bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneous treatment effects of intensive glycemic control on major adverse cardiovascular events in the ACCORD and VADT trials: a machine-learning analysis
Authors: Edward Justin A. , Josey Kevin , Bahn Gideon , Caplan Liron , Reusch Jane E. B. , Reaven Peter , Ghosh Debashis , Raghavan Sridharan 
Published: April 2022

Abstract
Background
Evidence to guide type 2 diabetes treatment individualization is limited. We evaluated heterogeneous treatment effects (HTE) of intensive glycemic control in type 2 diabetes patients on major adverse cardiovascular events (MACE) in the Action to Control Cardiovascular Risk in Diabetes Study (ACCORD) and the Veterans Affairs Diabetes Trial (VADT).

Methods
Causal forests machine learning analysis was performed using pooled individual data from two randomized trials (n = 12,042) to identify HTE of intensive versus standard glycemic control on MACE in patients with type 2 diabetes. We used variable prioritization from causal forests to build a summary decision tree and examined the risk difference of MACE between treatment arms in the resulting subgroups.

Results
A summary decision tree used five variables (hemoglobin glycation index, estimated glomerular filtration rate, fasting glucose, age, and body mass index) to define eight subgroups in which risk differences of MACE ranged from − 5.1% (95% CI − 8.7, − 1.5) to 3.1% (95% CI 0.2, 6.0) (negative values represent lower MACE associated with intensive glycemic control). Intensive glycemic control was associated with lower MACE in pooled study data in subgroups with low (− 4.2% [95% CI − 8.1, − 1.0]), intermediate (− 5.1% [95% CI − 8.7, − 1.5]), and high (− 4.3% [95% CI − 7.7, − 1.0]) MACE rates with consistent directions of effect in ACCORD and VADT alone.

Conclusions
This data-driven analysis provides evidence supporting the diabetes treatment guideline recommendation of intensive glucose lowering in diabetes patients with low cardiovascular risk and additionally suggests potential benefits of intensive glycemic control in some individuals at higher cardiovascular risk.
Nine-fold higher risk of acute myocardial infarction in subjects with type 1 diabetes compared to controls in Norway 1973–2017
Authors: Saeed Maryam , Stene Lars C. , Ariansen Inger , Tell Grethe S. , Tapia German , Joner Geir , Skrivarhaug Torild 
Published: April 2022

Abstract
Background
We aimed to study the cumulative incidence and risk factors (sex, age, calendar year of diabetes onset, country of origin and educational level) of acute myocardial infarction (AMI) in subjects with type 1 diabetes and matched controls.

Methods
A nationwide cohort of subjects with type 1 diabetes diagnosed at age < 15 years in Norway during 1973–2000 was followed until the first AMI event, emigration, death or 31st of December 2017. The Norwegian Childhood Diabetes Registry was linked to five nationwide registries, and up to ten sex- and age-matched controls per case were included.

Results
Among 7086 subjects with type 1 diabetes, 170 (2.4%) were identified with incident AMI, compared to 193 (0.3%) of 69,356 controls. Mean age and diabetes duration at first AMI was 40.8 years and 30.6 years, respectively. The probability of AMI after 40 years of follow-up was 8.0% in subjects with type 1 diabetes and 1.1% in controls, aHR 9.05 (95% CI 7.18–11.41). In type 1 diabetes, male sex (aHR 1.45), higher age at onset of diabetes and lower education (higher compared to lower, aHR 0.38) were significantly associated with higher risk of AMI. There was no significant time trend in AMI by calendar year of diabetes onset.

Conclusions
We found nine-fold excess risk of AMI in subjects with type 1 diabetes, and three-fold higher risk in subjects with low versus high education. These results highlight a strengthened focus on prevention of cardiovascular disease, and diabetes education tailored to the subjects’ educational background.
Engineered probiotics
Authors: Ma Junheng , Lyu Yuhong , Liu Xin , Jia Xu , Cui Fangyun , Wu Xiaoheng , Deng Shanshan , Yue Changwu 
Published: April 2022

AbstractEngineered probiotics are a kind of new microorganisms produced by modifying original probiotics through gene editing. With the continuous development of tools and technology progresses, engineering renovation of probiotics are becoming more diverse and more feasible. In the past few years there have been some advances in the development of engineered probiotics that will benefit humankind. This review briefly introduces the theoretical basis of gene editing technology and focuses on some recent engineered probiotics researches, including inflammatory bowel disease, bacterial infection, tumor and metabolic diseases. It is hoped that it can provide help for the further development of genetically modified microorganisms, stimulate the potential of engineered probiotics to treat intractable diseases, and provide new ideas for the diagnosis of some diseases or some industrial production.
A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana
Authors: De-Gaulle Virtue Fiawokome , Kamgno Joseph , Orish Verner N. , Kotoh Agnes , Mbacham Wilfred , Tagbor Harry , Magnussen Pascal 
Published: April 2022

Abstract
Background
Ghana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency facilitated by a free maternal health care policy in Ghana does not correspond with the uptake of IPTp-SP and ITN use among pregnant women. This study sought to elucidate the contextual health system factors influencing the delivery of IPTp-SP and ITN from a related quantitative study conducted in Ghana.

Methods
This is the qualitative section of a mixed-methods study design, where audio recorded key informant interviews (KIIs) were conducted with health workers from across health facilities, districts, regional and national health directorates. The KIIs elicited information on health worker knowledge, perceptions, and rationale for the delivery practices of IPTp-SP and ITN revealed in the quantitative findings. The interviews were transcribed and imported into NVivo for analysis. Using the World Health Organization (WHO) Health Systems Framework as the theoretical basis, thematic analysis was conducted under broad themes of the building blocks. Findings are presented in narrative quotes, with a mindmap used to summarize the various health system factors and their interrelated relationship influencing the delivery of IPTp-SP and ITN.

Results
Health system factors identified included health staff untrained on malaria delivery directives due to an ineffective trainer of trainer (ToT) system. Additionally, health worker confusion on when to commence SP (at quickening or ≥ 16 weeks) was found to result in delayed start of SP. Stock-outs in facilities due to procurement delays at the national level resulted in missed opportunities to deliver SP to eligible pregnant women at the ANC. Similarly, ITN stock outs led to eligible pregnant women not receiving one at ANC clinics.

Conclusion
Poor health worker knowledge on policy directives, a consequence of ineffective training strategy led to delayed delivery of IPTp-SP to eligible pregnant women. Supply chain management challenges related to stock of SP and ITN resulted in missed opportunities to deliver the interventions to pregnant women attending ANC.
Validation and minimally important difference of the Child-OIDP in a socioeconomically diverse sample of Indian adolescents
Authors: Mathur Manu Raj , Nagrath Deepti , Yusuf Huda , Mishra Vijay Kumar , Tsakos Georgios 
Published: April 2022

Abstract
Introduction
While different measures have been validated and used to assess the oral health related quality of life (OHRQoL) of children and adolescents, no previous study has tested the psychometric performance of OHRQoL amongst the most marginalized adolescents, living in extremely deprived neighbourhoods like urban slums and resettlement areas in modern cities. Our study assessed the internal consistency reliability, construct validity and Minimally Important Difference (MID) of the Child-OIDP in a sample of adolescents aged 12–15 years reporting oral health problems that lived in three different types (including two extremely vulnerable) of neighbourhoods (urban slums, resettlement colonies, and middle and upper middle-class neighbourhoods) in the National Capital Territory of Delhi.

Methods
We conducted data analysis on a cross-sectional study, comprising of 840 adolescents. The Child-OIDP was used as a measure of OHRQoL. Internal consistency reliability was tested using the standardized Cronbach’s Alpha Coefficient. The Child-OIDP was also tested for content and construct validity (the latter through the median test), while a distribution-based approach was used to identify the MID.

Results
The Indian Child-OIDP showed good internal consistency, as the Cronbach’s alpha coefficient was 0.77. Inter-item correlation coefficients among the items ranged from 0.13 to 0.50, with the mean inter-item correlation being 0.30. The corrected item-total correlations ranged from 0.30 (social contact) to 0.54 (speaking). For construct validity, the Child-OIDP extent was significantly associated with three subjective oral and general health variables in the expected direction. The calculated effect sizes for these differences indicated that they were moderate (0.50–0.79). We also calculated the standard error of measurement (SEM) of Child-OIDP extent as 0.75.

Conclusion
This study demonstrated that the Indian Child-OIDP is a reliable and valid measure for the assessment of the oral health related quality of life among Indian adolescents especially from marginalised and socioeconomically vulnerable groups. This is an essential step towards assessing oral health and evaluating oral health promotion interventions in those populations and settings.
Sexual function and sexual quality of life in men with genital warts: a cross-sectional study
Authors: Nia Marzieh Hosseini , Rahmanian Fatemeh , Ghahartars Mehdi , Janghorban Roksana 
Published: April 2022

Abstract
Background
Human papillomavirus is the most common sexually transmitted infection, usually passing from one person to another after the first sexual activity. Infection with this virus and the occurrence of genital warts (GWs) could have several effects on patients’ health. This study was performed to evaluate the sexual function and sexual quality of life (SQOL) in men with GWs.

Methods
This cross-sectional study was conducted from September 2019 to March 2020 with a sample size of 105 men with GWs in the dermatology clinic of Shahid Faghihi Hospital in Shiraz University of Medical Sciences, Iran. Data were collected using a demographic questionnaire, the International Index of Erectile Function (IIEF), and the Sexual Quality of Life-Men (SQOL-M) questionnaires and analyzed by descriptive and inferential tests with SPSS software version 22.

Results
The mean score for overall sexual function in men was 48.50 ± 8.89. About 35.2% of men had overall sexual dysfunction (SD). The highest disorder rate was related to the erection domain (85.7%), and the lowest was related to the desire domain (5.7%). In the erection domain, most men (54.3%) experienced mild to moderate erectile dysfunction. The mean score for SQOL-M was 38.36 ± 14.47, and 56.2% of them had a good SQOL.

Conclusions
GWs affected men’s erection more than the other sexual function domains. SD in men with GWs has a significant impact on their SQOL and ED was associated with impaired SQOL. Therefore, it is recommended to pay more attention to SD screening alongside SQOL assessment of men with GW.
Pseudoaneurysm with a fistula to the right ventricle late after surgical repair of type A aortic dissection in a patient with systemic lupus erythematosus
Authors: Shimada Akie , Yamamoto Taira , Endo Daisuke , Nishida Kousuke , Matsushita Satoshi , Asai Tohru , Amano Atsushi 
Published: April 2022

Abstract
Background
Pseudoaneurysm with a shunt to the right ventricle after aortic repair for acute aortic dissection is an extremely rare and life-threatening condition. Surgical treatment is unavoidable, but surgery is complicated, and there are some pitfalls. This study describes the reoperation performed in a patient at a high surgical risk by clarifying the shunt site using multimodality imaging before surgery.

Case presentation
A 69-year-old woman with a history of systemic lupus erythematosus (SLE) and Sjogren’s syndrome presented with a pseudoaneurysm 1 year after emergency surgery for acute type A aortic dissection. Eight years after the first surgery, she experienced sudden chest pain and presented to the emergency department. Her dyspnea worsened; therefore, echocardiography and three-dimensional computed tomography (3DCT) were performed, and a pseudoaneurysm and shunt to the right ventricle were identified. The medical team attempted to close the shunt with a percutaneous catheter but was unsuccessful, and she was referred to our department for surgical treatment. The pseudoaneurysm originating from the proximal side of the aorta was large (diameter = 55 mm), and echocardiography-gated 3DCT identified the shunt from the pseudoaneurysm to the right ventricle. First, extracorporeal circulation was initiated, and resternotomy was performed. We could not insert the left ventricular venting tube from the right side because of the pseudoaneurysm size. Instead, the tube was inserted from the left atrial appendage. We found a half-circumferential disengaged anastomosis around the proximal anastomosis, which formed the large pseudoaneurysm leading to a fistula in the right ventricle. We closed the fistula and performed a Bentall operation. The patient had a good postoperative course and was discharged on postoperative day 21. She continued treatment for SLE and Sjogren’s syndrome, and her inflammatory reaction improved.

Conclusions
We performed a Bentall operation and fistula closure with resternotomy in a patient with type A aortic dissection with SLE and Sjogren’s syndrome. Multimodal imaging is essential in defining the pseudoaneurysm and the fistula surrounding the anatomy while ensuring their resolution and guiding the approach for operation.
Predictive value of ACEF score for clinical prognosis of patients with heavily calcified coronary lesions after percutaneous coronary intervention with rotational atherectomy
Authors: Chen Hongwu , Yu Xiaofan , Qiu Guangquan , Ma Likun 
Published: April 2022

Abstract
Background
To inquiry the predictive value of the age, creatinine, and ejection fraction (ACEF) score for cardiac mortality in patients diagnosed with heavily calcified coronary lesions at 1 year after percutaneous coronary intervention (PCI) with rotational atherectomy (RA).

Methods
275 patients with heavily calcified coronary lesions undergoing PCI with RA in the Department of Cardiology of Anhui Provincial Hospital from January 2017 to December 2019 were consecutively recruited. The primary endpoint event was cardiac death at postoperative 1 year. The ROC curve was used to assess ACEF scoring system and predict cardiac mortality.

Results
In term of ACEF score upon admission, 275 patients were divided into low-to-intermediate risk group (n = 130) with ACEF score < 1.23 and high-risk group (n = 145) with ACEF score ≥ 1.23. The age, gender proportion and left ventricular ejection fraction (LVEF) have a significant difference between the low-to-intermediate risk group and the high-risk group (all P < 0.05). The area under ROC curve for ACEF scoring system to predict cardiac mortality at 1 year after PCI with RA was 0.756 and 0.715, respectively.

Conclusions
ACEF value upon admission can predict the cardiac mortality at 1 year following PCI with RA in heavily calcified coronary lesions patients.
The role of ATP-binding cassette subfamily A in the etiology of Alzheimer’s disease
Authors: Bossaerts Liene , Cacace Rita , Van Broeckhoven Christine 
Published: April 2022

AbstractBackgroundAlzheimer’s disease (AD) is the leading cause of dementia, clinically characterized by memory deficits and progressive cognitive decline. Despite decades of research effective therapies are lacking, and a large part of the genetic heritability remains unidentified.ABCA7andABCA1, members of the ATP-binding cassette subfamily A (ABCA), were identified as AD risk genes in genome-wide association studies. Nevertheless, genetic and/or functional studies propose a link between AD and two other members of the ABCA subclass, i.e., ABCA2 and ABCA5.Main bodyChanges in expression or dysfunction of these transporters were found to increase amyloid β levels. This might be related to the common role of ABCA transporters in cellular cholesterol homeostasis, for which a prominent role in AD development has been suggested. In this review, we provide a comprehensive overview and discussion on the contribution of the ABCA subfamily to the etiopathogenesis of AD.ConclusionsA better understanding of the function and identification of disease-associated genetic variants in ABCA transporters can contribute to the development of novel therapeutic strategies for AD.
The boundaries between complex posttraumatic stress disorder symptom clusters and post-migration living difficulties in traumatised Afghan refugees: a network analysis
Authors: Schiess-Jokanovic Jennifer , Knefel Matthias , Kantor Viktoria , Weindl Dina , Schäfer Ingo , Lueger-Schuster Brigitte 
Published: April 2022

AbstractBackgroundPsychological distress due to the ongoing war, violence, and persecution is particularly common among Afghan asylum seekers and refugees. In addition, individuals face a variety of post-migration living difficulties (PMLDs). Complex posttraumatic stress symptoms are among the most common mental health problems in this population, and were associated with the overall burden of PMLDs. The complex interplay of posttraumatic symptoms has been investigated from a network perspective in previous studies. However, individuals are embedded in and constantly react to the environment, which makes it important to include external factors in network models to better understand the etiology and maintaining factors of posttraumatic mental health problems. PMLDs are a major risk factor for posttraumatic distress and considering their impact in interventions might improve response rates. However, the interaction of these external factors with posttraumatic psychopathological distress is not yet fully understood. Thus, we aimed to illuminate the complex interaction between PMLDs and CPTSD symptom clusters.ObjectiveThe main objective is the exploration of the network structure and the complex interplay of ICD-11 CPTSD symptom clusters and distinct forms of PMLDs.MethodThe symptom clusters of CPTSD and PMLDs were collected within a randomised controlled trial among 93 treatment-seeking Afghan asylum seekers and refugees via a fully structured face-to-face and interpreter assisted interview. Using a network analytical approach, we explored the complex associations and network centrality of the CPTSD symptom clusters and the PMLD factors: discrimination & socio-economical living conditions, language acquisition & barriers, family concerns, and residence insecurity.ResultsThe results suggest direct links within and between the constructs (CPTSD, PMLD). Almost all PMLD factors were interrelated and associated to CPTSD, family concerns was the only isolated variable. The CPTSD symptom cluster re-experiencing and the PMLD factor language acquisition & barriers connected the two constructs. Affective dysregulation had the highest and avoidance the lowest centrality.ConclusionsRe-experiencing and affective dysregulation have the strongest ties to PMLDs. Thus, these domains might explain the strong association of posttraumatic psychopathology with PLMDs and, consequently, prioritization of these domains in treatment approaches might both facilitate treatment response and reduce burden caused by PMLDs.
Stasis ulcer and hydronephrosis after severe genital prolapse: a case report
Authors: Leanza Vito , Di Stefano Alessandra , Paladino Erika Carlotta , Rivoli Luca , Distefano Rosario Emanuele Carlo , Palumbo Marco 
Published: April 2022

Abstract
Introduction and importance
The most common complication of pelvic organ prolapse is stress urinary incontinence, whereas hydronephrosis or stasis ulcers are quite rare and typical of severe stages. The best treatment for this unusual presentation is still controversial. Here we present our approach.

Case presentation
Here we present the case of a 70-year-old White/Caucasian woman who presented to our hospital with genital procidentia lasting for 10 years that was associated with both hydronephrosis and stasis ulcers.

Clinical findings and investigations
The Pelvic Organ Prolapse Quantitation system was used to assess the severity of the prolapse, being evaluated as stage IV with the apical compartment leading. A thorough search of the literature was conducted to find any similar cases and evaluate the best evidence treatment.

Interventions and outcomes
A no-mesh procedure comprising vaginal hysterectomy, axial apex suspension, and anterior and posterior repair with ulcerated skin removal resulted in complete resolution of both mechanical and functional symptoms. At 3- and 6-month follow-up visits, a satisfying vaginal profile without hydronephrosis was seen. The Pelvic Organ Prolapse Quantitation at 6 months follow-up was as follows: Aa -3, Ba -3, C -7; gh 2, pb 3, tvt 9; Ap -3, Bp -3.

Relevance and impact
Pelvic organ prolapse involves many organs and causes further complications, leading seldom to renal insufficiency and stasis ulcers. A temporary solution to the obstruction can be achieved by utilizing a pessary, but this device cannot be applied when a stasis ulcer has been previously established. The use of mesh for pelvic floor repair is controversial, but a previous vaginal ulcer may represent a contraindication. A complete evaluation and a challenging surgery may allow the recovery of complicated and severe pelvic organ prolapse. Native tissue pelvic repair gives no erosion postsurgical risk, which is the typical complication of the prosthesis.
Function of epithelial stem cell in the repair of alveolar injury
Authors: Chan Manwai , Liu Yuru 
Published: April 2022

AbstractAlveoli are the functional units of blood-gas exchange in the lung and thus are constantly exposed to outside environments and frequently encounter pathogens, particles and other harmful substances. For example, the alveolar epithelium is one of the primary targets of the SARS-CoV-2 virus that causes COVID-19 lung disease. Therefore, it is essential to understand the cellular and molecular mechanisms by which the integrity of alveoli epithelial barrier is maintained. Alveolar epithelium comprises two cell types: alveolar type I cells (AT1) and alveolar type II cells (AT2). AT2s have been shown to function as tissue stem cells that repair the injured alveoli epithelium. Recent studies indicate that AT1s and subgroups of proximal airway epithelial cells can also participate alveolar repair process through their intrinsic plasticity. This review discussed the potential mechanisms that drive the reparative behaviors of AT2, AT1 and some proximal cells in responses to injury and how an abnormal repair contributes to some pathological conditions.