bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of inhaled ipratropium bromide to improve exercise-induced laryngeal obstruction cannot be recommended
Authors: Muralitharan Praveen , Carlsen Petter , Hilland Magnus , Delestre-Levai Irisz , Vollsæter Maria , Hufthammer Karl Ove , Engan Mette , Røksund Ola Drange , Halvorsen Thomas , Clemm Hege H. 
Published: November 2022

IntroductionExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young adults. Current management generally consists of breathing advice, speech therapy, inspiratory muscle training or supraglottoplasty in highly motivated subjects with supraglottic collapse. Inhaled ipratropium bromide (IB) is a muscarinic receptor antagonist used to treat asthma that is suggested in a few reports to improve EILO symptoms. The aim of the present study was to investigate effects of inhaled IB in EILO diagnosed by continuous laryngoscopy exercise (CLE) test and classified by CLE scores.MethodsA randomised crossover trial was conducted at Haukeland University Hospital, Bergen, Norway, enrolling participants diagnosed with EILO defined by characteristic symptoms and CLE score ≥3 (range 0–12). Two consecutive CLE tests were performed within 2 weeks, one test with and one test without prior administration of inhaled IB in a randomised order. Main outcomes were the CLE score, dyspnoea measured using a modified BORG scale (range 0–10) and cardiopulmonary exercise data provided by the CLE test.Results20 participants (14 females) aged 12–25 years participated, and all ran to exhaustion on both tests. Mean CLE score, BORG score and peak oxygen consumption were similar in tests performed with and without IB; mean differences (95% confidence interval) were 0.08 (−0.28–0.43), 0.35 (−0.29–0.99) and −0.4 (−1.9–1.1) mL·kg−1·min−1, respectively.ConclusionInhaled IB did not improve CLE score, dyspnoea or exercise capacity in subjects with EILO. The study does not support the use of inhaled IB to treat EILO.
Responses of transcriptome and metabolome in the roots of Pugionium cornutum (L.) Gaertn to exogenously applied phthalic acid
Authors: Zhang Xiaoyan , Ning Kezhen , Yang Zhongren , Huang Xiumei , Yu Hongtao , Fu Nana , Qin Xinyuan , Hao Lizhen , Zhang Fenglan 
Published: November 2022

Abstract
Background
The yield and quality of Pugionium cornutum (L.) Gaertn., a healthy, green vegetable with low sugar and high protein contents and high medicinal value, is severely affected by autotoxicity, which is a leading factor in the formation of plant disease. To help characterize the autotoxicity mechanism of P. cornutum (L.) Gaertn., we performed transcriptomic and metabolic analysis of the roots of P. cornutum (L.) Gaertn. response to phthalic acid, an autotoxin from P. cornutum (L.) Gaertn.

Results
In this study, high-throughput sequencing of nine RNA-seq libraries generated from the roots.of P. cornutum (L.) Gaertn. under different phthalic acid treatments yielded 37,737 unigenes. In total, 1085 (703 upregulated and 382 downregulated) and 5998 (4385 upregulated and 1613 downregulated) DEGs were identified under 0.1 and 10 mmol·L− 1 phthalic acid treatment, respectively, compared with the control treatment. Glutathione metabolism was among the top five important enriched pathways. In total, 457 and 435 differentially accumulated metabolites were detected under 0.1 and 10 mmol·L− 1 phthalic acid treatment compared with the control, respectively, of which 223 and 253, respectively, increased in abundance. With the increase in phthalic acid concentration, the accumulation of ten metabolites increased significantly, while that of four metabolites decreased significantly, and phthalic acid, dambonitol, 4-hydroxy-butyric acid, homocitrulline, and ethyl β-D-glucopyranoside were 100 times more abundant under the 10 mmol·L− 1 phthalic acid treatment than under the control. Seventeen differentially expressed genes significantly associated with phthalic acid content were identified. In addition, the L-histidinol content was highest under 0.1 mmol·L− 1 phthalic acid, and a total of eleven differentially expressed genes were significantly positively correlated with the L-histidinol content, all of which were annotated to heat shock proteins, aquaporins and cysteine proteases.

Conclusions
Accumulation of autotoxins altered the metabolic balance in P. cornutum (L.) Gaertn. and influenced water absorption and carbon and nitrogen metabolism. These important results provide insights into the formation mechanisms of autotoxicity and for the subsequent development of new control measures to improve the production and quality of replanted plants.
Enhancing the role of the social network in activity (re)engagement post-stroke: a focus group study with rehabilitation professionals
Authors: van der Veen Dinja J. , Jellema Sandra , van der Wees Philip J. , Graff Maud J. L. , de Swart Bert J. M. , Steultjens Esther M. J. 
Published: November 2022

AbstractBackgroundPeople post-stroke are at risk of not being able to participate in valued activities. It is important that rehabilitation professionals prepare people post-stroke for the transition home and provide needed support when they live at home. Several authors have suggested that members of the broad social network should play an active role in rehabilitation. This includes informing them about the importance of activity (re)engagement post-stroke and learning strategies to provide support. It is not clear when and how the broad social network can best be equipped to provide adequate activity support. This study aimed to explore stroke professionals’ perspectives on strategies that establish a social network that supports activity (re)engagement of people post-stroke, when strategies are best implemented, and the factors that influence the implementation of these strategies.MethodsTwo focus groups were executed. Content analysis was used to analyze the transcripts of the recorded conversations.ResultsEighteen professionals with various professional backgrounds and roles in treating people post-stroke participated. Strategies to establish a supportive social network included identifying, expanding, informing, and actively engaging network members. Working with the network in the immediate post-stroke phase was regarded as important for improving long-term activity outcomes. Participants expressed that most strategies to equip the social network to support people post-stroke need to take place within community care. However, the participants experienced difficulties in implementing network strategies. Perceived barriers included interprofessional collaboration, professional knowledge, self-efficacy, and financial structures.ConclusionsStrategies to involve the social network of people post-stroke are not fully implemented. Although identifying members of a social network should begin during inpatient rehabilitation, the main part of actively engaging the network will have to take place when the people post-stroke return home. Implementing social network strategies requires a systematic process focusing on collaboration, knowledge, attitude, and skill development.
Measuring the geographic disparity of comorbidity in commercially insured individuals compared to the distribution of physicians in South Africa
Authors: Mannie Cristina , Strydom Stefan , Kharrazi Hadi 
Published: November 2022

Abstract
Background
Measuring and addressing the disparity between access to healthcare resources and underlying health needs of populations is a prominent focus in health policy development. More recently, the fair distribution of healthcare resources among population subgroups have become an important indication of health inequities. Single disease outcomes are commonly used for healthcare resource allocations; however, leveraging population-level comorbidity measures for health disparity research has been limited. This study compares the geographical distribution of comorbidity and associated healthcare utilization among commercially insured individuals in South Africa (SA) relative to the distribution of physicians.

Methods
A retrospective, cross-sectional analysis was performed comparing the geographical distribution of comorbidity and physicians for 2.6 million commercially insured individuals over 2016–2017, stratified by geographical districts and population groups in SA. We applied the Johns Hopkins ACG® System across the claims data of a large health plan administrator to measure a comorbidity risk score for each individual. By aggregating individual scores, we determined the average healthcare resource need of individuals per district, known as the comorbidity index (CMI), to describe the disease burden per district. Linear regression models were constructed to test the relationship between CMI, age, gender, population group, and population density against physician density.

Results
Our results showed a tendency for physicians to practice in geographic areas with more insurance enrollees and not necessarily where disease burden may be highest. This was confirmed by a negative relationship between physician density and CMI for the overall population and for three of the four major population groups. Among the population groups, the Black African population had, on average, access to fewer physicians per capita than other population groups, before and after adjusting for confounding factors.

Conclusion
CMI is a novel measure for healthcare disparities research that considers both acute and chronic conditions contributing to current and future healthcare costs. Our study linked and compared the population-level geographical distribution of CMI to the distribution of physicians using routinely collected data. Our results could provide vital information towards the more equitable distribution of healthcare providers across population groups in SA, and to meet the healthcare needs of disadvantaged communities.
Prevalence and correlates of cognitive impairment in schizophrenia: a cross-sectional study from a teaching hospital southern Sri Lanka
Authors: Goonathilake Praveen , Ediriweera Dileepa , Ruban Rumi , Isuru Amila 
Published: November 2022

Abstract
Introductions
This study assessed the prevalence of cognitive impairment, the degree of impairment in individual cognitive domains and sociodemographic and clinical correlates among patients attending to psychiatry clinics at Teaching Hospital, Karapitiya, Sri Lanka.

Methods
A cross-sectional study was carried out at the psychiatry outpatient clinics of Teaching Hospital, Karapitiya, Sri Lanka. Their cognitive functions were assessed using the culturally validated Sinhala version of Addenbrooke’s Cognitive Examination – III (ACE-III-S). ACE-III-S score below 85.5 was considered as significant cognitive impairment. Linear regression analysis was used to assess the factors associated with cognitive impairment. A P value of 0.05 is considered significant.

Results
One hundred forty patients with schizophrenia were assessed. Of this, 125 patients had significant cognitive impairment with a prevalence of 89.3% (95% CI:84.1–94.5). Impairment in each cognitive domain was as follows: 60% in attention, 65.7% in memory, 55% in fluency, 61.4% in language, and 63.6% in visuospatial skills. Impairment was not different between cognitive domains. Advancing age (P < 0.001), shorter duration of formal education (P = < 0.001), longer duration of illness (P = < 0.001) and not having a full-time employment (P = 0.020) showed a positive association with cognitive impairment.

Conclusions
Nine out of ten patients with schizophrenia experienced significant cognitive impairment. Patients showed more than 50% impairment in all cognitive domains. The cognitive domains did not show disproportionate impairment. This study highlights the importance of introducing routine cognitive assessment protocols in patients with schizophrenia.
The public health exposome and pregnancy-related mortality in the United States: a high-dimensional computational analysis
Authors: Harville E. W. , Grady S.K. , Langston MA , Juarez P. J. , Vilda D. , Wallace M. E. 
Published: November 2022

AbstractBackgroundRacial inequities in maternal mortality in the U.S. continue to be stark.MethodsThe 2015–2018, 4-year total population, county-level, pregnancy-related mortality ratio (PRM; deaths per 100,000 live births; National Center for Health Statistics (NCHS), restricted use mortality file) was linked with the Public Health Exposome (PHE). Using data reduction techniques, 1591 variables were extracted from over 62,000 variables for use in this analysis, providing information on the relationships between PRM and the social, health and health care, natural, and built environments. Graph theoretical algorithms and Bayesian analysis were applied to PHE/PRM linked data to identify latent networks.ResultsPHE variables most strongly correlated with total population PRM were years of potential life lost and overall life expectancy. Population-level indicators of PRM were overall poverty, smoking, lack of exercise, heat, and lack of adequate access to food.ConclusionsIn this high-dimensional analysis, overall life expectancy, poverty indicators, and health behaviors were found to be the strongest predictors of pregnancy-related mortality. This provides strong evidence that maternal death is part of a broader constellation of both similar and unique health behaviors, social determinants and environmental exposures as other causes of death.
Systematic realist synthesis of health-related and lifestyle interventions designed to decrease overweight, obesity and unemployment in adults
Authors: Amenyah Sophia D. , Waters Diane , Tang Wen , Fenge Lee-Ann , Murphy Jane L. 
Published: November 2022

AbstractBackgroundObesity and unemployment are complex social and health issues with underlying causes that are interconnected. While a clear link has been established, there is lack of evidence on the underlying causal pathways and how health-related interventions could reduce obesity and unemployment using a holistic approach.ObjectivesThe aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce obesity, overweight and unemployment and to determine for whom and under what circumstances these interventions were successful or unsuccessful and why.MethodsA realist synthesis approach was used. Systematic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. The evidence from included studies were synthesised into Context-Mechanism-Outcome configurations (CMOcs) to better understand when and how programmes work, for which participants and to refine the final programme theory.ResultsA total of 83 articles met the inclusion criteria. 8 CMOcs elucidating the contexts of the health-related interventions, underlying mechanisms and outcomes were identified. Interventions that were tailored to the target population using multiple strategies, addressing different aspects of individual and external environments led to positive outcomes for reemployment and reduction of obesity.ConclusionThis realist synthesis presents a broad array of contexts, mechanisms underlying the success of health-related interventions to reduce obesity and unemployment. It provides novel insights and key factors that influence the success of such interventions and highlights a need for participatory and holistic approaches to maximise the effectiveness of programmes designed to reduce obesity and unemployment.Trial registrationPROSPERO 2020CRD42020219897.
The prognostic value of tumor mutational burden related 6-gene-based Risk Score in laryngeal cancer patients
Authors: Yang Dong , Liu Juan , Liu Naibin , Yin Chunlei , Zhang Huan , Xu Jianhua 
Published: November 2022

AbstractBackgroundLaryngeal cancer (LC) is the second frequent malignant head and neck cancer around world, while LC patients’ prognosis is unsatisfactory. This study aims to investigate the prognostic value of tumor mutation burden (TMB)-related genes in LC.MethodsLC data was downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases. TMB values of all samples were calculated basing on mutation data. The differentially expressed genes (DEGs) between LC samples with distinct TMB were subjected to univariate and LASSO Cox regression analysis to build Risk Score. Immune cell infiltration analysis was conducted in CIBERSORT.ResultsBetween high and low TMB LC samples, we identified 210 DEGs. Of which, six optimal genes were included to construct Risk Score, comprising FOXJ1, EPO, FGF5, SPOCK1, KCNF1 and PSG5. High risk LC patients had significantly poorer overall survival than low risk patients. The nomogram model constructed basing on Risk Score and gender showed good performance in predicting LC patients’ survival probability.ConclusionsThe prognostic Risk Score model, basing on six TMB-related genes (FOXJ1, EPO, FGF5, SPOCK1, KCNF1 and PSG5), was a reliable prognostic model to separate LC patients with different prognoses.
Pulp blood flow changes in maxillary and mandibular anterior teeth after orthodontic retraction: a prospective study
Authors: Guo Runzhi , Yu Qianyao , Lin Yifan , Li Jing , Huang Yiping , Li Weiran 
Published: November 2022

Abstract
Background
Previous studies of pulpal blood flow (PBF) changes in anterior teeth have been limited in the early phase of orthodontic treatment; less is known about the blood supply of anterior teeth in bimaxillary protrusion patients after orthodontic retraction.

Methods
Fifty bimaxillary protrusion patients (25 orthodontic patients ready for debonding and 25 non-orthodontic patients) were selected as study participants. The PBF of maxillary and mandibular anterior teeth were measured using laser Doppler flowmetry. For orthodontic patients, the PBF was measured at 1 day (T1), 1 month (T2), and 3 months (T3) after fixed appliance removal. Non-orthodontic patient PBF was measured as a control. Cone-beam computed tomography (CBCT) examinations before and after orthodontic treatment were performed for orthodontic patients to measure the root resorption. The anterior teeth in orthodontic group were further divided into subgroups according to root resorption and patient age.

Results
At T1 and T3, PBF changes did not differ significantly between the orthodontic and non-orthodontic groups. Maxillary lateral incisor, maxillary central incisor, and mandibular lateral incisor PBFs at T2 were significantly higher in the orthodontic group (P = 0.048, P = 0.04, and P = 0.021). No significant difference in PBF was found between the root resorption and non-resorption subgroups at any time point. Adolescent patients showed a higher PBF in the maxillary lateral incisor at T2 (12.23 ± 3.48) relative to that at T1 (9.10 ± 3.76) and T3 (9.81 ± 2.80) with statistically significant difference (P = 0.020).

Conclusion
For bimaxillary protrusion patients with four premolars extraction, PBF in the maxillary anterior teeth increased transiently after orthodontic appliance removal and then returned to non-orthodontic levels 3 months later. This effect was more pronounced in adolescents. The PBF of anterior teeth after orthodontic retraction may not be influenced by root resorption.
Effect of Liuzijue on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: study protocol for a multicenter, non-randomized, prospective study
Authors: Hu Jiaming , Gao Rundi , Wang Yiting , Li Yan , Wang Yaqin , Wang Zhen , Yang Junchao 
Published: November 2022

Abstract
Background
Traditional Chinese exercise as a new pulmonary rehabilitation technique has been increasingly used and achieved good results in pulmonary rehabilitation of chronic obstructive pulmonary disease (COPD). The aim of this study is to investigate the protective effects of Liuzijue on exercise tolerance, lung function, and quality of life in patients with COPD.

Methods
This study is a multicenter, non-randomized, prospective study. Patients will be divided into a control group (CG) and a Liuzijue group (LG) based on their willingness to learn Liuzijue. None of the outcome assessors will know the grouping of patients. Participants in this study will be collected from stable COPD patients who are outpatients or inpatients in 3 centers in China since September 2021. Patients will meet the diagnostic criteria for GOLD stage I-II COPD (FEV1% ≥ 0.5 and FEV1/FVC < 0.7) and be aged 40 years or older. Patients voluntarily will take part in the clinical study and sign an informed consent form. All participants will follow their existing medication. For LG patients, Liuzijue training has been added. Patients will practice Liuzijue for more than 30 minutes a day, more than 5 days a week, and adhere to the training for 3 months. Outcome indicators are 6-minute walk test (6MWT), lung function (FEV1%, FEV1/FVC, MMEF, PEF), modified British Medical Research Council (mMRC) score, COPD assessment test score (CAT), acute exacerbations and changes in drug treatment.

Discussion
This study quantified the effect of Liuzijue on the pulmonary rehabilitation of COPD patients in the stable phase of the disease, and provided a basis for the use of Liuzijue in COPD patients.

Trial registration
Chinese clinical trial registry, ChiCTR2100048945. Date: 2021-07-19. http://www.chictr.org.cn/showproj.aspx?proj=129094
Impact of medicine shortages on patients - a framework and application in the Netherlands
Authors: Postma Doerine J. , De Smet Peter A. G. M. , Notenboom Kim , Leufkens Hubert G. M. , Mantel-Teeuwisse Aukje K. 
Published: November 2022

Abstract
Background
Medicine shortages are often described in plain numbers, suggesting all shortages have a uniform impact. However, some shortages have a direct and serious effect on patients and need a prompt reaction from stakeholders. This study aims to create a broad framework to assess the impact of a shortage.

Method
We identified high impact shortages and selected exemplary shortages which we considered our learning cases. From five learning cases, we identified elements that had a potentially profound impact on one or more of these cases. We tested data saturation on the elements with another five test cases. Based on these elements, we created a framework to assess impact of shortages on patients and presented practical examples how to rate these different elements. Subsequently, we visualised the impact of these five learning cases on patients in radar charts.

Results
The five elements which we identified as potentially having a large impact were 1) alternative product, 2) disease, 3) susceptibility, 4) costs and 5) number of patients affected. The five learning cases rated high on different elements, leading to diverse and sometimes even opposite patterns of impact.

Conclusion
We created a framework for assessing the impact of a medicine shortage on patients by means of five key elements. By rating these elements, an indication of the impact can be obtained.