bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discussing Personalized Prognosis in Amyotrophic Lateral Sclerosis: Development of a Communication Guide
Authors: Eenennaam Remko M. van , Kruithof Willeke J. , Es Michael A. van , Reenen Esther T. Kruitwagen-van , Westeneng Henk-Jan , Visser-Meily Johanna M.A. , Berg Leonard H. van den , Beelen Anita 
Published: September 2020

Abstract
Background: Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families.Methods: A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist and spiritual counsellor).Results: A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity.Communication guide: We recommend discussing prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Regardless of cultural background, investigate needs and preferences of the patients and their families regarding prognostic disclosure. If the patient does not want to know their prognosis, with patient permission this can be discussed with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time.Conclusion: This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
Impacts on Surgery Resident Education at a first wave COVID-19 Epicenter
Authors: Ostapenko Alexander , McPeck Samantha , Liechty Shawn , Kleiner Daniel 
Published: September 2020

Abstract
Background: This study aims to identify the effects of the COVID-19 pandemic on surgical resident training and education at Danbury Hospital.Methods: We conducted an observational study at a Western Connecticut hospital heavily affected by the first wave of the COVID-19 pandemic to assess its effects on surgical residents, focusing on surgical education, clinical experience, and operative skills development. Objective data was available through recorded work hours, case logs, and formal didactics. In addition, we created an anonymous survey to assess resident perception of their residency experience during the pandemic. Results: There are 22 surgical residents at our institution; all were included in the study. Resident weekly duty hours decreased by 23.9 hours with the majority of clinical time redirected to caring for COVID-19 patients. Independent studying increased by 1.6 hours (26.2%) while weekly didactics decreased by 2.1 hours (35.6%). The operative volume per resident decreased by 65.7% from 35.0 to 12.0 cases for the period of interest, with a disproportionately high effect on junior residents, who experienced a 76.2% decrease. Unsurprisingly, 70% of residents reported a negative effect of the pandemic on their surgical skills.Conclusions: During the first wave of the COVID-19 pandemic, surgical residents’ usual workflows changed dramatically, as much of their time was dedicated to the critical care of patients with COVID-19. However, the consequent opportunity cost was to surgery-specific training; there was a significant decrease in operative cases and time spent in surgical didactics, along with elevated concern about overall preparedness for their intended career.
Culinary nutrition course equips future physicians to educate patients on healthy diet
Authors: Wood Nathan I , Gleit Rebecca D , Levine Diane L 
Published: September 2020

Abstract
BACKGROUND

Poor-quality diet is associated with one in five deaths globally. In the United States, it is the leading cause of death, representing a bigger risk factor than even smoking. For many, education on a healthy diet comes from their physician. However, as few as 25% of medical schools currently offer a dedicated nutrition course. We hypothesized that an active learning, culinary nutrition experience for medical students would improve the quality of their diets and better equip them to counsel future patients on food and nutrition.
METHODS

This was a prospective, interventional, uncontrolled, non-randomized study. Ten first-year medical students at the Wayne State University School of Medicine completed a 4-part, 8-hour course in culinary-nutritional instruction and hands-on cooking. Online assessment surveys were completed immediately prior to, immediately following, and 2 months after intervention. There was a 100% retention rate and 98.8% item-completion rate on the questionnaires. The primary outcome was changes in attitudes regarding counseling patients on a healthy diet. Secondary outcomes included changes in dietary habits and acquisition of culinary knowledge. Average within-person change between timepoints was determined using ordinary least squares fixed-effect models. Statistical significance was defined as P ≤ .05.
RESULTS

Participants felt better prepared to counsel patients on a healthy diet immediately post-intervention (coefficient = 2.8; 95% confidence interval: 1.6 to 4.0 points; P < .001) and 2 months later (2.2 [1.0, 3.4]; P = .002). Scores on the objective test of culinary knowledge increased immediately after (3.6 [2.4, 4.9]; P < .001) and 2 months after (1.6 [0.4, 2.9]; P = .01) the intervention. Two months post-intervention, participants reported that a higher percentage of their meals were homemade compared to pre-intervention (13.7 [2.1, 25.3]; P = .02).
CONCLUSIONS

An experiential culinary nutrition course may improve medical students’ readiness to provide dietary counseling. Further research will be necessary to determine what effects such interventions may have on the quality of participants’ own diets.
Construction and Comprehensive Analysis of the Competing Endogenous Rna Network in Endometrial Adenocarcinoma
Authors: Feng Chong , Cui Lei , Jin Zhen , Sun Lei , Wang Xiaoyan , Chi Xinshu , Sun Qian , Lian Siyu 
Published: September 2020

Abstract
Background: Endometrial carcinoma (EC) is one of the most common gynecological malignant tumors. In this study, we constructed gene co-expression networks to identify key modules and hub genes involved in the pathogenesis of EC. Methods: The RNA profiles of adenocarcinoma and non-adenocarcinoma tissues of patients with EC from The Cancer Genome Atlas were analyzed. MicroRNA, mRNA, and long non-coding RNA networks were constructed based on the differentially expressed RNAs between the two tissues. RNAs from the competing endogenous RNA (ceRNA) networks were then used to construct co-expression networks by weighted gene co-expression network analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed by the Database for Annotation, Visualization and Integrated Discovery tool. Results: The MEturquoise module was found to be significantly related to hypertension and the MEbrown module was significantly related to the history of other malignancies. Functional enrichment analysis showed that the MEturquoise module was associated with the GO biological process terms of transcription from RNA polymerase II promoter, positive regulation of male gonad development, endocardial cushion development, and endothelial cell differentiation. The MEbrown module was associated with GO terms DNA binding, epithelial-to-mesenchymal transition, and transcription from RNA polymerase II promoter. A total of 10 hub genes were identified and validated at transcriptional and translational levels. Conclusions: The identified ceRNAs may play a critical role in the progression and metastasis of EC and are thus candidate therapeutic targets and potential prognostic biomarkers. The two modules constructed further provide a useful reference that will advance understanding of the mechanisms of tumorigenesis in EC.
Endostar Rebuilding Vascular Homeostasis and Enhancing Chemotherapy Efficacy in Cervical Cancer Treatment
Authors: guan liming 
Published: September 2020

Abstract
Background:The incidence rate of cervical cancer is the highest in the reproductive tract, and is not sensitive to chemotherapy. An appropriate amount of antiangiogenic agents can reconstruct tumor blood vessels in a short period of time and form vascular homeostasis, increase the function of blood vessel perfusion and reverse the multidrug resistance of chemotherapy, which is also called "vascular normalization".Endostar(a recombinant human endostatin) was developed by China and as a multi-target anti-angiogenesis agent.Endostar was mainly used in the treatment of non-small cell lung cancer, fewer reported in the treatment of cervical cancer.Purpose:To determine whether endostar can rebuild tumor vascular homeostasis and enhance chemotherapy effects for patients with cervical cancer.Methods:In this study,the patients with cervical cancer within stage IIB2 were selected,endostar combined with cisplatin+paclitaxel neoadjuvant chemotherapy(NACT) before radical surgical operation was adopted, patients outcome and adverse reaction were followed up.The changes of tumor vascular structure and perfusion function before and after endostar given were evaluated by histopathology and dynamic contrast-enhanced magnetic resonance imaging(DEC-MRI). VEGF-Notch signal pathway was detected for the regulating mechanism of vascular proliferation in different groups. GraphPad Prism 6 software were used for statistical analysis of the study results.Results:Endostar enhanced short-term (2 year) overall survival(OS) ,progression free survival(PFS) rates for cervical cancer patients.All the same,endostar increased long term (5 year) OS and PFS for cervical cancer patients.Endostar therapy exhibited with mild adverse reaction.MRI showed endostar+NACT further reduce tumor volume than NACT alone.The parameters of Ktrans,Ve for DEC-MRI in endostar group exhibited obviously increase than NACT group.Tumor vascular maturation index α-SMA/CD31 in endostar group increased obviously than NACT group, correspondingly Ki67 staining for tumor proliferative rates,lymphvascular space invasion in endostar group further declined than NACT group. The genes and proteins expression of VEGFR2,Notch1,Notch1,4,Dll4,Jagged-1 were obviously down regulated in endostar group comparing to NACT group.Conclusions: Endorstar restored vascular homeostasis in cervical cancer temporarily, enhanced chemotherapeutic agents resistance in cervical cancer, increased patient overall survival ratio.The VEGF-Notch connection blocked by endostar may play a role in this effects.
Screening of cognitive impairment in childhood acute lymphoblastic leukemia survivors with P300 event-related potentials: comparison of different treatment protocols.
Authors: Kroczka Slawomir , Stepien Konrad , Skoczen Szymon 
Published: September 2020

Abstract
BackgroundModern treatment protocols in childhood acute lymphoblastic leukemia (ALL) resulted in high cure rate and improved long-term survival. However, due to their high intensity, they are also associated with many side effects, including central nervous system toxicity. The aim of our study was to evaluate the use of P300 event-related potentials in screening of cognitive impairment in childhood ALL survivors.MethodsA group of 136 patients, 66 males (48.5%), aged 4.9 to 27.9 years who have completed ALL therapy, were screened for cognitive impairment with endogenous P300 potentials. ALL therapy was conducted according to modified New York (NY) (30 patients) and subsequent revisions of modified Berlin-Frankfurt-Münster (BFM): previous BFM protocols (pBFM) (32 patients) and BFM95 (74 patients). The control group consisted of 58 patients, 34 males (58.6%), aged 6 to 17 years after a syncope episode (n = 29) as well as healthy subjects (n = 29).ResultsThe total group of ALL survivors had significantly prolonged the mean latency of P300 (331.31 vs 298.14 ms, P < 0.001) and reaction time (439.51 vs 380.11 ms, P = 0.002) compared to the control group. Abnormalities in endogenous evoked potentials were observed in 10 (33.33%) NY, 5 (15.63%) pBFM and 21 (28.38%) BFM95 patients. The mean latency time was significantly longer compared to the control group (298.14 ms) in all analyzed protocols and the highest values were observed in pBFM patients (NY: 329.13 ms, P = 0.001; pBFM: 332.97 ms, P < 0.001; BFM95: 331.47 ms, P < 0.001). The reaction time was similarly prolonged compared to the control group. The largest and also significant prolongation was recorded in the NY group (461.8 vs 380.1 ms, P = 0.039).Analyzing the effect of radiotherapy on P300 potentials, a significantly higher frequency of prolonged reaction time in non-irradiated BFM95 patients was found (21.62 vs 15.85%, P=0.007). Radiotherapy methods used in NY and pBFM protocols have also significantly reduced the P300 wave amplitude (mean values: 10.395 vs 12.739 ms, P=0.027).ConclusionsEndogenous P300 event-related potentials may be useful in screening assessment of late cognitive impairment in ALL survivors. The type of treatment protocol significantly modulates the individual parameters of the registered P300 potentials.
Maternal pregestational glucose level and adverse neonatal outcomes: a population-based retrospective cohort study
Authors: Zeng Mengyao , He Yang , Li Min , Yang Liu , Zhu Qianxi , Liu Jun , Mao Yanyan , Chen Qing , Du Jing , Zhou Weijin 
Published: September 2020

Abstract
Background: Women with diabetes or hyperglycemia during the pregnancy have been proved to be at increased risk for adverse outcomes such as primary cesarean section rate and macrosomia. However, a lack of studies have focused on the maternal glucose level prior to the pregnancy and the effect of maternal pregestational hyperglycemia or hypoglycemia on pregnancy outcomes is unclear. Hence, we conducted this study to investigate the association between maternal pregestational fasting blood glucose level and adverse neonatal outcomes.Methods: A retrospective cohort study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. A total of 54365 women with their live birth singletons from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project were included. They all took a once fasting glucose testing within one year prior to pregnancy and without a definite diagnosis of diabetes at that point. Our primary outcomes were preterm birth, very preterm birth, macrosomia, large for gestational age (LGA), low birth weight (LBW) and small for gestational age (SGA). Results: Of the 54365 women, 2813 (5.17%) were hypoglycemia, 48400 (89.03%) were normoglycemia, 2582 (4.75%) had impaired fasting glucose (IFG) and 570 (1.05%) were diabetic hyperglycemia. Compared to the normoglycemia group, women with pregestational glucose at the diabetic level had a higher rate of macrosomia (4.16% vs. 6.18%), while impaired fasting glucose group seemed to be associated with decreased risks for preterm birth (7.38% vs. 5.78%), very preterm birth (1.25% vs. 0.74%), LBW (1.18% vs. 0.59%) and SGA (5.92% vs. 4.29%), p<.05 for all. No significant difference was found between hypoglycemia and normoglycemia in the neonatal outcomes. After adjusting for potential confounders, pregestational diabetic hyperglycemia was remained significantly associated with an increased risk for macrosomia (aRR, 1.49; 95%CI, 1.07-2.09). Conclusion: Though without an overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations were still associated with an increased risk for macrosomia. Once fasting glucose within one year before pregnancy might also be considered as an early sign to help the obstetricians to prejudge and control the risk of macrosomia in advance.
Knee ankle joint line angle: a critical value at 10。 for decompensated knee joint line obliquity in medial opening wedge osteotomy.
Authors: Tseng Tzu-Hao , Hsu Kuan-Hung , Wang Jyh-Horng 
Published: September 2020

Abstract
Background: Medial opening wedge high tibial osteotomy (MOWHTO) changes the knee joint inclination in the coronal plane, which can be compensated by the ankle joint. Once there is a decompensated knee joint obliquity, it can induce excessive shear force on the articular cartilage. This study aimed to investigate the capacity of the compensation by analyzing the correlation of the knee-ankle joint line angle (KAJA) and the knee joint line obliquity (KJLO).Methods: The correlations between postoperative KJLO and body mass index (BMI), correction amount, KAJA, mechanical lateral distal femoral angle (mLDFA), preoperative medial proximal tibia angle (MPTA), ankle joint line obliquity (AJLO), KJLO and mechanical hip-knee-ankle angle (mHKA) were analyzed using Pearson correlation coefficient. The contribution of significant factors was further analyzed using multiple linear regression. The KJLO between ≦ 5。, 5。-10。And ≧ 10。KAJA groups were compared using Kruskal-Wallis test.Results: Postoperative KAJA and preoperative KJLO moderately correlated to postoperative KJLO. Preoperative MPTA, mHKA, AJLO weakly correlated to postoperative KJLO. After multiple linear regression, only postoperative KAJA, preoperative MPTA and mHKA still showed significant contribution, while preoperative KAJA made the greatest contribution. The KJLO was substantial higher in the ≧ 10。KAJA group with a high rate (68%) of high-degree KJLO.Conclusions: 10。postoperative KAJA is a critical value for decompensated KJLO. The results suggest us carefully assess the KAJA intraoperatively. Double osteotomy should be considered if ideal alignment cannot be achieved when the KAJA reach 10。.
Selection of metastasis competent subclones in the tumour interior: TRACERx renal
Authors: Zhao Yue , Fu Xiao , Lopez Jose , Rowan Andrew , Au Lewis , Fendler Annika , Hazell Steve , Xu Hang , Horswell Stuart , Shephard Scott , Spain Lavinia , Byrne Fiona , Stamp Gordon , O'Brien Tim , Nicol David , Augustine Marcellus , Chandra Ashish , Rudman Sarah , Toncheva Antonia , Pickering Lisa , Larkin James , Sahai Erik , Bates Paul , Swanton Charles , Turajlic Samra , Litchfield Kevin 
Published: September 2020

Abstract
While the genetic evolutionary features of solid tumour growth are becoming increasingly described, the spatial and physical nature of subclonal growth remains unclear. Here we utilise 102 macroscopic whole tumour images from clear cell renal cell carcinoma (ccRCC) patients, with matched genetic and phenotypic data from 756 biopsies. Utilising a digital image processing pipeline the boundaries between tumour and normal tissue were marked by a renal pathologist, and positions of boundary line and biopsy regions were extracted to X- and Y-coordinates. The coordinates were then integrated with genomic data to map exact spatial subclone locations, revealing how genetically distinct subclones grow and evolve spatially. A phenotype of advanced and more aggressive subclonal growth was present in the tumour centre, characterised by an elevated burden of somatic copy number alterations, higher necrosis, proliferation rate and Fuhrman grade. Moreover, metastasising subclones were found to preferentially originate from the tumour centre. Collectively these observations suggest a model of accelerated evolution in the tumour interior, with harsh hypoxic environmental conditions leading to heightened cellular turnover and greater opportunity for driver SCNAs to arise and expand due to selective advantage. Tumour subclone growth was found to be predominantly spatially contiguous in nature, with subclone dispersal a rare event found in two cases, which notably was associated with metastasis. In terms of genetic events, the largest subclones spatially were dominated by driver somatic copy number alterations, suggesting a large selective advantage can be conferred to subclones upon acquisition of these alterations. In conclusion, spatial dynamics is strongly associated with genomic alterations and plays an important role in tumour evolution.
Polygenic Risk Score is a Predictor of Adenomatous Polyps at Screening Colonoscopy&nbsp;
Authors: Northcutt Michael , Shi Zhuqing , Zijlstra Michael , Shah Ayush , Zheng Siqun , Yen Eugene , Khan Omar , Beig Mohammad Imran , Imas Polina , Vanderloo Adam , Ansari Obaid , Xu Jianfeng , Goldstein Jay 
Published: September 2020

Abstract
Background: SNP-based polygenic risk scoring is predictive of colorectal cancer (CRC) risk. However, few studies have investigated the association of genetic risk score (GRS) with detection of adenomatous polyps at screening colonoscopy. Methods: We randomly selected 1,769 Caucasian subjects who underwent screening colonoscopy from the Genomic Health Initiative (GHI), a biobank of NorthShore University HealthSystem. Outcomes from initial screening colonoscopy were recorded. Twenty-two CRC risk-associated SNPs were obtained from the Affymetrix™ SNP array and used to calculate an odds ratio (OR)-weighted and population-standardized GRS. Subjects with GRS of <0.5, 0.5-1.5, and >1.5 were categorized as low, average and elevated risk.Results: Among 1,769 subjects, 520 (29%) had 1 or more adenomatous polyps. GRS was significantly higher in subjects with adenomatous polyps than those without; mean (95% confidence interval) was 1.02 (1.00-1.05) and 0.97 (0.95-0.99), respectively, p<0.001. The association remained significant after adjusting for age, gender, body mass index, and family history, p<0.001. The detection rate of adenomatous polyps was 10.8%, 29.0% and 39.7% in subjects with low, average and elevated GRS, respectively, p-trend <0.001. Higher GRS was also associated with early age diagnosis of adenomatous polyps, p<0.001. In contrast, positive family history was not associated with risk and age of adenomatous polyps.Conclusions: GRS was significantly associated with adenomatous polyps in subjects undergoing screening colonoscopy. This result may help in stratifying average risk patients and facilitating personalized colonoscopy screening strategies.