bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Extended Intraoperative Peritoneal Lavage Really Bring Benefit on Patients With Gastric Cancer? A Meta-Analysis of Published Clinical Trials
Authors: Tao Wei , Liu Xiao-Yu , Cheng Yu-Xi , Kang Bing , Zhang Hua , Yuan Chao , Zhang Bin , Peng Dong
Published: August 2021

Purpose

The purpose of the current meta-analysis is to analyze whether extended intraoperative peritoneal lavage (EIPL) can bring benefit on short-term outcomes or survival for patients undergoing curative gastrectomy for gastric cancer.

Methods

The PubMed, Embase, and Cochrane Library databases were searched from inception to May 3, 2021, to find eligible studies. Postoperative complications, overall survival (OS), disease-free survival (DFS), and peritoneal recurrence–free survival (PRFS) were compared between EIPL group and No EIPL group.

Results

A total of five randomized controlled trials with 1,790 patients were included in the current meta-analysis. No difference was found in baseline information (p > 0.05). After pooling up the data of overall postoperative complications, no significant difference was found between EIPL group and No EIPL group (OR = 0.88, 95% CI = 0.51 to 1.53, P = 0.65). Furthermore, there was no significant difference between EIPL group and No EIPL group in terms of OS (HR = 0.77, 95% CI = 0.36 to 1.64, P = 0.49), DFS (HR = 0.97, 95% CI = 0.71 to 1.33, P = 0.87), and PRFS (HR = 1.03, 95% CI = 0.74 to 1.43, P = 0.86). In terms of subgroup analysis of OS, no significant difference was found as well (HR = 1.05, 95% CI = 0.82 to 1.34, P = 0.69).

Conclusions

EIPL did not bring benefit in terms of short-term outcomes or survival. Therefore, EIPL is not recommended for patients undergoing curative gastrectomy for gastric cancer.
The Benefit of Apparent Diffusion Coefficient in Evaluating the Invasiveness of Hepatocellular Carcinoma
Authors: Jing Mengyuan , Cao Yuntai , Zhang Peng , Zhang Bin , Lin Xiaoqiang , Deng Liangna , Han Tao , Zhou Junlin
Published: August 2021

Background

This study aimed to evaluate hepatocellular carcinoma (HCC) invasiveness using the apparent diffusion coefficient (ADC).

Methods

Eighty-one patients with HCC confirmed by pathology and examined by preoperative magnetic resonance imaging diffusion-weighted imaging from January 2015 to September 2020 were retrospectively analyzed. Clinical and pathological data were recorded. The minimum ADC (ADCmin), average ADC (ADCmean), and the ratio of ADCmean to normal-appearing hepatic parenchyma ADC (ADCnahp) were assessed. The associations between clinical information, ADC value, and HCC invasiveness (microvascular invasion [MVI], tumor differentiation, and Ki-67 expression) were evaluated statistically. Independent risk factors related to HCC invasiveness were screened using binary logistic regression, and the diagnostic efficiency was evaluated by the receiver operating characteristic curve and its area under the curve (AUC) value.

Results

Tumor size was related to HCC MVI and tumor differentiation (P < 0.05). HCC MVI was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.860, 0.860, and 0.909, respectively. If these were combined with tumor size, the AUC value increased to 0.912. The degree of tumor differentiation was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.719, 0.708, and 0.797, respectively. If these were combined with tumor size, the AUC value increased to 0.868. Ki-67 expression was associated with ADCmin, ADCmean, and the ADCmean-to-ADCnahp ratio (all P < 0.05) with AUC values of 0.731, 0.747, and 0.746, respectively. Combined them, the AUC value increased to 0.763.

Conclusions

The findings indicated that the ADC value has significant potential for the non-invasive preoperative evaluation of HCC invasiveness.
Overall Survival of Patients With Unresectable or Metastatic BRAF V600-Mutant Acral/Cutaneous Melanoma Administered Dabrafenib Plus Trametinib: Long-Term Follow-Up of a Multicenter, Single-Arm Phase IIa Trial
Authors: Mao Lili , Ding Ya , Bai Xue , Sheng Xinan , Dai Jie , Chi Zhihong , Cui Chuanliang , Kong Yan , Fan Yun , Xu Yanjun , Wang Xuan , Tang Bixia , Lian Bin , Yan Xieqiao , Li Siming , Zhou Li , Wei Xiaoting , Li Caili , Guo Jun , Zhang Xiaoshi , Si Lu
Published: August 2021

Objectives

To examine the long-term survival outcome of dabrafenib in combination with trametinib in Chinese patients with unresectable or metastatic acral/cutaneous melanoma with BRAF-V600 mutation and to explore potential predictors of effectiveness.

Methods

This was a long-term follow-up of Chinese patients with unresectable or metastatic BRAF V600-mutant acral/cutaneous melanoma administered dabrafenib (150 mg twice daily) plus trametinib (2 mg once daily) in an open-label, multicenter, single-arm, phase IIa study (NCT02083354). Efficacy endpoints included objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS). The impacts of baseline characteristics on PFS and OS were analyzed.

Results

A total of sixty patients were included. The median age was 48 years, and 24 patients (40.0%) were male. Totally 12 individuals (20.0%) had acral melanoma, and 45 (75.0%) had failed previous systemic therapy. Up to July 2020, the median duration of follow-up was 37.0 (95% confidence interval [CI] 29.1-44.9) months. The updated ORR was 71.7% (95%CI 60.3%-83.1%). The 3-year OS rate was 28.8% (95%CI 19.1-43.6%) in the overall population, and 35.7% (95%CI 15.5–82.4%) in acral melanoma patients. The median DOR was 7.5 months (95%CI 4.5 to 10.5). Baseline normal lactic dehydrogenase (LDH), metastatic organ sites<3 and complete response to combination therapy with dabrafenib plus trametinib were associated with improved PFS and OS.

Conclusion

Dabrafenib combined with trametinib confer long-term survival in Chinese patients with BRAF V600-mutant, unresectable or metastatic acral/cutaneous melanoma.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT02083354, identifier NCT02083354.
The Emerging Role of T-Cell Immunoglobulin Mucin-3 in Breast Cancer: A Promising Target For Immunotherapy
Authors: Cong Yizi , Liu Jing , Chen Gang , Qiao Guangdong
Published: August 2021

Cancer treatment through immune checkpoint receptor blockade has made significant advances in the recent years. However, resistance to the current immune checkpoint inhibitors (ICIs) has been observed in many patients, who consequently do not respond to these treatments. T-cell immunoglobulin mucin-3 (Tim-3) is a novel immune checkpoint molecule emerging as a potential therapeutic target for cancer immunotherapy. Epidemiologic findings reveal that genetic polymorphisms in the Tim-3 gene are associated with increased susceptibility to breast cancer. In patients with breast cancer, Tim-3 is expressed both on immune and tumor cells. Accumulating evidence demonstrates that Tim-3 can notably affect breast cancer treatment outcome and prognosis. Therefore, Tim-3 is being regarded as a high-potential target for improving breast cancer therapy. In this review, we summarize the role of Tim-3 in breast cancer and the regulation mechanisms of Tim-3 to furnish evidences for future research and therapy.
Case Report: Alpelisib-Induced Drug Reaction With Eosinophilia and Systemic Symptoms: A Rare Manifestation of a Common Side Effect
Authors: Majeed Umair , Puiu Tudor , Sluzevich Jason , Reynolds Gina , Acampora Marites , Moreno-Aspitia Alvaro , Bodiford Katherine J. , Advani Pooja
Published: August 2021

Alpelisib is a PIK3a inhibitor approved for the treatment of metastatic ER+ breast cancer in combination with fulvestrant. Although rash is a common side effect of this medication, we present the first case of drug reaction with eosinophilia and systemic symptoms (DRESS) upon initial exposure to alpelisib. Here we describe the clinical-pathological findings and management of our patient with alpelisib-induced life-threatening DRESS syndrome. The goal of this case report is to highlight association of alpelisib with DRESS syndrome, in clinical practice, so that alpelisib can be immediately stopped and treatment for this serious condition promptly initiated.
Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report
Authors: Muller Gerrit J. , Hovenier Renee , Spijker Jip , van Gestel Monica , Klein-Blommert Rozalinde , Markhorst Dick , Dijkman Coen , Bem Reinout A.
Published: August 2021

Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.
Temperature Monitoring Devices in Neonates
Authors: Lei Donna , Tan Kenneth , Malhotra Atul
Published: August 2021

Introduction:Accurate temperature monitoring of neonates is vital due to the significant morbidities and mortality associated with neonatal hypothermia. Many studies have compared different thermometers in neonates, however, there is a lack of consensus regarding which of the currently available thermometers is most suitable for use in neonates.

Objectives:The aim of this review was to identify and compare current methods available for temperature monitoring of neonates beyond the delivery room, including the accuracy, advantages and disadvantages of each.

Methods:A recent search and narrative synthesis of relevant studies published between January 1, 1949 and May 5, 2021 on the OVID Medline, PubMed and Google Scholar databases.

Results:A total of 160 papers were retrieved for narrative synthesis. The main methods available for temperature monitoring in neonates are human touch and mercury-in-glass, electronic, infrared tympanic and other infrared thermometers. Newer innovations that are also available include liquid crystal thermometers and the BEMPU TempWatch. This paper discusses the current evidence available regarding the utility of these devices, and identifies barriers to valid comparison of different thermometry methods.

Conclusion:Many methods for temperature monitoring in neonates are currently available, each with their own advantages and disadvantages. However, the accuracies of different devices are hard to determine due to variable methodologies used in relevant studies and hence, further research that addresses these gaps is needed.
Ethnopharmacological, Phytochemical, Pharmacological, and Toxicological Review on Senna auriculata (L.) Roxb.: A Special Insight to Antidiabetic Property
Authors: Nille Guruprasad C. , Mishra Shardendu Kumar , Chaudhary Anand Kumar , Reddy K. R. C.
Published: August 2021

Avartaki (Senna auriculata(L.) Roxb. syn.Cassia auriculataL.; Family- Fabaceae ) is a traditional medicinal plant, widely used for the treatment of various ailments in Ayurveda and Siddha system of medicine in India. Almost all the parts of the plant, such as flowers, leaves, seeds, barks, and roots have been reported for their medicinal uses. Traditionally, it has been used in the treatment of diabetes, asthma, rheumatism, dysentery, skin disease, and metabolic disorders. The principle phytochemicals inSenna auriculata(L.) Roxb. are alkaloids, anthraquinone, flavone glycosides, sugar, saponins, phenols, terpenoids, flavonoids, tannins, steroids, palmitic acid, linoleic acid, benzoic acid 2-hydroxyl methyl ester, 1-methyl butyl ester, resorcinol, α-tocopherol-β-D-mannosidase, epicatechin, ferulic acid, quercetin-3-O-rutinoside, quercetin, proanthocyanidin B1. The extracts from its different parts and their isolated compounds possess a wide range of pharmacological activities such as antidiabetic, antioxidant, anti-inflammatory, antihyperlipidemic, hepatoprotective, nephroprotective, cardioprotective, anti-atherosclerotic, anticancer, antimutagenic, antimicrobial, antiulcer, antipyretic, anthelmintic, immunomodulatory, antifertility, anti-venom, and anti-melanogenesis. The toxicological findings from preclinical studies ensured the safety of the plant, but comprehensive clinical studies are required for the safety and efficacy of the plant in humans. The current review article aimed to provide up-to-date information aboutSenna auriculata(L.) Roxb. covering its ethnomedicinal, phytochemical, pharmacological, and toxicological aspects with special emphasis on its clinical implications in diabetes.
Bioactive Compounds as Potential Agents for Sexually Transmitted Diseases Management: A Review to Explore Molecular Mechanisms of Action
Authors: Sharifi-Rad Javad , Quispe Cristina , Rahavian Amirhossein , Pereira Carneiro Joara Nályda , Rocha Janaína Esmeraldo , Alves Borges Leal Antônio Linkoln , Bezerra Morais Braga Maria Flaviana , Melo Coutinho Henrique Douglas , Ansari Djafari Anahita , Alarcón-Zapata Pedro , Martorell Miquel , Antika Gizem , Tumer Tugba Boyunegmez , Cruz-Martins Natália , Helon Paweł , Paprocka Paulina , Koch Wojciech , Docea Anca Oana , Calina Daniela
Published: August 2021

Sexually transmitted diseases (STDs) are produced by pathogens like bacteria, fungi, parasites, and viruses, and may generate severe health problems such as cancer, ulcers, and even problems in the newborn. This narrative review aims to present updated information about the use of natural bioactive compounds for the prevention and treatment of sexually transmitted infections. A search of the literature was performed using databases and search engines such as PubMed, Scopus, Google Scholar and Science Direct. From the pharmacotherapeutic management point of view, any strategies for prevention should contain medical approaches. The bioactive compounds obtained from natural products have shown biological effects against different microorganisms for the treatment of these diseases. The main results showed antimicrobial, antiprotozoal, antifungal and antiviral effects such as HIV. Also, the molecular mechanisms, signalling pathways and action targets of natural compounds were highlighted, thus justifying bacterial and antifungal inhibition, apoptosis or reduction of viral replication. From the data of our study, we can conclude that natural compounds may be a significant source for adjuvant drugs / complementary therapies in the treatment of STDs. With all these benefits, the future must conduct extensive clinical trials and the development of pharmaceutical nanotechnologies for a greater therapeutic effect.
Case Report: A Case Report and Literature Review on Severe Bullous Skin Reaction Induced by anti-PD-1 Immunotherapy in a Cervical Cancer Patient
Authors: Li Xiang , Qu Li-Xin , Ren Yu-Mei , Hu Chang
Published: August 2021

Background: Anti-programmed cell death protein 1 (PD-1) has been successfully used in carcinomas treatment. However, it causes significant adverse effects (AEs), including cutaneous reactions, particularly the life-threatening severe bullous skin reactions (SBSR) and toxic epidermal necrolysis (TEN).

Case summary: Herein, we described for the first time a case report of SBSR induced by anti-PD-1 therapy in a cervical cancer patient. In addition, we revised existing literature on anti-PD-1 induced cutaneous reactions. We reported a cervical cancer patient who was treated with four successive cycles of Sintilimab and Toripalimab injections and developed systemic rashes, bullae, and epidermal desquamation, which worsened and led to infection, eventually causing death after being unresponsive to aggressive treatments.

Conclusion: Anti-PD-1 antibodies commonly cause skin toxicity effects, some of which may be deadly. Therefore, healthcare providers should observe early symptoms and administer proper treatment to prevent aggravation of symptoms.
Ascorbic Acid Inhibits Liver Cancer Growth and Metastasis in vitro and in vivo, Independent of Stemness Gene Regulation
Authors: Wan Jingjing , Zhou Juan , Fu Lu , Li Yubin , Zeng Huawu , Xu Xike , Lv Chao , Jin Huizi
Published: August 2021

Experimental and clinical evidence has indicated that the natural product ascorbic acid (AA) is effective in preventing and treating various types of cancers. However, the effect of AA on liver cancer metastasis has not yet been reported. Cancer stem cells (CSCs) play pivotal roles in cancer metastasis. Here, we demonstrated that AA selectively inhibited the viability of both liver cancer cells and CSCs, reduced the formation of cancer cell colonies and CSC spheres, and inhibited tumor growth in vivo. Additionally, AA prevented liver cancer metastasis in a xenotransplantation model without suppressing stemness gene expression in liver CSCs. Further study indicated that AA increased the concentration of H2O2 and induced apoptosis in liver CSCs. Catalase attenuated the inhibitory effects of AA on liver CSC viability. In conclusion, AA inhibited the viability of liver CSCs and the growth and metastasis of liver cancer cells in vitro and in vivo by increasing the production of H2O2 and inducing apoptosis. Our findings provide evidence that AA exerts its anti-liver cancer efficacy in vitro and in vivo, in a manner that is independent of stemness gene regulation.
Scientific Challenges on Theory of Fat Burning by Exercise
Authors: Harris M. Brennan , Kuo Chia-Hua
Published: August 2021

GRAPHICAL ABSTRACT

Exercise decreases abdominal fat mass, especially at high intensity. This outcome is not causally associated with fat burning, but better explained by carbon and nitrogen redistribution. Since abdominal fat tissue constantly releases fatty acids into circulation under post-absorptive condition with natural cell deaths, exercise diverts more post-meal carbon and nitrogen to muscle for energy repletion and cell regeneration after phagocytosis and stem cell homing. This in turn leads to concurrent fat mass loss and muscle mass gain. Respiratory ventilation during high-intensity aerobic exercise amplifies the competition for post-meal carbon and nitrogen against adipose tissues.
High Intensity Interval Training (HIIT) as a Potential Countermeasure for Phenotypic Characteristics of Sarcopenia: A Scoping Review
Authors: Hayes Lawrence D. , Elliott Bradley T. , Yasar Zerbu , Bampouras Theodoros M. , Sculthorpe Nicholas F. , Sanal-Hayes Nilihan E. M. , Hurst Christopher
Published: August 2021

Background: Sarcopenia is defined as a progressive and generalized loss of skeletal muscle quantity and function associated predominantly with aging. Physical activity appears the most promising intervention to attenuate sarcopenia, yet physical activity guidelines are rarely met. In recent years high intensity interval training (HIIT) has garnered interested in athletic populations, clinical populations, and general population alike. There is emerging evidence of the efficacy of HIIT in the young old (i.e. seventh decade of life), yet data concerning the oldest old (i.e., ninth decade of life onwards), and those diagnosed with sarcopenic are sparse.

Objectives: In this scoping review of the literature, we aggregated information regarding HIIT as a potential intervention to attenuate phenotypic characteristics of sarcopenia.

Eligibility Criteria: Original investigations concerning the impact of HIIT on muscle function, muscle quantity or quality, and physical performance in older individuals (mean age ≥60 years of age) were considered.

Sources of Evidence: Five electronic databases (Medline, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched.

Methods: A scoping review was conducted using the Arksey and O'Malley methodological framework (2005). Review selection and characterization were performed by two independent reviewers using pretested forms.

Results: Authors reviewed 1,063 titles and abstracts for inclusion with 74 selected for full text review. Thirty-two studies were analyzed. Twenty-seven studies had a mean participant age in the 60s, two in the 70s, and three in the 80s. There were 20 studies which examined the effect of HIIT on muscle function, 22 which examined muscle quantity, and 12 which examined physical performance. HIIT was generally effective in Improving muscle function and physical performance compared to non-exercised controls, moderate intensity continuous training, or pre-HIIT (study design-dependent), with more ambiguity concerning muscle quantity.

Conclusions: Most studies presented herein utilized outcome measures defined by the European Working Group on Sarcopenia in Older People (EWGSOP). However, there are too few studies investigating any form of HIIT in the oldest old (i.e., ≥80 years of age), or those already sarcopenic. Therefore, more intervention studies are needed in this population.
Factors Related to Mental Health During the COVID-19 Lockdown in Spain
Authors: Pinedo Ruth , Vicario-Molina Isabel , González Ortega Eva , Palacios Picos Andrés
Published: August 2021

The COVID-19 disease has forced governments to adopt exceptional measures. The lockdown decreed in Spain in 2020 required citizens to stay confined at home, which might have affected their mental health. The objective is to identify factors that influenced adults' mental health during this period. A sample of 3,508 adults from the Spanish general population completed an online survey that collected sociodemographic data and information about daily planning and activities, healthy habits, loneliness, coping humor and mental health. Data were analyzed using Structural Equation Modeling. According to the results, the proposed model showed good fit values, and latent variables explained 30% of the variance in mental health. Loneliness, coping humor, healthy habits, age and gender had a significant weight in the prediction of mental health during lockdown. Area of residence, number of days of confinement and number of people in the household were not related to mental health. This study addresses the effect of COVID-19 and social distancing measures by identifying risk and protective factors for the development of mental health difficulties. There is a need to target specific and early interventions aimed at mitigating the psychological impact of the pandemic while increasing well-being, especially in more vulnerable groups.
Possible Vicarious Traumatization Among Psychiatric Inpatients During the Remission Phase of the COVID-19: A Single-Center Cross-Sectional Study
Authors: Zheng Yage , Xiao Ling , Huang Yonglan , Wang Qing , Xie Yinping , Wang Huiling , Wang Gaohua
Published: August 2021

Background: Far from being a clinical disease, the COVID-19 pandemic has become a threatening social event worldwide exerting long-term impacts on human beings.

Objective: This study was designed to determine if and to what extent psychiatric inpatients during the remission phase of the pandemic suffered from vicarious traumatization.

Method: Totally 266 eligible participants from psychiatric and psychological wards in a hospital were recruited during October 26th, 2020 to February 4th, 2021 to finish a self-made online questionnaire consisting of Impact of Event Scale-Revised (IES-R), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Obsessive-Compulsive Inventory-Revised (OCI-R), Pittsburgh Sleep Quality Index-Revised (PSQI-R), Social Support Rating Scale (SSRS), Beck Suicide Ideation Scale (SSI), 12-Item Short-Form Health Survey (SF-12). Meanwhile, some socio-demographics and information related to the pandemic were also recorded.

Results: The detection rate of vicarious traumatic symptoms (VTS) was 80.83%, including 40.98% for mild ones, 25.56% for moderate ones, and 14.29% for severe ones, among whom 98.14% possessed all three phenotypes. 27.07% of the sample were considered possible vicarious traumatization (pVT). Having acquaintances infected with or died from COVID-19, worries on re-outbreak of COVID-19, a higher score of OCI-R or lower score of SF-12, and long latency of VTS were independent risk factors of pVT.

Conclusion: Our study showed that COVID-19 could have profound mental influences on psychiatric inpatients. It is high time we did some screening in the wards to seek for patients at risk.
Defense Mechanisms and Borderline Personality Organization Among COVID-19 Believers and Non-believers During Complete Lock-Down
Authors: Zajenkowska Anna , Nowakowska Iwona , Bodecka-Zych Marta , Rajchert Joanna , Kaźmierczak Izabela , Jakubowska Adrianna , Pinkham Amy E.
Published: August 2021

The aim of the current study was to investigate whether a specific social perception of the pandemic—believing or not in COVID-19—predicts borderline personality organizations and whether this relationship is mediated by more primitive maladaptive mechanisms—splitting, denial, and dissociation. The online study included 720 organization aged 25–45. Participants were diverse in terms of place of residence, being in a relationship, and education level. Approximately 30% of the general population reported not believing in the COVID-19 pandemic. Non-believers scored slightly higher on borderline symptoms and used more maladaptive defense mechanisms than believers. Individuals who deny COVID-19 are more likely to show characteristics of borderline personality organization. Splitting is an important mechanism in this relationship.
Consumers' Knowledge, Attitudes, and Practices Toward Medicine Price Transparency at Private Healthcare Setting in Malaysia
Authors: Ahmad Nur Sufiza , Hatah Ernieda , Jalil Mohamad Ridha , Makmor-Bakry Mohd
Published: August 2021

Background:Medicine price transparency refers to the practice of making prices available to consumers for them to identify, compare, and select the medicine that provides the desired value. This study aimed to evaluate consumer knowledge, attitudes, and practices regarding Malaysia's medicine price transparency initiative, as well as factors that may influence related good consumer practices in private healthcare settings.

Methods:A cross-sectional, self-administered survey was conducted between May and July 2019 among consumers attending private healthcare institutions in Malaysia. The self-developed and validated survey consisted of four sections on the following: respondents' demographics, and 28 close-ended and graded Likert scale answer options on knowledge, attitudes, and practices toward medicine price transparency. Factors influencing good consumer practices toward the transparency initiative were modeled using binary logistic regression.

Results:A total of 679 respondents were part of the study. The mean age of respondents was 38 ± 13.3, with the majority (n= 420, 61.9%) being female. The respondents' mean score of knowledge and attitudes toward the price transparency initiative was 5.6 ± 1.5 of the total score of 8 and 31.9 ± 4.0 of the total score of 40, respectively. The respondents had the lowest score in the practice of price transparency, with a mean score of 31.5 ± 5.6 of the total score of 60. Male gender, Chinese ethnicity, high score on knowledge and attitudes, and high expenses on medicines influenced respondents' good practices of medicine price transparency.

Conclusion:Respondents had good knowledge and attitudes, but their usage and implementation of the medicine price transparency initiative was still inadequate. A number of factors influence this inadequacy, including gender, race, consumers' out-of-pocket spending on medication, and knowledge of and attitudes toward price transparency practices. Consumer-driven market price control would be impossible to achieve without the good consumer practices of medicine price transparency.
Health-Care Professionals' Assessments of, and Recommendations for, Sexual-Health Education and Service Provision for Young People in Tehran
Authors: Sheikhansari Narges , Abraham Charles , Denford Sarah
Published: August 2021

Background: Only limited Sexual Health and Relationships Education (SHRE) is provided in Iranian schools and universities while research has highlighted demand and need for improved SHRE among young adults. We explored health-care professionals' (HCPs) assessments of, and recommendations for, SHRE and service provision for young people in Tehran.

Design and Methods: Semi-structured interviews were conducted with a sample of 17 HCPs based in Tehran and verbatim transcripts were analyzed using thematic analysis.

Results: Participants confirmed the need for improved SHRE and service provision for young adults. HCPs described how a lack of reliable educational resources for young adults, taboo and cultural barriers, and a lack of trust and confidentiality prevented young people from accessing information and services. They unanimously supported education and services to be augmented, and provided recommendations on how this could be achieved.

Conclusions: A number of positive suggestions for the improvement of SHRE and Iranian sexual health services in Iran were identified.
The Social Housing Crisis and the Barriers to Developing Dementia-Friendly Communities in Chile
Authors: Jiménez Daniel A. , Cancino-Contreras Francisca
Published: August 2021

Interaction with living place and neighbourhood is one of the cornerstones for creating dementia-friendly communities (DFC). Chile has one of the largest proportions of older adults in Latin America and is currently facing an increase in the number of people with dementia. In this context, the Chilean government has launched a national strategy that involves actions in the health and social care system, including the promotion of DFC. From a multisectoral approach, social and environmental aspects involving engagement with local communities and access to social connections and services are directly related to urban policies. This perspective article focuses on urban aspects of social housing policy, such as placement, networks, affordability and the relationship between subsidy structure and adequate housing provision in a country with a qualitative housing deficit of around 1,200,000 units and where a large proportion of people with dementia and their families live in poverty. We identified several barriers to delivering appropriate environments for people living with dementia in relation to a two-fold problem: (a) the social housing subsidy displaces caregivers and/or older adults to satellite towns where social connections and access to services and urban equipment are lost; and (b) people resisting displacement live in overcrowded neighbourhoods where dementia is a common problem. In both scenarios, a detrimental environment and social conditions directly affect the quality of life of elderly people living with dementia and their caregivers.
Mild Botulism From Illicitly Brewed Alcohol in a Large Prison Outbreak in Mississippi
Authors: Marlow Mariel , Edwards Leslie , McCrickard Lindsey , Francois Watkins Louise K. , Anderson Jannifer , Hand Sheryl , Taylor Kathryn , Dykes Janet , Byers Paul , Chatham-Stephens Kevin
Published: August 2021

Botulism is typically described as a rapidly progressing, severe neuroparalytic disease. Foodborne botulism is transmitted through consuming food or drink that has been contaminated with botulinum toxin. During a botulism outbreak linked to illicitly brewed alcohol (also known as “hooch” or “pruno”) in a prison, 11 (35%) of 31 inmates that consumed contaminated hooch had mild illnesses. This includes 2 inmates with laboratory confirmed botulism. The most frequently reported signs and symptoms among the 11 patients with mild illness included dry mouth (91%), hoarse voice (91%), difficulty swallowing (82%), fatigue (82%), and abdominal pain (82%). Foodborne botulism is likely underdiagnosed and underreported in patients with mild illness. Botulism should be considered on the differential diagnosis for patients with cranial nerve palsies.
Cosmic Ray Background Removal With Deep Neural Networks in SBND
Authors: Acciarri R. , Adams C. , Andreopoulos C. , Asaadi J. , Babicz M. , Backhouse C. , Badgett W. , Bagby L. , Barker D. , Basque V. , Bazetto M. C. Q. , Betancourt M. , Bhanderi A. , Bhat A. , Bonifazi C. , Brailsford D. , Brandt A. G. , Brooks T. , Carneiro M. F. , Chen Y. , Chen H. , Chisnall G. , Crespo-Anadón J. I. , Cristaldo E. , Cuesta C. , de Icaza Astiz I. L. , De Roeck A. , de Sá Pereira G. , Del Tutto M. , Di Benedetto V. , Ereditato A. , Evans J. J. , Ezeribe A. C. , Fitzpatrick R. S. , Fleming B. T. , Foreman W. , Franco D. , Furic I. , Furmanski A. P. , Gao S. , Garcia-Gamez D. , Frandini H. , Ge G. , Gil-Botella I. , Gollapinni S. , Goodwin O. , Green P. , Griffith W. C. , Guenette R. , Guzowski P. , Ham T. , Henzerling J. , Holin A. , Howard B. , Jones R. S. , Kalra D. , Karagiorgi G. , Kashur L. , Ketchum W. , Kim M. J. , Kudryavtsev V. A. , Larkin J. , Lay H. , Lepetic I. , Littlejohn B. R. , Louis W. C. , Machado A. A. , Malek M. , Mardsen D. , Mariani C. , Marinho F. , Mastbaum A. , Mavrokoridis K. , McConkey N. , Meddage V. , Méndez D. P. , Mettler T. , Mistry K. , Mogan A. , Molina J. , Mooney M. , Mora L. , Moura C. A. , Mousseau J. , Navrer-Agasson A. , Nicolas-Arnaldos F. J. , Nowak J. A. , Palamara O. , Pandey V. , Pater J. , Paulucci L. , Pimentel V. L. , Psihas F. , Putnam G. , Qian X. , Raguzin E. , Ray H. , Reggiani-Guzzo M. , Rivera D. , Roda M. , Ross-Lonergan M. , Scanavini G. , Scarff A. , Schmitz D. W. , Schukraft A. , Segreto E. , Soares Nunes M. , Soderberg M. , Söldner-Rembold S. , Spitz J. , Spooner N. J. C. , Stancari M. , Stenico G. V. , Szelc A. , Tang W. , Tena Vidal J. , Torretta D. , Toups M. , Touramanis C. , Tripathi M. , Tufanli S. , Tyley E. , Valdiviesso G. A. , Worcester E. , Worcester M. , Yarbrough G. , Yu J. , Zamorano B. , Zennamo J. , Zglam A.
Published: August 2021

In liquid argon time projection chambers exposed to neutrino beams and running on or near surface levels, cosmic muons, and other cosmic particles are incident on the detectors while a single neutrino-induced event is being recorded. In practice, this means that data from surface liquid argon time projection chambers will be dominated by cosmic particles, both as a source of event triggers and as the majority of the particle count in true neutrino-triggered events. In this work, we demonstrate a novel application of deep learning techniques to remove these background particles by applying deep learning on full detector images from the SBND detector, the near detector in the Fermilab Short-Baseline Neutrino Program. We use this technique to identify, on a pixel-by-pixel level, whether recorded activity originated from cosmic particles or neutrino interactions.
Learning to Frame Complex Sustainability Challenges in Place: Explorations Into a Transdisciplinary “Challenge Lab” Curriculum
Authors: McCrory Gavin , Holmén Johan , Holmberg John , Adawi Tom
Published: August 2021

Complex sustainability challenges may never be fully solved, rather requiring continuous, adaptive, and reflexive responses over time. Engagement of this nature departs from well-structured problems that entail expected solutions; here, focus shifts toward ill-structured or ill-defined issues characterized by wickedness. In the context of complex challenges, inadequate or absent framing has performative implications on action. By overlooking the value of framing, eventual responses may not only fall short; they may even displace, prolong, or exacerbate situations by further entrenching unsustainability. In educational settings, we know little about how curriculum designs support challenge framing, and how students experience and learn framing processes. In this paper we explore a transdisciplinary “Challenge Lab” (C-Lab) curriculum from a perspective of challenge framing. When considering framing in higher education, we turn to the agenda in education for, as and with sustainable development to be problem-solving, solutions-seeking or challenge-driven. We introduce framing as a boundary object for transformative praxis, where sustainability is held to be complex and contextual. This study is qualitative and case-based, designed to illuminate processes of and experiences into sustainability challenge framing in a transdisciplinary learning setting. Methodologically, we draw from student reflective diaries that span the duration of a curriculum design. We structure our results with the support of three consecutive lenses for understanding “curriculum”: intended, enacted, and experienced curriculum. First, we present and describe a C-Lab approach at the level of ambition and design. Here it is positioned as a student-centered space, process, and institutional configuration, working with framing and re-framing complex sustainability challenges in context. Second, we present a particular C-Lab curriculum design that unfolded in 2020. Third, we illustrate the lived experiences and practical realities of participating in C-Lab as students and as teachers. We reflect upon dilemmas that accompany challenge framing in C-Lab and discuss the methodological implications of this study. Finally, we point toward fruitful research avenues that may extend understandings of challenge framing in higher education.
Quantification of Global DNA Methylation in Canine Melanotic and Amelanotic Oral Mucosal Melanomas and Peripheral Blood Leukocytes From the Same Patients With OMM: First Study
Authors: Scattone Nayra Villar , Epiphanio Tatiane Moreno Ferrarias , Caddrobi Karine Germano , Ferrão Juliana Shimara Pires , Hernandez-Blazquez Francisco Javier , Loureiro Ana Paula de Melo , Massoco Cristina de Oliveira , Dagli Maria Lucia Zaidan
Published: August 2021

Oral mucosal melanomas (OMMs) are aggressive and resistant cancers of high importance in veterinary oncology. Amelanotic OMM produces comparatively less melanin and is considered to be more aggressive than melanotic OMM. Global DNA methylation profiles with hypomethylated or hypermethylated patterns have both been associated with aggressive neoplasms; however, global DNA hypomethylation seems to correlate to higher aggressiveness. Accordingly, global DNA methylation in peripheral blood leukocytes has been investigated to understand the role of systemic or environmental factors in cancer development. This study aimed to quantify global DNA methylation in canine melanotic and amelanotic OMM samples and in the peripheral blood leukocytes of the same dogs. Tumor tissue samples were collected from 38 dogs, of which 19 were melanotic and 19 were amelanotic OMM. These were submitted to immunohistochemistry (IHC) with anti-5-methylcytosine (5mC) and anti-Ki67 primary antibodies. Ki67- and 5mC-positive nuclei were manually scored with the help of an image analysis system. Peripheral blood samples were collected from 18 among the 38 OMM-bearing dogs and from 7 additional healthy control dogs. Peripheral blood leukocytes were isolated from the 25 dogs, and DNA was extracted and analyzed by high-performance liquid chromatography (HPLC) for global DNA methylation. The pattern of global DNA methylation in both canine melanotic and amelanotic OMM indicated higher percentages of weakly or negatively stained nuclei in most of the OMM cells, presuming predominant global DNA hypomethylation. In addition, Ki67 counts in amelanotic OMM were significantly higher than those in melanotic OMM (p < 0.001). Global DNA methylation different immunostaining patterns (strong, weak or negative) correlated with Ki67 scores. Global DNA methylation in circulating leukocytes did not differ between the 9 melanotic and 9 amelanotic OMM or between the 18 OMM-bearing dogs and the 7 healthy dogs. This study provides new information on canine melanotic and amelanotic OMM based on global DNA methylation and cell proliferation.
Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study
Authors: Ndaki Pendo , Mushi Martha , Mwanga Joseph , Konje Eveline , Ntinginya Nyanda , Mmbaga Blandina , Keenan Katherine , Sabiiti Wilber , Kesby Mike , Benitez-Paez Fernando , Sandeman Alison , Holden Matthew , Mshana Stephen ,   HATUA Consortium
Published: August 2021

Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a ‘mystery client’ method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3–89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.
The Accuracy of Molecular Detection Targeting the Mutation C2611T for Detecting Moderate-Level Azithromycin Resistance in Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis
Authors: Zhou Qian , Liu Jingwei , Chen Shaochun , Xu Wenqi , Han Yan , Yin Yueping
Published: August 2021

Background: Neisseria gonorrhoeae (N. gonorrhoeae) is now recognized as a commonly reported sexually transmitted pathogen, and the increasing drug resistance of N. gonorrhoeae has become a serious public health problem. The accuracy of molecular detection for detecting moderate-level azithromycin resistance is not well-established. We summarized the data from studies of the N. gonorrhoeae 23S rRNA mutation at position 2611 with azithromycin resistance to determine the relationship between the mutation and resistance. Methods and Findings: In this systematic review and meta-analysis, two researchers independently searched six databases for studies with data for the azithromycin minimum inhibitory concentrations (MICs) and the 23S rRNA mutation C2611T of each N. gonorrhoeae isolate. Since the breakpoint of moderate-level resistance to azithromycin (ML-AzmR) was not determined, we divided the moderate level into two groups according to the range of MICs (moderate resistance limited to 2–128 mg/L or 4–128 mg/L) for data extraction. A random-effects model was used to calculate the pooled sensitivity rate, the specificity rate, the pooled positive likelihood ratio (PLR), the negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR). Meta-regression analyses by detection method, isolates sampling (a random sample or not), location, and sample size were performed to explore the possible causes of heterogeneity. The potential publication bias of the included studies was conducted by the Deeks’ test. We included 20 studies in our study: 20 studies have data of N. gonorrhoeae with MICs between 2 and 128 mg/L with mutation or without mutation at position 2611(4759 samples), and 14 studies have data of N. gonorrhoeae with MICs between 4 and 128 mg/L (3367 samples). In the group with the moderate level of 2–128 mg/L, the pooled sensitivity rate of the molecular assays was determined to be 71.9% (95% CI, 67.6–74%), the pooled specificity rate was 98.7% (95% CI, 98.2–99.0%), and the DOR ranged from 55.0 to 351.3 (mean, 139.1). In the 4–128 mg/L group, the pooled sensitivity rate was 91.9% (95% CI, 88.9–94.2%), the pooled specificity rate was 95.9% (95% CI, 95.1–96.6%), and the DOR ranged from 41.9 to 364.1 (mean, 123.6). Conclusion: Through this meta-analysis, we found that the C2611T mutation of 23S rRNA is valuable for the molecular diagnostic of moderate-level azithromycin resistance (ML-AzmR) in N. gonorrhoeae, especially when the moderate level is set at 4–128 mg/L. This rapid molecular detection method can be used for the rapid identification of ML-AzmR isolates in the clinic.
WTA: A Static Taint Analysis Framework for PHP Webshell
Authors: Zhao Jiazhen , Lu Yuliang , Wang Xin , Zhu Kailong , Yu Lu
Published: August 2021

Webshells are a malicious scripts that can remotely control a webserver to execute arbitrary commands, steal sensitive files, and further invade the internal network. Existing webshell detection methods, such as using pattern matching for webshell detection, can be easily bypassed by attackers using the file include and user-defined functions. Furthermore, detecting unknown webshells has always been a problem in the field of webshell detection. In this paper, we propose a static webshell detection method based on taint analysis, which realizes accurate taint analysis based on ZendVM. We first converted the PHP code into Opline sequences, analyzed the Opline sequences in order, and marked the externally imported taint source. Then, the propagation of the taint variables was tracked, and the interprocedural analysis of the taint variables was performed. Finally, considering the dangerous functions’ call and the referencing of the taint variables at the point of the taint sink, we completed the webshell judgment. Based on this method, we constructed a taint analysis prototype system named WTA and evaluated it with a benchmark dataset by comparing its performance with popular webshell detection tools. The results showed that our method supports interprocedural analysis and has the ability to detect unknown webshells and that WTA’s performance surpasses well-known webshell detection tools such as D-shield, SHELLPUB, WebshellKiller, CloudWalker, ClamAV, LoKi, and findbot.pl.
The Different Effect of Decellularized Myocardial Matrix Hydrogel and Decellularized Small Intestinal Submucosa Matrix Hydrogel on Cardiomyocytes and Ischemic Heart
Authors: Yang Xifeng , Chen Shihao , Chen Jiaxin , Liu Yunqi , Bai Ying , Yin Shengli , Quan Daping
Published: August 2021

Injectable decellularized matrix hydrogels derived from either myocardium or small intestinal submucosa (pDMYO-gel, pDSIS-gel) have been successfully used for myocardial injury repair. However, the relationship between tissue-specific biological functions and protein composition in these two materials is not clear yet. In this study, the protein composition, mechanical properties, and morphology of these two hydrogels and their effects on the behavior of neonatal rat cardiomyocytes (NRCMs) and human umbilical vein endothelial cells (HUVECs), are investigated. The results show that pDMYO-gel is more conducive to growth, adhesion, spreading, and maintenance of normal NRCM beating, due to its higher proportion of extracellular matrix (ECM) glycoproteins (49.55%) and some unique functional proteins such as annexin-6 (ANXA6), agrin (AGRN), cathepsin D (CTSD) and galectin-1 (LGALS1), whereas pDSIS-gel is more conducive to the proliferation of HUVECs. Animal study shows that pDMYO-gel has a better effect on improving cardiac function, inhibiting myocardial fibrosis and maintaining ventricular wall thickness in acute myocardial infarction models in vivo. Therefore, it is proposed that injectable pDMYO-gel hydrogel may be more suitable for functional recovery of myocardial injuries.