bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Model for Sleep Apnea Management in Underserved Patient Populations
Authors: Henry Olivia , Brito Alexandra , Lloyd Marguerite Cooper , Miller Robert , Weaver Eleanor , Upender Raghu 
Published: January 2022

Introduction: Obstructive sleep apnea (OSA) is a common condition in the United States that is strongly linked to metabolic disease, cardiovascular disease, and increased mortality. Uninsured populations experience sleep health disparities, including delayed recognition, diagnosis, and treatment of OSA due to barriers accessing and affording care. Partnerships between primary care clinics and sleep medicine specialists for sleep apnea management have the potential to increase screening, testing, and treatment among underserved populations. Here, we present an integrated and cost-effective model that is easier to navigate for patients while maintaining high quality care. Methods: We designed and implemented a specialty sleep clinic at Shade Tree Clinic, Vanderbilt’s student-run, free primary care clinic. Patients with signs and symptoms of OSA were identified at primary care appointments and screened using the STOP-BANG questionnaire. Clinic visits took place over telehealth with a medical student and sleep specialist. Patients were diagnosed using a home sleep test, and if indicated, were prescribed and given a CPAP device for treatment. CPAP adherence was monitored using a cloud-based remote monitoring system. Results: From December 2020 through August 2021, we hosted 6 telehealth Sleep Clinics, seeing a total of 28 patients across these visits. We have received a total of 37 referrals and have coordinated sleep evaluations and diagnostic testing for 18 of these patients so far. Prior to initiation of the sleep clinic, there were 17 patients on our primary care panel at Shade Tree with a diagnosis of OSA. These patients were using donated equipment and many had been lost to follow-up or had broken parts. We were able to replace 10 of these patient’s CPAP devices and plan to replace the remaining seven. Conclusions: We have created a model of integrated specialty care that is efficient and cost-effective. This paradigm can be replicated for the many specialties that are typically overlooked and undertreated when working with uninsured patients. As awareness of this sleep medicine program becomes more widespread at Shade Tree Clinic, we anticipate reaching more primary care patients with signs and symptoms of sleep apnea through student education, cost-effective diagnostics, and partnership with sleep specialists.
Adolescent Athletes Demonstrate Inferior Objective Profiles at the Time of Return to Sport After ACLR Compared With Healthy Controls
Authors: Robinson John D. , Hannon Joseph , Goto Shiho , Singleton Steven B. , Garrison J. Craig 
Published: January 2022

Background: Athletes display persistent muscle deficits and altered limb-loading mechanics at the time of return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR). Purpose: To compare an objective profile of adolescent athletes at RTS after ACLR to matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 124 participants; 62 patients who underwent ACLR (15.4 ± 1.7 years) and 62 healthy controls (15.3 ± 1.7 years). Motion capture and force plates were used to capture joint motions during jump landing (JL) and single-limb squat (SLS) tasks. Energy absorption contribution (EAC) was calculated, and repeated-measures analysis of variance was used to assess for EAC differences between groups. Participants completed an International Knee Documentation Committee (IKDC) Subjective Knee Form, and isokinetic quadriceps and hamstring strength testing was performed on each limb. Independent t tests were run to examine age, height, weight, and IKDC scores as well as compare differences between groups for quadriceps and hamstring strength. Results: A significant group × joint interaction was found for JL ( P < .001) and SLS ( P < .001). For JL, patients who underwent ACLR utilized significantly greater hip ( P < .001) and significantly less knee ( P < .001) EAC on the surgical limb compared with controls. During SLS, patients who underwent ACLR utilized significantly greater hip ( P < .001) and significantly less knee ( P < .001) EAC on the surgical limb compared with controls. The ACLR cohort demonstrated lower IKDC scores ( P < .001) and significantly lower quadriceps strength on the surgical limb ( P < .001) than controls. There were no differences in surgical limb hamstring strength between the ACLR cohort and healthy controls ( P = .701). Conclusion: Compared with matched healthy controls, the participants who underwent ACLR in this study demonstrated an inferior objective profile at RTS, consisting of deficits in surgical limb loading, self-reported outcomes, and strength.
Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic Review
Authors: Piussi Ramana , Berghdal Tora , Sundemo David , Grassi Alberto , Zaffagnini Stefano , Sansone Mikael , Samuelsson Kristian , Senorski Eric Hamrin 
Published: January 2022

Background: Depression and anxiety symptoms can occur in patients following an anterior cruciate ligament (ACL) injury, and the presence of these symptoms has been associated with poorer self-reported knee function in this type of injury. Purpose: To investigate the prevalence and severity of self-reported symptoms of depression and anxiety following an ACL injury. Study Design Systematic review; Level of evidence, 4. Methods: PubMed, Cochrane Library, Embase, PsycINFO, AMED, and PEDro databases were searched using a combination of keywords relating to ACL, depression, anxiety, and their synonyms. Inclusion criteria were clinical studies written in English that reported on patients with an injured and/or reconstructed ACL and assessed symptoms of depression and/or anxiety. Data extraction was performed independently by 2 authors. Data synthesis was performed using an emergent synthesis approach. The quality of the included studies was assessed using the methodological index for non-randomized studies or the Mixed-Methods Appraisal Tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation. Results: After abstract screening, 37 studies were assessed in full text, of which 16 were included. The studies comprised 682 patients (417 male [61%]). The depression symptoms appeared to be more severe in elite athletes compared with recreational athletes. Symptoms decreased over time from moment of ACL reconstruction to up to 2 years postoperatively. The prevalence of self-reported symptoms of anxiety after an ACL injury was reported in 1 study (2%). There were no differences in anxiety symptoms between professional and amateur athletes or between adolescents and adults. The overall quality of the studies was low or very low. Conclusion: Patients who sustain an ACL injury can suffer from symptoms of depression, especially during the first 6 weeks after ACL reconstruction. Depressive symptoms are more common among professional versus nonprofessional athletes. Levels of anxiety symptoms were not above the cutoffs for a diagnosis of anxiety after an ACL injury.
Disentangling barrier effects of transport infrastructure: synthesising research for the practice of impact assessment
Authors: van Eldijk Job , Gil Jorge , Marcus Lars 
Published: January 2022

AbstractTransport infrastructure such as railways, motorways and arterial roads increases regional accessibility for motorised transport but simultaneously can create barriers in local street networks that can decrease accessibility for pedestrians and cyclists. Although several tools for an objective assessment of these barrier effects have been developed, their use in practice is limited; impact assessments are instead based on subjective descriptions. This article reviews the literature on barrier effects of the last 60 years and aims to offer guidance for the use of objective methods of assessment of barrier effects. The first contribution is a conceptual model for the barrier effects of transport infrastructure and their determinants. The second contribution is an overview of tools for the assessment of barrier effects. We conclude that a multi-disciplinary approach is required, supported by the conceptual model and the overview of assessment tools. Investments in transport infrastructure can then be based on broader decision support involving not only the benefits of increasing regional accessibility but also the cost of reducing local accessibility.
N6-Methyladenosine-Related lncRNAs as potential biomarkers for predicting prognoses and immune responses in patients with cervical cancer
Authors: Zhang He , Kong Weimin , Zhao Xiaoling , Han Chao , Liu Tingting , Li Jing , Song Dan 
Published: January 2022

Abstract
Background
Several recent studies have confirmed epigenetic regulation of the immune response. However, the potential role of RNA N6-methyladenosine (m6A) modifications in cervical cancer and tumour microenvironment (TME) cell infiltration remain unclear.

Results
We evaluated and analysed m6A modification patterns in 307 cervical cancer samples from The Cancer Genome Atlas (TCGA) dataset based on 13 m6A regulators. Pearson correlation analysis was used to identify lncRNAs associated with m6A, followed by univariate Cox regression analysis to screen their prognostic role in cervical cancer patients. We also correlated TME cell infiltration characteristics with modification patterns. We screened six m6A-associated lncRNAs as prognostic lncRNAs and established the prognostic profile of m6A-associated lncRNAs by least absolute shrinkage and choice of operator (LASSO) Cox regression. The corresponding risk scores of the patients were derived based on their prognostic features, and the correlation between this feature model and disease prognosis was analysed. The prognostic model constructed based on the TCGA-CESC (The Cancer Genome Cervical squamous cell carcinoma and endocervical adenocarcinoma) dataset showed strong prognostic power in the stratified analysis and was confirmed as an independent prognostic indicator for predicting the overall survival of patients with CESC. Enrichment analysis showed that biological processes, pathways, and markers associated with malignancy were more common in the high-risk subgroup. Risk scores were strongly correlated with the tumour grade. ECM receptor interactions and pathways in cancer were enriched in Cluster 2, while oxidative phosphorylation and other biological processes were enriched in Cluster 1. The expression of immune checkpoint molecules, including programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1), was significantly increased in the high-risk subgroup, suggesting that this prognostic model could be a predictor of immunotherapy.

Conclusions
This study reveals that m6A modifications play an integral role in the diversity and complexity of TME formation. Assessing the m6A modification patterns of individual tumours will help improve our understanding of TME infiltration characteristics and thus guide immunotherapy more effectively. We also developed an independent prognostic model based on m6A-associated lncRNAs as a predictor of overall survival, which can also be used as a predictor of immunotherapy.
The inconsistency between two major aneuploidy-screening platforms—single-nucleotide polymorphism array and next-generation sequencing—in the detection of embryo mosaicism
Authors: Chen Dongjia , Xu Yan , Ding Chenhui , Wang Yali , Fu Yu , Cai Bing , Wang Jing , Li Rong , Guo Jing , Pan Jiafu , Zeng Yanhong , Zhong Yiping , Shen Xiaoting , Zhou Canquan 
Published: January 2022

Abstract
Background
In preimplantation genetic testing for aneuploidy (PGT-A), appropriate evaluation of mosaic embryos is important because of the adverse implications of transferring embryos with high-level mosaicism or discarding those with low-level mosaicism. Despite the availability of multiple reliable techniques for PGT-A, data comparing the detection of mosaicism using these techniques are scarce. To address this gap in the literature, we compared the detection ability of the two most commonly used PGT-A platforms, next-generation sequencing (NGS) and the single-nucleotide polymorphism (SNP) array, for mosaic embryos.

Results
We retrospectively reviewed the data of PGT-A or preimplantation genetic testing for chromosomal structural rearrangements (PGT-SR) conducted at our center from January 2018 to October 2020, and selected blastocysts that underwent aneuploidy screening with both an SNP array and NGS. Trophectoderm biopsy, multiple displacement amplification (MDA), and aneuploidy screening with an SNP array were conducted on the enrolled blastocysts. When the SNP array indicated mosaicism, NGS was performed on the corresponding MDA product for verification. Among the 105 blastocysts diagnosed with mosaicism with the SNP array, 80 (76.19%) showed mosaicism in NGS, with complete and partial concordance rates of 47.62% (50/105) and 18.10% (19/105), respectively. The complete discordance rate of the two platforms was 34.29% (36/105). That is, 10.48% (11/105) of the blastocysts were diagnosed with completely different types of mosaicism with the two platforms, while 13.33% (14/105) and 10.48% (11/105) of the embryos diagnosed as showing mosaicism with SNP were detected as showing aneuploidy and euploidy with NGS, respectively.

Conclusions
The consistency of NGS and the SNP array in the diagnosis of embryo mosaicism is extremely low, indicating the need for larger and well-designed studies to determine which platform is more accurate in detecting mosaic embryos.
Thymol improves salinity tolerance of tobacco by increasing the sodium ion efflux and enhancing the content of nitric oxide and glutathione
Authors: Xu Liang , Song Jia-Qian , Wang Yue-Lin , Liu Xiao-Han , Li Xue-Li , Zhang Bo , Li Ai-Jie , Ye Xie-Feng , Wang Jing , Wang Peng 
Published: January 2022

Abstract
Background and objective
Salt stress is one of the most important abiotic stresses affecting the yield and quality of tobacco (Nicotiana tabacum). Thymol (a natural medicine) has been widely used in medical research because of its antibacterial and anti-inflammatory activities. However, the influence of thymol on the root growth of tobacco is not fully elucidated. In this study, the regulatory effects of different concentrations of thymol were investigated.

Methodology
Here, histochemical staining and biochemical methods, non-invasive micro-test technology (NMT), and qPCR assay were performed to investigate the effect of thymol and mechanism of it improving salinity tolerance in tobacco seedlings.

Results
In this study, our results showed that thymol rescued root growth from salt stress by ameliorating ROS accumulation, lipid peroxidation, and cell death. Furthermore, thymol enhanced contents of NO and GSH to repress ROS accumulation, further protecting the stability of the cell membrane. And, thymol improved Na+ efflux and the expression of SOS1, HKT1, and NHX1, thus protecting the stability of Na+ and K+.

Conclusion
Our study confirmed the protecting effect of thymol in tobacco under salt stress, and we also identified the mechanism of it, involving dynamic regulation of antioxidant system and the maintenance of Na+ homeostasis. It can be a new method to improve salinity tolerance in plants.
Etiologies of fever of unknown origin in HIV/AIDS patients, Hanoi, Vietnam
Authors: Nguyen Thu Kim , Nguyen Yen Hai , Nguyen Hao Thi , Khong Quang Minh , Tran Ngoc Kim 
Published: January 2022

Abstract
Background
Fever of unknown origin (FUO) is a challenge for clinicians treating patients with HIV/AIDS. CD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of FUO stratified by CD4 count levels in HIV/AIDS patients.

Methods
A cross-sectional retrospective and prospective study was conducted in 195 HIV/AIDS patients with FUO admitted to the National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratios were calculated to compare the distributions of common etiologies in groups with two different CD4 count levels: < 50 cells/mm3 and ≥ 50 cells/mm3.

Results
The proportions of opportunistic infections and noninfectious etiologies were 93.3% and 3.6%, respectively. Tuberculosis was the most common opportunistic infection (46.7%), followed by talaromycosis (29.2%) and Pneumocystis jiroveci (PCP) infection (20.5%). Tuberculosis was predominant in all CD4 level groups. Most patients with talaromycosis had CD4 counts below 50 cells/mm3. In total, 53.8% of the patients were infected by one pathogen. The risks of tuberculosis and talaromycosis in FUO-HIV patients were high when their CD4 counts were below 50 cells/mm3.

Conclusions
Opportunistic infections, especially tuberculosis, are still the leading cause of FUO in HIV/AIDS patients. Tuberculosis and Talaromyces marneffei (TM) infection should be considered in patients with CD4 cell counts < 50 cells/mm3. This study implies that guidelines for appropriate testing to identify the etiology of FUO in HIV/AIDS patient based on the CD4 cell count should be developed, thereby reducing resource waste.
Acute hepatitis E virus superinfection increases mortality in patients with cirrhosis
Authors: Choi Jung Woo , Son Ho Jin , Lee Sang Soo , Jeon Hankyu , Cho Jin-Kyu , Kim Hee Jin , Cha Ra Ri , Lee Jae Min , Kim Hyun Jin , Jung Woon Tae , Lee Ok-Jae 
Published: January 2022

Abstract
Background
Although acute hepatitis E is not fatal in healthy individuals, it is unclear whether hepatitis E superinfection increases the mortality in patients with pre-existing liver disease. Thus, we investigated the prognosis of patients with acute hepatitis E according to their cirrhosis diagnosis, and the prognosis according to the development of acute-on-chronic liver failure (ACLF) in patients with cirrhosis and chronic liver disease (CLD).

Methods
This study included 74 consecutive patients who were diagnosed with acute viral hepatitis E between January 2007 and December 2019. Of them, 39 patients without CLD, 13 patients with non-cirrhotic CLD, and 22 patients with cirrhotic CLD were analyzed.

Results
Among the 74 patients with HEV infection, 7 (9.5%) died within 180 days: 5 with underlying cirrhosis (71.4%) and 2 without cirrhosis (28.6%). The 180-day mortality was significant higher for patients with cirrhosis than for patients without cirrhosis (22.7% vs. 3.8%, P = 0.013). The age- and sex-adjusted proportional-hazard model revealed an approximately eightfold increase in the 180-day mortality risk in patients with cirrhosis compared to patients without cirrhosis. In addition, development of hepatitis E virus-related ACLF due to acute liver function deterioration in patients with pre-existing CLD or cirrhosis worsened the 180-day mortality rate.

Conclusions
Our findings suggest that the acute hepatitis E mortality rate was low in healthy individuals but higher in patients with cirrhosis, and especially high in those with ACLF.
Does previous stroke modify the relationship between inflammatory biomarkers and clinical endpoints in CKD patients?
Authors: Tollitt James , Allan Stuart M. , Chinnadurai Rajkumar , Odudu Aghogho , Hoadley Margaret , Smith Craig , Kalra Philip A. 
Published: January 2022

Abstract
Background
Chronic kidney disease (CKD) is an independent risk factor for stroke. Stroke is also an independent risk factor for worse CKD outcomes and inflammation may contribute to this bidirectional relationship. This study aims to investigate inflammatory biomarkers in patients with non-dialysis CKD (ND-CKD) with and without stroke.

Methods
A propensity matched sample from > 3000 Salford Kidney Study (SKS) patients, differentiated by previous stroke at study recruitment, had stored plasma analyzed for interleukin- 6 (IL-6), Von Willebrand Factor (VWF) and C-reactive protein (CRP). Multivariable cox regression analysis investigated associations between inflammation and death, end-stage renal disease (ESRD) and future non-fatal cardiovascular events (NFCVE).

Results
A total of 157 previous stroke patients were compared against 162 non-stroke patients. There were no significant differences in inflammatory biomarkers between the two groups. Previous stroke was associated with greater mortality risk, hazard ratio (HR) (95% CI) was 1.45 (1.07–1.97). Higher inflammatory biomarker concentrations were independently associated with death but not ESRD or NFCVE in the total population. For each 1 standard deviation (SD) increase in log IL-6, VWF and CRP, the HR for all-cause mortality were 1.35 (1.10–1.70), 1.26 (1.05–1.51) and 1.34 (1.12–1.61), respectively. CRP retained its independent association (HR 1.47 (1.15–1.87)) with death in the stroke population.

Conclusion
Previous stroke is an important determinant of mortality. However, the adverse combination of stroke and ND-CKD does not seem to be driven by higher levels of inflammation detected after the stroke event. Biomarkers of inflammation were associated with worse outcome in both stroke and non-stroke ND-CKD patients.

Trial registration
15/NW/0818.
Perceived causes and diagnosis of febrile convulsion in selected rural contexts in Cape Coast Metropolis, Ghana
Authors: Owusu Bernard Afriyie 
Published: January 2022

Abstract
Background
Febrile convulsion (FC) is a common seizure disorder among children aged 9 months to 5 years. It is usually benign and self-limiting with favourable prognosis. However, in Ghana, FC is commonly perceived as “not for hospital” and widely diagnosed and managed at home based on several beliefs and practices which are limited in related literature.

Objective
This study explored the perceived causes and diagnosis of FC in selected rural communities in the Cape Coast Metropolis, Ghana.

Methods
A descriptive phenomenological study design underpinned the study at five selected communities located not more than 2 Kilometres from the University of Cape Coast Hospital. Purposive and snowball sampling techniques were used to interview 42 participants made up of 27 parents, two grandmothers, seven registered traditional health practitioners, four herbalists, and two faith healers in the communities. The data was analysed using QSR NVivo 12.

Results
Three perceived causes of FC were identified – biological, social/behavioural, and spiritual. Biological causes include genetic abnormalities and other underlying health conditions. The behavioural factors include poor childcare practices and nutrition. Spiritual causes include harm caused by evil spirits. The diagnosis of FC were observed prior, during and after FC attack, and these includes high body temperature, extreme body jerking, and disability outcomes respectively.

Conclusion
The perceived causes of FC are interplay of complex natural, social and spiritual factors that were deep-rooted in local socio-cultural beliefs and FC experiences. Unlike the attack stage, pre-attack diagnosis were usually missed, or misconstrued to mean other health conditions. These findings indicate the need to intensify maternal and child health (MCH) education programmes on FC in the study area through improved primary healthcare.