bluuebunny/crossref_metadata_2025_split huggingface dataset:
Closed drainage versus non-drainage for single-level lumbar discectomy: a prospective randomized controlled study
Authors: Guo Hua , Wang Biao , Ji Zhaohua , Gao Xi , Zhang Yuting , Yuan Li , Hao Dingjun 
Published: July 2020

Abstract
Background
Postoperative epidural haematoma and wound infection can cause devastating neurological damage in spinal surgery. Closed drainage is a common method to prevent epidural haematoma, infection and related neurological impairment after lumbar decompression; however, it is not clear whether drainage can reduce postoperative complications and improve clinical efficacy. This randomized study aims to explore the role of closed drainage in reducing postoperative complications and improving the clinical efficacy of single-level lumbar discectomy.

Methods
A total of 420 patients with single-level lumbar disc herniation were finally included in this study (169 females and 251 males, age 50.0 ± 6.4 years). A total of 214 patients were randomly assigned to the closed drainage group, and 206 patients were assigned to the non-drainage group. The incidence of postoperative fever, symptomatic epidural haematoma, wound infection and the need for revision surgery were compared between the two groups by the chi-square test or Fisher’s exact test. The visual analogue scale (VAS) and oswestry disability index (ODI) were used to evaluate the improvement of pain relief and the recovery of lumbar function. The VAS and ODI scores were compared between the two groups using t tests.

Results
The complications of the two groups were compared and analysed. There was only a statistically significant difference in the postoperative fever rate (p = 0.022), as the non-drainage group had a higher fever rate, but there were no significant differences in the rates of symptomatic epidural haematoma, wound infection or revision operation (p > 0.05). After concrete analysis, for the rate of fever less than 38.5 degrees, there was a statistically significant difference (p = 0.027), but there was no significant difference when the fever was greater than 38.5 degrees (p > 0.05). When comparing the VAS scores of the operation area on the first day after the operation, the pain relief in the closed drainage group was significantly better than that in the non-drainage group, with scores of 5.1 ± 0.8 and 6.0 ± 0.7, respectively (p < 0.001). However, there was no significant difference between the two groups in the other VAS scores of operation areas, the VAS scores of the lower extremity, or the ODI scores (p > 0.05).

Conclusions
For single-level lumbar discectomy, closed drainage is beneficial for reducing postoperative low-grade fever and relieving pain in the operation area in the very early postoperative stage. However, drainage does not have a significant impact on reducing the incidence of postoperative complications or improving clinical efficacy.

Trial registration
Current Controlled Trials ChiCTR1800016005, May/06/2018, retrospectively registered.
Straighter low lumbar curvature in isthmic spondylolisthesis at L4
Authors: Zheng Shaoli , Zhong Zhaoming , Zhu Qingan , Li Zongze , Zhu Siyuan , Yao Xinqiang , Zheng Shuai , Liao Congrui , Zhu Yongjian , Chen Jianting 
Published: July 2020

Abstract
Background
This study was conducted to compare differences in imaging features and clinical symptoms between patients with single-level isthmic spondylolisthesis (IS) at L4 and at L5 and to investigate the correlation between imaging and clinical parameters.

Methods
This cross-sectional study evaluated patients with single-level IS who were enrolled between June 2011 and June 2018. A total of 139 patients, 44 in the L4 IS group and 95 in the L5 IS group, met the study criteria and were included. Imaging and clinical parameters obtained from the two groups were compared and analyzed.

Results
Patients in the L4 IS group had smaller lower lumbar lordosis (LLL) (27.1 ± 8.2 vs. 30.9 ± 9.3, P = 0.021) and were of older age (58.5 ± 8.7 vs. 52.8 ± 10.1, P < 0.01) than those in the L5 IS group. As per the Roussouly classification system, most patients with L4 IS were classified as Type 2 (43.2%), whereas most patients with L5 IS fell under Type 3 (44.2%). In the L5 IS group, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and L5 incidence (L5I) were positively associated with slippage rate (SR), but the lumbosacral angle (LSA) was negatively associated with SR (P < 0.01). In the L4 IS group, only L5I showed a positive association with SR (P < 0.01). More significant associations were found among sagittal lumbo-pelvic parameters in the L5 IS group, but none were found between SR and Oswestry Disability Index (ODI) in either group.

Conclusions
When compared with patients with L5 IS, patients with L4 IS were of older age and had straighter low lumbar curvature when they were obviously symptomatic. PI was an important parameter for patients with L5 IS while for those with L4 IS, L5I deserved more attention for its significantly positive correlation with the degree of slippage.
Parental understanding of crucial medical jargon used in prenatal prematurity counseling
Authors: Rau Nicole M. , Basir Mir A. , Flynn Kathryn E. 
Published: July 2020

Abstract
Background
Parent-clinician shared decision making is the recommended model for the care of premature infants; thus, clinicians provide prenatal prematurity counseling to parents in the event of a mother’s hospitalization for premature birth. However, parental understanding of medical jargon commonly used during prematurity counseling is unknown.

Methods
Within an overall research agenda to develop and test an educational aid for prenatal prematurity education, we designed the Parental Knowledge of Premature Birth questionnaire. To evaluate parental comprehension of the medical jargon contained within the questionnaire, we conducted cognitive interviews, a formal method for evaluating comprehension and response to questionnaire items. Parents were recruited from a Level IV Neonatal Intensive Care Unit; purposeful recruitment ensured diversity with respect to gender, race, literacy level, and child’s gestational age. Data collection and analysis followed standard qualitative methods for cognitive interviewing. We report on the insights gained from these cognitive interviews regarding parental understanding of crucial medical jargon commonly used during prenatal prematurity counseling.

Results
Participants included 10 women and 6 men who ranged in age from 23 to 38 years and represented Black/African-American (38%), Asian (6%), and white (56%) backgrounds. Five participants (31%) had less than a high school education or reading level below 9th grade (Wide Range Achievement Test version 4 reading subtest). In the first round of interviews, parents of all education and literacy levels had difficulty with medical jargon commonly used in prematurity counseling. Terms that parents found difficult to understand included “gestational age”, “mild or no developmental problems”, and “neonatologist”. Modified terms tested in a second round of interviews showed improved comprehension.

Conclusion
Cognitive interviews provided empirical testing of parental understanding of crucial medical jargon and highlighted that language commonly used during prenatal prematurity counseling is not understood by many parents. For parents to participate in shared decision making, plain language should be used to maximize their understanding of medical information.
Role of MMP-9 in epithelial-mesenchymal transition of thyroid cancer
Authors: Li Yuanchun , He Jing , Wang Feng , Wang Xin , Yang Fan , Zhao Chunyang , Feng Chunling , Li Tiejun 
Published: July 2020

AbstractBackgroundThe purpose of this study is to explore the role and mechanism of MMP-9 in the EMT process of thyroid cancer (TC), so as to provide a basis for clinical exploration of invasion and metastasis process of TC, looking for biological markers of tumor metastasis and molecular intervention therapy.MethodsWestern blot and RT-PCR were employed to detect the expression of MMP-9 in human normal thyroid cell line HT-ori3 and human TC cell lines IHH-4 (PTC), FTC-133, and 8505C. Expression levels of EMT-related markers: epithelial cell marker E-cadherin and stromal cell marker Vimentin in TGF-1-induced TC cell lines were detected by Western blot and RT-PCR, respectively. The effects of MMP-9 downregulation on cell invasion and metastasis were investigated by wound-healing assay and cell invasion experiment.ResultsThe protein and mRNA expression levels of MMP-9 in TC cell lines were increased compared with the human normal thyroid cell line HT-ori3. When TGF-β1 was added, the expression of EMT and Vimentin increased while the expression of E-cadherin decreased. Compared with the control group, the TC cells stably transfected with MMP-9 shRNA showed inhibited EMT, decreased Vimentin expression, and increased E-cadherin expression. The induction of TGF-β1 did not promote the occurrence of EMT in TC cells which were stably transformed with MMP-9 shRNA. The addition of TGF-β1 to TC cells increased the ability of the cells to migrate and invade. Compared with the control group, the migration and invasion ability of TC cells stably transfected with MMP-9 shRNA was significantly reduced, and the induction of TGF-β1 could not restore the migration and invasion ability of cells without MMP-9.ConclusionsIn conclusion, we found that MMP-9 can be used as a biomarker for TC, which can promote the EMT process of TGF-β1 induced TC, and thus affecting the cell migration and invasion ability.
Blue toe syndrome caused by emboli from anomalous left atrial septal pouch thrombus: a case report
Authors: Pradhan Snehasis , Gresa Kciku , Röing genannt Nölke Jan-Peter , Trappe Hans-Joachim 
Published: July 2020

Abstract
Background
Left atrial septal pouches (LASPs) are a relatively newly described but common anatomical cardiac variant thought to be associated with atrial fibrillation (AF) and cardio-embolic stroke. Blue toe syndrome (BTS) describes ischemic changes in the toes due to microembolisation of the digital arteries. Establishing the etiology of BTS is vital so that the underlying cause can be treated. Here we describe the first case of BTS arising due to emboli from LASP thrombus arising on a background of new-onset AF.

Case presentation
A 65-year-old man presented with a two-day history of progressive painful swelling and bluish-purple discoloration of the second and fourth toes of his left foot and new-onset AF. Tests for hypercoagulability disorders were negative. Duplex ultrasound and CT angiography excluded deep venous thrombosis and an absence of embolus, thrombus, or occlusion in the arterial tree in the lower extremities bilaterally, so BTS was diagnosed. While transthoracic echocardiography and chest CT initially showed no cardiac abnormalities or mural thrombus, subsequent transesophageal echocardiography revealed a LASP with an associated pedunculated thrombus. The affected toes were amputated due to wet gangrene, but the patient recovered well with thrombus resolution after anticoagulation.

Conclusion
The presence of a LASP in the absence of any other identifiable cause of BTS should trigger careful investigation of the interatrial septum, preferably using a multimodality imaging approach. The possibility that LASPs may not merely be an innocent bystander but a causative mechanism for peripheral ischemia must be considered.
Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation
Authors: Memirie Solomon Tessema , Desalegn Hailemichael , Naizgi Mulugeta , Nigus Mulat , Taddesse Lisanu , Tadesse Yared , Tessema Fasil , Zelalem Meseret , Girma Tsinuel 
Published: July 2020

Abstract
Background
Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.

Methods
We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.

Results
In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.

Conclusions
Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.
Protocol: examining the effectiveness of an adaptive implementation intervention to improve uptake of the VA suicide risk identification strategy: a sequential multiple assignment randomized trial
Authors: Bahraini Nazanin H. , Matarazzo Bridget B. , Barry Catherine N. , Post Edward P. , Forster Jeri E. , Dollar Katherine M. , Dobscha Steven K. , Brenner Lisa A. 
Published: July 2020

Abstract
Background
In 2018, the Veterans Health Administration (VHA) mandated implementation of a national suicide risk identification strategy (Risk ID). The goal of Risk ID is to improve the detection and management of suicide risk by standardizing suicide risk screening and evaluation enterprise-wide. In order to ensure continuous quality improvement (QI), ongoing evaluation and targeted interventions to improve implementation of Risk ID are needed. Moreover, given that facilities will vary with respect to implementation needs and barriers, the dose and type of intervention needed may vary across facilities. Thus, the objective of this study is to examine the effectiveness of an adaptive implementation strategy to improve the uptake of suicide risk screening and evaluation in VHA ambulatory care settings. In addition, this study will examine specific factors that may impact the uptake of suicide risk screening and evaluation and the adoption of different implementation strategies. This protocol describes the stepped implementation approach and proposed evaluation plan.

Methods
Using a sequential multiple assignment randomized trial (SMART) design, two evidence-based implementation strategies will be evaluated: (1) audit and feedback (A&F); (2) A&F plus external facilitation (A&F + EF). Implementation outcomes of interest include uptake of secondary suicide risk screening and uptake of comprehensive suicide risk evaluation (stages 2 and 3 of Risk ID). Secondary outcomes include rates of other clinical outcomes (i.e., safety planning) and organizational factors that may impact Risk ID implementation (i.e., leadership climate and leadership support).

Discussion
This national QI study will use a SMART design to evaluate whether an adaptive implementation strategy is effective in improving uptake of a mandated VHA-wide suicide risk screening and evaluation initiative. If this study finds that the proposed stepped implementation strategy is effective at increasing uptake and maintaining performance improvements, this approach may be used as an overarching QI strategy for other national suicide prevention programs.

Trial registration
ClinicalTrials.gov NCT04243330. Registered 28 January 2020
Clinician-centric diagnosis of rare genetic diseases: performance of a gene pertinence metric in decision support for clinicians
Authors: Segal Michael M. , George Renee , Waltman Peter , El-Hattab Ayman W. , James Kiely N. , Stanley Valentina , Gleeson Joseph 
Published: July 2020

Abstract
Background
In diagnosis of rare genetic diseases we face a decision as to the degree to which the sequencing lab offers one or more diagnoses based on clinical input provided by the clinician, or the clinician reaches a diagnosis based on the complete set of variants provided by the lab. We tested a software approach to assist the clinician in making the diagnosis based on clinical findings and an annotated genomic variant table, using cases already solved using less automated processes.

Results
For the 81 cases studied (involving 216 individuals), 70 had genetic abnormalities with phenotypes previously described in the literature, and 11 were not described in the literature at the time of analysis (“discovery genes”). These included cases beyond a trio, including ones with different variants in the same gene. In 100% of cases the abnormality was recognized. Of the 70, the abnormality was ranked #1 in 94% of cases, with an average rank 1.1 for all cases. Large CNVs could be analyzed in an integrated analysis, performed in 24 of the cases. The process is rapid enough to allow for periodic reanalysis of unsolved cases.

Conclusions
A clinician-friendly environment for clinical correlation can be provided to clinicians who are best positioned to have the clinical information needed for this interpretation.
Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016
Authors: Desai Angel N. , Ramatowski John W. , Marano Nina , Madoff Lawrence C. , Lassmann Britta 
Published: July 2020

Abstract
Background
The United Nations Refugee Agency (UNHCR) estimates the number of forcibly displaced people increased from 22.7 million people in 1996 to 67.7 million people in 2016. Human mobility is associated with the introduction of infectious disease pathogens. The aim of this study was to describe the range of pathogens in forcibly displaced populations over time using an informal event monitoring system.

Methods
We conducted a retrospective analysis of ProMED, a digital disease monitoring system, to identify reports of outbreak events involving forcibly displaced populations between 1996 and 2016. Number of outbreak events per year was tabulated. Each record was assessed to determine outbreak location, pathogen, origin of persons implicated in the outbreak, and suspected versus confirmed case counts.

Results
One hundred twenty-eight independent outbreak events involving forcibly displaced populations were identified. Over 840,000 confirmed or suspected cases of infectious diseases such as measles, cholera, cutaneous leishmaniasis, dengue, and others were reported in 48 destination countries/territories. The average rate of outbreak events concerning forcibly displaced persons per total number of reports published on ProMED per year increased over time. The majority of outbreak events (63%) were due to acquisition of disease in the destination country.

Conclusion
This study found that reports of outbreak events involving forcibly displaced populations have increased in ProMED. The events and outbreaks detected in this retrospective review underscore the importance of capturing displaced populations in surveillance systems for rapid detection and response.
The origins and genomic diversity of American Civil War Era smallpox vaccine strains
Authors: Duggan Ana T. , Klunk Jennifer , Porter Ashleigh F. , Dhody Anna N. , Hicks Robert , Smith Geoffrey L. , Humphreys Margaret , McCollum Andrea M. , Davidson Whitni B. , Wilkins Kimberly , Li Yu , Burke Amanda , Polasky Hanna , Flanders Lowell , Poinar Debi , Raphenya Amogelang R. , Lau Tammy T. Y. , Alcock Brian , McArthur Andrew G. , Golding G. Brian , Holmes Edward C. , Poinar Hendrik N. 
Published: July 2020

AbstractVaccination has transformed public health, most notably including the eradication of smallpox. Despite its profound historical importance, little is known of the origins and diversity of the viruses used in smallpox vaccination. Prior to the twentieth century, the method, source and origin of smallpox vaccinations remained unstandardised and opaque. We reconstruct and analyse viral vaccine genomes associated with smallpox vaccination from historical artefacts. Significantly, we recover viral molecules through non-destructive sampling of historical materials lacking signs of biological residues. We use the authenticated ancient genomes to reveal the evolutionary relationships of smallpox vaccination viruses within the poxviruses as a whole.
Differential chromatin accessibility landscape reveals structural and functional features of the allopolyploid wheat chromosomes
Authors: Jordan Katherine W. , He Fei , de Soto Monica Fernandez , Akhunova Alina , Akhunov Eduard 
Published: July 2020

Abstract
Background
Our understanding of how the complexity of the wheat genome influences the distribution of chromatin states along the homoeologous chromosomes is limited. Using a differential nuclease sensitivity assay, we investigate the chromatin states of the coding and repetitive regions of the allopolyploid wheat genome.

Results
Although open chromatin is found to be significantly enriched around genes, the majority of MNase-sensitive regions are located within transposable elements (TEs). Chromatin of the smaller D genome is more accessible than that of the larger A and B genomes. Chromatin states of different TEs vary among families and are influenced by the TEs’ chromosomal position and proximity to genes. While the chromatin accessibility of genes is influenced by proximity to TEs, and not by their position on the chromosomes, we observe a negative chromatin accessibility gradient along the telomere-centromere axis in the intergenic regions, positively correlated with the distance between genes. Both gene expression levels and homoeologous gene expression bias are correlated with chromatin accessibility in promoter regions. The differential nuclease sensitivity assay accurately predicts previously detected centromere locations. SNPs located within more accessible chromatin explain a higher proportion of genetic variance for a number of agronomic traits than SNPs located within more closed chromatin.

Conclusions
Chromatin states in the wheat genome are shaped by the interplay of repetitive and gene-encoding regions that are predictive of the functional and structural organization of chromosomes, providing a powerful framework for detecting genomic features involved in gene regulation and prioritizing genomic variation to explain phenotypes.