bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective cohort study of the relationship of female genital mutilation with birth outcomes in Somalia
Authors: Kulaksiz Deniz , Abdi Nor Ifrah , Erin Recep , Baki Erin Kubra , Toprak Tuncay 
Published: May 2022

Abstract
Background
Female genital mutilation (FGM) is defined as the partial or complete removal of the external female genitalia for non-medical reasons. There are some complications related to childbirth that concern both the mother and the baby. In this study, we aimed to evaluate the birth outcomes of FGM, which is widely applied in Somalia.

Methods
The study included 268 women who gave birth at 37–42 weeks of gestation with a cephalic singleton, 134 with FGM and 134 without FGM. This study was designed a prospective cohort study and conducted between January 2019 and December 2020. Patients’ ages, duration of delivery, FGM types, caesarean section requirements, before and after birth hemoglobin levels, birth weeks, baby birth weights and perineal tear data were recorded. In addition, we analyzed neonatal intensive care needs and APGAR scores for infants.

Results
In patients with FGM, it was determined that the outlet obstruction increased 2.33 times, perineal tears increased 2.48 times, the need for caesarean section increased 2.11 times compared to the control group, and the APGAR score below 7 at the 5th minute in the children increased 2 times and the need for neonatal intensive care increased 1.87 times.

Conclusions
FGM causes increased risk of perineal tear, prolongation in the second stage of labour, increased need for emergency caesarean section, and increased need for NICU for infants. Prevention of FGM will help reduce both obstetric and neonatal complications.
Curricular changes and interim posts during Covid-19: graduates’ perspectives
Authors: Goble Mary , Whitfield Andrew , Ogden-Newton Joseph , Vivekananda-Schmidt Pirashanthie 
Published: May 2022

Abstract
Background
During the COVID-19 pandemic UK medical schools facilitated the early graduation of their final-year medical students to ‘Foundation interim Year 1 (FiY1) doctors’ through amendments made to curricula and final assessment. Such changes gave opportunity for evaluation. This study therefore aimed to explore 1) graduate perspective on the implementation of FiY1 and 2) how changes to course structures have affected self-reported preparedness for work.

Methods
Questionnaire surveys using Likert scale and free-text responses (n = 45), and semi-structured interviews (n = 7) were conducted with FiY1s from two UK medical schools contrasting in the amendments made to course structures. Data were analysed using quantitative methods and thematic analysis; 44% (n = 20) of respondents believed that governing health bodies had not communicated sufficiently prior to starting work.

Results
Graduates who had sat modified practical and written examinations reported ‘legitimacy’ and feeling more prepared compared to having not sat examinations (practical 100%, n = 17; written 88.3%, n = 15). Graduates from both schools agreed that carrying out assistantships as originally scheduled would have made them feel more prepared (91.1%, n = 41).

Conclusions
The implementation of FiY1 was largely well received by graduates yet assistantship programmes may fulfil a similar role in normal times. Medical schools and governing bodies must ensure effective communication channels exist with students in order to better prepare them for their first posts, especially in times of crisis. Additionally, final examinations contribute to feelings of preparedness for work and instil a sense of legitimacy, a finding which is relevant to working within the current programmatic assessment structure.
Public availability of information from officially accredited medical schools in China
Authors: Li Shaowen , Su Kun , Li Peiwen , Sun Yifei , Pan Ying , Wang Weimin , Cui Huixian 
Published: May 2022

AbstractBackgroundMedical education accreditation in China has been conducted by the Working Committee for the Accreditation of Medical Education (WCAME) and 129 medical schools have completed accreditation by December 2021. Despite studies on the standards, process and effectiveness of accreditation, the actual information transparency of accredited medical schools in China has not been examined. The study investigated the status of publicly available information from WCAME-accredited medical schools in China, and whether public availability of information had significant differences among different types of universities.MethodsThe 129 medical schools’ official websites were reviewed for the 21 criteria of theWFME Global Standards for Quality Improvement: Basic Medical Education. Dichotomous method was used to record information as presence or absence. SPSS was utilized for descriptive and ANOVA analyses.ResultsThe mean of the publicly available information on the 21 criteria was 13.77 ± 3.57, and only 5 (3.9%) accredited medical schools had all relevant information available. Publicly available information on Governance (100%) and Administration (100%) was the most, whereas information on Assessment in support of learning (16.3%) was the least. Public availability of information differed significantly among schools accredited with higher (18.15 ± 2.16), medium (13.69 ± 3.41) and lower results (12.79 ± 3.19) (F = 14.71,p < 0.05). Medical universities and comprehensive universities did not show significant differences in their overall information availability (F = 0.25,p > 0.05). Central government funded universities had a remarkably larger amount of publicly available information than local government funded universities (17.86 ± 1.98 vs. 12.75 ± 2.93,p < 0.05).ConclusionPublic availability of information from the accredited medical schools in China needs to be improved to promote transparency and continuous quality improvement, especially with regard to information on curriculum, assessment and quality assurance. Explicit information availability requirements need to be considered to include in medical education standards, and further studies are warranted to explore which information elements should be made publicly available.
Effects of a smartphone application named “Shared Decision Making Assistant” for informed patients with primary liver cancer in decision-making in China: a quasi-experimental study
Authors: Wang Sitong , Lu Qingwen , Ye Zhixia , Liu Fang , Yang Ning , Pan Zeya , Li Yu , Li Li 
Published: May 2022

Abstract
Background
It is well known that decision aids can promote patients’ participation in decision-making, increase patients’ decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a “Shared Decision Making Assistant” smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China.

Methods
In this quasi-experimental study
, 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the “Shared Decision Making Assistant” application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann–Whitney tests.

Results
Informed PLC patients in the intervention group (“SDM Assistant” group) had significantly lower decision conflict scores than those in the control group. (“SDM Assistant” group: 16.89 ± 8.80 vs. control group: 26.75 ± 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 ± 8.16), decision self-efficacy score (87.75 ± 6.87), decision satisfaction score (25.68 ± 2.10) and knowledge of PLC treatment score (14.52 ± 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of “regret of decision making” between the two groups had no statistical significance after 3 months (P > 0.05).

Conclusions
Access to the “Shared Decision Making Assistant” enhanced the PLC patients’ performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the “Shared Decision Making Assistant” in clinical employment and future studies.
Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: a network meta-analysis
Authors: Charitakis Emmanouil , Metelli Silvia , Karlsson Lars O. , Antoniadis Antonios P. , Rizas Konstantinos D. , Liuba Ioan , Almroth Henrik , Hassel Jönsson Anders , Schwieler Jonas , Tsartsalis Dimitrios , Sideris Skevos , Dragioti Elena , Fragakis Nikolaos , Chaimani Anna 
Published: May 2022

AbstractBackgroundThere is no consensus on the most efficient catheter ablation (CA) strategy for patients with atrial fibrillation (AF). The objective of this study was to compare the efficacy and safety of different CA strategies for AF ablation through network meta-analysis (NMA).MethodsA systematic search of PubMed, Web of Science, and CENTRAL was performed up to October 5th, 2020. Randomized controlled trials (RCT) comparing different CA approaches were included. Efficacy was defined as arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of 6 months.ResultsIn total, 67 RCTs (n = 9871) comparing 19 different CA strategies were included. The risk of recurrence was significantly decreased compared to pulmonary vein isolation (PVI) alone for PVI with renal denervation (RR: 0.60, CI: 0.38–0.94), PVI with ganglia-plexi ablation (RR: 0.62, CI: 0.41–0.94), PVI with additional ablation lines (RR: 0.8, CI: 0.68–0.95) and PVI in combination with bi-atrial modification (RR: 0.32, CI: 0.11–0.88). Strategies including PVI appeared superior to non-PVI strategies such as electrogram-based approaches. No significant differences in safety were observed.ConclusionsThis NMA showed that PVI in combination with additional CA strategies, such as autonomic modulation and additional lines, seem to increase the efficacy of PVI alone. These strategies can be considered in treating patients with AF, since, additionally, no differences in safety were observed. This study provides decision-makers with comprehensive and comparative evidence about the efficacy and safety of different CA strategies.Systematic review registrationPROSPERO registry number:CRD42020169494.
Temporal patterns of multi-morbidity in 570157 ischemic heart disease patients: a nationwide cohort study
Authors: Haue Amalie D. , Armenteros Jose J. Almagro , Holm Peter C. , Eriksson Robert , Moseley Pope L. , Køber Lars V. , Bundgaard Henning , Brunak Søren 
Published: May 2022

Abstract
Background
Patients diagnosed with ischemic heart disease (IHD) are becoming increasingly multi-morbid, and studies designed to analyze the full spectrum are few.

Methods
Disease trajectories, defined as time-ordered series of diagnoses, were used to study the temporality of multi-morbidity. The main data source was The Danish National Patient Register (NPR) comprising 7,179,538 individuals in the period 1994–2018. Patients with a diagnosis code for IHD were included. Relative risks were used to quantify the strength of the association between diagnostic co-occurrences comprised of two diagnoses that were overrepresented in the same patients. Multiple linear regression models were then fitted to test for temporal associations among the diagnostic co-occurrences, termed length two disease trajectories. Length two disease trajectories were then used as basis for constructing disease trajectories of three diagnoses.

Results
In a cohort of 570,157 IHD disease patients, we identified 1447 length two disease trajectories and 4729 significant length three disease trajectories. These included 459 distinct diagnoses. Disease trajectories were dominated by chronic diseases and not by common, acute diseases such as pneumonia. The temporal association of atrial fibrillation (AF) and IHD differed in different IHD subpopulations. We found an association between osteoarthritis (OA) and heart failure (HF) among patients diagnosed with OA, IHD, and then HF only.

Conclusions
The sequence of diagnoses is important in characterization of multi-morbidity in IHD patients as the disease trajectories. The study provides evidence that the timing of AF in IHD marks distinct IHD subpopulations; and secondly that the association between osteoarthritis and heart failure is dependent on IHD.
Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model
Authors: Garcia Klauss Kleydmann Sabino , Abrahão Amanda Amaral , Oliveira Ana Flávia de Morais , Henriques Karina Medeiros de Deus , de Pina-Costa Anielle , Siqueira André Machado , Ramalho Walter Massa 
Published: May 2022

Abstract
Background
In Brazil, malaria is caused mainly by the Plasmodium vivax and Plasmodium falciparum species. Its transmission occurs in endemic and non-endemic areas. Malaria geography in Brazil has retracted and is now concentrated in the North region. The Brazilian Amazon region accounts for 99% of Brazil's cases. Brazil’s extra-Amazon region has a high frequency of imported cases and in 2019 presented a mortality rate 123 times higher than the Amazon region. Extra-Amazon cases present risks of reintroduction. This study aims to characterize the epidemiological scenario for malaria in the extra-Amazon region of Brazil from 2011 to 2020 with a two-year forecast.

Methods
Time-series study with description of malaria cases and deaths registered in Brazilian extra-Amazon region from 2011 to 2020. Public data from the Notifiable Diseases Information System (Sinan) and the Mortality Information System (SIM) were used. Descriptive analysis, incidence, and notification rates were calculated. Flow charts analysed the flux between Places of Probable Infection (PI) and places of notification. The prediction model utilized a multiplicative Holt-winters model for trend and seasonality components.

Results
A total of 6849 cases were registered. Cases were predominantly white males with 9 to 11 years of education, mostly between 30 and 39 years old. Imported cases accounted for 78.9% of cases. Most frequent occupations for imported cases are related to travelling and tourism activities. Among autochthonous cases, there is a higher frequency of agriculture and domestic economic activities. In the period there were 118 deaths due to malaria, of which 34.7% were caused by P. falciparum infections and 48.3% were not specified. The most intense flows of imported cases are from Amazonas and Rondônia to São Paulo, Rio de Janeiro, and Paraná. The prediction estimates around 611 cases for each of the following two years.

Conclusion
The time series allows a vast epidemiological visualization with a short-term prediction analysis that supports public health planning. Government actions need to be better directed in the extra-Amazon region so the objective of eliminating malaria in Brazil is achieved. Carrying out quality assessments for information systems and qualifying personnel is advisable. Malaria outside the Amazon region is mainly due to imported cases and delay in diagnosis is associated with a higher fatality rate. Better strategies to diagnose and treat suspected cases can lead to lower risk of deaths and local outbreaks that will be important for achieving malaria elimination in Brazil.
Patient involvement in rare diseases research: a scoping review of the literature and mixed method evaluation of Norwegian researchers’ experiences and perceptions
Authors: Velvin Gry , Hartman Thale , Bathen Trine 
Published: May 2022

Abstract
Background
Patients’ involvement (PI) in research is recognized as a valuable strategy for increasing the quality, developing more targeted research and to speed up more innovative research dissemination. Nevertheless, patient involvement in rare diseases research (PI-RDR) is scarce. The aims were: To study the Norwegian researchers` experiences and perceptions of PI-RDR and review the literature on PI-RDR.

Methods
1. A systematic scoping review of the literature on PI-RDR. 2. A cross-sectional questionnaire study with close-ended and open-ended questions to investigate the researchers` experiences.

Results
In the scoping review 608 articles read in full-text and 13 articles (one review and twelve primary studies) were included. The heterogeneity of the design, methodology and results was large. Most studies described several benefits of PI, but few described methods for measuring impacts and effectiveness of PI-RDR. In the cross sectional part of this study, 145 of 251 employees working in the nine Norwegian Centers on Rare Diseases participated, of these 69 were researchers. Most (95%) of the researchers claimed that rare diseases research is more challenging than for the more common diseases. The majority (95%) argued that PI-RDR may increase the quality of the studies and the relevance, and most (89%) agreed that PI-RDR in dissemination may increase the awareness and public interest for rare diseases. In the open-ended questions several researchers also claimed challenges related to PI-RDR, and many had proposal for improving PI and promotion of rare disease research.

Conclusion
Both the literature and researchers emphasized that PI-RDR is important for improving research quality and increase the public attention on rare diseases, but what constitutes effective PI-RDR still remain unclear. More research on the design, methodology and assessment for measuring the impact of PI-RDR is warranted.
Bilateral symmetry of vertical time to stabilization in postural sway after double‐leg landing in elite athletes with unilateral chronic ankle sprain
Authors: Yalfani Ali , Raeisi Zahra 
Published: May 2022

AbstractBackgroundLower limb asymmetry among athlete with unilateral chronic ankle instability (CAI) during bilateral landing can be a potential source of ankle sprain reinjury. The aim of study was to investigate the effect of bilateral symmetry of vertical time to stabilization (vTTS) in postural sway after double‐leg landing (DLL) in elite athletes with unilateral CAI.MethodsTwenty professional players with unilateral CAI and ten healthy controls were assigned to three groups (soccer, basketball, and control groups, n = 10 each). The postural balance during DLL tasks was assessed based on center of pressure (CoP) and vTTS. Multiple analysis of variance was conducted to statistically analyse the CoP and vTTS which followed by Bonferroni's post hoc test (P < 0.05).ResultsThe vTTS of the injured foot was significantly longer in the soccer and basketball players than in the control players (P = 0.006, p < 0.001 respectively). The intragroup comparison showed a significant difference in the vTTS of CAI and uninjured feet among the basketball players (mean difference = 1.3 s). The basketball group exhibited a worse balance in CoP oscillations results between groups.ConclusionsThe findings suggested that symmetry between double‐leg vTTS values, may be important as much as the sooner vTTS in reduced CoP oscillations and enhanced balance after DLL. Balancing exercises should achieve sooner vTTS in soccer players and symmetry in the double‐leg vTTS of basketball players with unilateral CAI while maintaining static balance during dynamic‐to‐static postural changes to reduce recurrent ankle sprain.
Metabolomic, proteomic and lactylated proteomic analyses indicate lactate plays important roles in maintaining energy and C:N homeostasis in Phaeodactylum tricornutum
Authors: Huang Aiyou , Li Yuanxiang , Duan Jiawen , Guo Shiyi , Cai Xiaoni , Zhang Xiang , Long Hao , Ren Wei , Xie Zhenyu 
Published: May 2022

Abstract
Background
Phaeodactylum tricornutum accumulates lipids while the growth also increases under high CO2, shedding light on its potential application in the reduction of CO2 emissions and at the same time acquiring biodiesel raw materials. However, the sensing and transducing of high C:N signals and the related response mechanism(s) remained unknown.

Results
In this study, a multiple omics analysis was performed with P. tricornutum under low nitrogen (LN) and high CO2 (HC) conditions. The results indicated that 2-oxoglutarate was significantly increased under both LN and HC. Meanwhile, proteins involved in carbon concentration mechanism decreased, indicated that 2-oxoglutarate might regulate C:N balance through suppressing carbon fixation. Lactate, which acts in energy metabolism, signal transduction and ‘LactoylLys’ modification on proteins, was the most upregulated metabolite under both LN and HC conditions. Meanwhile, proteins involved in carbon, nitrogen and energy metabolisms were significantly regulated. Western blotting analysis suggested that non-histone L-lactylation modification was enhanced under LN and HC. Moreover, lactylated proteins were enriched in photosynthesis, central carbon metabolism, nitrogen metabolism, fatty acid synthesis and oxidative phosphorylation.

Conclusion
It is suggested that lactate might play important roles in energy homeostatic maintenance and C:N balance regulation in P. tricornutum through protein lactylation modification.
The two-faced role of ATF2 on cisplatin response in gastric cancer depends on p53 context
Authors: Xu Lingxue , Wang Jingjing , Zhang Danhua , Song Lijie , Wu Han , Wang Jianyao , Miao Jinxin , Guo Haoran , Fang Sujuan , Si Lingling , Chen Jingfei , Wu Yifan , Wu Yangyang , Wang Lihong , Zhang Na , Chard Louisa , Wang Yaohe , Cheng Zhenguo 
Published: May 2022

Abstract
Background
Activating transcription factor-2 (ATF2) is a member of the basic leucine zipper family of DNA-binding proteins, which exhibits both oncogenic and tumor suppression activity in different tumors. However, the molecular mechanism of its dual function in cancer chemotherapy especially in gastric cancer has still not been elucidated.

Methods
The protein expression and location of ATF2 in gastric cancer tissues was detected with immunohistochemistry assay, and the clinical significance was analyzed using TCGA and GEO database. The activation and impact of ATF2 in cisplatin treated cells were evaluated with western blot, incucyte live cell analysis, clone formation and tumor xenografts assays. Interaction between ATF2 and p53 was confirmed with immunoprecipitation and GST-pull down. Potential molecular mechanism of ATF2 in different p53 status cells was analyzed with RNA sequencing and real-time quantitative PCR.

Results
ATF2 mainly located in the nucleus of cancer cells, higher ATF2 level was associated with poor five-year survival of gastric patients, especially in those undergone chemotherapy treatment. Cisplatin treatment significantly activated ATF2 in p53 mutant cells. ATF2 could interact with the trans-activation domain of p53 and enhance cisplatin sensitivity in p53 wild type cell lines, while promoted cell survival in mutant p53 cancer cells by affecting ERK1/2 pathway.

Conclusions
This study confirmed the effect of ATF2 on cisplatin sensitivity was associated with the functional status of p53 in gastric cancer cells. Integrated analysis of ATF2 expression and P53 status could be used to evaluate the chemotherapy sensitivity and prognosis of gastric cancer patients.