bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatial analysis of hypospadias cases in northern France: taking clinical data into account
Authors: Lauriot Dit Prevost Arthur , Genin Michael , Occelli Florent , Priso René-Hilaire , Besson Remi , Lanier Caroline , Sharma Dyuti 
Published: September 2020

AbstractBackgroundStrong evidence for a causal role of environmental factors in a congenital anomaly is still difficult to produce. The collection of statistical data is crucial for gaining a better understanding of the epidemiology and pathophysiology of these anomalies. We aimed to evaluate spatial variations in hypospadias within our region and it’s association to socioeconomic and ecological factors, taking clinical data into account.MethodsAll boys with hypospadias born in northern France and seen in Lille University Medical Center (Lille, France) between 1999 and 2012 were included in the analysis. We retrospectively collected geographic data, clinical data (especially known confounding factors associated with an elevated risk of hypospadias), and demographic, socio-economic and ecological data. We analyzed the entire study population and subsequently the subset of boys lacking confounding factors.ResultsThe study sample of 975 cases of hypospadias over the 13-year period resulted in an incidence of 25.4/10,000 male births, and was characterized by significant spatial heterogeneity (p < 0.005) and autocorrelation (p < 0.001). We detected two high-incidence clusters that differed with regard to their land use. After the exclusion of 221 patients with confounding factors, two high-incidence clusters with significant disease risks (1.65 and 1.75, respectively;p < 0.001) and a significant difference in land use (p < 0.001) again appeared. The first cluster contained a higher median [interquartile range] proportion of artificialized land (0.40 [0.22;0.47]) than the remaining “neutral areas” (0.19 [0.08;0.53]) did (p < 0.001). Conversely, the second cluster contained a higher median proportion of rural land (0.90 [0.78;0.96]) than the “neutral areas” (0.81 [0.47;0.92]) did (p < 0.001). The median deprivation index was significantly lower in the urban cluster (0.47 [0.42;0.55]) and significantly higher in the rural cluster (0.69 [0.56;0.73]) (p < 0.001).ConclusionsOur results evidenced the heterogeneous spatial distribution of cases of hypospadias in northern France. We identified two clusters with different environmental and social patterns – even after the exclusion of known confounding factors.
Toothbrush deterioration and parents’ suggestions to improve the design of toothbrushes used by children with special care needs
Authors: Zhou Ni , Wong Hai Ming , McGrath Colman 
Published: September 2020

Abstract
Background
Biting objects was a parafunctional oral habit among children with special care needs. Chewing or biting toothbrushes could expedite the process of toothbrush wear. However, few studies evaluated the deterioration levels of toothbrushes used by children with special needs. This study aimed to assess the deterioration level of toothbrushes used by children with special care needs, and collect parents’ feedbacks to improve the design of children’s toothbrushes.

Methods
The cross-sectional study recruited 277 children who had special care needs. Children’s toothbrushing behaviors, background information, and parents’ comments on toothbrushes were obtained. Toothbrush deterioration was assessed by bristle wear and bite mark scores. Higher scores indicated severe deterioration.

Results
Three hundred twenty-one toothbrushes were collected. Children who used 2 to 6 toothbrushes in a 3-month period showed higher toothbrush deterioration scores than children who used a single toothbrush. Over 40% children’s toothbrushes presented excessive wear. Excessive wear was associated with social skills and parents’ education background. Distinct bite marks tended to exist on toothbrushes which had been used by children who showed challenging behaviors during toothbrushing (OR = 1.96, 95%CI1.15–3.32, p < 0.05). Approximately 27% parents reported that children’s toothbrushes should be modified. Parents recommended that the size of toothbrush heads, the angle of handles, and the texture/length/distribution/diameter of bristles should be adjusted. Besides, ideal toothbrushes should be able to provide verbal or visual instructions to children, motivate children to brush teeth, simplify toothbrushing procedure, and protect children who had toothbrush-biting habits.

Conclusions
Excessive wear and distinct bite marks can be found on toothbrushes that had been used by children with special care needs. Toothbrush deterioration was associated with children’s social skills, toothbrushing behaviors, and parents’ educational attainment. The commercially available toothbrushes should be modified to meet the additional needs of young children.
Flash glucose monitoring system was applied to cortisol treatment for a patient with congenital adrenal hyperplasia and 17α-hydroxylase deficiency
Authors: Xiang Chenyu , Han Minmin , Zhang Yi , Yin Jianhong , Pei Li’e , Yang Jing , Liu Yunfeng 
Published: September 2020

Abstract
Background
Congenital adrenal hyperplasia (CAH) with 17α-hydroxylase deficiency is a rare disease; patients often require lifetime cortisol treatment. In this case report, we presented a patient with CAH and 17α-hydroxylase deficiency, who was previously misdiagnosed as having primary aldosteronism. Furthermore, the flash glucose monitoring system (FGMS) was used to ascertain a suitable cortisol therapeutic regimen for this patient.

Case presentation
A 29-year-old woman presented with sex dysgenesis, hypertension and hypokalaemia. She had been diagnosed with primary aldosteronism at a local hospital. The re-measured aldosterone level in our hospital was below the normal range after antihypertensive medication adjustment, suggesting that the primary aldosteronism was a misdiagnosis. The patient was finally diagnosed as having CAH with 17α-hydroxylase deficiency according to the endocrine profile, adrenocorticotropic hormone stimulation test, and genetic analysis. Then, the patient was recommended cortisol treatment, during which the endocrine profile, blood pressure, plasma potassium level, and blood glucose level were observed to ascertain a suitable dosage. The FGMS was used to monitor blood glucose level, which indicated that the patient’s glucose metabolism was maintained normally under the final treatment dosage.

Conclusion
The misdiagnosis might have been because of the effects of the antihypertension medications on aldosterone and renin levels. The final dosage of cortisol treatment achieved a normal endocrine profile, while maintaining the homeostasis of blood glucose level, plasma potassium level and blood pressure. FGMS may be an effective method to ascertain a suitable cortisol therapeutic regimen for patients with CAH and 17α-hydroxylase deficiency.
Co-construction of the family-focused support conversation: a participatory learning and action research study to implement support for family members whose relatives are being discharged for end-of-life care at home or in a nursing home
Authors: Duke Sue , Campling Natasha , May Carl R. , Lund Susi , Lunt Neil ,   Hospital to Home Co-researcher group, Bartlett Gemma , Harris Lucy , Flannery Elizabeth , Connolly Michael , Booth Pam , Galpin Gillian , Wells Emma , Price Elizabeth , Faulkner-Butcher Alison , Petch Leanne , Ward Chris , Richardson Alison 
Published: September 2020

Abstract
Background
Many people move in and out of hospital in the last few weeks of life. These care transitions can be distressing for family members because they signify the deterioration and impending death of their ill relative and forthcoming family bereavement. Whilst there is evidence about psychosocial support for family members providing end-of-life care at home, there is limited evidence about how this can be provided in acute hospitals during care transitions. Consequently, family members report a lack of support from hospital-based healthcare professionals.

Methods
The aim of the study was to implement research evidence for family support at the end-of-life in acute hospital care. Informed by Participatory Learning and Action Research and Normalization Process Theory (NPT) we co-designed a context-specific intervention, the Family-Focused Support Conversation, from a detailed review of research evidence. We undertook a pilot implementation in three acute hospital Trusts in England to assess the potential for the intervention to be used in clinical practice. Pilot implementation was undertaken during a three-month period by seven clinical co-researchers - nurses and occupational therapists in hospital specialist palliative care services. Implementation was evaluated through data comprised of reflective records of intervention delivery (n = 22), in-depth records of telephone implementation support meetings between research team members and co-researchers (n = 3), and in-depth evaluation meetings (n = 2). Data were qualitatively analysed using an NPT framework designed for intervention evaluation.

Results
Clinical co-researchers readily incorporated the Family-Focused Support Conversation into their everyday work. The intervention changed family support from being solely patient-focused, providing information about patient needs, to family-focused, identifying family concerns about the significance and implications of discharge and facilitating family-focused care. Co-researchers reported an increase in family members’ involvement in discharge decisions and end-of-life care planning.

Conclusion
The Family-Focused Support Conversation is a novel, evidenced-based and context specific intervention. Pilot implementation demonstrated the potential for the intervention to be used in acute hospitals to support family members during end-of-life care transitions. This subsequently informed a larger scale implementation study.

Trial registration
n/a.
Differences in clerkship development between public and private Brazilian medical schools: an overview
Authors: Zanolli Mauricio Braz , Streit Derly Silva , Maciel Dione Tavares , Muraguchi Evelin Massae Ogata , Martins Milton Arruda , Fátima Lopes Calvo Tibério Iolanda 
Published: September 2020

Abstract
Background
Around the world, it is very expensive to become a physician. Although public medical schools are less expensive than private medical schools, tuition fees are charged at public medical schools in the majority of countries. In Brazil, public medical schools, with the exception of municipal schools, are free. There has been little investigation of any differences in conditions offered by paid or free medical schools or what occurs in public and private clerkships in Brazil. We investigated the clerkship conditions offered to the students in both public and private Brazilian medical schools by gathering the opinions of clerkship coordinators and others responsible for clerkships.

Methods
A cross-sectional, descriptive, analytical study using an electronic questionnaire was answered by clerkship coordinators to compare the clerkships of 30 public and 38 private Brazilian medical schools from all regions of the country. The questionnaires covered various aspects of the clinical environments, student supervision, faculty development, student assessments, rotation evaluations and extracurricular activities developed by students.

Results
We observed significant differences between public and private medical schools in several aspects investigated. Based on the opinions of the clerkship coordinators, with the exception of access to university hospitals, which was predominantly offered by public medical schools, private medical schools offer better clerkship conditions. The main differences were related to the number of positions, infrastructure, clinical learning environments, faculty development, student assessments, rotation evaluations and students’ extracurricular activities.

Conclusion
This is the first study comparing Brazilian medical clerkships in private and public medical schools and provides a general vision of these programmes. It is necessary to further investigate clerkship development in the Brazilian medical school system and to study the differences between private and public medical schools globally.
Relationship between level of empathy during residency training and perception of professionalism climate
Authors: Aziz Aliya B. , Ali Syeda Kauser 
Published: September 2020

Abstract
Background
Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician’s empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

Objective
This study examines the relationship between empathy level and perception of climate of professionalism among residents.

Method
The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and “Professionalism Climate Instrument”(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

Results
The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach’s coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (rs = 0.56, p = 0.64).

Conclusion
The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.
The role of histogram analysis in diffusion-weighted imaging in the differential diagnosis of benign and malignant breast lesions
Authors: Jin Ya-Nan , Zhang Yan , Cheng Jing-Liang , Zhang Xiao-Pan , Hu Ying , Shao Xiao-Ning 
Published: September 2020

Abstract
Background
The present study aims to investigate the role of histogram analysis of intravoxel incoherent motion (IVIM) in the differential diagnosis of benign and malignant breast lesions.

Methods
The magnetic resonance imaging and clinical data of 55 patients (63 lesions) were retrospectively analyzed. The multi-b-valued diffusion-weighted imaging image was processed using the MADC software to obtain the gray-scaled maps of apparent diffusion coefficient (ADC)-slow, ADC-fast and f. The MaZda software was used to extract the histogram metrics of these maps. Combined with the conventional sequence images, the region of interest (ROI) was manually drawn along the edge of the lesion at the maximum level of the gray-scale image, and the difference of the data was analyzed between the benign and malignant breast lesions.

Results
There were 29 patients with 37 benign lesions, which included 23 fibroadenomas, 6 adenosis, 1 breast cysts, 4 intraductal papillomas, and 3 inflammations of breast. Furthermore, 26 malignant lesions in 26 patients, which included 20 non-specific invasive ductal carcinomas, 5 intraductal carcinomas and 1 patient with squamous cell carcinoma. The ADC-slow (mean and the 50th percentile) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile) of these malignant breast lesions were significantly lower than those of benign lesions (P < 0.05), while ADC-fast (kurtosis) and f (variance, skewness) of these malignant breast lesions were significantly higher than those of benign lesions (P < 0.05).

Conclusion
The histogram analysis of ADC-slow (mean and the 50th percentile), ADC-fast (kurtosis) and f (minimum, mean, kurtosis, the 10th percentile and 50th percentile. Variance, skewness) can provide a more objective and accurate basis for the differential diagnosis of benign and malignant breast lesions.
Transcription factor expression as a predictor of colon cancer prognosis: a machine learning practice
Authors: Liu Jiannan , Dong Chuanpeng , Jiang Guanglong , Lu Xiaoyu , Liu Yunlong , Wu Huanmei 
Published: September 2020

Abstract
Background
Colon cancer is one of the leading causes of cancer deaths in the USA and around the world. Molecular level characters, such as gene expression levels and mutations, may provide profound information for precision treatment apart from pathological indicators. Transcription factors function as critical regulators in all aspects of cell life, but transcription factors-based biomarkers for colon cancer prognosis were still rare and necessary.

Methods
We implemented an innovative process to select the transcription factors variables and evaluate the prognostic prediction power by combining the Cox PH model with the random forest algorithm. We picked five top-ranked transcription factors and built a prediction model by using Cox PH regression. Using Kaplan-Meier analysis, we validated our predictive model on four independent publicly available datasets (GSE39582, GSE17536, GSE37892, and GSE17537) from the GEO database, consisting of 925 colon cancer patients.

Results
A five-transcription-factors based predictive model for colon cancer prognosis has been developed by using TCGA colon cancer patient data. Five transcription factors identified for the predictive model is HOXC9, ZNF556, HEYL, HOXC4 and HOXC6. The prediction power of the model is validated with four GEO datasets consisting of 1584 patient samples. Kaplan-Meier curve and log-rank tests were conducted on both training and validation datasets, the difference of overall survival time between predicted low and high-risk groups can be clearly observed. Gene set enrichment analysis was performed to further investigate the difference between low and high-risk groups in the gene pathway level. The biological meaning was interpreted. Overall, our results prove our prediction model has a strong prediction power on colon cancer prognosis.

Conclusions
Transcription factors can be used to construct colon cancer prognostic signatures with strong prediction power. The variable selection process used in this study has the potential to be implemented in the prognostic signature discovery of other cancer types. Our five TF-based predictive model would help with understanding the hidden relationship between colon cancer patient survival and transcription factor activities. It will also provide more insights into the precision treatment of colon cancer patients from a genomic information perspective.
Whole-exome sequencing reveals potential mechanisms of drug resistance to FGFR3-TACC3 targeted therapy and subsequent drug selection: towards a personalized medicine
Authors: Tong Zhou , Yan Cong , Dong Yu-An , Yao Ming , Zhang Hangyu , Liu Lulu , Zheng Yi , Zhao Peng , Wang Yimin , Fang Weijia , Zhang Feifei , Jiang Weiqin 
Published: September 2020

Abstract
Background
Drug resistance is a major obstacle to effective cancer therapy. In order to detect the change in tumor genomic states under drug selection pressure, we use next-generation sequencing technology to investigate the underlying potential mechanisms of drug resistance.

Methods
In our study, we presented a bladder cancer patient who had been a bona fide responder to first-line gemcitabine plus cisplatin regimen and second-line pazopanib (tyrosine kinase inhibitor (TKI) for FGFR3-TACC3 fusion) but finally had disease progression as an ideal case for showing genomic alteration during drug resistance. We applied whole-exome sequencing and ultra-deep target sequencing to the patient pre- and post- pazopanib resistance. Protein-protein interaction (PPI) network and Gene Ontology (GO) analyses were used to analysis protein interactions and genomic alterations. Patient-derived xenograft (PDX) model was built to test drug sensitivity.

Results
Twelve mutations scattered in 12 genes were identified by WES pre- pazopanib resistance, while 63 mutations in 50 genes arose post- pazopanib resistance. PPI network showed proteins from multiple epigenetic regulator families were involved post- pazopanib resistance, including subunits of chromatin remodeler SWI/SNF complex ARID1A/1B and SMARCA4, histone acetylation writers CREBBP, histone methylation writer NSD1 and erasers KDM6A/5A. GO enrichment analysis showed pazopanib resistance genes were prominently tagged for chromatin modification, transcription, as well as gland development, leaving genes with the best adaptive FGFR TKI-coping mechanisms. In addition, significantly elevated tumor mutational burden suggested possible utility of immunotherapy. Intriguingly, PDX model suggested that, sensitivity to original chemotherapy regimen (cisplatin) was restored in patient tumor post-pazopanib.

Conclusions
Epigenetic regulation may play a role in acquired TKI resistance. Our study traced the complete tumor genomic variation course from chemo-resistant but TKI-sensitive to TKI-resistant but chemo-(re) sensitive, revealing the potential complex dynamic drug-driven mechanisms of resistance.
Airway nitrite is increased in extremely preterm infants with bronchopulmonary dysplasia
Authors: Gentle Samuel J. , Freeman Amelia , Patel Rakesh P. , Ambalavanan Namasivayam , Lal Charitharth V. 
Published: September 2020

Abstract
Rationale
Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity and significantly contributes to mortality and morbidity with few predictive biomarkers. Given that nitrites have been implicated in pathways associated with lung disease, we hypothesized that nitrite levels would be altered in the airways of premature infants diagnosed with BPD.

Methods
This was a prospective cohort study of extremely low birth infants (< 28 weeks’ gestation) at the University of Alabama at Birmingham. Nitrite levels from tracheal aspirates (TAs) were compared between intubated and ventilated infants with BPD and gestation matched full term (FT) controls. TA derived nitrite levels from day one after birth were also compared between preterm infants who did and did not develop BPD.

Results
Infants with BPD were found to have significantly elevated nitrite levels in their tracheal aspirates compared to gestation matched FT controls (p < 0.05). There was a trend for increased nitrite levels on postnatal day one in infants that developed BPD compared to infants that did not develop BPD (p = 0.05).

Conclusions
In conclusion, nitrite levels are significantly increased in airways of infants with BPD. Data from a larger cohort are needed to further support the utility of nitrite for BPD prediction.

Trial registration
Not applicable.