bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic Injury Caused by the Environmental Toxicant Vinyl Chloride is Sex-Dependent in Mice
Authors: Wahlang Banrida , Hardesty Josiah E , Head Kimberly Z , Jin Jian , Falkner Keith C , Prough Russell A , Cave Matthew C , Beier Juliane I 
Published: November 2019

Abstract
Vinyl chloride (VC), a common industrial chemical, has been associated with hemangiosarcoma and toxicant-associated steatohepatitis (TASH) in men working at rubber-production plants. Our group previously demonstrated that chronic VC inhalation at environmentally relevant levels (&lt; 1 ppm) in male mice exacerbated hepatic injury caused by high-fat diet (HFD) feeding. Because VC studies on TASH have only been performed in male models, the objective of this study is to examine VC inhalation in female mice in the context of TASH mechanisms. Male and female C57Bl/6 mice were fed either a low-fat diet or HFD and exposed to VC or room air using an inhalation chamber, for 12 weeks (6 h, 5 days/week); and plasma and liver samples were collected after euthanasia. Compared with males, females were less susceptible to HFD+VC-induced obesogenic effects demonstrated by lower body weight and fat composition. Histological analysis revealed that whereas VC exacerbated HFD-induced steatosis in males, this effect was absent in females. In addition, females were more resistant to VC-induced hepatic inflammation whereas males had increased liver weights and higher hepatic Tnfα mRNA levels. Systemic markers of hepatic injury, namely alanine aminotransaminase and thrombin/antithrombin levels were increased by HFD+VC co-exposures only in males. In addition, females did not show significant cell death as previously reported in males. Taken together, the results suggested that VC inhalation led to sex-dependent liver and metabolic toxicity. This study implicated the importance of assessing sex differences in environmental basic science and epidemiologic studies to better identify at-risk populations in both men and women.
The Profits of Wisdom: The Impact of a Business Support Program in Tanzania
Authors: Bardasi Elena , Gassier Marine , Goldstein Markus , Holla Alaka 
Published: November 2019

Abstract
Business training programs in low-income settings have shown only limited impacts on firm revenues and profits, particularly for female entrepreneurs. A randomized design was used to compare the impacts of two types of business training programs targeting women with established small businesses in urban Tanzania. The basic version relied on in-class sessions to strengthen the participants’ managerial and technical skills. In the enhanced version, training was supplemented by visits from business coaches to the sites of participants’ activities, as well as other services tailored to their individual needs. The basic training had no impact on business practices or outcomes. The enhanced training positively impacted the adoption of new practices but had no effects on revenue or profits. However, the average masks large heterogeneous effects: only more experienced entrepreneurs benefited from the program. This finding suggests that more careful targeting can improve the impact of business training programs.
The Analgesic Effects of Intrathecal Morphine in Comparison With Ultrasound-Guided Transversus Abdominis Plane Block After Caesarean Section: A Randomised Controlled Trial at a Ugandan Regional Referral Hospital
Authors: Kwikiriza A. , Kiwanuka J.K. , Firth P.G. , Hoeft M.A. , Modest V.E. , Ttendo S.S. 
Published: November 2019

(Anaesthesia. 2019;74:167–173)
Worldwide, cesarean section is the most frequently performed major surgery. However, most research regarding anesthesia and postoperative analgesia for cesarean section has been performed in high-income countries that have extensive health care resources. In comparison, low-income and middle-income countries have markedly fewer resources for health care in general and postoperative nursing care specifically. This study was performed to compare analgesic outcomes after cesarean section. At a hospital in Southwestern Uganda where this study was undertaken, most of the basic postoperative nursing care after cesarean section is provided by family or friends of the patient. The current study was performed to compare outcomes when intrathecal morphine or transversus abdominis plane (TAP) block was used to provide postcesarean pain control in a resource-limited setting.
Successful Treatment of Chronic Lower Extremity Ulcers with Allogeneic Platelet-Rich Plasma and Artificial Dermis: A Case Report
Authors: Zhao Qiannan , Ma Yuanyuan , Lu Yuquan , Chai Yuan , Zhou Yuemin 
Published: November 2019

ABSTRACT
Hydroxyurea is an oral medication associated with painful, nonhealing ulcers, for which there is no effective treatment but permanent discontinuation of hydroxyurea. The authors present a case of leg ulcers that likely occurred as a result of hydroxyurea use in a patient with essential thrombocythemia. Topical treatment with allogeneic platelet-rich plasma and artificial dermis completely healed the leg ulcers without hydroxyurea cessation.
The Impact of Extracorporeal Shock Wave Therapy on Microcirculation in Diabetic Feet: A Pilot Study
Authors: Yang Jong-Phil , Lee Ye-Na , Son Ji Won , Han Seung-Kyu 
Published: November 2019

ABSTRACT

BACKGROUND
Patients with diabetic foot commonly experience vascular insufficiency and compromised tissue perfusion. Extracorporeal shockwave therapy (ESWT) reportedly promotes wound healing and angiogenesis, but clinical studies on the effect of ESWT on angiogenesis are scarce and the exact mechanism remains unclear.

OBJECTIVE
To investigate the effect of ESWT on cutaneous microcirculation in diabetic feet.

METHODS
Ten patients with diabetic feet received ESWT twice weekly for a total of six sessions. Transcutaneous partial oxygen pressure (Tcpo
2) and cutaneous blood flow were measured before and after ESWT.

MAIN RESULTS
The treated feet showed statistically significant improvements in the mean Tcpo
2 (P < .01) and cutaneous blood flow level (P < .05) compared with control feet. In treated feet, Tcpo
2 increased by 19.6%, from 41.4 ± 9.9 to 49.5 ± 8.7 mm Hg (P < .05). In control feet, Tcpo
2 decreased by 11.6%, from 39.5 ± 14.0 to 34.9 ± 14.5 mm Hg (P = .059). The average cutaneous blood flow level of treated feet before ESWT was 36.9 ± 25.6, which increased to 48.3 ± 32.4 AU after ESWT (30.9% increase; P = .646). In control feet, the cutaneous blood flow level decreased from 80.5 ± 36.7 to 60.4 ± 38.8 AU, a decrease of 25.0% (P = .241).

CONCLUSIONS
These results demonstrate that ESWT may have beneficial effects on microcirculation in diabetic feet.
Interpreters in healthcare
Authors: Salavati Darya , Lindholm Fanny , Drevenhorn Eva 
Published: November 2019

Abstract

Purpose:
This study explored nursing experiences using interpreters in primary healthcare settings.

Methods:
Eight nurses in southern Sweden were subjected to semistructured interviews. The responses were divided into three categories using content analysis: interpreter influence, challenges, and strategies.

Results:
Despite using an interpreter to minimize language barriers, nurses do not achieve the same level of person-centered care as those who speak the same language as their patients, but translation services remain a useful communication tool for patient care.

Conclusion:
Communication through an interpreter is an inevitability for healthcare professionals, and formal education is recommended to improve nurses' utilization of these services.
Deep neural network-assisted computed tomography diagnosis of metastatic lymph nodes from gastric cancer
Authors: Gao Yuan , Zhang Zheng-Dong , Li Shuo , Guo Yu-Ting , Wu Qing-Yao , Liu Shu-Hao , Yang Shu-Jian , Ding Lei , Zhao Bao-Chun , Li Shuai , Lu Yun 
Published: November 2019

Abstract

Background:
Artificial intelligence-assisted image recognition technology is currently able to detect the target area of an image and fetch information to make classifications according to target features. This study aimed to use deep neural networks for computed tomography (CT) diagnosis of perigastric metastatic lymph nodes (PGMLNs) to simulate the recognition of lymph nodes by radiologists, and to acquire more accurate identification results.

Methods:
A total of 1371 images of suspected lymph node metastasis from enhanced abdominal CT scans were identified and labeled by radiologists and were used with 18,780 original images for faster region-based convolutional neural networks (FR-CNN) deep learning. The identification results of 6000 random CT images from 100 gastric cancer patients by the FR-CNN were compared with results obtained from radiologists in terms of their identification accuracy. Similarly, 1004 CT images with metastatic lymph nodes that had been post-operatively confirmed by pathological examination and 11,340 original images were used in the identification and learning processes described above. The same 6000 gastric cancer CT images were used for the verification, according to which the diagnosis results were analyzed.

Results:
In the initial group, precision-recall curves were generated based on the precision rates, the recall rates of nodule classes of the training set and the validation set; the mean average precision (mAP) value was 0.5019. To verify the results of the initial learning group, the receiver operating characteristic curves was generated, and the corresponding area under the curve (AUC) value was calculated as 0.8995. After the second phase of precise learning, all the indicators were improved, and the mAP and AUC values were 0.7801 and 0.9541, respectively.

Conclusion:
Through deep learning, FR-CNN achieved high judgment effectiveness and recognition accuracy for CT diagnosis of PGMLNs.

Trial Registration:
Chinese Clinical Trial Registry, No. ChiCTR1800016787; http://www.chictr.org.cn/showproj.aspx?proj=28515.
First-line atezolizumab plus chemotherapy in treatment of extensive small cell lung cancer: a cost-effectiveness analysis from China
Authors: Li Ling-Yu , Wang Hong , Chen Xiao , Li Wen-Qian , Cui Jiu-Wei 
Published: November 2019

AbstractBackground:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer (SCLC). While, overprice limited its broad use in clinical. The aim of this study was to evaluate the cost-effectiveness of atezolizumab plus chemotherapy in treatment of extensive SCLC as first line in China.Methods:A Markov model was established by extracting data from the IMpower 133 trial with untreated extensive SCLC patients. Utility values were obtained from published studies, and the costs were acquired from real world and literature. Additionally, sensitivity analyses based on a willingness-to-pay (WTP) threshold were performed to identify the uncertain parameters of Markov model.Results:Total costs of atezolizumab group were $48,129, while cost of chemotherapy alone was just $12,920 in placebo group. The quality-adjusted life-years (QALYs) in atezolizumab group was just 0.072 higher than that in placebo group (0.858 QALYsvs. 0.786 QALYs). The cost-effectiveness ratio between atezolizumab combination with chemotherapy and chemotherapy alone was $489,013/QALY in China. The net benefit of placebo group was significantly higher than atezolizumab group. One-way sensitivity analyses highlighted that utilities of the progression-free survival (PFS) and progression disease state in placebo group were the most influential parameter.Conclusions:Atezolizumab combination therapy was not more cost-effective than chemotherapy alone at a WTP threshold of $25,929/QALY in China.
Involvement of hydrogen sulfide in the progression of renal fibrosis
Authors: Wang Yu , Xing Qi-Qi , Tu Jing-Ke , Tang Wen-Bin , Yuan Xiang-Ning , Xie Yan-Yun , Wang Wei , Peng Zhang-Zhe , Huang Ling , Xu Hui , Qin Jiao , Xiao Xiang-Cheng , Tao Li-Jian , Yuan Qiong-Jing 
Published: November 2019

Abstract

Objective
Renal fibrosis is the most common manifestation of chronic kidney disease (CKD). Noting that existing treatments of renal fibrosis only slow disease progression but do not cure it, there is an urgent need to identify novel therapies. Hydrogen sulfide (H2S) is a newly discovered endogenous small gas signaling molecule exerting a wide range of biologic actions in our body. This review illustrates recent experimental findings on the mechanisms underlying the therapeutic effects of H2S against renal fibrosis and highlights its potential in future clinical application.

Data sources
Literature was collected from PubMed until February 2019, using the search terms including “Hydrogen sulfide,” “Chronic kidney disease,” “Renal interstitial fibrosis,” “Kidney disease,” “Inflammation factor,” “Oxidative stress,” “Epithelial-to-mesenchymal transition,” “H2S donor,” “Hypertensive kidney dysfunction,” “Myofibroblasts,” “Vascular remodeling,” “transforming growth factor (TGF)-beta/Smads signaling,” and “Sulfate potassium channels.”

Study selection
Literature was mainly derived from English articles or articles that could be obtained with English abstracts. Article type was not limited. References were also identified from the bibliographies of identified articles and the authors’ files.

Results
The experimental data confirmed that H2S is widely involved in various renal pathologies by suppressing inflammation and oxidative stress, inhibiting the activation of fibrosis-related cells and their cytokine expression, ameliorating vascular remodeling and high blood pressure, stimulating tubular cell regeneration, as well as reducing apoptosis, autophagy, and hypertrophy. Therefore, H2S represents an alternative or additional therapeutic approach for renal fibrosis.

Conclusions
We postulate that H2S may delay the occurrence and progress of renal fibrosis, thus protecting renal function. Further experiments are required to explore the precise role of H2S in renal fibrosis and its application in clinical treatment.
Pathogenesis, disease course, and prognosis of adult-onset Still's disease: an update and review
Authors: Wang Meng-Yan , Jia Jin-Chao , Yang Cheng-De , Hu Qiong-Yi 
Published: November 2019

Abstract

Objective:
Adult-onset Still's disease (AOSD) is a rare but clinically well-known polygenic systemic autoinflammatory disease. In this review, we aim to present frontiers in the pathogenesis, clinical features, diagnosis, biomarkers, disease course, prognosis, and treatment in AOSD.

Data sources:
We retrieved information from the PubMed database up to July 2019, using various search terms and relevant words, including AOSD and Still's disease.

Study selection:
We included data from peer-reviewed journals. Both basic and clinical studies were selected.

Results:
Pathogenesis of AOSD involves genetic background, infectious triggers, and immunopathogenesis, mainly the activation of macrophages and neutrophils followed by a cytokine storm. Diagnosis and prognosis evaluation of AOSD is still challenging; therefore, there is an urgent need to identify better biomarkers. Biologic agents, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-α antagonists in the treatment of AOSD, have good prospect.

Conclusion:
This review highlights the advances in pathogenesis, potential biomarkers, disease course, and treatment in AOSD.
The Reliability of Intraoperative Assessment on Predicting Tumor Size, Myometrial Invasion, and Cervical Involvement in Patients With a Preoperative Diagnosis of Complex Atypical Hyperplasia or (Clinical Stage I) Endometrial Cancer
Authors: Smith Brentley Q. , Boone Jonathan D. , Thomas Eric D. , Turner Taylor B. , McGwin Gerald , Stisher Amanda M. , Leath Charles A. , Novak Lea , Huh Warner K. 
Published: November 2019

Objectives:
The objective of this study is to assess the reliability of intraoperative uterine assessment compared with the final pathologic evaluation in patients with endometrial cancer (EC) and whether assessment improves with experience.

Methods:
After Institutional Review Board approval, a prospective cohort study of women surgically managed with biopsy-proven complex atypical hyperplasia (CAH) or EC between March 2015 and December 2016 was performed. Demographics, preoperative biopsy results, procedure, intraoperative and final pathologic evaluation of lesion size, myometrial invasion, and lower uterine segment/cervical involvement were abstracted. The agreement between the intraoperative and final pathologic evaluation of tumor involvement of the uterus was determined using the kappa statistic and the intraclass correlation coefficient.

Results:
A total of 264 patients with a preoperative diagnosis of CAH or EC were included—71 (26.9%) with CAH and 193 (73.1%) with EC. The mean age was 62.6±11.5, and mean body mass index was 37.2±10.1. The majority of women were white (67%). A total of 227 (85.9%) patients underwent a laparoscopic or robotic hysterectomy, whereas 36 (13.6%) underwent an abdominal hysterectomy. 233 (88.3%) patients had EC and 21 (7.9%) patients had CAH on final pathology. There was a fair agreement between the intraoperative estimation of myometrial invasion (κ=0.37). A moderate agreement exists between the intraoperative estimation of lower uterine segment/cervical involvement (κ=0.57). There was a strong agreement between intraoperative tumor size assessment and the final path (intraclass correlation coefficient=0.74). The intraoperative correlation of tumor size was similar for the first half of the cohort (κ=0.50) and the second half (κ=0.46) chronologically.

Conclusions:
Despite only a fair correlation in the myometrial invasion, intraoperative assessment of cervical involvement and especially tumor size is more readily identified and overall accurate. Therefore, intraoperative evaluation is an additional tool to use when making the decision to proceed with surgical staging.
Mohs Micrographic Surgery at Challenging Anatomical Sites
Authors: Mori Westley S. , Demer Addison M. , Mattox Adam R. , Maher Ian A. 
Published: November 2019

BACKGROUND
Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.

OBJECTIVE
To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.

METHODS
A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.

CONCLUSION
These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.
Approaches to Perineural, Lymphovascular, and Single-Cell Disease
Authors: Collins Mary-Katharine , Behshad Ramona , Maloney Mary , Pugliano-Mauro Melissa 
Published: November 2019

BACKGROUND
Mohs micrographic surgeons should be adept in identifying and managing perineural invasion (PNI), lymphovascular invasion (LVI), and single-cell spread (SCS), features denoting high-risk behavior of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and microcystic adnexal carcinoma (MAC).

OBJECTIVE
The purpose of this article is to review the literature and guidelines regarding the diagnosis of PNI, LVI, and SCS in BCC, cSCC, and MAC and examine the role of advanced diagnostic studies, adjuvant therapy, and reconstructive techniques of these high-risk tumors.

MATERIALS AND METHODS
We performed a literature search including the following terms: PNI, LVI, SCS, BCC, cSCC, keratinocyte carcinoma, MAC, sentinel lymph node biopsy, radiation, chemotherapy, and staging. Relevant studies, case reports, and review articles were included, as well as National Comprehensive Cancer Network guidelines.

RESULTS
Pancytokeratin immunohistochemistry may aid in the diagnosis of high-risk features of BCC and cSCC. Reconstruction of the Mohs defect should be carefully considered to allow for thorough inspection. Radiation therapy should be considered as an adjuvant treatment option for high-risk cSCC and BCC. Close surveillance for recurrence is warranted.

CONCLUSION
The Mohs surgeon should be competent in identification of high-risk tumors and to understand how best to manage, further treat, and follow these tumors.
“HIDE AND SEEK” NEUROSENSORY RETINAL DETACHMENTS IN PERIPAPILLARY PACHYCHOROID SYNDROME ASSOCIATED WITH PULMONARY ARTERIAL HYPERTENSION
Authors: Govetto Andrea , Sarraf David , Scialdone Antonio 
Published: November 2019

Purpose:
To report the case of a patient with peripapillary pachychoroid syndrome and recurrent and spontaneous resolving peripapillary neurosensory retinal detachments associated with pulmonary arterial hypertension.

Methods:
Case report imaged with spectral-domain optical coherence tomography, swept-source optical coherence tomography angiography, fundus autofluorescence, and fluorescein and indocyanine green angiography.

Results:
A 47-year-old woman presented with unilateral blurred vision and metamorphopsia in her left eye and was diagnosed with peripapillary serous retinal detachments associated with peripapillary pachychoroid syndrome. Cardiologic examination was remarkable for heart failure secondary to severe pulmonary arterial hypertension. Neurosensory detachments spontaneously resolved after 1 day but recurred again three days from baseline. Fluorescein and indocyanine green angiography illustrated choroidal hyperpermeability associated with pachyvessels, whereas optical coherence tomography angiography displayed numerous areas of choriocapillaris nonperfusion, more severe in the left eye of the patient.

Conclusion:
In pulmonary arterial hypertension, hemodynamic changes caused by increased central venous pressure and endothelin-1 may explain the development of exudative retinal detachment and choroidal ischemia. The pathophysiological mechanisms explaining the peripapilary location of the fluid and the thick choroid, as with the peripapillary pachychoroid syndrome, are explored and discussed.
Factors Associated With Intensive Care Attention of Dengue Patients
Authors: Chieng Jin Yu , Aravan Logaruban , Arimuthu Durga A. , Tan Wendy Ai Ying , Naidu Tharani , Pan Yan 
Published: November 2019

Background
Dengue is caused by dengue virus infection, and it is widespread globally. This study aimed to identify indicative markers for intensive care unit admission.

Methods
A retrospective study was conducted via recruiting dengue patients (≥15 years) admitted to Hospital Serdang, Malaysia, from January to April 2017.

Results
In total, 455 patients were included in this study. Among the factors considered, older age (P = 0.0226), Chinese (P = 0.0297), dengue with comorbidity (P = 0.0039), severe dengue (P < 0.0001), acute kidney injury (P < 0.0001), lower platelet level (P < 0.0001), higher bilirubin level (at admission, P = 0.0089; at highest concentrations, P = 0.0479), and prolonged activated partial thromboplastin time (P = 0.0144) were associated with intensive care unit admission.

Conclusions
Demographic characteristics (older and Chinese), clinical presentations (dengue with comorbidity, severe dengue, acute kidney injury), and laboratory findings (lower platelet, higher bilirubin, and prolonged activated partial thromboplastin time) could be used as suggestive indicators for dengue patients requiring intensive care to minimize mortality and to improve prognosis.