32 themes omitted), resulting in 5 short-listed topics: 1) congenital heart disease; 2) valvular heart disease; 3) hypercholesterolaemia, 4) hypertension and 5) ischaemic heart diseases and diseases of the coronary artery. The Expert Committee applied the prioritisation matrix to all five short-listed topics during a consensus meeting and voted to prioritise topics. Unanimous consensus was reached for the topic voted the highest priority: ischaemic heart disease and diseases of the coronary arteries, resulting in the decision to update the organisation’s 2016 clinical guidelines for acute coronary syndromes. Evaluation indicated that initial public consultation was highly valued by the Expert Committee, the matrix tool was easy to use and improved transparency in priority setting.ConclusionDeveloping a multistage, systematic process, incorporating public consultation, and an international classification system led to improved transparency in our clinical guideline priority setting processes and that topics chosen would have the greatest impact on health outcomes These methods are potentially applicable to other national and international organisations responsible for developing clinical guidelines.
High Expression of CXCL10/CXCR3 in Ventilator-Induced Lung Injury Caused by High Mechanical Power
Authors: Xie Yongpeng , Zheng Hui , Mou Zhifang , Wang Yanli , Li Xiaomin 
Published: September 2021

Abstract
Background: The energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). However, the effect of the ventilator-induced lung injury (VILI) in patients suffering of acute respiratory distress syndrome (ARDS) is still unknown. Our previous studies revealed that CXCL10 may be a potential biomarker of lung injury in ARDS. Therefore, the aim of this study was to compare the lung injury of rats and patients under different MP conditions to explore the involvement of CXCL10 and its receptor CXCR3 in VILI. Methods: Patients were divided into high mechanical power group (HMP) and low mechanical power group (LMP), while rats were assigned to the high mechanical power group (HMP), medium mechanical power group (MMP) and low mechanical power group (LMP). CXCL10 and CXCR3 plasma content in ARDS patients and rats under ventilation at different MP was measured, as well as their protein and mRNA expression in rat lungs. Results: CXCL10 and CXCR3 content in the plasma of ARDS patients in the HMP was significantly higher than that in the LMP. The increase of MP during mechanical ventilation in the rats gradually increased lung damage, and CXCL10 and CXCR3 level in rat plasma gradually increased with the increase of MP. CXCL10 and CXCR3 protein and mRNA expression in the HMP group and MMP group was significantly higher than that in the LMP group (P<0.05). More mast cells were present in the trachea, bronchus, blood vessels, and lymphatic system in the rat lungs of the HMP group and the number of mast cells in the HMP group (13.32±3.27) was significantly higher than that in the LMP group (3.25±0.29) (P＜0.05). Conclusion: The higher the MP, the more severe the lung injury, the higher CXCL10/CXCR3 expression. Therefore, CXCL10/CXCR3 might participate in VILI by mediating mast cell chemotaxis.
Support for Lowering Cervical Cancer Screening Age To 25 for Women Living With HIV: Retrospective Cross-Sectional Programmatic Data From Botswana
Authors: Ramogola-Masire Doreen , Grover Surbhi , Mathoma Anikie , Monare Barati , Gabaitiri Lesego , Bazzett-Matabele Lisa , Hofmeyr G Justus , Morroni Chelsea , Luckett Rebecca 
Published: September 2021

Abstract
Background: Women living with human immunodeficiency virus (HIV) tend to develop cervical cancer at a younger age than HIV-negative women. The World Health Organization’s (WHO) new guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention include a conditional recommendation for initiating screening at age 25 for women living with HIV (WLWH). This recommendation is based on low-certainty evidence, and WHO calls for additional data. We describe the association of age and HIV status with visual inspection with acetic acid (VIA) positivity and cervical intra-epithelial neoplasia grade two or higher (CIN2+) in Botswana. Methods: A retrospective cross-sectional study of 5,714 participants aged 25 through 49 years who underwent VIA screening. VIA-positive women received cryotherapy if indicated or were referred for colposcopy. Known cervical cancer risk factors, screening, and histological results were extracted from the program database. We compared the proportions and association of VIA positivity and CIN2+ by age and HIV status.Results: Median age was 35 years [IQR 31-39], and 18% of the women were aged 25-29. Ninety percent were WLWH; median CD4 count was 250 cells/µL [IQR 150-428], and 34.2% were on anti-retroviral treatment (ART). VIA-positivity was associated with younger age (OR 1.48, CI 1.28, 1.72 for 25-29 years versus age 30-49 years ), and HIV-positivity (OR 1.85, CI 1.51, 2.28). CIN2+ was associated with HIV positivity (OR 6.12, CI 3.39, 11.10), and proportions of CIN2+ were similar for both age groups in WLWH (12.1% versus 10.8%).Conclusions: Younger WLWH in Botswana had a significant burden of CIN2+. This finding further supports lowering the screening age for WLWH from 30 to 25.
Cold plasma enamel surface treatment to increase fluoride varnish uptake
Authors: Fathollah S. , Abbasi H. , Akhoundi S. , Naeimabadi A. , Emamjome S. 
Published: September 2021

Abstract
Enamel strengthening to prevent the first stage of caries has been an essential issue in oral health recently. Among the available methods to increase enamel strength, fluoride varnish treatment has relatively better results in preventing tooth decay. Cold plasma capabilities in sterilizing the environment, surface modification, and improving adhesion are well known. Accordingly, this study aims to increase the enamel layer's adhesion hoping that the intensity and time of enamel interaction with FV and the absorption of fluoride ions will increase. Accordingly, we randomly divided twenty bovine teeth into two groups A (consisting of four teeth) and B (composed of four subgroups, each containing four teeth). Samples of group A and one specimen of each subset B investigate the effect of using Helium-DBD (He-DBDJ), Argon (ArJ), and Air-DBD jet on the enamel surface. Other B specimens are devoted to the study of the release of FV fluoride ions from processed enamel. The scanning electron microscope (SEM) images show that although ArJ and Air-DBD have significantly damaged the enamel's hexagonal structures, they are only changed from convex to concave in the He-DBDJ case. For this reason, enamel effectively enhances the capacity to accept more FV. The energy-dispersive X-ray spectroscopy (EDX) indicates an increase in calcium ratio to phosphorus and the amount of fluoride and sodium absorption in the enamel layer in processing with He-DBDJ plasma. The latter helps restore the damaged parts of the enamel. Analysis of fluoride released from the FV did not show a significant change owing to plasma processing. The combination of Cold plasma and varnish fluoride on treatment enamel could be unique ability to improve reinforcement of tooth enamel against of tooth decay.
Impact of Type 2 Diabetes on the Association Between Neurodegenerative Diseases and Cancer in Elderly Koreans: A 10-year Retrospective Cohort Study Using the National Health Insurance Service Database
Authors: Kim Hee-Cheol , Kim Ji-Hun , Lee Ho-Jun , Kim Yang-Tae , Jang Byeong-Churl 
Published: September 2021

Abstract
BackgroundSome studies suggest that cancer and type 2 diabetes (T2D), as well as neurodegenerative diseases (NDs), are related to protein misfolding and possibly to each other. This study aimed to investigate the association between NDs and cancer, and to determine the impact of T2D on the association between NDs and cancer.MethodsA population-based 10-year follow-up study was conducted using the Korean National Health Insurance Service Database between 2002 and 2015. The study population included an ND group (n = 9,292) and control group (n = 46,742), aged ≥60 years. A multivariable Cox proportional hazards regression model was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for cancer risk.ResultsVarious another NDs and/or T2D were newly diagnosed in ND and control groups during the 10-year follow-up periods. Newly developed another ND cases before cancer onset were 2,412 (26.0%) in the ND group and 15,435 (33.0%) in the control group (χ2 = 178.19, p < 0.01). Newly developed T2D cases before cancer onset were 4,691 (50.5%) and 25,695 (55.0%) in the ND and control groups, respectively (χ2 = 62.89, p < 0.01). As of December 31, 2015 (the end of the observation period), the number of cancer patients in the ND group was 2,040 (22.0%) and that in the control group was 8,628 (18.5%) (χ2 = 61.45, p < 0.01). The ND group was associated with an increased risk of cancer (HR, 1.25; 95% CI, 1.19–1.31). In both groups, newly diagnosed another NDs and T2D showed an additive effect on cancer incidence during the follow-up period. The additive effect on cancer incidence was higher in T2D than in ND.ConclusionThis study showed a positive association between NDs and cancer, and an additive effect of T2D on this association. Further replication studies are needed to address the association among NDs, cancer, and T2D.
Emerging Technology Innovation in Gaza Strip Municipalities: An Entrepreneurial Approach
Authors: AlAstal Ashraf 
Published: September 2021

Abstract
To boost corporate efficiency in both the public and private sectors, innovation is fundamental. Efficient technological transfer and the role of public-private sector collaboration play a major role in the modern growth of knowledge-based economies. As a public service organization, municipalities normally coordinate with all partners to draw up strategies and use them in communities. A new vision is needed for the Gaza Strip municipalities, where all public and private stakeholders work together to co-design and co-develop new cutting-edge products and services aimed at generating shared value through entrepreneurial behaviour. However, concrete examples of smart city projects revealed that municipalities often do not have the necessary capabilities as well as innovative approaches to collaborate with start-ups and other stakeholders’ ecosystems. So, this paper aims at analyzing (open) innovation in the municipal sector shedding lights on the barriers and challenges that municipalities in Gaza Strip face in smart city development. This study uses primary data gathered from various stakeholders through focus groups, semi-structured interviews and webinars to demonstrate how municipalities can work to address challenges in the smart city context, and to promote an ecosystem of entrepreneurship and innovation. Gaza Strip municipalities need to offer the necessary conditions for entrepreneurial talents who can bring their creative mindset, and technological experiences to the table, making it possible to build the best teams to solve any challenge. The research also concluded that Open Innovation Platforms can be seen as an important tool for enabling start-ups and researchers in developing emerging technologies.
Application of Objective Structured Clinical Examinations (OSCE) for The Evaluation of Kampo Medicine Training
Authors: Amitani Marie , Amitani Haruka , Suzuki Hajime , Kawazu Suguru , Mizuma Kimiko , Yamaguchi Kojiro , Oki Toshimichi , Nitta Hideaki , Sonoda Takuro , Kawano Keiko , Tanaka Yasuhiro , Uto Nanami , Ibusuki Rie , Arita Ryutaro , Takayama Shin , Mitsuma Tadamichi , Takezaki Toshiro , Asakawa Akihiro , Owaki Tetsuhiro 
Published: September 2021

Abstract
Background
The purpose of study was to develop an objective, valid, and reliable assessment method for Kampo medicine using an OSCE for the evaluation of clinical competence in Kampo medicine
Methods
We developed a blueprint followed by a list of 47 assessment items and three task scenarios related to clinical competence in Kampo medicine. An eight-member test committee checked the relevance and pass/fail criteria of the assessment items on a Likert scale. We calculated a content validity index and content validity ratio, and used the Angoff method to set the passing threshold. We trained a total of nine simulated patients with three assigned to each scenario. We conducted an OSCE for 11 candidates with varying medical abilities, and conducted three stations per person, and one evaluator in one room by direct observation evaluated. We used video recordings to test the inter-rater reliability of the three raters. We used the test results to verify the reliability of the evaluation scale.
Results
The inter-rater reliability (Cronbach’s α) was 0.92–1.00, intra-examinee reliability was 0.59–0.95, and the reliability of each task was 0.86, 0.89, and 0.86 for Scenarios 1, 2, and 3, respectively.
Conclusions
We developed a content-valid new OSCE assessment method for Kampo medicine and obtained high inter-rater and test reliabilities. Our findings suggest that this is one of the most reliable and valid evaluation methods for assessing clinical competence in Kampo medicine.
Skeletal Muscle Loss During Neoadjuvant Chemotherapy Predicts Poor Prognosis in Patients with Breast Cancer
Authors: Amitani Masatsugu , Oba Takaaki , Morikawa Hiroki , Chino Tatsunori , Soma Ai , Shimizu Tadafumi , Ohno Koichi , Ono Mayu , Ito Tokiko , Kanai Toshiharu , Maeno Kazuma , Ito Ken-ichi 
Published: September 2021

Abstract
Background: The skeletal muscle index (SMI), which is calculated as the ratio of skeletal muscle area at the third lumbar vertebral level divided by height squared, has been considered a prognostic factor in patients with breast cancer. However, the prognostic impact of changes in SMI during treatment remains unclear. This study aimed to evaluate the influence of SMI changes in patients with breast cancer undergoing neoadjuvant chemotherapy (NAC).Methods: We reviewed patients with breast cancer who underwent NAC and subsequent surgery for breast cancer between 2010 and 2017. The rate of SMI change during NAC was calculated, and the association between SMI changes and prognosis was retrospectively analyzed.Results: In total, 144 patients were evaluated. 48 (33.3%), 56 (38.9%), and 40 (27.8%) patients exhibited increased (≥ 3%), maintained (−3% <, < 3%), and decreased (−3% ≥) SMI during NAC, respectively. The decreased SMI group showed significantly poorer disease-free survival than the maintained and increased SMI groups (hazard ratio [HR] 8.82, p < 0.001 for the decreased vs. increased SMI groups; HR 3.72, p < 0.001 for the decreased vs. maintained SMI groups). Moreover, decreased SMI was an independent risk factor for disease-free survival in multivariate analysis (HR 4.20, p < 0.01).Conclusions: Skeletal muscle loss during NAC predicts poor prognosis. Our results underscore the importance of monitoring and maintaining skeletal muscle mass during NAC.