bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-articular Injection of Autologous Adipose-Derived Stem Cells or Stromal Vascular Fractions: Are They Effective for Patients With Knee Osteoarthritis? A Systematic Review With Meta-analysis of Randomized Controlled Trials
Authors: Kim Kang-Il , Kim Myung-Seo , Kim Jun-Ho 
Published: January 2022

Background: Intra-articular injection of adipose-derived stem cells, which are divided into adipose-derived mesenchymal stem cells (ASCs) and adipose-derived stromal vascular fractions (ADSVFs), has been reported to be a viable treatment modality for knee osteoarthritis (OA); however, its efficacy remains limited. Purpose: This study aimed to provide comprehensive information about the efficacy and safety of intra-articular injections of autologous ASCs and ADSVFs without adjuvant treatment in patients with knee OA. Study Design: Meta-analysis; Level of evidence, 1. Methods: A systematic search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy and safety of intra-articular injections of autologous ASCs or ADSVFs without adjuvant treatments compared with placebo or hyaluronic acid in patients with knee OA. Clinically, the 100-mm visual analog scale for pain relief and the Western Ontario and McMaster Universities Osteoarthritis Index for functional improvement were implemented. Radiologically, cartilage status was assessed using magnetic resonance imaging (MRI). Procedure-related knee pain, swelling, and adverse events (AEs) were evaluated for safety. Additionally, we performed subgroup analyses comparing ASCs versus ADSVFs. Methodological quality was assessed using the modified Coleman Methodology Score (mCMS). Results: A total of 5 RCTs were included in this study. Based on the meta-analysis, ASCs or ADSVFs showed significantly better pain relief at 6 months ( Z = 7.62; P < .0001) and 12 months ( Z = 7.21; P < .0001) and functional improvement at 6 months ( Z = 4.13; P < .0001) and 12 months ( Z = 3.79; P = .0002), without a difference in procedure-related knee pain or swelling compared with controls. Although a meta-analysis with regard to cartilage improvements was not performed owing to heterogeneous MRI assessment, 3 studies reported significantly improved cartilage status after the injection. No serious AEs associated with ASCs or ADSVFs were reported. Subgroup analyses showed similar efficacy between ASC and ADSVF treatments. The median mCMS was 70 (range, 55-75). Conclusion: For patients with knee OA, intra-articular injection of autologous ASCs or ADSVFs without adjuvant treatment showed remarkable clinical efficacy and safety at short-term follow-up. Some degree of efficacy has been shown for cartilage regeneration in knee OA, although the evidence remains limited. Further RCTs that directly compare ASCs and ADSVFs are needed.
Effects of Different Irradiation Treatments on Total Saponins Content of Sapindus mukorossi
Authors: Shi Yu-Min , Yan Heng , Wu Lin-Sen , Xie Jia-Jia , Chen Hong-Guo 
Published: January 2022

Sapindus mukorossi Gaertn is also known as Mu Huanzi, You Huanzi, soap tree, etc. The pericarp of Sapindus mukorossi contains many saponins, which is a type of natural non-ionic surfactant. Its extract has vigorous surface activity and biological activities such as bacteriostasis, oxidation resistance, and free radical scavenging. The Sapindus mukorossi extract is an environmentally friendly washing product that microorganisms can be rapidly decompose in nature without any environmental pollution.This study aims to investigate the effects of E-beam and Co60-γ irradiation on the total saponins content in the crude extract of the S mukorossi. The S mukorossi powder is irradiated with E-beam and Co60-γ ray at doses of 0, 4, 6, 8, 10, and 12 kGy for E-beam and 0, 50, 100, 150, and 200 Gy, respectively, for Co60-γ ray. The changes in the content of total saponins in the crude extract, total detergency, and the bacteriostatic abilities before and after the irradiation were analyzed. The results showed that the content of total saponins in samples irradiated by E-beam was significantly higher than that in non-irradiated samples. The saponins yield was the highest at a radiation dose of 6 kGy, and the detergency and bacteriostatic ability were also the strongest. After low-dose Co6-γ irradiation, the total saponins in the S mukorossi crude extract, and detergency and bacteriostatic ability had no apparent change. Conclusion: E-beam irradiation at a dose of 6 kGy can effectively improve the content of total saponins in the crude extract of S mukorossi powder. In addition, its effects on detergency and bacteriostatic abilities are relatively significant. The findings provide sufficient reference data for the further development of S mukorossi commodities.
Medical Students’ Attitudes Towards Cardiothoracic Surgery in the United Kingdom: A Cross-Sectional Survey of 1675 Students
Authors: Dost Samiullah , Al-Nusair Lana , Shehab Mai , Hagana Arwa , Hossain Aleena , Dost Ahmed Jawad , Abdelwahed Aida 
Published: January 2022

Objectives The objectives of this study were the following: (i) assess interest levels in cardiothoracic surgery (CTS) among UK-based medical students, (ii) identify potential motivators and barriers to pursuing CTS training, (iii) explore the influence of gender on interest in CTS in greater depth. Methods Medical students from all year groups across UK medical schools were invited to participate in a cross-sectional, national online survey. Responses were collected from 02/12/2019 to 08/12/2019. Results 1675 medical students from 31 UK medical schools responded, with an estimated 5.3% response rate. Of the respondents, 33.7% respondents reported having exposure to CTS, primarily through their medical school or through extracurricular activities (48.4% and 38.8%, respectively). When assessing interest in CTS, 31.4% were interested in undertaking a career in CTS, with a larger proportion of students expressing interest with no exposure to CTS than those with exposure. However, interest in pursuing CTS decreased with exposure as medical students transitioned from pre-clinical to clinical stages. Additionally, male participants were more interested in seeking a CTS post than their female counterparts (38% vs. 27.6%). The length of training ( p = 0.0009) and competitive nature ( p < 0.0001) of gaining a CTS post were the primary deterring factor for female participants, compared to their male counterparts. Conclusions This study shows the importance of quality of exposure and its impact on students’ interests in pursuing a career in CTS. The negative relationship between exposure and interest in CTS can be associated with the realisation of the challenges that come with pursuing CTS.
Multiphasic screening of priority chemical compounds in drinking water by process control and human health risk
Authors: Liu Yan , Li Xue , Qiao Xiaocui , Zhao Xingru , Ge Simin , Wang Haiyan , Li Dan 
Published: January 2022

Abstract
Background
The residual chemical pollutants in drinking water may cause adverse effects on human health. Chemical compounds potentially affecting human health have been widely explored, while the multiphasic evaluation of chemical compounds by process control and human health risk is still rarely reported. In the present study, we used multiphasic criteria to assess the health risk including effluent concentration, accumulation index, purification index for the removal efficiency during the drinking water treatment processes, carcinogen classification based on the International Agency for Research on Cancer standards, non-carcinogenic health hazards and carcinogenic risk.

Results
Among the monitored chemicals, 47 and 44 chemical compounds were detected in raw water and treated water, respectively. The generation and removal of chemical compounds implied that the migration and transformation of chemicals during the purification processes affected the effluent concentration, posing a direct potential health risk. Of these compounds, 41 contaminants’ profiles were screened as priority chemical compounds (PCCs).

Conclusions
The top eight PCCs with high carcinogenic risk were highlighted. Some effective steps, such as protecting the raw water sources, improving the removal performance and reducing the disinfection by-products during the purification process by introducing advanced treatment technologies, were suggested to maintain drinking water security. Collectively, our findings provided novel scientific supports for the sustainable management of drinking water to promote human health.

Graphical Abstract
Effects of delta-opioid receptor agonist pretreatment on the cardiotoxicity of bupivacaine in rats
Authors: Wang Chenran , Sun Shen , Jiao Jing , Yu Xinhua , Huang Shaoqiang 
Published: January 2022

Abstract
Background
Delta-opioid receptor is widely expressed in human and rodent hearts, and has been proved to protect cardiomyocytes against ischemia/reperfusion and heart failure. The antagonist of delta-opioid receptor could block the rescue effect of lipid emulsion against local anesthetic cardiotoxicity. However, no evidence is available for the direct effect of delta-opioid-receptor agonists on the cardiotoxicity of local anesthetics.

Methods
Anesthetized Sprague Dawley rats were divided into five groups. Group NS received 2 ml·kg−1·min−1 normal saline, group LE received 2 ml·kg−1·min−1 30% lipid emulsion and group BW received 0.1, 1.0, or 5.0 mg/kg BW373U86, a delta-opioid-receptor agonist, for 5 min. Then 0.5% bupivacaine was infused intravenously at a rate of 3.0 mg·kg−1·min−1 until asystole. The time of arrhythmia, 50% mean arterial pressure-, 50% heart rate-reduction and asystole were recorded, and the dose of bupivacaine at each time point was calculated.

Results
All three different doses of BW373U86 did not affect the arrhythmia, 50% mean arterial pressure-reduction, 50% heart rate-reduction and asystole dose of bupivacaine compared with group NS. 30% LE significantly increased the bupivacaine threshold of 50% mean arterial pressure-reduction (17.9 [15.4–20.7] versus 7.2 [5.9–8.7], p = 0.018), 50% heart rate-reduction (18.7 ± 4.2 versus 8.8 ± 1.7, p < 0.001) and asystole (26.5 [21.0–29.1] versus 11.3 [10.7–13.4], p = 0.008) compared with group NS. There was no difference between group LE and group NS in the arrhythmia dose of bupivacaine (9.9 [8.9–11.7] versus 5.6 [4.5–7.0], p = 0.060).

Conclusions
Our data show that BW373U86 does not affect the cardiotoxicity of bupivacaine compared with NS control in rats. 30% LE pretreatment protects the myocardium against bupivacaine-induced cardiotoxicity.
Usefulness of estimated pulse wave velocity for identifying prevalent coronary heart disease: findings from a general Chinese population
Authors: He Xiao-Wu , Park Jieun , Huang Wen-Sheng , Leng Li-Hua , Yu Yan , Pei Yi-Bin , Zhu Gao , Wu Shaohui 
Published: January 2022

Abstract
Background
Aortic stiffness and coronary heart disease (CHD) share a similar spectrum of risk factors; previous studies have identified the association between aortic stiffness and CHD. Recent studies have demonstrated estimated pulse wave velocity (ePWV) as a simple and easy-acquired indicator of aortic stiffness. Our work aims to evaluate the association between ePWV and the prevalence of CHD and assess the value of ePWV for the identification of prevalent CHD.

Methods
The current cross-sectional work included 7012 subjects from rural areas of southeastern China between September 2020 and February 2021. ePWV was calculated from age and mean blood pressure by specific algorithm.

Results
The prevalence of CHD in our population was 3.58% (251 patients among 7012 subjects). After adjusting for age, sex, education, income and exercise level, current smoking and drinking status, body mass index, waist circumference, fasting plasma glucose, total cholesterol, high density lipoprotein, estimated glomerular filtration rate and cerebrovascular diseases, each standard deviation increment of ePWV would produce an additional 37.8% risk of prevalent CHD. Moreover, after dividing ePWV into quartiles, the 4th quartile of ePWV showed a significant risk of prevalent CHD (OR (95% CI): 3.567 (1.963–6.479)) when compared with the 1st quartile. Additionally, the subgroup analysis showed the association between ePWV and prevalent CHD was robust to several common risk factors of CHD, including age, sex, body mass index, hypertension, diabetes and reduced estimated glomerular filtration rate. Finally, the area under curve (AUC) displayed an improvement when adding ePWV into common CHD risk factors (0.705 vs. 0.718. P = 0.044). Consistently, net reclassification index (0.436, 95% CI: 0.301–0.571, P < 0.001) and integrated discrimination index (0.004, 95% CI: 0.001–0.006, P = 0.002) demonstrated the value of ePWV to optimize the identification of prevalent CHD in the general population.

Conclusion
The present analysis implicates the robust association between ePWV, a simple, rapid, and practical marker of aortic stiffness, and prevalent CHD in the general Chinese population. More importantly, the results suggest the value of ePWV as a potential marker to improve the identification of prevalent CHD.
K-means for shared frailty models
Authors: Govindarajulu Usha , Bedi Sandeep 
Published: January 2022

Abstract
Background
The purpose of this research was to see how the k-means algorithm can be applied to survival analysis with single events per subject for defining groups, which can then be modeled in a shared frailty model to further allow the capturing the unmeasured confounding not already explained by the covariates in the model.

Methods
For this purpose we developed our own k-means survival grouping algorithm to handle this approach. We compared a regular shared frailty model with a regular grouping variable and a shared frailty model with a k-means grouping variable in simulations as well as analysis on a real dataset.

Results
We found that in both simulations as well as real data showed that our k-means clustering is no different than the typical frailty clustering even under different situations of varied case rates and censoring. It appeared our k-means algorithm could be a trustworthy mechanism of creating groups from data when no grouping term exists for including in a frailty term in a survival model or comparing to an existing grouping variable available in the current data to use in a frailty model.
Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke
Authors: Ilves Nigul , Lõo Silva , Ilves Norman , Laugesaar Rael , Loorits Dagmar , Kool Pille , Talvik Tiina , Ilves Pilvi 
Published: January 2022

AbstractBackgroundPerinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge.AimsTo evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls.MethodsTerm born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS).ResultsCompared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p < 0.005). Affected hand function in children with AIS was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5;p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < − 0.5;p < 0.05).In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p ≤ 0.001) and hippocampus (p < 0.03) was smaller compared to controls. Smaller volume of the ipsi- and contralesional thalami and ipsilesional caudate nucleus was correlated with affected hand function (r > 0.55;p < 0.05) in children with PVI.ConclusionsSmaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.
Nanoparticle albumin-bound paclitaxel and PD-1 inhibitor (sintilimab) combination therapy for soft tissue sarcoma: a retrospective study
Authors: Tian Zhichao , Dong Shuping , Yang Yang , Gao Shilei , Yang Yonghao , Yang Jinpo , Zhang Peng , Wang Xin , Yao Weitao 
Published: January 2022

Abstract
Background
There is increasing evidence that combination therapy with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) and programmed cell death protein 1 (PD-1) inhibitor is safe and efficacious in treating many types of malignant tumors. However, clinical data demonstrating the effect of this treatment combination for patients with metastatic soft tissue sarcoma (STS) are currently limited.

Methods
The clinical data of patients with metastatic STS who received nab-paclitaxel plus PD-1 inhibitor (sintilimab) therapy between January 2019 and February 2021 were retrospectively analyzed. The effectiveness and safety of the combined treatment were evaluated in terms of the median progression-free survival (PFS), estimated using the Kaplan–Meier method. The univariate Cox proportional hazards model was used to analyze the relationship between clinicopathological parameters and PFS. All statistical analyses were two-sided; P < 0.05 was considered statistically significant.

Results
A total of 28 patients treated with nab-paclitaxel plus sintilimab were enrolled in this study. The objective response rate was 25%, the disease control rate was 50%, and the median PFS was 2.25 months (95% CI = 1.8–3.0 months). The most common grade 1 or 2 adverse events (AEs) were alopecia (89.3%; 25/28), leukopenia (25.0%; 7/28), fatigue (21.4%; 6/28), anemia (21.4%; 6/28), and nausea (21.4%; 6/28). The most common grade 3 AEs were neutropenia (10.7%; 3/28) and peripheral neuropathy (10.7%; 3/28). No grade 4 AEs were observed. Among the present study cohort, patients with angiosarcoma (n = 5) had significantly longer PFS (P = 0.012) than patients with other pathological subtypes, including undifferentiated pleomorphic sarcoma (n = 7), epithelioid sarcoma (n = 5), fibrosarcoma (n = 4), synovial sarcoma (n = 3), leiomyosarcoma (n = 2), pleomorphic liposarcoma (n = 1), and rhabdomyosarcoma (n = 1); those who experienced three or more AEs had significantly longer median PFS than those who experienced less than three AEs (P = 0.018).

Conclusion
Nab-paclitaxel plus PD-1 inhibitor is a promising treatment regimen for advanced STS. Randomized controlled clinical trials are required to further demonstrate its efficacy and optimal application scenario.
Ocular phenotype and genetical analysis in patients with retinopathy of prematurity
Authors: Tao Tianchang , Meng Xianfen , Xu Ningda , Li Jiarui , Cheng Yong , Chen Yi , Huang Lvzhen 
Published: January 2022

Abstract
Background
Retinopathy of prematurity (ROP) is a multifactorial retinal disease, involving both environmental and genetic factors; The purpose of this study is to evaluate the clinical presentations and genetic variants in Chinese patients with ROP.

Methods
A total of 36 patients diagnosed with ROP were enrolled in this study, their medical and ophthalmic histories were obtained, and comprehensive clinical examinations were performed. Genomic DNA was isolated from peripheral blood of ROP patients, polymerase chain reaction and direct sequencing of the associated pathogenic genes (FZD4, TSPAN12, and NDP) were performed.

Results
All patients exhibited the clinical manifestations of ROP. No mutations were detected in the TSPAN12 and NDP genes in all patients; Interestingly, three novel missense mutations were identified in the FZD4 gene (p.A2P, p.L79M, and p.Y378C) in four patients, for a detection rate of 11.1% (4/36).

Conclusions
This study expands the genotypic spectrum of FZD4 gene in ROP patients, and our findings underscore the importance of obtaining molecular analyses and comprehensive health screening for this retinal disease.
Psychosocial and mental health challenges faced by emerging adults living with HIV and support systems aiding their positive coping: a qualitative study from the Kenyan coast
Authors: Nyongesa Moses K. , Nasambu Carophine , Mapenzi Rachael , Koot Hans M. , Cuijpers Pim , Newton Charles R. J. C. , Abubakar Amina 
Published: January 2022

Abstract
Background
In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV transitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults.

Methods
In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18–24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software.

Results
Young adults living with HIV from this setting face various challenges at different levels of the social ecosystem. At the individual level, key challenges they reported included acceptance of HIV positive status, antiretroviral adherence, economic burden associated with access to healthcare, building an intimate relationship, mental health problems, and HIV status disclosure. At the family level, death of parents, poverty, and being unaccepted were the commonly mentioned challenges. At the community level, socialization difficulties and long waiting time at the HIV clinic were highlighted. HIV stigma and discrimination were frequently reported across the different levels. Economic independence, social support (from families, friends, organizations, healthcare providers and peer meetings), and reliance on spirituality aided positive coping among these young adults amidst the challenges of living with HIV.

Conclusions
In this rural setting, emerging adults living with HIV face various challenges at the individual, family, and community level, some of which are cross-cutting. Our findings underscore the need for designing multi-level youth-friendly interventions that can address modifiable challenges encountered by emerging adults living with HIV in this and similar settings. Such interventions should incorporate appropriate context-specific support structures that may help these young people smoothly transit into adult life.