bluuebunny/crossref_metadata_2025 huggingface dataset:
Willingness to perform induced abortion and associated factors among graduating Midwifery, Medical, Nursing, and Public health officer students of University of Gondar, Northwest Ethiopia: Institution based Cross sectional study
Authors: Enyew Mihretu Molla
Published: November 2020

Background: In developing countries, abortion is often unsafe and a signiﬁcant cause of maternal morbidity and mortality accounting for about 8% (4.7%–13.2%) of maternal mortality worldwide. Internationally, safe abortion services are recognized as reducing maternal mortality, and liberalized abortion laws are associated with reduced mortality resulting from unsafe abortion procedures. However, health care providers have moral, social and gender-based reservations that affects their willingness towards providing induced abortion services. The purpose of this study was to assess willingness to perform induced abortion and associated factors among graduating Midwifery, Medical, Nursing, and Public health officer students of University of Gondar. Methods: Institution based cross sectional study was conducted from March 29 to May 30, 2019. All graduating students available during data collection period were considered as study population. Stratified simple random sampling technique was used to select 424 study participants. Pre tested, semi- structured, self-administered questionnaire was used to collect data. Data analysis was done using SPSS version 20. Ethical clearance was obtained from School of midwifery under the delegation of institutional review board of university of Gondar.Results: 290 students out of 424 students were willing to perform induced abortion for indications supported by Ethiopian abortion law, making a proportion of 68.4% (95%Cl: 64.2, 72.9). Sex (Being male (AOR = 4.89, 95%CI: 3.02, 7.89)), religion (being orthodox than protestant (AOR = 10.41, 95%CI: 3.02, 21.57)), being Muslim than protestant (AOR = 5.73, 95%CI: 1.37, 15.92)) and having once or less a week religious attendance (AOR=2.00, 95% CI: 1.20, 3.34) were factors associated with willingness towards performing induced abortion.Conclusions: According to this study willingness of students towards providing induced abortion services was good. However female students, protestant followers and those students with more than once a week religious attendance should be encouraged to support women’s access to induced abortion services by referring them to other health care professionals willing to provide induced abortion services.
Minimum Clinical Important Difference for Resilience Scale Specific to Cancer: A Prospective Analysis
Authors: YE ZENG JIE , ZHANG ZHANG , TANG YING , LIANG JIAN , ZHANG XIAO YING , HU GUANG YUN , SUN ZHE , LIANG MU ZI , YU YUAN LIANG
Published: November 2020

Background: The minimum clinical important differences (MCIDs) of resilience instruments in patients with cancer have not been comprehensively described. This study was designed to evaluate MCIDs of 10-item and 25-item resilience scales specific to cancer (RS-SC-10 and RS-SC-25).Methods: From June 2015 to December 2018, RS-SCs were longitudinally measured in 765 patients with different cancer diagnoses at baseline (T0) and 3 months later (T1). The EORTC QLQ-C30, Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Allostatic Load Index were measured concurrently as anchors. Anchor-based methods (linear regression, within-group), distribution-based methods(within-group), and receiver operating characteristic curves (ROCs, within-subject) were performed to evaluate the MCIDs.Results: 623 of 765 (84.1%) patients had paired RS-SCs scores. Moderate correlations were identified between the change in RS-SCs and change in anchors (r= 0.38-0.44, all p<0.001). Linear regression estimated +8.9 and -6.7 as the MCIDs of RS-SC-25, and +3.4 and -2.5 for RS-SC-10. Distribution-based methods estimated +9.9 and -9.9 as the MCIDs of RS-SC-25, and +4.0 and -4.0 for RS-SC-10. ROC estimated +5.5 and -4.5 as the MCIDs of RS-SC-25, and +2.0 and -1.5 for RS-SC-10.Conclusions: The most reliable MCID is around 5 points for RS-SC-25 and 2 points for RS-SC-10. RS-SCs are more responsive to the worsening status of resilience in patients with cancer and these estimates could be useful in future resilience-based intervention trials.
A Pilot Study of Team-based Learning in Paediatric Clerkships
Authors: Xu Luojia , Zhang Yuanyuan , Chen Yifang , Xu Yingchun , Wang Yujia , Chen Zhimin , Shu Qiang
Published: November 2020

Background: Team-based learning (TBL) is widely used in health profession education. However, the use of TBL in paediatric clerkships is rare. In this study, we explore the efficacy and feasibility of TBL in paediatric clerkships. Methods: We retrospectively reviewed the TBL course for paediatric clerkships from August to October 2019 at the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. The TBL group (with 107 students) was compared to the students from the prior year that learned using case-based discussion (control group with 222 students). The learning outcomes were measured using theoretical exams when the paediatric clerkships ended. The satisfaction with TBL was evaluated by an anonymous questionnaire in the TBL group. Results: The grade point averages before paediatric clerkships in the TBL group (3.58, 3.04-3.96) were similar to those in the control group (3.62, 3.16-4.00). However, the theoretical exam scores in the TBL group (76, 67-82) were significantly higher than those in the control group (72, 64-78) (p=0.002). In addition, 92.5% of the students in the TBL group rated that their level of satisfaction was higher than 90%. Conclusions: Our study demonstrated that TBL in paediatric clerkships was effective and feasible and that it led to better learning outcomes.
Identification of Candidate Genes Controlling Fiber Quality Traits in Upland Cotton through Integration of Meta-QTL, Significant SNP and Transcriptomic Data
Authors: Shudi XU , Pan Zhenyuan , Yin Feifan , Yang Qingyong , Lin Zhongxu , Wen Tianwang , Zhu Longfu , Zhang Dawei , Nie Xinhui
Published: November 2020

Background: Meta-analysis of quantitative trait locus (QTL) is a computational technique to identify consensus QTL and refine QTL positions on the consensus map from multiple mapping studies. The combination of meta-QTL intervals, significant SNPs and transcriptome analysis has been widely used to identify candidate genes in various plants. Results: In our study, 884 QTLs associated with cotton fiber quality traits from 12 studies were used for meta-QTL analysis based on reference genome TM-1, as a result, 74 meta-QTLs were identified, including 19 meta-QTLs for fiber length (FL); 18 meta-QTLs for fiber strength (FS); 11 meta-QTLs for fiber uniformity (FU); 11 meta-QTLs for fiber elongation (FE); and 15 meta-QTLs for micronaire (MIC). Combined with 8,589 significant SNPs associated with fiber quality traits collected from 15 studies, 297 candidate genes were identified in the meta-QTL intervals, 20 of which showed high expression levels specifically in the developing fibers. According to the function annotations, some of the 20 key candidate genes are associated with the fiber development. Conclusions: This study provides not only stable QTLs used for marker-assisted selection (MAS), but also candidate genes to uncover the molecular mechanisms for cotton fiber development.
“I think everybody should take it if they’re doing drugs, doing heroin, or having sex for money”: A qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program
Authors: Przybyla Sarahmona , Cerulli Catherine , Bleasdale Jacob , Wilson Kennethea A. , Hordes Melissa , El-Bassel Nabila , Morse Diane
Published: November 2020

BackgroundWomen’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opioid intervention court program.MethodsThe authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court,a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. ResultsPrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged: HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.
Increased Leukotriene B4 Plasma Concentration in Type 2 Diabetes Individuals with Cardiovascular Autonomic Neuropathy
Authors: NEVES JOSE ANTONIO JANUARIO , DE MATOS MOZÂNIA REIS , RAMALHO THERESA , SANTOS-BEZERRA DANIELE PEREIRA , CAVALCANTE CRISTIANE DAS GRAÇAS DIAS , ALPINO RENATA D’ , QUEIROZ MÁRCIA SILVA , JANCAR SONIA , Correa-Giannella Maria Lucia
Published: November 2020

Background and Aim: A low-grade inflammation is associated with cardiac autonomic neuropathy (CAN) and increased concentration of leukotriene B4 (LTB4) was found in individuals with type 1 diabetes and definitive CAN. This cross-sectional study evaluated plasma concentration of LTB4 and of other inflammatory mediators, namely, tumor necrosis factor (TNF), interleukin (IL)1B, and IL10 in individuals with T2D and different degrees of CAN, and correlated these inflammatory mediators with the degree of glycemic control and with a surrogate marker of insulin resistance. Methods: TNF, IL1B, IL10 and LTB4 plasma concentrations were measured in 129 T2D subjects (62% women with [median] age of 63 years, disease duration of 8 years and HbA1c of 7.3%) with or without CAN. The Lipid accumulation product index was used as a surrogate marker of insulin resistance. Results LTB4 concentration was significantly higher in those presenting incipient CAN (69.7 ± 16.6 pg. mL-1) and definitive CAN (71.5 ± 15.7 pg. mL-1) versus those without CAN (57.0 ± 13.9 pg. mL-1). The groups without CAN and with incipient CAN were pooled (group without definitive CAN) and compared to those with definitive CAN. LTB4 concentration was higher in the latter group, as well as TNF concentration, while IL10 concentration was lower in this group. After adjustment for confounding variables, only LTB4 concentration remained significantly different between the groups with and without definitive CAN. Plasma concentration of LTB4 did not correlate with the degree of glycemic control. After sorting the participants by sex, a borderline weak correlation was found between LTB4 and the Lipid accumulation product index in women. Conclusion: In the T2D setting, circulating LTB4 concentration seems to be associated with cardiovascular dysautonomia.
Instance segmentation based method to obtain the phenotypic information of weeds in complex field environments
Authors: longzhe Quan , Wu Bing , Mao Shou ren , Feng Huaiqu , Yang Chunjie , Wei Jiang , Li Hengda
Published: November 2020

Background: Weeds pose a critical threat to crop growth. The leaf age and plant centre, which represent the key phenotypic information of weeds, can help understand the morphological structure of weeds, thereby facilitating precise targeted spraying and a reduction in the herbicide usage. However, determining the weed types, leaf age and plant centre under complex field conditions involving variations in the light and plant appearance along with leaf occlusion is challenging. With the advancement in the application of deep learning with computer vision, such approaches can likely overcome these challenges, as demonstrated in other complex agricultural applications.Results: We developed a weed segmentation method based on BlendMask, which could obtain the weed types, leaf age and plant centre under complex field conditions. Mobile devices were used to capture digital images at different angles (front, side, and top views) of certain weeds (Solanum nigrum, Barnyard grass, and Abutilon theophrasti Medicus) in the field. Subsequently, two datasets (with and without data enhancement) were produced and input to the network. Moreover, two backbone networks, ResNet50 and ResNet101, were compared, along with six instance segmentation algorithms, and the instance segmentation results of the model under different angles were evaluated. The results indicated that data enhancement could enhance the model performance. In the case with data enhancement, the F1 value, AP50 and AP70 scores, and mIOU with ResNet101 as the backbone network were 0.9479, 0.720, 0.592, and 0.607, respectively, corresponding to the highest segmentation performance. Furthermore, the top view images of the weeds corresponded to the highest detection accuracy, compared to that for the other two angles.Conclusion: BlendMask can realize accurate segmentation of weeds to obtain the types, leaf age and plant centre of weeds. Data enhancement and use of the weed image corresponding to the top view angle can help enhance the model performance. The dataset and research results can provide guidance to further develop precision agriculture practices.
Infiltration and sealing for managing non-cavitated proximal lesions: A systematic review and meta-analysis
Authors: Chen Yuanyuan , Chen Dongru , Lin Huan Cai
Published: November 2020

Background: Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.Methods: Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings.Results: In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs non-invasive: OR = 0.21, 95% CI: 0.15 to 0.30; sealing vs placebo: OR = 0.27, 95% CI: 0.18 to 0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI: 0.20 to 0.45; permanent dentition: OR = 0.20, 95% CI: 0.14 to 0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI: 0.14 to 0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI: 0.01 to 8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI: 0.08 to 0.72; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR = 0.17, 95% CI: 0.10 to 0.29; and high risk: OR = 0.14, 95% CI: 0.07 to 0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI: 0.01 to 8.27), infiltration was superior (low risk: OR = 0.24, 95% CI: 0.08 to 0.72; low to moderate risk: OR = 0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR = 0.20, 95% CI: 0.10 to 0.39; and high risk: OR = 0.14, 95% CI: 0.05 to 0.37).Conclusion: Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.
A Revealed Preference Analysis to Develop Composite Scores Approximating Lung Allocation Policy in the U.S.
Authors: Stewart Darren E , Wood Dallas W , Alcorn James B , Lease Erika D , Hayes Michael , Hauber Brett , Goff Rebecca E
Published: November 2020

Background: The patient ranking process for donor lung allocation in the United States is carried out by a classification-based, computerized algorithm, known as the match system. Experts have suggested that a continuous, points-based allocation framework would better serve waiting list candidates by removing hard boundaries and increasing transparency into the relative importance of factors used to prioritize candidates. We applied discrete choice modeling to match run data to determine the feasibility of approximating current lung allocation policy by one or more composite scores. Our study aimed to demystify the points-based approach to organ allocation policy; quantify the relative importance of factors used in current policy; and provide a viable policy option that adapts the current, classification-based system to the continuous allocation framework.Methods: Rank ordered logistic regression models were estimated using 6,466 match runs for 5,913 adult donors and 534 match runs for 488 pediatric donors from 2018. Four primary attributes are used to rank candidates and were included in the models: (1) medical priority, (2) candidate age, (3) candidate’s transplant center proximity to the donor hospital, and (4) blood type compatibility with the donor.Results: Two composite scores were developed, one for adult and one for pediatric donor allocation. Candidate rankings based on the composite scores were highly correlated with current policy rankings (Kendall’s Tau ~0.80, Spearman correlation >90%), indicating both scores strongly reflect current policy. In both models, candidates are ranked higher if they have higher medical priority, are registered at a transplant center closer to the donor hospital, or have an identical blood type to the donor. Proximity was the most important attribute. Under a points-based scoring system, candidates in further away zones are sometimes ranked higher than more proximal candidates compared to current policy. Conclusions: Revealed preference analysis of lung allocation match runs produced composite scores that capture the essence of current policy while removing rigid boundaries of the current classification-based system. A carefully crafted, continuous version of lung allocation policy has the potential to make better use of the limited supply of donor lungs in a manner consistent with the priorities of the transplant community.
Successful live birth in a Chinese woman with P450 oxidoreductase deficiency through frozen-thawed embryo transfer and review of the literature
Authors: Pan Ping , Zheng Lingyan , Chen Xiaoli , Huang Jia , Yang Dongzi , Li Yu
Published: November 2020

Background: Congenital adrenal hyperplasia (CAH) caused by P450 oxidoreductase deficiency (PORD) in 46,XX patients is characterized by genital ambiguity, primary amenorrhea, absent or incomplete sexual maturation, infertility, skeletal malformations and so on. But few pregnancies have been reported from these female patients with PORD. Case Description: A 29-year-old Chinese woman with PORD due to the compound heterozygous mutation (c.1370G>A/c.1196_1204del) in the P450 oxidoreductase( POR ) gene had suffered from primary amenorrhea and infertility. She had one cancelled cycle of ovulation induction due to low serum estradiol(E 2 ), high progesterone(P) levels and thin endometrium,then in vitro fertilization (IVF) was recommended. At the first IVF cycle, 4 oocytes were retrieved and 4 viable embryos were cryopreserved due to thin endometrium associated with low E 2 and prematurely elevated P after ovarian stimulation, even though oral dexamethasone were used to control adrenal P overproduction at the same time. When basal P fell to <1.5ng/ml, artificial endometrial preparation and frozen embryo transfer were performed, resulting in a twin pregnancy. She delivered a healthy boy and a healthy girl by caesarean section at 37 weeks and 2 days of gestation. Conclusions: We report the pregnancy achieved in a CAH woman caused by a compound heterozygous POR mutation, with primary amenorrhea and disorders of steroidogenesis. It seemed that disorders of steroidogenesis caused by PORD didn’t impair the developmental potential of oocytes. IVF and frozen embryo transfer after adequate hormonal control and endometrial preparation should be an effective infertility treatment for PORD women.
Predictors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case-control study
Authors: Hu Weiping , Lhamo Tsokyi , Zhang Feng-ying , Hang Jing-qing , Zuo Yi-hui , Hua Jian-lan , Li Shan-qun , Zhang Jing
Published: November 2020

BackgroundFor patients with chronic obstructive pulmonary disease (COPD), the incidence of acute cardiovascular events (CVEs) increases during acute exacerbation (AE) period, causing increased inpatient mortality. Thus, we try to identify predictors of acute CVEs in patients with AECOPD via a nested case-control study.MethodsA total of 496 cases hospitalized for AECOPD were included into analysis, and followed-up for 6 months after discharge. Acute CVEs in the AE period were defined as the new or worsening acute coronary syndrome (ACS), arrhythmia, left ventricular disfunction (LVD). Predictors were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period.ResultsThirty cases (6.05%) had acute CVEs, including 2 with ACS, 13 with LVD and 19 with arrhythmia. Four deaths were observed in the CVE group, with significantly increased death risk compared with the non-CVE group (P=0.001, OR=5.81). Moreover, patients who have had CVEs were vulnerable to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P=0.004, OR=5.06), 20% increase in heart rate (HR) (P=0.003, OR= 10.19), electrolyte disturbance (P=0.01, OR= 4.24) and diuretics (P=0.002, OR = 6.37) were independent predictors. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs.ConclusionsOur study preliminarily indicated that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with electrolyte monitoring. These findings needs to be confirmed in a large cohort.
Atorvastatin combined with dexamethasone in chronic subdural haematoma (ATOCH II): study protocol for a randomised controlled trial
Authors: Jiang Rong Cai , Wang Dong , Zhao Shi Guang , Wang Ren Zhi , Kang De Zhi , Zhu Xin Gen , Zhao Zong Mao , Wei Jun Ji , Huang Ying , Qu Yan , Sun Xiao Chuan , Ji Hong Ming , Jiang Xiao Chun , Liu Jin Fang , De Zhu Xi , Wang Jian Jun , Tian Ye , Gao Chuang , Wei Hui Jie , Zhang Shu , Quan Wei , Yue Shu Yuan , Lei Ping , Li Xian , Song Li Li , Anderson Craig S , Zhang Jianning
Published: November 2020

Background
Chronic subdural haematoma (CSDH) is a common condition in the elderly that often requires neurosurgical management. For small CSDH, evidence has emerged that statins may reduce haematoma volume and improve outcomes, presumably by reducing local inflammation and promoting vascular repair. We wish to extend this evidence in a study that aims to determine the efficacy and safety of atorvastatin combined with low-dose dexamethasone in patients with CSDH.
Methods
The second ATorvastatin On Chronic subdural Hematoma (ATOCH-II) study is a multi-center, randomized, placebo-controlled, double blind trial which aims to enroll 240 adult patients with a conservative therapeutic indication for CSDH, randomly allocated to standard treatment with atorvastatin 20 mg combined with low-dose dexamethasone (or matching placebos) daily for 28 days, and with 152 days of follow-up. The primary outcome is a composite good outcome defined by any reduction from baseline in haematoma volume and survival free of surgery at 28 days. Secondary outcomes include functional outcome on the modified Rankin scale (mRS) and modified Barthel Index at 28 days, surgical transition, and reduction in haematoma volumes at 14, 28 and 90 days.
Discussion
This multi-centre clinical trial aims to provide high-quality evidence on the efficacy and safety of the combined treatment of atorvastatin and low-dose dexamethasone to reduce inflammation and enhance angiogenesis in CSDH.
Trial registration:
ChiCTR, ChiCTR1900021659. Registered 3 March 2019, http://www.chictr.org.cn/showproj.aspx?proj=36157
Effect of cyclic wetting-drying on tensile mechanical behavior and microstructure of clay-bearing sandstone
Authors: guo Pingye , Juan Gu , Yi Su , Wang Jiong , Ding Zhanwen
Published: November 2020

The understanding of the weakening mechanism of tensile strength of rock subjected to cyclic wetting-drying is critical for rock engineering. Tensile strength tests were conducted on a total of 35 sandstone specimens with different wetting-drying cycles. The crack propagation process and acoustic emission characteristics of the tested samples were obtained through a high-speed camera and acoustic emission system. The results indicate that the tensile strength is observably reduced after cyclic wetting-drying, and the extent of the reduction is not only related to the number of wetting-drying cycle, but also closely related to the clay mineral content of the sample. In addition, as the cycles of wetting-drying increase, the effect of each single cycle on tensile strength get reduced until it becomes constant.. Moreover, the crack initiation and penetration time is prolonged as the number of wetting-drying cycle increases, which indicates that cyclic wetting-drying weakens the rock stiffness and enhances the ductility of sandstone. Meanwhile, the acoustic emission characteristics of the tested samples further confirmed the ductile behaviour of the sandstone samples with increasing wetting-drying cycle. Furthermore, through the analysis of the microstructure and mineral composition of the samples with different wetting-drying cycles, it is concluded that the main weakening mechanisms of sandstones containing clay minerals are frictional reduction, chemical and corrosive deterioration.
Impact of Previous Abdominal Surgery on Robotic-Assisted Rectal Surgery in Patients with Locally Advanced Rectal Adenocarcinoma: A Propensity Score Matching Study
Authors: Huang Ching-Wen , Su Wei-Chih , Chang Tsung-Kun , Ma Cheng-Jen , Yin Tzu-Chieh , Tsai Hsiang-Lin , Chen Po-Jung , Chen Yen-Cheng , Li Ching-Chun , Hsieh Yi-Chien , Wang Jaw Yuan
Published: November 2020

Background: The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with locally advanced rectal adenocarcinoma undergoing preoperative concurrent chemoradiotherapy (CCRT).Methods: In total, 203 patients with locally advanced rectal adenocarcinoma who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 match was used to match PAS patients with non-PAS.Results: Of the 203 enrolled patients, 35 were PAS patients 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time [165 min (PAS) vs 175 min (non-PAS), P = 0.4542)] and median operation time [275 min (PAS) vs 290 min (non-PAS), P = 0.5943)] after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.Conclusion: The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with locally advanced rectal adenocarcinoma undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.
Real-World Clinical Outcomes of Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma
Authors: Kadono Yoshifumi , Kawaguchi Shohei , Nohara Takahiro , Shigehara Kazuyoshi , Izumi Kouji , Kamijima Taiki , Seto Chikashi , Takano Akinobu , Yotsuyanagi Satoshi , Nakagawa Ryunosuke , Miyagi Tohru , Aoyama Shuhei , Asahi Hideki , Fukuda Rie , Mizokami Atsushi
Published: November 2020

Background: Pembrolizumab is currently considered the standard second-line treatment for advanced urothelial carcinoma (UC). This study aimed to investigate the efficacy and safety of pembrolizumab in patients with advanced UC in real-world data, which is not well-reported.Methods: The study included 98 patients with advanced UC who were treated with pembrolizumab after platinum-based chemotherapy at eight hospitals. The efficacy, safety, and risk factors for prognosis were evaluated. Results: The median age was 73 years. Nineteen patients (19%) with performance status (PS) 2-4 were included. The percentages of liver, lung, bone, and lymph node metastasis were 18%, 27%, 19%, and 76%, respectively. The best response was complete response in nine patients (9%) and partial response in 16 patients (17%). The median progression-free survival and overall survival were 3.7 months (95% confidence interval [CI]: 2.8–4.7) and 11.8 months (95% CI: 6.7–17.0), respectively. Poor PS, liver metastasis, and higher C-reactive protein were poor prognostic factors. Hyperprogression was observed in nine patients (9%), who were mostly of poor PS and had high-volume lesions. Severe adverse events (AEs) were observed in 18 patients (19%), and five patients died because of AEs (5%). Atypical AEs, such as pneumocystis pneumonia and acute myeloid leukemia, were observed in our cohort. Conclusion: The efficacy of pembrolizumab for advanced UC in our cohort was better than a previous phase III trial (KEYNOTE-045), possibly owing to lower cancer volume and fewer visceral metastases in our patients.
Dietary Isoleucine Improved Flesh Quality, Muscle Antioxidant Capacity, and Muscle Growth Associated with AKT/TOR/S6K1 and AKT/FOXO3a Signaling in Hybrid Bagrid Catfish (Pelteobagrus vachelli ♀ × Leiocassis longirostris♂)
Authors: Jiang Qin , Yan Ming-Yao , Zhao Ye , Zhou Xiao-Qiu , Yin Long , Feng Lin , Liu Yang , Jiang Wei-Dan , Wu Pei , Wang Yan , Chen De-Fang , Yang Shi-Yong , Huang Xiao-Li , Jiang Jun
Published: November 2020

Background: Muscle is the complex and heterogeneous tissue, which comprises the primary edible part of the trunk of fish and mammals. Previous study has shown that dietary isoleucine (Ile) exerts beneficial effects on animals’ growth. However, limited studies have evaluated the benefits of Ile on fish muscle and their effects on flesh quality and muscle growth. Thus, this study was conducted to explore whether dietary Ile had affected flesh quality and muscle growth in hybrid bagrid catfish (Pelteobagrus vachelli × Leiocassis longirostris). Results: In the current study, we demonstrated that Ile significantly: (1) increased muscle protein and lipid contents and the frequency distribution of muscle fibers with ≤ 20 and ≥ 50 µm of diameter; (2) improved pH value, shear force, cathepsin B and L activities, hydroxyproline content, resilience, cohesiveness, and decreased cooking loss, lactate content, hardness, springiness, gumminess, and chewiness; (3) decreased reactive oxygen species (ROS), malondialdehyde (MDA), and protein carbonyl (PC) contents, GCLC and Keap1 mRNA levels, and up-regulated CuZnSOD, CAT, GST, and Nrf2 mRNA levels; (4) up-regulated the insulin-like growth factor 1, 2 (IGF-1, IGF-2), insulin-like growth factor 1 receptor (IGF-1R), proliferating cell nuclear antigen (PCNA), Myf5, MyoD, MyoG, MRF4, and MyHC mRNA levels, and decreased MSTN mRNA level; (5) increased muscle protein deposition by activating AKT-TOR-S6K1 and AKT-FOXO3a signaling pathways. Conclusion: These results revealed that Ile improved flesh quality, which might be due to increasing nutritional content, physicochemical, texture parameters, and antioxidant ability; promoting muscle growth by affecting myocytes hyperplasia and hypertrophy, and muscle protein deposition associated with protein synthesis and degradation signaling pathways. Finally, the quadratic regression analysis of chewiness, ROS, and protein contents against dietary Ile levels suggested that the optimal dietary Ile levels for hybrid bagrid catfish was estimated to be 14.19, 12.36, and 12.78 g Ile kg-1 diet, corresponding to 36.59, 31.87, and 32.96 g kg-1 dietary protein, respectively.
A Review Of The Clinical Outcomes In Idursulfase-Treated And Untreated Filipino Patients With Mucopolysaccharidosis Type II: Data From The Local Lysosomal Storage Disease Registry
Authors: Racoma Marie Julianne Castillo , Calibag Maria Kristina Karizza B. , Chiong Mary Anne D. , Abacan Mary Ann R. , Cordero Cynthia
Published: November 2020

Background: Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is an X-linked multisystem disorder characterized by glycosaminoglycan (GAG) accumulation, caused by a deficiency of iduronate-2-sulfatase (I2S). Enzyme replacement therapy (ERT) with recombinant I2S, the standard of care, was started in the Philippines in 2017. This study reviewed the clinical outcomes in idursulfase-treated and untreated Filipino MPS II patients who were included in the local Lysosomal Storage Disease (LSD) registry of the Institute of Human Genetics-National Institutes of Health (IHG-NIH) from January 1999 to December 2019.Methods: A retrospective audit of records of MPS II patients listed in the registry was done. Qualified patients were divided into two cohorts: idursulfase-treated group (patients on enzyme replacement therapy, ERT, for >6 months) and untreated group. Baseline characteristics, including demographic data, biochemical results, neurocognitive classification, respiratory involvement, mortality, and adverse events, were recorded. Height, weight, cardiac pathology, liver and spleen sizes, six-minute walk test (6MWT), joint mobility, were determined at baseline and at year 1 and 2 of follow up.Results: Forty male patients were included in this review, with 8 receiving ERT since 2017. The mean age at diagnosis was 6.99 years (SD 4.15; 0.75-20) and mean age at start of ERT was 14.03 years (SD 7.1; 4-21.5), more delayed than previous reports. Eighty percent have early progressive phenotype which was higher than reported average. The early growth pattern differed in our Filipino cohort, but was followed by the expected slowed growth in later years. Improvements in the following endpoints were observed in the treated cohort: height and weight, cardiac disease, liver and spleen sizes, and joint mobility. There were also positive effects on respiratory involvement and mortality rate. Adverse events were consistent with previous reports.Conclusions: ERT is generally well tolerated and effective in reducing GAG storage and improving clinical endpoints among our Filipino MPS II patients. In untreated patients, typical disease progression was observed.
Parent-Child-Agreement on Health-Related Quality of Life and its Determinants in Patients Born with Esophageal Atresia – A Swedish-German Cross-Sectional Study
Authors: Witt Stefanie , Dellenmark-Blom Michaela , Kuckuck Susanne , Dingemann Jens , Abrahamsson Kate , Dingemann Carmen , Chaplin John Eric , Ure Benno , Bullinger Monika , Gatzinsky Vladimir , Jönsson Linus , Quitmann Julia Hannah
Published: November 2020

Background The aim was to compare parent and child reported health-related quality of life (HRQOL) of children born with esophageal atresia (EA) and to determine factors that affect the level of parent-child agreement. Methods We included 63 parent-child dyads of children born with EA aged 8-18 from Germany and Sweden. The generic PedsQL questionnaire and the condition-specific EA QOL questionnaire were used to assess children’s HRQOL from parents- and child’s perspective. The Peds QL Family Impact Module was used to assess parental HRQOL and Family Functioning.Results On an individual level, intra-class correlation coefficients indicated strong levels of parent-child agreement (.61-.97). At the group level, the analyses showed no significant differences between the responses of parents and children. In cases where disagreement occurred, parents were more likely to rate generic HRQOL lower than the children (19-35%) and condition-specific HRQOL higher than the children (17-33%). Findings of the multiple regression analysis showed that the country (Germany vs. Sweden) was found to be a significant predictor of parent-child agreement in generic HRQOL and parental HRQOL to be a significant predictor of parent-child agreement in condition-specific HRQOL.Conclusion The parent-child agreement is mostly good, suggesting that parent-reports are a reliable source of information. However, discrepancies may occur and cannot be explained by the child's age and gender, nor severity of the disease or Family Functioning, but solely by country respectively parental HRQOL. Clinicians should therefore not only observe the pediatric patient but also the parents.
Psychometric Properties of ‘Attitudes to Health Professionals Questionnaire’ (AHPQ) in Iranian Context
Authors: Najafi Maryam , Motlagh Maryam Karbasi , Najafi Minoo , Kajeazad Mojtaba , Zarghi Nazila , Shirazi Mandana
Published: November 2020

Background: The professional life has been frequently made by social interactions in which different forms of professional collaboration appear. Everybody has different attitudes through his/her life that could influence on choosing profession and probably the approach towards inter professional work. In order to study the current attitude towards planning educational courses and assess efficiency of the ongoing educational courses, the present study has normalized the Persian version of the ‘Attitudes to Health Professionals Questionnaire’ (AHPQ).Method: After permission from questionnaire developers, in order to confirm face and content validity, the process of translation and back translation was performed. Then it was sent to ten scholars (Delphi Technique) and their comments were considered for providing the final copy. The questionnaire was back translation from Persian into English. The final version was compared with the original questionnaire in terms of concepts. Reliability confirm by test-retest and internal consistency (intra class correlation and Cronbach alpha coefficient).The construct validity was confirmed by exploratory factor analysis. Results: According to the first phase (67 participants), wide range has caused unnecessary variations in answers; so reliability has been confirmed in larger sample size (104 participants) after decreasing the extent of scale from 10 to 5 points. Exploratory factor analysis was used by main construct and rotation of maximum variance. Final reliability was confirmed by Cronbach alpha as 0. 899. Three underlying constructs of professional ethics, professional autonomy and patient-centered care had been revealed in the questionnaire.Conclusion: In addition to confirmation of AHPQ construct validity, reveals that such a tool is able to specify the attitude of health team members based on their perceived importance towards the basis of inter professional collaboration. Thus, recognizing and directing priorities of health care team in inter professional collaboration enables us to manage establishment, integrity, sustainability and coordination of group activities.
Geranylgeranylacetone Attenuates Cerebral Ischemia-reperfusion Injury in Rats Through the Augmentation of HSP 27 Phosphorylation: A Preliminary Study
Authors: Matsuo Kazuya , Hosoda Kohkichi , Tanaka Jun , Yamamoto Yusuke , Imahori Taichiro , Nakai Tomoaki , Irino Yasuhiro , Shinohara Masakazu , Sasayama Takashi , Kohmura Eiji
Published: November 2020

BackgroundWe previously reported that heat shock protein 27 (HSP27) phosphorylation plays an important role in the activation of glucose-6-phosphate dehydrogenase (G6PD), resulting in the upregulation of the pentose phosphate pathway and antioxidant effects against cerebral ischemia-reperfusion injury. The present study investigated the effect of geranylgeranylacetone, an inducer of HSP27, on ischemia-reperfusion injury in male rats as a preliminary study to see if further research of the effects of geranylgeranylacetone on the ischemic stroke was warranted.MethodsIn all experiments, male Wistar rats were used. First, we conducted pathway activity profiling based on a gas chromatography-mass spectrometry to identify ischemia-reperfusion-related metabolic pathways. Next, we investigated the effects of geranylgeranylacetone on the pentose phosphate pathway and ischemia-reperfusion injury by real-time polymerase chain reaction (RT-PCR), immunoblotting, and G6PD activity, protein carbonylation and infarct volume analysis. Geranylgeranylacetone or vehicle was injected intracerebroventricularly 3 h prior to middle cerebral artery occlusion or sham operation.ResultsPathway activity profiling demonstrated that changes in the metabolic state depended on reperfusion time and that the pentose phosphate pathway and taurine-hypotaurine metabolism pathway were the most strongly related to reperfusion among 137 metabolic pathways. RT-PCR demonstrated that geranylgeranylacetone did not significantly affect the increase in HSP27 transcript levels after ischemia-reperfusion. Immunoblotting showed that geranylgeranylacetone did not significantly affect the elevation of HSP27 protein levels. However, geranylgeranylacetone significantly increase the elevation of phosphorylation of HSP27 after ischemia-reperfusion. In addition, geranylgeranylacetone significantly affected the increase in G6PD activity, and reduced the increase in protein carbonylation after ischemia-reperfusion. Accordingly, geranylgeranylacetone significantly reduced the infarct size (median 31.3% vs 19.9%, p = 0.0013).ConclusionsAs a preliminary study, these findings suggest that geranylgeranylacetone may be a promising agent for the treatment of ischemic stroke and would be worthy of further study. Further studies are required to clearly delineate the mechanism of geranylgeranylacetone -induced HSP27 phosphorylation in antioxidant effects, which may guide the development of new approaches for minimizing the impact of cerebral ischemia-reperfusion injury.
Radiation-induced Metabolic Shifts in the Hepatic Parenchyma: Findings from 18F-FDG PET Imaging and Tissue NMR Metabolomics in a Mouse Model for Hepatocellular Carcinoma
Authors: Chung Yi-Hsiu , Tsai Cheng-Kun , Yu Ching-Fang , Wang Wan-Ling , Yang Chung-Lin , Hong Ji-Hong , Yen Tzu-Chen , Chen Fang-Hsin , Lin Gigin
Published: November 2020

Purpose: By taking advantage of 18F-FDG PET imaging and tissue nuclear magnetic resonance (NMR) metabolomics, we examined the dynamic metabolic alterations induced by liver irradiation in a mouse model for hepatocellular carcinoma (HCC). Methods: After orthotopic implantation with the mouse liver cancer BNL cells in the right hepatic lobe, animals were divided into two experimental groups. The first received irradiation (RT) at 15 Gy whereas the second (no-RT) did not. Intergroup comparisons over time were performed in terms of 18F-FDG PET findings, NMR metabolomics results, and expression of genes involved in inflammation and glucose metabolism. Results: As of day 1 post-irradiation, mice in the RT group showed an increased 18F-FDG uptake in the right liver parenchyma compared with the no-RT group. However, the difference reached statistical significance only on the third post-irradiation day. NMR metabolomics revealed that glucose concentrations peaked on day 1 post-irradiation both in the right and left lobes – the latter reflecting a bystander effect. Increased pyruvate and glutamate levels were also evident in the right liver on the third post-irradiation day. The expression levels of the glucose-6-phosphatase (G6PC) and fructose-1, 6-bisphosphatase 1 (FBP1) genes were down-regulated on the first and third post-irradiation days, respectively. Thus, liver irradiation was associated with a metabolic shift from an impaired gluconeogenesis to an enhanced glycolysis from the first to the third post-irradiation day. Conclusion: Radiation-induced metabolic alterations in the liver parenchyma occur as early as the first post-irradiation day and show dynamic changes over time.
Risk Factors Impacting Intra- and Postoperative Cerebrospinal Fluid Rhinorrhea on the Endoscopic Treatment of Pituitary Adenomas: Retrospective Experience From 250 Patients
Authors: Wang Ming , Yang Cai , Jiang Yugang , Peng Yong
Published: November 2020

Aim: We aimed to identify the risk factors associated with intra- and postoperative cerebrospinal fluid leakage in pituitary adenomas treated by endoscopic transsphenoidal surgery. Material and methods: A retrospective analysis of 250 pituitary adenoma cases from January 2017 to December 2019 at our hospital was conducted; all patients underwent endoscopic endonasal transsphenoidal surgeries. A univariate analysis and multivariate analysis was performed to investigate the risk factors associated with intra- and postoperative CSF rhinorrhea.Results: Eighty(32.0%) and nine(3.6%) patients had intraoperative and postoperative CSF leakages, respectively. Tumor size was an independent risk factor for intraoperative CSF leakage (OR, 1.229; 95% CI, 1.133–1.334; P<0.001); intraoperative CSF leakage was an independent risk factor for postoperative CSF leakage (OR, 7.707; 95% CI, 1.336–44.455; P=0.022). Chronic respiratory disease (OR, 57.500; 95% CI, 8.031–411.682; P<0.001) was also an independent risk factor for postoperative CSF leakage; vascularized septal mucosal flap was a protective factor for such (OR, 0.107; 95% CI, 0.013–0.894; P=0.039).Conclusion: Intraoperative CSF leakages are more likely to occur in large pituitary adenomas; in the presence of intraoperative CSF leakages, postoperative CSF rhinorrhea is very likely to occur. Patients with chronic respiratory disease are also more likely to develop postoperative CSF leakages. However, the sellar base reconstructed using vascularized nasal septal flaps can significant decrease the risk for such. Knosp grade, degree of tumor resection, postoperative lumbar subarachnoid drain use did not seem to have effect on the postoperative CSF rhinorrhea.