bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Simple Brochure Improves Disposal of Unused Opioids: An Observational Cross-Sectional Study
Authors: Bettlach Carrie L. Roth , Hasak Jessica M. , Santosa Katherine B. , Larson Ellen L. , Tung Thomas H. , Fox Ida K. , Moore Amy M. , Mackinnon Susan E. 
Published: October 2020

Background We evaluated the effectiveness of a simple, low-cost educational brochure in improving disposal rates of unused opioids after outpatient upper extremity surgery. Methods This cross-sectional study enrolled eligible adult patients from a peripheral nerve clinic between November 2017 and September 2018. Patients either received or did not receive the educational brochure, which outlined a simple method to dispose of unused opioids and completed a survey at 2 weeks after surgery. We compared the proportion of patients who disposed of unused opioids after surgery between the group that had received the brochure and the group that had not. Categorical data were analyzed with χ2 test, proportions data with binomial tests, and numerical data with Mann-Whitney U test, all with a significance level of P < .05. Results There were 339 survey respondents. Nineteen patients who did not meet inclusion criteria were excluded. Of the 320 remaining patients, 139 received the brochure and 181 did not. An additional 55 patients were excluded due to preoperative opioid use. Overall, 35.3% of recipients and 38.3% of those who did not receive the brochure used all of their prescribed opioid medication ( P = .625; confidence interval = −14.6%-8.8%). Among patients with unused opioid medication, a significantly higher proportion of brochure recipients disposed of the medicine compared with those who did not receive the brochure (46.7% vs 19.6%, P < .001). Conclusions Distribution of an educational brochure significantly improved disposal of unused opioids after surgery. This easily implemented intervention can improve disposal of unused opioids and ultimately decrease excess opioids available for diverted use in the community.
The Effect of Body Mass Index and Metformin on Matrix Gene Expression in Arthritic Primary Human Chondrocytes
Authors: Schadler Paul , Lohberger Birgit , Stündl Nicole , Stradner Martin Helmut , Glänzer Dietmar , Sadoghi Patrick , Leithner Andreas , Steinecker-Frohnwieser Bibiane 
Published: October 2020

Objective Obesity is a known risk factor for knee osteoarthritis (OA). Diabetes has been associated with progression of OA and metformin is the first-line treatment in type 2 diabetes. The effect of the body mass index (BMI) and metformin on the expression of certain matrix genes in human chondrocytes is unclear. The purpose of this study was to investigate the effect of BMI and metformin on the expression of matrix genes in primary human chondrocytes. Design Adult female patients undergoing knee arthroplasty for end-stage OA were enrolled. Primary chondrocytes were cultivated and stimulated with metformin. Matrix gene expression was analyzed using polymerase chain reaction. Clinical data were used in multivariable regression models to assess the influence of BMI and metformin stimulation on gene expression. Results A total of 14 patients were analyzed. BMI was a predictor of increased expression in ADAMTS5 (β = −0.11, P = 0.03). Metformin slightly reduced expression in ADAMTS5 (β = 0.34, P = 0.04), HIF-1a (β = 0.39, P = 0.04), IL4 (β = 0.30, P = 0.02), MMP1 (β = 0.47, P < 0.01), and SOX9 (β = 0.37, P = 0.03). The hip-knee-ankle angle and proton pump inhibitors (PPIs) intake were associated with reduced SOX9 expression (β = 0.23, P < 0.01; β = 2.39, P < 0.01). Higher C-reactive protein (CRP) levels were associated with increased MMP1 expression (β = −0.16, P = 0.02). Conclusion We found that BMI exerts a destructive effect via induction of ADAMTS5. Metformin reduced the expression of catabolic genes ADAMTS5 and MMP1 and might play a role in disease prevention. Limb malalignment and PPI intake was associated with a reduced expression of SOX9, and higher CRP levels correlated with increased MMP1 expression, indicating a destructive process.
Balloon atrial septostomy as initial therapy in pediatric pulmonary hypertension
Authors: Critser Paul J. , Evers Patrick D. , McGovern Eimear , Cash Michelle , Hirsch Russel 
Published: October 2020

Balloon atrial septostomy is a palliative procedure currently used to bridge medically refractory pulmonary hypertension patients to lung transplantation. In the current report, we present balloon atrial septostomy as an initial therapy for high‐risk pediatric pulmonary hypertension patients at our institution. Nineteen patients with median age of 4.3 years (range 0.1–14.3 years) underwent balloon atrial septostomy during initial admission for pulmonary hypertension. There were no procedural complications or deaths within 24 h of balloon atrial septostomy. Patients were followed for a median of 2.6 years (interquartile range 1.0–4.8 years). Three (16%) patients died, 3 (16%) underwent lung transplantation, and 1 (5%) underwent reverse Potts shunt. Transplant‐free survival at 30 days, 1 year, and 3 years was 84%, 76%, and 67% respectively. This single‐center experience suggests early‐BAS in addition to pharmacotherapy is safe and warrants consideration in high‐risk pediatric pulmonary hypertension patients.
Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity
Authors: Lam Angela Kit Ying , Wong Kathie , Nitkunan Tharani 
Published: October 2020

Objectives: This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population. Methods: This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised. Results: In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box. Conclusion: Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity. Level of evidence: Level 2c.
Validation of finger test for necrotising soft tissue infection
Authors: Lau Jimmy KY , Kwok KB , Hung YW , Fan CH 
Published: October 2020

Background: Necrotising soft tissue infection (NSTI) is rare but fatal. Andreasen proposed finger test as an early diagnostic tool to differentiate NSTI from other soft tissue infections. We aim to evaluate the accuracy and reproducibility of the test for the diagnosis of NSTI. Methods: Patients who were admitted to our department from 2012 to 2016 with suspicion of NSTI and finger test done were retrospectively reviewed. Finger test was done and interpreted as described by Andreasen. Definitive diagnosis of NSTI was confirmed with surgical and pathological findings. Results: Among the 35 patients included in the study, NSTI was confirmed in 10 cases. Finger test had a sensitivity of 100%, a specificity of 80%, positive predictive value of 66.7%, negative predictive value of 100% and an overall accuracy of 85.7%. There was no difference in demographics or comorbidities between NSTI and non-NSTI groups. Surgeons involved had 76.7% agreement and moderate reproducibility (kappa = 0.48) on the diagnostic criteria of finger test. Conclusion: A negative finger test was reliable to exclude NSTI and a positive test suggested further surgical exploration. Yet, clinical judgement was still of paramount importance to treat NSTI promptly.
Retinoschisis in Coats Disease: Clinical Picture, Therapeutic Considerations, and Management Outcomes
Authors: Scott Nathan L. , Cernichiaro-Espinosa Linda A. , Russell Jonathan F. , Murray Timothy G. , Dubovy Sander R. , Berrocal Audina M. 
Published: October 2020

Purpose: Retinoschisis in inflammatory and exudative retinopathy is a known but rare entity. We describe the presentation and clinical and surgical outcomes of a series of patients with retinoschisis in the setting of Coats disease. Methods: This retrospective case series of patients with Coats disease recorded visual acuity and the number and type of treatments (eg, angiography-guided photocoagulation, intravitreal bevacizumab, sub-Tenon triamcinolone, or vitreoretinal surgery). Results: Eighteen of 133 patients with Coats disease were diagnosed with retinoschisis by color imaging. All (100%) of the areas of schisis or macrocyst were associated with dense subretinal exudation, whereas only 7 (38.8%) were associated with exudative retinal detachment. Initial best-corrected visual acuity in the schisis cohort was 1.14 ± 1.19 (Snellen equivalent, 20/276) vs 1.42 ± 1.40 (Snellen, 20/526) in those without ( P = .56). Final best-corrected visual acuity was 1.76 ± 1.37 (Snellen, 20/1150) and 1.45 ± 1.44 (Snellen, 20/563), respectively ( P = .43). The mean number of treatments in individuals with schisis was 4.8 ± 2.9 for angiography-guided photocoagulation, 4.5 ± 2.9 for intravitreal bevacizumab, and 1.7±1.2 for sub-Tenon triamcinolone. Intraocular surgery was required in 39% (7 of 18) of patients with schisis vs 22% (25 of 115) for patients without schisis ( P = .14). One eye required enucleation, and histopathology of the schisis pocket was obtained. Conclusions: The pathophysiology of retinoschisis in Coats disease is not completely understood. We propose that telangiectatic leakage, hypoxia, and toxicity to the retinal pigment epithelial cells play a role in cavity development, and therefore may represent a clinical feature of advanced or uncontrolled disease.
Risk factors in multiple myeloma: is it time for a revision?
Authors: Corre Jill , Munshi Nikhil C. , Avet-Loiseau Hervé 
Published: October 2020

Abstract
Although therapeutic strategies have been adapted to age and comorbidities for a long time, almost all multiple myeloma (MM) patients currently receive similar treatment, whatever their disease risk category. However, high-risk MM patients still constitute an unmet medical need and should benefit from the most efficient drug combinations. Herein, we review and discuss how to optimally define risk and why a revision of the current definition is urgently needed.
The impact of training on data from genetically-related lines on the accuracy of genomic predictions for feed efficiency traits in pigs
Authors: Aliakbari Amir , Delpuech Emilie , Labrune Yann , Riquet Juliette , Gilbert Hélène 
Published: October 2020

AbstractBackgroundMost genomic predictions use a unique population that is split into a training and a validation set. However, genomic prediction using genetically heterogeneous training sets could provide more flexibility when constructing the training sets in small populations. The aim of our study was to investigate the potential of genomic prediction of feed efficiency related traits using training sets that combine animals from two different, but genetically-related lines. We compared realized prediction accuracy and prediction bias for different training set compositions for five production traits.ResultsGenomic breeding values (GEBV) were predicted using the single-step genomic best linear unbiased prediction method in six scenarios applied iteratively to two genetically-related lines (i.e. 12 scenarios). The objective for all scenarios was to predict GEBV of pigs in the last three generations (~ 400 pigs, G7 to G9) of a given line. For each line, a control scenario was set up with a training set that included only animals from that line (target line). For all traits, adding more animals from the other line to the training set did not increase prediction accuracy compared to the control scenario. A small decrease in prediction accuracies was found for average daily gain, backfat thickness, and daily feed intake as the number of animals from the target line decreased in the training set. Including more animals from the other line did not decrease prediction accuracy for feed conversion ratio and residual feed intake, which were both highly affected by selection within lines. However, prediction biases were systematic for these cases and might be reduced with bivariate analyses.ConclusionsOur results show that genomic prediction using a training set that includes animals from genetically-related lines can be as accurate as genomic prediction using a training set from the target population. With combined reference sets, accuracy increased for traits that were highly affected by selection. Our results provide insights into the design of reference populations, especially to initiate genomic selection in small-sized lines, for which the number of historical samples is small and that are developed simultaneously. This applies especially to poultry and pig breeding and to other crossbreeding schemes.
Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial
Authors: Patel Meenal , James Kirsty , Moss-Morris Rona , Ashworth Mark , Husain Mujtaba , Hotopf Matthew , David Anthony S. , McCrone Paul , Landau Sabine , Chalder Trudie ,   on behalf of the PRINCE Primary trial team, Ferreira Nicola , Watts Katie , Turner Richard , Carnemolla Alisia , Robertson Jennifer , Patel Shinal , Frank Philipp , Fisher-Smith Paige , Childs Abigale , Mosweu Iris , Willis Claire , Simiao Fabio 
Published: October 2020

Abstract
Background
Patients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an ‘integrated GP care’ approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit.

Methods
A feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to ‘integrated GP care plus treatment as usual’ or ‘treatment as usual’. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level.

Results
Two thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small.

Conclusions
It was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients’/GPs’ utilisation of audio/visual and training resources before proceeding to a full trial evaluation.

Trial registration
NCT02444520 (ClinicalTrials.gov).
Women’s perceptions of COVID-19 and their healthcare experiences: a qualitative thematic analysis of a national survey of pregnant women in the United Kingdom
Authors: Karavadra Babu , Stockl Andrea , Prosser-Snelling Edward , Simpson Paul , Morris Edward 
Published: October 2020

Abstract
Background
The aim of this national survey was to explore pregnant women’s perceptions of COVID-19 and their healthcare experiences.

Methods
Through patient and public involvement, a questionnaire was developed and advertised via the BBC website, Twitter and other online media during May 2020. The findings were analysed by qualitative thematic analysis. Women who are currently pregnant, or who have delivered during the COVID-19 pandemic were invited to partake in a national online survey.

Results
One thousand four hundred fifty-one participants replied to the online questionnaire. Participants provided significant insight into the perceived barriers to seeking healthcare during this pandemic. These include ‘not wanting to bother anyone’, ‘lack of wider support from allied healthcare workers’ and the influence of the media. Other concerns included the use of virtual clinics antenatally and their acceptability to patients, the presence of birthing partners, and the way in which information is communicated about rapidly changing and evolving services. The influence of the media has also had a significant impact on the way women perceive hospital care in light of COVID-19 and for some, this has shaped whether they would seek help.

Conclusions
This is the first ever reported study in the United Kingdom to explore pregnant women’s perceptions of COVID-19 and their subsequent healthcare experiences. It has also provided insight into perceived barriers into seeking care as well as maternal concerns antenatally, intrapartum and postpartum.
Prognosis prediction model based on competing endogenous RNAs for recurrence of colon adenocarcinoma
Authors: Jin Li Peng , Liu Tao , Meng Fan Qi , Tai Jian Dong 
Published: October 2020

Abstract
Background
Colon adenocarcinoma (COAD) patients who develop recurrence have poor prognosis. Our study aimed to establish effective prognosis prediction model based on competing endogenous RNAs (ceRNAs) for recurrence of COAD.

Methods
COAD expression profilings downloaded from The Cancer Genome Atlas (TCGA) were used as training dataset, and expression profilings of GSE29623 retrieved from Gene Expression Omnibus (GEO) were set as validation dataset. Differentially expressed RNAs (DERs) between non-recurrent and recurrent specimens in training dataset were screened, and optimum prognostic signature DERs were revealed to establish prognostic score (PS) model. Kaplan-Meier survival analysis was conducted for PS model, and GEO dataset was used for validation. Prognosis prediction efficiencies were evaluated by area under curve (AUC) and C-index. Meanwhile, ceRNA regulatory network was constructed by using signature mRNAs, lncRNAs and miRNAs.

Results
We identified 562 DERs including 42 lncRNAs, 36 miRNAs, and 484 mRNAs. PS prediction model, consisting of 17 optimum prognostic signature DERs, showed that high risk group had significantly poorer prognosis (5-year AUC = 0.951, C-index = 0.788), which also validated in GSE29623. Prognosis prediction model incorporating multi-RNAs with pathologic distant metastasis (M) and pathologic primary tumor (T) (5-year AUC = 0.969, C-index = 0.812) had better efficiency than clinical prognosis prediction model (5-year AUC = 0.712, C-index = 0.680). In the constructed ceRNA regulatory network, lncRNA NCBP2-AS1 could interact with hsa-miR-34c and hsa-miR-363, and lncRNA LINC00115 could interact with hsa-miR-363 and hsa-miR-4709. SIX4, GRAP, NKAIN4, MMAA, and ERVMER34–1 are regulated by hsa-miR-4709.

Conclusion
Prognosis prediction model incorporating multi-RNAs with pathologic M and pathologic T may have great value in COAD prognosis prediction.
Lacrimal sac bacteriology and susceptibility pattern in infants with congenital nasolacrimal duct obstruction in the 1st year of life: a cross-sectional study
Authors: Zheng Xiao-Yu , Choy Bonnie Nga Kwan , Zhou Ming-Ming , Shi Cai-Ping , Zhao Zheng-Yan 
Published: October 2020

AbstractBackgroundCongenital nasolacrimal duct obstruction (CNLDO) is one of the main causes of epiphora in infants, and antibiotics are usually used as a conservative therapy in the first year. Yet, little is known about the bacteriology of the occluded lacrimal drainage system in this group of patients. The aim of this study was to evaluate the microbiology of lacrimal sac (LS) in Chinese children with CNLDO in their first year of life.MethodsPatients with CNLDO between May 1, 2017 and August 31, 2018 at a tertiary care children’s hospital were enrolled. The study recruited infants who received lacrimal probing under 1 year old, and refluxed discharge from LS was collected. Samples were cultured and susceptibility test was performed for positive culture.ResultsThirty-two patients with CNLDO were included. The ratio of male to female was 23:9. The mean age was 6.7 ± 2.4 (1.7–12) months. Positive cultures was identified in 87.5% of the sample, and presented 38 strains of bacteria. Mixed infection was identified in 10 (31.3%) children. Gram-positive bacteria accounted for 60.5% of all the strains, withStreptococcus(50%) being the most frequent species, whereasHaemophilus(21.1%) andNeisseriae(13.2%) were most common isolates for Gram-negative organisms.Methicillin-resistant Staphylococcus aureus(MRSA) was detected in 2 infants whose symptoms resolved by a routine probing. No difference of bacteriology pattern was detected between patients under 6 months old and those beyond. The pathogens were highly sensitive to chloramphenicol (88%) and levofloxacin (84%), but resistant to erythromycin (40%) and sulfamethoxazole (32%).ConclusionsInfants with CNLDO under 1 year of age presented predominance ofStreptococcusas Gram-positive organism, andHaemophilusas Gram-negative organism. Levofloxacin was an active topical antibiotic agent with few chance of resistance especially for Chinese children. These findings could help clinicians choose optimal medicine for CNLDO as the conservative treatments.