bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival Analysis of Elderly Patients Over 65 Years Old With Stage Ii/iii Gastric Cancer Treated With Adjuvant Chemotherapy After Laparoscopic D2 Gastrectomy: a Retrospective Cohort Study
Authors: Liang Yanrui , Zhao Liying , Chen Hao , Lin Tian , Chen Tao , Zhao Mingli , Hu Yanfeng , Yu Jiang , Liu Hao , Li Guoxin 
Published: August 2020

Abstract
Background: The benefits of adjuvant chemotherapy for elderly patients (age >65) with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. To evaluate the effectiveness and complications of adjuvant chemotherapy in elderly patients (>65 years of age) after laparoscopic D2 gastrectomy.Methods: This was a retrospective cohort study of elderly patients (>65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy between 2004 and 2018. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), circulating tumor cells (CTCs), chemotherapy duration, and toxicity were examined. Results: There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were ten (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1-/3-/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P=0.018). For stage III patients, the 1-/3-/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P=0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR=0.568, 95%CI: 0.357-0.903, P=0.017) and DFS (HR=0.511, 95%CI: 0.322-0.811, P=0.004) in stage III patients. CTC >0 had no significant impact on the benefits of adjuvant chemotherapy on OS and DFS.Conclusions: This study suggested that adjuvant chemotherapy significantly improves OS and DFS for elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.
ITGA5 Is a Prognostic Biomarker and Correlated with Immune Infiltration In Gastrointestinal Cancers
Authors: Zhu Hai , Wang Gang , Zhu Haixing , Xu Aman 
Published: August 2020

Abstract
Background: Integrin Subunit Alpha 5 (ITGA5) belongs to the integrin alpha chain family, is vital for promoting cancer cell invasion, metastasis. However, the correlation between ITGA5 expression and immune infiltration in gastrointestinal (GI) tumors remain unclear.Methods: The expression levels of ITGA5 were detected by Oncomine and Tumor Immune Estimation Resource (TIMER). The association between ITGA5 and prognosis of patients was identified by Kaplan–Meier plotter, Gene Expression Profiling Interactive Analysis 2(GEPIA2) and PrognoScan. We evaluated the correlation between ITGA5 expression and immune infiltrating level via TIMER. Besides, TIMER and immunohistochemistry (IHC) staining were used to explore correlations between ITGA5 expression and markers of immune infiltrates cells. Furthermore, we constructed protein-protein interaction (PPI) network and performed functional enrichment by GeneMANIA and Metascape.Results: ITGA5 was generally overexpressed and correlated with worse prognosis in multiple types of GI tumors. In addition, ITGA5 expression levels was significantly associated with tumor purity and immune infiltration levels of different immune cells in GI tumors. Interestingly, Immune markers for monocytes, tumor - associated macrophages (TAMs), macrophages 2 (M2) cells and T-helper 2 (Th2) cells were found to be significantly and positively correlated with ITGA5 expression levels in colon and gastric cancer. Results from IHC staining further proved that markers of Th2 and M2 cell were significantly increased in gastric cancer patients with high ITGA5 expression levels. Lastly, interaction network and function enrichment analysis revealed ITGA5 were mainly involved in “integrin mediated signaling pathway”, “leukocyte migration”, “cell-substrate adhesion”.Conclutions: our study demonstrated that ITGA5 may act as an essential regulator of tumor immune cell infiltration and a valuable prognostic biomarker in GI tumors. Additional work is needed to fully elucidate the underlying mechanisms behind these observations.
The Mechanism of Jinqi Jiangtang Tablet in Treatment of Type 2 Diabetes Mellitus Based on Network Pharmacology
Authors: Yang Mingjun , Song Boni , Bing Zhitong , Liu Juxiang , Li Rui , Zhang Jingyun , Yuan Lingyan , Yang Lijuan 
Published: August 2020

Abstract
Background: Type 2 Diabetes Mellitus(T2DM) is an endocrine disease that caused mainly by insulin resistance (IR) and β cell dysfunction. The incidence of T2DM is quite high in the worldwide. To explore the molecular mechanism of Jinqi Jiangtang Tablet(JJT) in treating of T2DM based on Network Pharmacology. Methods: The active compounds, targets of three Traditional Chinese medicines in JJT were obtained by the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） database and Uniprot database; The targets of T2DM were screened through the Drugbank database; The compound-target network was constructed via the Cytoscape 3.7.2 software and used the built-in Network analyzer to analyze and select the key active compounds; The overlapping targets of drug and disease targets were gained by the VENNY online tool and the targets were built by STRING website to select the key genes; Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were performed on the potential targets using DAVID6.8 online tool to study the mechanism of overlapping targets. Via Systems Dock platform to validate the interaction between compound and targets Results: Twenty-five active compounds of JJT were screened, 101 drug targets, 142 disease targets and twenty-one overlapping targets. GO enrichment analysis showed that the biological processes (BP)mainly included the blood circulation ,etc. Cell composition(CC) mainly affected the integral component of plasma membrane, etc. Molecular functions(MF) mainly involved alpha-adrenergic receptor activity, etc. KEGG pathway analysis showed that there were twelve pathways related to T2DM, among which PPAR signaling pathway was related to T2DM mostly. RXRA is one of key targets of JJT and berberine performed well. Conclusions: This study revealed the mechanism of JJT in treatment of T2DM preliminarily and supplied a further foundation for studying its mechanism.
Factors Associated with Adult Mental Health Treatment Among Youth with and without Adverse Childhood Experiences from the 1997 National Longitudinal Survey of Youth
Authors: Benevides Teal W. , Heboyan Vahe , Tiwari Ashwini , Douglas Megan 
Published: August 2020

Abstract
Background: Evidence suggests that childhood is an important critical period for adult mental health outcomes. Most studies evaluating childhood factors use cross-sectional data, limiting our understanding of life course factors contributing to mental health. The purpose of this study was to evaluate the contribution of life course factors on adult mental health treatment from a longitudinal cohort of U.S. respondents. Methods: We used data from the National Longitudinal Survey of Youth-1997 (N=8,984) through the 2011 data collection year, in which n=7,009 adult respondents reported on the number of mental health visits between 2009-2011. We used zero-inflated negative binomial regression to evaluate the impact of childhood, adolescent, and adult factors on mental health visits. Results: Respondents with more than three adverse childhood experiences (ACE) reported in adolescence were significantly more likely to utilize mental health treatment as an adult (Incidence Rate Ratio[IRR]=1.30). No other childhood or adolescent factors contributed to adult mental health utilization. Adult factors associated with greater mental health visits included: having any health insurance (IRR=1.40), being unemployed (IRR=1.56) or employed part-time (IRR=1.31). African-American respondents had significantly fewer mental health visits than white respondents (IRR=0.79). Non-significant factors included: gender, ethnicity, parent-reported childhood emotional problem, family receipt of governmental assistance as an adolescent, living in a high-poverty household as an adult, and living in a state with high unemployment. Conclusions: Critical periods of development, combined with cumulative risk and protective factors, contribute to adult mental health seeking. Adolescence is a critical period for trauma and later need for mental health treatment. Other factors, such as full-time employment, appear to be associated with reduced likelihood of the need for mental health treatment. Future evaluation of community and population-based approaches, including policy interventions, is needed to understand risk and protective factors contributing to mental health across the life course.
Scutellarin Ameliorated Carbon Tetrachloride-Induced Chronic Liver Injury in Mice
Authors: Miao Zhimin , Zhao Yingying , Li Chunyan , Chen Lingmin , Zhou Jianeng , Lai Yong , Lan Hai 
Published: August 2020

Abstract
Background: Erigeron breviscapus (Vant.) Hand. -Mazz. is an edible and traditional medical herb and its extract scutellarin (SCU) is a widely used flavonoid showing anti-oxidant and anti-inflammatory activities. The purpose of this study was to evaluate the hepatoprotective effect of SCU on carbon tetrachloride (CCl4)-induced chronic liver injury in mice and reveal the underlying mechanisms. Methods: Chronic liver injury in mice was induced by intraperitoneal injection of 1 ml/kg CCl4 every three days. SCU (15 mg/kg, 30 mg/kg and 60 mg/kg) was administered through gavage every day. Bifendate (120 mg/kg) serves as a positive drug to validate the effectiveness of SCU.Results: The hepatoprotective effect of SCU was confirmed by liver function analysis, histological analysis and TUNEL assay. Administration of SCU recovered the activities of superoxide dismutase (SOD) and reduced the production of malondialdehyde (MDA). Additionally, treatment with SCU significantly decreased the mRNA levels of pro-inflammatory cytokines including IL-6, IL-1β and TNF-α. Moreover, SCU treatment suppressed the activation of NF-κB by decreasing the degradation of IκBα and inhibited the expression of CYP2E1. The 16S rRNA sequencing demonstrated that intake of SCU significantly remodeled gut microbiota, especially enriching the following: Lactobacillus, Coprobacillus, Akkermansia, Bifidobacterium, Parabacteroides. Conclusion: Our findings showed that SCU effectively ameliorated CCl4-induced chronic liver injury. This hepatoprotective effects might be attributed to inhibition of CCl4-induced NF-κB and CYP2E1 activation and enrichment of beneficial microbial community.
Radical Hysterectomy Versus Simple Hysterectomy and Brachytherapy for Patients with Stage II Endometrial Cancer
Authors: Wang Ming , Ran Ran , Wu Yumei 
Published: August 2020

Abstract
BACKGROUND: To compare the survival outcome between radical hysterectomy and simple hysterectomy with implants radiation in patients with stage II endometrial cancer.METHODS: This is a retrospective cohort study. We identified 1349 patients diagnosed with stage II endometrial cancer from Jan 1, 1988 to Dec 31 2015 in the Surveillance, Epidemiology, and End Results. Patients were divided into two groups based on the primary treatment (simple hysterectomy combined with brachytherapy or radical hysterectomy). The primary outcome was the rate of overall survival and cause-specific survival of two groups.RESULTS: A total of 1349 patients were enrolled in the study, 117(7.35%) patients received radical hysterectomy and 460 patients who received simple hysterectomy and vaginal brachytherapy were selected as control. All patients received external beam radiation therapy after the surgery. Overall, the median follow-up duration was 82.77±1.44months (95%CI: 79.94-85.61months). There was no difference in the baseline information between two groups, including ages, ethnicity, and rates of histologic subtypes. The 5-year mortality was 62.31% among women who underwent radical hysterectomy which was lower than 78.48% among those who underwent simple hysterectomy and vaginal brachytherapy (HR, 2.22; 95% CI, 1.52 to 3.24; P <0.001 by the log-rank test). Women who underwent radical hysterectomy also had shorter 5-year cause-specific survival (74.60 vs.85.38%; HR, 1.91; 95% CI, 1.13 to 3.23; P =0.01 by the log-rank test) than those who underwent simple hysterectomy and vaginal brachytherapy. However, the negative outcomes were further validated in patients with high-risk endometrial cancer, not in patients with grade 1-2 low-risk EC both on cause-specific survival and overall survival. Grade 3 low-risk endometrial cancer was only found with lower overall survival not cause-specific survival.CONCLUSIONS: This study revealed that in patients’ stage II high-risk endometrial cancer, radical hysterectomy radiation was associated with shorter overall survival and cause-specific survival than simple hysterectomy and vaginal brachytherapy.
Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.
Authors: Osuafor Christopher N , Davidson Catriona , Mackett Alistair J , Goujon Marie , Poel Lelane Van Der , Taylor Vince , Preller Jacobus , Goudie Robert J B , Keevil Victoria L 
Published: August 2020

Abstract
Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.
Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome
Authors: YAMAN Ferda , Baydogan Nurdan , İncesulu Armağan , Bilir Ayten 
Published: August 2020

Abstract
Background

Long QT syndrome (LQTS) is an inherited disorder of the heart’s electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. The clinical symptoms of LQTS are heart palpitations, syncope, anoxic seizures secondary to ventricular arrhythmia, and torsades de pointes.
Case:

We present here a 17-month-old male patient with bilateral sensorineural hearing loss who underwent general anesthesia for a cochlear implant. The surgical team was advised about the possible risks of using local anesthesia without adrenaline. A defibrillator, which was checked for pediatric use, was made available in the operating room. After the vascular access was opened, the patient was provided with induction propofol, remifentanil, and rocuronium, and anesthesia was maintained using an intravenous anesthetic. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex.
Discussion

LQTS patients have developed arrhythmia and sudden cardiac arrest from administration of sevoflurane and neostigmine during anesthesia. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied. In addition, a defibrillator was available for immediate use during the perioperative period.
Conclusion

Anesthesia can be safe by using intravenous rocuronium and sugammadex and local anesthetic without adrenaline.
Investigation of the Mechanisms of Neuroprotection Mediated by Lobelia Species via Computational Network Pharmacology and Molecular Modeling
Authors: Zheng Qinfang , Fang Liangzi , Huang Xiaolong , Wang Ye , Zhang Shuihan 
Published: August 2020

Abstract
BackgroundSeveral species of the medicinally valuable genus Lobelia (Campanulaceae) exhibit neuroprotection. While the neuroprotective mechanisms of some components (e.g. lobeline, lobelanine, and lobelanidine) belonging to the L. nicotianaefolia or L. inflata are extensively characterized, there remains the need to study and elucidate the mechanism of action of other species and their active components. In this work, we have studied the neuroprotective mechanism of the pharmacokinetically favorable active compounds of 17 Lobelia species.MethodsNetwork pharmacology approach and molecular modeling were employed. We have conducted drug-likeness evaluation, oral bioavailability prediction followed by the Gene Ontology (GO) terms and pathways enrichment analysis, protein-protein and protein-compound interaction network construction and analysis, and molecular docking studies. Five neurodegenerative diseases viz. Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, epilepsy, and Amyotrophic lateral sclerosis along with the common neuroprotection mechanism-associated genes were evaluated.ResultsWe revealed the neuroprotective mechanism of the active ingredients of Lobelia species. Our study strongly indicates that 12 unique active ingredients viz. luteolin, kaempferol, acacetin, chryseriol, norlobelanine, lobelanine, 2-[(2R,6S)-6-[(2R)-2-hydroxy-2-phenylethyl]-1-methylpiperidin-2-yl]-1-phenylethanone, hydroxygenkwanin, lobelanidine, quercetin, and diosmetin regulates 31 targets within multiple signaling pathways. The nitric oxide synthase, brain (NOS1), androgen receptor (ANDR), sodium- and chloride-dependent GABA transporter 1 (SC6A1), apoptosis regulator Bcl-2 (BCL2), RAC-alpha serine/threonine-protein kinase (AKT1), cellular tumor antigen p53, apoptosis regulator BAX, and tumor necrosis factor (TNFA) were identified as the majorly regulated genes. A majority of these target proteins act via several cancer-related pathways proven to have cross-talks with the pathogenesis of neurodegenerative diseases.ConclusionsThis study explains how the active ingredients of the Lobelia species exhibit their neuroprotective actions and provide a reference basis to investigate their pharmacological effects in detail.
Knowledge of Resident Doctors Regarding Palliative Care: A Systematic Review
Authors: Oliveira Arlene Sousa Barcelos , Hernandes Janete Capel , Castro Viviane Cruvinel Di , Santana Cristina Celia Almeida Pereira , Montagnini Marcos Luis , Porto Celmo Celeno 
Published: August 2020

Abstract
Background: Palliative care aims to improve life quality of patients and their families, preventing and relieving people's suffering in coping life-threatening diseases. Many challenges are linked to palliative care, such as the lack of specific disciplines in doctors training; the scarcity of services and specialized programs in palliative care in public and private health systems and the lack of training for resident doctors. Objective: To identify knowledge of resident doctors regarding palliative care. Method: A systematic review according to PRISMA (2009), with searches carried out in Cochrane Library, MEDLINE / PubMed, Scopus, Web of Science databases and gray literature of Brazilian Digital Library of Theses and Dissertations (BDTD), with the acceptance of articles in English, Portuguese and Spanish, without delimitation of publication date, geographic location and type of study. Only studies with resident doctors were included. Results: During the search, 931 articles were found. Of these, 363 were discarded because they were duplicated and 568 were discarded after reading titles and abstracts, leaving 24 articles for complete reading, which after reading and consensus of the three researchers, only 07 of these articles were included in the comparative synthesis. Three intervention studies, two cross-sectional and two qualitative studies were found. In the observed data, all the analyzed studies had a sample of less than 100 subjects, with a total of 442 subjects, of which 137 (30.99%) were women and 111 (25.12%) men, with average age ranging from 26.6 to 32.1. Conclusions: The studies analyzed in this review indicate that the knowledge of resident doctors was limited and insufficient related to palliative care, what indicates the need of greater investments in training, through teaching-learning methods based on rotation, simulation and others, thus improving not only knowledge, but also the practice in palliative care. PROSPERO record: CRD42020159428
Oral beta-lactam step down in bacteremic E. coli urinary tract infections
Authors: Saad Stephan , Mina Neil , Lee Colin , Afra Kevin 
Published: August 2020

Abstract
Background: Literature is scarce regarding oral step down to beta-lactams in bacteremic urinary tract infections. Oral fluoroquinolones are an accepted and common step down for bacteremic urinary tract infections; however, their use is associated with mounting safety concerns. We compared clinical cure in patients with E. coli bacteremic urinary tract infections who were stepped down to oral beta-lactams compared to oral fluoroquinolones.Methods: This multicentre retrospective cohort study included patients with first positive concurrent urine and blood cultures from January 2016 to December 2016. Patients were included if they received empiric intravenous beta-lactam therapy with step down to either oral beta-lactam or fluoroquinolone for treatment completion. The primary outcome was clinical cure. Secondary outcomes were length of hospitalization, all-cause mortality and C. difficile infection. Multivariate analysis and propensity score were used to control for confounding.Results: A total of 207 patients were identified with bacteremic E.coli urinary tract infections. Clinical cure was achieved in 72/77 (94%) in the oral beta-lactam group versus 127/130 (98%) in the oral fluoroquinolone group (absolute difference − 4.2%, 95% confidence interval [CI] -10.3–1.9%, p = 0.13). The adjusted odds ratio (OR) for clinical cure with oral beta-lactams was 0.31 (95% CI 0.05–1.90, p = 0.21); propensity score adjusted analysis showed a similar result. There was no statistically significant difference in secondary outcomes.Conclusions: Oral beta-lactams appear to be a safe and effective step down option in bacteremic E. coli urinary tract infections compared to oral fluoroquinolones.