bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infiltration of immune competent cells into primary tumors and their surrounding connective tissues in mice
Authors: Metzen Marlon , Bruns Michael , Deppert Wolfgang , Schumacher Udo 
Published: June 2020

Abstract
Background: Due to the fact that a close physical contact between NK- and T-cells and cancer cells themselves is necessary to kill cancer cells, we wanted to study the distribution of immunocompetent cells in syngeneic and xenograft tumor models with immunodeficiency of the specific (T- and B-cells) immune system. Because of this approach we focused on the cells of the innate immune system. Methods: Paraffin wax embedded primary breast cancers from the syngeneic mouse WAP-T model and from xenografted tumors of breast, colon, melanoma, ovarian, neuroblastoma, pancreatic, prostate and small cell lung cancer were investigated for the infiltration of immunocompetent cells. The percentage of the labelled cells was semiquantitatively recorded and attributed to the following locations: adjacent adipose tissue, the tumor capsule, the intra-tumoral septae and the malignant cells themselves. The following markers were used: CD45 as a pan-leukocyte marker, BSA-I as a marker for dendritic cells, CD11b as a marker for NK cells and CD68 for macrophages. Results: Xenograft tumors: in relation to the localisation of CD45, CD11b positive, NK and dendritic cells, the highest score was found in the adjacent adipose tissue, followed by lesser infiltration in the malignant tissue. The detected numbers of CD45 positive cells differed between the tumor entities: few infiltrating cells in breast, small cell lung cancer and in neuroblastoma, a moderate infiltration in colon cancer, melanoma and ovarian cancer and strongest in prostate and pancreatic cancer.Syngeneic tumors: the highest score of CD45, CD11b positive, NK and dendritic cells were observed in the tumor capsule, followed by a lesser degree of infiltration of the cancer tissue itself.Conclusions: Our findings show in several neoplastic entities that the majority of immune competent cells are not directly located at the malignant cells but are present in the surrounding tumor stroma and connective tissue capsule. Hence the tumor stroma represents a considerable barrier for lymphocytes to come in direct contact with the malignant cells. Therefore strategies should be employed to make the tumor stroma more penetrable for immune cells in order to increase their efficacy.
Pelvic Rotation Parametersrelated to in-brace Correction in Patients With Idiopathic Scoliosis
Authors: li kepeng , Miao Jun , Jing-an Zhang 
Published: June 2020

Abstract
BACKGROUND: To identify the pelvic parameters affecting in-brace correction (IBC) in patients with idiopathic scoliosis (IS). METHODS: Patients with IS receiving Chêneau brace treatment in our scoliosis center from January 2019 to November 2019 were retrospectively analyzed. Pelvic rotation parameters, including Pelvic incidence (PI), Sacral slope (SS), pelvic tilt (PT), L/R ratio, were collected. Other radiographic data, such as Risser sign, coronal and sagittal balance, curve location, kyphosis, lordosis of each patient was also recorded to analyze their correlations with IBC. Correlation analyses were performed to identify the classified variables influencing IBC. The principal component analysis was used to extract common factors of radiographic parameters to eliminate interaction effects. The linear regression equation was established using principal components, the variables influencing IBC were identified.RESULTS: A cohort of 44 patients with IS (36 girls and 8 boys) were included in the present study. The mean IBC was 49.87% (range, 3%∽100%). IBC of lumbar IS was negatively correlated with apical rotate factor (ARF, B=-0.385), mainly consisted of pelvic coronal plane rotation (PCPR, 0.449), cobb angle (CA,0.575), apical vertebral rotation (AVR, 0.918), and pelvic rotate factor (PRF, B=-0.387), mainly consisted of PT (0.861), PI (0.728), PCPR (-0.570). The regression equation of lumbar IS had statistical significance (F=6.500, P=0.005，R2=0.317). Whereas statistically significance was not found in the regression equation of thoracic IS (F=2.913, P=0.106). The remaining parameters were not related to IBC.CONCLUSIONS: For lumbar IS, ARF and PRF have negative effects on IBC, Coronal and sagittal rotation of the pelvis is related to IBC.
The K nearest neighbor algorithm for imputation of missing longitudinal prenatal alcohol data
Authors: Sania Ayesha , Pini Nicolò , Nelson Morgan E. , Myers Michael M. , Shuffrey Lauren C. , Lucchini Maristella , Elliott Amy J. , Odendaal Hein J. , Fifer William P. 
Published: June 2020

Abstract
Background — Missing data are a source of bias in many epidemiologic studies. This is problematic in alcohol research where data missingness may not be random as they depend on patterns of drinking behavior. Methods — The Safe Passage Study was a prospective investigation of prenatal alcohol consumption and fetal/infant outcomes (n=11,083). Daily alcohol consumption for the last reported drinking day and 30 days prior was recorded using the Timeline Followback method. Of 3.2 million person-days, data were missing for 0.36 million. We imputed missing exposure data using a machine learning algorithm; “K Nearest Neighbor” (K-NN). K-NN imputes missing values for a participant using data of other participants closest to it. Since participants with no missing days may not be comparable to those with missing data, segments from those with complete and incomplete data were included as a reference. Imputed values were weighted for the distances from nearest neighbors and matched for day of week. We validated our approach by randomly deleting non-missing data for 5-15 consecutive days. Results — We found that data from 5 nearest neighbors (i.e. K=5) and segments of 55 days provided imputed values with least imputation error. After deleting data segments from a first trimester data set with no missing days, there was no difference between actual and predicted values for 64% of deleted segments. For 31% of the segments, imputed data were within +/-1 drink/day of the actual. Conclusions — K-NN can be used to impute missing data in longitudinal studies of alcohol use during pregnancy with high accuracy.
Metabolomic analysis of biosynthesis mechanism of ε-polylysine produced by Streptomyces diastatochromogenes
Authors: Wang Ziyuan , Guo Fengzhu , Dong Tianyu , Tan Zhilei , Abdelraof Mohamed , Cui Jiandong , Jia Shiru 
Published: June 2020

Abstract
The authors have withdrawn this preprint due to author disagreement.
Reduced translation efficiency due to novel splicing variants in 5′ untranslated region and identification of novel cis-regulatory elements in canine and human BRCA2
Authors: Yoshikawa Yasunaga , Morimatsu Masami , Kozuma Hajime , Sugawara Kaori , Orino Koichi 
Published: June 2020

Abstract
Background
Breast cancer 2, early onset (BRCA2) is a tumor suppressor gene. The protein encoded by this gene plays an important role in homologous recombination (HR)-mediated DNA repair. Deleterious mutations in BRCA2 and downregulation of its expression have been associated with tumorigenesis in dogs and humans. Thus, regulation of BRCA2 expression level is important for maintaining homeostasis in homologous recombination.
Results
In this study, the mechanisms that regulate the expression of BRCA2 were proposed. Novel splicing variants were identified in the 5′ untranslated region (UTR) of canine and human BRCA2 in canine testis, canine ovary, and canine and human cultured cell lines. In cultured cells, the ratio of BRCA2 splicing variants at 5′ UTR was altered by serum starvation. These novel splicing variants, excluding one of the canine splicing variants, were found to reduce the translational efficiency. Additionally, the DNA sequence in human BRCA2 intron 1 harbored novel cis-regulatory elements. Three silencer and two enhancer cis-regulatory elements were identified in human BRCA2 intron 1.
Conclusions
This study demonstrates that BRCA2 expression level is regulated via 5′ UTR splicing variants and that the BRCA2 intron 1 region harbors cis-regulatory elements.
Dynamic changes of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predicts breast cancer prognosis
Authors: Kim Ju-Yeon , Jung Eun Jung , Kim Jae-Myung , Lee Han Shin , Kwag Seung-Jin , Park Ji-Ho , Park Taejin , Jeong Sang-Ho , Jeong Chi-Young , Ju Young-Tae 
Published: June 2020

Abstract
Background We aimed to determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are more useful predictors after initial intention to treat than at the time of diagnosis.Methods We collected the medical records of 533 patients. The results of the peripheral blood sampling before the primary treatments were labeled as initial cohort, and those obtained between 24 and 36 months after initial treatment were defined as the 2nd cohort. Delayed metastasis has been defined as distant metastasis 2 years after treatment, and survival outcome was estimated and compared across groups.Results Median follow-up duration was 74 months (24–162 months), and 53 patients experienced delayed metastasis. In univariate analysis, metastasis-free survival, patient age at diagnosis, tumor size, lymph node metastasis, HER-2 status, initial NLR and PLR, and 2nd NLR and PLR were found to be significantly associated with delayed metastasis. However, in multivariate analysis, only the 2nd NLR and PLR were found to be significantly associated with delayed metastasis, excluding initial NLR and PLR. Metastasis-free survival was analyzed through the pattern changes of NLR or PLR. The results revealed that patients with continued low NLR and PLR values at pre- and post-treatment (low initial values and 2nd values) showed a significantly better prognosis than those with a change in value or continued high NLR and PLR.Conclusions We identified that patients with persistent high NLR and PLR after initial treatment have significant worse prognosis in terms of late metastasis. Therefore, these results suggest that NLR and PLR are more useful in predicting prognosis post-treatment.
Is 99mTechnetium Pertechnetate Thyroid Uptake accurate in Thyrotoxicosis Evaluation?
Authors: al-muqbel kusai , Tashtoush Reema , Mayyas Fadia , Marashdeh Wael , Tashtoush Amr , AbuGhanmi Raya , Kareem Ali Abdel 
Published: June 2020

Abstract
BackgroundThis study aimed to evaluate the 99mTc thyroid uptake (TcTU) in terms of (1) normal mean and range, (2) level of uncertainty in thyrotoxic patients and (3) effectiveness of adding radioiodine uptake in patients with uncertain TcTU values.MethodsPatients referred for TcTU test were included and categorized into groups: euthyroid, Graves’ disease, toxic nodular goiter and subacute thyroiditis. Mean and range of TcTU were obtained separately for each group. Second radioiodine uptake test was performed in patients who had uncertain TcTU (overlap with normal range). Results209 patients were included (54 euthyroid, 112 Graves’ disease, 29 toxic nodules and 17 subacute thyroiditis patients). Normal mean and range of TcTU were 1.5 +/- 1.1% and 0.17-4.8%, respectively. Mean TcTU was high in hyperthyroid patients and was extremely low in subacute thyroiditis patients, however, uncertain values was noted in about 30% of the patients. TcTU was uncertain in 39 hyperthyroid patients and in 10 subacute thyroiditis patients, while second radioiodine uptake was high in the former and extremely low in the latter.Test sensitivity was 68%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 52% and accuracy was 76%. ConclusionTcTU major disadvantage is the uncertainty seen in third of patients degrading test sensitivity and accuracy. We managed to overcome this uncertainty by adding second radioiodine thyroid uptake test. Accordingly, single visit TcTU was accurate and sufficient in about two thirds of patients while the remainder required second radioiodine uptake to reach accurate diagnosis.
Factors that impact the adoption of clinical decision support systems (CDSS) in healthcare settings for evidence-based decision making
Authors: LAKA MAH , MILAZZO ADRIANA , MERLIN TRACY 
Published: June 2020

Abstract
Background: Clinical decision support systems (CDSS) are designed to promote evidence-based patient care and shared-decision making in healthcare settings. Despite these benefits, adoption and long-term use of the systems remain limited. There is a need to identify different factors that influence CDSS adoption in healthcare settings.Objective: The Unified Theory of Acceptance and Use of Technology (UTAUT) model was applied to determine different factors that influence the adoption of CDSS in healthcare settings.Methods. A cross-sectional online survey examining clinicians’ perceptions about CDSS implementation in hospital and primary care settings in Australia was undertaken from June - October 2019. Multivariate logistic regression was used to examine the association of UTAUT moderators (age, gender and experience) and care settings (hospital and primary care) with perceived benefits, barriers and facilitators to CDSS adoption.Results: Access to information required for evidence-based decision making, and improvements in quality and safety of patient care were the most common perceived benefits of CDSS. Mapping of different barriers and facilitators to the UTAUT model indicated that ease of use (effort expectancy), perceived benefit (performance expectancy) and a facilitating environment greatly influence the adoption of CDSS. Respondents indicated that systems providing a better fit between relevance, content and timeliness greatly facilitates uptake. Adoption of CDSS also depends on the ability of an organisation to create a facilitating environment that can help address the lack of users’ trust in these systems. The type of healthcare setting was found to be a significant predictor of lack of confidence in the content within CDSS, threat to professional autonomy, and time constraints as barriers to CDSS implementation. Therefore, setting dynamics as well as user-specific requirements need to be considered to improve the acceptability and use of CDSS. Conclusion: Our study has explored different factors that may help address implementation challenges for CDSS. By combining internal factors of users’ inclination and perceptions about the system’s perceived benefits, coupled with external factors of system design requirements, training and support, and stakeholders’ consultations, our findings highlight the need for a holistic implementation framework to enable effective CDSS adoption.
Epidemiology, Hot Spots and Socio-Demographic Risk Factors of Alcohol Consumption in Indian Men and Women: Analysis of National Family Health Survey-4, A Nationally Representative Cross Sectional Study
Authors: Paulson Winnie , Karuppusamy Balasubramani , Chellappan Savitha , Behera Sujit Kumar , Nina Praveen Balabaskaran 
Published: June 2020

Abstract
BackgroundAlcohol consumption is a serious health crisis in India that needs urgent attention. An estimated 160 million Indians consume alcohol. Despite the widespread alcohol use across India, there is no information on the alcohol hot spots. Along with hot spots, understanding the Socio-Demographic Indices (SDI) affecting alcohol consumption in Indian men and women will help guide public health policies on alcohol use. MethodsData from National Family Health Survey-4 carried out from 2015-2016 with a sample size of 103 411 men and 699 686 women were used for the analysis. Epidemiology of alcohol use was mapped by Geographic Information System, and hot spots were identified by spatial statistics (Getis-OrdGi*). Bivariate analyses and binary logistic regression were used to analyse SDI. ResultsIndia has three major alcohol hot spots: (1) North East (NE) states, (2) Eastern Peninsular states formed by Chhattisgarh, Odisha, Jharkhand and Telangana, and (3) Southern states of Tamil Nadu and Kerala. Among these hot spots, the districts of Tamil Nadu, Telangana and Assam fall under high risk category. Hot spot analysis strongly correlated with region-wise analysis of SDI. South (Men aOR - 1.0, 95% CI: 39.1 - 42.1) and NE India (Men aOR - 0.6, 95% CI: 38.4 - 42.6; Women aOR - 2.05, 95% CI: 6.4 - 7.5) have higher odds of alcohol use. Schedule tribe men (aOR-1.67, 95% CI: 1.53-1.82) and women (aOR-5.99, 95% CI: 4.71-7.63) have higher odds of alcohol consumption. Compared to other religions, Muslim men (aOR: 0.11) and women (aOR: 0.06) consume less alcoholConclusionsHot spots and, high risk districts of alcohol consumption identified in this study can guide public health policies for targeted intervention. Except for religion and social category, other socio-economic factors have a low to moderate effect on alcohol consumption. India does not have concrete anti-alcohol policies at the national level. Alcohol use is at the discretion of individual states and union territories, and appears to be the major determinant of alcohol use in India. Stringent anti-alcohol policies strictly enforced across India is the key to control alcohol use.
A Conceptual Model of Functional Health Literacy to Improve Chronic Airway Disease Outcomes
Authors: Poureslami Iraj , Fitzgerald J. Mark , Tregobov Noah , Shum Jessica , Akhtar Alizeh , Kassay Saron , Starnes Kassandra , McMillan Austin , Mahjob Maryam 
Published: June 2020

Abstract
Background: Current conceptual models of health literacy (HL) illustrate the link between HL skills and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into a comprehensive framework. This article summarizes the process of developing a Chronic Airway Disease Management and Health Literacy (CADMaHL) conceptual model.Methods: The proposed CADMaHL model is developed within the following six stages: (1) Systematic review of HL measurement tools. (2) Patient-oriented focus group sessions. (3) HL and health professions (key-informants) interviews. (4) Attain perspectives and feedback of respirologists. (5) Develop a HL measurement tool for chronic airway disease (CAD) patients (e.g., asthma and COPD), pilot test, and tool modification. (6) Tool validation with asthma and COPD patients. Results: Throughout the study process, patient population groups, an advisory panel of HL experts, clinician scientists, and researchers reviewed the information acquired. This review process enabled us to organize the CADMaHL model into 6 primary modules, including INPUT, consists of four HL core components (access, understand, communicate, evaluate) and numeracy skill; OUTPUT, includes use/application of the obtained information; OUTCOME, covers patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, comprises HL assessment tools and strategies; IMPACT, includes mediators between HL and health outcomes; and CROSSCUTTING FACTORS, consists of diverse socio-demographics and health-system factors with applicability across the HL domains.Conclusions: We developed and validated the proposed HL tool using the CADMaHL model. We anticipate that the model may inform development of interventions aiming to improve HL and disease management outcomes of CAD patients, by properly identifying and mitigating HL gaps among these patient population groups.
Incidence, prediction, and the long-term outcome of solid pseudopapillary tumor of the pancreas with malignant behaviors: a pooled-analysis
Authors: Li Yifei , Wang Shijie , Li Yifan , Zhou YanMing 
Published: June 2020

Abstract
Background: Microscopic malignancy or gross metastasis of solid pseudopapillary tumor of the pancreas were considered to be malignant behaviors. The clinical status of solid pseudopapillary tumors of the pancreas with malignant behaviors (SPTM) are unclear. This study was to perform a review and pooled-analysis to determine the incidence and predictors of SPTM, and explore the survival and prognostic factors.Methods: A registered meta-analysis (PROSPERO: CRD42020163788) was performed. Studies reporting on SPTM and follow-up information were identified between 1960 and 2020 by searching PubMed, Scopus, and Embase. The search process followed the PRISMA guidelines.Results: A total of 98 articles were included in this study, including 22 articles reporting the incidence of SPTM, and 159 SPTM cases containing survival information in 77 articles. Pooled estimates showed that the incidence of SPTM in solid pseudopapillary tumors of the pancreas was 22% [95% CI：19~24%], and tumor size ≥5 cm (OR: 2.03，95%CI: 1.28~3.22) was the only risk factor for predicting the occurrence of SPTM. The 5-, and 10-year survival rates of SPTM patients after complete surgical resection were 92% and 77%, respectively. Larger tumors (diameter ≥5cm) (p=0.046), lymphovascular invasion (p=0.005), lymph node metastasis (p=0.02), cellular atypia (0.018), Ki67 index ≥5% (p=0.001), tumor recurrence (p=0.004), recurrent time <5 years (p=0.005) and positive margin (p=0.003) were prognosis unfavorable factors for survival. Additionaly, lymphovascular invasion (OR:8.25, 95% CI:2.26-30.1), lymph node metastasis (OR:25.28, 95% CI:3.01-211.74), extrapancreatic invasion (OR:9.07, 95% CI:2.36-34.84), cellular atypia (OR:16, 95% CI:3-85.3), and Ki67 ≥5% (OR: 7.88, 95%CI: 1.53~40.51) increased the risk of recurrences of resected SPTM. Conclusion: Tumor size is an important factor in predicting the occurrence of SPTM before operation, and complete surgical resection can provide SPTM patients a expected long-term survival. Proved clinicopathological factors by current research will help to determine prognosis and recurrence, and close follow-up of five years or more after operation is essential.
Relationship between School Gardening and Self-Efficacy on Weekly Fruit &amp; Vegetable Intake
Authors: Kafeero Hussein Mukasa , Kavuma David , Mbabazi Scovia 
Published: June 2020

Abstract
Background: The study was designed to understand the relationship between school gardens and student’s self-efficacy and its effect on weekly intake of fruits and vegetables. The survey used two Ugandan secondary schools; one having a well established school garden with all students having equal opportunities to participate in the growing, harvesting and consumptions of fruits and vegetables.Methods: The study followed a cross-sectional study design employing quantitative research methods. The target population comprised of late adolescents 18–25 years attending the two-selected secondary school; one in Kampala and another in Luwero districts. The school in Luwero district engaged students in gardening activities while the school in Kampala did not. Self-administered structured questionnaire was given to students to answer questions in line with the specific objectives. Quantitative data was analyzed by t-test, Mann Whitney U test, Pearson Rank Correlation, Odds ratio and Chi-square.Results: The students exposed to gardening had a higher self-efficacy (p = 0.03217) towards weekly consumption of fruits and vegetables with slightly higher scores of fruits and vegetable weekly intake as compared to those not exposed (OR = 1.0370). However, the weekly consumption of fruits and vegetables was low among both groups as compared to the World Health Organization (WHO), Food and Agricultural Organization (FAO) and United States Department of Agriculture (USDA) recommendation of ≥ 35 servings per week (≥ 5 servings per day) for both fruits and vegetables. The students in the exposed group were more confident in consuming fruits and vegetables rather than a snack (p = 0.008), ice cream (p = 0.004), three times a day (p < 0.0001) compared to the control group.Conclusion: School garden based intervention can significantly improve student’s self-efficacy towards fruit & vegetable dietary intake increasing the weekly consumption of fruits and vegetables.