bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin D Status in Dupuytren’s Disease: Association with Clinical Status and Vitamin D Receptor Expression
Authors: Park Jin Woo , Kim Sung Taeck , Lee Kyu Sang , Gong Hyun Sik 
Published: November 2020

Abstract
BackgroundDupuytren’s disease(DD) is a progressive fibroproliferative condition involving contractures of the fascia of the palm. Up to now, there are no relevant investigations on patients with DD in case of serum vitamin D deficiency. We hypothesized that transforming growth factor-β1 (TGF-β1) is increased in patients with DD in consequence of vitamin D deficiency, thereby leading to myofibroblast differentiation and subsequent progression of contractures. MethodsThe study’s aim was to analyze serum vitamin D levels and explore possible clinical and immunohistochemical correlates with vitamin D concentrations in a group of patients with DD. Vitamin D levels were measured in all DD patients and healthy controls. In the patient group, clinical characteristics were compared between vitamin D deficient and non-deficient subgroups. Diseased palmar fascia samples were obtained from 14 patients undergoing fasciectomy for DD. Correlations between vitamin D levels and vitamin D receptor(VDR), TGF-β1 expression levels in collected fascia samples were evaluated. ResultsVitamin D concentrations were significantly lower in patients than healthy controls. In addition, total extension deficit of involved fingers was higher in vitamin D deficient patients. Moreover, a positive correlation was found between vitamin D levels and expression of VDR in pathologic fascia in patients undergoing fasciectomy for contracture. Serum vitamin D levels were found to be low in DD patients. Expression of VDR was lower in the vitamin D deficient group.ConclusionsThe results suggest a potential link between vitamin D status and DD but causation is not yet established. The potential role of vitamin D and its interaction with VDR and the TGF-β1 signaling pathway in the pathogenesis of DD needs to be explored further.
Cost-effectiveness of a Hybrid Emergency Room System for Severe Trauma: A health technology assessment from the perspective of the third-party payer in Japan
Authors: Kinoshita Takahiro , Moriwaki Kensuke , Hanaki Nao , Kitamura Tetsuhisa , Yamakawa Kazuma , Fukuda Takashi , Hunink Myriam GM , Fujimi Satoshi 
Published: November 2020

Abstract
Background

Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI).

Methods

We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted.

Results

The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was <0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability.

Conclusion

The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.
Evaluation of Indicators for Cyanobacterial Risk in 108 Temperate Lakes Using 23 Years of Environmental Monitoring Data
Authors: LI JING , Person Kenenth M , Pekar Heidi , Jansson Daniel 
Published: November 2020

Abstract
Background: Cyanobacterial blooms are of increasing concern for drinking water supply. Cyanobacterial risk in 108 temperate freshwater lakes were examined for drinking water supply. Results: In Sweden, a survey among drinking water producers showed that the sense of urgency was little. At 60 % of the Swedish drinking water treatment plants, operators lacked monitoring strategies. The study shows that blooms can produce a variety of toxins such as anatoxins, cylindrospermopsins, microcystins and saxitoxins. We confirmed the anthropogenic activities’ impact on cyanobacterial risk and evaluated that total phosphorus (TP) concentration can be used to indicate cyanobacterial risk by applying non-linear quantile regression for 108 Swedish monitoring lakes.Conclusion: We suggest that TP concentration should be investigated thoroughly to provide important knowledge which can be used to set nutrient targets to sustain safe drinking water supply and recreational services.TP should be targeted lower than 15 μg L-1, allowing 10 % exceedance of WHO Drinking Water Alert Level 1.
Pregnant Women’s Well-being and Worry During the COVID-19 Pandemic: A Comparative Study
Authors: Mortazavi Forough , Mehrabadi Maryam , KiaeeTabar Roya 
Published: November 2020

Abstract
Background: COVID-19 caused some worries among pregnant women. Worries during pregnancy can affect women’s well-being. We investigated worry and well-being and associated factors among pregnant women during the COVID-19 epidemic.Methods: This descriptive cross-sectional study was conducted on 484 pregnant women using an online questionnaire. Sampling was performed in a period between May 5 and Aug 5, 2020. Inclusion criteria were having a single healthy fetus and having no significant psychological disorder. We collected the data using the Persian versions of the World Health Organization's well-being Index (WHO-5 well-being index) and the Cambridge worry scale.Results: The mean total scores of the WHO-5 well-being index and the rate of WHO-5 score < 50 were 64.9 ± 29.0 and 24.4%, respectively. Predictors of women’s worry are the increased level of fear of COVID-19, a low family income, employment situation, nulliparity, and having no close family member with chronic disease (p < 0.05). The results of logistic regression analysis on well-being scores showed that the worry about fetus health (OR = 1.081, p = 0.005), women’s own health and relationships (OR = 1.055, p = 0.047), and having an infected person with COVID-19 among relatives (OR = 2.095, p = 0.039) could predict the well-being in pregnant women. The mean score of worry about fetus health in the current study was lower than that of the previous study (p = 0.024). The mean score of socio-economic worry in the current study was higher than that of the previous cross-sectional study (p = 0.025). The result indicates that the percentage of participants with a low level of well-being did not differ by the two periods under study (chi-square = 0.099, p = 0.753) (table 7). Conclusions: The percentage of women experiencing a low well-being state was relatively high. This result is worthy of attention by health care providers and policy makers. To decrease women’s socio economic concerns, governments and charities should expand programs providing financial support to pregnant women in low-income families. Providing care and support to pregnant women should have high priority during the COVID-19 pandemic.
Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization
Authors: Zheng Duzhou , Shen Huawei , Liu Mingxing , Huang Shikuan , Liu Weifeng , Zhou Mimi , Cai Mingjin 
Published: November 2020

Abstract
Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.
Usefulness of Shock Index and Delta Shock Index for Management of Postpartum Hemorrhage in Hypertensive Disorder in Pregnancy Cases
Authors: Mori Hiroshi , Shibata Eiji , Kuwazuru Tomoichiro , Kondo Emi , Uchimura Takayuki , Sakuragi Toshihide , Amimoto Shoko , Yoshino Kiyoshi 
Published: November 2020

Abstract
Background : Although the SI (Shock index; heart rate / systolic blood pressure) is a useful indicator in the management of PPH (postpartum hemorrhage), there are few reports of SI in pregnant women with complicated with HDP (hypertensive disorder in pregnancy) cases. HDP patients have a high systolic blood pressure and the bleeding volume may not be reflected in SI. The purpose of this study was to examine whether SI and ΔSI (peak SI−baseline SI) would be clinically useful indicators, and to detect the cut-off value for judging abnormal obstetric bleeding. Methods: Retrospective case-control study in 107 patients with HDP in an single perinatal medical center. The values ​​of prepartum SI, postpartum highest SI (peak SI), and the amount of bleeding until peak SI were retrospectively examined. The Kruskal-Wallis test was used to determine the relationship between peak SI, ΔSI and the amount of bleeding until peak SI. ROC(receiver operatorating characteristic) analysis was performed to determine the cut-off value. Results: Both peak SI and ΔSI were significantly related to the amount of bleeding up to peak SI (p <0.001). ROC analysis showed a cut-off values of peak SI where the amount of bleeding exceeded 500ml, 1,000ml, and 1,500ml. The values ​​are 0.77 (sensitivity 64%, specificity 84%; AUC 0.81), 0.76 (sensitivity 87%, specificity 69%; AUC 0.86), 0.99 (sensitivity 100%, specificity 91%; AUC 0.97). And ΔSI, respectively, were 0.25 (sensitivity 66.6%, specificity 88.7%; AUC 0.84), 0.31 (sensitivity 81%, specificity 87.9%; AUC 0.91), and 0.43 (sensitivity 100%, specificity 93.1%; AUC 0.98).Conclusion: In HDP cases, if the peak SI is greater than 0.99, similar to non-HDP pregnancies, or if the ΔSI is greater than 0.43, we need to recognize it as bleeding of 1,500ml or more. In addition, ΔSI may be a more sensitive and specific indicator than conventional peak SI in HDP cases.
Validation of Sonographic Fetal Weight Estimators Among Term Parturients in Uganda
Authors: Sereke Senai Goitom , Omara Richard Okello , Bongomin Felix , Nakubulwa Sarah , Kisembo Harriet Nalubega 
Published: November 2020

Abstract
BackgroundAccuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population isn’t known since no validation of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges. MethodsThis was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within three days of birth, prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight. ResultsThe overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9%, 73.3%, 77.3%, 78.4% and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p<0.01) whereas Shepard formula did not [p - 0.2], when no stratification of fetal weights was done. However, all Hadlocks showed a none significant (p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0gms. Shepard weight estimates showed a none significant mean difference when actual birth weight was <4000gms. Bland-Altman graphs also showed a better agreement of weight estimated by Shepard formula and actual birth weights. ConclusionAll the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights <4000grams whereas all Hadlocks were more accurate when the actual birthweight was ≥ 4000grams.
Development and Validation of a questionnaire to describe behaviours and attitudes of physicians towards their own process of falling ill.
Authors: Peña Maria Pilar Astier , Boyero Teresa Martínez , Marco Barbara Gómez , Alvarez Candela Pérez , Royo Alba Gállego , Marroquin Maria Teresa Delgado , Trota Rogelio Altisent 
Published: November 2020

Abstract
Background: Physicians have not learned their role as patients. Medical associations focused mainly on mental health programs for doctors in different countries. Nevertheless, the anomalous behaviours of ill doctors exist independently of their health problem. We described the development and validation of a questionnaire to describe Behaviours and Attitudes of Doctors towards their Own Illness (BADOI).Methods: Development of the questionnaire and appearance and content validation (ACV) by experts’ debriefings; construct validation by exploratory (EFA) and confirmatory factor analysis (CFA); reliability by Cronbach's alpha index (CAI) and feasibility by completion time (CT), accessibility to questionnaire platform and % of not answer items.Results: A Questionnaire with 56 items was developed with 3 sections: 1) socio-demographic, professional and work-related data. 2) Activities for self-care and work impact (sick leaves and presenteeism) and physicians’ healthcare pathways (Self-management and use of healthcare services). 3) Doctors of ill doctors and the role of medical associations. The validation sample size was of 4308 physicians’ answers. The factorial model presented 5 factors explaining 78.08% variance, a high value. Factor 1 explained 26.75% of the model describing the relationship between illness and work; Factor 2 explained 16.68%, with items regarding the negative impact of mental issues, toxic habits and the use of healthcare services; Factor 3 explained 15.06%, with items considering presenteeism and sick leaves; Factor 4 explained 9.95% regarding the handling of an ill colleague and medical associations. Finally, Factor 5 explained 9.64%, with items describing healthcare given to ill physicians and the revalidation of medical profession. Discussion: The factors grouped together items relating to self-care, impact on work and physicians’ healthcare pathways (F1-F2-F3) and the role of doctors of ill doctors and of the professional associations (F4-F5), being consistent with the 2 main perspectives: personal experience and caring for ill colleagues.Conclusion: A reliable Multidimensional Questionnaire on the process of physicians becoming ill has been validated in a large sample of registered doctors. It will help to identify and quantify physicians’ healthcare pathways allowing healthcare managers to set evidence-based interventions and formulate policies and ethical recommendations regarding the management of sick doctors.
Disentangling Depression in Belgian Higher Education Students Amidst a COVID-19 Lockdown
Authors: Man Jeroen De , Buffel Veerle , Velde Sarah van de , Bracke Piet , Hal Guido F Van , Wouters Edwin 
Published: November 2020

Abstract
BackgroundThe surge of COVID-19 infections has prompted many countries to take unprecedented policy measures. In Belgium, the authorities implemented a nation-wide stay-at-home order for several months. Evidence of the mental health effect of such measures is scarce. A recent review by Brooks et al. has compiled a defined list of stressors affecting people's mental health under quarantine during previous epidemic settings. This study aims to test the association between these stressors and the mental health of students attending higher education during the stay-at-home order in Belgium. MethodsIn this cross-sectional study, 18,301 students from 13 higher education institutions (HEI) participated in an online survey between 26 April and 11 May 2020. Structural equation modeling was used to assess associations between potential stressors and depressive symptoms severity scores and to assess the mediation effect of stressors between duration of exposure and depressive symptoms severity. ResultsThe stressors proposed by Brooks et al. were found to be associated with depressive symptoms severity. The stressors 'perceived academic stress', 'institutional dissatisfaction' and 'fear of being infected' were associated with substantially higher depressive symptoms severity scores. The association between duration of exposure and depressive symptoms severity was mediated by 'academic stress'. Being in a steady relationship and living together with others were both associated with a lower depressive symptoms severity.ConclusionFindings underline the need for a student-centered approach and mental health prevention. Authorities and HEIs should consider whether and if so, how a stay-at-home order should be implemented.
Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.
Authors: Ke Wujian , Li Dongling , Tso Lai Sze , Wei Ran , Lan Yinyuan , Chen Zhengyu , Zhang Xiaohui , Wang Liuyuan , Liang Chunmei , Liao Yuying , Chen Huiru , Liu Yahui , Zheng Heping , Yang Ligang 
Published: November 2020

Abstract
Background Antimicrobial resistance in M. genitalium is a growing clinical problem. We investigated the mutations associated with macrolide and fluoroquinolone resistance, two commonly used medical regimens for treatment in China. Our aim is to analyze the prevalence and diversity of mutations among M. genitalium-positive clinical specimens in Guangzhou, south China.Methods A total of 154 stored M. genitalium positive specimens from men and women attending a STI clinic were tested for macrolide and fluoroquinolone mutations. M. genitalium was detected via TaqMan MGB real-time PCR. Mutations associated with macrolide resistance were detected using primers targeting region V of the 23S rRNA gene. Fluoroquinolone resistant mutations were screened via primers targeting topoisomerase IV (parC) and DNA gyrase (gyrA).Results 98.7% (152/154), 95.5% (147/154) and 90.3% (139/154) of M. genitalium positive samples produced sufficient amplicon for detecting resistance mutations in 23S rRNA, gyrA and parC genes, respectively. 66.4% (101/152), 0.7% (1/147) and 77.7% (108/139) samples manifested mutations in 23S rRNA, gyrA and parC genes, respectively. A2072G (59/101, 58.4%) and S83I (79/108, 73.1%) were highly predominating in 23S rRNA and parC genes, respectively. Two samples had amino acid substitutions in gyrA (M95I and A96T, respectively). Two samples had two amino acid substitutions in parC (S83I + D87Y). 48.6% (67/138) of samples harbored both macrolide and fluoroquinolone resistance-associated mutations. The most common combination of mutations was A2072G (23S rRNA) and S83I (parC) (40/67, 59.7%). One sample had three amino acid changes in 23S rRNA, gyrA and parC genes (A2072G + A96T + S83I).Conclusions The high antimicrobial resistance rate of M. genitalium in Guangzhou is a very worrying problem and suggests that antimicrobial resistance testing and the development of new antibiotic regimens are crucially needed.
The role of Nrf2 in acute and chronic muscle injury
Authors: Bronisz-Budzyńska Iwona , Kozakowska Magdalena , Podkalicka Paulina , Kachamakova-Trojanowska Neli , Łoboda Agnieszka , Dulak Józef 
Published: November 2020

Abstract
The nuclear factor erythroid 2-related factor 2 (Nrf2) is considered as a master cytoprotective factor regulating the expression of genes encoding anti-oxidant, anti-inflammatory, and detoxifying proteins. The role of Nrf2 in the pathophysiology of skeletal muscles has been evaluated in different experimental models, however, due to inconsistent data, we aimed to investigate how Nrf2 transcriptional deficiency (Nrf2tKO) affects muscle functions both in an acute and chronic injury. The acute muscle damage was induced in mice of two genotypes – WT and Nrf2tKO mice by cardiotoxin (CTX) injection. To investigate the role of Nrf2 in chronic muscle pathology, mdx mice that share genetic, biochemical, and histopathological features with Duchenne muscular dystrophy (DMD) were crossed with mice lacking transcriptionally active Nrf2 and double knockouts (mdx/Nrf2tKO) were generated. To worsen the dystrophic phenotype, the analysis of disease pathology was also performed in aggravated conditions, by applying a long-term treadmill test. We have observed slightly increased muscle degeneration in Nrf2tKO mice after CTX treatment. Nevertheless, transcriptional ablation of Nrf2 in mdx mice did not significantly aggravate the most deleterious, pathological hallmarks of DMD related to degeneration, inflammation, fibrotic scar formation, angiogenesis, and the number and proliferation of satellite cells in non-exercised conditions. On the other hand, upon chronic exercises, the degeneration and inflammatory infiltration of the gastrocnemius muscle, but not diaphragm, turned to be increased in Nrf2tKOmdx in comparison to mdx mice. In conclusion, the lack of transcriptionally active Nrf2 influences moderately muscle pathology in acute CTX-induced muscle injury and chronic DMD mouse model, without affecting muscle functionality. Hence, in general, we demonstrated that the deficiency of Nrf2 transcriptional activity has no profound impact on muscle pathology in various models of muscle injury.