bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of vascular invasion in pancreatic ductal adenocarcinoma using endoscopic ultrasound elastography
Authors: Yamada Kenta , Kawashima Hiroki , Ohno Eizaburo , Ishikawa Takuya , Tanaka Hiroyuki , Nakamura Masanao , Miyahara Ryoji , Ishigami Masatoshi , Hirooka Yoshiki , Fujishiro Mitsuhiro
Published: March 2020

Background: Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC.Methods: The subjects were 44 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. Results: In 44 subjects (48 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.697 and 0.708 on dynamic CT (48 sites); 0.733, 0.606 and 0.646 in EUS B-mode (48 sites); and 0.917, 0.900 and 0.906 in EUS-EG (32 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG.Conclusions: These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.Trial registration: UMIN 000016497
Perspectives on a psychiatric outpatient service for immigrants and refugees in São Paulo, Brazil over a 15-year period.
Authors: Carvalho Luciana de Andrade , Andrade Laura Helena , Ang Patrícia Lin , Santana Carmen Lucia de Albuquerque , Albertin Paula de Vries , Neto Francisco Lotufo , Junior Claudinei Eduardo Biazoli
Published: March 2020

Background Immigrants and refugees have specific mental health needs. Studies of immigrant/refugee psychiatric patients in Latin America are scarce. This article presents the profile of patients from an outpatient psychiatric service in Sao Paulo (Brazil) and aims to better inform mental health service planning for immigrants and refugees. Methods This was an exploratory study to characterize the sociodemographic and mental health profile of refugees and immigrants attending outpatient psychiatric service from 2003 to 2018. Chi-square tests and logistic regressions were used to examine the association of demographic variables, exposure to violence, and immigrant status with psychiatric diagnosis. Cluster analysis was used to identify subgroups within the sample. Results A total of 162 immigrants and refugees referred to the service obtained treatment. Of these patients, 57.4% were men, 59.8% were refugees/asylum seekers, 51.9% were Black, 48.8% were single, 64.2% had ten years of education, and 57.4% were unemployed; the mean age of the sample was 35.9. Half of the sample (52.5%) was exposed to violence. The most common diagnosis was depression (54.2%), followed by PTSD (16.6%). Approximately 34% of the participants sought psychiatric care within six months of arrival. Logistic regressions showed that men had lower odds of presenting with depression (OR= 0.34). Patients with PTSD were more likely to be refugees (OR= 3.9) and not have a university degree (OR= 3.1). In the cluster analysis, a cluster of patients with PTSD included almost all Black refugee men exposed to violence. Most patients diagnosed with psychotic disorders were also Black refugee men. Conclusion : Immigrants and refugees represent a vulnerable group. The majority of the sample was Black, refugee men, who were also more likely to present with PTSD. Future studies are needed to better understand issues in treatment adherence in relation to socioeconomic characteristics.
Facilitating International Participation in Core Outcome Set Development: A Proposed Approach for Multi-language Delphi Surveys, a Review of Current Practice and Issues to Consider
Authors: Alkhaffaf Bilal , Williamson Paula , Blazeby Jane M , Glenny Anne-Marie , Adeyeye Ademola , Costa Paulo Matos , Val Ismael Diez del , Gisbertz Suzanne , Guner Ali , Law Simon , Lee Hyuk-Joon , Li Ziyu , Nakada Koji , Nunez Rafael Mauricio Restrepo , Reim Daniel , Reynolds John V , Vorwald Peter , Zanotti Daniela , Allum William , Chaudry Asif , Griffiths Ewen , Bruce Iain
Published: March 2020

Background Core outcome sets (COS) should be relevant to key stakeholders and widely applicable so that researchers are willing to use them when designing trials. Many COS developers have utilised online Delphi surveys which enable wider international stakeholder participation. Despite broader participation, most international COS projects have restricted Delphi surveys to a single language potentially excluding important opinion from those who are not fluent in the survey language.Methods A structured review of current approaches to translating Delphi surveys for COS development was undertaken. We present a proposed methodology adapted from international guidance. Results Four studies were identified from our structured review. Wide variation exists in the methodological approaches to translating Delphi surveys for the developing of COS. Issues which arise when developing multi-language Delphi surveys include establishing translation groups, timelines, financial implications, strategies to maximise recruitment and regulatory approvals.Conclusion Consideration of the issues described will improve planning by other COS developers and can be used to widen international participation from both patients and healthcare professionals.
Effects of preoperative oral carbohydrate electrolyte drinks on preoperative hypokalemia incidence in patients scheduled for laparoscopic colorectal resection: a randomized clinical trial
Authors: Tan Fang , Deng Yingqing , Hu Jingping , Gong Chulian , Zhu Qianqian , Zhou Shaoli
Published: March 2020

Background:In our previous study, hypokalemia incidence was high in patients scheduled for laparoscopic colorectal resection. The present trial was conducted to verify the effects of preoperative carbohydrate drinks containing potassium in these patients.
Methods: Patients were randomly assigned to control, placebo, and case groups. In control group, patients were fasted from midnight. In placebo group, patients were fasted from midnight and received carbohydrate drinks 2–3 h before surgery. In case group, patients were fasted from midnight and received carbohydrate drinks containing potassium supplementation 2–3 h before surgery. The primary outcome was the incidence and severity of preoperative hypokalemia. The other outcomes included postoperative gastrointestinal function, including the time to postoperative first flatus (FFL) and first feces (FFE) and other complications.
Results: The final analysis included 122 participants. The incidence of preoperative hypokalemia in case group was significantly lower than that in control and placebo groups (50% vs. 88.1% vs. 77.5%, p < 0.001). The severity of hypokalemia in control and placebo groups was greater than that in case group. No regurgitation or aspiration occurred in the three groups. No significant differences were observed among the three groups regarding time to FFL and FFE.
Conclusions: Preoperative carbohydrate drinks containing potassium may have significantly reduced the incidence of preoperative hypokalemia and improved preoperative thirst and hunger, but did not improve postoperative well-being. However, as part of the enhanced recovery after surgery protocol, preoperative carbohydrate drinks containing potassium should be recommended, as early as first admittance to hospital.
Bisphenol-A Dose-dependently Regulates The Development of Ovary and Uterus through Differential Expression of METTL3
Authors: Zhang Zhe , Zhu Yuan , Zhang Zhifan , Wang Daojuan , Wang Hongwei , Yan Guijun , Wang Yong
Published: March 2020

Background: Environmental endocrine disruptors, which have a profound impact on the reproductive system, can cause endocrine and reproductive disorders, such as polycystic ovary syndrome (PCOS). Bisphenol-A (BPA) is a common endocrine disruptor which can affect the function of the reproductive system under low-dose conditions. However, the mechanism by which this molecule disrupts normal reproduction is still unclear. In this study, we investigated the effects of BPA on the RNA methyltransferase METTL3 in adolescent female rats which may be a possible mode of action of BPA. Methods: 4-week-old Sprague-Dawley (SD) rats were intragastrically treated for 10 weeks, which were divided into blank group (n = 8), control group (soybean oil, n = 8), three BPA-treatment groups (0.5 mg/kg BPA + soybean oil, 5 mg/kg BPA + soybean oil, 50 mg/kg BPA + soybean oil, n = 8). Results: The results showed that low-dose BPA (0.5 mg/kg) increased the coefficient of uteri and ovaries, and promoted the growth of uteri in rats without causing hyperandrogenism and ovarian polycystic changes. Oral BPA disturbed the expression of CYP17A1, CYP11A1 and METTL3 in ovaries and effected the level of serum testosterone. Conclusions: Our results suggested that oral BPA might interfere uterine and ovarian morphology and the level of hormone with RNA methylation by disturbing the expression level of METTL3. RNA methylation will be a new way to explain the interference mechanism of BPA.
A Phase Ii Study Of The Combination Of Oxaliplatin, Capecitabine, And Trastuzumab And Chemo-radiotherapy In The Adjuvant Setting In Operated Patients With Her2+ Gastric Or Gastroesophageal Junction Cancer (Toxag Study), A Turkish Oncology Group Study
Authors: Abali Huseyin , Yalcin Suayib , Onal Huseyin Cem , Dane Faysal , Oksuzoglu Berna , Ozdemir Nuriye , Mertsoylu Huseyin , Artac Mehmet , Camci Celaletdin , Karabulut Bulent , Basal Fatma Bugdayci , Budakoglu Burcin , Sendur Mehmet Ali , Goktaş Burce , Ozdener Fatih , Baygul Arzu
Published: March 2020

BackgroundTrastuzumab prolonged the overall survival in patients with advanced gastric cancer with HER2 overexpression in combination with chemotherapy. In this phase II open-label prospective study, the tolerability and safety of trastuzumab with chemotherapy, and chemoradiotherapy for curatively resected patients with HER2 + gastric carcinoma was investigated. MethodsThe patients with HER2-positive gastric, or gastroesophageal junction adenocarcinoma, after gastrectomy plus D2 dissection were included. They received 3 cycles of oxaliplatin (100 mg/m2 IV day 1) plus capecitabine (850 mg/m2 PO days 1-14), trastuzumab (8 mg/kg IV day 1 in cycle 1, 6 mg/kg thereafter) every 21 days, followed by chemoradiotherapy. Trastuzumab was given for 1 year.ResultsOf the 212 patients screened, 35 were eligible, and 34 were treated. The median age was 56 years (Min-max: 35-75), male patients constituted 73.5% (n=25), and 33 (97.1%) had gastric adenocarcinoma. R0 resection was performed in 30 (88.2%). The majority (26, 61.7%) were in stage III disease. Most of the AEs were grade I/II, the most frequent grade III side effects were nausea (3, 8.8%), vomiting (3, 8.8%), diarrhoea (2, 5.9%) and weight loss (N=2, 5.9%). Two patients died during the first 3 cycles of chemotherapy and chemoradiotherapy; 1 secondary to pulmonary thrombo-embolism, and the other due to cerebral ischemia. After excluding 2 with early progression and 1 consent withdrawal, of the remaining 31 patients, 28 (90.3%) were able to complete the chemotherapy and chemoradiotherapy part of the trial. After the 25 months follow up period, 21 patients (61.8%) were alive. Overall survival at 12 and 24 months was 75.0% and 65.7%, while disease-free survival at 12 and 24 months was 65.7% and 55.0%, respectively.ConclusionsTrastuzumab in combination with capecitabine, oxaliplatin and radiotherapy as the adjuvant therapy for gastric or gastroesophageal junction adenocarcinoma was considered safe and tolerable. The frequency of HER2 overexpression in curatively resected patients is comparable to that in patients with metastatic disease.
Clinical factors associated with susceptibility to infection stone formation: A Retrospective Single-Center Analysis
Authors: Wang Daming , Ding Demao , Sun Hongliang , Chen Lei , Zhang Zhiqiang , Liu Zhiqi , Ye Qinglin , Zhang Dazhao , Yu Dexin , Xie Dongdong
Published: March 2020

Background: To investigate the clinical factors associated with susceptibility to infection stone formation and to analyze the variations in the clinical characteristics of stones with different compositions. Methods: A total of 1213 patients were included in the study. The patients were grouped based on stone composition; 581 cases of infection stones (ammonium magnesium phosphate calculi or apatite carbonate content more than 50%), 418 stones were composed of pure calcium oxalate, and 214 uric acid stone. The associations of infection stones with age, sex, body mass index, habits, working environment, recurrent stones, diabetes, hypertension, urinary tract infection, urine culture, urine pH, and triglycerides were determined using logistic regression analysis. The variations in the clinical characteristics of the 3 groups were analyzed using analysis of variance or the chi-square test. Results: The occurrence of infection stones was significantly associated with the patient’s age (odds ratio [OR]: 1.031, 95% confidence interval [CI]: 1.020–1.041, P<0.001), high urine pH (OR: 1.974, 95% CI: 1.357–2.872, P<0.001), urinary tract infection (OR: 1.438, 95% CI: 1.072–1.928, P=0.015), positive urine cultures (OR: 1.541, 95%CI: 1.143–2.078, P=0.005), and recurrent stones (OR: 1.346, 95% CI: 1.045–1.734, P=0.022), other clinical factors have no correlation. The clinical characteristics of the three groups were significantly different. The occurrence of infection stones is significantly associated with age, urinary tract infection, positive urine cultures, urine pH, and stone recurrence. Conclusions: Compared with previous studies, this study found that infection stones tend to occur in younger patients and stones resulting from non-urease-producing bacteria have significantly increased.
Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis
Authors: Kang Dong Hyuk , Cho Kang Su , Chung Doo Yong , Jeong Won Sik , Jung Hae Do , Kim Do Kyung , Lee Joo Yong
Published: March 2020

Background: Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are performed to treat renal stones. PCNL is effective for kidney stones >2 cm but is invasive compared with RIRS. Miniature PCNL (mPCNL) has been used as an alternative treatment for conventional PCNL, and employs a miniature endoscope of 11–18 Fr. We conducted a systematic review of published studies regarding the RIRS, PCNL, and mPCNL treatment modalities, and performed a network meta-analysis of the success or stone-free rates.Methods: The data collected up to January 2016 were searched using PubMed and EMBASE, and references were searched electronically. Two researchers used data extraction formats to extract data on the stone-free or success rates, study design, number of subjects and characteristics, and treatments for renal stones (i.e., RIRS, PCNL, and mPCNL). To evaluate the quality of the studies, the Downs and Black checklist, which is an observational research quality evaluation tool, was used and analyzed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Twenty-five studies were used to compare the stone-free or success rates of RIRS, PCNL, and mPCNL for renal stones. Six comparisons of PCNL and mPCNL, seven of mPCNL and RIRS, and 12 of RIRS and PCNL were analyzed. No difference in the stone-free rate was found between PCNL and mPCNL (OR: 0.95; 95% CI: 0.51–1.9) in network mata-analysis. Between RIRS and mPCNL, the stone-free rate of RIRS was lower than mPCNL (OR: 0.41; 95% CI: 0.021–0.82). Comparison of RIRS and PCNL revealed that RIRS was also lower than PCNL in terms of stone-free rate (OR: 0.43; 95% CI: 0.22–0.82). In the ranking analysis, rankogram showed that mPCNL was ranked as No. 1 and PCNL was ranked as No. 2. The P-score was 0.820 for mPCNL, 0.680 for PCNL and 0 for RIRS.Conclusions: PCNL and mPCNL showed higher success or stone-free rates than RIRS for the treatment of renal stones. However, PCNL and mPCNL showed no difference in the treatment outcome.
Development and Deployment of Electronic Dispensing and Inventory Management system (eDIM) for a Rural Clinic in Honduras
Authors: Mtonga Timothy Mayamiko , Connor Sharon E , Fisher Arielle Marie , Jonkman Lauren Jennifer , Meyer Mark W. , Douglas Gerald P.
Published: March 2020

Background: Availability of complete, accurate, and timely information is essential for efficient planning and purchasing of medications. This is especially important in remote low-resource clinics that are often difficult to access, have limited health personnel, and receive supplies infrequently. Appropriate application of information technology can help address challenges in the availability and quality of data used for making decisions about purchasing medical supplies.Methods: We used a phased deployment of electronic information systems to address challenges in quantification of the available medical supplies at the clinic in San José. First, we deployed a patient identification system to ensure that all medicines dispensed in the system were associated with a specific patient. This was followed by the deployment of an electronic dispensing and inventory management system that tracks available medicine and automatically deducts from these counts during electronic dispensation.Results: Twenty months post-deployment of the patient identification application and electronic dispensing and inventory management system, 3,238 unique patients have been registered and 22,236 dispensations have been recorded. Of these dispensations, 226 unique drugs have been recorded with acetaminophen being the most prescribed medication followed by adult multivitamins.Conclusion: Electronic interventions show significant promise for dispensaries in limited resource settings globally. However, strong user value propositions are needed to ensure continued usage.
A Cellular Study of Inflammatory Responses in Women with Polycystic Ovary Syndrome as: “An In vitro Model of Anti Breast Tumor Response” Anti-Breast Tumor Response
Authors: Rezayat Fatemeh , Hajiaghaei Mehri , Ghasemi Nazanin , Mesdaghi Mehrnaz , Tehrani Fahimeh Ramezani , Mosaffa Nariman
Published: March 2020

Background: Although Polycystic Ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age; is unclear whether PCOS increases the risk of subsequent development of, Gynecologic cancers namely breast cancer. The present study we aimed to compare the antitumoral ability of peripheral blood mononuclear cells (PBMCs) of women with PCOS with that of healthy controls using the co-culture system between effector cells and target tumor cell lines.
Materials & Methods: PBMCs were isolated from 25 women with PCOS and 25 non hirsute eumenorrheic healthy controls by density gradient centrifugation ficoll. Breast tumor cell lines (MDA-468, MCF-7) were incubated as the two target cells and were cultured adjacent to PBMCs in the transwell co-culture system. Proliferation rate of the effectors cells evaluated by BrdU cell proliferation assay after 48 and 72 hours and T CD3+ lymphocytes were assessed using flow cytometry. TNF-α cytokine production was evaluated in cell culture supernatant by sandwich ELISA technique.
Results: After 48 hours incubation with MDA-468 and MCF-7, the mean proliferation score of PBMCs was significantly higher in women with PCOS compared to that of healthy controls (921.04; P=0.021 vs 287.6; P=0.002, respectively). In PCOS women, after 72 hours of incubation, TNF-α concentration was significantly reduced compared to 48-hour cultures (921.04 ± 271.4 pg/dl vs 545.6 ± 151.1 pg/dl at 48 h and 72 h intervals respectively, P<0.05); it was increased in healthy controls. There was no significant difference in CD3+ CD8+ cells between the PCOS group and healthy controls.
Conclusion: The ability of PBMCs to produce of TNF-α in women with PCOS decreased gradually; as a result of which they may lack the ability required to form an in vitro efficient antitumor response to breast tumor cell lines. It is assumed that threshold activation of mononuclear cells is reduced in women with PCOS and a low-grade inflammatory condition may provide a positive background for arising myeloid derived suppressor cells (MDSCs).
Analysis of the efficacy and prognostic factors of linear accelerator-based hypofractionated stereotactic radiotherapy for brain metastasis of non-small-cell lung cancer
Authors: Wu Xi , Xia Yaoxiong , Hou Yu , Li Lan , Wang Li , Li Rong , Lu Fei , Chang Li , Li Wenhui
Published: March 2020

Objective To investigate the efficacy and prognostic factors of treatment of brain metastases (BMs) of non-small-cell lung cancer (NSCLC) patients with hypofractionated stereotactic radiotherapy (HSRT) based on linear accelerators. Methods A total of 80 NSCLC patients with BMs were treated with HSRT under the image guidance of tomotherapy (TOMO) or volumetric modulated arc therapy (VMAT) in Yunnan Cancer Hospital from Jan 1 st , 2017 to Aug 7 th , 2019. The outcome measures included overall survival (OS), intracranial local progression-free survival (iLPFS) and intracranial regional progression-free survival (iRPFS). The related prognostic factors were analyzed. Results The median OS, iLPFS and iRPFS in 80 patients were 29.2 months, 19.3 months and 20.5 months, respectively. Using HSRT to treat BMs, whether combined with platinum-containing chemotherapy, targeted therapy, or both chemotherapy and targeted therapy, could improve OS ( P =0.027), iLPFS ( P =0.050) and iRPFS ( P =0.124). Among these patients, there were no significant differences in median OS (28.5 months vs 28.3 months, P =0.785), 6-month iLPFS rates (81.3% vs 72.9%, P =0.998) and 6-month iRPFS rates (92.9% vs 74.8%, P =0.974) between patients with 4-10 BMs and those with 1-3 BMs. Conclusion The use of HSRT to treat BMs of NSCLC based on linear accelerators is safe and effective. Use of HSRT in combination with other antitumor therapies to treat BMs is a favorable prognostic factor that can affect OS and iLPFS. HSRT treatment of 4-10 BMs or 1-3 BMs resulted in similar OS, and there were no significant differences in 6-month iLPFS rates and 6-month iRPFS rates.
A Comparison of Methods for Disease Progression Prediction Through a GoDARTS Study
Authors: Nielsen Agnes Martine , Nielsen Rikke Linnemann , Donnelly Louise , Zhou Kaixin , Dahl Anders , Gupta Ramneek , Ersbøll Bjarne , Pearson Ewan , Clemmensen Line
Published: March 2020

Background: In recent years, a variety of new machine learning methods are being employed in prediction of disease progression, e.g. random forest or neural networks, but how do they compare to and are they direct substitutes for the more traditional statistical methods like the Cox proportional hazards model? In this paper, we compare three of the most commonly used approaches to model prediction of disease progression. We consider a type 2 diabetes case from a cohort-based population in Tayside, UK. In this study, the time until a patient goes onto insulin treatment is of interest; in particular discriminating between slow and fast progression. This means that we are both interested in the results as a raw time-to-insulin prediction but also in a dichotomized outcome making the prediction a classification.Methods: Three different methods for prediction are considered: A Cox proportional hazards model, random forest for survival data and a neural network on the dichotomized outcome. The performance is evaluated using survival performance measures (concordance indices and the integrated Brier score) and using the accuracy, sensitivity, specificity, and Matthews correlation.coefficient for the corresponding classification problems.Results: We found no improvement when using the conditional inference forest over the Cox model. The neural network out performed the conditional inference forest in the classification problem. We discuss the limitations of the three approaches and where they each excel in terms of prediction performance, interpretation, and how they handle data imbalance.
Putting together the pieces of the puzzle – Part II - Assessing harbour porpoise (Phocoena phocoena) carcasses potentially subjected to grey seal (Halichoerus grypus) predation
Authors: Neer Abbo van , Gross Stephanie , Kesselring Tina , Grilo Miguel L. , Ludes-Wehrmeister Eva , Roncon Giulia , Siebert Ursula
Published: March 2020

The authors have requested that this preprint be removed from Research Square.
Virtual Reality Therapy in Long Term Care Resident Older Adults With Dementia: A Case Series
Authors: Sultana Munira , Campbell Karen , Jennings Morgan , Montero-Odasso Manuel , Orange Joseph. B. , Knowlton Jill , George Armin St. , Bryant Dianne
Published: March 2020

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) worsens as dementia progresses, intensifies caregiver distress and consequent institutionalization. We wanted to evaluate 1) feasibility of Virtual Reality (VR) as cognitive stimulation therapy for BPSD in a Long-Term Care (LTC) home, 2) participants’ tolerance for the therapy, 3) facilitators and barriers to implementing VR therapy, 4) sensitivity to change of the participants’ BPSD to VR therapy, and 5) longitudinal construct validity of BPSD measuring tools. METHODS: A single site (Henley Place at London, Ontario) case series with a convenience sample (24 older adult residents with moderate to severe dementia). Intervention was 30 minutes of VR therapy with Broomx©, five days a week for two weeks. The change in BPSD was measured with Cornell Scale for Depression in Dementia (CSDD), Cohen-Mansfield Agitation Inventory (CMAI) scale, Dementia Observation System (DOS) scale, and proportion of night-time sleep. We validated selected tools with Global Rating of Change (GRC) scale. RESULTS: Implementing VR therapy was possible at Henley Place (recruitment rate=40%, the adherence rate=21%, and the attrition=0%) and participants could tolerate it. No emergency transfers or one-to-one staff use were recorded during the intervention period. CONCLUSION: VR therapy can be implemented in a LTC home. TRIAL REGISTRATION: The study was not registered as clinical trial. We obtained ethics approval from ADVARRA Canada Ethics Board before recruiting participants for the study.
Integrated analysis reveals the prognostic significance of pyrimidine metabolic rate limiting enzymes in patients with lung adenocarcinoma
Authors: Wang Haiwei , Wang Xinrui , Xu Liangpu , Zhang Ji , Cao Hua
Published: March 2020

Background: Reprogramming of metabolism is illustrated in many types of cancer and is associated with the clinical outcomes of cancer patients. However, the prognostic significance of pyrimidine metabolism signaling pathway in patients with lung adenocarcinoma (LUAD) is unclear.Methods: Using the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) datasets, we determined the prognostic significance of pyrimidine metabolic rate limiting enzymes in patients with lung cancer. The enrichment of pyrimidine metabolism signaling pathway was analyzed by gene set enrichment analysis (GSEA). The expression profiles of pyrimidine metabolic rate limiting enzymes were identified from Affymetrix gene expression data and RNA-seq data. The Kaplan-Meier Plotter was used to identify the prognostic significance of the pyrimidine metabolic rate limiting enzymes. Spearman’s correlation and multivariate cox regression were used to determine the correlation efficiency of pyrimidine metabolic rate limiting enzymes.Results: The pyrimidine metabolism signaling pathway is significantly enriched in LUAD tissues, but not in lung squamous cell carcinoma (LUSC) tissues. Compared with normal lung tissues, the pyrimidine metabolic rate limiting enzymes are highly expressed in lung tumor tissues. Furthermore, the high expression levels of pyrimidine metabolic rate limiting enzymes are associated with unfavorable prognosis in patients with LUAD. Moreover, we demonstrate that the hypo-DNA methylation, DNA amplification and TP53 mutation are contributing to the high expression levels of pyrimidine metabolic rate limiting enzymes in cancer cells. Finally, we reveal the significant connections between the pyrimidine metabolic rate limiting enzymes. Comprehensively, the pyrimidine metabolic rate limiting enzymes are highly expressed in patients with bladder cancer, breast cancer, colon cancer, liver cancer and stomach cancer. And the high expression levels of pyrimidine metabolic rate limiting enzymes are associated with unfavorable prognosis in patients with liver cancer. Conclusions: Pyrimidine metabolism signaling pathway is associated with the development of lung adenocarcinoma. Pyrimidine metabolic rate limiting enzymes CAD, DTYMK, RRM1, RRM2, TK1, TYMS, UCK2, NR5C2 and TK2 have significant prognostic effects in patients with lung adenocarcinoma.
Assessment of Common Mental Disorders among Visitors to Traditional Healers: a Mixed Study in North Ethiopia
Authors: Mossie Tilahun Belete , Tesfay Kenfe
Published: March 2020

Background: People with common mental disorders have instability, poor self-care, social withdrawal, poor communication with others and frequent somatic pains. Seeking help from traditional healers which offer Prayer and treatment with holy water have been strategies reported by several studies particularly in developing world.Purpose : to assess perceived causes, associated factors and prevalence of common mental disorders among visitors to traditional healers in Mekelle town, North Ethiopia.Methods and subjects: We used a mixed study design; a quantitative study on 380 subjects and a qualitative study among fifteen subjects. We used Self-reported questionnaire (SRQ 20) to screen common mental disorders. Also perceived causes of mental illness and psycho-social stressful situations were assessed using a semi structured tool and in-depth interview. We analyzed data using Statistical Package for Social Sciences software, windows 25. Findings in the qualitative study were triangulated with the quantitative finding.Result: the prevalence of common mental disorders was 38.7% (95% CI; 33.7, 43.6). Factors independently associated with common mental disorders were being a woman (AOR= 1.68 (95% CI; 1.04, 2.72)), low level of education (AOR=3.2 (95% CI; 1.28, 6.91)), a conflict in the family (AOR= 3.82 (95% CI; 1.89, 7.68)) and traditional belief about the cause of mental illness (AOR= 2.33 (95% CI; 1.43, 3.79)). Experience of poor/no religious rituals, evil spirit, personal sin and will of God were the top traditional causes of common mental disorders.Conclusion : prevalence of common mental disorders was higher among the visitors as compared to prior studies. This refers the importance of establishing a link between traditional healers and modern treatment of mental illness with special attention to women, low socio-economic class and people with poor family dynamics.
Psychological suffering, medicalization and women: a perspective of Institutional Ethnography
Authors: Medeiros Luciana Fernandes , Veras Renata Meira , Costa Loyanne Monyk Torres , Araujo Gisely da Costa , Oliveira Isabelly Cristina Soares
Published: March 2020

Background Recent years have seen a growing psychological suffer in women attended in primary health care in developing countries. This paper aims to analyze the psychological suffering in a small city in northeastern Brazil and its relationship with medicalization from the perspective of Institutional Ethnography (IE).Methods We applied 202 SRQ-20 questionnaires in the first research step. In the second step, four women were interviewed in the primary health care service.Results The results demonstrated a high number of primary health care users in psychological suffering (47.02%). The data also point to a significant prevalence of women in psychological suffering, the use of medicines and the struggles in dealing with the difficulties of everyday life.Conclusions The medicalization of psychological suffering appeared several times in this study through the invisibility of these sufferings under the blanket of biomedical and medicalizing discourse. Those facts can affect contemporary women and the contradictions of being a woman in a capitalist and patriarchal society.
Converting DICOM to STL for 3D Printing: A Process, and Software Package Comparison
Authors: KAMIO Takashi , SUZUKI Madoka , ASAUMI Rieko , KAWAI Taisuke
Published: March 2020

Background : Extracting and three-dimensional (3D) printing an organ in a region of interest in DICOM images typically calls for segmentation in support of 3D printing as a first step. Next, the DICOM images are converted to STL data. After primary and secondary processing, including noise removal and hole correction, the STL data can be 3D printed. The quality of the 3D model is directly related to the quality of the STL data. This study focuses and reports on conversion performance for nine software packages. Methods : Multi-detector row CT scanning was performed on a dry human mandible with two 10-mm-diameter bearing balls as a phantom. The DICOM images file was then converted to a STL file using nine different commercial/open-source software packages. Once the STL models were constructed, the data properties and the size and volume of each were measured and differences across the software packages were noted. Additionally, to evaluate differences between the shapes of the STL models by software package, each pair of STL models was superimposed, with observed differences between their shapes characterized as shape error. Further, deformation caused by reduction in the number of triangles was evaluated. Results : The data size and the number of triangles were different across all software packages. The constructed ball STL model expanded in the X-, Y-, and Z-axis directions, with the length in the Z-axis direction (body axis direction) being slightly longer than other directions. There were no significant differences in shape error across software packages for the mandible STL model. No shape change was observed relative to reduction in the number of triangles. Conclusions : Statistically, no significant differences were found across software packages for size and volume. However, different characteristics of each software package were noticeable, such as different effects in the thin cortical bone area, likely due to the partial volume effect, which may reflect differences in image binarization algorithms. Although the shape of the STL model differs slightly depending on the software, our results indicate that shape error in 3D printing for clinical use in oral and maxillofacial surgery remains within acceptable limits.
Flipping the Paradigm: A Qualitative Exploration of Research Translation Centres in the UK and Australia
Authors: Robinson Tracy , Skouteris Helen , Burns Prue , Melder Angela , Bailey Cate , Croft Charlotte , Spyridonidis Dimitrios , Teede Helena
Published: March 2020

Background: Over the past decade Research Translation Centres have been established in many countries. These Centres (sometimes referred to as Academic Health Science Centres) were established to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This effectively ‘flips’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RCTs are high, the literature confirms a need to better understand the processes RTCs use to mobilise knowledge, build workforce capacity and co-produce research with patients and the public to ensure population impact and drive healthcare improvement is needed. Methods: Semi structured interviews were conducted with selected leaders and members from RTCs in the UK and Australia. Convenience sampling was utilised based on geography, accessibility and availability. In addition, a snowballing approach was employed with further participants identified by RTC leaders and advisors from Public and Patient initiatives in the UK. Interviews were conducted face to face or via videoconferencing and were recorded, transcribed verbatim and analysed using a reflexive and inductive approach described by Braun and Clarke (2???). This involved re-reading and coding transcripts to generate initial themes. This inductive approach was used to identify patterns and common threads that were subsequently reviewed by two researchers to ensure consistentcy of themes. Results: A total of 41 participants, 22 from the UK and 19 from Australia were interviewed. Five major themes emerged including (1) dissonant metrics, (2) Different models of leadership (3) Public-Patient Involvement and research co-production (4) Workforce development (5) Barriers to collaboration. Conclusions: Participants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.
Management of intraoperative acetabular fracture in primary total hip arthroplasty
Authors: Li Juncheng , Ji Quanbo , Ni Ming , Zheng Qingyuan , Sun Jinyang , Zhang Guoqiang
Published: March 2020

Background Intraoperative acetabular fracture(IAF)is a rare complication of primary total hip arthroplasty(THA). Previous report have locked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem. Methods Between 2015 to 2018, 4,888 primary THA were enrolled. We retrospectively reviewed the records in our Total Joint Registry Database and found that 24 patients (24 hips) had sustained IFAs .24 patients(16 females and 8males)were all treated with posterolateral approach using uncemented components. 20 patients underwent supplemental screw fixation, of which 2 patients were treated with plate fixation. 2 Patients femoral head was used as a graft. In 4 patients, the acetabular component was judged to be stable despite the fracture and no additional treatment was performed All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays which follow up for a mean period of 34.0±12.6 months. We evaluated the anatomic location, cause, treatment, and outcome of the fractures. Results The fracture rate associated with uncemented components was 0.49%. In 17(70.8%) of the these patients, the fracture was noted during impaction of the real acetabular component.6 patients with Ankylosing Spondylitis had fracture 4 in anterior wall,1 in anterior column because of patient with hip joint fusion need to pre-osteotomy before dislocation .The HHS score increased from 30.8±9.7 preoperatively to 90.2±4.2 postoperatively. All the latest x-ray showed that the fracture did not move, and there is no translucent line formed in the acetabular cup bone interface.Conclusion IAFs are rare complications of THA, and most commonly occur during the implantation of the acetabular components. It is necessary to prevent the occurrence of fractures as much as possible even if the fractures are found during the operation. It should be noted that patients with ankylosing spondylitis involving hip joints during THA surgery must be careful to prevent IAFs during dislocation and pre-osteotomy.
Clinical course and outcome of novel coronavirus COVID-19 infection in 107 patients discharged from the Wuhan hospital
Authors: Wang Dawei , Yin Yimei , Hu Chang , Liu Xing , Zhang Xingguo , Zhou Shuliang , Jian Mingzhi , Xu Haibo , Prowly John , Hu Bo , Li Yirong , Peng Zhi-Yong
Published: March 2020

Background In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical progress and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical progress of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical progression of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 progression. Age and male gender were independent risk factors for death of COVID-19.
Smokers who have not tried alternative nicotine products: a 2019 survey of adults in Great Britain
Authors: Simonavicius Erikas , McNeill Ann , Cheeseman Hazel , Arnott Deborah , Brose Leonie S.
Published: March 2020

Aims: Switching from smoking to using nicotine replacement therapy (NRT), electronic cigarettes (e‑cigarettes) or heated tobacco products can reduce tobacco-related health risks. However, not all smokers in Great Britain have tried these products, which is a missed opportunity for harm reduction. This study aims to identify and describe smokers who have never tried alternative nicotine products. Methods: Study analysed cross-sectional survey data of smokers ( n =1777) from a representative adult sample from Great Britain. The online survey was run in March 2019. The proportion of smokers who had never used alternative nicotine products was measured. A multivariate logistic regression assessed the association between never using alternative nicotine products and smokers’ sociodemographic and smoking characteristics and motivation to stop smoking. Results: One in four smokers (27.8%, 95% CI: 25.8%–29.9%) had never tried NRT, e-cigarettes or heated tobacco products. These smokers were more commonly from Black and Minority than White ethnic groups (AOR=1.55; 95% CI: 1.02–2.31), were more likely to smoke up to 10 versus more cigarettes per day (AOR=1.52; 95% CI: 1.14–2.03) and reported low versus moderate or high motivation to stop smoking (AOR=1.79; 95% CI: 1.20–2.74). Conclusion: Light smokers, those unmotivated to stop and smokers from Black and Minority ethnic groups are less likely to have ever tried alternative nicotine products. Different approaches are needed to facilitate harm reduction and smoking cessation among these groups of smokers.
Outpatient treatment in low-risk pulmonary embolism patients receiving direct acting oral anticoagulants is associated with cost savings.
Authors: Ghazvinian Raein , Elf Johan , Gottsäter Anders , Löfvendahl Sofie , Holst Jan
Published: March 2020

Background Direct oral anticoagulants (DOAC) are first line treatment for pulmonary embolism (PE). Treatment of acute PE is traditionally hospital based and associated with high costs, in spite of recent guidelines suggesting outpatient treatment for low-risk patients. The aims of this study were to evaluate potential cost savings with outpatient DOAC treatment of patients with low risk PE compared to DOAC treatment of low risk PE patients in hospital. Methods A retrospective comparatory multicenter cohort study in patients with low risk PE (simplified pulmonary severity index [sPESI]) ≤ 1 admitted to the eight hospitals in Sweden´s southernmost healthcare region during 2013-2015, and treated with DOAC. Local criteria guiding outpatient treatment had been used, and sPESI was calculated retrospectively. Health care costs were analysed in the 223 (44%) patients treated as outpatients and the 287 (56%) treated in hospital. Results Total cost per patient was 7334 EUR in the inpatient group, and 2088 EUR in the outpatient group (p<0.001). In multivariate analysis, type of treatment (in- or outpatient, p=<0.001) and sPESI group (0 or 1, p=<0.001) were significantly associated with total cost below or above median, whereas age (p=0.565) and gender (p=0.177) was not. Total cost for inpatients was higher (p<0.001) compared to outpatients in subgroups with sPESI 0 and 1. Conclusion Better adherence to current guidelines recommending outpatient treatment with DOAC in patients with low risk PE would potentially lead to significant savings in healthcare expenditure.
Precise lysosome pH indicator based on self-decomposable nanoparticles
Authors: Pang Cui , Song Chaojun , Li Yize , Wang Qiaofeng , Zhu Xiaosheng , Wu Jianwei , Tian Yi , Fan Hao , Hu Jinwei , Li Chen , Wang Baolong , Liu Wenchao , Fan Li
Published: March 2020

Acidic pH of lysosomes are closely related to the autophagy, thus well known of the precise lysosomes pH changes will give more information on the autophagy process and status. So far, however, only pH changes in a relative broad range could be indicated, the exactly lysosomes pH detection has never arrived. In our study, we established an endo/lysosome pH indicator based on self-decomposable SiO2 nanoparticle system with specific synthesis parameters. The central concentrated MB in the central-hollow structural nanoparticles presented sensitive release as a function of pH values from pH 4.0-4.8, which is the exactly the pH range of lysosomes. The linear correlation of the OD values and the pH values has been built up, which has been used for detection of lysosomes pH in 6 different cell lines. Moreover, by this system, we succeeded in precise detecting the pH average changes of lysosomes before and after BPSi NPs endocytosis, clarifying the mechanism of the autophagy termination after BPSi endocytosis. So, the self-decomposable nanoparticles based luminal pH indicator may provide a new methodology and strategy to know better of the lysosome pH, then indicate more details on autophagy process or other important signaling about metabolism.