bluuebunny/crossref_metadata_2025_split huggingface dataset:
Language Discordance Between Students and Patients: Impact on Clinical Learning
Authors: Rustandy Felicia , Yann Foo Y , Compton Scott 
Published: February 2022

Background The clinical education of medical students relies on having direct patient experiences, which can be challenging when the patient population speaks multiple languages. In Singapore, students regularly encounter patients with whom they do not speak the same language. Objective The purpose of this study was to examine the role of student–patient language discordance (SPLD) on students’ clinical education experience. Methods In this sequential mixed-methods study, medical students who have completed at least 1 year of clinical education at the Duke-NUS Medical School in Singapore were asked to complete an online survey to obtain their self-reported language proficiency in local languages, experiences interacting with patients who do not speak English, and perceptions of the impact on clinical learning. A follow-up interview with selected participants was conducted. Results Overall, 35.9% of eligible students responded to the survey. Demographic analysis of respondents adequately represented the school’s overall student population. Non-Mandarin-speaking respondents reported that learning medicine in a multilingual environment negatively impacts clinical learning due to significantly more frequent challenges to clerking patients and feeling hindered from learning from doctors due to language barriers. However, no difference was observed in the performance on clinical exams of the three groups. Qualitative interviews uncovered possible reasons for the confounding results and two interrelated themes that highlight clinical learning experiences and challenges in a multilingual environment. Conclusion Students perceive SPLD as a hindrance toward their clinical education experience. Follow-up interviews uncovered the quandary of using translators and how language discordance impacts student’s professional identity formation.
Severe pneumonia: Treatment outcome and its determinant factors among under-five patients, Jimma, Ethiopia
Authors: Tegenu Kenenisa , Geleto Gelane , Tilahun Desalew , Bayana Ebissa , Bereke Bayisa 
Published: February 2022

Introduction: Over 2 million children die from pneumonia each year accounting for almost one in five children’s deaths worldwide which is estimated to be 18% of mortality cases. Therefore, this study is aimed to assess treatment outcome and its determinant factors among under-five patients, Jimma, Ethiopia. Methods: Study design was conducted on 522 under-five children with severe pneumonia from 1 January 2017 to 30 December 2020. Pretested chart review format was used to collect data. Data were entered into EpiData, version 3.1, and exported to Statistical Package for the Social Sciences, version 23, for analysis. Logistic regression analysis with 95% confidence interval was used to declare statistical significance at p value <0.05. Results: Among 522 under-five children with severe pneumonia, majority (83.91%) of them were improved, whereas 1 over 6 (16.09%) of them were died. This finding showed that children who have malnutrition (adjusted odds ratio = 7.23 (3.17–14.51), p = 0.000), positive serostatus for HIV (adjusted odds ratio = 5.01 (1.91–12.13), p = 0.001), history of upper respiratory tract infections (adjusted odds ratio = 3.27 (1.55–6.91), p = 0.002), unvaccinated (adjusted odds ratio = 4.35 (1.60–11.79), p = 0.004), having complicated types of pneumonia (adjusted odds ratio = 8.48 (4.22–16.65), p < 0.001), and comorbidity disease (adjusted odds ratio = 5.21 (2.03–13.3), p < 0.001) were statistically significant with mortality. Conclusion: This study showed that mortality secondary to severe pneumonia was high. Being malnourished, positive serostatus for HIV infection, history of upper respiratory tract infections, unvaccinated, having complicated type of pneumonia, and other comorbidity disease were identified as determinant factors of mortality. Committed, harmonized, and integrated intervention needs to be taken to reduce mortality from severe pneumonia by enhancing child’s nutrition status, early detection and treatment, effectively vaccinating children, and preventing other comorbidity diseases.
Prevalence and its predictors of intimate partner violence against pregnant women amid COVID-19 pandemic in Southwest Ethiopia, 2021: A cross-sectional study
Authors: Fetene Gossa , Alie Melsew Setegn , Girma Desalegn , Negesse Yilkal 
Published: February 2022

Objectives: Preventive measures like staying-at-home and social distancing are among the top strategies on the list to avert the spread of coronavirus disease 2019 and its consequences. However, this strategy brings off another shadow pandemic of intimate partner violence against women, and no study has been done to assess the magnitude of intimate partner violence against pregnant women during the pandemic in Ethiopia. Therefore, this study was aimed to determine the prevalence of intimate partner violence and its predictors in Southwest Ethiopia amid the coronavirus disease 2019 pandemic. Methods: A community-based cross-sectional study was conducted, from 15 June 2021 to 15 August 2021, on a total of 590 pregnant women recruited by systematic random sampling techniques. Pretested structured questionnaires were used to collect data, and the data were entered using EpiData version 3.1 and analyzed by SPSS version 24. Logistic regression analysis was used to identify predictors of intimate partner violence. Finally, statistical significance was declared at a p-value <0.05. Results: The prevalence of intimate partner violence was 39.2%. Of this, 29.8%, 26.8%, and 22.2% of the pregnant women had experienced physical, sexual, and emotional intimate partner violence, respectively. Being illiterate (adjusted odds ratio = 2.36, 95% confidence interval: 1.33–4.19), having illiterate husbands (adjusted odds ratio = 4.79, 95% confidence interval: 2.69–8.55), household decisions made by the husband alone (adjusted odds ratio = 4.91, 95% confidence interval: 3.74–9.33), and pandemic-induced economic downturns (adjusted odds ratio = 9.03, 95% confidence interval: 5.18–15.98) were the predictors that were significantly associated with intimate partner violence. Conclusion: The prevalence of intimate partner violence against pregnant women during the coronavirus disease 2019 pandemic has been found to be high in the study area. Thus, more efforts should be tried to integrating intimate partner violence screening in maternal and child healthcare services, and early identification of high-risk individuals, and continuous community-based awareness creation activities are recommended.
Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler’s Classification Revisited – A Narrative Review
Authors: Kanna Rishi M , Rajasekaran Shanmuganathan , Schroeder Gregory D , Schnake Klaus , Vaccaro Alexander R , Benneker Lorin , Oner Cumhur F , Kandziora Frank , Vialle Emiliano 
Published: February 2022

Study Design Narrative review Objectives Multiple classifications have been proposed for sacral fractures since the last century. While initial classifications focussed on vertical and transverse fractures, the recent fracture classifications encompass all injury patterns. In 1990, Isler classified unilateral vertical sacral fractures based on its potential influence on lumbo-sacral joint (LSJ) stability. Methods We re-visited the original description of Isler’s classification of sacral fractures and subsequent studies that have cited it. We will further describe basic LSJ anatomy, evolution of sacral classification systems and the use of Isler’s classification system as it relates to LSJ instability and chronic low back pain. Results Isler described a subset of unilateral vertical sacral fractures where the fracture line exited medial or through the L5-S1 facet joint, based on radiographic review of 193 sacral fractures (incidence -3.5%). He stated that such a fracture should be recognised as it can impede hemi-pelvis reduction and can result in late LSJ instability. The article has been cited in 106 studies and only a few studies have described the incidence of this variant. Nevertheless, the injury is considered as an indication for surgical fixation. Conclusion A review of various classifications indicates that sacral fractures have three important bio-mechanical implications, namely, pelvic ring continuity (vertical fractures), spino-pelvic alignment (high transverse fractures) and lumbo-sacral joint integrity (Isler’s fractures). Though there is a universal recognition of Isler’s fractures and its impact on LSJ integrity, there is a lack of clinical and bio-mechanical evidence regarding the concept of instability caused by a unilateral Isler fracture.
Transcriptional regulation of metal metabolism- and nutrient absorption-related genes in Eucalyptus grandis by arbuscular mycorrhizal fungi at different zinc concentrations
Authors: Wang Xinyang , Liang Jingwei , Liu Ziyi , Kuang Yuxuan , Han Lina , Chen Hui , Xie Xianan , Hu Wentao , Tang Ming 
Published: February 2022

AbstractBackgroundEucalyptusspp. are candidates for phytoremediation in heavy metal (HM)-polluted soils as they can adapt to harsh environments, grow rapidly, and have good economic value. Arbuscular mycorrhizal fungi (AMF) are the most widely distributed plant symbiotic fungi in nature, and they play an important role in promoting the phytoremediation of HM-polluted soils. However, few studies have evaluated the HM detoxification mechanism ofE.spp. in symbiosis with AMF, and thus, the molecular mechanism remains unclear.ResultsThe gene transcription and metabolic pathways ofE.grandiswere studied with and without inoculation with AMF and at different zinc (Zn) concentrations. Here, we focused on the transcript level of six HM-related gene families (ZNT, COPT/Ctr, YSL, ZIFL and CE). Under high-Zn conditions, thirteen genes (ZNT:2, COPT/Ctr:5, YSL:3, ZIFL:1, CE:2) were upregulated, whereas ten genes (ZNT:3, COPT/Ctr:2, YSL:3, ZIFL:1, CE:1) were downregulated. With AMF symbiosis under high-Zn conditions, ten genes (ZNT:4, COPT/Ctr:2, YSL:3, CE:1) were upregulated, whereas nineteen genes (ZNT:9, COPT/Ctr:2, YSL:3, ZIFL:4, CE:1) were downregulated. Under high-Zn conditions, genes of three potassium-related transporters, six phosphate transporters (PHTs), and two nitrate transporters (NRTs) were upregulated, whereas genes of four potassium-related transporters,four PHTs, and four nitrogen-related transporters were downregulated. With AMF symbiosis under high-Zn conditions, genes of two potassium-related transporters, six ammonium transporters (AMTs) and five PHTs were upregulated, whereas genes of six potassium-related transporters, two AMTs and five PHTs were downregulated.ConclusionsOur results indicates that AMF increases the resistance ofE.grandisto high-Zn stress by improving nutrients uptake and regulating Zn uptake at the gene transcription level. Meanwhile, our findings provide a genome-level resource for the functional assignments of key genes regulated by Zn treatment and AM symbiosis in six HM-associated gene families and macromineral nutrient-related gene families ofE.grandis. This may contribute to the elucidation of the molecular mechanisms of the response to Zn stress inE.grandiswith AM symbiosis at the aspect of the interaction between HM tolerance and nutrient acquisition.
Reproductive biology of an endangered lithophytic shrub and implications for its conservation
Authors: Wu Yuan-Mi , Shen Xue-Li , Tong Ling , Lei Feng-Wei , Xia Xiao-Fei , Mu Xian-Yun , Zhang Zhi-Xiang 
Published: February 2022

Abstract
Background
Plants in cliff habitats may evolve specific reproductive strategies to cope with harsh environments, and unraveling these reproductive characteristics can improve our understanding of survival strategies and lithophyte evolution. This understanding is especially important for efforts to protect rare and endemic plants. Here, we investigated the reproductive biology of Lonicera oblata, an endangered lithophytic shrub that is scattered in highly fragmented and isolated cliff habitats of the Taihang and Yan mountains in North China.

Results
Flowers of L. oblata are herkogamous and protandrous, characteristics that can prevent autogamy at the single-flower level, and insects are necessary for pollination. The outcrossing index, pollen/ovule ratio, and the results of hand pollination were measured and all revealed a mixed mating system for L. oblata, that combines cross-fertilization and partial self-fertilization. The floral traits of L. oblata of zygomorphic and brightly yellowish corolla, heavy fragrance, and rich nectar, suggest an entomophilous pollination system. Sweat bees were observed as the most effective pollinators but their visiting frequencies were not high. Pollen limitation may limit the reproductive success of L. oblata.

Conclusions
We determined the reproductive characteristics of L. oblata, a critically endangered species endemic to cliffs in North China, providing insight into its endangerment and suggesting conservation strategies. L. oblata has highly pollinator-dependent self-fertilization as part of a mixed mating system. Floral features such as low-flowering synchrony, asynchronous anthers dehiscence, and high duration of stigma receptivity, improve pollination efficiency in the case of low pollinator service. Our work provides reference information to understand the survival strategies and conservation of L. oblata and other lithophytes.
Correlation analysis between heart rate variability, epicardial fat thickness, visfatin and AF recurrence post radiofrequency ablation
Authors: Jian Bin , Li Zhen , Wang Jianing , Zhang Chuanlin 
Published: February 2022

AbstractBackgroundThe aim of the present study is to investigate the possible correlation between heart rate variability (HRV), epicardial fat thickness (EFT), visfatin and AF recurrence post radiofrequency ablation.MethodsData of 337 AF patients to whom radiofrequency ablation therapy had been initiated at our hospital over the past three years were evaluated. The patients enrolled were divided into the non-recurrence group (102 patients) and the recurrence group (235 patients) according to AF recurrence in the preceding 12 months. General data in the two groups were collected and HRV, EFT, and visfatin levels were comprehensively compared for each patients of the two groups.ResultsThe recurrence group showed significantly higher results in rMSSD, PNN50, HF, total EFT, and visfatin but with evidently lower results in LF/HF when comparing the non-recurrence group (P < 0.05). The significantly different general variables in the general data and laboratory parameters, rMSSD, PNN50, HF, total EFT, visfatin, LF/HF were used as independent variables, and AF recurrence post radiofrequency ablation was used as dependent variables. Logistic regression analysis revealed that the risk factors of AF recurrence post radiofrequency ablation were rMSSD, PNN50, HF, total EFT, visfatin, and LF/HF, and the difference was statistically significant (P < 0.05).ConclusionHRV, EFT, visfatin appear to show high association with AF recurrence post radiofrequency ablation.
Step length and fall risk in adults with chronic kidney disease: a pilot study
Authors: Kimura Atsumi , Paredes William , Pai Rima , Farooq Hina , Buttar Rupinder S. , Custodio Matthew , Munugoti Samhitha , Kotwani Sonia , Randhawa Lovepreet S. , Dalezman Solomon , Elters Antonio C. , Nam Kate , Ibarra Jose S. , Venkataraman Sandheep , Abramowitz Matthew K. 
Published: February 2022

Abstract
Background
Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease.

Methods
We performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status.

Results
Assessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status.

Conclusions
Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.
A short peptide derived from pigment epithelial-derived factor exhibits an angioinhibitory effect
Authors: Ho Tsung-Chuan , Yeh Shu-I , Chen Show-Li , Chu Ting-Wen , Tsao Yeou-Ping 
Published: February 2022

Abstract
Background
Pigment epithelial-derived factor (PEDF), a 50 kDa secreted glycoprotein, exhibits distinct effects on a range of cell types. PEDF has been shown to inhibit vascular endothelial growth factor (VEGF)-mediated angiogenesis and widely accepted as a promising agent for treatment eye diseases related to neovascularization. A pool of short peptide fragments derived from PEDF reportedly manifests angioinhibitory activity. This study aims to determine the minimal PEDF fragment which can exert the anti-VEGF effect.

Methods
A series of shorter synthetic peptides, derived from the 34-mer (PEDF amino acid positions Asp44-Asn77), were synthesized. An MTT assay was used to evaluate the ability of the 34-mer-derived peptides to inhibit VEGF-induced proliferation of multiple myeloma RPMI8226 cells. Cell apoptosis was monitored by annexin V-FITC staining. Western blot analysis was used to detect phosphorylated kinases, including c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK), and the expression of apoptosis-associated proteins, including p53, bax and caspase-3. VEGF-mediated angiogenesis of human umbilical vein endothelial cells (HUVECs), rat aortic ring and mouse cornea were used to detect the angioinhibitory activity of the PEDF-derived peptides.

Results
The MTT assay showed that the anti-VEGF effect of a 7-mer (Asp64-Ser70) was 1.5-fold greater than the 34-mer. In addition, massive apoptosis (37%) was induced by 7-mer treatment. The 7-mer induced JNK phosphorylation in RPMI8226 cells. Cell apoptosis and apoptosis-associated proteins induced by the 7-mer were blocked by pharmacological inhibition of JNK, but not p38 MAPK. Moreover, the 7-mer prevented VEGF-mediated angiogenesis of endothelial cells (ECs), including tube formation, aortic EC spreading and corneal neovascularization in mice.

Conclusions
This is the first study to show that the PEDF 7-mer peptide manifests anti-VEGF activity, further establishing its potential as an anti-angiogenic agent.
Data-driven study on resting-state functional magnetic resonance imaging during early abstinence of alcohol dependence in male patients and its predictive value for relapse
Authors: Deng Renhao , Yang Xia , Meng Ya-jing , Tao Yu-jie , Wang Hui-yao , Li Xiao-jing , Wei Wei , Yu Hua , Wang Qiang , Deng Wei , Zhao Lian-sheng , Ma Xiao-hong , Li Ming-li , Xu Jia-jun , Li Jing , Liu Yan-song , Tang Zhen , Du Xiang-dong , Coid Jeremy W. , Greenshaw Andrew J. , Li Tao , Guo Wan-jun 
Published: February 2022

Abstract
Background
Alcohol dependence is a mental disorder with a high relapse rate. However, specific neuroimaging biomarkers have not been determined for alcohol dependence and its relapse. We conducted data-driven research to investigate resting-state functional magnetic resonance imaging (rs-fMRI) during early abstinence from alcohol dependence and its potential ability to predict relapse.

Methods
Participants included 68 alcohol-dependent patients and 68 healthy controls (HCs). The regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF) were compared between the alcohol dependence group and the HCs and between the relapse group and the nonrelapse group. The brain regions that presented significantly different ReHo and/or fALFF between the alcohol-dependent patients and HCs and/or between the relapsed and nonrelapsed patients were selected as the seeds to calculate the functional connectivities (FCs).

Results
During a 6-month follow-up period, 52.24% of alcohol-dependent patients relapsed. A regression model for differentiating alcohol-dependent patients and HCs showed that reductions in ReHo in the left postcentral region, fALFF in the right fusiform region, and FC in the right fusiform region to the right middle cingulum were independently associated with alcohol dependence, with an area under the receiver operating characteristic curve (AUC) of 0.841. The baseline FC of the left precentral to the left cerebellum of the relapse group was significantly lower than that of the nonrelapse group. The AUC of this FC to predict relapse was 0.774.

Conclusions
Our findings contribute to advancing research on the neurobiological etiology and predictive biomarkers for relapse associated with alcohol dependence.