bluuebunny/crossref_metadata_2025_split huggingface dataset:
EPAS1 and VEGFA gene variants are related to the symptoms of acute mountain sickness in Chinese Han population: a cross-sectional study
Authors: Zhang Ji-Hang , Shen Yang , Liu Chuan , Yang Jie , Yang Yuan-Qi , Zhang Chen , Bian Shi-Zhu , Yu Jie , Gao Xu-Bin , Zhang Lai-Ping , Ke Jing-Bin , Yuan Fang-Zheng-Yuan , Pan Wen-Xu , Guo Zhi-Nian , Huang Lan 
Published: July 2020

Abstract
Background
More people ascend to high altitude (HA) for various activities, and some individuals are susceptible to HA illness after rapidly ascending from plains. Acute mountain sickness (AMS) is a general complaint that affects activities of daily living at HA. Although genomic association analyses suggest that single nucleotide polymorphisms (SNPs) are involved in the genesis of AMS, no major gene variants associated with AMS-related symptoms have been identified.

Methods
In this cross-sectional study, 604 young, healthy Chinese Han men were recruited in June and July of 2012 in Chengdu, and rapidly taken to above 3700 m by plane. Basic demographic parameters were collected at sea level, and heart rate, pulse oxygen saturation (SpO2), systolic and diastolic blood pressure and AMS-related symptoms were determined within 18–24 h after arriving in Lhasa. AMS patients were identified according to the latest Lake Louise scoring system (LLSS). Potential associations between variant genotypes and AMS/AMS-related symptoms were identified by logistic regression after adjusting for potential confounders (age, body mass index and smoking status).

Results
In total, 320 subjects (53.0%) were diagnosed with AMS, with no cases of high-altitude pulmonary edema or high-altitude cerebral edema. SpO2 was significantly lower in the AMS group than that in the non-AMS group (P = 0.003). Four SNPs in hypoxia-inducible factor-related genes were found to be associated with AMS before multiple hypothesis testing correction. The rs6756667 (EPAS1) was associated with mild gastrointestinal symptoms (P = 0.013), while rs3025039 (VEGFA) was related to mild headache (P = 0.0007). The combination of rs6756667 GG and rs3025039 CT/TT further increased the risk of developing AMS (OR = 2.70, P < 0.001).

Conclusions
Under the latest LLSS, we find that EPAS1 and VEGFA gene variants are related to AMS susceptibility through different AMS-related symptoms in the Chinese Han population; this tool might be useful for screening susceptible populations and predicting clinical symptoms leading to AMS before an individual reaches HA.

Trial registration
Chinese Clinical Trial Registration, ChiCTR-RCS-12002232. Registered 31 May 2012.
Role of 18-FDG/PET in evaluation of hepatocellular carcinoma managed locally by transarterial chemoembolization compared to triphasic computed tomography
Authors: Gomaa Manal Ibraheim 
Published: July 2020

Abstract
Background
This study was done to evaluate the role of FDG/PET compared to CECT in evaluating HCC after local interventional treatment. We evaluate forty-six patients with known history of TACE as a locoregional treatment of pathologically proved HCC. There were forty-three males and three females.

Results
The collected data were statistically analyzed, and we found that FDG-PET has a sensitivity of 94%, specificity of 84%, positive predictive value of 86.7%, negative predictive value of 86.4%, and accuracy of 93.4% in the detection of residual or recurrent at the managed tumor bed compared to CECT which shows a sensitivity of 94%, specificity of 84%, positive predictive value of 86.7%, negative predictive value of 86.4%, and accuracy of 93.4 %). Combined views ( FDG-PET/CT ) are better in evaluation.

Conclusion
FDG-PET is better in the detection of residual or recurrence in HCC which is locally managed by TACE.
Perspectives of GCSE students attending a psychiatry summer school in south London
Authors: Wyke Clementine , de Bernier Glori-Louise , Sin Fai Lam Chun Chiang , Holt Clare , Butler Sophie , Rajamani Anto Praveen Rajkumar , Wilson Jones Charlotte 
Published: July 2020

Aims and MethodThis study evaluated a pilot psychiatry summer school for GCSE students in terms of participant experience, effects on attitudes to mental illness and perception of psychiatry as a career option. This was done using the Community Attitudes towards the Mentally Ill scale, career choice questionnaires and a discussion group following the week-long programme attended by 26 students.ResultsStudents were significantly more likely to choose psychiatry after the summer school (P = 0.01). There were statistically significant changes in scores for social restrictiveness (P = 0.04) and community mental health ideology (P = 0.02). Qualitative analysis generated four themes: variation in expectations, limited prior knowledge, perception of the summer school itself and uniformly positive attitudes to psychiatry after the summer school.Clinical implicationsTargeting students at this early stage appears to be an underexplored positive intervention for improving both attitudes towards mental illness and recruitment to psychiatry.
Real-world effectiveness, its predictors and onset of action of cholinesterase inhibitors and memantine in dementia: retrospective health record study
Authors: Vaci Nemanja , Koychev Ivan , Kim Chi-Hun , Kormilitzin Andrey , Liu Qiang , Lucas Christopher , Dehghan Azad , Nenadic Goran , Nevado-Holgado Alejo 
Published: July 2020

BackgroundThe efficacy of acetylcholinesterase inhibitors and memantine in the symptomatic treatment of Alzheimer's disease is well-established. Randomised trials have shown them to be associated with a reduction in the rate of cognitive decline.AimsTo investigate the real-world effectiveness of acetylcholinesterase inhibitors and memantine for dementia-causing diseases in the largest UK observational secondary care service data-set to date.MethodWe extracted mentions of relevant medications and cognitive testing (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores) from de-identified patient records from two National Health Service (NHS) trusts. The 10-year changes in cognitive performance were modelled using a combination of generalised additive and linear mixed-effects modelling.ResultsThe initial decline in MMSE and MoCA scores occurs approximately 2 years before medication is initiated. Medication prescription stabilises cognitive performance for the ensuing 2–5 months. The effect is boosted in more cognitively impaired cases at the point of medication prescription and attenuated in those taking antipsychotics. Importantly, patients who are switched between agents at least once do not experience any beneficial cognitive effect from pharmacological treatment.ConclusionsThis study presents one of the largest real-world examination of the efficacy of acetylcholinesterase inhibitors and memantine for symptomatic treatment of dementia. We found evidence that 68% of individuals respond to treatment with a period of cognitive stabilisation before continuing their decline at the pre-treatment rate.
Low-Cost Technology for the Prevention of Cervical Cancer in Cameroon
Authors: Blaise Nkegoum , Liliane Mboumtou 
Published: July 2020

PURPOSE Our aim was to assess the accuracy of visual inspection with acetic acid (VIA) as a screening method for cervical lesions. METHODS VIA and cytologic smears were carried out on the cervices of nonpregnant women age 30 to 60 years with no previous history of cervical cancer. Cervices with acetowhite lesions or positive Pap smears, as well as 1 in 10 negative cervices (control), were biopsied. RESULTS Of patients, 10,020 women were enrolled and 9,626 (96.1%) were screened. With screening, 9,534 patients (99.0%) had adequate cytology smears, 1,148 (11.9%) underwent colposcopy, and 3,486 biopsies were obtained, of which 1,056 were controls. Sensitivity of VIA was 70.4% versus 47.7%, specificity was 77.6% versus 94.2%, positive predictive value was 44.0% versus 67.2%, and negative predictive value was 91.3% versus 87.8% for Papanicolau test, respectively. CONCLUSION VIA has acceptable test qualities and is now well implemented as a large-scale screening method in Cameroon.
Access to Breast Cancer Diagnostic Devices in the East African Community: Moving the Needle
Authors: Wagner Claire M. , Rubagumya Fidel , Mutebi Miriam , Mutiibwa David , Ngendahayo Louis , Nyagabona Sarah K. , Oromo Seriano , Farmer Paul E. , Binagwaho Agnes , Milner Dan A. 
Published: July 2020

PURPOSE Globally, two million women develop breast cancer each year. Low-income countries bear a disproportionate burden as a result of systems strapped by limited resources. Inadequate access to diagnostic services is widely recognized as a driver of unfavorable outcomes, yet baseline data on supply, use, and pricing for breast cancer diagnostic devices are scant. The purpose of this study was to assess access to cancer biopsy devices in Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda, and to ascertain related pricing, procurement, and payment models. METHODS We conducted an observational online survey to capture institution-based data that address demographics, facility capacity, human capital, pathology systems, device sourcing and pricing, supply chains, and workarounds. Additional manufacturer information was obtained through public sources and communication with industry. RESULTS We received 58 survey responses from the 6 East African Community countries, most representing urban public hospitals (68%). Pathology laboratory capacity varied drastically: Although basic histopathology was consistently performed (92% of respondents), hormone receptor, human epidermal growth factor receptor 2, and genetic studies were not (63%, 53%, and 11%, respectively). Training varied among practitioners performing biopsies—for example, surgeons or nurses—and most practitioners did not have ultrasound guidance (80%). Both disposable and reusable core needle devices were in use, and stockouts were reported by most respondents (69%). Workarounds included reuse of disposable devices, alternative procedures (eg, surgical excision or fine-needle aspiration), patient rescheduling, and referral. Most patients received results at follow up, but one fifth of all respondents reported that some patients never received results. Of importance, there was no observable pattern to procurement channels or pricing. CONCLUSION Reliable, accurate, and timely diagnosis is vital to improving outcomes for patients with breast cancer in low-income countries. Significant variation related to operations, human capital management, product mix, procurement methods, and pricing was observed between and within the East African Community countries. Additional investigation is needed to identify opportunities for applying best practices and leveraging regional synergies for impact.
Performance of Lung Cancer Screening With Low-Dose Computed Tomography in Gejiu, Yunnan: A Prospective, Population-Based, Screening Cohort Study
Authors: Wei Meng-Na , Su Zheng , Wang Jian-Ning , Yu Xiao-Yun , Zhou Qing-Hua , Fan Ya-Guang , Qiao You-Lin 
Published: July 2020

PURPOSE Low-dose computed tomography (LDCT) screening has been recommended for individuals with high lung cancer risk, but the performance of lung cancer screening with LDCT in China is uncertain. This study aims to evaluate the performance of LDCT lung cancer screening in the Chinese setting. METHODS From June 2014 through December 2014, a prospective cohort of patients to undergo lung cancer screening with LDCT was established in Gejiu, Yunnan Province, using one screening center of the Lung Cancer Screening Program in Rural China. Participants received baseline screening and 4 rounds of annual screening with LDCT until June 2019. The participation rate, detection rate, early detection rate, and clinical characteristics of lung cancer were reported. RESULTS Of participants, 2,006 had complete baseline screening results with a compliance rate of 98.4%. Of these, 1,411 were high-risk and 558 were non–high-risk individuals. During this period, 40 lung cancer cases were confirmed, and of them, 35 were screen detected, 4 were postscreening, and 1 was an interval case. The positive rate of baseline and annual screening was 9.7% and 9.0%, respectively, whereas the lung cancer detection rate was 0.4% and 0.6%, respectively. The proportion of early lung cancer increased from 37.5% in T0 to 75.0% in T4. Adenocarcinoma was the most common histologic subtype. Lung cancer incidence according to the criteria of the Lung Cancer Screening Program in Rural China and the National Lung Cancer Screening Trial was 513.31 per 100,000 person-years and 877.41 per 100,000 person-years, respectively CONCLUSION The lung cancer screening program with LDCT was a successful performance in Gejiu, Yunnan; however, additional studies are warranted to refine the high-risk population who will benefit most from LDCT screening and reduce the high false-positive results.
Genotypes and Prevalence of High-Risk Human Papillomavirus Among Patients Diagnosed With Head and Neck Cancer at Alexandria Cancer Centre
Authors: Ombiro Eva M. , Kwena Arthur , Melly Elias , Kamau Tabitha , Maiyoh Geoffrey K. 
Published: July 2020

PURPOSE The purpose of this study was to provide original data on the prevalence of head and neck cancer (HNC) and high-risk human papillomavirus (HPV) genotypes among patients diagnosed with HNC in Kenya. Globocan 2018 findings indicate that cervical cancer is the second most frequent cancer in women in East Africa, which suggests a high prevalence of oncogenic HPV among the general population in this region. METHODS This was a retrospective study with laboratory analysis involving histologically confirmed head and neck tissue samples between January 2017 and December 2018. Stored tissues were retrieved and subjected to repeat microscopy, p16 immunohistochemistry, and HPV polymerase chain reaction at the Pathologists Lancet Group of Laboratories. Data were analyzed using descriptive statistics with Excel. RESULTS HNC accounted for 8.8% of all malignancies at Alexandria Cancer and Palliative Care Hospital. There were more males (64%) than females (36%). Mean age was 50.9 years (± 17.6 years). Most patients came from the western Kenya region. Approximately one third (35.7%) of participants were farmers and students combined. The following were most common subsites identified: nasopharynx (n = 25), larynx (n = 12), and tongue (n = 10); 93.5% were squamous cell carcinoma. Sixteen samples (55.2%) tested p16 positive, of these 2 (12.5%) tested positive with HPV polymerase chain reaction. One of these was from an 87-year-old female who was diagnosed with tongue cancer. Molecular analysis revealed the genotype to be HPV52, and the other was from a 49-year-old male with cancer of the postnasal space who had multiple coinfection with HPV35, -52, and -59 genotypes. CONCLUSION HNC represented 8.8% of the malignancies at Alexandria Cancer and Palliative Care Hospital; 55.2% tested p16 positive and the study managed to detect 3 high-risk HPV genotypes, HPV35, HPV52, and HPV59.
Improving Care for Children With Cancer in Sub-Saharan Africa Through Distance-Based Nursing Education
Authors: Hockenberry Marilyn , Mulemba Tadala , Nedege Aisha , Madumetse Kitsiso , Higgins Jennifer 
Published: July 2020

PURPOSE Nursing specialization in the care of children with cancer provides the foundation for implementing successful pediatric oncology treatment programs throughout the world. Whereas the burden of childhood cancer care is highest in low- and middle-income countries (LMICs), opportunities for continuing nursing specialization are extremely limited. The Global HOPE Initiative, part of Texas Children’s Hospital in Houston, TX, has developed and implemented a distance-based training program for nurses working in sub-Saharan Africa. METHODS After a needs assessment, the program was developed using the Internet-based, open-sourced education platform, MOODLE. MOODLE is an acronym for Modular Object-Oriented Dynamic Learning Environment, an online learning management system that provides custom learning environments. As Internet access can be difficult at the clinical sites, computer tablets are provided with all educational materials downloaded from the MOODLE learning site. Courses are taught using a modular approach and core competencies established for each module. Zoom and WhatsApp technologies are used for shared learning discussions. A Project ECHO (Extension for Community Healthcare Outcomes) for Global HOPE Nursing was implemented monthly to support the growth of the distance-based learning network. RESULTS This distance-based education program teaches the principles of nursing care for a child with cancer and has been implemented in Malawi, Uganda, and Botswana, where 35 nurses are now enrolled. Formal course evaluation includes written pre- and post-tests and simulated checkoffs on essential pediatric oncology nursing competencies, such as chemotherapy administration. Sixteen nurses have completed the program in the first year and significant improvement in knowledge, self-competency, and skills was found. CONCLUSION The success of this distance-based learning program emphasizes the importance of formal training for nurses in LMICs to become full-time specialists in pediatric oncology nursing. Education programs that build capacity to develop specialists in pediatric oncology nursing are essential to improve global cure rates for children with cancer in LMICs.
Toward Cervical Cancer Elimination: Evaluation of Access to Diagnostic Services After Referral to a Specialist Gynecologist Clinic at a Major Referral Hospital in Kisumu, Kenya
Authors: Mungo Chemtai , Omoto Jackton , Gwer Stephen , Wameyo Akwabi , Kays Muruka , Ganda Gregory 
Published: July 2020

PURPOSE Women in low- and middle-income countries bear a disproportionate burden of cervical cancer incidence and mortality. WHO recommends screening with visual inspection with acetic acid (VIA), followed by treatment in a screen-and-treat approach. We evaluate access to diagnostic services after referral for VIA-positive or suspicious lesions to a gynecologist-led colposcopy clinic at a major government referral and teaching hospital in Kisumu, Kenya. METHODS Data on women who were referred for colposcopy at a gynecologist clinic at the Jaramogi Oginga Odinga Teaching and Referral Hospital with positive VIA from referral clinics from 2014 to 2017 were abstracted. We determined the proportion of referred women screening positive after colposcopy-based screening by a gynecologist, the proportion accessing diagnostic biopsy, and histologic results after positive or suspicious lesions. Treatment ascertainment is ongoing. RESULTS Four hundred five women were evaluated after referral for positive VIA screening or suspicious lesions. Mean age was 40.2 years and mean parity was 4 children, with 53% of women self-reporting positive HIV status. Two hundred thirty-three referred women (57.5%) were found to have positive or suspicious lesions after colposcopy-based screening by a gynecologist. Of these women, 147 (63%) had a biopsy performed and results were available for 110 patients (74.8%). Eighty-six women did not receive biopsy, despite positive colposcopy, primarily because of associated costs or lack of supplies. Among women with biopsy results, 25 (22.7%) were benign, 18 (16.4%) had cervical intraepithelial neoplasia grade 1, 9 (8.2%) had cervical intraepithelial neoplasia grade 2 and 3, 57 (51.8%) had squamous cell carcinoma, and 1 (0.9%) had nondiagnostic results. CONCLUSION While drawing from observational, paper-based clinical data with incomplete records, our evaluation demonstrates significant challenges in the cervical cancer prevention cascade at a tertiary referral hospital. This calls for strengthening the ability of facilities to adequately evaluate at-risk women, remove financial barriers, and invest in database systems to facilitate evaluation.
Implementation of Tanzania’s National Cancer Treatment Guidelines: A Qualitative Approach to Clinical Systems
Authors: Luhar Rohan , Nyagabona Sarah K. , Tarimo Edith , Said Mwamvita , Selekwa Msiba , Meena Stephene S. , Mushi Beatrice , Mvungi Nanzoke , Siu Sadiq , Ngoma Mamsau , Van Loon Katherine , Ndumbalo Jerry , DeBoer Rebecca J. 
Published: July 2020

PURPOSE In response to the increasing burden of cancer in Tanzania, the Tanzanian Ministry of Health Community Development, Gender, Elderly, and Children plans to launch their first National Cancer Treatment Guidelines. These guidelines will provide an opportunity to improve and standardize care at Ocean Road Cancer Institute (ORCI), the national cancer center, where previous data suggest that patients do not consistently receive standard treatment. A theory-informed implementation strategy will be conducted to facilitate the routine use of guidelines among health care providers at ORCI. As part of the needs assessment for this effort, this study explored the barriers to and facilitators of guideline-concordant care at ORCI. METHODS We conducted three focus groups with participants stratified by profession, which included oncologists, radiotherapists, oncology residents, and nurses. A discussion guide was used to generate discussion about multiple aspects of current clinical processes at ORCI. Audio recordings were transcribed and translated to English, and data were analyzed using the framework method. RESULTS A total of 21 participants helped identify institutional and systemic factors that were internal and external to the clinical systems at ORCI that may affect guideline-concordant care. These can be categorized into the following: strengths and facilitators, barriers, and suggestions for improvement. Internal facilitators include multidisciplinary patient management, government-sponsored free cancer care, community engagement, and providers’ motivation for continuous learning and improvement. Internal barriers include interdepartmental and interinstitutional communication gaps, resource limitations for specialized services, high patient volumes, and patient misconceptions and nonadherence. Participants offered many practical suggestions for improving clinical systems at ORCI. CONCLUSION Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect the uptake of the National Cancer Treatment Guidelines. Findings have been used to recommend quality improvement and environmental restructuring measures at ORCI that will inform the broader guideline implementation strategy.