bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing system-wide implementation of opioid prescribing guidelines in primary care: findings from a non-randomized stepped-wedge quality improvement project.
Authors: Zgierska Aleksandra E , Robinson James M , Lennon Robert P , Smith Paul D , Nisbet Kate , Ales Mary W , Boss Deanne , Tuan Wen-Jan , Vidaver Regina M , Hahn David L 
Published: January 2020

Abstract
Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of “opioid guidelines” is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of “routine” system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations. Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The intervention subjects were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p<0.05, 95% confidence intervals and/or Cohen’s d. Results: Two-hundred-fifteen intervention subjects, a subset of clinical staff, received at least one intervention component; 1,255 patients in the intervention and 1,632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more intervention than comparison clinic patients were screened for depression (8.1% vs 1.1%, p=0.019) and prescribed ≥90mg/day MED (23.0% vs 15.5%, p=0.038). The stepped-wedge analysis did not show statistically significant change in outcomes in the intervention clinics, when accounting for the comparison clinics’ trends. The Cohen’s d values favored the intervention clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90mg/day MED in the intervention compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p=0.02), but not other outcomes (p³0.05). Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, under more rigorous implementation conditions.
Novel circular RNA hsa_circ_0077837 suppresses colorectal cancer cell proliferation by regulating the microRNA 21/phosphatase and tensin homolog axis
Authors: Sheng Wei-Zhong , Dong Tian-Geng , Zhang Bo , Gong Yu-Da , Gao Wei-Dong 
Published: January 2020

Abstract
Background: Circular RNA (circRNA) is a novel noncoding RNA (ncRNA) that assumes critical roles in tumor occurrence and progression. circRNA functions in many tumors as a kind of microRNA (mRNA) “sponge.” The present study sought to investigate the part played by circRNA in colorectal cancer (CRC) progression and to elucidate the relevant action mechanism(s). Methods: We detected lower hsa_circ_0077837 (circEPB41L2) expression in CRC by data analysis based on previous studies. We demonstrated the antitumor part of circEPB41L2 in CRC cells via a group of biological experiments. We subsequently took advantage of pull-down and dual-luciferase reporter assays to recognize circEPB41L2 downstream microRNA 21 (miR-21). Western blotting was conducted to confirm that the circEPB41L2–miR-21–phosphatase and tensin homolog (Pten)/AKT axis is responsible for CRC tumor growth suppression. The antitumor part of circEPB41L2 in vivo was eventually demonstrated by HCT116 xenograft model. Results: We found that circEPB41L2 overexpression inhibited the proliferation of CRC cells. Further, the miR-21 phenocopy suppressed circNRIP1 overexpression, while its overexpression also inhibited the cancer suppressive function of circEPB41L2. circEPB41L2 was confirmed to be able to inhibit tumor growth by enhancing Pten expression. Finally, the antitumor part of circEPB41L2 was confirmed. Conclusions: We demonstrated that circEPB41L2 sponges miR-21 to increase the Pten expression level and consequently serve as a cancer suppressor in CRC.
Live birth rates in different subgroups of poor ovarian responders according to Bologna criteria and POSEIDON group classification
Authors: Mashayekhy Mehri , Arabipoor Arezoo , Barabi Forouzan , Zolfaghari Zahra 
Published: January 2020

Abstract
Background Recently, some studies evaluated the live births rates (LBRs) in two poor ovarian responders (POR) classification methods separately, but present study was designed to compare the LBRs among different groups of patients on the basis of Bologna criteria or POSIEDON group classifications and find the important predictive factors for LBR in patients with POR.Methods In this cross-sectional study, the database containing clinical and laboratory information on infertility treatment cycles were evaluated from December 2015 to December 2017 and all the patients with at least one POR after standard controlled ovarian stimulation (COH) during IVF/ICSI cycles were evaluated. The eligible patients were enrolled and divided into five and four groups according to the Bologna criteria and POSEIDON groups’ classifications, respectively.Results 812 patients with POR diagnosis were investigated which in overall 517 of them had embryo transfer in the last treatment cycle (63.6%) and total clinical pregnancy rate 19.3% (100 cases) and live birth rates 16.1% (86 cases) were found. When the patients were grouped on the Basis of the POSEIDON classification, the highest LBR was observed in the POSEIDON group III. On the other hand, according to the Bologna criteria, 41 patients were not included in any group, and in the analysis of cycle outcome, the LBR in the Bologna group II was more than other groups. The multivariable regression analysis revealed that the significant independent variables remained in the model as important predictive factor for live births in the study population were the number and quality of the transferred embryos transmission (good and excellent quality), and the POSSIDON classification group (POSSIDON group III).ConclusionsOn the basis of present results, the POSEIDON group classification could be more comprehensive and practical than Bologna criteria for diagnosing and categorizing POR patients. In addition, it was found the number and quality of transferred embryos were the most important prognostic factor for live birth in POR patients; therefore we suggest to consider COH protocols with a freezing embryos strategy, and the collection of more good quality embryos to improve the probability of a live birth.
Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis: A case report and literature review
Authors: Yang Weiming , Zhao Caiqiong , Cao Xuewei 
Published: January 2020

Abstract
Background: Spontaneous osteonecrosis of the knee (SONK) was defined as a distinct clinical entity with characteristical findings that subchondral lesions in the weight-bearing region of a single condyle. In the early stage of SONK, we usually think that injury of meniscus was to blame for the knee pain. Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis. Case presentation：A 67-year-old male complained of pain in the left knee for 3 months in 2013. Magnetic resonance imaging (MRI) revealed a medial meniscal root tear (level III), so that he patient underwent arthroscopic meniscectomy. However, no obvious pain relief achieved at the follow-up. The pain was associated with weight bearing, of which was initially intermittent, gradually progressed in intensity and became frequent even at rest. At 18 months after the first visit, we re-examined the knee MRI and results clearly revealed subchondral bone osteonecrosis of the condyle. Finally, we performed unicompartmental arthroplasty which significantly relieved the pain and restored the walking ability of the patient. Conclusions: Meniscus injury often coexist with SONK. In the early stages of SONK, the area of necrosis is small which is very easy to be ignored causing a misdiagnosis. The case reminds us should pay much attention to the possibility of subchondral bone necrosis in patients with knee pain and meniscal injury.
Autumn migration direction of juvenile willow warblers (Phylloscopus t. trochilus and P. t. acredula) and their hybrids by qPCR SNP genotyping
Authors: Zhao Tianhao , Ilieva Mihaela , Larson Keith , Lundberg Max , Neto Júlio M. , Sokolovskis Kristaps , Åkesson Susanne , Bensch Staffan 
Published: January 2020

Abstract
Background: Geographic regions, where two close-related taxa with different migration routes come into contact, are known as migratory divides. Hybrids originating from migratory divides are hypothesized to migrate intermediately relative to the parental populations. However, to date and due to technical limitations, few studies testing this hypothesis in wild birds and these have been to hybrids that have completed the migration back to the breeding grounds. Here, we make use of the well-established migration routes of willow warblers ( Phylloscopus trochilus ), for which the subspecies trochilus and acredula have migration-associated genetic markers on chromosomes 1 and 5. This enabled us to analyses the geographic distribution of pure and hybrid genotypes among juvenile birds on their first migration. Methods: Blood and feather samples were collected from wintering birds in eastern and western Africa (n = 69), and from juveniles during autumn migration in Portugal (n = 33), Italy (n = 38) and Bulgaria (n = 32). Genotyping was carried out by qPCR SNP assays, one SNP on chromosome 1 (SNP 65) and one on chromosome 5 (SNP 285). Both these SNPs have alternative alleles that are highly fixed (allele frequency>97%) in each of the subspecies. Results: The observed combined genotypes of the two SNPs were associated with the known migration routes and wintering distributions of trochilus and acredula . We found hybrids (HH) among the juveniles in Italy (5/38) and in Portugal (2/33). The proportion of hybrids in Italy was significantly higher than expected from a background rate of hybrid genotypes (1.5%) in allopatric populations of trochilus and acredula . Conclusions: Our genetic approach to assign individuals to subspecies and hybrids allowed us to investigate migration direction in juvenile birds on their first migration, which should illustrate the innate migratory direction with less of a bias than studies restricted to successful migrants. The excess of hybrid in Italy, suggests that they employ an intermediate route relative to the parental populations. Our qPCR SNP genotyping method is efficient for processing large sample sizes, and therefore powerful in migration research of species with known population genetic structure.
The association of the Arg1277Gln mutation in the MYH7 gene with myosin storage myopathy in a Chinese family
Authors: Li Li-li , Li Riu , Liu Dongyun 
Published: January 2020

Abstract
Background Myosin storage myopathy (MSM) is caused by missense mutations in the MYH7 gene, which encodes the β-cardiac/slow skeletal muscle myosin heavy chain rod (MyHCI). MSM is an autosomal dominant/recessive myopathy characterized by subsarcolemmal accumulations of myosin in type I muscle fibers that results in weakness of the scapula, limb and distal muscles.Methods Here, we report a MSM phenotype that was present across three generations of individuals from the same family, one of whom was a neonate.Results At birth, the neonate had an elevated creatine kinase level and decreased muscle tone in the limbs. At 2 months of age, the infant’s cervical vertebrae caused his head to be skewed to the right. At 7 months of age, the infant’s development was delayed.Whole exome sequencing showed a novel heterozygous variant NM_000257.3: c.3830G>A (p.Arg1277Gln) at exon 28 of the MYH7 gene in the DNA of the infant and his father.Conclusions Previously, which site has only been reported in 2 cases of cardiomyopathy; therefore, this study expands our knowledge of the clinical phenotypes associated with mutations within the rod region of MyHCI. Importantly, close follow-up of the neonate will provide important information on the natural history of MSM associated with MYH7 gene mutation.
Placenta previa rates in relation to prior cesarean section deliveries, A 15-year single-center analysis
Authors: Alwazzan Ahmad B. , Kafy abdullah , AlBasri Samera F. , Mousa Ahmed A. , Halawani Lujain K. , Farran Ibtisam H. 
Published: January 2020

Abstract
Background: To estimate the rate of placenta previa in relation to prior delivery via cesarean section (CS) during a 15-year period in an academic medical center, King Abdulaziz University Hospital (KAUH), in Jeddah, Saudi Arabia.Methods: In this retrospective study, we reviewed the medical records of all pregnant women who delivered at KAUH from January 2001 to December 2015. For each year, the research team recorded the total number of deliveries, as well as the number and percentage of CS deliveries and patients with placenta previa. The association between placenta previa and previous CS was assessed. Results: Out of the 62,701 deliveries at KAUH during the study period, 13,404 were CS deliveries, producing an overall CS rate of 21.4%. The total number of patients with placenta previa was 260, for a placenta previa rate of 4.14 cases/1,000 births. Of patients with placenta previa, 135 had a prior CS (60%), whereas 91 multigravida women had no previous CS (40%).There is positive correlation between number of CS and number of placenta pravia.Conclusion: In spite of, significant positive correlation between number of CS and number of placenta previa. The rate of placenta previa was not significantly different between patients with or without prior CS delivery. This suggests that factors other with previous CS could play role in the development of placenta previa especially in primgravida.
The effect of a Computer Lens Filter on visual performance in subjects with retinitis pigmentosa
Authors: Guo Zhangmei , Ni Lingzhi , Lin Na , Zhu Yu , Jiang Longfei , Deng RUzhi 
Published: January 2020

Abstract
Background： Retinitis pigmentosa (RP) patients usually complain about nyctalopia and reduced dark adaptation which cause their visual discomfort. In this study we aimed to explore the effects of a UV reduction Computer Lens Filter (CLF) on contrast sensitivity (CS), reading speed for computer screen text and visual comfort in subjects with retinitis pigmentosa (RP) to find if a CLF is helpful for RP patients . Method: Twenty-two subjects diagnosed with binocular RP participated. Bright CS using the Mars test and reading speed for screen text were measured both with and without CLF wear. Subjective estimates of computer screen brightness and visual comfort were evaluated by Linkert self-report estimates. These functions were compared for the two conditions of filter wear and non-wear. Result ： Mean subject age was 38.2±7.5 years and mean logMAR VA was 0.505± 0.324. Wearing a CLF did not improve bright CS ( t = 0.680, P=0.504 ) or increase reading speed ( t =-0.223, P = 0.826 ). CLF wear was judged to reduce screen brightness ( t = -5.412, P<0.0001 ) and improve visual comfort ( t = 6.897, P<0.0001 ). Conclusion ： CLF wear did not improve RP subjects’ CS or reading speed for screen text, but did reduce the appearance of screen brightness and improve subjects’ reported visual comfort. Improvement in comfort alone may be sufficient justification for filter use as a vision aid for RP patients during vision rehabilitation.
Optical Quality after Posterior Chamber Phakic Implantation of an Intraocular Lens with a Central Hole (V4c Implantable Collamer Lens) under Different Lighting Conditions
Authors: He Tianrui , Zhu Yi , Zhou Jibo 
Published: January 2020

Abstract
Background: The current study compared optical quality before and after implantation of a posterior chamber phakic intraocular lens with a central hole [V4c implantable collamer lens (ICL)] under bright and dark lighting conditions by means of the Optical Quality Analysis System™ (OQAS; Visiometrics, Terrassa, Spain).
Methods: This prospective study involved 91 eyes of 46 consecutive high myopia patients (15 males and 31 females, average spherical equivalent -10.50±0.33D) undergoing implantation of a V4c ICL. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs; 100%, 20%, and 9%), under different lighting conditions, were measured before and 1 week, 1 month, and 3 months after surgery.
Results: All optical parameters showed significant improvements, at all time points, under dark condition after surgery. We observed no significant changes in PVA 9% at 1 week (mean value 0.539, P=0.12) or 1 month after surgery (mean value 0.573, P=0.08) under bright condition; but all other postoperative parameters improved significantly. Comparing the two lighting conditions, the OSI decreased more under dark conditions at 1 week (P=0.02), 1 month (P=0.004), and 3 months (P=0.002), but there was no significant difference in any other parameter. In addition, patients were divided into super high myopia (group S, spherical equivalent greater than -10 D) and high myopia (group H, spherical equivalent from -6 D to -10 D), the group S improved significantly more than group H in all parameters, under both bright and dark conditions.
Conclusions: V4c ICL implantation improved optical quality under both bright and dark lighting conditions, and had a better ability to reduce the extent of scattering in the dark. Furthermore, group S achieved greater improvement in visual quality, which should be considered by physicians before surgery.
Comparison of Two Management Strategies, "Endoscopy First" and "Laparoscopic Cholecystectomy First", for Patients with Gallbladder Stones and Intermediate Risk for Choledocholithiasis: Study Protocol for a Diagnostic Randomized Trial
Authors: Aleknaite Ausra , Simutis Gintaras , Stanaitis Juozas , Jucaitis Tomas , Drungilas Mantas , Valantinas Jonas , Strupas Kestutis 
Published: January 2020

Abstract
Background: The optimal approach for patients with gallbladder stones and intermediate risk for choledocholithiasis still remains undetermined. Use of diagnostic endoscopic retrograde cholangiopancreatography should be minimized as it carries considerable risk of post-procedural complications. This study compares two different management strategies: intraoperative cholangiography and endoscopic ultrasound before laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis and intermediate risk for choledocholithiasis.
Methods: It is a diagnostic randomized active-controlled single-centre clinical trial enrolling adult patients undergoing laparoscopic cholecystectomy due to symptomatic gallbladder stones with intermediate risk for choledocholithiasis. The risk for choledocholithiasis is calculated using an original prognostic score – Vilnius University Hospital Index. A total of 106 participants will be included and randomized into two groups. Evaluation of bile ducts using endoscopic ultrasound and endoscopic retrograde cholangiography on demand will be performed before laparoscopic cholecystectomy for one arm (“Endoscopy first”). Intraoperative cholangiography during laparoscopic cholecystectomy and postoperative endoscopic retrograde cholangiopancreatography on demand will be administered in another arm (“Cholecystectomy first”). Postoperative follow-up is 6 months. The primary endpoint is the length of hospital stay. Secondary endpoints will include accuracy of the different management strategies, adverse events of interventions, duct clearance and technical success of interventions (intraoperative cholangiography, endoscopic ultrasound, endoscopic retrograde cholangiography), costs of treatment.
Discussion: This trial is planned determine which strategy is better approach for a patient with intermediate common bile duct stones risk and to define a simple to calculate and safe algorithm on managing choledocholithiasis.

Trial registration: The trial is registered at ClinicalTrials.gov, identification number NCT03658863.
Trend and change points of streamflow in the Yellow River and their attributions
Authors: Zhong Dunyu , Dong Zengchuan , Fu Guobin , Bian Jiaqi , Kong Feihe , Wang Wenzhuo , Zhao Yan 
Published: January 2020

Abstract
The impacts of climate change and human activity, combined with streamflow reduction in the Yellow River Basin, have presented significant challenges to water resource management strategies. Here, the trends and change points of streamflow were determined for the period 1956–2017 via five statistical methods. A runoff-sensitive coefficients method (the Budyko hypothesis) and a conceptual rainfall–runoff model (the TUW model) were applied to assess the streamflow variation. The following conclusions were ascertained: (1) 1989, 1986, and 1990 were the change points for streamflow in the upstream Tang-Nai-Hai and Lan-Zhou stations and the downstream Hua-Yuan-Kou hydrological station; (2) the streamflow showed statistically significant decreasing trends with spatiotemporal variations in the Yellow River Basin; (3) the relationship between runoff and precipitation showed a downward trend over time; (4) comparisons of the Budyko and TUW models show that human activity is responsible for more than 65% of streamflow reduction, while climate change contributes to less than 35% of the reduction. Therefore, human activity is the main reason for streamflow reduction in the Yellow River Basin. This finding is of critical importance for water resources management under changing environment.