bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nalmefene relieves epidural morphine-caused pruritus following caesarean section: a randomized and placebo-controlled clinical trial
Authors: Zhong Chaochao , Xu Xingguo , Zhu Xiang , Qin Yibin , Miao Haihang , Huang Xinchong , Cao Su 
Published: December 2019

Abstract
Background. Epidural morphine has an effective analgesic effect in cesarean section patients; however, a very common adverse effect caused by epidural morphine is pruritus, which is difficult to treat or prevent. Here, we aimed to investigate whether a μ-opioid antagonist with central and peripheral effects reduces morphine-induced pruritus. Methods. In this prospective randomized trial, eighty patients scheduled for an elective cesarean section under spinal aesthesia with 3 mg of epidural morphine were assigned into the nalmefene group (n=40) or placebo group (n=40). After delivery, either 50 μg of intravenous nalmefene hydrochloride (Nalmefene group) or an equivalent amount of normal saline (Placebo group) was administered to the patients. In the meantime, an assessment of a series of side effects such as pruritus, nausea, and pain was conducted at 2, 4, 8, 12, and 24h after epidural morphine administration. Results. All eighty participants completed this trial. The total incidence of pruritus in the first 24 hours following the section was reduced in IV nalmefene group compared with the placebo group (37.5% vs 65%, P=0.003). Moreover, IV nalmefene administration relieved the pruritus intensity, whereas the difference in the incidence of nausea and vomiting between the two groups was not significant. Besides, the nalmefene group displayed significantly higher pain scores at 8, 12 and 24h than the placebo group (all P<0.05). However, no significant difference in the percentage of patients with an analgesic treatment was found between the two groups (P=0.37). Conclusion. In this study, a single dose of 50 μg of IV nalmefene was found to decrease the overall severity and incidence of epidural morphine-induced pruritus, but cause no adverse effect on postoperative analgesia.
The association between daily physical activity and pain among women with fibromyalgia: the moderating role of pain catastrophizing
Authors: Lazaridou Asimina , Myrella Paschali , Kristin Schreiber , Galenkamp Laura , Berry Michael , Paschalis Theodoros , Napadow Vitaly , Edwards Robert R. 
Published: December 2019

Abstract
Introduction. Fibromyalgia (FM) is a condition marked by widespread chronic pain and psychological symptoms. The primary objective of this study was to examine the day-to-day association between physical activity and pain intensity among a sample of women with FM and the potential moderation of this association by pain catastrophizing. Methods. Women with FM (N =107) completed questionnaires assessing pain, FM symptoms (Brief Pain Inventory; Revised Fibromyalgia Impact Questionnaire) and psychological measures (PROMIS-anxiety, PROMIS-depression) and were then asked to report their levels of daily pain catastrophizing, physical activity, and pain intensity once per day for a period of seven days using an electronic diary. In addition, objective measures of physical activity were collected using a wrist-worn activity tracker (Fitbit Flex) which measured daily step counts. Moderation analyses were performed with the SPSS macro PROCESS. Daily self-report physical activity was used as the independent variable and pain intensity (BPI) was the primary outcome, while daily pain catastrophizing was tested in the model as the potential moderator in this relationship. Results. Moderation analyses indicated that association between physical activity and pain intensity was moderated by catastrophizing (B = .003, SE = .001, p < .05), with patients scoring higher in daily catastrophizing showing a relatively stronger link between lower day-to-day physical activity and increased daily FM pain. High catastrophizers were more likely to report more daily pain on days that they were more physically active, while this was not the case for low catastrophizers. Significant associations were observed between pain catastrophizing, pain intensity and Fitbit Flex step count (p < .05). Self-report physical activity (subjective) positively correlated with Fitbit Flex step count (objective; p < .005). Discussion. Our findings suggest that increases in daily physical activity are associated with more self-reported pain intensity in women with FM pain, particularly among those with higher levels of pain catastrophizing. These results may have clinical implications for the design and testing of future behavioral interventions targeted at increasing reducing physical activity and/or catastrophizing pain cognitions among women experiencing FM pain.
Impact of Spring Freshet Flooding and Summer Rainfall Flooding on the Water Quality of an Alpine Barrier Lake
Authors: LI Chun-hua , Ye Chun , LI Ji-xuan , WEI Wei-wei , ZHENG Ye , KONG Ming , WANG Hao 
Published: December 2019

Abstract
Background: Among the many types of lakes, the barrier lake attracts special attention. China’s Lake Jingpo is one of the world’s rare such alpine lakes. Spring freshet flooding and summer rainfall flooding are factors that significantly increase barrier lake instability while also impacting water quality. Results: This study constructed a hydrodynamic water-quality model to simulate the impacts of spring freshet flooding, summer rainfall flooding, and 30-year frequency rainfall flooding on the flow-field and water quality at Lake Jingpo. Results showed that the lake-area flow field was generally weak (mostly lower than 0.015 m/s), but spring freshet flooding in April and summer rainfall flooding in August-September increase flow velocities to 0.045 m/s and above, much higher than in other months. Mudanjiang is the largest river that enters Lake Jingpo. Its flow reaches 4.81×10 8 m 3 , 29.77×10 8 m 3 , and 58.4×10 8 m 3 during the spring freshet flooding, summer rainfall flooding and 30-year frequency rainfall flooding period, respectively. The longest diffusion distances were measured from the lake mouth to the point of impact; these were 16.3 km, 33.1km, and 43.6km for the above periods, respectively. Our research revealed that precipitation played an important role in seasonal water quality at Lake Jingpo, and larger amounts of precipitation, longer diffusion distances, and increased pollutant concentrations. Conclusions: Compared to the effects of the spring freshet flooding period, the summer rainfall flooding and 30-year frequency rainfall flooding period more significantly affected water quality at Lake Jingpo. There was more overall precipitation, longer diffusion distances, and increased pollutant concentrations in the lake area. Alpine barrier lake environments are very fragile, which need greater care efforts and more stringent measures to control pollution sources throughout entire catchment area.
Space-use and movement patterns in an arid-zone agamid lizard
Authors: Bernich Adam , Maute Kimberly , Contador-Kelsall Isabella C , Story Paul G , Hose Grant C , French Kris 
Published: December 2019

Abstract
Background Quantifying the space-use and movement patterns of animals is critical to understanding habitat use and social systems. Little is known of the finer details of lizard movement biology, due to the limitations of observational studies. Advancements in technology has greatly improved our ability to study animal space-use and movement, though new technology has rarely been used to quantify finer-scale lizard movements and space-use. Using Global Positioning Systems (GPS) tags and accelerometers we tracked 36 central bearded dragon ( Pogona vitticeps ) individuals over three seasons, with the aim to describe space-use and movement patterns and to determine how these patterns differ due to individual traits and environmental drivers.Results Home ranges were held by 23 out of 36 individuals and wider tailed males were more likely to be floaters (no evidence of a home range). Evidence of floater behaviour was shown by 45% of females and only 20% of males, though both sexes often roamed over distances greater than 1 km. No significant relationships were observed among home range parameters and the individual traits measured. Home range overlap occurred between both neighbouring males and females, and core areas were not exclusive. Air temperatures strongly influenced movement in both sexes. Movement was significantly higher for males than females during late-spring, but not mid-summer, and was inversely related to head sizes and body mass during mid-summer. Interestingly, no correlation was observed between daily movement rates and home range measures. However, the movement rates of home range holders were significantly different from floaters for each season.Conclusions These results confirm that wild P. vitticeps movement patterns are driven by temperature, though space-use patterns vary from previously studied agamids, with high rates of nomadism, possibly due to drought conditions and high intrasexual home range overlap. Individuals varied widely in their space-use tactics, which seem unrelated to size, a potential proxy for social status or age. Our detailed data highlights the utility of accelerometers and GPS tracking devices in the study of lizard ecology.
Quadriceps muscle atrophy and inflammatory markers in COPD patients
Authors: Ahmadi Majid , Nazemiyeh Masoud , Ghaebi Mahnaz , Mikaeili Haleh , Tarzamani Mohammadkazem , Valizadeh Hamed , Aslani Saeed 
Published: December 2019

Abstract
BackgroundCOPD (chronic obstructive pulmonary disease) is a systemic chronic inflammatory disease manifested by increased proinflammatory protein and cytokine levels. In this study, we aimed to investigate whether there is any correlation between systemic inflammatory mediators (CRP, ESR, PCT, IL-6, IL-1β, and TNF-α) and quadriceps muscle atrophy in patients with COPD.MethodsThe study group included forty patients with consecutive COPD followed at the Outpatient Pulmonology Unit of Imam Reza Hospital, Tabriz, Iran. Depth of quadriceps muscle was measured by B-mode ultrasonography using an 8 MHz 5.6 cm linear transducer array. Serum levels of CRP, PCT, IL-1β, IL-6 and TNF-α and the ESR were also measured. All patients were evaluated in three stages; the first day of mechanical ventilator admission, 48 hours later and at the seventh day.ResultsThe results showed that the depth of quadriceps muscle on the seventh day after mechanical ventilator admission was significantly lower than of the first day (P = 0.0008). Statistical analysis showed a significant difference between the level of all systemic biomarkers on day 1 and day 7 (P < 0.05). The correlation study showed the significant negative associations between systemic inflammation markers and depth of quadriceps muscle. We found that the increased level of systemic inflammation biomarkers such as ESR, CRP and PCT were associated with reduced quadriceps depth in COPD patients. Moreover, evaluation of proinflammatory cytokines in COPD patients showed that the elevated IL-1β, IL-6, and TNF-α levels were associated with quadriceps atrophy. ConclusionThe main finding of this study is the positive correlation of systemic biomarkers of inflammation with quadriceps muscle atrophy in COPD patients over 7 days of mechanical ventilator admission.
Incidence, Clinical Profile, and Risk Factors for Serious Bacterial Infections in Children Hospitalized With Fever in Ujjain, India
Authors: Pathak Ashish , Upadhayay Radika , Mathur Aditya , Rathi Sunil , Lundborg Cecilia Stålsby 
Published: December 2019

Abstract
Background Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted for fever. Method This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months–12 years, presenting with fever 100°F (37.7°C)or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled. Results The study included 302 patients of whom 47% presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI. Conclusion The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI.
WITHDRAWN: Why Did They Fail? A Case Study on Undergraduate First Year Medical Students
Authors: Holder Nurul Atira Khairul Anhar , Nazri Nik Nadia Nik , Foong Chan Choong , Pallath Vinod , Sim Joong Hiong , Hong Wei-Han , Vadivelu Jamuna 
Published: December 2019

Abstract
Background: Academic struggle is a concern for students, medical schools and the society. As academic struggle does not develop in one day, qualitative research could gain an in-depth understanding on why it occurs. This qualitative research aimed to explore the reasons for why Year 1 medical students failed in their studies.Methods: This study adopted a single, embedded case design. Six Year 1 medical students repeating their studies wrote an essay to describe their experiences during the previous year. Semi-structured interviews were then conducted with each student and data was analysed by two researchers. Independent analysis was compared, and discrepancies were resolved through discussions between the researchers. Results: Each student went through different experiences. Some students engaged less in studies and spent more time in leisure and extracurricular activities or having ineffective learning methods. These actions may be influenced by various reasonings such as being overconfident or unmotivated to study. However, interpreting on Theories of Action, the students’ failures may be explained by three types of invalid governing variables found in the data. Students may have performed their actions based on either inadequate knowledge, possessing misbeliefs or have no rationales at all. Invalid governing variables may have led to ineffective actions, and subsequently result in unintended consequences. Hence, all students failed the mid-year and/or end-year assessments. Conclusion: Struggling students lacked the valid governing variables in rationalising their actions. One suggestion based on the Theories of Action is the recommendation that students perform double loop learning to deeply assess and alter their governing variables.
Evidence-based practice work file: A learning strategy for occupational therapy students during clinical placements: a descriptive cross-sectional study
Authors: Johnson Susanne , Bruset Else Britt , Hjelle Kari Margrete , Mongs Malin , Sveen Unni 
Published: December 2019

Abstract
Background: Healthcare professionals and students are expected to work according to evidence-based practice (EBP). The EBP work file, an online learning tool that covers all steps in the EBP process, is an approach to teaching and learning EBP. The aim of this study was to examine possible differences in occupational therapy students’ self-reported attitude, skills, use and implementation of EBP during their second-year clinical placement by comparing students who applied the EBP work file with students who did not use it.Methods: A descriptive, cross-sectional comparative study was conducted. The sample comprised three cohorts (1, 2 and 3) of second-year occupational therapy students from Western Norway University of Applied Sciences and two cohorts (4 and 5) from Oslo Metropolitan University. Five cohorts in total took part in the study (n = 126 students). The students answered two questionnaires (“EBP Beliefs Scale” and “EBP Implementation Scale”) after completing their second-year clinical placement. The analysis was based on descriptive statistics and calculation of the frequencies, percentages, means and standard deviations of all participating students’ scores on the two questionnaires. ANOVA with Bonferroni correction was conducted to analyse differences between the mean totals of the questionnaires. Results: The response rate was 57.3%. The average scores were 56.8 on the EBP Beliefs Scale and 15.8 on the EBP Implementation Scale. Students from cohort 5 (who had extra instruction and assignments via the EBP work file) had statistically lower scores than students form cohort 1 on the Implementation Scale. These students believed that EBP results in the best clinical care for patients, but they lacked confidence in their ability to use EBP. Conclusions: Additional EBP work-file assignments were insufficient to support students in the implementation of EBP during clinical placements. It is important to teach students EBP skills and to demonstrate how they can use this competency in their work with patients. Including clinical instructors in EBP teaching and learning seems essential.
Adult-type ovarian granulosa cell tumour: Treatment Outcomes from a Single Institutional Experience
Authors: Badran Ahmed , Elshenawy Mahmoud A. , Soudy Hussein , Elshentenawy Ayman , Mohieldin Ahmed , Gad Ahmed , Omar Ayman , Shaheen Amgad , Elhassan Tusneem , AlHusaini Hamed 
Published: December 2019

Abstract
Background: Ovarian granulosa cell tumour is rare. This study aim is to report the clinical characteristics and long-term outcomes of adult-type OGCT (AOGCT) at King Faisal Specialist Hospital and Research Centre ( KFSH&RC) and to determine the prognostic factors affecting relapse and survival. we retrospectively reviewed patients with AOGCT, from 1988 to 2014, who were treated at our institution. Baseline characteristics, pathological findings, and outcomes were analysed, and reported. RESULTS: Sixty-one patients with AOGCT were identified with a median age of 49 years. Median follow-up was 5.0 years (range 2.1 -8.2 years). 74% of patients were FIGO stage I, whereas 7% stage II, 5% stage III and unknown in 14%. The most common presenting symptoms included abdominal pain (43%) and vaginal bleeding (43%). The majority of patients (38 patients, 62%) were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Five (8%) patients received adjuvant chemotherapy. Sixteen patients (26%) relapsed with a median time to relapse of 5.5 years (0.7-8.1 years). Half of the recurrences (8 patients, 50%) occurred after 5 years of diagnosis. Five-year overall survival and disease-free survival were 93% and 84%, respectively. Factors associated with high risk of recurrence were presence of ascites (p=0.000) and elevated preoperative CA 125 level (p=0.048). The overall survival was significantly influenced by the menopausal status (premenopausal 100% vs. postmenopausal 84%; p=0.02), preoperative CA 125 (normal 100% vs. elevated 64%; p=0.005), Ascites (present 33% vs. absent 100%; p=0.000), and age (<55 years 100% vs. ≥ 55 years 77%; p= 0.002). CONCLUSION: This study confirms a good outcome of patients with AOGCT. They require long-term follow-up because the recurrence can occur many years post the definitive therapy. The presence of ascites and elevated preoperative CA 125 levels were associated with a higher risk of recurrence and poor prognosis. The outcome seems not to be affected by fertility-sparing surgery and/or adjuvant chemotherapy.
HOXB4 promotes the malignant progression of ovarian cancer via DHDDS
Authors: Li Na , Xiong Jiao , Li Zhengyu 
Published: December 2019

Abstract
Background: Homeobox B4 (HOXB4) is associated with the poor prognosis of various cancer types. However, how HOXB4 promotes ovarian cancer (OV) progression remains to be determined. Methods：The Cancer Genome Atlas (TCGA) database indicated that high level of HOXB4 in OV was correlated with poor prognosis. The biological functions of HOXB4 were confirmed through a colony formation, migration, and invasion assay. The effect of HOXB4 on the expression of EMT and cancer stem cell markers was detected. The transcriptional target of HOXB4 was DHDDS, which was detected by a ChIP assay. A xenograft tumor model was performed in nude mice to detect the role of HOXB4 in tumor proliferation and metastasis. Results：Results showed that the expression of HOXB4 was higher in OV tissues than in normal tissues and correlated with the poor prognosis of OV. HOXB4 knockdown suppressed the proliferation and invasion ability of OV cells in vitro. Conversely, these effects were enhanced by the up-regulation of HOXB4 in OV cells. The binding of two DNA motifs through HOXB4 regulated DHDDS expression and contributed to the malignant progression of OV. The role of HOXB4 in promoting tumor proliferation and metastasis was verified in mice. Further investigation revealed that HOXB4 triggered Snail and Zeb1 expression. Conclusion: Overall, HOXB4 overexpression was remarkably correlated with the poor prognosis of OV. HOXB4 up-regulated DHDDS, which co-contributed to the enhancer proliferation and invasion of OV cells, thus accelerating the malignant progression of OV.
New models for predicting mortality and poor prognosis after supratentorial intracerebral hemorrhage
Authors: chu lulu , Pan Chao , Wang Hao , Liu Wenhua , Xu Shabei , Tang Zhouping 
Published: December 2019

Abstract
Background: The study aimed to determine the multiple related risk factors and their prognostic significance of intracerebral hemorrhage (ICH), and to develop models for predicting poor outcome and mortality. Methods: We retrospectively analyzed 141 consecutive patients with acute ICH presenting to the neurological department of Tongji Hospital from December 2016 to April 2018. Independent predictors of 6-month prognostic significance were identified by logistic regression, and discriminative performance was assessed by using the area under curve (AUC) of receiver-operating characteristic (ROC). Models of poor prognosis and mortality were developed. Results: Independent predictors of poor outcome (mRS≥3) were as follows: NIHSS score, D-Dimer, mixed hematoma density, irregular hematoma shape, ICH volume, cerebral cortical atrophy and midline shift. The sensitivity and specificity of poor prognosis model were 87.5% and 87.4%, respectively. Independent factors associated with 6-month mortality included：platelet counts at admission, NIHSS score, eGFR, presence of intraventricular hemorrhage ( IVH ), third ventricle Sylvian fissure distance. The sensitivity and specificity of the model for mortality were 90.0% and 94.4%, respectively. Conclusions: Two models for prognostic significance of ICH were developed and could well predict the poor prognosis and mortality.