bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania
Authors: Vedasto Osward , Morris Baraka , Furia Francis Fredrick 
Published: September 2020

Abstract
Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making.Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.
Histone H4 aggravates inflammatory injury through TLR4 in chlorine gas-induced acute respiratory distress syndrome
Authors: Zhang Yanlin , Zhao Jian , Guan Li , Mao Lijun , Li Shuqiang , Zhao Jinyuan 
Published: September 2020

Abstract
Background: Chlorine gas (Cl 2 ) exposure remains a public health concern in household, occupational, and transportation accidents around the world. The death rate associated with acute respiratory distress syndrome (ARDS) caused by high concentrations of Cl 2 is very high, mainly because the pathogenesis of ARDS remains unclear. Histone H4 has been identified as an important endogenous pro-inflammatory molecule. The present study aimed to examine the pathogenic role of histone H4 in Cl 2 -induced ARDS.Methods: ARDS was induced by Cl 2 exposure in male C57BL/6 mice. Circulating histone H4, blood gas, pulmonary edema, endothelial activation, and neutrophil infiltration were measured during acute lung injury (ALI). Histone H4 or anti-H4 antibody was administered through the tail vein 1 h prior to Cl 2 exposure to study the pathogenic role of histone H4. Toll-like receptor 2 knock-out ( Tlr2 -KO) and Tlr4 -KO mice were used in conjunction with blocking antibody against TLR1, TLR2, TLR4, or TLR6 to explore the mechanism involved in histone H4-mediated injury. Results: Cl 2 exposure induced a concentration-dependent ALI. The levels of circulating histone H4 were positively correlated with Cl 2 concentrations. Pretreatment with intravenous histone H4 further aggravated lethality rate, blood gas, endothelial activation, and neutrophil infiltration, while anti-H4 antibody showed protective effects. Tlr4 deﬁciency improved lethality rate, blood gas, and pulmonary edema, and prevented endothelial and neutrophil activation caused by Cl 2 exposure. More importantly, Tlr4 gene deletion greatly diminished the effect of histone H4 or anti-H4 antibody observed in wild-type (WT) mice. The impact of Tlr2 on inflammatory injury was not significant. The role of TLRs was also validated by endothelial activation mediated by histone H4 in vitro. Conclusions: Circulating histone H4 played a pro-inflammatory role in ARDS caused by Cl 2 . TLR4 was closely involved in histone H4-mediated inflammatory injury. Therefore, intervention targeting histone H4 is potentially protective.
Treatment of Secondary Hip Arthritis from Shell Fragment and Gunshot Injury in the Syrian Civil War
Authors: Özden Raif , Davut Serkan , Doğramacı Yunus , Kalacı Aydıner , Duman İbrahim Gökhan , Uruç Vedat 
Published: September 2020

Abstract
Background: In gunshot and shell fragment injuries to the hip joint, orthopaedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the syrian civil war were frequently transferred to the author's institution in neighboring city. Orthopaedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty. Methods: This retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients Harris Hip Score (HHS) were evaluated preoperatively and after surgery. Results: Mean age was 31,5 (range, 19-48) years. The mean preoperative HHS was 52.95 points and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint, had higher infection rates but it is not statistically significant.Conclusions: An anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot and shell fragment related posttraumatic arthritis. It is efective treatment choice to reduce pain and improve function but the surgeon must be very carefull because of high rate of infection.
Artificial Intelligence-Assisted Reduction in Patients’ Waiting Time for Outpatient Procedures: A Matched Case–Control Study
Authors: Li Xiaoqing , Tian Dan , Li Weihua , Dong Bin , Wang Hansong , Yuan Jiajun , Li Biru , Shi Lei , Lin Xulin , Zhao Liebin , Liu Shijian 
Published: September 2020

Abstract
Background: Many studies indicate that patient satisfaction is significantly negatively correlated with waiting time. A well-designed healthcare system should not keep patients waiting too long for appointment and consultation. However, in China, patients spend considerable time waiting, and the actual time spent on diagnosis and treatment in the consulting room is comparatively less.Methods: We developed an artificial intelligence (AI)-assisted module that is embedded in hospital information systems. Through its use, outpatients were automatically recommended an imaging examination or a laboratory test based on their symptoms and chief complaint. Thus, they could get examined or tested before they went to see the doctor. People who saw a doctor in the traditional way were assigned to the conventional group, and those who used the AI-assisted system were assigned to the AI-assisted group. We conducted a 1:1 case–control study that applied propensity score matching to pair the data from patients in a pediatric tertiary hospital between August 1, 2019 and January 31, 2020. Waiting time was defined as the time from registration to preparation for a laboratory test or an imaging examination. The total cost included the registration fee, test fee, examination fee, and drug fee. The Wilcoxon rank-sum test was used to compare the differences in time and cost between the AI-assisted group and the conventional group. The statistical significance level was set at 0.05 for two sides.Results: A total of 12,342 visits were recruited for this study, consisting of 6,171 visits in the conventional group and 6,171 visits in the AI-assisted group. The median waiting time was 0.38 (inter-quartile range: 0.20, 1.33) hours for the AI-assisted group compared with 1.97 (0.76, 3.48) hours for the conventional group (p < 0.05).Conclusions: Using AI can significantly reduce the waiting time of patients for outpatient procedures, and thus, enhance the outpatient process of hospitals.
Clinical trials and drug cost savings for Italian Health Service
Authors: D’Ambrosio Francesca , De Feo Gianfranco , Botti Gerardo , Capasso Arturo , Pignata Sandro , Maiolino Piera , Triassi Maria , Nardone Antonio , Perrone Franco , Piezzo Michela , Grimaldi Antonio Maria , Palazzo Ida , De Stasio Immacolata , D’Aniello Roberta , Morabito Alessandro , Pascarella Giacomo 
Published: September 2020

Abstract
Background: The cost of anticancer drugs is constantly growing. The aim of this study was determine the impact in terms of cost reduction for anticancer drug in the Italian Health Service due to patient participation in clinical trials.Methods: We evaluated the cost of drugs administered to patients treated in clinical trials at the National Cancer Institute of Naples in a four-week time period. Patients with a diagnosis of different cancers were considered, including adjuvant therapy and treatment for advanced disease, pharma sponsored and investigator initiated phase I, II and III clinical studies. We defined the expected standard treatment for each patient and we calculated the cost of the standard antineoplastic drugs that should be administered in clinical practice outside clinical trials. We used the market price of drugs to determine the cost savings value. Costs other than drugs were not included in the cost saving calculation. Results: From 23.10.2017 to 17.11.2017, 126 patients were treated in 34 pharma sponsored and investigator initiated clinical trials, using experimental drugs provided free of charge by the sponsors, for an overall number of 152 cycles of therapy. If these patients were treated with conventional therapies in clinical practice the cost of antineoplastic drugs would account for 517,658 Euros, with an average of 5,487 Euros saved per patients for a period of four weeks.Conclusions: Clinical trials with investigational antineoplastic drugs provided free of charge by Sponsors render considerable cost savings, with a tangible benefit in clinical and administrative strategies to reduce drug expenditures.
Solid-state NMR spectroscopic studies of 13C,15N,29Si-enriched biosilica from the marine diatom Cyclotella cryptica
Authors: Kolbe Felicitas , Ehren Helena Leona , Kohrs Simon , Butscher Daniel , Reiß Lukas , Baldus Marc , Brunner Eike 
Published: September 2020

Abstract
Diatoms are algae producing micro- and nano-structured cell walls mainly containing amorphous silica. The shape and patterning of these cell walls is species-specific. Herein, the biosilica of Cyclotella cryptica, a centric marine diatom with a massive organic matrix, is studied. Solid-state NMR spectroscopy is applied to gain deeper insight into the interactions at the organic-inorganic interface of the cell walls. The various organic compounds like polysaccharides as well as proteins and long-chain polyamines (LCPAs) are detected by observation of heteronuclei like 13C and 15N whereas the silica phase is studied using 29Si NMR spectroscopy. The sensitivity of the NMR experiments is strongly enhanced by isotope-labeling of the diatoms during cultivation with 13C, 15N and 29Si. The presence of two different chitin species in the biosilica is demonstrated. This observation is supported by a monosaccharide analysis of the silica-associated organic matrix where a high amount of glucosamine is found. Moreover, the Rotational Echo Double Resonance (REDOR) experiment provides distance information for heteronuclear spins. 13C{29Si} REDOR experiments reveal proximities between different organic compounds and the silica phase. The closest contacts between silica and organic compounds appear for different signals in the 13C-chemical shift range of 40 – 60 ppm, the typical range for LCPAs.
The Main Components of Body Image from the Perspectives of Iranian Adolescents: A Qualitative Study
Authors: Jalali-Farahani Sara , Amiri Parisa , Zarani Fariba , Azizi Fereidoun 
Published: September 2020

Abstract
Background: This study investigates main components of body image from the perspectives of Iranian boys and girls. Methods: A qualitative approach was used to identify the main components of body image in Iranian adolescents. A total of 13 semi-structured focus group discussions were conducted with 84 adolescents (42 girls and 42 boys), aged 15–18 years. All focus group discussions were audio recorded and transcribed verbatim, followed by a qualitative content analysis of the data.Results: The mean age and BMI of participants were 16.2±0.9 years and 24.3±8.0 kg/m2 respectively. Regarding main components of body image, three main themes emerged from the data: 1) perceived face/hair, which included three subthemes-facial features, facial shape/form and hair, 2) perceived body, which included three subthemes-body size, body shape and bone structure and 3) perceived physical functioning which included three subthemes-physical ability, physical health and voice tone. Among mentioned themes, perceived body was the concept which was most frequently addressed by both adolescent boys and girls. When adolescents were talking about their bodies, girls more frequently mentioned their faces and its components, while boys tended to talk more about their physical functioning. Conclusion: This qualitative study provide further insight into the components of body image as perceived by Iranian boys and girls. Current findings indicated that besides those features that focused on body appearance and its aesthetic aspects, physical functioning was another main component of perceived body image by participants. These findings can contribute to the design and implementation of effective interventions aiming at improving body image and its related disorders in Iranian adolescents.
Invasion of pterygoid plates; an indicator for regional lymph node failure in maxillary sinus cancer
Authors: Kosugi Yasuo , Kawamoto Terufumi , Oshima Masaki , Fujimaki Mitsuhisa , Ohba Shinichi , Matsumoto Fumihiko , Shikama Naoto , Sasai Keisuke 
Published: September 2020

Abstract
Background: The aim of this study was to evaluate the long-term treatment results of combined superselective intraarterial chemotherapy and radiation therapy for advanced maxillary sinus cancer (MSC) and the incidence of regional lymph node failure, and to reveal the clinical and anatomical predictive factors for metastasis.Methods: We retrospectively evaluated 55 consecutive patients with locally advanced squamous cell carcinoma of the maxillary sinus who were treated with external radiotherapy and superselective intraarterial chemotherapy. Elective nodal irradiation (ENI) was performed only in the clinical node-positive (cN+) cases and not in the clinical node-negative (cN0) cases.Results: Thirty-eight patients were cN0, and 17 were cN+ at diagnosis. Regional lymph node metastases occurred in 7 of 38 patients with cN0, and 2 of 17 with cN+ during the median follow-up period of 36 months. There were more cases of high-grade (3 or 4) late adverse events in the ENI group than in the non-ENI group (13% vs. 41%, respectively; p = 0.03). In cN0 cases without ENI, invasion of the pterygoid plates (57% vs. 90%; p < 0.01) and oral cavity (35% vs. 92%, with invasion vs without invasion, respectively; p = 0.02) was significantly correlated with a low 5-year regional recurrence-free rate.Conclusions: Patients with MCS and invasion of the pterygoid plates and oral cavity can be considered appropriate candidates for ENI.
Factors associated with preterm birth in Southern Ethiopia: Case-Control Study
Authors: Gejo Negeso Gebeyehu , W/mariam Melaku Tesfaye , Kebede Biruk Assefa , Abdo Ritbano Ahmed , Anshebo Abebe Alemu , Halil Hassen Mosa , Woldu Biruktawit Fekade , Katiso Nuradin Abusha 
Published: September 2020

Abstract
Background
Preterm birth is defined as one born alive before 37 weeks of pregnancy is completed. Worldwide, prematurity is the second foremost cause of death in children under the age of 5 years. Preterm birth also gives rise to short and long term complications. Therefore, the primary aim of this study was to identify the factors associated with preterm birth in Wachemo University Nigest Eleni Mohammed Memorial referral hospital, Hadiya Zone, Southern Ethiopia.
Methods
An institution-based unmatched case-control study was conducted from July 01, 2018 to June 30, 2019, among mothers who gave birth in Wachemo University Nigest Eleni Mohammed Memorial referral hospital. Simple random sampling technique was employed to approach study participants. SPSS version 20 software was used for data entry and computing statistical analysis. Both bivariable and multivariable logistic regression analyses were used to determine the association of each independent variable with the dependent variable. Odds ratio with their 95% confidence intervals was computed to identify the presence and strength of association, and statistical significance was affirmed if p < 0.05.
Result
The current study evaluated 213 medical records of mothers with index neonates (71 cases and 142 controls). Urban residency [AOR = 0.48; 95% Cl; 0.239, 0.962], ANC follow up [AOR = 0.08; 95 Cl; 0.008, 0.694], premature rupture of membranes [AOR = 3.78; 95% Cl; 1.467, 9.749], pregnancy induced hypertension [AOR = 3.77; 95% Cl; 1.408, 10.147], multiple pregnancies [AOR = 5.53; 95% Cl; 2.467, 12.412] were the factors associated with preterm birth. In the present study, more than one-third (36.6%) of preterm neonates have died.
Conclusions
The present study found that urban residency, ANC follow up, premature rupture of membranes, pregnancy induced hypertension and multiple pregnancies were factors associated with preterm birth. The mortality among preterm neonates is high. Enhancing ANC follow up and early detection and treatment of disorders among pregnant women during ANC and undertaking every effort to improve outcomes of preterm birth and reduce neonatal mortality associated with prematurity is decisive.
The rationality and mechanism of ACEIs for the treatment of proteinuria caused by antiangiogenic drugs in hepatocellular carcinoma
Authors: Zhang Su , Cao Man Qing , Hou Zhen Yu , Gu Xiao Ying , Chen Yong Zi , Chen Lu , Luo Yi , Chen Li Wei , Liu Dong Ming , Zhou Hong Yuan , Zhu Ke Yun , Wang Zhi Wei , Zhang Xi Hao , Zhu Xiao Lin , Cui Yun Long , Li Hui Kai , Guo Hua , Zhang Ti 
Published: September 2020

Abstract
Anti-angiogenic drugs (AADs) are currently the main choice for systemic treatment of hepatocellular carcinoma, but treatment-related proteinuria can affect the routine use of AADs, which in turn affects the overall efficacy, its prevention is a clinical aspiration. At present, most clinicians give angiotensin-converting enzyme inhibitors (ACEIs) to alleviate proteinuria according to diabetic nephropathy guidelines or expert recommendations. However, its efficacy and whether it promotes cancer are controversial. Our clinical work has found that the use of ACEIs has not effectively relieved proteinuria, and some cases even have obvious tumor progression. Here we confirmed that in different tumor-bearing mouse models, ACEIs not only did not delay the appearance of proteinuria or reduce the degree of proteinuria caused by AADs, but also reduced the anti-cancer efficacy of AADs, and the reduction of anticancer efficacy has nothing to do with the change of VEGF signaling pathway, Our study show the combination of ACEIs and AADs aggravates the production of kidney-derived erythropoietin(EPO). In turn, EPO compromises the anti-angiogenic effects of AADs and decreases antitumor activity. This study presents treatment of proteinuria caused by AADs with ACEIs is useless and plays a role in drug resistance. Our purpose is to contribute to the rational management of side effects of AADs and to develop relevant guidelines.
The expansion of large-scale tree plantations:
Detection, pathways, and development trade-offs
Authors: Bey Adia , Meyfroidt Patrick 
Published: September 2020

Abstract
Tree plantations can contribute to achieving several Sustainable Development Goals (SDGs) by creating job opportunities, storing carbon, and providing wood products that relieve pressure on natural forests. However, their impacts on SDGs are largely contingent upon the land uses they replace. Here we present a framework for understanding the development trade-offs associated with tree plantations and we introduce a new remote sensing technique to detect their expansion and pre-conversion land use. Using this approach in northern Mozambique, we found that 70% of 2001-2017 tree plantation expansion occurred on cropland, potentially exacerbating poverty, food insecurity and rural unemployment. The remainder occurred on natural vegetation, adversely affecting climate change mitigation efforts and life on land. Forty-one percent of plantation expansion occurred on land not designated for this land use. As tree plantations become more prevalent globally, monitoring their trajectories and expansion is critical to maximizing their benefits for people and the planet.
The Effect of Anesthesia Depth on Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Retrospective Study
Authors: Dong Hongquan , Li Nana , Sun Zhaochu 
Published: September 2020

Abstract
Background: Radiofrequency catheter ablation (RFCA) as a safe and effective method has been widely used in ventricular tachycardia (VT) patients, and with which anesthesiologists frequently manage their perioperative care. The aim of this study was to investigate the effects of different anesthetic depths on perioperative RFCA and recurrence in patients who with intractable VT and could not tolerate an awake procedure.Methods: We reviewed electronic medical records of patients with VT who underwent RFCA by general anesthesia from January 2014 to March 2019. According to intraoperative VT induction, they were divided into two groups: non-inducible group (group N) and inducible group (group I). We constructed several multivariable regression models, in which covariates included patient characteristics, comorbidities, protopathy and BIS value. Results: 101 patients were analyzed. 29 patients (28.7%) experienced VT no induction, and 26 patients (25.7%) recurrented within one year. Compared with group I, the proportion of patients with arrhythmogenic right ventricular cardiomyopathy in group NI were higher (P<0.05), and the recurrence rate of VT was significantly higher (51.7% vs 15.3%) (P<0.05). Based on pre-specified bispectral index (BIS), the BIS <40 was associated with elevated odds of VT no induction compared with a BIS value >50 (odds ratio, 6.92; 95% confidence interval, 1.47-32.56; P=0.01). VT no induction was an independent predictor of recurrence after RFCA (odds ratio, 5.01; 95% confidence interval, 1.88-13.83; P<0.01).Conclusion: Lower BIS value during VT induction in RFCA operation was associated with high risk of VT no induction, which affects postoperative outcomes. We proposed that appropriate depth of anesthesia should be maintained during the process of VT induction.Trial registrationChiCTR, ChiCTR2000034210. Registered 28 June 2020 - Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=55691&htm=4