bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Metabolic Syndrome among Breast Cancer Survivors in East Coast of Peninsular Malaysia
Authors: Shahril Mohd Razif , Amirfaiz Syed , Lua Pei Lin , Nurnazahiah Ali , Zakarai Nor Syamimi , Lok Ving , Ahmad Aryati , Sulaiman Suhaina 
Published: August 2020

Abstract
To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia. This cross-sectional study included 95 breast cancer survivors (age 53.7±7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method. According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p<0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p<0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study. In conclusion, metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome.
Methodology in core outcome set (COS) development: the impact of patient interviews and using a 5-point versus a 9-point Delphi rating scale on core outcome selection in a COS development study.
Authors: Remus Alexandria , Smith Valerie , Wuytack Francesca 
Published: August 2020

Abstract
Background: As the development of core outcome sets (COS) increases, guidance for developing and reporting high-quality COS continues to evolve; however, a number of methodological uncertainties still remain. The objectives of this study were: (1) to explore the impact of including patient interviews in developing a COS, (2) to examine the impact of using a 5-point versus a 9-point rating scale during Delphi consensus methods on outcome selection and the COS and (3) to inform and contribute to COS development methodology by advancing the evidence base on COS development techniques.Methods: Semi-structured patient interviews and a nested randomised controlled parallel group trial as part of the Pelvic Girdle Pain Core Outcome Set project (PGP-COS). Patient interviews, as an adjunct to a systematic review of outcomes reported in previous studies, were undertaken to identify preliminary outcomes for including in a Delphi consensus survey. In the Delphi survey, participants were randomised (1:1) to a 5-point or 9-point scale for rating the importance of the list of preliminary outcomes.Results: None of the outcomes identified from the patient interviews were included in the final PGP-COS. The 5-point rating scale resulted in twice as many outcomes reaching consensus after the 3-round Delphi survey compared to the 9-point scale. Consensus on all five outcomes included in the final PGP-COS was achieved by participants allocated the 5-point rating scale, whereas consensus on four of these was achieved by those using the 9-point scale.Conclusions: Using patient interviews to identify preliminary outcomes as an adjunct to conducting a systematic review of outcomes measured in the literature does not appear to influence outcome selection in developing a COS. The use of different rating scales in a Delphi survey, however, does appear to impact on outcome selection. The 5-point scale demonstrated greater congruency than the 9-point scale with the outcomes included in the final PGP-COS. Use of a 5-point scale might be considered for Delphi surveys in COS development studies. Future research to substantiate our findings and to explore the impact of other rating scales on outcome selection during COS development, however, is still warranted.
Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma
Authors: Zheng Wenwen , Zhu Weiwei , Yu Shengqiang , Li Kangqi , Ding Yuexia , Wu Qingna , Tang Qiling , Zhao Quan , Lu Congxiao , Guo Chenyu 
Published: August 2020

Abstract
Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.
Analysis of Six Chloroplast Genomes Provides Insight into the Evolution of Chrysosplenium (Saxifragaceae)
Authors: Wu Zhihua , Liao Rui , Yang Tiange , Dong Xiang , Lan Deqing , Qin Rui , Liu Hong 
Published: August 2020

Abstract
Background: Chrysosplenium L. (Saxifragaceae) is a genus of plants widely distributed in Northern Hemisphere and usually found in moist, shaded valleys and mountain slopes. This genus is ideal for studying plant adaptation to low-light conditions. Although some progress has been made in the systematics and biogeography of Chrysosplenium , its chloroplast genome evolution remains to be investigated.Results: To fill this gap, we sequenced the chloroplast genomes of six Chrysosplenium species and analyzed their genome structure, GC content, and nucleotide diversity. Moreover, we performed a phylogenetic analysis and calculated non-synonymous (Ka) /synonymous (Ks) substitution ratios using the combined protein-coding genes of 29 species within Saxifragales and two additional species as outgroups, as well as a pair-wise estimation for each gene within Chrysosplenium . Compared with the outgroups in Saxifragaceae, the six Chrysosplenium chloroplast genomes had lower GC contents; they also had conserved boundary regions and gene contents, as only the rpl32 gene was lost in four of the Chrysosplenium chloroplast genomes. Phylogenetic analyses suggested that the Chrysosplenium separated to two major clades (the opposite group and the alternate group). The selection pressure estimation (Ka/Ks ratios) of genes in the Chrysosplenium species showed that matK and ycf2 were subjected to positive selection.Conclusion: This study provides genetic resources for exploring the phylogeny of Chrysosplenium and sheds light on plant adaptation to low-light conditions. The lower average GC content and the lacking gene of rpl32 indicated selective pressure in their unique habitats. Different from results previously reported, our selective pressure estimation suggested that the genes related to photosynthesis (such as ycf2 ) were under positive selection at sites in the coding region.
Clinical characteristics, treatment and outcome of adnexal torsion in pregnant women: a retrospective study
Authors: Wang Yong-xue , Deng Shan 
Published: August 2020

Abstract
Background: Adnexal torsion during pregnancy is a gynecological emergency. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women.Methods: A retrospective study was conducted at a tertiary center between January 2008 and January 2018. Eighty-two pregnant women with surgically confirmed adnexal torsion were included. The clinical characteristics, ultrasound data, surgical interventions and pregnancy outcomes were analyzed.Results: The median age of the patients was 28 (range, 18-38) years. The median gestational age was 11 (range, 6-31) weeks: 53 (64.6%) were in the first trimester, 21 (25.6%) were in the second trimester, and 8 (9.8%) were in the third trimester. The most common symptoms and signs were sudden pelvic pain (100%) and adnexal or pelvic masses (97.6%), followed by nausea and vomiting (61%). The Doppler blood flow signal disappeared in 62.5% of the patients. Sixty-three (76.8%) patients underwent laparoscopy, and 29 (24.2%) underwent laparotomy. The median gestational age in patients undergoing laparotomy was higher than that in those undergoing laparoscopy (26 weeks vs 10 weeks, p<0.001). Fifty-three (64.6%) patients underwent conservative surgery, with 48 detorsions and cystectomies, 2 detorsions and cyst fenestrations, 1 detorsion only and 2 salpingectomies only. Twenty-nine (25.4%) patients underwent unilateral salpingo-oophorectomy. There were no cases of postoperative thrombosis, spontaneous abortion or recurrence during the same pregnancy. Seven patients underwent simultaneous artificial abortion. One patient experienced intrauterine fetal death, and 74 patients had live births.Conclusion: Surgical intervention was required as soon as possible. Laparoscopic conservative surgery is safe and may be appropriate to preserve ovarian function.
Improving precision of field inventory estimation of above ground biomass through an alternative view on plot biomass
Authors: Kleinn Christoph , Magnussen Steen , Noelke Nils , Magdon Paul , Álvarez-González Juan Gabriel , Fehrmann Lutz , Pérez-Cruzado César 
Published: August 2020

Abstract
We contrast a new continuous approach (CA) to estimation of plot level above-ground biomass (AGB) in forest inventories with the current approach of deriving the AGB estimate exclusively from the tree-level AGB predicted for each tree in a plot; henceforth called DA (discrete approach). In CA the AGB in a forest is modelled as a continuous surface and the AGB estimate for a fixed area plot is computed as the integral of the AGB surface taken over the plot. Hence with CA, the portions of biomass in plot-trees that extend across a plot perimeter is ignored while the biomass from trees outside the plot reaching inside the plot is added. We use a sampling simulation with data from a fully mapped 2 ha area to illustrate, that important differences in plot-level AGB estimates can emerge, and that one should expect CA-based estimates of AGB to be less variable than with the DA, which translates to a higher precision of estimates from field plots: in our case study, for a target precision of estimation of 5%, the required sample size was 27% lower for small plots of 100m 2 when using the CA and 10% lower for larger plots of 1700m 2 . We discuss practical issues to implementing CA in field inventories and discuss the expected potential for applications that model biomass from remote sensing data.
Cross-cultural adaptation, validity, and reliability of the Nepali version of the Exercise Adherence Rating Scale: A methodological study
Authors: Adhikari Shambhu Prasad , Dev Rubee , Shrestha Jayana N 
Published: August 2020

Abstract
Background: The Exercise Adherence Rating Scale (EARS) is a commonly used outcome tool, which helps to identify the adherence rate of exercises and reasons for adherence and non-adherence. There is no evidence of the availability of any measurement tools to assess exercise adherence in the Nepalese context and cultural background. Therefore, we conducted a cross-cultural adaptation of the EARS into the Nepali language and investigated its reliability and validity. Methods: Cross-cultural adaptation of the EARS was done based on Beaton guidelines. Psychometric properties were evaluated among 18 participants aged 18 years or older with pre-diabetes or confirmed diagnosis of any disease who were prescribed with home exercises by physiotherapists. Any disease that limited participants from doing exercise and individuals unwilling to participate were excluded. Reliability was evaluated through internal consistency, using Cronbach’s alpha. Exploratory Factor Analysis (EFA) was performed to explore construct validity and confirm its unidimensionality. Receiver Operating Characteristic (ROC) curve was analyzed to identify cut-off score, sensitivity and specificity of the tool.Results: The Cronbach’s alpha was 0.94 for EARS-adherence behavior. The EFA of 6-items adherence behavior revealed the presence of one factor with an eigenvalue exceeding one. The scree-plot suggested for extraction of only one factor with strong loading (75.84%). The Area Under the Curve was 0.91 with 95% confidence interval 0.77 to 1.00 at p = 0.004. The cutoff score was found 17.5 with 89% sensitivity and 78% specificity.Conclusions: The EARS was cross-culturally adapted to the Nepali language. The reliability and construct validity of the Nepali version of the EARS were acceptable to assess exercise adherence in Nepali-speaking individuals. This validated tool might facilitate the evaluation of exercise-related interventions. Future studies could investigate other psychometric properties of the Nepali EARS.
Role of Circulating Tumor DNA in Evaluating Clinical Tumor Burden and Predicting Survival in Chinese Metastatic Colorectal Cancer Patients
Authors: xu xiaojing , yu yiyi , shen minna , liu menglin , wu shengchao , liang li , huang fei , zhang chenlu , guo wei , liu tianshu 
Published: August 2020

Abstract
Background:The aim of this study was to further explore the utility of ctDNA in the evaluation of clinical tumor burden and survival in Chinese metastatic CRC (mCRC) patients and to preliminarily summarize some metastatic characteristics associated with mutations in ctDNA. Patients and Methods:A four-gene mutation testing panel covering a total 197 mutation hotspots of KRAS, NRAS, BRAF and PIK3CA was used to evaluate their mutant status via next-generation sequencing of plasma from patients with mCRC. Clinical markers including CEA, CA199, CA125,NSE and LDH in serum and the sum of all tumor diameters on CT or PET/CT were collected to indicate clinical tumor burden. The correlations between cfDNA levels and clinical tumor burden were analyzed using Pearson correlation and linear regression models. The median PFS and 1-year OS rates were calculated by Kaplan–Meier (K–M) survival analysis. Results：The study enrolled 126 mCRC patients for ctDNA testing. Wild-type patients accounted for 54.8% (69/126) of the total patients, and mutated patients accounted for 45.2% (57/126) of the total patients. Mutations in KRAS, NRAS, BRAF and PIK3CA were detected in 37.3% (47/126), 1.6% (2/126), 3.2% (4/126) and 13.5% (17/126) of patients, respectively. The overall concordance rate of gene status between ctDNA and matched tissues was 78.6% (99/126). The concentration of cfDNA was significantly correlated with the levels of clinical markers, especially CEA (P<0.0001, Pearson r = 0.81), LDH (P<0.0001, Pearson r = 0.84) and the sum of tumor diameters (P<0.0001, Pearson r = 0.80). The median PFS (11.7 versus 6.6 months, P<0.0001) and 1-year OS rates (94% versus 56%, P<0.0001) were significantly different between patients with a low cfDNA concentration (≤17.91 ng/ml) and those with a high cfDNA concentration (>17.91 ng/ml). The most common metastatic site was liver (77.8%), followed by lymph nodes (62.7%), lung (40.5%), peritoneum (14.3%) and bone (10.3%), in all patients. There was no significant difference in metastasis regardless of gene status. Conclusion:These results suggested that the level of cfDNA could be a quantitative biomarker of tumor burden and could predict survival in Chinese patients with mCRC. Patients with gene mutations had a similar metastatic pattern to those with wild-type genes.
Statistical Design of Phase II/III Clinical Trials for Testing Therapeutic Interventions in COVID-19 Patients
Authors: Rai Shesh , Qian Chen , Pan Jianmin , Seth Anand , Srivast Deo K , Bhatnagar Aruni 
Published: August 2020

Abstract
Background Due to unknown features of the COVID-19 disease and complexity of the patient population, standard clinical trial designs on treatments may not be optimal in such patients. We propose two independent clinical trials designs based on careful grouping of patient and outcome measures.Methods Using the World Health Organization ordinal scale on patient status, we classify treatable patients (Stages 3-7) into two risk groups. Patients in Stages 3, 4 and 5 are categorized as the intermediate-risk group while patients in Stages 6 and 7 are categorized as the high-risk group. To ensure that an intervention, if deemed efficacious, is promptly made available to vulnerable patients, we propose a group sequential design incorporating four factors stratification, two interim analyses, and a toxicity monitoring rule for the intermediate-risk group. The primary response variable (binary variable) is based on the proportion of patients discharged from hospital by the 15th day. The goal is to detect a meaningful improvement in this response rate. For the high-risk group, we propose a group sequential design incorporating three factors stratification, two interim analyses, and without toxicity monitoring. The primary response variable for this design is the 30 days mortality, and the goal is to detect a meaning reduction in mortality rate.Results Required sample size and toxicity boundaries are calculated for each scenario. Sample size requirements for the designs with interim analyses are marginally greater than the ones without. In addition, for both the intermediate-risk group and the high-risk group, conducting two interim analyses have almost identical required sample size compared with just one interim analysis. Conclusions We recommend using binary outcome with composite endpoints for those in Stages 3, 4 and 5 with a power of 90% to detect an improvement of 20% in response rate, and 30 days mortality rate outcome for those in Stages 6 and 7 with a power of 90% to detect 15% (effect size) reduced mortality rate, in the trial design. For the intermediate-risk group, two interim analyses for efficacy evaluation along with toxicity monitoring are encouraged. For the high-risk group, two interim analyses without toxicity monitoring is advised.
Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes: What can we use?
Authors: Grassi Thaiciane , Boeno Francesco Pinto , de Freitas Mauren Minuzzo , de Paula Tatiana Pedroso , Viana Luciana Vercoza , de Oliveira Alvaro Reischak , Steemburgo Thais 
Published: August 2020

Abstract
Background: Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method.Methods: A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland–Altman plots, paired t-tests, and Pearson’s correlation coefficients.Results: 62 patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1-36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (-1.8% difference) and Oxford in men (-1.3% difference).Conclusion: In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively.
Emission factor, relative ozone formation potential and relative carcinogenic risk assessment of VOCs emitted from manufacturing industries
Authors: Yang Hsi-Hsien , Gupta Sunil Kumar , Dhital Narayan Babu 
Published: August 2020

Abstract
Manufacturing industries are one of the important emission sectors of anthropogenic volatile organic compounds (VOCs). In this study, VOC emission factors, relative ozone formation potential (ROFP) and relative carcinogenic risk (RCR) were estimated for some important manufacturing industries (n = 13) located in central Taiwan. Emission samples were collected in stainless steel canisters and were analyzed with a system of gas chromatography-mass spectroscopy. Higher emission factors of total VOCs (∑VOCs) were observed for stencil printing (423 mg-VOC kg-1) compared to other emission industries. Alkanes constituted the most prominent group of VOCs for steel foundry (41.6%), aluminum foundry (25.1%) and synthetic resin industries (25.0%). Oxygenated VOCs were obtained as the most abundant group in the organic solvent (80.3%), polyester resin (80.0%) and PU leather (75.0%) industries. Moreover, emissions from acrylic resin manufacturing had higher contributions from aromatic compounds (> 95%). Toluene was the topmost compound in terms of its contribution to ∑VOCs in plastic tape manufacturing (44.4%), aluminum foundry (39.6%), steel foundry (11.6%), plastic coating (64.3%) and stencil printing (35.3%). Analysis of ozone formation potentials showed that the metal product and machinery acrylic resin manufacturing and stencil printing had a higher normalized ROFP index and belonged to Level-I emission sources. However, in terms of the RCR, integrated iron and steel manufacturing had the highest normalized RCR index belonged to level-I emission sources. Level-I represents the most important VOC emission sources. This study provides a reactivity- and carcinogenicity-based approach to identify high-priority VOC emission sources. The results of this study would help formulate emission reduction policies and strategies for manufacturing industries.