bluuebunny/crossref_metadata_2025 huggingface dataset:
Penetrating Injuries in Germany – Epidemiology, Management and Outcome - An Analysis Based on The TraumaRegister DGU®
Authors: Bieler Dan , Kollig Erwin , Hackenberg Lisa , Rathjen Jan-Henrik , Lefering Rolf , Franke Axel
Published: December 2020

BackgroundThe management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5% of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment.Materials and methodsSince 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. ResultsFrom 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5%, and 4333 patients with stab wounds (1.8%), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41% for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8%). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3% required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit.ConclusionsIn Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.
A Study of the Correlation Between M2 Macrophages and Lymph Node Metastasis of Colorectal Cancer
Authors: Wang Yanping , Wang Jikun , Liu Jinhao , Shi Zuoxiu , Chen Yanlei , Feng Yang , Ma Xueqian , Qiao Shifeng
Published: December 2020

Background: Lymph node metastasis is a major prognostic factor of colorectal cancer and an important indicator for individualized treatment. M2 macrophages play a key role in carcinogenesis and tumor development, not only enhancing invasiveness, but also promoting lymph node metastasis. The purpose of this study was to investigate the effect of CD163-positive M2 macrophages on lymph node metastasis in colorectal cancer.Methods: Postoperative lymph node tissues were obtained from 120 patients with colorectal cancer who underwent radical surgery in the First Affiliated Hospital of Jinzhou Medical University between December 2019 and May 2020. We detected the expression of the CD163 protein in lymph nodes by immunohistochemistry. Furthermore, the relationship between M2 macrophages identified by this marker and lymph node metastasis were analyzed using the independent sample T-test and Chi-square test.Results: M2 macrophages were increased not only in metastatic lymph nodes, but also in non-metastatic lymph nodes adjacent to the cancer. The M2 macrophage count was higher in patients with macro-metastases than in those with micro-metastases.Conclusions: M2 macrophages represent an important factor for the promotion of lymph node metastasis in colorectal cancer, and may be a potential marker for its prediction. This may offer a new target for the comprehensive treatment of colorectal cancer.
Penthorum Chinense Pursh Protects Liver From Alcohol-induced Steatosis in Zebrafish by Mechanisms Including Inhibition of Oxidative Stress and Increase in Autophagy
Authors: Zhao Xingtao , Zhou Mengting , Deng Ying , Guo Chaocheng , Liao Li , He LinFeng , Peng Cheng , Li Yunxia
Published: December 2020

BackgroundAs an ATP-gated ion channel, P2X7 receptor (P2X7R) affects lipid metabolism by activating the dangerous molecule ATP derived from liver cells caused by alcohol. Penthorum chinense Pursh (PCP), known as “shenxiancao”, plays a significant role in treating liver disease among Miao people. We first investigated whether liver protection mechanism of PCP mediated by P2X7R. MethodsFirst, treatment of zebrafish transgenic (fabp10: EGFP) larvae with different concentrations of PCP after 48 h at 3 dpf, then soaked in 350 mmol/L ethanol for 32 h. Subsequently the ameliorative effect of PCP in zebrafish with alcoholic hepatosteatosis was studied. In addition, gene expression related to lipid metabolism, oxidative stress, and autophagy was detected from the mRNA level by RT-qPCR and related proteins were measured by Western blot. Then, larvae were stimulated with ATP alone to explore whether PCP was the target of P2X7R.ResultsPCP significantly improved liver function and lipid deposition in zebrafish with alcoholic hepatosteatosis, and regulated the expression of SREBP1, CHREBP and FAS by elevating LKB1 and AMPK, thereby inhibiting the synthesis of fatty acids. Also, SIRT1 was suppressed in the model group, while PCP upregulated the expression. Inecreased expression of PPARα, decreased PPARγ, and CPT1 then promoted the oxidation of fatty acids. PCP dose-dependently decreased intracellular ROS production in zebrafish, then reduced MDA activity elevation and increased GSH, CAT and SOD levels. The specific mechanism may be realized by up-regulating the antioxidant pathway of Keap1/Nrf2 and down-regulating the autophagy pathway of PI3K/Akt/mTOR to regulate lipid metabolism. After ATP stimulation, P2X7R is further activated, which in turn regulated Keap1/Nrf2 and mTOR/PI3K/Akt mRNA expression, while PCP reversed these changes.ConclusionsPCP may be a target of P2X7R involvement in the regulation of this mechanism through up-regulation of the antioxidant pathway of Keap1/Nrf2 and down-regulation of the autophagic pathway of mTOR/ PI3K/Akt to regulate lipid metabolism, suggesting that blocking P2X7R is an emerging strategy for the therapy of ALD.
Transcriptomic analysis of s-methoprene resistance in the lesser grain borer, Rhyzopertha dominica, and evaluation of piperonyl butoxide as a resistance breaker
Authors: SAKKA MARIA , Riga Maria , Ioannidis Panagiotis , Baliota Georgia V , Tselika Martha , Jagadeesan Rajeswaran , Nayak Manoj K. , Vontas John , Athanassiou Christos
Published: December 2020

Background: The lesser grain borer, Rhyzopertha dominica is a serious pest of stored grains. Fumigation and contact insecticides play a major role in managing this pest globally. While insects are developing genetic resistance to chemicals, hormonal analogues such as s-methoprene play a key role in reducing general pest pressure as well as managing pest populations that are resistant to fumigants and neurotoxic contact insecticides. However, resistance to s-methoprene has been reported in R. dominica with some reports showing a remarkable high resistance, questioning the use of this compound and other related analogues in grain protection. The current study attempts to identify possible molecular mechanisms that contribute in resistance to s-methoprene in R. dominica. Results: Transcriptome analysis of resistant and susceptible strains of this pest species identified a set of differentially expressed genes related to cytochrome P450s, indicating their potential role in resistance to s-methoprene. Laboratory bioassays were performed with s-methoprene treated wheat grains in presence and absence of piperonyl butoxide (PBO), a cytochrome P450 inhibitor. The results indicate that PBO, when applied alone, at least at the concentration tested here, had no effect on R. dominica adult emergence, but has a clear synergistic effect to s-methoprene. The number of produced progeny decreased in presence of the inhibitor, especially in the resistant strain. In addition, we also identified CYP complement (CYPome) of R. dominica, annotated and analysed phylogenetically, to understand the evolutionary relationships with other species.Conclusions: The information generated in current study suggest that PBO can effectively be used to break resistance to s-methoprene in R. dominica.
Prognostic impact of the prognostic nutritional index in cases of resected oral squamous cell carcinoma: a retrospective study
Authors: Abe Atsushi , Hayashi Hiroki , Ishihama Takanori , Furuta Hiroshi
Published: December 2020

Background: The systemic inflammatory response and nutritional status of patients with malignant tumors are related to postoperative results. We examined the usefulness of the prognostic nutritional index (PNI) as a prognostic tool in patients with oral squamous cell carcinoma who underwent radical surgery. Methods: From 2008 to 2019, 102 patients (73 males, 29 females; age, 65.6 ± 9.8 years) who visited our hospital and underwent surgical therapy were included in this study. The endpoint was the total survival period, and the evaluation markers included the lymphocyte count and albumin level in peripheral blood obtained 4 weeks preoperatively, age, sex, alcohol consumption, smoking history, site of the tumor, pathological stage, and surgery status. The PNI was calculated using serum albumin levels and the peripheral blood lymphocyte count. The relationship between the PNI and patient characteristics were analyzed using Fisher's exact test. The Kaplan–Meier method was used to evaluate the survival rate. The survival periods were compared using the log-rank method. We evaluated the prognostic factors for overall survival (OS) and disease-free survival (DFS) in a logistic regression model.Results: The tumor sites included the maxilla (n = 12), buccal mucosa (n = 11), mandible (n = 17), floor of the mouth (n = 9), and tongue (n = 53). The number of patients with stage I, II, III, and IV oral cancers was 28 (27.5%), 34 (27.5%), 26 (33.3%), and 14 (13.7%), respectively. During the observation period, 21 patients died of head and neck cancer. The optimal cut-off PNI value was 42.9, according to the receiver operating characteristic analysis. The proportion of patients with a short OS was lower in those with PNI higher than 42.9, and the 5-year OS in patients with PNI higher and lower than the cut-off value was 62.3% and 86.0%, respectively (P = 0.0105).Conclusions: The OS of patients with PNI < 42.9 was lower than that of patients with PNI ≥ 42.9. The PNI, which is a preoperative head-to-foot inflammatory marker, can help in estimating the prognosis of oral cancer.
Disability, Frailty and Depression in the Community-dwelling Elderly with Osteosarcopenia
Authors: Park Ki-Soo , Lee Gyeong-Ye , Seo Sung-Hyo , Seo Young-Mi , Yoo Jun-Il
Published: December 2020

Background: The purpose of this study was to investigate the prevalence of osteosarcopenia in the over 60-year-old community and to evaluate whether osteosarcopenia is associated with disability, frailty and depression.Methods: This study was performed using the baseline data of Namgaram-2, among the 1010 surveyed subjects, 885 study subjects who were 60 years or older and had all necessary tests performed were selected. The Kaigo-Yobo checklist (frailty), World Health Organization Disability Assessment Schedule (WHODAS) and Geriatric Depression Scale-Short Form-Korean (GDSSF-K) were used. The Asian Working Group for Sarcopenia (AWGS 2019) were applied in this study. Osteopenia was measured using data from dual energy X-ray absorptiometry (DEXA) and osteopenia was diagnosed when the T-score was less than -1.0.The study subjects were divided into four groups: the normal group, in which both sarcopenia and osteopenia were undiagnosed, osteopenia only, sarcopenia only and the osteosarcopenia group, which was diagnosed with both sarcopenia and osteopenia.Results: Of the 885 subjects over 60 years old evaluated, the normal group comprised 34.0%, the only osteopenia group 33.7%, the only sarcopenia group 13.1%, and the osteosarcopenia group 19.2%. WHODAS (17.5, 95% CI: 14.8-20.1), Kaigo-Yobo (3.0, 95% CI: 2.6-3.4), and GDSSF mean score (4.6, 95% CI: 3.9-5.4) were statistically significantly higher in the osteosarcopenia group compared the other groups. Partial eta squared (ηp2) of WHODAS (0.199) and Kaigo-Yobo (0.148) values ​​according to Osteosarcopenia were large, and GDSSF (0.096) was medium.Conclusions: Osteosarcopenia is a relatively common disease group in the elderly community that may cause deterioration of health outcomes. Therefore, when evaluating osteopenia or sarcopenia in the elderly, management of those in both disease groups should occur together.
Knockdown of hspg2 is associated with abnormal mandibular joint formation and neural crest cell dysfunction in zebrafish
Authors: Castellanos Barbara S. , Reyes-Nava Nayeli G , Quintana Anita
Published: December 2020

Background: Heparan sulfate proteoglycan 2 (HSPG2) encodes for perlecan, a large proteoglycan that plays an important role in cartilage formation, cell adhesion, and basement membrane stability. Mutations in HSPG2 have been associated with Schwartz-Jampel Syndrome (SJS) and Dyssegmental Dysplasia Silverman-Handmaker Type (DDSH), two disorders characterized by skeletal abnormalities. These data indicate a function for HSPG2 in cartilage development/maintenance. However, the mechanisms in which HSPG2 regulates cartilage development are not completely understood. Here, we explored the relationship between this gene and craniofacial development through morpholino-mediated knockdown of hspg2 using zebrafish.Results: Knockdown of hspg2 resulted in abnormal development of the mandibular jaw joint at 5 days post fertilization (DPF). We surmised that defects in mandible development were a consequence of neural crest cell (NCC) dysfunction, as these multipotent progenitors produce the cartilage of the head. Early NCC development was normal in morphant animals as measured by distal-less homeobox 2a (dlx2a) and SRY-box transcription factor 10 (sox10) expression at 1 DPF. However, subsequent analysis at later stages of development (4 DPF) revealed a decrease in the number of Sox10 + and Collagen, type II, alpha 1a (Col2a1a)+ cells within the mandibular jaw joint region of morphants relative to random control injected embryos. Concurrently, morphants showed a decreased expression of nkx3.2, a marker of jaw joint formation, at 4 DPF.Conclusions: Collectively, these data suggest a complex role for hspg2 in jaw joint formation and late stage NCC differentiation.
Early intravenous tranexamic acid intervention reduces post-traumatic hidden blood loss in elderly patients with intertrochanteric fracture: a randomized controlled trial
Authors: Ma Hui Xu , Wang Hairuo , Long Xiaotao , Xu Zexiang , Chen Xiaohua , Li Mingjin , He Tao , Wang Wei , Liu Lei , Liu Xi
Published: December 2020

Purpose Elderly patients with intertrochanteric fractures exhibit post-traumatic hidden blood loss (HBL). This study aimed to evaluate the efficacy and safety of reducing post-traumatic HBL via early intravenous (IV) tranexamic acid (TXA) intervention in elderly patients with intertrochanteric fracture.Methods A prospective, randomized, controlled study was conducted with 125 patients (age ≥65 years, injury time ≤6 h) who presented with intertrochanteric fracture from September 2018 and September 2019. Patients in the TXA group (n=63) received 1 g of IV TXA at admission, whereas those in the normal saline (NS) group (n=62) received an equal volume of saline. Hemoglobin (Hgb) and hematocrit (Hct) were recorded at post-traumatic admission (PTA) and on post-traumatic day (PTD) 1–3. HBL was calculated using the Gross formula. Lower extremity venous ultrasound was performed to detect venous thrombosis.Results Hgb on PTD 2 and 3 were statistically higher in the TXA group than in the NS group. Hct and HBL on PTDs 1-3 were significantly less in the TXA group compared to the NS group. Preoperative transfusion rate was significantly lower in the TXA group compared with the NS group. There was no difference between the two groups with regard to the rates of complications.Conclusion Early IV TXA intervention could reduces post-traumatic HBL and pre-operative transfusion rate in elderly patients with intertrochanteric fractures without increasing the risk of venous thrombosis.
Polysaccharide from Angelica sinensis attenuates SNP-induced apoptosis in osteoarthritis chondrocytes by inducing autophagy via ERK1/2 pathway
Authors: Xu Chao , Ni Su , Zhuang Chao , Li Chenkai , Zhao Gongyin , Jiang Shijie , Wang Liangliang , Zhu Ruixia , Wijnen Andre J. van , Wang Yuji
Published: December 2020

ObjectiveChondrocyte apoptosis plays a vital role in osteoarthritis (OA) progression. Angelica sinensis polysaccharide (ASP), a traditional chinese medicine, possesses anti-inflammatory and anti-apoptotic properties in chondrocytes. This study aimed to determine the protective role of ASP on sodium nitroprusside (SNP)-induced chondrocyte apoptosis, and explore the underlying mechanism.MethodHuman primary chondrocytes isolated from articular cartilage of OA patients were treated with SNP alone or in combination with different doses of ASP. Cell viability and apoptosis were assessed, and apoptosis-related proteins including Bcl-2 and Bax were detected. Autophagy levels were evaluated by light chain 3 (LC3)II immunofluorescence staining, mRFP-GFP-LC3 fluorescence localisation and western blot (LC3II, p62, Beclin-1, Atg5). Meanwhile, activation of ERK 1/2 pathway was determined by western blot. The autophagy inhibitors, 3-Methyladenine (3-MA), chloroquine (CQ) and a specific inhibitor of ERK1/2, SCH772984, were used respectively to confirm the autophagic effect of ASP.ResultsThe results showed that SNP-induced chondrocyte apoptosis was significantly rescued by ASP, whereas ASP alone promoted chondrocytes proliferation. The anti-apoptotic effect of ASP was related to the enhanced autophagy and depended on the activation of ERK1/2 pathway.ConclusionASP markedly rescued SNP-induced apoptosis by activating ERK1/2-dependent autophagy in chondrocytes, and it made ASP a potential therapeutic supplementation for OA treatment.
A comparative study of multimodal magnetic resonance in the differential diagnosis of acquired immune deficiency syndrome related primary central nervous system lymphoma and infection
Authors: Li Jingjing , Xue Ming , Yan Shuo , Guan Chunshuang , Xie Ruming , Chen Budong
Published: December 2020

Background: Patients with acquired immune deficiency syndrome (AIDS) often suffer from opportunistic infections and related primary central nervous system lymphoma (AR-PCNSL). Both diseases showed multiple ring enhancement lesions in conventional magnetic resonance (MR). It is very difficult to make the differential diagnosis. We aimed to investigate whether multimodal MR (diffusion weighted imaging (DWI)/ apparent diffusion coefficient (ADC), 3D pseudo-continuous arterial spin labeling (3D-pCASL) and susceptibility-weighted imaging (SWI)) combined with conventional MR can differentiate AR-PCNSL from infection. Methods: This was a prospective study. We recruited 19 AIDS patients who were divided into AR-PCNSL group (9 cases) and infection group (10 cases) by pathological results. We analyzed whether there was statistical (Fisher’s method) difference in multimodal MR between the two groups. We analyzed whether multimodal MR combined with conventional MR could improve the diagnosis of AR-PCNSL. Results: The lesions were more likely involved the paraventricular (0.020) and corpus callosum (0.033) in AR-PCNSL group in conventional MR. In multimodal MR, AR-PCNSL group showed low ADC value, with p values of 0.001. Infection group more inclined to high ADC value, with p was 0.003. In multimodal MR, AR-PCNSL group had more low signal intensity(grade 2-3) in the degree of intratumoral susceptibility signal intensity in SWI(SWI-ITSS) ,with p values of 0.001. The sensitivity, specificity of conventional MR in the diagnosis of AR-PCNSL was 88.9%, and 70.0%. The conventional MR sequence combined with DWI/ADC sequence in the diagnosis of AR-PCNSL had a sensitivity of 100.0%, and a specificity of 60.0%. The sensitivity and specificity of the conventional MR sequence combined with the SWI-ITSS sequence in the diagnosis of AR-PCNSL were 100% and 70.0%. The conventional MR combined with ADC or SWI-ITSS improved the diagnosis of AR-PCNSL. Conclusion: Multimodal MR could help distinguish AR-PCNSL from infectious lesions. The multimodal MR (DWI/ADC or SWI-ITSS) combined with conventional MR could improve the diagnosis of AR-PCNSL. The ADC value should be attached importance in clinical work.When distinguishing AR-PCNSL from toxoplasmosis or tuberculoma, SWI should be used to obtain a correct diagnosis.
Harmonization of medical products regulation: A key factor for improving regulatory capacity in the East African Community
Authors: Ndomondo-Sigonda Margareth , Miot Jacqueline , Naidoo Shan , Masota Nelson Enos , Ng'andu Brian , Ngum Nancy , Kaale Eliangiringa
Published: December 2020

Background: Limited capacity to regulate medical products is associated with circulation of products which do not meet standards of quality, safety and efficacy with negative public health and economic outcomes. This study focused on assessing the effect of the East African Community (EAC) medicines regulatory harmonization initiative on the capacity of national medicines regulatory agencies, with a focus on registration and inspection systems. Methods: An exploratory mixed-method design using both qualitative and quantitative data to access data from six national medicines regulatory authorities (NMRAs) and the EAC Secretariat. Data was collected using a combination of semi-structured interviews, questionnaires, and checklists for the period 2010/11-2015/16 with 2010/11 data serving as baseline. Heads of NMRAs, regulatory and monitoring and evaluation experts, and the EAC Secretariat Project Officer were enrolled in the study. A set of 14 indicators grouped into 6 categories were used to assess NMRAs performance. Results: Policy and legal frameworks provide a foundation for effective regulation. Collaboration, harmonization, joint dossier reviews and inspections of manufacturing sites, reliance and cooperation are key factors for building trust and capacity among NMRAs. Five out of six of the EAC Partner States have comprehensive medicines laws with autonomous NMRAs. All the NMRAs have functional registration and good manufacturing practice inspection systems supported by regional harmonised guidelines for registration, inspection, quality management and information management systems with four NMRAs attaining ISO 9001:2015 certification.Conclusions: The EAC regulatory harmonization initiative has contributed to improved capacity to regulate medical products. The indicators generated from this research can be replicated for evaluation of similar initiatives across and beyond the African continent and contribute to public health policy.
Identification of key regulators responsible for dysregulated networks in osteoarthritis by large-scale expression analysis
Authors: Shi Song , Wan Fuyin , Zhou Zhenyu , Tao Ran , Lu Yue , Zhou Ming , Liu Fan , Liu Yake
Published: December 2020

Background: Osteoarthritis (OA) is a worldwide musculoskeletal disorder. However, disease-modifying therapies for OA are not available. Here, we aimed to characterize the molecular signatures of OA and to identify novel therapeutic targets and strategies to improve the treatment of OA. Methods: We collected genome-wide transcriptome data performed on 132 OA and 74 normal human cartilage or synovium tissues from 7 independent datasets. Differential gene expression analysis and functional enrichment were performed to identify genes and pathways that were dysregulated in OA. The computational drug repurposing method was used to uncover drugs that could be repurposed to treat OA.Results: We identified several pathways associated with the development of OA, such as extracellular matrix organization, inflammation, bone development, and ossification. By protein-protein interaction (PPI) network analysis, we prioritized several hub genes, such as JUN, CDKN1A,VEGFA, and FOXO3. Moreover, we repurposed several FDA-approved drugs, such as cardiac glycosides, that could be used in the treatment of OA. Conclusions: We proposed that the hub genes we identified would play a role in cartilage homeostasis and could be important diagnostic and therapeutic targets. Drugs such as cardiac glycosides provided new possibilities for the treatment of OA.
Navigate: A study protocol for a randomized controlled trial of an online treatment decision aid for men with low risk prostate cancer and their partners
Authors: Schofield Penelope , Gough Karla , Hyatt Amelia , White Alan , Frydenberg Mark , Chambers Suzanne , Gordon Louisa , Gardiner Robert , Murphy Declan , Cavedon Lawrence , Richards Natalie , Murphy Barbara , Quinn Stephen , Juraskova Ilona
Published: December 2020

Background Active surveillance (AS) is the disease management option of choice for low risk prostate cancer. Despite this, men with low risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate, an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on: uptake of AS; decision-making preparedness; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol.Methods 304 men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects; and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia’s peak national body for prostate cancer. Eligible patients will be men within three months of being diagnosed with LRPC, aged 18 years or older and who are yet to make a treatment decision and who are deemed eligible for AS by their treating clinician, and who have internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life. Uptake of AS one month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation, and one, three and six months after study consent.Discussion The Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients’ and partners’ confusion and distress in management decision-making, and increase their quality of life.Trial registration Australian and New Zealand Clinical Trial Registry: ACTRN12616001665426. Registered 2 December 2016, https://www.anzctr.org.au/ACTRN12616001665426. All items from the WHO Trial Registration Data set can be found in this manuscript.
An Evaluation of Cascading Mentorship as Advocacy Training in Undergraduate Medical Education 
Authors: Patel Mitesh , Aitken Devon , Xue Yunlin , Sockalingam Sanjeev , Simpson Alexander
Published: December 2020

Background Physicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education. Methods Medical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized. Results Fifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p<0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p<0.01) in their understanding of social determinants of health and concepts related to children’s health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants’ career trajectories in terms of interest in working with youth, psychiatry, and advocacy. Conclusions AMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.
Predicting Incidence of Long-term Care Insurance Certification in Japan with the Kihon Checklist for Frailty Screening Tool: Analysis of Local Government Survey Data
Authors: Ito Kumiko , Kawai Hisashi , Tsuruta Harukazu , Obuchi Shuichi
Published: December 2020

Background: Predicting incidence of long-term care insurance (LTCI) certification in the short term is of increasing importance in Japan. The present study examined whether the Kihon Checklist (KCL) can be used to predict incidence of LTCI certification (care level 1 or higher) in the short term among older Japanese persons.Methods: In 2015, the local government in Tokyo, Japan, distributed the KCL to all individuals older than 65 years who had not been certified as having a disability or who had already been certified as requiring support level 1–2 according to LTCI system. We also collected LTCI certification data within the 3 months after collecting the KCL data. The data of 17785 respondents were analyzed. First, we selected KCL items strongly associated with incidence of LTCI certification, using stepwise forward-selection multiple logistic regression. Second, we conducted receiver operating characteristic (ROC) analyses for three conditions (1: Selected KCL items, 2: The main 20 KCL items (nos. 1–20), 3: All 25 KCL items). Third, we estimated specificity and sensitivity for each condition.Results: During a 3-month follow-up, 81 (0.5%) individuals required new LTCI certification. Eight KCL items were selected by multiple logistic regression as predictive of certification. The area under the ROC curve in the three conditions was 0.92–0.93, and specificity and sensitivity for all conditions were greater than 80%.Conclusions: Three KCL conditions predicted short-term incidence of LTCI certification. This suggests that KCL items may be used to screen for the risk of incident LTCI certification.
Civilian gunshot wounds to the head: a case report, clinical management, and literature review.
Authors: Qi Haoyi , Li Kunzheng
Published: December 2020

Background: Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion. Gunshot wounds to the head are the deadliest of all gun injuries. According to literature statistics, the survival rate of patients with gunshot wounds to the head is only 9%. Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost entirely based on military experience, and there are few related reports, especially of the head, in which an individual suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time.Case Presentations: We present a case of a 53-year old man who suffered two gunshot injuries to the head under unknown circumstances. On initial presentation, the patient had a Glasgow Coma Scale score of 6, was unable to communicate, and had loss of consciousness. The first bullet penetrated the right frontal area and finally reached the right occipital lobe. When the patient reflexively shielded his head with his hand, the second bullet passed through the patient's right palm bone, entered the right frontotemporal area, and came to rest deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan. After two foreign body removals and skull repair, the patient recovered completely.Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital, followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is usually necessary, and its key points include the timing, method, and scope of the operation.
Nursing Students’ Satisfaction towards Clinical Learning Environment (CLE) in Universiti Kebangsaan Malaysia Medical Centre
Authors: Karim Jalina , Abdul Majid Amirun Hani Farhan , Mohd Rashdan Nurul Fazira , Awang Besar Mohd Nasri , Yaman Mohamad Nurman
Published: December 2020

In the previous studies, it was found that many nursing students have the highest satisfaction towards clinical learning environment (CLE). CLE has an impact on nursing students in preparing them in terms of knowledge and providing quality care for patients. The objective of this study was to determine the level of satisfaction among nursing students in the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) towards CLE. A purposive sampling technique was used in quantitative and cross-sectional descriptive design. Ninety-three of Year 1 to Year 4 nursing students participated by answering modified self-reported Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale questionnaire. The questionnaire consisted of three sections; sociodemographic, clinical placement and five dimensions of satisfaction towards CLE (pedagogical atmosphere, leadership style of the head nurse, premises of nursing in the ward, preceptor relationship and role of the preceptor). In medical ward, 51.6% of nursing students had high satisfaction towards CLE and 48.4% reported to have low satisfaction. Whereas for surgical, orthopaedic, homecare and critical area wards reported to have 50% for both high and low satisfaction towards CLE. The relationship between year of study, gender and level of satisfaction towards CLE among nursing students in UKMMC were statistically not significant (p = 0.715, p = 0.139). Among the five dimensions of satisfaction towards CLE, leadership style of the head nurse was the highest (72.0%) and the lowest (30.1%) was from pedagogical atmosphere. This study showed that regardless of specific clinical placement for the nursing students, their satisfaction towards CLE were almost similar and the leadership style of the head nurse had the highest impact. Perhaps, the impact of involvement of the head nurse in the clinical teaching should be explored further in the future.
Using the ADDIE Model to Develop a Rusnani Concept Mapping Guideline for Nursing Students
Authors: Ab Latif Rusnani , Mat Nor Mohd Zarawi
Published: December 2020

Background: Concept mapping has been established as a learning strategy that encourages critical thinking and creativity among students, leading to the development of a concept mapping guideline designed to guide nurse educators in using this teaching strategy.
Objectives: This paper illustrates the development of a guideline to build a concept mapping based-learning strategy. Called the Rusnani concept mapping (RCM) protocol guideline, it was adapted from the Mohd Afifi learning model (MoAFF) and the analysis, design, development, implementation and evaluation (ADDIE) model, integrated with the Kemp model.
Methods: This model uses the five phases of analysis, design, development, implementation and evaluation. The validity of the guideline was determined by using content and face validity and the Delphi technique. Content validity for this RCM guideline was established using expert review. This formula suggested that if the content validity is greater than 70%, it shows good content validity, and if it is less than 70%, the content validity is low and it is advisable to recheck the content according to the objective of the study.
Results: The reliability of the RCM was 0.816, showing that the RCM guideline has high reliability and validity.
Conclusion: It is practical and acceptable for nurse educators to apply RCM as an effective and innovative teaching method to enhance the academic performance of their nursing students.
Surgical Triage of Breast Disorders During the COVID-19 Pandemic: An Indian Perspective
Authors: Yelamanchi Raghav , Agrawal Himanshu , Durga C K
Published: December 2020

Breast complaints are a very common cause of healthcare visits in the female population. They range in severity from benign to malignant, and treatment options vary from simple observation to mastectomy. As healthcare facilities are overburdened with coronavirus disease 2019 (COVID-19) patients, properly triaging patients diagnosed with breast disorders is necessary for the optimal use of limited resources in developing countries. We are proposing a concise triage system for timely intervention among patients with breast disorders during the havoc of the COVID-19 pandemic.
PEDAGOGICAL GUIDE ON PROJECT ACTIVITIES FOR FUTURE DESIGNERS
Authors:   Department of Design, Bashkir State Pedagogical University named after M.Akmulla (Ufa), Plotnikova Elena V. , Dorofeeva Elena N. ,   Department of Design, Bashkir State Pedagogical University named after M.Akmulla (Ufa), Kondrov Alexander V. ,   Department of Design, Bashkir State Pedagogical University named after M.Akmulla (Ufa), Kondrova Elena A. ,   Department of Design, Bashkir State Pedagogical University named after M.Akmulla (Ufa)
Published: December 2020

The subject of research is pedagogical conditions for the development of project competencies of future graphic designers in the process of professional training. The topic of the research is the pedagogical guidance of the students’ project activities. The purpose of the research is theoretical grounds, development and experimental verification of a complex of organizational and pedagogical conditions to manage the project activities of future graphic designers in the process of professional training at a university. The methodology of the research. The authors applied: the method of theoretical analysis (analysis of current psychological and pedagogical works, curricula, teaching aids, theses, scientific literature and periodicals on pedagogy, psychology and design); observational method (observation of educational and artistic-creative activities of students); method of selection and compilation of design assignments for the course "Design"; diagnostic methods (testing, questioning, expert assessment). The result of the study was in improving the speed of creative thinking in students within the process of project activities and in increasing the quality of project implementation. As a result of managing the students’ project activities according to the developed pedagogical conditions the authors set increase in the indicators in the project activities of the students being trained. The results of the study can be used in the process of managing the project activities of future graphic designers in universities during the assessment period. The proposed pedagogical methods allow improving the quality of students' graphic design projects, which will result in bringing the project activity to a new level.
LEADERSHIP IN GOOD CORPORATE GOVERNANCE (GCG) AS A ROLE MODEL OF ANTI-FRAUD CULTURE
Authors: Kusumawati Mustika Prabaningrum
Published: December 2020

The presence of Good Corporate Governance (GCG) in Indonesia is one of the solutions in creating activities that can help to avoid any form of scandal in the company including fraud. However, the reality of Good Corporate Governance (GCG) to date has not been fully implemented. The rules of Good Corporate Governance (GCG) itself can not necessarily be applied well by the parties in the company. It takes a leadership and maximal support from regulators in the form of legal umbrella that is expected to create an anti fraud culture in the implementation of Good Corporate Governance (GCG). In order to succeed, an organization requires a strong leader. The success and the failure of an organization are determined by its leader. It takes a leader who is able to carry out collaboration, inspire and motivate subordinates he leads because leadership is the main factor of the success or even the failure of an organization. In addition, a positive leadership type will also form a positive culture in a company that will eventually become a role model of anti fraud culture.
The Effect of Halal Certification, Halal Awareness and Product Knowledge on Purchase Decisions for Halal Fashion Products
Authors: Afendi Arif
Published: December 2020

In this modern era, many companies produce fashion products labeled halal to increase sales value and increase public awareness about the importance of buying products tagged halal according to religious law. This study aims to examine the effect of halal certification, halal awareness and product knowledge on purchasing decisions for halal fashion products and provide a perspective on the importance of using halal products in society. This article type of research is quantitative; this journal's research data were obtained from 100 respondents who used halal fashion products in Semarang. The research data were analyzed using multiple linear regression. This article's research shows that halal certification has a positive but insignificant effect on fashion products' purchasing decisions labeled halal. Halal awareness has a positive and significant impact on product purchasing decisions. Product knowledge also has a positive and significant effect on purchasing decisions.
Green Marketing Exploration on Customer Retention in Improving Business Performance with Tacit Entrepreneurship Knowledge as Moderator
Authors: Anggraeni Fadjar Setiyo
Published: December 2020

Global warming is a central issue, so it needs strategic steps for organizations or companies to find solutions because it threatens the future. This article aims to provide an overview of the importance of research on the role of green marketing and customer retention in improving business performance, using the factor of tacit entrepreneurial knowledge as a moderating variable. This research is qualitative, using a library research approach. The results obtained six preparations: First, the more effective the implementation of green marketing by the organization, the more it will improve customer retention patterns. The second proposition, the more effective green marketing is, the more business performance will be—the third proposition, the stronger the customer retention, the stronger the effect on improving organizational performance. The fourth proposition, the higher tacit knowledge about entrepreneurship possessed by organizations and individuals followed up intensively through interaction with customers, the customer resistance will increase, and the higher tacit knowledge owned by organizations and individuals in it, the more effective it will be. Green marketing. The fifth proposition, the higher the organization's tacit knowledge and the individuals in it, the higher the organizational performance will be.
Analysis of Factors that Increase Customer Satisfaction Coffee Products
Authors: Suryawardana Edy , Nurdeagraha Doni
Published: December 2020

Satisfaction is the level of feeling where someone states the comparison of the product's performance (service) received and expected. This study aimed to determine the effect of price, service quality, product quality, product diversity, promotion, and location on customer satisfaction. This study uses a quantitative approach. The sample is the consumer "P" Coffe Gajahmada Semarang branch. The sampling technique used purposive sampling—sources of data were obtained through the distribution of closed-question questionnaires. The data analysis technique used multiple linear regression analysis. Hypothesis test results show that price, service quality, product quality, product diversity, promotion, and location have a positive and significant effect because all independent variables have a significant probability value 0.05. The coefficient of determination showed 0.845 or 84.5%. It is necessary to increase product diversity in the form of completeness, brand, and variety in the future.