bluuebunny/crossref_metadata_2025_split huggingface dataset:
Causal association of NAFLD with osteoporosis, fracture and falling risk: a bidirectional Mendelian randomization study
Authors: Cui Aiyong , Xiao Peilun , Fan Zhiqiang , Lei Jinlai , Han Shuang , Zhang Danlong , Wei Xing , Wang Pengfei , Zhuang Yan 
Published: August 2023

IntroductionThe causal association between non-alcoholic fatty liver disease (NAFLD) and osteoporosis remains controversial in previous epidemiological studies. We employed a bidirectional two-sample Mendelian analysis to explore the causal relationship between NAFLD and osteoporosis.MethodThe NAFLD instrumental variables (IVs) were obtained from a large Genome-wide association study (GWAS) meta-analysis dataset of European descent. Two-sample Mendelian randomization (MR) analyses were used to estimate the causal effect of NAFLD on osteoporosis, fracture, and fall. Reverse Mendelian randomization analysis was conducted to estimate the causal effect of osteoporosis on NAFLD. The inverse-variance weighted (IVW) method was the primary analysis in this analysis. We used the MR-Egger method to determine horizontal pleiotropic. The heterogeneity effect of IVs was detected by MR-Egger and IVW analyses.ResultsFive SNPs (rs2980854, rs429358, rs1040196, rs738409, and rs5764430) were chosen as IVs for NAFLD. In forward MR analysis, the IVW-random effect indicated the causal effect of NAFLD on osteoporosis (OR= 1.0021, 95% CI: 1.0006-1.0037, P= 0.007) but not on fracture (OR= 1.0016, 95% CI: 0.998-1.0053, P= 0.389) and fall (OR= 0.9912, 95% CI: 0.9412-1.0440, P= 0.740). Furthermore, the reverse Mendelian randomization did not support a causal effect of osteoporosis on NAFLD (OR= 1.0002, 95% CI: 0.9997-1.0007, P= 0.231). No horizontal pleiotropic was detected in all MR analyses.ConclusionsThe results of this study indicate a causal association between NAFLD and osteoporosis. NAFLD patients have a higher risk of osteoporosis but not fracture and falling risk. In addition, our results do not support a causal effect of osteoporosis on NAFLD.
Antibodies against angiotensin II receptor type 1 and endothelin A receptor are increased in COVID-19 patients
Authors: Miedema Jelle R. , Janssen Matthijs L. , Thüsen Jan von der , Endeman Henrik , Langerak Anton W. , Hellemons Merel E. , van Nood Els , Peeters Bas W. A. , Baart Sara J. , Schreurs Marco W. J. 
Published: August 2023

BackgroundIncreased titers of autoantibodies targeting the G-protein-coupled receptors angiotensin II type 1 receptor (AT1R) and endotelin-1 type A receptor (ETAR) are associated with severe coronavirus disease 2019 (COVID-19) infection. The aim of this study was to determine whether 1) these antibodies are specifically related to COVID-19 disease pathogenesis or increased during any severe respiratory illness, 2) if they are formed during illness, and 3) if they correlate with inflammatory markers or long-term symptoms.MethodsAntibodies against AT1R, ETAR, and antinuclear antibodies (ANAs) were measured in n=40 prospectively enrolled COVID-19 patients and n=207 COVID-19 patients included in a biobank. Clinical and laboratory findings were prospectively and retrospectively assessed in both cohorts, and results were combined for analysis. The presence of auto-antibodies against AT1R or ETAR in peripheral blood was compared between hospitalized patients with COVID-19 and controls (n=39). Additionally, AT1R and ETAR titers were compared between patients with an unfavorable disease course, defined as intensive care admission and/or death during hospital admission (n=121), to those with a favorable disease course (n=126). A subset of intubated patients with severe COVID-19 were compared to intubated patients with acute respiratory distress syndrome (ARDS) due to any other cause.ResultsSignificantly increased AT1R and ETAR antibody titers were found in COVID-19 patients compared to controls, while titers were equal between favorable and unfavorable COVID-19 disease course groups. On ICU, intubated patients with COVID-19 had significantly increased AT1R and ETAR titers compared to patients with ARDS due to any other cause. The titers did not correlate with baseline inflammatory markers during admission or with diffusion capacity, cognitive impairment, or fatigue measured at 3 months follow-up.ConclusionsIn patients hospitalized for COVID-19, antibodies against AT1R and ETAR are increased compared to controls and patients with ARDS due to other causes than COVID-19. The baseline antibody titers do not correlate with inflammatory markers or long-term symptoms in this study.
Viral Immune signatures from cerebrospinal fluid extracellular vesicles and particles in HAM and other chronic neurological diseases
Authors: Pleet Michelle L. , Welsh Joshua A. , Stack Emily H. , Cook Sean , Johnson Dove-Anna , Killingsworth Bryce , Traynor Tim , Clauze Annaliese , Hughes Randall , Monaco Maria Chiara , Ngouth Nyater , Ohayon Joan , Enose-Akahata Yoshimi , Nath Avindra , Cortese Irene , Reich Daniel S. , Jones Jennifer C. , Jacobson Steven 
Published: August 2023

Background and objectivesExtracellular vesicles and particles (EVPs) are released from virtually all cell types, and may package many inflammatory factors and, in the case of infection, viral components. As such, EVPs can play not only a direct role in the development and progression of disease but can also be used as biomarkers. Here, we characterized immune signatures of EVPs from the cerebrospinal fluid (CSF) of individuals with HTLV-1-associated myelopathy (HAM), other chronic neurologic diseases, and healthy volunteers (HVs) to determine potential indicators of viral involvement and mechanisms of disease.MethodsWe analyzed the EVPs from the CSF of HVs, individuals with HAM, HTLV-1-infected asymptomatic carriers (ACs), and from patients with a variety of chronic neurologic diseases of both known viral and non-viral etiologies to investigate the surface repertoires of CSF EVPs during disease.ResultsSignificant increases in CD8+ and CD2+ EVPs were found in HAM patient CSF samples compared to other clinical groups (p = 0.0002 and p = 0.0003 compared to HVs, respectively, and p = 0.001 and p = 0.0228 compared to MS, respectively), consistent with the immunopathologically-mediated disease associated with CD8+ T-cells in the central nervous system (CNS) of HAM patients. Furthermore, CD8+ (p &lt; 0.0001), CD2+ (p &lt; 0.0001), CD44+ (p = 0.0176), and CD40+ (p = 0.0413) EVP signals were significantly increased in the CSF from individuals with viral infections compared to those without.DiscussionThese data suggest that CD8+ and CD2+ CSF EVPs may be important as: 1) potential biomarkers and indicators of disease pathways for viral-mediated neurological diseases, particularly HAM, and 2) as possible meditators of the disease process in infected individuals.
Individual and combined associations of alanine aminotransferase and hemoglobin with metabolic syndrome in the elderly in Qingdao, China
Authors: Liu Li , Shao Yuhan , Feng Enqiang , Shao Zhugang , Xing Dongming 
Published: August 2023

Background and aimsCombined associations of alanine aminotransferase (ALT) and hemoglobin (Hb) with metabolic syndrome (MetS) have not been assessed yet. The current study investigated the independent and combined relationships between ALT, Hb, and MetS in the elderly.MethodsThe 37,966 elderly participants aged 65 years and older were recruited from community centers in Qingdao, China. The sampled elderly population visited the health centers once a year where they were offered a free health checkup. Based on a combination of ALT and Hb levels categorized by tertile, participants were grouped into nine groups (Group 1–9). Logistic regression models were used to analyze the individual and combined associations of ALT and Hb with MetS.ResultsALT and Hb were both independently related to MetS in both genders. With the elevation of ALT or Hb levels, risks for MetS and its components increased. Compared to the reference group (the 1st tertiles of both ALT and Hb levels), respective odds ratio of combined ALT and Hb for MetS in Group 2–9 ranged from 1.32–3.38 and 1.14–2.31 in men and women after adjusting for age, sex, education, married status, current smoking, current drinking, physical activity, and diet habit.ConclusionALT and Hb were both independently related to MetS and its components. Combined ALT and Hb levels could increase risks of MetS and its components than an elevation in ALT or Hb alone.
Influence of online collaborative learning on social network and academic performance of medical students: lessons learned from the COVID-19 pandemic
Authors: Zhou Yan , Xu Xiaoming , Schönrock-Adema Johanna , Brouwer Jasperina , Bos Nicolaas A. , Diemers Agnes D. 
Published: August 2023

IntroductionThe social distancing restrictions due to the COVID-19 pandemic have changed students’ learning environment and limited their social interactions. Therefore, the objective of this study was to investigate the influence of the social distancing restrictions on students’ social networks, wellbeing, and academic performance.MethodsWe performed a questionnaire study in which 102 students participated before and 167 students during the pandemic. They completed an online questionnaire about how they formed their five peer social networks (study-related support, collaboration, friendship, share information, and learn-from) out-of-class. We performed social network analysis to compare the sizes, structures, and compositions of students’ five social networks before and during the pandemic, between first- and second-year students, and between international and domestic students. Additionally, we performed Kruskal–Wallis H test to compare students’ academic performance before and during the pandemic. We performed thematic analysis to answers for two open-end questions in the online questionnaire to explore what difficulties students encountered during the COVID-19 pandemic and what support they needed.ResultsThe results showed that the size of students’ social networks during the pandemic was significantly smaller than before the pandemic. Besides, the formation of social networks differed between first- and second-year students, and between domestic and international students. However, academic performance did not decline during the COVID-19 pandemic. Furthermore, we identified three key areas in which students experienced difficulties and needed support by thematic analysis: social connections and interactions, learning and studying, and physical and mental wellbeing.ConclusionWhen institutions implement learning with social distancing, such as online learning, they need to consider changes in students’ social networks and provide appropriate support.
Rapid review of factors influencing dietary behaviors in Fiji
Authors: Boxer Benjamin , Trübswasser Ursula , Lesi Viola , Naika Asaeli , Dahal Pradiumna , Sagan Sonya , Joshi Kshitij , Irache Ana , Singh Pragya , Nand Devina , Kama Ateca , Deo Alvina , Goudet Sophie 
Published: August 2023

IntroductionIn Fiji, multiple burdens of malnutrition including undernutrition, overweight/obesity, and micronutrient deficiencies coexist at the individual, household, and population levels. The diets of children, adolescents, and adults are generally unhealthy. The objective of this review was to understand how the dietary behaviors of children, adolescents, and women in Fiji are influenced by individual, social, and food environment factors.MethodsThis rapid review was conducted to synthesize existing evidence, identify research gaps in the evidence base, and make recommendations for future research. The Cochrane Rapid Reviews Methods and the updated guideline for reporting systematic reviews were used. The search strategy for this rapid review was based on the Population Context Outcome [P(E)CO] framework, including search terms for population (children, adolescents, and adults), context (Fiji), and outcome (dietary behaviors). Searches were conducted in PubMed, Scopus, PsycINFO, and Google Scholar.ResultsThe 22 studies included in this review identified different factors influencing dietary behaviors in Fiji. Individual preferences for processed and imported foods, especially of younger generations, and social dynamics, especially gender norms and social pressure, to serve meat and overeat appeared to be prominent in driving dietary habits. The ongoing nutrition transition has led to increasing availability and affordability of ultra-processed and fast foods, especially in urban areas. Concerns about food safety and contamination and climate change and its effect on local food production also appear to influence dietary choices.DiscussionThis review identified different dynamics influencing dietary behaviors, but also research gaps especially with regard to the food environment, calling for an integrated approach to address these factors more systemically.
Global burden of esophageal cancer attributable to smoking: a systematic analysis for the Global Burden of Disease Study 2019
Authors: Wu Shilong , Jiang Wenfa , Li Jiufei , Wu Zeqin , Xu Chenyang , Xie Ning 
Published: August 2023

BackgroundEpidemiological trends of esophageal cancer attributable to smoking remain unclear. This study aimed to estimate the spatiotemporal trends of the esophageal cancer burden attributable to smoking to assist in global esophageal cancer prevention and smoking cessation.MethodsData on esophageal cancer attributable to smoking were obtained from the Global Burden of Disease Study 2019. The number and age-standardized rates of esophageal cancer mortality (ASMR) and disability-adjusted life years (ASDR) were analyzed by age, sex, and location. Joinpoint regression analysis was used to analyze the temporal trends of esophageal cancer burden attributable to smoking over 30 years.ResultsIn 2019, the number of global esophageal cancer deaths and disability-adjusted life years (DALYs) attributable to smoking was approximately 203,000 and 475 million, respectively. The global esophageal cancer deaths and DALYs due to smoking were approximately 1.5-fold increased from 1990 to 2019, but the corresponding ASMR and ASDR had decreased. The heaviest burden occurred in East Asia, Mongolia, and the middle socio-demographic index (SDI) region. The male-to-female ratio was approximately 12.7 in the esophageal cancer deaths and DALYs and was approximately 14.3 in the ASMR and ASDR. The heaviest burden appeared in the 60–74 years age group. The estimated annual percentage change (EAPC) in ASMR was highly negatively associated with ASMR in 1990 (ρ = −0.41, p &lt; 0.001) and SDI in 2019 (ρ = −0.29, p &lt; 0.001).ConclusionDespite reductions in ASMR and ASDR, the esophageal cancer burden attributable to smoking remains heavy, especially in middle SDI regions. Active tobacco control can reduce esophageal cancer burden.
Shaping success: clinical implementation of a 3D-printed electron cutout program in external beam radiation therapy
Authors: Schulz Joseph B. , Gibson Clinton , Dubrowski Piotr , Marquez Caroline M. , Million Lynn , Qian Yushen , Skinner Lawrie , Yu Amy S. 
Published: August 2023

PurposeThe integration of 3D-printing technology into radiation therapy (RT) has allowed for a novel method to develop personalized electron field-shaping blocks with improved accuracy. By obviating the need for handling highly toxic Cerrobend molds, the clinical workflow is significantly streamlined. This study aims to expound upon the clinical workflow of 3D-printed electron cutouts in RT and furnish one year of in-vivo dosimetry data.Methods and materials3D-printed electron cutouts for 6x6 cm, 10x10 cm, and 15x15 cm electron applicators were designed and implemented into the clinical workflow after dosimetric commissioning to ensure congruence with the Cerrobend cutouts. The clinical workflow consisted of four parts: i) the cutout aperture was extracted from the treatment planning system (TPS). A 3D printable cutout was then generated automatically through custom scripts; ii) the cutout was 3D-printed with PLA filament, filled with tungsten ball bearings, and underwent quality assurance (QA) to verify density and dosimetry; iii) in-vivo dosimetry was performed with optically stimulated luminescence dosimeters (OSLDs) for a patient’s first treatment and compared to the calculated dose in the TPS; iv) after treatment completion, the 3D-printed cutout was recycled.ResultsQA and in-vivo OSLD measurements were conducted (n=40). The electron cutouts produced were 6x6 cm (n=3), 10x10 cm (n=30), and 15x15 cm (n=7). The expected weight of the cutouts differed from the measured weight by 0.4 + 1.1%. The skin dose measured with the OSLDs was compared to the skin dose in the TPS on the central axis. The difference between the measured and TPS doses was 4.0 + 5.2%.ConclusionThe successful clinical implementation of 3D-printed cutouts reduced labor, costs, and removed the use of toxic materials in the workplace while meeting clinical dosimetric standards.
Exploring the optimal impact force for chronic skeletal muscle injury induced by drop-mass technique in rats
Authors: Ge Haiya , Wang Zhengming , Yang Zongrui , Shi Jinyu , Lu Jiehang , Wang Yuanyuan , Li Zhengyan , Du Guoqing , Shen Zhibi , Zhan Hongsheng 
Published: August 2023

Introduction:Skeletal muscle injuries are widespread in sports, traffic accidents and natural disasters and some of them with poor prognoses can lead to chronic skeletal muscle damage in the clinic. We induced a chronic skeletal muscle injury by controlling time and contusion force using an acute blunt trauma model that will help us better comprehend the pathological features of chronic skeletal muscle injury.Methods:Several levels of injury were induced by repeatedly striking in 5, 10, and 15 times the gastrocnemius muscle from the same height with 200 g weights. After injury, the markers of muscle injury were assessed at 2 and 4 weeks by serum elisa. Electron microscopy, histologic and immunohistochemical staining, and mRNA analysis were used to evaluate the ultrastructure, inflammation, extracellular matrix decomposition, and anabolism of injured muscle in 2 and 4 weeks.Results:All three different kinetic energies can result in skeletal muscle injuries. However, the injured skeletal muscles of rats in each group could not recover within 2 weeks. After 4 weeks, tissue self-repair and reconstruction caused the damage induced by 5 J kinetic energy to almost return to normal. In contrast, damage induced by 10 J kinetic energy displayed slight improvement compared to that at 2 weeks. Despite this, collagen fibers on the surface of the tissue were disorganized, directionally ambiguous, and intertwined with each other. Myofilaments within the tissue were also arranged disorderly, with blurry and broken Z-lines. Damage caused by 15 J kinetic energy was the most severe and displayed no improvements at 4 weeks compared to 2 weeks. At 4 weeks, IL-1β, IL-6, Collagen I, and Collagen III, MMP2 expressions in the 10 J group were lower than those at 2 weeks, showing a tendency towards injury stabilization.Conclusion:After 4 weeks of remodeling and repair, the acute skeletal muscle injury model induced by 10 J kinetic energy can stabilize pathological manifestations, inflammatory expression, and extracellular matrix synthesis and catabolism, making it an appropriate model for studying chronic skeletal muscle injuries caused by acute injury.
Are “outsiders” in? Exploring the impact of outsourced workers’ perceived insider status and job value status on job performance
Authors: Yang Jean Fan , Shi Wei , Chen Erica Wen , Luo Ben Nanfeng , Zhao Jenny Zejun , Yin Zhechen , Tao Jiaqi 
Published: August 2023

IntroductionOutsourcing, one of the nonstandard employment forms, has been increasingly popular with a wide variety of industries and employers. However, much less is known about its consequences at the employee level, especially relative to standard-employed colleagues. Drawing on social categorization theory and the human resource architecture model, the study was to investigate how outsourced (vs. standard) employment form impacts employees’ perceived insider status and then job performance, as well as the moderating role of job value status.MethodsTo examine these effects, we collected two-wave and multi-source questionnaires from a sample of 147 outsourced employees, 279 standard employees, and their immediate supervisors. And interviews with 31 employees, their supervisors, and human resources personnel provided further support for our findings.ResultsThe results showed that relative to standard employees, outsourced employees were lower in perceived insider status and indirectly worse in job performance. Furthermore, both the comparative effects were stronger among core-status than peripheral-status employees.DiscussionOur study contributes to outsourcing and widely nonstandard employment literature, bringing the research focus from employers to outsourced employees’ psychological and behavioral consequences. Also, we extended literature on the human resource architecture, through a deeper investigation on the issue of employment form-job value status (mis)matching as well as its impacts on employees.
Community hospitals of the future—challenges and opportunities
Authors: Phang Sean Kia Ann , Lin Ming , Kho Yong Xiang , Toh Rui Jie Rachel , Kuah Ting Ting , Lai Yi Feng , Xie JiaJing Kim 
Published: August 2023

BackgroundMedical training through specialization and even subspecialization has contributed significantly to clinical excellence in treating single acute conditions. However, the needs of complex patients go beyond single diseases, and there is a need to identify a group of generalists who are able to deliver cost-effective, holistic care to patients with multiple comorbidities and multi-faceted needs. Community hospitals (CHs) are a critical part of Singapore's shift toward a community-centric care model as the population ages. Community Hospitals of the Future (“CHoF”) represent a series of emerging conversations around approaches to reimagine and redesign care delivery in a CH setting in response to changing care needs.MethodsAn environmental scan in the CH landscape using semi-structured interviews was conducted with 26 senior management, management, and working-level staff from seven community hospitals in Singapore. This environmental scan aims to understand the current barriers and future opportunities for CHs; to guide how CHs would have to shift in terms of (i) care delivery and resourcing, (ii) information flow, and (iii) financing; and to conceptualize CHoF to meet the changing care needs in Singapore.FindingsThe analysis of all transcripts revealed four broad sections of themes: (i) current care delivery in CHs, (ii) current challenges of CHs, (iii) future opportunities, and (iv) challenges in reimagining CHs. An emerging theme regarding the current key performance indicators used also surfaced. Resource limitations and financing structure of CH surfaced as limitations to expanding its capability. However, room for expansion of CH roles tapping on the current expertise were acknowledged and shared.ConclusionWith the current issues of (i) rapidly aging population, (ii) specialist-centric healthcare system, and (iii) fragmentation of care ecosystem, there is a need to further understand how CHoF can be modeled to better tackle them. Therefore, several important questions have been devised to land us in a microscopic view on how to develop CHoF in the right constructs. Demographic changes, patient segmentation, service and regulatory parameters, patient's perspective, care delivery, and financial levers (or lack of) are some of the categories that the interview questions looked into. Therefore, the data gathered would be used to guide and refine the concept of CHoF.