bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphocyte-to-monocyte ratio associated with severe post-stenotic aortic dilation in a case–control study
Authors: Chen Shanghao , Wu Zezhong , Yun Yan , Shen Hechen , Zhao Diming , Liu Yanwu , Zou Chengwei , Zhang Haizhou , Wang Zhengjun , Ma Xiaochun 
Published: April 2022

Abstract
Background
Calcific aortic valve stenosis (CAVS) represents a serious health threat to elderly patients. Post-stenotic aortic dilation, a common feature in CAVS patients, might progress into aneurysm and even dissection, potential consequences of CAVS, and predicts a poor prognosis. This study sought to investigate the association of lymphocyte-to-monocyte ratio (LMR), an inflammatory biomarker, with severe post-stenotic aortic dilation in a case–control study in Chinese population.

Materials and methods
208 consecutive patients with CAVS were recruited retrospectively in a case–control study in Chinese population, from July 1, 2015 to June 31, 2018. LMR was statistically analyzed using the ROC curve and binary logistic regression analyses for its prognostic value in severe post-stenotic aortic dilation.

Results
LMR was significantly reduced in patients with severe post-stenotic aortic dilation (2.72 vs. 3.53, p = 0.002 < 0.05) compared to patients without severe post-stenotic aortic dilation. There was an inverse correlation observed between the maximal diameter of ascending aorta and LMR in the overall patients (r = − 0.217, p = 0.002 < 0.05). For post-stenotic aortic dilation, the prevalence of high-LMR group was statistically lower than that of low-LMR group (19.7% vs. 43.9%, p < 0.001). The maximal diameter of ascending aorta was significantly reduced in the high-LMR group (4.35 vs. 4.76, p = 0.003 < 0.05) compared to low-LMR group. Additionally, LMR was identified in the multivariate analysis independently associated with severe post-stenotic aortic dilation (AUC 0.743, 95% CI: [0.573–0.964], p = 0.025).

Conclusions
This study provided the evidence of an inverse correlation between severe post-stenotic aortic dilation and LMR. LMR is potentially independently associated with severe post-stenotic aortic dilation.
High-risk pregnant women’s experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study
Authors: Mirzakhani Kobra , Shoorab Nahid Jahani , Akbari Azam , Khadivzadeh Talat 
Published: April 2022

Abstract
Background
Women with high-risk pregnancies are among the most vulnerable groups that require additional precautionary measures against the spread of COVID-19 plus receiving prenatal care. Yet, there is limited information on the status of prenatal care in women with high-risk pregnancies. The purpose of this study was to explore the experiences of women with high-risk pregnancies who were receiving prenatal care during the COVID-19 pandemic.

Methods
The present qualitative study was conducted on mothers with high-risk pregnancies from September 2020 to March 2021. Purposeful sampling continued until achieving data saturation. Ghaem, Ommolbanin, and Imam Reza in Mashhad, Iran served as the research environment. Face-to-face and semi-structured interviews were effective data collection methods. Each interview lasted between 20 to 45 min (on average 30). The total number of participants was 31. Data analysis was carried out simultaneously with data collection using the qualitative content analysis method developed by Granheim and Landman (2004).

Results
Following the reduction and analysis of data from women in high-risk pregnancies, as well as their perceptions and experiences with health services during the COVID-19 pandemic, eight subcategories and three main categories were identified, including 1) “Negative psychology responses,” 2) “Adoption behavior,” and 3) “Adjustment of health services in mutual protection.”
Fear, anxiety, stress, feelings of loneliness, sadness, depression, guilt, doubt and conflict in receiving services were examples of negative psychological responses. The adaptive behaviors’ category reflected the behaviors of women with high-risk pregnancies in the context of the COVID COVID-19 pandemic. The Adjustment of health services in mutual protection indicated that health workers took preventive and protective measures against COVID-19, which, in addition to protecting themselves and their clients against COVID-19, gave women a sense of security.

Conclusion
Receiving prenatal care during the COVID-19 pandemic presents challenges for women with high-risk pregnancies, negatively impacting their psychological state and health-seeking behavior. Supportive and preventive care can ensure that women with high-risk pregnancies receive optimal prenatal care that focuses on COVID-19 prevention. We recommend implementing screening, psychological counseling, and education for women with high-risk pregnancies, as well as ensuring that they have access to women-centered health care services.
Alcohol use during pregnancy and associated factors among pregnant women in Sub-Saharan Africa: further analysis of the recent demographic and health survey data
Authors: Mulat Bezawit , Alemnew Wallelign , Shitu Kegnie 
Published: April 2022

Abstract
Background
Alcohol drinking during pregnancy is towering despite the well-established proof of its unfavorable pregnancy results and destitute child improvement. Despite such enormous consequences, there are limited data that explore the extent of alcohol drinking and its associated factors among mothers during pregnancy in sub-Saharan Africa.

Objective
This study aimed to assess the prevalence and associated factors of alcohol consumption during pregnancy among pregnant mothers in sub-Saharan Africa.

Method
A community-based crossectional demographic and health survey was conducted from 2013 to 2017 among four Sub-Sahara African countries: Burundi, Ethiopia, Liberia, and Zimbabwe. A two-stage stratified sampling technique was employed to select the participants. Multivariable Logistic regression analysis was used to identify factors associated with alcohol consumption during pregnancy. A p-value less than 0.05 and a 95% confidence interval were used to declare statistical significance.

Result
A total of 3953 weighted sample of pregnant mothers were included in the study. The mean age of the participants was 27.3 (± 6.8) years with an age range of 15–49 years. The overall prevalence of alcohol use during pregnancy was 22.8% with (95% CI (21.5, 24)) and it was significantly associated with increased age (AOR = 1.02, 95% CI (1.01, 1.04)), Muslim religion follower ( AOR = 0.07, 95% CI (0.05,0.11), husband/partner’s educational status( primary (AOR = 0.7,95% CI (0.55,0.84), secondary (AOR = 0.53, 95% CI ( 0.41,0.7)) and higher (AOR = 0.49, 95% CI (0.31,0.8), being currently working (AOR = 1.5,95% CI ( 1.09,1.55), having ANC visit ( AOR = 0.82, 95% C I(0.68,0.98) and increased gravidity ( AOR = 0.93,95% CI( 0.86,0.99).

Conclusion
Alcohol drinking during pregnancy was high among pregnant women in sub-Saharan African countries. Maternal age, religion, husband educational status, current working status of the mother, presence of ANC visit, and gravidity of the mother were factors that have a significant association with alcohol drinking during pregnancy. This calls for a tailored behavior change intervention to reduce alcohol use during pregnancy. More emphasis should also be given to pregnant women with no ANC visit, lower gravidity, and an illiterate husband, currently working and Christianity followers.
Tryptophan hydroxylase 1 drives glioma progression by modulating the serotonin/L1CAM/NF-κB signaling pathway
Authors: Zhang Jie , Guo Zhangchao , Xie Qiangli , Zhong Chuanhong , Gao Xiangyu , Yang Qiumei 
Published: April 2022

Abstract
Background
Glioma is one of the main causes of cancer-related mortality worldwide and is associated with high heterogeneity. However, the key players determining the fate of glioma remain obscure. In the present study, we shed light on tumor metabolism and aimed to investigate the role of tryptophan hydroxylase 1 (TPH-1) in the advancement of glioma.

Method
Herein, the levels of TPH-1 expression in glioma tissues were evaluated using The Cancer Genome Atlas (TCGA) database. Further, the proliferative characteristics and migration ability of TPH-1 overexpressing LN229/T98G cells were evaluated. Additionally, we performed a cytotoxicity analysis using temozolomide (TMZ) in these cells. We also examined the tumor growth and survival time in a mouse model of glioma treated with chemotherapeutic agents and a TPH-1 inhibitor.

Results
The results of both clinical and experimental data showed that excess TPH-1 expression resulted in sustained glioma progression and a dismal overall survival in these patients. Mechanistically, TPH-1 increased the production of serotonin in glioma cells. The elevated serotonin levels then augmented the NF-κB signaling pathway through the upregulation of the L1-cell adhesion molecule (L1CAM), thereby contributing to cellular proliferation, invasive migration, and drug resistance. In vivo experiments demonstrated potent antitumor effects, which benefited further from the synergistic combination of TMZ and LX-1031.

Conclusion
Taken together, these data suggested that TPH-1 facilitated cellular proliferation, migration, and chemoresistance in glioma through the serotonin/L1CAM/NF-κB pathway. By demonstrating the link of amino acid metabolic enzymes with tumor development, our findings may provide a potentially viable target for therapeutic manipulation aimed at eradicating glioma.
Disc repositioning by open suturing vs. mini-screw anchor: stability analysis when combined with orthognathic surgery for hypoplastic condyles
Authors: Hua Jiangshan , Lu Chuan , Zhao Jieyun , Yang Zhi , He Dongmei 
Published: April 2022

Abstract
Background
Disc repositioning by Mitek anchors for anterior disc displacement (ADD) combined with orthognathic surgery gained more stable results than when disc repositioning was not performed. But for hypoplastic condyles, the implantation of Mitek anchors may cause condylar resorption. A new disc repositioning technique that sutures the disc to the posterior articular capsule through open incision avoids the implantation of the metal equipment, but the stability when combined with orthognathic surgery is unknown. The purpose of this study was to evaluate the stability of temporomandibular joint (TMJ) disc repositioning by open suturing in patients with hypoplastic condyles when combined with orthographic surgery.

Methods
Patients with ADD and jaw deformity from 2017 to 2021 were included. Disc repositioning by either open suturing or mini-screw anchor were performed simultaneously with orthognathic surgery. MRI and CT images before and after operation and at least 6 months follow-ups were taken to evaluate and compare the TMJ disc and jaw stability. ProPlan CMF 1.4 software was used to measure the position of the jaw, condyle and its surface bone changes.

Results
Seventeen patients with 20 hypoplastic condyles were included in the study. Among them, 12 joints had disc repositioning by open suturing and 8 by mini-screw anchor. After an average follow-up of 18.1 months, both the TMJ disc and jaw position were stable in the 2 groups except 2 discs moved anteriorly in each group. The overall condylar bone resorption was 8.3% in the open suturing group and 12.5% in the mini-screw anchor group.

Conclusions
Disc repositioning by open suturing can achieve both TMJ and jaw stability for hypoplastic condyles when combined with orthognathic surgery.
Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. Results from DISCOVER
Authors: Arnold Suzanne V. , Tang Fengming , Cooper Andrew , Chen Hungta , Gomes Marilia B. , Rathmann Wolfgang , Shimomura Iichiro , Vora Jiten , Watada Hirotaka , Khunti Kamlesh , Kosiborod Mikhail 
Published: April 2022

Abstract
Background
Despite strong evidence of benefit, uptake of newer glucose-lowering medications that reduce cardiovascular risk has been low. We sought to examine global trends and predictors of use of SGLT2i and GLP-1 RA in patients with type 2 diabetes.

Methods
DISCOVER is a global, prospective, observational study of patients with diabetes enrolled from 2014–16 at initiation of second-line glucose-lowering therapy and followed for 3 years. We used hierarchical logistic regression to examine factors associated with use of either an SGLT2i or GLP-1 RA at last follow-up and to assess country-level variability.

Results
Among 14,576 patients from 37 countries, 1579 (10.8%) were started on an SGLT2i (1275; 8.7%) or GLP-1 RA (318; 2.2%) at enrollment, increasing to 16.1% at end of follow-up, with large variability across countries (range 0–62.7%). Use was highest in patients treated by cardiologists (26.1%) versus primary care physicians (10.4%), endocrinologists (16.9%), and other specialists (22.0%; p < 0.001). Coronary artery disease (OR 1.29, 95% CI 1.08–1.54) was associated with greater use of SGLT2i or GLP-1 RA while peripheral artery disease (OR 0.73, 95% CI 0.54–1.00) and chronic kidney disease (OR 0.73, 95% CI 0.58–0.94) were associated with lower use (OR 0.73, 95% CI 0.54–1.00). The country-level median odds ratio was 3.48, indicating a very large amount of variability in the use of SGLT2i or GLP-1 RA independent of patient demographic and clinical factors.

Conclusions
Global use of glucose-lowering medications with established cardiovascular benefits has increased over time but remains suboptimal, particularly in sub-groups most likely to benefit. Substantial country-level variability exists independent of patient factors, suggesting structural barriers may limit more widespread use of these medications.
Do physicians with academic affiliation have lower burnout and higher career-related satisfaction?
Authors: Zhuang Chu , Hu Xiaochu , Dill Michael J. 
Published: April 2022

Abstract
Background
Physicians report increasing burnout and declining career-related satisfaction, negatively impacting physician well-being and patient care quality. For physicians with academic affiliations, these issues can directly affect future generations of physicians. Previous research on burnout and satisfaction has focused on factors like work hours, gender, race, specialty, and work setting. We seek to contribute to the literature by examining these associations while controlling for demographic, family, and work-related characteristics. Furthermore, we aim to determine any differential effects of faculty rank.

Methods
We analyzed data on practicing physicians in the U.S. from the Association of American Medical College’s (AAMC) 2019 National Sample Survey of Physicians (NSSP,) which includes variables adapted from the Maslach Burnout Inventory. We used ordinal logistic regressions to explore associations between academic affiliation and burnout. We conducted a factor analysis to consolidate satisfaction measures, then examined their relationship with academic affiliation using multivariate linear regressions. All regression analyses controlled for physicians’ individual, family, and work characteristics.

Results
Among respondents (n = 6,000), 40% were affiliated with academic institutions. Physicians with academic affiliations had lower odds than their non-affiliated peers for feeling emotional exhaustion every day (Odds Ratio [OR] 0.87; 95% CI: 0.79–0.96; P < .001) and reported greater career-related satisfaction (0.10–0.14, SE, 0.03, 0.02; P < .001). The odds of feeling burnt out every day were higher for associate professors, (OR 1.57; 95% CI: 1.22–2.04; P < .001) assistant professors, (OR 1.64; 95% CI: 1.28–2.11; P < .001), and instructors (OR 1.72; 95% CI, 1.29–2.29; P < .001), relative to full professors.

Conclusions
Our findings contribute to the literature on burnout and career satisfaction by exploring their association with academic affiliation and examining how they vary among different faculty ranks. An academic affiliation may be an essential factor in keeping physicians’ burnout levels lower and career satisfaction higher. It also suggests that policies addressing physician well-being are not “one size fits all” and should consider factors such as academic affiliation, faculty rank and career stage, gender identity, the diversity of available professional opportunities, and institutional and social supports. For instance, department chairs and administrators in medical institutions could protect physicians’ time for academic activities like teaching to help keep burnout lower and career satisfaction higher.
Assessment of safety attitudes, professionalism and exploration of medical students’ experiences
Authors: Keshmiri Fatemeh , Raadabadi Mehdi 
Published: April 2022

Abstract
Background
The present study was conducted to examine the interns’ perceptions of safety attitude and professionalism and to explore their experiences about adherence to the principles during the COVID-19 pandemic.

Method
The present study was a mixed-method that was performed in two quantitative and qualitative stages. The medical interns at X University (n = 140) were entered. In the quantitative phase, the assessment of the interns’ Safety Attitudes and Professionalism was conducted by a survey. In the qualitative phase, data were gathered by semi-structured interviews. The experiences of participants were analyzed by the inductive content analysis approach of Graneheim and Lundman.

Results
Participants’ perception scores on safety attitude and professionalism were 98.02 (14.78). The results were explained in a theme of “weakness in systemic accountability in compliance with professionalism and safety”. The theme included three categories: ‘support system inadequacy’, and ‘null curriculum in safety and professionalism education’.

Conclusion
The present results showed participants’ perception scores on safety attitude and professionalism were below the moderate level. The systemic issues were explored as influencing factors in the occurrence of unsafe and unprofessional behaviors. They reported the weakness of the support system (individual, teamwork, mental health, well-being, management, and culture), and the null curriculum in education of professional, and safety principles effective on unprofessional and unsafe behaviors. During the COVID-19 pandemic, it is recommended to create mechanisms to support the development of professionalism of healthcare workers, especially, novice providers and students, and pay attention to the safety and professionalism in formal and informal educational programs.
Priorities among effective clinical preventive services in British Columbia, Canada
Authors: Krueger Hans , Robinson Sylvia , Hancock Trevor , Birtwhistle Richard , Buxton Jane A. , Henry Bonnie , Scarr Jennifer , Spinelli John J. 
Published: April 2022

AbstractBackgroundDespite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing.MethodsWe calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained.ResultsClinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services.ConclusionsThese results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
Survival among people hospitalized with COVID-19 in Switzerland: a nationwide population-based analysis
Authors: Anderegg Nanina , Panczak Radoslaw , Egger Matthias , Low Nicola , Riou Julien 
Published: April 2022

AbstractBackgroundIncreasing age, male sex, and pre-existing comorbidities are associated with lower survival from SARS-CoV-2 infection. The interplay between different comorbidities, age, and sex is not fully understood, and it remains unclear if survival decreases linearly with higher ICU occupancy or if there is a threshold beyond which survival falls.MethodThis national population-based study included 22,648 people who tested positive for SARS-CoV-2 infection and were hospitalized in Switzerland between February 24, 2020, and March 01, 2021. Bayesian survival models were used to estimate survival after positive SARS-CoV-2 test among people hospitalized with COVID-19 by epidemic wave, age, sex, comorbidities, and ICU occupancy. Two-way interactions between age, sex, and comorbidities were included to assess the differential risk of death across strata. ICU occupancy was modeled using restricted cubic splines to allow for a non-linear association with survival.ResultsOf 22,648 people hospitalized with COVID-19, 4785 (21.1%) died. The survival was lower during the first epidemic wave than in the second (predicted survival at 40 days after positive test 76.1 versus 80.5%). During the second epidemic wave, occupancy among all available ICU beds in Switzerland varied between 51.7 and 78.8%. The estimated survival was stable at approximately 81.5% when ICU occupancy was below 70%, but worse when ICU occupancy exceeded this threshold (survival at 80% ICU occupancy: 78.2%; 95% credible interval [CrI] 76.1 to 80.1%). Periods with higher ICU occupancy (>70 vs 70%) were associated with an estimated number of 137 (95% CrI 27 to 242) excess deaths. Comorbid conditions reduced survival more in younger people than in older people. Among comorbid conditions, hypertension and obesity were not associated with poorer survival. Hypertension appeared to decrease survival in combination with cardiovascular disease.ConclusionsSurvival after hospitalization with COVID-19 has improved over time, consistent with improved management of severe COVID-19. The decreased survival above 70% national ICU occupancy supports the need to introduce measures for prevention and control of SARS-CoV-2 transmission in the population well before ICUs are full.