bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis
Authors: Ko Ching-Chung , Hung Kuo-Chuan , Illias Amina M. , Chiu Chong-Chi , Yu Chia-Hung , Lin Chien-Ming , Chen I-Wen , Sun Cheuk-Kwan 
Published: February 2023

Background: The primary objective of this study was to compare the risk of hypotension, as well as the induction and recovery characteristics between remimazolam and propofol in patients receiving surgery under general anesthesia.Methods: The Embase, Medline, Google scholar, and the Cochrane Library databases were searched from inception to March 2022 for randomized controlled trials The primary outcome was the risk of post-induction hypotension between the two agents, while the secondary outcomes included anesthetic depth, induction efficacy, time to loss of consciousness (LOC), hemodynamic profiles, time to eye opening, extubation time as well as the incidence of injection pain and postoperative nausea/vomiting (PONV).Results: Meta-analysis of eight studies published from 2020 to 2022 involving 738 patients revealed a significantly lower risk of post-induction hypotension with the use of remimazolam compared to that with propofol [risk ratio (RR) = 0.57, 95% confidence interval (CI): 0.43 to 0.75, p &lt; 0.0001, I2 = 12%, five studies, 564 patients]. After anesthetic induction, the anesthetic depth measured by bispectral index (BIS) was lighter in the remimazolam group than that in the propofol group (MD = 9.26, 95% confidence interval: 3.06 to 15.47, p = 0.003, I2 = 94%, five studies, 490 patients). The time to loss of consciousness was also longer in the former compared to the latter (MD = 15.49 s, 95%CI: 6.53 to 24.46, p = 0.0007, I2 = 61%, three studies, 331 patients). However, the use of remimazolam correlated with a lower risk of injection pain (RR = 0.03, 95%CI: 0.01 to 0.16, p &lt; 0.0001, I2 = 0%, three studies, 407 patients) despite comparable efficacy of anesthetic induction (RR = 0.98, 95%CI: 0.9 to 1.06, p = 0.57, I2 = 76%, two studies, 319 patients). Our results demonstrated no difference in time to eye opening, extubation time, and risk of PONV between the two groups.Conclusion: Remimazolam was associated with a lower risk of post-induction hypotension after anesthetic induction compared with propofol with similar recovery characteristics. Further studies are required to support our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/; Identifier: CRD42022320658.
Averrhoa carambola leaves prevent dyslipidemia and oxidative stress in a rat model of poloxamer-407-induced acute hyperlipidemia
Authors: Abduh Maisa Siddiq , Saghir Sultan A. M. , Al Hroob Amir M. , Bin-Ammar Albandari , Al-Tarawni Ayat H. , Murugaiyah Vikneswaran , Mahmoud Ayman M. 
Published: February 2023

Background:The star fruit [Averrhoa carambolaL (Oxalidaceae)] is traditionally used in the treatment of many ailments in many countries. It possesses several pharmacological activities, including antioxidant and anti-inflammatory effects. However, it contains the neurotoxic caramboxin and its high content of oxalic acid limits its consumption by individuals with compromised kidney function. This study assessed the anti-hyperlipidemic and antioxidant activities of different fractions of the methanolic extract ofA. carambolaleaves (MEACL).Methods:The antioxidant activity was investigated using FRAP, and ABTS and DPPH radical-scavenging assays and the inhibitory activity toward pancreatic lipase (PL) and HMG-CoA reductase was assayedin vitro. Acute hyperlipidemia was induced by poloxamer-407 (P-407) in rats and different fractions of MEACL (n-hexane, chloroform,n-butanol, ethyl acetate (EA), water, and chloroform) were orally administered. Cholesterol and triglycerides were determined at 0, 12, 24, and 48 h and LDL-C, vLDL-C, HDL-C, lipid peroxidation (LPO) and antioxidants were assayed after 48 h. The expression of ABCA1, ABCG5, ABCG8, LDL-R, SREBP-1, and SREBP-2 and the activity of HMG-CoA reductase were assayed in the liver of P-407-administered rats treated with the EA fraction.Results:Thein vitrodata revealed potent radical-scavenging activities of MEACL fractions with the most potent effect showed by the EA fraction that also suppressed the activities of HMG-CoA reductase and PL. In P-407-induced hyperlipidemic rats, all fractions prevented dyslipidemia as shown by the decrease in total cholesterol, triglycerides, LDL-C, vLDL-C and atherogenic index. MEACL and its fractions prevented LPO and boosted GSH, superoxide dismutase, glutathione peroxidase, and catalase in P-407-administered rats. The EA fraction showed more effective anti-hyperlipidemic and antioxidant effects than other fractions and downregulated SREBP-2 while upregulated ABCA1 and LDL-R and ameliorated LPL and HMG-CoA reductase in hyperlipidemic rats.Conclusion:MEACL showedin vitroandin vivoantioxidant activity and the EA fraction significantly ameliorated dyslipidemia in a rat model of P-407-induced acute hyperlipidemia by modulating LPL, PL, HMG-CoA reductase, and cholesterolgenesis-related factors. Therefore, the leaves ofA. carambolarepresent a safe alternative for the star fruit particularly in kidney disease patients, and the EA is the most effective anti-hyperlipidemic and antioxidant fraction.
Individuals with a previous symptomatic COVID-19 infection have altered heart rate and blood pressure variability during acute exercise
Authors: Chan Jillian , Senior Hailey , Homitz Jessica , Cashin Niamh , Guers John J. 
Published: February 2023

Introduction: As the number of COVID-19 cases begin to diminish it is important to turn our attention to any long-term issues that may be associated with a prior infection. Cardiovascular defects have been noted following prior SARS-CoV-2 infections. However, less is known about how a previous infection alters the cardiovascular response to exercise. Further, differences may exist during exercise between previously SARS-CoV-2 positive individuals who had symptoms (symptomatic) relative to those who did not have symptoms (asymptomatic). We hypothesized that previously symptomatic (S) COVID-19 recoveries have an altered cardiovascular response to acute exercise relative to both control (CON; never infected), and previously COVID-19 positive asymptomatic (AS) individuals.Methods: Twenty-seven subjects (CON = 9; AS = 9; S = 9) underwent 30 min of submaximal treadmill exercise. During exercise, blood pressure was recorded on the brachial artery every 5 min and 3-lead electrocardiography was measured continuously. Indirect indicators of autonomic nervous system health: heart rate variability and blood pressure variability were measured during each session. Baseline mean arterial pressure (MAP) was taken prior to exercise in seated, standing and supine positions.Results: Blood pressure was similar (p &gt; 0.05) amongst all three groups. There were no differences between average heart rate (HR; CON = 104 ± 4 BPM vs AS = 118 ± 6 BPM vs. S = 112 ± 3 BPM), mean arterial pressure (MAP; CON = 108 ± 4 mmHg vs. AS = 105 ± 13 mmHg vs. S = 108 ± 7 mmHg) or oxygen consumption (VO2) between groups during a bout of exercise. However, the standard deviation of the inter beat intervals of normal sinus beats, a measure of heart rate variability (HRV) (CON = 138 ± 2.8 m vs. AS = 156 ± 6 m vs. S = 77.7 ± 11 m; p &lt; 0.05) and blood pressure variability (BPV; CON = 5.18 ± 1.1 vs. AS = 12.1 ± 0.88 mmHg vs. S = 10.2 ± 10.7 mmHg; p &lt; 0.05) were different in our S group. Further, when HRV was assessed in the frequency domain the very low frequency was different during exercise in the S group relative to the other groups.Discussion: Collectively, these data suggest that a previous symptomatic SARS-CoV-2 infection may alter heart rate and blood pressure regulation during exercise.
Na+ and K+ transport and maturation stage ameloblast modulation
Authors: Ngu Jake , Bronckers Antonius L. J. J. , Katsura Kaitlin , Zhang Yan , Den Besten Pamela K. 
Published: February 2023

Introduction: Enamel mineralization requires calcium transport into the extracellular matrix for the synthesis of hydroxyapatite (HA) crystals. Formation of HA releases protons into the matrix, which are then neutralized when ameloblasts modulate from cells with apical invaginations, the so-called ruffle-ended ameloblasts (RE), to smooth-ended ameloblasts (SE). Ameloblast modulation is associated with the translocation of the calcium exchanger Nckx4 to the apical border of RE, to remove Na+ from the enamel matrix in exchange for Ca2+ and K+. As enamel matures, Na+ and K+ in the matrix progressively decrease. However, the transporter to remove K+ from mineralizing enamel has not been identified.Methods: Expression of K+ exchangers and channels in secretory and maturation stage of enamel organs were compared following an RNA-seq analysis. Kcnj15, which encodes the Kir4.2 inwardly rectifying K+ channel, was found to be the most upregulated internalizing K+ transporter in maturation stage of enamel organs. Kir4.2 was immunolocalized in wt, Nckx4−/−, Wdr72−/−, and fluorosed ameloblasts. Regulation of Wdr72 expression by pH was characterized in vitro and in vivo.Results: Kir4.2 immunolocalized to the apical border of wild type (wt) mouse RE and cytosol of SE, a spatial distribution pattern shared by NCKX4. In Nckx4−/− ameloblasts, Kir4.2 also localized to the apical surface of RE and cytosol of SE. However, in fluorosed and Wdr72−/− ameloblasts, in which vesicle trafficking is disrupted, Kir4.2 remained in the cytosol. In vitro, Wdr72 was upregulated in LS8 cells cultured in medium with a pH 6.2, which is the pH of the enamel matrix underlying RE, as compared to pH 7.2 under SE.Conclusion: Taken together these results suggest that Kir4.2 participates in K+ uptake by maturation ameloblasts, and that K+ and Na+ uptake by Kir4.2 and Nckx4, respectively, may be regulated by pH through WDR72-mediated endocytosis and membrane trafficking.
Predicting VO2max in competitive cyclists: Is the FRIEND equation the optimal choice?
Authors: Jurov Iva , Cvijić Marta , Toplišek Janez 
Published: February 2023

Predicting VO2max in athletes is vital for determining endurance capacity, for performance monitoring, in clinical diagnostic procedures, and for disease management. This study aimed to assess the most suitable equation for predicting VO2max in competitive cyclists. Competitive cyclists (496 males, 84 females, Caucasian, 580 total) were included in the study from 1 January 2014 to 31 December 2019. Only subjects who were actively participating in national or international competitions and who were registered competitive cyclists and part of cycling teams at the time of the measurements were included. Subjects performed an incremental test on a cycle ergometer, and VO2max was measured as indicated by a plateau in VO2. In addition, four prediction equations (the FRIEND, Storer, Fairbarn, and Jones) were used to estimate VO2max. The predicted VO2max using the FRIEND equation was in good agreement with the measured VO2max in male and female athletes. This was reflected by a high correlation with r = 0.684 for men and r = 0.897 for women (p = 0.000), with ICC = 0.568 (95% CI 0.184, 0.752) for men and ICC = 0.881 (95% CI 0.813, 0.923) for women. Total error was 1.56 and 1.48 ml/min/kg and a minimal bias of−3.6 and −1.1 ml/min/kg (men and women, respectively). Using other equations resulted in a slight decline in agreement with the measured standard. The FRIEND equation predicted VO2max accurately with small total error, small prediction errors, and with the smallest constant error in our study cohort, indicating the potential value of using FRIEND equation also in competitive cyclists. This equation proved to have the highest accuracy both in male and female cyclists.
Impact of COVID-19 on Rocky Vista University medical students’ mental health: A cross-sectional survey
Authors: Paz Dean C. , Bains Manav Singh , Zueger Morgan L. , Bandi Varasiddimounish R. , Kuo Victor Y. , Payton Mark , Ryznar Rebecca Jean 
Published: February 2023

BackgroundThe COVID-19 pandemic brought immense changes to medical school curriculums world-wide, such as the widespread adoption of virtual learning. We sought to better understand the impact on medical students’ mental health at Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States. This study assessed the impact the pandemic had on anxiety and depression levels of medical students. It also assessed the impact of several domains on student mental health during the pandemic and how various sub-groups within the studied population were affected.MethodsA cross-sectional survey was sent to students through an online anonymous google survey in May to June 2021, centered around the 7-item questionnaire used to screen for Generalized Anxiety Disorder GAD-7, 9-item questionnaire used to screen for depression PHQ-9, and self-designed questions to assess the personal impact of the pandemic. Data obtained were screened for error and analyzed with significance value of p &lt; 0.05.ResultsA total of 152 responses were received (25.5% response rate). Of these, 64.1% identified as female, 75.8% were white, 50.3% were between ages 21–25, and 77.8% were first year medical students. During the pandemic, 79.6% of respondents felt more anxious and 65.1% felt more depressed. 67.8% of students reported feeling social isolation amidst the pandemic. Students living with friends were more likely to see a therapist for depression during the pandemic (p = 0.0169) and prescribed an antidepressant (p = 0.0394). Females and students in relationships were more likely to score higher on GAD-7 (p = 0.0194) and (p = 0.0244), respectively.ConclusionThis study investigated the effect of the pandemic on medical students’ mental health and the need to address this issue. Results suggest that the pandemic had a negative impact on medical student’s mental health and that anxiety and depression levels worsened for pre-clinical medical students at Rocky Vista University. As such, it is imperative to incorporate additional resources to protect the well-being of medical students as they progress through their medical careers.
Risk factors of social anxiety in patients with essential tremor
Authors: Hou Lijun , Lei Xiaoguang 
Published: February 2023

ObjectiveTo study the risk factors of social anxiety (SA) in essential tremor (ET) patients.MethodsMotor, cognition, and SA were evaluated using the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS), Mini-Mental State Examination (MMSE), and Liebowitz Social Anxiety Scale (LSAS) for each subject. The potential risk factors of SA in ET were analyzed using univariate analysis.ResultsA total of 80 ET patients and 85 healthy controls completed the evaluation. The LSAS evaluation showed that the prevalence of SA in the ET group was 48.8%, higher than that in controls (12.9%, P &lt; 0.001). Female (OR = 4.959, P = 0.014), younger age (OR = 4.172, P = 0.037), and head tremor (OR = 4.707, P = 0.025) were risk factors of SA among ET patients.ConclusionSA is prevalent in patients with ET. Risk factors, such as female sex, age, and head tremor, should be considered for the prevention and intervention of SA in ET patients.
Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis
Authors: Li Jun , Wu Di , Li Haomiao , Chen Jiangyun 
Published: February 2023

ObjectivesOlder populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China.MethodsThe association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure.ResultsAt baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02–1.35) and lagged (aOR, 1.24; 95% CI, 1.05–1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00–1.64; lagged: aOR, 1.55; 95% CI, 1.17–2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05–1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11–1.99) with increased risk of developing frailty.ConclusionsReducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.
Effects of a cognitive-based intervention program using social robot PIO on cognitive function, depression, loneliness, and quality of life of older adults living alone
Authors: Lim JunSeo 
Published: February 2023

ObjectiveSocial robot interventions are being implemented to reduce cognitive decline, depression, and loneliness among older adults. However, the types, functions, and programs of effective social robots have not yet been confirmed. This study investigated whether a social robot intervention is effective in improving cognitive function, depression, loneliness, and quality of life in older adults living alone.MethodsThis study used a non-equivalent control group pre-test–post-test design. It was conducted twice a week, with each session lasting 50 mi; twelve sessions were conducted over 6 weeks. This study was conducted at three senior welfare centers in Korea. In each group, 10 or fewer participants used the PIO social robot. The total participants included 64 people in the experimental (n = 31) and control groups (n = 33), and consisted of older people over 65 years of age living alone.ResultsThere was a statistically significant difference in the pre-post values for cognitive function (z = 5.21, p &lt; 0.001), depression (z = −2.99, p = 0.003), and loneliness (t = −4.27, p &lt; 0.001) in the experimental and control groups. However, there was no statistically significant difference for quality of life (z = 1.84, p = 0.066).ConclusionsIt was confirmed that a cognitive intervention program using the social robot PIO can improve cognitive function and reduce depression and loneliness in older adults living alone.
What are the sources of contraceptives for married and unmarried adolescents: Health services or friends? Analysis of 59 low- and middle-income countries
Authors: Hellwig Franciele , Barros Aluísio J. D. 
Published: February 2023

BackgroundDespite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status.MethodsWe used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15–19, 20–34, or 35–49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union.ResultsmDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions.ConclusionsOur findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.
Prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under five diarrheic children attending public health facilities in Debre Markos town, Northwest Ethiopia
Authors: Dessale Mesfin , Mengistu Getachew , Mengist Hylemariam Mihiretie 
Published: February 2023

BackgroundUnder five children are at risk of diarrhea-associated morbidity and mortality. Salmonella and Shigella are major causes of diarrhea in under-five children, especially in developing countries. This study aimed to assess the prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under-five diarrheic children in Debre Markos town public health facilities.MethodsA cross-sectional study was conducted at public health facilities in Debre Markos town using a consecutive convenient sampling technique. Data on socio-demographic and associated factors were collected using a structured questionnaire. Salmonella serovars and Shigella species were identified using MacConkey, Xylose Lysine Deoxycholate, Salmonella Shigella agar, and biochemical tests. The antimicrobial resistance pattern was determined by using the modified Kirby-Bauer disk diffusion technique.ResultsThe overall prevalence of Salmonella and Shigella was 11.7% (26/222; 95% CI = 7.2–17.5%). Isolated Salmonella serovars showed a higher rate of resistance (85.7%, 6/7) for both Ampicillin and Amoxicillin/Clavulanic acid while Shigella isolates showed a higher resistance rate to Amoxicillin/Clavulanic acid (78.9%, 15/19) and Ampicillin (73.7%, 14/19). The overall multidrug resistance (MDR) rate of Salmonella and Shigella isolates was 88.5% (23/26). Parent/guardian educational status ≤ elementary school (AOR = 3.783; 95% CI = 1.28–11.19; P = 0.016), presence of two or more under-five children in the family (AOR = 8.999; 95% CI = 2.93–27.69; P &lt; 0.001), unimproved source of drinking water (AOR = 5.010; 95% CI = 1.56–16.10; P = 0.007), the habit of storing cooked foods for later use (AOR = 3.199; 95% CI = 1.07–9.54; P = 0.037), attendance of the child at social gatherings (AOR = 5.387; 95% CI = 1.78–16.35; P = 0.003), and infrequent child fingernail trimming (every ≥ 2 weeks; AOR = 4.693; 95% CI = 1.47–14.94; P = 0.009) showed statistically significant association with the prevalence of culture-confirmed Salmonella and Shigella isolates.ConclusionThe prevalence of culture-confirmed Salmonella and Shigella isolates was significantly high in the study area. Salmonella and Shigella isolates exhibited a high rate of MDR pattern. Parent/guardian education level below the elementary school, the presence of two or more under-five children in the family, using unimproved water source, a habit of storing cooked food, and infrequent fingernail trimming were independent predictors of culture-confirmed Salmonella and Shigella. Therefore, besides public health measures, regular surveillance of the prevalence and antimicrobial resistance pattern of Salmonella and Shigella should be routinely practiced in the study setting.