bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transperineal ultrasound of fetal head progression in prolonged labor: women’s acceptance and ability to predict the mode of delivery
Authors: Solaiman Sara A. , Atwa Khaled A. , Gad Azza A. , al-Shatouri Mohammad 
Published: June 2020

Abstract
Background
Digital transvaginal examination of fetal head progression is subjective evaluation with many limitations. Using ultrasound (US) in the assessment of labor progression in prolonged labor is the current trend to predict the mode of delivery. The study intends to evaluate the women’s acceptance to the transperineal ultrasound (TPUS) compared with digital transvaginal examination, and its ability to predict the mode of delivery in prolonged labor. We included 28 pregnant ladies in a prolonged active phase of first or second stages of labor and followed them till delivery. TPUS was used to measure the fetal head–perineum distance (FHPD) and the angle of fetal head descent.

Results
Of the 28 participants, 53.5% of them delivered vaginally and 46.5% by Cesarean section (CS). All pregnant ladies described the TPUS as more convenient and less painful than digital vaginal examination. Cervical dilatation was negatively correlated with FHPD, and positively correlated with angle of fetal head descent. Both FHPD and angle of fetal head descent had a strong significant negative correlation. Using a cutoff value of 115° for the angle of fetal head descent, the positive predictive value (PPV) of vaginal delivery was 87%; using a cutoff value of 4.2 cm for FHPD, the PPV for vaginal delivery was 85%.

Conclusion
TPUS is more convenient, more accepted, and less painful than digital vaginal examination. Angle of head descent and FHPD are reliable predictors of the mode of delivery in prolonged labor.
Predictors of subclinical shoulder joint affection in patients with rheumatoid arthritis by ultrasonography
Authors: Alian Samah M. , Elsiad Elsayed A. , Elsayed Alzahraa E. , Hammad Mohamed A. 
Published: June 2020

Abstract
Background
To assess subclinical involvement of shoulder joints in patients with rheumatoid arthritis (RA) by using musculoskeletal ultrasound (MSUS) and detect their predictors.

Results
We found 75% of the patients have subclinical ultrasound changes in their shoulder joints where 65% of the patient’s shoulders are affected. About 57.5% of the shoulder joints showed peri-articular structural changes by ultrasound, while the articular changes were 36.9% with the most frequent one being supraspinatus tendinopathy (43.12%) followed by subacromial-subdeltoid bursitis [total (31.87%), effusion (16.87%), and synovial hypertrophy (15%)], supraspinatus tendon partial tear (30.62%), and long head of biceps tenosynovitis (effusion only) (28.75%), while the least frequencies were glenohumeral joint erosion (11.25%) and synovitis (12.5%). Older age and longer disease duration were significant predictors for the peri-articular changes with p value < 0.5, while high disease activity, seropositive rheumatoid factor, and long disease duration were significant predictors for the articular changes with p value < 0.5.

Conclusion
Although shoulders were clinically silent in RA patients, we found a high percentage of subclinical abnormalities detected by MSUS, which were more predominant in the peri-articular structures. MSUS is a simple and non-invasive technique that can be used to detect RA shoulder subclinical affection.
Predictors of subclinical cardiovascular affection in Egyptian patients with juvenile idiopathic arthritis subtypes
Authors: Alian Samah M. , Esmail Hanan A. , Gabr Marwa M. , Elewa Enass A. 
Published: June 2020

Abstract
Background
To assess the subclinical cardiovascular affection in juvenile idiopathic arthritis (JIA) Egyptian patient subtypes using Doppler ultrasonography (US) for carotid and femoral arteries and detecting their predictors

Results
Forty percent of the patients were polyarticular type, while 40% were systemic onset and 20% were oligoarticular. There was a statistically significant difference between JIA and controls in all parameters of subclinical atherosclerosis by ultrasonography except right external carotid velocity and (right and left) femoral velocity. There was also a highly significant increase in intima-media thickness (IMT) in systemic onset type of JIA. There was a statistically positive correlation between increased internal carotid velocity (right and left) and high erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), lipid profile, and disease activity. High disease activity and lipid profile were valid predictors of subclinical atherosclerotic cardiovascular affection in JIA.

Conclusion
Increased cardiovascular risks and subclinical atherosclerosis in patients with JIA especially systemic onset type may be due to higher prevalence of multiple risk factors in these patients. Doppler ultrasonography is a simple, non-invasive technique which can be used to detect subclinical atherosclerosis in JIA. Control of disease activity by treat to target strategy and proper diet control should be applied for every patient with JIA especially those with systemic onset type for future prevention of cardiovascular disease.
Interface between community intellectual disability and general adult psychiatry services
Authors: Hawramy Muzafar 
Published: June 2020

SUMMARYPeople with intellectual disability can have a range of common mental health difficulties that sit at the interface of two psychiatry subspecialties: intellectual disability and general adult psychiatry. Clinical presentations, comorbidities and complexities can affect the setting of boundaries between the two disciplines. This article touches on current concepts, drives for inclusion of people with intellectual disability in mainstream psychiatry services and some of the difficulties at the interface. It focuses on potential solutions for managing this interface between the two subspecialties.
Encouraging recruitment into psychiatry: practical initiatives
Authors: Halder Neel , Mulliez Zoé 
Published: June 2020

SummaryThis article highlights key findings from a recent Royal College of Psychiatrists project showing that many UK medical schools are embracing the dual challenge of raising students’ interest in psychiatry and ensuring that all doctors can support patients with mental illness. It focuses on two novel approaches to boosting recruitment into psychiatry: I'm a Medic Get Me Out of Here, an online outreach activity enabling schoolchildren to ask questions of health professionals in real time; and a living library, which creates a safe space for dialogue where topics are discussed openly between human books (professionals) and readers (undergraduate students) to challenge stereotypes. It is recommended that sharing these and other examples of good practice will help all medical schools encourage recruitment in psychiatry more widely.
Salvage Therapy With Multikinase Inhibitors and Immunotherapy in Advanced Adrenal Cortical Carcinoma
Authors: Miller Kevin C , Chintakuntlawar Ashish V , Hilger Crystal , Bancos Irina , Morris John C , Ryder Mabel , Smith Carin Y , Jenkins Sarah M , Bible Keith C 
Published: June 2020

Abstract

Background
Median overall survival is 12 to 15 months in patients with metastatic adrenal cortical carcinoma (ACC). Etoposide, doxorubicin, and cisplatin with or without the adrenolytic agent mitotane is considered the best first-line approach in this context, but has limited activity and no curative potential; additional salvage therapeutic options are needed.

Methods
Fifteen total patients with recurrent/metastatic ACC were treated with single-agent multikinase inhibitors (MKI) (n = 8), single-agent PD-1 inhibition (n = 8), or cytotoxic chemotherapy plus PD-1 inhibition (n = 4) at our institution as later-line systemic therapies in efforts to palliate disease and attempt to achieve a therapeutic response when not otherwise possible using standard approaches.

Results
Two of 8 patients (25%) treated with single-agent MKI achieved a partial response (PR), including 1 PR lasting 23.5 months. Another 3 patients (38%) had stable disease (SD); median progression-free survival (PFS) with single-agent MKI was 6.4 months (95% confidence interval [CI] 0.8—not reached). On the other hand, 2 of 12 patients (17%) treated with PD-1 inhibitors (either alone or in combination with cytotoxic chemotherapy) attained SD or better, with 1 patient (8%) achieving a PR; median PFS was 1.4 months (95% CI 0.6-2.7).

Conclusions
Our single-institution experience suggests that select ACC patients respond to late-line MKI or checkpoint inhibition despite resistance to cytotoxic agents. These treatments may be attractive to ACC patients with limited other therapeutic options. The use of MKI and immunotherapy in ACC warrants prospective investigation emphasizing parallel correlative studies to identify biomarkers that predict for response.
Impact of dosimetric differences between CT and MRI derived target volumes for external beam cervical cancer radiotherapy
Authors: Batumalai Vikneswary , Burke Siobhan , Roach Dale , Lim Karen , Dinsdale Glen , Jameson Michael , Ochoa Cesar , Veera Jacqueline , Holloway Lois , Vinod Shalini 
Published: June 2020

Objectives:
The use of MRI is becoming more prevalent in cervical cancer external beam radiotherapy (RT). The aim of this study was to investigate the impact of dosimetric differences between CT and MRI-derived target volumes for cervical cancer external beam RT.

Methods:
An automated planning technique for volumetric modulated arc therapy was developed. Two automated planning plans were generated for 18 cervical cancer patients where planning target volumes (PTVs) were generated based on CT or MRI data alone. Dose metrics for planning target volumes and organs at risk (OARs) were compared to analyse any differences based on imaging modality.

Results:
All treatment plans were clinically acceptable. Bladder doses (V40) were lower in MRI-based plans (p = 0.04, 53.6 ± 17.2 % vs 60.3 ± 13.1 % for MRI vs CT, respectively). The maximum dose for left iliac crest showed lower doses in CT-based plans (p = 0.02, 47.8 ± 0.7 Gy vs 47.4 ± 0.4 Gy MRI vs CT, respectively). No significant differences were seen for other OARs.

Conclusions:
The dosimetric differences of CT- and MRI-based contouring variability for this study was small. CT remains the standard imaging modality for volume delineation for these patients.

Advances in knowledge:
This is the first study to evaluate the dosimetric implications of imaging modality on target and OAR doses in cervical cancer external beam RT.
Increased visceral adipose tissue in clear cell renal cell carcinoma with and without peritumoral collateral vessels
Authors: Greco Federico , Quarta Luigi Giuseppe , Grasso Rosario Francesco , Beomonte Zobel Bruno , Mallio Carlo Augusto 
Published: June 2020

Objective:
The excessive amount of adipose tissue, mainly visceral, determines adiposopathy. With respect to oncogenesis, visceral adipose tissue (VAT) releases secretes adipokines, proinflammatory citokines and growth factors, considered mediating molecules in the development of obesity-related tumors. In this study, we quantify VAT in male patients with clear cell renal cell carcinoma (ccRCC) subgrouped according to the presence or absence of peritumoral collateral vessels.

Methods:
in this retrospective study, we enrolled 141 male caucasian patients divided into 2 groups: the ccRCC group (n = 106) composed of patients with ccRCC and control group (n = 35). The ccRCC group was further divided into two subgroups: the ccRCCa subgroup which showed absence of collateral vessels (n = 48) and ccRCCp subgroup with collateral vessels (n = 58).
Total adipose tissue (TAT) area, VAT area and subcutaneous adipose tissue (SAT) area were measured in the groups and subgroups. VAT/SAT ratio was calculated for each subject.

Results:
Statistically significant differences were obtained between ccRCC group and control group for TAT area (p &lt; 0.005), VAT area (p &lt; 0.005) and SAT area (p = 0.01). Between ccRCCa subgroup and control group for TAT area (p &lt; 0.001), VAT area (p = 0.005) and SAT area (p = 0.001). Between ccRCCp subgroup and control group for TAT area (p = 0.01) and VAT area (p = 0.01).

Conclusion:
This study confirms the increase of abdominal, especially visceral, adipose tissue in ccRCC patients and demonstrates a significant VAT accumulation in both categories of patients with and without peritumoral collateral vessels.

Advances in knowledge:
Visceral adiposity is present in patients with ccRCC regardless the presence of peritumoral collateral vessels, with surprisingly stronger results in the ccRCCa subgroup.
Perception of effective access to health services in Territorial Spaces for Training and Reincorporation, one year after the peace accords in Colombia: a cross-sectional study
Authors: Fernández-Niño Julián Alfredo , Chavarro Lud Magdy , Vásquez-Rodríguez Ana Beatriz , Rojas-Botero Maylen Liseth , Hernández-Neuta Ginna Esmeralda , Peñuela-Poveda Ana Maria , Rodríguez David Alejandro 
Published: June 2020

Backgrounds: The signing of the peace accords in Colombia created challenges that are inherent to post-conflict transitions. One of those is the process of reintegrating ex-combatants into society, in which ensuring their rights to health is a particularly significant challenge in rural areas affected by armed conflict. These areas, known as Territorial Spaces for Training and ReintegrationReincorporation (ETCR, in Spanish), are geographically dispersed throughout 24 municipalities and 13 departments in Colombia. This study aimed to describe how ex-combatants in ETCR regions perceived access to health services one year after the signing of the peace accords.Methods:A descriptive, cross-sectional study was performed between September and October 2018. It included 591 adults and their families, from 23 ETCRs. The study was designed, culturally validated, and piloted. Interviewers were trained and a structured survey was administered containing five dimensions that characterized the perception of effective access to health services.Results: The majority of interviewees were women, heads of household, young adults, ex-combatants, and residents in an ETCR. In total of 96.4% were enrolled in Colombia’s subsidized health system, and 20.8% indicated that a member of their household required emergency health services. The regional health center provided the majority of the services. Most of those surveyed (96.0%) reported that they did not have to pay for the services, and that they received respectful (91.6%) and good quality (66.6%) care. There were few referrals to disease prevention and health promotion activities, and only 19.0% of households reported having been visited by extramural health care teams, whose activities were highly valued (80%). Lastly, there was little knowledge about community health activities.Conclusions: While residents of ETCR regions have a favorable perception of their access to health services, they need to be made aware of extramural and public health activities.
Topical ozonated virgin coconut oil improves wound healing and increases HSP90α, VEGF-A, EGF, bFGF and CD34 in diabetic ulcer mouse model of wound healing
Authors: Yuniati Renni , Subchan Prasetyowati , Riawan Wibi , Khrisna Matthew Brian , Restiwijaya Maryam , Dyan Kusumaningrum Niken Safitri , Nur Muhammad 
Published: June 2020

Background: Diabetes is a disease that affects people worldwide, including in Indonesia. The prevalence of diabetes in Indonesia is increasing from year to year. One of the most devastating complications of diabetes mellitus is diabetic ulcers, which is a limb-threatening complication. Over the past few decades, ozone generated using plasma medical technology has been investigated as an agent that helps wound healing. This study aims to evaluate the effects of topical ozonated virgin coconut oil (VCO) in a diabetic wound mouse model. Methods: This study was an experimental study with a post-test control design. An ulcer wound model was made in 50 diabetic male Wistar mice, divided into five groups, and a control group of 10 non-diabetic mice. The control groups were given conventional therapy only and the treatment groups were also given topical ozonated VCO with different flow durations (0 min, 90 min, 7 h, 14 h). Macroscopic appearance and wound contraction were observed. HSP90β, VEGF-A, EGF, bFGF and CD34 levels were measured from the immunostained slices of wound margins. Results: The reduction of wound length was proportionally related to the duration of ozone flow. Ozonated VCO with a longer duration of ozone flow healed the wound more quickly and had the shortest wound length. VCO with ozone flow for 14 hours (16837.10 µm) had the biggest reduction in wound length compared to other groups. The wounds treated with ozonated VCO showed an increase in HSP90β, VEGF-A, EGF, bFGF and CD34 levels that correlated to improved wound healing. A longer period of treatment resulted in higher levels of wound healing biomarkers compared to shorter therapeutic durations. Conclusions: Topical ozonated VCO improved the wound healing process in a diabetic ulcer mouse model by improving macroscopic wound appearance and increasing levels of wound healing biomarkers.
Enclosing a pen to improve response rate to postal questionnaire: an embedded randomised controlled trial
Authors: Cunningham-Burley Rachel , Roche Jenny , Fairhurst Caroline , Cockayne Sarah , Hewitt Catherine , Iles-Smith Heather , Torgerson David J. ,   SSHeW Study Team
Published: June 2020

Background: Poor response to questionnaires collecting outcome data in randomised controlled trials (RCTs) can affect the validity of trial results. The aim of this study within a trial (SWAT) was to evaluate the effectiveness of including a pen with a follow-up postal questionnaire on response rate. Methods: A two-armed RCT was embedded within SSHeW (Stopping Slips among Healthcare Workers), a trial of slip-resistant footwear to reduce slips in NHS staff. Participants were randomised 1:1 to receive a pen or no pen with their follow-up questionnaire. The primary outcome was the proportion of participants who returned the questionnaire. Secondary outcomes were: time to response, completeness of response, and whether a postal reminder notice was required. Data were analysed using logistic regression, linear regression and Cox proportional hazards regression. Results: Overall, 1466 SSHEW trial participants were randomised into the SWAT. In total, 13 withdrew from the host trial before they were due to be sent their follow-up questionnaire, 728 participants received a pen with their questionnaire, and 725 did not receive a pen. A questionnaire was returned from 67.7% of the pen group and 64.7% of the group who did not receive a pen. There was no significant difference in return rates between the two groups (OR 1.15, 95% CI 0.92 to 1.43, p=0.22), nor level of completeness of the questionnaires (AMD -0.01, 95% CI 0.06 to 0.05, p=0.77). There was weak evidence of a reduction in the proportion of participants requiring a reminder and in time to response in the pen group. Conclusion: Inclusion of a pen with the follow-up postal questionnaire sent to participants in the SSHeW trial did not statistically significantly increase the response rate. These results add to the body of evidence around improving response rates in trials. Trial registration: ISRCTN 33051393 (for SSHEW). Registered on 14/03/2017.
Potential chimeric peptides to block the SARS-CoV-2 spike receptor-binding domain
Authors: Barh Debmalya , Tiwari Sandeep , Silva Andrade Bruno , Giovanetti Marta , Almeida Costa Eduardo , Kumavath Ranjith , Ghosh Preetam , Góes-Neto Aristóteles , Carlos Junior Alcantara Luiz , Azevedo Vasco 
Published: June 2020

Background:There are no known medicines or vaccines to control the COVID-19 pandemic caused by SARS-CoV-2 (nCoV). Antiviral peptides are superior to conventional drugs and may also be effective against COVID-19. Hence, we investigated the SARS-CoV-2 Spike receptor-binding domain (nCoV-RBD) that interacts with hACE2 for viral attachment and entry.Methods:Three strategies and bioinformatics approaches were employed to design potential nCoV-RBD - hACE2 interaction-blocking peptides that may restrict viral attachment and entry. Firstly, the key residues interacting with nCoV-RBD - hACE2 are identified and hACE2 sequence-based peptides are designed. Second, peptides from five antibacterial peptide databases that block nCoV-RBD are identified; finally, a chimeric peptide design approach is used to design peptides that can bind to key nCoV-RBD residues. The final peptides are selected based on their physiochemical properties, numbers and positions of key residues binding, binding energy, and antiviral properties.Results:We found that: (i) three amino acid stretches in hACE2 interact with nCoV-RBD; (ii) effective peptides must bind to three key positions of nCoV-RBD (Gly485/Phe486/Asn487, Gln493, and Gln498/Thr500/Asn501); (iii) Phe486, Gln493, and Asn501 are critical residues; (iv) AC20 and AC23 derived from hACE2 may block two key critical positions; (iv) DBP6 identified from databases can block the three sites of the nCoV-RBD and interacts with one critical position, Gln498; (v) seven chimeric peptides were considered promising, among which cnCoVP-3, cnCoVP-4, and cnCoVP-7 are the top three; and (vi) cnCoVP-4 meets all the criteria and is the best peptide.Conclusions:To conclude, using three different bioinformatics approaches, we identified 17 peptides that can potentially bind to the nCoV-RBD that interacts with hACE2. Binding these peptides to nCoV-RBD may potentially inhibit the virus to access hACE2 and thereby may prevent the infection. Out of 17, 10 peptides have promising potential and need further experimental validation.
CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol
Authors: McDonnell Thérèse , McAuliffe Eilish , Barrett Michael , Conlon Ciara , Cummins Fergal , Deasy Conor , Hensey Conor , Martin Ciara , Nicholson Emma 
Published: June 2020

Background:Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves.Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify changes in attendances at emergency healthcare. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic.Results and Conclusion:This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.