bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated serum cholesterol levels are associated with proteinuria over 0.5 g/day in premenopausal women with systemic lupus erythematosus
Authors: Liu Haijun , Li Qianhua , Wei Xiuning , Ma Jianda , Long KangXia , Ouyang Xia , Liu Nemin , Li Yongsheng , He Liping , Dai Lie , Cai Xiaoyan 
Published: May 2022

Background: Systemic lupus erythematosus (SLE) commonly occurs in premenopausal women and is associated with elevated estrogen levels. Patients with SLE may have abnormal serum triglyceride (TG) levels, and lipid reportedly promotes kidney damage in patients with nephrosis. Since estrogen regulates lipid levels, we investigated the serum lipid levels of premenopausal women with SLE and their relationship with proteinuria. Methods: This cross-sectional study included 123 premenopausal women with SLE (SLE group), who were classified into 24-h urine protein exceeding 0.5 g (24 h-UPRO > 0.5 g, n = 22) and 24 h-UPRO ≤ 0.5 g ( n = 101) subgroups, and 100 similarly aged healthy women (control group). Clinical characteristics and biomarker levels were compared between these groups. The associated factors of proteinuria over 0.5 g/day were evaluated using multivariate logistic regression. A receiver operating characteristic (ROC) curve was plotted to assess the cholesterol (CH) cut-off associated with increased development of proteinuria over 0.5 g/day. Results: The SLE group had significantly higher serum TG levels than that of control group. 24 h-UPRO were significantly correlated with serum creatinine, CH, TG, and uric acid levels. Serum CH level was the greatest associated factor for proteinuria over 0.5 g/day. The area under the ROC curve was 0.843, with a CH cut-off of 4.58 mmol/L. Patients with serum CH above 4.58 mmol/L had a higher proportion of type IV LN, but with no statistical difference. Conclusions: In premenopausal SLE patients, serum TG levels were higher than in healthy women, and serum CH levels were the primary associated factor for proteinuria over 0.5 g/day. Proteinura over 0.5 g/day may occur in women with SLE with serum CH levels >4.58 mmol/L. CH levels may be useful for predicting proteinuria.
Acute Stress in Parents of Patients Admitted to the Pediatric Intensive Care Unit: A Two-Center Cross-Sectional Observational Study
Authors: Kaplan Daniel , Nesfield Mekela Whyte , Eldridge Peter S , Cuddy WIlliam , Ansari Nadia , Siller Pamela , Li Simon 
Published: May 2022

Objective To examine medical and psychosocial risk factors associated with the development of acute stress in parents of patients unexpectedly admitted to the PICU. Design Cross-sectional observational study. Setting Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICU. Patients Parents of patients unexpectedly admitted to the PICU. Intervention None. Measurements and Main Results 265 parents of 188 children were enrolled of whom 49 parents (18%) met ASD qualification and 108 (41%) parents developed ASD symptoms as determined by the ASDS-5 scale. Risk factors making parents likely to meet ASD qualification include parents from area served by Penn State (p < 0.001), prior psychiatric illness (p < 0.01), and female gender (p < 0.05), while graduating college was protective (p < 0.05). In the multivariate analysis, parents from area served by Penn State (OR 3.00 (1.49-6.05) p < 0.01) and parents with prior psychiatric illness (OR 2.16 (1.03-4.52) p < 0.05) were associated with ASD qualification. Parents who graduated college or had prior medical problems were not significant. Risk factors making parents more likely to develop ASD symptoms (significant symptoms that do not meet ASD qualification) include patients with higher PRISM-III scores (p < 0.01), patients receiving cardiovascular support (p < 0.05), parents with a history of prior physical/sexual abuse (p < 0.01), parental involvement in the past with a major disaster/accident (p < 0.01), a family member admitted to an ICU in the past (p < 0.05) and preexisting parental psychiatric/medical disorders (p < 0.001). In a multivariate analysis, prior parental psychiatric disorder (OR 4.11 (1.80-6.42) p < 0.001), history of parental abuse (OR 3.11 (1.14-5.08) p < 0.05), and parental prior medical problem (OR 2.03 (1.01-3.05) p < 0.05) were associated with the development of ASD symptoms. However, PRISM-III score and prior involvement in major disaster were not significant. Conclusions A combination of psychosocial parental risk factors and patient factors were associated with acute stress in parents. Further studies evaluating targeted hospital interventions towards parents most at-risk are needed.
Fabrication, mechanical and electrical properties of polyimide films cured at low-temperature assisted by microwave radiation
Authors: Tao Kangkang , Qin Fei , Li Yahui , Zhang Shuai , Han Shihui , Liu Guangmin , Wang Jun , Shen Jun , Yang Zailin , Tang Yi , Sun Gaohui 
Published: May 2022

Polyimide (PI) films with excellent mechanical and electrical properties were produced at a low temperature assisted by microwave. Depending on the reciprocating movement of dipole molecules excited by microwave, even though under a low temperature, the rotation and conformational changes of functional groups could also be promoted. Thus, reaction between N-H bond and -OH in carboxyl which could realize dehydration and cyclization of polyamic acid proceeded normally. Results revealed that the combination between ambient temperature only at 70°C and microwave power at 2000 W or higher could also produce PI films with imidization degree of 100%. For PI-2000W, compared with traditional PI film (PI-300°C) that generated only at temperature of 300°C, even though on the basis of no any change in molecular structure and addition of filler, the tensile strength, elastic modulus, crystallinity, and apparent density increased by about 21%, 51%, 37%, and 5%, respectively. For electrical properties, conductivity enhanced by one to two orders of magnitude comparing with PI-300°C. Results indicated that while keeping the original molecular structure of PI films unchanged, this work provided a new and effective method to assist the enhancement in mechanical and electrical properties of PI films.
New methods for dynamically substructured system testing of a railway car pantograph
Authors: Kobayashi Shigeyuki , Koyama Tatsuya , Harada Satoshi , Stoten David P 
Published: May 2022

This study proposes new pantograph testing methods for railway pantograph/overhead catenary systems (OCS), based upon substructured testing consisting of a physical pantograph and a numerical OCS model. Hence, this work builds upon a previously presented work, (using the dynamically substructured system approach developed by Stoten and Hyde), which was conducted on a relatively simple mechanical structure in the Automatic Control and Test Laboratory (ACTLab), University of Bristol, UK. In this current paper, the dynamically substructured system (DSS) testing method is applied to a real shinkansen pantograph, using various actuator/DSS configurations that have been implemented at the Railway Technical Research Institute, Tokyo, Japan. In the first of these tests, a conventional servohydraulic actuated rig is used to represent phenomena due to the dropper-passing frequency. Resulting DSS test data are compared with those generated by a numerical simulation of the emulated system, i.e. the system to be represented by the DSS experimentation. Then, in the second set of investigations, the DSS method is used in conjunction with a new ‘rotational disc’ test rig that is arranged to be in dynamic interaction with the shinkansen pantograph contact head. This novel experimental system enables the investigation of dynamic interactions between the overhead catenary system contact wire and the pantograph head, due to span-passing. Again, results from this experimental investigation are compared with those generated by a purely numerical simulation of the emulated system.
Identification of ferroptosis-related molecular markers in glomeruli and tubulointerstitium of lupus nephritis
Authors: Wang Wenqian , Lin Zeying , Feng Jieye , Liang Qixuan , Zhao Jinjin , Zhang Gengbiao , Chen Ruilin , Fu Rong 
Published: May 2022

Purpose Ferroptosis, characterized by iron accumulation and lipid peroxidation, is a newly demonstrated form of programed cell death. Present studies reveal that ferroptosis is involved in tumor and neurodegenerative disease. Regarding its roles in the development of LN, it is least interrogated. In this study, we explored whether ferroptosis is activated and how does it change at transcriptomic level in LN. Methods 4-Hydroxynonenal (4-HNE) was stained to explore whether ferroptosis is activated. Subsequently, by using bioinformatic methods, public GSE32591 dataset was analyzed. Ferroptosis-related differentially expressed genes (FR-DEGs) were identified in both glomeruli and tubulointerstitium. Immune cell infiltration was evaluated. Correlation between FR-DEGs and infiltrated immune cells was also calculated. Finally, dataset of GSE113342, qPCR, and immunofluorescence staining were also used or performed to validate the results. Results Expression of 4-HNE was significantly increased in both glomeruli and tubulointerstitium. At transcriptomic level, 19 FR-DEGs in glomeruli and 15 FR-DEGs in tubulointerstitium including genes of iron metabolism, antioxidant system inhibitors, and ferroptosis suppressors were significantly altered in LN. Of which, LTF, CYBB, and CCL5 were upregulated and G0S2 and AKR1C1 were downregulated in both glomeruli and tubulointerstitium of LN. qPCR further validated the alteration of LTF, CYBB, CCL5, G0S2, and AKR1C1 in the whole kidney. Correlation analysis showed that CYBB positively correlated with monocyte infiltration in glomeruli and positively correlated with response to therapy. Conclusion Lipid peroxidation was aberrantly activated in LN, suggesting the activation of ferroptosis. LTF, CYBB, CCL5, G0S2, and AKR1C1, especially CYBB, might be good biomarkers of ferroptosis in LN.
Deep Learning Algorithms Improve the Detection of Subtle Lisfranc Malalignments on Weightbearing Radiographs
Authors: Ashkani-Esfahani Soheil , Mojahed-Yazdi Reza , Bhimani Rohan , Kerkhoffs Gino M. , Maas Mario , DiGiovanni Christopher W. , Lubberts Bart , Guss Daniel 
Published: May 2022

Background: Detection of Lisfranc malalignment leading to the instability of the joint, particularly in subtle cases, has been a concern for foot and ankle care providers. X-ray radiographs are the mainstay in the diagnosis of these injuries; thus, improving the performance of clinicians in interpreting radiographs can noticeably affect the quality of health care in these patients. Here we assessed the performance of deep learning algorithms on weightbearing radiographs for detection of Lisfranc joint malalignment in patients with Lisfranc instability. Methods: In a retrospective study, 640 patients with Lisfranc malalignment leading to instability were recruited plus 640 individuals with uninjured feet and healthy Lisfranc joint as the control group. All radiographs were screened by orthopaedic surgeons. Two deep learning models were trained, validated, and tested (in a ratio 80:10:10) using a single-view (anteroposterior) and 3-view (anteroposterior, lateral, oblique) radiographs. The performances of the models were reported as sensitivity, specificity, positive and negative predictive values, accuracy, F score, and area under the curve (AUC). Results: No significant differences were observed between the patients and the controls regarding age, gender, race, and body mass index. The best deep learning algorithm outperformed our human interpreters (<1% vs ~10% misdiagnosis), 94.8% sensitivity, 96.9% specificity, 98.6% accuracy, 95.8% F score, and 99.4% AUC. Conclusion: Deep learning methods have shown promising potential in acting as an assistant interpreter of radiographic images in patients with Lisfranc malalignment. Developing these algorithms can hasten and improve the accuracy of diagnosis and reduce further costs and burdens on the patients and health care system. Level of Evidence: Level III, case-control Machine Learning study.
Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV − 2 Infection
Authors: Muñoz Oscar M , Ruiz-Talero Paula , Hernández-Florez Catalina , Lombo-Moreno Carlos Ernesto , Casallas-Rivera Martha Alejandra , Mayorga-Hernández Carol Anne 
Published: May 2022

Objective To evaluate the discriminative ability and the calibration of the Pulmonary Embolism Severity Index (PESI) to predict in-hospital mortality in patients with Pulmonary Embolism (PE) secondary to COVID 19 in two hospitals in Bogotá. Methods External validation study of a prediction model based on a retrospective cohort of patients with PE secondary to COVID-19 treated at Hospital Universitario San Ignacio and Hospital universitario La Samaritana, between March 2020 and August 2021. Calibration of the scale was evaluated using the Hosmer-Lemeshow test and a calibration belt diagram. Discrimination ability was evaluated using a ROC curve. Results 272 patients were included (median age 61.5 years, male 58.8%). PE was diagnosed in 45.6% of the patients at the time of admission. Of the remaining 54.4%, 95.9% received thromboprophylaxis until the time of diagnosis.17.6% of the patients died. Regarding calibration, the scale systematically underestimates risk in all classes of PESI. For class I, the ratio of observed/expected events was 4.4 vs 0.8%, class II 4.8 vs 1.8%, class III 15.2 vs 4.2%, class IV 14.3 vs 5.9% and class V 46.7 vs 5.8%. The calibration test rejected the adequate calibration hypothesis (p < 0.001). The discriminatory ability was adequate (AUC = 0.7128, 95% CI 0.63-0.79). Conclusions The PESI scale in patients with PE secondary to COVID 19 underestimates the risk of in-hospital mortality, while maintaining adequate discrimination. It is suggested not to use the PESI scale until it is recalibrated in this context.
Prevalence and Associated Factors of Substance Use Male Population in East African Countries: A Multilevel Analysis of Recent Demographic and Health Surveys From 2015 to 2019
Authors: Fentaw Kenaw Derebe , Fenta Setegn Muche , Biresaw Hailegebrael Birhan 
Published: May 2022

Background: East Africa is still home to one of the world’s highest rates of substance user. Substance use is primarily associated with male behavior and is becoming one of the region’s most public health issues. Methods: The study included data from 11 East African countries’ Demographic and Health Surveys. About 55 307 men were enrolled in the study and multilevel logistic regression model was applied Result: East African countries had a 43.70% prevalence of substance abuse coverage. Education level, age, current working status, marital status, wealth index, media exposure, residence, and nation were all found to be statistically associated with substance use of males. Conclusion: In East African countries, the prevalence of substance abuse among men was high. As a result, substance control programs should focus on the poor, not (least) educated, rural people, and adult age groups, who are the region’s most vulnerable social groups.
The experience of informal caregivers in providing patient care in hospitals in low- and middle-income countries: A qualitative meta-synthesis
Authors: Hogan Unarose , Bingley Amanda , Morbey Hazel , Walshe Catherine 
Published: May 2022

Objective In low- and middle-income countries, informal caregivers frequently stay in hospitals and perform patient care tasks typically performed by nurses in other contexts. This article reviews qualitative research on these informal caregivers, to gain insight and understanding of their experiences. Methods We undertook a qualitative meta-synthesis. Relevant literature was identified through searches of electronic databases in 2021. Thematic analysis was conducted to facilitate the identification of conceptual relationships to formulate synthesised findings. Results Twenty-four studies met the inclusion criteria – 13 from Sub-Saharan Africa, five from Bangladesh, two from India, two from Iran, one from Brazil and one from Peru. Three themes were generated from the meta-synthesis: (1) The unwelcome but tolerated guest, (2) Enduring personal sacrifice and (3) Fulfilling familial obligations. These themes emphasised the significant burden associated with the hospital caregiving experience and highlighted the implicit reliance on informal caregivers in low- and middle-income countries. Conclusions Informal caregivers perform an essential caregiving role, yet occupy a peripheral and voluntary space in hospitals. There is a clear need to support informal caregivers so that they can safely perform their tasks.
Acquired HIV drug resistance among adults living with HIV receiving first-line antiretroviral therapy in Rwanda: A cross-sectional nationally representative survey
Authors: Musengimana Gentille , Tuyishime Elysee , Kiromera Athanase , Malamba Samuel S. , Mulindabigwi Augustin , Habimana Madjid R. , Baribwira Cyprien , Ribakare Muhayimpundu , Habimana Savio D. , DeVos Josh , Mwesigwa Richard C. N. , Kayirangwa Eugenie , Semuhore Jules M. , Rwibasira Gallican N. , Suthar Amitabh B. , Remera Eric 
Published: May 2022

Background We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda. Methods This cross-sectional study included 702 patients receiving first-line ART for at least 6 months with last viral load (VL) results ≥1000 copies/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA/SE. Results Median time on ART was 86.4 months (interquartile range [IQR], 44.8–130.2 months), and median CD4 count at ART initiation was 311 cells/mm3 (IQR, 197–484 cells/mm3). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutations were K65R (22.7%), M184V (15.4%) and D67N (9.8%) for NRTIs and K103N (34.4%) and Y181C/I/V/YC (7%) for NNRTIs. Independent predictors of acquired HIVDR included current ART regimen of zidovudine + lamivudine + nevirapine (adjusted odds ratio [aOR], 3.333 [95% confidence interval (CI): 1.022–10.870]; p = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028–0.779]; p = 0.025), zidovudine + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016–0.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084–0.793]; p = 0.019) for NNRTI resistance. History of ever switching ART regimen was associated with NRTI resistance (aOR, 2.53 [95% CI: 1.198–5.356]; p = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435–7.278], p = 0.005). Conclusion The prevalence of acquired HIV drug resistance (HIVDR) was high among patient failing to re-suppress VL and was associated with current ART regimen and ever switching ART regimen. The findings of this study support the current WHO guidelines recommending that patients on an NNRTI-based regimen should be switched based on a single viral load test and suggests that national HIV VL monitoring of patients receiving ART has prevented long-term treatment failure that would result in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs.
Insights into the house dust-bound polycyclic aromatic hydrocarbons and their potential human health risk in Greater Cairo, Egypt
Authors: Hassan Salwa K. , El-Mekawy Asmaa , Alghamdi Mansour A. , Khoder Mamdouh I. 
Published: May 2022

Data dealing with polycyclic aromatic hydrocarbons (PAHs) levels in settled dust of Greater Cairo houses (GCH), Egypt, and their implication on human health risk are scarce. The goal of this study was to gain insights into the characterisations of PAHs in settled dust in GCH and their associated carcinogenic and mutagenic risks. ƩPAH concentrations were 3125 and 268 ng/g in settled dust in GCH and rural houses (RH), respectively. Heavier congeners (4–6 aromatic ring PAHs) represented 86.5% (GCH) and 92% (RH) of ƩPAHs. Houses on main streets are exposed to higher levels of PAHs than those on the side streets. The main sources of PAHs in GCH and RH were vehicular emissions (pyrogenic sources) and PAHs in GCH come from local emissions and in RH from the surrounding urban cities. Results showed that the carcinogenicity of PAHs associated with dust exceeds their mutagenicity. Based on Incremental Lifetime Cancer Risk (ILCR) estimations, the order of cancer risk (CR) was as follows: urban houses (UH) > suburban houses (SUH) > RH. CR and ILCRs calculations suggest that children and adults exposed to settled dust-bound PAHs in GCH and RH have an increase in CR, as CR and ILCRs values exceeded accepted levels.
Perspectives of undergraduate and graduate medical trainees on documenting clinical notes: Implications for medical education and informatics
Authors: Rajaram Akshay , Patel Nimesh , Hickey Zachary , Wolfrom Brent , Newbigging Joseph 
Published: May 2022

Ensuring the accuracy of unstructured clinical notes is critical for patient care, research, and quality improvement. Understanding how trainees learn to document these notes and the challenges they encounter are important steps to developing educational and informatics solutions. Authors conducted focus groups to gather the perspectives of 40 medical students (MS) and family and emergency medicine (EM) residents on recording clinical notes in the electronic medical record (EMR). Focus groups were audio recorded, transcribed, and thematically analyzed. Thematic analysis with a deductive approach revealed: a lack of formal education, a shift from information gathering to documenting clinical reasoning with seniority, and barriers to charting development, including variable preceptor expectations and EMR design constraints. Participating trainees report gaps in education around the documentation of notes in the EMR. Future work should explore opportunities to reduce gaps, including more formal education, the creation of specific competencies, and improvements to the EMR.