bluuebunny/crossref_metadata_2025_split huggingface dataset:
CTLA4 has a profound impact on the landscape of tumor-infiltrating lymphocytes with a high prognosis value in clear cell renal cell carcinoma (ccRCC)
Authors: Liu Shiyi , Wang Feiyan , Tan Wei , Zhang Li , Dai Fangfang , Wang Yanqing , Fan Yaqi , Yuan Mengqin , Yang Dongyong , Zheng Yajing , Deng Zhimin , Cheng Yanxiang , Liu Yeqiang 
Published: September 2020

Abstract
Background: Cytotoxic T-lymphocyte associated protein 4 (CTLA4) inhibitors have been shown to significantly prolong the overall survival (OS) in a wide range of cancers. However, its application in clear cell renal cell carcinoma (ccRCC) is limited due to the therapy response, and the prognostic value of CTLA4 in ccRCC has not been investigated in detail.Methods: By using immunohistochemistry, Kaplan-Meier (K-M) analysis, uni- and multi-variate Cox analysis, we comprehensively and systematically studied the prognostic value of CTLA4 in ccRCC. Then, we applied Gene Ontology (GO), the Kyoto Encyclopedia of Genes and Genomes (KEGG) and CIBERSORT, ESTIMATE algorithm, ssGSEA and somatic mutation analyses to reveal the impact of CTLA4 on the landscape of tumor-infiltrating lymphocytes (TILs) infiltration and genetic mutation. Besides, given current concerns caused by combined immunotherapy, we also investigated the relationship between CTLA4 and other immune checkpoints.Results: In vitro experiment and data mining showed that, CTLA4 was up-regulated in ccRCC tissues and closely related to the disease progression as well as a poor prognosis. Deeper researches demonstrated that CTLA4 regulates T cell activation and was significantly linked to TIL-abundant tumor microenvironment (TME), but was accompanied by an immunosuppressed phenotype. Mutation analysis showed that CTLA4 was associated with more frequent BRCA-associated protein 1 (BAP1) mutation. Moreover, we found that CTLA4 was markedly correlated with multiple immune checkpoints, which suggested that ccRCC patients with high expressed CTLA4 may benefit more from immune checkpoint blockades (ICBs) combined therapy.Conclusion: CTLA4 has a profound impact on the landscape of TILs and genetic mutation, and can be used as the biomarker with high prognosis value in ccRCC.
Enhanced Recovery After Surgery – ERAS in Elective Craniotomies-a Non-randomized Controlled Trial
Authors: Elayat Anirudh , Jena Sritam Swarup , Sahu Rabi Narayan , Nayak Sukdev , Tripathy Swagata 
Published: September 2020

Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups.Methods: This was a pragmatic non-randomized controlled trial (CTRI/2017/07/015451). Consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Patients in the ERAS group received a fixed bundle of care. Pre-operative –family education,, complex-carbohydrate drink, scalp blocks, and flupiritine ; Intraoperative –limited opioids,fluid and temperature regulation; Post operative- early mobilization, removal of catheters and initiation of feeds. In the control group, standard practice and protocols of perioperative care were followed. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control and the overall duration of stay in the hospital. Results: Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 hrs after surgery, the cumulative insulin requirement and the episodes of VAS scores > 4 in first 48 hours after surgery was significantly less in the ERAS group – 40.6% vs 65.7%, 0.6 (±2.5) units vs 3.6 (±8.1 ) units and 1 vs 10 episodes ( p= 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups.Conclusion: The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 hrs. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results.
The Effects of Nigella Sativa Extract Oil Supplementation on Plasma Level of ICAM-1, VCAM-1, Metabolic and Oxidative Parameters and Nutritional Status in Patients With Coronary Artery Disease: Study Protocol for A Double-Blind, Randomized Controlled Trial
Authors: Tavakoli-Rouzbehani Omid Mohammad , Abbasnezhad Mohsen , Maleki Vahid , Rahmani Alireza , Alizadeh Mohammad 
Published: September 2020

Abstract
Background: endothelial and metabolic dysfunction are the main risk factors for atherosclerosis, which eventually leads to cardiovascular diseases, such as coronary artery disease (CAD). However, it has been shown that increased inflammation and oxidative stress play an essential role in this process. Nigella sativa may affect declining atherosclerosis and CAD by reducing inflammation and improving vascular function.Methods: Two sections that are presented in this article include; first, a review of recent findings related to cardiovascular disease, CAD, and their association with N. sativa supplementation. Secondly, we will illustrate a randomized, double-blind clinical trial in 46 Iranian adults with CAD. The subjects (age: 35-65, proof of 50% stenosis in at least one of their major coronary arteries in angiography) will be selected by a simple random sampling method and will be assigned to two months supplementation of N. sativa extract oil or placebo group. The primary outcome is the inflammatory and oxidative variables. The secondary outcomes measures include lipid profile, quality of life, depression, and anthropometric indices. The data will be equated within and between groups using appropriate statistical methods. Discussion: The result of this trial will offer evidence about the efficacy of N. sativa supplementation by improving risk factors related to atherosclerosis and coronary artery disease. Trial registration: Iranian clinical trial registry: IRCT20190506043494N1, Date of registration: November 8, 2019.
Cone-Beam Computed Tomographic Analysis of Apical Transportation and Centering Ratio of Protaper and XP-Endo Shaper Niti Rotary Systems in Curved Canals: An in Vitro Study
Authors: Karkehabadi Hamed , Siahvashi Zeinab , Shokri Abbas , Hasani Nasin Haji 
Published: September 2020

Abstract
Background: Cleaning and shaping of the root canal system is important in an endodontic treatment. Canal transportation is a common procedural error in preparation of curved canals. This study aimed to compare the canal transportation and centering ratio of two rotary files in curved canals using cone-beam computed tomography (CBCT). Methods: 44 extracted human mandibular first molars with mature apices and apical curvature of 10° to 30° were selected. The samples were randomly divided into two groups (n=22) with similar curvature. The canals were prepared with ProTaper and XP-endo Shaper file systems according to the manufacturers’ instructions. CBCT images were captured using Cranex 3D CBCT system before and after root canal preparation, and canal transportation and centering ratio of the files at 3, 4 and 5 mm from the apex were calculated. Data were analyzed and compared between two groups using independent t-test at 0.05 level of significance.Results: The ProTaper Universal caused greater canal transportation and had lower centering ratio than XP-endo Shaper in both mesiodistal and buccolingual directions at all levels from the apex. The difference between two groups regarding transportation was significant at all levels from the apex in buccolingual direction (P<0.05) except for 3 mm from the apex (P>0.05). The difference between two groups regarding centering ratio was not significant (P>0.05) in mesiodistal direction at all levels except for 4 mm from the apex (P<0.05). Conclusion:The ProTaper Universal causes greater canal transportation in both buccolingual and mesiodistal directions than XP-endo Shaper.
Medical Care-seeking Patterns Among Women with Diagnoses Associated with Menstrual Syndromes: A Longitudinal Population-based Study
Authors: Guo Jong Long , Lee Tzu Chi , Hsu Hsiao Pei , Huang Chiu Mieh 
Published: September 2020

Abstract
Background: This study aimed to explore women’s tendency to seek Traditional Chinese Medicine and/or Western Medicine when newly diagnosed with menstrual syndromes, and to identify factors associated with their medical care-seeking behavior. Methods: Women aged 15 to 50 years with newly diagnosed menstrual syndromes were selected from Taiwan’s 2005 National Health Insurance Database. Follow-up was divided into 10 time-periods (1-6, 7-12, 13-18, 19-24, 25-30, 31-36, 37-42, 43-48, 49-54 and 55-60 months) after patients’ first visits for obstetric/gynecologic care. Patients’ tendency for medical care utilization was estimated using Poisson regression. Unadjusted and adjusted relative risks and their 95 % confidence intervals were calculated.Results: The number of Traditional Chinese Medicine utilization was 0.69, and Western Medicine utilization was 1.75 within six months after the first menstrual syndrome diagnosis. The tendency for Traditional Chinese Medicine utilization increased as follow-up time increased after controlling for potential confounders, while Western medicine utilization decreased gradually as follow-up time increased. Women’s age, economic status, infertility, value of prevention, baby delivery and Obstetric/ Gynecologic inpatient histories were significantly associated with their medical care-seeking behavior.Conclusions: Traditional Chinese Medicine and Western Medicine medical care-seeking patterns are significantly different among women with diagnoses associated with menstrual syndromes. Related factors affecting Medical care-seeking behavior have been explored in this study.
Prevalence of postoperative delirium according to the intraoperative general anesthetic agents in patients undergoing cardiac surgery: A retrospective and propensity-score matched study
Authors: Shin Hyun-Jung , Choi Soo Lyoen , Na Hyo-Seok 
Published: September 2020

Abstract
Background: Postoperative delirium (PD) is still an issue in post-cardiac surgery patients despite the constant efforts to reduce it. Although various risk factors for PD after cardiac surgery have been identified, there is limited clinical data regarding the effect of intraoperative anesthetic agents on the PD.Methods: The medical records of 534 patients, who had undergone heart valve surgery or coronary artery bypass graft surgery with cardiopulmonary bypass (CPB) between January 2012 and August 2017, were investigated. They were divided into two groups according to the main anesthetic agent: sevoflurane with dexmedetomidine (sevo-dex group, n = 340) and propofol (propofol group, n = 194). The incidence of PD was evaluated as the primary outcome. PD was defined as the positive Confusion Assessment Method for the Intensive Care Unit during the intensive care unit stay. Patient-, surgery-, and anesthesia-related factors and postoperative complications were investigated as secondary outcomes. To reduce the risk of confounder effects between the two groups, 194 patients were selected from the sevo-dex group after propensity-score matching.Results: After propensity-score matching, the incidence of PD was not significantly different between the sevo-dex (6.2%) and propofol (10.8%) groups (P = 0.136). In comparison of the incidence of each type of PD, only hyperactive PD occurred significantly less in the sevo-dex group than in the propofol group (P = 0.021). Older age, lower preoperative albumin levels, and emergency surgery were significant risk factors for PD.Conclusions: The overall incidence of PD after cardiac surgery with CPB is not associated with the main anesthetic agents, sevoflurane and dexmedetomidine-based vs. propofol-based anesthesia. Only hyperactive PD occurred less frequently after in patients receiving sevoflurane and dexmedetomidine-based anesthesia.
Factors Associated with Health Literacy Competencies: Analysis of Thai Health Literacy Survey 2019
Authors: Khampang Roongnapa , Kloyiam Saichon , Butchon Rukmanee 
Published: September 2020

Abstract
Background The consumption of health-related products has been increasing continuously. Information on health-related products can make it difficult for some people with limited health literacy to use. This study investigated the extent to which health literacy competencies in the aspect of consumer protection related to demographic and socio-economic factors, using data from the Thai Health Literacy Survey (THL-S) among Thai citizens aged 15 years and above (2019). Methods The THL-S used a stratified three-stage-sampling to draw a sample of Thais aged 15 years and above. Participants were interviewed with a questionnaire of 34 items measuring health literacy and 8 items measuring behavioural practices. Proportions of responses (the 6-Likert scales) in accessing, understanding, communicating and making decisions related to the consumer protection aspect were performed. Logistic regression models were used to explore the association between health literacy competencies and participant’s socioeconomic, demographic, health and social characteristics.Results Levels of difficulties in the consumer protection aspect varied among health competencies, with the most difficult in communicating and the least difficult in understanding. Half of Thais (around 42%) felt difficult to ask for information from healthcare providers. One-third of Thais (38%) experienced difficulties in accessing reliable information about medicine, cosmetic products, herbal products and food supplements. Participants who had a lower level of education, cannot read, did not have health screenings, were living in poverty, did not hold leading roles in the community, were male, had hearing impairment, or were at an older age, experienced more difficulties in practising health literacy competencies.Conclusions Vulnerable consumers face significant barriers in accessing, understanding, communicating and making decisions in the consumer protection aspect. Health literacy programs that aim to build competencies and empower vulnerable consumers should be developed. There is also a need to adapt current information on health related products to be as clear an accessible as possible but reliable to meet health literacy needs.
Reducing Fast Food Consumption in Students Using a Parent-Teacher Participation-Based Intervention: An Experimental Approach
Authors: Rakhshanderou Sakineh , Charkhabi Morteza , Sherizadeh Yousef , Koukamari Parisa Hosseini , Seidel Laura , Dutheil Frederic , Ghaffari Mohtasham 
Published: September 2020

Abstract
Background: Fast food consumption among students is increasing dramatically. This study aims to evaluate the effect of an intervention based on the Theory of Planned Behavior (TPB) in reducing fast food consumption among high school students. Method: 160 high school students from Iran were randomly recruited and assigned to experiment or control groups. The intervention was conducted over three consecutive weeks, consisting of four, 45-minute teaching sessions. Parameters were assessed on three occasions: pretest, posttest, and follow-up. In these stages, participants responded to a scale on fast food consumption which measures the beliefs and behaviors toward fast food. Results: findings revealed a statistically significant difference in the posttest between experiment and control groups in the major components of fast food consumption including behavioral beliefs (t = 5.1, p < 0001), evaluation of behavioral outcomes (t = 5.3, p < 0001), normative beliefs (t = 2.3, p < 05), motivation to comply (t = 5.5, p < 0001), control beliefs (t = 4.4, p < 0001), perceived power (t = 3.3, p < 0001), and behavioral intention (t = .68, p < 0001). Similar results were obtained in the follow-up stage. Conclusion: The findings suggest that the parent-teacher participation based intervention can be used to reduce fast food consumption amongst high school students both cognitively and behaviorally. Moreover, this intervention can be further customized to increase healthy food consumption in school students and other age groups beyond the context of school.
Factors Associated with Crack Cocaine Early Initiation: A Brazilian Multicentric Study
Authors: Perrenoud Luciane Ogata , Laranjeira Ronaldo , Ribeiro Marcelo 
Published: September 2020

Abstract
Background: Crack cocaine is a serious public health issue, with many psychiatric and psychosocial consequences. The crack cocaine user is usually inserted in a context of great social vulnerability, often associated to violence, unstructured family functioning, antisocial peer factors and easy access to the consumption of alcohol, tobacco and illicit drugs such as crack, since an early age. Objective: To compare whether there was a relative influence of risk and protection factors in several domains on the age of onset of crack use by therapeutic community patients. Methods: This cross-sectional enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in different Brazilian states between September 2012 and September 2013. A detailed structured questionnaire was developed to be used that included investigations into possible pre-use predictive factors, such as parental monitoring in childhood, deviant behaviors and peer pressure, and subsequent factors such as deviant behaviors and involvement with crime. Student t test were performed to assess the association between associated factors and the mean age of onset of crack use. Results: The presence of constant problems in the family relationship (p=0.0020), situations of maltreatment (p=0.0162), and the presence of deviant behaviors resulted in significant differences in the age at which crack consumption began. Whereas, adolescents who had parental monitoring until the beginning of adolescence started use later (p=0.000). Conclusions: The age of onset of crack consumption seems to be influenced by numerous combinations of protective and risk factors, within a system that integrates social environments, relationship groups, individual characteristics and behavior patterns, highlighting these factors will allow the development of prevention strategies, as well as specific control strategies, both based on scientific-based information.
Evolution of Bystander Intention to Perform Resuscitation since last Training: an Online Survey
Authors: Regard Simon , Rosa Django , Suppan Mélanie , Giangaspero Chiara , Larribau Robert , Niquille Marc , Sarasin François P , Suppan Laurent 
Published: September 2020

Abstract
BackgroundAccording to the theory of planned behaviour, the probability of executing an action is strongly linked to the intention of performing it. The aim of this study was to measure the variation over time of the three dimensions of the intention to perform resuscitation, i.e. attitude, subjective normative beliefs, and control beliefs.MethodsThe two largest companies delivering first aid courses in the region of Geneva, Switzerland, sent invitation e-mails on our behalf to people who had followed a first aid course in the last five years. Participants were asked to answer a set of 17 psychometric questions designed to assess each dimension of the intention to perform resuscitation. The primary outcome was the change in each dimension at 6 months. Secondary outcomes were the change in each dimension at one and two years and change in each individual question at 6 months, one year and two years.ResultsOut of 270 completed surveys, 204 were analysed. Control beliefs was the only dimension that displayed a significant change at 6 months (p < 0.001). Participants who had followed their last BLS course more than 6 months ago were however more prone to diffusion of responsibility, a key element of subjective normative beliefs (p = 0.001). Fear of legal action was higher in participants who had followed their last BLS course more than 2 years ago (p = 0.040).ConclusionsControl belief, a dimension of the intention to perform resuscitation, rapidly decreases after the last first aid course.
The epidemiologic trends of neuroendocrine tumors in Taiwan: an updated analysis of a nation-wide population-based study
Authors: Chang Jeffrey S. , Chen Li-Tzong , Shan Yan-Shen , Chu Pei-Yi , Tsai Chia-Rong , Tsai Hui-Jen 
Published: September 2020

Abstract
Background

The incidence of neuroendocrine tumors (NETs) has been increasing in recent decades and there has been a rising awareness by the physicians for the diagnosis of NETs. Several novel agents have been developed and demonstrated to improve the survival of NETs recently. Previously, we reported the incidence and survival of NETs in Taiwan by analyzing the 1996–2008 data from the Taiwan Cancer Registry (TCR). Here we performed an updated analysis on the incidence and survival of NETs in Taiwan from 1996 to 2015.
Methods

Data for the current analysis were obtained from the TCR and the Death Registry Database. The incidence was age-standardized to the WHO 2000 population and the overall survival was calculated by life-table method. The risk of NETs death was evaluated by performing Cox proportional hazards regression analysis.
Results

There were a total of 7,760 cases of NETs diagnosed during 1996–2015. The most common site of NETs was rectum (29.65%), followed by lung and bronchus (17.22%), and pancreas (10.71%). The incidence of NETs was 0.244 per 100,000 in 1996 and increased to 3.162 per 100,000 in 2015 with an annual percentage change (APC) of 15.44 (P < 0.0001). The site with the most rapid increase was pancreas with an APC of 28.04 (P < 0.0001). The 5- and 10-year survival rates of all NETs were 54.6% and 45.3%, respectively. Female and younger NETs patients had a better survival. The HR for survival of all NETs diagnosed between 2010 and 2015 was 0.91 (95%CI, 0.84–0.99) compared to those diagnosed between 2004 and 2009. Among the common sites of NETs, an improved survival of NETs diagnosed between 2010 and 2015 compared to those diagnosed between 2004 and 2009 was only observed in pancreatic NET (HR = 0.52, 95% CI, 0.41–0.66). This result was likely due to the early diagnosis and improvement in the treatment of pancreatic NET.
Conclusions

Overall, the incidence of NETs in Taiwan has continued to increase. The survival of pancreatic NET has shown recent improvement. The development of novel therapeutic agents has the potential to improve the prognosis of NETs of other primary sites in the near future.