bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circular RNA Calm4 Regulates Hypoxia-Induced Pulmonary Arterial Smooth Muscle Cells Pyroptosis via the Circ-Calm4/miR-124-3p/PDCD6 Axis
Authors: Jiang Yuan , Liu Huiyu , Yu Hang , Zhou Yang , Zhang Junting , Xin Wei , Li Yiying , He Siyu , Ma Cui , Zheng Xiaodong , Zhang Lixin , Zhao Xijuan , Wu Bingxiang , Jiang Chun , Zhu Daling 
Published: March 2021

Objective:
Circular RNAs are emerging as important regulators of pulmonary hypertension where pyroptosis plays a critical role. However, whether and how the circular RNAs regulate pyroptosis remained unexplored. Here, we show evidence for the involvement of a specific circular RNA known as circ-Calm4 in pulmonary hypertension and the underlying signaling pathway in pyroptosis.

Approach and Results:

Circ-Calm4 was upregulated in both mouse model of pulmonary hypertension in vivo and cultured smooth muscle cells in vitro. We performed immunoblotting, quantitative real-time PCR, LDH (lactate dehydrogenase) release assay, Annexin V-FITC/propidium iodide double staining, Hoechst 33342/propidium iodide fluorescence staining, and immunostaining to clarify the roles of circ-Calm4 in pulmonary arterial smooth muscle cell pyroptosis. Silencing the circ-Calm4 with its small-interfering RNA mitigated the upregulation of pyroptosis related phenotypes induced by hypoxia. Luciferase reporter assays confirmed that miR-124-3p suppressed the luciferase activity of the circ-Calm4 and RNA fluorescence in situ hybridization showed the colocalization of circ-Calm4 and miR-124-3p. The circ-Calm4 was found to act as a competitive endogenous RNA to regulate miR-124-3p. The pyroptosis-related alterations were all diminished with miR-124-3p in hypoxic pulmonary arterial smooth muscle cells. Inhibition of the gene targeted by miR-124-3p encoding the
Pdcd6
(programmed cell death protein 6) abrogated pyroptosis-related phenotypes under hypoxia stimulation.

Conclusions:

Our findings show a new signaling pathway, the circ-Calm4/miR-124-3p/
Pdcd6
axis was demonstrated in regulation of hypoxia-induced pyroptosis, which may potentially be useful for the design of therapeutic strategies for protecting the cellular functionality against pyroptosis as well as pulmonary hypertension.
Late Survival Benefit of Percutaneous Coronary Intervention Compared With Medical Therapy in Patients With Coronary Chronic Total Occlusion: A 10‐Year Follow‐Up Study
Authors: Park Taek Kyu , Lee Seung Hun , Choi Ki Hong , Lee Joo Myung , Yang Jeong Hoon , Song Young Bin , Hahn Joo‐Yong , Choi Jin‐Ho , Gwon Hyeon‐Cheol , Lee Sang Hoon , Choi Seung‐Hyuk 
Published: March 2021

Background
As an initial treatment strategy, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) did not show midterm survival benefits compared with optimal medical therapy (OMT). We sought to evaluate the benefit of PCI compared with OMT in patients with CTO over extended long‐term follow‐up.

Methods and Results

Between March 2003 and February 2012, 2024 patients with CTO were enrolled in a single‐center registry and followed for ≈10 years. We excluded patients with CTO who underwent coronary artery bypass graft (n=477) and classified patients into the CTO‐PCI group (n=883) or OMT group (n=664) according to initial treatment strategy. Patients with multivessel disease received PCI for obstructive non‐CTO lesions in both groups. In the CTO‐PCI group, 699 patients (79.2%) underwent successful revascularization. The CTO‐PCI group had a lower 10‐year rate of cardiac death (10.4% versus 22.3%; hazard ratio [HR], 0.44 [95% CI, 0.32–0.59];
P
<0.001) than the OMT group. After propensity score matching analyses, the CTO‐PCI group had a lower 10‐year rate of cardiac death (13.6% versus 20.8%; HR, 0.64 [95% CI, 0.45–0.91];
P
=0.01) than the OMT group. The relative reduction in cardiac death at 10 years was mainly driven by a relative reduction between 3 and 10 years (8.3% versus 16.6%; HR, 0.43 [95% CI, 0.27–0.71];
P
<0.001) but not at 3 years (5.7% versus 5.0%; HR, 1.12 [95% CI, 0.63–2.00];
P
=0.71). The beneficial effects of CTO‐PCI were consistent among subgroups.

Conclusions
As an initial treatment strategy, CTO‐PCI might reduce late cardiac death compared with OMT in patients with CTO. Extended follow‐up of randomized trials may confirm the findings of the present study.
Time to Thrombolysis and Long-Term Outcomes in Patients With Acute Ischemic Stroke
Authors: Yafasova Adelina , Fosbøl Emil Loldrup , Johnsen Søren Paaske , Kruuse Christina , Petersen Jeppe Kofoed , Alhakak Amna , Vinding Naja Emborg , Torp-Pedersen Christian , Gislason Gunnar Hilmar , Køber Lars , Butt Jawad Haider 
Published: March 2021

Background and Purpose:
It is well-established that increasing treatment delay reduces the benefits of thrombolysis in patients with acute ischemic stroke. However, most studies focus on short-term outcomes. This study examined long-term outcomes according to time to thrombolysis in patients with first-time ischemic stroke.

Methods:
In this nationwide cohort study, all Danish patients with first-time ischemic stroke treated with intravenous thrombolysis between 2011 and 2017 and alive at discharge were identified through the Danish Stroke Registry. The association between time from symptom onset to thrombolysis and the long-term rate of the composite of death and recurrent ischemic stroke was examined using multivariable Cox regression and restricted cubic spline analysis.

Results:
The study population included 6252 patients with first-time ischemic stroke treated with thrombolysis (median age, 69 years [25th–75th percentile 60–78 years], 60% men). The median follow-up was 2.5 years (25th–75th percentile 1.2–4.1 years). The median time to thrombolysis was 138 minutes (25th–75th percentile 101–185 minutes), and the median National Institutes of Health Stroke Scale score at presentation was 5 (25th–75th percentile 3–10). The absolute 3-year risk of the composite outcome was 19.0% (95% CI, 16.4%–21.8%) in the 0 to 90 minute group, 23.3% (21.8%–24.9%) in the 91 to 180 minute group, and 23.8% (21.6%–26.1%) in the 181 to 270 minute group. Compared with thrombolysis within 90 minutes, time to thrombolysis >90 minutes was associated with a higher rate of the composite outcome (91–180 minute: adjusted hazard ratio, 1.25 [95% CI, 1.06–1.48]; 181–270 minutes: adjusted hazard ratio, 1.35 [95% CI, 1.12–1.61]). In restricted cubic spline analysis, the rate of the composite outcome increased with increasing time to thrombolysis and leveled off after 138 minutes.

Conclusions:
In this nationwide cohort of patients with ischemic stroke, the long-term rate of the composite of death and recurrent ischemic stroke increased with increasing time from symptom onset to initiation of thrombolysis.
Communication and Teamwork During Telemedicine-Enabled Stroke Care in an Ambulance
Authors: Joseph Anjali , Chalil Madathil Kapil , Jafarifiroozabadi Roxana , Rogers Hunter , Mihandoust Sahar , Khasawneh Amro , McNeese Nathan , Holmstedt Christine , McElligott James T. 
Published: March 2021

Objective The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance. Background Telemedicine can have a significant impact on acute stroke care by enabling timely intervention in an ambulance before a patient reaches the hospital. However, limited research has been conducted on understanding and supporting team communication during the care delivery process for telemedicine-enabled stroke care in an ambulance. Method Video recordings of 13 simulated stroke telemedicine consults conducted in an ambulance were coded to document the tasks, communication events, and flow disruptions during the telemedicine-enabled stroke care delivery process. Results The majority (82%) of all team interactions in telemedicine-enabled stroke care involved verbal interactions among team members. The neurologist, patient, and paramedic were almost equally involved in team interactions during stroke care, though the neurologist initiated 48% of all verbal interactions. Disruptions were observed in 8% of interactions, and communication-related issues contributed to 44%, with interruptions and environmental hazards being other reasons for disruptions in interactions during telemedicine-enabled stroke care. Conclusion Successful telemedicine-enabled stroke care involves supporting both verbal and nonverbal communication among all team members using video and audio systems to provide effective coverage of the patient for the clinicians as well as vice versa. Application This study provides a deeper understanding of team interactions during telemedicine-enabled stroke care that is essential for designing effective systems to support teamwork.
Methylphenidate exerts neuroprotective effects through the AMPK signaling pathway
Authors: Li P , Huang Y , Yang Y , Huang X 
Published: March 2021

Purpose: Cerebral ischemia is the main cause of permanent adult disabilities worldwide. This study investigated the reparative effects and potential mechanisms of methylphenidate (MPH), a medication for the treatment of attention-deficit/hyperactivity disorder. Methods: In vitro oxygen-glucose deprivation/reperfusion (OGD/R) and in vivo cerebral ischemia-reperfusion models were established. Sprague-Dawley (SD) rats were randomly divided into four groups ( n = 20): Sham, Model, and MPH (0.5 and 1 mg/kg). Rats in MPH groups were treated with 0.5 or 1 mg/kg MPH via intraperitoneal injection for 7 days. Rats in the Sham and Model groups were treated with PBS during the same period. Cell viability was measured using MTT assay. Apoptosis was detected by Annexin V/PI staining. Protein expression was detected by Western blot. The volume of cerebral infarction was detected by triphenyltetrazolium chloride (TTC) staining. The DNA damage in ischemic brain tissues was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Results: MPH treatment significantly reduced OGD/R-induced cell damage, shown by the increased cell viability and decreased apoptotic rate. p-AMPK and p-ACC protein expression increased in the OGD/R model after MPH treatment. The addition of AMPK inhibitor largely abolished the neuroprotective effects of MPH, evidenced by the reduced cell viability, increased apoptotic rate, and decreased protein expression of p-AMPK as well as p-ACC. Moreover, MPH treatment significantly alleviated the cerebral ischemia-reperfusion injury and decreased apoptosis in brain tissues, which may be associated with the AMPK/ACC pathway. Conclusions: MPH exerted protective activities against oxidative stress in the OGD/R model and ameliorated brain damage of rats in the middle cerebral artery occlusion model, at least in part, through activating the AMPK pathway. These data demonstrated neuroprotective properties of MPH and highlighted it as a potential therapeutic agent against cerebral ischemia-reperfusion injury.
Teaching Empathic Communication to Pediatric Interns: Immediate and 3-Month Impact
Authors: Niehaus Jason Z. , Palmer Megan M. , Slaven James E. , Fettig Lyle 
Published: March 2021

Objective: Evaluate pediatric intern self-reported preparedness to Deliver Serious News, Express Empathy, and Medical Error Disclosure after a 1-day simulation based-empathic communication training. Additionally, we sought to evaluate self-reported use of communication skills and describe the clinical scenarios in which the skills were used. Methods: Pediatric interns completed the survey immediately and 3 months after participating in the communication course. Results: Self-reported preparedness to Deliver Serious News, Express Empathy, and Medical Error Disclosure all significantly improved. At 3 months, 73.9% of respondents reported using the skills at least weekly and 62% described the clinical scenarios in which they used skills. These descriptions show an ability to use the skills appropriately, and in some cases apply the skills in advanced, more difficult scenarios. Conclusion: A 1 day simulation-based reflective teaching course for pediatric interns is an effective way to teach empathic communication skills. They feel more prepared to deliver serious news, respond with empathy and disclose a medical error. In addition, the interns value the training as a part of their education and report using the skills in appropriate scenarios at 3 months.
Pluralistic Ignorance as a Contributing Factor to Concussion Underreporting
Authors: Baugh Christine M. , Foster Craig A. , Johnson Brian R. , D’Lauro Christopher 
Published: March 2021

Background Concussion underreporting is endemic, and social norms are an established predictor of concussion reporting behavior. However, pluralistic ignorance—a situation in which most individuals in a group hold the belief that their peers’ views differ from their own, despite views actually being similar—has not been studied in this context. Aim To assess whether pluralistic ignorance contributes to concussion underreporting. Method We surveyed 2,504 military service academy cadets. Each cadet was presented with a survey asking about their willingness to self-report a concussion, their perception of other cadets’ willingness to report a concussion, and personal and demographic factors. Results Most cadets viewed themselves as more willing to report a concussion than others (mean difference = 1.12, 95% CI [1.02, 1.21]), a belief consistent with pluralistic ignorance. Demographic characteristics were associated with holding this belief. For example, female cadets and upper-class cadets were more likely to show this disparity than male or under-class cadets, respectively. Collegiate athletes not only showed similar willingness to report concussion as nonathletes but also perceived other cadets as less likely to report concussions. Meanwhile, future pilots showed less self-report willingness and perceived that others were similarly unwilling to report concussions. Discussion A majority of this economically and geographically diverse population displays characteristics of pluralistic ignorance: They largely share proconcussion reporting sentiments but incorrectly perceive that others do not. This belief is not held uniformly in all subpopulations, which may inform how these beliefs are developed and maintained. Conclusions Pluralistic ignorance is an important consideration in concussion education efforts.
Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia
Authors: Soboksa Negasa Eshete , Gari Sirak Robele , Hailu Abebe Beyene , Mengistie Alemu Bezatu 
Published: March 2021

Background: Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices. Methods: A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used. Results: A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition. Conclusions: Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.
Evaluating Screw Stability After Pedicle Screw Fixation With PEEK Rods
Authors: Wu Jie , Shi Lei , Liu Daohong , Wu Zhigang , Gao Peng , Liu Wenwen , Li Xiaokang , Guo Zheng 
Published: March 2021

Study Design: Animal experiment. Objective: To evaluate whether the use of polyetheretherketone (PEEK) rods for posterior spinal fixation can improve screw stability. Methods: Sheep models of anterior-posterior cervical fusion were used in this study. Six sheep were randomly assigned to the PEEK rod group and titanium alloy group. A total of 8 screws and 2 fixing rods were implanted in each sheep. At 24 weeks postoperatively, a computed tomography (CT) evaluation, pull-out test, micro-CT evaluation and histological evaluation were conducted to evaluate screw stability in the harvested surgical segments. Result: According to the CT evaluation, there were no signs of screw loosening in either group. The pull-out force and energy of the PEEK rod group were significantly higher than those of the titanium alloy rod group. Denser and thicker trabecular bone around the screw was observed in the PEEK rod group according to the micro-CT reconstructed images, and quantitative analysis of the micro-CT data confirmed this finding. In the histological evaluation, more abundant and denser bone trabeculae were also observed in the PEEK rod group. However, there was no significant difference in the bone-screw interface between the 2 groups. Conclusion: Posterior spinal fixation with PEEK rods can increase screw stability by promoting bone growth around the screw but cannot promote bone integration at the bone-screw interface in an animal model study. This finding presents a new idea for clinical practices to reduce screw loosening rate.
HIV-Related Knowledge, Attitudes, Behaviors and Experiences of Kenyan Adolescents Living with HIV Revealed in WhatsApp Group Chats
Authors: Chory Ashley , Nyandiko Winstone , Martin Roxanne , Aluoch Josephine , Scanlon Michael , Ashimosi Celestine , Njoroge Tabitha , McAteer Carole , Apondi Edith , Vreeman Rachel 
Published: March 2021

Introduction: Mobile technologies represent a scalable platform for delivering knowledge and interventions targeting adolescents living with HIV (ALWH) in low and middle income countries. Data from mobile interventions can be used to assess the contextual understanding and experiences of ALWH. Methods: We examined HIV-related knowledge, attitudes, beliefs, behaviors, and experiences of Kenyan ALWH revealed in the contextual data from enrollment in a WhatsApp® group chat intervention. Results: Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. Qualitative analysis of WhatsApp® chat discussions identified a gap in HIV knowledge, high medication-taking literacy, need for mental health support and significant barriers to adherence. Participants discussed challenges with HIV stigma and medication-taking in the school setting. Conclusion: These discussions demonstrate a need for education on HIV topics, mental health support for ALWH, and interventions for stigma mitigation in the school setting.
Endoscopically Assisted, Minimally Invasive Reconstruction for Chronic Achilles Tendon Rupture With a Double-Bundle Flexor Hallucis Longus
Authors: Zou Yunxuan , Li Xue , Wang Lei , Tan Caixia , Zhu Yongzhan 
Published: March 2021

Background: High morbidity has been reported regarding Achilles tendon (AT) injuries, and the upward trend has accelerated since the mid-1990s. A chronic Achilles tendon rupture usually results from a neglected or misdiagnosed acute rupture, and about one-fifth of acute AT ruptures are missed and lead to chronic AT rupture. Although many techniques have been described, there is no gold standard in the treatment of chronic AT ruptures. Hypothesis: Endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle flexor hallucis longus (FHL) tendon would result in improvement of the overall function, with a low rate of wound complications. Study Design: Case series; Level of evidence, 4. Methods: Between May 2015 and November 2016, a total of 19 consecutive patients were enrolled and treated using endoscopically assisted, minimally invasive reconstruction for chronic AT rupture using a double-bundle FHL. The operative assessment comprised the Achilles Tendon Total Rupture Score, the American Orthopaedic Foot & Ankle Society score, the Victorian Institute of Sports Assessment–Achilles score, and a postoperative questionnaire. All postoperative complications were recorded. Results: The mean follow-up time for all patients was 31 months (range, 20-42 months). According to the postoperative questionnaire, the result of surgery was excellent in 8 (42%) of 19 patients, good in 10 (53%), and fair in 1 (5%). All clinical outcome scores (mean ± SD) improved significantly after surgery: Achilles Tendon Total Rupture Score, 23.3 ± 10.3 vs 98.3 ± 9.2 (postoperatively vs preoperatively); American Orthopaedic Foot & Ankle Society, 52.1 ± 12.4 vs 97.5 ± 18.9; and Victorian Institute of Sports Assessment–Achilles, 23.4 ± 11.2 vs 95.7 ± 17.1 ( P < .05). No complications with regard to wound healing or infection were noted. Twelve relatively young patients returned to preinjury activity levels, such as playing basketball or badminton, and the older patients were able to meet their daily needs, such as walking up stairs and jogging. Conclusion: Chronic AT ruptures were successfully treated via minimally invasive reconstruction using a double-bundle FHL, which provided excellent functional improvement. It is best suited for patients with complex requirements who are at high risk for wound complications.