bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metabolic Alterations in Meningioma Reflect Clinical Course
Authors: Masalha Waseem , Daka Karam , Woerner Jakob , Pompe Nils , Weber Stefan , Delev Daniel , Krueger Marie T. , Schnell Oliver , Beck Jürgen , Heiland Dieter Henrik , Grauvogel Juergen 
Published: October 2020

Abstract
BackgroundMeningiomas are common brain tumors, defined by an innocent clinical course. However, some meningiomas reveal a malignant transformation and recur within a short time period regardless of their WHO grade. The current study aims to identify potential markers, which can discriminate between benign and malignant meningioma courses. MethodsFor this purpose, we profiled the metabolites of 43 patients with low- and high-grade meningiomas. Tumor specimens were analyzed by NMR analysis; 270 metabolites were identified and clustered with the AutoPipe algorithm. ResultsWe observed two distinct clusters marked by alterations in the glycine-serine, choline or tryptophan metabolism. Both clusters showed significant differences between WHO graduation and proliferation index.ConclusionOur findings suggest that alterations of glycine-serine are associated with a lower proliferation and frequencies of recurrent tumors. Alterations of the choline-tryptophan metabolism causes increased proliferation and recurrence is more common. Our results suggest, that tumor malignancy is reflected by metabolic alterations, which can support histological classifications in order to predict the clinical outcome of patients with meningiomas.
S-1 plus leucovorin and oxaliplatin versus S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer: a cost-effectiveness analysis
Authors: Feng Mingyang , Liao Weiting , Yang Yang , Li Qiu 
Published: October 2020

Abstract
Background: A multicenter, open-label, randomized, phase 3 trial (SOLAR) conducted in 62 centers across Japan and South Korea showed that S-1 plus leucovorin and oxaliplatin showed improved overall response rate, progression-free survival (PFS), and overall survival (OS) compared with S-1 plus cisplatin. This study aimed to investigate whether S-1 plus leucovorin and oxaliplatin is cost-effective compared with S-1 plus cisplatin as the first-line therapy of advanced gastric cancer from the perspective of Chinese society.Materials and methods: The clinical data for this model was derived from the SOLAR trial. Costs and utility were either derived from the standard fee database or extracted from previously published literature. A Markov model was developed to simulate the disease process of patients with advanced gastric cancer. One-way sensitivity analyses were conducted to investigate the impact of variables on the analysis model. A second-order probabilistic sensitivity analysis was performed based on 1,000 Monte-Carlo simulations.Results: S-1 plus leucovorin and oxaliplatin cohort provided an incremental 0.02 QALYs with an incremental cost of $1,527.31, compared with the S-1 plus cisplatin cohort, resulting in the incremental cost-effectiveness ratio (ICER) of $61,331.63/QALY, which beyond the willingness to pay threshold. Costs of drugs in the PFS state in both cohorts and utility of PFS state were the most influential factors in this study.Conclusion: S-1 plus leucovorin and oxaliplatin is not cost-effective compared with S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer from the Chinese society perspective.
Chiropractic Student Perspectives on The Use of Virtual Radiography Simulation An Observational Study Reporting on Chiropractic Students’ Perception on The Use of Virtual Radiography as A Clinical Learning Tool
Authors: Shanahan Madeleine , Molyneux Tom , Vindigni Dein 
Published: October 2020

Abstract
Background Virtual radiography provides students with an opportunity to practise their clinical skills in patient positioning and evaluating radiographic images. The purpose of this pilot study was to introduce Projection VR™, a software radiography simulation program, into a student chiropractic program and evaluate its potential application as a teaching and learning tool. Methods Undergraduate chiropractic students, enrolled in a radiographic course (unit within the chiropractic program), were invited to attend a scheduled laboratory where they were introduced to, and undertook purposefully designed activities using the radiography simulation. At the end of this activity, students were asked to complete an online survey to describe their perceptions of the educational value of the software program. Descriptive and inferential statistics were used to evaluate outcomes.Results Responses were received from 44 out of the 47 students who attended the scheduled laboratory (response rate 92%). Overall students were positive about this simulation identifying that it was easy to use (95%) and that they could control the equipment as needed (95%). The main reported benefits included students being enabled to repeat tasks until they were satisfied with the results (98%) and being able to quickly assess images and determine if changes needed to be made (98%). Participants reported improvement in their understanding of the effect of exposure factors on patient radiation dose (93%) as well as their technical image evaluation (84%) and problem-solving skills (80%).Conclusions The results of this study suggest that virtual radiography is a valuable complementary resource in providing chiropractic students with radiographic knowledge and skills.
Individual Dosimetry System for Targeted Alpha Therapy Based on PHITS Coupled with Microdosimetric Kinetic Model
Authors: Sato Tatsuhiko , Furuta Takuya , Liu Yuwei , Naka Sadahiro , Nagamori Shushi , Kanai Yoshikatsu , Watabe Tadashi 
Published: October 2020

Abstract
Background: An individual dosimetry system is essential for the evaluation of precise doses in nuclear medicine. The purpose of this study was to develop a system for calculating not only absorbed doses but also EQDX(α/β) from the PET-CT images of patient for targeted alpha therapy (TAT), considering the dose dependence of the relative biological effectiveness, the dose-rate effect, and the dose heterogeneity. Methods: A general-purpose Monte Carlo particle transport code PHITS was employed as the dose calculation engine in the system, while the microdosimetric kinetic model was used for converting the absorbed dose to EQDX(α/β). PHITS input files for describing the geometry and source distribution of a patient are automatically created from PET-CT images, using newly developed modules of DICOM2PHITS. We examined the performance of the system by calculating several organ doses using the PET-CT images of four healthy volunteers after injecting 18F-NKO-035. Results: The deposition energy map obtained from our system seems to be a blurred image of the corresponding PET data because annihilation γ-rays deposit their energies rather far from the source location. The calculated organ doses agree with the corresponding data obtained from OLINDA 2.0 within 20%, indicating the reliability of our developed system. Test calculations by replacing the labeled radionuclide from 18F to 211At suggest that large dose heterogeneity in a target volume is expected in TAT, resulting in a significant decrease of EQDX(α/β) for higher-activity injection. Conclusions: An individual dosimetry system including the function for calculating EQDX(α/β) was developed based on PHITS coupled with the microdosimetric kinetic model. It enables us to predict the therapeutic and side effects of TAT based on the clinical data largely available from conventional external radiotherapy.
Using Dynamic Time Warping Self-Organizing Maps to Characterize Diurnal Patterns in Environmental Exposures
Authors: Li Kenan , Sward Katherine , Deng Huiyu , Morrison John , Habre Rima , Franklin Meredith , Chiang Yao-Yi , Ambite Jose-Luis , Wilson John P. , Eckel Sandrah P. 
Published: October 2020

Abstract
BackgroundAdvances in measurement technology are producing increasingly time-resolved environmental exposure data. We aim to gain new insights into exposures and their potential health impacts by moving beyond simple summary statistics (e.g., means, maximums) to characterize more detailed features of high-frequency time-series data. MethodsThis study proposes a novel variant of the Self-Organizing Map (SOM) algorithm called Dynamic Time Warping Self-Organizing Map (DTW-SOM) for unsupervised pattern discovery in time series. This algorithm uses DTW, a similarity measure for sequential data that optimally aligns interior patterns, both as the similarity measure and for training the neural network.ResultsWe applied DTW-SOM to a panel study monitoring indoor and outdoor residential environmental exposures for 10 patients with asthma from 7 households near Salt Lake City, Utah; each patient was followed for up to 373 days. Compared to other SOM algorithms using Euclidean distance, the DTW-SOM algorithm maintained the topological properties of the input time series and generated more detailed diurnal patterns. We observed seasonal patterns in outdoor temperature and distinct patterns of indoor peak PM2.5 exposure, which was likely linked to both combustion sources and days with increased inhaler usage. ConclusionsThe new algorithm, DTW-SOM, better preserved the topology relationship of time-series data and better summarized time-series patterns as compared to the original version of SOM.
In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh
Authors: Akhtar Zubair , Aleem Mohammad Abdul , Ghosh Probir Kumar , Islam A.K.M. Monwarul , Chowdhury Fahmida , MacIntyre C Raina , Fröbert Ole 
Published: October 2020

Abstract
Background: There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information.Methods: We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of total death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE.Results: A total of 601 patients, mean age 51.6±10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8±2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI, 1.64–13.23).Conclusions: A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.
Self-management behavior and fasting plasma glucose control in patients with type 2 diabetes mellitus over 60 years old: Multiple effects of social support on quality of life
Authors: Qi Xinye , Xu Jiao , Chen Guiying , Liu Huan , Liu Jingjing , Wang Jiahui , Zhang Xin , Hao Yanhua , Wu Qunhong , Jiao Mingli 
Published: October 2020

Abstract
Objective: Elderly patients with type 2 diabetes mellitus are highly vulnerable due to serious complications. Thus far, there is little research on the relationship between social support and quality of life, which warrants further exploration of the internal mechanism. This study assessed quality of life and its interfering factors in this patient population.Methods: In total, 571 patients with type 2 diabetes mellitus over 60 years old were recruited from two community clinics in Heilongjiang province, China. We collected data on health status, quality of life, self-management behavior, fasting plasma glucose (FPG) level, and social support. Structural equation modeling and the bootstrap method were used to analyze the data. Results: The average quality of life score was -29.25 ± 24.41. Poorly scored domains of quality of life were “Psychological feeling” (-8.67), “Activity” (-6.36), and “Emotion” (-6.12). Of the 571 patients, 65.32% had normal FPG, 9.8% had high-risk FPG, 15.94% had good self-management behavior, and 22.07% had poor social support. Significant correlations among social support, self-management behavior, FPG level, and quality of life were noted. A multiple mediator model revealed that social support influenced quality of life in three ways: (i) directly (c´ = 0.6549); (ii) indirectly through self-management behavior (a1*b1 = 0.2596); and (iii) indirectly through FPG control (a2*b2 = 0.2825). Self-management behavior influenced quality of life directly and indirectly through FPG control. Conclusion: Improving self-management behavior and monitoring hypoglycemia should become priority targets for future intervention. Scheduled social support to self-management projects should be put into the standardized management procedure. Physicians should provide substantial and individualized support to elderly patients with type 2 diabetes mellitus regarding medication, blood glucose monitoring, and physical exercise.
What do the General Public Believe About the Causes, Prognosis and Best Management Strategies for Low Back Pain? A Cross Sectional Study
Authors: Hall Amanda , Coombs Danielle , Richmond Helen , Bursey Krystal , Furlong Bradley , Lawrence Rebecca , Kamper Steven 
Published: October 2020

Abstract
Background: Low back pain (LBP) is one of the most common reasons for seeking health care and is costly to the health care system. Recent evidence has shown that LBP care provided by many providers is divergent from guidelines and one reason may be patient’s beliefs and expectations about treatment. Thus, examining the nature of patient beliefs and expectations regarding low back pain treatment will help coordinate efforts to improve consistency and quality of care. Methods: This study was a cross-sectional population-based survey of adults living in Newfoundland, Canada. The survey included demographic information (e.g. age, gender, back pain status and care seeking behaviors) and assessed outcomes related to beliefs about the inevitable consequences of back pain with the validated back beliefs questionnaire as well as six additional questions relating beliefs about imaging, physical activity and medication. Surveys were mailed to 3000 households in July-August 2018 and responses collected until September 30th, 2018.Results: 428 surveys were returned (mean age 55 years (SD 14.6), 66% female, 90% had experienced an episode of LBP). The mean Back Beliefs Questionnaire score was 27.3 (SD 7.2), suggesting that people perceive back pain to have inevitable negative consequences. Large proportions of respondents held the following beliefs that are contrary to best available evidence: (i) having back pain means you will always have weakness in your back (49.3%), (ii) it will get progressively worse (48.0%), (iii) resting is good (41.4%) and (iv) x-rays or scans are necessary to get the best medical care for LBP (54.2%). Conclusions: A high proportion of the public believe LBP to have inevitable negative consequences and hold incorrect beliefs about diagnosis and management options, which is similar to findings from other countries. This presents challenges for clinicians and suggests that considering how to influence beliefs about LBP in the broader community could have value. Given the high prevalence of LBP and that many will consult a range of healthcare professionals, future efforts could consider using broad reaching public health campaigns that target patients, policy makers and all relevant health providers with specific content to change commonly held unhelpful beliefs.
Central Lymph Node Metastasis is Predictive of Survival in Advanced Gastric Cancer Patients Treated with D2 Lymphadenectomy
Authors: Lu Huiwen , Zhao Bochao , Huang Rui , Sun Yimeng , Zhu Zirui , Xu Huimian , Huang Baojun 
Published: October 2020

Abstract
BackgroundThe number of positive lymph nodes, which was defined as “N stage”, is mostly used to predict the survival of D2-resected gastric cancer patients, not the location. A “central lymph node” (CnLN) was defined by Ikoma et al, included common hepatic, celiac and proximal splenic artery LNs. CnLNs located in the extraperigastric area are included in the D2 LN station for gastric cancer. We speculate that CnLNs can be regarded as a predictor of survival.Methods Eligible advanced gastric cancer patients who underwent curative resection and D2 lymph node dissection between 2004 and 2012 at our institution were identified. The frequency of CnLN metastases and risk factors affecting DFS were examined. Survival differences were assessed by log-rank tests and Kaplan–Meier curves.ResultsThe study identified 1178 patients who underwent curative surgery or D2 or more extensive lymphadenectomy. A total of 342 patients had been proven to have CnLN metastasis. Larger tumor size (p<0.001), more frequent lymphatic vessel invasion (p<0.001), signet ring cell histology (p=0.014), and more advanced pathological T stage (p=0.013) were significantly related to CnLNs metastasis. The patients with CnLN metastasis had a poor prognosis (HR for DFS of 1.366, 95%CI=1.138-1.640, p=0.001). For the pN2/3 patients, CnLN metastasis was associated with shorter 5-year DFS (for pN2 patients: 25.9% vs 39.3%, p=0.017; for pN3 patients: 11.5% vs 23.4%, p=0.005).ConclusionGastric cancer patients with CnLN metastasis who underwent D2 resection had a poor prognosis. With the same N stage, the patients with positive CnLNs had shorter survival. CnLNs metastasis could be a supplement to N stage and a predictor of survival in gastric cancer patients. Large sample, multicenter, randomized clinical trials are still needed in the future.
Effects of Combining Diaphragm Training With TENS&nbsp;on Balance, Pain, and Function in Athletes With Chronic Low Back Pain: A Randomized Clinical Trial
Authors: Otadi Khadijeh , Ansari Noureddin Nakhostin , Sharify Shahriar , Fakhari Zahra , Sarafraz Hadi , Aria Amir , Rasouli Omid 
Published: October 2020

Abstract
Background: there is a lack of evidence about the effects of diaphragm training combined with TENS on balance, pain, and function in athletes with CLBP.Objectives: This study aimed to investigate the effects of combining diaphragm training with electrical stimulation on core stability, dynamic balance, pain, and function in young athletes with nonspecific CLBP.Design: Randomized clinical trialMethod: A total of 24 young adult athletes (12 women, 12 men) with non-specific CLBP were randomly allocated into experimental and control group. The experimental group received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group received only TENS. Both groups underwent 12 sessions over a 4-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention.Results: Significant improvements in pain and function scores were found in both groups after completing the interventions. However, only the experimental group showed significant improvements in the static stability and dynamic balance post-intervention. The experimental group showed greater improvements in pain and static stability. No significant differences in function or dynamic balance were observed between the groups. Conclusions: The present study indicates that diaphragm training plus TENS can improve static stability, dynamic balance, function, and pain in young athletes with non-specific CLBP. It seems beneficial to add diaphragm training to rehabilitation programs for athletes with CLBP.The trial was retrospectively registered at the Iranian Registry of Clinical Trials on www.irct.ir (Identification number: IRCT20090228001719N8).
Factors Associated with Delayed Initiation of Breastfeeding in Health Facilities: Secondary Analysis of Bangladesh Demographic and Health Survey 2014
Authors: Raihana Shahreen , Alam Ashraful , Huda Tanvir M , Dibley Michael J 
Published: October 2020

Abstract
Background: Irrespective of the place and mode of delivery, 'delayed' initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). Objective: This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh. Methods and Study Design: We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the two years preceding the survey. 'Delayed' breastfeeding was defined using WHO recommendations as initiating after one hour of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation. Results: About three-fifth (n=785,62%) of the children born at a health facility delayed initiation of breastfeeding beyond one hour. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (aOR:2.93; 95%CI:2.17-3.98), and who were exposed to media less than once a week (aOR:1.53; 95%C:1.07-2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR:1.05; 95%CI:1.01-1.11). Multiparous women were less likely to delay (aOR:0.71; 95%CI:0.53-0.96). Conclusions: Delayed initiation following caesarean deliveries continues to be a challenge. Several other health facility and maternal factors also contribute to the delayed. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.