bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified Kocher-Langenbeck approach for the treatment of posterior wall or column acetabular fractures: The one-incision two-window method
Authors: Yang Tien-Yu , Huang Kuo-Chin 
Published: November 2020

Abstract
Abstract
The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach.
Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach.
Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse with posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients.
Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.
Infant sex modifies associations between placental malaria and risk of malaria in infancy
Authors: Kakuru Abel , Roh Michelle E. , Kajubi Richard , Ochieng Teddy , Ategeka John , Ochokoru Harriet , Nakalembe Miriam , Clark Tamara D. , Ruel Theodore , Staedke Sarah G. , Chandramohan Daniel , Havlir Diane V. , Kamya Moses R , Dorsey Grant , Jagannathan Prasanna 
Published: November 2020

Abstract
BackgroundPlacental malaria (PM) has been associated with a higher risk of malaria during infancy. However, it is unclear whether this association is causal, and is modified by infant sex, and whether intermittent preventive treatment in pregnancy (IPTp) can reduce infant malaria by preventing PM. MethodsData from a birth cohort of 656 infants born to HIV-uninfected mothers randomized to IPTp with dihydroartemisinin-piperaquine (DP) or sulfadoxine-pyrimethamine (SP) was analyzed. PM was categorized as no PM, active PM (presence of parasites), mild-moderate past PM (>0-20% high powered fields [HPFs] with pigment), or severe past PM (>20% HPFs with pigment). The association between PM and incidence of malaria in infants stratified by infant sex was examined. Causal mediation analysis was used to test whether IPTp can impact infant malaria incidence via preventing PM. ResultsThere were 1088 malaria episodes diagnosed among infants during 596.6 person years of follow-up. Compared to infants born to mothers with no PM, the incidence of malaria was higher among infants born to mothers with active PM (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.00-1.71, p=0.05) and those born to mothers with severe past PM (aIRR 1.28, 95% CI 0.89-1.83, p=0.18), but the differences were not statistically significant. However, when stratifying by infant sex, compared to no PM, severe past PM was associated a higher malaria incidence in male (aIRR 2.17, 95% CI 1.45-3.25, p<0.001), but not female infants (aIRR 0.74, 95% CI 0.46-1.20, p=0.22). There were no significant associations between active PM or mild-moderate past PM and malaria incidence in male or female infants. Male infants born to mothers given IPTp with DP had significantly less malaria in infancy than males born to mothers given SP, and 89.7% of this effect was mediated through prevention of PM.ConclusionPM may have more severe consequences for male infants, and interventions which reduce PM could mitigate these sex-specific adverse outcomes. More research is needed to better understand this sex-bias between PM and infant malaria risk.Trial registrationTrial registration: ClinicalTrials.gov, NCT02793622. Registered 8 June 2016, https://clinicaltrials.gov/ct2/show/NCT02793622
Lower Mutant-allele tumor heterogeneity is a biomarker in FGFR3-mutant bladder cancer for better prognosis
Authors: Han Yuying , Liu Xu , Ye Haihong , Tian Ye , Ji Zhengguo 
Published: November 2020

Abstract
Background: Bladder cancer displays a broad mutational spectrum and intratumor heterogeneity (ITH), which results in difference in molecular phenotypes and resistance to therapies. However, there are currently no clinically available measures to predict patient prognosis using ITH. We aimed to establish clinically relevant biomarker by using ITH for informing predictive of outcomes.Methods: We used the Bioconductor R package Maftools to efficiently and comprehensively analyze somatic variants of muscle-invasive bladder cancer (MIBC) from The Cancer Genome Atlas (TCGA). We then used a mutant-allele tumor heterogeneity (MATH) algorithm to measure ITH and explored its correlation with clinical parameters as well as mutational subtypes.Results: We observed a broad range of somatic mutations in MIBC from TCGA. MATH value was higher for the high-grade group than for the low-grade group (p < 0.05). There was a strong correlation between higher MATH value and presence of TP53 mutations (p = 0.008), as well as between lower MATH value and presence of FGFR3 mutations (p = 0.006). Patients with FGFR3 mutation and low MATH value exhibit longer overall survival time than that of all BLCA patients (p = 0.044), which was replicated in another bladder cancer database composed of 109 BLCA patients.Conclusion: Measures of tumor heterogeneity may be useful biomarkers for identifying patients with bladder cancer. Low MATH value was an independent risk factor that predicted better prognosis for patients with FGFR3 mutation compared to all BLCA patients.
Analysis of accreditation standards for undergraduate medical studies in Serbia through the lens of the National Health Workforce Accounts
Authors: Buljugic Biljana , Milicevic Milena Santric 
Published: November 2020

Abstract
BackgroundUnderstanding the importance of educational accreditation standards for health and health workforce policymaking is needed more than ever given the growing circulation of physicians, cross-border care and population needs. The World Health Organization National Health Workforce Accounts (WHO/NHWA) for education and training could support the achievement of health care quality through health workforce strategies. ObjectiveTo assess the effect of the accreditation standards on the quality of undergraduate medical studies and to assess their potential to support quality improvement in health workforce education and health policy planning.MethodsStudy design is based on a multimodal approach revealing the qualitative (review of official documents, two internal reports on accreditation, literature) and quantitative data (descriptive analysis, 2010-2018) as resources for evaluation of the national accreditation standards, and mapping with WHO/NHWA indicators on education and training for medical undergraduate studies at the Faculty of Medicine University of Belgrade, Serbia (FMUB).ResultsThe mechanism of compulsory accreditation implies standards for the quality of education (except for inter-professional education). The standards partially cover social determinants and social accountability. Students participate optionally in the adoption of regulations. Like health managers who are also providers of student training during their studies, students participate in FMUB accreditation surveys. Based on the reports from two accreditation cycles, the satisfaction of graduates and employers with the quality of undergraduate medical studies has been partially improved. The downward trend in freshman enrollment has been observed for last nine years. The average duration of a six-year undergraduate study of medicine was extended to 7.2 ± 0.4 years.Conclusion Social accountability and social determinants must be taken as priority standards in the future revisions of accreditation mechanism in order to improve communication, organizational skills and independent work of medical students. Health workforce organizations, civil society and the community should participate in regulatory bodies for accreditation to establish the basis for socially accountable and inter-professional education. If applied at the institutional, local and national levels, the WHO/NHWA indicator system can support the alignment of higher education standards and plans with the standards and strategy/plan of the health care and health workforce.
Comparison of analgesic efficacy between rectus sheath bupivacaine or intrathecal morphine with bupivacaine versus intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study
Authors: Shim Jung-Woo , Cho Yun Jeong , Kim Minhee , Hong Sang Hyun , Moon Hyong Woo , Hong Sung Hoo , Chae Min Suk 
Published: November 2020

Abstract
Background: We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB). Methods: This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.Results: The preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups.Conclusion: Although ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery.
Administration of Mesenchymal Stem Cells in Diabetic Kidney Disease: A Systematic Review and Meta-analysis
Authors: Lin Wenshan , Yang Qian , Chen Guangyong , Lin Shujun , Liao Chunling , Zhou Tianbiao 
Published: November 2020

Abstract
Background: Mesenchymal stem cell (MSC) therapy shows great promise for diabetic kidney disease (DKD) patients. Research has been carried out on this topic in recent years. The main goal of this paper is to evaluate the therapeutic effects of MSCs on DKD through a meta-analysis and address the mechanism through a systematic review of the literature.Method: An electronic search of the Embase, Cochrane Library, ISI Web of Science, PubMed and U.S National Library of Medicine (NLM) databases was performed for all articles about MSC therapy for DKD, without species limitations, up to January 2020. Data were pooled for analysis with Stata SE 12.Result: The MSC-treated group showed a large and statistically significant hypoglycemic effect at 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months and 6 months. Total hypoglycemic effect was observed (SMD=-1.954, 95%CI: -2.389 to -1.519, p＜0.001). The overall effects on serum creatinine (SCr) and blood urea nitrogen (BUN) were analyzed, suggesting that MSC decreased SCr and BUN and mitigated the impairment of renal function (SCr: SMD= -4.838, 95%CI: -6.789 to -2.887, p＜0.001; BUN: SMD= -4.912, 95%CI: -6.402 to -3.422, p＜0.001). Furthermore, MSC therapy decreased the excretion of urinary albumin. Fibrosis indicators were assessed, and the results showed that transforming growth factor-β, collagen-I, fibronectin and α-smooth muscle actin were significantly decreased in the MSC-treated group compared to the control group.Conclusion: MSCs may improve glycemic control and reduce SCr, BUN, and urinary protein. MSCs can also alleviate renal fibrosis. MSC therapy is a potential treatment for DKD.
Acute pulmonary embolism in patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19.
Authors: FRIZ Hernan POLO , GELFI Elia , ORENTI Annalisa , MOTTO Elena , PRIMITZ Laura , DONZELLI Tino , INTOTERO Marcello , SCARPAZZA Paolo , VIGHI Giuseppe , CIMMINIELLO Claudio , BORACCHI Patrizia 
Published: November 2020

Abstract
INTRODUCTION. Emerging evidence associates COVID-19 to an increased risk of acute pulmonary embolism (APE). The present study aimed to assess the prevalence of APE in patients admitted to internal medicine department wards for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS. All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p=0.073.CONCLUSION. Among patients presenting pulmonary deterioration after admission to internal medicine wards for non-critical COVID-19, the prevalence of APE was high. The traditional diagnostic tools to identify high APE pre-test probability patients does not seem to be clinically useful. These results support the use of a low threshold of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.
Health Technology Assessment of Kidney Transplantation and Hemodialysis for the Treatment of End-Stage Kidney Disease
Authors: Widiana I Gde Raka , Marbun Maruhum Bonar H. , Ayu Nyoman Paramita , Sudhana I Wayan , Kandarini Yenny , Mahendra IB , Duarsa Renny SP , Putra Made Rama , Mahadita Gede Wira 
Published: November 2020

Abstract
BACKGROUNDKidney transplantation is an expensive procedure, and it is an alternative treatment of end-stage renal disease other than dialysis. Cost-Effectiveness and the cost-utility study was undertaken at Sanglah Hospital Bali Indonesia, aiming to assess whether living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.METHODSA health technology assessment was done in living-related kidney transplant and hemodialysis during 2018. Data search from internet resources using the electronic library and critically appraised the best evidence of the data of the best data of five-year mortality and survival of kidney transplant and hemodialysis. A preliminary study about quality of life was also done among kidney transplant and hemodialysis patients. Data about kidney transplant costs and hemodialysis for five years was taken from the Sanglah General Hospital database. RESULTSDuring the study, Fourteen living-related kidney transplant patients at Sanglah Public Hospital Denpasar Bali Indonesia consisted of 14 recipients, 12 males, and 2 females aged 27 -55 years, and 14 donors, three males and 11 females aged 24-63 years were included. Thirty HEMODIALYSIS patients at the same hospital were recruited. They consisted of 20 males and ten females, with an average age of 50.9 years. The average five-year cost of kidney transplant was 741,078 M IDR. In comparison, hemodialysis's five-year cost was 581,514 M IDR, leading to a cost difference was 159,564 M IDR. Five-year mortality of kidney transplant was 55% (survival 45%), five years survival rate was 18.9%. Five years of survival difference between kidney transplant and hemodialysis was 26.1 %. Meanwhile, QOL for a kidney transplant was 0,7063, and QOL for hemodialysis was 0,5596, leading to a QOL difference of 0.15. Kidney transplantation will spend 6.11 M IDR for every 1% increase of survival for five years with 15% better QOL. In five years, kidney transplantation produces 67% ICER. From cost-utility perspective, kidney transplantation yields 31.04 M IDR per QALY or 2,217 USD per QALY.CONCLUSIONLiving-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.
Comparison of intravesical instillation of Bacille Calmette-Guérin and epirubicin: a randomized controlled trial
Authors: Shao Yanxiang , Yang Weixiao , Lia Thongher , Hu Xu , Yang Zhen , Ren Shangqing , Wu Kan , Liu Jianbang , Dou Weichao , Xiong Sanchao , Feng Shuyang , Wang Yaohui , Liu Yang , Li Xiang 
Published: November 2020

Abstract
Background

The optimal regimen of instillation for patients with non-muscle invasive bladder cancer (NMIBC) and the recurrence-related factors are still needed to be clear.
Methods

The patients underwent transurethral resection of bladder tumor who diagnosed as intermediate or high risk NMIBC were randomized to receive bacillus Calmette–Guérin (BCG) 19, 15 times or epirubicin (EPI) 18 times (2:2:1). The primary end point was disease-free survival (DFS), the secondary end point was progression free survival (PFS). Associations between clinicopathological factors and prognosis were estimated, with accuracy of the prognostic models Spanish Urological Club for Oncological Treatment (CUETO) and European Organization for Research and Treatment of Cancer (EORTC) evaluated.
Results

A total of 93 patients (BCG19 for 35; BCG15 for 37 and EPI18 for 21) were included, with median follow-up time for 33.46 months. Recurrence and progression occurred in 22 and 8 of patients separately, and significant longer recurrence-free survival was noted in the BCG and primary bladder cancer groups. Higher general complication rate was seen in BCG group compared with EPI groups (83.33% and 61.90%, respectively; P = 0.022), but no grade 3–5 adverse events happened in both groups. Concordance indices for the CUETO and EORTC models were 0.766 and 0.741 for all our series and 0.812 and 0.817 for the BCG subgroup, respectively.
Conclusion

BCG instillation significantly reduced the rate of recurrence compared with epirubicin in this population. The EORTC and CUETO models exhibited high accuracies for the prediction of BCG treatment failure.
Trial registration:

This study was approved by Center for Drug Evaluation of National Medical Products Administration (CDENMPA, China) and Ethics Committee of our institute, with the whole process supervised. The registration number in CDE-NMPA was CTR20150840 (website of CDE: http://www.cde.org.cn/).
A cortical-hypothalamic circuit decodes social rank and promotes dominance behavior
Authors: Padilla-Coreano Nancy , Batra Kanha , Patarino Makenzie , Chen Zexin , Rock Rachel , Zhang Ruihan , Hausmann Sebastien , Weddington Javier , Patel Reesha , Zhang Yu , Fang Hao-Shu , Keyes Laurel , Libster Avraham , Matthews Gillian , Curley James , Fiete Ila , Lu Cewu , Tye Kay 
Published: November 2020

Abstract
How do we know our social rank? Most social species, from insects to humans, self-organize into social dominance hierarchies (1–4). The establishment of social ranks serves to decrease aggression, conserve energy, and maximize survival for the entire group (5–8). Despite dominance behaviors being critical for successful interactions and ultimately, survival, we have only begun to learn how the brain represents social rank (9–12) and guides behavior based on this representation. The medial prefrontal cortex (mPFC) has been implicated in the expression of social dominance in rodents (10,11), and in social rank learning in humans (13,14). Yet precisely how the mPFC encodes rank and which circuits mediate this computation is not known. We developed a trial-based social competition assay in which mice compete for rewards, as well as a computer vision tool to track multiple, unmarked animals. With the development of a deep learning computer vision tool (AlphaTracker) and wireless electrophysiology recording devices, we have established a novel platform to facilitate quantitative examination of how the brain gives rise to social behaviors. We describe nine behavioral states during social competition that were accurately decoded from mPFC ensemble activity using a hidden Markov model combined with generalized linear models (HMM-GLM). Population dynamics in the mPFC were predictive of social rank and competitive success. This population-level rank representation translated into differences in the individual cell responses to task-relevant events across ranks. Finally, we demonstrate that mPFC cells that project to the lateral hypothalamus contribute to the prediction of social rank and promote dominance behavior during the reward competition. Thus, we reveal a cortico-hypothalamic circuit by which mPFC exerts top-down modulation of social dominance.